Wilcoxon Sign Rank Research Articles

Comparison of curettage vs. trephination technique for harvesting anterior iliac crest bone graft: A cadaveric study

PurposeThe purpose of this cadaveric study was to compare the volume and weight of bone graft harvested using the curettage vs. the trephination technique from the anterior iliac crest. MethodsEmbalmed cadavers were studied in this experimental research. The right hemipelvis of each cadaver was used for the trephine bone harvesting technique, whereas the left hemipelvis was used for the conventional curettage technique. The weight and the volume of the harvested bone were measured and statistically compared between the 2 sides. The Wilcoxon Signed-Rank test was employed to compare the graft volume and weight obtained from the right and left sides of the hemipelvis. ResultsTen embalmed adult cadavers were used in this study. All subjects were Caucasian males with a mean age of 59.8 years (range 44 – 73 years) at the time of death. A total of 81 cylindrical bone grafts were harvested from the right iliac crest. In 9 out of 81 (11.1 %), the cortex of the ilium was penetrated by the chisel. The mean weight of the bone graft harvested with the trephine technique (26.97 ± 2.32) g was heavier than the curettage technique (23.74 ± 2.09) g (p = 0.007). Similarly, the volume of the bone graft was higher in the trephine technique (8.40 ± 0.84) cm3 compared to the curettage technique (6.60 ± 1.26) cm3 (p = 0.011). The trephination technique lasted a mean of (12.76 ± 1.87) min (range 10.30–16.10 min), while the curettage technique lasted a mean of (14.53 ± 0.89) min (range 13.50–16.00 min) (p = 0.028). ConclusionHarvesting anterior iliac crest bone graft with the trephine technique provides a higher bone volume and weight than the conventional curettage technique. The trephine technique might be advocated over the curettage technique, especially when a large amount of autologous bone graft is required. However, a meticulous harvesting technique should be followed to prevent complications, particularly the three-dimensional anatomy should be kept in mind, and the depth of trephination should be well-controlled. Clinical trial registrationInstitutional Review Board registration: 2022/499.

Effects of Modulated Transcutaneous Electrical Nerve Stimulation on Incisional Pain Post Cardiac Surgery. A Randomized Controlled Trial

Purpose: To evaluate effects of modulated transcutaneous nerve stimulation on incisional pain post cardiac surgery. Methods/design: 40 patients undergoing cardiac surgery were randomized into 2 groups (20 in each) by single blinded envelope sealed method. Experimental group has been given Modulated TENS following normal cardiac rehabilitation while Control Group has been given Placebo TENS Following normal cardiac rehabilitation respectively. TENS was given for 30 minutes once in a day after the removal of pacing wire till the day of discharge. Pre intervention outcome measure for pain (VAS) and Anxiety (BAI) was evaluated on the first and last day of the treatment. Results: Between the group analysis is done using Mann Whitney U Test. The results showed there is significant difference between the groups in pre and post values VAS, where as for BAI there is no significant difference between the groups in pre and post values. Within the group analysis was done by Wilcoxon Sign Rank Test. The results indicated a significant difference in the pre and post values of VAS and BAI. Conclusion: From the study conducted, we came to a conclusion that transcutaneous electrical nerve stimulation was found to be effective in reducing incisional pain post cardiac surgery.

The Effect of Dismenorerage Exercise on Dysmenorerage in Adolescent Women in Bah Jambi Private Junior High School

Dysmenorrhea is pain during menstruation that is felt in the lower abdomen and also in muscle pain in the upper thighs, lower back, pelvis, and waist to calves. Dysmenorrhea also affects emotions and anxiety due to feelings that are uncomfortable and foreign to adolescents. Therefore dysmenorrhea must be handled so that these impacts can be minimized. Every year, dysmenorrhea is a problem that always arises among women of childbearing age. This research was conducted because there was data from a preliminary study and it was found that 90% of young women experienced dysmenorrhea, namely in young women at Bah Jambi Private Middle School. The purpose of this study was to determine the effect of dysmenorrhea exercise on menstrual pain (dysmenorrhea) in young women at Bah Jambi Private Middle School. Quasi-experimental research with a one-group pre-test post-test design scheme. A total of 37 young women were selected to be the sample, which was determined by purposive sampling. The resulting data in the form of a search scale will be analyzed using the Wilcoxon Sign Rank Test. The pain scale before the dysmenorrhea exercise showed that most of the respondents experienced menstrual pain that interfered with their activities. After doing the exercise, the menstrual pain for young women becomes a little painful. Based on the Wilcoxon Sign Rank Test with a 95% level of confidence, the value of p = 0.00 is obtained, where this value is less than 0.05, which means that the alternative hypothesis is accepted. So it can be concluded that dysmenorrhea exercise affects reducing menstrual pain in young women at Bah Jambi Private Middle School.

The Influence of Diabetic Foot Exercise On Foot Sensitivity Of Diabetes Mellitus Patient Type 2

Introduction: Diabetes mellitus (DM), a chronic metabolic condition marked by elevated blood sugar levels (hyperglycemia), is brought on by an imbalance between the supply and demand for insulin. Decreased or missing insulin causes glucose to be retained in the circulation, increasing blood sugar levels while depleting the glucose that is required for cell survival and function. In type 2 DM patients, complaints of neuropathy are common.The aim of this study was to evaluate the impact of diabetic foot exercise on patients with Type 2 Diabetes Mellitus at the Selemadeg Timur II Health Center. Methods: Pre-experimental research is the type of study being conducted. During December 2022 to January 2023, the study was conducted at the Selemadeg Timur II Health Center. A total of 34 people were included in the sampling method with purposive sampling. The Wilcoxon Sign Rank test was used for analysis.Result: This study included 34 samples, and convenience or accidental sampling was used to choose the samples. The Wilcoxon test's asymp sign (2 tailed), which is 0.02 or 0.05, reveals the significance value. The results of the research show that before intervention the most sensitivity is moderate with 18 (61,2%) after treatment, data show that the most sensitivity is good with 16 (47%); p value 0,02<0,05. The sensitivity of the feet of Type II Diabetes Mellitus patients at the Selemadeg Timur II Health Center is influenced by diabetic foot exercise. Conclusion: Patients with Type II Diabetes Mellitus at the Selemadeg Timur II Health Center have sensitive feet, which is influenced by diabetic foot activity). It is important for families and communities to give motivation to the diabetes mellitus patients to do diabetic foot as one of alternative therapies to prevent foot complications such and increase foot sensitivity.Keywords: Diabetes Mellitus Type 2, Foot Sensitivity, and Diabetic Foot Exercise

The Influence Of Giving Education About Diarrhea On Mother Level Of Knowledge In Diarrhea Prevention In Children

Diarrhea was a major disease killer in the age group of children. Diarrhea is transmitted by 4 factors, namely food (food), feces (feces), flies (air), and fingers (hands). Therefore, it was necessary to pay attention to the pattern of children's daily activities so that they do not endanger the child's health. Mothers play an important role in protecting and saving children from diarrhea armed with a good level of knowledge. Research Objectives: To determine the effect of providing education about diarrhea on the level of knowledge of mothers in preventing diarrhea in children. Methods: Quasy experimental design with one group pre-test post-test. The research sample was 60 respondents with a consecutive sampling technique. The instruments in the study were questionnaires and counseling programs regarding diarrhea. Statistical data analysis using the Wilcoxon Sign Rank Test analysis.
 The results of the mother's knowledge level in the pre-test category were enough for 27 respondents (45%) and the mother's level of knowledge
 most of the post-test in the good category as many as 47 respondents (78.3%), statistical test results show p-value
 0.000 < α 0.05, it means that there is a significant influence between the provision of education about diarrhea on the level of knowledge of mothers in preventing diarrhea in children.
 live clean and healthy. Providing education about clean and healthy lifestyles and the understanding of diarrhea can be given to nurse mothers using both the lecture method and educational videos in reducing the incidence of diarrhea in children.

The Effect of Benson Relaxation on Anxiety Levels In Major Surgical Preoperative Patients in the Dahlia Room Mardi Waluyo Blitar Hospital

Surgery can cause excessive fear and anxiety and can lead to complications. To reduce anxiety, non-pharmacological techniques is Benson Relaxation Therapi which is carried out by deep breathing and accompanied by beliefs held by the patient to achieve a relaxed state. Population on this research is preoperative major surgery patients. Sampling technique with Purposive Sampling 22 respondent. This research method : Quasy Experimental with One Group Pre-Test Post-Test, using questionnaire sheets, Standard Operating Procedures of Benson’s Relaxations, and Wilcoxon Sign Rank Test analysis. The purpose of study to determine the effect of Benson’s Relaxations on anxiety levels in preoperative major surgery patients. The Results of the Study : Using the analysis with the results of p-value = 0.000 which means <0.005. Conclusion : There is an effect of Benson’s Relaxation on the anxiety levels of pre operative major surgery patients. With the result of this reseach be used as a reference for Mardi Waluyo Blitar District Hospital in publishing of SPO Benson’s Relaxation it can be used to treat anxiety non-pharmacologically. Beside that, of nurses are expected to be able and willing to implement of Benson’s Relaxation which is proven effective in treating anxiety patients in all patients who experience anxiety in general.Keywords : Surgery, Benson Relaxation Technique, Anxiety

The Effect of Benson Relaxation on Anxiety Levels In Major Surgical Preoperative Patients in the Dahlia Room Mardi Waluyo Blitar Hospital

Surgery can cause excessive fear and anxiety and can lead to complications. To reduce anxiety, non-pharmacological techniques is Benson Relaxation Therapi which is carried out by deep breathing and accompanied by beliefs held by the patient to achieve a relaxed state. Population on this research is preoperative major surgery patients. Sampling technique with Purposive Sampling 22 respondent. This research method : Quasy Experimental with One Group Pre-Test Post-Test, using questionnaire sheets, Standard Operating Procedures of Benson’s Relaxations, and Wilcoxon Sign Rank Test analysis. The purpose of study to determine the effect of Benson’s Relaxations on anxiety levels in preoperative major surgery patients. The Results of the Study : Using the analysis with the results of p-value = 0.000 which means <0.005. Conclusion : There is an effect of Benson’s Relaxation on the anxiety levels of pre operative major surgery patients. With the result of this reseach be used as a reference for Mardi Waluyo Blitar District Hospital in publishing of SPO Benson’s Relaxation it can be used to treat anxiety non-pharmacologically. Beside that, of nurses are expected to be able and willing to implement of Benson’s Relaxation which is proven effective in treating anxiety patients in all patients who experience anxiety in general.Keywords : Surgery, Benson Relaxation Technique, Anxiety

Autistic Communication: A Survey of School-Based Professionals

Purpose: Access to communication is a basic human right, yet autistic adults have reported challenges fully and effectively expressing themselves throughout childhood. This may be due to the historical (and ongoing) focus and prioritization of speech skills as a barometer of communicative success. The result is a lack of support for other forms of communication for children who may speak but still require support to fully meet their communication needs. This study aimed to examine the knowledge, experience, and training of school-based professionals in order to better understand one possible barrier to early communication access for autistic children. Method: Using a participatory research method, we designed and administered a 35-question online survey. A total of 567 participants completed the survey, including 465 special educators, 71 speech-language pathologists (SLPs), and 31 other professionals. A segment of the survey data was analyzed in R. Comparisons between and within the largest groups (SLPs and special educators) were made with nonparametric statistics, including Fisher's exact, Wilcoxon signed-ranks, and Quade tests. Results: SLPs and special educators differed significantly on a variety of survey measures, including undergraduate coursework in augmentative and alternative communication (AAC) and autism, caseloads, and confidence related to working with autistic students and AAC users. Regardless of profession, most respondents reported completing what they considered to be an AAC assessment. Conclusions: Increasing school-based professionals' knowledge related to autism and AAC, as well as opportunities to improve skills, is critical to resolving access and opportunity barriers for autistic children who speak but may benefit from AAC. Partnering with autistic people to better understand autistic speech and careful collaboration among team members are recommended. Supplemental Material: https://doi.org/10.23641/asha.24299422

Autoimmune PaneLs as PrEdictors of Toxicity in Patients TReated with Immune Checkpoint InhibiTors (ALERT)

BackgroundImmune-checkpoint inhibitors (ICI) can lead to immune-related adverse events (irAEs) in a significant proportion of patients. The mechanisms underlying irAEs development are mostly unknown and might involve multiple immune effectors, such as T cells, B cells and autoantibodies (AutoAb).MethodsWe used custom autoantigen (AutoAg) microarrays to profile AutoAb related to irAEs in patients receiving ICI. Plasma was collected before and after ICI from cancer patients participating in two clinical trials (NCT03686202, NCT02644369). A one-time collection was obtained from healthy controls for comparison. Custom arrays with 162 autoAg were used to detect IgG and IgM reactivities. Differences of median fluorescent intensity (MFI) were analyzed with Wilcoxon sign rank test and Kruskal–Wallis test. MFI 500 was used as threshold to define autoAb reactivity.ResultsA total of 114 patients and 14 healthy controls were included in this study. irAEs of grade (G) ≥ 2 occurred in 37/114 patients (32%). We observed a greater number of IgG and IgM reactivities in pre-ICI collections from patients versus healthy controls (62 vs 32 p < 0.001). Patients experiencing irAEs G ≥ 2 demonstrated pre-ICI IgG reactivity to a greater number of AutoAg than patients who did not develop irAEs (39 vs 33 p = 0.040). We observed post-treatment increase of IgM reactivities in subjects experiencing irAEs G ≥ 2 (29 vs 35, p = 0.021) and a decrease of IgG levels after steroids (38 vs 28, p = 0.009).ConclusionsOverall, these results support the potential role of autoAb in irAEs etiology and evolution. A prospective study is ongoing to validate our findings (NCT04107311).

A pilot study of low-intensity focused ultrasound for treatment-resistant generalized anxiety disorder

ObjectiveThis study intended to evaluate a possible therapeutic effect among patients with treatment-refractory generalized anxiety disorder (trGAD) by using transcranial focused ultrasound (tfUS) to modulate amygdalar activity. MethodsTwenty-five participants with severe trGAD as outlined in the DSM-V were recruited from Los Angeles neurology and psychiatry clinics. All participants completed eight weekly 10-min tfUS sessions targeting the right amygdala. Functional and structural neuroimaging were used to navigate individual targets. Outcome measures including the Hamilton Anxiety Inventory (HAM-A, primary outcome) and Beck Anxiety Inventory (BAI) were collected at baseline and protocol completion. Upon study completion, participants were asked to report perceived change in clinical status using the Patient Global Impression – Improvement (PGI-I) scale. Data was collected from May 2020 through January 2023. ResultsAll participants were able to tolerate treatment without notable side effects. No adverse events were reported. A Wilcoxon Signed-Rank Test was conducted to compare pre- and post-tfUS measures of anxiety. tfUS resulted in a significant decrease in anxiety as measured by the HAM-A (W = −3.69, p < 0.001, pre-post-Δ = −12.64 ± 12.51) and the BAI (W = −3.94, p < 0.001, pre-post-Δ = −12.88 ± 10.42). Sixteen (16) of twenty-five (25) total participants indicated clinically significant benefit on PGI-I scores at completion. ConclusionThis study provides preliminary evidence supporting the safety and efficacy of tfUS as a clinical intervention. These results warrant further investigation of tfUS as a therapeutic intervention for anxiety and other psychiatric and neurological disorders. ClinicalTrials.gov identifierNCT04250441.

Adjunct Nondamaging Focal Laser Reduces Intravitreal Injection Burden in Diabetic Macular Edema.

This study aims to determine the impact of adjunct nondamaging focal laser therapy on the number of anti-vascular endothelial growth factor (anti-VEGF) injections and visual acuity (VA) and imaging in patients with diabetic macular edema (DME). A retrospective analysis of 18 eyes of 14 patients with DME treated with a single session of the PASCAL 532 nm Synthesis Photocoagulator with Endpoint Management was conducted. Demographic data, VA, imaging, laser parameters, and anti-VEGF injection burden six months before and after treatment were collected. Wilcoxon Signed-rank tests were used to assess changes in VA and injection burden before and after treatment. The mean number of intravitreal injections in the six-month period prior to laser treatment was 3.39 ± 2.57 injections compared to 2.33 ± 2.40 injections following laser treatment (p = 0.02). There was no significant difference between the mean VA on the day of treatment logMAR VA of 0.38 ± 0.27 (approx. Snellen equivalent 20/50) and the visual acuity on the most recent follow-up 6 months after laser logMAR VA of 0.35 ± 0.32 (approx. Snellen equivalent 20/40) (p = 0.34). There was also no significant difference in OCT central macular thickness before (311 μm) compared to 6 months after (301 μm, p = 0.64). Adjunct focal macular laser therapy is associated with a statistically and clinically significant decrease in the number of intravitreal injections required in the six-month period immediately following treatment, without compromising visual acuity or macular thickness. Nondamaging focal laser has the potential to alleviate the burden of injections for both patients and clinics.

Anti-infective Efficacy of Mechanical Debridement with Adjunctive Modalities on Clinical and Cytokine Parameters in Treatment of Chronic Periodontitis: Randomized Controlled Clinical Trial.

Periodontal debridement involves conventional scaling and root planing (SRP) along with variant forms of adjunctive therapies. In the present clinical trial, we investigated if the adjunctive use of HybenX gel or diode laser along with SRP could provide a favorable outcome for the treatment of chronic periodontitis. The present study involved 60 subjects diagnosed with chronic periodontitis who were randomly assigned as test groups (laser or HybenX) or control group (SRP alone). The primary outcomes of the clinical trial were pocket probing depth (PPD) and clinical attachment level (CAL), which was evaluated at baseline and at third-month time interval. Additionally, secondary outcomes included estimation of reduction in inflammatory mediators interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) in gingival crevicular fluid using enzyme-linked immunosorbent assay at baseline and third-month intervals. Normality determination was checked using Shapiro-Wilk test. Since the data was not normally distributed, nonparametric tests were applied. The comparison of clinical parameters between the groups was analyzed with Kruskal-Wallis test. Wilcoxon sign rank test was used to compare the pairwise comparison of clinical parameters among the groups from baseline to third-month follow-up. The inflammatory mediators at various time points were compared using a One-way analysis of variance test, and the inflammatory mediators in each study group were compared using a paired t-test. Both the test groups demonstrated a decrease in PPD and CAL. However, the HybenX group exhibited statistically significant reduction at the end of the third-month study interval compared to the laser group and SRP alone. Further, the secondary outcome IL-1β and TNF-α analysis exhibited statistically significant reduction in all the groups posttherapy. The adjunctive application of HybenX gel yielded an advantage compared to laser and SRP for the treatment of chronic periodontitis. Adjunctive use of the oral tissue desiccant (HybenX gel) combined with SRP improved the periodontal pocket disinfection process and enhanced tissue healing devoid of adverse effects.

Comparing the Effects of Post Facilitation Stretching and Active Release Technique on Pain, Pain Pressure Threshold and Patients Satisfaction in Upper Trapezius Trigger Points

Purpose: Trigger points are localized, hyperirritable areas term as “Knots” and are palpable in taut band of muscle fibers, tendon or a ligament. To compare the effects on Post facilitation stretching and Active release technique on pain, pain pressure threshold and level of patients’ satisfaction in upper trapezius trigger points.&#x0D; Methodology: It was a quasi-experimental study with sample size of 30 and convenient sampling was used. Inclusion criteria of study were females and males of age 25 to 40 years, positive jump sign and persistent pain for more than 4 months. Study setting was the physical therapy departments of private hospitals of Faisalabad and Lahore. Study duration was 6 months. Out of 30 patients 15 were enrolled in group-A (baseline therapy and Post facilitation stretching) and remaining 15 were enrolled in group-B (baseline therapy and Active release technique). Pain pressure threshold was measured by algometer, Intensity of pain was assessed by NPRS before and after the treatment of one week and patient satisfaction was measure by PSQ-18 after the treatment. Data was analyzed by software SPSS 24. Demographic data and test statistics was presented in form of tables.&#x0D; Findings: Out of 30 patients, 33.3% were male and 66.7% were females. Wilcoxon Signed-Rank Test for within-group analysis revealed a significance difference (p≤0.05) in NPRS and PPT before and after the treatment in both groups. Mann-Whitney U test for between-group analyses showed the p&gt;0.05, which means that no significant differences was observed in results produced by Post facilitation stretching in group A and Active release technique in group B.&#x0D; Recommendations: A significantly reduction in the pain intensity and enhancement in pain pressure threshold was observed in both groups. Both Post facilitation stretching and active release techniques were equally effective in reducing intensity of pain, improving pain pressure threshold in upper trapezius trigger points and patients of both groups showed equally satisfaction level after the treatment. Informed by targeted intervention theories, the study utilized rigorous research methodologies for validation. Practitioners are advised to undergo specialized training for PFS and ART application, ensuring a tailored approach per individual needs. Policymakers should set stringent licensing standards and promote continued research to bolster the techniques' efficacy and widespread adoption.

A novel self-adaptive multi-population quadratic approximation guided jaya for solving real-parameter constrained optimization problems

Despite the inherent stability of Quadratic Approximation based Jaya (JaQA) in solving constrained optimization problems, its effectiveness in exploring the search space is limited. Furthermore, the user-defined penalty parameter utilized to mitigate constraint violation poses another impediment to the efficiency of JaQA. In light of these drawbacks, this paper introduces a new meta-heuristic algorithm, namely Self-adaptive Multi-population Quadratic Approximation guided Jaya (SMP-JaQA). The three additional key features of the SMP-JaQA over JaQA are (i) the inclusion of a multi-population technique to ensure sufficient diversity in the search process (to address the exploration), (ii) a self-adaptation strategy to make it more user-friendly for complex problems in various domains (to address the exploration further), and (iii) a dynamic penalty factor (to automate the penalty parameter). These novel changes help strike a balance between exploration and exploitation too by identifying potential areas in the search space and reduces the likelihood of getting stuck in a local optima. The validity of SMP-JaQA is tested over 18 and 28 benchmark functions of varying dimensions from the CEC-2010 and CEC-2017 test suites, respectively. In order to justify the wide applicability of the proposed algorithm, a set of four real-life constrained problems (includes two mechanical design problems, an electronics design problem and an agricultural problem) are being solved through SMP-JaQA. A thorough analysis of computational outcomes, exploration–exploitation phases, and scalability are presented to shed light on the efficacy and stability levels of SMP-JaQA. The results are compared with those of other state-of-the-art meta-heuristics using Friedman's and Wilcoxon Signed-Rank tests. The outcomes indicate that SMP-JaQA produces reasonable solutions in terms of global optimality and solution quality.

A new robust modified capuchin search algorithm for the optimum amalgamation of DSTATCOM in power distribution networks

Very sensitive loads require the safe operation of electrical distribution networks, including hospitals, nuclear and radiation installations, industries used by divers, etc. To address this issue, the provided paper suggests an innovative method for evaluating the appropriate allocation of Distribution STATic COMpensator (DSTATCOM) to alleviate total power losses, relieve voltage deviation, and lessen capital annual price in power distribution grids (PDGs). An innovative approach, known as the modified capuchin search algorithm (mCapSA), has been introduced for the first time, which is capable of addressing several issues regarding optimal DSTATCOM allocation. Furthermore, the analytic hierarchy process method approach is suggested to generate the most suitable weighting factors for the objective function. In order to verify the feasibility of the proposed mCapSA methodology and the performance of DSTATCOM, it has been tested on two standard buses, the 33-bus PDG and the 118-bus PDG, with a load modeling case study based on real measurements and analysis of the middle Egyptian power distribution grid. The proposed mCapSA technique's accuracy is evaluated by comparing it to other 7 recent optimization algorithms including the original CapSA. Furthermore, the Wilcoxon sign rank test is used to assess the significance of the results. Based on the simulation results, it has been demonstrated that optimal DSTATCOM allocation contributes greatly to the reduction of power loss, augmentation of the voltage profile, and reduction of total annual costs. As a result of optimized DSTATCOM allocation in PDGs, distribution-level uncertainties can also be reduced.

Avoiding misclassification of acute kidney injury: Timing is everything.

Accurate detection of acute kidney injury (AKI) in clinical trials is important. Using a 'baseline' creatinine from trial enrolment may not be ideal for understanding a participant's true baseline kidney function. We aimed to determine if a 'pre-trial baseline creatinine' resulted in comparable creatinine concentrations to a 'trial baseline creatinine', and how the timing of baseline creatinine affected the incidence of AKI in the Combination Antibiotic therapy for MEthicillin Resistant Staphylococcus aureus (CAMERA2) randomised trial. Study sites retrospectively collected a pre-trial baseline creatinine from up to 1 year before CAMERA2 trial enrolment ideally when the patient was medically stable. Baseline creatinine from CAMERA2 (the 'trial baseline creatinine'), was the highest creatinine measurement in the 24 h preceding trial randomisation. We used Wilcoxon sign rank test to compare pre-trial and trial baseline creatinine concentrations. We included 217 patients. The median pre-trial baseline creatinine was significantly lower than the median trial baseline creatinine (82 μmol/L [IQR 65-104 μmol/L] versus 86 μmol/L [IQR 66-152 μmol/L] p = <0.001). Using pre-trial baseline creatinine, 48 of 217 patients (22%) met criteria for an AKI at CAMERA2 enrolment and only 5 of these patients met criteria for an AKI using the CAMERA2 study protocol (using baseline creatinine from trial entry). Using a baseline creatinine from the time of trial enrolment failed to detect many patients with AKI. Trial protocols should consider the optimal timing of baseline creatinine and the limitations of using a baseline creatinine during an acute illness.

THU154 The Effects Of Combined Arginine And Sinemet Stimulation On Copeptin Levels In The Pediatric Population

Abstract Disclosure: S. Sastry: None. C. March: None. L. Garibaldi: None. M.J. McPhaul: None. S. Wheeler: None. Introduction: Most agents that stimulate the secretion of growth hormone (GH) also induce secretion of copeptin (COP), a stable surrogate of AVP. For the evaluation of the polyuria-polydipsia syndrome (PPS), COP stimulation by intravenous (IV) arginine (ARG) has been proposed as a less invasive test than those based on osmotic stimulation of the posterior pituitary, though it provides a weaker stimulus in children than in adults (∼30% vs. 50% increase). After having observed a robust COP response to combined ARG and insulin stimulation (March C, Horm Res Pediatr 2023, PMID: 36513057), we explored the effect of combined IV ARG and oral L-Dopa/carbidopa (LDc, 10:1 ratio), another known stimulus for GH secretion, on COP secretion in non-AVP deficient children. Subjects and Methods: We enrolled 30 healthy subjects with short stature (73% male, mean age ± SD 10.5±3.0 years) undergoing fasting GH stimulation testing in a prospective, single-arm study to assess their COP response. At 0 minutes (min), ARG (500 mg/kg) was infused over 30 min IV and LDc (200 mg/m2 BSA of L-Dopa) was given orally. Serum COP (B.R.A.H.M.S Kryptor assay, Quest Diagnostics) was measured at 0, 60, 90 and 120 min. Results: Median (interquartile range (IQR)) COP values (pmol/L) were 8 (5-10) at 0 min, 17 (13-44) at 60 min, 24 (13-41) at 90 min, and 30 (16-56) at 120 min. Peak COP concentrations at 60, 90, and 120 min all increased significantly from baseline (p&amp;lt;0.001, Wilcoxon sign rank test), but were highly variable in both value (range 10-449) and the timing of the peak (60 min in 33%, 90 min in 17%, 120 min in 50%). Except for 1 subject whose COP values did not change, all subjects had a robust COP peak, ranging from 1.6 to ∼90x the baseline value. The median (IQR) copeptin peak value [50 (41-129) pmol/L] was higher in subjects experiencing nausea/vomiting than in those who did not show this known side effect of LDc [25 (16-44), p=0.03 by Wilcoxon test]. Conclusions: Combined ARG and LDc appear to induce intense stimulation of COP secretion, with widely variable stimulated COP responses. The lowest COP peak value and the median response in this series were much greater than those previously reported to ARG alone in our previous study and the literature. Side effects were well tolerated. The data suggest that this test should be piloted for the differential diagnosis PPS as an alternative to ARG stimulation alone and/or the water deprivation test. Presentation: Thursday, June 15, 2023

SAT304 Improved Biochemical Control With Dose Reduction In Chronic Glucocorticoid Therapy: A Phase III Extension Study Of Chronocort (Efmody) In The Treatment Of Congenital Adrenal Hyperplasia (CAH)

Abstract Disclosure: R.J. Ross: Employee; Self; Diurnal, A Neurocrine Biosciences Company. D.P. Merke: None. A. Mallappa: None. W. Arlt: None. A. Brac de la Perriere: None. A.L. Hirschberg: None. A. Juul: None. J.D. Newell-Price: None. C.G. Perry: None. A. Prete: None. A. Rees: None. N. Reisch: None. M. Stikkelbroeck: None. P.A. Touraine: None. N. Aslam: Employee; Self; Diurnal Ltd, a Neurocrine Biosciences company. H. Coope: Employee; Self; Diurnal Ltd, a Neurocrine Biosciences company. J. Porter: Employee; Self; Diurnal Ltd, a Neurocrine Biosciences Company. Background: Management of congenital adrenal hyperplasia (CAH) involves replacing cortisol deficiency and controlling raised adrenal androgens. Guidelines recommend a target daily hydrocortisone dose of ≤25mg to replace adrenal insufficiency; however, cohort studies show doses &amp;gt;25mg are used to control androgens in CAH patients. Modified-release hydrocortisone (MRHC) capsules, (Efmody, UK), replicate the cortisol diurnal rhythm and improve the control of CAH compared to standard glucocorticoid therapy1. This post-hoc analysis examines total glucocorticoid daily dose and 9am 17-hydroxyprogesterone (17-OHP) levels in MRHC treated patients after 24 months in an ongoing MRHC single-arm extension study. Methods: All patients (n=71) that completed 24 months in the extension study at the time of the interim data cut were reviewed. Patients were recruited predominantly from the 6-month randomised phase III study comparing MRHC to standard glucocorticoid with blind titration of MRHC doses. In this extension phase the dose was titrated by the investigator on the 17-OHP and androstenedione levels at 4, 12, 24 weeks and 6 monthly. Androgen control was defined as 17-OHP &amp;lt;36 nmol/L (&amp;lt;1190 ng/dL). After 24 months, 64 of the patients had 9am 17-OHP data. A Wilcoxon-signed ranks test was performed to assess the change in total MRHC daily dose from baseline to 24 months. A Fisher’s exact test was performed to determine if the number of patients that achieved androgen control on a hydrocortisone (HC) dose ≤25 mg showed a statistically significant increase. Results: The median daily HC dose at baseline was 30mg (Inter-quartile range (IQR) 25-40) and at 24 months had reduced to 20mg (IQR 15-25), p&amp;lt;0.0001.Quadrant analysis revealed the following data: Baseline: &amp;gt 36nmol/L 17-OHP &amp; &amp;lt 25mg/day 9/71 (13%). &amp;gt 36nmol/L 17-OHP &amp; &amp;gt 25mg/day18/71 (25%). &amp;lt 36nmol/L 17-OHP &amp; &amp;lt 25mg/day 22/71 (31%). &amp;lt 36nmol/L 17-OHP &amp; &amp;gt 25mg/day 22/71 (31%). 24 months: &amp;gt 36nmol/L 17-OHP &amp; &amp;lt 25mg/day 16/64 (25%). &amp;gt 36nmol/L 17-OHP &amp; &amp;gt 25mg/day 2/64 (3%). &amp;lt 36nmol/L 17-OHP &amp; &amp;lt 25mg/day 31/64 (48%). &amp;lt 36nmol/L 17-OHP &amp; &amp;gt 25mg/day 15/64 (23%). 48% of subjects achieved androgen control based on 9am 17-OHP level at a HC dose ≤ 25 mg following 24 months of MRHC treatment compared with 31% at baseline (31% vs 48%, p= 0.03 by Fisher’s exact test). Conclusions: After 24 months of MRHC treatment the median daily HC dose was reduced from a median of 30mg to 20mg and the number of patients achieving androgen control based on 9am 17-OHP while receiving HC ≤25mg/day increased significantly.

Supporting scheduling decisions by using genetic algorithm based on tourists’ preferences

As the tourism industry switches from mass to personalized solutions, tourists’ preferences should be considered. This study aims to optimize tourists’ activity chains based on their preferences and 10 realistic parameters. A method using activity-based modeling and genetic algorithm is developed. The method handles flexible touristic activities with time window restrictions. Then scenarios including private vehicles (PV) and public transport (PT) are created. The results show high priority for security and provide significant reduction in journey times, particularly in case of flexible activities. The outcomes confirm that the proposed method provides an optimized solution to generate personalized travel itineraries that enhance tourists’ travel experience. To evaluate the performance of the algorithm, Wilcoxon Signed-Ranks Test is applied. The statistical results confirm that the performance of the GA significantly differs in the various scenarios. Travelers can benefit from the proposed approach since it offers a solution to complex real-world scheduling problems. In addition, travel patterns can be derived thus supporting the work of planners and decision-makers in the tourism industry.

Supine mini percutaneous nephrolithotomy in horseshoe kidney.

The percutaneous nephrolithotomy (PCNL) in Horseshoe kidneys (HSK) is usually performed in the prone position, allowing entry through the upper pole and providing good access to the collecting system. However, in patients with normal kidney anatomy, the supine position is reliable and safe in most cases, but it is unknown whether the supine position is adequate in patients with HSK. The purpose of this study was to describe the results of PCNL in HSK in three different surgical institutions and to evaluate the impact of supine position during surgery, comparing pre-operative and post-operative data, complications, and stone status after surgery. Between 2017 and 2022, a total of 10 patients underwent percutaneous renal surgery for stone disease in HSK. All patients were evaluated pre- and post- operatively with non-contrast CT. we evaluated patients (age and gender), stones characteristics (size, number, side, site and density ), and outcomes. The change in haemoglobin, hematocrit, creatinine and eGFr were assessed between the most recent preoperative period and the first postoperative day. Procedure success was defined as stone-free or presence of ≤4 mm fragments (Clinically Insignificant residual Fragments - CIrF). Complications were registered and classified according to Clavien-dindo Grading System, during the 30 - day postoperative period and Clavien scores ≥ 3 were considered as major complications. Statistical analysis was performed using "r 4.2.1" software, with a 5% significance level. we also compared pre-operative and post-operative data using "wilcoxon signedrank test". No statistical difference was observed between preoperative and post-operative renal function data. At one post operative day CT scan, an overall success rate of 100% was registered. 9/10 patients were completely free from urolithiasis (stone-free rate: 90%), while 1/10 patients had ≤4 mm residual stone fragments (CIrF rate: 10%). No cases of intraoperative complications were registered. Post-operative complications were reported in 1/10 patients. A patient developed urosepsis (defined as SIrS with clinical signs of bacterial infections involving urogenital organs - Clavien-dindo Grade II) after procedure, and was treated with intravenous antibiotic therapy successfully. Conclusions: This study shows that in patients with HSK mini- PCNL in supine position allows to achieve good stone free rate with a very low morbidity. According to our series, the described technique for PCNL in HSK should be an option. Nevertheless these results must be confirmed by further studies.