Compromised Item Detection for Computerized Adaptive Testing

Item leakage has been a serious issue in continuous, computer-based testing, especially computerized adaptive testing (CAT), as compromised items jeopardize the fairness and validity of the test. Strategies to detect and address the problem of compromised items have been proposed and investigated, but many solutions are computationally intensive and thus difficult to apply in real-time monitoring. Recently, researchers have proposed several sequential methods aimed at fast detection of compromised items, but applications of these methods have not considered various scenarios of item leakage. In this paper, we introduce a model with a leakage parameter to better characterize the item leaking process and develop a more generalized detection method on its basis. The new model achieves a high level of detection accuracy while maintaining the type-I error at the nominal level, for both fast and slow leakage scenarios. The proposed model also estimates the time point at which an item becomes compromised, thus providing additional useful information for testing practitioners.

Bacterial Isolate Inhabiting Spitsbergen Soil Modifies the Physiological Response of Phaseolus coccineus in Control Conditions and under Exogenous Application of Methyl Jasmonate and Copper Excess

The aim of the study was to demonstrate the potential of the promotion and regulation of plant physiology and growth under control and copper stress conditions, and the impact of the exogenous application of methyl jasmonate on this potential. Runner bean plants were treated with methyl jasmonate (1 or 10 µM) (J; J1 or J10) and Cu (50 µM), and inoculated with a bacterial isolate (S17) originating from Spitsbergen soil, and identified as Pseudomonas luteola using the analytical profile index (API) test. Above- and under-ground plant parts were analyzed. The growth parameters; the concentration of the photosynthetic pigments, elements, flavonoids (FLAVO), phenolics (TPC), allantoin (ALLA), and low molecular weight organic acids (LMWOAs); the activity of antioxidant enzymes and enzymes of resistance induction pathways (e.g., superoxide dismutase (SOD), catalase (CAT), ascorbate (APX) and guaiacol (GPX) peroxidase, glucanase (GLU), and phenylalanine (PAL) and tyrosine ammonia-lyase (TAL)), and the antioxidant capacity (AC) were studied. The leaves exhibited substantially higher ALLA and LMWOA concentrations as well as PAL and TAL activities, whereas the roots mostly had higher activities for a majority of the enzymes tested (i.e., SOD, CAT, APX, GPX, and GLU). The inoculation with S17 mitigated the effect of the Cu stress. Under the Cu stress and in the presence of J10, isolate S17 caused an elevation of the shoot fresh weight, K concentration, and TAL activity in the leaves, and APX and GPX (also at J1) activities in the roots. In the absence of Cu, isolate S17 increased the root length and the shoot-to-root ratio, but without statistical significance. In these conditions, S17 contributed to a 236% and 34% enhancement of P and Mn, respectively, in the roots, and a 19% rise of N in the leaves. Under the Cu stress, S17 caused a significant increase in FLAVO and TPC in the leaves. Similarly, the levels of FLAVO, TPC, and AC were enhanced after inoculation with Cu and J1. Regardless of the presence of J, inoculation at Cu excess caused a reduction of SOD and CAT activities, and an elevation of GPX. The effects of inoculation were associated with the application of Cu and J, which modified plant response mainly in a concentration-dependent manner (e.g., PAL, TAL, and LMWOA levels). The conducted studies demonstrated the potential for isolate S17 in the promotion of plant growth.

Iron mediated hematological, oxidative and histological alterations in freshwater fish Labeo rohita

Iron is an essential element for many physiological functions of several organisms but in excess it causes toxicity. High iron content in water bodies of mountainous states is considered as one of the major factor, responsible for low productivity in aquaculture systems. But, till date comprehensive reports on the adverse effect of iron overload in aquatic organisms, especially cultured fishes are scanty. Therefore, the present study was undertaken to investigate the adverse effects of iron overload in economically important aquaculture fish species Labeo rohita. Three sub-lethal test concentration of iron (ferrous) viz., 1/16th, 1/8th and 1/4th of LC₅₀ (post 96 h) i.e. 8.25, 16.51 and 33.01 mg L^-1, respectively, were used for in vivo exposure. Blood cells and tissue samples of the control & exposed specimens were sampled at intervals of 24, 48, 72 and 96 h to assess alterations in hematological, oxidative stress and histological parameters. Significant changes in erythrocyte and leukocyte counts, hemoglobin, lipid peroxidation, antioxidant enzyme activity (super oxide dismutase and catalase) and tissue iron accumulation were observed in the exposed fish. Significant increase in lipid peroxidation, coupled with significant reduction in free radicals scavengers like super oxide dismutase and catalase revealed a compromised anti-oxidative defense mechanism in the fishes exposed to iron overload. Histological examination of gills and liver showed severe tissue injury and histological alternations. Severity was found to increase in time and concentration dependent manner. Perl's staining revealed accumulation of excess iron in liver of the exposed fish. The observed patho-physiological changes in the present study provide the most comprehensive insight of iron overload stress in L. rohita.

Role of biocontrol yeasts Debaryomyces hansenii and Wickerhamomyces anomalus in plants' defence mechanisms against Monilinia fructicola in apple fruits

The role of killer yeasts of the species Debaryomyces hansenii and Wickerhamomyces anomalus in biocontrol of Monilinia fructicola, and their involvement in plant defence mechanisms against brown rot in apple fruits, were investigated. D. hansenii KI2a and W. anomalus BS91 strains showed the highest in vitro biocontrol activity, inhibiting mycelium growth by 69.53% and 66.08% respectively, as compared to control fungal cultures. Brown rot on apple fruits was significantly reduced by BS91 and two strains of D. hansenii KI2a and AII4b by 92.46%, 85.10% and 70.02%, respectively, in comparison to infected fruits, which did not receive any pre-treatment. In enzymatic tests, the most significant changes in peroxidase (POD) and catalase (CAT) activities were observed in fruits inoculated either with BS91 followed by M. fructicola infection or with AII4b yeast strain alone, where POD activities were significantly higher by 67% and 54%, respectively, and CAT activities were significantly lower by 65% and 68%, respectively, than in untreated control fruits. These results confirmed the ability of killer yeasts to influence host-defence related enzyme activities in apple fruit tissue and may suggest that AII4b killer strain has a potential as biocontrol agent prior to infection by triggering immune response mechanisms in plant tissue, whereas BS91 strain is the most effective during pathogen infection and could be used as biocontrol agent in postharvest disease onset. Accordingly, the antagonistic strains of W. anomalus BS91 and D. hansenii KI2a and AII4b could be proposed as active ingredients for the development of biofungicide against M. fructicola.

Determinants of CAT (COPD Assessment Test) scores in a population of patients with COPD in central and Eastern Europe: The POPE study

BACKGROUND

The COPD Assessment Test (CAT) has been proposed to help guide therapy in chronic obstructive pulmonary disease (COPD). It is important to understand the distribution of scores in different COPD populations and their determinants.

METHODS

The POPE study is an international, observational cross-sectional study of COPD subjects in 11 Central and Eastern European countries aimed at characterizing COPD phenotypes. Here we report the analysis of CAT scores with the objective of identifying their determinants, evaluating symptom load and investigating the distribution of scores among the participating countries. Additionally, we investigated the discrepancies between the CAT and modified Medical Research Council (mMRC) scores when used to classify patients according to the GOLD strategy.

RESULTS

The study included 3452 patients (69.2% men, mean forced expiratory volume in 1 s (FEV1% predicted) 52.5%). The mean CAT score was 17.5 (SD = 7.8), ranging from 15.1 in Hungary to 21.2 in Bulgaria. Multiple linear regression analysis showed six variables significantly associated with CAT scores: depression, number of previous exacerbations, 6-min walking distance, FEV1(%), mMRC and country and explained 47.2% of the variance of CAT. According to either CAT or mMRC, up to 23.9% patients would be classified in different GOLD groups.

CONCLUSIONS

The CAT score may be predicted by factors related to COPD severity, depression and exercise capacity, with significant differences in the distribution of CAT scores in different countries. According to our results CAT >10 is not equivalent to mMRC >2 for assessing symptom burden.

TRIAL REGISTRATION

ClinicalTrials.gov, identifier NCT02119494.

Determinants of frailty in primary care patients with COPD: the Greek UNLOCK study

Background

Frailty is a state of increased vulnerability that has a significant risk of unfavorable outcomes such as increased dependency and/or death, but little is known about frailty in people with chronic obstructive pulmonary disease (COPD).

Method

We aimed to determine the prevalence of frailty in COPD patients and to identify the associated risk factors. Two hundred fifty-seven COPD patients enrolled from primary care in Greece between 2015 and 2016. Physicians used structured interviews to collect cross-sectional data including demographics, medical history, symptoms and COPD Assessment Tool (CAT) or modified Medical Research Council Dyspnea scale (mMRC) score. Patients were classified into severity groups according to GOLD 2017 guidelines. Participants completed the The Frail Non-Disabled (FiND) questionnaire, exploring the frailty and disability domains. In the present analyses, frail patients with and without mobility disability were pooled and were compared to non-frail patients. Factors associated with frailty were analyzed using univariate and multivariate logistic regression.

Results

Mean (SD) age was 65 (12.3) with 79% males. The majority of patients suffered with frailty (82%) of which 76.8% had mobility disability. 84.2% were married/with partner and 55.4% retired. 55.6% were current smokers. Uncontrolled disease (≥10 CAT score) was reported in 91.1% and 37.2% of patients had ≥2 exacerbations in the past year. Dyspnea (38%) and cough (53.4%) were the main symptoms. Main comorbidities were hypertension (72.9%), hyperlipidaemia (24.6%) and diabetes (11%).

Risk of frailty was significantly increased with age (OR; 95%CI: 1.05; 1.02–1.08), hypertension (2.25; 1.14–4.45), uncontrolled disease (≥10 CAT score 4.65; 1.86–11.63, ≥2 mMRC score 5.75 (2.79–11.85) or ≥ 2 exacerbations 1.73; 1.07–2.78), smoking cessation (ex compared to current smokers: 2.37; 1.10–5.28) and GOLD status (B&D compared to A&C groups: CAT-based 4.65; 1.86–11.63; mMRC-based: 5.75; 2.79–11.85). In multivariate regression smoking cessation and GOLD status remained significant. Gender, body mass index, occupational or marital status, symptoms and other comorbidities were not significant.

Conclusions

Frailty with mobility disability is common in COPD patients and severity of disease increases the risk. It is possible that frail patients are more likely to quit smoking perhaps because of their disability and uncontolled disease. Routine assessment of frailty in addition to COPD control may allow early interventions for preventing or delaying progression of frailty and improvement in COPD disease.

Using the Patient-Reported Outcomes Measurement Information System (PROMIS) to measure symptom burden reported by patients with brain tumors

BACKGROUND

Children with brain tumors can experience symptom burden throughout their disease continuum. The aim of the study was to evaluate symptom burden reported by children with brain tumors and factors that potentially were associated with their symptoms.

METHODS

Data from 199 children with brain tumors aged 7-22 (mean age = 14 years; 52% males; 76% white) were analyzed. Symptom burden was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) via computerized adaptive testing (CAT)-anxiety, depression, fatigue, mobility, upper extremity function, peer relationship, and cognition. Patients and parents completed Symptom Distress Scales (SDS). Test statistics and ANOVA were used to evaluate relationships between PROMIS measures and potentially influential variables.

RESULTS

Significant results (P < 0.01) showing impact of symptom burden included: PROMIS measures correlated with SDSs reported by patients and parents on all comparisons. Fatigue, mobility, and upper extremity function were associated with Karnofsky functional performance status, number of treatment modalities (0-3), and time since last treatment (≤1 year, >1 year). Fatigue and cognition were associated with educational program (regular classroom without an individualized education plan vs those that had an individualized education plan); mobility and upper extremity function were associated with time since last radiation. Mobility, upper extremity function, and anxiety were associated with time since last chemotherapy.

CONCLUSIONS

Significant associations were found between PROMIS and SDS as well as clinical and demographic characteristics. Brief-yet-precise PROMIS CATs can be used to systematically assess symptom burden experienced by children with brain tumors.

COPD patients' characteristics, usual care, and adherence to guidelines: the Greek UNLOCK study

Purpose

GOLD guidelines classify COPD patients into A–D groups based on health status as assessed by COPD Assessment Test (CAT) or mMRC tools and exacerbations and recommend single or dual long-acting bronchodilators as maintenance therapy, with additional inhaled corticosteroids (ICS) if the disease remains uncontrolled. We aimed to classify primary care COPD patients into A–D groups, assess usual treatment and adherence to guidelines, potential mismatches between CAT-and mMRC-based classification and described symptoms within groups.

Patients and methods

A total of 257 primary care COPD patients were enrolled between 2015 and 2016 in Greece. Physicians used structured interviews to collect cross-sectional data including demographics, symptoms, CAT, mMRC scores, and medications. Patients were classified into A–D groups based on CAT and mMRC, and prevalence of symptoms and medication was estimated within A–D groups. Interviews with physicians were also performed to explore additional issues about treatment and adherence to guidelines.

Results

Mean (SD) age was 65 (12.3) years with 79% males. The majority of patients reported uncontrolled symptoms (91% and 61% with ≥10 CAT or ≥2 mMRC scores, respectively). Thirty-seven percentage had $2 exacerbations in the past year. Group B was the largest followed by Groups D, A, and C. Patients were classified as more severe by CAT than by mMRC. In all groups, the majority were treated with combined long-acting beta agonist/ICS (> 50%). When patients were asked to report their main symptoms, dyspnea and cough were the most important symptoms mentioned, and there was a great variation between the A–D groups. However, Groups A–C reported mainly morning symptoms, whereas Group D suffered symptoms all day. Physicians reported a significant number of barriers to implementing guidelines, eg, frequent lack of guideline updates, access to diagnostic procedures, and prescription-reimbursement issues.

Conclusion

Our study confirms poor adherence to guidelines regarding treatment with an overuse of ICS and important barriers to implementation. A mismatch in classification occurs depending on the tool used, which can mislead clinicians in their choice of treatment.

Possible involvement of alpha B-crystallin in the cardioprotective effect of n-butanol extract of Potentilla anserina L. on myocardial ischemia/reperfusion injury in rat

BACKGROUND

It has been reported that n-butanol extract of Potentilla anserina L (NP) had protective effect against acute myocardial ischemia/reperfusion (I/R) injury in mice. Because of limited phytochemical study on NP, its bioactive compounds and underlying protective mechanisms are largely unclear.

PURPOSE

The purpose of this study was to investigate the major bioactive compounds and possible mechanism for the cardioprotective effect of NP on rat with I/R injury.

METHODS

We analyzed the phytochemical isolation of NP and identified the structure of compounds, which was elucidated by a combination of spectroscopic analyses. An I/R model was established by I-30 min/R-2 h in Sprage-Dawley rats. The rats were given intragastric administration of NP (49.3, 98.6, and 197.2 mg•kg^-1) continuously for 10 days before I/R operation. The morphological changes and apoptosis of cardiomyocytes were observed by H&E staining, Transmission electron microscope and TUNEL staining respectively. The activities or contents of catalase (CAT), superoxide dismutase (SOD), malondialdehyde (MDA) and glutathione (GSH) in plasma were detected. Apoptosis related factors were also measured by RT-PCR and western blot. In order to discover the underlying mechanism of NP on I/R, we performed proteomic analysis using two-dimensional gel electrophoresis (2D-DIGE) and matrix assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF/MS) to describe differential proteins expression. Potential target protein resulted from 2D-DIGE coupled to MALDI-TOF/MS analysis were further confirmed by immunohistochemical staining, RT-PCR, and western blot.

RESULTS

We isolated and identified 14 compounds, of which 7 compounds belong to triterpenes. Rats pretreated with NP showed a significant increase on the activities of GSH, SOD and CAT, and remarkable decrease on the content of MDA. NP significantly inhibited the apoptosis of cardiomyocyte and decreased the expression of Cyt C and cleaved-caspase-3. Proteomic analysis revealed that alpha B-crystallin (CryAB) might participate in the NP protective effect against I/R. NP enhanced the level of pCryAB Ser59, whereas the expression of CryAB was decreased.

CONCLUSION

NP was showed to alleviate I/R injury and inhibit myocardial apoptosis, which might be associated with reduction on oxidative stress and apoptosis. CryAB as a possible target involved in the NP protective effect. This study supplied valuable information to develop novel cardioprotective agents from NP extract.

mRNA expression of antioxidant and biotransformation enzymes in zebrafish (Danio rerio) embryos after exposure to the tricyclic antidepressant amitriptyline

Now-a-days, the occurrence of antidepressant residues in surface waters has become a major concern. Amitriptyline (AMI) has been described to treat depression and other disorders for decades. However, little is known about its effect on non-target organisms. The aim of this study was to assess the potential impact of AMI on the mRNA expression of antioxidant and detoxification enzymes during the early embryonic development of zebrafish (Danio rerio). Fertilized D. rerio embryos were exposed to AMI at concentrations of 300 ng/L and 30 μg/L and sampled 24, 48, 96, and 144 h post fertilization (hpf) to assess the mRNA expressions of cytochrome P450 1A1, glutathione-S-transferase, glutathione peroxidase, superoxide dismutase, and catalase. The time courses of the mRNA expressions of antioxidant and detoxification enzymes revealed characteristic changes during embryonic development causing generally transient changes post hatching; however, AMI did not cause any significant impact except in the case of CAT after 144 h, which was significantly upregulated by the AMI concentration of 30 μg/L. The results suggest that the antidepressant AMI causes only moderate to minor impacts on antioxidant and detoxification enzymes during early embryonic development of the non-target organism D. rerio and that CAT is the only biomarker affected by AMI.

Green Synthesis of Chromium Nanoparticles and Their Effects on the Growth of the Prawn Macrobrachium rosenbergii Post-larvae

This study deals with synthesis of chromium nanoparticles (CrNPs) from potassium dichromate using the aqueous extract of Allium sativum. They were characterized through UV-VIS light, FE-SEM, EDX, XRD, and FT-IR, which revealed uniform, mono-dispersive, and highly stable CrNPs of 31-64-nm size. The Artemia nauplii was enriched with 4.94 mg/L of CrNPs (24-h LC₅₀) at different durations (½, 1, 2, and 4 h) and then fed to Macrobrachium rosenbegii post-larvae (PL) for 30 days as live feed. The results showed that ½- and 1-h enriched Artemia nauplii led to significant improvements in nutritional indices including growth and survival, and concentrations of tissue biochemical constituents, such as total protein, amino acid, carbohydrate, and lipid of M. rosenbergii PL (P < 0.05), which suggests that this concentration of CrNPs was non-toxic to M. rosenbergii PL. This was confirmed by the insignificant alterations recorded in activities of SOD and CAT (P > 0.05) in M. rosenbergii PL fed with ½- and 1-h enriched Artemia nauplii as live feed. After that, SOD and CAT activities started to increase. Therefore, this optimized concentration of CrNPs (4.94 mg/L) is recommended for enrichment of Artemia nauplii for ½-1-h duration as a sustainable material in the nursery of M. rosenbergii.

Psychometric evaluation of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function and Pain Interference Computer Adaptive Test for subacromial impingement syndrome

BACKGROUND

The Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Computer Adaptive Test (CAT) was previously validated for rotator cuff disease and shoulder instability. This study evaluated the psychometric properties of the PROMIS Physical Function (PF) CAT, PROMIS Pain Interference (PI) CAT, and the American Shoulder and Elbow Surgeons (ASES) Shoulder Function Score for subacromial impingement syndrome.

METHODS

PROMIS PF CAT, PI CAT, and ASES (Pain, Function, Total) were collected on all visits for 2 surgeons between January 2016 and August 2016. New patients, aged 18 years and older, were selected by International Classification of Diseases code for impingement syndrome of the shoulder. The mean number of questions answered determined efficiency. Person-item maps were created to determine ceiling and floor effects as well as person reliability. Convergent validity was determined by comparison of PROMIS domains to ASES scores with Pearson correlations.

RESULTS

For PROMIS PF CAT, the mean number of items answered was 4.54 (range 4-12). The ceiling effect was 1.56%, and the floor effect was 3.13%. The person reliability was 0.94. Pearson correlation coefficients between the PF CAT and ASES were 0.664 (ASES Function), 0.426 (ASES Pain), and 0.649 (ASES Total). For PROMIS PI CAT, the mean number of items answered was 4.27 (range 3-11). The ceiling effect was 4.69%, and the floor effect was 8.33%. The person reliability was 0.92. Pearson correlation coefficients between the PI CAT and ASES were: 0.667 (ASES Function), 0.594 (ASES Pain), and 0.729 (ASES Total).

CONCLUSIONS

The psychometric properties of PROMIS PF and PI CATs were favorable for subacromial impingement syndrome.

Methods for studying cultural attraction

Cultural attraction theory (CAT) describes a general evolutionary process, cultural attraction, by which the spread and stability of cultural items (beliefs, practices, artifacts, etc.) result not just from differential reproduction, but also from transformations that systematically favor the reconstruction of cultural items of specific types. In this way, CAT aims to provide a general framework for the study of cultural evolution. In a thoughtful critical analysis, Buskell questions the ability of CAT to provide methodological guidance for research in cultural evolution. Can CAT be used to develop the sort of mid-range theories and models that often drive empirical work? Here we argue that CAT can indeed be used in this way, and we outline the methodological practices that students of cultural attraction have used and are currently developing.

A narrative review of data collection and analysis guidelines for comparative effectiveness research in chronic pain using patient-reported outcomes and electronic health records

Chronic pain is a widespread and complex set of conditions that are often difficult and expensive to treat. Comparative effectiveness research (CER) is an evolving research method that is useful in determining which treatments are most effective for medical conditions such as chronic pain. An underutilized mechanism for conducting CER in pain medicine involves combining patient-reported outcomes (PROs) with electronic health records (EHRs). Patient-reported pain and mental and physical health outcomes are increasingly collected during clinic visits, and these data can be linked to EHR data that are relevant to the treatment of a patient's pain, such as diagnoses, medications ordered, and medical comorbidities. When aggregated, this information forms a data repository that can be used for high-quality CER. This review provides a blueprint for conducting CER using PROs combined with EHRs. As an example, the University of Pittsburgh's patient outcomes repository for treatment is described. This system includes PROs collected via the Collaborative Health Outcomes Information Registry software and cross-linked data from the University of Pittsburgh Medical Center EHR. The requirements, best practice guidelines, statistical considerations, and caveats for performing CER with this type of data repository are also discussed.

Subcellular cadmium distribution and antioxidant enzymatic activities in the leaves of four Hylotelephium spectabile populations exhibit differences in phytoextraction potential

Hylotelephium spectabile with high tolerance to cadmium (Cd) might be a potential candidate for phytoremediation. However, the mechanisms for Cd accumulation and tolerance in H. spectabile are poorly understood. Four H. spectabile populations, namely HB1, HB2, JS, and LN, were selected to investigate their Cd extraction potential and the underlying mechanism of Cd accumulation, focusing on subcellular distribution and antioxidant enzymes. The Cd concentration, bioconcentration factor and transfer factor of the LN was significantly higher than other populations, particularly with increasing Cd exposure, and no obvious growth inhibition observed. Segregation of excessive Cd to Cd-rich granule in LN was much higher than other populations which reveal one possible mechanism of Cd accumulation. A significant increase in superoxide dismutase (SOD) and catalase (CAT) activities with increasing Cd stress suggested SOD and CAT contribute to the Cd tolerance of H. spectabile. LN displayed significantly higher and constant peroxidase (POD) activities than other populations, which indicated that an effective mechanism existed in the LN to cope with Cd stress. Therefore, the subcellular distribution and antioxidant enzymes might play important roles in Cd accumulation and tolerance of H. spectabile. LN possessed high Cd extraction potential, and further studies under field conditions are warranted.

Direct Oral Anticoagulant Drugs: On the Treatment of Cancer-Related Venous Thromboembolism and their Potential Anti-Neoplastic Effect

Cancer patients develop a hypercoagulable state with a four- to seven-fold higher thromboembolic risk compared to non-cancer patients. Thromboembolic events can precede the diagnosis of cancer, but they more often occur at diagnosis or during treatment. After malignancy itself, they represent the second cause of death. Low molecular weight heparins are the backbone of the treatment of cancer-associated thromboembolism. This treatment paradigm is possibly changing, as direct oral anticoagulants (DOACs) may prove to be an alternative therapeutic option. The currently available DOACs were approved during the first and second decades of the 21st century for various clinical indications. Three molecules (apixaban, edoxaban and rivaroxaban) are targeting the activated factor X and one (dabigatran) is directed against the activated factor II, thrombin. The major trials analyzed the effect of these agents in the general population, with only a small proportion of cancer patients. Two published and several ongoing studies are specifically investigating the use of DOACs in cancer-associated thromboembolism. This article will review the current available literature on the use of DOACs in cancer patients. Furthermore, we will discuss published data suggesting potential anti-cancer actions exerted by non-anticoagulant effects of DOACs. As soon as more prospective data becomes available, DOACs are likely to be considered as a potential new therapeutic option in the armamentarium for patients suffering of cancer-associated thromboembolism.

MnSOD, CAT and GPx-3 genetic polymorphisms in coronary artery disease

In this study, we aimed to determine the gene polymorphisms of antioxidant enzymes that determine or affect antioxidant activity in the occurrence of the disease and/or complications during and after the surgery in patients who were decided to undergo coronary artery bypass surgery due to coronary artery disease. Blood samples taken before operation in 26 coronary artery patients who were decided to be operated according to the international procedure and the phenol/chloroform method was used to isolate DNA. DNA samples were amplified by using polymerase chain reaction (PCR) method with specific primers for MnSOD, CAT, GPx-3 antioxidant gene regions. As a result of the increasing process, the PCR products for the purpose of determining gene polymorphism, NGOMIV SMA f and BSA I restriction enzymes were used for MNSOD, CAT and GPx-3 gene region, respectively. Allele frequencies were determined and compared by Chi square test. VV (46.15%) and VA (53.85%) genotype for MnSOD region, i TT (22.22%), TC (16.67%) and CC (61.11%) genotype for CAT region, and CC (12.50%), TC (25%) and TT (62.50%) genotypes for GPx-3 region were obtained. While there was no statistically significant significance in terms of genotypes obtained in MnSOD and GPx-3 gene regions (P > 0.05), a significant difference was found in the CAT gene region in terms of genotypes (P < 0.01). Although oxidative stress is important in relation to cardiovascular diseases and postoperative complications, virtually no study of antioxidant enzymes in gene polymorphism are included in the literature. Work is lacking in relation to the subject.

Measurement Efficiency for Fixed-Precision Multidimensional Computerized Adaptive Tests: Comparing Health Measurement and Educational Testing Using Example Banks

It is currently not entirely clear to what degree the research on multidimensional computerized adaptive testing (CAT) conducted in the field of educational testing can be generalized to fields such as health assessment, where CAT design factors differ considerably from those typically used in educational testing. In this study, the impact of a number of important design factors on CAT performance is systematically evaluated, using realistic example item banks for two main scenarios: health assessment (polytomous items, small to medium item bank sizes, high discrimination parameters) and educational testing (dichotomous items, large item banks, small- to medium-sized discrimination parameters). Measurement efficiency is evaluated for both between-item multidimensional CATs and separate unidimensional CATs for each latent dimension. In this study, we focus on fixed-precision (variable-length) CATs because it is both feasible and desirable in health settings, but so far most research regarding CAT has focused on fixed-length testing. This study shows that the benefits associated with fixed-precision multidimensional CAT hold under a wide variety of circumstances.

The pulmonary artery-aorta ratio: Is it related to quality of life in chronic obstructive pulmonary disease?

INTRODUCTION

Little is known about the relationship between health status and pulmonary artery diameter in chronic obstructive pulmonary disease (COPD) patients. The aim of this study was to evaluate correlation between pulmonary artery-aorta ratio (P-A ratio) and health status of the individuals, using COPD assessment test (CAT).

MATERIALS AND METHODS

In a cross-sectional study, 112 COPD patients were recruited. The severity of COPD was determined by global initiative for obstructive lung disease (GOLD). After digital chest CT scan, the P-A ratio was measured at the level of bifurcation and compared with CAT score, GOLD stage, exacerbation rate and Modified Medical Research Council (MMRC) score.

RESULTS

The average P-A ratio was 0.89 ± 0.16 and 62.5% of patients had ratio less than one. The P-A ratio correlates significantly with different GOLD stages, CAT score and MMRC score (P < .001, P < .001, P < .001, respectively). Compared patients with low P-A ratio (<1), those with high P-A ratio (≥ 1) showed higher CAT score [11.94 ± 5.94 vs 25.17 ± 5.84] (P < .001). The P-A ratio was significantly higher in frequent (≥2) comparing low (<2) exacerbations [1.07 ± 0.07 vs 0.77 ± 0.06] (P < .001).

CONCLUSION

Significant correlations were found between P-A ratio and GOLD, exacerbation rate and health status, using CAT of patients with COPD. These findings also may suggest the potential role of P-A ratio, in the management of COPD patients.

Design and implementation of the Competency Assessment Tool (CAT): user experience usability study

The decision on patients' competency to manage their affairs and take care of themselves requires a rigorous evaluation process and consistency among practice settings. Research indicates there is a lack of resources to guide healthcare and social service professionals in the interprofessional decision-making process that such an evaluation requires. A web-based tool, the Competency Assessment Tool (CAT), was designed to assist professionals in that process. The authors conducted a usability study with a beta version of the CAT. The objectives of this study were to: (1) explore what is needed to support its use in community-based and specialized settings; and (2) identify barriers to and facilitators of implementation. A major concern was the perceived onerous nature of the tool. Participants indicated a need for different versions of the tool, depending on the complexity of the evaluation. They want to be directed to areas in the tool based on their field of expertise and want adjustments to functionalities related to collaborative work. This study highlights the importance of the awareness of User Experience (UX) considerations at the outset of the design process, to limit the impact of required modifications and facilitate implementation in the workplace.

The Investigation of the Antitumor Agent Toxicity and Capsaicin Effect on the Electron Transport Chain Enzymes, Catalase Activities and Lipid Peroxidation Levels in Lung, Heart and Brain Tissues of Rats

Cisplatin is one of the most active cytotoxic agents in cancer treatment. To clarify the interaction with mitochondria, we hypothesize that the activities of mitochondrial electron transport chain (ETC) enzymes succinate dehydrogenase (SDH) and cytochrome c oxidase (COX), nucleotide levels, as well as levels of catalase (CAT) enzyme and membrane lipid peroxidation (LPO) can be affected by cisplatin. There was a significant decrease of both SDH and COX activities in the lung, heart, and brain tissues at the 1st day after cisplatin exposure, and the observed decreased levels of adenosine triphosphate (ATP) and adenosine diphosphate (ADP) in comparison with the control could be because of cisplatin-induced mitochondrial dysfunction. The investigations suggested that cisplatin inhibits SDH, COX, and ATP synthase. The higher LPO level in the studied tissues after 1 and 4 days post-exposure to cisplatin compared to control can be inferred to be a result of elevated electron leakage from the ETC, and reactive oxygen species (ROS) can lead to wide-ranging tissue damage such as membrane lipid damage. Consequently, it was observed that capsaicin may have a possible protective effect on ETC impairment caused by cisplatin. The activities of SDH and COX were higher in heart and brain exposed to cisplatin + capsaicin compared to cisplatin groups, while LPO levels were lower. The investigated results in the cisplatin + capsaicin groups suggested that the antioxidant capacity of capsaicin scavenges ROS and prevents membrane destruction.

Degree of control of patients with chronic obstructive pulmonary disease in Spain: SINCON study

Background

Disease control is an important objective of COPD management. The SINCON study evaluated the level of control in terms of respiratory symptoms and exacerbations in Spanish patients with COPD for ≥2 years.

Methods

SINCON was a descriptive, cross-sectional, multicenter study that assessed degree of control using a combined index comprising COPD assessment test (CAT), modified Medical Research Council dyspnea scale (mMRC), and number of moderate/severe exacerbations in the last year. Based on this score, patients were categorized as “well controlled” or “poorly controlled”. Degree of control was also assessed relative to patient phenotype, setting (primary care [PC] vs respiratory care [RC]), and impact of treatment on morning symptoms.

Results

Of the 481 patients (PC: 307, RC: 174) analyzed, COPD was poorly controlled in 63.2%. Some differences were found between clinical settings: PC patients were more poorly controlled (PC: 66.4% vs RC: 57.5%; P = 0.06) and had higher CAT score (PC: 17.9 vs RC: 15.5; P < 0.05), and higher rate of moderate/severe exacerbations during previous year (PC: 1.5 vs RC: 1.1; P < 0.05), while dyspnea degree was similar in both settings. Regarding phenotypes, non-exacerbators demonstrated better control vs exacerbators. Morning symptoms score improved between waking and 3 h after bronchodilator treatment (P < 0.05), with greater improvements in PC patients (PC: − 6.5 vs RC: − 5.0 points; P < 0.05).

Conclusions

Most COPD patients were poorly controlled with some differences observed between PC and RC settings and between patient phenotypes. Our index may be easily used in PC settings to optimize COPD treatment.

Influence of comorbid heart disease on dyspnea and health status in patients with COPD - a cohort study

Purpose

The aim of this study was to examine the changing influence over time of comorbid heart disease on symptoms and health status in patients with COPD.

Patients and methods

This is a prospective cohort study of 495 COPD patients with a baseline in 2005 and follow-up in 2012. The study population was divided into three groups: patients without heart disease (no-HD), those diagnosed with heart disease during the study period (new-HD) and those with heart disease at baseline (HD). Symptoms were measured using the mMRC. Health status was measured using the Clinical COPD Questionnaire (CCQ) and the COPD Assessment Test (CAT; only available in 2012). Logistic regression with mMRC ≥2 and linear regression with CCQ and CAT scores in 2012 as dependent variables were performed unadjusted, adjusted for potential confounders, and additionally adjusted for baseline mMRC, respectively, CCQ scores.

Results

Mean mMRC worsened from 2005 to 2012 as follows: for the no-HD group from 1.8 (±1.3) to 2.0 (±1.4), (P=0.003), for new-HD from 2.2 (±1.3) to 2.4 (±1.4), (P=0.16), and for HD from 2.2 (±1.3) to 2.5 (±1.4), (P=0.03). In logistic regression adjusted for potential confounding factors, HD (OR 1.71; 95% CI: 1.03-2.86) was associated with mMRC ≥2. Health status worsened from mean CCQ as follows: for no-HD from 1.9 (±1.2) to 2.1 (±1.3) with (P=0.01), for new-HD from 2.3 (±1.5) to 2.6 (±1.6) with (P=0.07), and for HD from 2.4 (±1.1) to 2.5 (±1.2) with (P=0.57). In linear regression adjusted for potential confounders, HD (regression coefficient 0.12; 95% CI: 0.04-5.91) and new-HD (0.15; 0.89-5.92) were associated with higher CAT scores. In CCQ functional state domain, new-HD (0.14; 0.18-1.16) and HD (0.12; 0.04-0.92) were associated with higher scores. After additional correction for baseline mMRC and CCQ, no statistically significant associations were found.

Conclusion

Heart disease contributes to lower health status and higher symptom burden in COPD but does not accelerate the worsening over time.

Evaluating the impact of morning symptoms in COPD using the Capacity of Daily Living during the Morning (CDLM) questionnaire

Purpose

The aim of this study was to evaluate the impact of morning symptoms in COPD using the Capacity of Daily Living during the Morning (CDLM) questionnaire and to determine the clinical variables that are related to CDLM scores.

Methods

This was an observational, cross-sectional, and multicenter study conducted in stable COPD patients. CDLM scores ranged from 0 to 5 and were transformed into a qualitative variable according to tertile values to compare patient characteristics. A multivariate linear regression model was used to identify the clinical variables related to CDLM scores.

Results

A total of 605 patients were included in the study; the mean age (SD) was 68 years (9.1) and mostly were male (80.8%). The mean post-bronchodilator FEV₁% was 53.4% (19.2%), and the mean BODEx (body mass index, airway obstruction, dyspnea, exacerbation) score was 3.2 (2.0). The mean COPD assessment test (CAT) score was 16.6 (8.3), and the mean CDLM score was 4.2 (0.9). First tertile patients, that is, those with a higher impact in the morning, were older, had more respiratory symptoms, more dyspnea, a lower FEV₁%, lower CAT and BODEx scores, and more exacerbations. We found a ceiling effect on the CDLM scores: 194 (32%) patients scored 5.00 and no patients scored 0. On multivariate analysis, higher CAT and BODEx scores, a lower FEV₁%, and use of long-term oxygen therapy (LTOT) were all independently related to lower CDLM scores.

Conclusion

Morning respiratory symptoms are associated with more severe airflow obstruction, lower CAT and BODEx scores, and LTOT. The ceiling effect of the CDLM questionnaire does not allow it to discriminate well between low and high impact of morning symptoms.

Comparison of CAT-21A/T Gene Polymorphism in Women with Preeclampsia and Control Group

Background:

Preeclampsia (PE) is one of the main causes of maternal and perinatal mortality and morbidity. Evidence shows that oxidative stress plays an important role in the pathophysiology of the PE. As catalase is a key enzyme in antioxidant enzymatic defense which protects cell from oxidative damage, in this study, we aimed to investigate the relationship between CAT-21A/T (rs7943316) polymorphism and PE susceptibility.

Materials and Methods:

This case–control study was conducted on 155 PE women and 159 normotensive pregnant women. Polymerase chain reaction-restriction fragment length polymorphism method was used for genotyping.

Results:

There was no association between CAT-21AT and TT genotypes and PE susceptibility. However, the CAT-21A/T polymorphism was associated with 1.6-fold higher risk of PE in dominant model (AA vs. AT + TT) (odds ratio [OR] 1.6 [95% confidence interval [CI]: 0.9–2.9]; P = 0.04). However, the CAT-21A/T polymorphism was not associated with PE in recessive model (TT vs. AA + AT) (OR 1.3 [95% CI: 0.8–2.1]; P = 0.4).

Conclusions:

The CAT-21A/T polymorphism could be a risk factor for PE susceptibility in dominant model.