Wilcoxon Test Research Articles

Effect of rapid maxillary expansion on intracranial pressure

ObjectiveThe aim of this study was to evaluate the effects of rapid maxillary expansion on the optic nerve sheath diameter and to examine its possible effects on intracranial pressure. Design20 patients with bilateral crossbite were selected. Hyrax Expander was applied and activated twice daily until the overcorrection was achieved. The optic nerve sheath diameter (ONSD) was measured via ultrasonography before the first activation (T0), then repeated after 1 (T1) and 10 min (T2). At the end of the expansion, ONSD was measured (T3) again, then the screw was activated for the last time, and measurements were repeated after 1 (T4) and 10 min (T5). The Friedman test was performed to compare the changes, and The Wilcoxon Signed-Rank test was done to determine the significant intergroup changes (p < 0.05). ResultsThe ONSD increased significantly 1 min after the activations (T0-T1 and T3-T4) (P < 0.05). The ONSD values measured 10 min after the activations also increased significantly compared to the baseline values (T0-T2 and T3-T5) (P < 0.05). ConclusionThe activation of maxillary expansion appliances increased the optic nerve sheath diameter in adolescents. Therefore, orthodontists should be careful with patients at risk of intracranial hypertension.

Comparing physical therapist clinical specialists to experienced nonspecialists on physical activity education for patients with heart failure: A modified retrospective cohort study.

The purpose of this study was to compare the knowledge and practices of specialist and experienced nonspecialist physical therapists in performing patient education about physical activity with patients with heart failure (HF). Responses on a nationwide anonymous online survey were used to compare specialist and experienced nonspecialist physical therapists on knowledge and frequency of providing physical activity related education to patients hospitalized with acutely decompensated HF. Responses to survey items were scored on 5-point scales ranging from "Strongly agree" to "Strongly disagree" or "Always" to "Never."Mann-Whitney U statistics were used to compare specialist and experienced nonspecialist responses and Wilcoxon signed-ranks tests were used to examine the gap between knowledge and practice. Twenty-seven specialists and 43experienced nonspecialists completed the survey. Both groups were similar in age, and experience treating patients hospitalized with acutely decompensated HF. Both groups "strongly agree" that they had the required knowledge and skills to educate patients with HF on the physical activity topics. However, specialists more often than experienced nonspecialists provided education on topics such as how to monitor vital signs during physical activity ("most of the time" vs. "about half of the time") that promoted patient confidence and safety during exercise. Specialists demonstrated a smaller gap between knowledge and frequency of providing patient education than experienced nonspecialists on three of the four patient education topics. Specialist physical therapists treating patients with HF in the inpatient hospital setting provided patient education on physical activity at a level more closely matching their skills and the clinical practice guideline than did experienced nonspecialists. Physical therapy clinical specialists practicing in the inpatient hospital setting may improve patient outcomes and lower costs to the health care system by improving physical activity adherence and thereby may reduce avoidable hospital readmissions.

Integrating Trauma-Informed Clinical Interviewing Skills in Medical Education for Screening Domestic Violence and Abuse.

A pre-post-training workshop was conducted among 22 postgraduate trainees of the Psychiatry and Emergency Department of a public sector hospital in Karachi. The workshop aimed to build the capacity of postgraduate trainees in trauma management by providing training on screening, clinical interviewing skills, and Psychological first aid to those exposed to domestic violence (DV). The effectiveness of each training module was evaluated by conducting a brief assessment before and after each module and scores were compared using the Wilcoxon signed-rank test. The post-test showed significant improvement in participants' knowledge on screening of domestic violence and trauma symptoms (p = 0.026) and psychological first aid (p <0.001). Postgraduate training programmes need to integrate trauma screening and management education, to prepare healthcare professionals to deal with sensitive clinical presentations at their work settings. Key Words: Postgraduate trainees, Trauma, Domestic violence, Medical education, Workshop.

The effect of an 8-week fitness regime on low back pain and core strength in high-risk professionals.

Low back pain is prevalent among various populations and greatly impacts their quality of life. Professions that incorporate several working hours combined with heavy labor are the most affected. The aim of this study was to examine the effects of an 8-week core training intervention in emergency personnel. Sixteen randomly selected male participants; police officers (N.=8) and firefighters (N.=8) (mean age: 40.75 years; mean height: 177.69 cm; mean body mass: 85.50 kg) performed various testing procedures that assessed core muscle strength and endurance and filled the Oswestry Disability Index Questionnaire regarding the level of low back pain before and after the intervention. The 8-week intervention consisted of two 45-60-minute sessions per week that included ten core-related exercises. Statistical analysis; paired samples t-test and Wilcoxon Signed-Rank Test, demonstrated significant effects in the 30-sec sit-up test, the Double Leg Lowering Test and the isometric abdominal strength measurements; p value level of significance was set at P≤0.05. All participants had minimal lower back disability before and after the intervention. The results demonstrated that the prescribed regime could improve core strength and endurance in high-risk professionals. The most important finding is that training interventions for emergency personnel are most effective when they incorporate a variety of exercises that target the core musculature in all planes of movement and engage the whole range of motion.

Performance Status and End-of-Life Outcomes in Patients With Metastatic Castration-resistant Prostate Cancer Treated With Androgen Receptor Targeted Therapy.

Androgen receptor targeted therapies (ARTs) are widely preferred over taxane chemotherapy due to their good tolerability and similar efficacy. However, there is a paucity of data that support the use of ART therapy or describe end-of-life (EOL) outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC) with reduced performance status (PS) (European Cooperative Oncology Group [ECOG] ≥2). We performed a retrospective, single-institution study of 142 patients with mCRPC who received ART therapy between 2010 and 2021. We assessed each record for baseline demographic and clinical information, ART treatment course, and survival and EOL outcomes. Our primary aim was to compare overall survival (OS) between the two groups (ECOG ≥2 vs 0 to 1), and our secondary aim was to describe EOL outcomes. Fisher exact tests and Wilcoxon signed-rank tests were used to compare baseline characteristics. Cox regression was used to compare OS for patients with ECOG ≥2 at the start of treatment with those who had an ECOG of 0 or 1. Descriptive analyses were performed to assess EOL outcomes between the groups. Patients with mCRPC and decreased PS experienced shorter OS on ART compared with those with higher PS. Moreover, when examining EOL outcomes, a near majority of these patients died in the hospital, with a greater percentage among those with an ECOG ≥2. These findings highlight the need for continual assessment of PS, improved shared decision-making in ART treatment, and additional research exploring the association between PS and EOL outcomes.

Quantitative 99mTc-pyrophosphate Myocardial Uptake: Changes on Transthyretin Stabilization Therapy

Quantitative technetium-99m-pyrophosphate cardiac single photon emission computed tomography (99mTc-PYP SPECT/CT) is an emerging method for estimating myocardial burden of transthyretin cardiac amyloidosis (ATTR-CA), but its efficacy in monitoring longitudinal changes remains uncertain. We aimed to investigate longitudinal changes in cardiac ATTR amyloid burden following transthyretin stabilization therapy using visual and quantitative 99mTc-PYP SPECT/CT and to relate these with changes in cardiac biomarkers and function. This prospective longitudinal cohort study investigated changes in 99mTc-PYP SPECT/CT in 23 participants with ATTR-CA on transthyretin stabilization therapy (median 2.6 years). Quantitative analysis included left ventricular (LV) standardized uptake values (SUVmax, SUVmean), cardiac amyloid activity (CAA; SUVmean*LV activity volume), and percent injected dose (%ID) (mean activity concentration*LV activity volume/injected activity), calculated using a threshold of >1.5 times left atrial blood pool activity concentration on SPECT/CT. Longitudinal changes of paired continuous and ordinal variables were analyzed using Wilcoxon signed-rank test. Following therapy, visual grade decreased significantly (p=0.003). Several quantitative 99mTc-PYP metrics also decreased significantly: SUVmax (median -0.75, p=0.011), CAA (median -406.6, p<0.001), and %ID (median -0.45, p<0.001). Serum transthyretin levels improved (median +6.5 mg/dL, p=0.008). Echocardiographic parameters (global longitudinal strain, LV mass index, LV wall thickness), N-terminal pro-B-type natriuretic peptide, and estimated glomerular filtration rate remained stable. Favorable changes in 99mTc-PYP myocardial uptake were observed in participants on transthyretin stabilization therapy, while echocardiographic parameters and biomarkers remained stable. These results likely signify myocardial ATTR amyloid stabilization rather than amyloid burden regression. Further investigation is needed to understand the implications of these findings.

“Skeletal surgical approach in Down Syndrome with Obstructive Sleep Apnea.”

Failing to address Obstructive Sleep Apnea (OSA) in Down Syndrome (DS) patients can have serious consequences, leading to increased mortality. Moreover, a notable portion of individuals find it challenging to tolerate Continuous Positive Airway Pressure (CPAP). Therefore, this study aims to share our experiences in treating adult DS patients with moderate to severe OSA who don't tolerate CPAP using various surgical approaches.A retrospective analytical study including 20 DS with moderate to severe/very severe OSA who had no tolerance to Continuous Positive Airway Pressure (CPAP) was conducted. Regarding the individual skeletal characteristics of each patient various orthognathic surgery techniques were performed. Two in-hospital polysomnographies (PSG) were undertaken for every patient; one before the surgical procedure, while another was performed between 6 and 60 months of the follow-up post-surgery period.Polysomnographic variables were analyzed in this study such as AHI, ODI, and T90, which all showed statistically significant improvement after surgery with a p value in the Wilcoxon test <0,01. These results have remained stable over time, with no recurrences of OSA observed over the five years of follow-up. Thus, orthognathic surgery may be the only viable option for individuals with DS who are unable to tolerate CPAP.

Media Disc Triage Assessment on Improving Triage Skills Using the Australasian Triage Scale (ATS) on Students of Kusuma Husada University Surakarta

ABSTRACT The Australasian Triage Scale (ATS) is a tool used by triage officers in the emergency department to assess patient severity and prioritize services based on the severity of the patient's condition. To evaluate the effectiveness of using learning tools in the form of Disc Triage Assessment as a learning medium in improving understanding and accuracy in determining triage by nursing students in using ATS triage. The Community Service method used is quasi-experimental with a pre-post test without control design. Community Service will be carried out on Nursing Study Program Students, Diploma Three Program, Faculty of Health Sciences, Kusuma Husada University. Data analysis was performed using the Wilcoxon test. The pretest results showed that the moderate category was 1 respondent (3.1%) and the poor category was 31 respondents (96.9%). The posttest results with the Good category were 3 respondents (9.4%) and the Fair category were 5 respondents (75.0%). The results of the use of Disc Triage Assessment media show that the p-value is 0.016 (&lt;0.05) which means that there is an effect of Disc Triage Assessment Media on Skills to Determine Australasian Triage Scale (ATS) on Students of Kusuma Husada University Surakarta. Keywords: Media Disc Triage Assessment, Triage skills, Australasian Triage Scale (ATS)

Evaluation of treatment response with serial CT in patients with non-tuberculous mycobacterial pulmonary disease.

In patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD), the response to treatment is evaluated based on microbiological, clinical, and radiological data. However, little is known about the dynamics of CT findings. The aim of this study was to evaluate CT changes in NTM-PD in order to define radiological criteria for treatment success. Retrospective multicenter study (Hannover, Heidelberg, Gauting). Sixty patients with NTM-PD and at least two consecutive CT scans were included. Scoring for NTM-PD was performed by evaluating variables of bronchiectasis, mucus plugging, bronchiolitis, cavities, nodules, and consolidations on an ordinal scale from 0 to 3. Differences between baseline and follow-up were calculated, and patients with/without cultural conversion were compared using the Mann-Whitney U-test. For paired comparison of the two consecutive CT scans the Wilcoxon test was used. Comparing patients with and without culture conversion, there were significant differences in temporal changes of bronchiectasis (p < 0.001), cavities (p = 0.006), bronchiolitis (p < 0.001), consolidations (p = 0.004), and total score (p < 0.001). Nodules showed no significant differences between groups (p = 0.060). The Wilcoxon test showed significant differences between both CTs in patients with a microbiological cure for the total score (p < 0.001), cavities (p = 0.005), bronchiolitis (p < 0.001), and consolidations (p = 0.021) with a decrease after microbiological cure, whereas bronchiectasis (p = 0.102) and nodules (p = 0.18) stayed stable. In the case of persistently positive cultures, there was an increase in the total score (p = 0.010) which was attributable to progressivebronchiectasis (p < 0.001). Cavities, consolidations, and bronchiolitis are useful to assess treatment response, whereas bronchiectasis and nodules may remain stable despite successful treatment. Cavities, consolidations, and bronchiolitis can assess treatment response whereas bronchiectasis and nodules may remain stable despite successful treatment. In persistently positive cultures, bronchiectasis showed an increase over time indicating that NTM-PD is a progressive chronic disease. Little is known about CT changes in nontuberculous mycobacteriapulmonary disease (NTM-PD) and criteria to evaluate treatment response. In the case of culture conversion, cavities and bronchiolitis decreased whereas bronchiectasis and nodules remained stable. Cavities and bronchiolitis can evaluate treatment response in NTM, but bronchiectasis and nodules may persist despite successful treatment.

Morphology of the lateral circumflex femoral artery in adult cadavers.

The lateral circumflex femoral artery (LCFA) is important for surgical approaches to the hip joint; its branches are often used as grafts and pedicled flaps. Our aim was to contribute to the literature by reporting variations. The LCFA branching pattern was studied in 26 lower limbs of formalin-fixed cadavers. It was recorded whether the LCFA originated from the femoral artery (FA) or the deep femoral artery (DFA). The distances of LCFA from the mid-inguinal point (MIP) and DFA; and the diameters of LCFA and its branches were measured with metric caliper. Side differences were analyzed by Wilcoxon test. The mean shortest distance from the LCFA to the MIP was 59.45 ± 13.06mm and to the DFA was 19.23 ± 9.63mm. The mean diameters of LCFA and its ascending, transverse, and descending branches were 5.82 ± 1.87mm, 3.28 ± 0.87mm, 3.02 ± 0.92mm, and 3.61 ± 0.98mm, respectively. The LCFA originated from 80.8% DFA and 19.2% FA. Data were evaluated jointly (p > 0.05). In one case, an accessory transverse branch was found. Spearman analysis shows that as the distance between the LCFA and the MIP increased, the diameter of the LCFA and its branches increased. Knowledge of the LCFA branching pattern is essential for interventional options in arterial grafts, such as bypass surgery, pedicled flaps, and surgical approaches to the hip joint. Preoperative radiologic evaluation for accurate knowledge of the topography of the branching pattern and vessel size can contribute to successful management of intraoperative blood loss and avoidance of iatrogenic injury.

Clinical, Prognosis, and Treatment Effect Features Analysis of Metachronous and Synchronous UTUC and BUC

ObjectiveTo provide a comprehensive understanding of the clinical features of patients with synchronous and metachronous upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BUC) and inform surgical and postoperative adjuvant treatment planning. Patients and MethodA total of 292 consecutive patients with synchronous and metachronous UTUC-BUC were retrospectively enrolled and were categorized into three groups: (1) UTUC metachronous BUC (N = 185, UTUC-mBUC), (2) BUC-metachronous UTUC (N = 43, BUC-mUTUC), (3) synchronous UTUC-BUC (N = 64, sUTUC-BUC). We compared pathological characteristics and survival data among groups with Wilcoxon's rank sum tests, Pearson's chi-squared, and the Kaplan–Meier method. ResultsIn the sUTUC-BUC group, a higher proportion of patients exhibited UTUC tumors with grade G3 (56%, P = .001) and stage T4 (6%, P < .001) than group UTUC-mBUC (G3 = 16%, T4 = 0%). The proportion of patients with variant histology subtype in group sUTUC-BUC was higher than that of metachronous UTUC-BUC, involving squamous (P = .003), adenoid (P = .012), and sarcomatoid (P < .001) differentiation. It was also observed that the maximum diameter of the UTUC tumor of group sUTUC-BUC (median = 3.5) was significantly larger than group UTUC-mBUC (median = 2.5, P = .002) and group BUC-mUTUC (median = 2.2, P < .001). Notably, sUTUC-BUC has an increased risk of cancer-specific death compared with UTUC-mBUC (P < .001) and BUC-mUTUC (P < .001). On multivariable Cox regression, synchronous UTUC-BUC was an independent predictor of both RFS (P < .001; vs. UTUC-mBUC: HR 0.555, P = .004; vs. BUC-mUTUC: HR 0.279, P < .001) and CSS (P < .001, HR 29.737). Moreover, sUTUC-BUC showed a better response to intravesical therapy and chemotherapy with higher cancer-specific survival (P < .001) and recurrence-free survival (P = .034). ConclusionsThe prognosis and pathological characteristics among different metachronous and synchronous UTUC and BUC were diverse. The synchronous UTUC-BUC group showed variant histology subtype, high-grade tumors, advanced tumors, multifocal UTUC, worse cancer-specific survival, but better response to intravesical therapy and chemotherapy.

Population diversity control based differential evolution algorithm using fuzzy system for noisy multi-objective optimization problems

The objective measurements of the real-world optimization problems are mostly subject to noise which occurs due to several reasons like human measurement or environmental factors. The performance of the optimization algorithm gets affected if the effect of noise is higher than the negligible limit. The previous noise handling optimization algorithms use a large population size or multiple sampling at same region which increases the total count of function evaluations, and few methods work for a particular problem type. To address the above challenges, a Differential Evolution based Noise handling Optimization algorithm (NDE) to solve and optimize noisy bi-objective optimization problems is proposed. NDE is a Differential Evolution (DE) based optimization algorithm where the strategies for trial vector generation and the control parameters of DE algorithm are self-adapted using fuzzy inference system to improve the population diversity along the evolution process. In NDE, explicit averaging based method for denoising is used when the noise level is higher than negligible limit. Extending noise handling method enhances the performance of the optimization algorithm in solving real world optimization problems. To improve the convergence characteristics of the proposed algorithm, a restricted local search procedure is proposed. The performance of NDE algorithm is experimented using DTLZ and WFG problems, which are benchmark bi-objective optimization problems. The obtained results are compared with other SOTA algorithm using modified Inverted Generational Distance and Hypervolume performance metrics, from which it is confirmed that the proposed NDE algorithm is better in solving noisy bi-objective problems when compared to the other methods. To further strengthen the claim, statistical tests are conducted using the Wilcoxon and Friedman rank tests, and the proposed NDE algorithm shows significance over the other algorithms rejecting the null hypothesis.

Enhancing Critical Thinking through a Virtual Unfolding Maternity Escape Room Activity

BackgroundResearch suggests escape rooms in nursing education may provide students with an opportunity to build learning. However, limited literature is provided focusing on specialty nursing such as maternal-neonatal health. This quality improvement project explored the impact of an unfolding maternity virtual escape room on junior level nursing student's critical thinking. MethodThe Yoons Critical Thinking Disposition Tool was used to measure pre and posttest scores with a sample of 38 students. ResultsThe Wilcoxon Signed Rank test determined that there was improvement in critical thinking with an increase in median scores. Total score and three out of the seven subscales revealed statistical significance. Students also positively evaluated the activity. ConclusionA virtual escape room as a review activity in a maternity course provides an opportunity for students to apply information learned throughout the course in an innovative approach. Further research is needed to determine the impact of this activity.

Effect of Infra Low Frequency (ILF) neurofeedback training on EEG in children with autism spectrum disorders.

To investigate whether Infra-low frequency Neurofeedback (ILF-NFB) training can improve brain electrical activity in children with autism spectrum disorders ASD. This single arm pre and post intervention study was carried out at IBMS (Institute of Basic Medical Sciences), Khyber Medical University, Peshawar and Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad from January 2021 to December 2022. A purposive sampling technique was used. Thirty-five ASD children (male=24; female=11; 7-17 years) were provided with 30 sessions of infra low frequency (ILF) neurofeedback training for 15-20 minutes, during 10 weeks. Childhood Autism Rating Scale (CARS) scoring was done and electroencephalogram (EEG) activity was compared before and after ILF-NF training sessions. Around 62.9% participants had mild-moderate autism and 37.1% had severe autism. Wilcoxon Signed rank test revealed a significant decline in delta (Pre-test=47.31±19.22, Post-test=22.07±6.83; p=<0.001), theta (Pre-test=24.75±16.62, Post-test=12.37±3.59; p=<0.001) and alpha (Pre-test=12.01±9.81, Post-test=4.03±1.61; p=< 0.001) waves. Mann Whitney U test exhibited no significant gender differences in EEG pattern before and after neurofeedback except in theta waves (p=0.03) before the intervention. Decline in delta, theta, beta and alpha waves propose that ILF-NF training can be effective in improving the EEG activity. ILF-NFB can be perceived as a valuable non-invasive, non-pharmacological intervention for improving EEG pattern via reintegration of brain activity resulting in increased the attention and focus, enhanced mental stability and cognitive engagement.

The Effect of Pilates Exercise on Low Back Pain in Pregnant Women in the Second and Third Trimesters at Edelweiss Day Spa

Objective: This study aims to determine the effect of Pilates Exercise on Low Back Pain in pregnant women in the second and third trimesters. Method: Type of quantitative research with a pre-experimental design with a one-group pretest-posttest design. The purposive sampling technique obtained a total sample of 32 respondents from pregnant women in the second and third trimesters. Results: After doing Pilates exercise, there were 27 respondents with mild pain (84.4%) and 5 respondents in the no pain category (15.6%). The results of the Wilcoxon Signed Rank Test show a p-value of 0.000, so p&lt;0.05 so that Ha is accepted, which means there is an effect of Pilates exercise on the Low Back Pain of pregnant women in the second and third trimesters at Edelweiss Day Spa Klaten. Conclusion: There is an effect of Pilates exercise on the low back pain of pregnant women in the second and third trimesters at Edelweiss Day Spa Klaten

User Perspectives and Psychophysiological Manifestations of Fatigue with Trunk Orthosis for Dystrophinopathy Patients.

The chair-mounted passive trunk orthosis (CMPTO) is designed to enhance wheelchair safety for individuals with dystrophinopathy during their daily activities. Given the disease's progressive nature, it is crucial to ensure that assistive devices are carefully evaluated to prevent overexertion. This study aims to assess the CMPTO's user experience and its impact on fatigue-related psychophysiological measurements. We conducted electromyography (EMG) evaluations of four trunk muscles and assessed perceived exertion using the Borg CR-10 scale in 40 healthy subjects while they performed seated maximal reaching tasks with the CMPTO. Additionally, fifteen dystrophinopathy patients evaluated the CMPTO for usability with the System Usability Scale. Paired t-tests were employed to compare the median frequency (MDF) of EMG signals, the Wilcoxon signed-rank test for evaluating exertion, and the Mann-Whitney U test to compare the usability reported by patients to those of healthy subjects. The 4-way ANOVA revealed that MDF patterns were significantly influenced by task orientation for each muscle. The CMPTO did not cause a significant reduction in the MDF. Tasks requiring greater trunk rotation were perceived as more exhaustive. Patients reported acceptable usability with the CMPTO, with scores higher than those of healthy subjects. The CMPTO's usability was comprehensively evaluated in both healthy subjects and patients with dystrophinopathy. Our findings indicate that the CMPTO can be safely used by individuals with dystrophinopathy as an assistive device to improve seated comfort and functional abilities.

Importance of fourth heart sound and preserved left atrial function in wild-type transthyretin amyloidosis.

A fourth heart sound (S4) was reported to be almost never present in patients with amyloid light-chain cardiomyopathy. There have been no reports on S4 in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM). This study aimed to clarify the clinical implications of S4 in patients with ATTRwt-CM. Seventy-six patients with ATTRwt-CM (mean age: 80.4±5.4years, 68 males) who had undergone phonocardiography (PCG) were retrospectively assessed. We measured S4 amplitude on digitally recorded PCG. S4 was considered to be present when its amplitude was 1.0mm or greater on the PCG. Distinct S4 was defined as S4 with an amplitude of 2.0mm or greater, which is usually recognizable by auscultation. According to the rhythm and presence or absence of S4, the patients were divided into three groups, namely, sinus rhythm (SR) with S4, SR without S4, and non-SR. Non-SR consisted of atrial fibrillation, atrial flutter, and atrial tachycardia. Thirty-six patients were in SR and the remaining 40 patients were in non-SR. In the 36 patients in SR, S4 was shown by PCG to be present in 17 patients (47%), and distinct S4 was recognized in 7 patients (19%) by auscultation. In patients who were in SR, those with S4 had higher systolic blood pressure (124±15 vs. 99±8mmHg, P<0.001), lower level of plasma B-type natriuretic peptide (308 [interquartile range (IQR): 165, 354] vs. 508 [389, 765] pg/mL, P=0.034) and lower level of high-sensitivity cardiac troponin T (0.068 [0.046, 0.089] vs. 0.109 [0.063, 0.148] ng/mL, P=0.042) than those without S4. There was no significant difference in left atrium (LA) volume index or LA reservoir strain between patients with S4 and without S4. Patients with S4 had more preserved LA systolic function than those without S4 (peak atrial filling velocity: 53±25 vs. 34±9cm/s, P=0.033; LA contractile strain: 4.1±2.1 vs. 1.6±2.0%, P=0.012). Patients in SR without S4 had worse short-term prognosis compared with the other two groups (generalized Wilcoxon test, P=0.033). S4 was present in 47% of the patients in SR with ATTRwt-CM. Patients in SR without S4 had more impaired LA systolic function than those in SR with S4. The absence of S4 portends a poor short-term prognosis in patients with ATTRwt-CM.

Is Orthotic Treatment Beneficial for Fresh Osteoporotic Vertebral Fractures? A Propensity Score Matching Study

BACKGROUND CONTEXTOrthotic treatment is a common option for the conservative treatment of osteoporotic vertebral fractures (OVF). However, there is insufficient evidence of its clinical benefit. PURPOSETo investigate the effectiveness of orthotic treatment for OVF. STUDY DESIGN/SETTINGRetrospective cohort study with data from two prospective studies. PATIENT SAMPLEThis study included 160 patients with fresh OVF enrolled in 2012 and 2020 prospective cohort studies. OUTCOME MEASURESThe visual analog scale (VAS) score for low back pain was used for clinical outcomes, and radiographic parameters included the percent height of the vertebra and angular change of the vertebral body. Moreover, the occurrence of secondary vertebral fractures was followed-up over time. METHODSThe patients were divided into brace and no-brace groups and were matched according to propensity score for age, sex, anterior percent height at the initial examination, and presence of old OVFs. Hazard ratio for the cumulative incidence of secondary vertebral fractures with and without bracing were calculated and analyzed using the generalized Wilcoxon test. In addition, the brace group was divided into soft and rigid brace groups and compared with the no-brace group. RESULTSEach group had 61 cases after propensity score matching. There were no significant differences in the VAS improvement for low back pain and the change in percent height of the anterior and posterior walls from initial examination to 6 months after injury (p = 0.87, p = 0.39 and p = 0.14, respectively, mixed-effect models). Meanwhile, the mean angular change of fractured vertebrae was 4.3° / 3.2° initially and 1.2° / 2.5° at 6 months (the brace group / no-brace group, respectively; p = 0.007, mixed-effect models). A significant difference was also observed between the rigid brace group and the no-brace group (p = 0.008, mixed effect models). The incidence of secondary vertebral fractures was 1.6% / 11.4% at 1 month, indicating a significant difference (the brace group / no-brace group, respectively; p = 0.028). The hazard ratio for the cumulative incidence of secondary fractures due to orthotic treatment was 0.47 (95% confidence interval 0.20-1.09, p = 0.054). CONCLUSIONSAlthough orthotic treatment for fresh OVF did not relieve pain, it might contribute to the stabilization of the fractured vertebra, especially using a rigid brace. Moreover, it might influence a reduction of the imminent vertebral fracture risk immediately after the onset of OVF. ClassificationsClinical study

COMPARATIVE STUDY OF TIME ECHO VARIATIONS IN THE METABOLITE VALUES MR BRAIN SPECTROSCOPY

Background: MR spectroscopy is an additional sequence to evaluate lesion characteristics in the brain. Time Echo (TE) is crucial for analyzing MR spectroscopy metabolite. Purpose: This study aims to evaluate the best TE variations during MR spectroscopy examinations in brain lesions. Method: This research is an experimental quantitative study. Researchers used five samples focusing on the results of head multi-voxel spectroscopy charts with clinical lesions or masses that had been taken twice using TE 35 and TE 144. At each TE in each sample, three voxel areas were measured, namely normal, perilesional, and lesion. Each spectroscopy data result is processed individually through READY View software, automatically producing a spectroscopy graph pattern. The required data in this study is the value of each head spectroscopy metabolism: N-Acetyl Aspartate (NAA), Choline (Cho), Creatine (Cr), Myo-Inositol (MI), Lipids Lactate (LL). All statistical tests used the SPSS v.26 application. Result: Based on Paired T test results, NAA, Cho, Cr, and MI metabolites have p-values that account for 0.779 &gt; 0.05; 0.179 &gt; 0.05; 0.581 &gt; 0.05; and 0.057 &gt; 0.05. Based on the Wilcoxon Sign Rank test, the LL metabolite showed a p-value of 0.460 &gt; 0.05. Conclusion: There is no significant difference between TE 35 ms and TE 144 ms during MR spectroscopy examinations.

Four years of real-world sexual function outcomes after Rezum therapy in men with and without baseline erectile dysfunction.

Rezum alleviates lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) while preserving sexual function, but long-term sexual function outcomes are lacking in patients with baseline erectile dysfunction (ED). The study sought to analyze 4years of real-world sexual function outcomes of Rezum using the International Index of Erectile Function (IIEF) questionnaire, stratified by baseline ED status. Participants included multiethnic Rezum-treated patients from a single outpatient office. IIEF domains and BPH medication usage were compared at baseline and 6, 12, and 48months using t tests, Mann-Whitney U tests, chi-square tests, and Wilcoxon signed rank tests. Primary outcomes over 4years included the IIEF functional domains (erectile function [EF], orgasmic function [OF], sexual desire [SD], intercourse satisfaction [IS], overall satisfaction [OS]) and BPH medication usage. A total of 91 patients were included: 40 (44%) in the ED cohort and 51 (56%) in the no ED cohort. History of diabetes was more prevalent in the ED cohort (35% vs 15.7%; P = .048). Baseline scores in the EF, OF, IS, and OS domains were lower in the ED cohort. Compared with baseline, there were no significant changes in any IIEF domains in either cohort at 6months. At 12months, the ED cohort had significant percent decreases in OF (-25%; P = .02), SD (-22.2%; P = .04), and OS (-33.3%; P = .004); the no ED cohort had a significant percent increase in EF (5%; P = .04). At 48months, the no ED cohort had no significant changes in any IIEF domains, while the ED cohort had significant percent increases in EF (30%; P = .01), SD (22.5%; P = .02), IS (20%; P = .01), and OS (58.3%; P = .008). Both cohorts significantly discontinued BPH medications at all follow-ups. At 48months, there were no cases of de novo ED in the no ED cohort. As modern BPH therapies continue to demonstrate efficacy in alleviating lower urinary tract symptoms, the preservation or improvement of sexual function emerges as an increasingly important consideration for patients, with our study suggesting Rezum as a compelling option. Our study has the strength of long-term Rezum outcomes in an ethnically diverse patient population, stratified by the presence of baseline ED, but is limited by retrospective design, single-center nature, and small sample sizes at long-term follow-ups. Rezum preserved long-term sexual function in patients without baseline ED and improved sexual function in those with baseline ED; however, individuals with ED may experience temporary decreases in sexual function at 12months.