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Background: Endosseous zirconia implants have been established as an alternative to conventional titanium implants, especially in the aesthetic zone. This pilot study aimed to evaluate the outcome of rehabilitation with zirconia implants, in a subset of the Indian population, involving varying clinical scenarios. Methods: A total of 10 one-piece zirconia implants were placed in seven patients requiring rehabilitation of missing teeth. The survival rate and marginal bone levels were evaluated at six months and 12 months following implant placement. Results: Five implants were placed in the maxilla and five in the mandible, including well-healed sites, extraction sockets, a single cantilever in the lower anterior region, and a full-arch rehabilitation. During the observation period, two early implant failures were noted resulting in a survival rate of 80%. Mean marginal bone loss of 0.73mm was seen one year following implant placement, with maximum bone loss occurring in the first six months. Conclusion: The results of this study encourage the use of endosseous zirconia implants in diverse clinical scenarios with careful case selection. However, long-term studies are needed to further validate these findings.

Background: The advancement of large language models (LLMs) offers significant opportunities for health care, particularly in the generation of medical documentation. However, challenges related to ensuring the accuracy and reliability of LLM outputs, coupled with the absence of established quality standards, have raised concerns about their clinical application., Objective: This study aimed to develop and validate an evaluation framework for assessing the accuracy and clinical applicability of LLM-generated emergency department (ED) records, aiming to enhance artificial intelligence integration in health care documentation., Methods: We organized the Healthcare Prompt-a-thon, a competitive event designed to explore the capabilities of LLMs in generating accurate medical records. The event involved 52 participants who generated 33 initial ED records using HyperCLOVA X, a Korean-specialized LLM. We applied a dual evaluation approach. First, clinical evaluation: 4 medical professionals evaluated the records using a 5-point Likert scale across 5 criteria-appropriateness, accuracy, structure/format, conciseness, and clinical validity. Second, quantitative evaluation: We developed a framework to categorize and count errors in the LLM outputs, identifying 7 key error types. Statistical methods, including Pearson correlation and intraclass correlation coefficients (ICC), were used to assess consistency and agreement among evaluators., Results: The clinical evaluation demonstrated strong interrater reliability, with ICC values ranging from 0.653 to 0.887 (P<.001), and a test-retest reliability Pearson correlation coefficient of 0.776 (P<.001). Quantitative analysis revealed that invalid generation errors were the most common, constituting 35.38% of total errors, while structural malformation errors had the most significant negative impact on the clinical evaluation score (Pearson r=-0.654; P<.001). A strong negative correlation was found between the number of quantitative errors and clinical evaluation scores (Pearson r=-0.633; P<.001), indicating that higher error rates corresponded to lower clinical acceptability., Conclusions: Our research provides robust support for the reliability and clinical acceptability of the proposed evaluation framework. It underscores the framework's potential to mitigate clinical burdens and foster the responsible integration of artificial intelligence technologies in health care, suggesting a promising direction for future research and practical applications in the field., (©Junhyuk Seo, Dasol Choi, Taerim Kim, Won Chul Cha, Minha Kim, Haanju Yoo, Namkee Oh, YongJin Yi, Kye Hwa Lee, Edward Choi. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 20.11.2024.)

Cephalosporin resistance in Neisseria gonorrhoeae has severely compromised the efficacy of World Health Organization (WHO)-recommended therapies. This study aimed to methodologically evaluate the optimized Six-Codon Plus assay, and additionally conducted a multicenter evaluation to assess its clinical application, especially for predicting antimicrobial resistance (AMR). For methodological evaluation, 397 sequence-known N. gonorrhoeae isolates were evaluated for specificity, 17 nongonococcal isolates were assessed for cross-reactivity, 159 uncultured urogenital swabs and urine samples were evaluated for sensitivity at the clinical level. For multicenter evaluation, 773 isolates with confirmed phenotypic data and 718 clinical urogenital swabs collected from four geographical cities were, respectively, utilized for the evaluation of AMR-prediction strategies and the clinical application of the assay. The assay accurately identified specific single-nucleotide polymorphisms in resistance-associated genes, the detection limits dropped to 10 copies/reaction for individual targets. The specificity reached 100% and no cross-reactivity occurred with double-target confirmation. The assay could be directly applied to clinical samples containing over 20 copies/reaction. Multicenter evaluation formulated two optimal strategies for decreased susceptibility prediction in specific scenarios, and one tactic for prediction of resistance and identification of FC428-like strains. High sensitivity of 86.84% (95% CI, 71.11-95.05) and specificity of 99.59% (95% CI, 98.71-99.89) for resistance prediction were demonstrated for ceftriaxone (CRO). Regarding N. gonorrhoeae identification among multicenter swabs, specificity reached 97.53% (95% CI, 95.49-98.69), and sensitivity reached 93.77% (95% CI, 90.04-96.22). The Six-Codon Plus assay exhibited excellent detection performance and formulated optimal AMR-related prediction strategy with regional adaptability, providing critical information for population screening and clinical treatment.

Objective: This study aims to evaluate the diagnostic performance of a commercial, fully-automated, artificial intelligence (AI) driven software tool in identifying and grading prostate lesions in prostate MRI, using histopathological findings as the reference standard, while contextualizing its performance within the framework of PI-RADS v2.1 criteria., Material and Methods: This retrospective study analyzed 123 patients who underwent multiparametric prostate MRI followed by systematic and targeted biopsies. MRI protocols adhered to international guidelines and included T2-weighted, diffusion-weighted, T1-weighted, and dynamic contrast-enhanced imaging. The AI software tool mdprostate was integrated into the Picture Archiving and Communication System to automatically segment the prostate, calculate prostate volume, and classify lesions according to PI-RADS scores using biparametric T2-weighted and diffusion-weighted imaging. Histopathological analysis of biopsy cores served as the reference standard. Diagnostic performance metrics including sensitivity, specificity, positive and negative predictive value (PPV, NPV), and area under the ROC curve (AUC) were calculated., Results: mdprostate demonstrated 100 % sensitivity at a PI-RADS ≥ 2 cutoff, effectively ruling out both clinically significant and non-significant prostate cancers for lesions remaining below this threshold. For detecting clinically significant prostate cancer (csPCa) using a PI-RADS ≥ 4 cutoff, mdprostate achieved a sensitivity of 85.5 % and a specificity of 63.2 %. The AUC for detecting cancers of any grade was 0.803. The performance metrics of mdprostate were comparable to those reported in two meta-analyses of PI-RADS v2.1, with no significant differences in sensitivity and specificity (p > 0.05)., Conclusion: The evaluated AI tool demonstrated high diagnostic performance in identifying and grading prostate lesions, with results comparable to those reported in meta-analyses of expert readers using PI-RADS v2.1. Its ability to standardize evaluations and potentially reduce variability underscores its potential as a valuable adjunct in the prostate cancer diagnostic pathway. The high accuracy of mdprostate, particularly in ruling out prostate cancers, highlights its clinical utility by reducing workload and enhancing patient outcomes., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors declare that they received the mdprostate algorithm from mediaire GmbH free of charge for testing purposes. However, mediaire GmbH had no influence on the study design, data collection, analysis, interpretation of the data, or the decision to submit the manuscript for publication. The authors have no other conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Diseases associated with chronic respiratory failure have a negative impact on quality of life and life expectancy, notably through a reduction in patients' functional capacity. Assessing balance, coordination, muscular strength and endurance, as well as exercise tolerance, is therefore an important component of the evaluation of individuals with chronic respiratory failure. This evaluation can be made easier by using simple tools such as sit-to-stand tests. This review presents the main sit-to-stand tests that have been described and that can be used in everyday practice. The aim is to provide information to the clinician on the contribution of each test, and to identify the extent to which and the purpose for which these tests can be incorporated into a routine pulmonology and/or respiratory rehabilitation evaluation. Because of their inherently functional nature, these tests could help to identify the indications and/or the effects of respiratory rehabilitation., (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: Evaluating the psychological resilience of lung cancer (LC) patients helps understand their mental state and guides future treatment. However, there is limited research on the psychological resilience of LC patients with bone metastases., Aim: To explore the psychological resilience of LC patients with bone metastases and identify factors that may influence psychological resilience., Methods: LC patients with bone metastases who met the inclusion criteria were screened from those admitted to the Third Affiliated Hospital of Wenzhou Medical University. The psychological scores of the enrolled patients were collected. They were then grouped based on the mean psychological score: Those with scores lower than the mean value were placed in the low-score group and those with scores equal to or greater than the mean value was placed in the high-score group. The baseline data (age, gender, education level, marital status, residence, monthly income, and religious beliefs), along with self-efficacy and medical coping mode scores, were compared., Results: This study included 142 LC patients with bone metastases admitted to our hospital from June 2022 to December 2023, with an average psychological resilience score of 63.24 ± 9.96 points. After grouping, the low-score group consisted of 69 patients, including 42 males and 27 females, with an average age of 67.38 ± 9.55 years. The high-score group consisted of 73 patients, including 49 males and 24 females, with a mean age of 61.97 ± 5.00 years. χ 2 analysis revealed significant differences between the two groups in education level ( χ 2 = 6.604, P = 0.037), residence ( χ 2 = 12.950, P = 0.002), monthly income ( χ 2 = 9.375, P = 0.009), and medical coping modes ( χ 2 = 19.150, P = 0.000) . Independent sample t -test showed that the high-score group had significantly higher self-efficacy scores ( t = 3.383, P = 0.001) and lower age than the low-score group ( t = 4.256, P < 0.001). Furthermore, multivariate logistic regression hazard analysis confirmed that self-efficacy is an independent protective factor for psychological resilience [odds ratio (OR) = 0.926, P = 0.035, 95% confidence interval (CI): 0.862-0.995], while age (OR = 1.099, P = 0.003, 95%CI: 1.034-1.169) and medical coping modes (avoidance vs confrontation: OR = 3.767, P = 0.012, 95%CI: 1.342-10.570; resignation vs confrontation: OR = 5.687, P = 0.001, 95%CI: 1.974-16.385) were identified as independent risk factors. A predictive model based on self-efficacy, age, and medical coping modes was developed. The receiver operating characteristic analysis showed an area under the curve value of 0.778 (95%CI: 0.701-0.856, P < 0.001), indicating that the model has good predictive performance., Conclusion: LC patients with bone metastases are less psychologically resilient than the general population. Factors such as self-efficacy, age, and medical coping modes influence their psychological resilience. Patients with low self-efficacy, old age, and avoidance/resignation coping modes should be closely observed., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Introduction: European regulations have recently moved towards more stringent requirements for demonstrating the safety and performance of medical devices (MDs)., Objective: To apply an innovative testing method using medical simulation to the evaluation of three medical devices at different stages of their life cycle., Method: The methodology for evaluating DMs using simulation is based on seven stages: definition of the context, training, construction of a scenario to test the DM, validation of the scenario, realization of the scenario, evaluation of the scenario by the players and validation and exploitation of the results., Results: Our evaluation methodology enabled us to assess three DMs at different stages of their development: a respiratory protection device at the initial stage (prototype definition), a respiratory protection mask (prototype optimization) and bottle adapters (post-marketing)., Conclusion: Simulation is a valuable tool for evaluating DM. The proposed methodology enables it to be used and adapted to different contexts. It responds to the specificities of clinical evaluation of this class of products, and helps to better anticipate certain risks., (Copyright © 2024 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Delineating the clinical target volume (CTV) and organs at risk (OARs) is crucial in rectal cancer radiotherapy. However, the accuracy of manual delineation (MD) is variable and the process is time consuming. Automatic delineation (AD) may be a solution to produce quicker and more accurate contours. In the present study, a convolutional neural network (CNN)-based AD tool was clinically evaluated to analyze its accuracy and efficiency in rectal cancer. CT images were collected from 148 supine patients in whom tumor stage and type of surgery were not differentiated. The rectal cancer contours consisted of CTV and OARs, where the OARs included the bladder, left and right femoral head, left and right kidney, spinal cord and bowel bag. The MD contours reviewed and modified together by a senior radiation oncologist committee were set as the reference values. The Dice similarity coefficient (DSC), Jaccard coefficient (JAC) and Hausdorff distance (HD) were used to evaluate the AD accuracy. The correlation between CT slice number and AD accuracy was analyzed, and the AD accuracy for different contour numbers was compared. The time recorded in the present study included the MD time, AD time for different CT slice and contour numbers and the editing time for AD contours. The Pearson correlation coefficient, paired-sample t-test and unpaired-sample t-test were used for statistical analyses. The results of the present study indicated that the DSC, JAC and HD for CTV using AD were 0.80±0.06, 0.67±0.08 and 6.96±2.45 mm, respectively. Among the OARs, the highest DSC and JAC using AD were found for the right and left kidney, with 0.91±0.06 and 0.93±0.04, and 0.84±0.09 and 0.88±0.07, respectively, and HD was lowest for the spinal cord with 2.26±0.82 mm. The lowest accuracy was found for the bowel bag. The more CT slice numbers, the higher the accuracy of the spinal cord analysis. However, the contour number had no effect on AD accuracy. To obtain qualified contours, the AD time plus editing time was 662.97±195.57 sec, while the MD time was 3294.29±824.70 sec. In conclusion, the results of the present study indicate that AD can significantly improve efficiency and a higher number of CT slices and contours can reduce AD efficiency. The AD tool provides acceptable CTV and OARs for rectal cancer and improves efficiency for delineation., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Huang et al.)

Zhikai Liu,1 Fangjie Liu,2,&ast; Wanqi Chen,1,&ast; Yinjie Tao,1 Xia Liu,1 Fuquan Zhang,1 Jing Shen,1 Hui Guan,1 Hongnan Zhen,1 Shaobin Wang,3 Qi Chen,3 Yu Chen,3 Xiaorong Hou1 1Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China; 2Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People’s Republic of China; 3MedMind Technology Co., Ltd., Beijing, 100055, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaorong Hou Tel +86 138 1196 3013Email hxr_pumch@163.comObjective: Delineation of clinical target volume (CTV) and organs at risk (OARs) is important for radiotherapy but is time-consuming. We trained and evaluated a U-ResNet model to provide fast and consistent auto-segmentation.Methods: We collected 160 patients’ CT scans with breast cancer who underwent breast-conserving surgery (BCS) and were treated with radiotherapy. CTV and OARs were delineated manually and were used for model training. The dice similarity coefficient (DSC) and 95th percentile Hausdorff distance (95HD) were used to assess the performance of our model. CTV and OARs were randomly selected as ground truth (GT) masks, and artificial intelligence (AI) masks were generated by the proposed model. Two clinicians randomly compared CTV score differences of the contour. The consistency between two clinicians was tested. Time cost for auto-delineation was evaluated.Results: The mean DSC values of the proposed method were 0.94, 0.95, 0.94, 0.96, 0.96 and 0.93 for breast CTV, contralateral breast, heart, right lung, left lung and spinal cord, respectively. The mean 95HD values were 4.31mm, 3.59mm, 4.86mm, 3.18mm, 2.79mm and 4.37mm for the above structures, respectively. The average CTV scores for AI and GT were 2.89 versus 2.92 when evaluated by oncologist A (P=0.612), and 2.75 versus 2.83 by oncologist B (P=0.213), with no statistically significant differences. The consistency between two clinicians was poor (kappa=0.282). The time for auto-segmentation of CTV and OARs was 10.03 s.Conclusion: Our proposed model (U-ResNet) can improve the efficiency and accuracy of delineation compared with U-Net, performing equally well with the segmentation generated by oncologists.Keywords: clinical target volume, organ at risk, auto-segmentation, breast cancer radiotherapy, clinical evaluation

Male infertility (MI) is a multifactorial disease leading to the disorder of male reproductive dysfunctions, which affecting approximately 50% of male partners in infertile couples. Male infertility has become the third most difficult disease in the world, since cardiovascular disease and cancer. Although conventional treatments such as medication, surgical operation, and advanced techniques have helped many male with infertility cause pregnancy in their female partners, effectiveness is not satisfactory and associated with adverse effects. Traditional Chinese Medicine (TCM) has been taken for clinical application to improve male infertility for thousands of years in China. The pharmacological mechanism of TCM has also been widely studied. In this study, we will summarize the effective TCM in treating MI, the clinical evaluations of TCM in treating MI, and the molecular mechanisms of TCM effects. Additionally, we will point out the limitations of current research and the challenges faced by the modernization of TCM.

Practitioners have a clinical, ethical, academic, and economic responsibility to dispassionately consider how effective their services are. Approaches to measure how “good” or “bad” healthcare is include clinical audit, satisfaction surveys, and routine outcome measurement. However, the process of comparing the clinical outcomes of a specific service against the ‘best’ services in the same specialism, also known as benchmarking, remains challenging, and it is unclear how it affects quality improvement. This paper piloted and compared two different approaches to benchmarking to assess clinical outcomes in neurorehabilitation. Norming involved comparing routine measures of clinical outcome with external validators. Stacking involved pooling and comparing internal data across several years. The analyses of routine clinical outcome data from 167 patients revealed significant differences in the patient characteristics of those admitted to the same service provider over time, but no differences in outcomes achieved when comparing with historical data or with external reference data. These findings illustrate the potential advantages and limitations of using stacking and norming to benchmark clinical outcomes, and how the results from each approach might be used to evaluate service effectiveness and inform quality improvement within the field of brain injury rehabilitation.

The consensus systematic risk stratification algorithm from the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and The Hip Society summarizes clinical challenges in evaluation and treatment of metal-on-polyethylene total hip arthroplasty (THA) patients with adverse local tissue reaction (ALTR) due to mechanically assisted crevice corrosion (MACC), reviews up-to-date evidence, and identifies the areas for future research in order to provide a useful resource for orthopedic surgeons providing care to these patients. A painful THA has various intrinsic and extrinsic causes. ALTR is one of the intrinsic causes in patients with painful THA. The occurrence of ALTR due to MACC at modular junctions is likely to be multifactorial, including implant, surgical, and patient factors. Therefore, a systematic evaluation needs to involve a focused clinical history, detailed physical examination, laboratory tests, and imaging in order to identify potential differential diagnoses. There should be a low threshold to perform a systematic evaluation of patients with painful non-metal-on-metal THA, including patients with metal-on-polyethylene THA, and modular dual-mobility THA with the CoCr metal acetabular insert, as early recognition and diagnosis of ALTR due to MACC will facilitate initiation of appropriate treatment prior to significant adverse biological reactions. Specialized tests such as blood metal analysis and metal artifact reduction sequence magnetic resonance imaging are important modalities in evaluation and management of ALTR in patients with painful THA. [ABSTRACT FROM AUTHOR]

Objective: This paper presents the development and clinical evaluation of a foot stretching robot that simultaneously stretches the plantar fascia and Achilles tendon for the treatment of plantar fasciitis. The therapeutic effectiveness of the robot and feasibility of using metatarsophalangeal joint stiffness as an indicator of recovery were identified through the clinical evaluations. Methods: The robot implements an effective foot stretching protocol through a novel mechanism design that simultaneously stretches the plantar fascia and Achilles tendon using a single motor. Thirty patients with plantar fasciitis and fifteen healthy participants volunteered in the cross-sectional clinical evaluation, and nine patients from the patients group participated in the one-month clinical trial. Four main outcomes (Foot Function Index, Visual Analogue Scale-Foot and Ankle, plantar fascia thickness, and metatarsophalangeal joint stiffness) were used for the clinical evaluations. Results: In the cross-sectional clinical evaluation, the symptomatic feet of patients showed moderate negative correlation between normalized metatarsophalangeal joint stiffness and plantar fascia thickness with statistical significance. In the one-month clinical trial, all the main outcomes showed significant improvement after using the developed robot. Comparing our results with previous studies also indicated a therapeutic superiority of our robot for treating plantar fasciitis. Conclusion: Our foot stretching robot had significant therapeutic effect on plantar fasciitis, and normalized metatarsophalangeal joint stiffness measured by our robot could be used as a monitoring indicator for recovery from plantar fasciitis. Significance: This study contributed to practical issues related to treatment of plantar fasciitis, and our results could be applied to effective treatment of plantar fasciitis and progressive monitoring of recovery. [ABSTRACT FROM AUTHOR]

Pseudorabies caused by pseudorabies virus (PRV) infection is still a major disease affecting the pig industry; its eradication depends on effective vaccination and antibody (Ab) detection. For a more rapid and accurate PRV detection method that is suitable for clinical application, here, we established a poly (dimethylsiloxane)-based (efficient removal of non-specific binding) solidphase protein chip platform (blocking ELISA) for dual detection of PRV gD and gE Abs. The purified gD and gE proteins expressed in baculovirus were coated into the highly hydrophobic nanomembrane by an automatic spotter, and the gray values measured by a scanner were used for the S/N (sample/negative) value calculation (gD and gE Abs standard, positive: S/N value ≤0.6; negative: S/N value >0.7; suspicious: 0.6 < S/N ≤ 0.7). The method showed an equal sensitivity in the gD Ab test of immunized pig serum samples compared to the neutralization test and higher sensitivity in the gE Ab test compared to the commercial gE Ab detection kit. In the clinical evaluation, we found an agreement of 100% (122/122) in the gD Ab detection compared to the neutralization test and an agreement of 97.5% (119/122) in the gE Ab detection compared to the commercial PRV gE Ab detection kit. In summary, the protein chip platform for dual detection of PRV gD and gE Abs showed high sensitivity and specificity, which is suitable for PRV immune efficacy evaluation and epidemic monitoring. [ABSTRACT FROM AUTHOR]

We systematically evaluate a Deep Learning model in a 3D medical image segmentation task. With our model, we address the flaws of manual segmentation: high inter-rater contouring variability and time consumption of the contouring process. The main extension over the existing evaluations is the careful and detailed analysis that could be further generalized on other medical image segmentation tasks. Firstly, we analyze the changes in the inter-rater detection agreement. We show that the model reduces the number of detection disagreements by $\text{48}\%$ $\text {(p < 0.05)}$. Secondly, we show that the model improves the inter-rater contouring agreement from $\text {0.845}$ to $\text {0.871}$ surface Dice Score $\text {(p < 0.05)}$. Thirdly, we show that the model accelerates the delineation process between $\text {1.6}$ and $\text {2.0}$ times $\text {(p < 0.05)}$. Finally, we design the setup of the clinical experiment to either exclude or estimate the evaluation biases; thus, preserving the significance of the results. Besides the clinical evaluation, we also share intuitions and practical ideas for building an efficient DL-based model for 3D medical image segmentation. [ABSTRACT FROM AUTHOR]

Background: Dual-task (DT) walking has increasingly been investigated over the last decade because of its valuable role as a clinical marker of both cognitive impairment and fall risk in older adults based on cognitive and motor performance (DTEcog, DTEmotor). However, there is still a lack of information on what type of dual task to choose and which is the most adapted to the population of interest.Research Question: To evaluate the effect of different dual-tasks (DT3, DT7, FLU, STROOP) on the spatiotemporal and kinematic parameters of hip, knee, and ankle joints.Methods: Thirty-eight older adults were recruited (9 men, 29 women, mean age = 77.5 +/- 6.5 years, mean height = 163.6 +/- 8.6 cm, mean weight = 67.5 +/- 15.3 kg). They performed a single and dual-task walk with the 4 types of tasks during 1 min, equipped with an inertial system. Dual-task effect (DTE) on spatiotemporal and kinematic variables as well as cognitive score and speed were calculated.Results: An alteration in most of the spatiotemporal parameters was observed in each DT condition (p < 0.05), especially in arithmetic tasks (DT3, DT7), while no DT effect was noticed on kinematic parameters (RMSE<3°) except on hip and knee angular velocities (RMSE>15°). Arithmetic tasks seemed to alter more spatiotemporal and kinematic parameters than the verbal fluency or STROOP test. However, DT7 appeared to be too difficult for the population of interest.Significance: Arithmetic tasks seemed to be very pertinent as a clinical dual-task protocol for older adults. The use of an inertial system to retrieve kinematic variables is an improvement in these dual-task protocols. [ABSTRACT FROM AUTHOR]

Ferulic acid (FA) provides broad biological functions that have been used in cosmetics formulation as a photoprotection, anti-aging, and brightening agent. However, its application is limited by its tendency to deteriorate by exposure to heat, humidity, and light. This study aimed to enhance the stability of FA by encapsulation in phosphorylated rice starch (PRS) and evaluate its effect on improving human skin. First, FA was encapsulated in PRS and characterized by FTIR, SEM, XRD, and DSC. Then, its stability when exposed to a temperature of 45 °C and light and its anti-aging effect on 16 volunteers were investigated. The results indicated that FA was successfully encapsulated in PRS with an encapsulation yield of 77%, EE (73%) and LE (65%). After 1 month at the high temperature/80%RH, the encapsulated FA retained its quantity (70%), whereas free FA was retained at only 50%. Under light exposure conditions, the encapsulated FA was retained at 65%, which was higher than FA (35%). Franz diffusion cell was used and demonstrated that PRS provided the controlled release of FA. Application of encapsulated FA and FA creams showed an absence of skin irritation in all volunteers. After 1 month, the encapsulated FA cream was found to be better than the FA cream on skin lightening, elasticity, smoothness, roughness, scaliness, and wrinkle. The results indicated that PRS is a potential wall material for enhancing the stability of FA, resulting in more efficacious skin lightening and anti-aging properties. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate and to compare the clinical performance and survival rate of posterior monolithic and veneered zirconia fixed partial dentures (FPDs). Material and methods: Sixty 3-unit posterior FPDs were included in the study. The patients were randomly distributed into two groups (n = 30 each) to receive either a monolithic (Zenostar T, Wieland Dental) or veneered zirconia (IPS e.max ZirCAD, Ivoclar Vivadent) FPD. Each patient received only 1 FPD. Tooth preparations were scanned (Trios 3, 3Shape), designed (Dental System 2016, 3 Shape), milled (Zenotec CAM 3.2, Wieland Dental), and cemented with a resin cement. Technical and biological outcomes and periodontal parameters were assessed. Data analysis was made using the Friedman and the Wilcoxon signed-rank tests with the Bonferroni correction and the Mann–Whitney U test. Results: The survival rate at 3 years was 100% for veneered and 90% for monolithic zirconia restorations. Three monolithic zirconia FPDs were lost because of biologic complications. The main complication in the veneered zirconia FPDs was the fracture of the veneering ceramic in 4 of the veneered zirconia FPDs. No fracture of the frameworks was observed in any of the groups. All restorations were assessed as satisfactory after 3 years. No differences in periodontal parameters were observed between the groups. Conclusions: The results of this study suggest that monolithic zirconia and complete digital flow could be a viable alternative to veneered zirconia in the posterior regions. Clinical relevance: The monolithic zirconia restorations with a digital workflow can be a viable alternative in posterior fixed partial dentures, with good periodontal outcomes. Clinical trial registration number: ClinicalTrials.gov (Identifier NCT 04,879,498). [ABSTRACT FROM AUTHOR]

Introduction: Fine needle aspiration cytology (FNAC) is one of the most valuable tests in the initial assessment of the patient who presents with a mass in the neck region or where a recurrence is suspected after previous treatment. FNAC is simple, quick and low cost method and is usually performed on the OPD basis. Methodology: A total of 100 patients with neck masses attending ENT department of SVS Medical college/Hospital were studied. Clinical evaluation of the patient was done by proper history taking and clinical examination. Pathological evaluation was done by FNAC and Excisional biopsy. Results: In the present out of 49 thyroid masses the Sensitivity of FNAC is 77.78%, Specificity is 97.5%, PPV is 87.5%, NPV is 95.12%. In the present out of 40 lymph node masses the Sensitivity of FNAC is 75%, Specificity is 97.22%, PPV is 75%, NPV is 97.22 In the present study of 100 neck masses the overall Sensitivity of FNAC is 75.00%, Specificity is 97.62%, PPV is 85.71%, NPV is 95.35%. Conclusion: Hence we conclude that FNAC is a quick, convenient procedure with minimal cost, excellent patient compliance and should be considered as a first line investigation in evaluation of neck masses and it should be followed by Histopathological examination for the confirmation of diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: To characterise the assessment and management practices employed by Sports Dietitians when assessing and managing athletes at risk of low energy availability (LEA).Design: 55 Sports Dietitians participated in an online questionnaire that captured the typical methods used to identify and manage LEA in athletic populations.Methods: The questionnaire consisted of 27 questions which explored common methods used to identify and manage LEA, as well as dietary methods employed and barriers experienced by Sports Dietitians.Results: Broadly, the top 3 nutrition-related priorities for respondents were nutrition strategies to support training, competition, and recovery while 'LEA' was ranked fifth. 'Dietary intake', 'menstrual function' and 'training load (km/week)' were the primary methods used to assess LEA and respondents were 'confident' in their ability to correctly identify athletes at risk. Among support personnel, coaches were rarely a referral source for management of LEA but did present frequent communication difficulties. Respondents indicated athletes have concerns about undesirable changes in body composition when providing recommendations of increased energy intake for LEA management.Conclusions: Sport Dietitians appear to recognise and prioritise LEA management in athletes, but assessments are limited to dietary intake and training load (km/week); with collaborative approaches to LEA management lacking. Sports Dietitian may be overconfident in their ability to identify LEA as only a limited number of assessment methods are commonly used. Access to reliable assessments methods and collaborative management approaches are needed to improve athlete care when suspected of LEA. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Obstetrics & Gynecology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We correlated clinical, epidemiological, microbiological, and genomic data of an outbreak with polymyxin B (PB)- and carbapenem-resistant Klebsiella pneumoniae during the COVID-19 pandemic. Twenty-six PB- and carbapenem-resistant K. pneumoniae were isolated from patients in the COVID-19 ICU (Intensive Care Unit), non-COVID-19 ICU (Intensive Care Unit), clinical, or surgical ward. Bacterial identification, drug susceptibility tests, and DNA sequencing were performed, followed by in silico resistance genes identification. All isolates showed extensively drug-resistant (XDR) phenotypes. Four different sequence types (ST) were detected: ST16, ST11, ST258, and ST437. Nineteen isolates were responsible for an outbreak in the ICU in September 2020. They belong to ST258 and harbored the 42Kb IncX3plasmid (pKP98M3N42) with the same genomic pattern of two K. pneumoniae identified in 2018. Twenty-four isolates carried bla-KPC-2 gene. No plasmid-mediated colistin (mcr) resistance genes were found. Eight isolates presented mgrB gene mutation. The clonal isolates responsible for the outbreak came from patients submitted to pronation, with high mortality rates in one month. XDR-K. pneumoniae detected during the outbreak presented chromosomal resistance to PB and plasmid-acquired carbapenem resistance due to KPC production in most isolates and 42Kb IncX3(pKP98M3N42) plasmid carrying blaKPC-2 was associated with ST258 isolates. The outbreak followed the collapse of the local healthcare system with high mortality rates. [ABSTRACT FROM AUTHOR]

IntroductionNon-alcoholic fatty liver disease (NAFLD) has become the most common liver disorder across the world, and non-invasive evaluation approaches are in need to assess NAFLD disease progression. Serum ferritin has been proposed as one of the biomarkers for NAFLD diagnosis in previous studies. This systematic review aims to identify, report, and synthesize studies that investigated the association of serum ferritin level with the various stages of NAFLD among the adult population.MethodsThree databases – MEDLINE, EMBASE, and Scopus – were systematically searched to obtain potentially relevant publications before July 2022. No restrictions were applied to geographical region, study design, publication type and language. The association between serum ferritin level or different ferritin categories and the various stages of NAFLD was the primary outcome of interest. Title and abstract screenings, data extraction and coding, and quality assessment were independently completed by two authors with discrepancies resolved through discussion with a third author.ResultsThirty-two studies were included and heterogeneity was considerable. The associations between serum ferritin level and the stages of hepatic steatosis, fibrosis, inflammation and ballooning and the occurrence of non-alcoholic steatohepatitis (NASH) were investigated but inconsistent associations were reported. Most studies identified serum ferritin to be a predictor of advanced NAFLD, while several revealed the opposite end.ConclusionsSerum ferritin could be considered to act as a non-invasive biomarker for assessing various stages of NAFLD. Nevertheless, further studies are still in need to confirm its predictive value since this study reported inconsistent associations based on the qualitative synthesis.Systematic Review Registrationhttp://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021275630.

This study used systematic literature reviews conducted in Japan of a finished product or functional ingredient to identify foods with function claims. We used “stool frequency” as the benchmark for the health claim of “improvement of the intestinal environment.” We found 427 foods with function claims, 384 (89.9%) foods with function claims used “stool frequency.” We identified “supplement shape” (OR: 4.62; 95% CI [1.90, 11.20]) as a significant factor in the use of “stool frequency.” Our findings suggest that both supplements and using another shape as a food form could ensure real benefits for consumers by incorporating health-related outcomes.

Objective: The aim of this retrospective study was to evaluate the long-term clinical outcomes of posterior composite resin sandwich restorations, and secondarily to assess the influence of potential factors on survival and causes of failure. Method and Materials: Two hundred and four posterior Herculite XRV restorations due to primary caries performed between 1991 and 1997 were included. The restorations were assessed after 18 years, by two calibrated examiners, according to USPHS criteria. The survival of the restorations was estimated by the Kaplan-Meier estimator. Cox regression was applied to evaluate the influence of the cavity size, location of the tooth, caries risk, and gender on survival rate. The predictive power of the analyzed variables on survival rate was studied with multiple linear regression analysis. Results: After 10 years the survival rate was 92.6%, and 82.4% at the end of the study. Thirty-six (17.6%) restorations failed during the evaluation period, 21 (10.3%) of them after more than 10 years. The most common failure was secondary caries (69.4% of the failures). There were statistically significant differences in survival rate depending on caries risk (P = .000), but not between Class I and II (P = .106), and the type and localization of the tooth (P = .115). Conclusion: Posterior Herculite XRV restorations due to primary caries have high long-term survival rates. Generally, failures occur by secondary caries and are more common in molars. The patient's caries risk is the variable that best predicts the survival of posterior restorations. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to investigate the clinical performance of posterior complex resin composite (RC) and amalgam (AM) restorations after a five-year period. One hundred and nineteen complex Class II restorations placed by dental students were evaluated using the USPHS criteria. Data were analyzed using Chi-square, Mann–Whitney, and Wilcoxon tests at a 0.05 level of significance. After five years, the percentages of clinically satisfactory complex Class II RC and AM restorations were 78% and 76.8%, respectively. The main reasons for the failure of AM restorations included secondary caries (Bravo—10.1%), defective marginal adaptation (Charlie—8.7%), and fracture of the tooth (Bravo—7.2%). RC restorations presented failures related to the fracture of the restoration (Bravo—16%) and defective marginal adaptation (Charlie—8.2%). There was a significantly higher incidence of secondary caries for AM restorations (AM—10.1%; RC—0%; p = 0.0415) and a higher number of fractures for RC restorations (AM—4.3%; RC—16%; p = 0.05). Regarding anatomy, AM restorations presented a significantly higher number of Alfa scores (49.3%) compared to RC restorations (22.4%) (p = 0.0005). The results of the current study indicate that complex class II RC and AM restorations show a similar five year clinical performance.

Background: Cannabinoids (CBs) have been found to regulate the immune system, affect innate and adaptive immune responses, and reduce inflammatory reactions. This study assessed the therapeutic effects of GW-405833 synthetic CB2 agonist on inflammatory factors as well as locomotor activity in experimental autoimmune encephalomyelitis (EAE). Methods: In this experimental study, 48 adult male C57BL/6 mice were randomly and equally assigned to eight groups. By injecting 250 mg of MOG35-55 peptide, EAE was induced. Every other day for 17 days after EAE onset, EAE-afflicted mice in groups 1-3 received an intraperitoneal injection of GW-405833 at a dose of 3, 10, and 30 mg/kg, respectively. Clinical status and locomotor activity, measured using the beam walking assay, were assessed every other day during the first 17 days after EAE onset. Mice were euthanized in day 17th of treatment and the serum levels of the IL-1ß, IL-12, CRP, and TNF-a proinflammatory cytokines as well as IL-4 and TGF-ß anti-inflammatory cytokines were measured by ELISA method. Results: Clinical manifestations of EAE in groups 2 and 3 were significantly milder than group 4 and locomotor activity in groups 1-3 was significantly better than group 4 in days 5-17 (p< 0.05). GW-405833 also significantly decreased the levels of IL-12, TNF-a, and CRP and significantly increased the levels of IL-4 and TGF-ß but had no significant effects on the level of IL-1ß. GW-405833 was not associated with significant side effects. Conclusions: The CB2 receptor agonist GW-405833, improves clinical conditions and reduces inflammation in mice with EAE. [ABSTRACT FROM AUTHOR]

Monitoring concentrations of thiopurine metabolites is used clinically to prevent adverse effects in patients on thiopurine drug therapy. We developed a LC–MS/MS method for the quantification of 6-thioguanine (6-TG) and 6-methylmercaptopurine (6-MMP) in red blood cells (RBCs). This method utilizes an automated cell washer for RBC separation from whole blood samples and washing of the separated RBCs. The lower limit of quantification of the method was 0.2 μmol/L for 6-TG (∼50 pmol/8 × 108 RBC) and 4 μmol/L for 6-MMP (∼1,000 pmol/8 × 108 RBC). The total imprecision of the assay was <3.0%. The upper limit of linearity for 6-TG and 6-MMP was 7.5 μmol/L and 150 μmol/L, respectively. The stability of the thiopurine metabolites under pre- and post-analytically relevant conditions was also evaluated. A good agreement was observed between this method and validated LC–MS/MS methods from three laboratories, except for ∼40% low bias for 6-MMP observed in one of the methods. The assessment of the association between 6-TG and 6-MMP concentrations with thiopurine S-methyltransferase (TPMT) phenotype and genotype demonstrated a statistically significant difference in the thiopurine metabolite concentrations between the TPMT groups with normal and intermediate activity of 6-MMP (p < 0.0001), while the difference in 6-TG concentrations was statistically not significant (p = 0.096). Among the samples with normal TPMT activity, higher concentrations of 6-MMP (p = 0.015) were observed in pediatric samples than in the samples of adults. No statistically significant differences were observed in the distributions of 6-TG and 6-MMP concentrations among the evaluated genotypes. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence, particularly the deep learning (DL) model, can provide reliable results for automated cardiothoracic ratio (CTR) measurement on chest X-ray (CXR) images. In everyday clinical use, however, this technology is usually implemented in a non-automated (AI-assisted) capacity because it still requires approval from radiologists. We investigated the performance and efficiency of our recently proposed models for the AI-assisted method intended for clinical practice. Methods: We validated four proposed DL models (AlbuNet, SegNet, VGG-11, and VGG-16) to find the best model for clinical implementation using a dataset of 7517 CXR images from manual operations. These models were investigated in single-model and combined-model modes to find the model with the highest percentage of results where the user could accept the results without further interaction (excellent grade), and with measurement variation within ± 1.8% of the human-operating range. The best model from the validation study was then tested on an evaluation dataset of 9386 CXR images using the AI-assisted method with two radiologists to measure the yield of excellent grade results, observer variation, and operating time. A Bland–Altman plot with coefficient of variation (CV) was employed to evaluate agreement between measurements. Results: The VGG-16 gave the highest excellent grade result (68.9%) of any single-model mode with a CV comparable to manual operation (2.12% vs 2.13%). No DL model produced a failure-grade result. The combined-model mode of AlbuNet + VGG-11 model yielded excellent grades in 82.7% of images and a CV of 1.36%. Using the evaluation dataset, the AlbuNet + VGG-11 model produced excellent grade results in 77.8% of images, a CV of 1.55%, and reduced CTR measurement time by almost ten-fold (1.07 ± 2.62 s vs 10.6 ± 1.5 s) compared with manual operation. Conclusion: Due to its excellent accuracy and speed, the AlbuNet + VGG-11 model could be clinically implemented to assist radiologists with CTR measurement. [ABSTRACT FROM AUTHOR]

We sought to evaluate clinically a hepatitis C virus (HCV) whole-genome, next-generation sequencing (NGS) pipeline that is agnostic to viral genotype. Performance of the NGS pipeline was assessed through comparison of results with Sanger sequencing (SS) of partial HCV genomes. There was 98.7% (376/381) concordance for viral subtype between SS and NGS. The positive and negative per cent agreements for determination of resistance-associated substitutions were 97.8% (95% CI 92.5–99.4%) and 99.9% (95% CI 99.5–100.0%), respectively. The NGS pipeline was also able to detect novel subtypes, mixtures, recombinants, transiently occurring resistance mutations and distinguish re-infection with the same subtype from relapse. Particular scenarios where NGS may be used include settings without universal access to pan-genotypic antiviral regimens, those infected with a 'rare' subtype or who have been failed by first-line therapy, and in cases of suspected re-infection. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical performance of nano-hydroxyapatite reinforced glass ionomer (Carbomer) vs. conventional high viscosity glass-ionomer cement (Fuji IX) in root caries of geriatric patients. Materials and Methods: The current trial is a randomized controlled trial, with two parallel groups and a 1:1 allocation ratio. A total of 22 participants were recruited using convenience sampling and received 44 restorations randomly using either Carbomer or Fuji IX. After cavity preparation, restorative materials were applied according to manufacturers' instructions. Restorations were evaluated using modified United States Public Health Service criteria by two blinded assessors after 1, 3, 6, and 9 months and 1 year. The Χ2 test was used to associate between the type of restorative material, either Carbomer or Fuji IX, and clinical performance. A P-value ≤ 0.05 was considered statistically significant. Results: After 1 year, no statistically significant difference was found between both materials for marginal staining, surface texture, marginal adaptation, secondary caries, post-operative sensitivity, color match, and retention (P = 0.4885, P = 0.1320, P = 0.3483, P = 0.9170, P = 0.7518, P = 0.1043, and P = 0.2998, respectively), whereas there was statistically significant difference between both materials for anatomical contour after 12 months (P = 0.0477). Conclusion: Both Carbomer™ and Fuji IX showed similar and successful clinical performance in the purpose of restoring root surface of permanent teeth in geriatric patients. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background/Aim: An early evaluation concerning the effectiveness of supportive oligonucleotide therapy (SOT) in cancer as a monotherapy and in combination with other types of treatment. Patients and Methods: This study evaluated the clinical condition and performance status (Karnofsky-Index) of 95 patients, post-SOT administration. Furthermore, circulating tumor cells (CTCs) from 47 patients' pre- and post-SOT administration were measured and analyzed by repeated-measures ANOVA. Results: Improvement of the clinical condition was observed in all patients who used SOT (77.89%), SOT in combination with other therapy (69.77%) and SOT as a monotherapy or no information was given concerning another therapy (84.31%). Positive results for Karnofsky-Index were also observed in 71.58%, 61.36%, and 80.39%, respectively. Finally, statistically significant reductions in CTCs were observed for both SOT as a monotherapy and SOT as an adjunctive therapy. Conclusion: The preliminary results indicate that SOT therapy can be used both as monotherapy as well as in combination with other therapies for cancer. [ABSTRACT FROM AUTHOR]