Wilcoxon Rank Sum Test Research Articles

Effect of Patient Age on Decisional Regret After Laparoscopic Hysterectomy.

To compare long-term decision regret between younger (30 years or younger) and older (31-49 years) patients who underwent laparoscopic hysterectomy for benign disease. We conducted a matched retrospective cohort study to analyze patients who underwent laparoscopic hysterectomies for benign indications from 2009 to 2016. Respondents completed surveys including two validated decision regret scales: one measuring surgical decision regret and the other measuring loss-of-fertility regret. Participant aged was dichotomized as 30 years or younger and 31-49 years. Chi square, Fisher exact, and Wilcoxon rank sum tests and logistic regression were used to compare groups. Two hundred eighty-seven participants were successfully contacted, and 241 completed the survey (84.0%). Seventy-seven respondents (32.0%) were aged 30 years or younger, and 164 (68.0%) were aged 31-49 years. The average time since surgery was 7.2 years (±2.2 years; range 3.7-12.1 years). Participants aged 30 years or younger regretted both undergoing surgery (32.5% vs 9.1%, P<.001; OR 4.8, 95% CI, 2.3-9.8) and loss of fertility (39.0% vs 13.4%, P<.001, OR 4.1, 95% CI, 2.2-7.8) at significantly higher rates than participants aged 31-49 years. Overall, 83.1% of younger participants agreed that hysterectomy was the right choice compared with 97% of older participants (P<.001). Higher rates of surgical and loss-of-fertility regret were seen in participants with self-reported pelvic pain (P=.003, P=.011), preoperative diagnosis of endometriosis (P=.037, P=.046), and postoperative complications (P=.043, P<.001). Although time since hysterectomy did not affect rate of surgical regret (P=.138), participants further from their hysterectomies had lower rates of loss-of-fertility regret (P=.003). Patient age remained significantly associated with both surgical regret (adjusted OR 2.9 (95% CI, 1.3-6.5) and loss-of-fertility regret (adjusted OR 2.8 (95% CI, 1.3-6.0) on multivariable logistic regression. Participants aged 30 years or younger were more likely to regret their decision to undergo hysterectomy than participants aged 31-49 years, regardless of parity, prior sterilization, or previous treatment.

Higher rates of recurrence and worse quality of life in obese patients undergoing inguinal hernia repair.

Prior investigations regarding the effect of obesity on inguinal hernia repair have been mixed. The aim of our study was to retrospectively compare perioperative outcomes, recurrence rate, and quality of life between obese and non-obese patients undergoing inguinal hernia repair. Patients who underwent inguinal hernia repair by any approach at a single institution were identified from a prospectively maintained quality database. Patients with a body mass index (BMI) greater than or equal to 30kg/m2 were considered obese. Quality of life was measured with the Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CSS) surveys. Differences between obese and non-obese patients were assessed using independent samples t-tests, Wilcoxon rank-sum, and chi-square tests. Between 2010 and 2021, a total of 5575 patients underwent inguinal hernia repair. Fifteen percent of patients were identified as obese (835 patients, mean BMI 33.2 ± 3.3kg/m2). A significantly higher percentage of obese patients were diabetic, and operative time and estimated blood loss were higher in the obese group (all p < 0.001). Rates of hernia recurrence in obese patients was significantly more likely than in non-obese patients (4.2% vs 2.0%, p < 0.001). Up to 2 years postoperatively, a greater percentage of obese patients reported worse quality of life on the SOMS and more bothersome symptoms on the CCS. Inguinal hernia repair in obese patients is a more technically challenging operation. Long-term follow-up revealed a greater risk of hernia recurrence and worse quality of life up to 2 years postoperatively in this patient population.

A Retrospective Analysis of the Long-Term Safety and Efficacy of A1-UV Intraocular Lens Combined with Capsular Tension Ring in the Treatment of Patients with Cataract and Suspensory Ligament Abnormalities

Objective: To evaluate the long-term safety and efficacy of the combination therapy of A1-UV Intraocular Lens (IOL) and Capsular Tension Ring (CTR) for cataract patients with abnormal suspensory ligaments. Method: Retrospective data analysis. Extract all patient information related to A1-UV IOL and 920H IOL from the existing Clinical Trial Database of CTR to form a new dataset. The new dataset focuses on IOL and the clinical safety and efficacy of A1-UV IOL and 920H IOL combined with CTR was compared and analyzed based on it. The follow-up time points include 1-2 days, 1 week, 1 month, 3 months, 6 months and 1 year. Evaluation indicators include Best-Corrected Distance Visual Acuity (BCDVA), Uncorrected Distance Visual Acuity (UCDVA), spherical power, cylindrical power, Equivalent Spherical power (SE), Intraocular Pressure (IOP), corneal endothelial cell density, inflammatory response, Adverse Events (AE) and Serious Adverse Events (SAE). Statistical analysis was conducted using SPSS 22.0 software. All statistical tests are conducted using a two-sided test, and a P-value less than 0.05 is considered statistically significant for the difference being tested. Compare the quantitative data using t-test or Wilcoxon rank-sum test. Compare count data using chi-square test or Fisher's exact probability. Results: The number of cases in the A1-UV group and 920H group were both 27 (monocular), with an average age of 68.46 ± 6.93 years old and 70.27 ± 10.95 years old, respectively. The sample sizes at 6 months and 1 year after surgery were 26 cases (96.30%) and 21 cases (77.77%) in the A1-UV group, respectively, while the 920H group consisted of 26 cases (96.30%) and 22 cases (81.48%), respectively. The use of two types of IOLs combined with CTRs can significantly improve BCDVA and UCDVA (both P&lt;0.05). The differences between the groups during each follow-up period were not statistically significant (all P&gt;0.05). The average residual spherical power, residual cylindrical power, and residual SE of both groups of patients after surgery were close to emmetropic eye. There was no statistically significant difference (P&gt;0.05) in the comparison of other refraction indicators between the groups during each follow-up period, except for the cylindrical power at 3 months and 1 year after surgery. In the A1-UV group, a total of 2 patients experienced 3 episodes of mild IOP elevation, which was judged by the investigator to be unrelated to IOL, and no drug treatment was used, and it recovered spontaneously. 3 patients in the 920H group experienced three episodes of high IOP, including two mild cases (one possibly related to the IOL) and one moderate case (possibly related to the IOL), all of which were controlled by medication and recovered. In addition, the IOP of the remaining patients during each follow-up period after surgery was within the normal range. There was no AE or SAE related to implanted products in the A1-UV group. Conclusion: The combination of A1-UV IOL and CTR has long-term good safety and efficacy in the treatment of complex cataract patients with suspensory ligament abnormalities.

Prevalence, risk factors, and adverse outcomes of diastasis of rectus abdominis in men: a cross-sectional study.

This observational study aimed to investigate the prevalence of DRA, ascertain the possible risk factors and analyse the adverse outcomes of DRA among men. Moreover, the reasonable diagnostic criterion was further explored. 1575 men aged 18 years or older were recruited from a Grade III A Hospital. Data were obtained by electronic medical record, subsequent unified questionnaire and clinical examinations. Possible risk factors of DRA were confirmed in the univariate analysis and multivariate analysis. Based on two diagnostic criteria, Chi square test and Wilcoxon rank sum test were used to compare the difference of adverse outcomes among men with and without DRA. The prevalence of DRA in men was 29.78% when IRD > 2cm was used as a diagnostic criterion, but decreased to 10.16% when IRD > 3cm as a criterion. Age, BMI, smoking and physical exercise were proved as influencing factors for DRA. No association was found between DRA and abdominal wall muscle function, low back pain, and quality of life. But hernia was significant with DRA, when IRD>3cm as diagnostic criterion. Prevalence of DRA in male is high and taking measure on losing weight, giving up smoking and exercising properly may prevent DRA, along with reducing the possibility of DRA-related hernias. To be important, IRD>3cm as the reasonable diagnostic criterion was proposed.

Dose-exposure-response of CARDALIS® (benazepril/spironolactone) on the classical and alternative arms of the renin-angiotensin-aldosterone system in healthy dogs.

Benazepril exhibits a dose-dependent effect on biomarkers of the circulating renin-angiotensin-aldosterone system (RAAS) in dogs. To characterize the dose-exposure-response relationship of a fixed-dose combination product including benazepril and spironolactone (CARDALIS®) on RAAS biomarkers in dogs. Eighteen purpose-bred healthy beagle dogs. Three groups of 6 dogs received different doses of CARDALIS® for 14 days following induction of RAAS activation by feeding a low-sodium diet: (a) benazepril 0.25 mg/kg + spironolactone 2 mg/kg PO q24h (label dose); (b) benazepril 0.25 mg/kg + spironolactone 2 mg/kg PO q12h; or (c) benazepril 0.5 mg/kg + spironolactone 4 mg/kg PO q12h. Blood samples were collected at baseline and serial time intervals after CARDALIS® dosing to measure serum RAAS biomarkers and plasma concentrations of active drug metabolites. Time-weighted averages for serum RAAS biomarkers after CARDALIS® dosing at steady state were compared between dosage groups using Wilcoxon rank-sum testing. Compared to the label dose, the highest dose of CARDALIS® was associated with a 30% decrease in angiotensin II (P = .03), 94% increase in angiotensin 1-7 (P = .03), 71% decrease in surrogate activity of ACE (P = .002), and 116% increase in circulating aldosterone (P = .02). CARDALIS® was well-tolerated at all doses with no clinically relevant changes in renal values or serum electrolytes. The combined CARDALIS® product leads to dose-dependent alterations of RAAS metabolites. These results could help inform clinical trials in dogs with heart disease.

Lefser: Implementation of metagenomic biomarker discovery tool, LEfSe, in R.

LEfSe is a widely used Python package and Galaxy module for metagenomic biomarker discovery and visualization, utilizing the Kruskal-Wallis test, Wilcoxon Rank-Sum test, and Linear Discriminant Analysis. R/Bioconductor provides a large collection of tools for metagenomic data analysis but has lacked an implementation of this widely-used algorithm, hindering benchmarking against other tools and incorporation into R workflows. We present the lefser package to provide comparable functionality within the R/Bioconductor ecosystem of statistical analysis tools, with improvements to the original algorithm for performance, accuracy, and reproducibility. We benchmark the performance of lefser against the original algorithm using human and mouse metagenomic datasets. Our software, lefser, is distributed through the Bioconductor project (https://www.bioconductor.org/packages/release/bioc/html/lefser.html), and all the source code is available in the GitHub repository https://github.com/waldronlab/lefser. Institute for Implementation Science in Population Health, Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, United States. E-mail: Sehyun.Oh@sph.cuny.edu (S.O.). Supplementary data are available at Bioinformatics online.

Exploring the impact of 3,3’-diindolylmethane on the urinary estrogen profile of premenopausal women

Background3,3’-diindolylmethane (DIM) is a phytonutrient derived from cruciferous vegetables that is an often-used supplement in the complementary and alternative medicine space. The most common goal for providers when recommending DIM to their patients is to alter estrogen metabolism, yet research into DIM’s effect on the estrogen profile is lacking in the published literature. The objective of this study was to comprehensively evaluate DIM’s effect on the urinary estrogen profile.MethodsIn this retrospective cohort study, we analyzed data from a clinical laboratory, including urinary estrogen and estrogen metabolite concentrations. Analyte concentrations were determined from dried urine samples using a gas chromatography-tandem mass spectrometry assay. Individuals were separated into two groups, either reporting taking DIM (N = 909) or reporting not taking DIM (N = 18,385). Comparisons between individuals in these two groups were made using the Wilcoxon rank sum test. Additionally, we were also able to explore a subset of women who had laboratory results in the database before and after initiating DIM treatment (N = 53). In this subset, differences were assessed with Wilcoxon signed rank tests.ResultsIn the larger group that was separated into women reporting either DIM use or no use, significant differences were observed in the concentrations of almost every urinary estrogen and estrogen metabolite (with the only exception being 2-methoxyestrone) in the urinary estrogen profiles of those taking DIM compared to those not taking DIM (all P values < 0.001). In the smaller subset of individuals with results before and after initiating DIM use, differences were only seen in 4 of the urinary estrogens and estrogen metabolites (P < 0.001 for estrone, estradiol, estriol, and 16-hydroxyestrone). Differences in total estrogens were significant in both the larger group and the smaller subset (both with P < 0.001). Additionally, observed differences in the ratios of metabolites followed a similar trend with more significant differences observed in the larger group. Notably, the 2-hydroxyestrone:16-hydroxyestrone ratio increased significantly in both the larger group and the smaller subset with results before and after DIM use.ConclusionsThe results of this study provide the most comprehensive evaluation to date of DIM’s effect on the urinary estrogen profile. Additionally, the results demonstrate that the dried urine collection and accompanying assay used capture changes that are similar in direction, but not necessarily magnitude, to previous reports in the literature. Considered together, these two things highlight the clinical validity and utility of this approach to the evaluation of DIM supplementation and suggest the need for additional studies using this approach to fully understand the potential clinical utility of DIM.

The Hidden "Ear-Way": A Cohort Analysis of Otologic Manifestations in Aspirin Exacerbated Respiratory Disease.

This study aims to report otologic manifestations in a cohort of patients with aspirin exacerbated respiratory disease (AERD) to determine if severity of sinonasal inflammation is associated with presence of otologic sequalae (OS). All AERD patients treated at a tertiary care center between 2009 and 2016 were included in analysis. Demographics, history of hearing loss, Lund-Mackay (LMK) scores, number of previous sinus procedures, CT findings, and pure tone averages (PTA) were compared between patients with and without OS using chi-square test, Fisher's exact test, and Wilcoxon rank sum test. Of 255 AERD patients, 58.4% were female with a mean age of 48.9 (SD: 13.4) years. The majority (52.2%) had otologic manifestations, most commonly: otitis media requiring antibiotics (n = 89, 34.9%), peripheral vertigo (n = 59, 23.1%), and middle ear effusion (n = 44, 17.3%). A total of 74 patients (29.0%) had hearing loss. PTA ranged from 13.3 to 61.7 dB for the cohort, with no significant difference between those with and without OS. There was no significant difference in LMK in both groups. Patients with OS had a significantly greater number of sinus procedures than those without OS (median = 2.4 and 1.8 respectively; P = .01). Otologic manifestations are common in patients with AERD. While there was an increased number of sinonasal surgeries performed in the patients with OS, there was no correlation between sinonasal inflammation, and the presence of OS as measured by LMK score or PTA. Otologic signs and symptoms should be considered in patients with AERD to help mitigate patient morbidity. III.

Assessing the impact of COVID-19 on outpatient psychiatric population well-being and symptomology utilizing COVID-19 Events Checklist (CEC) and Measurement Based Care

BackgroundThis study examines the impact of SARS-CoV-2 (i.e., coronavirus, COVID, COVID-19) using data from a measurement-based care (MBC) system utilized in an outpatient psychiatric clinic providing telemedicine care. A novel Patient Rated Outcome Measure (PROM), the COVID-19 Events Checklist (CEC) was administered in a hospital system based ambulatory clinic beginning April 2020 to track COVID-19-19’s impact on patients’ mental, emotional, and health-related behaviors during the pandemic. The study (1) provides descriptive CEC data, and (2) compares CEC results with PROMs evaluating anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire; PHQ-9), and psychological distress (Brief Adjustment Scale-6; BASE-6).MethodsThis retrospective observational study included patient intake data collected from April 2020 to March 2021. Patient (N = 842) reports on the CEC’s five domain questions were aggregated to calculate average reports of COVID-19 related impacts at intake over the initial 12 months of the pandemic. Trends in COVID-19 related impacts were examined, and non-aggregated scores on the PHQ-9, GAD-7, and BASE-6 were compared to primary dichotomous (yes/no) CEC survey questions via Wilcoxon rand sum testing.ResultsResults capture the relationship between COVID-19 exposure, COVID-19- related sequelae and behaviors, and psychological symptom severity. Specifically, Wilcoxon rank-sum tests indicate that social determinants of health (SDOH), negative mental health impacts, and positive coping skill use were significantly associated with psychological symptomatology including overall psychological functioning via the BASE-6, anxiety via the GAD-7, and depressive symptoms via the PHQ-9. Results regarding SDOH were as follows: BASE-6 (w = 44,005, p < 0.001), GAD-7 (w = 44,116, p < 0.001), and PHQ-9 (w = 43,299, p < 0.001). Regarding negative mental health outcomes, the results were: BASE-6 (w = 38,374, p < 0.001), GAD-7 (w = 39,511, p < 0.001), and PHQ-9 (w = 40,154, p < 0.001). As the initial year of the pandemic elapsed, incoming patients demonstrated increased rates of suspected or confirmed exposure to COVID-19, (+2.29%, t = 3.19, p = 0.01), reported fewer negative impacts of COVID-19 on SDOH (−3.53%, t= −2.45, p = 0.034), and less engagement in positive coping strategies (−1.47%, t = −3.14, p = 0.010).ConclusionsPsychosocial factors related to COVID-19 are discussed, as well as opportunities for further research on the relationship between psychological symptomatology and the impact of COVID-19 on health-related behaviors.

Timing of Palliative Care Consultation and End-of-Life Care Intensity in Pediatric Patients With Advanced Heart Disease: Single-Center, Retrospective Cohort Study, 2014-2022.

Pediatric patients with advanced heart disease (AHD) often receive high intensity medical care at the end of life (EOL). In this study, we aimed to determine whether receipt and timing of pediatric palliative care (PPC) consultation was associated with EOL care intensity of pediatric patients with AHD. Retrospective cohort study. Single-center, 16-bed cardiac ICU (CICU) in a children's hospital in the Mountain West. Pediatric patients (0-21 yr) with AHD treated in the CICU and subsequently died from January 2014 to December 2022. None. We compared demographics, EOL characteristics and care, including medical interventions and mortality characteristics for patients by receipt and timing of PPC (i.e., ≥ 30 d from [early] or < 30 d of death [late]) using chi-square and Wilcoxon rank-sum tests. Of 218 patients, 78 (36%) did not receive PPC, 76 received early PPC (35%), and 64 received late PPC (29%). Compared with patients who did not receive PPC, patients receiving PPC had lower EOL care intensity (77% vs. 96%; p = 0.004) and fewer invasive interventions within 14 days of death (74% vs. 92%; p = 0.004). Receipt of PPC, vs. not, was associated with lower rate of death during cardiopulmonary resuscitation (12% vs. 32%; p = 0.004) and more use of comfort care (23% vs. 3%; p = 0.004). Among patients receiving PPC, early PPC was associated with fewer invasive interventions within 14 days of death (65% vs. 85%; p = 0.033). Care intensity was high for patients with early and late PPC. Early PPC was associated with fewer invasive interventions within 14 days of death, yet the care intensity at EOL remained high. With early PPC, families likely receive timely psychosocial and advance care planning support without significantly altering goals of care.

Multi-omics analysis reveals the role of the autophagy-related gene AGT in chemotherapy resistance in colorectal cancer and the therapeutic potential of its inhibitors.

Autophagy is a crucial mechanism for maintaining cellular homeostasis and responding to environmental stress, and it is closely linked to tumor drug resistance. Through multi-omics analysis, this study explores the expression patterns, functions, and potential role of the autophagy-related gene Angiotensinogen (AGT) in colorectal cancer (CRC), particularly in relation to chemotherapy resistance. This study first compared AGT expression between CRC and normal tissues using the GTEx and TCGA databases. Differences in expression were assessed using Wilcoxon Rank Sum Tests, and the prognostic impact of AGT was evaluated through univariate Cox survival analysis and meta-analysis. Functional enrichment was performed using the limma and fgsea packages. Drug sensitivity analysis was conducted based on the CTRP database, while immune infiltration was assessed using the CIBERSORT and ESTIMATE methods. Spatial transcriptomic characteristics were explored through 10x Visium technology and deconvolution analysis to investigate the correlation between AGT expression levels and tumor cell content.scRNA-seq data from CRC tissues were sourced from Tumor Immune Single Cell Hub (TISCH).Functional annotation was performed with Single-sample gene set enrichment analysis (SSGSEA), and pseudotime analysis using Monocle 2 mapped their developmental trajectories. The potential of AGT inhibitors in the treatment of CRC was analyzed using drug-target Mendelian randomization.Finally, Phenome-Wide Association Study (PheWAS) was conducted to evaluate genetic associations and potential side effects of AGT inhibitors. AGT expression was significantly higher in CRC tissues compared to normal tissues and was associated with shorter recurrence-free survival (RFS). Autophagy signaling pathways were markedly enriched in the high AGT expression group. AGT expression was positively correlated with resistance to chemotherapeutic agents such as gemcitabine, cisplatin, paclitaxel, and 5-fluorouracil. Spatial transcriptomic analysis revealed that AGT was predominantly expressed in malignant tumor regions. Single-cell analysis identified 21 distinct cell subpopulations across 13 major types. AGT expression was significantly higher in tumor samples, especially in the fibroblast C6 subpopulation. Tumor-related pathways were enriched in C1, C5, C6, and C8 subpopulations. Pseudotime analysis revealed that these subpopulations, particularly C6, were in terminal developmental stages.Drug-target Mendelian randomization analysis indicated a negative causal relationship between AGT inhibitors and the risk of both heart failure(ORdrug = 0.950, 95% CI, 0.912-0.990; P = 0.014) and CRC(ORdrug = 0.874, 95% CI: 0.792-0.964; P = 0.007).PheWAS analysis showed no genetic associations between AGT inhibitors and other traits, indicating its specificity and low risk of side effects. Elevated AGT expression in CRC is associated with resistance to chemotherapy, and its inhibition may offer a therapeutic avenue for the treatment of colorectal cancer.

Screen exposure status and related factors in children with epilepsy

To understand the status of screen exposure in children with epilepsy and analyze the influencing factors for screen exposure time, providing a scientific basis for managing screen exposure in these children. A convenience sampling method was used to select 275 children with epilepsy from outpatient clinics or those undergoing 24-hour electroencephalogram monitoring at two tertiary hospitals in Jinan from March to June 2023. Their parents (fathers or mothers) completed a questionnaire to collect data on screen exposure, parental screen regulation behaviors, and related information about the children and their families. The Wilcoxon rank-sum test or the Kruskal-Wallis H test was used to conduct a univariate analysis of the average screen exposure time of children on school days and weekends, as well as the daily average screen exposure time. A multivariate logistic regression analysis was used to identify the risk factors for children whose screen exposure time exceeded the recommended guidelines (average screen exposure time on school days >1 hour or average on weekends >2 hours). The median screen exposure duration on school days was 40 minutes, while on weekends it was 120 minutes. Among the children studied, 23.1% (63/273) had average screen exposure time exceeding 1 hour on school days, and 42.5% (117/275) had average screen exposure time exceeding 2 hours on weekends. Four children experienced seizures while using screen devices. Multivariate logistic regression analysis indicated that using screen devices shortly before sleep, lower educational levels of parents, caregivers discussing screen content with children, and longer seizure durations in children were risk factors for exceeding recommended guidelines (P<0.05). Some children with epilepsy have a screen exposure time exceeding the recommended guidelines. A longer seizure duration, lower parental education levels, and permissive digital parenting are closely associated with children's screen exposure time exceeding the recommended guidelines. Families and children exhibiting these characteristics should be prioritized for attention and health education.

Fractures in the Transgender Population: A Retrospective Study

Introduction. While data on the bone health of transgender individuals exist, less is known about related fractures. The authors aimed to compare the anatomic locations of and impact of co-morbidities on fractures between transgender and cisgender populations at a single institution. Methods. The authors conducted a retrospective chart review of patients with fractures at a single institution between January 2020 and January 2021. Demographics, fracture locations, and comorbidities were identified and compared between cisgender and transgender individuals. Statistical analyses included χ2 or Fisher exact tests for proportions and independent t-tests or Wilcoxon rank-sum tests for continuous measures. Results. Transgender patients, compared to cisgender patients, were younger (W=258823, p&lt;0.001) and had a higher incidence of shoulder/upper arm fractures (10/26 [38%] vs 1,847/12,463 [15%], p=0.003) but no lumbar spine fractures. There were no other significant differences in fracture locations. The transgender group had a higher prevalence of depression (14/26 [54%] vs 2,696/12,463 [22%], p&lt;0.001), while hypertension was more common in the cisgender population (6,211/12,463 [50%] vs 5/26 [19%], p=0.003). While most fractures in the transgender group were not due to high-energy trauma, none of the individuals had a history of bone mineral density disorders. Conclusions. Our findings show that there were no significant differences in fracture locations between transgender and cisgender patients, except at one site. Larger studies, including longitudinal prospective studies, are needed to better understand bone health and fracture risk among transgender patients, particularly regarding changes over time with gender-affirming treatment.

Multi-strategy cooperative enhancement dung beetle optimizer and its application in obstacle avoidance navigation

Path planning is a crucial component of unmanned driving systems designed to address the challenge of autonomous navigation. This article introduces a novel approach called the multi-strategy cooperative enhanced dung beetle optimization algorithm (RCDBO) and applies it to dispose of path planning issues. Its primary aim is to mitigate the shortcomings of the fundamental dung beetle optimization algorithm (DBO), namely, its tendency to prematurely converge to local optima and its limited global planning capability. Initially, population initialization leverages Bernoulli-based chaotic mapping to enhance diversity and ensure uniform randomness, thereby improving both the quality of initial solutions and optimization efficiency. Subsequently, a random walk strategy is employed to perturb the rolling behavior of the dung beetle population during the initial stage, thus mitigating potential algorithmic local stagnation. Finally, adopting a vertical and horizontal crossover strategy introduces perturbations to the current best value of the dung beetle population, thereby enhancing the DBO method’s global optimization capability during the later stages of evolution. The RCDBO method was evaluated against several well-established swarm intelligence algorithms using twelve benchmark test functions, the CEC2021 test suite, the Wilcoxon rank-sum test, and the Friedman test, to rigorously assess its feasibility. Additionally, the effectiveness of each strategy within the RCDBO framework was validated, and the algorithm’s capability to achieve an optimal balance between global exploration and local exploitation was systematically analyzed through the CEC2021 test suite. Furthermore, in path planning simulation experiments targeting maps of varying sizes and complexities, the RCDBO algorithm, compared to the basic DBO algorithm, results in shorter planned path lengths. In simpler map environments, it exhibits fewer turning points and smoother paths, indicating that the RCDBO algorithm also possesses certain advantages in addressing path-planning challenges.

Assessing the Performance of Artificial Intelligence Assistance for Prostate MRI: A Two-Center Study Involving Radiologists With Different Experience Levels.

Artificial intelligence (AI) assistance may enhance radiologists' performance in detecting clinically significant prostate cancer (csPCa) on MRI. Further validation is needed for radiologists with different experiences. To assess the performance of experienced and less-experienced radiologists in detecting csPCa, with and without AI assistance. Retrospective. Nine hundred patients who underwent prostate MRI and biopsy (median age 67 years; 356 with csPCa and 544 with non-csPCa). 3-T and 1.5-T, diffusion-weighted imaging using a single-shot gradient echo-planar sequence, turbo spin echo T2-weighted image. CsPCa regions based on biopsy results served as the reference standard. Ten less-experienced (<500 prostate MRIs) and six experienced (>1000 prostate MRIs) radiologists reviewed each case twice using Prostate Imaging Reporting and Data System v2.1, with and without AI, separated by 4-week intervals. Cases were equally distributed among less-experienced radiologists, and 90 cases were randomly assigned to each experienced radiologist. Reading time and diagnostic confidence were assessed. Area under the curve (AUC), sensitivity, specificity, reading time, and diagnostic confidence were compared using the DeLong test, Chi-squared test, Fisher exact test, or Wilcoxon rank-sum test between the two sessions. A P-value <0.05 was considered significant. Adjusting threshold using Bonferroni correction was performed for multiple comparisons. For less-experienced radiologists, AI assistance significantly improved lesion-level sensitivity (0.78 vs. 0.88), sextant-level AUC (0.84 vs. 0.93), and patient-level AUC (0.84 vs. 0.89). For experienced radiologists, AI assistance only improved sextant-level AUC (0.82 vs. 0.91). AI assistance significantly reduced median reading time (250 s [interquartile range, IQR: 157, 402] vs. 130 s [IQR: 88, 209]) and increased diagnostic confidence (5 [IQR: 4, 5] vs. 5 [IQR: 4, 5]) irrespective of experience and enhanced consistency among experienced radiologists (Fleiss κ: 0.53 vs. 0.61). AI-assisted reading improves the performance of detecting csPCa on MRI, particularly for less-experienced radiologists. 3 TECHNICAL EFFICACY: Stage 2.

Discriminating Parkinson’s disease patients from healthy controls using nasal respiratory airflow

BackgroundBreathing patterns may inform on health. We note that the sites of earliest brain damage in Parkinson’s disease (PD) house the neural pace-makers of respiration. We therefore hypothesized that ongoing long-term temporal dynamics of respiration may be altered in PD.MethodsWe applied a wearable device that precisely logs nasal airflow over time in 28 PD patients (mostly H&Y stage-II) and 33 matched healthy controls. Each participant wore the device for 24 h of otherwise routine daily living.ResultsWe observe significantly altered temporal patterns of nasal airflow in PD, where inhalations are longer and less variable than in matched controls (mean PD = −1.22 ± 1.9 (combined respiratory features score), Control = 1.04 ± 2.16, Wilcoxon rank-sum test, z = −4.1, effect size Cliff’s δ = −0.61, 95% confidence interval = −0.79 – (−0.34), P = 4.3 × 10−5). The extent of alteration is such that using only 30 min of recording we detect PD at 87% accuracy (AUC = 0.85, 79% sensitivity (22 of 28), 94% specificity (31 of 33), z = 5.7, p = 3.5 × 10−9), and also predict disease severity (correlation with UPDRS-Total score: r = 0.49; P = 0.008).ConclusionsWe conclude that breathing patterns are altered by H&Y stage-II in the disease cascade, and our methods may be further refined in the future to provide an indication with diagnostic and prognostic value.

Correlation of retinal fluid and photoreceptor and RPE loss in neovascular AMD by automated quantification, a real-world FRB! analysis.

To quantify ellipsoid zone (EZ) loss during anti-VEGF therapy for neovascular age-related macular degeneration (nAMD) and correlate these findings with nAMD disease activity using artificial intelligence-based algorithms. Spectral domain optical coherence tomography (Spectralis, Heidelberg Engineering) images from nAMD treatment-naïve patients from the Fight Retinal Blindness! (FRB!) Registry from Zürich, Switzerland were processed at baseline and over 3 years of follow-up. An approved deep learning algorithm (Fluid Monitor, RetInSight) was used to automatically quantify intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED). An ensemble U-net deep learning algorithm was used to automated quantify EZ integrity based on EZ layer thickness. The impact of fluid volumes on EZ thickness and late-stages outcomes were calculated using Wilcoxon rank-sum tests, a linear mixed model and a longitudinal panel regression model. Two hundred and eleven eyes from 158 patients were included. The mean ± SD EZ loss area in the central 6 mm was 1.81 ± 2.68 mm2 at baseline and reached 6.21 ± 6.15 mm2 at month 36. Higher fluid volumes (top 25%) of IRF and PED in the central 1 and 6 mm of the macula were significantly associated with more advanced EZ thinning and loss compared to the low fluid volume subgroup. The high SRF subgroup in the linear regression model showed no statistically significant association with EZ integrity in the central macula; however, the longitudinal analysis revealed an increased EZ thickness with no additional loss. Intraretinal fluid and PED volumes and their resolution pattern have an impact on alteration of the underlying EZ layer. AI-supported quantifications are helpful in quantifying early signs of macular atrophy and providing individual risk profiles as a basis for tailored therapies for optimized visual outcomes.

A Novel Pediatric Clinical Skills Curriculum to Prepare Medical Students for Pediatrics Clerkship

Abstract Introduction Medical students feel poorly prepared to examine pediatric patients during clerkship. Our institution’s introduction to clinical skills course lacked practice with pediatrics physical examination skills. We developed a novel clinical skills curriculum to increase students’ confidence in examining pediatric patients. Methods Ericsson’s deliberate practice conceptual framework guided curriculum design. We utilized a flipped-classroom model to teach the newborn examination. Students watched a video, then practiced with manikins and patients. For the child examination, students attended a lecture and practiced with hospitalized children and facilitators. Students then participated in a Home, Education, Eating/Exercise, Activities/Employment, Drugs, Suicidality, Sexuality, Safety (HEEADSSS) didactic and role play activity. Before and after participation, students completed REDCap surveys ranking confidence in performing pediatric examinations and identifying normal examination findings on a Likert scale (1 = “Not at all confident,” 4 = “Extremely confident”). We analyzed data using Wilcoxon rank sum tests. Results A total of 97 students participated in the curriculum. Respectively, 56 (58%) and 32 (30%) students completed pre- and post-participation surveys. Post-participation, students reported increased confidence in identifying normal infant (median [interquartile range]; (2 [2,2] vs 4 [3,4]; p &lt; 0.001) and child (2 [2,2] vs 3 [3,4]; p &lt; 0.001) examination findings as well as HEEADSSS assessment components (2 [1.5,2] vs 4 [3,4]; p &lt; 0.001), and had significantly higher scores on confidence performing infant (2 [2,2.5] vs 4 [3,4]; p &lt; 0.001), child (2 [2,2] vs 3 [3,4]; p &lt; 0.001), and HEEADSSS assessment (2 [2,3] vs 4 [3,4]; p &lt; 0.001). Discussion This multi-modal curriculum emphasizing pediatric examination skills improved students’ confidence in pediatric-specific knowledge and skills prior to clerkship.

Abstract B003: Dogs with cancer have higher plasma exosome concentrations compared with healthy dogs in the COED (canine osteosarcoma early detection) study

Abstract Background: Osteosarcoma a common cancer in dogs that can serve as a translational model for certain aspects of human osteosarcoma. We previously developed a serum exosome gene signature in dogs with osteosarcoma capable of detecting minimal residual disease and predicting prognosis after therapy. Our goal is to continue expanding our understanding of exosomes for liquid biopsy applications in dogs with cancer, and to leverage this information in the design of liquid biopsy tests to address risk, early detection, and management of human cancer patients. For this study, we hypothesized that dogs with cancer would have higher plasma exosome concentrations compared with healthy control dogs. Methods: Plasma exosomes were enriched from 29 dogs with cancer, including 8 dogs with osteosarcoma, and 26 healthy control dogs. Exosome size and concentration in the plasma samples were characterized with nanoparticle tracking analysis. Wilcoxon rank sum tests were performed to assess differences between groups. Results: Dogs with cancer had a higher mean exosome concentration at 1.4 x 1012 (+/- 1.1 x 1012) particles/ml, compared with 5.0 x 1011 (+/- 2.7 x 1011) particles/ml in healthy control dogs (p = 0.0046). There was no difference in exosome size between dogs with cancer (mean diameter = 99.9 nm) and healthy control dogs (107.8 nm; p = 0.16) when all cancer types were included. However, exosomes enriched from healthy control samples were found to be significantly larger when compared to the exosomes enriched from the subset of cancer dogs that had osteosarcoma (mean exosome diameter = 83.9 nm; p = 0.0065). Similarly, when comparing exosome size between dogs with osteosarcoma and dogs with other cancers, plasma exosomes were larger in the dogs with other cancers (107.4 nm; p = 0.023). Conclusions: In this population, dogs with cancer have higher plasma exosome concentrations compared with healthy control dogs. Interestingly, we also found that dogs with osteosarcoma had significantly smaller exosome size than dogs with other cancers and healthy control dogs. Though the size of exosomes from dogs with osteosarcoma was found to be smaller, it is possible that the larger exosome concentration in dogs with osteosarcoma results in a similar total exosomal mass. Ongoing work includes analysis of exosomal cargo to develop a liquid biopsy test capable of assessing risk of osteosarcoma development in dogs, and applying similar methodology to determine exosomal genes associated with prognosis in pediatric osteosarcoma. The higher exosome concentrations in dogs with cancer suggests that this feature, combined with analysis of exosomal cargo, may have utility in development of a liquid biopsy cancer test in dogs. Citation Format: Kelly M. Makielski, Jaron M. Magstadt, Courtney H. Labe, Ali Khammanivong, Meagan Wojtysiak, Kyle Duval, Mitzi Lewellen, Amber Winter, Kelly Reid, Andrea Chehadeh, Michelle Buettner, Caitlin Feiock, Aaron K. Rendahl, Gary R. Cutter, Logan G. Spector, Brenda J. Weigel, Jaime F. Modiano. Dogs with cancer have higher plasma exosome concentrations compared with healthy dogs in the COED (canine osteosarcoma early detection) study [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 B003.

HPB SO10 - Evaluation of the impact of an Enhanced Recovery Pathway on clinical outcomes after Pancreaticoduodenectomy

Abstract Background Southampton General Hospital (SGH) is a high-volume HPB centre with a well-established Enhanced Recovery After Surgery pathway (ERAS). Despite the morbidity associated with pancreatic surgery, there is a large body of evidence supporting the use of a multi-modal approach to accelerate patient recovery. Within SGH, ERAS is utilised for all patients undergoing Pancreaticoduodenectomy (PD). Initial assessment of the pathway in SGH demonstrated a reduction in length of stay. Since its implementation, ERAS has been modified to optimise the pathway. The aim of this study was to assess whether the impact of ERAS had progressed over time. Method Single centre retrospective analysis of patients undergoing open PD from 2007-2023. Pancreatic reconstruction was with pancreaticojejunostomy. Pre and Post ERAS data were analysed. Post ERAS data was subdivided into Early, Middle and Late implementation time phases. Length of Stay, Complications (Clavien-Dindo Grade 3 and above), Readmissions and Mortality were all examined. Non-parametric data analysis was undertaken with Kruskal-Wallis, Spearman rank correlation and Wilcoxon rank-sum tests. Significance further assessed with Multi-variate regression (MVR). All Data were analysed using STATA. Results Overall, 861 patients underwent an open PD, the yearly volume increasing with time. Mean age was 66 years, which did not change with time. With ERAS implementation, Median Length of Stay (LOS) fell 13 to 9 days (p&amp;lt;0.01) and there was no statistically significant increase in Grade 3 complications or Readmissions (p=0.931, p=0.163). Grade 3 complications increased LOS (p&amp;lt;0.01). Increased age led to a small increase in LOS (p&amp;lt;0.01). Median LOS across Early, Middle and Late ERAS periods was 10, 9 and 9 respectively. LOS did not consistently demonstrate a statistically significant improvement across ERAS phases (MVR p=0.387, K-Wallis p&amp;lt;0.05). Conclusion The implementation of ERAS significantly reduced the median LOS for patients undergoing PD, without increasing their risk of complications or readmissions. This benefit has also been safely maintained across the period of its implementation.