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Introduction: According to the guidelines, the mammograms obtained in a screening program must be evaluated to ensure that the quality of the images obtained is above 75% of score 1 (perfect and good) and less than 3% of score 3 (inadequate). This is performed by a person (usually a radiographer), so subjectivity may influence the final evaluation of the images. The aim of this study was to evaluate the impact of subjectivity on breast positioning assessments on resultant screening mammograms., Materials and Methods: Five radiographers evaluated a total of 1000 mammograms. One radiographer was an expert in assessing mammography images, while the other four evaluators had varying levels of experience. All images were anonymized, and the ViewDEX software was used for visual grading analysis. The evaluators were divided into two groups, each with two evaluators. Each group evaluated 600 images, with 200 images identical between the two groups. All images had already been evaluated by the expert radiographer. All scores were compared using the Fleiss' and Cohen's kappa coefficient and accuracy score., Results: The results from Fleiss' kappa showed fair agreement in the mediolateral oblique (MLO) projection in the first group of evaluators whereas the other results showed poor agreement. When comparing the results from Cohen's kappa a maximum value of agreement between the evaluators was moderate 0.433 [95% CI 0.264-0.587] for the craniocaudal (CC) projection and 0.374 [95% CI 0.212-0.538] for the MLO projection., Conclusions: Based on our results, we can conclude that the agreement between all five raters was poor for both CC (κ = 0.165) and MLO (κ = 0.135) projections, based on the results of Fleiss' kappa statistic. The results show that the influence of subjectivity has a great impact on the evaluation of the quality of mammography images., Implications for Practice: Thus, the images are evaluated by a person, which has a high impact on subjectivity in the assessment of positioning in mammography. To achieve a more objective assessment of the images and the resulting agreement between the evaluators, we would propose to change the method of assessment. The images could be evaluated by two persons, and in the event of a discrepancy, the images would be evaluated by a third person. A computer programme could also be developed that would allow a more objective evaluation based on the geometric characteristics of the image (angle and length of the pectoral muscle, symmetry, etc.)., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Quality control of magnetic resonance imaging includes image validation, which covers also artefact detection. The daily manual review of magnetic resonance images for possible artefacts can be time-consuming, so automated methods for computer-assisted quality assessment of magnetic resonance imaging need to be developed., Objective: The aim of this study was to develop automatic detection of Gibbs artefacts in magnetic resonance imaging using a deep learning method called transfer learning, and to demonstrate the potential of this approach for the development of an automatic quality control tool for the detection of such artefacts in magnetic resonance imaging., Methods: The magnetic resonance image dataset of the scanned phantom for quality assurance was created using a turbo spin-echo pulse sequence in the transverse plane. Images were created to include Gibbs artefacts of varying intensities. The images were annotated by two independent reviewers. The annotated dataset was used to develop a method for Gibbs artefact detection using the transfer learning approach. The VGG-16, VGG-19, and ResNet-152 convolutional neural networks were used as pre-trained networks for transfer learning and compared using 5-fold cross-validation., Results: All accuracies of the classification models were above 97%, while the AUC values were all above 0.99, confirming the high quality of the constructed models., Conclusion: We show that transfer learning can be successfully used to detect Gibbs artefacts on magnetic resonance images. The main advantages of transfer learning are that it can be applied on small training datasets, the procedures to build the models are not so complicated, and they do not require much computational power. This shows the potential of transfer learning for the more general task of detecting artefacts in magnetic resonance images of patients, which consequently can improve and speed up the process of quality assessment in medical imaging practice.

Background/aims: Central precocious puberty (CPP) is due to premature activation of the hypothalamic-pituitary-gonadal axis. It predominantly affects girls. CPP leads to lower final height (FH), yet the treatment benefit in girls between 6 and 8 years is equivocal. Our main goal was to evaluate the effects of gonadotropin-releasing hormone analog (GnRHa) on FH and identify factors that predict FH., Methods: In a retrospective study, children with CPP (12 boys, 81 girls) that reached FH were included. Their clinical data at diagnosis and up to their final height was compared by descriptive statistics among idiopathic (iCPP) (n=68) and non-idiopathic CPP (nCPP) and between GnRHa treated (n=48) and untreated (n=15) girls with iCPP. The treatment effect of body weight (BW) adjusted GnRHa dosing was evaluated. Univariate linear regression and step-wise multivariable regression including 48 girls with iCPP treated with GnRHa were performed to identify predicting factors for FH., Results: Children with idiopathic CPP (iCPP) reached higher FH (p=0.002) than children with non-idiopathic CPP. After the diagnosis, the treated group gained 7.0 cm more than the untreated group. Yet, attributable to individualized decision-making, the FH in both groups was comparable (161.5 cm in treated, 161.0 cm in untreated girls with iCPP), although the onset of menarche was 2.5 years earlier among untreated girls. BW-adjusted dosing suppressed peak luteinizing hormone (LH) below 4.5 IU/L in 95% of children; however, bone age further advanced during therapy in 38% of patients. Predicting factors revealed by multivariable regression were bone age at diagnosis, BMI SDS at diagnosis, LH basal, age at start and cessation of treatment, predicted adult height and target height. (R2 = 0.72)., Conclusion: Children with nCPP had worse FH outcome compared to iCPP despite similar CPP onset and therapeutic characteristics. Treatment by GnRHa using BW-adjusted dosing was effective in delaying menarche onset and reaching target height in girls with iCPP. Multiple factors affecting FH outcome indicated individualized decision-making regarding therapeutic intervention remains challenging. In the treated patients, among the factors that can be influenced, height at treatment cessation most significantly influenced the outcome., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Knific, Lazarevič, Žibert, Obolnar, Aleksovska, Šuput Omladič, Battelino and Avbelj Stefanija.)

In the absence of a systematic approach to epidemiological modeling in Slovenia, various isolated mathematical epidemiological models emerged shortly after the outbreak of the COVID-19 epidemic. We present an epidemiological model adapted to the COVID-19 situation in Slovenia. The standard SEIR model was extended to distinguish between age groups, symptomatic or asymptomatic disease progression, and vaccinated or unvaccinated populations. Evaluation of the model forecasts for 2021 showed the expected behavior of epidemiological modeling: our model adequately predicts the situation up to 4 weeks in advance; the changes in epidemiologic dynamics due to the emergence of a new viral variant in the population or the introduction of new interventions cannot be predicted by the model, but when the new situation is incorporated into the model, the forecasts are again reliable. Comparison with ensemble forecasts for 2022 within the European Covid-19 Forecast Hub showed better performance of our model, which can be explained by a model architecture better adapted to the situation in Slovenia, in particular a refined structure for vaccination, and better parameter tuning enabled by the more comprehensive data for Slovenia. Our model proved to be flexible, agile, and, despite the limitations of its compartmental structure, heterogeneous enough to provide reasonable and prompt short-term forecasts and possible scenarios for various public health strategies. The model has been fully operational on a daily basis since April 2020, served as one of the models for decision-making during the COVID-19 epidemic in Slovenia, and is part of the European Covid-19 Forecast Hub., (© 2022. The Author(s).)

Background: Early diagnosis of acute kidney injury (AKI) after cardiac surgery is based on serum creatinine which is neither a specific nor a sensitive biomarker. In our study, we investigated the role of serum Klotho in early prediction of AKI after cardiac surgery using cardiopulmonary bypass (CPB)., Methods: The included patients were classified into three groups according to AKI stages using KDIGO criteria. The measurements of creatinine and Klotho levels in serum were performed before surgery, at the end of CPB, 2 hours after the end of CPB, 24 hours and 48 hours postoperatively., Results: Seventy-eight patients were included in the study. A significant increase of creatinine levels (p<0.001) was measured on the first day after the surgery in both AKI groups compared to the non-AKI group. However, a significant difference between AKI-2 and AKI-1 groups (p=0.006) was not measured until the second day after the operation. Using decision trees for classification of patients with a higher or lower risk of AKI we found out that Klotho discriminated between the patients at low risk of developing more severe kidney injury in the first hours after surgery and the patients at high risk better than creatinine. Adding also the early measurements of creatinine in the decision tree model further improved the prediction of AKI., Conclusions: Serum Klotho may be useful to discriminate between the patients at lower and the patients at higher risk of developing severe kidney injury after cardiac surgery using CPB already in the first hours after surgery., Competing Interests: Conflict of Interest: The authors stated that they have no conflicts of interest regarding the publication of this article., (2020 Aleš Jerin, Osama F. Mosa, Jurij M. Kališnik, Janez Žibert, Milan Skitek, published by CEON/CEES.)

Background: Changes in cardiac autonomic regulation and P-wave characteristics are associated with the occurrence of atrial fibrillation. The purpose of this study was to evaluate whether combined preoperative non-invasive determination of cardiac autonomic regulation and PR interval allows for the identification of patients at risk of new-onset atrial fibrillation after cardiac surgery., Methods: RR, PR and QT intervals, and linear and non-linear heart rate variability parameters from 20 min high-resolution electrocardiographic recordings were determined one day before surgery in 150 patients on chronic beta blockers undergoing elective coronary artery bypass grafting, aortic valve replacement, or both, electively., Results: Thirty-one patients (21%) developed postoperative atrial fibrillation. In the atrial fibrillation group, more arterial hypertension, a greater age, a higher EuroSCORE II, a higher heart rate variability index (pNN50: 9 ± 20 vs. 4 ± 10, p = 0.050), a short PR interval (156 ± 23 vs. 173 ± 31 ms; p = 0.011), and a reduced short-term scaling exponent of the detrended fluctuation analysis (DFA1, 0.96 ± 0.36 vs. 1.11 ± 0.30 ms; p = 0.032) were found compared to the sinus rhythm group. Logistic regression modeling confirmed PR interval, DFA1 and age as the strongest preoperative predictors of postoperative atrial fibrillation (area under the receiver operating characteristic curve = 0.804)., Conclusions: Patients developing atrial fibrillation after cardiac surgery presented with severe cardiac autonomic derangement and a short PR interval preoperatively. The observed state characterizes both altered heart rate regulation and arrhythmic substrate and is strongly related to an increased risk of postoperative atrial fibrillation., (Copyright © 2019 Elsevier B.V. All rights reserved.)

There is a wide range of factors affecting bacterial adhesion and biofilm formation. However, in both food processing and medical settings, it is very hard to obtain suitably controlled conditions so that the factors that reduce surface colonisation and biofouling can be studied. The aim of this study was to evaluate the effect of glucose concentration, temperature and stainless steel (SS) surface roughness on biofouling by four common pathogens ( Escherichia coli , Staphylococcus aureus , Pseudomonas aeruginosa and L. monocytogenes ). Among the tested variables, the untreated SS surface (3C) was shown to be fouled more than 3D polished, brushed or electropolished SS surfaces. Although an array of parameters influenced biofouling, the most promising control measure was the influence of low temperature (4 °C) that reduced biofouling even in the case of the psychrophilic Listeria monocytogenes . The study findings could significantly contribute to the prevention of SS surface contamination and consequential biofouling by food and healthcare associated pathogens.

Acute kidney injury (AKI) represents frequent complication after cardiac surgery using cardiopulmonary bypass (CPB). In the hope to enhance earlier more reliable characterization of AKI, we tested the utility of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (CysC) in addition to standard creatinine for early determination of AKI after cardiac surgery using CPB. Forty-one patients met the inclusion criteria. Arterial blood samples collected after induction of general anesthesia were used as baseline, further sampling occurred at CPB termination, 2 h after CPB, on the first and second day after surgery. According to AKIN classification 18 patients (44%) developed AKI (AKI1-2 groups) and 23 (56%) did not (non-AKI group). Groups were similar regarding demographics and operative characteristics. CysC levels differed already preoperatively (non-AKI vs. AKI2; P = 0.045; AKI1 vs. AKI2; P = 0.011), while postoperatively AKI2 group differed on the first day and AKI1 on the second regarding non-AKI group (P = 0.004; P = 0.021, respectively). NGAL and creatinine showed significant difference already 2 h after CPB between groups AKI2 and non-AKI and later on the first postoperative day between groups AKI1 and AKI2 (P = 0.028; P = 0.014, respectively). This study shows similar performance of early plasma creatinine and NGAL in patients with preserved preoperative renal function. It demonstrates that creatinine, as well as NGAL, differentiate subsets of patients developing AKI of clinically more advanced grade early after 2 h, also when used single and uncombined., (© 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Broca's region and adjacent cortex presumably take part in working memory (WM) processes. Electrophysiologically, these processes are reflected in synchronized oscillations. We present the first study exploring the effects of a stroke causing Broca's aphasia on these processes and specifically on synchronized functional WM networks. We used high-density EEG and coherence analysis to map WM networks in ten Broca's patients and ten healthy controls during verbal WM task. Our results demonstrate that a stroke resulting in Broca's aphasia also alters two distinct WM networks. These theta and gamma functional networks likely reflect the executive and the phonological processes, respectively. The striking imbalance between task-related theta synchronization and desynchronization in Broca's patients might represent a disrupted balance between task-positive and WM-irrelevant functional networks. There is complete disintegration of left fronto-centroparietal gamma network in Broca's patients, which could reflect the damaged phonological loop., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: The mechanism by which methotrexate (MTX) improves glucose homeostasis in patients with rheumatoid (RA) and psoriatic arthritis (PsA) remains undetermined. Animal studies indicate a role for intracellular accumulation of 5-aminoimidazole-4-carboxamide-1-β-d-ribofuranosyl 5'-monophosphate (ZMP) but this has not been directly demonstrated in humans. We explored whether accumulation of ZMP is associated with improvements in glucose homeostasis during MTX therapy., Method: MTX-naïve, non-diabetic RA (n = 16) and PsA (n = 10) patients received uninterrupted MTX treatment for 6 months. To evaluate whether ZMP accumulated during MTX therapy, we measured the concentration of ZMP in erythrocytes and the concentration of its dephosphorylated derivative 5-aminoimidazole-4-carboxamide-1-β-d-ribofuranoside (AICAR) in urine using liquid chromatography mass spectrometry (LC-MS/MS). To assess glucose homeostasis, we determined the concentration of glycated haemoglobin (HbA1c) and homeostasis model assessment of insulin resistance [HOMA-IR: fasting glucose (mmol/L) × fasting insulin (μU/mL)/22.5]., Results: Erythrocyte ZMP and urinary AICAR concentrations did not increase during 6 months of MTX therapy. HbA1c concentration was reduced from 5.80 ± 0.29% at baseline to 5.51 ± 0.32% at 6 months (p < 0.001), while HOMA-IR remained unaltered. Reduction in HbA1c concentration was not associated with increased ZMP or AICAR concentrations., Conclusions: MTX therapy probably does not produce a chronic increase in erythrocyte ZMP or urinary AICAR concentrations. Collectively, our data do not support the hypothesis that MTX improves glucose homeostasis through chronic accumulation of ZMP.

We report results of analysis of a month-long measurement of indoor air and environment quality parameters in one gym during sporting activities such as football, basketball, volleyball, badminton, boxing, and fitness. We have determined an average single person's contribution to the increase of temperature, humidity, and dust concentration in the gym air volume of 12500 m(3) : during 90-min exercise performed at an average heart rate of 143 ± 10 bpm, a single person evaporated 0.94 kg of water into the air by sweating, contributed 0.03 K to the air temperature rise and added 1.5 μg/m(3) and 5 ng/m(3) to the indoor concentration of inhalable particles (PM10 ) and Ca concentration, respectively. As the breathing at the observed exercise intensity was about three times faster with respect to the resting condition and as the exercise-induced PM10 concentration was about two times larger than outdoors, a sportsman in the gym would receive about a sixfold higher dose of PM10 inside than he/she would have received at rest outside., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Synchronization between prefrontal (executive) and posterior (association) cortices seems a plausible mechanism for temporary maintenance of information. However, while EEG studies reported involvement of (pre)frontal midline structures in synchronization, functional neuroimaging elucidated the importance of lateral prefrontal cortex (PFC) in working memory (WM). Verbal and spatial WM rely on lateralized subsystems (phonological loop and visuospatial sketchpad, respectively), yet only trends for hemispheric dissociation of networks supporting rehearsal of verbal and spatial information were identified by EEG. As oscillatory activity is WM load dependent, we applied an individually tailored submaximal load for verbal (V) and spatial (S) task to enhance synchronization in the relevant functional networks. To map these networks, we used high-density EEG and coherence analysis. Our results imply that the synchronized activity is limited to highly specialized areas that correspond well with the areas identified by functional neuroimaging. In both V and S task, two independent networks of theta synchronization involving dorsolateral PFC of each hemisphere were revealed. In V task, left prefrontal and left parietal areas were functionally coupled in gamma frequencies. Theta synchronization thus provides the necessary interface for storage and manipulation of information, while left-lateralized gamma synchronization could represent the EEG correlate of the phonological loop.

Objective: Postoperative atrial fibrillation (POAF) is a frequent complication after heart surgery. It has been shown that cardiac autonomic derangement plays a significant role in the genesis of atrial fibrillation (AF) and that AF might also be promoted by altered repolarization. Thus, the aim of our study was to determine the levels of cardiac autonomic modulation and repolarization properties in patients developing POAF., Methods: Seventy-nine patients scheduled for aortic and/or coronary artery bypass grafting surgery with cardiopulmonary bypass were enrolled prospectively. High-resolution 20-minute electrocardiogram recordings were obtained day before surgery to determine P, PR, QT, and QTc intervals, as well as linear (time and frequency domain) and nonlinear heart rate variability parameters (fractal dimension and detrended fluctuation analysis). QTc interval was calculated using Framingham correction., Results: Twenty-nine patients developed POAF (AF group), and 50 did not (non-AF group). Groups were similar regarding demographics, surgery type, and perioperative characteristics, except for older age in the AF group. QT and QTc intervals (Framingham) were longer in the AF group [442 (44) vs 422 (28) milliseconds, P = 0.018; and 448 (44) vs 431 (24) milliseconds, P = 0.031 and P = 0.019, respectively]. Time domain heart rate variability parameter PNN50 (percentage of pairs of adjacent NN intervals differing >50 milliseconds) was higher [14% (21%) vs 8% (16%), P = 0.015], and nonlinear parameter detrended fluctuation analysis α2 was lower in the AF group [0.81 (0.21) vs 0.91 (0.20), P = 0.031]., Conclusions: Profound cardiac autonomic derangement, suggestive of parasympathetic excessive modulation, exists preoperatively in patients inclined to POAF after cardiac surgery, whereby parameters PNN50 and α2 differentiated the AF from the non-AF group. Prolonged QTc intervals are associated with an increased risk of POAF.

Tumour necrosis factor-alpha (TNF-α) inhibitors are widely used in the management of patients with rheumatoid arthritis (RA) and spondylarthritides. However, TNF-α inhibition may lead to adverse events, including liver injury. The RA patients are frequently treated with several potentially hepatotoxic drugs concomitantly; hence, a causative link between TNF-α inhibitors and liver injury is usually difficult to establish. We report two cases of RA patients who developed histologically manifest liver injury shortly after the introduction of treatment with two different TNF-α inhibitors. Furthermore, we present the analysis of the laboratory data from the BioRx.si registry (the Slovenian national registry of rheumatologic patients treated with biologicals) and provide evidence that elevated levels of serum aminotransferase can be observed in patients treated with TNF-α inhibitors. Additionally, our analysis suggests no significant differences between the impact of adalimumab and etanercept on aminotransferase levels. Although the use of TNF-alpha inhibitors is safe and efficient, we suggest that continuous careful monitoring of aminotransferase levels in patients treated with these agents is probably warranted.