Category: Statistics

Cureus. 2024 May 24;16(5):e61027. doi: 10.7759/cureus.61027. eCollection 2024 May.

ABSTRACT

BACKGROUND: Cognitive communication abilities, such as working memory (WM), are vital for accomplishing daily activities and are also important for higher-order processes such as planning and problem-solving. The current study investigates the simultaneous effect of kapalabhati (KBH) on WM and phasic heart rate variability (HRV).

METHODS: Twenty participants who fulfilled the inclusion and exclusion criteria, with an average age of 23.65±3.07 years (mean±SD), were recruited for the study. Prior to data collection, the participants underwent a seven-day orientation to maintain uniformity in KBH practice. EKGs were assessed using a 16-channel polygraph system arranged in a standard limb lead II configuration. WM was assessed using E-Prime version 2.0 (Psychology Software Tools, Sharpsburg, PA, USA).

RESULTS: There was a significant increase in accuracy after the immediate KBH practice in all three conditions of the WM task (i.e., n-back task: 0-back, 1-back, and 2-back). However, there was also an increase in reaction time. Repeated measures ANOVA of HRV measures showed statistically significant changes in mean rhythm-to-rhythm (RR) intervals, heart rate (HR), number of adjacent N-N intervals over 50 milliseconds (NN50), percentage of successive normal sinus RR intervals greater than 50 milliseconds (pNN50 RR), low frequency (LF), and high frequency (HF), with HR, NN50, pNN50, LF, and HF all significant at p<0.001 and the LF/HF ratio significant at the p<0.01 level.

CONCLUSION: The results of the current study suggest that KBH practice can modulate vagal tone or parasympathetic activity and improve WM performance. Furthermore, the parasympathetic shift found in the present study may promote better cardioprotective health and longevity.

PMID:38915978 | PMC:PMC11194464 | DOI:10.7759/cureus.61027

Cureus. 2024 May 25;16(5):e61048. doi: 10.7759/cureus.61048. eCollection 2024 May.

ABSTRACT

BACKGROUND AND AIM: The coronavirus disease 2019 (COVID-19) pandemic necessitates continuously evaluating antiviral treatments, especially for high-risk groups, including older individuals. This study aimed to compare the efficacy of three antiviral drugs, including remdesivir, molnupiravir, and ensitrelvir, in hospitalized patients as measured by our own institution’s antigen test, focusing on outcomes, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen levels, hospitalization duration, and fever resolution.

METHODS: This retrospective observational study was conducted at Yoshida Hospital, Asahikawa City, Japan, enrolling 154 patients who received antiviral treatment upon COVID-19 diagnosis from July 1, 2022, to September 15, 2023. The diagnosis was confirmed by proprietary antigen tests or loop-mediated isothermal amplification assays. Patients who received treatment outside the hospital or with consistently negative antigen results were excluded. Drug administration was determined by attending physicians, considering oral administration challenges and renal dysfunction. The data were statistically analyzed using an unpaired two-tailed Student’s t-test and one-way analysis of variance complemented by the Tukey post-hoc test for detailed group comparisons.

RESULTS: No significant differences were observed in the initial antigen levels among the treatment groups. By day 10, the ensitrelvir group showed lower antigen levels than the other groups, but not significantly. The ensitrelvir group had a higher antigen-negative conversion rate and a significantly shorter hospital stay than the molnupiravir group. However, no significant differences were noted in the fever resolution time among the groups.

CONCLUSION: This study suggests the potential benefits of ensitrelvir in reducing antigen levels and hospitalization duration. However, the overall efficacy of the antiviral agents for symptomatic relief appears similar. These findings underscore the need for further research to optimize COVID-19 management by considering personalized treatment approaches and long-term outcomes.

PMID:38915977 | PMC:PMC11195001 | DOI:10.7759/cureus.61048

Cureus. 2024 May 24;16(5):e60976. doi: 10.7759/cureus.60976. eCollection 2024 May.

ABSTRACT

Introduction Oral presentation and public speaking skills are poorly emphasised in the medical school curriculum. The student grand round was created to tackle this deficiency by changing the way in which students are taught, from traditional lecture-based learning to interactive small-group peer-to-peer teaching. This approach encourages students to become responsible for their own learning, develop their public speaking and teaching skills, as well as identify and address gaps in their knowledge. Aims The primary aims of this study were to determine the understanding of students before and after peer teaching, including retention of concepts via quiz scores and confidence of students in giving SBAR (Situation, Background, Assessment, Recommendation) handovers. The secondary aim is to determine the place of student-led grand round teaching in the medical curriculum as a means of developing teaching skills and encouraging active learning. Methods A cohort of 21 third-year medical students from Leicester University attended a weekly peer teaching programme where students presented a case they had encountered during their clinical attachment. Peer teachers were required to research some background and pathophysiology regarding the topic and teach in an interactive manner and create discussion regarding the topic. The students then summarised the case and practised the skill of concise handovers using the SBAR format. Knowledge and understanding were assessed with an interactive quiz, and feedback via a survey was gathered before and after sessions. Each student engaged in case discussion and received input from a specialty registrar regarding their presentation skills, case knowledge, and SBAR handover. Results Individual and combined session analysis demonstrated a significant improvement in scores across understanding the topic and confidence in SBAR. Student recommendation for the session cumulatively was significant (p=0.02); however, comparison of medical student recommendations of individual sessions did not yield statistically significant results. There was a significant improvement in the overall quiz score (p=0.045), and average scores improved from 51% to 70% (p=0.043). There was a significant increase in the mean quiz result after the first two sessions (28-55% (p=0.002) and 56-85% (p=0.0001), respectively). Summary The student grand round is a promising teaching initiative that capitalises on peer teaching, a valuable learning theory that centres around students taking on the role of teachers to instruct their peers. Results from this study have shown that this method of collaborative teaching is effective in improving the understanding of medical topics, increases confidence in public speaking and precise handover skills, and therefore better prepares medical students for their career as future clinicians.

PMID:38915976 | PMC:PMC11194139 | DOI:10.7759/cureus.60976

Cureus. 2024 May 24;16(5):e61032. doi: 10.7759/cureus.61032. eCollection 2024 May.

ABSTRACT

INTRODUCTION: Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide, owing to its aggressive nature and poor prognosis. The role of folate receptors, particularly folate receptor 1 (FOLR1) and folate receptor 2 (FOLR2), in cancer has been increasingly recognized due to their overexpression in various malignancies including gastric cancer, and its potential implications in cancer progression, treatment resistance and as therapeutic targets.

OBJECTIVE: To evaluate the expression patterns of FOLR1 and FOLR2 in GC patients’ tissue and blood specimens and to correlate these patterns with clinicopathological variables.

METHODS: A total of 58 gastric cancer patients were enrolled at the Regional Cancer Centre (RCC) from March 2017 to March 2020. Immunohistochemical analysis was performed to examine the expression of FOLR1 and FOLR2 in formalin-fixed paraffin-embedded (FFPE) tissue samples. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was performed to analyze FOLR1 and FOLR2 expression in blood samples. Statistical analyses were conducted using chi-square tests, independent T-tests, and Kaplan-Meier survival analysis.

RESULTS: FOLR1 and FOLR2 were overexpressed in 82.76% and 70.69% of gastric cancer tissues, respectively. High expression levels of FOLR1 were significantly associated with the diffuse type of gastric cancer (p<0.005). qRT-PCR showed significant overexpression of FOLR1 in gastric cancer blood samples compared to control samples, with a median fold change of approximately 14.18 times. Conversely, FOLR2 was significantly underexpressed in gastric cancer samples, with a fold change of 0.30. However, no significant correlation was found between FOLR2 expression and the clinicopathological features. The overall survival analysis did not show a significant difference in survival rates based on the expression levels of FOLR1 and FOLR2.

CONCLUSIONS: This study highlights the differential expression patterns of FOLR1 and FOLR2 in gastric cancer and underscores the complexity of their roles in cancer biology. While FOLR1 shows potential as a biomarker for gastric cancer due to its overexpression, further studies are needed to fully elucidate the therapeutic and prognostic implications of folate receptors in gastric cancer.

PMID:38915965 | PMC:PMC11194536 | DOI:10.7759/cureus.61032

Cureus. 2024 May 24;16(5):e60988. doi: 10.7759/cureus.60988. eCollection 2024 May.

ABSTRACT

Background While two-dimensional (2D) turbo spin echo (TSE) sequences offer better through-plane resolution than three-dimensional (3D) isotropic TSE sequences images, with a narrower thickness of the slice, 3D isotropic TSE sequences are known to have a weaker in-plane resolution as well as blurring of the image. These elements may make it more difficult to distinguish between nearby structures that may affect nerve roots and small nerve roots during spinal imaging. This study aimed to analyze the accuracy of T2 TSE sequence and volumetric isotropic TSE acquisition in determining the indentation of nerve roots and perineural diseases such as nerve sheath tumors and Tarlov cysts. Methods Fifty patients who attended the Department of Radiodiagnosis for magnetic resonance (MR) spine participated in this prospective study. Routine MR lumbosacral (LS) spine sequences, such as survey, coronal T2 short-tau inversion recovery (STIR), sagittal T2 TSE, sagittal T1 TSE, and axial T2 TSE, were carried out after a localizer was acquired. More sequences from volume isotropic turbo spin echo acquisition (VISTA) were acquired. For both 2D and 3D sequences, the visibility ratings for perineural cysts, spinal canal stenosis, and nerve root indentation were evaluated. Visibility ratings ranged from zero to four. Results In the cases of perineural cyst, spinal canal stenosis, and nerve root impingement, the mean difference between the VISTA and T2 TSE visibility scores was 0.04, 0.54, and 0.56, respectively. The VISTA and T2 TS had standard deviation differences of 0.006, 0.026, and 0.06, respectively. The “t” values for nerve root impingement, spinal canal stenosis, and perineural cysts were, in order, 50, 180, and 70. Because the p-value was <0.01, a statistically significant variation has been observed. Conclusion In the diagnosis of neural and perineuronal disorders, the visibility scores for 3D T2 TSE (VISTA) were considerably better than those for 2D T2 TSE in identifying perineural cysts, spinal canal stenosis, and nerve root indentation.

PMID:38915957 | PMC:PMC11195522 | DOI:10.7759/cureus.60988

J Neurointerv Surg. 2024 Jun 24:jnis-2024-021782. doi: 10.1136/jnis-2024-021782. Online ahead of print.

ABSTRACT

BACKGROUND: Carotid web (CaW) is a risk factor for ischemic stroke, mainly in young patients with stroke of undetermined etiology. Its detection is challenging, especially among non-experienced physicians.

METHODS: We included patients with CaW from six international trials and registries of patients with acute ischemic stroke. Identification and manual segmentations of CaW were performed by three trained radiologists. We designed a two-stage segmentation strategy based on a convolutional neural network (CNN). At the first stage, the two carotid arteries were segmented using a U-shaped CNN. At the second stage, the segmentation of the CaW was first confined to the vicinity of the carotid arteries. Then, the carotid bifurcation region was localized by the proposed carotid bifurcation localization algorithm followed by another U-shaped CNN. A volume threshold based on the derived CaW manual segmentation statistics was then used to determine whether or not CaW was present.

RESULTS: We included 58 patients (median (IQR) age 59 (50-75) years, 60% women). The Dice similarity coefficient and 95th percentile Hausdorff distance between manually segmented CaW and the algorithm segmented CaW were 63.20±19.03% and 1.19±0.9 mm, respectively. Using a volume threshold of 5 mm³, binary classification detection metrics for CaW on a single artery were as follows: accuracy: 92.2% (95% CI 87.93% to 96.55%), precision: 94.83% (95% CI 88.68% to 100.00%), sensitivity: 90.16% (95% CI 82.16% to 96.97%), specificity: 94.55% (95% CI 88.0% to 100.0%), F1 measure: 0.9244 (95% CI 0.8679 to 0.9692), area under the curve: 0.9235 (95%CI 0.8726 to 0.9688).

CONCLUSIONS: The proposed two-stage method enables reliable segmentation and detection of CaW from head and neck CT angiography.

PMID:38914461 | DOI:10.1136/jnis-2024-021782

BMJ. 2024 Jun 24;385:q1397. doi: 10.1136/bmj.q1397.

NO ABSTRACT

PMID:38914441 | DOI:10.1136/bmj.q1397

AJNR Am J Neuroradiol. 2024 Jun 24:ajnr.A8393. doi: 10.3174/ajnr.A8393. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: A cleft-like non-enhancing hypointensity was observed repeatedly in the pituitary gland at the adenohypophysis/neurohypophysis border on contrast-enhanced 3D-Fat-Saturated T1-MPRAGE (C+3D-FS-T₁ MPRAGE) using clinical 7T MRI. Our primary goal is to assess the prevalence of this finding. The secondary goals are to evaluate the frequency of other incidental pituitary lesions, MRI artifacts, and their effect on pituitary imaging on the C+3D-FS-T₁ MPRAGE at 7T.

MATERIALS AND METHODS: 100 patients who underwent 7T neuroimaging between 10/27/2021 and 8/10/23 were included. Each case was evaluated for cleft-like pituitary hypointensity, pituitary masses, and artifacts on C+3D-FS-T₁ MPRAGE. Follow-up exams were evaluated if present. The average prevalence for each finding was calculated, as were descriptive statistics for age and sex.

RESULTS: A cleft-like hypointensity was present in 66% of 7T MRIs. There were no significant differences between the “cleft-like present” and “cleft-like absent” groups regarding sex (P = .39) and age (P = .32). The cleft-like hypointensity was demonstrated in follow-up MRIs in 3/3 patients with 7T, 1/12 with 3T, and 1/5 with 1.5T. A mass was found in 22%, while 75% had no mass, and 3% were indeterminate. A mass was found in 18 (27%) of the “cleft-like present” and 4 (13%) of the “cleft-like absent” groups. The most common mass types were Rathke cleft cyst (RCC) in 7 (31.8%) patients, “RCC vs. entrapped CSF” in 6 (27.3%), and microadenoma in 6 (22.2%) in the “cleft-like present” group. There were no significant differences in the mass types between the “cleft-like present” and “cleft-like absent” groups (P = .23). Susceptibility and/or motion artifacts were frequent in general using C+3D-FS-T₁ MPRAGE (54%). Artifact-free scans were significantly more frequent in the “cleft-like present” group (P =.03).

CONCLUSIONS: A cleft-like non-enhancing hypointensity was frequently seen on the C+3D-FS-T1 MPRAGE at 7T MRI, which most likely represents a normal embryological Rathke’s cleft remnant and cannot be seen in lower field strength MRIs. Susceptibility and motion artifacts are common in the sella. They may affect image quality, and the artifacts at 7T may lead to an underestimation of the prevalence of Rathke cleft and other incidental findings.

ABBREVIATIONS: C+3D-FS-T ₁MPRAGE = Contrast-Enhanced 3D-Fat-Saturated T₁-Magnetization Prepared Rapid Gradient Echo Imaging; RCC = Rathke’s Cleft Cyst.

PMID:38914432 | DOI:10.3174/ajnr.A8393

BMJ. 2024 Jun 24;385:q1353. doi: 10.1136/bmj.q1353.

NO ABSTRACT

PMID:38914429 | DOI:10.1136/bmj.q1353

Clin Exp Optom. 2024 Jun 24:1-5. doi: 10.1080/08164622.2024.2371360. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Isotretinoin has been the best treatment option for moderate and severe acne vulgaris since the 1980s. Some studies have shown evidence of subclinical anterior segment involvement of the eye in patients treated with isotretinoin.

BACKGROUND: This study aimed to evaluate lens clarity with the densitometry software of Scheimpflug tomography in patients treated with isotretinoin and to compare with healthy control subjects.

METHODS: Thirty-seven acnepatients treated with isotretinoin who met the inclusion criteria (24 males and 13 females, mean age 22.94 ± 4.21 years) and 39 healthy control subjects were included in the study. Clinical characteristics of the isotretinoin and control subjects were recorded. Lens density was evaluated with the densitometry software of the Scheimpflug tomography device (PentacamHR, Oculus, Wetzlar, Germany).

RESULTS: There was no statistically significant difference between the groups in age, gender distribution, spherical equivalent, or anterior segment parameters measured by the Pentacam system (p > 0.05 for all). Lens density values in zones 2 and 3 were significantly higher in the isotretinoin group (p = 0.042, p < 0.001) and positively correlated with cumulative isotretinoin dose (zone 2: r = 0.384, p = 0.032; zone 3: r = 0.384, p = 0.005).

CONCLUSION: Zone 2 and zone 3 lens density are higher in patients treated with isotretinoin when compared to healthy controls.

PMID:38914426 | DOI:10.1080/08164622.2024.2371360