Explorations in statistics: the bootstrap

Predicting and analysing of the unfavourable outcomes of early applicated percutaneous endoscopic interlaminar discectomy for lumbar disc herniation: development and validation based nomogram

OBJECTIVE

To predict and analyse the unfavourable outcomes of early applicated percutaneous endoscopic interlaminar discectomy for lumbar disc herniation.

METHODS

Information of 426 patients treated by early applicated percutaneous endoscopic interlaminar discectomy (PEID) for lumbar disc herniation (LDH) at our hospital from June 2017 to October 2021 in addition to 17 other features was collected. The risk factors were selected by the least absolute shrinkage and selection operator method (LASSO) regression. Then, a prediction model (nomogram) was established to predict the unfavourable outcomes of using the risk factors selected from LASSO regression. Bootstrap (n = 1000) was used to perform the internal validation, and the performance of the model was assessed by the concordance index (C-index), receiver operating characteristic curve, and calibration curve. The decision curve analysis (DCA) and clinical impact curve (CIC) were used to assess the clinical utility of the model, respectively.

RESULTS

Finally, 53 of 426 patients showed unfavourable outcomes. Five potential factors, Modic change, Calcification, Lumbar epidural steroid injection preoperative, Articular process hyperplasia and cohesion, and Laminoplasty technique, were selected according to the LASSO regression, that identified the predictors to establish nomogram model. Meanwhile, the C-index of the prediction nomogram was 0.847, the area under the receiver operating characteristic curve value was 0.847, and the interval bootstrapping (n = 1000) validation C-index was 0.809. The model has good practicability for clinics according to the DCA and CIC.

CONCLUSION

This nomogram model has good predictive performance and clinical practicability, which could provide a certain basis for predicting unfavourable outcomes of early applicated PEID for LDH.

Effect of the Fran CrossFit Workout on Oxygen Uptake Kinetics, Energetics, and Postexercise Muscle Function in Trained CrossFitters

PURPOSE

Fran is one of the most popular CrossFit benchmark workouts used to control CrossFitters' improvements. Detailed physiological characterization of Fran is needed for a more specific evaluation of CrossFitters' training performance improvements. The aim of the study was to analyze the oxygen uptake (V˙O2) kinetics and characterize the energy system contributions and the degree of postexercise fatigue of the unbroken Fran.

METHODS

Twenty trained CrossFitters performed Fran at maximal exertion. V˙O2 and heart-rate kinetics were assessed at baseline and during and post-Fran. Blood lactate and glucose concentrations and muscular fatigue were measured at baseline and in the recovery period.

RESULTS

A marked increase in V˙O2 kinetics was observed at the beginning of Fran, remaining elevated until the end (V˙O2peak: 49.2 [3.7] mL·kg-1·min-1, V˙O2 amplitude: 35.8 [5.2] mL·kg-1·min-1, time delay: 4.7 [2.5] s and time constant: 23.7 [11.1] s; mean [SD]). Aerobic, anaerobic lactic, and alactic pathways accounted for 62% (4%), 26% (4%), and 12% (2%) of energy contribution. Reduction in muscle function in jumping ability (jump height: 8% [6%], peak force: 6% [4%], and maximum velocity: 4% [2%]) and plank prone test (46% [20%]) was observed in the recovery period.

CONCLUSIONS

The Fran unbroken workout is a high-intensity effort associated with an elevated metabolic response. This pattern of energy response highlights the primary contribution of aerobic energy metabolism, even during short and very intense CrossFit workouts, and that recovery can take >24 hours due to cumulative fatigue.

Effects of Blood Flow Restriction on O2 Muscle Extraction and O2 Pulmonary Uptake Kinetics During Heavy Exercise

This study aimed to determine the effects of three levels of blood flow restriction (BFR) onV ˙ O 2 and O 2 extraction kinetics during heavy cycling exercise transitions. Twelve healthy trained males completed two bouts of 10 min heavy intensity exercise without BFR (CON), with 40% or 50% BFR (BFR40 and BFR50, respectively).V ˙ O 2 and tissue saturation index (TSI) were continuously measured and modelled using multiexponential functions. The time constant of theV ˙ O 2 primary phase was significantly slowed in BFR40 (26.4 ± 2.0s; p < 0.001) and BFR50 (27.1 ± 2.1s; p = 0.001) compared to CON (19.0 ± 1.1s). The amplitude of theV ˙ O 2 slow component was significantly increased (p < 0.001) with BFR in a pressure-dependent manner 3.6 ± 0.7, 6.7 ± 0.9 and 9.7 ± 1.0 ml·min-1·kg-1 for CON, BFR40, and BFR50, respectively. While no acceleration of the primary component of the TSI kinetics was observed, there was an increase (p < 0.001) of the phase 3 amplitude with BFR (CON -0.8 ± 0.3% VS BFR40 -2.9 ± 0.9%, CON VS BFR50 -2.8 ± 0.8%). It may be speculated that BFR applied during cycling exercise in the heavy intensity domain shifted the working muscles to an O 2 dependent situation. The acceleration of the extraction kinetics could have reached a plateau, hence not permitting compensation for the slowdown of the blood flow kinetics, and slowingV ˙ O 2 kinetics.

The impact of a single surfing paddling cycle on fatigue and energy cost

Surfing is one additional sport proposed by the Tokyo 2020 Organizing Committee. Surprisingly, substantial efforts to understand surfing energetics are recent, and the impact of a single surfing paddling cycle on fatigue and energy cost is still not clear. Since surfing paddling technique is highly specific, experiments in real practice conditions are necessary to provide deeper insights. Through a biophysical approach, biomechanical and energetics responses of surfing paddling were quantified and compared from 16 competitive male surfers (23.5 ± 10.0 years old, 65.3 ± 11.4 kg and 1.72 ± 0.01 m) during two sets (PRE and POST) of 10 s all-out tethered paddling plus 20 m sprint paddling, interposed by 6 min of endurance paddling. Faster surfers presented lower energy cost during sprint PRE (r² = 0.30, p = 0.03) and endurance (r² = 0.35, p = 0.02) relative surfing paddling velocities. Although the energy cost was higher for a lower velocity at maximal paddling velocity POST, the energy cost of surfing paddling increased with absolute velocity according to a power function (R² = 0.83). Our results suggest that fatigue seems to occur even following a single surfing paddling cycle. Developing a powerful and endurable metabolic base while reducing energy cost during surfing paddling should be seen as key factors in surfing training programs.

Profile of the use of dermoscopy among dermatologists in Brazil (2018)

BACKGROUND

Dermoscopy increases the diagnostic accuracy in dermatology. The aspects related to training, usage profile, or perceptions of usefulness of dermoscopy among dermatologists in Brazil have not been described.

OBJECTIVES

To evaluate the profile of the use of dermoscopy and the perception of the impact of the technique on clinical practice.

METHODS

The Brazilian Society of Dermatology invited all members to complete an online form with 20 items regarding demographic data, dermatological assistance, use of dermoscopy, and perceptions of the impact of the technique on clinical practice. The proportions between the categories were compared by analysis of residuals in contingency tables, and p-values < 0.01 were considered significant.

RESULTS

The answers from 815 associates (9.1% of those invited to participate) were assessed, 84% of whom were female, and 71% of whom were younger than 50 years of age. The use of dermoscopy was reported in the daily practice of 98% of dermatologists: 88% reported using it more than once a day. Polarized light dermoscopy was the most used method (83%) and pattern analysis was the most used algorithm (63%). The diagnosis and follow-up of melanocytic lesions was identified as the main use of the technique, while the benefit for the diagnosis of inflammatory lesions was acknowledged by less than half of the sample (42%).

STUDY LIMITATIONS

This was a non-randomized study.

CONCLUSION

Dermoscopy is incorporated into the clinical practice of almost all Brazilian dermatologists, and it is recognized for increasing diagnostic certainty in different contexts, especially for pigmented lesions.

A method for reducing animal use whilst maintaining statistical power in electrophysiological recordings from rodent nerves

The stimulus evoked compound action potential, recorded from ex vivo nerve trunks such as the rodent optic and sciatic nerve, is a popular model system used to study aspects of nervous system metabolism. This includes (1) the role of glycogen in supporting axon conduction, (2) the injury mechanisms resulting from metabolic insults, and (3) to test putative benefits of clinically relevant neuroprotective strategies. We demonstrate the benefit of simultaneously recording from pairs of nerves in the same superfusion chamber compared with conventional recordings from single nerves. Experiments carried out on mouse optic and sciatic nerves demonstrate that our new recording configuration decreased the relative standard deviation from samples when compared with recordings from an equivalent number of individually recorded nerves. The new method reduces the number of animals required to produce equivalent Power compared with the existing method, where single nerves are used. Adopting this method leads to increased experimental efficiency and productivity. We demonstrate that reduced animal use and increased Power can be achieved by recording from pairs of rodent nerve trunks simultaneously.

Ten common statistical mistakes to watch out for when writing or reviewing a manuscript

Inspired by broader efforts to make the conclusions of scientific research more robust, we have compiled a list of some of the most common statistical mistakes that appear in the scientific literature. The mistakes have their origins in ineffective experimental designs, inappropriate analyses and/or flawed reasoning. We provide advice on how authors, reviewers and readers can identify and resolve these mistakes and, we hope, avoid them in the future.

Basic statistical considerations for physiology: The journal Temperature toolbox

The average environmental and occupational physiologist may find statistics are difficult to interpret and use since their formal training in statistics is limited. Unfortunately, poor statistical practices can generate erroneous or at least misleading results and distorts the evidence in the scientific literature. These problems are exacerbated when statistics are used as thoughtless ritual that is performed after the data are collected. The situation is worsened when statistics are then treated as strict judgements about the data (i.e., significant versus non-significant) without a thought given to how these statistics were calculated or their practical meaning. We propose that researchers should consider statistics at every step of the research process whether that be the designing of experiments, collecting data, analysing the data or disseminating the results. When statistics are considered as an integral part of the research process, from start to finish, several problematic practices can be mitigated. Further, proper practices in disseminating the results of a study can greatly improve the quality of the literature. Within this review, we have included a number of reminders and statistical questions researchers should answer throughout the scientific process. Rather than treat statistics as a strict rule following procedure we hope that readers will use this review to stimulate a discussion around their current practices and attempt to improve them. The code to reproduce all analyses and figures within the manuscript can be found at https://doi.org/10.17605/OSF.IO/BQGDH.

Profile of dermatological consultations in Brazil (2018)

BACKGROUND

Dermatological diseases are among the primary causes of the demand for basic health care. Studies on the frequency of dermatoses are important for the proper management of health planning.

OBJECTIVES

To evaluate the nosological and behavioral profiles of dermatological consultations in Brazil.

METHODS

The Brazilian Society of Dermatology invited all of its members to complete an online form on patients who sought consultations from March 21-26, 2018. The form contained questions about patient demographics, consultation type according to the patient's funding, the municipality of the consultation, diagnosis, treatments and procedures. Diagnostic and therapeutic decisions were compared between subgroups.

RESULTS

Data from 9629 visits were recorded. The most frequent causes for consultation were acne (8.0%), photoaging (7.7%), nonmelanoma skin cancer (5.4%), and actinic keratosis (4.7%). The identified diseases had distinct patterns with regard to gender, skin color, geographic region, type of funding for the consultation, and age group. Concerning the medical conducts, photoprotection was indicated in 44% of consultations, surgical diagnostic procedures were performed in 7.3%, surgical therapeutic procedures were conducted in 19.2%, and cosmetic procedures were performed in 7.1%.

STUDY LIMITATIONS

Nonrandomized survey, with a sample period of one week.

CONCLUSION

This research allowed us to identify the epidemiological profiles of the demands of outpatients for dermatologists in various contexts. The results also highlight the importance of aesthetic demands in privately funded consultations and the significance of diseases such as acne, nonmelanoma skin cancer, leprosy, and psoriasis to public health.

VO₂FITTING: A Free and Open-Source Software for Modelling Oxygen Uptake Kinetics in Swimming and other Exercise Modalities

The assessment of oxygen uptake (VO₂) kinetics is a valuable non-invasive way to evaluate cardiorespiratory and metabolic response to exercise. The aim of the study was to develop, describe and evaluate an online VO₂ fitting tool (VO₂FITTING) for dynamically editing, processing, filtering and modelling VO₂ responses to exercise. VO₂FITTING was developed in Shiny, a web application framework for R language. Validation VO₂ datasets with both noisy and non-noisy data were developed and applied to widely-used models (n = 7) for describing different intensity transitions to verify concurrent validity. Subsequently, we then conducted an experiment with age-group swimmers as an example, illustrating how VO₂FITTING can be used to model VO₂ kinetics. Perfect fits were observed, and parameter estimates perfectly matched the known inputted values for all available models (standard error = 0; p < 0.001). The VO₂FITTING is a valid, free and open-source software for characterizing VO₂ kinetics in exercise, which was developed to help the research and performance analysis communities.

Statistical considerations in reporting cardiovascular research

The problem of inadequate statistical reporting is long standing and widespread in the biomedical literature, including in cardiovascular physiology. Although guidelines for reporting statistics have been available in clinical medicine for some time, there are currently no guidelines specific to cardiovascular physiology. To assess the need for guidelines, we determined the type and frequency of statistical tests and procedures currently used in the American Journal of Physiology-Heart and Circulatory Physiology. A PubMed search for articles published in the American Journal of Physiology-Heart and Circulatory Physiology between January 1, 2017, and October 6, 2017, provided a final sample of 146 articles evaluated for methods used and 38 articles for indepth analysis. The t-test and ANOVA accounted for 71% (212 of 300 articles) of the statistical tests performed. Of six categories of post hoc tests, Bonferroni and Tukey tests were used in 63% (62 of 98 articles). There was an overall lack in details provided by authors publishing in the American Journal of Physiology-Heart and Circulatory Physiology, and we compiled a list of recommended minimum reporting guidelines to aid authors in preparing manuscripts. Following these guidelines could substantially improve the quality of statistical reports and enhance data rigor and reproducibility.

Explorations in statistics: the log transformation

Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This thirteenth installment of Explorations in Statistics explores the log transformation, an established technique that rescales the actual observations from an experiment so that the assumptions of some statistical analysis are better met. A general assumption in statistics is that the variability of some response Y is homogeneous across groups or across some predictor variable X. If the variability-the standard deviation-varies in rough proportion to the mean value of Y, a log transformation can equalize the standard deviations. Moreover, if the actual observations from an experiment conform to a skewed distribution, then a log transformation can make the theoretical distribution of the sample mean more consistent with a normal distribution. This is important: the results of a one-sample t test are meaningful only if the theoretical distribution of the sample mean is roughly normal. If we log-transform our observations, then we want to confirm the transformation was useful. We can do this if we use the Box-Cox method, if we bootstrap the sample mean and the statistic t itself, and if we assess the residual plots from the statistical model of the actual and transformed sample observations.

The Effects of Prosthesis Inertial Parameters on Inverse Dynamics: A Probabilistic Analysis

Joint kinetic measurement is a fundamental tool used to quantify compensatory movement patterns in participants with transtibial amputation (TTA). Joint kinetics are calculated through inverse dynamics (ID) and depend on segment kinematics, external forces, and both segment and prosthetic inertial parameters (PIPS); yet the individual influence of PIPs on ID is unknown. The objective of this investigation was to assess the importance of parameterizing PIPs when calculating ID using a probabilistic analysis. A series of Monte Carlo simulations were performed to assess the influence of uncertainty in PIPs on ID. Multivariate input distributions were generated from experimentally measured PIPs (foot/shank: mass, center of mass (COM), moment of inertia) of ten prostheses and output distributions were hip and knee joint kinetics. Confidence bounds (2.5–97.5%) and sensitivity of outputs to model input parameters were calculated throughout one gait cycle. Results demonstrated that PIPs had a larger influence on joint kinetics during the swing period than the stance period (e.g., maximum hip flexion/extension moment confidence bound size: stance = 5.6 N·m, swing: 11.4 N·m). Joint kinetics were most sensitive to shank mass during both the stance and swing periods. Accurate measurement of prosthesis shank mass is necessary to calculate joint kinetics with ID in participants with TTA with passive prostheses consisting of total contact carbon fiber sockets and dynamic elastic response feet during walking.

Explorations in statistics: the assumption of normality

Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This twelfth installment of Explorations in Statistics explores the assumption of normality, an assumption essential to the meaningful interpretation of a t test. Although the data themselves can be consistent with a normal distribution, they need not be. Instead, it is the theoretical distribution of the sample mean or the theoretical distribution of the difference between sample means that must be roughly normal. The most versatile approach to assess normality is to bootstrap the sample mean, the difference between sample means, or t itself. We can then assess whether the distributions of these bootstrap statistics are consistent with a normal distribution by studying their normal quantile plots. If we suspect that an inference we make from a t test may not be justified-if we suspect that the theoretical distribution of the sample mean or the theoretical distribution of the difference between sample means is not normal-then we can use a permutation method to analyze our data.

A Novel Protocol for Directed Differentiation of C9orf72-Associated Human Induced Pluripotent Stem Cells Into Contractile Skeletal Myotubes

In the present study, functional skeletal myotubes were efficiently generated from human induced pluripotent stem cells using a small molecule-based approach. Myotubes derived from patients carrying the C9orf72 repeat expansion show no change in differentiation efficiency and normal TDP-43 localization after as many as 120 days in vitro when compared to unaffected controls. The protocol described in this study for the generation of skeletal myotubes from human induced pluripotent stem cells may serve as a valuable tool in drug discovery and modeling of musculoskeletal and neuromuscular diseases.

Induced pluripotent stem cells (iPSCs) offer an unlimited resource of cells to be used for the study of underlying molecular biology of disease, therapeutic drug screening, and transplant-based regenerative medicine. However, methods for the directed differentiation of skeletal muscle for these purposes remain scarce and incomplete. Here, we present a novel, small molecule-based protocol for the generation of multinucleated skeletal myotubes using eight independent iPSC lines. Through combinatorial inhibition of phosphoinositide 3-kinase (PI3K) and glycogen synthase kinase 3β (GSK3β) with addition of bone morphogenic protein 4 (BMP4) and fibroblast growth factor 2 (FGF2), we report up to 64% conversion of iPSCs into the myogenic program by day 36 as indicated by MYOG⁺ cell populations. These cells began to exhibit spontaneous contractions as early as 34 days in vitro in the presence of a serum-free medium formulation. We used this protocol to obtain iPSC-derived muscle cells from frontotemporal dementia (FTD) patients harboring C9orf72 hexanucleotide repeat expansions (rGGGGCC), sporadic FTD, and unaffected controls. iPSCs derived from rGGGGCC carriers contained RNA foci but did not vary in differentiation efficiency when compared to unaffected controls nor display mislocalized TDP-43 after as many as 120 days in vitro. This study presents a rapid, efficient, and transgene-free method for generating multinucleated skeletal myotubes from iPSCs and a resource for further modeling the role of skeletal muscle in amyotrophic lateral sclerosis and other motor neuron diseases.

Significance

Protocols to produce skeletal myotubes for disease modeling or therapy are scarce and incomplete. The present study efficiently generates functional skeletal myotubes from human induced pluripotent stem cells using a small molecule-based approach. Using this strategy, terminal myogenic induction of up to 64% in 36 days and spontaneously contractile myotubes within 34 days were achieved. Myotubes derived from patients carrying the C9orf72 repeat expansion show no change in differentiation efficiency and normal TDP-43 localization after as many as 120 days in vitro when compared to unaffected controls. This study provides an efficient, novel protocol for the generation of skeletal myotubes from human induced pluripotent stem cells that may serve as a valuable tool in drug discovery and modeling of musculoskeletal and neuromuscular diseases.

Explorations in statistics: statistical facets of reproducibility

Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This eleventh installment of Explorations in Statistics explores statistical facets of reproducibility. If we obtain an experimental result that is scientifically meaningful and statistically unusual, we would like to know that our result reflects a general biological phenomenon that another researcher could reproduce if (s)he repeated our experiment. But more often than not, we may learn this researcher cannot replicate our result. The National Institutes of Health and the Federation of American Societies for Experimental Biology have created training modules and outlined strategies to help improve the reproducibility of research. These particular approaches are necessary, but they are not sufficient. The principles of hypothesis testing and estimation are inherent to the notion of reproducibility in science. If we want to improve the reproducibility of our research, then we need to rethink how we apply fundamental concepts of statistics to our science.

The Analgesic Effect of Oxytocin in Humans: A Double-Blind, Placebo-Controlled Cross-Over Study Using Laser-Evoked Potentials

Oxytocin is a neuropeptide regulating social-affiliative and reproductive behaviour in mammals. Despite robust preclinical evidence for the antinociceptive effects and mechanisms of action of exogenous oxytocin, human studies have produced mixed results regarding the analgesic role of oxytocin and are yet to show a specific modulation of neural processes involved in pain perception. In the present study, we investigated the analgesic effects of 40 IU of intranasal oxytocin in 13 healthy male volunteers using a double-blind, placebo-controlled, cross-over design and brief radiant heat pulses generated by an infrared laser that selectively activate Aδ- and C-fibre nerve endings in the epidermis, at the same time as recording the ensuing laser-evoked potentials (LEPs). We predicted that oxytocin would reduce subjective pain ratings and attenuate the amplitude of the N1, N2 and P2 components. We observed that oxytocin attenuated perceived pain intensity and the local peak amplitude of the N1 and N2 (but not of P2) LEPs, and increased the latency of the N2 component. Importantly, for the first time, the present study reports an association between the analgesic effect of oxytocin (reduction in subjective pain ratings) and the oxytocin-induced modulation of cortical activity after noxious stimulation (attenuation of the N2 LEP). These effects indicate that oxytocin modulates neural processes contributing to pain perception. The present study reports preliminary evidence that is consistent with electrophysiological studies in rodents showing that oxytocin specifically modulates Aδ/C-fibre nociceptive afferent signalling at the spinal level and provides further specificity to evidence obtained in humans indicating that oxytocin may be modulating pain experience by modulating activity in the cortical areas involved in pain processing.

Explorations in statistics: the analysis of change

Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This tenth installment of Explorations in Statistics explores the analysis of a potential change in some physiological response. As researchers, we often express absolute change as percent change so we can account for different initial values of the response. But this creates a problem: percent change is really just a ratio, and a ratio is infamous for its ability to mislead. This means we may fail to find a group difference that does exist, or we may find a group difference that does not exist. What kind of an approach to science is that? In contrast, analysis of covariance is versatile: it can accommodate an analysis of the relationship between absolute change and initial value when percent change is useless.

Pharmacokinetics and tolerability of oral sildenafil in adults with cystic fibrosis lung disease

RATIONALE

Airway inflammation is central to cystic fibrosis (CF) pathophysiology. Pre-clinical models have shown that phosphodiesterase inhibitors (PDEi) like sildenafil have anti-inflammatory activity. PDEi have not been studied in CF subjects.

OBJECTIVES

We evaluated the pharmacokinetics, tolerability, and safety of sildenafil in subjects with CF. Sputum biomarkers were used to explore efficacy.

METHODS

An open-label pilot study of oral sildenafil administration was conducted in adults with mild to moderate CF lung disease. Subjects received oral sildenafil 20 or 40 mg p.o. t.i.d. for 6 weeks.

MEASUREMENTS AND MAIN RESULTS

Twenty subjects completed the study. Estimated elimination rate constants were statistically different in subjects with CF compared to previously published non-CF subjects. Side effects were generally mild. There were no drug-related serious adverse events. Sputum neutrophil elastase activity decreased.

CONCLUSIONS

Subjects with CF may eliminate sildenafil at a faster rate than non-CF subjects. Sildenafil administration was safe in subjects with CF and decreased sputum elastase activity. Sildenafil warrants further study as an anti-inflammatory in CF.

Metabolite of tryptophan promoting changes in EEG signal and the oxidative status of the brain

Tryptophan is an essential amino acid precursor of neurotransmitter serotonin and triptamine. During its metabolism, indole-3-acetic acid (IAA) is generated; this substance presents both antioxidant and prooxidant effects in different biological systems in addition to hipoglicemic effects. To date, electroencephalography (EEG) has been used to evaluate the temporal effect of several substances in neurotransmission. The goal of this study was to characterize the effect of IAA in the brain by analysing the EEG signal and evaluate the oxidative status by means of biochemical parameters. The EEG was acquired by using a noninvasive method, and the brain electric signal was analysed by advanced digital signal processing techniques to determinate the energy signal filtered in different band frequencies. Furthermore, the oxidative status of the brain was investigated by measuring the activity of antioxidant enzymes and lipid peroxidation as well as blood glucose rates of the animals treated with different doses of IAA. Our results showed the relationship of IAA administration with changes in EEG signals. The oxidative status of the brain was modified by IAA after 14 days of treatment.

Partners' empathy increases pain ratings: effects of perceived empathy and attachment style on pain report and display

Pain can be influenced by its social context. We aimed to examine under controlled experimental conditions how empathy from a partner and personal attachment style affect pain report, tolerance, and facial expressions of pain. Fifty-four participants, divided into secure, anxious, and avoidant attachment style groups, underwent a cold pressor task with their partners present. We manipulated how much empathy the participants perceived that their partners had for them. We observed a significant main effect of perceived empathy on pain report, with greater pain reported in the high perceived empathy condition. No such effects were found for pain tolerance or facial display. We also found a significant interaction of empathy with attachment style group, with the avoidant group reporting and displaying less pain than the secure and the anxious groups in the high perceived empathy condition. No such findings were observed in the low empathy condition. These results suggest that empathy from one's partner may influence pain report beyond behavioral reactions. In addition, the amount of pain report and expression that people show in high empathy conditions depends on their attachment style.

Perspective

Believing that one's partner feels high empathy for one's pain may lead individuals to rate the intensity of pain as higher. Individual differences in attachment style moderate this empathy effect.

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The role of empathy and attachment style on pain was studied experimentally.

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Empathy from one's partner may influence pain report and behavioral reactions.

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Perceived high empathy from a partner may lead to higher pain ratings.

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Individual differences in attachment style moderate this empathy effect.

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Individual differences in attachment style also moderate facial display of pain.

Age differences in the variability and distribution of sleep spindle and rapid eye movement densities

The present study had two main objectives. The first objective was to compare the sleep architecture of young and older adults, with an emphasis on sleep spindle density and REM density. The second objective was to examine two aspects of age differences that have not been considered in previous studies: age differences in the variability of sleep measures as well as the magnitude of age differences in phasic events across the distribution of values (i.e., at each decile rather than a single measure of location such as the mean or median. A total of 24 young (mean age=20.75 ± 1.78 years) and 24 older (mean age=71.17 ± 6.15 years) adults underwent in-home polysomnography. Whole-night spindle density was significantly higher in young adults than older adults. The two age groups did not differ significantly in whole-night REM density, although significant increases in REM density across the night were observed in both age groups. These results suggest that spindle density is more affected by age than REM density. Although age differences were observed in the degree of absolute variability (older adults had significantly larger variances than young adults for sleep efficiency and time spent awake after sleep onset), a similar pattern was also observed within the two age groups: the four sleep measures with the lowest degrees of relative variability were the same and included time spent in REM and Stage 2 sleep, total sleep time, and sleep efficiency. The distributional analysis of age differences in sleep spindle density revealed that the largest age differences were initially observed in the middle of the distributions, but as the night progressed, they were seen at the upper end of the distributions. The results reported here have potential implications for the causes and functional implications of age-related changes in sleep architecture.

Relationships between airflow obstruction and quantitative CT measurements of emphysema, air trapping, and airways in subjects with and without chronic obstructive pulmonary disease

OBJECTIVE

This study evaluates the relationships between quantitative CT (QCT) and spirometric measurements of disease severity in cigarette smokers with and without chronic obstructive pulmonary disease (COPD).

MATERIALS AND METHODS

Inspiratory and expiratory CT scans of 4062 subjects in the Genetic Epidemiology of COPD (COPDGene) Study were evaluated. Measures examined included emphysema, defined as the percentage of low-attenuation areas≤-950 HU on inspiratory CT, which we refer to as "LAA-950I"; air trapping, defined as the percentage of low-attenuation areas≤-856 HU on expiratory CT, which we refer to as "LAA-856E"; and the inner diameter, inner and outer areas, wall area, airway wall thickness, and square root of the wall area of a hypothetical airway of 10-mm internal perimeter of segmental and subsegmental airways. Correlations were determined between spirometry and several QCT measures using statistics software (SAS, version 9.2).

RESULTS

QCT measurements of low-attenuation areas correlate strongly and significantly (p<0.0001) with spirometry. The correlation between LAA-856E and forced expiratory volume in 1 second (FEV1) and the ratio of FEV1 to forced vital capacity (FVC) (r=-0.77 and -0.84, respectively) is stronger than the correlation between LAA-950I and FEV1 and FEV1/FVC (r=-0.67 and r=-0.76). Inspiratory and expiratory volume changes decreased with increasing disease severity, as measured by the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) staging system (p<0.0001). When airway variables were included with low-attenuation area measures in a multiple regression model, the model accounted for a statistically greater proportion of variation in FEV1 and FEV1/FVC (R2=0.72 and 0.77, respectively). Airway measurements alone are less correlated with spirometric measures of FEV1 (r=0.15 to -0.44) and FEV1/FVC (r=0.19 to -0.34).

CONCLUSION

QCT measurements are strongly associated with spirometric results showing impairment in smokers. LAA-856E strongly correlates with physiologic measurements of airway obstruction. Airway measurements can be used concurrently with QCT measures of low-attenuation areas to accurately predict lung function.

Explorations in statistics: the analysis of ratios and normalized data

Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This ninth installment of Explorations in Statistics explores the analysis of ratios and normalized-or standardized-data. As researchers, we compute a ratio-a numerator divided by a denominator-to compute a proportion for some biological response or to derive some standardized variable. In each situation, we want to control for differences in the denominator when the thing we really care about is the numerator. But there is peril lurking in a ratio: only if the relationship between numerator and denominator is a straight line through the origin will the ratio be meaningful. If not, the ratio will misrepresent the true relationship between numerator and denominator. In contrast, regression techniques-these include analysis of covariance-are versatile: they can accommodate an analysis of the relationship between numerator and denominator when a ratio is useless.

Increased lymphatic vessel length is associated with the fibroblast reticulum and disease severity in usual interstitial pneumonia and nonspecific interstitial pneumonia

BACKGROUND

Lymphangiogenesis responds to tissue injury as a key component of normal wound healing. The development of fibrosis in the idiopathic interstitial pneumonias may result from abnormal wound healing in response to injury. We hypothesize that increased lymphatic vessel (LV) length, a marker of lymphangiogenesis, is associated with parenchymal components of the fibroblast reticulum (organizing collagen, fibrotic collagen, and fibroblast foci), and its extent correlates with disease severity.

METHODS

We assessed stereologically the parenchymal structure of fibrotic lungs and its associated lymphatic network, which was highlighted immunohistochemically in age-matched samples of usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP) with FVC &lt; 80%, COPD with a Global Initiative for Obstructive Lung Disease stage 0, and normal control lungs.

RESULTS

LV length density, as opposed to vessel volume density, was found to be associated with organizing and fibrotic collagen density (P &lt; .0001). Length density of LVs and the volume density of organizing and fibrotic collagen were significantly associated with severity of both % FVC (P &lt; .001) and diffusing capacity of the lung for carbon monoxide (P &lt; .001).

CONCLUSIONS

Severity of disease in UIP and NSIP is associated with increased LV length and is strongly associated with components of the fibroblast reticulum, namely organizing and fibrotic collagen, which supports a pathogenic role of LVs in these two diseases. Furthermore, the absence of definable differences between UIP and NSIP suggests that LVs are a unifying mechanism for the development of fibrosis in these fibrotic lung diseases.

Explorations in statistics: permutation methods

Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This eighth installment of Explorations in Statistics explores permutation methods, empiric procedures we can use to assess an experimental result-to test a null hypothesis-when we are reluctant to trust statistical theory alone. Permutation methods operate on the observations-the data-we get from an experiment. A permutation procedure answers this question: out of all the possible ways we can rearrange the observations we got, in what proportion of those arrangements is the sample statistic we care about at least as extreme as the one we got? The answer to that question is the P value.

Angular-stable locked intramedullary nailing of two-part surgical neck fractures of the proximal part of the humerus. A multicenter retrospective observational study

BACKGROUND

The ideal fixation technique for the treatment of proximal humeral fractures remains unclear. In the present study, we evaluated the experience of three surgeons with the treatment of two-part surgical neck fractures with angular-stable intramedullary fixation.

METHODS

Forty-eight patients with forty-eight Neer two-part surgical neck proximal humeral fractures were managed with locked angular-stable intramedullary nail fixation by three surgeons. Shoulder pain and outcomes were quantified with Constant scores and standard radiographs.

RESULTS

Thirty-eight patients (including twenty-eight female patients and ten male patients) with a mean age of sixty-five years were followed for at least twelve months (mean, twenty months; range, twelve to thirty-six months). All fractures healed primarily. The mean follow-up Constant score (and standard deviation) was 71 ± 12 points (range, 37 to 88 points), with a mean age-adjusted Constant score of 97% (range, 58% to 119%). The mean Constant pain score was 13 ± 2.2 (possible range, 0 to 15 points, with 15 points representing no pain). The mean forward flexion was 132° ± 22°. All fractures but one healed with a neck-shaft angle of ≥125°.

CONCLUSIONS

Patients who were managed with locked angular-stable intramedullary nailing of two-part surgical neck proximal humeral fractures via an articular entry point had reliable fracture-healing, favorable clinical outcomes, and little residual shoulder pain.

Explorations in statistics: regression

Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This seventh installment of Explorations in Statistics explores regression, a technique that estimates the nature of the relationship between two things for which we may only surmise a mechanistic or predictive connection. Regression helps us answer three questions: does some variable Y depend on another variable X; if so, what is the nature of the relationship between Y and X; and for some value of X, what value of Y do we predict? Residual plots are an essential component of a thorough regression analysis: they help us decide if our statistical regression model of the relationship between Y and X is appropriate.

Explorations in statistics: correlation

Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This sixth installment of Explorations in Statistics explores correlation, a familiar technique that estimates the magnitude of a straight-line relationship between two variables. Correlation is meaningful only when the two variables are true random variables: for example, if we restrict in some way the variability of one variable, then the magnitude of the correlation will decrease. Correlation cannot help us decide if changes in one variable result in changes in the second variable, if changes in the second variable result in changes in the first variable, or if changes in a third variable result in concurrent changes in the first two variables. Correlation can help provide us with evidence that study of the nature of the relationship between x and y may be warranted in an actual experiment in which one of them is controlled.

Explorations in statistics: power

Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This fifth installment of Explorations in Statistics revisits power, a concept fundamental to the test of a null hypothesis. Power is the probability that we reject the null hypothesis when it is false. Four things affect power: the probability with which we are willing to reject-by mistake-a true null hypothesis, the magnitude of the difference we want to be able to detect, the variability of the underlying population, and the number of observations in our sample. In an application to an Institutional Animal Care and Use Committee or to the National Institutes of Health, we define power to justify the sample size we propose.