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The aim of our study is to evaluate objective and subjective vocal outcomes in patients undergoing vagus nerve stimulation (VNS) therapy for drug-resistant epilepsy and to assess the vocal outcome in the known laryngeal dysmotility patterns induced by VNS. We enrolled 16 adult patients without cognitive impairment who had undergone VNS implant for drug-resistant epilepsy at least 1 year prior. They were evaluated by flexible fibreoptic laryngeal examination and Voice Handicap Index questionnaire administration; acoustic and perceptual voice analysis was performed both at rest and during VNS activation. All recruited patients were admitted to the study. The VNS implant systematically determined laryngeal motility alterations, which were in turn mirrored by perceptual, subjective, and/or acoustic analysis voice alterations in all patients. Patients with intact vocal fold function at rest performed worse during acoustic voice analysis in terms of jitter during VNS activation and shimmer at rest when compared to other laryngeal patterns (P= 0.027 and P = 0.034, respectively, Kruskal-Wallis test). Furthermore, VNS activation determined an overall worsening of the perceptual and acoustically analysed voice quality: the grade of hoarseness, instability and breathiness parameters of the GRBASI (grade, roughness, breathiness, asthenia, strain, instability) scale and the jitter, shimmer and noise-to-harmonic ratio of the acoustic analysis worsened significantly during VNS activation (P = 0.001, P = 0.021, P = 0.012, P.001, P = 00.002, P = 0.039, respectively, Wilcoxon test). According to our results, the VNS implant determines a significantly impaired vocal outcome that has a surprisingly mild impact on Voice Handicap Index scores. Such impairment is significantly greater in patients with intact vocal fold function at rest.

OBJECTIVE The goal of this study is to analyze the voice in patients with thyroid pathology through two objective indexes with great diagnostic accuracy. Overall vocal quality was evaluated with the Acoustic Voice Quality Index (AVQI v.03.01) and the breathy voice with the Acoustic Breathiness Index (ABI). DESIGN Observational case-control study. SETTING Hospital Universitario Nuestra Senora de Candelaria. PARTICIPANTS Fifty-eight subjects, 29 controls and 29 thyroidectomy candidates. MAIN OUTCOME MEASURES All participants with thyroid pathology completed the Spanish version of Voice Handicap Index-10. Also, patient complaints relating to possible laryngeal dysfunction were assessed through closed questions. A sustained vowel and three phonetically balanced sentences were recorded for each subject (118 samples). AVQI v.03.01 and ABI were assessed using the Praat program. Two raters perceptually evaluated each voice sample by using the Grade parameter of GRABS scale. RESULTS Acoustic analysis shows that 55.17% of subjects present values above the pathological threshold of the AVQI, and 58.62% above that of the ABI. Results of the Student's test comparisons of the AVQI and ABI values between the control group and the thyroid group show significantly higher values of AVQI (t[56] = -3.85, p

Background: Apolipoprotein E (APOE) genotypes typically increase risk of amyloid-β deposition and onset of clinical Alzheimer’s disease (AD). However, cognitive assessments in APOE transgenic AD mice have resulted in discord. Objective: Analysis of 31 peer-reviewed AD APOE mouse publications (n = 3,045 mice) uncovered aggregate trends between age, APOE genotype, gender, modulatory treatments, and cognition. Methods: T-tests with Bonferroni correction (significance = p

Correction (and over-correction) of asymmetries of the orbital shape and brow position in unilateral coronal craniosynostosis (UCS) is critical to successful fronto-orbital advancement. Here we quantify and three-dimensionally assess fronto-orbital irregularities in UCS patients compared to controls.Twenty-three patients with UCS evaluated at the Children's Hospital of Pittsburgh between 2006 and 2016 were age and gender-matched to controls. Computed tomography scans were reconstructed and evaluated for orbital metrics. A three-dimensional heat map of orbital regions was generated and evaluated for shape differences.Brow protrusion of the orbit ipsilateral to the synostotic suture did not differ significantly from healthy controls. Orbital height was significantly increased while orbital width was decreased on the UCS ipsilateral side compared to the contralateral side and controls. The ipsilateral cornea was overprojected relative to the brow and the infraorbital rim, but similar to controls relative to the lateral rim. The contralateral orbit had increased brow protrusion with decreased orbital height. The cornea was underprojected relative to the brow, but overprojected relative to the lateral orbital rim and similar to controls at the infraorbital rim. Three-dimensional comparison demonstrated significant overprojection of the contralateral brow, with some more mild and inconsistent underprojection of the lateral aspect of the ipsilateral brow.Key orbital and brow differences exist between the affected and unaffected sides in UCS. This study provides quantitative data that further characterize the orbital dysmorphology observed in UCS and identifies unique aspects of the diagnosis that should be taken into consideration during surgical planning.

Callanan, D, Rankin, P, and Fitzpatrick, P. Analysis of the game movement demands of women's interprovincial rugby union. J Strength Cond Res 35(12S): S20-S25, 2021-The purpose of this study was to provide an objective analysis of the game movement demands of women's interprovincial rugby union (RU). Sixty-three (N = 128) interprovincial women RU players wore 10-Hz global positioning systems (PlayerTek by Catapult, Australia) during 12 interprovincial matches (116 individual player data sets). Players were classified according to forwards and backs, and positional subcategory groups: front row second row, back row, half-back, midfield, and back three. The mean total distance covered across the series was 5,696 ± 822 m, at a relative distance of 67.9 ± 6.9 m·min-1, while recording a mean maximal velocity of 6.5 ± 0.7 m·s-1. The backs covered a greater total distance (5,964 ± 807 m; d = 0.65), relative distance (70.1 ± 7.5 m·min-1; d = 0.63), mean maximal velocity (6.9 ± 0.5 m·s-1; d = 1.27), distance walking (1,152 ± 152 m; d = 0.54), jogging (3,120 ± 519 m; d = 0.56), and high-speed running (294 ± 150 m; d = 0.99) than the forwards. The midfield recorded the greatest total distance (6,144 ± 516 m; p = 0.013), with the front row registering the lowest. The half backs documented the greatest relative distance (73.2 ± 8.0 m·min-1; p = 0.005), with the back three reported to cover the greatest distances walking (1,169 ± 178 m; p = 0.001) and at high-speed distances (353 ± 175 m; p = 0.002). The back three also recorded the greatest mean maximal velocity (7.2 ± 0.4 m·s-1; p = 0.000). This is the first study in the Northern hemisphere to report the game movement demands of interprovincial women's RU and the information derived from this study may provide practitioners with normative data to assist coaches with preparation.

The accurate assessment of burn wounds is challenging but crucial for correct diagnosis and following therapy. The most frequent technique to evaluate burn wounds remains the clinical assessment, often subjective depending on the experience of the physician. Hyperspectral imaging (HIS) is intended to improve on this subjective diagnosis by accurate and objective analyses of perfusion parameters. The purpose of this study was to analyze the ability of technical burn depth assessment and to investigate a link between a certain value to burn depth versus the value of healthy skin references. One hundred and eighteen HSI analyses were included in this study between July 2017 and July 2019. We analyzed 74 recordings with dorsal hand burns and 44 recordings of healthy skin on the dorsal hand as control group. HSI recordings’ investigation was performed with special interest to wound center, intermediate zone, and wound margin. The results indicate that a differentiation between burned tissue and healthy skin was feasible and also significant in almost all HSI analysis parameters (P < .05). No significant distinction between superficial and deep partial thickness burns could be determined. However, in the wound center, we recorded smaller values with a more pronounced tissue damage. Our preliminary results demonstrate that HSI can distinguish between normal and burned hands. However, as currently used, HSI could not accurately determine the depth of indeterminate burns.

Background The treatment of facial erythema and subjective symptoms of rosacea patients remains challenging in clinical practice. Cosmeceuticals, care components containing active ingredients such as phytochemicals, play a growing role in treatment plans. However, well-designed studies on their efficacy and limitations are widely missing. Objective A foam and a cream for rosacea patients were assessed based on objective and subjective methodology. The tolerability of skin and eyes was evaluated. Methods A randomized, double-blinded, split-face, and vehicle-controlled trial was conducted. At baseline and after four weeks of product use, dermatological and ophthalmological investigations were performed, employing image analysis of facial erythema, clinical assessments, and questionnaires. Results The patient cohort comprised 33 females with persistent facial erythema due to rosacea. No significant differences were found between the vehicle and the verum. According to the analysis of facial erythema, a "less pronounced" or "much less pronounced" appearance was seen in two thirds of patients comparing V1 to V0. Especially, the dryness of the skin improved by the use of the vehicle and the verum. Adverse subjective skin sensations decreased by 61.3% for the verum side and by 58.6% for the vehicle side. Subjective and objective analysis of ocular manifestation differed, with subjective manifestations reported more frequently, thus highlighting underdiagnosis of ocular rosacea. Conclusions As no clear differences between the verum and the vehicle were found, an optimal skin care regime itself seems to have a superior effect in the relief of facial erythema and foremost of subjective symptoms, rather than certain active ingredients.

Fraud in herbal medicines (HMs), commonplace throughout human history, is significantly related to medicinal effects with sometimes lethal consequences. Major HMs fraud events seem to occur with a certain regularity, such as substitution by counterfeits, adulteration by addition of inferior production-own materials, adulteration by chemical compounds, and adulteration by addition of foreign matter. The assessment of HMs fraud is in urgent demand to guarantee consumer protection against the four fraudulent activities. In this review, three analysis platforms (targeted, non-targeted, and the combination of non-targeted and targeted analysis) were introduced and summarized. Furthermore, the integration of analysis technology and chemometrics method (e.g., class-modeling, discrimination, and regression method) have also been discussed. Each integration shows different applicability depending on their advantages, drawbacks, and some factors, such as the explicit objective analysis or the nature of four types of HMs fraud. In an attempt to better solve four typical HMs fraud, appropriate analytical strategies are advised and illustrated with several typical studies. The article provides a general workflow of analysis methods that have been used for detection of HMs fraud. All analysis technologies and chemometrics methods applied can conduce to excellent reference value for further exploration of analysis methods in HMs fraud.

Aims. Raynaud's phenomenon (RP) is a relatively common disease. There are two distinct forms of RP - primary (PRP), where no other associated diseases are present, and secondary (SRP), where RP is associated with other diseases. It can be challenging to differentiate between RP and other diseases through medical history alone, due to the episodic nature of RP. Objective analysis of anamnestic data was performed in our study using infrared thermography (IRT) and a cold pressor test (CPT). Capillaroscopy was performed to assess morphological changes in the acral circulation. Methods. Patients with a history of cold hands were included in the study. IRT was performed before and after the CPT, and then capillaroscopy was performed. The results (including epidemiologic data) were statistically evaluated. Results. A total of 150 patients were included in the study. Summarisation of the results from the IRT and capillaroscopy determined the final diagnosis - 4.7% acrocyanosis, 10.7% physiologic findings, 31.3% PRP, 29.3% borderline SRP and 24% SRP. The coldest fingers following the CPT were, in most patients, the 2nd and 3rd fingers. The correlation between the presence of connective tissue disease and the diagnosis of borderline SRP and SRP was significant (P=0.0001). Conclusions. Using the combination of the IRT and capillaroscopy in the diagnostic algorithm for RP has its justification. IRT distinguishes healthy patients from patients with RP, and capillaroscopy can then be used to differentiate PRP from SRP. IRT can also detect which fingers are more affected, and then these can direct the focus of capillaroscopy.

Background Male factor infertility (MFI) is a common medical condition which requires high-quality research to guide clinical practice; however, systematic reviews (SRs) and meta-analyses (MAs) often vary in quality, raising concerns regarding the validity of their results. We sought to perform an objective analysis of SRs and MAs in MFI treatment and management and to report on the quality of published literature. Methods A comprehensive search in PubMed/MEDLINE and Embase was used to identify relevant publications. Primary search terms were male infertility, male sterility, and male subfertility. Two authors independently performed searches, screened citations for eligibility, extracted data for analysis, and graded methodological quality using the validated AMSTAR (A Measurement Tool to Assess Systematic Reviews) instrument, a validated tool used in the critical appraisal of SRs/MAs. Results Of 27 publications met inclusion criteria and were included in the analysis. Mean AMSTAR score (± SD) among all publications was 7.4 (1.9) out of 11, reflecting "fair to good" quality. Non-pharmacological medical treatment for MFI was the most commonly assessed intervention (n = 13, 48.1%). No publications met all AMSTAR criteria. While the number of SRs/MAs has increased over time (P = 0.037), the quality of publications has not significantly changed (P = 0.72). SRs/MAs of the Cochrane Library had higher AMSTAR score than non-Cochrane SRs/MAs (8.5 vs 6.3, P = 0.002). Conclusions The methodological quality of SRs/MAs should be assessed to ensure high-quality evidence for clinical practice guidelines in MFI treatment and management. This review highlights a need for increased effort to publish high-quality studies in MFI treatment and management.

Background: This study aims to assess dry eye indices following cataract surgery. Materials and Methods: A single center descriptive and comparative study was performed. A total of 100 eyes of 100 cases fulfilling the inclusion criteria from 1st June 2017 to 30th May 2018 were enrolled. Out of 100 eyes, 50 eyes each went through manual small incision cataract surgery (MSICS) and phacoemulsification respectively. For objective analysis : schirmer 1 test(ST-I), tear breakup Time(TBUT) along with lissamine Green Surface Staining(LGSS) was performed on pre-operative day, 1st, 4th and 12th week respectively. Ocular Surface Disease Index (OSDI) was done for subjective analysis on pre-operative day and at 12th week. Results: The mean age of the patient was 53.66 ± 7.839 years with 34 (68%) being female in a small incision cataract surgery group. In the phacoemulsification group, mean age was 54.72 ± 7.985 years and 32 (64%) were female. On analyzing the objective dry eye indices: ST-I,TBUT and LGSS at 12thweek was 18.80 ± 7.393 mm, 11.30 ± 5.456 seconds and 1.62 ± 1.193 in Small incision cataract surgery group and 27.10 ± 6.326 mm, 16.60 ± 4.699 seconds and 0.38 ± 0.602 in Phacoemulsification group respectively which was statistically significant. (p< 0.001). Conclusion: Regardless of the type of cataract surgery, dry eye disease is unavoidable affecting both tear quality and quantity postoperatively. In our study, phacoemulsification had lesser effect in dry eye indices than small incision cataract surgery.

The purpose was to explore the effects of total-body PET/CT with half-dose 18F-FDG activity on image quality, compared with those of conventional PET/CT with clinical routine full-dose 18F-FDG in lung cancer. Fifty-six primary lung cancer patients who underwent total-body PET/CT on a uEXPLORER scanner with half-dose (1.85 MBq/kg) 18F-FDG activity before treatment were retrospectively studied; among them, 28 patients were confirmed by postoperative pathologic examination and 28 patients by biopsy. After matching with the pathological study results, the other 28 patients with lung cancer who underwent surgery were selected for the full-dose (3.70 MBq/kg) group. Patients in the full-dose group were studied with a conventional uM780 PET/CT scanner. The acquisition time of the half-dose group was 15 min, split into 4-min and 2-min duration groups, which were all referred to as G15, G4 and G2, respectively. The PET/CT scanning speed in the full-dose group was 2 min/bed. Image quality was evaluated by subjective and objective analyses. The subjective analysis method was carried out with a 5-point scale (5-excellent, 1-poor). Objective analysis indicators of PET image quality included the SUVmax, SUVmean and signal-to-noise ratio (SNR) of the liver; the SUVmax and SUVmean of the blood pool; and the SUVmax and tumour-to-background ratio (TBR) of the lesions. G15 served as the reference for G2 and G4 to test lesion detectability. Image quality scores in G2 (4.3 ± 0.7) were significantly higher than those in the full-dose group (3.7 ± 0.6) (p = 0.004). The mean and SD of the image quality scores in G4 and G15 were 4.9 ± 0.2 and 5.0 ± 0.0, respectively. The liver SNR in G2 was significantly higher than that in the full-dose group; the corresponding SNR were 11.7 ± 1.5 and 8.3 ± 1.2 (p

Summary Green space is important for health, yet, objective research on children’s use of green space is sparse. This study aimed to objectively assess children’s use of green space in both public and private settings during their summer leisure time, using wearable cameras. Images from cameras worn by 74 children were analysed for green space use over 4 days. Children spent an average of ∼1/10 h of leisure time in green space in the summer months, were physically active 68%, and with others 85%, of the time. Green spaces are important places for children’s health because they are places they frequent and places where they are physically active and socialize. Wearable cameras provide an effective method for objective assessment of green space use.

OBJECTIVE. Analysis of data on hepatitis C, collected as part of epidemiological surveillance in 2018, compared to previous years. MATERIAL AND METHODS. Analysis of: 1) individual data from surveillance in 2018 2) diagnosis rate from bulletins “Infectious diseases and poisonings in Poland” for the years 2012-2018 and 3) data about deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of the Central Statistical Office. RESULTS. In 2018, there was a decrease in the number of reported hepatitis C cases (3,442 cases) and the diagnosis rate (8.96 per 100,000; taking into account the territorial distribution: from 3.29 per 100,000 in the Podkarpackie voivodeship to 13.69 per 100,00 in the Lubuskie voivodeship). The disproportion of the rates between the sexes returned (in men 9.34 per 100,000 vs. women: 8.61 per 100,000). The disproportion of the diagnosis rate depending on the place of residence was still evident (urban: 10.84 per 100,000 vs. rural: 6.12 per 100,000). There are differences in the values of the diagnosis rates, analyzed in terms of gender, age groups and the place of residence. Based on the EU definition, 14 acute hepatitis C were reported, while according to the PL definition, 88 cases (0.4% and 2.6% of all reported cases, respectively). HCV infections due to medical procedures are still the main route of transmission, also in cases of acute hepatitis C - which indicates the current route of transmission. According to the Demographic Surveys and Labour Market Department of the Central Statistical Office, 119 deaths related to hepatitis C were reported. CONCLUSIONS. For years, the general picture of hepatitis C in Poland, observed through epidemiological surveillance, is determined by the availability of testing for HCV infections. The analysis identified subpopulations in which primary prevention activities (e.g. safer medical procedures, intensifying activities in the area of harm reduction for people who inject drugs) as well as secondary prevention (access to testing and quick inclusion in treatment) should be particularly strengthened. According to the micro-elimination strategy, the improvement of testing in particularly affected groups, including marginalized populations, is necessary to achieve the WHO goal of eliminating HCV by 2030.

Introduction: This study aims to analyze possible preoperative factors taken from the medical history that may assist the otolaryngologist in counseling an adult patient before cochlear implantation (CI). Objective: Analysis of preoperative factors taken during the initial patient presentation for a possible prognostic role in the auditory rehabilitation outcome. Methods: A cohort of 232 (272 CI implantations) postlingually deafened adults was evaluated in this study. Hearing results at 1, 2, and up to 3 years postoperatively were compared with various preoperative factors: living status, cause of deafness, gender, side of implantation, residual hearing, and duration of deafness. Postoperative hearing performance was measured based on the German Freiburg monosyllabic word test and the Oldenburg sentence test. Results: Duration of deafness showed a negative correlation to word recognition and a positive correlation to increased speech reception threshold in sentence testing. A significant decline in hearing outcome was shown starting around the second decade of deafness. Residual hearing as defined in our cohort and side of implantation showed limited benefit in speech understanding. Living status, gender, and cause of deafness did not show any prognostic value. Conclusion: In this retrospective review it could be shown that simple case history information can only provide limited prognostic insight before CI. The duration of deafness is the most reliable anamnestic factor present on initial patient evaluation.

The current state of computer vision methods applied to autism spectrum disorder (ASD) research has not been well established. Increasing evidence suggests that computer vision techniques have a strong impact on autism research. The primary objective of this systematic review is to examine how computer vision analysis has been useful in ASD diagnosis, therapy and autism research in general. A systematic review of publications indexed on PubMed, IEEE Xplore and ACM Digital Library was conducted from 2009 to 2019. Search terms included [‘autis*’ AND (‘computer vision’ OR ‘behavio* imaging’ OR ‘behavio* analysis’ OR ‘affective computing’)]. Results are reported according to PRISMA statement. A total of 94 studies are included in the analysis. Eligible papers are categorised based on the potential biological/behavioural markers quantified in each study. Then, different computer vision approaches that were employed in the included papers are described. Different publicly available datasets are also reviewed in order to rapidly familiarise researchers with datasets applicable to their field and to accelerate both new behavioural and technological work on autism research. Finally, future research directions are outlined. The findings in this review suggest that computer vision analysis is useful for the quantification of behavioural/biological markers which can further lead to a more objective analysis in autism research.

Loop-mediated isothermal amplification (LAMP) as a diagnostic tool is rapidly gaining recognition and maturity. Among various advantages over traditional polymerase chain reaction, the ability to visually detect amplification by the incorporation of colorimetric indicators is one of its most unique features. There is an overwhelming variety of LAMP indicators in the literature, yet a comprehensive comparative study is lacking. This study evaluates the use of hydroxynaphthol blue, phenol red, calcein, leuco crystal violet, malachite green, and a fluorescent dye for visual detection. A method for objective quantitative analysis using ImageJ is described that is readily implemented in standard and microfluidic workflows. The work here also includes the largest inter-reader variability study involving 24 participants to evaluate these indicators. We found inaccuracies in visual assessment as bias and/or individual-based perception can exist, solidifying the need for objective analysis. There was not a "universal" indicator, although considerations in sample preparation, storage, and applicability are discussed in length.

To evaluate artifact reduction by virtual monoenergetic images (VMI) and metal artifact reduction algorithms (MAR) as well as the combination of both approaches (VMIMAR) compared to conventional CT images (CI) as standard of reference. In this retrospective study, 35 patients were included who underwent spectral-detector CT (SDCT) with additional MAR-reconstructions due to artifacts from coils or clips. CI, VMI, MAR and VMIMAR (range: 100–200 keV, 10 keV-increment) were reconstructed. Region-of-interest based objective analysis was performed by assessing mean and standard deviation of attenuation (HU) in hypo- and hyperdense artifacts from coils and clips. Visually, extent of artifact reduction and diagnostic assessment were rated. Compared to CI, VMI ≥ 100 keV, MAR and VMIMAR between 100–200 keV increased attenuation in hypoattenuating artifacts (CI/VMI200keV/MAR/VMIMAR200keV, HU: −77.6 ± 81.1/−65.1 ± 103.2/−36.9 ± 27.7/−21.1 ± 26.7) and decreased attenuation in hyperattenuating artifacts (HU: 47.4 ± 32.3/42.1 ± 50.2/29.5 ± 18.9/20.8 ± 25.8). However, differences were only significant for MAR in hypodense and VMIMAR in hypo- and hyperdense artifacts (p ≥140/100keV, MAR and VMIMAR≥100keV. Diagnostic assessment of surrounding brain tissue was significantly improved in VMI≥100keV, MAR and VMIMAR≥100keV. The combination of VMI and MAR facilitates a significant reduction of artifacts adjacent to intracranial coils and clips. Hence, if available, these techniques should be combined for optimal reduction of artifacts following intracranial aneurysm treatment.

INTRODUCTION Several different whole-body physiology simulation tools (PST) using modeling techniques are now available with potential use for healthcare simulation, but these novel technologies lack objective analysis from an independent organization. METHODS We identified BioGears, HumMod, and Muse as 3 PSTs that met our requirements for testing. We ran mild, moderate, and severe hemorrhage scenarios on each PST and collected outputs for comparison with each other and published human physiology data. RESULTS All PSTs tested followed the expected tachycardic and hypotensive response to hemorrhage for all levels of severity with variable qualitative patterns. Complete data for analysis were not available in all PSTs for urine output, stroke volume, blood volume, hemoglobin, and serum epinephrine concentration, but the partial findings are discussed in detail. We determined the predicted time to reach hemorrhage shock based on the hemorrhage guidelines and compared this with time to cardiovascular collapse from each PST. Overall, the differences from known human physiology were much larger than expected before testing and trends show HumMod with the smallest difference for severe (-6.25%) and moderate (-1.42%) and Muse with the smallest difference for mild hemorrhage (27.9%). BioGears demonstrated the largest differences in all classifications of severity. CONCLUSIONS Our analysis of currently available whole-body PSTs provides insight into the novel, evolving field. We hope our efforts shed light to a wider audience to the exciting developments and uses of mathematical modeling for whole-body simulation and the potential for integration into healthcare simulation for medical education.

Background: Impairment in voice and swallowing functions are common after thyroidectomy. We aimed to evaluate the objective functional voice and swallowing outcomes in a series of patients undergoing thyroidectomy. Methods: A total of 43 consenting patients who underwent thyroidectomy were prospectively recruited. Subjective evaluation of swallowing was assessed with 'Swallowing Impairment Score' and 'MD Anderson Dysphagia Inventory'. Fiberoptic endoscopic evaluation of swallowing (FEES) was applied for objective evaluation. Also, functional oral intake scale (FOIS) and functional outcome swallowing scale (FOSS) were used for swallowing assessment. Voice evaluation was assessed with videostrobolaryngoscopy (VSL) and 'The Multi-Dimensional Voice Program (MDVP)' was used for capturing and analyzing the voice samples. All evaluations were performed preoperatively and on 1st day, 2nd week and 6th months postoperatively. This study is registered with ClinicalTrials.gov, number NCT03436186. Results: According to the objective analyses there was no difference between pre- and postoperative scores for the intake of fluid and thickened liquid food. There was a significant difference regarding light and moderate residual accumulation in solid food intake (p = 0. 013). FOSS showed no difference, but FOIS revealed specific functional limitation (p = 0. 034). Subjective data showed no correlation with objective findings (p > 0.05). Regarding voice evaluation, a significant increase was observed in standard deviation of average fundamental frequency and degree of subharmonics (p < 0.01). Conclusion: Even in the absence of recurrent laryngeal nerve injury, subjective and objective swallowing and voice alterations do occur after thyroidectomy. (C) 2019 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V., European Soc Endocrine Surg

Introduction Accurately confirming surgical trainees have met the requirements of entrusted professional activities (EPAs) will require rigorous staff input. We pondered whether such simulation-driven evaluations might prove useful to the current ABS/APDS pilot effort on EPA analysis. Methods Our surgical trainees participate biannually in a 59-min simulation-based assessment (X-Games) which covers surgical technique, knowledge and critical thinking in a host of domains. The content and difficulty of the stations differed between the PGY levels. Only 4 EPA topics (inguinal hernia repair, appendectomy, cholecystectomy, and trauma resuscitation) were tabulated for this study. Results 16-PGY-2s, 8-PGY-3s, 10-PGY-4s, and 10-PGY-5s surgical residents completed the X-Games. Performance within and between PGY levels was variable. The mean(SD) EPA scores for all PGY levels are listed in Table- 1. Conclusion Analysis gleaned from a 59-min OSCE in a simulated-setting offers objective data that appears to have construct-validity. Refining our Surgical X-Games to cater to the specific EPA scoring system may better allow objective analysis of when trainees cross the threshold from “can do with some help” to “can do autonomously”.

Background Pressure ulcers (PUs) are injuries resulting from ischemia caused by prolonged compression or shear forces on the skin, adjacent tissues, and bones. Advanced stages of PUs are associated with infectious complications and constitute a major clinical challenge, with high social and economic impacts in health care. Goals This study aims to identify and describe the relationship between PUs risk factors, stages, and anatomical locations, and the relevance of microbial cohabitation and biofilm growth. Methods The narrative review method to advocating a critical and objective analysis of the current knowledge on the topic was performed. Indexed databases and direct consultation to specialized and high-impact journals on the subject were used to extract relevant information, guided by co-authors. The Medical Subject Heading of pressure ulcer (or injury), biofilms, infection, and other analogues terms were used. Results Development of PUs and consequent infection depend on several direct and indirect risk factors, including cutaneous/PUs microbiome, microclimate, and behavioral factors. Infected PUs are polymicrobial and characterized by biofilm-associated infection, phenotypic hypervariability of species, and inherent resistance to antimicrobials. The different stages and anatomical locations also play an important role in their colonization. The prevention and monitoring of PUs remain crucial for avoiding the emergence of systemic infections and reducing healthcare-associated costs, improve the quality of life of patients, and reduce de mortality-associated infected PUs., The authors acknowledge the financial support of the project 4NoPressure, reference n. POCI-01- 0247-FEDER-039869, co-funded by the Operational Programme for Competitiveness and Internationalisation (COMPETE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF)., info:eu-repo/semantics/publishedVersion

PURPOSE OF REVIEW A continent vesicostomy represents a useful alternative for adult patients with impaired bladder emptying who are unable to perform clean intermittent (self-) catheterization through the urethra. In a pediatric setting, there exists a vast experience in these procedures. But experience with continent catheterizable vesicostomies is less abundant in adult patients. We want to give an overview and discuss recent literature about catheterizable conduits in the adult population. RECENT FINDINGS Adult patients who undergo continent vesicostomy comprise a diverse cohort. Because of this very heterogeneous population, it can be difficult to make an objective analysis and draw conclusions on both the success rate and complication rate of these diversions. We will discuss short- and long-term surgical outcomes and changes in quality of life after the procedure in these patients. SUMMARY A continent vesicostomy is a valuable and durable reconstructive technique for adult patients with impaired bladder emptying. Surgery can be challenging and a better knowledge of complications can help with patient counseling. In the future we hope that minimally invasive surgery will decrease the morbidity of such surgery and hopefully also improve functional outcomes and diminish the complication rate.

Was there quality in the Chinese epidemiological surveillance system during the COVID-19 pandemic? Using data of World Health Organization’s situation reports (until situation report 55), an objective analysis was realized to answer this important question. Fulfillment of Benford’s law (first digit law) is a rapid tool to suggest good data quality. Results suggest that China had an acceptable quality in its epidemiological surveillance system. Furthermore, more detailed and complete analyses could complement the evaluation of the Chinese surveillance system.

Background: It is anticipated that the combined treatments of ablative laser and human stem cell-conditioned media produce the synergistic effects. Objectives: To investigated the effects of human stem cell-conditioned media (HSCM) as a post-procedural agent after fractional CO2 laser procedure in patients with atrophic acne scars and skin pores. Method: Both cheeks of 15 subjects were treated with a fractional CO2 laser. HSCM was randomly applied to one of the resurfacing sites (T) and normal saline was applied to the other site as a control (C). During the next six days, a solution containing 80% HSCM and hyaluronic acid (HA) was applied on the treated side (T) and HA alone was applied to the control side (C). Scar volume and erythema were objectively evaluated using an Antera 3D® CS. Result: After two months, the scar volume was reduced by 23.5% (T) versus 15.0% (C) (p = .143) and the volume of the skin pores was reduced by 37.6% (T) versus 15.9% (C) (p = .006), while the erythema was increased by 2.8% (T) versus 3.1% (C) (p = .934). Atrophic scar and the skin pores in the HSCM-applied area improved by at least 15.0% after a single treatment session, suggesting better results compared with the control side. Conclusion: HSCM may augment the regenerative effects of fractional CO2 laser.

OBJECTIVES: Auditory brainstem responses (ABRs) are commonly generated using simple, transient stimuli (e.g., clicks or tone bursts). While resulting waveforms are undeniably valuable clinical tools, they are unlikely to be representative of responses to more complex, behaviorally relevant sounds such as speech. There has been interest in the use of more complex stimuli to elicit the ABR, with considerable work focusing on the use of synthetically generated consonant-vowel (CV) stimuli. Such responses may be sensitive to a range of clinical conditions and to the effects of auditory training. Several ABR features have been documented in response to CV stimuli; however, an important issue is how robust such features are. In the current research, we use time- and frequency-domain objective measures of quality to compare the reliability of Wave V of the click-evoked ABR to that of waves elicited by the CV stimulus /da/.DESIGN: Stimuli were presented to 16 subjects at 70 dB nHL in quiet for 6000 epochs. The presence and quality of response features across subjects were examined using Fsp and a Bootstrap analysis method, which was used to assign p values to ABR features for individual recordings in both time and frequency domains.RESULTS: All consistent peaks identified within the /da/-evoked response had significantly lower amplitude than Wave V of the ABR. The morphology of speech-evoked waveforms varied across subjects. Mean Fsp values for several waves of the speech-evoked ABR were below 3, suggesting low quality. The most robust response to the /da/ stimulus appeared to be an offset response. Only click-evoked Wave V showed 100% wave presence. Responses to the /da/ stimulus showed lower wave detectability. Frequency-domain analysis showed stronger and more consistent activity evoked by clicks than by /da/. Only the click ABR had consistent time-frequency domain features across all subjects.CONCLUSIONS: Based on the objective analysis used within this investigation, it appears that the quality of speech-evoked ABR is generally less than that of click-evoked responses, although the quality of responses may be improved by increasing the number of epochs or the stimulation level. This may have implications for the clinical use of speech-evoked ABR.

Ethnopharmacological relevance Different orchids are important in traditional medicine, and species belonging to the genus Bletilla are important. Bletilla species have been used for thousands of years in Traditional Chinese Medicine (TCM) for the treatment of several health disorders, such as gastrointestinal disorders, peptic ulcer, lung disorders, and traumatic bleeding etc. Aim of this review This review aims to provide a systematic overview and objective analysis of Bletilla species and to find the probable relationship between their traditional use, chemical constituents, and pharmacological activities, while assessing their therapeutic potential in treatment of different human diseases. Materials and methods Relevant literatures on Bletilla species have been collected using the keywords “Bletilla”, “phytochemistry”, and “pharmacology” in scientific databases, such as “PubMed”, “Scifinder”, “The Plant List”, “Elsevier”, “China Knowledge Resource Integrated databases (CNKI)”, “Google Scholar”, “Baidu Scholar”, and other literature sources, etc. Results This review indicates the isolation and identification of over 261 compounds from this genus, till December 2020. These chemical isolates belong to the stilbenes (bibenzyls and phenanthrenes), flavonoids, triterpenoids, steroids, simple phenolics, and glucosyloxybenzyl 2-isobutylmalates classes of compounds. These compounds have been reported to be characteristically distributed in Bletilla striata (Thunb.) Rchb. f. (BS), Bletilla ochracea Schltr. (BO), and Bletilla formosana (Hayata) Schltr. (BF). The crude extracts and pure compounds derived from the three Bletilla species have reportedly exhibited a wide spectrum of in vitro and in vivo pharmacological effects, such as hemostatic, anti-inflammatory, anti-tumor, and anti-microbial activities. As a Traditional Chinese Medicine (TCM), Bletilla species or preparations containing Bletilla species have been used for the treatment of epistaxis, gastrointestinal bleeding, cough and hemoptysis, gastric and duodenal ulcer, and traumatic injuries. Thus, Bletilla species have proven potential both in traditional uses and scientific studies. Conclusions Pharmacological studies have validated the use of Bletilla species in the traditional medicine, especially hemorrhagic diseases. Polysaccharides and stilbenes are the major bioactive chemical constituents of Bletilla genus according to the literatures. However, the mechanism of action of these molecules is yet to be studied. In addition, a detailed comparative analysis of the phytochemistry and biological activities of the three Bletilla species (BS, BO and BF) is highly recommended for understanding their ethnopharmacological uses and applications in clinics. Clinical toxicity tests on BS have been found to be negative, but it can't be used with Aconitum carmichaeli in traditional uses. Furthermore, not many reports are present in the literature regarding the conservation of Bletilla species.

BACKGROUND Various approaches have been used to evaluate callus stiffness in distraction osteogenesis. This assessment becomes even more critical as inadequate corticalization and premature removal of the frame lead to bending, refracture, and loss of length. This study aimed to verify the objective Pixel Value Ratio (PVR) and define an evaluation scheme to assess callus tissue development during internal and external bone lengthening. HYPOTHESIS There are no differences between subjective parameters and objective evaluation for external and internal bone lengthening. PATIENTS AND METHODS We included 24 patients in this retrospective study, treated by distraction osteogenesis of the lower limb. Ten patients were treated with external ring fixators and 14 with intramedullary lengthening devices. The minimum distraction distance was 3cm. Callus tissue was evaluated with the PVR, using digital X-rays during and after treatment. We combined this method with subjective evaluation parameters, including the continuity, signal intensity, and the regeneration tissue's homogeneity, presented in the X-ray Evaluation System for Distraction Osteogenesis (XESDO). RESULTS The subjective evaluation showed an increase of continuity and signal-intensity between 4th postoperative weeks and complete healing with significant differences between the external and internal groups for homogeneity only after four weeks and for all parameters at 3C (p

At the end of last century a prominent biochemist once opened the discussion of a controversial issue in the field of Bioenergetics with the following statement: “This is a long story, that shouldn’t be long, but it will take a long time to make it short”. As it happens, such a statement would apply perfectly well to the story of chloroquine (CQ) and hydroxychloroquine (HCQ) in the COVID-19 infection: it has become a veritable saga, with conflicting views that have often gone beyond the normal scientific dialectic, and with conclusions that have frequently been polluted by non scientific opinions: thus, for instance, when National Agencies have taken positions against CQ and HCQ, the move has been seen as a pro-vaccine attempt to block low cost therapy means. And it is difficult to avoid the feeling that the opposition to CQ and HCQ has in large measure been shaped not by scientific arguments, but by the fact that their use has been strongly endorsed by National leaders whose popularity among Western intellectuals is extremely low. The role of the two drugs in the COVID-19 infection thus deserves an objective analysis solely based on scientific facts. This contribution will attempt to produce it.

PURPOSE: Quantitative assessment of prospective motion correction (PMC) capability at 7T MRI for compliant healthy subjects to improve high-resolution images in the absence of intentional motion. METHODS: Twenty-one healthy subjects were imaged at 7 T. They were asked not to move, to consider only unintentional motion. An in-bore optical tracking system was used to monitor head motion and consequently update the imaging volume. For all subjects, high-resolution T1 (3D-MPRAGE), T2 (2D turbo spin echo), proton density (2D turbo spin echo), and T∗2 (2D gradient echo) weighted images were acquired with and without PMC. The images were evaluated through subjective and objective analysis. RESULTS: Subjective evaluation overall has shown a statistically significant improvement (5.5%) in terms of image quality with PMC ON. In a separate evaluation of every contrast, three of the four contrasts (T1 , T2 , and proton density) have shown a statistically significant improvement (9.62%, 9.85%, and 9.26%), whereas the fourth one ( T∗2) has shown improvement, although not statistically significant. In the evaluation with objective metrics, average edge strength has shown an overall improvement of 6% with PMC ON, which was statistically significant; and gradient entropy has shown an overall improvement of 2%, which did not reach statistical significance. CONCLUSION: Based on subjective assessment, PMC improved image quality in high-resolution images of healthy compliant subjects in the absence of intentional motion for all contrasts except T∗2, in which no significant differences were observed. Quantitative metrics showed an overall trend for an improvement with PMC, but not all differences were significant.

Background To determine if late phase is superior to arterial phase intraindividually regarding conspicuity of MPM in contrast enhanced chest MDCT. Methods 28 patients with MPM were included in this retrospective study. For all patients, chest CT in standard arterial phase (scan delay ca. 35 s) and abdominal CT in portal venous phase (scan delay ca. 70 s) was performed. First, subjective analysis of tumor conspicuity was done independently by two radiologists. Second, objective analysis was done by measuring Hounsfield units (HU) in tumor lesions and in the surrounding tissue in identical locations in both phases. Differences of absolute HUs in tumor lesions between phases and differences of contrast (HU in lesion – HU in surrounding tissue) between phases were determined. HU measurements were compared using paired t-test for related samples. Potential confounding effects by different technical and epidemiological parameters between phases were evaluated performing a multiple regression analysis. Results Subjective analysis: In all 28 patients and for both readers conspicuity of MPM was better on late phase compared to arterial phase. Objective analysis: MPM showed a significantly higher absolute HU in late phase (75.4 vs 56.7 HU, p p Conclusions In contrast enhanced chest-MDCT for MPM late phase scanning seems to provide better conspicuity and higher contrast to surrounding tissue compared to standard arterial phase scans.

Snacking is a common eating behaviour, but there is little objective data about children&rsquo, s snacking. We aimed to determine the frequency and context of children&rsquo, s snacking (n = 158, mean age = 12.6 years) by ethnicity, gender, socioeconomic deprivation and body mass index (BMI) children. Participants wore wearable cameras that passively captured images of their surroundings every seven seconds. Images (n = 739,162) were coded for snacking episodes, defined as eating occasions in between main meals. Contextual factors analysed included: snacking location, food source, timing, social contact and screen use. Rates of total, discretionary (not recommended for consumption) and healthful (recommended for consumption) snacking were calculated using negative binomial regression. On average, children consumed 8.2 (95%CI 7.4, 9.1) snacks per day, of which 5.2 (95%CI 4.6, 5.9) were discretionary foods/beverages. Children consumed more discretionary snacks than healthful snacks in each setting and at all times, including 15.0&times, more discretionary snacks in public spaces and 2.4&times, more discretionary snacks in schools. Most snacks (68.9%) were sourced from home. Girls consumed more total, discretionary and healthful snacks than boys, and Māori and Pacific consumed fewer healthful snacks than New Zealand (NZ) Europeans. Results show that children snack frequently, and that most snacking involves discretionary food items. Our findings suggest targeting home buying behaviour and environmental changes to support healthy snacking choices.

Analysis of national and foreign trials investigating accumulation of experience in innovative technologies using the learning curves.Earching for Russian-language manuscripts was carried out within the references of the articles and in the ELIBRARY database. Foreign trials were selected from the PubMed database according to the keywords «learning curves in surgical practice». The discovered publications were studied for accordance with the objectives of this study.Accumulation of experience in new technologies by using of learning curves is valuable to improve the training, determine duration of development of new technology and the factors affecting its characteristics.The method is high-quality for comprehensive analysis of experience accumulation in new surgical technologies.Одним из основных методов изучения опыта при освоении новых технологий является анализ кривых обучения, построенных по моделям различных математических функций. Этот метод исследования открывает широкие возможности для характеристики процесса приобретения опыта.Обзор исследований, изучающих опыт освоения инновационных технологий с помощью кривой обучения, в стране и за рубежом.Анализ публикаций. Поиск русскоязычных источников осуществлен в библиографиях статей, в поисковой системе E LIBRERY, иностранных — по словам «Learning curves in surgical practice» в базе данных PubMed.Изучение опыта освоения новых технологий методом построения кривых обучения позволяет совершенствовать обучение специальности, определить продолжительность периода освоения новой технологии и факторы, влияющие на его характеристики.Метод обладает высокой возможностью всестороннего изучения процесса накопления опыта при освоении новых технологий в хирургии.

The term Attention Deficit Hyperactivity Disorder (ADHD) has a long history of problems behind it. The origin of all these problems lies in the lack of agreement in the assessment procedures and evaluation instruments. The diagnosis is clinical and is determined by the observation and information provided by parents and teachers. So, this is highly subjective and leads to disparate results. Therefore, on the one hand the inaccuracy of the diagnosis of ADHD, which has been based on subjective criteria, together with the fact that hyperactivity is one of the main symptoms of this disorder, implies that several studies (with limitations) have been carried out to record objective measures of movement in subjects in at least the last ten years. In order to solve some of this derived problems and limitations of previous studies, a computer program has been developed to objectively record the amount of movement of subjects. The main objective of this study is threefold: first to register the amount of movement of both experimental group and control group, then to compare them with the movement registered by observers and finally to determine the validity of the software developed as a tool to support the diagnosis of ADHD. Results show that there are significant differences in the amount of objective movement between a clinical group of subjects with ADHD and a control group, obtaining a higher average of movement the experimental group. In addition, results also demonstrate that the developed software is a valid tool for the evaluation of movement that solves the limitations of previous studies. The proposed tool is developed from different aspects to give it a multidisciplinary character. This work has been supported by the Ministerio de Ciencia, Innovación y Universidades (Spain), project RTI2018-096219-B-I00. Project cofinanced with FEDER funds.

To identify the problematic issues of assessing the hygienic state of the oral cavity and the clinical development of possible algorithms for their solution using our modified, highly sensitive (up to 150 CFU/ml versus 5·10In a clinical study on 20 patients of working age, it was shown that the authors modified fluorescence spectroscopy method allows each patient to individually perform a comprehensive digital express indication and objective analysis of the oral hygiene state based on express registration and analysis of the entire aggregate of aerobic-anaerobic microflora of various oral biotopes (biotope teeth, lips, gums, cheeks, palate, tongue and saliva) online.Integral indicators of the hygienic state of the oral cavity in individuals with satisfactory oral hygiene before and after brushing have been obtained, which describe the hygienic state of both the oral cavity as a whole and individual biotope in their relationship.The results made it possible to substantiate a more objective quantitative methodology for assessing the hygienic state of the oral cavity for the implementation of its individually substantiated clinical use with the identification of the biotope (biotopes) of the mouth, which is the main source of its pollution.Обозначение проблемных вопросов оценки гигиенического состояния полости рта и клиническая проработка возможных алгоритмов их решения с использованием модифицированного нами, высокочувствительного (до 150 КОЕ/мл против 5·10В клиническом исследовании с участием 20 пациентов трудоспособного возраста показано, что модифицированный авторами метод флюоресцентной спектроскопии позволяет проводить индивидуально каждому пациенту комплексную цифровую экспресс-индикацию и объективный анализ гигиенического состояния полости рта на основе экспресс-регистрации и анализа всей совокупности аэробно-анаэробной микрофлоры различных биотопов полости рта (биотоп зубов, губ, десен, щек, неба, языка и слюны) в режиме онлайн.Получены интегральные показатели гигиенического состояния полости рта у лиц с удовлетворительной гигиеной полости рта до и после чистки зубов, описывающие гигиеническое состояние как полости рта в целом, так и отдельно взятых биотопов в их взаимосвязи.Полученные результаты позволили обосновать более объективную количественную методику оценки гигиенического состояния полости рта для реализации индивидуально обоснованного ее клинического применения с выявлением биотопа (биотопов) рта, который является основным источником ее загрязнения.

Increasing rates of childhood obesity worldwide has focused attention on the obesogenic food environment. This paper reports an analysis of children&rsquo, s interactions with food in convenience stores. Kids&rsquo, Cam was a cross-sectional study conducted from July 2014 to June 2015 in New Zealand in which 168 randomly selected children aged 11&ndash, 14 years old wore a wearable camera for a 4&ndash, day period. In this ancillary study, images from children who visited a convenience store were manually coded for food and drink availability. Twenty-two percent of children (n = 37) visited convenience stores on 62 occasions during the 4-day data collection period. Noncore items dominated the food and drinks available to children at a rate of 8.3 to 1 (means were 300 noncore and 36 core, respectively). The food and drinks marketed in-store were overwhelmingly noncore and promoted using accessible placement, price offers, product packaging, and signage. Most of the 70 items purchased by children were noncore foods or drinks (94.6%), and all of the purchased food or drink subsequently consumed was noncore. This research highlights convenience stores as a key source of unhealthy food and drink for children, and policies are needed to reduce the role of convenience stores in the obesogenic food environment.

Analysis of comorbid pathology based on the use of methods for its quantitative assessment in personswho were exposed to radiation because of the Chornobyl accident.Comorbid pathology was studied in 608 men, including 420 clean-up workers (CW) of theaccident consequences at the Chornobyl NPP (main group) and 188 non-irradiated persons (control group - CG). Allpatients had cardiovascular diseases as their main pathology and were examined in the cardiology department ofthe NRCRM hospital during 2011-2019. The groups did not differ by age, either at the beginning of the accident orat the time of their last examination. Patients of both groups before the accident were practically healthy peopleand were not registered at the dispensary. The Cumulative Illness Rating Scale (CIRS) was used to quantify comorbid pathology.Comorbid pathology was detected in 418 CW (99.5 %) and 183 patients of CG (99.3 %). The total score inCW (10.3 ± 2.9) units significantly (р = 0.000) exceeded the same index in non-irradiated patients (8.8 ± 3.0) units,as well as the mean number of CIRS categories, whose level severity was 1 point (3.3 ± 1.7 vs. 2.6 ± 1.5, р = 0.000),2 points (1.8 ± 1.0 vs. 1.6 ± 1.0, p = 0.032) and 3-4 points (1.2 ± 0.8 vs. 1.0 ± 0.9, р = 0.062). In contrast, the meanvalue of the categories with zero score, i.e. without diseases, was more common in CG (7.8 ± 1.8 vs. 8.8 ± 1.7,р = 0.000). The most common pathology in CW and CG were heart (98.3 % vs. 94.7 %, р0.05) and vascular diseases(92.9 % vs. 87.8 %, р0.05), followed by diseases of nervous system (79.0 % vs. 57.4 %, р0.001), musculoskeletal system and skin (69.8 % vs. 56.9 %, р0.01), endocrine (56.0 % vs. 49,5 %, р0.05) and the respiratory system (53.8 % vs. 53.7 %, р0.05) and liver (51.2 % vs. 36.2 %, р0.001), which were detected more than in halfpatients of the main group. Diseases of the kidneys (3.3 % vs. 4.8 %, р0.05) and lower gastrointestinal tract(3.3 % vs. 0.5 %, р0.01) were quite rare. The incidence of the other four CIRS categories was 18.6-34 %. The totalscore in subgroups with different ages varied in descending order of mean values as follows: CW65 years (10.5 ± 2.9)units, CW65 years (9.9 ± 2.8) units, CG65 years (9.5 ± 2.8) units and CG65 years (7.8 ± 2.9) units with significant differences both between age subgroups in each of the groups and between CW and CG older subgroups.Quantitative assessment of comorbidity by CIRS showed that in persons irradiated during their emergency work due to the Chornobyl accident, the incidence of combined pathology of such organ systems as cardiovascular, nervous, endocrine, hematopoietic, urogenital, musculoskeletal, gastrointestinal, liver and kidneys wassignificantly higher than in non-irradiated patients. In irradiated patients, the course of comorbid pathology wasmore severe for each system and in general, reflecting higher values of the total CIRS score. Both among CW andnon-irradiated controls, higher values of the total comorbidity score were observed in patients 65 years and older,compared with younger individuals. In both age subgroups of CW the total score was higher than in patients of thecontrol group.Meta: provedennia analizu komorbidnoï patologiï na osnovi vykorystannia metodiv ïï kil'kisnoï otsinky v osib, iakizaznaly radiatsiĭnogo vplyvu vnaslidok avariï na Chornobyl's'kiĭ AES.Materialy ta metody. Doslidzhennia komorbidnoï patologiï provodyly u 608 cholovikiv, iz nykh 420 uchasnykylikvidatsiï naslidkiv avariï (ULNA) na Chornobyl's'kiĭ AES (osnovna grupa) i 188 neoprominenykh osib – kontrol'na grupa (KG). Vsi patsiienty prokhodyly obstezhennia v kardiologichnomu viddilenni kliniky NNTsRM vprodovzh2011–2019 rr. z pryvodu sertsevo-sudynnykh zakhvoriuvan', iaki buly osnovnoiu patologiieiu. Grupy ne rozriznialys'za vikom, iak na pochatok avariï, tak i na moment ostann'ogo obstezhennia. Patsiienty obokh grup do avariï buly praktychno zdorovymy liud'my ta ne perebuvaly na dyspansernomu obliku. Dlia kil'kisnogo analizu komorbidnoï patologiï vykorystovuvaly shkalu otsinky sukupnoï zakhvoriuvanosti (Cumulative Illness Rating Scale – CIRS).Rezul'taty. Komorbidna patologiia vyiavlena u 418 ULNA (99,5 %) i 183 khvorykh KG (99,3 %). Zagal'na suma balivv ULNA (10,3 ± 2,9) od. dostovirno (r = 0,000) perevyshchuvala analogichnyĭ pokaznyk u neoprominenykh patsiientiv(8,8 ± 3,0) od., a takozh i serednie chyslo system CIRS, tiazhkist' patologichnykh staniv iakykh stanovyla 1 bal (3,3 ± 1,7 proty 2,6 ± 1,5, r = 0,000), 2 baly (1,8 ± 1,0 proty 1,6 ± 1,0, r = 0,032) ta 3–4 baly (1,2 ± 0,8 proty 1,0 ± 0,9, r = 0,062).Navpaky, serednie znachennia system z nul'ovym balom, tobto bez zakhvoriuvan', chastishe zustrichalosia v KG (7,8 ± 1,8proty 8,8 ± 1,7, r = 0,000). Naĭbil'sh poshyrenoiu patologiieiu v ULNA i KG buly khvoroby sertsia (98,3 % proty94,7 %, r0,05) ta sudyn (92,9 % proty 87,8 %, r0,05), potim ĭshly zakhvoriuvannia nervovoï systemy (79,0 %proty 57,4 %, r0,001), oporno-rukhovogo aparatu ta shkiry (69,8 % proty 56,9 %, r0,01), endokrynnoï (56,0 %proty 49,5 %, r0,05) i dykhal'noï system (53,8 % proty 53,7 %, r0,05) ta pechinky (51,2 % proty 36,2 %,r0,001), iaki vyiavleni bil'sh nizh u polovyny patsiientiv osnovnoï grupy. Dosyt' ridko zustrichalys' zakhvoriuvannia nyrok (3,3 % proty 4,8 %, r0,05) i nyzhnikh viddiliv shlunkovo-kyshkovogo traktu (3,3 % proty 0,5 %, r0,01).Chastota zustrichal'nosti zakhvoriuvan' inshykh chotyr'okh system CIRS stanovyla 18,6–34 %. Zagal'na bal'na otsinkav pidgrupakh riznogo viku zminiuvalas' v poriadku zmenshennia serednikh znachen' nastupnym chynom: ULNA65 rokiv –(10,5 ± 2,9) od., ULNA65 rokiv – (9,9 ± 2,8) od., KG65 rokiv – (9,5 ± 2,8) od. i KG65 rokiv – (7,8 ± 2,9) od.pry vysokiĭ dostovirnosti vidminnosteĭ iak mizh vikovymy pidgrupamy v kozhniĭ z grup, tak i mizh bil'sh starshoiupidgrupoiu sered ULNA i KG.Vysnovky. Kil'kisna otsinka komorbidnosti za shkaloiu CIRS pokazala, shcho v osib, oprominenykh pid chas robit polikvidatsiï naslidkiv Chornobyl's'koï avariï, chastota zustrichal'nosti poiednanoï patologiï takykh organiv i systemorganizmu, iak sertsevo-sudynna, nervova, endokrynna, krovotvorna, urogenital'na, oporno-rukhova, shlunkovokyshkova, pechinka i nyrky, bula dostovirno vyshcha, nizh u neoprominenykh patsiientiv. V oprominenykh patsiientiv perebig komorbidnoï patologiï buv vazhchym za kozhnoiu systemoiu i v tsilomu, shcho vidobrazhaly bil'sh vysoki znachennia sumarnogo balu CIRS. Iak sered ULNA, tak i neoprominenogo kontroliu bil'sh vysoki znachennia sumarnogo balukomorbidnosti vidznacheni u patsiientiv 65 rokiv i starshe, v porivnianni z osobamy menshogo viku. V obokh vikovykhpidgrupakh ULNA sumarnyĭ bal buv vyshche, nizh u patsiientiv kontrol'noï grupy.

Background: Little is known about simulated students’ ability in assessing feedback received in Objective Structured Teaching Encounters (OSTEs). We aimed to assess to which extent students’ perceptions matched objective analysis regarding quality of received feedback, to explore what elements of feedback they emphasized and what they learned about feedback. Methods: In this mixed-method study, 43 medical students participated as simulated residents in five OSTEs at Geneva University Hospitals. They assessed quality of feedback from faculty using a 15-item questionnaire and gave written/oral comments. Videotaped feedbacks were assessed using an 18-item feedback scale. During four focus groups, 25 students were asked about what they learned as feedback assessors. Results: 453 students’ questionnaires and feedback scale were compared. Correlations were moderate for stimulating self-assessment (0.48), giving a balanced feedback (0.44), checking understanding (0.47) or planning (0.43). Students’ feedback emphasized elements such as faculty’s empathy or ability to give concrete advice. They reported that being a feedback assessor helped them to realize importance of making the learner active and that giving effective feedback required structure and skills. Conclusion: Medical students may identify quality of feedback. Involving them in OSTEs could be interesting to train them to become valid raters of supervisors’ teaching skills.

This systematic review offers a comprehensive examination of the relationship between leisure and self-esteem. The different perspectives were analyzed according to a framework that includes the different approaches for defining and measuring leisure, and a similar one was proposed for self-esteem. Articles indexed in the Web of Science (WoS) up to the end of 2018 were reviewed, specifically those that contained the keywords “leisure”, “self-esteem” or “self esteem” anywhere in the manuscript. Articles that did not present the qualitative or quantitative instruments needed to evaluate leisure or self-esteem were excluded. A total of 49 articles included the final quantitative synthesis. The overall findings showed that the prevailing methodology was objective (external). As regards content, the following combinations predominated: the behavioral approach to leisure with the unidimensional approach to self-esteem and the experiential approach to leisure with the unidimensional approach to self-esteem. Less studies were observed with the combination of mixed approaches and more comprehensive analyses: the behavioral-experiential combined with the multidimensional. To conclude, this study shows there is a demand for further empirical studies that explore the relationships between leisure and self-esteem. It also identified which approaches are most desirable to expand our understanding of the relationships between leisure and self-esteem., This contribution has received financial support from REDICE16-1320, University of Barcelona; RTI2018-094405-B-100, Ministerio de Ciencia, Innovación y Universidades of Spain, and the PsicoSAO-ResearchGroup in Social, Environmental, and Organizational Psychology (2017 SRG 564 Comissionat per a Universitats iRecerca del DIUE of the Generalitat de Catalunya)

MicroRNAs (miRNAs) are small non-coding RNAs that are involved in the regulation of major pathways in eukaryotic cells through their binding to and repression of multiple mRNAs. With high-throughput methodologies, various outcomes can be measured that produce long lists of miRNAs that are often difficult to interpret. A common question is: after differential expression or phenotypic screening of miRNA mimics, which miRNA should be chosen for further investigation? Here, we present miRViz (http://mirviz.prabi.fr/), a webserver application designed to visualize and interpret large miRNA datasets, with no need for programming skills. MiRViz has two main goals: (i) to help biologists to raise data-driven hypotheses and (ii) to share miRNA datasets in a straightforward way through publishable quality data representation, with emphasis on relevant groups of miRNAs. MiRViz can currently handle datasets from 11 eukaryotic species. We present real-case applications of miRViz, and provide both datasets and procedures to reproduce the corresponding figures. MiRViz offers rapid identification of miRNA families, as demonstrated here for the miRNA-320 family, which is significantly exported in exosomes of colon cancer cells. We also visually highlight a group of miRNAs associated with pluripotency that is particularly active in control of a breast cancer stem-cell population in culture.

Oral leukoplakia represents the most common oral potentially malignant disorder, so early diagnosis of leukoplakia is important. The aim of this study is to propose an effective texture analysis algorithm for oral leukoplakia diagnosis. Thirty-five patients affected by leukoplakia were included in this study. Intraoral photography of normal oral mucosa and leukoplakia were taken and processed for texture analysis. Two features of texture, run length matrix and co-occurrence matrix, were analyzed. Difference was checked by ANOVA. Factor analysis and classification by the artificial neural network were performed. Results revealed easy possible differentiation leukoplakia from normal mucosa (p<0.05). Neural network discrimination shows full leukoplakia recognition (sensitivity 100%) and specificity 97%. This objective analysis in the neural network revealed that involving 3 textural features into optical analysis of the oral mucosa leads to proper diagnosis of leukoplakia. Application of texture analysis for leukoplakia is a promising diagnostic method.

This study aimed to quantitatively compare radiation dermatitis due to hypofractionated (Hypo) and conventionally fractionated (Conv) external-beam radiotherapy in patients who underwent postoperative radiotherapy after breast-conserving surgery. Skin color changes, in terms of L* (brightness, white-black), a* (red-green), and b* (yellow-blue) values, due to external-beam radiotherapy were examined at alternate fractions using an objective method. Twenty-six patients were included in the Hypo group (42.56 Gy/16 fractions) and 46 in the Conv group (50 Gy/25 fractions). Radiotherapy decreased the L* value (darker) and increased the a* value (redder) gradually. These color alterations progressed linearly according to elapsed fractions and were similar between Hypo and Conv per fraction. The Hypo group showed significantly milder alterations in L* and a* values than the Conv group. The maximal dosage was significantly correlated to alterations in L* and a* values. Common Terminology Criteria for Adverse Events v4 assessment did not show a statistically significant difference between the Hypo (Grade 0:1:2 = 2:24:1) and Conv (1:39:6, p = 0.25) groups. The results of our objective analysis revealed that patients undergoing Hypo show milder color alteration than those undergoing Conv and that the maximal dosage is a useful predicator of color alteration.

OBJECTIVE Analysis of the efficacy of sphenopalatine artery (SPA) and internal maxillary artery (IMAX) ligation within the pterygopalatine fossa to control posterior epistaxis. METHODS Demographic and clinical data were collected in sixty-two consecutive patients who had SPA/IMAX ligation surgery. Clinical outcomes such as re-bleed rates and complications were acquired. RESULTS A total of 62 patients were studied. Thirty-eight percent of patients had previously undergone silver nitrate nasal cautery for epistaxis. Nine patients had undergone previous attempt of SPA procedure or embolization in other services. Two patients returned to the operating room for anterior ethmoid ligation. There was one mortality within 30 days of surgery. Follow up ranged from 3 months to 56 months (median= 28 months). CONCLUSIONS Dual SPA and IMAX ligation is effective in the control of difficult epistaxis cases, even in those patients with prior surgical intervention.

BACKGROUND Current treatment of facial capillary malformations (CM) has limited efficacy. OBJECTIVE To assess the efficacy of large spot 532 nm lasers for the treatment of previously treated facial CM with the use of 3-dimensional (3D) image analysis. PATIENTS AND METHODS Forty-three white patients aged 6 to 59 were included in this study. Patients had 3D photography performed before and after treatment with a 532 nm Nd:YAG laser with large spot and contact cooling. Objective analysis of percentage improvement based on 3D digital assessment of combined color and area improvement (global clearance effect [GCE]) were performed. RESULTS The median maximal improvement achieved during the treatment (GCE) was 59.1%. The mean number of laser procedures required to achieve this improvement was 6.2 (range 1-16). Improvement of minimum 25% (GCE25) was achieved by 88.4% of patients, a minimum of 50% (GCE50) by 61.1%, a minimum of 75% (GCE75) by 25.6%, and a minimum of 90% (GCE90) by 4.6%. Patients previously treated with pulsed dye lasers had a significantly less response than those treated with other modalities (GCE 37.3% vs 61.8%, respectively). CONCLUSION A large spot 532 nm laser is effective in previously treated patients with facial CM.

Acupuncture and moxibustion treatment has been widely spread all over the world because it has few side effects and is effective for ahead sick and incurable disease. However, the treatment is often performed empirically and clinically, and the mechanism and process of the treatment are not yet scientifically elucidated. Therefore, it is required to establish objective and unified research methods and evaluation criteria that incorporate modern Western medicine and scientific and technological viewpoints. In this paper, a human body model is constructed, which includes the internal organs and the meridians for acupuncture and moxibustion treatment based on traditional Chinese medicine using colored Petri nets. This model aims at expressing the relationship between acupoints and internal organs realistically and accurately in acupuncture and moxibustion treatment, and leading to realization of an objective analysis method of the mechanism and process of acupuncture and moxibustion treatment. Firstly, the calculation of the acupoints’ efficacy on internal organs is discussed, and measurement equations and model construction methods are proposed. Next, an interface is established as a bridge to connect the internal organs and the meridians with acupoints. By Java language, a simulation system is developed based on the proposed Petri net model. Finally, simulations of acupuncture and moxibustion treatment are performed to verify the validity of model.

To evaluate objective and subjective results after bilateral implantation of a diffractive trifocal intraocular lens (IOL) in a Mexican population. Prospective, interventional case series involved 15 cataract surgery patients who underwent bilateral implantation of the trifocal Micro F lens FineVision IOL (PhysIOL, Liege, Belgium). Objective analysis involved assessment of monocular uncorrected distance (UDVA), near (UNVA) at 30 and 40 cm, and intermediate visual acuity (UIVA) at 50, 60, and 70 cm, preoperatively, and at postoperative months 1, 3, and 6. Higher-order aberrations were assessed via aberrometry. Contrast sensitivity was determined via modulation transfer function. Subjective outcomes were assessed using the National Eye Institute Visual Functioning Questionnaire-25 (VFQ-25). At postoperative month 6, mean monocular UDVA was 0.06 ± 0.11 logMAR, and UNVA was 0.03 ± 0.04 logMAR at 30 cm and 0.05 ± 0.08 logMAR at 40 cm. Mean UIVA at 50, 60, and 70 cm was 0.12 ± 0.06, 0.13 ± 0.08, and 0.04 ± 0.08 logMAR, respectively. Spherical equivalent at postoperative month 3 was 0.23 ± 0.4 diopters (D). Aberrometry revealed a mean RMS of 0.18 microm and PSF of 0.19 (Strehl ratio). VFQ-25 questionnaire results showed a mean score of 93.64 ± 4.19 points (maximum 100 points). Vision during distance and near activities was reported as “excellent.” Adverse events were reported as occurring “never to occasionally.” Implantation of a diffractive trifocal IOL in a Mexican population appears safe and effective, both objectively and subjectively. Good uncorrected visual acuity outcomes were achieved at far, near, and intermediate distances. Overall patient satisfaction was excellent.

Cases concerning the withdrawal or withholding of artificial nutrition and hydration from patients in a vegetative or minimally conscious state raise difficult medical, legal and ethical questions including the diagnosis and classification of disorders of consciousness, the legal processes to be followed, and the legal and ethical principles to be applied when making decisions. There is also an issue as to whether it is necessary or appropriate for such decisions to be taken by judges. This article, based on a lecture given in Oxford in October 2016, considers a number of these issues and concludes that any consideration of the question from the patient's point of view must include an objective analysis of what is in his or her best interests, as well as subjective expressions of wishes and feelings. Whilst noting that it has been suggested that applications to the court should be confined to those cases where there is a dispute as to whether withdrawal of artificial nutrition and hydration (ANH) would be in the patient's best interests, the author proposes that, until such time as we have greater clarity and understanding about the disorders of consciousness, and about the legal and ethical principles to be applied, there remains a need for independent oversight and that applications to the court should continue to be obligatory in all cases where the withdrawal of ANH is proposed, at least for the time being.

Background Red man syndrome (RMS) occurs because of non–IgE-mediated histamine release. Unlike vancomycin allergy, which necessitates the use of an alternative drug (often linezolid), RMS does not typically preclude further vancomycin use. Care should be taken to differentiate these reaction types from one another to prevent unnecessary vancomycin avoidance. Objective To characterize vancomycin reaction types in our population, and to determine whether having a reaction consistent with RMS is associated with otherwise unexplained vancomycin avoidance and linezolid use. Methods We retrospectively reviewed charts for children with documented vancomycin reactions. We classified the in-hospital reactions via an objective analysis and estimated the prevalence of different reaction types. We then identified children who received linezolid over 3 years, and investigated reasons for linezolid use instead of vancomycin. Results Of the 78 in-hospital reactions we characterized, 72 (92%) were objectively consistent with RMS, 5 we could not objectively classify (2 most likely RMS, 3 more suspicious for possible IgE-mediated allergy), and 1 was a non-RMS/non-IgE reaction. Of 60 children who received linezolid, 19 had previous reactions consistent with RMS, which should not preclude further vancomycin. Nevertheless, only 7 of 19 (37%) had a clear explanation for receiving linezolid instead of vancomycin compared with 32 of 39 (82%) children without previous vancomycin reactions ( P Conclusions The vast majority of patients had vancomycin reactions consistent with RMS. These patients are at risk for unnecessary vancomycin avoidance and linezolid utilization. We propose that this may be related to how reactions appear in the electronic medical record.

Purpose The study sought to assess the frequency and prognostic value of hyperattenuating adrenal glands on contrast-enhanced computed tomography (CT) scans of surgical intensive care unit (ICU) patients with acute clinical deterioration. Methods Eighty-eight consecutive ICU patients (63.2 ± 14.5 years of age) were included in this retrospective analysis. All patients underwent biphasic contrast-enhanced CT due to an acute clinical deterioration. Hyperattenuation of the adrenal glands was assessed subjectively and objectively. Subjective presence or absence of hyperattenuating adrenal glands was assessed by 2 blinded radiologists (J.B. and R.S.L.) in consensus. Hounsfield units (HU) were measured in the adrenal glands and in the inferior vena cava. Objective hyperattenuation was defined as HU (adrenal glands) > HU (inferior vena cava) with a 15-HU threshold. Death within 14 days following CT was set as endpoint and acquired from electronic patient data. Results Thirty-eight patients (43.2%, Group Asubj) exhibited hyperattenuation of the adrenal glands, whereas 50 patients (56.8%, Group Bsubj) did not. Concerning the objective analysis, 31 patients (35.2%, Group Aobj) exhibited hyperdense adrenal glands, whereas 53 patients (64.8%, Group Bobj) did not. Overall 27 of 88 patients (30.6%) died within 14 days following the CT examination. Lethal outcome was significantly more frequent among patients in Group Asubj and Aobj (19 of 38 patients [50.0%] and 15 of 31 patients [48.4%]) as compared with patients in Group Bsubj (8 of 50 patients [16.0%]) and Group Bobj (12 of 57 patients [21.1%]; P < .05). Subjective and objective analysis correlated significantly ( P < .05). Conclusions Hyperattenuation of adrenal glands on contrast-enhanced CT of ICU patients with acute clinical deterioration is associated with a high mortality and might serve as a prognostic marker for patients' outcome.