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OBJECTIVE: To compare the cosmetic appeal of incisions used for open (Pfannenstiel or Vertical midline) versus robotic-assisted laparoscopic lower urinary tract reconstructive surgery in women. STUDY DESIGN: Cross-sectional descriptive study PLACE AND DURATION: Outpatient Urology Clinic of Western General Hospital, Edinburgh Scotland, UK from 1st February 2019 till 28th February 2020. METHODS: All patients were provided illustrations of Pfannenstiel incision (incision at “bikini line”- (A), Vertical midline laparotomy incision (incision from midline symphysis to umbilicus –( B), Robotic-assisted laparoscopic incisions-variation I- (C) and Robotic-assisted laparoscopic incisions-variation II (-D). Patients were asked to rate each incision in order of their preference. Chi square distribution was used to compare mean previous surgeries and no previous surgeries between different preferred incisional groups and ages of the patients. RESULTS: One hundred patients with mean age were 53.11±15.05 years with minimum 19 years and maximum 84 years and mean BMI was 28.18±7.05 kg/m2 with minimum 15.6 and maximum 55 kg/m2 calculated. Out of 100 patients (1st preference of incision), 78% preferred incision A, 3% preferred B incision and 16% & 3% patients preferred incision C and D respectively. Similarly (2nd preference of incision) 3% patients preferred incision A, 19% preferred B incision and 56% & 22% patients preferred incision C and D respectively. The mean comparison between first preferred incision with second preferred incision with respect of surgeries (previous surgeries and no previous surgeries) showed significant difference p≤0.05 (chi value=167.692, p=0.000). Relation of preferred incisions with respect to ages of the patients showed no significant difference (Pearson relation value -0.182 and p=0.069). CONCLUSION: Overall, open incisions were preferred over robotic incisions. Patient perception of the "visibility" of abdominal incisions and previous experience in term of surgical scars may be the distinguishing issue to explain the difference in the preferences between open versus robotic-assisted laparoscopic incisions in women.

The Generalized F-test is derived based on the Generalized P-value Method to test the equality of normally distributed group means under unequal variances. There are two approaches to compute the p-value of the GF test, based on beta and chi-squared random numbers. From prior art in the literature, it appears that the two computation approaches of the Generalized tests are equivalent. In this study, the equivalence of these approaches is investigated in an extensive Monte-Carlo simulation study in terms of Type I error probability and penalized power. It is found that the equivalence of the computation approaches is not quite correct and that there is a difference between their conclusion, and researchers should decide which one is powerful than the others according to the structure of data, such as sample size, and the number of groups. Also, real data examples are given to show the opposite decisions of the computation approaches.

Chen, Bunce and Jiang (In: Proceedings of the International Con- ference on Computational Intelligence and Software Engineering, pp. 1-4) claim to have proposed a new extreme value distribution. But the formulas given for the distribution do not form a valid probability distribution. Here, we correct their formulas to form a valid probability distribution. For this valid distribution, we provide a comprehensive treatment of mathematical properties, estimate parameters by the method of maximum likelihood and provide the observed information matrix. The exibility of the distribution is illustrated using a real data set.

Since the end of February 2020, Italy has suffered one of the most severe outbreaks of coronavirus disease 2019 (COVID-19). However, what happened just before the Italian index case has not yet been investigated. To answer this question, we evaluated the potential impact of COVID-19 on the clinical features of a cohort of neurological inpatients admitted right before the Italian index case, as compared to the same period of the previous year. Demographic, clinical, treatment and laboratory data were extracted from medical records. The data collected included all inpatients who had been admitted to the Neurology and Stroke Units of the Ospedale Maggiore Policlinico, Milan, Italy, from December 15, 2018 to February 20, 2019 and from December 15, 2019 to February 20, 2020. Of the 248 patients, 97 subjects (39.1%) were admitted for an acute cerebrovascular event: 46 in the 2018/2019 period (mean [SD] age, 72.3 [15.6] years; 22 men [47.8%]), and 51 in the 2019/2020 interval (mean [SD] age, 72.8 [12.4] years; 24 men [47.1%]). The number of cryptogenic strokes has increased during the 2019–2020 year, as compared to the previous year (30 [58.8%] vs. 18 [39.1%], p = 0.05). These patients had a longer hospitalization (mean [SD] day, 15.7 [10.5] days vs. mean [SD] day, 11.7 [7.2] days, p = 0.03) and more frequent cerebrovascular complications (9 [30.0%] vs. 2 [11.1%]), but presented a lower incidence of cardiocerebral risk factors (18 [60.0%] vs. 14 [77.8%]). Right before the Italian index case, an increase in cryptogenic strokes has occurred, possibly due to the concomitant COVID-19.

OBJECTIVE To evaluate the result of an inpatient postpartum human papillomavirus (HPV) immunization pilot program in a diverse, low-income patient population from an urban, hospital-based obstetrics and gynecology clinic. METHODS In this cohort study, we present results from the first 2 years of the inpatient postpartum HPV immunization program, in which vaccine-eligible postpartum women were identified and immunized during their hospital stays. The program was implemented after educational outreach with prenatal and postpartum clinicians and nurses. Associations between receipt of the HPV vaccine as an inpatient and the characteristics of patients, and the likelihood of and missed opportunities for receiving a subsequent dose of the HPV vaccine as an outpatient were determined using logistic regression, time-to-event analyses, chi-squared tests and t-tests. RESULTS From April 11, 2017, to April 10, 2019, 394 (59.2%) of 666 postpartum women were eligible for the inpatient postpartum HPV immunization program. The majority (265/394, 67.3%) received the immunization pilot program HPV dose; 36 of those 265 (13.6%) completed the series with that dose. Among women due for additional doses after hospital discharge, those who received the inpatient dose were more likely to receive a subsequent outpatient dose (138/229) than were those who did not receive an inpatient dose (39/129; hazard ratio 2.51, 95% CI 1.76-3.58). On average, there were 30.7 fewer (95% CI 5.8-55.6, P

Background Chronic tension type headache (CTTH) is one of the common cause of hospital visits among adolescents and adults. Chronic tension type headache produces pain, sleep disturbances, and disability among patients leading to a poor quality of life. Knowledge pattern of headache and various associated factors will aid appropriate management. Aims To identify the headache dimensions and their various influencing factors among patients of chronic tension-type headache. Methods Using consecutive sampling techniques, 169 patients with chronic tension-type headache were recruited in this cross-sectional survey. Approval was obtained from the Institute's Ethics Committee. The Wong-Baker Foundation Pain intensity scale was used to assess the pain severity. Results A pain severity score of 6 out of 10 was reported by 56% of the patients, and the mean pain score reported by the patients was 6.62 ± 1.16. The mean weekly headache frequency was 4.95 ± 0.38, and the mean daily headache duration was 8.68 ± 1.68 hours. Significantly more patients who are married, patients who had a duration of illness less than two years, and patients who were treated with only analgesics reported higher headache severity. Higher headache frequency was reported by significantly more patients who were male, married, from a nuclear family, educated, unskilled laborers or employed, urban inhabitants, or only on analgesics, or had illness duration less than two years. Headache duration was significantly higher in patients who were unskilled laborers or only on analgesics, or had illness duration less than two years. Conclusions Patients with chronic tension-type headache experience moderate to high severity of headache, along with substantial duration and frequency, an outcome that was associated with various lifestyle-related factors that can result in stress. Lifestyle modification and nonpharmacological management are thus essential to reduce the severity, frequency, and duration of headache in patients with a chronic tension-type headache and medication overuse.

Objectives We aimed to assess the diagnostic performance of CT in patients with a negative first RT-PCR testing and to identify typical features of COVID-19 pneumonia that can guide diagnosis in this case. Methods Patients suspected of COVID-19 with a negative first RT-PCR testing were retrospectively revalued after undergoing CT. CT was reviewed by two radiologists and classified as suspected COVID-19 pneumonia, non-COVID-19 pneumonia or negative. The performance of both first RT-PCR result and CT was evaluated by using sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) and by using the second RT-PCR test as the reference standard. CT findings for confirmed COVID-19 positive or negative were compared by using the Pearson chi-squared test (P values

Chi square distribution is a continuous probability distribution primarily used in hypothesis testing, contingency analysis, and construction of confidence limits in inferential statistics but not necessarily in the modeling of real-life phenomena. The closed-form expression for the quantile function (QF) of Chi square is not available because the cumulative distribution function cannot be transformed to yield the QF and consequently places limitations on the use of the QF. Researchers have over the years proposed approximations that improve over time in terms of speed, computational efficiency, and precision, and so on. However, most of the available closed-form expressions (quantile approximation) fail at the extreme tails of the distribution. This paper used the Quantile mechanics approach to obtain second-order nonlinear ordinary differential equations whose solutions using the power series method yielded initial approximates in form of series for different values of the degrees of freedom. The initial approximate varies with the exact (R software) values which serve as the reference and the error between them was minimized by the natural cubic spline interpolation. The final approximates are correct up to an average of 8 decimal places, have small error, and is closer to the exact when compared with some other results from other researchers. The upper tail of the distribution was considered and excellent results were obtained which is a major improvement over the existing results in the literature. The approach used in this work is a hybrid of series expansions and numerical algorithms. Computer codes can be written for the application.

Background Reports indicate that those most vulnerable to developing severe coronavirus disease 2019 (COVID-19) are older adults and those with underlying illnesses, such as diabetes mellitus, hypertension, or cardiovascular disease, which are common comorbidities among patients undergoing maintenance hemodialysis. However, there is limited information about the clinical characteristics of hemodialysis patients with COVID-19 or about interventions to control COVID-19 in hemodialysis centers. Methods We collected data retrospectively through an online registration system that includes all patients receiving maintenance hemodialysis at 65 centers in Wuhan, China. We reviewed epidemiologic and clinical data of patients with laboratory-confirmed COVID-19 between January 1, 2020 and March 10, 2020. Results Of 7154 patients undergoing hemodialysis, 154 had laboratory-confirmed COVID-19. The mean age of the 131 patients in our analysis was 63.2 years; 57.3% were men. Many had underlying comorbidities, with cardiovascular disease (including hypertension) being the most common (68.7%). Only 51.9% of patients manifested fever; 21.4% of infected patients were asymptomatic. The most common finding on chest computed tomography (CT) was ground-grass or patchy opacity (82.1%). After initiating comprehensive interventions-including entrance screening of body temperature and symptoms, universal chest CT and blood tests, and other measures-new patients presenting with COVID-19 peaked at 10 per day on January 30, decreasing to 4 per day on February 11. No new cases occurred between February 26 and March 10, 2020. Conclusions We found that patients receiving maintenance hemodialysis were susceptible to COVID-19 and that hemodialysis centers were high-risk settings during the epidemic. Increasing prevention efforts, instituting universal screening, and isolating patients with COVID-19 and directing them to designated hemodialysis centers were effective in preventing the spread of COVID-19 in hemodialysis centers.

Objective This study was aimed to compare maternal and pregnancy outcomes of symptomatic and asymptomatic pregnant women with novel coronavirus disease 2019 (COVID-19). Study Design This is a retrospective cohort study of pregnant women with COVID-19. Pregnant women were divided into two groups based on status at admission, symptomatic or asymptomatic. All testing was done by nasopharyngeal swab using polymerase chain reaction (PCR) for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Initially, nasopharyngeal testing was performed only on women with a positive screen (symptoms or exposure) but subsequently, testing was universally performed on all women admitted to labor and delivery. Chi-square and Wilcoxon's rank-sum tests were used to compare outcomes between groups. Results Eighty-one patients were tested because of a positive screen (symptoms [ n = 60] or exposure only [ n = 21]) and 75 patients were universally tested (all asymptomatic). In total, there were 46 symptomatic women and 22 asymptomatic women (tested based on exposure only [ n = 12] or as part of universal screening [ n = 10]) with confirmed COVID-19. Of symptomatic women ( n = 46), 27.3% had preterm delivery and 26.1% needed respiratory support while none of the asymptomatic women ( n = 22) had preterm delivery or need of respiratory support ( p = 0.007 and 0.01, respectively). Conclusion Pregnant women who presented with COVID19-related symptoms and subsequently tested positive for COVID-19 have a higher rate of preterm delivery and need for respiratory support than asymptomatic pregnant women. It is important to be particularly rigorous in caring for COVID-19 infected pregnant women who present with symptoms. Key Points Respiratory support is often needed for women who present with symptoms. Low rate of severe disease in women who present without symptoms. There were no neonatal infections on day 0 of life.

Background: Aberrant activation of the complement system plays an important role in the pathogenesis and development of immunoglobulin A nephropathy (IgAN). The relationship between serum complement and the clinical-histopathological features and outcomes of IgAN is controversial. This retrospective study aimed to examine the relationship between the complement 3/4 (C3/C4) ratio and the clinicopathologic changes and prognosis of patients with IgAN. Methods: A total of 397 patients with primary IgAN from January 2007 to December 2012 at the Chinese People’s Liberation Army General Hospital were included in this study. The correlation test and Chi-square test or one-way analysis of variance test were performed to evaluate the relationship between the C3/C4 ratio and other clinical-pathological factors. Propensity score matching and a multivariate Cox regression model were used to calculate the risk factors of renal outcome. Results: The median follow-up period was 75 months. During the follow-up period, 62 patients (15.6%) developed into the end-stage renal disease (ESRD). The C3/C4 ratio at baseline was associated with the level of serum creatinine (SCr), 24 h urinary protein excretion (24 h Upre), global glomerular sclerosis, and tubulointerstitial lesion. The level of SCr and 24 h Upre and the degree of chronic kidney injury were statistically different among groups defined by different C3/C4 ratio levels. The survival rates of patients among groups with different C3/C4 ratio levels were different. After propensity score matching, eighty-eight pairs of patients were successfully matched, and the C3/C4 ratio was an influencing factor for the patients’ outcome (hazard ratio 0.587, 95% confidence interval 0.329-0.880). Patients with a C3/C4 ratio

Nurse practitioner (NP) faculties are challenged to offer programs that balance didactic knowledge with the clinical experiences required to prepare graduates for the complexities of health care. Students have the stress of extrapolating the information they obtain during these programs and applying it to postgraduation certification examinations. Innovative educational tools are necessary to ease the uncertainty that NP students experience to graduate and pass certification examinations. Tools include academic-clinical partnerships (ACPs) to enhance clinical opportunities and resources to integrate diagnostic readiness tests (DRTs) into curricula.This was a quasi-experimental one group, pretest/posttest design using a convenience sample of NP students randomly assigned to clinical in ACP or non-ACP clinical placements. They completed the DRTs twice during their final program semesters.The overall DRT group scores for the NP students significantly improved over time. The Wilcoxon signed ranks test showed that the posttest scores were significantly higher than the pretest scores. The Mann-Whitney U test revealed no differences between the ACP and non-ACP students. Students performed the best on assessment, diagnosis, management, and pharmacology domains. This demonstrates support for the integration of DRTs into NP programs.Integrating DRTs into NP programs can facilitate transition to the NP role.

Although urinary incontinence (UI) in hospitalized patients is a frequent health problem, research on the subject is limited. Purpose A prospective, descriptive study was conducted to evaluate the prevalence of UI, care implemented among hospitalized adult patients, and impact of UI on quality of life (QoL) in a large private institution in Brazil. Methods All patients admitted during November 2018 who were at least 18 years of age, sufficiently conscious and oriented to answer questions, able to undergo skin inspection, and had the ability to urinate (ie, did not use an indwelling bladder catheter or have a nephrostomy, cystostomy, urostomy, or vesicostomy) were eligible to participate. Data were collected through interviews, physical examinations, chart review, and completion of the International Consultation on Incontinence Questionnaire-Short Form (ICQI-SF), a self-diagnostic, 6-item survey of UI frequency, amount of leakage, and overall impact of UI; answers for items 3 (6 answer options), 4 (4 answer options), and 5 (Likert scale ranging from 0 to 10) were considered individually and summed for a total score ranging from 0 to 21. Data were collected using paper forms and then double-entered and validated in a spreadsheet for statistical analysis. Continuous variables were described as mean/median and standard deviation. Categorical variables were described in absolute numbers and percentages. Pearson's chi-squared test and Fischer's exact test were used to investigate the variable statistical differences. The level of significance was 5%, and the intervals were obtained with 95% confidence. Prevalence was defined as the percentage of people with UI over the study period in all admitted patients. Results Of the 858 eligible patients, 114 were incontinent (13.3%), but 61 were unable to answer the research questions, 2 used catheterization, and 9 refused to participate; therefore 42 patients (age 80 [range 77.6-82.3] years, 30 [71.4%] women) completed the study. All patients (100%) were managed using diapers. Twenty-one (21, 50%) were married, 24 (57.1%) were white, and 25 (59.5%) were retired. Sixteen (16, 38.1%) had urine loss several times a day, and 17 (40.5%) had urine loss in large amounts; 10 (23.8%) had incontinence-associated dermatitis. The ICQI-SF item regarding interference of urine loss in daily life had a reported mean of 4.1 ± 4.0, inferring urine loss interfered with life; mean ICQI-SF score was 12.1 ± 5.86, implying UI had a moderate impact on QoL. Conclusion The 13.3% prevalence of UI was similar to previous studies. The absence of a protocol for incontinence management was identified. The results suggest additional, larger sample UI prevalence studies need to be conducted.

Liver cancer is a high morbidity and low survival disease all over the world. Chromosomal instability is hallmark of liver cancer. Microtubule-associated serine and threonine kinase 2 (MAST2), as a microtubule associated protein, may involve in tumorous chromosomal instability and plays important roles in cell proliferation and survival. The role of MAST2 in liver cancer has not been well elucidated, which is the aim of our study. In this study, The Cancer Genome Atlas database was used to study the MAST2 mRNA expression in liver cancer, and Chi-squared tests were performed to test the correlation between clinical features and MAST2 expression. ROC curve was performed to examined the diagnostic capacity. The prognostic value of MAST2 in liver cancer was assessed through Kaplan–Meier curves as well as Cox analysis. Our results showed MAST2 was upregulated in liver cancer, and the area under the curve (AUC) was 0.925 and indicated powerful diagnostic capability. High MAST2 expression was associated with advanced clinical status such as histological type (p = 0.0059), histologic grade (p = 0.0142), stage (p = 0.0008), T classification (p = 0.0028), N classification (p = 0.0107), survival status (p = 0.0062), and poor prognosis of patients. Importantly, MAST2 was an independent risk factor for patients’ prognosis after adjusting for other risk factors including stage, T classification, and residual tumor. In total, MAST2 is a potential diagnostic and prognostic biomarker of liver cancer.

Objective: To investigate associations between quality of life, sex, age, burden, and nature of emotional support available in the family in older adults who are caregivers of older relatives. Method: Cross-sectional and correlational study on 148 caregivers gathered in public and private healthcare services, who were subjected to psychological measures of quality of life, burden, exchange of emotional support, sex, and age. Data were analyzed using Chi-square, Fisher’s exact test and path analyses (p < 0.05). Results: A total of 77% women, average age of 69.7 years. There were significant associations between exchange of support and burden due to the provided assistance, being a woman and satisfaction with the received support, satisfaction with the received support and burden, burden and quality of life, and satisfaction with the received support and feeling of burden due to the provided support. Conclusion: Satisfaction with the received emotional support moderate the association between sex and burden, and such moderate the association between satisfaction with emotional support and perceived quality of life. RESUMEN Objetivo: Investigar relación entre calidad de vida, sexo, edad, sobrecarga y tipos de apoyo emocional disponibles en la familia de ancianos cuidadores de parientes ancianos. Método: Estudio transversal y correlacional con 148 cuidadores reclutados en servicios públicos y privados de salud, fueron sometidos a medidas psicológicas de calidad de vida, sobrecarga, intercambio de apoyo emocional, sexo y edad. Los datos fueron analizados mediante test Chi-cuadrado, prueba exacta de Fisher y path análisis (p

Pneumonia readmissions have significant quality of care and policy implications for patients and health care providers. Research indicates that initiatives to decrease readmissions should target high-risk subgroups. Older adults with dementia have an increased risk of pneumonia and subsequent hospitalizations, suggesting that they may be at high-risk of pneumonia readmissions. The purpose of this study was to determine if associations between patient factors and readmission rates differ for older adults with and without dementia who were hospitalized for pneumonia.This was a retrospective study of secondary data.A nationally representative sample of 389,198 discharge records was extracted from the 2013 Nationwide Readmission Database.Differences between groups were analyzed using χ and t tests. A generalized linear model was utilized to examine associations between patient factors and pneumonia readmissions.Significant differences were found (P0.001) when comparing patient characteristics of older adults with and without dementia who were readmitted. Older adults with dementia had a readmission rate of 23.5% and were 2.9 times more likely to be readmitted (odds ratio; 95% confidence interval, 1.93, 4.40) than older adults without dementia. Associations were calculated using a generalized linear model with dementia included as an interactive effect. Dementia significantly modified (P0.05) the relationship between pneumonia readmissions and 4 factors; (a) discharge disposition, (b) chronic conditions, (c) risk of mortality, and (d) median household income.Classifying older adults with dementia as a high-risk subgroup for pneumonia readmissions is supported by the findings of this study. Development of strategies to reduce pneumonia readmissions that are tailored to individuals with dementia should be considered.

To determine whether the new American Joint Committee on Cancer (AJCC) 8 grouping of soft tissue sarcoma (STS) with nodal disease (N1M0) and metastatic disease (M1) as stage IV correctly represents the prognosis of these previously separate patient groups, using the National Cancer Database.Adults with STS identified in the 2004 to 2014 National Cancer Database, classified by the World Health Organization 2013 system into 10 histologic subgroups, were grouped according to AJCC 8 staging and analyzed according to demographic characteristics, histology, primary site, disease extent, and adjuvant treatment. Primary retroperitoneal sites, "other/unusual" histologic subgroups, and those with delays in therapy (180 days from diagnosis) were excluded. We used χOf 82,987 patients identified, 55,417 met inclusion criteria; 29,855 (53.9%) were male, and 25,262 (46.1%) were female. Median age was 60 years (range, 18-90 years). Overall survival (OS) of STS of all sites was significantly different between N1M0 and N0-1M1 patients at 5 years (34.4%; [95% confidence interval {CI}, 30.1%-38.8%] vs 10.1% [95% CI, 9%-11%], respectively) and 10 years (27.3% [95% CI, 22.5%- 32.2%] vs 5.4% [95% CI, 4.5%-6.5%], respectively; log-rank test, P.001). For STS of trunk and extremities in N1M0 and N0-1M1 patients, the N1M0 cohort was associated with significantly greater OS on multivariate Cox proportional hazards models (hazard ratio, 0.48; 95% CI, 0.41-0.58; P.001), and this OS difference remained significant for propensity-matched cohorts of all primary sites (HR, 0.53; 95% CI, 0.44-0.64; P.001).In adult STS, including those of the trunk and extremity, OS is superior with N1M0 compared with N0-1M1 disease. These results suggest that the AJCC 8th edition grouping of N1 and M1 patients into stage IV may obscure the more favorable prognosis of patients with N1M0 disease.

Background: longitudinal analyses of physical activity (PA) and arterial stiffness in populations of older adults are scarce. We examined associations between long-term change of PA and arterial stiffness in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). Methods: we assessed PA in SAPALDIA 2 (2001-03) and SAPALDIA 3 (2010-11) using a short questionnaire with a cut-off of at least 150 min of moderate-to-vigorous PA per week for sufficient activity. Arterial stiffness was measured oscillometrically by means of the brachial-ankle pulse wave velocity (baPWV) in SAPALDIA 3. We used multivariable mixed linear regression models adjusted for several potential confounders in 2,605 persons aged 50-81. Results: adjusted means of baPWV were significantly lower in persons with sufficient moderate-to-vigorous PA (i) in SAPALDIA 2 but not in SAPALDIA 3 (P = 0.048) and (ii) in both surveys (P = 0.001) compared with persons with insufficient activity in both surveys. There was a significant interaction between sex and the level of change in PA concerning baPWV (P = 0.03). The triples of parameter estimates describing the association between level of PA change and baPWV were not significantly different between the two sex-specific models (P = 0.07). Conclusions: keeping up or adopting a physically active lifestyle was associated with lower arterial stiffness in older adults after a follow-up of almost a decade. Increasing the proportion of older adults adhering to PA recommendations incorporating also vigorous PA may have a considerable impact on vascular health at older age and may contribute to healthy ageing in general.

Marcucci (1985) proposed a chi square goodness of fit statistic based generalized p-chart for multinomial process monitoring. A chi square distribution quantile was considered as a control chart limit. A weighted chi square goodness of fit statistic-based control chart is proposed for multinomial process monitoring in this paper, where more important weights are advocated to poor quality categories. The statistic distribution is approximated by a well-known linear combination of chi squares distribution. The approximation is assessed through a simulation, an extreme percentile of the approximated distribution is used as an upper control chart limit and a comparison is carried out with a chi square goodness of fit statistic-based control chart. The average run length is used as a benchmark and the comparison is performed using simulations considering two process shifts scenarios. Under some restrictions, the weighted statistic-based control chart allows an earlier detection of process shift in case of deterioration and postpones out of control signals in case of improvement. This benefit is clearer when the process is improved by a decrease in the poor quality probability category and an increase in the best quality category probability. Resumo: Marcucci (1985) propôs um gráfico generalizado baseado na estatística de bondade de ajuste do qui-quadrado para monitoramento de processos multinominais. Um quantil de distribuição do qui quadrado foi considerado como limite do gráfico de controle. Um gráfico de controle baseado em estatística de qualidade de ajuste chi-quadrado ponderado é proposto para monitoramento de processo multinominal neste artigo, onde pesos mais importantes são defendidos para categorias de baixa qualidade. A distribuição estatística é aproximada por uma combinação linear bem conhecida de distribuição de qui-quadrados. A aproximação é avaliada por meio de uma simulação, um percentil extremo da distribuição aproximada é usado como um limite superior do gráfico de controle e uma comparação é realizada com um gráfico de controle baseado na estatística de qualidade do qui quadrado do ajuste. O comprimento médio de execução é usado como referência e a comparação é realizada por meio de simulações considerando dois cenários de deslocamento de processo. Sob algumas restrições, o gráfico de controle baseado em estatística ponderada permite uma detecção precoce de mudança de processo em caso de deterioração e adia sinais fora de controle em caso de melhoria. Esse benefício fica mais claro quando o processo é aprimorado por uma diminuição na categoria de probabilidade de qualidade ruim e um aumento na probabilidade da categoria de melhor qualidade.

Several viral infections are known to increase the risk of dementia through brain cell damage and systemic infection. The association between hepatitis B and C virus (HBV and HCV) infections and dementia was evaluated using a national sample cohort from South Korea. Using the national cohort study from the Korean National Health Insurance Service, we extracted data for patients with HBV or HCV infection and for matched control participants. The controls were matched to the patients according to age, sex, income, region of residence, and past medical histories. The incidence of HCV infection was higher in the dementia group (1.0% [113/11,228]) than in the control group (0.8% [364/44,912], P = .043). However, there was no difference in the incidence of HBV infection in the dementia and control groups. The adjusted odds ratio (OR) for HCV infection was 1.25 (95% confidence interval [CI] = 1.01-1.54, P = .043) in the dementia group. According to the subgroup analysis by sex, the adjusted ORs for HCV infection were 1.04 (95% CI = 072-1.49, P = .851) in men and 1.38 (95% CI = 1.06-1.79, P = .016) in women. We concluded that the incidence of HCV infection was higher (with a higher OR) in women with dementia than in matched control participants in South Korea.

This study to analyze the clinical characteristics of patients with invasive pulmonary aspergillosis (IPA) following influenza A (H1N1) infection. We retrospectively analyzed 10 cases with IPA following H1N1 infection. The clinical manifestations, laboratory examination results, chest computed tomography, and treatments were analyzed. Clinical manifestations: all 10 cases had typical flu-like symptoms at the onset of the disease, among which 7 patients developed dyspnea in the late stage, and 8 patients had hemoptysis. Laboratory examination: the absolute and percentage of peripheral blood lymphocytes in all 10 patients were declined, among which 5 cases were with decreased CD3+ CD4+ T cells/lymphocytes; 9 cases with increased bronchoalveolar lavage fluid galactomannan; 6 cases with increased serum galactomannan; 1 case with bronchoalveolar lavage fluid cultured aspergillus fumigatus; and 2 cases with aspergillus by second-generation sequencing. Chest computed tomography: all patients showed multiple diffused ground-glass opacities at the beginning, along with linear or reticular interstitial changes. Two cases had multiple subarachnoid nodules with halo signs, 3 cases had consolidation in multiple segments of both lungs, 2 cases had cavities, and 4 cases were with pleural effusion. Treatment: 10 patients were treated with antiviral and anti-Aspergillus drugs after admission. Four patients received respiratory support. All 10 cases were cured and discharged. Early diagnosis of IPA in influenza A (H1N1) patients is the key to successful treatment.

Resumen Antecedentes y objetivos El proposito de este estudio en 265 pacientes con sindrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2) es establecer una relacion entre la cuantificacion inicial de los hallazgos en la radiografia de torax en pacientes con COVID-19 y un eventual empeoramiento clinico, asi como comparar tres sistemas de cuantificacion que se proponen. Material y metodos En este estudio retrospectivo se reviso la evolucion clinica y radiologica de 265 pacientes adultos con infeccion por COVID-19 atendidos en nuestro centro entre marzo y abril de 2020, registrandose la presencia de comorbilidades, asi como datos de estancia hospitalaria y empeoramiento clinico (ingreso en unidad de cuidados intensivos/intubacion y fallecimiento). La afectacion en la radiografia de torax inicial patologica de cada paciente se cuantifico siguiendo tres sistemas de puntuacion diferentes sobre 6 u 8 campos pulmonares (denominados 6 A, 6 B y 8) para determinar una afectacion leve, moderada o grave y establecer comparacion entre dichos sistemas. Tambien se registro la presencia de opacidades alveolares y opacidades lineales (fundamentalmente atelectasia laminar) en la primera radiografia patologica. Resultados La afectacion moderada o grave en los tres sistemas de cuantificacion (6 A, 6 B y 8) mostro correlacion en el estudio de χ2 con la variable ingreso hospitalario (p = 0,009, 0,001, 0,001, respectivamente) y fallecimiento de los pacientes (p = 0,02, 0,01, 0,006, respectivamente). El estudio de regresion mostro como mas significativas las asociaciones 6 B + afectacion alveolar [odds ratio (OR) 2,3, p = 0,025, intervalo de confianza (IC) al 95% 1,1-4,7) y clasificacion 8 + afectacion alveolar (OR 2,07, p = 0,046, IC 95% 1,01-4,25). La afectacion moderada o grave en la radiografia de torax no mostro diferencias significativas entre los tres sistemas de cuantificacion en el estudio predictivo de empeoramiento clinico. Conclusion La extension moderada/grave en los tres sistemas de puntuacion de la radiografia de torax valorando la extension de enfermedad sobre 6 y 8 campos pulmonares y la existencia de opacidades alveolares en la primera radiografia patologica se correlacionaron con la mortalidad y la tasa de hospitalizacion en los pacientes estudiados. No se aprecio una diferencia significativa en la capacidad predictiva de los tres sistemas de cuantificacion propuestos.

Variations of raw spectral estimates of ocean waves with quite different sea states are examined for confirming their fitness to theoretical chi-square distribution with two degrees of free...

Background: Compared with Caucasians, unique demographic and clinical features have been reported in Chinese patients with malignant melanoma, but similar comparative studies of melanocytic nevi (MN) are lacking. This study examined the clinical and dermoscopic features of MN in surgically treated Chinese cases. Methods: Clinical data and dermoscopic findings from 1046 cases of MN were collected and analyzed. Cases were treated from January 1 to December 31, 2014 at the Department of Dermatology and Venerology, Peking University First Hospital. The association between nevi location and histologic subtypes was examined with Chi-squared test and univariate logistic regression. Chi-squared test was also used to analyze the proportion of globular patterns across different body sites, and proportion of parallel furrow patterns across different histologic subtypes. Results: The majority of the nevi were from female patients, irrespective of location. The range of age at the time of nevi onset was from 0 (birth) to 79 years. There were 381 (36.4%, 381/1046) congenital nevi; of these 81.6% (311/381) were present at birth. Nevi appeared before 30 years of age in 83.2% (870/1046) of the cases. Median values of length growth rate in congenital and acquired MN were 2.0 and 1.6, respectively. Median values of length growth rates in four age groups (0–9, 10–19, 20–29, and ≥30 years) of congenital nevi were 2.2, 2.0, 2.4, and 2.0, respectively. In acral nevi, which often need to be differentiated from acral lentiginous melanoma, 50.2% (109/217) were junctional (odds ratio [OR]; 95% confidence interval [CI]: 91.572 [52.210–160.959], P < 0.05). Acral location was also associated with a higher likelihood of compound nevi subtype (OR [95% CI]: 14.468 [8.981–23.306], P < 0.05). The globular (59.4%, 354/596) and pseudonetwork (48.8%, 291/596) dermoscopic patterns were often seen in the head and neck region. In areas other than head and neck and acral regions, the globular pattern was the commonest pattern (34.8%, 71/204) regardless of age. Parallel furrow pattern occurred in 46.0% (87/189) of acral MN, followed by fibrillar pattern (21.7%, 41/189). Conclusion: Unique clinical and dermoscopic features exist in Chinese patients with MN compared with observations reported in other population. Key words: Nevus; Melanoma; Dermoscopy

Background Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can markedly reduce angina symptom burden, but many patients often remain on multiple antianginal medications (AAMs) after the procedure. It is unclear when, or if, AAMs can be de-escalated to prevent adverse effects or limit polypharmacy. We examined the association of de-escalation of AAMs after CTO PCI with long-term health status. Methods In a 12-center registry of consecutive CTO PCI patients, health status was assessed at 6 months after successful CTO PCI with the Seattle Angina Questionnaire and the Rose Dyspnea Scale. Among patients with technical CTO PCI success, we examined the association of AAM de-escalation with 6-month health status using multivariable models adjusting for revascularization completeness and predicted risk of post-PCI angina (using a validated risk model). We also examined predictors and variability of AAMs de-escalation. Results Of 669 patients with technical success of CTO PCI, AAMs were de-escalated in 276 (35.9%) patients at 1 month. Patients with AAM de-escalation reported similar angina and dyspnea rates at 6 months compared with those whose AAMs were reduced (any angina: 22.5% vs 20%, P = .43; any dyspnea: 51.8% vs 50.1%, P = .40). In a multivariable model adjusting for complete revascularization and predicted risk of post-PCI angina, de-escalation of AAMs at 1 month was not associated with an increased risk of angina, dyspnea, or worse health status at 6 months. Conclusions Among patients with successful CTO PCI, de-escalation of AAMs occurred in about one-third of patients at 1 month and was not associated with worse long-term health status.

Background Minimizing pain and disability are key postoperative objectives of robot-assisted distal pancreatectomy (RADP). This study tested effects of bupivacaine transversus abdominis plane (TAP) block on opioid consumption and pain after RADP. Methods Retrospective case-control study (June 2012 -Oct 2017) evaluating bilateral intraoperative bupivacaine TAP block as an interrupted time series. Linear regression evaluated opioid consumption in terms of intravenous (IV) morphine milligram equivalents (MME) and controlled for preoperative morbidity. Secondary outcomes included numerical rating scale (NRS) pain scores. Results 81 RADP patients met eligibility, 48 before and 33 after implementation of TAP. Baseline characteristics were equivalent with a trend toward higher age, Charlson comorbidity, and ASA score among the TAP cohort. TAP patients consumed on average 4.52 fewer IV MME than controls during the first six postoperative hours (p = 0.032) and reported lower mean NRS scores at six (p = 0.009) and 12 h (p = 0.006) but not at 24 h (p = 0.129). Postoperative morbidity and lengths of stay (LOS) were equivalent (5 vs. 6 days, p = 0.428). Conclusion Bupivacaine TAP block was associated with significant reductions in opioid consumption and pain after RADP but did not shorten hospital LOS consistent with bupivacaine's limited half-life.

Purpose Acute skin toxicity in the form of radiation dermatitis (RD) or skin hyperpigmentation (SH) is a common problem experienced by patients undergoing breast irradiation. Proton radiation has been thought to deliver higher doses to skin compared with photon radiation because of differences in the physical properties between photons and protons; however, limited literature exists directly comparing toxicity outcomes. Methods and Materials The highest recorded grades of acute RD and SH were analyzed in 86 patients undergoing adjuvant radiation therapy to the breast with or without regional lymph nodes after lumpectomy (breast-conserving surgery) or mastectomy with either proton pencil-beam scanning (n = 39) or photon (n = 47) radiation therapy within a single institution to analyze differences in severity of acute skin reactions. For 34 of 47 photon and 33 of 39 proton patients, a “skin” contour was retroactively created in our treatment planning systems, and multiple dosimetric parameters were calculated to quantify objective radiation doses received by skin. Results On χ2 analysis, the highest reported grade of RD was significantly higher in women undergoing proton radiation compared with photon radiation; grade ≥2 RD was present in 69.2% versus 29.8% of patients receiving proton and photon therapy, respectively (P = .002). Rates of grade 3 RD were 5.1% versus 4.3% for proton versus photon radiation, respectively (P = .848). Overall, there were no significant differences in rates of SH between modalities. There were no grade 4 to 5 toxicities in either cohort. Conclusions In a comparison with patients receiving photon radiation, a significantly higher rate of grade ≥2 RD was observed in patients undergoing proton radiation, with very low rates of grade 3 toxicity in both groups. Rates of SH did not differ significantly between modalities. Women should be counseled regarding the possibility of increased grade 2 toxicities, although this might present a dosimetric advantage for physicians when treating patients in the postmastectomy setting or when skin was involved on presentation.

Necrotizing enterocolitis (NEC) is a serious disease linked to prematurity. A variant, NEC totalis, is associated with nearly 100% mortality. There is wide variation in counseling practices for NEC totalis. Our objectives are to determine what treatment options, if any, are offered to families, and which factors influence these decisions. An anonymous survey was distributed to members of the AAP Sections on Neonatal-Perinatal Medicine and Pediatric Surgery. Data were analyzed utilizing chi-square tests and Spearman correlations, where applicable. In the setting of NEC totalis, 90% of the 378 respondents viewed offering life-sustaining interventions (LSI) as ethically permissible and 87% felt that transfer to another center willing to provide LSI should be considered; however, only 43% reported offering LSI to families. Management of NEC totalis remains challenging and significant practice variability persists. Most respondents do not offer ongoing medical/surgical management, despite believing it is an ethically permissible option.