Wilcoxon Two-sample Test Research Articles

Prognostic significance of a complement factor H autoantibody in early stage NSCLC.

Biomarkers that predict which patients with early stage NSCLC will develop recurrent disease would be of clinical value. We previously discovered that an autoantibody to a complement regulatory protein, complement factor H (CFH), is associated with early stage, non-recurrent NSCLC, and hypothesized that the anti-CFH antibody inhibits metastasis. The primary objective of this study was to evaluate the anti-CFH antibody as a prognostic marker for recurrence in stage I NSCLC. A secondary objective was to determine if changes in antibody serum level one year after resection were associated with recurrence. Anti-CFH antibody was measured in the sera of 157 stage I NSCLC patients designated as a prognostic cohort: 61% whose cancers did not recur, and 39% whose cancers recurred following resection. Impact of anti-CFH antibody positivity on time to recurrence was assessed using a competing risk analysis. Anti-CFH antibody levels were measured before resection and one year after resection in an independent temporal cohort of 47 antibody-positive stage I NSCLC patients: 60% whose cancers did not recur and 40% whose cancers recurred following resection. The non-recurrent and recurrent groups were compared with respect to the one-year percent change in antibody level. In the prognostic cohort, the 60-month cumulative incidence of recurrence was 40% and 22% among antibody negative and positive patients, respectively; this difference was significant (Gray's test, P= 0.0425). In the temporal cohort, the antibody persisted in the serum at one year post-tumor resection. The change in antibody levels over the one year period was not statistically different between the non-recurrent and recurrent groups (Wilcoxon two-sample test, P= 0.4670). The anti-CFH autoantibody may be a useful prognostic marker signifying non-recurrence in early stage NSCLC patients. However, change in the level of this antibody in antibody-positive patients one year after resection had no association with recurrence.

Characterizing Outcomes of Medial and Lateral Perforators in Deep Inferior Epigastric Perforator Flaps.

Perforators are typically found in rows in the deep inferior epigastric perforator (DIEP) flap. As methods to assess flap perfusion continue to improve, surgeons may be more likely to select perforators traditionally avoided. The purpose of this article is to describe clinical outcomes based on row and number of perforators to reevaluate flap and abdominal donor site morbidity. A retrospective analysis was performed on patients who underwent breast reconstruction with DIEP flaps by four microsurgeons from 2013 to 2020. The row and number of perforators were determined from operative reports. Chi-square and t-test or nonparametric Fisher's exact test and Wilcoxon two-sample test were used for discrete and continuous variable, respectively, as applicable. Logistic regression was used for multivariable analyses. Of 628 flaps, 305 were medial row (58.7%), 159 were lateral row (30.6%), and 55 had both rows (10.6%). Partial flap loss was higher in both rows (p = 0.003). Fat necrosis was higher with medial (p = 0.03) and both rows (p = 0.01) when compared with lateral using multivariable analysis. Hernia or bulge was higher in lateral row flaps (lateral: 8/157, 5.1%; medial, 5/299, 1.7%; both, 0/55; p = 0.05); however, mesh was more commonly used in both row flaps (p = 0.05). There was no difference in fat necrosis or abdominal morbidity between single and multiple perforators. There was no difference in fat necrosis based on the number or row of perforators. The lateral row provides adequate perfusion but may be associated with an elevated risk of hernia or bulge. Patients may benefit from mesh, especially when both rows are dissected.

Social isolation impairs feed intake, growth and behavioural patterns of catfish under culture conditions

Globally, the culture of fishes is important for food production. There is a growing interest in understanding and improving the welfare of cultured fish from both ethical and production perspectives. Social isolation is a common practice in catfish farming. This study assessed how social interactions affect the feeding behaviour, growth performance, and behavioural pattern of Clarias gariepinus under different social conditions. Juveniles of African catfish with a mean weight of 23.6 ± 1.09 g were stocked in 20L-aquaria (1.7 m × 1.2 m × 1.0 m) and fed twice daily in isolated (one fish/tank; N = 6 replicates) and non-isolated (six fish/tank; N = 6 replicates) conditions for a 36-day experimental period. Feed intake and growth response were monitored, while behavioural patterns were observed twice per week using focal sampling techniques for a total of 40 minutes per day. Wilcoxon two-sample tests and GLMs were used to analyse the data. Social context significantly (P < 0.001) affected the feed intake, feeding duration, and other observed behavioural patterns. However, the time of feeding (P > 0.001) did not affect the feed intake or the duration of feeding. Fish cultured in non-isolated conditions consumed more pellets (63 ± 2.36). The duration of feeding was longer in isolated conditions (431 s) while the latency to feed increased significantly (P < 0.001) from the first and fifth day of the experiment for the non-isolated and isolated, respectively. Behaviourally, isolated groups were inactive (Ws = 446.34, z = 5.397; P < 0.01) and displayed fewer aggressive acts (Ws = 0.95, z = 1.19; P < 0.01), while non-isolated groups were more active (Ws = 564.39, z = −5.397; P < 0.01) and displayed more escape attempts (Ws = 11.56, z = −5.47; P < 0.01). Non-isolated groups had higher (Ws = 23.41, z = 1.06; P < 0.01) number of scars and bruises. Furthermore, non-isolated fish had a higher specific growth rate (2.36 ± 0.12), feed conversion ratio (1.27 ± 0.01) and a better condition factor (1.01 ± 0.08). Conclusively, these findings are relevant to African catfish welfare as social isolation changes the behavioural attributes, feeding pattern and growth rate of C. gariepinus. However, social context should be monitored since it resulted in more scars and bruises, which might affect the acceptability and welfare of this aquatic fish species.

Sociodemographic variables affecting caregivers’ attitudes towards the provision of healthy breakfast and lunchboxes to children in their care

Objective: A study was undertaken to determine the sociodemographic variables (SDV) and caregivers’ attitudes that impact on healthy eating and the provision of healthy breakfast and school lunchboxes. Design: This was a cross-sectional, descriptive study using self-administered questionnaires. Setting: Participating Quintile 5 primary schools in Bloemfontein, South Africa (SA). Participants: Caregivers of learners, aged 6–12 years (N = 1 286). Main outcome measures: To determine associations between sociodemographic variables (SDV) and attitudes towards the provision of healthy breakfast and lunchbox foods. Analysis: Wilcoxon two-sample test for unpaired data or the chi-square test to compare groups. A p-value of <0.05 indicated statistical significance. Results: Caregivers with higher income and those living with a life partner were more likely to perceive healthy food as being more expensive than less healthy food (p < 0.01 and p < 0.01, respectively) and were of the opinion that preparing lunchboxes increased their workload (p < 0.01 and p < 0.01, respectively). Caregivers with lower income had a less positive attitude towards healthy eating habits (p < 0.01). Conclusions: Caregivers mostly had a positive attitude towards providing healthy breakfast and lunchbox foods. Discrepancies between caregivers’ perception of preparation time and cost of healthy food, and the provision of healthy food to learners, were observed.

75 Patient Reported Outcome Measures Associated with Burn Severity

IntroductionBurns continue to be a leading cause of unintentional injury sustained by children. The lasting effects of burn treatment on pediatric patients’ quality of life are still poorly understood. Patient-Reported Outcomes Measurement Information System (PROMIS) is a reliable tool that evaluates a patient’s physical, mental, and social health. To measure the impact of burn injuries on quality of life, we integrated the use of PROMIS into our outpatient clinic. Our aim for this study is to determine the effects of patient demographics, burn treatment, and burn characteristics on PROMIS scores.MethodsA retrospective review of patient and PROMIS data collected at our institution from June 2016 to August 2019 was conducted. Patient demographics, burn injury characteristics, PROMIS Pediatric Mobility, Upper Extremity, Pain Interference, and Peer Relationships scores were collected. Statistical analysis was conducted using Wilcoxon Two-Sample Test, Chi-Square, and Pearson’s Correlation Coefficient.Results163 pediatric burn patients completed PROMIS questionnaires. The median injury age was 5.94 years (interquartile range (IQR)= 6.9) and had a median total body surface area of 15% (IQR = 25.5). Individual burn characteristics did not impact Peer Relationships scores; however, they did have a significant effect on Upper Extremity, Mobility, and to a lesser extent, Pain Interference scores. Older injury age (-0.24, p = 0.02), longer length of stay (-0.25, p = 0.02), larger total body surface area (-0.27, p = 0.009), and more operating room visits (-0.28, p = 0.006), were associated with worse Upper Extremity scores. Similarly, older injury age (-0.2, p = 0.04), longer length of stay (-0.25, p = 0.01), more days in the intensive care unit (-0.24, p = 0.01), and more operating room visits (-0.26, p = 0.01) impacted Mobility scores. Worse Pain Interference scores were correlated with longer length of stay (0.24, p=0.01), and larger total body surface area (0.19, p=0.05). Upper Extremity scores correlated with Mobility scores (0.60, p < 0.0001); Pain Interference (-0.23, p < 0.02) and Upper Extremity (0.3, p < 0.003) scores correlated with Peer Relationships scores; and Upper Extremity (-0.48, p < 0.0001) and Mobility (-0.42, p < 0.0001) scores correlated with Pain Interference scores.ConclusionsPeer Relationships scores are not influenced by patient demographics or burn characteristics. This is in contrast with Upper Extremity, Mobility, and Pain Interference scores which are all directly affected by burn characteristics. The patients’ impression of their upper extremity function has the greatest impact on their perceived pain, peer relationships, and mobility.

Safety of Primary Versus Revisional Biliopancreatic Diversion with Duodenal Switch in Patients with Super Obesity Using the MBSAQIP database.

For patients with super obesity (BMI > 50kg/m2), biliopancreatic diversion/duodenal switch (BPD/DS) can be an effective bariatric operation. Technical challenges and patient safety concerns, however, have limited its use as a primary procedure. This study sought to assess the safety of primary versus revisional BPD/DS. The MBSAQIP database was queried for primary and revisional BPD/DS (2015-2018). Inclusion criteria were patients ≥ 18years of age, BMI > 50kg/m2, and with no concurrent procedures. Preoperative variables were compared using a chi-square test or Wilcoxon two-sample tests. Multivariate logistic or robust linear regression models were used to compare outcomes. There were 3,378 primary BPD/DS and 487 revisional BPD/DS patients. Primary BPD/DS patients had higher BMI (56.5 [IQR4.4] versus 54.8 [IQR4] kg/m2, p < 0.0001) and had more diabetes mellitus type II (29.1% versus 17.2%, p < 0.0001). Intraoperatively, revisional BPD/DS had longer operative time (165 [IQR47] min versus 139 [IQR100] min, p < 0.0001). After adjusting for preoperative characteristics, there was no difference in 30-day readmission or ED visits (primary 12.9% versus revisional 14.6%), reoperation or reintervention (primary 5.7% versus revisional 7.8%), or mortality (primary 0.4% versus revisional 0.6%). In contrast, the revisional BPD/DS patients had higher odds of major morbidity (primary 3.4% versus revisional 5.3%, OR 1.9, CI 1.1-3.2, p = 0.019). Revisional BPD/DS is associated with higher morbidity than primary BPD/DS in patients with super obesity. These patients should thus be counselled appropriately when choosing a primary or revisional bariatric procedure.

Fear behaviour in turkey poults of fast and slow growing breeds

Characterisation of fear response in turkey breeds could bring important beneficial information for future breeding, animal welfare and preservation of breeds. The two major turkey breeds raised presently in Nigeria are Hybrid Converter turkey (HCT) and Nigerian indigenous turkey (NIT). The HCT has been selected for fast growth and can adapt to different environmental and management conditions. In contrast, NIT is an unselected slow-growing bird that is hardy and well-adapted to the tropical climate of Nigeria. This study examined fear behaviour in turkey poults of fast and slow growing breeds to know how genetic selection for fast growth has shaped fear response in young turkeys. Twenty-five each of white NIT and HCT poults were used for this study. Fear tests such as tonic immobility, emergence, open field, inversion and attention bias tests were used to assess fear responses in the turkey poults during the first 16 days of life. A Wilcoxon Two-Sample test was used to determine the effect of the turkey breed on the poults’ fear responses. There was a significant breed effect on the duration of tonic immobility (Ws=482.00, z = −3.0138, p = 0.003) and latency to emerge from a dark box (Ws=382.00, z = −4.9521, p = 0.000). The HCT stayed in tonic immobility longer than NIT, while NIT emerged faster than HCT from the dark box. There was also a significant breed effect on vocalization duration (Ws=664.50, z = 3.65, p = 0.000) in the open field arena, with longer duration of vocalization in NIT compared with HCT. More escape attempts (Ws=598.00, z = 3.05, p = 0.004) and more explored floor squares (Ws=606.50, z = 2.43, p = 0.015) were observed in NIT compared with HCT during the open field test. The results obtained from this study showed significant breed differences in the fear responses of the turkey poults, with HCT poults being more fearful than NIT. The increased fear response observed in HCT poults appears to be an unintended consequence of selection for fast growth. Genetic selection programmes aimed at improving growth in turkeys should also consider their fear behaviour.

Contrast of Digital and Health Literacy Between IT and Health Care Specialists Highlights the Importance of Multidisciplinary Teams for Digital Health-A Pilot Study.

Despite their promises, digital innovations have scarcely translated to technologies used in routine clinical practice, making the identification of barriers to successful implementation a research priority. Low levels of transdisciplinary skills represent such a barrier but so far, this has not been evaluated and compared between information technology (IT) and health care specialists. In this study, we evaluated the level of digital health literacy among IT and health care specialists. An anonymous questionnaire was distributed to staff at a breast cancer unit and an IT department of two German universities in December 2020. The survey questionnaire consisted of the previously validated eHealth Literacy Assessment Toolkit and additional questions with respect to age, profession, and career stage. Mann-Whitney or Wilcoxon rank-sum tests and two-sample chi-square tests were used for the analysis. The survey was completed by 113 individuals: 70 (61.9%) IT specialists and 43 (38.1%) health care specialists. Health care specialists scored significantly higher on the health-related scales and IT specialists scored significantly higher on the digitally related scales. No single participant identified themselves to have the highest level of literacy on all survey questions (n = 0 of 113; 0%). Only one person (n = 1 of 113; 0.9%) consistently reported a high or the highest level of literacy. Although IT and health care specialists showed great literacy in their respective disciplines, only few individuals combined both digital and health care literacy. Multidisciplinary teams and transdisciplinary curricula are crucial to bridge skill gaps between disciplines and to drive the implementation of digital health initiatives.

Pretest Genetic Education Video Versus Genetic Counseling for Men Considering Prostate Cancer Germline Testing: A Patient-Choice Study to Address Urgent Practice Needs.

Germline testing (GT) for prostate cancer (PCA) is now central to treatment and hereditary cancer assessment. With rising demand for and shortage of genetic counseling (GC), tools to deliver pretest informed consent across practice settings are needed to improve access to GT and precision care. Here, we report on Evaluation and Management for Prostate Oncology, Wellness, and Risk (EMPOWER), a patient-choice study for pretest video-based genetic education (VBGE) versus GC to inform urgent practice needs. Men with PCA or at risk for PCA (family history of PCA) were eligible and could choose pretest VBGE or GC. Outcomes included decisional conflict for GT, change in genetics knowledge, satisfaction, and intention to share results with family and/or providers. Descriptive statistics summarized results with counts and percentages for categorical variables and mean ± standard deviation for continuous variables. Data were compared with Fisher's exact, chi-squared, or Wilcoxon two-sample tests. Mean change in genetics knowledge was compared with t tests. The significance level was set a priori at .05. Data on the first 127 participants were analyzed. Characteristics were White (85.8%), bachelor's degree (66.9%), and PCA diagnosis (90.6%). The majority chose VBGE (71%) versus GC (29%; P < .001). No differences were observed in decisional conflict for GT or satisfaction. Cancer genetics knowledge improved in both groups without significant difference (+0.9 VBGE, +1.8 GC, P = .056). Men who chose VBGE had higher intention to share GT results (96.4% VBGE v 86.4% GC, P = .02). Both groups had high rates of GT uptake (VBGE 94.4%, GC 92%). A substantial proportion of men opted for pretest VBGE, with comparable patient-reported outcomes and uptake of GT. The results support the use of pretest video to address the critical GC shortage in the precision era.

Smoking cessation intentions and attempts one year after the federally mandated smoke-free housing rule

The present study examines public housing residents’ smoking cessation intentions, expectancies, and attempts one year after implementation of the Department of Housing and Urban Development’s mandatory smoke-free rule in public housing. The sample includes 233 cigarette smokers, ages 18–80, who reside in the District of Columbia Housing Authority. Data collection occurred between March and August 2019. Descriptive statistics, chi-square, and Wilcoxon two-sample test analyses assessed smoking cessation intentions, expectancies, and attempts across resident demographics and characteristics. Findings showed 17.2% of residents reported not thinking about quitting, 39.1% reported thinking about quitting, and 48.6% reported thinking about quitting specifically because of the rule. Residents ages 60–80 were more likely to consider quitting because of the rule, compared to residents ages 18–59. Of those thinking of quitting, 58.6% were sure they could quit if they tried. Those thinking of quitting due to the rule (62.0%) were more likely to have made at least one quit attempt in the past 3 months than those i not attributinging thinking of quitting to the rule. Res Residents trying to quit reported an average of 2.7 attempts in the last 3 months;; most perceived evidence-based cessation supports as not helpful. A A majority reported thinking about quitting and attempting to quit but continuing to smoke, indicating a significant gap between intent to quit and successfully quitting. Results suggest that the rule positively influenced smoking behaviors. However, additional interventions are needed to assist public housing residents with successfully quitting smoking.

Characteristics of Clinical Trial Participants with Duchenne Muscular Dystrophy: Data from the Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet).

Background: Therapeutic trials are critical to improving outcomes for individuals diagnosed with Duchenne muscular dystrophy (DMD). Understanding predictors of clinical trial participation could maximize enrollment. Methods: Data from six sites (Colorado, Iowa, Piedmont region North Carolina, South Carolina, Utah, and western New York) of the Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet) were analyzed. Clinical trial participation and individual-level clinical and sociodemographic characteristics were obtained from medical records for the 2000–2015 calendar years. County-level characteristics were determined from linkage of the most recent county of residence identified from medical records and publicly available federal datasets. Fisher’s exact and Wilcoxon two-sample tests were used with statistical significance set at one-sided p-value (<0.05) based on the hypothesis that nonparticipants had fewer resources. Results: Clinical trial participation was identified among 17.9% (MD STARnet site: 3.7–27.3%) of 358 individuals with DMD. Corticosteroids, tadalafil, and ataluren (PTC124) were the most common trial medications recorded. Fewer non-Hispanic blacks or Hispanics than non-Hispanic whites participated in clinical trials. Trial participants tended to reside in counties with lower percentages of non-Hispanic blacks. Conclusion: Understanding characteristics associated with clinical trial participation is critical for identifying participation barriers and generalizability of trial results. MD STARnet is uniquely able to track clinical trial participation through surveillance and describe patterns of participation.

Provinciale responsverschillen in het Vlaamse Bevolkingsonderzoek Dikkedarmkanker: inzichten uit gemeentelijke socio-demografische en gezondheidsgerelateerde kenmerken

Municipal characteristics associated with response rate to organised colorectal cancer screening in Flanders Introduction In Flanders (Belgium), the response rate to organised colorectal cancer (CRC) screening is still suboptimal (~ 50%). We studied the characteristics of municipalities in the Flemish provinces with the highest and lowest response rates to explore factors that might be associated with the response rate to organised CRC screening. Methods The response rates of municipalities in 5 Flemish provinces and the characteristics of municipalities in the provinces with the highest and lowest response rates were compared to the average measures of Flanders (data 2017) using an unpaired two-sample Wilcoxon test. Results The municipal response rates in Limburg and Antwerp were significantly higher, and those in West Flanders and Flemish Brabant significantly lower compared to Flanders. Further analyses of Limburg (highest response rate) and Flemish Brabant (lowest response rate) suggested that municipalities with higher response rates had more men and people aged 60-64 in the target population, more jobseekers and more people who contacted GPs/specialists frequently, but fewer people aged 70-74 in the target population and with a lower average income compared to Flanders. In contrast, municipalities with lower response rates had fewer men in the target population, fewer people having a partner, fewer jobseekers and fewer people having a global medical file, but more people with a non-Dutch or non-Belgian nationality and a higher average income (p-values &lt; 0.01). Conclusion This exploratory study identifies certain demographic, socioeconomic and health‑related municipal characteristics that may be related to the response rate to CRC screening in Flanders. These findings can guide future research and investigations with the aim to improve the response rate to CRC screening.

The role of fitness trackers and tailored feedback messages in motivating endometrial cancer survivors to increase physical activity: results of the MOVES trial

Objectives: Endometrial cancer (EC) survivors are often overweight or obese and may benefit from increased physical activity. Increases in daily step count of 2,000 steps per day has been shown to improve cardiovascular health. We sought to assess a fitness intervention (fitness tracker + tailored feedback messages) for EC survivors. Methods: A prospective trial of EC survivors was undertaken from September 2018 to December 2019. Thirty-nine survivors were approached for enrollment with 36 randomized (18 intervention, 18 control). All participants received a fitness tracker. Survivors were randomized 1:1 to receipt or non-receipt of weekly tailored feedback messages. The primary outcome was change in average daily step count from baseline (week 1) to study completion (week 12). Secondary outcomes included acceptability, and changes in metabolic lab parameters (serum glucose, LDL, and insulin levels), body mass index (BMI) and waist to hip ratio (W/H). The trial was powered to detect a clinically significant change in daily step count of 2,000 steps. Comparisons of baseline to study completion labs were made using the Wilcoxon Two-sample test. Student's T-test was used for comparisons of control and intervention groups. Results: At baseline, there was no difference in BMI (35.9 vs 36.7, p=0.81) or W/H ratio (0.9 vs 0.89, p=0.40) between control and intervention arms. Baseline daily step count was 5291 steps in the control arm and 4295 in the intervention arm (p=0.16). There was no difference in baseline metabolic labs including glucose (100 vs 103, p=0.85), serum insulin (13.1 vs 16.8, p=0.78), and LDL (150 vs 113, p=0.07). The intervention group saw a statistical change in average daily step count (4295 to 5332, p=0.02). The control group did not have a statistically significant change (5291 to 5600, p=0.40). For the primary outcome of average daily step count change, there was no statistically significant difference between the two groups (+309 control vs +1037 intervention, p=0.21). There was no difference in change in BMI (-0.27 vs -0.02, p=0.7), glucose (+1 vs -3, p=0.29), LDL (-9.1 vs -3.5, p=0.95) or insulin (-2.15 vs -1.95, p=0.32) between the control and intervention arms. Regarding acceptability, survivors found the feedback to be helpful (87%) and easy to understand (87%). Two-thirds of survivors found the messages to be motivating, 47% desired increased frequency of messaging, and 53% thought the weekly message was adequate. Overall, 33% of intervention survivors versus 22% of control survivors had decline in fitness tracker use during the intervention, resulting in missing step data (p=0.46). Conclusions: A fitness intervention using fitness trackers and tailored feedback messaging may improve physical activity as measured by daily step count in EC survivors, however, significant noncompliance with fitness tracker use was seen in both groups by study end. Tailoring the frequency of feedback messages to survivor preference may be important to optimizing this intervention.

Does travel time effect genetic testing rates for women with ovarian, fallopian tube or primary peritoneal cancers in a rural catchment area?

<h3>Objectives:</h3> In 2014, the Society of Gynecologic Oncology (SGO) published guidelines regarding universal germline testing for women with ovarian, fallopian tube, or primary peritoneal cancers (Ov/FT/PC) cancer. The purpose of this study was to determine the rate of referral to- and completion of genetic testing after diagnosis of Ov/FT/PC in patients treated at a rural tertiary care center. The effect of time and distance traveled on completion of genetic consultation was also examined. <h3>Methods:</h3> This is a retrospective cohort study of women with a diagnosis of Ov/FT/PC cancers receiving care at the University of Vermont Medical Center (UVMMC) from October 2014 to November 2019. Clinical information was obtained from the UVMMC Cancer registry and electronic medical records. Median income by zip code was obtained from US census data while time and distance traveled was based on the Google Application Interface software. Data was analyzed with two-sample Wilcoxon tests and Chi-square analysis. <h3>Results:</h3> 151 patients were identified. Mean age at diagnosis was 62 years (23 - 88). Median income was $64,611 and BMI was 29. Eighty (53%) patients had a genetics referral placed while 71 (47%) did not. Of the 80 patients referred, 68 (85%) completed their consultation. Referral rates significantly increased over time, (p<0.001). Genetic consultation completion rates were similar over time, (p=0.578). Mean time traveled was 42 minutes (3 - 188), and mean distance traveled was 28 miles (0 - 154). Time and distance traveled were not significantly associated with completion of genetics consultation. <h3>Conclusions:</h3> While referral rates increased steadily over time, nearly half of the patients with Ov/FT/PC cancer were not referred for genetic consultation. The majority of patients, who were referred to genetics, completed their consultation regardless of time or distance traveled. Mechanisms to ensure timely referral for genetic testing need to be implemented as they can affect treatment.

Dynamic binning peak detection and assessment of various lipidomics liquid chromatography-mass spectrometry pre-processing platforms

Liquid chromatography-mass spectrometry (LC-MS)-based lipidomics generates large datasets that need to be interpreted using high-performance data pre-processing tools such as XCMS, mzMine, and Progenesis. These pre-processing tools rely heavily on accurate peak detection, which depends on proper setting of the peak detection mass tolerance (PDMT). The PDMT is usually set with a fixed value in either ppm or Da units. However, this fixed value may result in duplicates or missed peak detection and inaccurate peak quantification. To improve the accuracy of peak detection, we developed the dynamic binning method, which considers peak broadening described by the physics of ion separation and sets the PDMT dynamically in function of m/z. In our method, the PDMT is proportional to (mz)2 for Fourier-transform ion cyclotron resonance (FTICR), to (mz)1.5 for Orbitrap and to m/z for Quadrupole time-of-flight (Q-TOF), and is a constant for Quadrupole mass analyzer. The dynamic binning method was implemented in XCMS [1,2], and the adopted source code is available in GitHub at https://github.com/xiaodfeng/DynamicXCMS. We have compared the performance of the XCMS implemented dynamic binning with different popular lipidomics pre-processing tools to find differential compounds. We generated set samples with 43 lipid internal standards that were differentially spiked to aliquots of one human plasma lipid sample using Orbitrap LC-MS/MS. The performance of various pipelines using matched parameter sets was quantified by a quality score system that reflects the ability of a pre-processing pipeline to detect differential peaks spiked at various concentrations. The quality score indicated that our dynamic binning method improves the quantification performance of XCMS (maximum p-value 9.8·10−3 of two-sample Wilcoxon test) over its original implementation. We also showed that the XCMS with dynamic binning found differential spiked-in lipids better or with similar performance as mzMine and Progenesis do.

Accessing Targeted Therapies: A Potential Roadblock to Implementing Precision Oncology?

Advances in genomic techniques have led to increased use of next-generation sequencing (NGS). We evaluated the extent to which these tests guide treatment decisions. We developed and distributed a survey assessing NGS use and outcomes to a survey pool of ASCO members. Comparisons between groups were performed with Wilcoxon two-sample, chi-square, and Fisher's exact tests. Among 178 respondents, 62% were male, 54% White, and 67% affiliated with academic centers. More than half (56%) indicated that NGS provided actionable information to a moderate or great extent. Use was highest (median ≥ 70% of cases) for lung and gastric cancer, and lowest (median < 25% of cases) in head and neck and genitourinary cancers. Approximately one third of respondents reported that, despite identification of an actionable molecular variant, patients were sometimes or often unable to access the relevant US Food and Drug Administration-approved therapy. When NGS did not provide actionable results, individuals reporting great or moderate guidance overall from NGS in treatment recommendations were more likely to request the compassionate use of an unapproved drug (P < .001), enroll on a clinical trial (P < .01), or treat off-label with a drug approved for another indication (P = .02). When NGS identifies an actionable result, a substantial proportion of clinicians reported encountering challenges obtaining approved therapies on the basis of these results. Perceived overall impact of NGS appears associated with clinical behavior unrelated to actionable NGS test results, including pursuing off-label or compassionate use of unapproved therapies or referring to a clinical trial.

Clinical and Sociodemographic Profile of Patients With Thyroid Storm: A National Inpatient Sample Database Analysis

Background: Thyroid storm (TS) is a rare, life-threatening disease that is associated with significant mortality. The clinical outcome of these patients has not been evaluated in general practice on a national scale. Our study aimed to find the clinical characteristics and outcomes of patients admitted to community hospitals with TS using the National Inpatient Sample (NIS) database. Methods: We conducted a retrospective study of adult patients (>=18 years of age) diagnosed with primary and secondary TS from the NIS database from 2012 to 2014. The NIS is the largest all-payer inpatient care database in the United States, containing data on more than seven million hospital stays each year. Statistical analysis performed included Chi-Square test, Wilcoxon two-sample test, Fisher’s exact test and multiple logistic regression with a p-value<0.05 considered significant. Results: In total, 2,163 hospitalizations with TS were identified. The incidence of TS in hospitalized patients was 11.96 per 100,000 hospitalizations. Compared to all other adult hospitalizations reported over the same period, admission with TS was significantly associated with a higher prevalence in African Americans (31.4% vs 14.7%, p<0.001) as well as concomitant blood diseases (31.4% vs 21.9%, p<0.001), drug use disorder (11.4% vs 8.4%, p<0.001), electrolyte disturbance (36.9% vs 23.8%, p<0.001), and psychosis (38.1% vs 28.5%, p<0.001). Admission with TS was associated with lower prevalence of concomitant cancer (2.5% vs 4.9%, p<0.001) and renal disease (5.6% vs 12.2%, p<0.001), along with a higher risk of death during hospitalization (3.9% vs 2.2%, p<0.001). There was no significant association between TS and GI disease, cardiovascular disease, pulmonary disease or rheumatoid arthritis. Admission with TS was associated with longer average length of stay (TS median: 4 days, Non-TS: 3 days, p<0.001) and higher total hospital charge (TS median: $27,360, Non-TS: $24,346, p<0.001). Additionally, TS had a higher incidence in urban populations with large hospitals.Overall, inpatient mortality rate was 3.9%. For those with TS, the odds of inpatient death were greater for age group 30-59 compared to <30 (OR 2.916, p=0.026), age group >60 compared to <30 (OR 3.157, p=0.022), males (OR 2.20, p<0.001), those with cancer (OR 6.42, p<0.001), those with electrolyte disturbance (OR 6.12, p<0.001) and those with a neurologic disorder (OR 2.46, p=0.002). Admitted patients with a concomitant psychological disorder had lower odds of death (OR 0.38, p=0.03). Conclusions: This study identified clinical characteristics associated with TS-related admission including female gender, age 30-59, Caucasian race, and urban populations. Higher mortality was associated with patients 30-59 years and >60 years of age, electrolyte disturbances, blood disease, weight loss, paralysis, cancer, renal disease, and male gender.

Early Postoperative Pain After Total Knee Arthroplasty Is Associated With Subsequent Poorer Functional Outcomes and Lower Satisfaction

BackgroundThere are few studies investigating the effects of acute postoperative pain on functional outcomes after total knee arthroplasty (TKA). The aims of this study are to identify perioperative factors associated with increased early postoperative pain and investigate the effects of acute postoperative day 1 and 2 pain on outcomes at 6 months and 2 years post-TKA. Methods1041 unilateral TKA patients were included in this retrospective cohort study. Patients were categorized into minor (visual analog scale: VAS <5) and major (VAS ≥5) pain groups based on postoperative day 1/2 VAS scores. Patients were assessed preoperatively, at 6 months and 2 years using Knee Society Knee Score and Function Scores (KSFS), Oxford Knee Score (OKS), SF-36 physical and mental component score (SF-36 PCS), expectation and satisfaction scores. Perioperative variables including age, gender, race, body mass index, American Society of Anesthesiologist status, type of anesthesia, and presence of caregiver were analyzed as predictors of postoperative acute pain. Wilcoxon two-sample test was used to analyze outcomes significantly associated with “major pain.” Multiple logistic regression was used to identify predictors of “major pain.” ResultsPatients with “minor pain” had significantly better KSFS, Knee Society Knee Score, OKS, and SF-36 PCS scores at 6 months and significantly better KSFS, OKS, SF-36 PCS, and satisfaction at 2 years (P < .05). A significantly higher percentage of patients with “minor pain” met the minimal clinically important difference for SF-36 PCS at 6 months and KSFS at 2 years (P < .05). Women, Indian/Malay race, higher BMI, and use of general over regional anesthesia were independent predictors of getting “major pain” (P < .05). ConclusionPatients should be counseled about risk factors of postoperative pain to manage preoperative expectations of surgery. Patients should be managed adequately using multimodal pain protocols to improve subsequent functional outcomes while avoiding unnecessary opioid use.

Targeted inhibition of myeloid-derived suppressor cells in the tumor microenvironment by low-dose doxorubicin to improve immune efficacy in murine neuroblastoma.

BackgroundHigh agglomeration of myeloid-derived suppressor cells (MDSCs) in neuroblastoma (NB) impeded therapeutic effects. This study aimed to investigate the role and mechanism of targeted inhibition of MDSCs by low-dose doxorubicin (DOX) to enhance immune efficacy in NB.MethodsBagg albino (BALB/c) mice were used as tumor-bearing mouse models by injecting Neuro-2a cells, and MDSCs were eliminated by DOX or dopamine (DA) administration. Tumor-bearing mice were randomly divided into 2.5 mg/kg DOX, 5.0 mg/kg DOX, 50.0 mg/kg DA, and control groups (n = 20). The optimal drug and its concentration for MDSC inhibition were selected according to tumor inhibition. NB antigen-specific cytotoxic T cells (CTLs) were prepared. Tumor-bearing mice were randomly divided into DOX, CTL, anti-ganglioside (GD2), DOX+CTL, DOX+anti-GD2, and control groups. Following low-dose DOX administration, immunotherapy was applied. The levels of human leukocyte antigen (HLA)-I, CD8, interleukin (IL)-2 and interferon (IFN)-γ in peripheral blood, CTLs, T-helper 1 (Thl)/Th2 cytokines, perforin, granzyme and tumor growth were compared among the groups. The Wilcoxon two-sample test and repeated-measures analysis of variance were used to analyze results.ResultsThe slowest tumor growth (F = 6.095, P = 0.018) and strongest MDSC inhibition (F = 14.632, P = 0.001) were observed in 2.5 mg/kg DOX group. Proliferation of T cells was increased (F = 448.721, P < 0.001) and then decreased (F = 2.047, P = 0.186). After low-dose DOX administration, HLA-I (F = 222.489), CD8 (F = 271.686), Thl/Th2 cytokines, CD4+ and CD8+ lymphocytes, granzyme (F = 2376.475) and perforin (F = 488.531) in tumor, IL-2 (F = 62.951) and IFN-γ (F = 240.709) in peripheral blood of each immunotherapy group were all higher compared with the control group (all of P values < 0.05). The most significant increases in the aforementioned indexes and the most notable tumor growth inhibition were observed in DOX+anti-GD2 and DOX+CTL groups.ConclusionsLow-dose DOX can be used as a potent immunomodulatory agent that selectively impairs MDSC-induced immunosuppression, thereby fostering immune efficacy in NB.

New Technique for Intrathoracic Implantation of Extraluminal Spiral Prostheses in the Trachea

Background: Extraluminal surgical procedures for intrathoracic tracheal collapse in dogs are not routinely performed. The patients are normally treated with different drugs or by intraluminal stents. However, in more severe cases, drug treatment does not always have good outcomes, and intraluminal prostheses can be correlated to several postoperative problems. In order to obtain better results, we aimed to develop a surgical technique for implantation of a new extraluminal helical prosthesis in the thoracic segment of the trachea through cervical access, associated with pneumatic mediastinoscopy for certification of the technique and minimization of possible complications.Materials, Methods &amp; Results: Seven canine corpses (CCs) from non-traumatic death, weighing between 2 and 7 kg, were used. A ventral cervical approach to the trachea was associated with blunt mediastinal dissection. Trans cervical pneumatic mediastinoscopy was used for evaluation of the dissection and location of the implant. These were compared with the necropsy findings by the exact Wilcoxon two-sample test, with P &lt; 0.05. The results of necropsy and mediastinoscopy did not present significant differences at P &lt; 0.05. During the examinations, the presence of some mediastinal visceral lesions caused by the prosthesis, the integrity of the mediastinum and possible lesions to RLN and blood vessels (BV) were analyzed. We also investigated the location of the distal part of the prosthesis in the thoracic segment of the trachea and its dissection. To evaluate the technique, statistical comparison was made between mediastinoscopy and necropsy findings. The data were compared by the Wilcoxon test at 5% probability. The tracheas of all CCs were efficiently dissected, but in some cases problems that can happen during the procedure were noticed. This was checked by mediastinoscopy and confirmed by necropsy. The median of the scores was 1 (good dissection and visualization), with variance of zero for mediastinoscopy and 0.14 for necropsy. In the mediastinoscopy of one CC, the prosthesis crossed the tracheal bifurcation, involving the posterior vessels of this region, which was confirmed by necropsy. However, the dissection showed no vascular lesions. The integrity of the mediastinum was assessed only by mediastinoscopy. There was no impairment caused by any of the procedures performed. This resulted in a median score of 1 (integrity) with zero variance. When the positioning of the prosthesis was evaluated in relation to the tracheal bifurcation, identical values were obtained by both methods. The median score was 1, with variance of 0.62. No statistical differences were found between the two evaluation methods for the analyzed variables. This demonstrates the strong potential of the proposed evaluation techniques.Discussion: Our results show that the execution of the technique is possible, but some complications may occur. Mediastinoscopy as an evaluation procedure can pose some complications, these considerations are important, but by using technique proposed in this study, these factors are minimized due to the ease of technical implantation of the extraluminal tracheal stent, without the need for several instruments competing in the inflated mediastinal space. We concluded that the technique is viable and a safe method with minimal invasion for investigation and treatment of mediastinal diseases, presenting low impairment of the paratracheal structures, and that mediastinoscopy can be used as a transoperative evaluation method to minimize complications.