Wilcoxon Matched-pairs Signed-rank Test Research Articles

Abstract Su802: Feasibility of detecting CPR compression frequency using machine-learning software in video footage of CPR

Background: Several studies have demonstrated that video assisted cardiopulmonary resuscitation (V-CPR) is efficient in improving cardiopulmonary resuscitation (CPR) quality and patient outcome. However, currently the technique depends on 911 dispatchers who evaluate the video footage and may thus be subject to inter-operator variations. Research Question: We hypothesized that using an open-source machine learning supported software (“artificial intelligence” – AI) would be able to provide real-time feedback on CPR frequency in a video of CPR. Aims: To evaluate the feasibility and accuracy of a selected AI software to correctly detect the actual compression frequency in video footage of CPR performed in a CPR manikin. Methods: MediaPipe Pose Landmark Detection (Google LLC, Mountain View, CA, USA), an open-source AI software using machine-learning models to detect human body postures in images and videos, was programmed to assess compression frequency of nine videos showing CPR on a manikin, each with a different fixed compression frequency and compression depth. Camera angle and distance were standardized. Frequency was assessed from compression to compression with AI software and the manikin’s internal software (QCPR, Laerdal, Stavanger, Norway). After testing for Gaussian distribution, means were compared using Wilcoxon matched-pairs signed rank test. Results: There were high levels of agreement between compression frequencies derived from AI and manikin’s software (Statistic comparisons are presented in Figure 1, correlations of measurements are presented in Figure 2 ). Conclusions: In this pilot study, an open-source landmark detection AI software was able to assess CPR compression frequency with high agreement to actual frequency derived from a CPR manikin. Since the software used is currently not intended for medical use, further development is necessary before the technology can be evaluated for real-life CPR.

An evaluation of occlusal changes during orthodontic retention

The problem of orthodontic relapse is of fundamental importance for clinicians. In the literature there are few studies concerning the change in position of the teeth after orthodontic treatment. This study analyzes the occlusal changes during the first six months of orthodontic retention and the effectiveness of the Hawley retainer at the upper arch and the canine-to-canine multi-stranded fixed retainer at the lower arch in maintaining the anterior tooth alignment. 48 patients were recruited. PAR index, ABO DI, ABO CRE, Irregularity Index, intercanine, interpremolar and intermolar widths were measured for each patient before (T0) and at the end (T1) of the fixed orthodontic treatment and after 1 (T2), 3 (T3) and 6 (T4) months of retention. Statistics used were paired samples t-test and Wilcoxon matched-pairs signed-ranks test. The p-value was considered statistically significant for P<0.05. During 6 months in retention there was a worsening of PAR index (mean: 1.13±1.08; P<0.001), dental alignment (median: 2.5; P=0.0001) and occlusal relationships (median: 2; P=0.0101); a statistically significant improvement of posterior occlusal contacts (median: 2.54; P=0.0004), marginal ridges (median: 0.5; P=0.0250) and interproximal contacts (median: 0.46; P=0.0305). The stability of the orthodontic results has proved to be similar for the two dental arches, as well as the effectiveness of the two retainers in maintaining the alignment of the anterior teeth. During 6 months in retention the occlusal changes were minimal and didn’t affect the stability of the orthodontic treatment in a clinically significant manner. The effectiveness of the upper Hawley retainer and the lower multi-stranded fixed retainer in maintaining the alignment of the anterior teeth was similar.

The modernisation of newborn screening as a pan-European challenge – An international delphi study

Newborn screening is a public health measure to diagnose rare diseases at birth, thereby minimising negative effects of late treatment. Genomic technologies promise an unprecedented expansion of screened diseases at low cost and with transformative potential for newborn screening programmes. However, barriers to the public funding of genomic newborn screening are poorly understood, particularly in light of the heterogenous European newborn screening landscape. This study therefore aims to understand whether international newborn screening experts share a common understanding of the barriers to fund genomic newborn screening. For this purpose, we convened 21 European newborn screening experts across a range of professions and national backgrounds in a Delphi study. Stable consensus, determined via the Wilcoxon matched-pairs signed-ranks test, was found via three consecutive survey rounds for all presented barriers. Experts generally judged the scenario of genomic newborn screening being available to every newborn in seven years to be unlikely, identifying treatability and the absence of counselling and a skilled workforce as the most significant barriers to public funding. We identify value re-definition for rare disease treatments, centralisation of genomic expertise, and international research consortia as avenues for pan-European actions which build on the consensus achieved by our Delphi panel.

B - 107 Is the Flynn Effect Present in a Veteran Outpatient Clinic Sample?

Abstract Objective The Flynn Effect refers to improvement in cognitive scores over time due to advancements in education quality, nutrition, and socioenvironmental variables. Recent studies suggest cognitive scores may plateau or decline over time. Characterization of cohort effects in cognitive performance has implications for normative group selection and identification of brain illness. This study examines cognitive performances of veterans using older and newer versions of normative data to determine if a Flynn effect is present. Method Veterans (N = 189) who passed TOMM and completed the Trail-Making Test (TMT), Animal Naming, and California Verbal Learning Test-II (CVLT-II) were selected for inclusion. The sample was 81% male, racially diverse (49% White/Caucasian, 31% Black/African American, 16% Hispanic/Latino, 4% other), and diagnostically diverse (13% no diagnosis, 33% cognitive disorder, 54% psychiatric diagnosis). Normative scores were calculated from CVLT-II/CVLT-3 manuals for Trial 1, Trial 5, and LDFR; ADC Uniform Data Sets (UDS) were used for TMT-A/B and Animals. Wilcoxon matched-pairs signed rank tests examined differences in z-scores across older and newer normative data. Results Median z-scores were significantly lower using updated UDS norms for TMT-A (z = −11.60, p < 0.001), TMT-B (z = −10.41, p < 0.001), and Animals (z = −11.76, p < 0.001), while CVLT Trial 1 z-scores were significantly higher using CVLT-3 norms (z = 11.24, p < 0.001). CVLT Trial 5 and LDFR medians did not differ. Conclusion Findings demonstrate the need to examine cohort differences in normative reference groups to ensure accurate detection of brain illness. Furthermore, the Flynn Effect may not apply uniformly across domains within a period.

Glycemic Control in Diabetic Foot Ulcers: A Comparative Analysis of Wound and Wound-free Periods in Adults With Type 1 and Type 2 Diabetes

ObjectiveOur aim in this study was to determine whether there are differences in glycemia during wound and wound-free states among individuals with diabetes at a multidisciplinary diabetic foot and wound clinic from 2012 to 2019. MethodsWe conducted a retrospective analysis of prospectively collected data over 7.4 years from the Johns Hopkins Multidisciplinary Diabetic Foot and Wound Clinic. Participants with diabetic foot ulcers were observed during at least one wound period and one wound-free period and had at least one glycated hemoglobin (A1C) measurement in both a wound and wound-free period. The A1C measurements were aggregated and summarized across wound and wound-free periods, and compared using the Wilcoxon matched-pairs signed rank test. ResultsTwo hundred six eligible participants with a total of 623 wounds were included in this analysis. Participants were followed for a median period of 2.4 years (876 days). There were no significant differences in mean, minimum, and maximum A1C between the aggregate wound and wound-free periods, with median values of 7.6% (interquartile range [IQR] 6.6% to 9.1%) and 7.5% (IQR 6.6% to 9.1%) for mean A1C (p=0.43), 6.9% (IQR 6.0% to 8.0%) and 6.8% (6.0% to 8.1%) for minimum A1C (p=0.78), and 8.6% (IQR 7.1% to 10.9%) and 8.5% (IQR 7.0% to 10.7%) for maximum A1C (p=0.06) in the wound and wound-free periods, respectively. ConclusionsThis retrospective study shows similar levels of A1C during wound and wound-free periods; however, given the limitations of missing A1C and small sample size, further studies leveraging continuous glucose monitoring are needed to determine whether glycemia worsens in the setting of a DFU.

Evaluating the Impact of Ultrasonic Irrigation on Bacterial Levels and Activity Following Chemomechanical Procedures

IntroductionThis single-arm interventional trial aimed to investigate the efficacy of ultrasonic irrigation as a supplementary disinfection approach after chemomechanical procedures (CMP) using molecular techniques based on ribosomal RNA (rRNA) and rRNA genes (referred to as DNA). MethodsSamples were collected from 35 single-rooted teeth with radiographic evidence of apical periodontitis. Samples were taken after gaining root canal access (S1), (S2), and ultrasonic irrigation (S3). DNA-targeted quantitative polymerase chain reaction using universal primers was used to estimate total bacterial levels, while rRNA-targeted quantitative polymerase chain reaction was used to assess bacterial activity. Ratios between rRNA and DNA levels were calculated to search for active bacteria in the samples (rRNA/DNA ≥ 1). Wilcoxon matched-pairs signed-rank test was used to compare the differences in DNA levels between samples and DNA and rRNA levels within samples (P < .05). ResultsDNA-based methods revealed a significant decrease in bacterial levels from S1 to S2 and S2 to S3 (both P < .05). Notably, 11 out of 35 (31.4%) root canals did not harbor bacterial DNA after CMP, whereas ultrasonic activation increased DNA-negative samples to 17 (48.6%). However, all DNA-positive samples were also positive for rRNA, with significantly higher rRNA than DNA levels (P < .05), indicating bacterial activity at the sampling time. ConclusionsUltrasonic irrigation improved the disinfection of root canals after CMP by reducing bacterial levels. However, persisting bacteria remained active in the root canals after CMP and ultrasonic irrigation.

A veterinary-calibrated point-of-care glucometer accurately measures blood glucose concentration in dogs and cats.

To determine the clinical and analytical accuracy of a new veterinary-calibrated portable blood glucose monitor (PBGM) compared to a reference laboratory analyzer. Client-owned dogs (n = 77) and cats (n = 64). Peripheral and paired capillary whole-blood glucose concentrations measured via PBGM were compared to plasma glucose concentrations measured via a Cobas c501 reference analyzer (Roche). Analytical accuracy was evaluated with the Spearman rank correlation coefficient, Bland-Altman difference plot analysis, and Deming regression. Clinical accuracy was evaluated with Parkes error grid analysis. Paired peripheral and capillary blood samples were compared with the Wilcoxon matched-pairs signed-rank test. There was a high correlation between PBGM and reference analyzer readings in dogs and cats. Human quality assurance standards (International Organization for Standardization 15197:2013 guidelines) for analytical accuracy were met for 95% of feline peripheral blood samples and 89% of canine samples. Similar veterinary standards (American Society of Veterinary Clinical Pathology guidelines) were met for 89% of canine and 92% of feline peripheral blood glucose measurements. Error grid analysis showed that all peripheral canine and 97% of feline measurements were clinically accurate (zone A). Any altered clinical decision for the remaining feline measurements was expected to minimally impact outcome (zone B). No significant difference was found between peripheral and capillary blood glucose measurements in either species. The PBGM produced clinically accurate results and is suitable for use in veterinary and home settings to measure blood glucose.

15O]H2O PET/MRI for Assessment of Complete Response to Neoadjuvant or Induction Chemotherapy in Patients with Muscle-Invasive Bladder Cancer: A Pilot Study.

Background: Accurate assessment of therapy response to chemotherapy could possibly offer a bladder-sparing approach in selected patients with localized muscle-invasive bladder cancer (MIBC). The aim of this study was to evaluate whether [15O]H2O PET/MRI can be used for assessment of complete local pathological response to preoperative chemotherapy in patients with MIBC. Methods: This prospective pilot study included 13 patients with MIBC treated with neoadjuvant or induction chemotherapy and subsequent radical cystectomy. Patients underwent a [15O]H2O PET/MRI scan before chemotherapy and another scan after chemotherapy before radical cystectomy. Volumes of interest were delineated on T2-weighted MRI and transferred to parametric images for dynamic analysis. Tumor blood flow (TBF) was estimated by [15O]H2O PET. Changes in TBF were compared with histopathology. The Wilcoxon matched-pairs signed-ranks test was used for comparing pre- and post-chemotherapy measurements. Results: Mean TBF decreased by 49%. Mean TBF in complete responders (ypT0N0/ypTis) was not significantly different from non-complete responders (≥ypT1) (p = 0.52). Conclusions: Despite a measurable decrease in TBF after chemotherapy treatment, we were not able to estimate a TBF threshold for identifying complete responders to chemotherapy for MIBC patients. Further studies are needed to elucidate the potential of [15O]H2O PET/MRI in assessing therapy response in MIBC.

Short occupational exposure to glyphosate and its biomonitoring via urinary levels of glyphosate and metabolite AMPA (Amino-MethylPhosphonic acid), in Italian vineyard workers

Glyphosate, an herbicide largely used in various contexts, can have adverse effects on human health. Although it is currently the most applied pesticide worldwide, few studies evaluated the extent of human exposure via biomonitoring. To expand such information, biological monitoring of exposure to glyphosate was conducted.The study has a before-and-after design to demonstrate the immediate impact of short-term interventions. Accordingly, the urine concentrations of glyphosate and its main biodegradation product (amino-methylphosphonic acid- AMPA) were measured before and the day after the single herbicide application in 17 male winegrowers. Urine samples were analyzed by high performance liquid chromatography coupled with a triple quadrupole mass spectrometer equipped with an electrospray ionization source.Glyphosate and AMPA were not detectable in pre-application urine samples (limit of quantification for glyphosate (LOQG) was 0.1 μg/L; limit of quantification for AMPA (LOQAMPA) was 0.5 μg/L). After application, glyphosate urinary levels were above LOQG in all workers. The median, min, and max values were 2.30, 0.51, and 47.2 μg/L, respectively. The same values were found for 50 %, 5 % and 95 % percentiles. After assigning numerical values, such as one half the LOQ, to each of the non-detects, the “z” of Wilcoxon matched-pairs signed-ranks test was −3.62 (p = 0.0003), suggesting the pre-application values being significantly lower than the post-application urinary glyphosate concentration. A similar analysis was not feasible with AMPA urinary levels, which were detectable only in 3 workers, after application. 12 (71 %) workers were significantly exposed to glyphosate, but adherence to the adoption of personal protective equipment was good: 14 (82 %) workers used gloves, 13 (76 %) used overalls and 13 (76 %) facial masks.Our data show that glyphosate can be absorbed by the workers after a single application and confirms the usefulness of biomonitoring in exposed workers. Further studies are needed in larger working populations and with multiple glyphosate applications, as well as to evaluate the correlations of glyphosate urine levels with exposure questionnaire data, in order to assess the actual relevance of risk and protection factors.

A retrospective study of the effects of a vasopressor bolus on systolic slope (dP/dt) and dynamic arterial elastance (Eadyn)

BackgroundTo enhance the utility of functional hemodynamic monitoring, the variables systolic slope (dP/dt) and dynamic arterial elastance (Eadyn) are calculated by the Hypotension Prediction Index (HPI) Acumen® Software. This study was designed to characterize the effects of phenylephrine and ephedrine on dP/dt and Eadyn.MethodsThis was a retrospective, non-randomized analysis of data collected during two clinical studies. All patients required intra-operative controlled mechanical ventilation and had an indwelling radial artery catheter connected to an Acumen IQ sensor. Raw arterial pressure waveform data was downloaded from the patient monitor and all hemodynamic measurements were calculated off-line. The anesthetic record was reviewed for bolus administrations of either phenylephrine or ephedrine. Cardiovascular variables prior to drug administration were compared to those following vasopressor administrations. The primary outcome was the difference for dP/dt and Eadyn at baseline compared with the average after the bolus administration. All data sets demonstrated non-normal distributions so statistical analysis of paired and unpaired data followed the Wilcoxon matched pairs signed-rank test or Mann-Whitney U test, respectively.Results201 doses of phenylephrine and 100 doses of ephedrine were analyzed. All data sets are reported as median [95% CI]. Mean arterial pressure (MAP) increased from 62 [54,68] to 78 [76,80] mmHg following phenylephrine and from 59 [55,62] to 80 [77,83] mmHg following ephedrine. Stroke volume and cardiac output both increased. Stroke volume variation and pulse pressure variation decreased. Both drugs produced significant increases in dP/dt, from 571 [531, 645] to 767 [733, 811] mmHg/sec for phenylephrine and from 537 [509, 596] to 848 [779, 930] mmHg/sec for ephedrine. No significant changes in Eadyn were observed.ConclusionBolus administration of phenylephrine or ephedrine increases dP/dt but does not change Eadyn. dP/dt demonstrates potential for predicting the inotropic response to phenylephrine or ephedrine, providing guidance for the most efficacious vasopressor when treating hypotension.Trial registrationData was collected from two protocols. The first was deemed to not require written, informed consent by the Institutional Review Board (IRB). The second was IRB-approved (Effect of Diastolic Dysfunction on Dynamic Cardiac Monitors) and registered on ClinicalTrials.gov (NCT04177225).

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.

Objective assessment of tear film in blepharospasm, facial hemispam and aberrant regeneration with periocular botulinum toxin-A.

Study the effect on the tear film in blepharospasm (BEB), facial hemispasm (FH), or aberrant regeneration (AR) treated with Botulinum Toxin (BTX-A). A prospective study was used to evaluate the tear film in patients with BEB, FH, or AR treated with BTX-A. Schirmer tests, break-up time (BUT), optical coherence tomography (OCT) meniscus measurement, the Ocular Surface Disease Index (OSDI) questionnaire, and Oxford scale were documented before; 1 month after; and 3 months after BTX-A treatment. Comparisons were made with the Friedman test and Wilcoxon matched-pairs signed rank test was used. A p-value <0.05 was considered statistically significant. A total of 35 eyes from 27 patients were included. The mean patient age was 66.81 ± 12.94 years and 18 (66.7%) were female. Ten (37%) patients had BEB, six (22.2%) had FH, and 11 (40.74%) had AR. BTX-A improved the lid spasms. One month after BTX-A, Schirmer tests showed slight increments (Schirmer 1 p = 0.009; Schirmer 2 p = 0.05) and at 3 months they became similar to pre-treatment (p = 0.5). The BUT test was not significantly different at 1 month (p = 0.450) or at 3 months. On OCT 1 month after BTX-A, there was an increase in tear meniscus area (p = 0.004), height (p = 0.007), and depth (p = 0.004), and at 3 months the measurements also became similar to the pre-BTX-A values. No significant changes in the OSDI (p = 0.717) and Oxford scale (p = 0.255). OCT is a good tool to detect the increase in tear meniscus after periocular BTX-A in BEB, FH, and AR.

P-082 Use of TetraSOD® in male infertility: double-blind randomized placebo-controlled study

Abstract Study question Can the use of TetraSOD® (microalgae with high content of the antioxidant enzyme superoxide dismutase) improve semen quality and reduce oxidative stress in sperm? Summary answer The use of TetraSOD® reduces the oxidative stress of sperm, increasing the total sperm count in oligozoospermia and reducing the double-stranded DNA sperm fragmentation. What is known already Male factor is present in approximately 50% of the infertile couples, a large number of them of unknown or idiopathic origin. It has been demonstrated that semen quality is deteriorating over time, perhaps as a result of exposure to several environmental factors related with lifestyle that could impact both directly and indirectly on the complex process of spermatogenesis. Some of these bad habits of lifestyle increase the levels of oxidative stress in semen, which is associated with lower sperm concentration and motility. In this scenario, the use of antioxidants can be useful to increase sperm quality. Study design, size, duration Double-blind randomized placebo-controlled clinical study to assess the effect of 250 mg of TetraSOD® (microalgae with high content of the primary antioxidant enzyme superoxide dismutase). Eighty patients with idiopathic infertility showing asthenozoospermia, oligozoospermia or oligoasthenozoospermia were recruited and randomized to receive 250 mg of TetraSOD® (TSOD group) or placebo (Placebo group) for 3 months. Participants/materials, setting, methods Men with asthenozoospermia, oligozoospemia or aligoastenozoospermia and idiopatic infertility were recruited after informed consent signature. Patients were randomized into two groups. TetraSOD® group received 250 mg of TetraSOD®during 3 months, and Placebo group received capsules without TetraSOD® during the same period of time. Seminogram, double-strand sperm DNA fragmentation (COMET assay) and sORP (static oxidation- reduction potential) were studied at baseline (V0) and after 3 months (V3). Main results and the role of chance TetraSOD® consumption for three months elicited a statistically significant increase (Wilcoxon matched-pairs signed rank test; p=0.02) in the average number of sperms per ejaculate (from 17.06 x 106 to 41.94 x 106) in participants displaying oligozoospermia (&amp;lt;39 x 106 sperms) at V0. In contrast, the lower variation in the measured values in the Placebo group was not statistically significant. Regarding sORP, a statistically significant decrease (Wilcoxon matched-pairs signed rank test; p=0.0233) was observed in participants who displayed a value at V0 between 1.34-10. After TetraSOD® consumption, the average changed from 2.96 to 1.91 mv/106 sperm/ml from V0 to V3. However, not statistically significant changes were detected in the Placebo group between sORP values at V0 and V3. Moreover, in relation to double-stranded DNA breaks, a statistically significant decrease (Wilcoxon matched-pairs signed rank test; p=0.01) in the average percentages (from 31.81% to 25.93%) was measured after consumption of TetraSOD® at V3 in participants displaying a compromised redox status (sORP&amp;gt;1.34-10) at V0. No significant changes were found in the Placebo group. Limitations, reasons for caution The study was performed only in one ethnic group, so in future studies other ethnicities should be included. Wider implications of the findings TetraSOD® may improve male fertility because increases the number of sperms per ejaculate in oligozoospermia and reduces double-stranded DNA fragmentation in sperm when individuals display an altered redox status in semen. Such results might be related to the indirect antioxidant effect of TetraSOD®, reducing oxidative stress in seminal fluid. Trial registration number Not applicable

Orthognathic surgery improves compromised natural head position and pharyngeal airway in patients with Skeletal Class II or III malocclusion.

Natural head position (NHP), pharyngeal airway and maxillofacial growth pattern are correlated. The author's previous studies proved that following surgical correction of Skeletal Class II malocclusion, the over-extended NHP returned upright, and the pharyngeal airway space (PAS) dimension expanded. The present study compares the post-operative change in NHP and PAS after orthognathic surgery in Skeletal Class II and III malocclusion patients. Patients receiving orthognathic procedures to correct Skeletal Class II or III malocclusions were reviewed in this retrospective study. Pre-operative and 6-week post-operative cone-beam computed tomography datasets were collected. Variables representing the craniofacial pattern, the NHP and the PAS were measured three-dimensionally. Post-operative variables were compared with their pre-operative counterparts using either repeat-measure 2-way analysis of variance or Wilcoxon matched-pairs signed rank test. Thirty cases of Skeletal Class II malocclusion and 13 cases of Skeletal Class III malocclusion were collected. Preoperatively, the inter-group differences were significant in craniofacial pattern (68.14 ± 3.552 degree vs. 79.63 ± 2.497 degree, p < .0001) and the NHP (68.77 ± 11.02 degree vs. 82.83 ± 7.738 degree, p = .0002) while not significant in PAS; after surgery, the intergroup differences in craniofacial pattern and the NHP between groups decreased, and the PAS increased in both groups. Orthognathic surgery may improve compromised NHP and increase PAS in Skeletal Class II and III malocclusion patients.

Long Prime-Boost Interval and Heightened Anti-GD2 Antibody Response to Carbohydrate Cancer Vaccine.

The carbohydrate ganglioside GD2/GD3 cancer vaccine adjuvanted by β-glucan stimulates anti-GD2 IgG1 antibodies that strongly correlate with improved progression-free survival (PFS) and overall survival (OS) among patients with high-risk neuroblastoma. Thirty-two patients who relapsed on the vaccine (first enrollment) were re-treated on the same vaccine protocol (re-enrollment). Titers during the first enrollment peaked by week 32 at 751 ± 270 ng/mL, which plateaued despite vaccine boosts at 1.2-4.5 month intervals. After a median wash-out interval of 16.1 months from the last vaccine dose during the first enrollment to the first vaccine dose during re-enrollment, the anti-GD2 IgG1 antibody rose to a peak of 4066 ± 813 ng/mL by week 3 following re-enrollment (p < 0.0001 by the Wilcoxon matched-pairs signed-rank test). Yet, these peaks dropped sharply and continually despite repeated boosts at 1.2-4.5 month intervals, before leveling off by week 20 to the first enrollment peak levels. Despite higher antibody titers, patients experienced no pain or neuropathic side effects, which were typically associated with immunotherapy using monoclonal anti-GD2 antibodies. By the Kaplan-Meier method, PFS was estimated to be 51%, and OS was 81%. The association between IgG1 titer during re-enrollment and β-glucan receptor dectin-1 SNP rs3901533 was significant (p = 0.01). A longer prime-boost interval could significantly improve antibody responses in patients treated with ganglioside conjugate cancer vaccines.

#2843 Urinary extracellular vesicles in after deceased donor kidney transplantation

Abstract Background and Aims Urinary extracellular vesicles (uEV) are membrane-bound organelles which contain several molecules from their host tissue, including proteins, membrane receptors, nucleic acids, and lipids. Currently it is unknown whether uEV can be used as a liquid biopsy tool to determine injuries of the allograft after kidney transplantation. The objective of the present study was to compare uEV early posttransplant in kidney transplant recipients with allografts from deceased male and deceased female donors. Method We measured the principal cell specific aquaporine 2 (AQP2) abundance in uEV with an Enzyme-linked immunosorbent assay (ELISA) using novel generated specific antibodies, 19-64-1. The AQP2 abundance in uEV was detected in urine samples from incident deceased donor kidney transplant recipients during two periods posttransplant, i.e., the first period was from 6 to 11 hours and the second period was from 12 to 23 hours posttransplant, respectively. The AQP2 abundance in uEV was normalized to urinary creatinine, i.e., abundance/mmol creatinine. Results Complete data were obtained from 71 kidney transplant recipients with median age, 50 years (IQR, 42 to 57 years), median weight 73 kg (IQR, 64 to 86 kg), median systolic blood pressure, 144 mmHg (IQR, 130 to 160 mmHg), median diastolic blood pressure, 87 mmHg (IQR, 78 to 98 mmHg), median time on dialysis 25 months (IQR, 10 to 44 months). In 43 kidney transplant recipients with deceased male donors the AQP2 abundance in uEV significantly decreased from median 0.12 (IQR, 0.06 to 0.29) at the first postoperative period to median 0.05 (IQR, 0.03 to 0.12; P = 0.0004 by Wilcoxon matched-pairs signed rank test). On the other hand, in 31 kidney transplant recipients with deceased female donors the AQP2 abundance in uEV did no change from median 0.09 (IQR, 0.05 to 0.24) at the first postoperative period to median 0.05 (IQR, 0.03 to 0.13; P = 0.09 by Wilcoxon matched-pairs signed rank test). Conclusion The larger postoperative decline of the AQP2 abundance in uEV from deceased male donors compared to deceased female donors in early periods posttransplant may point to a larger principal cell mass in males.

Vitamin D Metabolites Before and After Kidney Transplantation in Patients Who Are Anephric

Rationale & ObjectiveKidneys are vital for vitamin D metabolism and disruptions in both production and catabolism occur in chronic kidney disease. Although vitamin D activation occurs in numerous tissues, the kidneys are the most relevant source of circulating active vitamin D. This study investigates extrarenal vitamin D activation and the impact of kidney transplantation on vitamin D metabolism in patients who are anephric. Study DesignCase series. Setting & ParticipantsAdult patients with previous bilateral nephrectomy (anephric) not receiving active vitamin D therapy were evaluated at the time of (N=38) and 1 year after (N=25) kidney transplantation. Liquid chromatography–tandem mass spectrometry was used to measure vitamin D metabolites. Metabolic ratios were expressed CYP24A1 (24,25(OH)2D/25(OH)D) and CYP27B1 (1α,25(OH)2D/25(OH)D) as activities. Differences between evaluation timepoints were evaluated by paired Student’s t-test or Wilcoxon matched-pairs signed-rank test. FindingsAt time of transplantation, 1α,25(OH)2D was detectable in all patients (4 to 36 pg/mL). There was a linear relationship between 25(OH)D and 1α,25(OH)2D-levels (r=0.58, p<0.001) with 25(OH)D explaining 34% of the variation in 1α,25(OH)2D-levels. There were no associations between 1α,25(OH)2D and biointact PTH or FGF23. One year after transplantation, 1α,25(OH)2D levels recovered (+205%) and CYP27B1 activity increased (+352%). Measures of vitamin D catabolism, 24,25(OH)2D and CYP24A1 activity increased 3-5 fold. Also at 12 months after transplantation, 1α,25(OH)2D was positively correlated with PTH (rho=0.603, p=0.04), but not with levels of 25(OH)D or FGF23. LimitationsRetrospective, observational study design with a small cohort size. ConclusionsLow-normal levels of 1α,25(OH)2D was demonstrated in anephric patients, indicating production outside of the kidneys. This extrarenal CYP27B1 activity may be more substrate-driven than hormonally regulated. Kidney transplantation seems to restore kidney CYP27B1 and CYP24A1 activity, as evaluated by vitamin D metabolic ratios, resulting in both increased vitamin D production and catabolism. These findings may have implications for vitamin D supplementation strategies in the setting of kidney failure and transplantation.

Dynamics of Urine Electrolytes in Term Neonates during the 1st Week of Life

Background: Urine electrolyte assessment is vital for diagnosing and managing neonatal conditions. However, the challenge of urine collection in neonates has resulted in a lack of standardized urine electrolyte reference values. Aim: This study seeks to explore the reference levels and potential trends in serum and urine electrolytes to better understand how the kidneys handle these substances. Methods: Healthy neonates were prospectively enrolled following normal births. Using biochemical methods, blood and urine samples were collected and analyzed on the 1st and 5th postnatal days. Statistical analysis was performed using descriptive statistics and the Wilcoxon matched-pairs signed-rank test. Results: This prospective study enrolled 55 healthy neonates. Significant changes in serum electrolyte concentrations were observed between the 1st and 5th days after birth. Notably, sodium, creatinine, urea nitrogen, and uric acid levels decreased, whereas potassium, calcium, and phosphate levels increased. Urine analysis revealed significant increases in the tubular maximum phosphate reabsorption per glomerular filtration rate and decreases in the fractional excretion of potassium and uric acid by Day 5. Conclusion: This study challenges prevailing assumptions about the stability of neonatal urine electrolytes and highlights dynamic changes in the first postnatal week. These insights lay the groundwork for further research into electrolyte disorders in newborns and have potential implications for improving neonatal care practices.

Omadacycline drug susceptibility testing for non-tuberculous mycobacteria using oxyrase to overcome challenges with drug degradation

BackgroundDrug susceptibility testing (DST) protocol of omadacycline against non-tuberculous mycobacteria has not yet been established. We developed a method to accurately determine MIC omadacycline MIC against Mycobacterium abscessus (Mab), Mycobacterium avium-complex (MAC), and Mycobacterium kansasii (Mkn). MethodsFirst, we identified the oxyrase concentration not affecting Mab, MAC, and Mkn growth followed by omadacycline MIC experiments with and without oxyrase using reference and clinical strains. ResultsOxyrase 0.5 % (v/v) stabilized omadacycline in the culture medium. The median omadacycline MIC was 1 mg/L for Mab and 8 mg/L for Mkn. For MAC, the median omadacycline MIC was 2 mg/L for M. avium, 256 mg/L for M. intracellulare, and 4 mg/L for M. chimaera (p < 0.0001). Wilcoxon matched-pairs signed rank test revealed statistically lower MICs with oxyrase for all MAC subspecies (p < 0.0001), all Mab subspecies (p < 0.0001), and Mkn (p = 0.0002). The decrease in MICs with oxyrase was 17/18 of Mab, 14/19 of Mkn, 8/8 of M. avium, 4/5 M. chimera, but only 11/18 of M. intracellulare (p < 0.013). ConclusionUse of 0.5 % oxyrase could be a potential solution to reliable and reproducible omadacycline MIC of Mab. However, oxyrase demonstrated a variable effect in reducing MICs against MAC and Mkn.

The PocketPerio application significantly increases the accuracy of diagnosing periodontal conditions in didactic and chairside settings

The study aimed to determine the accuracy of diagnosing periodontal conditions using the developed web-based PocketPerio application and evaluate the user’s perspective on the use of PocketPerio. First, 22 third-year dental students (DS3) diagnosed ten cases without PocketPerio (control) and with PocketPerio (test) during a mock examination. Then, 105 DS3, 13 fourth-year dental students (DS4), and 32 senior second-year International Standing Program students (ISP2) used PocketPerio chairside. Statistical analysis was performed using a non-parametric paired two-tailed test of significance with the Wilcoxon matched-pairs signed rank test. The null hypothesis that PocketPerio did not increase the accuracy of periodontal diagnoses was rejected at α < 0.01. Periodontal diagnoses made using PocketPerio correlated with those made by periodontics faculty (“gold standard") in all cases. During the mock examination, PocketPerio significantly increased the accuracy of periodontal diagnoses compared to the control (52.73 vs. 13.18%, respectively). Chairside, PocketPerio significantly increased the accuracy of primary (100 vs. 40.0%) and secondary (100 vs. 14.25%) periodontal diagnoses compared to the respective controls. Students regardless of their training year felt more confident in diagnosing periodontal conditions using PocketPerio than their current tools, provided positive feedback on its features, and suggested avenues for its further development.