Three-way ordinal non symmetrical correspondence analysis for the evaluation of the patient satisfaction

In some recent articles, emphasis has been given to the partition of the Goodman-Kruskal’s tau index using orthogonal polynomials for the study of the non symmetrical relations in three-way contingency tables. New graphical techniques that consider such a partition and allow for the analysis of asymmetric relationships have been proposed, including three-way ordinal non symmetrical correspondence analysis (Simonetti, 2003). Such a procedure takes into account the presence of an ordinal predictor and response variables. In this paper we demonstrate the applicability of such a technique for the patient satisfaction evaluation

Laparoscopic distal pancreatectomy in Italy: A systematic review and meta-analysis

Background The use of laparoscopic distal pancreatectomy (LDP) increased in the past twenty years but the real diffusion of this technique is still unknown as well as the type of centers (high or low volume) in which this procedure is more frequently performed. Data Source A systematic review was performed to evaluate the frequency of LDP in Italy and to compare indications and results in high volume centers (HVCs) and in low volume centers (LVCs). Results From 95 potentially relevant citations identified, only 5 studies were included. A total of 125 subjects were analyzed, of whom 95 (76.0%) were from HVCs and 30 (24.0%) from LVCs. The mean number of LDPs performed per year was 6.5. The mean number of patients who underwent LDP per year was 8.8 in HVCs and 3.0 in LVCs (P<0.001). The most frequent lesions operated on in HVCs were cystic tumors (62.1%, P<0.001) while, in LVCs, solid neoplasms (76.7%, P<0.001). In HVCs, malignant neoplasms were treated with LDP less frequently than in LVCs (17.9% vs 50.0%, P<0.001). Splenectomy was performed for non-oncologic reason frequenter in HVCs than in LVCs (70.2% vs 25.0%, P=0.004). The length of stay was shorter in HVCs than in LVCs (7.5 vs 11.3, P<0.001). No differences were found regarding age, gender, ductal adenocarcinoma treated, operative time, conversion, morbidity, postoperative pancreatic fistula, reoperation and margin status. Conclusions LDPs were frequently performed in Italy. The "HVC approach" is characterized by a careful selection of patients undergoing LDP. The "LVC approach" is based on the hypothesis that LDPs are equivalent both in short-term and long-term results to laparotomic approach. These data are not conclusive and they point out the need for a national register of laparoscopic pancreatectomy

Systematic changes of the Nb-Sn reaction with time, temperature and alloying in Restacked-Rod-Process (RRP) Nb3Sn strands

Reaction heat treatments spanning 605 to 750 C and 24 to {approx}400 hours were applied to several sets of RRP strands. Magnetization and transport measurements were used to track the changes of superconducting properties and the amounts of Nb{sub 3}Sn formed. The experiments showed that temperature increases of 15 C produced equivalent properties in half the time within the temperature range 620-680 C. This result was the same whether Ta or Ti was used to alloy the Nb{sub 3}Sn. The bulk pinning force Fp for Ta-alloyed wires displayed a significant drop for temperatures outside the range above, due to tin gradients at low temperatures and grain growth at high temperatures. The F{sub p} drop at high reaction temperatures prevents wire technology from taking advantage of significantly higher Kramer-plot intercept H{sub K} for high-temperature reactions. On the other hand, Ti alloying provides a quick and potent means to increase H{sub K} at reaction temperatures for which F{sub p} remains high

Surgical stress and metabolic response after totally laparoscopic right colectomy

No clear consensus on the need to perform an intracorporeal anastomosis (IA) after laparoscopic right colectomy is currently available. One of the potential benefits of intracorporeal anastomosis may be a reduction in surgical stress. Herein, we evaluated the surgical stress response and the metabolic response in patients who underwent right colonic resection for colon cancer. Fifty-nine patients who underwent laparoscopic resection for right colon cancer were randomized to receive an intracorporeal or an extracorporeal anastomosis (EA). Data including demographics (age, sex, BMI and ASA score), pathological (AJCC tumour stage and tumour localization) and surgical results were recorded. Moreover, to determine the levels of the inflammatory response, mediators, such as C-reactive protein (CRP), tumour necrosis factor (TNF), interleukin 1β (IL-1β), IL-6, IL-10, and IL-13, were evaluated. Similarly, cortisol and insulin levels were evaluated as hormonal responses to surgical stress. We found that the proinflammatory mediator IL-6, CRP, TNF and IL-1β levels, were significantly reduced in IA compared to EA. Concurrently, an improved profile of the anti-inflammatory cytokines IL-10 and IL-13 was observed in the IA group. Relative to the hormone response to surgical stress, cortisol was increased in patients who underwent EA, while insulin was reduced in the EA group. Based on these results, surgical stress and metabolic response to IA justify advocating the adoption of a totally laparoscopic approach when performing a right colectomy for cancer. This trial is registered on ClinicalTrials.gov (ID: NCT03422588)

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Correspondence analysis as an explorative tool to analyse different data structures

Correspondence analysis (CA) is popular method for providing a graphical summary of the association between two or more categorical variables. It has gained a reputation for being a quick easily interpreted method of detecting relationships. Despite its popularity, and its acceptance amongst European researchers and those in the UK, the theoretical development of CA in the Australasian region has been relatively slow. Typically CA has been applied exclusively to two-way, or more generally, multi-way contingency tables. However recent, and not so recent, advances make CA a very useful tool for the analysis of other types of data structures. We will look at its application in situations where two categorical variables are nominal data, ordinal data, ranks, continuous and reflect geographical two-dimensional distances. We will also look at some modifications of the classical approach, focusing on identifying an asymetric relationship between the categories using non-symmetrical correspondence analysis (NSCA)

CATANOVA for two-way contingency tables with ordinal variables using orthogonal polynomials

The analysis of variance of cross-classified (categorical) data (CATANOVA) is a technique designed to identify the variation between treatments of interest to the researcher. There are well-established links between CATANOVA and the Goodman and Kruskal tau statistic as well as the Light and Margolin R 2 for the purposes of the graphical identification of this variation. The aim of this article is to present a partition of the numerator of the tau statistic, or equivalently, the BSS measure in the CATANOVA framework, into location, dispersion, and higher order components. Even if a CATANOVA identifies an overall lack of variation, by considering this partition and calculations derived from them, it is possible to identify hidden, but statistically significant, sources of variation

Ordinal correspondence analysis based on cumulative chi-squared test

Taguchi's statistic has long been known to be a more appropriate measure of symmetric association for ordered categorical variables than the Pearson chi-squared statistic. Therefore, there is some advantage in using Taguchi's statistic for performing correspondence analysis when a two-way contingency table consists of ordered categorical variables. This paper will explore the development of ordered correspondence analysis using the Taguchi's index and show that is mathematically analogousto classical correspondence analysis

Exploring the regulatory role of circular RNAs in neurodegenerative disorders

Circular RNAs (circRNAs) are a distinctive class of regulatory non-coding RNAs characterised by the presence of covalently closed ends. They are evolutionary conserved molecules, and although detected in different tissues, circRNAs resulted specifically enriched in the nervous system. Recent studies have shown that circRNAs are dynamically modulated during neuronal development and aging, that circRNAs are enriched at synaptic levels and resulted modulated after synaptic plasticity induction. This has suggested that circRNAs might play an important role in neuronal specification and activity. Despite the exact function of circRNAs is still poorly understood, emerging evidence indicates that circRNAs have important regulatory functions that might extensively contribute to the dynamic modulation of gene expression that supports neuronal pathways. More interestingly, deregulation of circRNAs expression has been linked with various pathological conditions. In this review, we describe current advances in the field of circRNA biogenesis and function in the nervous system both in physiological and in pathological conditions, and we specifically lay out their association with neurodegenerative diseases. Furthermore, we discuss the opportunity to exploit circRNAs for innovative therapeutic approaches and, due to their high stability, to use circRNAs as suitable biomarkers for diagnosis and disease progression