Two-tailed P-values Research Articles

The optic nerve sheath in hypertensive disorders of pregnancy and perinatal outcomes: a cohort study

BackgroundPreeclampsia is implicated in 14% of maternal deaths worldwide, mostly due to complications such as intracranial hemorrhage and cerebral edema. Cerebral edema increases intracranial pressure, which can be predicted by ultrasonographic measurement of the optic nerve sheath diameter (ONSD). Greater diameters have been reported in women with preeclampsia and eclampsia; however, data are lacking on the possible association with maternal and neonatal adverse outcomes. This study aimed to determine whether there is an association between hypertensive disorders of pregnancy and the ONSD, and between this measurement and maternal and neonatal adverse outcomes.MethodsThis was a cohort study involving 183 women in the third trimester of pregnancy or within 24 h following childbirth, distributed as follows: control group (n = 30), gestational hypertension (n = 14), chronic hypertension (n = 12), preeclampsia without severe features (n = 12), preeclampsia with severe features (n = 62), superimposed preeclampsia (n = 23) and eclampsia (n = 30). The participants underwent ocular ultrasonography, and data on maternal and neonatal outcomes were collected from the medical records. To compare the groups, analysis of variance was used for the normally distributed numerical variables and the Kruskal–Wallis test was used for variables with non-normal distribution. Two-tailed p-values ≤ 0.05 were considered statistically significant.ResultsOverall comparison between the seven groups showed no statistically significant difference in the mean ONSD (p = 0.056). Nevertheless, diameters were significantly greater in the eclampsia group compared to the control group (p = 0.003). Greater diameters were associated with maternal admission to the intensive care unit (ICU) (p < 0.01) and maternal near miss (p = 0.01). There was no association between ONSD and admission to the neonatal ICU (p = 0.1), neonatal near miss (p = 0.34) or neonatal death (p = 0.26).ConclusionsNo association was found between ONSD and the hypertensive disorders of pregnancy in the overall analysis; however, ONSD was greater in women with eclampsia compared to controls. Greater diameters were associated with maternal admission to the ICU and maternal near miss. These findings suggest a potential use for bedside ultrasound as an additional tool for stratifying risk in patients with hypertensive disorders of pregnancy.

High b-Value and Ultra-High b-Value Diffusion Weighted MRI in Stroke.

To explore the application value of high-b-value and ultra-high b-value DWI in noninvasive evaluation of ischemic infarctions. Prospective. Sixty-four patients with clinically diagnosed ischemic lesions based on symptoms and DWI. 3.0 T/T2-weighted fast spin-echo, fluid-attenuated inversion recovery, pre-contrast T1-weighted magnetization prepared rapid gradient echo sequence, multi-b-value trace DWI and q-space sampling sequences. Lesions were segmented on standard b-value DWI (SB-DWI, 1000 s/mm2), high b-value DWI (HB-DWI, 4000 s/mm2) and ultra-high b-value DWI (UB-DWI, 10,000 s/mm2), and cumulative segmented areas were the final abnormality volumes. Normal white matter (WM) areas were obtained after binarization of segmented brain. In 47 patients, fractional anisotropy (FA) and apparent diffusion coefficients (ADCs) at b values of 1000, 4000, and 10,000 s/mm2 were extracted from symmetrical WM masks and lesion masks of contralateral WM (CWM) and lesion-side WM (LWM). Wilcoxon matched-pairs signed-rank test and Pearson correlation analysis. Two-tailed P-values <0.05 were considered statistically significant. Various signals of HB-/UB-DWI (hypo-, iso- or hyper-intensity) were observed in strokes compared with SB-DWI, and some areas with iso-intensity of SB-DWI manifested with hyper-intensity on HB-/UB-DWI. Abnormality volumes from SB-DWI were significantly smaller than those from HB-DWI and UB-DWI (10.32 ± 16.45 cm3, vs. 12.25 ± 19.71 cm3 and 11.83 ± 19.41 cm3), while no significant difference exist in volume between HB-DWI and UB-DWI (P = 0.32). In CWM, FA significantly correlated with ADC4000 and ADC10,000 (maximum r = -0.51 and -0.64), but did not significantly correlate with ADC1000 (maximum r = -0.20, P = 0.17). ADC1000 or ADC4000 of LWM not significant correlated with FA of CWM (maximum r = -0.28, P = 0.06), while ADC10,000 of LWM significantly correlated with FA of CWM (maximum r = -0.46). HB- and UB-DWI have potential to be supplementary tools for the noninvasive evaluation of stroke lesions in clinics. 2 TECHNICAL EFFICACY: Stage 2.

Food Desert Residence Is Not Associated With Dietary Adherence or Complication Rates in Patients With Isolated Mandibular Fractures

BackgroundMandible fracture management requires postoperative dietary modifications to promote healing. Over 20 million Americans live in food deserts, low-income neighborhoods over one mile from a grocery store. The relationship between food desert residence (FDR) and adherence to postoperative dietary instructions remains unexplored. PurposeThis study’s purpose is to evaluate the relationships between FDR, known risk factors, dietary adherence, and complications among patients with isolated mandible fractures.Study design, setting, sample: This retrospective cohort study was conducted at a level 1 trauma center and analyzed patients with mandible fractures between January 2015 and December 2020. Inclusion criteria included operative treatment of adult patients for mandible fractures; pregnant, incarcerated, and patients with incomplete data were excluded. PredictorFDR was the predictor variable of interest. FDR (coded yes or no) was generated by converting patient addresses to census tract GeoIDs and comparing them to the USDA Food Access Research Atlas. OutcomeThe study examined two outcome variables: dietary adherence and postoperative complications. Dietary adherence was coded as adherent or nonadherent, indicating documented compliance with postoperative dietary modifications. Postoperative complications were coded as present or absent, reflecting infection, hardware failure, and mandible malunion or nonunion. CovariatesThe covariates analyzed included age, sex, ethnicity, mechanism of injury, medical and psychiatric comorbidities (including diagnoses such as diabetes, hypertension, and schizophrenia), and tobacco use. AnalysisRelative risks and multivariate logistic regression models were generated for both outcome variables. Two-tailed p-values < 0.05 were considered statistically significant. ResultsDuring the study period, 143 patients had complete data allowing for FDR and dietary adherence determination; 124 of whom (86.7%) had complication data recorded. Of the cohort, 51/143 (35.7%) resided within a food desert, 30/143 (21.0%) exhibited dietary nonadherence, and 46/124 (37.1%) experienced complications. FDR was not associated with increased risk of dietary nonadherence (RR 0.92, 95% CI 0.52-1.61, p=0.76) or complications (RR 1.19, 95% CI 0.75 – 1.89; p=0.46). On multivariate regression, dietary nonadherence was associated with increased complications (OR 2.85, 95% CI 1.01-8.09, p=0.049). ConclusionThere was no association between FDR and dietary nonadherence or complications in mandible fracture patients. However, dietary nonadherence was associated with complications, highlighting the need for further research and intervention.

Analyzing post modern consumer behavior and beef consumption patterns: Insights from Sicilian market

In current events, consumers are subject to various stimuli (advertising campaigns, popular magazines, social) that affect their marginal consumption propensity. However, as Economic Theory teaches us, the marginal propensity to consume does not necessarily translate into consumer spending. This is strongly affected by consumers' eating habits and other variables that determine where the consumption phenomenon occurs. The study aims to analyze post-modern consumer behavior toward beef consumption. An online questionnaire was administered to 535 Sicilian participants to achieve this goal. Statistical analyses were performed by R statistical software, using two-tailed P-values, and setting statistical significance at P ≤ 0.05. The results show that consumption choices are influenced by beef meat's impact on health. In addition, consumers consider the origin and certifications of the raw material to be extremely crucial.

Single patient learning for adaptive radiotherapy dose prediction.

Throughout a patient's course of radiation therapy, maintaining accuracy of their initial treatment plan over time is challenging due to anatomical changes-for example, stemming from patient weight loss or tumor shrinkage. Online adaptation of their RT plan to these changes is crucial, but hindered by manual and time-consuming processes. While deep learning (DL) based solutions have shown promise in streamlining adaptive radiation therapy (ART) workflows, they often require large and extensive datasets to train population-based models. This study extends our prior research by introducing a minimalist approach to patient-specific adaptive dose prediction. In contrast to our prior method, which involved fine-tuning a pre-trained population model, this new method trains a model from scratch using only a patient's initial treatment data. This patient-specific dose predictor aims to enhance clinical accessibility, thereby empowering physicians and treatment planners to make more informed, quantitative decisions in ART. We hypothesize that patient-specific DL models will provide more accurate adaptive dose predictions for their respective patients compared to a population-based DL model. We selected 33 patients to train an adaptive population-based (AP) model. Ten additional patients were selected, and their respective initial RT data served as single samples for training patient-specific (PS) models. These 10 patients contained an additional 26 ART plans that were withheld as the test dataset to evaluate AP versus PS model dose prediction performance. We assessed model performance using Mean Absolute Percent Error (MAPE) by comparing predicted doses to the originally delivered ground truth doses. We used the Wilcoxon signed-rank test to determine statistically significant differences in terms of MAPE between the AP and PS model results across the test dataset. Furthermore, we calculated differences between predicted and ground truth mean doses for segmented structures and determined statistical significance in the differences for each of them. The average MAPE across AP and PS model dose predictions was 5.759% and 4.069%, respectively. The Wilcoxon signed-rank test yielded two-tailed p-value= , indicating that the MAPE differences between the AP and PS model dose predictions are statistically significant, and 95% confidence interval=[-2.1610, -1.0130], indicating 95% confidence that the MAPE difference between the AP and PS models for a population lies in this range. Out of 24 total segmented structures, the comparison of mean dose differences for 12 structures indicated statistical significance with two-tailed p-values<0.05. Our study demonstrates the potential of patient-specific deep learning models in application to ART. Notably, our method streamlines the training process by minimizing the size of the required training dataset, as only a single patient's initial treatment data is required. External institutions considering the implementation of such a technology could package such a model so that it only requires the upload of a reference treatment plan for model training and deployment. Our single patient learning strategy demonstrates promise in ART due to its minimal dataset requirement and its utility in personalization of cancer treatment.

Larger hypothalamic volume in narcolepsy type 1.

Narcolepsy type 1 (NT1) is a neurological sleep disorder. Postmortem studies have shown 75%-90% loss of the 50 000-70 000 hypocretin-producing neurons and 64%-94% increase in the 64 000-120 000 histaminergic neurons and conflicting indications of gliosis in the hypothalamus of NT1 patients. The aim of this study was to compare MRI-based volumes of the hypothalamus in patients with NT1 and controls in vivo. We used a segmentation tool based on deep learning included in Freesurfer and computed the volume of the whole hypothalamus, left/right part of the hypothalamus, and 10 hypothalamic subregions. We included 54 patients with post-H1N1 NT1 (39 females, mean age 21.8 ± 11.0 years) and 114 controls (77 females, mean age 23.2 ± 9.0 years). Group differences were tested with general linear models using permutation testing in Permutation Analysis of Linear Models and evaluated after 10 000 permutations, yielding two-tailed P-values. Furthermore, a stepwise Bonferroni correction was performed after dividing hypothalamus into smaller regions. The analysis revealed larger volume for patients compared to controls for the whole hypothalamus (Cohen's d = 0.71, p = 0.0028) and for the left (d = 0.70, p = 0.0037) and right part of the hypothalamus (d = 0.65, p = 0.0075) and left (d = 0.72, p = 0.0036) and right tubular-inferior (d = 0.71, p = 0.0037) hypothalamic subregions. In conclusion, patients with post-H1N1 NT1 showed significantly larger hypothalamic volume than controls, in particular in the tubular-inferior subregions which could reflect several processes as previous studies have indicated neuroinflammation, gliosis, and changes in the numbers of different cell types.

Effect of chemical disinfection on the dimensional stability of polyvinyl ether siloxane impression material: a systemic review and meta-analysis

Background and objectivesPolyvinyl ether siloxane (PVES) possesses ideal characteristics for making precise and accurate dental impressions. PVES dimensional stability owes to its better polymeric properties derived from its parent materials poly ethers and polyvinyl siloxanes. As recommended use of chemical disinfecting agents is getting more popular, there is a growing concern associated with the effect of disinfectants on PVES dimensional stability. This study was aimed to understand the PVES behavior when subjected to chemical disinfectants.Materials and methodologyThe data was collected from research studies retrieved from Google Scholar, Scopus, and PubMed using MeSH terms of keywords “vinyl polyether siloxane AND Disinfection” or (Vinyl polyether siloxane OR polyvinyl siloxane ether OR PVES) AND (disinfectant OR disinfection)” without any restriction to publication date. The PRISMA (Preferred Reporting Items for Systemic Review and Meta-Analysis) directions were observed during the data collection, screening of studies, and meta-analysis. The primary data were retrieved, and batch exported from databases using Harzing’s Publish or Perish software; primary analysis was performed in Microsoft Excel, while statistical analysis for effect size, two-tailed p-values, and heterogeneity among studies was performed using Meta Essentials. The effect size was calculated using Hedge’s g values at the 95% confidence level using the random-effects model. Heterogeneity among studies was measured using the Cochrane Q and I2.Results and conclusionDental impressions made from the PVES elastomeric impression materials showed no significant changes in dimensional stability. Immersion in the chemical disinfectant for 10 min was associated with clinically irrelevant changes in the dimensions of the PVES impressions. Disinfection with sodium hypochlorite was associated with clinically significant changes in dimensions, with a two-tailed p-value of 0.049. Disinfection with 2–2.5% glutaraldehyde solution was not associated with any significant dimensional variability.

Serum Vitamin D Levels in Pediatric Tuberculosis Patients in a Tertiary Care Center in India: A Case-Control Study.

Background Mycobacterium is certainly one individual organism contributing to the most deaths of children among the world's lower- and medium-income nations. According to earlier studies, vitamin D insufficiency is one of the risk factors. We undertook this study since very few case-control studies are present. This study aimed to evaluate the role of vitamin D in tuberculosis (TB). Methods This case-control study was carried out in a tertiary care center at Niloufer Hospital over a period of one year and five months. The sample size was 140. SPSS (Statistical Package for the Social Sciences) Version 19 (IBM Corp., Armonk, NY) was used for statistical analysis. Two-tailed p-values and odds ratios were obtained. The chi-square test was applied to differentiate between two categorical variables. For means, the Student t-test was applied. We usually take baseline investigations before starting ATT (anti-TB treatment) with the blood sample we tested for vitamin D levels. Results With p-values of 0.767 and 0.866, the age and sex distributions in the cases and controls were comparable. Rural and urban area distribution and malnutrition distribution were not similar in both groups, with a p-value of 0.001. The mean vitamin D level in cases was 10.4, while controls it was 22.8, and this difference is statistically significant (p = 0.001). Conclusion Vitamin D deficiency is more common in children with TB than in normal children. In addition, a severe form of vitamin D deficiency (less than 10 ng/mL) was higher among children with TB. Clinicians should be aware of associated malnutrition and low socioeconomic status as risk factors for severe vitamin D deficiencies among them.

Premenopausal women with PTSD display blunted vagal control of the heart and elevated central hemodynamics

Introduction: Post‐traumatic stress disorder (PTSD) is associated with significant cardiovascular disease (CVD) risk. Women are twice as likely as men to develop PTSD after a traumatic event. Although premenopausal women are thought to be protected from CVD, a diagnosis of PTSD increases CVD risk by up to three-fold. Available data in predominantly male cohorts point to autonomic nervous system dysfunction as a potential underlying mechanism. Therefore, the aim of this study was to determine if premenopausal women diagnosed with PTSD, compared to those without, present a blunted parasympathetic control of the heart and elevated cardiovascular hemodynamics. Methods: Thirty-five otherwise healthy young women (18-40 years) with a history of trauma exposure were included in this study, 14 with PTSD and 21 without PTSD diagnostic. The study took place during two visits. At visit one, we collected anthropometric measures, assessed PTSD symptom severity with the PTSD checklist for DSM 5 (PCL5) and depression severity using the Beck Depression Inventory (BDI). At visit two, we measured resting heart rate variability (HRV) using the finger volume pulse waveforms obtained from a peripheral arterial tone signal and central hemodynamics (i.e., aortic blood pressure and augmentation index) via pulse wave analysis using applanation tonometry. We compared the two groups with independent t-tests and we report two-tailed p-values. Results: Age (27±7years) and BMI (27±6 kg/m2) were comparable between the two groups (p&gt;0.05). Women diagnosed with PTSD had higher PCL5 (48±9 vs 32±18 a.u., p=.001) and BDI (27±10 vs 15±7 a.u., p&lt;0.001) scores compared to women without PTSD. Resting brachial blood pressure [systolic, 120±12 vs 108±8 mmHg, p=.001; diastolic, 76±6 vs 67±7 mmHg, p&lt;0.001] and heart rate (76±10 vs 66±7 bpm, p=0.002) were also higher in women with PTSD. Our primary outcome measures of HRV [SDNN, 40±25 vs 61±17 ms, p=0.005; RMSSD, 36±28 vs 57±23 ms, p=0.029] were lower in women with PTSD compared to women without PTSD. When examining central hemodynamics, aortic blood pressure [systolic, 110±11 vs 97±8 mmHg, p&lt;0.001; diastolic, 77±6 vs 67±7 mmHg, p&lt;0.001] was higher in women with PTSD compared to women without PTSD. Likewise, aortic augmentation index (26±14 vs 17±10 a.u., p=0.030) and augmentation pressure (9±4 vs 6±3 mmHg, p=0.017) were higher in women with PTSD. Conclusion: In sum, our results show that among premenopausal women with a PTSD diagnosis is associated with higher heart rate, higher peripheral and central blood pressure, and blunted parasympathetic control of the heart. These findings suggest that PTSD may impose a high allostatic load on the heart in young women, who are typically thought to be protected from CVD. These data also provide mechanistic insight into links between PTSD and hypertension prior to menopause. UL1TR002494, NIH K01HL161027 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The average 30-minute post-prandial C-peptide predicted diabetic retinopathy progress: a retro-prospective study

BackgroundThe conclusion between Connecting peptide (C-peptide) and diabetic chronic complication was controversial. The purpose of this study is to explore the possible association between average C-peptide with diabetic retinopathy (DR) progression in Chinese patients with type 2 diabetes.MethodsThis is a retro-prospective study. 622 patients with type 2 diabetes were included. DR was evaluated using non-mydriatic fundus photography and DR progression was defined as any deterioration of either eye. Fasting and postprandial c-peptide levels were assayed at baseline and follow-up period. Differences between continuous variables were compared using the Mann–Whitney U test; and categorical variables were analyzed by the chi-square test. Correlation between parameters and 30-minute postprandial C-peptide were determined by Spearman correlation test. The relationship between C-peptide and DR progression was evaluated by multivariable binary logistic regression. Two-tailed P-values < 0.05 were regarded as statistically significant.ResultsDR was present in 162 (26.0%) patients at baseline, and 26.4% of patients were found progression of DR at follow-up. Patients with progression of DR had lower average levels of 30-minute postprandial C-peptide (2.01 ng/ml vs. 2.6 ng/ml, p = 0.015) and 120-minute postprandial C-peptide (3.17 ng/ml vs. 3.92 ng/ml, p < 0.029), as well as average increment of 30-minute (0.41 ng/ml vs. 0.64 ng/ml, p = 0.015) and 120-minute postprandial C-peptide (1.48 ng/ml vs. 1.93 ng/ml, p < 0.017), than those without DR aggravation. Multivariate logistic regression analysis determined that 30-minute postprandial C-peptide and its increment were related to reduced odds ratios for DR progression (odds ratios [OR] = 0.83 and 0.74, respectively).ConclusionOur results suggest that the Average 30-minute post-prandial C-peptide and increment were negatively correlated with DR progression, which further demonstrates the importance to preserve β-cell residual function in the prevention for DR progression.Trial registrationNot applicable.

Reduction in solar PV soiling loss using hydrophobic coating with and without dew suppression

The deposition of particulate matter (PM) on PV surfaces reduces energy generation, which results in huge losses to the PV industry. Hydrophobic coatings are known to reduce PM deposition on PV surfaces. Covering panels during the night is expected to reduce the PM deposition as well as suppress the dew formation on the surface. The objective of the present study is to compare the soiling on the hydrophobic coating with and without dew suppression. Uncoated and hydrophobic coated slides were kept for PM deposition in a 70-day field study. The dew formation was suppressed on some of the uncoated and coated slides by covering them from sunset to sunrise. The results show that the % reduction in soiling of coated slides under dew suppression is higher (50 ± 13%) compared to the coated slides without dew suppression (31 ± 15%) (statistically different; two-tailed p-value < 0.05). In addition, the particle size analysis using optical microscopy shows that the hydrophobic coating (under dew suppression) reduces the particles deposition by 60.0 ± 8.1% (mainly 10 to 30 μm range) compared to the uncoated slides (under dew suppression) over the entire sampling period. However, the dust potency (soiling loss per unit deposited mass loading) for uncoated and coated samples is found to be statistically similar (5 to 6 % g−1 m2; two-tailed p-values > 0.05). Overall, the present study advances the understanding of the impact of dew on hydrophobic coating, thereby adding to the existing knowledge of soiling mitigation approaches for solar PV industries.

Quantifying the accuracy of optical transmission loss techniques and identifying the best wavelengths for estimating soiling in a field study

The optical transmittance loss (OTL) of glass coupons is frequently used to estimate the soiling losses of solar PVs. The soiling loss estimation methodologies (SLEMs) and selection range of wavelengths for OTL evaluation vary significantly, influencing the accuracy of soiling loss estimation. To our knowledge, no studies have quantified the accuracy of SLEMs (requiring hemispherical transmittances of glass coupons) with a standard soiling reference station in the field. Moreover, the data regarding the best single wavelengths for estimating the soiling loss with minimum error is significantly lacking in the literature. The present study focuses on quantifying the accuracy of SLEMs and single wavelengths by using multiple glass samples over a 150-day sampling period. The results showed that SLEMs that consider either the spectral irradiance of the solar spectrum or both the spectral irradiance of the solar spectrum and the spectral response of the polycrystalline PV material provided the best soiling estimates (no statistically significant difference between SLEMs: two-tailed p-values > 0.05). Moreover, the Ultraviolet (RMSE: 7.89 ± 6.39) and the Visible (RMSE: 1.49 ± 0.47) regions have low accuracy in estimating actual soiling losses. The results also show that the best single wavelengths for estimating the soiling loss are 760 to 850 nm (for polycrystalline), significantly different from the previous studies (Spain-600 nm and Golden Colorado-700 nm). Overall, the present study has implications for independent monochromatic optical soiling technologies. The use of multiple glass samples in the study provides reasonable statistical confidence in the correctness of the results.

High Fever, Wide Distribution of Viral Pneumonia, and Pleural Effusion are More Critical Findings at the First Visit in Predicting the Prognosis of COVID-19: A Single Center, retrospective, Propensity Score-Matched Case-Control Study.

Currently, infection control measures for SARS-COV2 are being relaxed, and it is important in daily clinical practice to decide which findings to focus on when managing patients with similar background factors. We retrospectively evaluated 66 patients who underwent blood tests (complete blood count, blood chemistry tests, and coagulation tests) and thin slice CT between January 1 and May 31, 2020, and performed a propensity score-matched case-control study. Cases and controls were a severe respiratory failure group (non-rebreather mask, nasal high-flow, and positive-pressure ventilation) and a non-severe respiratory failure group, matched at a ratio of 1:3 by propensity scores constructed by age, sex, and medical history. We compared groups for maximum body temperature up to diagnosis, blood test findings, and CT findings in the matched cohort. Two-tailed P-values <0.05 were considered statistically significant. Nine cases and 27 controls were included in the matched cohort. Significant differences were seen in maximum body temperature up to diagnosis (p=0.0043), the number of shaded lobes (p=0.0434), amount of ground-glass opacity (GGO) in the total lung field (p=0.0071), amounts of GGO (p=0.0001), and consolidation (p=0.0036) in the upper lung field, and pleural effusion (p=0.0117). High fever, the wide distribution of viral pneumonia, and pleural effusion may be prognostic indicators that can be easily measured at diagnosis in COVID-19 patients with similar backgrounds.

Modeling RBE with other quantities than LET significantly improves prediction of in vitro cell survival for proton therapy.

For proton therapy, a relative biological effectiveness (RBE) of 1.1 has broadly been applied clinically. However, as unexpected toxicities have been observed by the end of the proton tracks, variable RBE models have been proposed. Typically, the dose-averaged linear energy transfer (LETd ) has been used as an input variable for these models but the way the LETd was defined, calculated, or determined was not always consistent, potentially impacting the corresponding RBE value. This study compares consistently calculated LETd with other quantities as input variables for a phenomenological RBE model and attempts to determine which quantity that can best predicts proton RBE. The comparison was performed within the frame of introducing a new model for the protonRBE. High-throughput experimental setups of in vitro cell survival studies for proton RBE determination are simulated using the SHIELD-HIT12A Monte Carlo particle transport code. Together with LET, , here called effective Q (Qeff ), and Q are scored. Each quantity is calculated using the dose and track averaging methods, because the scoring includes all hadronic particles, all protons or only primaries. A phenomenological linear-quadratic-based RBE model is subsequently applied to the in vitro data with the various beam quality descriptors used as input variables and the goodness of fit is determined and compared using a bootstrapping approach. Both linear and nonlinear fit functions weretested. Versions of Qeff and Q outperform LET with a statistically significant margin, with the best nonlinear and linear fit having a relative root mean square error (RMSE) for RBE2Gy ± one standard error of 1.55 ± 0.04 (Qeff, t, primary ) and 2.84 ± 0.07 (Qeff, d, primary ), respectively. For comparison, the corresponding best nonlinear and linear fits for LETd, all protons had a relative RMSE of 2.07 ± 0.06 and 3.39 ± 0.08, respectively. Applying Welch's t-test for comparing the calculated RMSE of RBE2Gy resulted in two-tailed p-values of <0.002 for all Q and Qeff quantities compared to LETd, all protons . The study shows that Q or Qeff could be better RBE descriptors that dose averagedLET.

A multicenter, non-comparative study to evaluate the efficacy and safety of fixed- dose olmesartan/amlodipine in hypertensive patients

Background: Uncontrolled blood pressure (BP) is a major healthcare issue and responsible for high risk of cardiovascular disease (CVD) mortality and morbidity. Physicians of Bangladesh had been using amlodipine and Olmesartan combination for a long period of time but have very limited evidence-based information regarding the efficacy and safety of this combination. The aim of this study was to evaluate the efficacy and safety of fixed dose combination of olmesartan/amlodipine in hypertensive patients. Methods: This open-label, non-randomized, non-comparative observational study was conducted in different centers of Bangladesh during the period from January 2020 to November 2020. In total 443 Bangladeshi adult patients with hypertension were selected as the study population. Proper written consent was taken from all the participants before collecting data. Inter-group differences in the baseline characteristics were compared using analysis of variance (ANOVA). Two-tailed p-values of less than 0.05 were considered to be statistically significant. Statistical analyses were conducted by using SPSS for Windows, version 25 (SPSS Inc., Chicago, IL, USA). Results: Among all the participants, more than 70% were above 46 years of age and 55% were male. More than 60% of them were either overweight or obese. Among them, dyslipidemia, diabetes, and Chronic renal failure (CRF) was found among 14.22%, 28.44%, and 4.29% participants respectively Mean systolic (SBP) and diastolic blood pressures (DBP) were reduced to 36.61 and 18.69 mm of Hg respectively after 12 weeks of therapy. Besides these, the targeted SBP was achieved among 92% and targeted DBP was achieved among 98.3% of participants after 12 weeks. Achievement of BP goal in respect to Body mass index (BMI) of the patient (P-value 0.019), family history of hypertension (P-value 0.028), and dose of the drug in initial visit (P-value 0.001) was found statistically significant. There was no discontinuation of study medication due to intolerance or adverse events. Conclusion: Olmesartan/Amlodipine is an effective combination for reducing the blood pressure along with achievement of BP goal. Future studies on Olmesartan/Amlodipine in Bangladesh could be conducted with a longer treatment duration to examine the maintenance of effect and long-term safety.

P257 Amplified fragment length polymorphism fingerprinting supports the absence of correlation of genotype with clinical phenotype or source of the isolate in Aspergillus flavus infections

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectives Aspergillus flavus accounts for ∼ 10% of bronchopulmonary aspergillosis and is the second leading etiological agent of invasive aspergillosis worldwide. It is the commonest cause of fungal rhinosinusitis and ocular mycoses in tropical countries including India. We report amplified fragment length polymorphism genotyping of a set of clinical and environmental isolates to unravel the genetic diversity of A. flavus in India and to further determine correlation between isolate genotype and the source/clinical phenotype of the Aspergillus infection.MethodsTwo sets of morphologically identified isolates of A. flavus from clinical (n = 71) and environmental sources (n = 22) were included in the study using a stratified random sampling method. Clinical strains were isolated from lower respiratory tract specimens (n = 22), sinus and sino-nasal biopsies (n = 25), corneal samples (n = 12), and others (n = 12). Environmental strains were isolated from different niches like air, soil, and infected crop samples. Aspergillus fumigatus F145 was used as an out-group. DNA was extracted from the fungal broth culture following the method of Lee et al. AFLP was done as per an earlier described method using HpyCH41V and Mse1 (New England BioLabs) for restriction digestion followed by selective amplification of restriction-digested products with 1 mm HpyCH4 IV primer with one selective residue (5-Flu-GTA-GACTGCGTACCCGTC-3’), 1 mm MseI primer with four selective residues (5-GATGAGTCCTGACTAATGAA). Fingerprint data was analyzed in BioNumerics software version 7.6 (Applied Maths, Belgium). The phylogenetic tree was constructed using Pearson's Correlation coefficient. An AFLP genotype was assigned to a cluster using an arbitrary cut-off value of ≥90% fingerprint similarity. The distribution of genotypes among different categories was analyzed by Fisher's exact test or Pearson's χ 2 goodness of fit test with Yates correction factor as appropriate and two-tailed P-values of <.05 were considered statistically significant.ResultsThe analyses revealed a total of 16 AFLP genotypes with 5 major clusters (≥ 5 isolates) reflecting the extent of genetic diversity in A. flavus. Genotype VIII encompassed predominantly clinical isolates (P <.01) and genotype XI with majority of isolates from environmental sources (P <.0001). The strains which were isolated from invasive and non-invasive forms or from different sites (pulmonary, sinus, and ocular) did not diverge into separate or unique clusters. Although the genotypes had an asymmetric distribution in different clinical presentations as revealed by the χ2 goodness of fit test, none of the genotypes was exclusively responsible for causing a particular infection. Isolates from the north zone of India shared genotypes with those from the southern region of the country. Three isolates formed a separate genotype XVI and diverged from the A. flavus cluster by 42% fingerprint similarity. Partial β-tubulin and calmodulin gene sequencing-based phylogeny reconstruction placed those three isolates in A. tamarii clade of the A. flavus species complex.Conclusions: This study suggests that every genotype of A. flavus has the potential of causing an allergic, non-invasive or invasive infection. Further, A. flavus sensu stricto was predominantly (97%) isolated from clinical specimens revealing the majority of infections/colonization are caused by this species compared to other members in the Flavi complex.

Association between Atrioventricular Block and Mortality in Primary Care Patients: The CODE Study.

ResumoFundamento O bloqueio atrioventricular (BAV) descreve um comprometimento na condução dos átrios para os ventrículos. Embora o curso clínico do BAV tenha sido avaliado, os achados são de países de alta renda e, portanto, não podem ser extrapolados para a população latina.Objetivo Avaliar a associação entre BAV e mortalidade.Métodos Foram incluídos pacientes do estudo CODE (Clinical Outcomes in Digital Electrocardiology), maiores de 16 anos que realizaram eletrocardiograma (ECG) digital de 2010 a 2017. Os ECGs foram relatados por cardiologistas e por software automatizado. Para avaliar a relação entre BAV e mortalidade, foram utilizados o modelo log-normal e as curvas de Kaplan-Meier com valores de p bicaudais < 0,05 considerados estatisticamente significativos.Resultados O estudo incluiu 1.557.901 pacientes; 40,23% eram homens e a média de idade foi de 51,7 (DP ± 17,6) anos. Durante um seguimento médio de 3,7 anos, a mortalidade foi de 3,35%. A prevalência de BAV foi de 1,38% (21.538). Os pacientes com BAV de primeiro, segundo e terceiro graus foram associados a uma taxa de sobrevida 24% (taxa de sobrevida relativa [RS] = 0,76; intervalo de confiança [IC] de 95%: 0,71 a 0,81; p < 0,001), 55% (RS = 0,45; IC de 95%: 0,27 a 0,77; p = 0,01) e 64% (RS = 0,36; IC de 95%: 0,26 a 0,49; p < 0,001) menor quando comparados ao grupo controle, respectivamente. Os pacientes com BAV 2:1 tiveram 79% (RS = 0,21; IC de 95%: 0,08 a 0,52; p = 0,005) menor taxa de sobrevida do que o grupo controle. Apenas Mobitz tipo I não foi associado a maior mortalidade (p = 0,27).Conclusão BAV foi um fator de risco independente para mortalidade geral, com exceção do BAV Mobitz tipo I.

Poster 242: Deep Learning for Identifying Patellofemoral Measurements Associated with Cartilage Lesions on MRI

Poster 242: Deep Learning for Identifying Patellofemoral Measurements Associated with Cartilage Lesions on MRI

Novel Signatures Based on the Lymphocyte-to-C-Reactive Protein Ratio Predict the Prognosis of Patients with Early Breast Cancer: A Retrospective Study.

BackgroundThe value of the lymphocyte-to-C-reactive protein (CRP) ratio (LCR) in early breast cancer (BC) is unclear. We explored the correlation between the LCR and survival of patients with early BC and established effective LCR-based prognostic signatures for predicting prognosis.MethodsIn this retrospective study, we randomized 623 patients with early-stage BC diagnosed in December 2010 to October 2012 at the Sun Yat-sen University Cancer Center to training and verification datasets. The median follow-up of all patients was 109 months. The survival differences were calculated by Kaplan–Meier method using the Log rank test. For overall survival (OS) and disease-free survival (DFS), the independent factors in the training dataset were identified using univariate and multivariate Cox analyses, in which two-tailed P-values < 0.05 were considered statistically significant. Based on this, we respectively constructed novel signatures for survival prediction and validated the efficiency of signatures through the concordance index (C-index), calibration and receiver operating characteristic (ROC) curves in both datasets.ResultsThe LCR, lymphatic vessel invasion (LVI), progesterone receptor (PR) status, and Ki67 index were independent prognostic factors of OS. And the LCR and LVI are associated to DFS too. High LCR was associated with better OS and DFS. We constructed the prediction signatures based on those independent prognostic factors and calculated the risk scores. Patients in the training dataset with higher risk scores had significantly worse prognosis (P < 0.001). The signature had excellent discrimination capacity, with an OS C-index of 0.785 [95% confidence interval (CI): 0.713–0.857] and 0.750 (95% CI: 0.669–0.832) in the training and verification datasets, respectively. The time–ROC curves also suggest accurate prediction by the signature.ConclusionThe LCR was a significant prognostic predictor of OS and DFS in early BC. The LCR-based prognostic signatures could be a useful tool for individualized therapeutic guidance.

FC 126: Association Between Circulating Levels of 25-Hydroxyvitamin D and Metalloproteinase-10 (MMP 10) in Patients With Type 2 Diabetes Mellitus. Cross-Sectional Study

Abstract BACKGROUND AND AIMS Matrix metalloproteinases (MMP) play an important role in diabetic kidney disease (DKD) (1). MMP-10 levels have been shown to increase progressively starting from the early stages of DKD (2). Vitamin D (vitD) deficit is associated with a higher risk of microangiopathy in diabetes. In humans, vitD status correlates inversely with MMP-9 circulating levels and VitD supplementation is associated with a decrease in these levels (3). In vitro, studies demonstrated reduced expression of MMP-10 after an exposure to vitD (4). However, no studies have yet assessed how vitD status is related to MMP-10 circulating levels. We aimed (1) to evaluate the association between the serum levels of 25-hydroxyvitamin D [25(OH)D3] and MMP-10 in a cohort of type 2 diabetes (T2D) patients and (2) to study a potential effect of chronic kidney disease (CKD) stage or estimated glomerular filtration rate (eGFRcr) on this association. METHOD The cross-sectional association between MMP-10 and 25(OH)D3 levels (&amp;gt;30 ng/mL, normal; 20–30 ng/mL, insufficiency; &amp;lt;20 ng/mL, deficiency; and relevant cut-offs 45 and 15 ng/mL) was investigated, by multivariate linear regression analysis after MMP-10 logarithm transformation, in 256 T2D patients recruited (2009–2016) in the Clinica Universidad de Navarra (Spain). Study protocol was approved by the Ethical Committee (2021.183TFG). Covariates were smoking habit, body adiposity percentage estimated by CUN-BAE formula, CKD stage and vitD3 supplement use. Age and sex were already included in the CKD-EPI formula. Interactions and collinearities were also analysed. Statistical analysis was performed using STATA software and two-tailed P-values &amp;lt;0.05 were considered statistically significant. RESULTS Characteristics of patients are given in Table 1. VitD deficit was significantly (P &amp;lt;0.001) more prevalent in patients with CKD (61%) compared with those without CKD (40%). MMP-10 showed a significant negative correlation with 25(OH)D3 (rho = –0.246; P &amp;lt;0.001), which remained significant including only CKD patients (rho = –0.283; P &amp;lt;0.001) and stronger above 45 ng/mL (rho = –0.7308, P &amp;lt;0.001) or moderate between 30 and 45 ng/mL (rho = –0.3290, P = 0.0045) (Fig. 1). In the fully adjusted model, MMP-10 was negatively associated (P = 0.019) with severe vitD deficiency [estimated coefficient –0.86 (–0.76 to –0.97)]. There was no interaction between covariates and 25(OH)D levels and collinearities were also discarded. CONCLUSION In T2D patients, circulating MMP-10 was inversely associated with serum 25(OH)D3 levels, especially in those patients with CKD and at the extremes of vitD level range. These results suggest that higher values of 25(OH)D3 should be targeted in these patients. The efficacy of vitD supplementation in reducing circulating MMP-10 levels should be further examined.