Littérature scientifique sur le sujet « Shuster's test »

It has been claimed that lipid emulsions with a restricted linoleic acid content can improve the safety of total parenteral nutrition (TPN). The tolerability of TPN and its effects on the metabolism of fatty acids were assessed in this prospective, double-blind, randomised study comparing an olive/soyabean oil long-chain triacylglycerol (LCT) with a medium-chain triacylglycerol (MCT)/LCT; 50:50 (w) based lipid emulsion in two groups (O and M, respectively; eleven per group) of severely burned patients. After resuscitation (48–72 h), patients received TPN providing 147 kJ/kg per d (35 kcal/kg per d) with fat (1·3 g/kg per d) for 6 d Plasma fatty acids, laboratory parameters including liver function tests, and plasma cytokines were assessed before and after TPN. Adverse events encountered during TPN and the clinical outcomes of patients within the subsequent 6 months were recorded. With both lipid emulsions, the conversion of linoleic acid in its higher derivatives (di-homo-γ-linolenic acid) improved and essential fatty acid deficiency did not appear. Abnormalities of liver function tests occurred more frequently in the M (nine) than in the O (three) group (P=0·04, Suissa–Shuster test). Seven patients (four from group O and three from group M) died as a consequence of severe sepsis 3–37 d after completion of the 6 d TPN period. When compared with the surviving patients, those who died were older (P=0·01) and hyperglycaemic at baseline (P<0·001), and their plasma IL-6 levels continued to increase (P<0·04). Although fatty acid metabolism and TPN tolerability were similar with both lipid emulsions, the preservation of liver function noted with the use of the olive oil-based lipid emulsions deserves confirmation.

Aim — to determine the changes in carbohydrate metabolism in case of intact gallbladder(GB) and its disorders including the condition after cholecystectomy in patients with coronary heart disease (CHD). Materials and methods. Examinations involved 71 inpatients (52.11 % males, 47.89 % females, median age 65 years) with various forms of CHD (acute coronary syndrome, acute myocardial infarction, postinfarction cardiosclerosis), who were treated in cardiological and infarctional wards. All patients were divided into groups depending on the sonographically determined GB status: the 1st group (n = 30) with intact GB, 2ndgroup (n = 24) with inflections, sludge or signs of chronic cholecystitis, the 3rd group (n = 7) withcholelithiasis and calculous cholecystitis, the 4th(n = 10) with the history of cholecystectomy. Thegroupswereage- and no­sology-matching. Apart from routine investigations, 20 parameters of glucose metabolism were determined: oral glucosetolerance test (OGTT) with the estimation of glucose, insulin and C-peptide levels at baseline (0’) and on 30, 60 and 120 minutes after taking of 75 g of glucose; glycated hemoglobin(НbА1c) levels; increasing areas under curves in the early and late phases for glucose (iAUCG 0-30’, 30-120’) and insulin (iAUCI 0-30’, 30-120’); seevral indexes (HOMA-IR, Quicki, Matsuda, Shuster, DeFronzo). Results. It has been established that GB disorders were accompanied by the significantly less frequent normal glucose metabolism (6.4 % vs 26.7 %) and higher diabetes incidence (19.4 % vs 3.3 %, both p < 0.05) compared to the intact GB. GB condition did not affect the liver insulin sensitivity, the peripheral tissues’ insulin sensitivity, liver clearance of insulin, C-peptide level, as well as the early or late insulin secretion phase, although it was significantly associated with glycemia levels, glycated hemoglobin and the ratio between insulin secretion and the tissue sensitivity. The worst condition of carbohydrate metabolism was observed in case of sludge, GB deformations and signs of chronic cholecystitis: these changes were accompanied by significantly higher glycemia at all points (0’, 30’, 60’, 120’), bigger area under curve for glucose in the late phase (30—120’), higher glycated hemoglobin and lower DeFronzo index. The condition after cholecystectomy was associated with a lower level of glycated hemoglobin, although during the first hour after glucose loading levels of glycemia exceeded the values of people with intact GB. Conclusion. The gallbladder condition affects carbohydrate metabolism, and its pathological changes are associated with a deterioration of carbohydrate balance.

Abstract Introduction: The Cancer Health Risk Assessments Reaching Many (CHARM) study (NCT03426878) aims to increase access to genetic testing for hereditary cancer in low-income, low-literacy, and minority populations (hereafter referred to as “underserved”). To implement the study, we have capitalized on the availability of electronic medical record (EMR) systems, developed innovative web-based tools, and designed a novel telemedicine protocol for return of clinical genetic testing results. Methods: Patients aged 18-49 years are recruited from two centers: Kaiser Permanente Northwest (KPNW; an integrated health care system in Portland, OR) and Denver Health (DH; a federally qualified health care center in Denver, CO). Specific protocols were developed to identify potentially eligible patients from the EMR and invite them to complete a web-based family history assessment. KPNW patients were recruited using email, text messaging, and in-clinic booths; DH patients were recruited via mail, phone, and provider referral. Validated risk assessment tools for Lynch syndrome (PREMM5) and heredity breast and ovarian cancer syndrome (B-RST) were adapted for our low-literacy and bilingual (English and Spanish) target population. Genetic testing is offered to patients with greater than average risk for hereditary cancer, or where risk cannot be assessed because of unknown family history or limited family structure. Eligible patients review a multipart, multimedia online consent. Those who consent to participate provide a saliva sample for clinical exome sequencing. Genetic counselors return results by telephone using traditional (usual care active comparator) or modified, communication-focused (experimental) counseling for pathogenic variants, likely pathogenic variants, and select variants of uncertain significance in 39 genes related to cancer risk, pathogenic variants in 79 genes related to medically actionable secondary findings, and 14 genes related to carrier status. Results: In the first four months of recruitment, 258 patients have completed the risk assessment tool (48% are underserved). Of those, 180 (70%) had greater than average risk of hereditary cancer (or limited family history information) and were invited to participate (53% were underserved); 86% of underserved patients and 78% of patients who do not meet criteria for the underserved category have consented. The vast majority of participants complete enrollment without assistance from study staff, and in-person visits are not required for participation. Telephone genetic test result disclosure will begin in December 2018. Conclusions: We have successfully developed online tools for cancer risk assessment that are accessible to underserved and low-literacy populations. These tools may be a cost-effective approach for improving the capture of family history data in the EMR. It does not require a provider to gather the information and the patient gets immediate feedback on results of the risk assessment and appropriate next steps. This abstract is also being presented as Poster A37. Citation Format: Heather Spencer Feigelson, Kathleen F. Mittendorf, Tia L. Kauffman, Katherine Anderson, Sonia Okuyama, Benjamin Wilfond, Gail P. Jarvik, Laura M. Amendola, Carmit McMullen, Fances Lynch, Donna Eubanks, Elizabeth Shuster, Jake Allen, Stephanie A. Kraft, Galen Joseph, Sandra Soo-Jin Lee, Katrina A.B. Goddard. Using web-based tools to assess familial cancer risk in diverse populations [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr PR02.

Abstract Abstract 3223 Background: Delays in treatment are common in pediatric ALL and may occur more often in high risk ALL (HR-ALL). Delays during maintenance therapy have adverse impact on survival, but the significance of delays prior to maintenance is unknown (Schmiegelow, et al, American Journal of Pediatric Hematology Oncology 1990 and Dibenedetto et al, Pediatric Hematology Oncology 1994). We studied the effect of delays in therapy prior to maintenance by analyzing data from two HR-ALL clinical trials, CCG1961 and POG9906. The objective was to determine the association between time to maintenance (TTM) from starting induction therapy and event-free survival (EFS) in children with high-risk ALL. Methods: CCG1961 enrolled 2078 patients from September 1996 to May 2002 with B- and T-lineage ALL with high-risk features, defined as those aged 1–9 years with initial white blood cell count (WBC) ≥ 50,000/μl, any patient aged ≥ 10 years and ≤ 21 years, and those with central nervous system (CNS) leukemia or overt testicular leukemia. Rapid early responders (RERs), those with < 25% blasts in the bone marrow on day 7 of therapy, were randomized to receive standard or augmented BFM therapy with either a single interim maintenance and delayed intensification phase (SDI) or two interim maintenance and delayed intensification (DDI) courses as outlined in Table 1. Slow early responders (SERs) were randomized to augmented BFM with DDI with either doxorubicin or idarubicin and cyclophosphamide in the DI courses. POG9906 enrolled 276 patients from March 2000 to April 2003 with high-risk B-precursor ALL, defined as all patients with CNS disease, testicular disease, MLL rearrangement, age ≥ 16 years, or WBC ≥ 100K. In addition, it included selected patients aged 12–15 with high-risk disease based on the Shuster criteria for age and initial WBC. Patients with favorable cytogenetic features (ETV6-RUNX1 fusion or trisomy of chromosomes 4 and 10) were excluded unless they had CNS or testicular leukemia. Patients were treated with augmented BFM with DDI. Patients who made it to start of maintenance are included in this report. TTM was calculated as time from start induction until start of maintenance therapy. Expected TTM for those with B-lineage ALL is shown in Table 1. TTM was dichotomized by plotting the Akaike information criterion (AIC) versus all possible cutoff values of TTM and identifying the cut-point which best discriminated between groups who did and did not fail. The identified threshold was then examined as a predictor of EFS using the Kaplan Meier method and log rank test. The outcomes were 5-year EFS for CCG1961 and 4-year EFS for POG9906. Results: Among the B-lineage patients, longer TTM was significantly associated with improved EFS in CCG1961 Std BFM DI and SER Aug BFM Doxo arms, as well as on POG 9906. For example, in Std BFM DI, 5-year EFS was 83% in those with longer TTM and 71.9% in those with shorter TTM (P=.036). Among the T lineage cohort enrolled on CCG1961, similar results were seen with longer TTM being significantly associated with improved EFS in Std BFM DDI and SER Aug BFM Ida, and a trend toward improved EFS with longer TTM in each of the other arms. Conclusions: These data suggest that longer TTM may be associated with superior EFS in pediatric high-risk ALL. Multiple factors may contribute to this association. For instance, pharmacogenetic differences resulting in more treatment toxicity and delays may also be associated with more potent anti-leukemic effects, or patients with infectious complications may have an endogenous immune response that also has an anti-leukemia effect. Further research is needed to validate the association between TTM and EFS and to characterize the timing and causes of these delays in protocol therapy. Disclosures: No relevant conflicts of interest to declare.

Abstract Introduction and hypothesis Urinary incontinence (UI) is common in women who exercise. We aimed to investigate new onset UI in formerly inactive, overweight or obese women (BMI > 25) participating in three different strength training modalities compared with a non-exercising control group. Methods This was a secondary analysis of an assessor blinded randomized controlled trial investigating the effect of 12 weeks of three strength training concepts for women on muscle strength and body composition. None of the programs included pelvic floor muscle training. International Consensus on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was used to investigate primary outcome; new onset UI, and secondary outcome; ICIQ-UI-SF sum score. Suissa and Shuster’s exact unconditional test was used to analyze difference in new onset UI. Difference in ICIQ-UI-SF sum score is presented as mean with 95% CI. Results At baseline 40 out of 128 (31.2%) participants reported UI. Three out of 27, 2 out of 17, 2 out of 23, and 0 out of 21 women in the three training and control groups respectively had new onset UI. There were no statistically significant differences in new onset UI across the groups or when collapsing new onset UI in the intervention groups compared with the controls (7 out of 67 vs 0 out of 21), p = 0.124. After the intervention the control group reported worse ICIQ-UI-SF sum score than any of the training groups; mean difference − 6.6 (95% CI: −11.9, −1.27), p = 0.012, but there was no difference in change from baseline to 12 weeks between the groups p = 0.145). Conclusions There was no statistically significant change in UI after strength training.

The paper is focused on the critical exploration of an experiment held in the Ukrainian media environment. Results of the experiment are reflected in the book Freedom of Speech Against Fear and Humiliation ... published by Savik Shuster, the Ukrainian political journalist and the Freedom of Speech TV talk show host. The study aims to define factors and predictors of the Ukrainian audience’s social behavior. In this regard, narrative, conversational, and intent analyses of his talk shows participants’ conflict interaction described in the book, were applied. These tools made it possible to explicate his narratives’ main topics, their prominence, role positions, archetypal patterns of the participant and host’s behavior. The narrative structure of “negative” scenarios of the talk shows described in the book enabled defining the host as the encourager of the speakers’ conflict behavior, high tension of their discourse that leads to deconstructing, discrediting, and demonizing the opponent’s political party image. Although S. Schuster's conclusions were full of dramatic statements and almost apocalyptic predictions, their reinterpretation was necessary. The application of F-test as a measure of testing statistical hypotheses relevant to empirical data, allowed to search for additional political and psychological explanatory models of the “emotional map of Ukraine”. Results of the study demonstrate hidden suggestion of hopelessness, feelings of betrayal, inspiration of protest moods,inspired by the speakers invited to the TV show. This adversely affects the critical understanding of current social processes along with radicalization of public sentiment by shifting the locus of control to the outside, when the audience invited to the show delegates responsibility for the state of affairs in the country and their own well-being to their political leaders.

The use of unconditional tests for comparing hypotheses on the 2×2 binomial trial is still not widespread in the applications, despite these preserve the signi cance level and usually are more powerful than conditional exact tests for moderate to small samples. Previously, this was due to the bigger computational demand of this approach with respect to the conditional approach. Today, softwares can easily compute the p-values of both conditional and unconditional tests. In this thesis the Suissa and Shuster (1985)'s unconditional test is reviewed and a new R algorithm aimed to derive exact unconditional p-values is proposed. We use both the classical Lehmann (1959)'s procedure and the Berger and Boos (1994)'s procedure, which calculates the p-values by maximizing the null power function on a con dence interval for the nuisance parameter. Optimal values for the con dence level are derived for di erent degrees of imbalance of the sample sizes. Furthermore, we propose the use of the unconditional approach for testing statistical hypotheses within the framework of the Rubin Causal Model.