Wilcoxon Signed Rank Sum Test Research Articles

Nursing students and role modeled behavior while caring for LGBTQ + people: a cross-sectional, descriptive study

BackgroundWhile efforts to improve the educational preparedness of nurses to care for lesbian, gay, bisexual, transgender, and queer (LGBTQ +) people have increased, the influence of role-modeled behaviors by healthcare professionals working with nursing students and recent graduates is not well understood. The purpose of this study is to describe the role-modeled behaviors of healthcare professionals observed by nursing students and recent graduates caring for LGBTQ + patients in clinical settings.MethodsA cross-sectional, online survey was conducted. Recruitment of nursing students who had completed one or more clinical rotations or were recent graduates (≤ 2 years) was performed through university emails and social media. Items included measurement of stigmatizing attitudes, observed stigmatizing behaviors, and ability to provide inclusive/affirming care for LGBTQ + patients. Open-text items prompted participants to describe observed behaviors. Data were analyzed using descriptive statistics and Wilcoxon signed rank sum tests to evaluate differences between LGB (lesbian, gay, bisexual) and T + (transgender and gender diverse) subscales. Open-text responses were analyzed using thematic analysis to identify relevant themes.ResultsParticipants (N = 73) had a low level of stigmatizing attitudes toward LGBTQ + people (M = 1.8, SD = 0.4), although higher stigmatizing attitudes toward T + people were reported (M = 3.0, SD = 0.2; Z = -7.254, p < .001). Half of the participants reported that they observed LGBTQ + stigmatizing behaviors role-modeled by two + healthcare professional roles; approximately one-third of participants personally engaged in one + LGBTQ + stigmatizing behaviors, most commonly toward T + people. Themes from participants’ examples of observed stigmatizing behaviors included: cis-heteronormative bias, non-affirmation of chosen name/pronouns, outing patients, and rejected competency.ConclusionsThe majority of participants described observing stigmatizing behaviors toward LGBTQ + people in clinical settings. Poorer attitudes and a higher frequency of stigmatizing behaviors observed towards T + people point to deficits in healthcare provided to T + people in particular. Efforts to address LGBTQ + stigma in healthcare should be expanded to include clinical settings to address role-modeled behaviors and socialization of nurses.

The impact of an extreme observation in a paired samples design

The effect of systematically altering the value of a single observation within a paired differences design is considered. A paradox is observed for the paired samples t test, where increasing the value of an observation in the direction of the true mean difference results in a higher p value. Using simulation, deviations from robustness of the paired samples t test is demonstrated, and is contrasted with Yuen's paired samples t test and the Wilcoxon signed rank sum test.

Dosimetric Evaluation of Beam-specific PTV and Worst-case Optimization Methods for Liver Proton Therapy.

In spot-scanning proton therapy, intra-fractional anatomical changes by organ movement can lead to deterioration in dose distribution due to beam range variation. To explore a more robust treatment planning method, this study evaluated the dosimetric characteristics and robustness of two proton therapy planning methods for liver cancer. Two- or three-field treatment plans were created for 11 patients with hepatocellular carcinoma or metastatic liver cancer using a single-field uniform dose (SFUD) technique. The plans were optimized using either beam-specific planning target volume (BSPTV) or worst-case optimization (WCO). The target coverage for the gross tumor volume (GTV), planning target volume (PTV), and organs at risk (OAR) parameters related to toxicity were calculated from the perturbed dose distributions, considering setup and range uncertainties. Statistical analyses of the BSPTV and WCO plans were performed using the Wilcoxon signed-rank sum test (p<0.05). The calculation times for a single optimization process were also recorded and compared. The robustness of the WCO plans in the worst-case scenario was significantly higher than that of the BSPTV plan in terms of GTV target coverage, prevention of maximum dose increase to the gastrointestinal tract, and the dose received by normal liver regions. However, there were no significant differences in PTV, and the calculation time required to create the WCO plan was considerably longer. In SFUD proton therapy for liver cancer, the WCO plans required a longer optimization time but exhibited superior robustness in GTV coverage and sparing of OARs.

Intensity-modulated proton radiotherapy spares musculoskeletal structures in regional nodal irradiation for breast cancer: a dosimetric comparison.

Regional nodal irradiation (RNI) for breast cancer delivers radiation in proximity to the shoulder and torso, and radiation exposure may contribute to long-term upper extremity and postural morbidity. To date, no studies have assessed the differential dosimetric impact of proton versus photon radiation on shoulder and torso anatomy. This study examined clinically relevant musculoskeletal (MSK) structures and assessed the dose delivered with each modality. Ten MSK structures were contoured on IMPT (intensity-modulated proton therapy) and VMAT (volumetric modulated arc therapy) plans for 30 patients receiving RNI. Relevant dose metrics were compared for each of the structures. Intensity-modulated proton therapy dose was calculated using the relative biological effective value of 1.1. Hypo-fractionated plans were scaled to the equivalent dose in 2 Gy fractions (EQD2) using an alpha/beta ratio of four. Wilcoxon signed rank sum tests compared doses. Select three-dimensional and optimised VMAT plans were also informally compared. Each of the 10 structures received a statistically significantly lower dose with the use of IMPT compared with VMAT. Differences were greatest for posterior structures, including the trapezius, latissimus dorsi and glenohumeral joint. Mean absolute differences were as great as 23 Gy (supraspinatus D5cc) and up to 30-fold dose reductions were observed (deltoid D50cc). An average 3.7-fold relative dose reduction existed across all structures. Measures of low/intermediate dose (V15Gy and D50cc) showed the largest differences. Intensity-modulated proton therapy results in statistically lower radiation exposure to relevant shoulder and torso anatomy compared to photon radiation for patients requiring RNI. Prospective study is needed to correlate functional outcomes with radiation dose.

Outcomes of proton therapy to infradiaphragmatic sites in pediatric patients with Hodgkin lymphoma.

Proton therapy (PT) has potential advantages in pediatric Hodgkin lymphoma (pHL). However, there are limited data on PT, specifically to infradiaphragmatic targets. We report on PT planning details, doses achieved to organs at risk (OARs), and clinical and toxicity outcomes for patients with pHL who received PT to infradiaphragmatic regions. This is a retrospective study including patients treated between 2011 and 2022. Demographic and clinical factors were collected, and toxicity was reported using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Dosimetric and clinical factors associated with key outcomes were assessed via Cox regression. Photon plans were generated for all patients, and the paired t-tests or Wilcoxon signed rank sum tests were used for dosimetric comparisons. Twenty-one patients comprising 22 PT courses were included. Median follow-up was 5.0years, and mean age was 14.2years. Median dose was 21 Gray equivalent (GyE) over 14 fractions. Top acute grade 1 (G1) toxicities included fatigue (59%) and anorexia (36%). Rates of acute G2 and G3+ toxicity were 18% and 0%, respectively. After PT, no local or marginal failures occurred. Five percent experienced disease progression, who were all successfully salvaged, and all patients were alive and disease-free at last follow-up. No secondary malignancies developed. Compared to photon radiotherapy, PT achieved significantly lower doses to the bowels, stomach, spleen, pancreatic tail, liver, kidneys, and pelvic bones. PT is well-tolerated and leads to excellent oncologic and toxicity outcomes with long-term follow-up. PT confers dosimetric advantages when compared to photons.

An Innovation Technique in East Asia Rhinoplasty.

To investigate the application and therapeutic efficacy of a novel cartilage framework: the external septa framework in East Asian rhinoplasty. From November 2021 to April 2023, Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital, Central South University, treated 41 patients with autologous costal cartilage rhinoplasty using an innovation external septal framework. The surgical open approach used an inverted V-shaped trans-columellar incision and marginal incision. The sixth or seventh costal cartilage was harvested to form the nasal columella support grafts (strut), external nasal septal graft, cap grafts, and shield grafts, in which the nasal column support graft and external nasal septal graft are connected in a way of tongue in groove to form a external septum framework to support and lengthen the tip. A cap graft is used to shape the tip of the nose, the rectus abdominis fascia is used to cover the tip of the nose, and the shield grafts are used to augment the inferior lobules. ePTFE was sculpted according to the degree of augment of the nasal dorsum and implanted on the dorsal to augment the nasal dorsum. Clinical outcomes were assessed through standard facial photographs taken during the preoperative and follow-up periods, and a postoperative satisfaction survey was completed with regular follow-up using the rhinoplasty outcome evaluation scale (ROE) and visual analogue scale (VAS). Results of objective and subjective measurements before and after surgery were compared utilizing paired-sample t tests. Values of P < 0.05 were considered significant. Nasal framework's objective evaluation outcomes were assessed by measuring the patients' preoperative and postoperative nasolabial angle, nasal length, and nasal tip projection. (The distance between the pronasale and the alar-cheek junction was calculated as the tip projection.) The comparison of preoperative and postoperative nasolabial angle and nasal length was performed using the paired-sample t test, and the comparison of nasal tip projection was performed using the Wilcoxon signed rank-sum test for the comparison of paired samples. Values of P < 0 .05 were considered significant. A total of 41 patients were treated, including 9 males and 32 females, ranging in age from 17 to 48 years(32.8 ± 1.5 years old), In the study, an average follow-up period of 19.85 ± 4.88 months was observed (range 12-29 months). There was no long-term or short-term complication observed. The aesthetic outcome of all cases such as saddle nose, deviated nasal columella, bilateral asymmetry of the nose, bilateral nasal base depression, and bulbous tip was satisfactory. Patient satisfaction evaluation: The ROE scale was (11.85 ± 2.46) preoperatively and (17.43 ± 2.15) postoperatively. The VAS scores were (4.86 ± 1.60) preoperatively and (8.48 ± 1.25) postoperatively. The difference of ROE scale and VAS scores among the patients was statistically significant (P < 0. 05), and 88.9% of patients were satisfied following those procedures. In terms of nasolabial angle, preoperative and postoperative measurements of 41 patients were (86.11 ± 2.25)° and (98.66 ± 1.90)°, respectively, and the difference of nasolabial angle was statistically significant (P < 0.05); nasal length measurements were 39.43 ± 1.55mm (37.95-43.51mm) preoperatively and 42.17 ± 1.46mm (40.23-45.62mm) postoperatively; in terms of nasal tip projection, preoperative and postoperative measurements of median values were 1.84(1.73,2.01)cm and 2.15(2.02,2.32)cm, respectively; and the difference between preoperative and postoperative values was statistically significant (P < 0.05). The innovative cartilage framework-external septal framework, avoids the dissection of septa and absorption of septal cartilage with compression of ESG, it is easy to be performed, and it is also stable and strong to achieve in good aesthetic result. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Self-adjusted Nitrous Oxide During Urodynamic Studies Reduces Patient Pain Without Compromising Study Quality: A Randomized Controlled Trial

Background and objectiveA urodynamic study (UDS) is a routine clinic procedure that can cause significant discomfort for certain patients, with no satisfactory analgesic alternatives currently available. Our aim was to evaluate the effectiveness of low-dose self-adjusted nitrous oxide (SANO), titrated to the patient’s desired effect, on standard metrics for bladder function and on patient-reported pain and anxiety. MethodsWe conducted a single-institution, double-blind, randomized crossover trial in adults undergoing UDS. Each patient underwent two consecutive UDS runs, randomized to receive oxygen during the first run followed by SANO during the second run, or vice versa. UDS outcomes (capacity, detrusor strength, residual volume) and patient subjective outcomes (Visual Analog Scale for pain and anxiety, operator assessment of verbal feedback) were compared between the two runs. Secondary analyses were performed to compare outcomes during the first UDS run and adjust for treatment order. A paired Wilcoxon signed rank-sum test and McNemar’s χ2 test were used to compare continuous and categorical variables, respectively. Adverse events were recorded. Key findings and limitationsNineteen patients were randomized (10 to oxygen for the first run, 9 to SANO for the first run). UDS outcomes did not differ between the two arms. Patients reported significantly less pain during the SANO run than during the oxygen run (p = 0.046). Verbal feedback was significantly better with SANO (p = 0.001). Most patients (15/19, 79%) stated that they would prefer to receive SANO during future UDS. There were no significant complications. Conclusions and clinical implicationsSANO oxide is a safe and effective means of preserving standard adult UDS metrics while significantly reducing patient-reported pain. Patient summaryUrodynamic tests (UDS) for evaluation of lower urinary tract symptoms can cause discomfort and pain. Our study shows that nitrous oxide gas self-adjusted by patients had no effect on UDS test outcomes or on verbal feedback during the procedure, and reduced discomfort and pain in comparison to oxygen. Nitrous oxide may an attractive option for patients who are reluctant to undergo UDS.

Self-assessment and Modulation of Traction During Shoulder Dystocia Simulation Training.

The aim of the study is to determine diagnostic traction for shoulder dystocia and to assess whether applied traction is modifiable with force training. We tethered a force-measuring fetal mannequin (PROMPT, Limbs & Things) within a simulated pelvis such that it would not deliver. We asked participants to apply traction to diagnose shoulder dystocia then stop. Blinded from participants' view, we recorded the peak traction. We then asked them to apply what they perceived to be 20 lb (89 N) traction. Each participant estimated the traction s/he applied. The actual force applied was then revealed to the participants and another blinded sequence was performed. We then allowed participants to view actual force measurements in real time while they practiced getting to their diagnostic traction and to 20 lb (89 N); this was followed by another blinded sequence of traction applications and estimations. Median diagnostic traction and injury threshold values (20 lb [89 N]), and mean ratio of estimated to actual force applied were compared pretraining and posttraining, using Wilcoxon signed rank sum test and t test. Rates of clinical shoulder dystocia and associated brachial plexus injury before and after the study period were compared using chi-square. Significance was set at P < 0.05. One hundred participants demonstrated a range of diagnostic traction. For 23 participants, traction exceeded injury thresholds, but the average was lowered with training. Before training, participants underestimated their own applied traction by an average of 30%. Subjective diagnosis of shoulder dystocia during simulation training varies widely and exceeds possible injury threshold for 22% of participants. Accuracy of self-assessment applied delivery traction improves significantly with force training as does clinical diagnosis of shoulder dystocia and decrease in brachial plexus injury incidence.

Commercially Available Guides Overestimate Socket Length During Anterior and Posterior Cruciate Ligament Socket Retrograde Drilling

To objectively assess the accuracy of socket measurements taken during cruciate ligament reconstruction using a retrograde reaming technique. Six complete knee sawbone specimens were used to ream anterior and posterior cruciate ligament sockets in the femur and tibia in a retrograde fashion using a standard retrograde reaming device. The longest and shortest sides of the sockets were measured using a ruler. One-sided Wilcoxon signed-rank sum tests were used to evaluate whether the actual measured socket length matched the estimated length set on the drill guide. One fellowship-trained surgeon reamed 24 total sockets in sawbone specimens using guides. Statistical analysis revealed a significant difference between the estimated measurement and the actual shortest tunnel length in each of the sockets. The median short side socket lengths were shorter than their respective intended depths by 4 mm for the femoral anterior cruciate ligament socket, 6 mm for the femoral posterior cruciate ligament socket, 6 mm for the tibial anterior cruciate ligament socket, and 4.5 mm for the tibial posterior cruciate ligament socket. All differences were significant at α= 0.05. The estimated cruciate socket lengths reamed during ligament reconstruction using a retrograde reamer and standard intra-articular measuring instrumentation were greater than the actual measured socket lengths. Successful cruciate ligament reconstruction relies on accurate socket measurements. This study examined the accuracy of commercially available cruciate ligament socket drill guides and the implications for clinical practice, to include graft-tunnel mismatch and surface area available for healing. Surgeons may consider reaming slightly longer than estimated sockets when performing all-inside cruciate ligament reconstructions to ensure appropriate socket depth for graft fixation.

Effects of applying high-pass filtering in pelvimetry with Martius images.

The aim of this study is to investigate whether the results of pelvimetry using original radiographic Martius images and the same images with high-pass filtering applied ("edge images") would be consistent. A total of 30 primagravidas were included in this study. Three obstetricians independently measured the anteroposterior and transverse diameters of the pelvic inlet in the original and the edge images, recording the x- and y-coordinates of the four endpoints. A Wilcoxon signed rank sum test was performed on the coordinate data to evaluate differences between the original and edge images. In the analysis of all coordinate data, statistically significant differences were found in both x- and y-coordinates of the sacral promontory point (SPP). In the y-coordinate of the SPP, a statistically significant difference was found in 9 of 30 pairs of images, and in all 9 the anteroposterior diameter was shorter in the edge images compared to the original images due to the more caudal placement of the SPP. The coordinates of the SPP on original radiographs and their edge images were not consistent in pelvimetry using Martius images. Our results suggest that improved image contrast will allow obstetricians to better assess pelvic narrowing and cephalopelvic disproportion and even reduce radiographic dose, thereby reducing risks for pregnant women and their fetuses.

Qualitative and quantitative assessment of non-clear cell renal cell carcinoma using contrast-enhanced ultrasound

BackgroundNon-clear cell renal cell carcinoma (nccRCC) represents a rare form of renal cell carcinoma (RCC) in the clinic. It is now understood that contrast-enhanced ultrasound (CEUS) exhibits diverse manifestations and can be prone to misdiagnosis. Therefore, summarizing the distinctive features of contrast-enhanced ultrasonography is essential for differentiation from ccRCC.ObjectiveThis study aims to evaluate the diagnostic efficacy of qualitative and quantitative CEUS in diagnosing nccRCC to enhance our understanding of this condition.MethodsWe conducted a retrospective analysis of 21 patients with confirmed nccRCC following surgery and assessed the characteristic conventional ultrasound and CEUS imaging features. The paired Wilcoxon signed-rank sum test was employed to compare differences in CEUS time-intensity curve (TIC) parameters between the lesions and the normal renal cortex.ResultsRoutine ultrasound revealed the following primary characteristics in the 21 nccRCC cases: hypoechoic appearance (10/21, 47.6%), absence of liquefaction (18/21, 66.7%), regular shape (19/21, 90.5%), clear boundaries (21/21, 100%), and absence of calcification (17/21, 81%). Color Doppler flow imaging (CDFI) indicated a low blood flow signal (only 1 case of grade III). Qualitative CEUS analysis demonstrated that nccRCC predominantly exhibited slow progression (76.1%), fast washout (57%), uniformity (61.9%), low enhancement (71.5%), and ring enhancement (61.9%). Quantitative CEUS analysis revealed that parameters such as PE, WiAUC, mTTI, WiR, WiPI, WoAUC, WiWoAUC, and WOR in the lesions were significantly lower than those in the normal renal cortex (Z=-3.980, -3.563, -2.427, -3.389, -3.980, -3.493, -3.528, -2.763, P < 0.001, < 0.001, = 0.015, = 0.001, < 0.001, < 0.001, < 0.001, = 0.006). However, there were no significant differences in RT, TTP, FT, or QOF (all P > 0.05).ConclusionnccRCC exhibits distinctive CEUS characteristics, including slow progression, fast washout, low homogeneity enhancement, and ring enhancement, which can aid in distinguishing nccRCC from ccRCC.

A Comparative Study of Mulligan Taping Versus McConnell Taping along with SNAGS in the Treatment of Mechanical Low Back Pain

Abstract Introduction: Mechanical back pain, a common name for a range of pain conditions caused by shear forces on muscles and aberrant tension on the spinal column, refers to discomfort caused by overloading of anatomical systems, which increases joint stiffness and reduces the elasticity and flexibility of the spine. Mulligan taping and Kinesio taping have both been effective in improving the range of motion by reducing pain and correcting the positional fault and repositioning joints and decreasing stress on the anatomical structures. This study compares the effects of Mulligan taping versus Kinesio taping along with with sustained natural apophyseal glides (SNAGS) on pain, range of motion, and disability in individuals having mechanical low back pain. Materials and Methods: Fifty people aged between 21 and 50 years were recruited with informed consent following approval from the ethical committee. Two sets of participants were selected by convenient sampling: Group B (SNAGS + Kinesio taping) and Group A (SNAGS + Mulligan taping). The Modified Schober’s test, the Roland–Morris low back pain and disability questionnaire, and the Numerical Pain Rating Scale pain score were used as outcome measures. Measurements were taken on day 1 and day 14. Results: Data were analyzed using WinPepi software. Normality was checked with the Shapiro–Wilks test. The Wilcoxon signed rank-sum test was used to compare differences within the groups. The Mann–Whitney U test was used to compare differences between the groups. Significant differences (P &lt; 0.05) were observed in both groups, whereas no significant differences were observed between groups (P &gt; 0.05). Conclusion: SNAGS along with Mulligan taping and SNAGS with Kinesio taping are equally effective for reducing pain and disability and improving the range of motion in individuals undergoing mechanical low back pain treatment.

Changes in salivary biomarkers of burning mouth syndrome patients after clonazepam treatment.

There is a lack of objective indicators to evaluate the treatment effect of burning mouth syndrome, a neuropathic pain of unknown causes. Therefore, this study aimed to evaluate potential salivary biomarkers by analyzing saliva before and after clonazepam treatment in patients with burning mouth syndrome. Saliva was collected from 23 patients with burning mouth syndrome before and 4 weeks after the topical administration of clonazepam. Patients were classified as responders (pain relief of 50% or more, n = 10) or non-responders (n = 13) based on pain relief after treatment. Clinical examination data of responders and non-responders were compared using Mann-Whitney U test and Fisher's exact test. Changes in the level of salivary biomarkers (salivary α-amylase, cortisol, calmodulin, α-enolase and interleukin-18) were evaluated before and after treatment using Wilcoxon signed-rank sum test, and their association with treatment response was examined using Fisher's exact test. The salivary biomarker levels showed no significant differences between the responders and non-responders. However, the change in salivary α-amylase activity after treatment revealed a significant difference between the two groups (p = 0.039). Although not all patients showed the same pattern, there was a difference in the alteration of salivary α-amylase activity before and after treatment between responders and non-responders. Further study is required to clarify whether there is a causal relationship between salivary α-amylase activity and treatment response. However, considering that salivary α-amylase activity is related to orofacial pain and psychological stress, this suggests the potential use of salivary α-amylase as a biomarker for burning mouth syndrome.

Investigation on the treatment of empagliflozin in glycogen storage disease type Ib

Objective: To investigate the safety, efficacy and effective dose of empagliflozin in the treatment of glycogen storage disease type Ⅰb (GSD Ⅰb). Method: This was a cross sectional study. A total of 28 children with GSDⅠb who started oral empagliflozin treatment from January 2021 to June 2023 in the WeChat group of patients with glycogen storage disease were selected as the study objects. Clinical data such as general situation, current situation of medication and adverse reactions of the children were collected through questionnaires from June 18 to 30, 2023. The differences of symptoms and laboratory tests before and after empagliflozin treatment were compared by using paired chi-square test and Wilcoxon signed rank sum test. Results: Totally 28 children with GSD Ⅰb were from 12 different provinces, autonomous regions and municipalities in China. There were 14 males and 14 females, Empagliflozin treatment was started at the age of 4.8(2.4, 10.8) years, the time of treatment was 14.5(11.3, 21.5) months, the initial dosage was (0.23±0.11) mg/(kg·d), and the maintenance dosage was (0.28±0.12) mg/(kg·d). Empagliflozin showed positive effects on neutropenia, severity of inflammatory bowel disease like symptoms(Z=-3.70, -2.65, both P<0.05), The proportion of recurrent oral ulcers, recurrent bacterial infections and anemia was significantly lower than that before medication 18% (5/28) vs. (46% (13/28), 14% (4/28) vs. 46% (13/28), 21% (6/28) vs. 46% (13/28), χ²=4.05, 5.26, 3.05, all P<0.05). GCSF was once used in 5 children with GSD Ⅰb, all of them had completely stopped GCSF after empagliflozin treatment. The most common adverse events during empagliflozin treatment were hypoglycemia (5 children) and urinary infection (3 children). All 28 patients had no serious adverse reactions. Conclusions: Empagliflozin can increase the neutrophil count of children with GSD Ⅰb, and had a favorable effect on symptoms such as recurrent oral ulcers, and recurrent infection. The common adverse events during empagliflozin treatment were hypoglycemia and urinary infection.

Computerized diagnostic decision support systems- a comparative performance study of Isabel Pro vs. ChatGPT4.

Validate the diagnostic accuracy of the Artificial Intelligence Large Language Model ChatGPT4 by comparing diagnosis lists produced by ChatGPT4 to Isabel Pro. This study used 201 cases, comparing ChatGPT4 to Isabel Pro. Systems inputs were identical. Mean Reciprocal Rank (MRR) compares the correct diagnosis's rank between systems. Isabel Pro ranks by the frequency with which the symptoms appear in the reference dataset. The mechanism ChatGPT4 uses to rank the diagnoses is unknown. A Wilcoxon Signed Rank Sum test failed to reject the null hypothesis. Both systems produced comprehensive differential diagnosis lists. Isabel Pro's list appears immediately upon submission, while ChatGPT4 takes several minutes. Isabel Pro produced 175 (87.1 %) correct diagnoses and ChatGPT4 165 (82.1 %). The MRR for ChatGPT4 was 0.428 (rank 2.31), and Isabel Pro was 0.389 (rank 2.57), an average rank of three for each. ChatGPT4 outperformed on Recall at Rank 1, 5, and 10, with Isabel Pro outperforming at 20, 30, and 40. The Wilcoxon Signed Rank Sum Test confirmed that the sample size was inadequate to conclude that the systems are equivalent. ChatGPT4 fabricated citations and DOIs, producing 145 correct references (87.9 %) but only 52 correct DOIs (31.5 %). This study validates the promise of Clinical Diagnostic Decision Support Systems, including the Large Language Model form of artificial intelligence (AI). Until the issue of hallucination of references and, perhaps diagnoses, is resolved in favor of absolute accuracy, clinicians will make cautious use of Large Language Model systems in diagnosis, if at all.

Impact of foot ulcer-related factors on quality of life in patients with diabetes: Prospective observational study.

Quality of life (QOL) may be impacted by foot ulcer-related factors, with prevention of diabetes-related foot ulcers or more effective early healing helping to improve overall patient QOL. This study, which examined the relationship between foot ulcer-related factors and QOL in patients with diabetes, was conducted as a secondary analysis of a prospective observational study entitled: "Factors associated with the discontinuation of wound care specialist clinic visits in patients with diabetic foot ulcers". We investigated EQ-5D-5L, patient characteristics and foot ulcer-related factors of 73 patients with diabetes-related foot ulcers who visited one wound clinic in Indonesia between August 2020 and February 2021. Results showed that the mean health utility was 0.294 ± 0.371. Factors selected for the multiple regression analysis included inflammation/infection of DMIST, first-ever foot ulcer, and size of DMIST. First-ever foot ulcer (β = 0.309, p = 0.003) and size of DMIST (β = -0.316, p = 0.015) were significantly associated with the health utility (p < 0.001). Significant improvement in the health utility of 15 patients was observed when the ulcer healed (Wilcoxon signed-rank sum test, p = 0.001). In conclusion, not only ulcer severity but also the first-ever foot ulcer itself affected the QOL in patients with diabetes. These results suggest there will be a greater impact on the QOL of patients who develop diabetes-related foot ulcers for the first time, along with the importance of prevention and early healing, through early infection control and wound size reduction.

3D Printer-Assisted Layered Fabrication of a Novel Appliance for Oral Myofunctional Therapy and Functional Evaluation of Its Effects on Orofacial Muscles During Wear.

Aim Balanced function of the orofacial muscles is important for normal occlusion and dentition; however, patients with malocclusion often present with myofunctional disorder (MFD). Myofunctional therapy (MFT) has received much attention as a method for reducing MFD. Moreover, prefabricated functional appliances (PFAs) have been developed as a method to eliminate abnormal muscle pressure and guide the tongue into the correct position. However, PFAs have disadvantages, such as poor intraoral retention, limited usage time due to discomfort and poor patient compliance, and changes in the axis of the mandibular anterior teeth.Therefore, this study aimed to develop a new custom-made splint-type orthodontic appliance with CAD/CAM technology. Moreover, we evaluated the characteristics of the appliance and conducted functional tests to determine the effects of the appliance on the orofacial muscles and the discomfort associated with its use. Materials and methods Twenty-five volunteers (nine females and 16 males; mean age 28.4 ± 3.4 years) with normal swallowing function were included in the study. Lip-closing strength (LCS), electromyogramduring swallowing, oxygen saturation, and pulse rate were measured and compared when the appliance was not worn and when it was worn. In addition, tongue habits were evaluated, and the maximum tongue pressure was measured when the appliance was not worn. The subjects were asked to answer a questionnaire using a numerical rating scale (NRS) regarding discomfort when wearing the appliance. The evaluation items were swallowing difficulty, speaking difficulty, and breathlessness, which were rated on an 11-point scale ranging from 0 to 10. Statistical tests were conducted using IBM SPSS version 28.0.1 (IBM, Armonk, NY, USA) with the Shapiro-Wilk and Levene's test, followed by the Wilcoxon signed rank sum test. The significance level was set at α = 0.05. The measurement error for each measurement item was evaluated using an intraclass correlation coefficient. Results A new custom-made splint-type orthodontic appliance was fabricated for each subject. The fit and retention of the appliance in the mouth were good when fitted, and a comparison of the functional test measurements of 25 subjects with and without the appliance showed that the LCS decreased significantly (p<0.05) before and after wearing the appliance. However, no statistically significant differences were found for the other items. The Mann-Whitney U test regarding the effects of sex, previous orthodontic treatment, or MFT, and oral habits did not statistically significantly influence the effects of wearing the device. In the NRS results, "difficulty swallowing" was observed in half of the subjects, "difficulty breathing" was rarely observed, and "difficulty speaking" was observed in all subjects. Conclusions A novel custom-made splint-type orthodontic appliance was designed and fabricated using digital workflow and 3D printing technology. This appliance was designed to correct oral habits and was made from a new material classified as a class II medical appliance according to the international harmonized classification.

Monitoring of Home Respiratory Polygraphy During Mandibular Distraction Osteogenesis Succeeded by LeFort I Osteotomy in Adult Patients With Obstructive Sleep Apnea

BackgroundBilateral Internal Ramus Distraction (BIRD) is now part of select protocols for treating obstructive sleep apnea (OSA). Introducing a home monitoring protocol offers a valuable alternative to overnight laboratory polysomnography (PSG). PurposeThe purpose of this study was to evaluate and compare OSA parameters obtained via home respiratory polygraphy (HRP) and hospital PSG in a cohort of patients undergoing mandibular distraction (MD) for OSA management. Study designHospital Universitario La Princesa (Madrid) researchers conducted a prospective cohort study with patients diagnosed with moderate (AHI=15-30) to severe (AHI>30) OSA undergoing BIRD followed by LeFort maxillary osteotomy. Exclusion criteria were: severe systemic diseases, central apneas, smoking, poor dental hygiene, or prior OSA interventions. Predictor variableThe predictor variable was PSG and HRP techniques. Main outcome variablesThe main outcome variable comprises a collection of OSA parameters, including the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and time spent below 90% oxygen saturation (T90). These data were measured both before and after distraction, as well as after 6 mm, 9 mm, and 12 mm of mandibular distraction (MD). CovariatesThe covariates were age, sex, cardiovascular risk parameters, and Epworth sleepiness scale. AnalysesPearson’s correlation analyzed AHI, ODI, and T90 values from PSG and HRP. Wilcoxon Signed Rank Sum Test compared two distraction stages, and the Friedman Test evaluated three stages (p<0.05). Multiple regression analysis assessed if covariates were independent risk factors for postoperative persistent OSA. ResultsThe study included 32 patients (25% with moderate and 75% with severe OSA). Final AHI was 10.9±8.9 (events/hour) with HRP, compared to 15.2±13.4 with PSG (r=0.7, p<0.05). ODI was 9.0±8.1 (des/h) with HRP and 8.7±9.5 with PSG (r=0.85, p<0.05). T90 was 1.6±2.2 with HRP and 1.3±3.0 with PSG (r=0.6, p<0.05). Based on HRP data, AHI improved from D1 (34.0±19.5) to D2 (20.8±14.1) and D3 (12.5±10.4) (p<0.05). ODI decreased from D1 (26.1±19.0) to D2 (16.0±12.6) and D3 (9.4±8.8) (p<0.05). T90 reduced from D1 (8.2±12.6) to D2 (4.1±5.2) and D3 (1.9±2.8) (p<0.05). Multiple regression analysis of comorbidities produced non-significant results. ConclusionTo monitor BIRD through HRP has demonstrated efficacy in yielding results that align with PSG.

Electrical stimulation of the lower eyelid orbicularis oculi muscle improves periocular dark circles.

We developed and tested the safety and efficacy of a cosmetic device to improve dark circles using electrical muscle stimulation of the orbicularis oculi muscle. Overall, 18 participants (36 eyes) were studied. The following five items were evaluated before and after the intervention:(1) the Clinical Dark Circle Score using clinical findings and photographs, (2) transcutaneous oxygen partial pressure (TcPO2) on the lower eyelid, (3) thermography, (4) two-dimensional laser blood flowmetry, and (5) spectrophotometry. The mean score at baseline was 2.0±0.90 (mean±standard deviation), and that at the end of the study was 1.2±1.0 (Wilcoxon signed-rank sum test, p<0.0001), indicating a significant reduction. The spectrophotometer showed a significant decrease in a* and L* values before and after use (Wilcoxon signed-rank sum test, p<0.0001). There was also a weak negative correlation between the change in score and the change in blood flow and TcPO2 measured using a laser perfusion device (Spearman's rank correlation coefficient, r=-0.32 and -0.39, respectively). Stratified analysis of the baseline score showed a strong negative correlation between the change in score and the change in spectrophotometric a* in the subjects/group with mild periocular dark circles (Spearman's rank correlation coefficient, r=-0.46). Contrastingly, no correlation was observed for any of the measurements in the subjects/group with severe periocular dark circles. After 1 month, no device-related ophthalmic adverse events were observed in any of the participants. Electrical muscle stimulation could improve periocular dark circles, especially in the subjects/group with mild periocular dark circles, and was safe.

Comparing the Effects of Two Culture Methods to Determine the Total Heterotrophic Bacterial Colony Count in Hospital Purified Water

BackgroundAccurately detecting the quantity of microorganisms in hospital purified water is of significant importance for early identification of microbial contamination and reducing the occurrence of water-borne hospital infections. The choice of detection method is a prerequisite for ensuring accurate results. Traditional Plate Count Agar (PCA) belongs to a high-nutrient medium, and there may be limitations in terms of accuracy or sensitivity in detecting microorganisms in hospital purified water. On the other hand, Reasoner’s 2A agar (R2A) has characteristics, such as low-nutrient levels, low cultivation temperature, and extended incubation time, providing advantages in promoting the growth of aquatic microorganisms. This study, through comparing the differences in total colony counts between two detection methods, aims to select the method more suitable for the growth of aquatic microorganisms, offering new practical insights for accurately detecting the total count of heterotrophic bacteria in hospital purified water.MethodsThe most commonly used plate count agar (PCA) method, and the R2A agar culture were adopted to detect microorganisms and determine the total number of bacterial colonies in the water for oral diagnosis and treatment water and terminal rinse water for endoscopes in medical institutions. The two water samples were inoculated by pour plate and membrane filtration methods, respectively. Using statistical methods including Spearman and Pearson correlation, Wilcoxon signed-rank sum test, paired-Chi-square test, and linear regression, we analyze the differences and associations in the bacterial counts cultivated through two different methods.ResultsIn 142 specimens of the water, the median and interquartile range of the heterotrophic bacterial colony number under the R2A culture method and under the PCA culture method were 200 (Q1–Q3: 25–18,000) and 6 (Q1–Q3: 0–3700). The total number of heterotrophic bacteria colonies cultured in R2A medium for 7 days was more than that cultured in PCA medium for 2 days (P < 0.05). The linear regression results showed a relatively strong linear correlation between the number of colonies cultured by the R2A method and that cultured by the PCA method (R2 = 0.7264). The number of bacterial species detected on R2A agar medium is greater than that on PCA agar medium.ConclusionThe R2A culture method can better reflect the actual number of heterotrophic bacterial colonies in hospital purified water. After logarithmic transformation, the number of colonies cultured by the two methods showed a linear correlation.