Wilcoxon Rank Sum Test Research Articles

Bibliometric analysis of the top 100 most cited articles on the immunotherapy for glioblastoma.

The nature of immunotherapy has rendered it a focal point in the management of glioblastoma (GBM). This bibliometric analysis aimed to analyze the top 100 most cited articles about immunotherapy for GBM to expand the knowledge of research related to this therapeutic approach. The retrieval of the top 100 articles on "Immunotherapy AND Glioblastoma" was performed using the Web of Science Core Collection database. Relevant details were extracted for bibliometric analysis, and to gain insights, a comparison was made between older and newer articles. Categorical data underwent analysis utilizing Pearson's chi-square test, while continuous data were analyzed using the Wilcoxon rank-sum test. The top 100 articles were distributed across the years 2000 to 2021, with the number of citations ranging from 135 to 1058. Among these articles, publications peaked in 2017 and 2018 (n = 12), and the most common country of correspondence was the USA (n = 73). Clinical Cancer Research was the most cited journal, and authors SAMPSON JH and LIM M had the highest number of papers (n = 6). Newer articles had significantly higher citation rates (p < 0.01), more authors (p < 0.05), more institutes (p < 0.01), and more collaborations between institutions (p < 0.01). Subspecialties showed a trend of more "TME" (1% vs 7%, p = 0.05945) in the before and after group comparison, although this difference was not statistically significant (p > 0.05). The study of the top 100 cited articles on immunotherapy for GBM shows that researchers are actively working together to develop novel approaches to GBM immunotherapy. The high citations, leading countries, journals, and authors, along with evolving research characteristics, indicate a field with great interest and potential. Immunotherapy holds significant promise in GBM treatment.

Google Trends Assessment of Keywords Related to Smoking and Smoking Cessation During the COVID-19 Pandemic in 4 European Countries: Retrospective Analysis

Background Smoking is a modifiable risk factor for SARS-CoV-2 infection. Evidence of smoking behavior during the pandemic is ambiguous. Most investigations report an increase in smoking. In this context, Google Trends data monitor real-time public information–seeking behavior and are therefore useful to characterize smoking-related interest over the trajectory of the pandemic. Objective This study aimed to use Google Trends data to evaluate the effect of the pandemic on public interest in smoking-related topics with a focus on lockdowns, vaccination campaigns, and incidence. Methods The weekly relative search volume was retrieved from Google Trends for England, Germany, Italy, and Spain from December 31, 2017, to April 18, 2021. Data were collected for keywords concerning consumption, cessation, and treatment. The relative search volume before and during the pandemic was compared, and general trends were evaluated using the Wilcoxon rank-sum test. Short-term changes and hereby temporal clusters linked to lockdowns or vaccination campaigns were addressed by the flexible spatial scan statistics proposed by Takahashi and colleagues. Subsequently, the numbers of clusters after the onset of the pandemic were compared by chi-square test. Results Country-wise minor differences were observed while 3 overarching trends prevailed. First, regarding cessation, the statistical comparison revealed a significant decline in interest for 58% (7/12) of related keywords, and fewer clusters were present during the pandemic. Second, concerning consumption, significantly reduced relative search volume was observed for 58% (7/12) of keywords, while treatment-related keywords exhibited heterogeneous trends. Third, substantial clusters of increased interest were sparsely linked to lockdowns, vaccination campaigns, or incidence. Conclusions This study reports a substantial decline in overall relative search volume and clusters for cessation interest. These results underline the importance of intensifying cessation aid during times of crisis. Lockdowns, vaccination, and incidence had less impact on information-seeking behavior. Other public measures that positively affect smoking behavior remain to be determined.

Standardized List Evaluating Apnea (SLEAP): A Comprehensive Survey to Define the Quality of Life in OSA.

To develop and validate a patient-reported outcome measure (PROM) to evaluate the quality of life (QoL) among patients with obstructive sleep apnea (OSA). A prospective cohort study. Tertiary referral center. We developed a 15-item English questionnaire that was administered to 176 adults with OSA and 22 adult controls without symptoms of OSA in a tertiary sleep surgery clinic between June 2021 and December 2021. The internal consistency and test-retest reliability were measured using the Cronbach's α and the intraclass correlation coefficient, respectively. The 2-sample Wilcoxon rank-sum (Mann-Whitney) test was applied to compare the 2 groups. Convergent validity of the test scores of the questionnaire was compared to previously validated outcome measures and objective sleep study outcomes using the Spearman correlation coefficient. Of the 198 respondents (176 cases and 22 controls); 71% were men and 29% were women. The internal consistency was excellent with the α of .92 (lower 95% confidence limit of 0.90). All the test-retest correlations were positive, significant, and strong ranging from 0.50 to 0.90. The differences between cases and controls were statistically significant for all the items and for the total score. The total score of the questionnaire with the Epworth Sleepiness Scale and objective OSA measures was moderate to strong. The new tool provides a validated PROM to evaluate the QoL among OSA patients specifically, with excellent internal consistency, reasonable test-retest reliability, discriminant validity, and construct validity. Level 4.

Effect of Patient Age on Decisional Regret After Laparoscopic Hysterectomy.

To compare long-term decision regret between younger (30 years or younger) and older (31-49 years) patients who underwent laparoscopic hysterectomy for benign disease. We conducted a matched retrospective cohort study to analyze patients who underwent laparoscopic hysterectomies for benign indications from 2009 to 2016. Respondents completed surveys including two validated decision regret scales: one measuring surgical decision regret and the other measuring loss-of-fertility regret. Participant aged was dichotomized as 30 years or younger and 31-49 years. Chi square, Fisher exact, and Wilcoxon rank sum tests and logistic regression were used to compare groups. Two hundred eighty-seven participants were successfully contacted, and 241 completed the survey (84.0%). Seventy-seven respondents (32.0%) were aged 30 years or younger, and 164 (68.0%) were aged 31-49 years. The average time since surgery was 7.2 years (±2.2 years; range 3.7-12.1 years). Participants aged 30 years or younger regretted both undergoing surgery (32.5% vs 9.1%, P<.001; OR 4.8, 95% CI, 2.3-9.8) and loss of fertility (39.0% vs 13.4%, P<.001, OR 4.1, 95% CI, 2.2-7.8) at significantly higher rates than participants aged 31-49 years. Overall, 83.1% of younger participants agreed that hysterectomy was the right choice compared with 97% of older participants (P<.001). Higher rates of surgical and loss-of-fertility regret were seen in participants with self-reported pelvic pain (P=.003, P=.011), preoperative diagnosis of endometriosis (P=.037, P=.046), and postoperative complications (P=.043, P<.001). Although time since hysterectomy did not affect rate of surgical regret (P=.138), participants further from their hysterectomies had lower rates of loss-of-fertility regret (P=.003). Patient age remained significantly associated with both surgical regret (adjusted OR 2.9 (95% CI, 1.3-6.5) and loss-of-fertility regret (adjusted OR 2.8 (95% CI, 1.3-6.0) on multivariable logistic regression. Participants aged 30 years or younger were more likely to regret their decision to undergo hysterectomy than participants aged 31-49 years, regardless of parity, prior sterilization, or previous treatment.

Librarian involvement on knowledge synthesis articles and its relationship to citation counts and Journal Impact Factor

Introduction: Our aim was to determine if there is a relationship between librarian involvement on a knowledge synthesis project and the synthesis’s citation count or the Journal Impact Factor (JIF) of its publication venue. Methods: A total of 551 knowledge syntheses published during a one-year period (2020) from a single category, “Psychology, Clinical”, in Clarivate’s Journal Citation Reports were exported from Web of Science along with the citation counts for each synthesis and the JIF of its publication venue. The full-text of each article was examined in order to code each as either co-author, acknowledged, or unknown to reflect the level of librarian involvement in the synthesis. The Wilcoxon Rank Sum test on bootstrapped samples was used to determine the significance of the results. Results: Librarians were co-authors or acknowledged in 80 (15%) of the syntheses examined. Analyzing two levels of librarian involvement (involved, unknown) indicated no relationship between the level of librarian involvement and the JIF of the journal nor the citation count the synthesis received since publication. Discussion: There is no evidence of a relationship between librarian involvement in knowledge syntheses and the JIF of the publication or citation count of documents published in journals falling in the JCR category of “Psychology, Clinical” in the year 2020. Repeating this methodology in a different JCR category could help determine whether this lack of a relationship extends beyond the “Psychology, Clinical” category.

Survival Outcomes and Disparities in Surgery Refusal for Papillary Thyroid Cancer.

Surgery is the cornerstone of treatment for papillary thyroid cancer (PTC), yet some patients refuse surgery, which may impact their survival outcomes. Understanding factors associated with surgery refusal could inform interventions to improve acceptance of recommended care. This retrospective cohort study evaluated the impact of surgery refusal on overall survival (OS) and identified associated demographic and clinical factors using data on patients with PTC from the National Cancer Database from 2004 to 2019. OS was analyzed using the Kaplan-Meier method, with survival curves compared using the log-rank test. Patient characteristics were analyzed using Pearson Chi-square tests or Wilcoxon Rank Sum tests. Of the 201,051 patients with PTC who were advised to undergo surgery, 200,656 (99.8%) underwent surgery, while 395 (0.2%) refused. Patients who refused surgery were older (mean age 55.2 years vs. 48.7 years), more often male (27.8% vs. 22.8%), and represented higher proportions of Black, Asian, Hispanic, lower-income, uninsured, and non-privately insured patients (p<0.001). OS rates were significantly lower in patients who refused surgery, with one-year and five-year survival rates of 87% and 34%, respectively, compared to 96% and 56% for those who underwent surgery. Surgery refusal in patients with PTC was associated with poorer OS outcomes and was more frequent among older adults, socioeconomically disadvantaged populations, and racial and ethnic minorities. Interventions addressing patient concerns and barriers to surgery are critical to improving treatment acceptance and survival among these groups.

Predictors of cost of admission for robot-assisted pedicle screw placement.

The authors investigated the predictors of cost of admission (CoA) for robot-assisted pedicle screw placement to assess the value of robotic systems in spine operations. Demographic, operative, and postoperative variables were retrospectively collected from 506 patients undergoing robot-assisted spine surgery utilizing the ExcelsiusGPS robot at two high-volume tertiary care centers from 2017 to 2023. Perioperative parameters were evaluated against total hospital admission cost utilizing the Kruskal-Wallis and Wilcoxon rank-sum tests followed by multivariable linear regression. The majority of patients were female (53.6%), 50-80 years of age (77.7%), and White (73.9%); had at least 1 comorbidity (58.1%); and presented with an average functional preoperative Frankel grade (57.5%). The mean CoA was $69,458 ± $47,910. On univariable analysis, demographic data including sex, age, race, and Frankel grade were not associated with CoA. The presence of a comorbidity, however, was associated with increased CoA (p < 0.001). Intraoperatively, one-third of the operations (31.8%) were revisions from prior operations and were subsequently associated with increased CoA (p = 0.021). Thoracic-level operations constituted roughly one-quarter of the cohort (24.1%) and were also associated with increased CoA (p < 0.001). Intraoperative durotomies occurred in 7.7% of patients, leading to increased CoA (p = 0.003). Extended surgical durations also demonstrated elevated CoA (p < 0.001). Postoperatively, the median length of stay (LOS) was 3 days, and an LOS of greater than 3 days was one of the primary drivers of cost (p < 0.001). Postoperative complications occurred in just 6.3% of the cohort but were also associated with increased CoA (p < 0.001). On multivariable analysis, LOS, number of screws placed, operative duration, and postoperative complications were the primary predictors of increased CoA. Understanding the drivers of cost in robot-assisted pedicle screw placement is crucial to elucidate the value associated with the use of robotic systems in spine surgery. These results indicate that patient and surgical complexity influence cost and that robotic systems may augment management in spine surgery. Further investigation is warranted to determine the long-term benefits and cost-effectiveness of new technologies compared with traditional techniques in spine surgery.

Higher rates of recurrence and worse quality of life in obese patients undergoing inguinal hernia repair.

Prior investigations regarding the effect of obesity on inguinal hernia repair have been mixed. The aim of our study was to retrospectively compare perioperative outcomes, recurrence rate, and quality of life between obese and non-obese patients undergoing inguinal hernia repair. Patients who underwent inguinal hernia repair by any approach at a single institution were identified from a prospectively maintained quality database. Patients with a body mass index (BMI) greater than or equal to 30kg/m2 were considered obese. Quality of life was measured with the Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CSS) surveys. Differences between obese and non-obese patients were assessed using independent samples t-tests, Wilcoxon rank-sum, and chi-square tests. Between 2010 and 2021, a total of 5575 patients underwent inguinal hernia repair. Fifteen percent of patients were identified as obese (835 patients, mean BMI 33.2 ± 3.3kg/m2). A significantly higher percentage of obese patients were diabetic, and operative time and estimated blood loss were higher in the obese group (all p < 0.001). Rates of hernia recurrence in obese patients was significantly more likely than in non-obese patients (4.2% vs 2.0%, p < 0.001). Up to 2 years postoperatively, a greater percentage of obese patients reported worse quality of life on the SOMS and more bothersome symptoms on the CCS. Inguinal hernia repair in obese patients is a more technically challenging operation. Long-term follow-up revealed a greater risk of hernia recurrence and worse quality of life up to 2 years postoperatively in this patient population.

Actigraphy-derived multidimensional sleep health among breast cancer survivors and controls: Pink SWAN.

To compare breast cancer survivors (BCS) to women without breast cancer (controls) on sleep health risk factors and actigraphy-derived dimensions of sleep (duration, maintenance, timing, and regularity) and examine whether the effect of breast cancer on sleep differs by time since diagnosis. Analyses included data from 68 BCS and 1042 controls who participated in actigraphy and Pink SWAN sub-studies within the Study of Women's Health Across the Nation. BCS and control characteristics were compared using chi-square, Fisher's exact, and Wilcoxon rank sum tests. Sleep measures were regressed onto breast cancer status using binomial logistic and linear regression. The interaction between BCS status and years since diagnosis (< 5; ≥ 5) was tested in these models before and after covariate adjustment. There were no overall sleep differences between BCS and controls; both groups experienced poor sleep health on average across multiple dimensions. Physical inactivity, sleep apnea, and vasomotor and depressive symptoms were associated with worse sleep in both groups. Total sleep time was lower among BCS than controls within 5years of diagnosis (6.13 vs. 6.57h; p = .03) but did not differ at > 5years post-diagnosis (6.59 vs. 6.45h; p = .32). BCS reported greater use of exogenous hormones (p < .0001) and were twice as likely to have initiated anxiolytic use post-diagnosis (p = .03). BCS within 5years of diagnosis experienced shorter sleep duration than controls but did not differ on other sleep parameters. Both groups experienced poor sleep health. BCS and similarly-aged women experience poor sleep health requiring assessment and treatment.

A Retrospective Analysis of the Long-Term Safety and Efficacy of A1-UV Intraocular Lens Combined with Capsular Tension Ring in the Treatment of Patients with Cataract and Suspensory Ligament Abnormalities

Objective: To evaluate the long-term safety and efficacy of the combination therapy of A1-UV Intraocular Lens (IOL) and Capsular Tension Ring (CTR) for cataract patients with abnormal suspensory ligaments. Method: Retrospective data analysis. Extract all patient information related to A1-UV IOL and 920H IOL from the existing Clinical Trial Database of CTR to form a new dataset. The new dataset focuses on IOL and the clinical safety and efficacy of A1-UV IOL and 920H IOL combined with CTR was compared and analyzed based on it. The follow-up time points include 1-2 days, 1 week, 1 month, 3 months, 6 months and 1 year. Evaluation indicators include Best-Corrected Distance Visual Acuity (BCDVA), Uncorrected Distance Visual Acuity (UCDVA), spherical power, cylindrical power, Equivalent Spherical power (SE), Intraocular Pressure (IOP), corneal endothelial cell density, inflammatory response, Adverse Events (AE) and Serious Adverse Events (SAE). Statistical analysis was conducted using SPSS 22.0 software. All statistical tests are conducted using a two-sided test, and a P-value less than 0.05 is considered statistically significant for the difference being tested. Compare the quantitative data using t-test or Wilcoxon rank-sum test. Compare count data using chi-square test or Fisher's exact probability. Results: The number of cases in the A1-UV group and 920H group were both 27 (monocular), with an average age of 68.46 ± 6.93 years old and 70.27 ± 10.95 years old, respectively. The sample sizes at 6 months and 1 year after surgery were 26 cases (96.30%) and 21 cases (77.77%) in the A1-UV group, respectively, while the 920H group consisted of 26 cases (96.30%) and 22 cases (81.48%), respectively. The use of two types of IOLs combined with CTRs can significantly improve BCDVA and UCDVA (both P&lt;0.05). The differences between the groups during each follow-up period were not statistically significant (all P&gt;0.05). The average residual spherical power, residual cylindrical power, and residual SE of both groups of patients after surgery were close to emmetropic eye. There was no statistically significant difference (P&gt;0.05) in the comparison of other refraction indicators between the groups during each follow-up period, except for the cylindrical power at 3 months and 1 year after surgery. In the A1-UV group, a total of 2 patients experienced 3 episodes of mild IOP elevation, which was judged by the investigator to be unrelated to IOL, and no drug treatment was used, and it recovered spontaneously. 3 patients in the 920H group experienced three episodes of high IOP, including two mild cases (one possibly related to the IOL) and one moderate case (possibly related to the IOL), all of which were controlled by medication and recovered. In addition, the IOP of the remaining patients during each follow-up period after surgery was within the normal range. There was no AE or SAE related to implanted products in the A1-UV group. Conclusion: The combination of A1-UV IOL and CTR has long-term good safety and efficacy in the treatment of complex cataract patients with suspensory ligament abnormalities.

Comparative efficacy and safety of mid-neck vs. supraclavicular vagus nerve stimulation in pediatric drug-resistant epilepsy.

A supraclavicular insertion approach for vagus nerve stimulation (VNS) may permit a wider range of VNS settings compared to traditional insertion techniques due to increased anatomic distance between VNS leads and the recurrent laryngeal nerve. Beyond potential technical advantages, this approach could offer greater cosmetic satisfaction for patients. However, the safety and efficacy of the supraclavicular approach is uncertain. We compared safety and efficacy of supraclavicular versus mid-neck insertion techniques for VNS in the treatment of pediatric drug-resistant epilepsy (DRE). Single-center retrospective analysis of children with epilepsy (< 21 years of age) who received VNS via supraclavicular or mid-neck insertion from May 2017 to December 2022. Continuous variables were compared using Wilcoxon rank-sum tests, while categorical variables were analyzed with Fisher's exact tests. The study included a total of 88 patients (Male/Female:38/50), with 18 having supraclavicular and 70 mid-neck VNS insertions. No significant differences between groups were found in demographics, clinical/seizure characteristics, VNS settings, side-effect profile related to VNS surgery or stimulation, or seizure outcomes at last follow up. The supraclavicular approach to VNS does not differ from the mid-neck method in terms of efficacy and overall safety profile. Future research with a larger cohort and longer-term follow-up is needed to explore the clinical significance of VNS settings in the context of different lead locations.

Integrating Differential Evolution into Gazelle Optimization for advanced global optimization and engineering applications

The Gazelle Optimization Algorithm (GOA) is an innovative metaheuristic inspired by the survival tactics of gazelles in predator-rich environments. While GOA demonstrates notable advantages in solving unimodal, multimodal, and engineering optimization problems, it struggles with local optima and slow convergence in high-dimensional and non-convex scenarios. This paper proposes the Hybrid Gazelle Optimization Algorithm with Differential Evolution (HGOADE), which combines Differential Evolution (DE) with GOA to leverage their complementary strengths for addressing limitations. HGOADE initializes a population of candidate solutions using GOA, then enhances these solutions through DE’s mutation and crossover operations. The algorithm subsequently employs GOA’s exploration and exploitation phases to refine the solutions. By integrating DE’s robust exploration capabilities with GOA’s dynamic search patterns, HGOADE aims to improve global and local search performance. The effectiveness of HGOADE is validated through experiments on benchmark functions from the CEC 2017, CEC 2020, CEC 2022 suite, comparing with ten established optimization techniques, including classical GOA, Salp Swarm Algorithm (SSA), Grey Wolf Optimizer (GWO), Gravitational Search Algorithm (GSA), Arithmetic Optimization Algorithm (AOA), Constriction Coefficient-Based Particle Swarm Optimization Gravitational Search Algorithm (CPSOGSA), Sine Cosine Algorithm (SCA), Particle Swarm Optimization (PSO), Biogeography-Based Optimization (BBO), and DE. Additionally, the performance of HGOADE is assessed against prominent winners from CEC competitions, specifically CMA-ES, LSHADEcnEpSin, and LSHADESPACMA, using the CEC-2017 test suite. Statistical analyses using the Wilcoxon Rank Sum Test and Wilcoxon Signed-Rank Test, along with the Weighted Aggregated Sum Product Assessment (WASPAS) method, confirm that HGOADE significantly outperforms existing algorithms in terms of solution quality and convergence speed. HGOADE’s superiority is validated through six complex engineering design problems, demonstrating its higher feasibility and effectiveness than GOA and other methods. This paper addresses GOA’s shortcomings and advances metaheuristic optimization by integrating DE strategies, offering valuable insights and practical applications for global optimization and engineering design.

Effects of Postoperative Oral Corticosteroids on Infection Rates in Upper Extremity Surgery.

The recent trend in administering postoperative oral corticosteroids has proven effective in alleviating pain and improving surgical outcomes for hand and upper extremity procedures. However, concerns persist regarding potential infection risks despite a lack of supporting evidence in the current literature. We propose that a 6-day regimen of low-dose postoperative oral corticosteroids is safe and does not increase the likelihood of surgical site infections (SSIs) in adult upper extremity surgeries. A retrospective study of all adult patients who underwent clean, upper extremity surgery, including both soft tissue and hardware implantation cases, between November 2021 and November 2023, performed at a single institution were included in the study. Primary outcome measures were diagnosis of SSI by 14 days and 30 days. Categorical variables were compared using χ2 tests, and continuous variables were compared using Wilcoxon rank-sum tests. A P value less than .05 was considered statistically significant. A total of 813 cases were included for analysis-196 received a 6-day course of postoperative oral steroids (methylprednisolone) and 617 did not. Both groups had similar SSI rates of 4.1% and 3.1%, respectively, with no statistical differences between the groups at any postoperative time. Subgroup analysis of patients diagnosed with an SSI identified no statistically different demographic factors or medical comorbidities when comparing patients who received postoperative oral corticosteroids versus those who did not. Low-dose, postoperative oral steroid use following adult upper extremity surgery is safe and does not increase the risk of SSI. Further investigations with prospective studies on postoperative oral corticosteroids would prove advantageous.

Retention in primary care among unstably housed residents of a low-income, inner-city neighborhood with a high prevalence of substance use and related disorders

IntroductionAccess to and engagement with primary healthcare can be difficult for marginalized low-income populations residing in inner cities in high-income countries. We designed a study to examine retention in primary care among clients of a novel interdisciplinary primary care clinic in the Downtown Eastside of Vancouver, Canada who did not previously have access to care.MethodsBeginning in June 2021, clients of the Hope to Health clinic were offered enrolment in a cohort study which involved a baseline and follow-up surveys every six months, and linking their data to information from the clinic’s electronic medical records. We used Chi-square or Fisher’s Exact test and Wilcoxon rank sum test to compare clients who were lost to follow-up (LTFU) or deceased, with clients who were retained in care at the end of follow-up, Cox proportional hazards modeling was used to examine independent associations with mortality or LTFU.ResultsAmong 425 participants enrolled, the median age was 50 years (IQR 40–59), 286 (67.3%) participants were men and 128 (25.4%) were unstably housed at enrollment. Among 338 participants with at least six months of follow-up after enrolment, 262 participants (67.5%) were retained in care, 20 (5.2%) had moved, 57 (14.7%) were classified as LTFU, and 28 (7.2%) had died with a median of 19.9 months of follow-up time. The risk of death or LTFU was independently associated diagnosed with alcohol use disorder (AUD) (adjusted hazard ratio [AHR] = 2.23 vs. not; 1.38–3.60), frequency of medical doctor visits (AHR = 0.69 per visit per 3 months; 0.60–0.79) and social work visits (AHR = 0.73 per visit per 3 months; 0.59–0.90. Stimulant use disorder or asthma were not significantly associated with retention in care.ConclusionWe found that a primary healthcare model of care was successful in retaining over two-thirds of clients in primary healthcare after more than 18 months of follow-up. Additional supports for those diagnosed with alcohol use disorder are needed to retain them in care.

Signatures of transmission in within-host Mycobacterium tuberculosis complex variation: a retrospective genomic epidemiology study

Mycobacterium tuberculosis complex (MTBC) species evolve slowly, so isolates from individuals linked in transmission often have identical or nearly identical genomes, making it difficult to reconstruct transmission chains. Finding additional sources of shared MTBC variation could help overcome this problem. Previous studies have reported MTBC diversity within infected individuals; however, whether within-host variation improves transmission inferences remains unclear. Here, we aimed to quantify within-host MTBC variation and assess whether such information improves transmission inferences. We conducted a retrospective genomic epidemiology study in which we reanalysed publicly available sequence data from household transmission studies published in PubMed from database inception until Jan 31, 2024, for which both genomic and epidemiological contact data were available, using household membership as a proxy for transmission linkage. Wequantified minority variants (ie, positions with two or more alleles each supported by at least five-fold coverage and with a minor allele frequency of 1% or more) outside of PE and PPE genes, within individual samples and shared across samples. We used receiver operator characteristic (ROC) curves to compare the performance of a general linear model for household membership that included shared minority variants and one that included only fixed genetic differences. We identified three MTBC household transmission studies with publicly available whole-genome sequencing data and epidemiological linkages: a household transmission study in Vitória, Brazil (Colangeli etal), a retrospective population-based study of paediatric tuberculosis in British Columbia, Canada (Guthrie etal), and a retrospective population-based study in Oxfordshire, England (Walker etal). We found moderate levels of minority variation present in MTBC sequence data from cultured isolates that varied significantly across studies: mean 168·6minority variants (95% CI 151·4-185·9) for the Colangeli etal dataset, 5·8 (1·5-10·2) for Guthrie etal (p<0·0001, Wilcoxon rank sum test, vsColangeli etal), and 7·1 (2·4-11·9) for Walker etal (p<0·0001, Wilcoxon rank sum test, vs Colangeli etal). Isolates from household pairs shared more minority variants than did randomly selected pairs of isolates: mean 97·7shared minority variants (79·1-116·3) versus 9·8 (8·6-11·0) in Colangeli etal, 0·8 (0·1-1·5) versus 0·2(0·1-0·2) in Guthrie etal, and 0·7 (0·1-1·3) versus 0·2 (0·2-0·2) in Walker etal (allp<0·0001, Wilcoxon rank sumtest). Shared within-host variation was significantly associated with household membership (odds ratio 1·51 [95% CI 1·30-1·71], p<0·0001), for one standard deviation increase in shared minority variants. Models that included shared within-host variation versus models without within-host variation improved the accuracy of predicting household membership in all three studies: area under the ROC curve 0·95versus 0·92for the Colangeli etal study, 0·99versus 0·95for the Guthrie etal study, and 0·93versus 0·91for the Walker etal study. Within-host MTBC variation persists through culture of sputum and could enhance the resolution of transmission inferences. The substantial differences in minority variation recovered across studies highlight the need to optimise approaches to recover and incorporate within-host variation into automated phylogenetic and transmission inference. National Institutes of Health.

Prevalence, risk factors, and adverse outcomes of diastasis of rectus abdominis in men: a cross-sectional study.

This observational study aimed to investigate the prevalence of DRA, ascertain the possible risk factors and analyse the adverse outcomes of DRA among men. Moreover, the reasonable diagnostic criterion was further explored. 1575 men aged 18 years or older were recruited from a Grade III A Hospital. Data were obtained by electronic medical record, subsequent unified questionnaire and clinical examinations. Possible risk factors of DRA were confirmed in the univariate analysis and multivariate analysis. Based on two diagnostic criteria, Chi square test and Wilcoxon rank sum test were used to compare the difference of adverse outcomes among men with and without DRA. The prevalence of DRA in men was 29.78% when IRD > 2cm was used as a diagnostic criterion, but decreased to 10.16% when IRD > 3cm as a criterion. Age, BMI, smoking and physical exercise were proved as influencing factors for DRA. No association was found between DRA and abdominal wall muscle function, low back pain, and quality of life. But hernia was significant with DRA, when IRD>3cm as diagnostic criterion. Prevalence of DRA in male is high and taking measure on losing weight, giving up smoking and exercising properly may prevent DRA, along with reducing the possibility of DRA-related hernias. To be important, IRD>3cm as the reasonable diagnostic criterion was proposed.

MRI-Based Circumferential Strain in Boys with Early Duchenne Muscular Dystrophy Cardiomyopathy

Background: In boys with Duchenne muscular dystrophy (DMD), cardiomyopathy has become the primary cause of death. Although both positive late gadolinium enhancement (LGE) and reduced left ventricular ejection fraction (LVEF) are late findings in a DMD cohort, LV end-systolic circumferential strain at middle wall (Ecc) serves as a biomarker for detecting early impairment in cardiac function associated with DMD. However, Ecc derived from cine Displacement Encoding with Stimulated Echoes (DENSE) has not been quantified in boys with DMD. We aim to: (1) use cine DENSE to quantify regional Ecc in LGE negative (-) boys with DMD and healthy controls; and (2) compare Ecc with LVEF in terms of differentiating DMD boys with LGE (-) from healthy boys. Methods: 10 LGE (-) boys with DMD and 12 healthy boys were enrolled prospectively in an IRB-approved study for CMR at 3T. Navigator-gated cine DENSE was used to obtain short-axis mid-ventricular data and estimate global and regional Ecc. Group-wise differences were tested via a Wilcoxon rank-sum test. Within-group differences were tested via a Skillings-Mack test followed by pairwise Wilcoxon signed-rank tests. A binomial logistic regression model was adopted to differentiate between DMD boys with LGE (-) and healthy boys. Results: When compared to healthy boys, LGE (-) boys with DMD demonstrated significantly impaired septal Ecc [−0.13 (0.01) vs. −0.16 (0.03), p = 0.019]. In comparison to the Ecc in other segments, both groups of boys exhibited significantly reduced septal Ecc and significantly elevated lateral Ecc. Septal Ecc outperformed LVEF in distinguishing DMD boys with LGE (-) from healthy boys. Conclusions: Reduced septal Ecc may serve as an early indicator of cardiac involvement in LGE (-) DMD boys prior to reduced LVEF and a positive LGE finding.

Qualitative Transcriptional Signature for Predicting the Pathological Response of Colorectal Cancer to FOLFIRI Therapy

FOLFIRI (5-FU, leucovorin, irinotecan) is the first-line chemotherapy for metastatic colorectal cancer (mCRC), but response rates are under 50%. This study aimed to develop a predictive signature for FOLFIRI response in mCRC patients. Firstly, Spearman’s rank correlation and Wilcoxon rank-sum test were used to select chemotherapy response genes and gene pairs, respectively. Then, an optimization procedure was used to determine the final signature. A predictive signature consisting of three gene pairs (3-GPS) was identified. In the training set, 3-GPS achieved an accuracy of 0.94. In a validation set of 60 samples, predicted responders had significantly better progression-free survival than the predicted non-responders (HR = 0.47, p = 0.01). A comparable result was observed in an additional validation set of 27 samples (HR = 0.06, p = 0.02). The co-expressed genes of the signature were enriched in pathways associated with the immunotherapy response, and they interacted extensively with FOLFIRI-related genes. Notably, the expression of signature genes significantly correlated with various immune cell types, including plasma cells and memory-resting CD4+ T cells. In conclusion, the REO-based signature effectively identifies mCRC patients likely to benefit from FOLFIRI. Furthermore, these signature genes may play a crucial role in the chemotherapy.

Dose-exposure-response of CARDALIS® (benazepril/spironolactone) on the classical and alternative arms of the renin-angiotensin-aldosterone system in healthy dogs.

Benazepril exhibits a dose-dependent effect on biomarkers of the circulating renin-angiotensin-aldosterone system (RAAS) in dogs. To characterize the dose-exposure-response relationship of a fixed-dose combination product including benazepril and spironolactone (CARDALIS®) on RAAS biomarkers in dogs. Eighteen purpose-bred healthy beagle dogs. Three groups of 6 dogs received different doses of CARDALIS® for 14 days following induction of RAAS activation by feeding a low-sodium diet: (a) benazepril 0.25 mg/kg + spironolactone 2 mg/kg PO q24h (label dose); (b) benazepril 0.25 mg/kg + spironolactone 2 mg/kg PO q12h; or (c) benazepril 0.5 mg/kg + spironolactone 4 mg/kg PO q12h. Blood samples were collected at baseline and serial time intervals after CARDALIS® dosing to measure serum RAAS biomarkers and plasma concentrations of active drug metabolites. Time-weighted averages for serum RAAS biomarkers after CARDALIS® dosing at steady state were compared between dosage groups using Wilcoxon rank-sum testing. Compared to the label dose, the highest dose of CARDALIS® was associated with a 30% decrease in angiotensin II (P = .03), 94% increase in angiotensin 1-7 (P = .03), 71% decrease in surrogate activity of ACE (P = .002), and 116% increase in circulating aldosterone (P = .02). CARDALIS® was well-tolerated at all doses with no clinically relevant changes in renal values or serum electrolytes. The combined CARDALIS® product leads to dose-dependent alterations of RAAS metabolites. These results could help inform clinical trials in dogs with heart disease.

The cultural adaption and validation of the Self-Regulated Learning Perception Scale (SRLPS) and the development of its short version in Chinese medical students

BackgroundSelf-regulated learning (SRL) is a pivotal skill in the digital era, closely correlating to academic performance and professional development, particularly within medicine, where rapid advancements in knowledge and technology demand continuous learning. The Self-Regulated Learning Perception Scale (SRLPS), validated for reliability and validity, is a critical tool for assessing SRL among medical students. However, its application in Chinese medical education remains largely unexplored. This study aims to adapt the SRLPS for Chinese medical students and to develop a concise version to reduce participant burden and enhance the scale’s practicality and generalizability.MethodsTwo stages of surveys were conducted. In Stage 1, SRLPS was translated into Chinese through forward translation, back translation, and review and then was administered to 339 medical students. To assess the internal reliability and construct validity of the Chinese version of SRLPS, we calculated Cronbach’s α values and conducted Confirmatory Factor Analysis (CFA), respectively. According to psychometric performance, some items were removed to create a short version of SRLPS (SRLPS-S). In Stage 2, the SRLPS-S was administered to 736 medical students to verify its reliability and construct validity using Cronbach’s α and CFA. Wilcoxon rank-sum tests were used to examine the associations between self-regulated learning perceptions and personal and household characteristics, including gender, maternal education level, and annual household income.ResultsThe Chinese SRLPS demonstrated acceptable internal consistency reliability and construct validity, although the elevated Cronbach’s α indicated possible item redundancy. The SRLPS-S exhibited satisfactory internal consistency reliability and construct validity, confirming the four-domain structure of the original SRLPS. Wilcoxon Rank-sum test showed students’ self-regulated learning positively linked to higher maternal education levels, higher annual household income, and male gender.ConclusionThe Chinese SRLPS and its short version are reliable and valid for assessing self-regulated learning. These scales can assist educators in identifying students who might require additional support in their learning strategies and can also be used for personal development. The short version is recommended for its enhanced psychometric properties and greater cost-efficiency.