Wilcoxon Signed Rank Sum Test Research Articles

The Intersectoral Systemic Risk Shock of Emergency Crisis Events in China’s Financial Market: Nonparametric Methods and Panel Event Study Analyses

By employing two systemic risk methods, the marginal expected shortfall (MES) and the component expected shortfall (CES), this paper measures the systemic risk level of all sectors in China’s financial market from 2014 to 2022; thereby, it researches the total effect of sectoral systemic risk using a panel event study model during the three main emergency crisis events. Moreover, two nonparametric methods are utilized, the Wilcoxon signed rank sum test and the bootstrap Kolmogorov–Smirnov test, in order to investigate the changes in individual effects and the dominant ranks of sectoral systemic risk. The empirical results show that (1) the mean values and volatilities of CES and MES of all sectors have a higher level of magnitude in the extreme risk status than those in the normal risk status; (2) by comparing the total effects of three crisis events, we find that different from the continuous shock effect caused by two other events, sectoral systemic risk has a hysteresis effect on the entire market after the outbreak of COVID-19; (3) the long-term and short-term individual effects of sectoral systemic risk in all sectors are different from each other during three events; and (4) the dominance tests of MES are more sensitive and thus better demonstrate the changes in the rankings of sectoral systemic risk than the dominant tests of CES during the emergency crisis events.

A New Lagrangian Problem Crossover—A Systematic Review and Meta-Analysis of Crossover Standards

The performance of most evolutionary metaheuristic algorithms relies on various operators. The crossover operator is a standard based on population-based algorithms, which is divided into two types: application-dependent and application-independent crossover operators. In the process of optimization, these standards always help to select the best-fit point. The high efficiency of crossover operators allows engineers to minimize errors in engineering application optimization while saving time and avoiding overpricing. There are two crucial objectives behind this paper; first, we provide an overview of the crossover standards classification that has been used by researchers for solving engineering operations and problem representation. This paper proposes a novel standard crossover based on the Lagrangian Dual Function (LDF) to enhance the formulation of the Lagrangian Problem Crossover (LPX). The LPX for 100 generations of different pairs parent chromosomes is compared to Simulated Binary Crossover (SBX) standards and Blended Crossover (BX) for real-coded crossovers. Three unimodal test functions with various random values show that LPX has better performance in most cases and comparative results in other cases. Moreover, the LPB algorithm is used to compare LPX with SBX, BX, and Qubit Crossover (Qubit-X) operators to demonstrate accuracy and performance during exploitation evaluations. Finally, the proposed crossover stand operator results are demonstrated, proved, and analyzed statistically by the Wilcoxon signed-rank sum test.

Comparison of Deep-Learning Image Reconstruction With Hybrid Iterative Reconstruction for Evaluating Lung Nodules With High-Resolution Computed Tomography.

This study aimed to investigate the impact of deep-learning reconstruction (DLR) on the detailed evaluation of solitary lung nodule using high-resolution computed tomography (HRCT) compared with hybrid iterative reconstruction (hybrid IR). This retrospective study was approved by our institutional review board and included 68 consecutive patients (mean ± SD age, 70.1 ± 12.0 years; 37 men and 31 women) who underwent computed tomography between November 2021 and February 2022. High-resolution computed tomography images with a targeted field of view of the unilateral lung were reconstructed using filtered back projection, hybrid IR, and DLR, which is commercially available. Objective image noise was measured by placing the regions of interest on the skeletal muscle and recording the SD of the computed tomography attenuation. Subjective image analyses were performed by 2 blinded radiologists taking into consideration the subjective noise, artifacts, depictions of small structures and nodule rims, and the overall image quality. In subjective analyses, filtered back projection images were used as controls. Data were compared between DLR and hybrid IR using the paired t test and Wilcoxon signed-rank sum test. Objective image noise in DLR (32.7 ± 4.2) was significantly reduced compared with hybrid IR (35.3 ± 4.4) (P < 0.0001). According to both readers, significant improvements in subjective image noise, artifacts, depictions of small structures and nodule rims, and overall image quality were observed in images derived from DLR compared with those from hybrid IR (P < 0.0001 for all). Deep-learning reconstruction provides a better high-resolution computed tomography image with improved quality compared with hybrid IR.

Effectiveness of a cervical cancer prevention program to improve health literacy among Japanese undergraduate females in their 20s: A quasi-experimental study

To improve health literacy (HL) regarding cervical cancer prevention, a health program for females in their 20s was previously developed. The present study aimed to examine the effectiveness of that program. We conducted a quasi-experimental study (with control groups) on female undergraduate students in a private university in Japan. In total, 15 and 60 students were categorized into the experimental and control groups, respectively. Intergroup pair-matching using the identified variables yielded a final assessment population of 28 students (n = 14 in each group). The data analysis consisted of group comparisons of the participants between baseline and final assessment using the Wilcoxon signed-rank sum test and McNemar's test. Experimental group comparisons revealed a significant difference in median HL scale scores (baseline, 57.0; final assessment, 66.0; p =.002), median women's health knowledge test scores (baseline, 14.5; final assessment, 16.0; p =.029), and the percentage of participants who felt confident explaining their own body to a medical practitioner (baseline, Y = 14.3, N = 0.0; final assessment, Y = 100.0, N = 0.0; p<.001); however, no significant difference was found for cervical cancer screening behavior. No changes were seen in any of the variables between baseline and final assessment in the control group. These results indicated that our program was effective for improving HL, confidence in explaining one's own body to a medical practitioner, and women's health knowledge test scores, but not for changing cervical cancer screening behaviors. Further research is needed to determine how to provide more appropriate health programs for females in their 20s.

A Hybrid STA Based on Nelder–Mead Simplex Search and Quadratic Interpolation

State transition algorithm (STA) is a metaheuristic method for global optimization. However, due to the insufficient utilization of historical information, it still suffers from slow convergence speed and low solution accuracy on specific problems in the later stages. This paper proposes a hybrid STA based on Nelder–Mead (NM) simplex search and quadratic interpolation (QI). In the exploration stage, NM simplex search utilizes the historical information of STA to generate promising solutions. In the exploitation stage, QI utilizes the historical information to enhance the local search capacity. The proposed method uses an eagle strategy to maximize the efficiency and stability. The proposed method successfully combines the merits of the three distinct approaches: the powerful exploration capacity of STA, the fast convergence speed of NM simplex search and the strong exploitation capacity of QI. The hybrid STA is evaluated using 15 benchmark functions with dimensions of 20, 30, 50 and 100. Moreover, the results are statistically analyzed using the Wilcoxon signed-rank sum test. In addition, the applicability of the hybrid STA to solve real-world problems is assessed using the wireless sensor network localization problem. Compared with six state-of-the-art metaheuristic methods, the experimental results demonstrate the superiority and effectiveness of the proposed method.

The Carbon Footprint and Cost of Virtual Residency Interviews.

The shift from in-person to virtual residency interviews may impact greenhouse gas emissions (GHGE) and costs but the direction and amount of this change is not yet clear. To estimate GHGE and financial impacts of virtual interviews among applicants and programs. In 2020-2021 we sent a postinterview survey to 1429 applicants from 7 residency programs and 1 clinical psychology program at 1 institution. The survey collected origin of travel and transit type if in-person interviews had been held and excluded responses if the applicant would not have participated in an in-person interview, or if travel type or original city was missing. We used the International Civil Aviation Organization calculator to estimate flight-related GHGE in metric tons of carbon dioxide equivalent (MTCO2e) and Google Maps to estimate ground travel, with a standard CO2e per mile. Flight, hotel, and airport taxi costs were estimated using Expedia.com, Hotels.com, Uber, and Lyft. We aggregated these data and calculated median and interquartile ranges (IQRs) for applicant GHGE and cost savings, and assumed no cost or GHGE from virtual interviews. We used Wilcoxon signed rank sum tests to compare in-person 2019-2020 and virtual 2020-2021 GME program interview budgets. The survey response rate was 565, or 40% of applicants; 543 remained after the exclusion criteria were applied. Reduction in applicant travel due to virtual interviews led to median estimated GHGE savings of 0.47 (IQR 0.30-0.61) MTCO2e and $490 (IQR $392-$544) per applicant, per interview. Programs savings ranged from $7,615 to $33,670 for the interview season. Virtual interviews in 8 GME programs were associated with lower estimated GHGE and costs, for applicants and programs, compared with in-person interviews.

Modified minimally invasive surgery in reconstructing the temporomandibular joint disk by transplantation of the temporalis myofascial flap

ObjectiveThe transplantation of temporalis myofascial flap (TMF) is an indispensable method to treat severe temporomandibular joint disorders with disk failure. How to select the indication and the ways of transplantation is still a challenging topic for achieving the ideal effect. We reported the new methods and follow-up results of the patients treated with pedicled TMF transplantation.MethodsRetrospective case series was performed at Temporomandibular Joint Specialist Clinic, the First Affiliated Hospital of Xinjiang Medical University, from December 2014 to August 2022. 39 patients (50 sides) included anterior disk displacement without reduction and disk perforation who underwent discectomy and immediate reconstruction with pedicled TMF. The initial and postoperative maximum mouth opening (MMO), and pain visual analogue scale (VAS) were compared via paired t-test and Wilcoxon signed-rank sum test, respectively.ResultsThe average of follow-up time was 30.07 months. The reconstructed temporomandibular joints basically achieved stable occlusion, good function, and satisfactory effect. The patients displayed a remarkable reduction of VAS score of pain, and improvement of the MMO compared with that before operation (P < 0.001). MR scanning revealed the grafts in joint space showed band-shaped soft tissue density of medium signal and had the clear edges, without interruption and fragment.ConclusionReconstruction of the temporomandibular joint disk by transplantation of the TMF applying modified minimally invasive surgery was a feasible method, which could improve the function of joints and prevent adhesion, without obvious complications in donor region.

Evaluating a Blended Learning Model for Medical Student ECG Teaching.

The ability to interpret a 12-lead electrocardiogram (ECG) is an essential skill in inpatient and outpatient settings. In medical school, this skill is generally taught during the Internal Medicine clerkship. Blended learning is a pedagogical tool that combines different modes of information delivery, models of teaching, and learning styles combining face-to-face learning sessions with online learning. The objectives of this study were to develop a curriculum using a blended educational model including lecture, focused educational videos, flipped classroom, and team-based learning to teach a systematic approach to ECG interpretation and enhance the ability of students to identify common and life-threatening electrocardiographic abnormalities. Between 2016 and 2019, 349 medical students from the University of Colorado School of Medicine received the blended learning curriculum, which included an introductory lecture followed by five 30-minute sessions. These sessions encompassed preclass videos and team-based learning in a flipped-classroom design covering critical concepts in electrocardiography. A sample of 64 students completed a survey evaluating confidence in ECG interpretation skills before and after the curriculum. All of the students completed a 17-item pretest and posttest. The new curriculum improved learner confidence in ECG interpretation (Wilcoxon signed rank-sum test, P < 0.001). Postcurriculum test scores showed statistically significant improvement in all of the diagnoses tested (paired Student t test, P < 0.01), the most significant gains occurring in the life-threatening tracings of ventricular fibrillation and in ventricular tachycardia. Using a blended learning model with multiple educational modalities resulted in significant improvement in learners' performance and confidence in ECG interpretation.

Association of CD10 and VEGF Expression with Tumour Characteristics and Treatment Response in Patients of Carcinoma BreastA Prospective Cohort Study

Introduction: Majority of breast cancer patients receive systemic therapy. This has led to an extensive search for effective factors to predict the outcome. Two such markers for breast cancer are Cluster of Differentiation 10 (CD10) and Vascular Endothelial Growth Factor (VEGF). There is limited data available in the literature to support these parameters in breast cancer patients, especially from the Indian subcontinent. Aim: To ascertain the association of pre-chemotherapy levels of CD10 and VEGF with tumour load in breast cancer and treatment response. Materials and Methods: A prospective cohort study was conducted in the Department of Surgery in collaboration with the Department of Pathology at Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India, from November 2015 to February 2017. A total of 39 patients with Locally Advanced Breast Cancer (LABC) were included in the study. Preoperative levels of CD10 and VEGF were estimated in large needle core biopsy specimens. Standard anthracycline based chemotherapy was given to all patients as a 21 days cycle for three cycles. All patients underwent modified radical mastectomy after Neoadjuvant Chemotherapy (NACT). Levels of CD10 and VEGF were estimated again in the mastectomy specimen. Increase/decrease or no change in VEGF and CD10 expression percentage was ascertained for each patient after systemic therapy. Variables that were studied in the present study were Tumour, Nodes, and Metastasis (TNM) staging of patient, expression of VEGF and CD10 in large needle core biopsy specimens and its association with tumour load, response to NACT and its association with CD10 and VEGF and histopathological characteristics like presence or absence of lymphovascular invasion oestrogen, progesterone and Human Epidermal Growth factor Receptor 2 (HER2)/neu receptor status. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) version 22.0. Association between two ordinal variables was established using Kruskal-Wallis test. A comparison of ordinal paired data was done using Wilcoxon signed-rank sum test. The p-value &lt;0.05 was taken as significant. Results: The mean age of study participants was 42.0±11.4 years. Increase in TNM staging lead to higher CD10 and VEGF expression (p-value&lt;0.05 and &lt;0.029, respectively). There was a significant reduction in CD10 and VEGF expression postchemotherapy (p-value&lt;0.05). CD10 expression was found higher in subjects with ER-negative status (22 patients) with p-value=0.014 and HER2/neu positive status (19 patients) with p-value=0.028. Subjects with HER2/neu positive status had higher VEGF expression (20 patients) with p-value=0.032. Conclusion: CD10 and VEGF can be used as independent markers for indicating poor prognosis and can be used as target for development of novel therapies in carcinoma breast.

Role of Biomarkers (Interleukins (IL)- 2,5,6,16,17,1ß) in Saliva and Serum for Diagnosis of Pulmonary Tuberculosis and for Monitoring Response to Intensive Phase Treatment

Introduction: Majority of the currently used diagnostic tests for Pulmonary Tuberculosis (PTB) have variability in sensitivity and specificity in diagnosing PTB. Therefore, evaluating new biomarkers in easily obtainable samples like serum and saliva can contribute to the diagnosis of PTB. Aim: To evaluate the role of Interleukins(IL)- 2,5,6,16,17,1β in the diagnosis of PTB by comparing their levels in Other Respiratory Diseases (ORD) group and monitoring the response to treatment in PTB group. Materials and Methods: This prospective observational study was conducted between January 2021 to May 2022 in a tertiary care hospital in New Delhi, India. A total of 80 cases were taken of which 40 cases of PTB and 40 cases having diagnosis of ORD were studied. IL-2,5,6,16,17,1β levels were measured in saliva and serum using Enzyme Linked Immune Sorbent Assay (ELISA) kits. These IL were also measured in diagnosed PTB patients in serum and saliva after two months of treatment. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 16.0. Kruskal Wallis H Test, Wilcoxon signed-rank sum test, Chi-square test and Fisher’s exact test were applied at appropriate areas and a p-value &lt;0.05 was taken as significant. Results: On comparing the levels of IL between serum and saliva in PTB group at baseline, IL-2, IL-17 levels were higher in serum while IL-5, IL-1β levels were higher in saliva with these results being statistically significant (p-value &lt;0.001). However, after two months of treatment, the levels of IL-2, IL16 decreased significantly in both serum and saliva whereas IL-17 level decreased significantly only in serum after treatment. None of the IL showed significant difference in levels between serum and saliva in PTB and ORD groups. Conclusion: The diagnostic role of IL in PTB could not be established whereas IL-2, IL-16 and IL-17 can be used for monitoring response to treatment as the levels decreased significantly with treatment.

A Comparison of Intensity-Modulated Radiotherapy With Simultaneous Integrated Boost With Three-Dimensional Conformal Radiotherapy With Sequential Boost for Locally Advanced Cervical Cancer: A Dosimetric Study.

Objective The aim of this study was to compare the dosimetric criteria between the intensity-modulated radiation therapy (IMRT) technique with a simultaneous integrated boost (SIB) and the three-dimensional conformal radiation therapy (3DCRT) technique with a sequential boost (SB) plans for patients with locally advanced cervical cancer (LACC). Materials and methods A retrospective dosimetric comparison was performed in 15 patients with locally advanced cervical cancer who had previously been treated with fractions of 1.8 Gy up to doses of 45, 54-55.8, and 59.4 Gy in 28-33 sessions using the three-dimensional conformal radiation therapy (3DCRT) technique with a sequential boost (SB)and who had a new planning that was made using the intensity-modulated radiation therapy (IMRT) technique with a simultaneous integrated boost (SIB) in 25 sessions.The conformity index, quality of coverage, homogeneity index, mean doses, maximum doses, and different organ at risk (OAR) dose constraints were calculated for the dosimetric comparison of treatment plans. Descriptive analysis was performed using measures of central tendency and dispersion for the quantitative variablesand absolute and relative frequencies for the qualitative variables. The comparison was made using the Wilcoxon signed rank sum test for a type I error level of 0.05. The statistical softwareStata 11 (StataCorp LLC, College Station, Texas, USA) was used in the analysis. Results The mean age of the patients was 52 years, 33% were stage IIIB, and 67% had squamous cell carcinomas. The conformity index was 0.74 and 0.46 (difference: 0.28; p<0.01), the quality of coverage was 0.84 and 0.94 (difference: -0.10; p<0.01), and the homogeneity index was 0.12 and 0.070 (difference: 0.052; p<0.01) for IMRT-SIB and 3DCRT-SB, respectively. When the mean doses of the OARs were compared, all were lower with the IMRT-SIB technique, with statistically significant differences in the rectum and bladder. Conclusions The IMRT-SIB technique achieves a greater conformation of the doses on the treatment volumes with a significant reduction of the doses on the bladder and rectum.

Comparison of the effects of self-made three-dimensional printed assistant tableware and traditional universal cuff assistant tableware in patients with upper limb dysfunction after burn injury

Objective: To compare the effects of self-made three-dimensional (3D) printed assistant tableware (hereinafter referred to as 3D assistive device) and traditional universal cuff assistant tableware (hereinafter referred to as universal cuff) on the voluntary eating function of patients with upper limb dysfunction after burns. Methods: The prospective self-control study was conducted. From March 2020 to June 2021, 18 patients with upper limb dysfunction after moderate to severe burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 15 males and 3 females, aged 21-58 (42±11) years. After using the 3D software and 3D printer to customize 3D assistive devices for patients, the patients were instructed to eat with the 3D assistive devices and the universal cuff on alternate days for 14 consecutive days, each for 7 days. During this time, the patients could also be fed by someone else without using the assistive device. The number of times the patients ate regular meals with each assistive device and the proportion of them to the total number of regular meals ate during the 7 days to which they belonged were counted. After the total use of two assistive devices for 14 days (hereinafter referred to as after use of 14 days), the amount and time of transferring liquid using the two assistive devices of patients were measured; the patients' feeding items in the modified Barthel index (MBI) were scored respectively when eating without the assistive device, with the 3D assistive device, or with the universal cuff; the satisfaction degree of feeding when eating without the assistive device, with the 3D assistive device, or with the universal cuff was evaluated using the 5-grade Likert scale. Data were statistically analyzed with paired sample t test, Wilcoxon signed rank sum test, and chi-square test. Results: The number of the patients ate regular meals with the 3D assistive device during the 7 days was (18.1±2.0) times, which was significantly more than (4.0±2.0) times with the universal cuff (t=53.72, P<0.01). The proportion of the number of the patients ate regular meals with the 3D assistive device to the total number of regular meals ate during the 7 days to which it belonged was 72.4% (325/449), which was significantly higher than 16.7% (72/431) with the universal cuff (χ2=257.36, P<0.01). After use of 14 days, the patients' time and amount of transferring liquid using the 3D assistive device were respectively significantly shorter and more than using the universal cuff (with t values of 2.49 and 7.52, respectively, P<0.05 or P<0.01). The patients' MBI feeding scores when eating with the 3D assistive device and with the universal cuff were close (P>0.05), which were both significantly higher than the score when eating without the assistive device (with Z values of 3.90 and 3.86, respectively, P<0.01).The patients' satisfaction scores of feeding when eating with the 3D assistive device and with the universal cuff were close (P>0.05), which were both significantly higher than the score when eating without the assistive device (with Z values of 3.61 and 3.00, respectively, P<0.01). Conclusions: Both the 3D assistive device and the universal cuff can compensate the limb function of patients with upper limb dysfunction after burns and improve their self-feeding ability, but the 3D assistive device has more advantages in improving patients' willingness to eat and the efficiency of food transfer.

Change in Daily Steps and Self-efficacy of Online Interactive Exercise Classes for Community-dwelling Older Adults in Japan: A Preliminary Study.

This study aimed to (1) examine the feasibility of an online interactive exercise class for community-dwelling older adults and (2) preliminarily examine changes in physical activity and self-efficacy. Participants were 25 community-dwelling older adults aged 65 years or older, but due to 5 dropouts, the final number of participants for analysis was 20 (mean age 76.9 ± 5.7 years). The intervention program was conducted for 40 minutes each session, twice a week for four consecutive weeks, using the LINE group call (LINE Corporation, Japan). An online questionnaire was used to assess participant characteristics, modified Fall Efficacy Scale score, modified Gait Efficacy Scale (m-GES) score, self-rated health, and daily steps, which were compared pre- and post-intervention using the Wilcoxon signed-rank sum and chi-square tests. The Wilcoxon signed-rank sum test showed significant improvement in the m-GES score and daily steps. The chi-square test showed that self-rated health was significantly greater in the maintenance/increase group. Online interactive exercise classes are feasible for community-dwelling older individuals. These results also suggest the possibility of using telehealth to improve physical activity and self-efficacy.

Generative compressed breast shape model for digital mammography and digital breast tomosynthesis.

Modelling of the 3D breast shape under compression is of interest when optimizing image processing and reconstruction algorithms for mammography and digital breast tomosynthesis (DBT). Since these imaging techniques require the mechanical compression of the breast to obtain appropriate image quality, many such algorithms make use of breast-like phantoms. However, if phantoms do not have a realistic breast shape, this can impact the validity of such algorithms. To develop a point distribution model of the breast shape obtained through principal component analysis (PCA) of structured light (SL) scans from patient compressed breasts. SL scans were acquired at our institution during routine craniocaudal-view DBT imaging of 236 patients, creating a dataset containing DBT and SL scans with matching information. Thereafter, the SL scans were cleaned, merged, simplified, and set to a regular grid across all cases. A comparison between the initial SL scans after cleaning and the gridded SL scans was performed to determine the absolute difference between them. The scans with points in a regular grid were then used for PCA. Additionally, the correspondence between SL scans and DBT scans was assessed by comparing features such as the chest-to-nipple distance (CND), the projected breast area (PBA) and the length along the chest-wall (LCW). These features were compared using a paired t-test or the Wilcoxon signed rank sum test. Thereafter, the PCA shape prediction and SL scans were evaluated by calculating the mean absolute error to determine whether the model had adequately captured the information in the dataset. The coefficients obtained from the PCA could then parameterize a given breast shape as an offset from the sample means. We also explored correlations of the PCA breast shape model parameters with certain patient characteristics: age, glandular volume, glandular density by mass, total breast volume, compressed breast thickness, compression force, nipple location, and centre of the chest-wall. The median value across cases for the 90th and 99th percentiles of the interpolation error between the initial SL scans after cleaning and the gridded SL scans was 0.50 and 1.16mm, respectively. The comparison between SL and DBT scans resulted in small, but statistically significant, mean differences of 1.6mm, 1.6mm, and 2.2cm2 for the LCW, CND, and PBA, respectively. The final model achieved a median mean absolute error of 0.68mm compared to the scanned breast shapes and a perfect correlation between the first PCA coefficient and the patient breast compressed thickness, making it possible to use it to generate new model-based breast shapes with a specific breast thickness. There is a good agreement between the breast shape coverage obtained with SL scans used to construct our model and the DBT projection images, and we could therefore create a generative model based on this data that is available for download on Github.

Educational significance and challenges of conducting the objective structured clinical examination twice for midwifery students before and after clinical training: A longitudinal single university study during 2014-2019 in Japan.

This study aimed to clarify the educational significance and issues associated with administering the objective structured clinical examination (OSCE) twice to midwifery students, i.e., before and after clinical training. In Sapporo City University in Japan, 37 assessment items of the OSCE were configured as "Overall," with 17 items as midwifery's normal delivery preparation (Part 1) and 20 items as midwifery's normal delivery assistance (Part 2). All students had attended lectures with textbooks. The first and second OSCEs were conducted before and after the clinical training, respectively. The scores of 54 students were retrospectively analyzed over 6 years (2014-2019). The results of the first and second OSCEs were compared. Statistical analysis was performed using Mann-Whitney U test, Wilcoxon signed rank-sum test, Fisher's exact test, and analysis of variance. The mean scores for "Overall" [0-37], "Part 1" [0-17], and "Part 2" [0-20] in the second OSCEs were significantly higher than those in the first OSCE (Overall: 22.7 vs 19.3, Part 1: 9.50 vs 7.71, Part 2: 13.2 vs 11.6, p<0.05, respectively). Regarding "Overall" and "Part 1," a positive correlation was observed between the first and second OSCEs, wherein the full scores of "Part 1," converted from 17 to 20 points to match the full scores of "Part 2," were significantly lower than those of Part 2 (p<0.05, respectively). There was a positive correlation between the scores of the first and second OSCEs in "Part 1" and "Part 2" (p<0.05). The scores increased between the two OSCEs, and participants could objectively grasp the knowledge and skills. The OSCEs conducted twice were useful in skilling-up the normal delivery preparation and assistance skills of midwifery students. However, developing an advanced educational method might be necessary for the midwifery students' preparation of normal delivery, because the scores in the OSCEs were lower.

Effects of a 9-weeks arch support intervention on foot morphology in young soccer players: a crossover study

BackgroundA flat foot is a common cause of chronic sports injuries and therefore many opportunities for arch support interventions exist. However, young athletes change their foot morphology due to developmental influences even without intervention. Therefore, developmental influences need to be considered when examining the effects of arch support, but there have not been sufficient longitudinal studies to date. This study aimed to determine the effect of the arch support intervention by performing a 9-weeks arch support intervention on the foot morphology and cross-sectional area of the foot muscles in flat-footed young athletes. Thirty-one elementary school boys (Age 11.4 ± 0.5 years, Height 145.2 ± 7.4 cm, Weight 38.8 ± 8.3 kg, BMI 18.2 ± 2.2 kg/m2) with a decreased medial longitudinal arch in the foot posture index were selected as participants from a local soccer club and randomly divided into two groups.MethodsIn one group, in the intervention period, an existing arch supporter was used to provide arch support, while in the other group, no special intervention was provided in the observation period. To account for developmental effects, the intervention study was conducted as an 18-weeks crossover study in which the intervention and observational phases were switched at 9 weeks after the intervention. Foot morphology was assessed using a three-dimensional foot measuring machine, and the cross-sectional area (CSA) of the internal and external muscles of the foot was assessed using an ultrasound imaging device. We examined the effect of the intervention by comparing the amount of change in the measurement results between the intervention and observation periods using corresponding t-tests and Wilcoxon signed-rank sum test, analysis of covariance methods.ResultsAfter adapting the exclusion criteria, 14 patients (28 feet) were included in the final analysis. The CSA of the abductor hallucis muscle (ABH) increased 9.7% during the intervention period and 3.0% during the observation period (p = 0.01). The CSA of the flexor digitorum longus muscle (FDL) increased 7.7% during the intervention period and 4.2% during the observation period (p = 0.02).ConclusionA 9-weeks arch supporter intervention may promote the development of the ABH and FDL CSA in young flat-footed soccer players.

Effects of Zinc Acetate Hydrate Supplementation on Renal Anemia with Hypozincemia in Hemodialysis Patients.

This study examined whether zinc supplementation with zinc acetate hydrate improved renal anemia with hypozincemia in patients undergoing hemodialysis. The study participants included 21 patients undergoing hemodialysis who presented with a serum zinc level &lt; 60 mg/dL and who were administered zinc acetate hydrate at 50 mg (reduced to 25 mg, as appropriate) for 6 months. Patients with a hemorrhagic lesion, acute-phase disease (pneumonia or cardiac failure), or hematologic disease and those whose treatment was switched from peritoneal dialysis to hemodialysis were excluded. The changes in the erythropoietin resistance index (ERI) before and after zinc acetate hydrate administration were examined. ERI was defined as the dose (IU) of erythropoiesis-stimulating agent (ESA)/week/body weight (kg)/hemoglobin content (g/dL). The differences between the two groups were analyzed using the Wilcoxon signed rank sum test, and p &lt; 0.05 was considered statistically significant. The study participants included 19 men and 2 women aged 41-95 years (mean ± standard deviation (SD): 67.1 ± 13.6). The changes in the values of parameters measured before and after zinc acetate hydrate administration were as follows: Blood Hb did not change significantly, from 10.0-13.6 g/dL (11.5 ± 1.0 g/dL) to 10.2-12.4 g/dL (11.4 ± 0.7 g/dL); serum zinc concentration significantly increased, from 33.0-59.0 mg/dL μg/dL (52.4 ± 7.6 mg/dL μg/dL) to 57.0-124.0 mg/dL μg/dL (84.1 ± 16.3 mg/dL μg/dL; p &lt; 0.01); the ESA dose significantly decreased, from 0-12,000 IU/week (5630 ± 3351 IU/week) to 0-9000 IU/week (4428 ± 2779; p = 0.04); and ERI significantly decreased, from 0.0-18.2 (8.1 ± 5.1) to 0.0-16.0 (6.3 ± 4.3; p = 0.04). Zinc supplementation increased the serum zinc concentration and significantly reduced the ESA dose and ERI, suggesting that a correction of hypozincemia contributes to lessening renal anemia in these patients.

Low-Temperature Plasma Short Exposure to Decontaminate Peri-Implantitis-Related Multispecies Biofilms on Titanium Surfaces In Vitro.

The use of low-temperature plasma (LTP) is a novel approach to treating peri-implantitis. LTP disrupts the biofilm while conditioning the surrounding host environment for bone growth around the infected implant. The main objective of this study was to evaluate the antimicrobial properties of LTP on newly formed (24 h), intermediate (3 days), and mature (7 days) peri-implant-related biofilms formed on titanium surfaces. Actinomyces naeslundii (ATCC 12104), Porphyromonas gingivalis (W83), Streptococcus oralis (ATCC 35037), and Veillonella dispar (ATCC 17748) were cultivated in brain heart infusion supplemented with 1% yeast extract, hemin (0.5 mg/mL), and menadione (5 mg/mL) and kept at 37°C in anaerobic conditions for 24 h. Species were mixed for a final concentration of ~105 colony forming units (CFU)/mL (OD = 0.01), and the bacterial suspension was put in contact with titanium specimens (7.5 mm in diameter by 2 mm in thickness) for biofilm formation. Biofilms were treated with LTP for 1, 3, and 5 min at 3 or 10 mm from plasma tip to sample. Controls were those having no treatment (negative control, NC) and argon flow under the same LTP conditions. Positive controls were those treated with 14 μg/mL amoxicillin and 140 μg/mL metronidazole individually or combined and 0.12% chlorhexidine (n = 6 per group). Biofilms were evaluated by CFU, confocal laser scanning microscopy (CLSM), and fluorescence in situ hybridization (FISH). Comparisons among bacteria; 24 h, 3-day, and 7-day biofilms; and treatments for each biofilm were made. Wilcoxon signed-rank and Wilcoxon rank sum tests were applied (α = 0.05). Bacterial growth was observed in all NC groups, corroborated by FISH. LTP treatment significantly reduced all bacteria species compared to the NC in all biofilm periods and treatment conditions (p ≤ 0.016), and CLSM corroborated these results. Within the limitation of this study, we conclude that LTP application effectively reduces peri-implantitis-related multispecies biofilms on titanium surfaces in vitro.

Effect of Combined Surgery in Patients with Complex Nanophthalmos.

(1) Background: To evaluate the efficacy and safety of combined surgery (limited pars plana vitrectomy, anterior-chamber stabilized phacoemulsification, IOL implantation and posterior capsulotomy, LPPV + ACSP + IOL + PC) in complex nanophthalmos. (2) Methods: Patients with complex nanophthalmos were recruited to undergo LPPV + ACSP + IOL + PC from January 2017 to February 2021. Preoperative and post-operative intraocular pressure (IOP), best corrected visual acuity (BCVA), anterior chamber depth (ACD), and number of glaucoma medications were compared using the paired t-test or Wilcoxon signed rank sum tests. Surgical success rate was evaluated. Surgery-associated complications were documented. (3) Results: Forty-five eyes of 37 patients with complex nanophthalmos were enrolled. The mean follow-up period was 21.7 ± 10.6 months after surgery. Mean IOP decreased from 32.7 ± 8.7 mmHg before surgery to 16.9 ± 4.5 mmHg (p < 0.001) at the final follow-up visit, mean logMAR BCVA improved from 1.28 ± 0.64 to 0.96 ± 0.44 (p < 0.001), mean ACD significantly increased from 1.14 ± 0.51 mm to 3.07 ± 0.66 mm (p < 0.001), and the median number of glaucoma medications dropped from 3 (1, 4) to 2 (0, 4) (p < 0.001). The success rate was 88.9% (40 eyes) at the final follow-up visit. Two eyes had localized choroidal detachments which resolved with medical treatment. (4) Conclusions: LPPV + ACSP + IOL + PC is a safe and effective surgical procedure, which can decrease IOP, improve BCVA, deepen the anterior chamber, and reduce the number of glaucoma medications in patients with complex nanophthalmos. It can be considered as one of the first treatment in nanophthalmic eyes with complex conditions.

Renal imaging at 5 T versus 3 T: a comparison study

BackgroundRecently, a whole-body 5 T MRI scanner was developed to open the door of abdominal imaging at high-field strength. This prospective study aimed to evaluate the feasibility of renal imaging at 5 T and compare the image quality, potential artifacts, and contrast ratios with 3 T.MethodsForty healthy volunteers underwent MRI examination both at 3 T and 5 T. MRI sequences included T1-weighted gradient-echo (GRE), T2-weighted fast spin echo, diffusion-weighted imaging, and multi-echo GRE T2* mapping. Image quality and presence of artifacts were assessed for all sequences using four-point scales. For anatomical imaging, the signal-to-noise ratio (SNR) and contrast ratio (CR) of abdomen organ tissues were calculated. Besides, for functional imaging, the contrast-to-noise ratio of cortex/medulla was calculated. Wilcoxon signed rank-sum test was used to compare the visual evaluation scores and quantitative measurements between 3 and 5 T images.ResultsCompared to 3 T examination, T1-weighted sequence at 5 T showed significantly better image quality with higher conspicuity of the renal veins and arteries, and comparable artifacts. Image quality was comparable between both field strengths on T2-weighted images, whereas a significantly higher level of artifacts was observed at 5 T. Besides, 5 T MRI contributed to higher SNR and CR for abdomen organ tissues. For functional imaging, 5 T MRI showed improved corticomedullar discrimination. There was no significant difference between apparent diffusion coefficient of renal at 3 T and 5 T, while 5 T MRI resulted in significantly shorter T2* values in both cortex and medulla.Conclusions5 T MRI provides anatomical and functional images of the kidney with sufficient image quality.