Analysis of Psychological Well-Being from a Compositional Data Analysis Perspective: A New Approach.

Well-being is a widely studied construct in psychology. In 1989, Carol Ryff proposed the "Scale of Psychological Well-Being (SPWB)", which has been validated in multiple languages. The instrument assesses six dimensions of psychological well-being: Self-acceptance, Positive Relationships with Others, Autonomy, Environmental Mastery, Purpose in Life, and Personal Growth. In this article, we propose to enrich the traditional approach of directly interpreting the raw scores in each dimension by incorporating Compositional Data Analysis. This new approach aims to identify "what proportion" of each dimension constitutes well-being, which will allow us to analyze the interactions between the different dimensions of well-being and balance among them. To achieve this, we introduce two position ratios (PR1 and PR2) and a general adjustment indicator called the General Indicator of Subjective Psychological Well-Being (GISPW), which characterizes individuals in a compositional manner, providing a fresh perspective in the interpretation of psychological test results, specifically those related to PWB. The proposal is illustrated with three cases taken from a study involving 628 university students who completed the psychological well-being scale questionnaire. The results show that the GISPW, PR1, and PR2 obtained offer relevant information about the overall balance of each case in the different dimensions.

Multivariate Statistical Techniques: A New Approach to Identify the Commercial Properties of Mixtures of Flours of Lentinula edodes and Cocoa Pod Husk.

Lentinula edodes is known to show high nutritional and organoleptic properties and can be mixed with different by-products in the production of new foods with important functional characteristics. Cocoa pod husk (CPH) is the main by-product in the cocoa industry and presents important bioactivities. In this research, two mixtures were applied based on Lentinula edodes mushroom flour from fifty different strains (strain 1 to strain 50) and cocoa pod husk flour (CPHF): 60% Lentinula edodes mushroom flour from each strain mixed with 40% CPHF (Mixture 1), and 80% Lentinula edodes mushroom flour from each strain mixed with 20% CPHF (Mixture 2). The parameters evaluated were moisture, proteins, fat, total dietary fiber (TDF), ash, carbohydrates, antioxidant capacity, antimicrobial activity, pH and water activity (aw). The multivariate statistical techniques evaluated those samples that exhibited the highest degree of correlation with the distinct chemical and commercial parameters, showing that sample 13 of both mixture flours (M1 and M2) obtained by the mushrooms of L. edodes (strain 13) with CPH indicated the higher significant of the parameters. In addition, the sensory test of the best flour (sample 13) was applied to 50 panelists, presenting the best sensory characteristics, such as color, aroma, texture and general acceptability.

Intermediate Molecular Phenotypes to Identify Genetic Markers of Anthracycline-Induced Cardiotoxicity Risk.

Cardiotoxicity due to anthracyclines (CDA) affects cancer patients, but we cannot predict who may suffer from this complication. CDA is a complex trait with a polygenic component that is mainly unidentified. We propose that levels of intermediate molecular phenotypes (IMPs) in the myocardium associated with histopathological damage could explain CDA susceptibility, so variants of genes encoding these IMPs could identify patients susceptible to this complication. Thus, a genetically heterogeneous cohort of mice (n = 165) generated by backcrossing were treated with doxorubicin and docetaxel. We quantified heart fibrosis using an Ariol slide scanner and intramyocardial levels of IMPs using multiplex bead arrays and QPCR. We identified quantitative trait loci linked to IMPs (ipQTLs) and cdaQTLs via linkage analysis. In three cancer patient cohorts, CDA was quantified using echocardiography or Cardiac Magnetic Resonance. CDA behaves as a complex trait in the mouse cohort. IMP levels in the myocardium were associated with CDA. ipQTLs integrated into genetic models with cdaQTLs account for more CDA phenotypic variation than that explained by cda-QTLs alone. Allelic forms of genes encoding IMPs associated with CDA in mice, including AKT1, MAPK14, MAPK8, STAT3, CAS3, and TP53, are genetic determinants of CDA in patients. Two genetic risk scores for pediatric patients (n = 71) and women with breast cancer (n = 420) were generated using machine-learning Least Absolute Shrinkage and Selection Operator (LASSO) regression. Thus, IMPs associated with heart damage identify genetic markers of CDA risk, thereby allowing more personalized patient management.

STATIS multivariate three-way method for evaluating quality of life after corneal surgery: Methodology and case study in Costa Rica.

Vision-related quality of life (QoL) analyzes the visual function concerning individual well-being based on activity and social participation. Because QoL is a multivariate construct, a multivariate statistical method must be used to analyze this construct. In this paper, we present a methodology based on STATIS multivariate three-way methods to assess the real change in vision-related QoL for myopic patients by comparing their conditions before and after corneal surgery. We conduct a case study in Costa Rica to detect the outcomes of patients referred for myopia that underwent refractive surgery. We consider a descriptive, observational and prospective study. We utilize the NEI VFQ-25 instrument to measure the vision-related QoL in five different stages over three months. After applying this instrument/questionnaire, a statistically significant difference was detected between the perceived QoL levels. In addition, strong correlations were identified with highly similar structures ranging from 0.857 to 0.940. The application of the dual STATIS method found the non-existence of reconceptualization in myopic patients, but a statistically significant recalibration was identified. Furthermore, a real change was observed in all patients after surgery. This finding has not been stated previously due to the limitations of the existing statistical tools. We demonstrated that dual STATIS is a multivariate method capable of evaluating vision-related QoL data and detecting changes in recalibration and reconceptualization.

Intermediate molecular phenotypes to identify genetic markers of anthracycline-induced cardiotoxicity risk.

Cardiotoxicity due to anthracyclines (CDA) affects cancer patients, but we cannot predict who may suffer from this complication. CDA is a complex disease whose polygenic component is mainly unidentified. We propose that levels of intermediate molecular phenotypes in the myocardium associated with histopathological damage could explain CDA susceptibility; so that variants of genes encoding these intermediate molecular phenotypes could identify patients susceptible to this complication. A genetically heterogeneous cohort of mice generated by backcrossing (N = 165) was treated with doxorubicin and docetaxel. Cardiac histopathological damage was measured by fibrosis and cardiomyocyte size by an Ariol slide scanner. We determine intramyocardial levels of intermediate molecular phenotypes of CDA associated with histopathological damage and quantitative trait loci (ipQTLs) linked to them. These ipQTLs seem to contribute to the missing heritability of CDA because they improve the heritability explained by QTL directly linked to CDA (cda-QTLs) through genetic models. Genes encoding these molecular subphenotypes were evaluated as genetic markers of CDA in three cancer patient cohorts (N = 517) whose cardiac damage was quantified by echocardiography or Cardiac Magnetic Resonance. Many SNPs associated with CDA were found using genetic models. LASSO multivariate regression identified two risk score models, one for pediatric cancer patients and the other for women with breast cancer. Molecular intermediate phenotypes associated with heart damage can identify genetic markers of CDA risk, thereby allowing a more personalized patient management. A similar strategy could be applied to identify genetic markers of other complex trait diseases.

The effect of mindfulness on the inflammatory, psychological and biomechanical domains of adult patients with low back pain: A randomized controlled clinical trial.

OBJECTIVE: This study aims to study the effect of mindfulness-based program on the psychological, biomechanical and inflammatory domains of patients with chronic low back pain. METHODS: A multicentre randomized and controlled clinical trial of parallel groups in patients with chronic low back pain between March 2019 to March 2020. Participants with no experience in mindfulness based intervention, were randomized to receive (36 patients) or not (34 patients) mindfulness-based stress reduction program for chronic back pain (MBSR-CBP). The program was performed in 9 sessions. Patients with chronic low back pain due to symptomatic discopathy (degenerative disc disease or herniated disc) were included. The principal outcome was changes in the blood level of cortisol and cytokines (tumor necrosis factor- α (TNF- α), interleukin-1ß (IL-1ß), interleukin-6 (IL-6) and interleukin-17 (IL-17)). Secondary outcomes (psychological factors, pain, and quality of life) were measured by validated questionnaires. RESULTS: Of the 96 randomized patients, 70 who completed the study were included in the analysis (mean [range] age: 53 [33-73] years; 66% females). MBSR-CBP stopped the increase in cortisol, and reduced pro-inflammatory cytokine IL-1ß (p = 0.05). It reduced depression (p = 0.046) and stress (p = 0.0438), perceived pain (p < 0.0001), and limitations related to health (p < 0.0001). It also increased the physical function (p = 0.002) and sleep quality (p = 0.05). Furthermore, it significantly increased life satisfaction (0.006), well-being (p = 0.001) and vitality (p < 0.0001). It also increased self-compassion (p < 0.0001) and significantly reduced the overidentification (p<0.0001) and catastrophization (p = 0.002). CONCLUSIONS: MBSR-CBP could be part of a multidisciplinary approach in the management of patients suffering from chronic low back pain.

Within-subject biological variation estimates using an indirect data mining strategy. Spanish multicenter pilot study (BiVaBiDa).

OBJECTIVES: The estimates of biological variation (BV) have traditionally been determined using direct methods, which present limitations. In response to this issue, two papers have been published addressing these limitations by employing indirect methods. Here, we present a new procedure, based on indirect methods that analyses data collected within a multicenter pilot study. Using this method, we obtain CVI estimates and calculate confidence intervals (CI), using the EFLM-BVD CVI estimates as gold standard for comparison. METHODS: Data were collected over a 18-month period for 7 measurands, from 3 Spanish hospitals; inclusion criteria: patients 18-75 years with more than two determinations. For each measurand, four different strategies were carried out based on the coefficient of variation ratio (rCoeV) and based on the use of the bootstrap method (OS1, RS2 and RS3). RS2 and RS3 use symmetry reference change value (RCV) to clean database. RESULTS: RS2 and RS3 had the best correlation for the CVI estimates with respect to EFLM-BVD. RS2 used the symmetric RCV value without eliminating outliers, while RS3 combined RCV and outliers. When using the rCoeV and OS1 strategies, an overestimation of the CVI value was obtained. CONCLUSIONS: Our study presents a new strategy for obtaining robust CVI estimates using an indirect method together with the value of symmetric RCV to select the target population. The CVI estimates obtained show a good correlation with those published in the EFLM-BVD database. Furthermore, our strategy can resolve some of the limitations encountered when using direct methods such as calculating confidence intervals.

Detection of response shift in health-related quality of life studies: a systematic review.

BACKGROUND: Response Shift (RS) refers to the idea that an individual may undergo changes in its health-related quality of life (HRQOL). If internal standard, values, or reconceptualization of HRQOL change over time, then answer to the same items by the same individuals may not be comparable over time. Traditional measures to evaluate RS is prone to bias and strong methodologies to study the existence of this phenomenon is required. The objective is to systematically identify, analyze, and synthesize the existing and recent evidence of statistical methods used for RS detection in HRQOL studies. METHODS: The analysis of selected studies between January 2010 and July 2020 was performed through a systematic review in MEDLINE/PubMed, Scopus, Web of Science, PsycINFO and Google Scholar databases. The search strategy used the terms "Health-Related Quality of Life" and "Response Shift" using the filters "Humans", "Journal Article", "English" and "2010/01/01-2020/07/31". The search was made in August 2020. RESULTS: After considering the inclusion and exclusion criteria, from the total selected articles (675), 107 (15.9%) of the publications were included in the analysis. From these, 79 (71.0%) detected the existence of RS and 86 (80.4%) only used one detection method. The most used methods were Then Test (n = 41) and Oort's Structural Equation Models (SEM) (n = 35). Other method used were Multiple Lineal Regression (n = 7), Mixed-Effect Regression (n = 6), Latent Trajectory Analysis (n = 6), Item Response Theory (n = 6), Logistics Regression (n = 5), Regression and Classification Trees (n = 4) and Relative Importance Method (n = 4). Most of these detected recalibration, including Then Test (n = 27), followed by Oort's SEM that detected the higher combination of RS types: recalibration (n = 24), reprioritization (n = 13) and reconceptualization (n = 7). CONCLUSIONS: There is a continuous interest of studying RS detection. Oort's SEM becomes the most versatile method in its capability for detecting RS in all different types. Despite results from previous systematic reviews, same methods have been used during the last years. We observed the need to explore other alternative methods allowing same detection capacity with robust and highly precise methodology. The investigation on RS detection and types requires more study, therefore new opportunity grows to continue attending this phenomenon through a multidisciplinary perspective.

A 29-gene signature associated with NOX2 discriminates acute myeloid leukemia prognosis and survival.

The molecular complexity displayed in acute myeloid leukemia (AML) hinders patient stratification and treatment decisions. Previous studies support the utility of using specific gene panels for this purpose. Focusing on two salient features of AML, the production of reactive oxygen species (ROS) by NADPH oxidases (NOX) and metabolism, we aimed to identify a gene panel that could improve patient stratification. A pairwise comparison of AML versus healthy gene expression revealed the downregulation of four members of the NOX2 complex including CYBB (coding for NOX2) in AML patients. We analyzed the expression of 941 genes related to metabolism and found 28 genes with expression correlated to CYBB. This panel of 29 genes (29G) effectively divides AML samples according to their prognostic group. The robustness of 29G was confirmed by 6 AML cohort datasets with a total of 1821 patients (overall accuracies of 85%, 78%, 80%, 75%, 59% and 83%). An expression index (EI) was developed according to the expression of the selected discriminatory genes. Overall Survival (OS) was higher for low 29G expression index patients than for the high 29G expression index group, which was confirmed in three different datasets with a total of 1069 patients. Moreover, 29G can dissect intermediate-prognosis patients in four clusters with different OS, which could improve the current AML stratification scheme. In summary, we have found a gene signature (29G) that can be used for AML classification and for OS prediction. Our results confirm NOX and metabolism as suitable therapeutic targets in AML.

Olfactory Groove Meningiomas: Comprehensive assessment between the different microsurgical transcranial approaches and the Endoscopic Endonasal Approaches, systematic review and metanalysis on behalf of the EANS skull base section.

•OGM surgery is much more complex than a simple debate of "from above or from below" (transcranial vs endoscopic).•Lateral Sub-frontal and Superior Interhemispheric seem the most effective, superior and versatile approaches for OGM.•Minimally Invasive Transcranial approaches showed no inferiority in OGM sized <4 â€‹cm.•Endoscopic Endonasal Approaches showed inferior results in surgical and in functional outcomes for OGM.

Frequency of Iatrogenic Sexual Dysfunction Associated with Antihypertensive Compounds.

Iatrogenic sexual dysfunction (SD) caused by antihypertensive (AH) compounds, provoking sexual desire, orgasm or arousal dysfunction, is a common clinical adverse event. Unfortunately, it is often underestimated and underreported by clinicians and prescribers in clinical practice, deteriorating the adherence and patient quality of life. The objective of this study was to investigate the frequency of SD in patients treated with different antihypertensive compounds; a real-life naturalistic and cross-sectional study in patients receiving AH treatment was carried out. Method: A total of 256 patients were included in the study (188 males and 68 females who met the inclusion and exclusion criteria). The validated Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) was transversally applied once at least every two months following the onset of the treatment in order to measure possible AH-related SD. Although the spontaneous reporting of SD was very low (6.81% females/24.8% males), 66.40% of the patients reported impaired sexual function through the SALSEX questionnaire after the treatment onset, as follows: decreased desire (55.8% females/54.2% males), delayed orgasm (42.6%/45.7%), anorgasmia (42.6%/43.6%) and arousal difficulties (53%/59.6%). The average frequency of moderate to severe iatrogenic SD was 66.4% with AH in monotherapy as follows: angiotensin II receptor antagonists (ARBs), 29.8%; calcium antagonists, 40%; diuretics, 42.9%; beta blockers, 43.8%; and angiotensin-converting enzyme (ACE) inhibitors, 77.8%. Combined treatments showed a higher percentage of main SD (70.3%): diuretic + ACE inhibitor, 42.3%; ARB + calcium antagonist, 55.6%; diuretic + calcium antagonist, 68.8%; and diuretic + ARB, 74.2%. The greatest risk factors associated with SD were poor general health, age over 60 with a comorbid coronary or musculoskeletal disease, mood disorder and diuretic +ARB combined therapy. Conclusion: SD is common in patients treated with antihypertensive drugs, and it is still underreported. The most harmful treatment deteriorating sexual function was the combination of diuretic +ARB, while the least harmful was monotherapy with ARBs. More research is needed on the clinical management of this problem to preserve the quality of life of patients and their partners.

Data-Mining Techniques: A New Approach to Identifying the Links among Hybrid Strains of Pleurotus with Culture Media.

In this study, a data set of mycelial and cultural characteristics of hybrid strains of Pleurotus ostreatus and Pleurotus djamor were analyzed using three data-mining techniques: the K-medoids clustering algorithm, PCA biplot and the association rules algorithm. The characteristics evaluated were as follows: maximum velocity; lag phase; biomass; and exopolysaccharides content in the cultivation of 50 hybrid strains of Pleurotus ostreatus and 50 hybrid strains of Pleurotus djamor. Different mixtures of culture media were used to supplement Ecuadorian agricultural products. Data of the parameters obtained in the experimental methods were grouped into four clusters, obtaining a presentation of the hybrid strains of Pleurotus with a higher relation to each characteristic measured. Data-mining tools showed the hybrid strains cultivated on solid-culture media (M1 = malt extract agar and rice flour) and liquid-culture media (L1 = maltose, yeast extract and rice flour) presented the highest mycelial and cultural characteristics. These results are good indicators to improve the industrial production of edible fungi by using rice flour in the cultivation, contributing to the mushroom market and circular economy.

Application of K-Means Clustering Algorithm to Commercial Parameters of Pleurotus spp. Cultivated on Representative Agricultural Wastes from Province of Guayas.

Data of the commercial parameters of Pleurotus ostreatus and Pleurotus djamor were analyzed using the data mining technique: K-means clustering algorithm. The parameters evaluated were: biological efficiency, crop yield ratio, productivity rate, nutritional composition, antioxidant and antimicrobial activities in the production of fruit bodies of 50 strains of Pleurotus ostreatus and 50 strains of Pleurotus djamor, cultivated on the most representative agricultural wastes from the province of Guayas: 80% sugarcane bagasse and 20% wheat straw (M1), and 60% wheat straw and 40% sugarcane bagasse (M2). The database of the parameters obtained in experimental procedures was grouped into three clusters, providing a visualization of the strains with a higher relation to each parameter (vector) measured.

Seroprevalence of SARS-CoV-2 Antibodies and Factors Associated with Seropositivity at the University of Salamanca: The DIANCUSAL Study.

BACKGROUND: Systematic screening for antibodies against SARS-CoV-2 is a crucial tool for surveillance of the COVID-19 pandemic. The University of Salamanca (USAL) in Spain designed a project called "DIANCUSAL" (Diagnosis of New Coronavirus, COVID-19, in University of Salamanca) to measure antibodies against SARS-CoV-2 among its ~34,000 students and academic staff, as the influence of the university community in the spread of the SARS-CoV-2 pandemic in the city of Salamanca and neighboring towns hosting USAL campuses could be substantial. OBJECTIVE: The aim of this study was to estimate the prevalence of SARS-CoV-2 antibodies among USAL students, professors and staff and to evaluate the demographic, academic, clinical and lifestyle and behavioral factors related to seropositivity. METHODOLOGY: The DIANCUSAL study is an ongoing university population-based cross-sectional study, with the work described herein conducted from July-October 2020. All USAL students, professors and staff were invited to complete an anonymized questionnaire. Seroprevalence of anti-SARS-CoV-2 antibodies was detected and quantified by using chemiluminescent assays for IgG and IgM. PRINCIPAL FINDINGS: A total of 8197 (24.71%) participants were included. The mean age was 31.4 (14.5 SD) years, and 66.0% of the participants were female. The seroprevalence was 8.25% overall and was highest for students from the education campus (12.5%) and professors from the biomedical campus (12.6%), with significant differences among faculties (p = 0.006). Based on the questionnaire, loss of smell and fever were the symptoms most strongly associated with seropositivity, and 22.6% of seropositive participants were asymptomatic. Social distancing was the most effective hygiene measure (p = 0.0007). There were significant differences in seroprevalence between participants with and without household exposure to SARS-CoV-2 (p = 0.0000), but not between students who lived in private homes and those who lived in dormitories. IgG antibodies decreased over time in the participants with confirmed self-reported COVID-19 diagnoses. CONCLUSIONS: The analysis revealed an overall 8.25% seroprevalence at the end of October 2020, with a higher seroprevalence in students than in staff. Thus, there is no need for tailored measures for the USAL community as the official average seroprevalence in the area was similar (7.8% at 22 June and 12.4 at 15 November of 2020). Instead, USAL members should comply with public health measures.

Multivariate analysis reveals differentially expressed genes among distinct subtypes of diffuse astrocytic gliomas: diagnostic implications.

Diagnosis and classification of gliomas mostly relies on histopathology and a few genetic markers. Here we interrogated microarray gene expression profiles (GEP) of 268 diffuse astrocytic gliomas-33 diffuse astrocytomas (DA), 52 anaplastic astrocytomas (AA) and 183 primary glioblastoma (GBM)-based on multivariate analysis, to identify discriminatory GEP that might support precise histopathological tumor stratification, particularly among inconclusive cases with II-III grade diagnosed, which have different prognosis and treatment strategies. Microarrays based GEP was analyzed on 155 diffuse astrocytic gliomas (discovery cohort) and validated in another 113 tumors (validation set) via sequential univariate analysis (pairwise comparison) for discriminatory gene selection, followed by nonnegative matrix factorization and canonical biplot for identification of discriminatory GEP among the distinct histological tumor subtypes. GEP data analysis identified a set of 27 genes capable of differentiating among distinct subtypes of gliomas that might support current histological classification. DA + AA showed similar molecular profiles with only a few discriminatory genes overexpressed (FSTL5 and SFRP2) and underexpressed (XIST, TOP2A and SHOX2) in DA vs AA and GBM. Compared to DA + AA, GBM displayed underexpression of ETNPPL, SH3GL2, GABRG2, SPX, DPP10, GABRB2 and CNTN3 and overexpression of CHI3L1, IGFBP3, COL1A1 and VEGFA, among other differentially expressed genes.

Machine Learning to Predict Stent Restenosis Based on Daily Demographic, Clinical, and Angiographic Characteristics.

BACKGROUND: Machine learning (ML) has arrived in medicine to deliver individually adapted medical care. This study sought to use ML to discriminate stent restenosis (SR) compared with existing predictive scores of SR. To develop an easily applicable model, we performed our predictions without any additional variables other than those obtained in daily practice. METHODS: The dataset, obtained from the Grupo de Análisis de la Cardiopatía Isquémica Aguda (GRACIA)-3 trial, consisted of 263 patients with demographic, clinical, and angiographic characteristics; 23 (9%) of them presented with SR at 12 months after stent implantation. A methodology to work with small imbalanced datasets, based in cross-validation and the precision/recall (PR) plots, was used, and state-of-the-art ML classifiers were trained. RESULTS: Our best performing model (0.46, area under the PR curve [AUC-PR]) was developed with an extremely randomized trees classifier, which showed better performance than chance alone (0.09 AUC-PR, corresponding to the 9% of patients presenting SR in our dataset) and 3 existing scores; Prevention of Restenosis With Tranilast and its Outcomes (PRESTO)-1 (0.31 AUC-PR), PRESTO-2 (0.27 AUC-PR), and Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) (0.18 AUC-PR). The most important variables ranked according to their contribution to the predictions were diabetes, ≥2 vessel-coronary disease, post-percutaneous coronary intervention thrombolysis in myocardial infarction (PCI TIMI)-flow, abnormal platelets, post-PCI thrombus, and abnormal cholesterol. To counteract the lack of external validation for our study, we deployed our ML algorithm in an open source calculator, in which the model would stratify patients of high and low risk as an example tool to determine generalizability of prediction models from small imbalanced sample size. CONCLUSIONS: Applied immediately after stent implantation, a ML model better differentiates those patients who will present with SR over current discriminators.

Heterogeneous EGFR, CDK4, MDM4, and PDGFRA Gene Expression Profiles in Primary GBM: No Association with Patient Survival.

BACKGROUND: The prognostic impact of the expression profile of genes recurrently amplified in glioblastoma multiforme (GBM) remains controversial. METHODS: We investigated the RNA gene expression profile of epidermal growth factor receptor (EGFR), cyclin-dependent kinase 4 (CDK4), murine doble minute 4 (MDM4), and platelet derived growth factor receptor alpha (PDGFRA) in 83 primary GBM tumors vs. 42 normal brain tissue samples. Interphase FISH (iFISH) analysis for the four genes, together with analysis of intragenic deletions in EGFR and PDGFRA, were evaluated in parallel at the DNA level. As validation cohort, publicly available RNA gene expression data on 293 samples from 10 different GBM patient series were also studied. RESULTS: At the RNA level, CDK4 was the most frequently overexpressed gene (90%) followed by EGFR (58%) and PDGFRA (58%). Chromosome 7 copy number alterations, i.e., trisomy (49%) and polysomy (44%), showed no clear association with EGFR gene expression levels. In turn, intragenic EGFR deletions were found in 39 patients (47%), including EGFRvIII (46%) in association with EGFRvIVa (4%), EGFRvII (2%) or other EGFR deletions (3%) and PDGFRA deletion of exons 8-9 was found in only two tumors (2%). CONCLUSIONS: Overall, none of the gene expression profiles and/or intragenic EGFR deletions showed a significant impact on overall survival of GBM supporting the notion that other still unraveled features of the disease might play a more relevant prognostic role in GBM.

Complications Associated with Enteral Nutrition: CAFANE Study.

OBJECTIVES: To determine the association between home enteral nutrition (HEN) administration modality and its complications in patients. METHODS: This is a prospective multicenter longitudinal study including 15 Spanish hospitals, from April 2015 to March 2017. A 4-month follow-up period was conducted for each patient by home visit. The study subjects were adult patients who began their nutrient intake by tube feeding, known as HEN, during the recruitment period. The variables studied included the type and modality of HEN administration and its related complications, such as vomiting, regurgitation, constipation, diarrhea, and abdominal distention. Mechanical complications and bronchoaspiration were also evaluated. Descriptive variables were used for fitting. RESULTS: The study consisted of 306 patients; 4 were lost due to death. Specific HEN modalities protected against constipation (odds ratio (OR) = 0.4) and regurgitation (OR = 0.4). The use of a nasogastric tube (NGT) resulted in a lower risk of diarrhea compared to percutaneous endoscopic gastrostomy (PEG) (OR = 0.4) but resulted in a higher risk of tube obstruction (OR = 7.4). The use of intermittent gravity versus bolus feeding was a protection factor against vomiting (OR = 0.4), regurgitation (OR = 0.3), constipation (OR = 0.3), diarrhea (OR = 0.4) and abdominal distension (OR = 0.4). The increase in the number of doses was a risk factor for the incidence of regurgitation (OR = 1.3). CONCLUSIONS: Gastrointestinal complications were the most frequent problems, but an adequate choice of the formula, route, feeding modality, number of doses, administration time, and dose volume can reduce the risk of these complications.

Toddler Screening for Autism Spectrum Disorder: A Meta-Analysis of Diagnostic Accuracy.

Great efforts focus on early detection of autism spectrum disorder, although some scientists and policy-makers have questioned early universal screening. The aim of this meta-analysis was to evaluate the diagnostic accuracy of the different screening tools. Several electronic databases were used to identify published studies. A Bayesian model was used to estimate the screening accuracy. The pooled sensitivity was 0.72 (95% CI 0.61-0.81), and the specificity was 0.98 (95% CI 0.97-0.99). Subgroup analyses to remove heterogeneity indicated sensitivity was 0.77 (95% CI 0.69-0.84), and specificity was 0.99 (95% CI 0.97-0.99; SD ≤ 0.01). Level 1 screening tools for ASD showed consistent statistically significant results and therefore are adequate to detect autism at 14-36 months.