Publishing nutrition research: a review of multivariate techniques--part 2: analysis of variance

Culture of attenuated Salmonella Typhimurium VNP20009 in animal-product-free media does not alter schwannoma growth control

Schwannomas are slow-growing benign peripheral nerve sheath tumors derived from Schwann-lineage cells that develop in association with NF2-related schwannomatosis (NF2) and schwannomatosis (NF3), as well as spontaneously. Individuals affected with NF2 and NF3 have multiple schwannomas with tumors arising throughout life. Surgical resection, the standard management, is limited in scope and efficacy and is itself associated with significant morbidity. We have previously shown that direct intratumoral injection of attenuated Salmonella Typhimurium (S. Typhimurium), strain VNP20009, showed a potent anti-tumor effect in preclinical NF-2 schwannoma models. The United States Federal Drug Administration (FDA) requires that bacterial products utilized in clinical trials be produced without exposure to animal-derived-products. In this context, we developed, characterized, and tested the antitumor efficacy of an attenuated S. Typhimurium serially passaged in animal-product-free media, naming it VNP20009-AF for "VNP20009-animal-product-free." Our in vitro data did not indicate any significant changes in the viability, motility, or morphology of VNP20009-AF, compared to its parental strain. In vivo efficacy data demonstrated that VNP20009-AF and VNP20009 controlled tumor growth to the same degree in both human NF2-schwannoma xenograft and murine-NF2 schwannoma allograft models. Together, these data support the use of VNP20009-AF for the translation of bacterial schwannoma therapy into clinical trials.

Open Book Exams and Flexible Grading Systems: Post-COVID University Policies from a Student Perspective

Due to COVID-19, many universities have started offering real time video or recorded courses. This situation raises concerns about a decline in students' learning outcomes and issues of unfairness regarding students' exams and grade evaluations. Korean universities have introduced online open book testing in courses and a flexible pass grading system that allows students to select their final grades to improve fairness. This research investigates students' thoughts and reasons for the test and the system through a questionnaire with 109 respondents and statistical methods such as nonparametric tests, multinomial regression and text-mining. Many students supported both the testing and the grading system, presenting balanced viewpoints by comparing their cons and pros. This finding suggests that these policies could be helpful in enhancing fairness in grade evaluation, relieving students of the learning burden and increasing their satisfaction. This study offers the implications that universities must develop standardized exam formats as well as various learning options in a rapidly changing situation with educational innovation (e.g., hyperscale and generative artificial intelligence).

Intratumoral injection of schwannoma with attenuated Salmonella typhimurium induces antitumor immunity and controls tumor growth

Schwannomas are slow-growing benign neoplasms that develop throughout the body causing pain, sensory/motor dysfunction, and death. Because bacterial immunotherapy has been used in the treatment of some malignant neoplasms, we evaluated attenuated Salmonella typhimurium strains as immunotherapies for benign murine schwannomas. Several bacterial strains were tested, including VNP20009, a highly attenuated strain that was previously shown to be safe in human subjects with advanced malignant neoplasms, and a VNP20009 mutant that was altered in motility and other properties that included adherence and invasion of cultured mammalian cells. VNP20009 controlled tumor growth in two murine schwannoma models and induced changes in cytokine and immune effector cell profiles that were consistent with induction of enhanced innate and adaptive host immune responses compared with controls. Intratumoral (i.t.) injection of S. typhimurium led to tumor cell apoptosis, decreased tumor angiogenesis, and lower growth of the injected schwannoma tumors. Invasive VNP20009 was significantly more efficacious than was a noninvasive derivative in controlling the growth of injected tumors. Bacterial treatment apparently induced systemic antitumor immunity in that the growth of rechallenge schwannomas implanted following primary bacterial treatment was also reduced. Checkpoint programmed death-1 (PD-1) blockade induced by systemic administration of anti-PD-1 antibodies controlled tumor growth to the same degree as i.t. injection of S. typhimurium, and together, these two therapies had an additive effect on suppressing schwannoma growth. These experiments represent validation of a bacterial therapy for a benign neoplasm and support development of S. typhimurium VNP20009, potentially in combination with PD-1 inhibition, as a schwannoma immunotherapy.

Schwannoma Gene Therapy via Adeno-Associated Viral Vector Delivery of Apoptosis-Associated Speck-like Protein Containing CARD (ASC): Preclinical Efficacy and Safety

Schwannomas are tumors derived from Schwann-lineage cells, cells that protect and support myelinated nerves in the peripheral nervous system. They are typically slow-growing, encapsulated and benign. These tumors develop along peripheral, spinal and cranial nerves causing pain, sensory-motor dysfunction and death. Primary treatment for schwannoma is operative resection which can be associated with significant morbidity. Pharmacotherapy is largely restricted to bevacizumab, which has minimal or no efficacy for many patients and can be associated with treatment-limiting adverse effects. Given the suffering and morbidity associated with schwannoma and the paucity of therapeutic options, there is an urgent need for safe and effective therapies for schwannomas. We previously demonstrated that adeno-associated virus serotype 1 (AAV1) vector mediated delivery of the inflammasome adaptor protein, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) under the control of the P0 promoter, produced a prolonged reduction in tumor volume and tumor-associated pain in human xenograft and mouse syngeneic schwannoma models. Here, we present data essential for the translation of our AAV1-P0-ASC schwannoma gene therapy to clinical trials. We determine the minimum effective dose of AAV1-P0-hASC required to induce an anti-tumor effect in the xenograft human-schwannoma model. We also show that the presence of preexisting AAV1 immunity does not alter the antitumor efficacy of AAV-P0-mASC in a syngeneic mouse schwannoma model. Furthermore, the maximum deliverable intratumoral dose of AAV1-P0-ASC was not associated with neuronal toxicity in immunocompetent mice. Taken together, these safety and efficacy data support the translation of the AAV1-P0-ASC schwannoma gene therapy strategy to clinical trials.

Pointers and Pitfalls in Interpreting Nutrition and Dietetics Research: The Importance of Statistical and Clinical Significance

This monograph focuses on understanding statistical and clinical significance and is one of a research and statistics series published by the statistical team of the Journal of the Academy of Nutrition and Dietetics. The content covers the research questions, the definition of clinical significance, hypothesis testing, p-values, effect sizes, sample sizes, confidence intervals, power analyses, minimal clinically important differences, and validity. This monograph concludes with a summary of the importance of clinical and statistical results, for nutrition professionals to consider when assessing statistical and clinical significance. The assessment will help readers make subjective clinical judgements in the application of research findings based on their experience.

Awareness and outcomes of the fruits and veggies (FNV) campaign to promote fruit and vegetable consumption among targeted audiences in California and Virginia: a cross-sectional study

Background

In 2015, the Partnership for a Healthier America launched the branded Fruits & Veggies (FNV) Campaign to apply a unique industry-inspired marketing approach to promote fruit and vegetable sales and intake to moms and teens in two US pilot markets: Fresno, California and Hampton Roads, Virginia. The aims of this cross-sectional study were to: 1) assess brand awareness and fruit- and vegetable-related outcomes among FNV Campaign target audiences in the California and Virginia market locations; and 2) examine whether reported awareness of the FNV Campaign was associated with differences in fruit- and vegetable-related cognitive and behavioral outcomes.

Methods

Data for this cross-sectional study were collected using an online survey administered to a non-probability convenience sample (n = 1604; February–July 2017) of youth aged 14–20 years (n = 744) and moms aged 21–36 years (n = 860) in the two pilot markets. Descriptive statistics were computed and outcomes compared between unaware and aware respondents, controlling for sociodemographic covariates. Multivariate analysis of covariance (MANCOVA) was conducted to assess whether fruit- and vegetable-related attitude, belief, and encouragement outcomes differed by FNV Campaign awareness; logistic regression was used to examine associations between FNV brand awareness and dichotomous variables (fruit- and vegetable-related behavioral intentions, trying new fruits and vegetables); and ANCOVA was used to assess associations with daily fruit and vegetable intake frequency.

Results

Approximately 20% (n = 315/1604) of respondents reported awareness of the FNV Campaign. Youth that reported awareness of the FNV Campaign (n = 167, 22.4%) had higher intentions to buy (p = 0.003) and eat (p = 0.009) fruits and vegetables than unaware respondents. Mothers that reported awareness of the FNV Campaign (n = 148, 17.2%) reported greater encouragement for friends and family to eat fruits and vegetables (p = 0.013) and were approximately 1.5 times more likely to report trying a new fruit or vegetable (p = 0.04) than mothers unaware of the Campaign. Daily fruit and vegetable intake frequency did not differ by Campaign awareness.

Conclusions

FNV Campaign awareness was associated with limited but positive short- and intermediate-term cognitive and behavioral outcomes among target audience respondents. These findings can inform future research to enhance understanding and improve the FNV Campaign as it is expanded to new markets nationwide.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11055-6.

Statistical analysis of continuous outcomes from parallel-arm randomized controlled trials in nutrition-a tutorial

Randomized controlled trials (RCTs) play a fundamental role in establishing evidence on benefits of diet changes in nutrition. There is, however, little literature on how to analyze data obtained from such trials. This tutorial provides a detailed introduction to the statistical analysis of parallel-arm RCTs in nutrition by means of modern statistical methodology, i.e., analysis of covariance and linear mixed models are informed using specific information about the trial design. Focus will be on understanding how the trial design and possibly other aspects of the trial influence the subsequent statistical analysis. All steps of the statistical analysis will be covered and a practical example is also provided.

Gene therapy with apoptosis-associated speck-like protein, a newly described schwannoma tumor suppressor, inhibits schwannoma growth in vivo

BACKGROUND

We evaluated apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) as a schwannoma tumor suppressor and explored its utilization in a schwannoma gene therapy strategy that may be translated to clinical use.

METHODS

ASC protein expression and mRNA level were assessed in human schwannoma by immunohistochemistry and quantitative PCR, respectively. Methylation- specific PCR was used to assess ASC promoter methylation. The effect of ASC overexpression in schwannoma cells was evaluated through ATP-based viability, lactate dehydrogenase release, and apoptosis staining. Western blotting and colorimetric assay were used to test the effect of ASC overexpression on endogenous pro-apoptotic pathways. Bioluminescence imaging, behavioral testing, and immunohistochemistry in human xenograft and murine allograft schwannoma models were used to examine the efficacy and toxicity of intratumoral injection of adeno-associated virus (AAV) vector encoding ASC.

RESULTS

ASC expression was suppressed via promoter methylation in over 80% of the human schwannomas tested. ASC overexpression in schwannoma cells results in cell death and is associated with activation of endogenous caspase-9, caspase-3, and upregulation of BH3 interacting-domain death agonist. In a human xenograft schwannoma model, AAV1-mediated ASC delivery reduced tumor growth and resolved tumor-associated pain without detectable toxicity, and tumor control was associated with reduced Ki67 mitotic index and increased tumor-cell apoptosis. Efficacy of this schwannoma gene therapy strategy was confirmed in a murine schwannoma model.

CONCLUSION

We have identified ASC as a putative schwannoma tumor suppressor with high potential clinical utility for schwannoma gene therapy and generated a vector that treats schwannomas via a novel mechanism that does not overlap with current treatments.

Adherence to lifestyle changes after coronary artery bypass graft: Outcome of preoperative peer education

OBJECTIVE

This study was done to investigate the effect of preoperative peer education on patients' adherence to medication and lifestyle changes after Coronary Artery Bypass Graft (CABG).

METHODS

In this randomized clinical trial, the peers of CABG patients conducted preoperative educational sessions at the ward in groups of 4-5 (n = 36) while the control group (n = 34) received routine education by a nurse. Adherence of both groups to medication and recommendations for lifestyle modification including physical activity, smoking, and diet was measured one and two months after discharge.

RESULTS

A multivariate analysis of co-variance showed the significant effect of peer education on adherence (F = 32.586, p < 0.001; η² = 0.671). Univariate ANCOVA revealed a significant difference in adherence to diet between the two groups (F = 62.316, p = 0 0.0001; η² = 0.482). Based on the repeated measures ANOVA, peer education significantly improved the CABG patients' adherence to diet (F = 55.373, p = 0.0001) and their total adherence (F = 9.911, p = 0.002) compared to the control group.

CONCLUSION

Preoperative peer education had a significant effect on improving CABG patients' adherence to lifestyle changes after hospital discharge.

PRACTICE IMPLICATION

Peer education can be used as an effective method to improve the CABG patients ' adherence to lifestyle changes.

Schwannoma gene therapy by adeno-associated virus delivery of the pore-forming protein Gasdermin-D

Schwannomas are peripheral nerve sheath tumors associated with three genetically distinct disease entities, namely sporadic schwannoma, neurofibromatosis type-2, and schwannomatosis. Schwannomas are associated with severe disability and in cases lead to death. The primary treatment is operative resection that itself can cause neurologic damage and is at times contra-indicated due to tumor location. Given their homogenous Schwann-lineage cellular composition, schwannomas are appealing targets for gene therapy. In the present study, we have generated an adeno-associated serotype 1 virus (AAV1)-based vector delivering N-terminal of the pyroptotic gene Gasdermin-D; (GSDMDNterm) under the control of the Schwann-cell specific promoter, P0. we have demonstrated that AAV1-P0-GSDMDNterm injection into intra-sciatic schwannomas reduces the growth of these tumors and resolves tumor-associated pain without causing neurologic damage. This AAV1-P0-GSDMDNterm vector holds promise for clinical treatment of schwannomas via direct intra-tumoral injection.

Changes in Plasma Metabolite Concentrations after a Low-Glycemic Index Diet Intervention

SCOPE

To examine whether a low-glycemic index (LGI) diet improves a set of plasma metabolites related to different metabolic diseases, and comparison to a high-glycemic index (HGI) diet and a low-fat (LF) diet.

METHODS AND RESULTS

A parallel, randomized trial with three intervention diets: an LGI diet, an HGI diet, and an LF diet. A total of 122 adult overweight and obese subjects were enrolled in the study for 6 months. Blood samples were collected at baseline and at the end of the intervention. The plasma metabolomic profile of 102 subjects was analyzed using three different approaches: GC/quadrupole-TOF, LC/quadrupole-TOF, and nuclear magnetic resonance. Both univariate and multivariate analysis were performed. Serine levels were significantly higher following the LGI diet compared to both the HGI and LF diets (q = 0.002), whereas leucine (q = 0.015) and valine (q = 0.024) were lower in the LGI diet compared to the LF diet. A set of two sphingomyelins, two lysophosphatidylcholines, and six phosphatidylcholines were significantly modulated after the LGI diet compared to the HGI and LF diets (q < 0.05). Significant correlations between changes in plasma amino acids and lipid species with changes in body weight, glucose, insulin, and some inflammatory markers are also reported.

CONCLUSION

These results suggest that an LGI diet modulates certain circulating amino acids and lipid levels. These findings may explain the health benefits attributed to LGI diets in metabolic diseases such as type 2 diabetes.

Therapeutic Taping for Scapular Stabilization in Children With Brachial Plexus Birth Palsy

OBJECTIVE. In this study, we aimed to assess whether therapeutic taping for scapular stabilization affected scapulothoracic, glenohumeral, and humerothoracic joint function in children with brachial plexus birth palsy and scapular winging.

METHOD. Motion capture data were collected with and without therapeutic taping to assist the middle and lower trapezius in seven positions for 26 children. Data were compared with one-way multivariate analyses of variance.

RESULTS. With therapeutic taping, scapular winging decreased considerably in all positions except abduction. Additionally, there were increased glenohumeral cross-body adduction and internal rotation angles in four positions. The only change in humerothoracic function was an increase of 3° of external rotation in the external rotation position.

CONCLUSION. Therapeutic taping for scapular stabilization resulted in a small but statistically significant decrease in scapular winging. Overall performance of positions was largely unchanged. The increased glenohumeral joint angles with therapeutic taping may be beneficial for joint development; however, the long-term impact remains unknown.

Personal protective equipment for the Ebola virus disease: A comparison of 2 training programs

BACKGROUND

Personal protective equipment (PPE) for preventing Ebola virus disease (EVD) includes basic PPE (B-PPE) and enhanced PPE (E-PPE). Our aim was to compare conventional training programs (CTPs) and reinforced training programs (RTPs) on the use of B-PPE and E-PPE.

METHODS

Four groups were created, designated CTP-B, CTP-E, RTP-B, and RTP-E. All groups received the same theoretical training, followed by 3 practical training sessions.

RESULTS

A total of 120 students were included (30 per group). In all 4 groups, the frequency and number of total errors and critical errors decreased significantly over the course of the training sessions (P < .01). The RTP was associated with a greater reduction in the number of total errors and critical errors (P < .0001). During the third training session, we noted an error frequency of 7%-43%, a critical error frequency of 3%-40%, 0.3-1.5 total errors, and 0.1-0.8 critical errors per student. The B-PPE groups had the fewest errors and critical errors (P < .0001).

CONCLUSION

Our results indicate that both training methods improved the student's proficiency, that B-PPE appears to be easier to use than E-PPE, that the RTP achieved better proficiency for both PPE types, and that a number of students are still potentially at risk for EVD contamination despite the improvements observed during the training.

Regression of schwannomas induced by adeno-associated virus-mediated delivery of caspase-1

Schwannomas are tumors formed by proliferation of dedifferentiated Schwann cells. Patients with neurofibromatosis 2 (NF2) and schwannomatosis develop multiple schwannomas in peripheral and cranial nerves. Although benign, these tumors can cause extreme pain and compromise sensory/motor functions, including hearing and vision. At present, surgical resection is the main treatment modality, but it can be problematic because of tumor inaccessibility and risk of nerve damage. We have explored gene therapy for schwannomas, using a model in which immortalized human NF2 schwannoma cells expressing a fluorescent protein and luciferase are implanted in the sciatic nerve of nude mice. Direct injection of an adeno-associated virus (AAV) serotype 1 vector encoding caspase-1 (ICE) under the Schwann-cell specific promoter, P0, leads to regression of these tumors with essentially no vector-mediated neuropathology, and no changes in sensory or motor function. In a related NF2 xenograft model designed to cause measurable pain behavior, the same gene therapy leads to tumor regression and concordant resolution of tumor-associated pain. This AAV1-P0-ICE vector holds promise for clinical treatment of schwannomas by direct intratumoral injection to achieve reduction in tumor size and normalization of neuronal function.