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Objective: Mood assessment is challenging when people have cognitive and receptive communication impairments after severe brain injury. This study explored how UK-based medical and psychology professionals working with people with severe cognitive and communication impairments after brain injury assess mood in this population. Design: Following their participation in an online survey, professionals were invited to participate in individual semi-structured interviews. Interviews were analysed using thematic analysis to label explicit data (semantic themes) and implicit data (latent themes). Participants: Twenty-three clinical psychologists and nine medical professionals participated in online or in-person interviews. Results: Both groups explicitly reported using a combination of collateral information, history, observations, and patient interviews when assessing mood in this population. Medical professionals did not routinely use standardised measures and clinical psychologists often adjusted them when they used them. The respondents discussed difficulties conceptualising depression after brain injury, the experience needed by the assessor, and the need for an individualised approach for this population. Clinical psychologists discussed the pressures of working in healthcare systems and medical professionals discussed how symptoms may influence prescription choices. Seven latent themes were labelled which highlighted additional challenges and complexities experienced by those assessing mood, beyond the actual assessment process itself. Conclusions: No 'gold standard' approach to assessing mood in those with cognitive and communication difficulties after severe brain injury was identified. There was overlap in assessment approaches but no clear consensus. Interviewees felt that mood assessment must be approached differently in this population and that self-report measures are not useful. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The malaria vaccination landscape has seen significant advancements with the recent endorsement of RTS,S/AS01 and R21/Matrix-M vaccines, which target the pre-erythrocytic stages of Plasmodium falciparum (Pf) infection. However, several challenges remain to be addressed, including the incomplete protection afforded by these vaccines, their dependence on a single Pf antigen, and the fact that they were not designed to protect against P. vivax (Pv) malaria. Injectable formulations of whole-sporozoite (WSpz) malaria vaccines offer a promising alternative to existing subunit vaccines, with recent developments including genetically engineered parasites and optimized administration regimens. Clinical evaluations demonstrate varying efficacy, influenced by factors, such as immune status, prior exposure to malaria, and age. Despite significant progress, a few hurdles persist in vaccine production, deployment, and efficacy in malaria-endemic regions, particularly in children. Concurrently, transgenic parasites expressing Pv antigens emerge as potential solutions for PvWSpz vaccine development. Ongoing clinical studies and advancements in vaccine technology, including the recently described PfSPZ-LARC2 candidate, signify a hopeful future for WSpz malaria vaccines, which hold great promise in the global fight against malaria. This Review discusses challenges in developing malaria vaccines and promising recent developments in whole-sporozoite vaccines using genetically engineered parasites with a perspective on future directions of these vaccines for the prevention of malaria. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Materials and Methods Results Conclusions Clinical evaluation of chairside‐fabricated lithia‐zirconia glass–ceramic (LZGC) partial crowns (CCPCs) in a multicenter practice‐based study.Seventy‐one patients were restored with 92 adhesively luted CCPCs (Cerec SW 4.2/Cerec MC XL/Celtra Duo) in three private dental clinics (C1–C3). Time‐dependent (Kaplan–Meier) survival rates (SVR) and success rates (SCR) were calculated. The following possible covariates of SVRs and SCRs were evaluated in a Cox regression model: Restoration position (premolar/molar), luting material (Variolink/Calibra), and operator (C1–C3).Seventy‐three CCPCs were placed in 59 patients and were included in the study (mean observational period: 58.0 ± 15 months). Four complete failures (two tooth fractures, one restoration fracture, and one endodontic failure) were recorded. All failures and interventions occurred in one of the three centers (5‐year SCR: C1 + C2: 100%; C3: 71%; 95% confidence interval: [0.55; 0.87]). Additionally, three biological, and two technical complications required clinical intervention to maintain function, and all occurred in C3. Restorations placed in C1 and C2 showed a significantly reduced risk for failure/intervention (hazard ratio = 0.103, p = 0.026) compared with restorations placed in C3.LZGC CCPCs showed good five‐year clinical performance. However, SVRs and SCRs were significantly influenced by the operator. Additional clinical data are required for a more detailed investigation of this effect. [ABSTRACT FROM AUTHOR]

A precise radiotherapy plan is crucial to ensure accurate segmentation of glioblastomas (GBMs) for radiation therapy. However, the traditional manual segmentation process is labor‐intensive and heavily reliant on the experience of radiation oncologists. In this retrospective study, a novel auto‐segmentation method is proposed to address these problems. To assess the method's applicability across diverse scenarios, we conducted its development and evaluation using a cohort of 148 eligible patients drawn from four multicenter datasets and retrospective data collection including noncontrast CT, multisequence MRI scans, and corresponding medical records. All patients were diagnosed with histologically confirmed high‐grade glioma (HGG). A deep learning‐based method (PKMI‐Net) for automatically segmenting gross tumor volume (GTV) and clinical target volumes (CTV1 and CTV2) of GBMs was proposed by leveraging prior knowledge from multimodal imaging. The proposed PKMI‐Net demonstrated high accuracy in segmenting, respectively, GTV, CTV1, and CTV2 in an 11‐patient test set, achieving Dice similarity coefficients (DSC) of 0.94, 0.95, and 0.92; 95% Hausdorff distances (HD95) of 2.07, 1.18, and 3.95 mm; average surface distances (ASD) of 0.69, 0.39, and 1.17 mm; and relative volume differences (RVD) of 5.50%, 9.68%, and 3.97%. Moreover, the vast majority of GTV, CTV1, and CTV2 produced by PKMI‐Net are clinically acceptable and require no revision for clinical practice. In our multicenter evaluation, the PKMI‐Net exhibited consistent and robust generalizability across the various datasets, demonstrating its effectiveness in automatically segmenting GBMs. The proposed method using prior knowledge in multimodal imaging can improve the contouring accuracy of GBMs, which holds the potential to improve the quality and efficiency of GBMs' radiotherapy. [ABSTRACT FROM AUTHOR]

This study examined the morphometric and clinical aspects as well as the nutritional and dietary management of undernourished adult patients in the Marrakech Tensift Al Haouz region, Morocco. It highlighted the specific challenges faced by these patients, in particular the significant differences in nutritional requirements and management strategies. Our results showed a significant increase in caloric intake from 19.97±0.64 kcal/kg/d to 27.23±0.12 kcal/kg/d for all patients. Muscle mass increased from 16.71±4.76 kg to 18.75±3.58 kg. The mean albumin increased to 35.9 g/L, indicating an improved protein reserve. Similarly, pre-albumin increased to 186.3 mg/dL, suggesting a rapid response to nutritional intake. At the same time, Creactive protein levels fell, indicating a reduction in systemic inflammation. In addition, it is important to note that body mass index differed between the sexes, with women tending to gain muscle mass more slowly than men. The results highlight the urgent need to adopt a personalized approach to improving the health and well-being of undernourished patients by adjusting nutritional and dietary interventions to the specific needs of each individual. [ABSTRACT FROM AUTHOR]

Objective Early onset sepsis (EOS) is a significant cause of morbidity and mortality in the newborn period. This has led to overinvestigation and antibiotic overuse, which remains a concern in EOS management. Sepsis risk calculator (SRC), a tool validated in American and European populations, aids physicians in sepsis risk stratification and has been shown to decrease antibiotics overuse for EOS. The aim of the study was to evaluate the efficacy and safety of the SRC in a tertiary referral center in Lebanon. Methods This was a single-center retrospective cohort study, conducted at a tertiary medical center in Beirut, Lebanon, that included infants born at more than 34 weeks' gestational age between January 1, 2017 and January 1, 2019. Data was collected on risk factors for neonatal sepsis and the clinical management performed on each newborn. The SRC was used to calculate a sepsis risk score for each patient. Comparison between actual management performed and SRC recommendation was measured. Results We reviewed 3,085 charts, out of which 257 charts were excluded. Patients were stratified into two groups: high sepsis risk and low sepsis risk. Out of the 2,828 patients included, 81 infants (2.9%) had high risk of sepsis, out of which 2 patients had positive blood cultures. There were no patients with a low SRC score who had positive blood cultures. There were no patients who were supposed to receive antibiotics per the SRC recommendation who did not undergo workup for sepsis. Implementing SRC would have prevented antibiotics administration in 42 (1.5%) patients. Conclusion SRC was adequately capable of detecting neonates with sepsis without missing actual cases of EOS, providing initial support for its safety in the population studied. Implementing the SRC would result in reduced usage of antibiotics, laboratory tests, and admissions to the neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

Susceptibility source separation, or χ‐separation, estimates diamagnetic (χdia) and paramagnetic susceptibility (χpara) signals in the brain using local field and R2′ (= R2* − R2) maps. Recently proposed R2*‐based χ‐separation methods allow for χ‐separation using only multi‐echo gradient echo (ME‐GRE) data, eliminating the need for additional data acquisition for R2 mapping. Although this approach reduces scan time and enhances clinical utility, the impact of missing R2 information remains a subject of exploration. In this study, we evaluate the viability of two previously proposed R2*‐based χ‐separation methods as alternatives to their R2′‐based counterparts: model‐based R2*‐χ‐separation versus χ‐separation and deep learning‐based χ‐sepnet‐R2* versus χ‐sepnet‐R2′. Their performances are assessed in individuals with multiple sclerosis (MS), comparing them with their corresponding R2′‐based counterparts (i.e., R2*‐χ‐separation vs. χ‐separation and χ‐sepnet‐R2* vs. χ‐sepnet‐R2′). The evaluations encompass qualitative visual assessments by experienced neuroradiologists and quantitative analyses, including region of interest analyses and linear regression analyses. Qualitatively, R2*‐χ‐separation tends to report higher χpara and χdia values compared with χ‐separation, leading to less distinct lesion contrasts, while χ‐sepnet‐R2* closely aligns with χ‐sepnet‐R2′. Quantitative analysis reveals a robust correlation between both R2*‐based methods and their R2′‐based counterparts (r ≥ 0.88). Specifically, in the whole‐brain voxels, χ‐sepnet‐R2* exhibits higher correlation and better linearity than R2*‐χ‐separation (χdia/χpara from R2*‐χ‐separation: r = 0.88/0.90, slope = 0.79/0.86; χdia/χpara from χ‐sepnet‐R2*: r = 0.90/0.92, slope = 0.99/0.97). In MS lesions, both R2*‐based methods display comparable correlation and linearity (χdia/χpara from R2*‐χ‐separation: r = 0.90/0.91, slope = 0.98/0.91; χdia/χpara from χ‐sepnet‐R2*: r = 0.88/0.88, slope = 0.91/0.95). Notably, χ‐sepnet‐R2* demonstrates negligible offsets, whereas R2*‐χ‐separation exhibits relatively large offsets (0.02 ppm in the whole brain and 0.01 ppm in the MS lesions), potentially indicating the false presence of myelin or iron in MS lesions. Overall, both R2*‐based χ‐separation methods demonstrated their viability as alternatives to their R2′‐based counterparts. χ‐sepnet‐R2* showed better alignment with its R2′‐based counterpart with minimal susceptibility offsets, compared with R2*‐χ‐separation that reported higher χpara and χdia values compared with R2′‐based χ‐separation. [ABSTRACT FROM AUTHOR]

Background: Rupture of the long head of the distal bifid biceps tendon is a rare injury, for which surgical anatomical repair should be considered in active patients. The aim of this study was to review our patients who benefited from the EndoButton technique via a single anterior approach, comparing the clinical outcomes with the contralateral uninjured side and assessing their quality of life. Our hypothesis was that an “anatomical” insertion, through an anterior approach, by reinserting the 2 distinct tendons on the radial tuberosity, would restore the supination ability of the forearm more effectively than flexion strength. Methods: This study included 25 patients who underwent surgery between June 2015 and January 2021. All patients underwent distal biceps reattachment using an endo-osseous fixation technique with the same device. Each patient completed a quality-of-life questionnaire and participated in biomechanical performance tests. Results: We observed a significant 14% reduction in strength during flexion on the operated side compared to the healthy side. However, no significant differences in strength were found for supination, extension, and pronation between the operated and nonoperated limbs in these same patients. In terms of endurance, flexion on the operated side tended to exhibit greater endurance than on the healthy side, while endurance in supination appeared similar between the operated and healthy sides. This finding held irrespective of whether the operated limb was dominant or nondominant. We also discovered a strong correlation between the time elapsed since surgery and differences in strength during both flexion and supination. Conclusion: The ultimate goal is to achieve an anatomical surgical repair to restore all functions and maximize patient outcomes. As demonstrated, we have obtained good clinical results with EndoButton repair and a single anterior approach. The results in terms of strength and endurance are similar to those reported in the literature, and all our patients are satisfied. No postoperative complications were found.

Abstract The malaria vaccination landscape has seen significant advancements with the recent endorsement of RTS,S/AS01 and R21/Matrix-M vaccines, which target the pre-erythrocytic stages of Plasmodium falciparum (Pf) infection. However, several challenges remain to be addressed, including the incomplete protection afforded by these vaccines, their dependence on a single Pf antigen, and the fact that they were not designed to protect against P. vivax (Pv) malaria. Injectable formulations of whole-sporozoite (WSpz) malaria vaccines offer a promising alternative to existing subunit vaccines, with recent developments including genetically engineered parasites and optimized administration regimens. Clinical evaluations demonstrate varying efficacy, influenced by factors, such as immune status, prior exposure to malaria, and age. Despite significant progress, a few hurdles persist in vaccine production, deployment, and efficacy in malaria-endemic regions, particularly in children. Concurrently, transgenic parasites expressing Pv antigens emerge as potential solutions for PvWSpz vaccine development. Ongoing clinical studies and advancements in vaccine technology, including the recently described PfSPZ-LARC2 candidate, signify a hopeful future for WSpz malaria vaccines, which hold great promise in the global fight against malaria.

The global rise of drug resistant tuberculosis has highlighted the need for improved diagnostic technologies that provide rapid and reliable drug resistance results. Here, we develop and validate a whole genome sequencing (WGS)-based test for identification of mycobacterium tuberculosis complex (MTB) drug resistance to rifampin, isoniazid, pyrazinamide, ethambutol, and streptomycin. Through comparative analysis of drug resistance results from WGS-based testing and phenotypic drug susceptibility testing (DST) of 38 clinical MTB isolates from patients receiving care in Los Angeles, CA, we found an overall concordance between methods of 97.4% with equivalent performance across culture media. Critically, prospective analysis of 11 isolates showed that WGS-based testing provides results an average of 36 days faster than phenotypic culture-based methods. We showcase the additional benefits of WGS data by investigating a suspected laboratory contamination event and using phylogenetic analysis to search for cryptic local transmission, finding no evidence of community spread amongst our patient population in the past six years. WGS-based testing for MTB drug resistance has the potential to greatly improve diagnosis of drug resistant MTB by accelerating turnaround time while maintaining accuracy and providing additional benefits for infection control, lab safety, and public health applications.

ABSTRACTIntroduction Following the coronavirus disease pandemic, respiratory mucosal vaccines that elicit both mucosal and systemic immune responses have garnered increasing attention. However, human physiological characteristics pose significant challenges in the evaluation of mucosal immunity, which directly impedes the development and application of respiratory mucosal vaccines.Areas Covered This study summarizes the characteristics of immune responses in the respiratory mucosa and reviews the current status and challenges in evaluating immune response to respiratory mucosal vaccines.Expert Opinion Secretory Immunoglobulin A (S-IgA) is a major effector molecule at mucosal sites and a commonly used indicator for evaluating respiratory mucosal vaccines. However, the unique physiological structure of the respiratory tract pose significant challenges for the clinical collection and detection of S-IgA. Therefore, it is imperative to develop a sampling method with high collection efficiency and acceptance, a sensitive detection method, reference materials for mucosal antibodies, and to establish a threshold for S-IgA that correlates with clinical protection. Sample collection is even more challenging when evaluating mucosal cell immunity. Therefore, a mucosal cell sampling method with high operability and high tolerance should be established. Targets of the circulatory system capable of reflecting mucosal cellular immunity should also be explored.

Acute abdomen cases are among the most prevalent and challenging illnesses in equine medicine. The diagnosis includes anamnesis and detailed clinical evaluation of the patient, allowing the gathering of several important information and, additionally, the use of complementary exams helps to define the diagnosis and prognosis of each case. This research applied the multiple correspondence analysis (MCA) in data referring to clinical examination information and outcome of horses with colic referred to a hospital in Rio Grande do Sul, Brazil. Fifty eight horses were included in the analysis and, it was possible to identify significant differences between the groups, survivors and non-survivors. Related to clinical signs, non-survivor cases are distinguished by severe pain, lack of motility, mucosal alteration, capillary refill time greater than 2sec, heart rate more than 48bpm and presence of nasogastric reflux. As complementary exams, hematocrits and blood lactate demonstrate significative difference among the groups. The cardiovascular parameters, including heart rate, mucosal color and capillary refill time, were the variables with the greatest contribution to discriminate animals that non-survive from those that were discharged. Thus, clinical evaluation should not be underestimated and complementary exams should be used in conjunction to seek a better prognosis. The MCA allowed to visualize the data and predict the outcome of the patients. [ABSTRACT FROM AUTHOR]

Objective: The assessment of mood after brain injury is more challenging when people have ongoing severe cognitive and receptive communication impairments. There is no gold standard on how these assessments should be undertaken. This study aimed to reach a consensus on this among specialists working with this population. Design: Focus groups were completed using a structured nominal group technique. Groups were compared for overlapping themes and agreed processes. Participants: Five focus groups with a total of 14 participants who work with the population of interest were completed. Participants included 12 clinical psychologists, one psychiatrist and one consultant in rehabilitation medicine. Results: Each of the five groups reached a consensus on a process for assessing mood in this population. Results overlapped and were combined into a proposed circular and iterative model of assessment that includes: (pre) information gathering, (peri) assessment processes, and (post) treatment; with formulation being seen as a vital part of the process. Standardised measures were not recommended for use with this population. Beyond the consensus processes, three implicit themes were identified: (1) depression is different after severe brain injury, (2) overlapping tasks and roles, and (3) looking at the bigger picture. Conclusions: A good level of consensus was achieved across the five groups on processes to follow when assessing mood when people have ongoing cognitive and receptive communication impairments after severe brain injury. We recommend that this formulation-based model be followed when assessing people in this clinical population. [ABSTRACT FROM AUTHOR]

Introduction: Adhesive capsulitis (AC), often referred to as frozen shoulder, presents a diagnostic challenge due to its insidious onset and progressive nature. The condition is characterized by pain and restricted motion in the shoulder, with a predilection for individuals between 40 and 60 years of age. A novel scoring system was developed to enhance the accuracy of diagnosing AC and distinguishing between its stages, aiming to streamline clinical decision-making and treatment planning. Methods: A cohort of patients with symptoms suggestive of AC was assessed using the new scoring system, which integrates clinical, radiological, and patient history factors. Parameters included comorbidities like diabetes mellitus, recent immobility, rotator cuff tears, and specific ultrasound findings. Patients were scored and categorized into definitive AC, uncertain diagnosis, or exclusion from AC, with scores > 7, 6–2, and < 2, respectively. Results: The scoring system effectively categorized patients, with those scoring > 7 demonstrating pronounced symptoms and ultrasound changes consistent with Phase 2 AC. Patients with scores between 6 and 2 were classified into uncertain Phase 1 or Phase 3, necessitating further observation. Scores < 2 effectively excluded AC, indicating a need to explore alternative diagnoses. Conclusion: The structured scoring system demonstrated potential as a comprehensive tool for diagnosing AC. By quantitatively assessing a range of contributory factors, it allowed for the stratification of the disease into distinct stages. This system is anticipated to improve early diagnosis and the precision of treatment interventions, although further validation in larger cohorts is warranted. Level of evidence: II-III. [ABSTRACT FROM AUTHOR]

As the direct microenvironment of assisted reproductive technology, the evaluation of culture medium for human assisted reproduction technology is particularly important. This paper discussed the classification management, technical review points, clinical evaluation and review thinking, focusing on the basic requirements, raw material control, biological evaluation, sterilization process of culture medium for human assisted reproduction technology, combined with some material limit, new added material and quality system control to thoroughly assess management risk of the whole life cycle of culture medium for human assisted reproduction technology.

Background and purpose: Idiopathic normal pressure hydrocephalus (iNPH) is a chronic neurological disease resulting in progressive gait and cognitive disorders. We investigated whether the gait phenotype is associated with the severity of cognitive deficits in iNPH. Methods: This retrospective study recruited 88 patients (mean age = 76.18 ± 7.21 years, 42% female). Patients were initially referred for suspicion of iNPH and underwent a comprehensive analysis, including gait analysis and cognitive evaluation. Results: In this cohort (27% normal gait, 25% frontal gait, 16% parkinsonian gait, 27% other gait abnormalities), patients with parkinsonian and frontal gait had the lowest Mini‐Mental State Examination (MMSE) scores and the slowest gait speed. Patients with normal gait had the highest MMSE scores and gait speed. Frontal gait was associated with lower MMSE score, even after adjusting for age, gender, comorbidities, white matter lesions, and education level (β = −0.221 [95% confidence interval (CI) = −3.718 to −0.150], p = 0.034). Normal gait was associated with the best MMSE scores, even after adjusting for the abovementioned variables (β = 0.231 [95% CI = 0.124–3.639], p = 0.036). Conclusions: Gait phenotypes among iNPH patients are linked to global cognition as assessed with MMSE. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: Reference values for isokinetic knee extensor strength were established for geriatric day hospital patients aged 75 to 94 years. Findings: Those patients present a significant decrease in absolute and relative isokinetic knee extensor strength after the age of 85. Message: Isokinetic knee extensor strength may better reflect physical function than grip strength in geriatric day hospital patients. Purpose: Isokinetic knee extensor strength is poorly evaluated in geriatric day hospitals (GDHs), despite its potential functional significance compared to grip strength. This study aimed to investigate age-related effects on absolute and relative isokinetic knee extensor peak torque (KEPT) data in community-dwelling older GDH patients. Methods: A total of 472 French GDH patients (179 men and 293 women, aged 75–94 years) participated in this study. Absolute and relative KEPT were measured at six distinct angular velocities between 0.52 and 3.14 rad/s. In addition, comfortable gait speed and grip strength were assessed. Participants were stratified by sex and age using 5-year intervals. One-way ANOVAs were used to examine age-related effects on KEPT values. Multiple linear regression models were employed to investigate the associations between gait speed and both mean KEPT values and grip strength, with separate models conducted on absolute and relative values. Results: The recruited GDH patients presented lower absolute and relative KEPT values in comparison with established reference values for healthy community-dwelling older individuals, with men being consistently stronger than women. Notably, there was a significant decline in both absolute and relative KEPT values beyond the age of 85 for both sexes. Importantly, the multiple linear regression analyses conducted revealed a significant positive relationship between gait speed and mean KEPT values, surpassing the association with grip strength. Conclusions: These findings underscore the clinical importance of assessing isokinetic knee extensor strength in community-dwelling older GDH patients, particularly for tailoring personalized physical activity interventions. [ABSTRACT FROM AUTHOR]

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This document is an editorial published in the journal Frontiers in Neurology, discussing new insights and perspectives on traumatic brain injury (TBI). It emphasizes the importance of integration, translation, and multidisciplinary approaches in TBI research. The editorial highlights various aspects of TBI-related research, including basic and translational research, clinical research, and forensic and precision identification research. It mentions several research articles and reviews that contribute to these areas and provide valuable references for understanding TBI. The document also emphasizes the need for further research to improve TBI models, expand clinical studies, and explore biomarkers and imaging techniques for forensic identification. The document concludes a research topic on TBI and related fields, aiming to disseminate high-quality research and bridge the gap between basic neuroscience knowledge and the unmet needs in brain health. It emphasizes the importance of addressing the service provision system, including prevention, care, rehabilitation, and resocialization of TBI victims. The authors express gratitude to the groups that submitted their scientific findings and the reviewers who enhanced the quality of each study. [Extracted from the article]

The point-of-care ultrasonography (POCUS) has become integral for physicians working in critical care set-ups.It has been used for acute and crisismanagement, ongoing care of the patient, real-time guidance for performing procedures, diagnostic and screening aids, etc. Interestingly, the use of POCUS is increasing daily, and intensivists and critical care physicians are routinely scanning the lung, heart, vascular structure, abdomen, optic nerves, etc. Presently, literature for the routine and emergency use of ultrasound for protocolized assessment for differentiating and diagnosing acute respiratory failure, acute shock, and undifferentiated shock is available. Although there is some overlap, most of the protocolized approach primarily aims at respiratory or circulatory failure. On the other hand, the respiratory and cardiovascular system is well integrated. Moreover, critically ill patients also suffer other organ insufficiencies because of cardiorespiratory insufficiencies or vice versa. Nevertheless, POCUS is now considered the visual stethoscope of critical care physicians. Therefore, a multiorgan integrated approach is justified for assessing the patient right from the first clinical evaluation on admission. This article is intended to provide brief information related to the use and current practice of ultrasonology for critical care patient management by the residents and provide a technical framework for multiorgan integrated critical care ultrasonology (MICCUS) approach for evaluating patients having a new or ongoing acute cardiorespiratory insufficiencies with particular emphasize on the respiratory, cardiac, and vascular systems and integrating the evaluation of the abdomen and urological system. Nevertheless, the MICCUS is just an approach (how critical care ultrasonology can be integrated), not a protocol. It is developed by using existing and validated protocols on topics. [ABSTRACT FROM AUTHOR]

Introduction: Prostate-specific membrane antigen (PSMA) is increasingly recognized as a viable target for imaging and therapy of Prostate cancer (PCa). In this study, we introduce the freeze-dried kit formulation of [99mTc]Tc-HYNICALUG for easy clinical evaluation of prostate cancer. Methods: In this work, an in silico modeling of the urea-based PSMA small molecule (HYNIC-ALUG) was performed to check its interaction with human glutamate carboxypeptidase II and compared it with experimental results. The HYNIC-PSMA kit was formulated for easy preparation of [99mTc]Tc-HYNIC-ALUG. The kit contained a freeze-dried mixture of HYNIC-ALUG, coligands SnCl2.2H2O, and antioxidant D-mannitol. Results: The calculated Ki value (inhibition/dissociation constant) was 4.55 which showed excellent binding affinity of HYNIC-ALUG with PSMA. miLogP and cLogS values are -4.04 and -3.07 respectively showing its hydrophilic character and predicting its excellent distribution in biological fluids. Subsequently, the radiochemical purity of the HYNIC-PSMA kit was 99.1 ± 1.32% (n = 6) determined by radio-ITLC and by HPLC as well. In vitro stability in saline and serum was studied up to 4 h and showed high stability (≥ 96%). The distribution of [99mTc]Tc-HYNIC-ALUG was carried out in two patients and SPECT/CT planar images were acquired at 2h and 4h respectively. Bio-physiological distribution of [99mTc]Tc- HYNIC-ALUG was observed normally in lacrimal, salivary glands, liver, spleen, gut, kidneys, and urinary bladder. Conclusion: The HYNIC-ALUG freeze-dried kit could be used for easy preparation of [99mTc]Tc-HYNIC-ALUG and can be considered as a potential agent for the diagnosis, staging, and restaging of advanced prostate cancer. [ABSTRACT FROM AUTHOR]

Composite resin is utilised as an aesthetically acceptable substitute for amalgam in the restoration of posterior teeth. The choice between direct and indirect composite restorations poses a significant clinical challenge. The databases used for this review were PubMed Advanced Search (up to 2024), Medline, and the Cochrane Database. The primary aim was to evaluate the durability of both direct and indirect composite restorations. Indirect composite restorations are renowned for their outstanding surface texture, anatomically accurate form, optimal occlusal characteristics, enhanced tooth strength, reduced sensitivity, low gum bleeding, and minimum discoloration around the borders. Conversely, direct composite restorations have shown superior restorative integrity. Composite restorations frequently fail as a result of tooth fracture, while indirect restorations commonly fail owing to adhesive failure. Sixteen studies conducted a comparative analysis of the clinical efficacy of direct and indirect composite restorations in posterior teeth. Multiple studies have concluded that there is no significant disparity between direct and indirect approaches. Nevertheless, the data is inconclusive. In order to assess the clinical effectiveness of direct and indirect composite restorations, it is recommended that future research focusses on conducting randomised controlled trials with extended periods of follow-up. This review aims at comparing the clinical performance of direct versus indirect composite restorations . [ABSTRACT FROM AUTHOR]

After a wave of breakthroughs in image‐based medical diagnostics and risk prediction models, machine learning (ML) has turned into a normal science. However, prominent researchers are claiming that another paradigm shift in medical ML is imminent—due to most recent staggering successes of large language models—from single‐purpose applications toward generalist models, driven by natural language. This article investigates the implications of this paradigm shift for the ethical debate. Focusing on issues like trust, transparency, threats of patient autonomy, responsibility issues in the collaboration of clinicians and ML models, fairness, and privacy, it will be argued that the main problems will be continuous with the current debate. However, due to functioning of large language models, the complexity of all these problems increases. In addition, the article discusses some profound challenges for the clinical evaluation of large language models and threats to the reproducibility and replicability of studies about large language models in medicine due to corporate interests. [ABSTRACT FROM AUTHOR]

Purpose: Preventing positive margins is essential for ensuring favorable patient outcomes following breast-conserving surgery (BCS). Deep learning has the potential to enable this by automatically contouring the tumor and guiding resection in real time. However, evaluation of such models with respect to pathology outcomes is necessary for their successful translation into clinical practice. Methods: Sixteen deep learning models based on established architectures in the literature are trained on 7318 ultrasound images from 33 patients. Models are ranked by an expert based on their contours generated from images in our test set. Generated contours from each model are also analyzed using recorded cautery trajectories of five navigated BCS cases to predict margin status. Predicted margins are compared with pathology reports. Results: The best-performing model using both quantitative evaluation and our visual ranking framework achieved a mean Dice score of 0.959. Quantitative metrics are positively associated with expert visual rankings. However, the predictive value of generated contours was limited with a sensitivity of 0.750 and a specificity of 0.433 when tested against pathology reports. Conclusion: We present a clinical evaluation of deep learning models trained for intraoperative tumor segmentation in breast-conserving surgery. We demonstrate that automatic contouring is limited in predicting pathology margins despite achieving high performance on quantitative metrics. [ABSTRACT FROM AUTHOR]

This study examined the morphometric and clinical aspects as well as the nutritional and dietary management of undernourished adult patients in the Marrakech Tensift Al Haouz region, Morocco. It highlighted the specific challenges faced by these patients, in particular the significant differences in nutritional requirements and management strategies. Our results showed a significant increase in caloric intake from 19.97±0.64 kcal/kg/d to 27.23±0.12 kcal/kg/d for all patients. Muscle mass increased from 16.71±4.76 kg to 18.75±3.58 kg. The mean albumin increased to 35.9 g/L, indicating an improved protein reserve. Similarly, pre-albumin increased to 186.3 mg/dL, suggesting a rapid response to nutritional intake. At the same time, C-reactive protein levels fell, indicating a reduction in systemic inflammation. In addition, it is important to note that body mass index differed between the sexes, with women tending to gain muscle mass more slowly than men. The results highlight the urgent need to adopt a personalized approach to improving the health and well-being of undernourished patients by adjusting nutritional and dietary interventions to the specific needs of each individual.

ABSTRACT: Acute abdomen cases are among the most prevalent and challenging illnesses in equine medicine. The diagnosis includes anamnesis and detailed clinical evaluation of the patient, allowing the gathering of several important information and, additionally, the use of complementary exams helps to define the diagnosis and prognosis of each case. This research applied the multiple correspondence analysis (MCA) in data referring to clinical examination information and outcome of horses with colic referred to a hospital in Rio Grande do Sul, Brazil. Fifty eight horses were included in the analysis and, it was possible to identify significant differences between the groups, survivors and non-survivors. Related to clinical signs, non-survivor cases are distinguished by severe pain, lack of motility, mucosal alteration, capillary refill time greater than 2sec, heart rate more than 48bpm and presence of nasogastric reflux. As complementary exams, hematocrits and blood lactate demonstrate significative difference among the groups. The cardiovascular parameters, including heart rate, mucosal color and capillary refill time, were the variables with the greatest contribution to discriminate animals that non-survive from those that were discharged. Thus, clinical evaluation should not be underestimated and complementary exams should be used in conjunction to seek a better prognosis. The MCA allowed to visualize the data and predict the outcome of the patients.

A study published in the International Journal of Dermatology explores the differences in how atopic dermatitis (AD) presents in adults of different racial backgrounds. The study reveals that Black individuals with AD are more likely to have involvement in the neck area, as well as other specific symptoms such as darkening around the eyes and dry skin. They also tend to have a higher prevalence of asthma and an earlier onset and more persistent AD compared to White patients. The study emphasizes the need to consider these racial differences when diagnosing and treating AD to ensure that individuals who do not fit the typical presentation are not overlooked. [Extracted from the article]

Introduction: Non-carious cervical lesions (NCCL) raise a considerable restorative challenge for the dentist in bonding, as adhesion is not as strong and predictable as enamel bonding. A critical factor for restorative success is the selection of restorative material. Clinicians have tried many restorative materials and techniques to obtain the best performance. The aim of the present study was to evaluate and compare the clinical outcome of a Giomer and Resin modified glass ionomer cement (RMGIC) restoration in NCCL using united states public health service (USPHS) criteria at baseline, 3, 6 and 12 months. Materials and Method: Patients from age 25 - 50 years having non-carious cervical lesions on both the sides and requiring restorations were screened. 20 patients were selected and further divided into 2 groups using simple random sampling technique. Group A- Beautifil II restoration using G-Premio bond (n = 10) and Group B- Ketac N100 restoration (n = 10). Restorations were done according to manufacturer's instructions and consequently evaluated at baseline, 3, 6 and 12 months using the USPHS criteria for marginal discolouration, marginal integrity, surface texture, colour match, gross fracture and post-operative sensitivity. Results: Giomer restorations showed better results than RMGIC. There was decrease in alpha ratings in both the study groups i.e., Giomer and RMGIC from 6 to 12 months. Discussion: The overall findings suggest that both Giomer and RMGIC gave satisfactory clinical results when used to restore non-carious cervical lesions. Both the materials can successfully be used since there was no statistically significant difference in the clinical outcome.

Objective To study the clinical effect of a polyetheretherketone (PEEK) bonding bridge on the loss of 3 internal incisors in patients with periodontitis. Methods This study was reviewed and approved by the ethics committee, and informed consent was obtained from the patients. Thirty-eight patients with periodontitis and 3 missing central or lateral teeth were selected to undergo restoration with a PEEK bonding bridge and then returned to the hospital 3, 6, 12, and 24 months after the restoration was completed. The survival rate of the restorations was assessed by the modified USPHS/Ryge criteria. The plaque index, gingival index, periodontal probing depth and attachment loss of the abutments were recorded, and the changes in periodontal tissues after restoration were observed and compared. Results Over 24 months of clinical follow-up observation of 38 patients, only 1 patient underwent secondary bonding after partial debonding (evaluated as grade B), while bonding was successful in the other 37 cases (evaluated as grade A). The plaque index, gingival index and periodontal probing depth were significantly lower after restoration than before (PP>0.05). Conclusion For periodontitis patients missing 3 internal incisors, short-term PEEK bonding bridge repair has good clinical efficacy.

ObjectiveThe applications of personalized abutments and abutment crown bridge products have increased year by year, but there is no clear requirement for clinical evaluation of the same variety of such products. This study mainly introduces the clinical evaluation concerns of personalized abutments and abutment crown bridge products, in order to provide reference for the declaration and registration of such products. MethodsThe clinical evaluation of personalized abutments and crown bridge products are summarized, and the research content of clinical evaluation is clarified. ResultsThe clinical evaluation requirements that need to be considered by enterprises are introduced. ConclusionPersonalized abutment and abutment crown bridge products can refer to this study when they are launched in China, mainly using in vitro performance comparison tests for equivalence verification.

Objective To develop a comprehensive framework for selecting outcomes in evaluating the clinical efficacy of Chinese herbal injections and to scientifically select outcomes for the clinical randomized controlled trial (RCT) of Tan-Re-Qing injection intervening AECOPD.Methods A comprehensive literature review and consensus methods, including focus groups and Delphi surveys, were utilized.Results Literature analysis identified 513 publications, encompassing regulatory guidance, guidelines, expert consensus, and RCTs. Initial dimensions include clinical efficacy, safety, and health economics. Primary outcomes should align with study objectives. Recommended evaluation domains include death, treatment outcome, future impact, quality of life, and safety. Commonly recommended outcomes comprise mortality, arterial blood gases, CAT, exacerbation frequency, adverse events, and lung function. Network meta-analysis identified specific therapeutic efficacy markers (white blood cell count, IL-6, IL-8). Quality of life assessment recommended SF-12, EQ-5D, or CAT. Emphasis on AECOPD frequency and lung function was noted. Delphi survey yielded 41 outcomes across various domains for evaluating Tan-Re-Qing in AECOPD.Conclusion The findings contribute to developing a robust and reliable trial design for Tan-Re-Qing injection in AECOPD. The methodology employed in this study ensures a systematic and comprehensive approach to the selection of outcomes for the clinical evaluation of future studies in this field.

AbstractAutomatic type identification of sub-axial spine fractures is of prime importance for orthopaedicians to reduce image interpretation time and increase patient care time. But identifying fracture types is challenging due to imbalanced datasets. In this work, CT scan images of fractured spine has been collected from a Tertiary Care hospital and extended Deep Convolutional Generative Adversarial Network (DCGAN) architecture is developed for generating spine fracture images that overcomes the imbalanced dataset problem. These enhanced dataset are clinically evaluated with Two Visual Turing Tests (VTTs): the first test to “identify real and generated images” and second test to determine “type of fractures in the generated images.” The first VTT demonstrates that generated images of fractures are realistic and that even spine surgeons have difficulty in distinguishing them from real. The second VTT demonstrates that fracture lines are clearly visible in the generated images. The VTT results are analyzed using Fleiss Kappa statistical techniques to determine the inter-observer reliability of spine surgeons’ clinical evaluation. The results showed high interobserver agreement for “type identification” in the generated images. The clinically evaluated generated images are provided to the proposed ensemble based type identification model, which outperformed other models in type identification.

Objective The aim of this study is to identify whether low lupus disease activity status (LLDAS) and clinical remission (CR) of belimumab plus standard of care (SoC) therapy are achievable goals in childhood-onset SLE (cSLE). Methods This multicentre, one arm pre-post intervention study was conducted at 15 centres in China. The primary end point was to describe the proportion of patients who achieved LLDAS and CR after 3, 6 and 12 months after treatment with belimumab plus SoC therapy. A multiple regression model was used to impute missing data. A Poisson regression model was used to calculate the effect of belimumab treatment on the reduced risk of serious diseases and the incidence of new damage. Result A total of 193 (92.2% female) with active cSLE from 15 centres were included. At 3, 6 and 12 months, the proportion of LLDAS (CR) was 12.4% (1.0%), 25.6% (4.5%) and 70.3% (29.7%), respectively. The mean SELENA-SLEDAI score decreased from 11.0 at baseline to 3.7, 2.9 and 1.7 at 3, 6 and 12 months. At baseline, all patients received steroids at a mean (s. d.) prednisone equivalent dose of 31.0 (18.2) mg/day, which decreased to 19.4 (10.8) mg/day at month 3, 12.6 (7.2) mg/day at month 6 and 6.7 (5.3) mg/day at month 12. The symptoms and immunological indicators were also significantly improved. Conclusion This is the first and largest sample size prospective clinical intervention study of cSLE patients treated with belimumab in China. LLDAS and CR were attainable treat-to-target of belimumab plus SoC therapy in cSLE. [ABSTRACT FROM AUTHOR]

Melatonin's cytoprotective properties may have therapeutic implications in treating ocular diseases like glaucoma and age-related macular degeneration. Literature data suggest that melatonin could potentially protect ocular tissues by decreasing the production of free radicals and pro-inflammatory mediators. This study aims to summarize the screened articles on melatonin's clinical, pharmacological, and formulation evaluation in treating ocular disorders. The identification of relevant studies on the topic in focus was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. The studies were searched in the following databases and web search engines: Pubmed, Scopus, Science Direct, Web of Science, Reaxys, Google Scholar, Google Patents, Espacenet, and Patentscope. The search time interval was 2013–2023, with the following keywords: melatonin AND ocular OR ophthalmic AND formulation OR insert AND disease. Our key conclusion was that using melatonin-loaded nano-delivery systems enabled the improved permeation of the molecule into intraocular tissues and assured controlled release profiles. Although preclinical studies have demonstrated the efficacy of developed formulations, a considerable gap has been observed in the clinical translation of the results. To overcome this failure, revising the preclinical experimental phase might be useful by selecting endpoints close to clinical ones. [ABSTRACT FROM AUTHOR]

To investigate the best predictor of muscle strength assessed with both Modified Sphygmomanometer Test (MST) methods (bag adaptation and non-adapted) and to provide normative values for these two MST methods for the strength assessment of the trunk, upper, and lower limb muscles. Cross-sectional study. The strength of 42 muscle groups were assessed with the MST in the bag adaptation and non-adapted methods in 120 healthy individuals, 50 % males, divided into three age groups (20–39, 40–59, 60–79) with 40 subjects per group. Stepwise multiple regression analysis was performed to investigate which independent variables (sex, age, and limb dominance) is the best predictor of muscle strength (α = 5 %). Sex was the best independent predictor for all muscle groups for both MST methods (8.8 % < R2<57.8 %, p < 0.0001), except for the ankle plantar flexors assed with the non-adapted sphygmomanometer, in which age was the best independent predictor (R2 = 25.6 %; p < 0.0001). The normative values of muscle strength were reported for both MST methods considering the subgroups (sex, age, and limb dominance). Ceiling effect was observed when the MST bag adaptation was used to assess some muscles (8.8 %). Sex was the best predictor of muscle strength, as commonly found for muscle strength assessment with the dynamometer. The normative values provided have high clinical utility and can be used to interpret results of muscle strength assessment using both MST methods. For the MST in the bag adaptation method, caution is advised for the assessment of some muscles. [ABSTRACT FROM AUTHOR]

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A combination of a ruptured sinus of Valsalva (RSOV) with Ebstein anomaly is a rare and clinically challenging entity. We describe a case of a 29-year-old female who presented with progressive dyspnoea and epigastric discomfort with symptoms and clinical findings not consistent with any single definitive diagnosis. In the primary echocardiography assessment, she was diagnosed with Ebstein anomaly. On the grounds of several unexplained clinical features and routine review echocardiography by the cardiology team, she was found to have a rare combination of Ebstein anomaly associated with RSOV. A cath study was performed to study the interplay of the hemodynamics of the two lesions, not described before in the literature, and also explain the clinical features not consistent with any one entity. We emphasize the significance of meticulous history-taking and sound clinical evaluation followed by corroboration with the diagnostic modalities for precise diagnosis and timely planned intervention in such rare associations. [ABSTRACT FROM AUTHOR]

Lumpy skin disease is a viral disease of cattle and buffaloes which causes skin nodules in susceptible animals. Implementation of mass vaccination is the most effective way for LSD control in endemic countries. LSD vaccine that was used in the current study is a domestically produced vaccine containing live attenuated Neethling strain. In this clinical trial, 11 male calves aged 6 to 9 months with an approximate weight of 150 to 250 kg and without antibodies against LSDV were used. The calves were divided into three groups: the first group consisted of two animals that were injected with ten times the vaccine dose, the second group comprised of four calves that were injected with one dose of vaccine and the third group consisted of five calves that received the vaccine diluent and assigned as control. On the 21st day after vaccination, the calves were challenged with a pathogenic strain of LSD virus through simultaneous intravenous and intradermal inoculation. All 11 calves were examined clinically daily for 14 days after the challenge and all clinical signs were recorded. None of the vaccinated animals (ten times the dose and one dose) showed any clinical signs of LSD including cutaneous nodules and fever within 14 days after challenge, while all the animals in the control group (non-vaccinated) showed clinical signs of LSD including cutaneous nodules. Therefore, the vaccine used in the present study was effective in protecting against wild LSD virus.

Abstract Objective We aimed to evaluate the contribution of simultaneous recording of electroencephalography–functional magnetic resonance imaging (EEG‐fMRI) in the diagnosis of epilepsy syndrome, localization of the epileptogenic zone (EZ), and decision‐making regarding surgical treatment. Methods We performed a retrospective study to evaluate patients with focal epilepsy who underwent EEG‐fMRI. Two evaluators assessed epilepsy syndrome, presumed focus, and surgical candidacy and defined confidence levels. They assessed these clinical characteristics first without EEG‐fMRI and then including EEG‐fMRI to assess how the results of EEG‐fMRI changed the evaluations. We also determined how the clinical evaluation was affected by the concordance level between the blood oxygen level‐dependent (BOLD) response and the presumed focus location, and by the confidence level of the BOLD response itself based on the t‐value of the primary and secondary clusters. Results Fifty‐one scans from 48 patients were included. The BOLD map affected 66.7% of the evaluations by altering evaluation items (epilepsy syndrome, presumed focus, or surgical candidacy) or their confidence levels. EEG‐fMRI results increased the confidence levels of epilepsy syndrome, presumed focus, or surgical candidacy in 47.1% of patients but reduced clinical confidence in these features in 11.8%. More specifically, the confidence levels increased for epilepsy syndrome in 28.5%, identification of presumed focus in 33.9%, and determination of surgical candidacy in 29.4%. The BOLD signal confidence level, whether high or low, did not influence these clinical factors. Significance Previous studies have emphasized the utility of EEG‐fMRI for the localization of the epileptogenic zone. This study demonstrated the potential of EEG‐fMRI to influence clinical confidence when determining epilepsy syndrome, the presumed epileptic focus, and surgical candidacy.

Objective: We aimed to evaluate the contribution of simultaneous recording of electroencephalography–functional magnetic resonance imaging (EEG‐fMRI) in the diagnosis of epilepsy syndrome, localization of the epileptogenic zone (EZ), and decision‐making regarding surgical treatment. Methods: We performed a retrospective study to evaluate patients with focal epilepsy who underwent EEG‐fMRI. Two evaluators assessed epilepsy syndrome, presumed focus, and surgical candidacy and defined confidence levels. They assessed these clinical characteristics first without EEG‐fMRI and then including EEG‐fMRI to assess how the results of EEG‐fMRI changed the evaluations. We also determined how the clinical evaluation was affected by the concordance level between the blood oxygen level‐dependent (BOLD) response and the presumed focus location, and by the confidence level of the BOLD response itself based on the t‐value of the primary and secondary clusters. Results: Fifty‐one scans from 48 patients were included. The BOLD map affected 66.7% of the evaluations by altering evaluation items (epilepsy syndrome, presumed focus, or surgical candidacy) or their confidence levels. EEG‐fMRI results increased the confidence levels of epilepsy syndrome, presumed focus, or surgical candidacy in 47.1% of patients but reduced clinical confidence in these features in 11.8%. More specifically, the confidence levels increased for epilepsy syndrome in 28.5%, identification of presumed focus in 33.9%, and determination of surgical candidacy in 29.4%. The BOLD signal confidence level, whether high or low, did not influence these clinical factors. Significance: Previous studies have emphasized the utility of EEG‐fMRI for the localization of the epileptogenic zone. This study demonstrated the potential of EEG‐fMRI to influence clinical confidence when determining epilepsy syndrome, the presumed epileptic focus, and surgical candidacy. [ABSTRACT FROM AUTHOR]