Do machine learning methods lead to similar individualized treatment rules? A comparison study on real data

Identifying patients who benefit from a treatment is a key aspect of personalized medicine, which allows the development of individualized treatment rules (ITRs). Many machine learning methods have been proposed to create such rules. However, to what extent the methods lead to similar ITRs, that is, recommending the same treatment for the same individuals is unclear. In this work, we compared 22 of the most common approaches in two randomized control trials. Two classes of methods can be distinguished. The first class of methods relies on predicting individualized treatment effects from which an ITR is derived by recommending the treatment evaluated to the individuals with a predicted benefit. In the second class, methods directly estimate the ITR without estimating individualized treatment effects. For each trial, the performance of ITRs was assessed by various metrics, and the pairwise agreement between all ITRs was also calculated. Results showed that the ITRs obtained via the different methods generally had considerable disagreements regarding the patients to be treated. A better concordance was found among akin methods. Overall, when evaluating the performance of ITRs in a validation sample, all methods produced ITRs with limited performance, suggesting a high potential for optimism. For non-parametric methods, this optimism was likely due to overfitting. The different methods do not lead to similar ITRs and are therefore not interchangeable. The choice of the method strongly influences for which patients a certain treatment is recommended, drawing some concerns about their practical use.

A Comparison Study between Traditional and Deep-Reinforcement-Learning-Based Algorithms for Indoor Autonomous Navigation in Dynamic Scenarios

At the beginning of a project or research that involves the issue of autonomous navigation of mobile robots, a decision must be made about working with traditional control algorithms or algorithms based on artificial intelligence. This decision is not usually easy, as the computational capacity of the robot, the availability of information through its sensory systems and the characteristics of the environment must be taken into consideration. For this reason, this work focuses on a review of different autonomous-navigation algorithms applied to mobile robots, from which the most suitable ones have been identified for the cases in which the robot must navigate in dynamic environments. Based on the identified algorithms, a comparison of these traditional and DRL-based algorithms was made, using a robotic platform to evaluate their performance, identify their advantages and disadvantages and provide a recommendation for their use, according to the development requirements of the robot. The algorithms selected were DWA, TEB, CADRL and SAC, and the results show that-according to the application and the robot's characteristics-it is recommended to use each of them, based on different conditions.

Multicenter Evaluation Study Comparing a New Factory-Calibrated Real-Time Continuous Glucose Monitoring System to Existing Flash Glucose Monitoring System

This study reports a clinical evaluation of AiDEX CGM system featuring a 14-day sensor, real-time glucose monitoring and factory-calibration. A multicenter, prospective, masked clinical study was conducted at with a total of 120 participants. Each participant wore 4 studied sensors and had one in-clinic visit for venous blood reference tests. 40 out of the 120 participants wore additional Abbott Libre sensors and performed at least 7 capillary BG tests daily for additional reference and comparison. Continuous glucose error grid analysis (CG-EGA) showed that AiDEX and Abbott Libre had good agreement with venous blood glucose, with 98.69% and 98.96% accurate readings, respectively. Overall MARD of AiDEX CGM systems was 9.08% when compared to venous blood reference and 10.1% when compared to finger capillary BG reference.

Agreement between standard and continuous wireless vital sign measurements after major abdominal surgery: a clinical comparison study

Objective. Continuous wireless monitoring outside the post-anesthesia or intensive care units may enable early detection of patient deterioration, but good accuracy of measurements is required. We aimed to assess the agreement between vital signs recorded by standard and novel wireless devices in postoperative patients.Approach. In 20 patients admitted to the post-anesthesia care unit, we compared heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO₂), and systolic and diastolic blood pressure (SBP and DBP) as paired data. The primary outcome measure was the agreement between standard wired and wireless monitoring, assessed by mean bias and 95% limits of agreement (LoA). LoA was considered acceptable for HR and PR, if within ±5 beats min^-1(bpm), while RR, SpO2, and BP were deemed acceptable if within ±3 breaths min^-1(brpm), ±3%-points, and ±10 mmHg, respectively.Main results.The mean bias between standard versus wireless monitoring was -0.85 bpm (LoA -6.2 to 4.5 bpm) for HR, -1.3 mmHg (LoA -19 to 17 mmHg) for standard versus wireless SBP, 2.9 mmHg (LoA -17 to 22) for standard versus wireless DBP, and 1.7% (LoA -1.4 mmHg to 4.8 mmHg) for SpO₂, comparing standard versus wireless monitoring. The mean bias of arterial blood gas analysis versus wireless SpO₂measurements was 0.02% (LoA -0.02% to 0.06%), while the mean bias of direct observation of RR compared to wireless measurements was 0.0 brpm (LoA -2.6 brpm to 2.6 brpm). 80% of all values compared were within predefined clinical limits.Significance.The agreement between wired and wireless HR, RR, and PR recordings in postoperative patients was acceptable, whereas the agreement for SpO₂recordings (standard versus wireless) was borderline. Standard wired and wireless BP measurements may be used interchangeably in the clinical setting.

A Comparative Analysis of the Effect of Carbonaceous Nanoparticles on the Physicochemical Properties of Hybrid Polyethersulfone Ultrafiltration Membranes

Numerous studies have been previously reported on the use of nanoscale carbonaceous fillers, such as multi-walled carbon nanotubes (MWCNTs) and graphene oxide (GO), in polymeric ultrafiltration (UF) membranes; however, no insight has been clearly reported on which material provides the best enhancements in membrane performance. In this study, a comparative analysis was carried out to establish a comprehensible understanding of the physicochemical properties of hybrid polyethersulfone (PES) UF membranes incorporated with MWCNTs and GO nanoparticles at various concentrations. The hybrid membranes were prepared via the non-solvent-induced phase separation process and further characterized by field emission scanning electron microscopy and atomic force microscope (AFM). The AFM images showed homogeneous membrane surfaces with a reduction in the membrane surface roughness from 2.62 nm for bare PES to 2.39 nm for PES/MWCNTs and to 1.68 nm for PES/GO membranes due to improved hydrophilicity of the membranes. Physicochemical properties of the hybrid PES membranes were assessed, and the outcomes showed an enhancement in the porosity, pore size, water contact angle, and water permeability with respect to nanoparticle concentration. GO-incorporated PES membranes exhibited the highest porosity, pore size, and lowest contact angle as compared to PES/MWCNTs, indicating the homogeneous distribution of nanoparticles within the membrane structure. PES/MWCNTs (0.5 wt.%) and PES/GO (1.0 wt.%) hybrid membranes exhibited the highest water flux of 450.0 and 554.8 L m^-2 h^-1, respectively, at an applied operating pressure of 1 bar. The filtration and antifouling performance of the PES hybrid membranes were evaluated using 50 mg L^-1 of humic acid (HA) as a foulant at pH = 7. Compared to the bare PES membrane, the MWCNTs and GO-incorporated PES hybrid membranes exhibited enhanced permeability and HA removal. Moreover, PES/MWCNTs (0.5 wt.%) and PES/GO (1 wt.%) hybrid membranes reported HA rejection of 90.8% and 94.8%, respectively. The abundant oxygen-containing functional groups in GO-incorporated PES membranes resulted in more hydrophilic membranes, leading to enhanced permeability and fouling resistance. The antifouling properties and flux recovery ratio were improved by the addition of both nanoparticles. Given these findings, although both MWCNTs and GO nanoparticles are seen to notably improve the membrane performance, PES membranes with 1 wt.% GO loading provided the highest removal of natural organic matter, such as HA, under the same experimental conditions.

Fever Correlation with Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) Concentrations in Patients with Isolated Polymyalgia Rheumatica (PMR): A Retrospective Comparison Study between Hospital and Out-of-Hospital Local Registries

Background: Polymyalgia rheumatica (PMR) is the most common systemic inflammatory rheumatic disease affecting the elderly. Giant cell arteritis (GCA) is a granulomatous vasculitis affecting the aorta and its branches associated with PMR in up to 20% of cases. In recent studies based on university hospital registries, fever correlated with the erythrocyte sedimentation rate (ESR) but not with C-reactive protein (CRP) concentrations at the time of diagnosis in patients with isolated PMR. A long delay to a PMR diagnosis was suggested to explain this discrepancy, possibly caused by laboratory alterations (for instance, anemia of chronic disease type) that can influence only ESR. We performed a retrospective comparison study between the university hospital and two out-of-hospital public ambulatory databases, searching for any differences in fever/low-grade fever correlation with ESR and CRP. Methods: We identified all patients with newly diagnosed PMR between 2013 and 2020, only including patients who had a body temperature (BT) measurement at the time of diagnosis and a follow-up of at least two years. We considered BT as normal at <37.2 °C. Routine diagnostic tests for differential diagnostics were performed at the time of diagnosis and during follow-ups, indicating the need for more in-depth investigations if required. The GCA was excluded based on the presence of suggestive signs or symptoms and routine ultrasound examination of temporal, axillary, subclavian, and carotid arteries by experienced ultrasonographers. Patients with malignancies, chronic renal disease, bacterial infections, and body mass index (BMI) > 30 kg/m2 were excluded, as these conditions can increase CRP and/or ESR. Finally, we used the Cumulative Illness Rating Scale (CIRS) for quantifying the burden of comorbidities and excluded patients with a CIRS index > 4 as an additional interfering factor. Results: We evaluated data from 169 (73 from hospital and 96 from territorial registries) patients with newly diagnosed isolated PMR. Among these, 77.7% were female, and 61.5% of patients had normal BT at the time of diagnosis. We divided the 169 patients into two cohorts (hospital and territorial) according to the first diagnostic referral. Age at diagnosis, ESR, CRP, median hemoglobin (HB), and diagnostic delay (days from first manifestations to final diagnosis) were statistically significantly different between the two cohorts. However, when we assessed these data according to BT in the territorial cohort, we found a statistical difference only between ESR and BT (46.39 ± 19.31 vs. 57.50 ± 28.16; p = 0.026). Conclusions: ESR but not CRP correlates with fever/low-grade fever at the time of diagnosis in PMR patients with a short diagnosis delay regardless of HB levels. ESR was the only variable having a statistically significant correlation with BT in a multilevel regression analysis adjusted for cohorts (β = 0.312; p = 0.014).

Comparison of clinical imaging and pathological findings of various brain lesions including cerebrovascular diseases and other systemic diseases

Looking back at the cases of brain cutting conducted in Sumitomo Hospital over the past 32 years, cases where clinical brain imaging could be compared with pathological findings other than degenerative diseases are examined and carefully selected, and instructive examples of them are presented. Although there are some limitations, the comparison between clinical brain imaging and pathological finding is significant to the final diagnosis and understanding of the pathogenesis of brain lesions.

Comparison Study of Mini-Incision Versus Original Open Technique of the Half-Mini-Bunnell Achilles Tendon Repair

Mini-incision surgical procedures in our institution have been developed by decreasing the total skin incision length from the original mini half-Bunnell tendon repair technique. We hypothesized that the mini-incision, or minimum invasive Achilles tendon repair technique, would promote the tendon healing process leading to better outcomes and a reduced complication rate compared to the conventional open repair. The study sought to determine the more optimal method by comparing 44 mini-incision sutures to the 99 sutures in the original open Achilles tendon repairs. The mean skin incision length of the mini-incision surgery was 2.9 (range 2.5-3.0) cm and the original repair was 4.2 (range 3.5-7.0) cm. The mean surgery time was 60.0 minutes in the mini-incision repair and 68.1 minutes in the original one (p = .0003). The mean achievement time of bilateral heel-rise, starting jogging, single-legged heel-rise movement and the time to return-to-play was not significantly different between the 2 groups. Achilles Tendon Rupture Score was not significantly different from 3 to 9 months after surgery. Re-injury rate was 1/44 (2.3%) in mini-incision and 4/99 (4.0%) in conventional open repair (p = .36). No patients in either group developed any postoperative infections nor deep vein thrombosis complications. Although the mini-incision half-mini-Bunnell suture was showed equivalent clinical results to the original open repair, the technique is recommended in terms of curtailment of the surgery time without increase of complication ratio.

Validation of a smart shirt for heart rate variability measurements at rest and during exercise

Heart rate variability (HRV) monitoring is a promising option to estimate the autonomic nervous system regulation responding to exercise. Textiles with embedded sensors recording heartbeat intervals are a simple tool for data collection. So-called smart shirts offer comfort for a daily use and are managed easily. Their measurement accuracy for HRV calculation at rest is promising but remains questionable during exercise. Therefore, the present study validated the Ambiotex smart shirt using HRV indices (RMSSD, rel. HF power and rel. LF power) during exercise. Eighty-three healthy participants (31 ± 6 years; 39 females, 44 males) completed an incremental exercise test on a bicycle ergometer wearing the smart shirt and an electrocardiogram simultaneously. We compared HRV indices of segments at rest (5 min), at warm-up (3 min) and twice at the exercise test (each 5 min). At rest and at warm-up, we observed excellent linear relationship (r > 0.96; R² > 0.94), excellent relative reliability (ICC ≥ 0.98; α ≥ 0.98) and acceptable agreement (bias < 10%). During the exercise test, measurement accuracy declined with increasing intensity but remained high (> 0.8), although results for partial HRV indices were insufficient. In addition, percentage bias was unacceptable during exercise test. However, the findings support the validity of the smart shirt for measuring HRV especially at rest and at warm-up. We suggest using the smart shirt for monitoring HRV indices on a daily basis but caution should be taken in the interpretation of HRV indices obtained during moderate to vigorous exercise intensities. This article is protected by copyright. All rights reserved.

Likelihood-based tests for detecting circadian rhythmicity and differential circadian patterns in transcriptomic applications

Circadian rhythmicity in transcriptomic profiles has been shown in many physiological processes, and the disruption of circadian patterns has been found to associate with several diseases. In this paper, we developed a series of likelihood-based methods to detect (i) circadian rhythmicity (denoted as LR_rhythmicity) and (ii) differential circadian patterns comparing two experimental conditions (denoted as LR_diff). In terms of circadian rhythmicity detection, we demonstrated that our proposed LR_rhythmicity could better control the type I error rate compared to existing methods under a wide variety of simulation settings. In terms of differential circadian patterns, we developed methods in detecting differential amplitude, differential phase, differential basal level and differential fit, which also successfully controlled the type I error rate. In addition, we demonstrated that the proposed LR_diff could achieve higher statistical power in detecting differential fit, compared to existing methods. The superior performance of LR_rhythmicity and LR_diff was demonstrated in four real data applications, including a brain aging data (gene expression microarray data of human postmortem brain), a time-restricted feeding data (RNA sequencing data of human skeletal muscles) and a scRNAseq data (single cell RNA sequencing data of mouse suprachiasmatic nucleus). An R package for our methods is publicly available on GitHub https://github.com/diffCircadian/diffCircadian.

Differences Between MR Brain Region Segmentation Methods: Impact on Single-Subject Analysis

For the segmentation of magnetic resonance brain images into anatomical regions, numerous fully automated methods have been proposed and compared to reference segmentations obtained manually. However, systematic differences might exist between the resulting segmentations, depending on the segmentation method and underlying brain atlas. This potentially results in sensitivity differences to disease and can further complicate the comparison of individual patients to normative data. In this study, we aim to answer two research questions: 1) to what extent are methods interchangeable, as long as the same method is being used for computing normative volume distributions and patient-specific volumes? and 2) can different methods be used for computing normative volume distributions and assessing patient-specific volumes? To answer these questions, we compared volumes of six brain regions calculated by five state-of-the-art segmentation methods: Erasmus MC (EMC), FreeSurfer (FS), geodesic information flows (GIF), multi-atlas label propagation with expectation–maximization (MALP-EM), and model-based brain segmentation (MBS). We applied the methods on 988 non-demented (ND) subjects and computed the correlation (PCC-v) and absolute agreement (ICC-v) on the volumes. For most regions, the PCC-v was good (>0.75), indicating that volume differences between methods in ND subjects are mainly due to systematic differences. The ICC-v was generally lower, especially for the smaller regions, indicating that it is essential that the same method is used to generate normative and patient data. To evaluate the impact on single-subject analysis, we also applied the methods to 42 patients with Alzheimer’s disease (AD). In the case where the normative distributions and the patient-specific volumes were calculated by the same method, the patient’s distance to the normative distribution was assessed with the z-score. We determined the diagnostic value of this z-score, which showed to be consistent across methods. The absolute agreement on the AD patients’ z-scores was high for regions of thalamus and putamen. This is encouraging as it indicates that the studied methods are interchangeable for these regions. For regions such as the hippocampus, amygdala, caudate nucleus and accumbens, and globus pallidus, not all method combinations showed a high ICC-z. Whether two methods are indeed interchangeable should be confirmed for the specific application and dataset of interest.

Comparison of Perioperative Outcomes Using the da Vinci S, Si, X, and Xi Robotic Platforms for BABA Robotic Thyroidectomy

Background and Objectives: Robotic thyroidectomy via the bilateral axillo-breast approach (BABA), first introduced in Korea in 2008, has become a standard method of thyroid removal worldwide. The introduction of robotic surgical systems has enabled more patients to benefit from BABA robotic thyroidectomy, with good postoperative and excellent cosmetic results. To date, no studies have compared the benefits of the four currently available da Vinci robotic systems (S, Si, X, and Xi) for BABA robotic thyroidectomy. To determine the da Vinci model most suitable for BABA robotic thyroidectomy, the present study compared the perioperative outcomes in patients who underwent BABA robotic thyroidectomy using the four da Vinci models. Materials and Methods: This retrospective study evaluated outcomes in patients (n = 750) who underwent BABA robotic thyroidectomy using the four da Vinci systems from 2013 to 2019. The clinicopathologic data, including operation time, were compared. Substudy A compared the da Vinci models S and Si from 2013 to 2017, and substudy B compared models Si, X, and Xi from 2018 to 2019. Results: Substudy A, comparing the da Vinci S and Si systems, found no statistically significant differences between the two groups, whereas substudy B found that operation time was shorter in patients who underwent BABA robotic thyroidectomy with the da Vinci Xi system than with the Si and X systems. Conclusions: The da Vinci model Xi system can benefit patients undergoing BABA robotic thyroidectomy by shortening the operation time.

Evaluation of point-of-care testing device for anemia detection: A cross-sectional method comparison study from Thailand

BACKGROUND

A comparison study is crucial before launching a new medical device; therefore, we compared the Mission Ultra Hb Testing System with the Sysmex XN-3000 automated hematology analyzer in Thai adult males and non-pregnant adult females.

METHODS

Parallel studies were conducted using discarded venous K2-ethylenediaminetetraacetic acid samples from participants requiring hematological investigations. According to the World Health Organization criteria, the participants were categorized as overall, anemia, and non-anemia for analysis.

RESULTS

Three hundred participants were included in this study. In all participants, near-perfect correlation and agreement were observed between the two methods for Hb measurement (r = 0.963, p < 0.001) with an interclass correlation coefficient (ICC) of 0.981 (95% confidence interval [CI]: 0.976-0.985) and Hct measurement (r = 0.941, p < 0.001) with an ICC of 0.965 (95% CI: 0.956-0.972). The sensitivity and specificity of the device in detecting anemia were 86.2% (95% CI: 79.7-91.2) and 98.6% (95% CI: 95.2-99.8), respectively. The area under the curve was 0.976 (95% CI: 0.963-0.989). The device showed average biases of 0.76 g/dl (95% limits of agreement [LOA]: -1.03 to 2.54) for Hb measurement and -2.73% (95% LOA: -9.28 to 3.82) for Hct measurement in all participants.

CONCLUSION

Agreement between the Mission Ultra Hb Testing System and Sysmex XN-3000 was observed. The device was excellent for detecting anemia. However, the essential evidence showing biases of the Hb and Hct measurements obtained from the device was revealed. Laboratory interpretation should be carefully performed, particularly at the near cut-off values.

Validation of the Sysmex XN-V hematology analyzer for canine specimens

Background

The Sysmex XN‐V is derived from the new Sysmex XN series of human hematology analyzers. The main changes from the previously validated XT‐2000iV analyzer include an optic‐fluorescent analysis for platelets and nucleated RBC count.

Objective

We aimed to validate the Sysmex XN‐V for canine blood according to American College for Veterinary Clinical Pathology and International Council for Standardization in Hematology recommendations.

Materials and Methods

Canine EDTA blood specimens and quality control material were analyzed on the Sysmex XN‐V to evaluate imprecision, bias, linearity, a comparison with the XT‐2000iV analyzer, interference effects, carry‐over, and stability. We also verified previously established Sysmex XT‐2000iV reference intervals (RIs).

Results

Imprecision and bias were low (<5%) for most variables. Observed total error was lower than allowable total error for most measured variables except lymphocytes and monocytes. Visually determined linearity was excellent for all variables, except for lymphocytes. The correlation between the XN‐V and XT‐2000iV analyzers was high (>0.93) for all variables except MCHC and reticulocyte indices. Correlations between the Sysmex XN‐V and manual differential counts were good for neutrophils and eosinophils, acceptable for lymphocytes, and fair for monocytes. Hemolysis, lipemia, and to a lesser extent icterus, had significant effects on measured hemoglobin concentration and associated variables. Carry‐over was not visually observed for any variable. Changes in the Sysmex XN‐V measurements after storage at 4℃ and 24℃ were similar to those described for the Sysmex XT‐2000iV analyzer. The previously established Sysmex XT‐2000iV RIs can be used to interpret results from the Sysmex XN‐V analyzer for most variables except red blood cell distribution width and mean platelet volume.

Conclusions

The performance of the Sysmex XN‐V analyzer was excellent and compared favorably with the Sysmex XT‐2000iV analyzer.

The Impact of Systematic Review Automation Tools on Methodological Quality and Time Taken to Complete Systematic Review Tasks: Case Study

BACKGROUND

Systematic reviews (SRs) are considered the highest level of evidence to answer research questions; however, they are time and resource intensive.

OBJECTIVE

When comparing SR tasks done manually, using standard methods, versus those same SR tasks done using automated tools, (1) what is the difference in time to complete the SR task and (2) what is the impact on the error rate of the SR task?

METHODS

A case study compared specific tasks done during the conduct of an SR on prebiotic, probiotic, and synbiotic supplementation in chronic kidney disease. Two participants (manual team) conducted the SR using current methods, comprising a total of 16 tasks. Another two participants (automation team) conducted the tasks where a systematic review automation (SRA) tool was available, comprising of a total of six tasks. The time taken and error rate of the six tasks that were completed by both teams were compared.

RESULTS

The approximate time for the manual team to produce a draft of the background, methods, and results sections of the SR was 126 hours. For the six tasks in which times were compared, the manual team spent 2493 minutes (42 hours) on the tasks, compared to 708 minutes (12 hours) spent by the automation team. The manual team had a higher error rate in two of the six tasks-regarding Task 5: Run the systematic search, the manual team made eight errors versus three errors made by the automation team; regarding Task 12: Assess the risk of bias, 25 assessments differed from a reference standard for the manual team compared to 20 differences for the automation team. The manual team had a lower error rate in one of the six tasks-regarding Task 6: Deduplicate search results, the manual team removed one unique study and missed zero duplicates versus the automation team who removed two unique studies and missed seven duplicates. Error rates were similar for the two remaining compared tasks-regarding Task 7: Screen the titles and abstracts and Task 9: Screen the full text, zero relevant studies were excluded by both teams. One task could not be compared between groups-Task 8: Find the full text.

CONCLUSIONS

For the majority of SR tasks where an SRA tool was used, the time required to complete that task was reduced for novice researchers while methodological quality was maintained.

Improvement of the Diagnostic Performance of Facial Neuritis Using Contrast-Enhanced 3D T1 Black-Blood Imaging: Comparison with Contrast-Enhanced 3D T1-Spoiled Gradient-Echo Imaging

This study aims to investigate the diagnostic ability of the contrast-enhanced 3D T1 black-blood fast spin-echo (T1 BB-FSE) sequence compared with the contrast-enhanced 3D T1-spoiled gradient-echo (CE-GRE) sequence in patients with facial neuritis. Forty-five patients with facial neuritis who underwent temporal bone MR imaging, including T1 BB-FSE and CE-GRE imaging, were examined. Two reviewers independently assessed the T1 BB-FSE and CE-GRE images in terms of diagnostic performance, and qualitative (diagnostic confidence and visual asymmetric enhancement) and quantitative analysis (contrast-enhancing lesion extent of the canalicular segment of the affected facial nerve (LEC) and the affected side-to-normal signal intensity ratio (rSI)). The AUCs of each reviewer, and the sensitivity and accuracy of T1 BB-FSE were significantly superior to those of CE-GRE (p < 0.05). Regarding diagnostic confidence and visual asymmetric enhancement, T1 BB-FSE tended to be rated greater than CE-GRE (p < 0.05). Additionally, in quantitative analysis, LEC and rSI of the canalicular segment on T1 BB-FSE were larger than those on CE-GRE (p < 0.05). The T1 BB-FSE sequence was significantly superior to the CE-GRE sequence, with more conspicuous lesion visualization in terms of both qualitative and quantitative aspects in patients with facial neuritis.

A Treatment-Response Comparison Study of Resting-State Functional Magnetic Resonance Imaging Between Standard Treatment of SSRI and Standard Treatment of SSRI Plus Non-dominant Hand-Writing Task in Patients With Major Depressive Disorder

Background: Researches have recently shifted from functional/structural imaging studies to functional connectivity (FC) studies in major depressive disorder (MDD). We aimed to compare treatment response of two treatment groups before and after treatment, in terms of both with psychiatric evaluation scales and resting-state functional connectivity (RSFC) changes in order to objectively demonstrate the possible contribution of the non-dominant hand-writing exercise (NHE) effect on depression treatment. Methods: A total of 26 patients who were right-handed women with similar sociodemographic characteristics were enrolled. Their pre-treatment resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychiatric tests were recorded, and then, patients were divided into two groups randomly. A standard treatment (ST) (fix sertraline 50 mg/day) was given to both groups. One randomly selected group was given the NHE in addition to the ST. After 8 weeks of treatment, all patients were reevaluated with rs-fMRI and neuropsychiatric tests. Pre- and post-treatment FC changes within the groups and post-treatment connectivity changes between groups were evaluated. Results: Post-treatment neuropsychiatric tests were significantly different in both groups. Post-treatment, two brain regions' connectivity changed in the ST group, whereas 10 brain regions' connectivity changed significantly in the ST + NHE group. When treatment groups were compared with each other after the treatment, the FC of 13 regions changed in the ST + NHE group compared to the ST group (p-unc/p-PFD <0.05). The density of connectivity changes in the frontal and limbic regions, especially connectivities shown to change in depression treatment, in the ST + NHE group indicates a positive contribution to depression treatment, which is also supported by neuropsychiatric scale changes. Conclusion: NHE, which we developed with inspiration from the Eye Movement Desensitization and Reprocessing (EMDR) method, showed significantly more connecitivity changes related with MDD treatment. Beyond offering a new additional treatment method, our study will also contribute to the current literature with our efforts to evaluate all brain regions and networks that may be related to MDD and its treatment together, without being limited to a few regions. Trial Registration: The rs-fMRI and treatment registers were recorded in the BizMed system, which is the patient registration system of Bezmialem Vakif University Medicine Faculty, under the BAP support project approval code and the registration number 3.2018/8.

Performance evaluation of immunoassay for infectious diseases on the Alinity i system

Background

Although a diagnosis of infectious diseases is essential for timely treatment, the performance of diagnostic tests has been hardly evaluated due to variable results that are influenced by multiple factors in different conditions. In the present study, the performance of the Alinity i system, which is a newly developed immunoassay to diagnose infectious diseases, was evaluated.

Methods

We evaluated the precision, linearity, correlation, and carryover of 16 analytes (HAV Ab IgG, HBsAg, HBeAg, anti‐HBc, anti‐HBe, anti‐HBs, anti‐HCV, HIV Ag/Ab, EBV VCA IgM, EBV VCA IgG, EBV EBNA IgG, CMV IgM, CMV IgG, Toxoplasma IgG, Rubella IgG, and Syphilis TP) of Alinity i by comparison with ARCHITECT i2000_SR system following the rationale of the Clinical and Laboratory Standards Institute (CLSI).

Results

For quantitative tests, the coefficients of variation (CV) % of repeatability and intermediate precision were between 0% and 4.18%. The coefficients of the linearity (r²) over a widely tested analytical range were ≥ 0.990 and the correlation between Alinity i and the ARCHITECT i2000_SR system was strong (r ≥ 0.994). For qualitative tests, the agreement between Alinity i and the ARCHITECT i2000_SR system was excellent (kappa coefficient 1) with 100% sensitivity and specificity. Carryover rates for all analytes were less than 1.0% (−0.11% ~ 0.21%).

Conclusion

The Alinity i system showed good analytical performance and favorable comparability with the ARCHITECT i2000_SR. It could be suitable as a routine immunoassay analyzer for screening and diagnosis of infectious disease.

Nursing student-patient relationship - a 10-year comparison study in Finland

Objective This study aimed to describe and compare the group-level findings from 2005-2006 and 2015-2016 regarding students' and patients' views of the nursing student-patient relationship and associated factors. Methods The data were in both cases collected using Student-Patient Relationship Scales. The data were analysed statistically. Results In both student cohorts, authoritative and facilitative student-patient relationships were reported by the students more frequently than mechanistic relationships. Authoritative relationships were most common in both patient cohorts, whereas facilitative relationships had become more frequent than mechanistic relationships. A positive change of views in the student and patient cohorts was found in factors associated with the relationship. Conclusion In order to strengthen a clinical learning culture that reflects a facilitative student-patient relationship, further research is needed on the processes and outcomes of that relationship.

Metabolism study of hesperetin and hesperidin in rats by UHPLC-LTQ-Orbitrap MS n

Hesperidin (HPD) and hesperetin (HPT), as a kind of flavonone compounds, are abundant in citrus fruits with various pharmacological effects. HPD and HPT are not always consistent in some biological activities, even if they have the same skeletal structure. The aim of this study was to screen and identify HPT and HPD metabolites in rats using UHPLC-LTQ-Orbitrap MS ⁿ , compare the possible metabolism and provide the research basis for further understanding the similarities and differences in pharmacodynamics and pharmacokinetics of HPT and HPD. A total of 17 and 52 metabolites were identified in rats after oral administration of HPT or HPD, respectively. Three of HPT and HPD metabolites, glucuronidation, sulfation and diglucuronidation of HPT, were the same and could be the active components for the same pharmacodynamic action of them. We could find prototype in the urine sample of HPD group, but no prototypes in any samples of HPT group. There were hardly any general phase I metabolites of HPT, while 33 phase I metabolites of HPD could be identified. These data suggested that the poorer bioavailability of HPD compared with HPT.

Performance and Usability of Three Systems for Continuous Glucose Monitoring in Direct Comparison

BACKGROUND

To be able to compare continuous glucose monitoring (CGM) systems, they have to be worn in parallel by the same subjects. This study evaluated the performance and usability of three different CGM systems in direct comparison.

METHOD

In this open, prospective study at two sites, 54 patients with diabetes wore three CGM systems each (Dexcom G5™ Mobile CGM system [DG5], Guardian™ Connect system [GC], and a Roche CGM system [RCGM]) in parallel for 6 or 7 days in a mixed inpatient and outpatient setting. Capillary comparison measurements were performed using a self-monitoring of blood glucose (SMBG) system. During study site visits, glucose excursions were induced. Performance of the systems was evaluated by calculating mean absolute relative differences (MARD, calculated as absolute differences for glucose concentrations <100 mg/dL and as relative differences for glucose concentrations ≥100 mg/dL), and mean relative differences (MRD, bias) between CGM and SMBG results. In addition, usability of the systems was assessed.

RESULTS

Overall MARD was 10.1 ± 2.1 for DG5, 11.5 ± 4.2 for GC, and 11.9 ± 5.6 for RCGM. Performance improved in all systems after the first day of use. All systems showed >99% of values within zones A and B of the consensus error grid. Overall, all CGM systems showed a small negative bias compared to SMBG. Usability of the systems differed regarding patch adhesion rate, failure rate, and patient rating. Most patients preferred GC, but in general all systems were rated positively.

CONCLUSION

All three CGM systems showed similar overall accuracy in this direct comparison, but small differences were observed with regard to specific glucose ranges and usability aspects.

Analysis of Obesity among Malaysian University Students: A Combination Study with the Application of Bayesian Structural Equation Modelling and Pearson Correlation

In obesity modelling studies, researchers have been seeking to identify the effective indicators of obesity by using appropriate statistical or mathematical techniques. The main objective of the present study is addressed in three stages. First, a new framework for modelling obesity in university students is introduced. The second stage involves data analysis based on Bayesian Structural Equation Modelling (BSEM) for estimating the Body Mass Index (BMI) (representative of the obesity level) of students at three university levels: Bachelor, Master and PhD. In the third stage, the highest significant correlation is determined between the BMI and other variables in the research model that were found significant through the second phase. The data for this study were collected from students at selected Malaysian universities. The results indicate that unhealthy food intake (fast food and soft drinks), social media use and stress exhibit the highest weightage contributing to overweight and obesity issues for Malaysian university students.

Essential medicines lists for children of WHO, India, South Africa, and EML of China: A comparative study

OBJECTIVE

Comparing the essential medicine lists for children and China national essential medicine list 2012, to provide the evidence for establishing essential medicine list for children in China.

METHODS

Search the official websites of WHO and some other countries' ministry of health to get essential medicine lists for children (EMLc) that have already established. Compare the situation of updating, the number and classification of medicines, and the dosage forms in essential medicine lists for children and China national essential medicine list 2012.

RESULTS

By December 2013, the WHO, India, and South Africa have established EMLc. The list of China was for people in all ages, so the number of medicines ranked first in four lists. WHO, India, and China classified the medicines by pharmacologic action, South Africa classified by ATC classification. Except for WHO, India, South Africa, and China did not have specific medicines for neonatal care or medicines for diseases of joints. The main administration routes in these four lists were oral administration, injection, and topical application. There were medicine restrictions in lists of WHO and India, but there were no medicine restrictions in the lists of South Africa and China.

CONCLUSION

Compared with EMLs for children, the 2012 National Essential Medicine List for China is not suitable for children in China. Development of Chinese EMLc should be based on the burden of diseases for children, and should select applicable dosage forms and specifications.

Comparison of Total Hip Arthroplasty With and Without Femoral Shortening Osteotomy for Unilateral Mild to Moderate High Hip Dislocation

BACKGROUND

This study compares the outcome between THA with and without femoral shortening osteotomy for unilateral mild to moderate high hip dislocation in developmental dysplasia of the hip patients.

METHODS

The data on 42 hips in 42 patients who had undergone THA for unilateral mild to moderate high hip dislocation were retrospectively reviewed after being prospectively collected. In 22 patients, hips were reduced by soft tissue release and direct leverage using an elevator, without the osteotomy. The remaining 20 patients were treated with a subtrochanteric transverse shortening osteotomy. The mean follow-up of patients was 5 years (standard deviation = 1.0) for the nonosteotomy group and 6.2 years (standard deviation = 1.6) for the osteotomy group.

RESULTS

The Harris Hip Score significantly improved in both groups. In the nonosteotomy group, we observed a lower leg length discrepancy compared with the osteotomy group (0.4 cm and 2.2 cm, respectively). Four patients (18.2%) in the nonosteotomy group and 15 patients (75%) in the osteotomy group developed a limp (P < .0001). Three patients (13%) developed femoral nerve palsy in the nonosteotomy group, but they all recovered completely within 6 months after the surgery. Nineteen patients in the nonosteotomy group showed knee valgus deformity immediately after the surgery but only 4 cases in the osteotomy group.

CONCLUSION

Compared with THA with femoral shortening osteotomy, THA without the osteotomy was associated with a lower number of patients who developed a limp at the end of follow-up; however, the rehabilitation was slower and more difficult, and a larger number of patients showed reversible nerve palsy and knee valgus deformity.

An international comparison study of pharmacy students' achievement goals and their relationship to assessment type and scores

OBJECTIVE

To identify pharmacy students' preferred achievement goals in a multi-national undergraduate population, to investigate achievement goal preferences across comparable degree programs, and to identify relationships between achievement goals, academic performance, and assessment type.

METHODS

The Achievement Goal Questionnaire was administered to second year students in 4 universities in Australia, New Zealand, England, and Wales. Academic performance was measured using total scores, multiple-choice questions, and written answers (short essay).

RESULTS

Four hundred eighty-six second year students participated. Students showed an overall preference for the mastery-approach goal orientation across all sites. The predicted relationships between goal orientation and multiple-choice questions, and written answers scores, were significant.

CONCLUSION

This study is the first of its kind to examine pharmacy students' achievement goals at a multi-national level and to differentiate between assessment type and measures of achievement motivation. Students adopting a mastery-approach goal are more likely to gain high scores in assessments that measure understanding and depth of knowledge.

Comparison of benazepril and losartan on endothelial function and vascular stiffness in patients with Type 2 diabetes mellitus and hypertension: A randomized controlled trial

INTRODUCTION

The purpose of this study was to compare the effects of benazepril and losartan on endothelial function and vascular stiffness, in patients with diabetes mellitus and hypertension.

MATERIALS AND METHODS

We included hypertensive diabetic patients with an office systolic blood pressure (BP) ⩾ 130 mmHg and/or diastolic BP ⩾ 80 mmHg. Patients were rolled over to amlodipine for 6 weeks, then we performed C-reactive protein assays, BP measurement and vascular tests; next, patients were randomized to benazepril or losartan. The tests were repeated after 12 weeks.

RESULTS

We randomized 14 patients to benazepril and 16 to losartan. There were no differences in systolic (139 versus 134 mmHg, p = 0.618) and diastolic (82 versus 80 mmHg, p = 0.950) BP at the end of the study. C-reactive protein values were lower in the benazepril group (0.38 versus 0.42 mg/dl, p = 0.020). There was a slightly higher flow-mediated vasodilation (FMD) response in the benazepril group (45% increase, p = 0.057) than in the losartan group (19% increase, p = 0.132). Both central systolic BP (129 versus 123 mmHg, p = 0.934) and carotid-femoral pulse wave velocity (cfPWV) (8.5 versus 8.5 m/s, p = 0.280) were the same between groups.

CONCLUSIONS

Hypertensive diabetic patients using benazepril had a greater reduction in C-reactive protein, and a slight improvement in FMD, than those taking losartan.

Capturing citation activity in three health sciences departments: a comparison study of Scopus and Web of Science

Scopus and Web of Science are the two major citation databases that collect and disseminate bibliometric statistics about research articles, journals, institutions, and individual authors. Liaison librarians are now regularly called upon to utilize these databases to assist faculty in finding citation activity on their published works for tenure and promotion, grant applications, and more. But questions about the accuracy, scope, and coverage of these tools deserve closer scrutiny. Discrepancies in citation capture led to a systematic study on how Scopus and Web of Science compared in a real-life situation encountered by liaisons: comparing three different disciplines at a medical school and nursing program. How many articles would each database retrieve for each faculty member using the author-searching tools provided? How many cited references for each faculty member would each tool generate? Results demonstrated troubling differences in publication and citation activity capture between Scopus and Web of Science. Implications for librarians are discussed.

Perceptions of barriers to cardiac rehabilitation use in Brazil

Cardiovascular diseases (CVD) are the leading cause of mortality in middle-income countries, such as Brazil. However, given the diversity in health care systems in Brazil, access to proven services, such as cardiac rehabilitation (CR), varies widely.