Wilcoxon Test Research Articles

Metastasis Detection Using True and Artificial T1-Weighted Postcontrast Images in Brain MRI

Objectives Small lesions are the limiting factor for reducing gadolinium-based contrast agents in brain magnetic resonance imaging (MRI). The purpose of this study was to compare the sensitivity and precision in metastasis detection on true contrast-enhanced T1-weighted (T1w) images and artificial images synthesized by a deep learning method using low-dose images. Materials and Methods In this prospective, multicenter study (5 centers, 12 scanners), 917 participants underwent brain MRI between October 2021 and March 2023 including T1w low-dose (0.033 mmol/kg) and full-dose (0.1 mmol/kg) images. Forty participants with metastases or unremarkable brain findings were evaluated in a reading (mean age ± SD, 54.3 ± 15.1 years; 24 men). True and artificial T1w images were assessed for metastases in random order with 4 weeks between readings by 2 neuroradiologists. A reference reader reviewed all data to confirm metastases. Performances were compared using mid-P McNemar tests for sensitivity and Wilcoxon signed rank tests for false-positive findings. Results The reference reader identified 97 metastases. The sensitivity of reader 1 did not differ significantly between sequences (sensitivity [precision]: true, 66.0% [98.5%]; artificial, 61.9% [98.4%]; P = 0.38). With a lower precision than reader 1, reader 2 found significantly more metastases using true images (sensitivity [precision]: true, 78.4% [87.4%]; artificial, 60.8% [80.8%]; P < 0.001). There was no significant difference in sensitivity for metastases ≥5 mm. The number of false-positive findings did not differ significantly between sequences. Conclusions One reader showed a significantly higher overall sensitivity using true images. The similar detection performance for metastases ≥5 mm is promising for applying low-dose imaging in less challenging diagnostic tasks than metastasis detection.

Evaluation of intra- and inter-rater agreement on ultrasound measurements of dairy cow teats by operators with different experience levels.

Ultrasound is a valuable, non-invasive technique. It allows for detailed examination, precise measurement, and effective monitoring of teats in dairy cows. This study aimed to evaluate the reliability of ultrasound measurements of teats in dairy cows, specifically focusing on intra- and inter-rater agreement between operators with different levels of experience. The study included 51 healthy Holstein cows, with two operators (experienced and inexperienced) performing measurements on ultrasound images obtained before and after milking. The parameters analyzed were teat-canal length (TCL), teat-end width (TEW), teat-wall thickness (TWT), and teat-cistern width (TCW). Differences in teat measurements before and after milking, as well as between operators, were assessed using the Wilcoxon Signed Rank test and the Mann-Whitney U test, respectively. Intra- and inter-rater agreement was calculated using the intra-class correlation coefficient (ICC). Statistical significance was set at p < 0.05. A total of 402 ultrasound images were analyzed. Significant differences were found in TCL, TWT, and TCW before and after milking, while TEW remained unaffected. Statistically significant differences in TWT and TCW were observed between the two operators, while TCL and TEW did not show significant differences. Intra-rater agreement for the experienced operator was excellent, and for the inexperienced operator, it was good. Inter-rater agreement ranged from good to excellent for most parameters, except for TWT, where it was poor. The study confirms that both milking and operator experience influence teat measurements. However, with proper training, ultrasonography can be a reliable tool for assessing udder health in dairy cows, supporting its use in field conditions.

Impact of adalimumab on erectile dysfunction, sperm parameters and hormonal profile in male psoriasis patients: a six-month observational study.

Psoriasis, a chronic inflammatory skin disease, is associated with systemic complications that extend beyond cutaneous lesions, including cardiovascular risks and sexual dysfunction. Erectile dysfunction (ED) is notably more prevalent in male psoriasis patients, likely driven by both systemic inflammation and psychological stress. Adalimumab (ADA), a tumor necrosis factor-alpha (TNF-α) inhibitor, has been shown to effectively reduce psoriasis severity, but its effects on sexual and reproductive health remain underexplored. This study investigates the impact of ADA on erectile function, sperm parameters, and hormonal profiles in male psoriasis patients. This six-month prospective observational study included 33 biologic-naïve male patients aged 18-50 years with moderate-to-severe plaque psoriasis (Psoriasis Area and Severity Index [PASI] > 10). Patients received ADA according to standard clinical protocols. Erectile function was assessed using the International Index of Erectile Function (IIEF-5). Sperm parameters, including ejaculate volume, sperm concentration, total sperm count, motility, vitality, and morphology, were analyzed following World Health Organization (WHO) 2010 criteria. Hormonal profiles (testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and prolactin) were measured via standardized assays. Statistical analyses were performed using paired t-tests or Wilcoxon signed-rank tests, with p-values < 0.05 considered significant. ADA significantly improved erectile function, as the mean IIEF-5 score increased from 21.3 ± 2.2 to 22.2 ± 1.9 (p = 0.03). The percentage of patients with ED decreased from 51.5% at baseline to 36.4% post-treatment (p < 0.001). Progressive sperm motility and vitality showed statistically significant improvement post-treatment (p = 0.02 and p = 0.04, respectively), while other sperm parameters remained unchanged. Total testosterone levels significantly increased from 3.4 ± 0.4 ng/ml to 3.5 ± 0.4 ng/ml (p = 0.02), while LH, FSH, estradiol, and prolactin levels showed no significant changes. The anti-inflammatory properties of adalimumab, through the inhibition of TNF-α, not only reduce psoriasis severity but also appear to exert positive effects on male sexual and reproductive health. Our study demonstrated significant improvements in erectile function, sperm motility, vitality, and testosterone levels in male psoriasis patients after adalimumab therapy. These findings suggest that beyond its role in controlling psoriatic skin lesions, adalimumab may help mitigate the systemic inflammatory burden that contributes to sexual dysfunction and impaired spermatogenesis. Future long-term studies are essential to further explore the sustained impact of TNF-α inhibition on male fertility and reproductive outcomes.

An investigation of the validity of the Bedek models and Cameriere-European formula used in dental age prediction in Turkish children.

Dental age estimation is one of the most reliable methods for determining age, commonly used for forensic, criminal, and anthropological purposes. The purpose of this study was to assess and compare the precision of the Bedek models and the Cameriere-European Formula (CF) in determinating dental age in a sample of Turkish individuals. Retrospective panoramic radiographs of 1018 subjects (497 boys and 521 girls) aged 5-14 years were evaluated using the Bedek models and the CF. The differences between calculated dental age (DA) and chronological age (CA) for each sex and age group were analyzed using the paired sample t-test and the Wilcoxon signed-rank test. The accuracy of the methods used to estimate dental age was determined by calculating the mean absolute error (MAE) based on the proximity of the dental age to the chronological age. The CF method overestimated CA by 0.1 year in the entire sample. Conversely, the Bedek models tended to overestimate CA, with the three-, four-, and seven-tooth models exhibiting the most significant difference. There was a statistically significant difference between boys and girls in the DA-CA calculation using the CF method in the entire sample. Among the Bedek models, the three- and four-tooth models had the lowest MAE in the entire sample, while the single-tooth model had the highest MAE. The CF method showed higher accuracy in predicting the age of children living in eastern Turkey compared to the Bedek Models.

Effectiveness of training on health care workers' knowledge, attitude and practice regarding COVID-19 infection prevention and control, Yemen, 2021.

Although several training courses for Health Care Workers (HCWs) on COVID-19 were conducted in Yemen, no evaluation has been done to assess the effectiveness of such training on the Knowledge, Attitude and Practice (KAP) of HCWs. Therefore, this study aimed to assess the effectiveness of training on the KAP of HCWs toward infection prevention and control (IPC) for COVID-19, determine the relationship between the change in the KAP of HCWs, and identify the associated factors with the change in KAP. A cross-sectional study was conducted from April to December 2021. It was conducted among 186 HCWs working at COVID-19 isolation centers and caring for COVID-19 patients, in all Yemen's governorates. The data were collected one week before and immediately after the training session. SPSS version 26 was used for data entry and analysis. The median, interquartile range (IQR) and median difference were calculated. The Wilcoxon Signed Ranks Test was used to estimate the significant difference between KAP pre- and post-training scores. Kurskal-Wallis and Mann-Whitney U tests were used to assess the associated factors. Spearman's correlation coefficient test was used to assess the statistical relationship between the change in KAP. A P value < 0.05 was considered statistically significant. Out of 186 HCWs, 181 HCWs filled the pre- and post-assessment, with a response rate of 97.3%. The median difference (IQR) in the KAP scores were 3.0 (1.0 and 6.0), 1.0 (-1.0 and 4.0) and 2.0 (-1.0 and 5.0), respectively. However, there are statistical difference in the KAP scores between the pre- and post-training (p value = 0.000, 0.004 and 0.000, respectively). There are significant positive correlations between the change in knowledge, attitude and practice (all p values < 0.01). A significantly change in knowledge was found among those working in epidemiological surveillance (p value = 0.031). This evaluation concludes that the training program is effective in improving the KAP of HCWs toward IPC for COVID-19. It provides scientific evidence about the importance of training courses for HCWs during the COVID-19 pandemic. Further study is recommended to evaluate the retention of the KAP after a period of training.

Dynamic changes of radiological and radiomics patterns based on MRI in viable hepatocellular carcinoma after transarterial chemoembolization.

This study aims to analyze the magnetic resonance imaging (MRI) change patterns of viable hepatocellular carcinomas (HCCs) following the initial transarterial chemoembolization (TACE). A retrospective analysis of HCC patients' initial TACE from February 2015 to October 2022 across three centers and a clinical trial (NCT03113955) was conducted. The viability of residual HCCs at one and six months after TACE was evaluated using the LI-RADS Treatment Response Algorithm (LR-TRA) v2024. The radiological and radiomics features of post-TACE viable tumors between baseline and one-month, and between one- and six- months were compared using Wilcoxon signed-rank test and McNemar's test. A total of 160 viable tumors were included in the study. Viable tumors at one month after TACE exhibited higher T1WI intensity (P =.024), lower T2WI intensity (P =.005), fewer washout features (P <.001), smaller size (P <.001), and higher ADC values (P <.001) compared to baseline HCC imaging.A significant reduction in DWI intensity (P =.002) and ADC values (P <.001) were observed in viable tumors at one month compared to those at six months. There were 82 (45.1%) radiomics features that changed significantly between the baseline and one-month. Only three radiomics features showed statistically significant difference of viable tumors between one- and six-month. Compared to the baseline, viable HCCs after TACE demonstrated significant changes of imaging characteristics in a series of radiological and radiomics features at one- and six-month follow-ups. Clinically diagnosing of viable HCCs using radiological methods is challenging. A comprehensive analysis of these imaging characteristics can facilitate the accurate identification of viable tumors.

Hybrid Mentorship of Medical Laboratories to Achieve ISO 15189:2012 Accreditation in Malawi: The University of Maryland Malawi Experience.

As part of a laboratory strengthening program in Malawi to achieve and maintain International Organization for Standardization (ISO) 15189 accreditation, we intended to mentor selected HIV molecular laboratories to achieve this accreditation. Due to the COVID-19 pandemic, mentorship pivoted to a hybrid model using an Internet-based approach and on-site mentorships. We describe the implementation of this strategy, successes, and challenges. We conducted weekly, 1-hour virtual mentorship sessions for the 5 initial laboratories (cohort 1) selected based on their Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) performance score of 3 or more stars. Laboratories presented updates and supporting documents electronically, and trainings were conducted virtually. In September 2020, when travel restrictions were relaxed, we initiated hybrid mentorships and audits for cohort 1 laboratories. The same hybrid approach was used to mentor 4 additional laboratories in cohort 2. We performed descriptive analysis, and the Wilcoxon signed-rank test was used to compare the training pre-and post-test scores. Between March 2020 and May 2023, the team completed a total of 54 virtual mentorship sessions and 20 on-site visits across 9 laboratories. Overall, the team conducted 8 training sessions for 35 laboratory quality officers. Median score improvement (pre-test vs. post-test scores) was observed across individual trainings and across cohorts (P<.01). At the end of cohort 1, 4 of 5 (80%) laboratories were accredited. One laboratory that did not reach accreditation joined cohort 2. At the end of the mentoring period, all 5 cohort 2 laboratories were accredited. We demonstrated that using a hybrid mentorship model for accreditation was a successful strategy during the COVID-19 pandemic. For the first time in Malawi, this strategy resulted in accrediting 9 of the 10 HIV molecular laboratories in 3 years at a reduced cost. Continuous mentorship is key in the maintenance of accreditation.

Comparison of Occupational Performance in Immersive Virtual and Real Environments Among Patients With Stroke: Observational Randomized Crossover Pilot Study.

Conventional rehabilitation approaches involve therapists simulating various occupational tasks in health care settings or recreating real-life situations to assess and train patients in instrumental activities of daily living (IADLs). As an alternative, immersive virtual reality (IVR) has been widely used in stroke rehabilitation for years, but research comparing occupational performance between virtual and real environments is limited. This study aims to introduce a novel IVR shopping system designed for patients with stroke and to investigate the correlation of occupational performance in virtual and real environments among patients with stroke. Ten patients with stroke were recruited from the Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, who met the inclusion and exclusion criteria for this observational, randomized crossover study; the patients were predominantly male (n=7), had experienced ischemic stroke (n=9), were aged 14 to 73 years, and had a time since stroke of 1 to 42 months. All patients attempted shopping tasks in virtual and real environments. The Mini-Mental State Examination (MMSE), Timed Up and Go Test (TUGT), modified Barthel index (MBI), and Lawton index (LI) were used to assess cognition, ambulation, and activities of daily living. Memory capacity and duration in the virtual and real environments were recorded as the primary parameters of occupational performance. The Wilcoxon test and Spearman correlation coefficients were used to analyze the differences and correlations between the 2 environments. The Wilcoxon test showed no significant differences between the virtual and real environments in memory capacity and duration of task completion (P>.99 and P=.99), and memory capacity in both environments correlated with the LI (ρ=0.81; P=.005). Memory duration had a relationship with the TUGT in the virtual environment (ρ=0.68; P=.03) and a borderline negative correlation with MMSE in the real environment (ρ=-0.58; P=.08). Considering the small sample size used in this study and the study's limitations, despite the significant correlation between shopping performance in IVR and the real world, it is still too early to conclude that IVR is a noninferior approach, but it presents the potential to be an alternative for assessment and training in IADLs when resources are limited. However, further research is needed to investigate the psychometric properties, clinical effects, and impact of virtual training on real-world performance. The implications for practice might include the following: (1) occupational performance in virtual shopping might be the same as real-world shopping, and more virtual IADLs could thus be developed; (2) virtual IADL assessment and training systems could be used in remote locations or locations with limited resources; and (3) more objective parameters of IADLs could be extracted from virtual environments.

Systemic immune-related spleen radiomics predict progression-free survival in patients with locally advanced cervical cancer underwent definitive chemoradiotherapy.

Systemic immunity is essential for driving therapeutically induced antitumor immune responses, and the spleen may reflect alterations in systemic immunity. This study aimed to evaluate the predictive value of contrast-enhanced CT-based spleen radiomics for progression-free survival (PFS) in patients with locally advanced cervical cancer (LACC) who underwent definitive chemoradiotherapy (dCRT). Additionally, we investigated the role of spleen radiomics features and changes in spleen volume in assessing systemic immunity. This retrospective study included 257 patients with LACC who underwent dCRT. The patients were randomly divided into training and validation groups in a 7:3 ratio. Radiomic features were extracted from CT images obtained before and after dCRT. Radiomic scores (Radscore) were calculated using features selected through least absolute shrinkage and selection operator (LASSO) Cox regression. The percentage change in spleen volume was determined from measurements taken before and after treatment. Independent prognostic factors for PFS were identified through multivariate Cox regression analyses. Model performance was evaluated with the receiver operating characteristic (ROC) curve and the C-index. The Radscore cut-off value, determined from the ROC curve, was used to stratify patients into high- and low-risk survival groups. The Wilcoxon test was used to analyze differences in hematological parameters between different survival risk groups and between different spleen volume change groups. Spearman correlation analysis was used to explore the relationship between spleen volume change and hematological parameters. Independent prognostic factors included FIGO stage, pre-treatment neutrophil-to-lymphocyte ratio (pre-NLR), spleen volume change, and Radscore. The radiomics-combined model demonstrated the best predictive performance for PFS in both the training group (AUC: 0.923, C-index: 0.884) and the validation group (AUC: 0.895, C-index: 0.834). Compared to the low-risk group, the high-risk group had higher pre-NLR (p = 0.0054) and post-NLR (p = 0.038). Additionally, compared to the decreased spleen volume group, the increased spleen volume group had lower post-NLR (p = 0.0059) and post-treatment platelet-to-lymphocyte ratio (p < 0.001). Spleen radiomics combined with clinical features can effectively predict PFS in patients with LACC after dCRT. Furthermore, spleen radiomics features and changes in spleen volume can reflect alterations in systemic immunity.

Evaluating sagittal condylar inclination: a comparative analysis of various digital workflow measures.

This study aims to compare sagittal condylar inclination (SCI) measurements derived from three workflows: intraoral scan (IOS) aligned with cone-beam computed tomography (CBCT), IOS aligned with facial scan (FS), and a jaw motion analyzer (JMA) system, in a cohort of young individuals with established normal occlusion. Additionally, the study aims to identify sources contributing to variance in these measurement approaches. Twenty-four healthy individuals exhibiting normal occlusion were enrolled in this clinical trial. The SCI was delineated using a virtual articulator (VA) by aligning IOS with both CBCT and FS, creating two distinct workflows labeled CBCT-IOS and FS-IOS, respectively. Concurrently, SCI measurements were also acquired using a JMA. The normality of data distribution for the difference in bilateral SCI measurements within each workflow was tested using the Shapiro-Wilk test. Depending on the outcomes of this test, we utilized either a paired-sample T-test or Wilcoxon test for bilateral SCI comparisons. The inter-workflow differences were assessed using the Kruskal-Wallis H test. Bland-Altman plots were assess the interchangeability and consistency across each pair of digital methods and to evaluate the aggregate consistency among the trio of digital approaches. The analysis revealed that the CBCT-IOS workflow yielded the lowest average SCI measurements, whereas the JMA workflow produced the highest values. No significant differences were found in the SCI measurements between the left and right sides obtained by CBCT-IOS and JMA (P > .05), with the exception of the FS-IOS workflow (P = .002). Additionally, inter-flow comparisons revealed no significant differences in SCI measurements (P > .05), except when contrasting the SCI as measured by CBCT-IOS and JMA (P = .0131). The Bland-Altman plots demonstrated a high degree of consistency and 95% limits of agreement across the three digital workflows. SCI measurements obtained from the three digital workflows exhibit a high degree of consistency and are interchangeable, affirming their clinical applicability for precise SCI assessment in young individuals with normal occlusion.

How does the direction of region of interest selection affect the fractal dimension?

Introduction Fractal analysis (FA) is a computational method used to quantify the complex trabecular structure of bone. While FA has been widely applied in dentistry, there are challenges in standardizing the technique due to factors such as image resolution, region of interest (ROI) selection, and image processing. This study aimed to investigate the impact of the direction of ROI selection (DROIS) on fractal dimension (FD) calculations. Panoramic radiographs of 226 individuals aged 20-35 years were analyzed. ROIs were selected on the mandibular condyle, angular region, and mental region, and oriented at 0°, 22.5°, 45°, and 67.5° angles. FD was calculated using the box-counting method in ImageJ. The Friedman test and Wilcoxon signed-rank test were used for statistical analysis. The FD values differed significantly between the angled ROI groups in all three regions (Friedman test, p < 0.0001).Pairwise comparisons showed significant differences in FD between most ROI orientations, except between 22.5° and 67.5° in the angular region. DROIS is an important factor that should be considered in FA studies to ensure reliable and reproducible FD values. Appropriate methodological choices can help account for the influence of DROIS on FD calculations..

The Effect of Emergency Training on Improving Knowledge and Skills in Emergency Management Among Students at MAN 2 Palu

Introduction: An emergency is a situation or condition where there is an immediate threat or occurrence of harm that may lead to further damage (loses). In modern times, emergency preparedness has become a critical aspect of daily life, particularly in school environments. Incidents such as accidents, fires, and the need for first aid interventions highlight the increasing importance of emergency training for students. Objective: To analyze the effect of emergency training on improving students' knowledge and skills in managing emergencies. Method: This study employed a pre-experimental design with a one-group pretest-posttest approach. A total of 81 students from MAN 2 Palu participated in the study. The Wilcoxon signed-rank test was used to assess changes in knowledge and skills, with a significance level set at p &lt; 0.05. Result:. The mean pretest knowledge score was 9.16 (SD: 1.94), and the posttest score was 17.54 (SD: 0.67). The Wilcoxon test indicated a significant improvement in knowledge following the training (p = 0.000, p &lt; 0.05). Similarly, the mean pretest score for basic life support skills was 3.44 (SD: 0.63), which increased to 5.93 (SD: 0.26) post-training. The mean score for splint dressing skills improved from 2.37 (SD: 0.64) pretest to 7.93 (SD: 0.30) posttest, and choking aid skills improved from 2.69 (SD: 0.54) to 3.98 (SD: 0.15) posttest. All skill improvements were statistically significant (p = 0.000, p &lt; 0.05), which means providing emergency training has a positive effect on improving emergency skills among students. Conclusion: Emergency training significantly improves both the knowledge and skills of students in managing emergencies. This training is expected to improve students' ability to provide effective first aid in emergencies before professional medical assistance is available.

Predicting the prognosis of Wilms tumor by peripheral blood cells: a real-world study of more than 30years.

Despite established excellent treatment strategies for Wilms tumor (WT), effective prognostic evaluation methods were lacking. This study aims to examine prognostic factors for WT through real-world peripheral blood cell profiling. Basic data and pre-treatment laboratory indices from WT and non-WT children underwent Wilcoxon test analysis. Chi-square tests assessed the correlation between blood cells and the overall survival (OS) and event-free survival (EFS) of WT. Further the Log-rank test and multivariate Cox were used to identify independent prognostic factors for OS. Traditional accepted factors were included in multi-Cox and the nomogram was constructed to further validate the outcome. Blood cells significantly differed between WT and non-WT groups (P < 0.05). Univariate analysis revealed that NLR above 1.380, stage IV, M below 0.325 × 103/μL were linked with lower OS, and PLR below 94.632, LB above 3.570 × 103/μL, stage IV, M above 0.325 × 103/μL,age ≤ 3years were meaningful for higher EFS (P < 0.05). While in the multifactorial COX, only M (HR:0.220, HR95%CI: 0.080 ~ 0.620, P = 0.004 and HR: 0.437, HR95%CI: 0.202 ~ 0.947, P = 0.036, respectively) and stage IV (HR: 7.890, HR95%CI: 1.650 ~ 37.770, P = 0.010 and HR: 3.720, HR95%CI: 1.330 ~ 10.408, P = 0.012, respectively) were independent prognostic factors for OS and EFS. These two variables also were significant after including recognized risk factors, and were demonstrated the predictability via nomogram. OS and EFS were poorer in WT children with M below 0.325 × 103/μL, suggesting the potential as a prognostic predictor for WT.

Frontal Horn of Lateral Ventricle of Brain and Its Relation with Age, Gender and Side: Morphometric Study by Computed Tomography among Bangladeshi Population

Background: Knowledge of the baseline reference value of frontal horn size is necessary for the initial and precise analysis of ventriculomegaly. The purpose of this study was to determine the size of frontal horn of lateral ventricle and its relation with age, gender and side among adult Bangladeshi population of Chattogram district. Materials and methods: This cross-sectional analytical study was conducted during the period from July 2022 to June 2023 in the Department of Anatomy, Chittagong Medical College, Chattogram, upon 150 respondents of 20-60 years who had normal Computed Tomography (CT) scans as reported by an expert radiologist. For statistical analysis, Mann-Whitney U test, Wilcoxon signed rank test and ANOVA test were done. p-value was considered significant if it was &lt;0.05 at 95% level of confidence. Results: The mean right and left frontal horn length was 25.50 (±3.95) mm and 25.28 (±4.04) mm respectively. The length of the frontal horn of both right and left sided lateral ventricle were significantly higher in male than that of female (p&lt;0.01). Spearman's correlation coefficient indicated positive linear correlation of length of frontal horn (Right and left side) with age, insignificant in right side (p=0.061) but significant in left side (p=0.046). Conclusion: Morphometric analysis of the frontal horn of the lateral ventricles among the Bangladeshi population produced a number of significant results that may help with the early diagnosis and treatment of neurological diseases that are particular to gender and age. These findings can be validated and expanded upon in future research using bigger sample sizes and cutting-edge imaging methods. IAHS Medical Journal Vol 7(1), June 2024; 54-59

Comparison of AI software tools for automated detection, quantification and categorization of pulmonary nodules in the HANSE LCS trial.

Participant management in a lung cancer screening (LCS) depends on the assigned Lung Imaging Reporting and Data System (Lung-RADS) category, which is based on reliable detection and measurement of pulmonary nodules. The aim of this study was to compare the agreement of two AI-based software tools for detection, quantification and categorization of pulmonary nodules in an LCS program in Northern Germany (HANSE-trial). 946 low-dose baseline CT-examinations were analyzed by two AI software tools regarding lung nodule detection, quantification and categorization and compared to the final radiologist read. The relationship between detected nodule volumes by both software tools was assessed by Pearson correlation (r) and tested for significance using Wilcoxon signed-rank test. The consistency of Lung-RADS classifications between Software tool 1 (S1, Aview v2.5, Coreline Soft, Seoul, Korea) and Software tool 2 (S2, Prototype ''ChestCTExplore'', software version ToDo, Siemens Healthineers, Forchheim, Germany) was evaluated by Cohen's kappa (κ) and percentual agreement (PA).The derived volumes of true positive nodules were strongly correlated (r > 0.95), the volume derived by S2 was significantly higher than by S1 (P < 0.0001, mean difference: 6mm3). Moderate PA (62%) between S1 and S2 was found in the assignment of Lung-RADS classification (κ = 0.45). The PA of Lung-RADS classification to final read was 75% and 55% for S1 and S2, but the incorporation of S1 into the initial nodule detection and segmentation must be considered here. Significant nodule volume differences between AI software tools lead to different Lung-RADS scores in 38% of cases, which may result in altered participant management. Therefore, high performance and agreement of accredited AI software tools are necessary for a future national LCS program.

The impact of covid-19 pandemic on syphilis notifications in northeast Brazil

This study aims to evaluate the impact of the COVID-19 pandemic on the number of syphilis notifications (acquired, during pregnancy and congenital) in northeastern Brazil. An ecological study was carried out using the database provided by the Ministry of Health through the Department of Informatics of the SUS (DATASUS). The monthly numbers of notifications of acquired, gestational and congenital syphilis were organized on the Google Sheets online platform and the data were statistically analyzed, using the Wilcoxon test, for the pandemic (Jan/2020-Jun/2021) and pre pandemic periods (Jan/2018-Dec/2019), with a statistical significance of 5%. There was a reduction in the number of notifications of total cases of syphilis in the Northeast in 2020 and in 2021 when compared to the pre-pandemic period (p &lt; 0.001 and p = 0.031, respectively). This reduction represents a drop of 32.38% in 2020 and 28.84% in 2021. Regarding the states, there was no statistical significance in the number of notifications for Sergipe in 2020 (p = 0.638), Ceará in 2021 (p = 0.156) and Rio Grande do Norte in 2021 (p = 0.219) compared to 2018 and 2019. In addition, it was observed that in Sergipe there was an increase of 53.96% in notifications in 2021 compared to the same period (p = 0.031). These variations may be a consequence of social distancing, the reallocation of resources during the pandemic and socioeconomic issues, or even all of these factors combined.

Abstract A024: Evaluating the effect of plasma-related preanalytical variables on the robustness of the liquid biopsy early CRC detection Signal-C assay

Abstract Liquid biopsies and cell-free DNA (cfDNA) analysis have emerged as novel non-invasive diagnostic tools in oncology. Analysis of cfDNA methylation status has been proposed as promising approach for several diagnostic purposes, and robust methylation-detecting technologies are of primary importance for the clinical implementation of novel diagnostic assays. Signal-C is an accurate NGS-based methyl-sensitive assay detecting colorectal cancer (CRC) currently under clinical validation. In this study we assessed the influence of different preanalytical variables influencing plasma stability, as the storage time of plasma samples and the tube type used for blood collection, on Signal-C assay results to determine its robustness. 958 samples with 3ml to 4ml plasma were used for cfDNA extraction and run through Signal-C assay following UDX protocol. In brief, 8 to 20ng cfDNA were used as an input for methylation- specific library preparation, which was run according to manufacturer’s instructions. Hybrid- capture was performed to enrich libraries for genomic regions included in Signal-C assay and sequenced on Illumina Novaseq machines. Relevant sequencing QC metrics, such as depth filtered, read yield from raw to filtered and PCR duplicate proportion were calculated, together with cancer predictions according to Signal-C test. Pearson coefficient and Pearson's Chi- squared test with Yates' continuity correction have been used to assess correlations, and Wilcoxon test has been used to measure the significance of the differences between quality metrics with respect to the tube type. We have analyzed the influence of different plasma-related preanalytical variables on sequencing metrics and cancer predictions of Signal-C assay. Plasma age, calculated as the time elapsed between blood collection and cfDNA quantification, shows a small negative correlation with YIELD_RAW_FILTERED (R = - 0.08, p=0.013) and a small positive correlation with PCR_DUP_PROP (R = 0.098, p=0.0024), while it doesn't influence DEPTH_FILTERED values (p&amp;gt;0.05). Use of different blood collection tubes (EDTA or Streck tubes) influenced in a small but significative manner the YIELD_RAW_FILTERED and the PCR_DUP_PROP (p&amp;lt;0.001), while it doesn’t affect the DEPTH_FILTERED values (p&amp;gt;0.05). Despite the sequencing QC metrics being subject to small but statistically significant differences, the overall cancer classification performance of Signal-C assay was not affected by the changes in plasma age (Pearson's product-moment correlation, sensitivity p=0.87, specificity p=0.091) nor in tube type used (Pearson's Chi-squared test with Yates' continuity correction, p=0.219). Here we evaluated the effect of plasma’s storage time and the type of blood collection tube on Signal-C assay performance. While signal processing features show small differences between the tested variables, this does not affect overall clinical performance of the test, supporting its robustness. Additional studies to analyze the effect of other preanalytical variables on Signal-C performance are underway to establish its robustness. Citation Format: Fernando Trincado Alonso, Pol Canal Noguer, Kristi Kruusmaa, Arianna Bertossi. Evaluating the effect of plasma-related preanalytical variables on the robustness of the liquid biopsy early CRC detection Signal-C assay [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr A024.

Double Materiality Approach and Sustainable Business Model Paradigm: A Three-Fold Analysis

Adopting the United Nations 2030 Agenda for Sustainable Development, governments commit to the 17 goals and 169 associated targets in areas of critical importance for humanity and planet, while companies manifest a growing interest in playing a significant role to SDGs prioritisation. Researchers, policymakers, stakeholders, and analysts are all preoccupied about responsible ways of redesigning the business model to mitigate the growing concerns, such as companies’ failures, global multidimensional crisis, and sustainability-related issues. Under the light of institutional theory, legitimacy theory, stakeholder theory, the aim of this research is to investigate how environmental, social and governance (ESG) policies and practices included in a sustainable business model may respond to the double materiality approach in order to contribute to a balance among divergent interests of managers, investors, and other stakeholders. The financial materiality is conceptualized using ESG data, that mainly targets investor’s needs. Stakeholder materiality, is concerned with external impact of companies, embodied in societal-level outcomes measured as the number of SDGs addressed in corporate reporting. In this study, company-year data are collected from Refinitiv Eikon database, starting with 2015, until current reporting period and analysed using frequency, univariate and correlation analyses. Based on Levene homogeneity, the ANOVA parametric t-test results are validated by Mann-Whitney Wilcoxon and Krushkal Wallis non-parametric tests. Three main research questions are responded. First, the findings examine and discuss the evolution of sustainability reporting measured with ESG scores, decomposed by the three pillars and ten categories, along with the SDGs prioritisation. Second, statistically significant differences in ESG and SDGs variables reported by various groups clustered on industry-related corporate characteristics are discussed. Third, the significant associations between ESG measures and SDGs are analysed from the double materiality perspective. The study contributes to the academic and practical understanding of the evolving business model under normative dimension of institutional theory, incorporating the decision to engage in current sustainability frameworks and policies.

Cervical Disc Arthroplasty for the Treatment of Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion

Study Design. A retrospective chart review was conducted at a single institution. Objective. The purpose of this study was to investigate clinical outcomes of cervical disc arthroplasty (CDA) used for the treatment of symptomatic adjacent segment disease (ASD) developed after anterior cervical discectomy and fusion (ACDF). Summary of Background Data. A major clinical concern following ACDF is the development of ASD. ASD after ACDF is often treated with an additional fusion, but risks include pseudoarthrosis and further ASD. CDA is a motion preserving alternative that addresses these concerns, and therefore, has been proposed as an alternative treatment for ASD after ACDF. Methods. CDA patients with prior adjacent-level ACDF (n=120) were identified from a consecutive series of CDA patients at one institution. Pre- to post- CDA patient-reported outcome measures were compared using the paired Wilcoxon signed-rank test. Results. A total of 142 devices were implanted – 98 patients underwent a one-level CDA, and 22 patients underwent two-level CDA. The mean follow-up duration after CDA was 32.11 months. Neck pain, arm pain, and Neck Disability Index (NDI) scores significantly improved from the preoperative to postoperative timepoint (respectively: 6.14 to 3.02, 4.42 to 1.61, 44.28 to 28.62, all P&lt;0.001). In total, 7 patients underwent reoperation (5.83%). One of these patients underwent reoperation for pseudarthrosis at the level of ACDF following a hybrid procedure. The indications for index level reoperations (n=3) were foraminal stenosis, osteolysis, and postoperative hematoma. All patients with an adjacent level reoperation (n=3) received surgery at levels adjacent to the prior fusion, not the more recent CDA. Conclusion. The results of this study found CDA was effective for the treatment of ASD following ACDF. CDA appears to be a viable treatment option for ASD after ACDF in appropriately selected patients.

Influence of a chatbot based on a conversational agent on the adaptability of first-year students of a Peruvian private university

ObjectiveThis study aims to evaluate the influence of using a chatbot-based conversational agent, named ODAbot, on the adaptability of first-year students at a private university in Peru.MethodsThe design of this study was pre-experimental with a quantitative approach. The sample consisted of 53 university students who participated in the research during March and April 2024. Participants completed pre-test and post-test questionnaires to assess their adaptability to university life before and after interacting with ODAbot. Additionally, a user experience questionnaire was used to measure satisfaction with the chatbot interaction. Data were analyzed using the Wilcoxon test to determine the statistical significance of the results.ResultsThe results showed that the use of ODAbot had a significant impact on students’ adaptability, especially in the social dimension (p = 0.000), while no significant differences were found in the institutional dimension (p = 0.124). The user experience was positive, with students reporting ease of navigation and understanding of the responses provided by the chatbot.ConclusionA notable improvement was recorded in the social dimension, promoting peer integration, as well as in the academic dimension, where students expressed greater satisfaction with the information provided. However, no significant differences were observed in the institutional dimension. Overall, the implementation of chatbots presents a promising opportunity to improve the adaptability of university students and ensure a quality educational experience.