Search

Background: Sacral neuromodulation is an effective treatment for fecal incontinence in the long term. Efficacy is typically assessed using bowel diary, symptom severity, and quality-of-life questionnaires, and "success" is defined as more than 50% improvement in these measures. However, patient satisfaction may be a more meaningful and individualized measure of treatment efficacy., Objective: To assess patient-reported satisfaction with long-term sacral neuromodulation and compare it to the frequently applied efficacy measures., Design: An observational study of a prospectively maintained database., Setting: A single tertiary pelvic floor referral unit., Patients: Data from 70 patients (68 women, median age 69 [60-74] years) were available. The median time since implantation was 11 (9-14) years. Nineteen patients reported inactive neuromodulation devices., Main Outcome Measures: Bowel diaries, the Manchester Health Questionnaire, and the St. Mark's Incontinence Score were recorded at baseline, after percutaneous nerve evaluation, and at the last follow-up. Patient-reported satisfaction, using a 0% to 100% visual analog scale, with treatment since implantation (overall) and in the 2 weeks preceding completion of the last outcome measures (current) were also assessed., Results: Satisfaction was significantly higher in those with active sacral neuromodulation devices (75% vs 20%, p < 0.001) at follow-up. No significant relationships exist between symptom improvement using conventional measures and patient-reported satisfaction. Current satisfaction was not associated with changes in bowel diary data after percutaneous nerve evaluation. Despite improvements in the St. Mark's Incontinence Score and Manchester Health Questionnaire below the 50% improvement threshold used to define "success," patients reported high (80%) satisfaction., Limitations: Retrospective design with gaps in the available data., Conclusions: High patient satisfaction with sacral neuromodulation can be achieved; however, the response to percutaneous nerve evaluation may not predict treatment satisfaction in the long term. The change in questionnaire results, which measure the use of compensatory behaviors and quality-of-life impact, may better correspond to treatment satisfaction., Satisfaccin a Largo Plazo En Los Pacientes Con La Neuromodulacin Sacra Para La Incontinencia Fecal Experiencia De Un Nico Centro Terciario: ANTECEDENTES:La neuromodulación sacra es un tratamiento eficaz para la incontinencia fecal a largo plazo. La eficacia suele evaluarse mediante cuestionarios sobre la frecuencia diaria intestinal, la gravedad de los síntomas o la calidad de vida, y el "éxito" se define como una mejoría >50% en estas medidas. Sin embargo, la satisfacción del paciente puede ser una medida más significativa e individualizada de la eficacia del tratamiento.OBJETIVO:Evaluar la satisfacción a largo plazo de los pacientes con la neuromodulación sacra y compararla con las medidas de eficacia aplicadas con frecuencia.DISEÑO:Estudio observacional de una base de datos mantenida prospectivamente.LUGAR:Unidad terciaria única de referencia de suelo pélvico.PACIENTES:Se dispuso de datos de 70 pacientes (68 mujeres, mediana de edad 69 [60-74]). La mediana de tiempo transcurrido desde la implantación fue de 11 (9-14) años. Diecinueve pacientes informaron de dispositivos de neuromodulación inactivos.PRINCIPALES MEDIDAS DE VALORACIÓN:Diarios intestinales, el Cuestionario de Salud de Manchester y la Puntuación de Incontinencia de St Marks registrados al inicio, tras la evaluación percutánea del nervio y en el último seguimiento. Los pacientes informaron de su satisfacción, utilizando una escala analógica visual de 0%-100%, con el tratamiento desde la implantación (global) y en las dos semanas anteriores a la realización de las últimas medidas de resultado (actual).RESULTADOS:La satisfacción fue significativamente mayor en los pacientes con dispositivos de neuromodulación sacra activos (75% frente a 20%, p < 0,001) durante el seguimiento. No existen relaciones significativas entre la mejoría de los síntomas mediante medidas convencionales y la satisfacción comunicada por el paciente. La satisfacción actual no se asoció con los cambios en los datos de la frecuencia diaria intestinal tras la evaluación percutánea de los nervios. A pesar de que las mejoras en la puntuación de incontinencia de St Mark y el Cuestionario de Salud de Manchester se situaron por debajo del umbral de mejora del 50% utilizado para definir el "éxito", los pacientes declararon un alto grado de satisfacción (80%).LIMITACIONES:Retrospectivo con lagunas en los datos disponibles.CONCLUSIONES:Puede lograrse una alta satisfacción de los pacientes con la neuromodulación sacra; sin embargo, la respuesta a la evaluación percutánea del nervio puede no predecir la satisfacción con el tratamiento a largo plazo. El cambio en los resultados del cuestionario, que mide el uso de conductas compensatorias y el impacto en la calidad de vida, puede corresponder mejor a la satisfacción con el tratamiento. (Traducción-Dr. Ingrid Melo )., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Colon and Rectal Surgeons.)

Camera-based object detection is integral to advanced driver assistance systems (ADAS) and autonomous vehicle research, and RGB cameras remain indispensable for their spatial resolution and color information. This study investigates exposure time optimization for such cameras, considering image quality in dynamic ADAS scenarios. Exposure time, the period during which the camera sensor is exposed to light, directly influences the amount of information captured. In dynamic scenarios, such as those encountered in typical driving scenarios, optimizing exposure time becomes challenging due to the inherent trade-off between Signal-to-Noise Ratio (SNR) and motion blur, i.e., extending exposure time to maximize information capture increases SNR, but also increases the risk of motion blur and overexposure, particularly in low-light conditions where objects may not be fully illuminated. The study introduces a comprehensive methodology for exposure time optimization under various lighting conditions, examining its impact on image quality and computer vision performance. Traditional image quality metrics show a poor correlation with computer vision performance, highlighting the need for newer metrics that demonstrate improved correlation. The research presented in this paper offers guidance into the enhancement of single-exposure camera-based systems for automotive applications. By addressing the balance between exposure time, image quality, and computer vision performance, the findings provide a road map for optimizing camera settings for ADAS and autonomous driving technologies, contributing to safety and performance advancements in the automotive landscape.

In recent years, significant advances have been made in the development of Advanced Driver Assistance Systems (ADAS) and other technology for autonomous vehicles. Automated object detection is a crucial component of autonomous driving; however, there are still known issues that affect its performance. For automotive applications, object detection algorithms are required to perform at a high standard in all lighting conditions; however, a major problem for object detection is poor performance in low-light conditions due to objects being less visible. This study considers the impact of training data composition on object detection performance in low-light conditions. In particular, this study evaluates the effect of different combinations of images of outdoor scenes, from different times of day, on the performance of deep neural networks, and considers the different challenges encountered during the training of a neural network. Through experiments with a widely used public database, as well as a number of commonly used object detection architectures, we show that more robust performance can be obtained with an appropriate balance of classes and illumination levels in the training data. The results also highlight the potential of adding images obtained in dusk and dawn conditions for improving object detection performance in day and night.

Background: Tumor-targeted therapy causes impressive tumor regression, but the emergence of resistance limits long-term survival benefits in patients. Little information is available on the role of the myeloid cell network, especially dendritic cells (DC) during tumor-targeted therapy., Methods: Here, we investigated therapy-mediated immunological alterations in the tumor microenvironment (TME) and tumor-draining lymph nodes (LN) in the D4M.3A preclinical melanoma mouse model (harboring the V-Raf murine sarcoma viral oncogene homolog B (BRAF) V600E mutation) by using high-dimensional multicolor flow cytometry in combination with multiplex immunohistochemistry. This was complemented with RNA sequencing and cytokine quantification to characterize the immune status of the tumors. The importance of T cells during tumor-targeted therapy was investigated by depleting CD4 + or CD8 + T cells in tumor-bearing mice. Tumor antigen-specific T-cell responses were characterized by performing in vivo T-cell proliferation assays and the contribution of conventional type 1 DC (cDC1) to T-cell immunity during tumor-targeted therapy was assessed using Batf3 -/- mice lacking cDC1., Results: Our findings reveal that BRAF-inhibitor therapy increased tumor immunogenicity, reflected by an upregulation of genes associated with immune activation. The T cell-inflamed TME contained higher numbers of activated cDC1 and cDC2 but also inflammatory CCR2-expressing monocytes. At the same time, tumor-targeted therapy enhanced the frequency of migratory, activated DC subsets in tumor-draining LN. Even more, we identified a cDC2 population expressing the Fc gamma receptor I (FcγRI)/CD64 in tumors and LN that displayed high levels of CD40 and CCR7 indicating involvement in T cell-mediated tumor immunity. The importance of cDC2 is underlined by just a partial loss of therapy response in a cDC1-deficient mouse model. Both CD4 + and CD8 + T cells were essential for therapy response as their respective depletion impaired therapy success. On resistance development, the tumors reverted to an immunologically inert state with a loss of DC and inflammatory monocytes together with the accumulation of regulatory T cells. Moreover, tumor antigen-specific CD8 + T cells were compromised in proliferation and interferon-γ-production., Conclusion: Our results give novel insights into the remodeling of the myeloid landscape by tumor-targeted therapy. We demonstrate that the transient immunogenic tumor milieu contains more activated DC. This knowledge has important implications for the development of future combinatorial therapies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Sacral neuromodulation is an effective treatment for fecal incontinence., Objective: To assess the long-term outcomes of sacral neuromodulation and establish the outcomes of patients with inactive devices., Design: This is an observational study of patients treated for >5 years. A positive outcome was defined as a more than 50% reduction in fecal incontinence episodes or improvement in a symptom severity score. Data were reviewed from a prospectively managed database., Settings: This study was conducted at a single tertiary referral center., Patients: Data from 74 patients (72 women) were available at long-term follow-up., Main Outcome Measures: Bowel diary, St. Mark's incontinence score, and Manchester Health Questionnaire data were prospectively recorded at baseline, after percutaneous nerve evaluation, and at last follow-up., Results: Patients were analyzed in cohorts based on time since sacral neuromodulation implantation: group 1: 5 to 10 years (n = 20), group 2: >10 years (n = 35), and group 3: inactive sacral neuromodulation devices (n = 19). Median St. Mark's incontinence score and Manchester Health Questionnaire improved from baseline to last follow-up in group 1 ( p ≤ 0.05) and group 2 ( p ≤ 0.05), but in group 3, results returned to baseline levels at the last follow-up. Similarly, weekly fecal incontinence episodes improved in both active device groups at the last follow-up. However, in group 3, incontinence episodes were no different from baseline ( p = 0.722). Despite active devices, fecal urgency episodes increased at the last follow-up after >10 years since percutaneous nerve evaluation ( p ≤ 0.05). Complete continence was reported by 44% of patients, and at least a 50% improvement was seen in 77% of patients with active devices., Limitations: This study is retrospective with some gaps in the available data at the last follow-up., Conclusions: Sacral neuromodulation is an effective treatment for fecal incontinence in the long term, but all outcomes are adversely affected by device inactivity. Therefore, ongoing stimulation is required for continued benefit. See Video Abstract., Resultados a Largo Plazo De La Neuromodulacin Sacra Para La Incontinencia Fecal Experiencia De Un Solo Centro: ANTECEDENTES:La neuromodulación sacra es un tratamiento eficaz para la incontinencia fecal.OBJETIVO:Este estudio tuvo como objetivo evaluar los resultados a largo plazo de la neuromodulación sacra y establecer los resultados de los pacientes con dispositivos inactivos.DISEÑO:Este es un estudio observacional de pacientes tratados durante más de 5 años. Un resultado positivo se definió como una reducción >50 % en los episodios de incontinencia fecal o una mejoría en la puntuación de gravedad de los síntomas. Los datos se revisaron a partir de una base de datos administrada prospectivamente.ENTERNO CLINICO:Este estudio se realizó en un solo centro de referencia terciario.PACIENTES:Los datos de 74 pacientes (72 mujeres) estaban disponibles en el seguimiento a largo plazo.PRINCIPALES MEDIDAS DE RESULTADO:Diario intestinal, puntuación de incontinencia de St. Mark y datos del Cuestionario de salud de Manchester se registraron prospectivamente al inicio, después de la evaluación de nervio periférico y en el último seguimiento.RESULTADOS:Los pacientes se analizaron en cohortes según el tiempo transcurrido desde la implantación de la neuromodulación sacra: Grupo 1: 5-10 años (n = 20), Grupo 2: >10 años (n = 35) y Grupo 3: dispositivos SNM inactivos (n = 19). La mediana de la puntuación de incontinencia de St. Mark y Questionnaire Cuestionario de salud de Manchester mejoraron desde el inicio hasta el último seguimiento en el Grupo 1 (p = < 0,05) y el Grupo 2 (p = < 0,05), pero en el Grupo 3 los resultados volvieron a los niveles iniciales en el último seguimiento. arriba. De manera similar, los episodios semanales de incontinencia fecal mejoraron en ambos grupos de dispositivos activos en el último seguimiento. Sin embargo, en el Grupo 3 los episodios de incontinencia no fueron diferentes de los basales (p = 0,722). A pesar de los dispositivos activos, los episodios de urgencia fecal aumentaron en el último seguimiento después de más de 10 años desde la evaluación del nervio periférico (p = < 0,05). Continencia completa se reportó en el 44 % de los pacientes, y al menos una mejora del 50 % en el 77 % con dispositivos activos.LIMITACIONES:Este estudio es retrospectivo con algunas vacíos en los datos disponibles en el último seguimiento.CONCLUSIONES:La neuromodulación sacra es un tratamiento eficaz para la incontinencia fecal a largo plazo, pero todos los resultados se ven afectados negativamente por la inactividad del dispositivo. Por lo tanto, se requiere estimulación continua para un beneficio continuo. (Traducción- Dr. Francisco M. Abarca-Rendon )., (Copyright © The ASCRS 2023.)

In advanced driver assistance systems (ADAS) or autonomous vehicle research, acquiring semantic information about the surrounding environment generally relies heavily on camera-based object detection. Image signal processors (ISPs) in cameras are generally tuned for human perception. In most cases, ISP parameters are selected subjectively and the resulting image differs depending on the individual who tuned it. While the installation of cameras on cars started as a means of providing a view of the vehicle's environment to the driver, cameras are increasingly becoming part of safety-critical object detection systems for ADAS. Deep learning-based object detection has become prominent, but the effect of varying the ISP parameters has an unknown performance impact. In this study, we analyze the performance of 14 popular object detection models in the context of changes in the ISP parameters. We consider eight ISP blocks: demosaicing, gamma, denoising, edge enhancement, local tone mapping, saturation, contrast, and hue angle. We investigate two raw datasets, PASCALRAW and a custom raw dataset collected from an advanced driver assistance system (ADAS) perspective. We found that varying from a default ISP degrades the object detection performance and that the models differ in sensitivity to varying ISP parameters. Finally, we propose a novel methodology that increases object detection model robustness via ISP variation data augmentation.

Interacting with other roads users is a challenge for an autonomous vehicle, particularly in urban areas. Existing vehicle systems behave in a reactive manner, warning the driver or applying the brakes when the pedestrian is already in front of the vehicle. The ability to anticipate a pedestrian's crossing intention ahead of time will result in safer roads and smoother vehicle maneuvers. The problem of crossing intent forecasting at intersections is formulated in this paper as a classification task. A model that predicts pedestrian crossing behaviour at different locations around an urban intersection is proposed. The model not only provides a classification label (e.g., crossing, not-crossing), but a quantitative confidence level (i.e., probability). The training and evaluation are carried out using naturalistic trajectories provided by a publicly available dataset recorded from a drone. Results show that the model is able to predict crossing intention within a 3-s time window.

Given that 20% to 40% of women who have percutaneous breast biopsy subsequently undergo breast surgery, knowledge of imaging women with a history of benign (including high-risk) disease or breast cancer is important. For women who had surgery for nonmalignant pathology, the surveillance recommendations are determined by their overall risk. Higher-than-average risk women with a history of benign surgery may require screening mammography starting at an earlier age before 40 and may benefit from screening MRI. For women with breast cancer who have undergone initial excision and have positive margins, imaging with diagnostic mammography or MRI can sometimes guide additional surgical planning. Women who have completed breast conservation therapy for cancer should get annual mammography and may benefit from the addition of MRI or ultrasound to their surveillance regimen. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation., (Copyright © 2022 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Motivation: Double minute (DM) chromosomes are acentric extrachromosomal DNA artifacts that are frequently observed in the cells of numerous cancers. They are highly amplified and contain oncogenes and drug-resistance genes, making their presence a challenge for effective cancer treatment. Algorithmic discovery of DM can potentially improve bench-derived therapies for cancer treatment. A hindrance to this task is that DMs evolve, yielding circular chromatin that shares segments from progenitor DMs. This creates DMs with overlapping amplicon coordinates. Existing DM discovery algorithms use whole genome shotgun sequencing (WGS) in isolation, which can potentially incorrectly classify DMs that share overlapping coordinates., Results: In this study, we describe an algorithm called 'HolistIC' that can predict DMs in tumor genomes by integrating WGS and Hi-C sequencing data. The consolidation of these sources of information resolves ambiguity in DM amplicon prediction that exists in DM prediction with WGS data used in isolation. We implemented and tested our algorithm on the tandem Hi-C and WGS datasets of three cancer datasets and a simulated dataset. Results on the cancer datasets demonstrated HolistIC's ability to predict DMs from Hi-C and WGS data in tandem. The results on the simulated data showed the HolistIC can accurately distinguish DMs that have overlapping amplicon coordinates, an advance over methods that predict extrachromosomal amplification using WGS data in isolation., Availability and Implementation: Our software, named 'HolistIC', is available at http://www.github.com/mhayes20/HolistIC., Supplementary Information: Supplementary data are available at Bioinformatics online., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Birth by Caesarean-section (C-section), which increases the risk for metabolic and immune disorders, disrupts the normal initial microbial colonisation of the gut, in addition to preventing early priming of the stress and immune-systems.. Animal studies have shown there are enduring psychological processes in C-section born mice. However, the long-term impact of microbiota-gut-brain axis disruptions due to birth by C-section on psychological processes in humans is unknown. Forty age matched healthy young male university students born vaginally and 36 C-section delivered male students were recruited. Participants underwent an acute stressor, the Trier social stress test (TSST), during a term-time study visit. A subset of participants also completed a study visit during the university exam period, representing a naturalistic stressor. Participants completed a battery of cognitive tests and self-report measures assessing mood, anxiety, and perceived stress. Saliva, blood, and stool samples were collected for analysis of cortisol, peripheral immune profile, and the gut microbiota. Young adults born by C-section exhibit increased psychological vulnerability to acute stress and a prolonged period of exam-related stress. They did not exhibit an altered salivary cortisol awakening response to the TSST, but their measures of positive affect were significantly lower than controls throughout the procedure. Both C-section and vaginally-delivered participants performed equally well on cognitive assessments. Most of the initial effects of delivery mode on the gut microbiome did not persist into adulthood as the gut microbiota profile showed modest changes in composition in adult vaginally-delivered and C-sectioned delivered subjects. From an immune perspective, concentrations of IL-1β and 1L-10 were higher in C-section participants. These data confirm that there is a potential enduring effect of delivery mode on the psychological responses to acute stress during early adulthood. The mental health implications of these observations require further study regarding policies on C-section use., Competing Interests: APC Microbiome Ireland has conducted studies in collaboration with several companies, including GSK, Pfizer, Cremo, Wyeth, Mead Johnson, Nutricia, 4D Pharma, and DuPont. T. G. Dinan has been an invited speaker at meetings organized by Servier, Lundbeck, Janssen, and AstraZeneca and has received research funding from Mead Johnson, Cremo, Nutricia, and 4D Pharma. J. F. Cryan has been an invited speaker at meetings organized by Mead Johnson, Yakult, and Alkermes, and has received research funding from Mead Johnson, Cremo, Nutricia, and IFF. GC has received honoraria from Janssen, Probi and Apsen as an invited speaker, is in receipt of research funding from Pharmavite and Fonterra and is a paid consultant for Yakult and Zentiva., (© 2021 Published by Elsevier Inc.)