Search

Abstract Background This study aimed to collect data regarding patient perception and knowledge of dental implants. It was conducted with the hope that the data would provide dental professionals and policymakers with a better understanding of ways to promote implant therapy. Methods An anonymous online survey with 10 questions was distributed through 12 dental offices in Tokyo and provincial cities in Japan to assess patient perception and knowledge of dental implants. Harvard Medical School’s IRB approved this study. Results We collected data from 1172 patients (59% female, 41% male). The most common perceptions of implant therapy were that it was “expensive,” “advanced,” and “scary”. Patients’ implant knowledge came primarily from magazines or books, while professional dental societies/associations were the least sought out source of information. Patients believed that the purpose of dental implants was to avoid dentures and improve chewing function. Their primary concerns about dental implants were the cost and longevity. Approximately 12% of patients with dental implants and 61% of patients without implants did not know that bone grafts may be required and that sedation during surgery was an option. For patients who experienced sedation during the procedure, 60% of them want it for future surgeries. Patients also had limited knowledge of bone-graft materials and the effects of CBCT radiation; 75% of the patients expressed concerns over the safety of graft materials and radiation exposure. For patients with a history of dental implant therapy, 80% of them would recommend dental implants to their family and friends. Conclusions Overall, patients’ experiences with dental implant therapy were positive, but there was a lack of patient education regarding dental implants and their associated procedures. Dental professionals need to take the initiative to improve patient education.

Denise A John, Beth Hansemann, Philip Lieu, Jennifer Weizer Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USACorrespondence: Denise A John, Department of Ophthalmology, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA, Tel +1-615-545-8940, Fax +1-734-647-3555, Email denisejo@med.umich.eduPurpose: At the Kellogg Eye Center, we identified a series of injection-related patient safety events that led to a systematic review and redesign of our intravitreal injection protocol. The objective was to reduce injection-related patient safety events to zero.Methods: A retroactive review, using the Healthcare Failure Mode and Effect Analysis model as a guide, was performed on our process for delivering intravitreal injections to identify potential failure modes and their impact.Results: The total number of injection-related safety events was 1 in 2017 and 16 in 2018 at baseline. Potential vulnerabilities identified included errors in communication, patient identification, clinical documentation, and medication orders. The injection protocol was redesigned. After implementation, there were zero injection-related safety events in all Kellogg Eye Center Retina clinics for the subsequent 18-month follow-up period.Conclusion: It is possible to redesign and implement an intravitreal injection protocol to reduce the rate of safety events in a large academic eye center.Keywords: adverse event, healthcare failure mode and effect analysis, intravitreal injections, patient safety

Abstract The aim of this study was to evaluate the biological efficacy of a unique perpendicular protrusion of type-I collagen (Col-I) from TiO2 nanotubes (NT-EPF surface). We hypothesized that the NT-EPF surface would play bifunctional roles in stimulating platelet-mediated fibroblast recruitment and anchoring fibroblast-derived Col-I to form a perpendicular collagen assembly, mimicking the connective tissue attachment around natural teeth for the long-term maintenance of dental implants. Ti surface modification was accomplished in two steps. First, TiO2 nanotubes (NT) array was fabricated via anodization. Diameters and depths of NTs were controlled by applied voltage and duration. Subsequently, an electrophoretic fusion (EPF) method was applied to fuse Col-I into nanotube arrays in a perpendicular fashion. Surface wettability was assessed by contact angle measurement. The bioactivity of modified TiO2 surfaces was evaluated in terms of NIH3T3 fibroblast attachment, platelet activation, and collagen extension. Early attachment, aggregation, and activation of platelets as well as release of platelet-related growth factors were demonstrated on NT-EPF surfaces. Platelet-mediated NIH3T3 cells migration toward NT-EPF was significantly increased and the attached cells showed a typical fibrous morphology with elongated spindle shape. A direct linkage between pseudopod-like processes of fibroblasts to NT-EPF surfaces was observed. Furthermore, the engineered EPF collagen protrusion linked with cell-derived collagen in a perpendicular fashion. Within the limitation of this in vitro study, the TiO2 nanotube with perpendicular Col-I surface (NT-EPF) promoted better cell attachment, induced a strong platelet activation which suggested the ability to create a more robust soft tissue seal.

Objectives. Although digital technology has been widely integrated into dental education, there is limited literature investigating the extent of the integration of computer-aided design and computer-aided manufacturing (CAD-CAM) for removable systems in the dental curriculum. The purpose of this study was to assess the current implementation of CAD-CAM complete and partial dentures in predoctoral (PP) and advanced graduate prosthodontic (AGP) education in US dental schools. The study also aimed to identify potential barriers to its implementation in the dental curriculum. Methods. An online survey with 15 questions was created using online survey software. The survey was distributed to the directors of predoctoral prosthodontics in 56 schools and advanced graduate programs of prosthodontics in 52 schools listed in the 2018–19 American Dental Education Association (ADEA) Directory. Results. The percentage of programs (PP and AGP) implementing CAD-CAM complete dentures (CAD-CAM CDs) and CAD-CAM removable partial dentures (CAD-CAM RPDs) in their didactic, preclinical, and clinical curricula was recorded. CAD-CAM CDs are taught in didactic courses in 54.2% of PP and 65.2% of AGP. However, CAD-CAM RPDs are only taught in 37.5% of PP and 47.8% of AGP. Programs are largely limited by a lack of funds, resources, time, and faculty members. Conclusion. While digital technologies have indeed become more prevalent in dental education, many institutions face barriers to implementation. More research must be conducted in order to support the continued incorporation of digital technologies into dental education.

Abstract Natural teeth are supported by connective tissue collagen fibers that insert perpendicularly in the tooth cementum. Perpendicular insertion plays an important role in the maintenance of the junction between the oral epithelium and the periodontal connective tissue. Most titanium dental implant surfaces have no micro or macro structure to support perpendicularly oriented collagen attachment. Without this tight biologic seal to resist bacterial invasion and epithelial downgrowth, progressive bone loss in peri-implantitis is seen around dental implants. The purpose of this study was to establish the perpendicularly oriented collagen attachment to titanium oxide nanotube (TNT), and to assess its binding stability. TNT was prepared on the titanium-surface by anodization. Scanning electron microscopy (SEM) showed a regularly aligned TNT with an average 67 nm-diameter when anodized at 30 V for 3 h. Subsequently, collagen type I (CoI) was electrophoretically fused to anodic TNT in native polyacrylamide gel system where negatively charged CoI-C term was perpendicularly navigated to TNT. SEM and atomic force microscopy (AFM) were used to analyze CoI on the TiO2 and TNT surface. Several tens of nanometers of CoI protrusion were recorded by AFM. These protrusions may be long enough to be priming sites for cell-secreted CoI. CoI laid parallel to the titanium surface when fused by a chemical linker. Binding resistance of CoI against drastic ultrasonication was measured by Fourier-transform infrared spectroscopy attenuated total reflection (FTIR-ATR). The electrophoretically fused CoI in the titanium nanotube (TNT–CoIEPF) showed the significantly greatest binding resistance than the other groups (P

Objectives: Magnets have many advantages in orthodontics, and our previous studies confirmed their therapeutic potential through 3D-data analysis. The aim of this study was to compare tooth movements, including rotation, obtained via magnetic and elastic forces in crowded cases in vitro. Methods: Typodont models mimicking a crowded case were prepared. In the magnetic force-driven orthodontics (MG) group, Nd-Fe-B magnets were attached to the labial surfaces from UR4 to UL4 for attracting force, and to UR6 and UL6 for repulsing force. For the elastic force-driven orthodontic (EL) group, brackets were placed on labial surfaces from UR2 to UL2 with power-chain elastics. A NiTi archwire was used in both groups. The models were 3D scanned before and after tooth movement and exported as STL files. The pre- and post-movement STL files were superimposed. The 3D coordinates of the measurement points of the crown and root apex were obtained, and tooth displacement, 3D movements (X, Y, and Z-axis), and rotation (yaw, pitch, and roll) were calculated. Two-tailed Student's t-test was performed for comparison of the results between MG and EL groups (n = 3). Results: Overall, both groups indicated similar movement and rotation to achieve the planned arch form. In the crown movement and rotation, no significant differences were observed between MG and EL groups. However, in the root movement, there was a significant difference between MG and EL groups in X and Z axis for the canines. Conclusions: Magnetic force-driven orthodontics demonstrated comparable results to elastics with less tipping movement, suggesting a potential future orthodontic modality. Clinical significance: This in vitro study showed the potential of magnetic force for orthodontic application. The magnetic force-driven orthodontics might provide less tipping tooth movement compared to conventional methods, such as power chains, and could be a future technique for comprehensive orthodontic treatment.

The aim of this study was to produce epithelial attachment on a typical implant abutment surface of smooth titanium. A challenging complication that hinders the success of dental implants is peri-implantitis. A common cause of peri-implantitis may results from the lack of epithelial sealing at the peri-implant collar. Histologically, epithelial sealing is recognized as the attachment of the basement membrane (BM). BM-attachment is promoted by activated platelet aggregates at surgical wound sites. On the other hand, platelets did not aggregate on smooth titanium, the surface typical of the implant abutment. We then hypothesized that epithelial BM-attachment was produced when titanium surface was modified to allow platelet aggregation. Titanium surfaces were coated with a protease activated receptor 4-activating peptide (PAR4-AP). PAR4-AP coating yielded rapid aggregation of platelets on the titanium surface. Platelet aggregates released robust amount of epithelial chemoattractants (IGF-I, TGF-β) and growth factors (EGF, VEGF) on the titanium surface. Human gingival epithelial cells, when they were co-cultured on the platelet aggregates, successfully attached to the PAR4-AP coated titanium surface with spread laminin5 positive BM and consecutive staining of the epithelial tight junction component ZO1, indicating the formation of complete epithelial sheet. These in-vitro results indicate the establishment of epithelial BM-attachment to the titanium surface.

Artificial intelligence (AI) has revolutionized ophthalmology by aiding in the diagnosis, prognosis, and treatment planning of various eye diseases. However, AI’s potential extends beyond ocular conditions. By analyzing eye-related biomarkers, AI can utilize the eye as a window into the body’s systemic health. This field, known as oculomics, leverages AI and deep learning algorithms to process vast amounts of data from imaging techniques such as fundus photography, optical coherence tomography (OCT), OCT angiography, infrared iris imaging, slit-lamp photography, and external eye photography. AI-powered analysis of these images can predict systemic diseases such as Alzheimer’s, Parkinson’s, cardiovascular disease, cerebrovascular disease, chronic kidney disease, and liver disease. Retinal changes —including alterations in the retinal nerve fiber layer, ganglion cell layer, and retinal vessels —serve as valuable indicators of these conditions. Additionally, AI can estimate age, sex, body composition, and other health parameters from eye images. While the potential of AI in oculomics is promising, challenges such as access to ophthalmic imaging, data quality, and the need for rigorous validation must be addressed to ensure its widespread adoption and clinical utility. Nevertheless, AI holds the potential to transform healthcare by enabling early detection, noninvasive screening, and personalized treatment for a wide range of systemic diseases.

Abstract Background Patients with brain damage often require mechanical ventilation. Although lung-protective ventilation is recommended, the application of increased positive end-expiratory pressure (PEEP) has been associated with elevated intracranial pressure (ICP) due to altered cerebral venous return. This study investigates the effects of flow-controlled ventilation (FCV) using negative end-expiratory pressures (NEEP), on cerebral hemodynamics in a swine model of intracranial hypertension. Methods A model of intracranial hypertension involving bilateral trepan bolt holes was performed in 14 pigs. Pressure-controlled volume-guaranteed ventilation (PCV-VG) with PEEP and FCV using PEEP and then NEEP were applied. Intracranial pressure and oxygenation, as well as systemic hemodynamics and gas exchange parameters, were continuously monitored. Data were collected at baseline and at varying PEEP levels for both PCV-VG and FCV ventilation modalities. Following this, FCV ventilation and NEEP levels of -3, -6 and -9 cmH2O were applied. Results ICP remained stable with low PEEP levels, but significantly decreased with NEEP. Lower ICP following NEEP improved cerebral perfusion pressure and cerebral tissue oxygenation (p

Abstract Iron homoeostasis is tightly regulated, with hepcidin and soluble transferrin receptor (sTfR) playing significant roles. However, the genetic determinants of these traits and the biomedical consequences of iron homoeostasis variation are unclear. In a meta-analysis of 12 cohorts involving 91,675 participants, we found 43 genomic loci associated with either hepcidin or sTfR concentration, of which 15 previously unreported. Mapping to putative genes indicated involvement in iron-trait expression, erythropoiesis, immune response and cellular trafficking. Mendelian randomisation of 292 disease outcomes in 1,492,717 participants revealed associations of iron-related loci and iron status with selected health outcomes across multiple domains. These associations were largely driven by HFE, which was associated with the largest iron variation. Our findings enhance understanding of iron homoeostasis and its biomedical consequences, suggesting that lifelong exposure to higher iron levels is likely associated with lower risk of anaemia-related disorders and higher risk of genitourinary, musculoskeletal, infectious and neoplastic diseases.

This paper presents a numerical method for solving the inverse problem of reconstructing the shape of periodic structures from scattering data. This inverse problem is motivated by applications in the nondestructive evaluation of photonic crystals. The numerical method belongs to the class of sampling methods that aim to construct an imaging function for the shape of the periodic structure using scattering data. By extending the results of Nguyen, Stahl, and Truong [Inverse Problems, 39:065013, 2023], we studied a simple imaging function that uses half the data required by the numerical method in the cited paper. Additionally, this imaging function is fast, simple to implement, and very robust against noise in the data. Both isotropic and anisotropic cases were investigated, and numerical examples were presented to demonstrate the performance of the numerical method.

Spindle cell lipoma (SCL) is a benign adipocytic tumor usually found in the subcutis of the posterior neck, upper back, and shoulder, predominantly in middle-aged males. This case report describes an atypical presentation of SCL in a 26-year-old male with a history of malignant melanoma. The patient presented with an erythematous plaque with central hyperpigmentation on the right upper arm, an uncommon location and presentation for SCL. Histopathological examination revealed an atypical myxoid spindle cell neoplasm with CD34 positivity and an overlying mildly atypical compound melanocytic nevus. The unusual clinical and histological features, combined with the patient’s melanoma history, complicated the differential diagnosis, which included dermatofibrosarcoma protuberans (DFSP) and solitary fibrous tumors (SFTs). A wide local excision with 2 cm margins was performed, and subsequent pathology confirmed clear margins, supporting the diagnosis of SCL. This case highlights the importance of including SCL in the differential diagnosis of CD34-positive spindle cell tumors, even when clinical and histological presentations are atypical, and underscores the need for thorough histopathological evaluation and a broad differential diagnosis in patients with a history of melanoma.

Given the complexity of cellular respiration, there is a significant need for effective assessment tools that can accurately gauge students’ understanding, identify misconceptions, and provide educators with actionable insights to improve instruction. Concept Inventory Test (CIT) has emerged as a valuable instrument in science education for this purpose. The aim of this study is to develop a Concept Inventory Test on cellular respiration and assess its reliability and validity. This study employed a mixed-method sequential exploratory approach for each assessment. The study was conducted in a private school in Cebu, targeting the senior high school students. The results of the study showed that the developed Concept Inventory Test’s reliability and validity are made apparent by the process used to gather supporting data, as well as by the findings and observations. Furthermore, this Concept Inventory Test serves a significant instrument for classroom assessment, promotes additional research on students’ critical comprehension, and shows how these diagnostic inventories link to the students’ competencies. However, a greater number of respondents should be taken to account to observe the consistency of the Concept Inventory Test results.

Abstract Close vital signs monitoring is crucial for the clinical management of patients with dengue. We investigated performance of a non-invasive wearable utilising photoplethysmography (PPG), to provide real-time risk prediction in hospitalised individuals. We performed a prospective observational clinical study in Vietnam between January 2020 and October 2022: 153 patients were included in analyses, providing 1353 h of PPG data. Using a multi-modal transformer approach, 10-min PPG waveform segments and basic clinical data (age, sex, clinical features on admission) were used as features to continuously forecast clinical state 2 h ahead. Prediction of low-risk states (17,939/80,843; 22.1%), defined by NEWS2 and mSOFA

Abstract The genetic factors of stroke in South Asians are largely unexplored. Exome-wide sequencing and association analysis (ExWAS) in 75 K Pakistanis identified NM_000435.3(NOTCH3):c.3691 C > T, encoding the missense amino acid substitution p.Arg1231Cys, enriched in South Asians (alternate allele frequency = 0.58% compared to 0.019% in Western Europeans), and associated with subcortical hemorrhagic stroke [odds ratio (OR) = 3.39, 95% confidence interval (CI) = [2.26, 5.10], p = 3.87 × 10−9), and all strokes (OR [CI] = 2.30 [1.77, 3.01], p = 7.79 × 10−10). NOTCH3 p.Arg231Cys was strongly associated with white matter hyperintensity on MRI in United Kingdom Biobank (UKB) participants (effect [95% CI] in SD units = 1.1 [0.61, 1.5], p = 3.0 × 10−6). The variant is attributable for approximately 2.0% of hemorrhagic strokes and 1.1% of all strokes in South Asians. These findings highlight the value of diversity in genetic studies and have major implications for genomic medicine and therapeutic development in South Asian populations.

Abstract Introduction Hidradenitis suppurativa (HS) is a painful, inflammatory skin disease associated with a high disease burden and long diagnostic delay. Prevalence estimates of HS vary widely in the literature owing to differing estimation methodologies. This study aimed to apply stepwise algorithms to estimate the prevalence of possible/diagnosed cases of HS in the US. Methods This was a retrospective cohort study in adult and pediatric patients with HS which utilized data from four US databases (MarketScan [Medicare and Medicaid] and Optum [electronic health record (EHR) and Clinformatics Data Mart (CDM)]). Patients with possible/diagnosed HS were identified using two algorithms (termed Algorithm 1 and Algorithm 2), which assessed symptoms such as multiple skin boils in site-specific areas based on international classification of disease (ICD) codes. Patients with diagnosed HS were defined as having ≥ 2 outpatient or ≥ 1 inpatient diagnosis codes of HS. In each database, patients with continuous medical and pharmacy benefits in the 365 days pre-index and 0–365 days post-index periods were eligible for inclusion. Results Across all databases, Algorithm 2 (MarketScan Medicare [N = 309,916]; MarketScan Medicaid [N = 188,783]; Optum EHR [N = 366,158]; Optum CDM [N = 173,812]) identified more patients with possible/diagnosed HS than Algorithm 1 (MarketScan Medicare [N = 194,353]; MarketScan Medicaid [N = 99,276]; Optum EHR [N = 177,957]; Optum CDM [N = 112,244]). Based on ICD-9/10 codes, the 5-year period prevalence of HS ranged from 0.06% to 0.12% across all databases, while for Algorithm 1 and Algorithm 2, this ranged from 0.27% to 0.41% and 0.49% to 0.78%, respectively. Adults and females generally had a higher 5-year period prevalence versus pediatric patients and males, respectively. Conclusion This real-world study highlights that HS diagnosis codes alone may be insufficient to estimate the prevalence of HS, demonstrating the value of employing algorithms in practice which assess for parameters such as multiple skin boils in site-specific areas. Integrating robust methods to identify the prevalence of HS may improve the diagnostic delay observed in HS and improve treatment outcomes.

Purpose Bangladesh has experienced a rapid epidemiological transition from communicable to non-communicable diseases (NCDs) in recent decades. There is, however, limited evidence about multidimensional determinants of NCDs in this population. The BangladEsh Longitudinal Investigation of Emerging Vascular and nonvascular Events (BELIEVE) study is a household-based prospective cohort study established to investigate biological, behavioural, environmental and broader determinants of NCDs.Participants Between January 2016 and March 2020, 73 883 participants (aged 11 years or older) were recruited from 30 817 households across urban, urban-poor (‘slum’) and rural settings in Bangladesh. A structured questionnaire was administered by trained personnel recording participants’ demographic, socioeconomic, behavioural, medical, environmental and other factors. Anthropometric measurements and blood pressure were recorded for each participant. Biological specimens were collected and aliquoted for long-term storage and analysis.Findings to date Of the 73 883 study participants (mean [SD] baseline age: 39 [15] years), 43 470 (59%) were females, and 38 848 (52%) had no or only primary-level education. Focusing only on the 65 822 adult participants aged 20–79 years at baseline, 15 411 (23%) reported being diagnosed with hypertension; 10 578 (16%) with type 2 diabetes and 7624 (12%) with hypercholesterolaemia. Age and sex-standardised prevalences of these conditions were much higher in urban than slum and rural settings. Overall, the mean (SD) body mass index (BMI) was 25 (5) kg/m2, with 10 442 (16%) participants aged 20–79, classified as obese (ie, BMI≥30 kg/m2). Mean BMI was also higher in urban than slum and rural areas.Future plans The collection of information during the baseline visit was completed in 2020. Regular longitudinal follow-up is ongoing for ascertainment and adjudication of a range of fatal and non-fatal health outcomes among participants. This cohort will provide a powerful resource to investigate multidimensional determinants of incident NCDs across diverse settings in Bangladesh, helping to advance scientific discovery and public health action in an archetypal low-middle-income country with pressing public health needs.

Category: Other Introduction/Purpose: The level of amputation for patients with non-traumatic foot pathologies is a complex decision that limb salvage surgeons face, with ambulation playing a crucial role in the quality of life and long-term survival of amputees. In recent years, gait sensors have been used to access ambulation. This study investigates functional outcomes of digit, ray, transmetarsal (TMA), and below-knee amputations (BKA) using wearable gait sensors. Methods: Between December 2021 and January 2024, adult patients who were able to ambulate unassisted, without experiencing pain, and without an open wound or lower extremity surgery in the preceding three months, were selected for participation. Inclusion was voluntary and offered to all patients who presented to the wound care center for a period of 3 years. Out of 451 patients, 77 patients who had undergone amputations at levels including digit amputation, ray resection, TMA, or BKA, were included in this analysis. Patient characteristics, preoperative factors, and surgical history were collected. Participants completed a standardized assessment protocol using wearable gait sensors. This involved completing a 120-second walk test at a self-selected pace. The data collected from the sensors were analyzed using the Motility Lab software, with statistical significance set at p < 0.05. Results: A total of 77 patients were included for analysis, comprising 30 (38.9%) digit, 12 ray (15.6%), 12 TMA (15.6%), and 23 BKA (29.9%). The average age (61.3 1.19 years), body mass index (30.8 0.71 kg/m 2 ), and Charlson Comorbidity Index (4.9 0.2) did not differ between groups. Proportion of smokers (n=30, 34.8%), diabetes mellitus type II (n=54, 62.8%), chronic kidney disease (n=24, 29.1%), end stage renal disease (n=7, 8.1%) was similar across all four groups. There were no differences in gait speed (0.80 0.02 m/s, p=0.414), elevation mid-swing (1.62 0.14 cm, p=0.063), step duration (0.63 0.01s, p=0.066), cadence (96.2 1.2 steps/min, p=0.434), single limb support (34.4 0.3%, p=0.185), double limb support (29.2 0.6%, p=0.089), and stride length (0.97 0.02 m, p=0.225) across level of amputations. Conclusion: Our study shows comparable ambulatory function across all levels of amputation. This may highlight the importance of selecting the right amputation per patient, multidisciplinary limb salvage, and improvements in wearable aids. We encourage other large limb salvage centers to utilize wearable sensors to assess functionality of non-traumatic amputations.

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Early detection of Lisfranc instability is critical for improving clinical outcomes, but more subtle instability can be difficult to diagnose. Weightbearing computed tomography (WBCT) provides a unique opportunity to evaluate such injuries in three dimensions (3D) while under physiologic load. This study aimed to assess the utility of one-dimensional, two-dimensional, and three-dimensional measurements on weight-bearing computed tomography (WBCT) to diagnose subtle instability in isolated ligamentous Lisfranc injuries. Methods: Ten cadaveric specimens underwent WBCT evaluation of the Lisfranc joint complex in the intact state and subsequently with sequential sectioning of the dorsal Lisfranc ligament (DLL) and interosseous Lisfranc ligament (IOL) to create subtle Lisfranc instability, and finally after transectioning of plantar Lisfranc ligament (PLL) to create complete Lisfranc instability. Measurements performed on WBCT images included: (1) Lisfranc joint (medial cuneiform-base of second metatarsal) volume, (2) Lisfranc joint area, (3) C1-C2 intercuneiform area, (4) C1-M2 distance, (5) C1-C2 distance, (6) M1-M2 distance, (7) first tarsometatarsal (TMT1) alignment, (8) second tarsometatarsal (TMT2) alignment, (9) TMT1 dorsal step off distance, and (10) TMT2 dorsal step-off distance. Results: In subtle Lisfranc injury state, Lisfranc joint volume and area, C1-M2 distance and M1-M2 distance measurements on WBCT significantly increased, when compared with the intact state (P values 0.001 to 0.014). Additionally, Lisfranc joint volume and area, C1-M2 distance, M1-M2 distance, TMT2 alignment and TMT2 dorsal step off measurements were increased in complete Lisfranc injury state. Of all measurements, C1-M2 had the largest area under the curve (AUC) of 0.96 (sensitivity = 90%; specificity = 90%), followed by Lisfranc volume (AUC = 0.90; sensitivity = 80%; specificity = 80%) and Lisfranc area (AUC = 0.89; sensitivity = 80%; specificity = 100%). Conclusion: WBCT scan can accurately diagnose subtle Lisfranc instability. Among the measurements, C1-M2 distance exhibited the highest level of accuracy. The 2D Joint Area and 3D Joint Volume also proved to be accurate, with 3D volume measurements of the Lisfranc joint displaying the most significant absolute difference between the intact state and increasing severity of Lisfranc instability. These findings suggest that 2D Joint Area and 3D Joint Volume have potential as supplementary measurements to more accurately diagnose subtle Lisfranc injuries.

Objective: In COVID-19, cytokine storms (CS) result in higher mortality and morbidity. Our study evaluated the rate of cytokine storms among COVID-positive Bangladeshi adults. Methods: From October 2020 to March 2022, this cohort study enrolled both COVID-positive and COVID-negative healthy adults. COVID-positive cases were treated in a makeshift COVID unit of icdr,b Dhaka Hospital. CS was defined as having IL-6 >80 pg/mL or any three of the following: high CRP, ferritin, LDH, D-dimer, or low lymphocyte. Stored plasma samples were tested for the cytokines IL-6, IL-1β, and TNF-α. Results: This study involved 77 participants, 32 were in the severe-critical group, 30 were in the mild-moderate group, and 14 were COVID-negative. Twelve participants in the severe-critical group had CS. Thus, the rate of CS was 37.5 % (12/32). Compared to COVID-19-negative patients, COVID-19-positive patients had higher IL-6 levels, which decreased at discharge except for those dying. Among the COVID-19-positive patients, nine died. For both the mild-moderate and severe-critical patients, IL-6 increased with increasing CRP (p

Quality assurance remains a significant challenge for laser powder bed fusion and metal additive manufacturing. Despite system manufacturers offering process monitoring as a possible solution, datasets are large and cumbersome with practical use limited without direct comparative data. Model datasets would enable individual build validation, highlight deviations, and facilitate intelligent build planning whereby challenging features or build strategies could be pre-emptively assessed.Herein a pragmatic approach has been developed to model process monitoring data from a commercial system using a relatively simple algorithm. Using a heuristic method, the algorithm response has been fitted to an experimental dataset to derive governing constants and their relationship to key process parameters. Predictability of constants and model fit has been shown to improve with increasing line energy up to a maximum R2=0.8. Algorithm variable trends, supported by corresponding sensitivity analysis, identified two different behavioural regimes. Under low linear energy density (

The acquisition and usage of phrasal verbs present significant challenges for second language (L2) learners due to their complex and idiomatic nature. This paper explores these difficulties through a multifaceted analysis of the linguistic and cognitive obstacles that phrasal verbs pose to learners. The study examines the study's participants, which can lead to misunderstandings and misinterpretations. The paper delves into the learners’ competence levels and other issues affecting their ability to grasp phrasal verbs, which often affects their competence and performance in this area of English grammar. The paper also discusses the pedagogical approaches that have helped to facilitate the learners’ learning of phrasal verbs, such as contextual learning, teachers’ ability, corpora, and technology-based tools. The research findings underscore the importance of innovative teaching strategies and continuous practice for L2 learners to effectively navigate the linguistic labyrinth of phrasal verbs. By identifying key challenges and potential solutions, this paper contributes valuable insights into the complexities of language acquisition and offers practical recommendations for educators and learners alike. Ultimately, it aims to enhance our understanding of the intricate relationship between language, culture, and cognition in the context of L2 learning.

Abstract Dose management systems (DMS) are an essential tool for quality assurance and optimising patient radiation exposure. For radiologists and medical physicists, they are important for managing many radiation protection tasks. In addition, they help fulfil the requirements of Directive 2013/59/EURATOM regarding the electronic transmission of dosimetric data and the detection of unintended patient exposures. The EuroSafe Imaging Clinical Dosimetry and Dose Management Working Group launched a questionnaire on the use of DMS in European member states and analysed the results in terms of modalities, frequency of radiological procedures, involvement of medical physics experts (MPEs), legal requirements, and local issues (support by information technology (IT), modality interfaces, protocol mapping, clinical workflow, and associated costs). Critical relevance statement Despite the great advantages of dose management systems for optimising radiation protection, distribution remains insufficient. This questionnaire shows that reasons include: a lack of DICOM interfaces, insufficient harmonisation of procedure names, lack of medical physicist and IT support, and costs. Key Points Quantitative radiation dose information is essential for justification and optimisation in medical imaging. Guidelines are required to ensure radiation dose management systems quality and for acceptance testing. Verifying dose data management is crucial before dose management systems clinical implementation. Medical physics experts are professionals who have important responsibilities for the proper management of dose monitoring. Graphical Abstract

Imaging for prostate cancer defines the extent of disease. Guidelines recommend against imaging low-risk prostate cancer patients with a computed tomography (CT) scan or bone scan due to the low probability of metastasis. We reviewed imaging performed for men diagnosed with low-risk prostate cancer across the Pennsylvania Urologic Regional Collaborative (PURC), a physician-led data sharing and quality improvement collaborative. The data of 10 practices were queried regarding the imaging performed in men diagnosed with prostate cancer from 2015 to 2022. The cohort included 13,122 patients with 3502 (27%) low-risk, 2364 (18%) favorable intermediate-risk, 3585 (27%) unfavorable intermediate-risk, and 3671 (28%) high-risk prostate cancer, based on the AUA guidelines. Amongst the low-risk patients, imaging utilization included pelvic MRI (59.7%), bone scan (17.8%), CT (16.0%), and PET-based imaging (0.5%). Redundant imaging occurred in 1022 patients (29.2%). There was variability among the PURC sites for imaging used in the low-risk patients, and iterative education reduced the need for CT and bone scans. Approximately 15% of low-risk patients had staging imaging performed using either a CT or bone scan, and redundant imaging occurred in almost one-third of men. Such data underscore the need for continued guideline-based education to optimize the stewardship of resources and reduce unnecessary costs to the healthcare system.

Abstract Background Healthy lifestyle changes for patients with stage 1 hypertension are recommended before antihypertensive medication. Exercise has antihypertensive benefits; however, low adoption and high attrition are common. Patients need easily adoptable, effective and manageable exercise interventions that can be sustained for life. We present participant and stakeholder perceptions of an isometric exercise intervention for stage 1 hypertension delivered in the National Health Service (NHS, UK). Methods An embedded qualitative study within a randomised-controlled feasibility study included intervention arm participants (n = 10), healthcare professionals from participating NHS sites (n = 3) and non-participating NHS sites (n = 5) taking part in semi-structured interviews to explore feasibility of delivering an isometric exercise intervention within the study design and an NHS context. Data was analysed using reflective thematic analysis. Results Three themes were identified: study deliverability; motivators and barriers; support for study participation. Findings indicated that the study was well designed. Health benefits, unwillingness to take medication, altruism and interest in the study helped motivation and adherence. Study support received was good, but healthcare professionals were insecure in intervention delivery with regular training/supervision needed. Perception of health improvement was mixed, but, in some, uptake of wider lifestyle changes resulted from participation. Stakeholders felt that current service challenges/demand would make implementation challenging. Conclusions Despite participant positivity, delivery of an isometric intervention in an NHS setting was considered challenging given the current service demand, although possible with robust effectiveness evidence. Findings support further effectiveness data and implementation development of the isometric exercise intervention. Trial registration ISRCTN, ISRCTN13472393 . Registered 18 September 2020.

Artificial intelligence (AI) has great potential for diagnosing and managing glaucoma, a disease that causes irreversible vision loss. Early detection is paramount to prevent visual field loss. AI algorithms demonstrate promising capabilities in analyzing various glaucoma investigations. In analyzing retinal fundus photographs, AI achieves high accuracy in detecting glaucomatous optic nerve cupping, a hallmark feature. AI can also analyze optical coherence tomography (OCT) images of the retinal nerve fiber layer(RNFL) and ganglion cell complex, identifying structural changes indicative of glaucoma and also Anterior Segment OCT(AS-OCT) for angle closure disease. OCT interpretation may even be extended to diagnose early features of systemic neurodegenerative diseases such as Alzheimer’s Disease and Parkinson’s Disease. Furthermore, AI can assist in interpreting visual field (VF) tests, including predicting future VF loss patterns for the next 5 years. The ability of AI to integrate data from multiple modalities, including fundus photographs, Intra Ocular Pressure(IOP) measurements, RNFL OCT, AS-OCT, and VF tests, paves the way for a more comprehensive glaucoma assessment. This approach has the potential to revolutionize ophthalmology by enabling teleophthalmology and facilitating the development of personalized treatment plans. However, the authors emphasize the crucial role of human judgement and oversight in interpreting AI-generated results. Ultimately, ophthalmologists must make the final decisions regarding diagnosis and treatment strategies.

Abstract Introduction Mortality due to injuries disproportionately impact low income countries. Knowledge of who is at risk of poor outcomes is critical to guide resource allocation and prioritization of severely injured. Kampala Trauma Score (KTS), developed in 1996 and last modified in 2002 as KTS II, is still widely being used to predict injury outcomes in resource-limited settings with no further revisions in the past two decades, despite ongoing criticism of some of its parameters. The New Trauma Score (NTS), a recent development in 2017, has shown potential in mortality prediction, but a dearth of evidence exist regarding its performance in the African population. Objectives To compare NTS to the modified Kampala Trauma Score (KTS II) in the prediction of 30-day mortality, and injury severity amongst patients sustaining road traffic crashes in Ugandan low-resource settings. Methods Multi-center prospective cohort study of patients aged 15 years and above. Of the 194 participants, 85.1% were males with a mean age of 31.7 years. NTS and KTS II were determined for each participant within 30-minutes of admission and followed-up for 30 days to determine their injury outcomes. The sensitivity, specificity, and area under receiver operating characteristics curve (AUC) for predicting mortality were compared between the two trauma scores using SPSS version 22. Ethical clearance: Research and Ethics Committee of Kampala International University Western Campus (Ref No: KIU-2022-125). Results The injury severity classifications based on NTS vs. KTS II were mild (55.7% vs. 25.8%), moderate (29.9% vs. 30.4%), and severe (14.4% vs. 43.8%). The mortality rates for each injury severity category based on NTS vs. KTS II were mild (0.9% v 0%), moderate (20.7% vs. 5.1%), and severe (50% vs. 28.2%). The AUC was 0.87 for NTS (95% CI 0.808–0.931) vs. 0.86 (95% CI 0.794–0.919) for KTS II respectively. The sensitivity of NTS vs. KTS II in predicting mortality was 92.6% (95% CI: 88.9–96.3) vs. 70.4% (95% CI: 63.0-77.8) while the specificity was 70.7% (95% CI: 64.2–77.2) vs. 78.4% (95% CI: 72.1–84.7) at cut off points of 17 for NTS and 6 for KTS II respectively. Conclusions NTS was more sensitive but its specificity for purposes of 30-day mortality prediction was lower compared to KTS II. Thus, in low-resourced trauma environment where time constraints and pulse oximeters are of concern, KTS II remains superior to NTS.

Abstract Vaccination reduces morbidity and mortality due to infections, but efficacy may be limited due to distinct immunogenicity at the extremes of age. This raises the possibility of employing adjuvants to enhance immunogenicity and protection. Early IFNγ production is a hallmark of effective vaccine immunogenicity in adults serving as a biomarker that may predict effective adjuvanticity. We utilized mass cytometry (CyTOF) to dissect the source of adjuvant-induced cytokine production in human blood mononuclear cells (BMCs) from newborns (~39-week-gestation), adults (~18-63 years old) and elders (>65 years of age) after stimulation with pattern recognition receptors agonist (PRRa) adjuvants. Dimensionality reduction analysis of CyTOF data mapped the BMC compartment, elucidated age-specific immune responses and profiled PRR-mediated activation of monocytes and DCs upon adjuvant stimulation. Furthermore, we demonstrated PRRa adjuvants mediated innate IFNγ induction and mapped NK cells as the key source of TLR7/8 agonist (TLR7/8a) specific innate IFNγ responses. Hierarchical clustering analysis revealed age and TLR7/8a-specific accumulation of innate IFNγ producing γδ T cells. Our study demonstrates the application of mass cytometry and cutting-edge computational approaches to characterize immune responses across immunologically distinct age groups and may inform identification of the bespoke adjuvantation systems tailored to enhance immunity in distinct vulnerable populations.

Abstract Ultraviolet (UV) colour patterns invisible to humans are widespread in nature. However, research bias favouring species with conspicuous colours under sexual selection can limit our assessment of other ecological drivers of UV colour, like interactions between predators and prey. Here we demonstrate widespread UV colouration across Western Hemisphere snakes and find stronger support for a predator defence function than for reproduction. We find that UV colouration has evolved repeatedly in species with ecologies most sensitive to bird predation, with no sexual dichromatism at any life stage. By modelling visual systems of potential predators, we find that snake conspicuousness correlates with UV colouration and predator cone number, providing a plausible mechanism for selection. Our results suggest that UV reflectance should not be assumed absent in “cryptically coloured” animals, as signalling beyond human visual capacities may be a key outcome of species interactions in many taxa for which UV colour is likely underreported.

Summary: Background: Nutri-Score is a scientifically validated 5-color front-of-pack nutrition label reflecting the nutrient profile of foods. It has been implemented in several European countries on a voluntary basis, pending the revision of the European labeling regulation. Hence, scientific evidence is needed regarding the ability of the nutrient profile underlying the Nutri-Score (uNS-NPS, 2023-updated version) to characterize healthier foods. Our objective was therefore to study the prospective association between the nutritional quality of diet characterized by the uNS-NPS and the risk of cardiovascular diseases in a large European population. Methods: Our analyses included 345,533 participants from the European Prospective Investigation into Cancer and Nutrition study (EPIC, 1992–2010, 7 European countries). Food intakes were assessed at baseline using country-specific dietary questionnaires. The uNS-NPS was calculated as a continuous scale for each food, based on its 100 g content of energy, sugars, saturated fatty acids, salt, fibre, and protein and percentage content of fruit, vegetables, and pulses. A dietary index was derived at the individual level (uNS-NPS DI: energy-weighted mean of uNS-NPS scores of all foods consumed by a participant). Cardiovascular events during follow-up were retrieved using country-specific methods (self-report, registry data). Multi-adjusted Cox models were computed. Findings: Overall, 16,214 first cardiovascular events were reported (median follow-up: 12.3 years; 4,103,133 person-years). The consumption of foods with a higher uNS-NPS score (reflecting a lower overall nutritional quality of diet) was associated with higher risks of total cardiovascular events (Hazards Ratio (HR) for an increment of 1 standard deviation: 1.03 (95% Confidence Interval 1.01–1.05)), especially myocardial infarction (HR = 1.03 (1.01–1.07)), and stroke (HR = 1.04 (1.01–1.07)). Interpretation: In this large prospective study among European adults, a higher risk of cardiovascular diseases (total and several subtypes) was observed in individuals consuming a diet with a lower nutritional value, as graded by the uNS-NPS score. This brings new evidence on the relevance of the updated nutrient profile underlying the Nutri-Score to characterize foods with a healthier nutrient profile. Funding: EPIC-CVD was supported by EU FP7, ERC, UK MRC, British Heart Foundation, and UK NIHR.

Compared to cigarette smoke, heated tobacco product (HTP) aerosol contains significantly fewer and lower levels of harmful and potentially harmful constituents (HPHCs). However, the impact on environmental air is relatively unexplored. Therefore, this study compared levels of secondhand aerosol (SHA) constituents in air following glo HTP use with secondhand smoke (SHS) constituents following cigarette smoking in an environmental test chamber (ETC). Extracted ETC air samples following product use sessions were analyzed for 27 SHS/SHA constituents, including HPHCs. The use of glo HTPs resulted in significantly lower SHA HPHC levels in the ETC air relative to SHS HPHC levels from cigarette smoking. Some aerosol constituents (benzene, CO, formaldehyde, nicotine, respirable suspended particles, toluene, ethylbenzene, fine particulate matter, m- and p-cresol, o-cresol, pyridine, styrene, and ultraviolet particulate matter) were either below the limit of detection in ETC air or at significantly low levels following glo HTP use relative to cigarette smoking. Mean concentrations of the assessed constituents were at least 90 % lower following use of glo HTPs compared to smoking combustible cigarettes. These results suggest that glo HTP use would not contribute significantly to indoor air contamination and would reduce non-user exposure to HPHCs and other harmful constituents relative to combustible cigarettes. Such reductions in non-user exposure should be considered when assessing the tobacco harm reduction potential of glo HTPs.

Background: People living with HIV/AIDS (PLHIV) are prone to other health issues that may result from the disease or antiretroviral medicines. These persons experience other psychosocial aspects of the illness, which may negatively affect their quality of life and overall treatment outcomes. This study assessed the medication-related burden and virological response of adult PLHIV. Method: This cross-sectional study involved 417 HIV-positive adults who had been on combined antiretroviral therapy for at least a year at the State Specialist Hospital Gombe. Nigeria. Patient medication experience was measured using the Living with Medication Questionnaire version-3 (LMQ-3). Virological suppression was assessed at viral loads

Introduction Successful organ transplantation in patients with end-stage organ failure improves long-term survival, improves quality of life and reduces costs to the NHS. Despite an increase in the number of deceased organ donors over the last decade, there remains a considerable shortfall of suitable organs available for transplantation. Over half of UK donors are certified dead by neurological criteria following brain stem compression, which leads to severe physiological stress in the donor, combined with a hyperinflammatory state. Brain stem death-related dysfunction is an important reason for poor organ function and hence utilisation. For example, more than 30% of donation after brain stem death cardiac transplant recipients need short-term mechanical cardiac support, reflecting donor heart dysfunction.A small, randomised study previously showed improved outcomes for cardiac transplant recipients if the donor was given simvastatin. SIGNET takes inspiration from that study and hypothesises a potential reduction in damage to the heart and other organs during the period after diagnosis of death and prior to organ retrieval in donors that receive simvastatin.Methods and analysis SIGNET is a multicentre, single-blind, prospective, group sequential, randomised controlled trial to evaluate the benefits of a single high dose of simvastatin given to potential organ donors diagnosed dead by neurological criteria on outcomes in all organ recipients. The trial will run across a minimum of 89 UK sites with a recruitment target of 2600 donors over 4 years.Ethics and dissemination SIGNET received a favourable opinion from the London, Queen Square Research Ethics Committee (Ref: 21/LO/0412) and following approval of substantial amendment 1 in January 2023, the current protocol is version 2 (7 December 2022). Substantial amendment 1 clarified consent procedures and added additional sites and prescribers. Findings from the study will be publicly available and disseminated locally and internationally through manuscript publications in peer-reviewed journals and conference presentations at national and international platforms.Trial registration number ISRCTN11440354

Abstract Soil organic carbon (SOC) is a soil health indicator and understanding dynamics changing SOC stocks will help achieving net zero goals. Here we present four datasets featuring 11,750 data points covering co-located aboveground and below-ground metrics for exploring ecosystem SOC dynamics. Five sites across England with an established land use contrast, grassland and woodland next to each other, were rigorously sampled for aboveground (n = 109), surface (n = 33 soil water release curves), topsoil, and subsoil metrics. Commonly measured soil metrics were analysed in five soil increments for 0–1 metre (n = 4550). Less commonly measured soil metrics which were assumed to change across the soil profile were measured on a subset of samples only (n = 3762). Additionally, we developed a simple method for soil organic matter fractionation using density fractionation which is part of the less common metrics. Finally, soil metrics which may impact SOC dynamics, but with less confidence as to their importance across the soil profile were only measured on topsoil (~5–15 cm = mineral soil) and subsoil (below 50 cm) samples (n = 2567).

Abstract Probabilistic computing is a computing scheme that offers a more efficient approach than conventional complementary metal-oxide–semiconductor (CMOS)-based logic in a variety of applications ranging from optimization to Bayesian inference, and invertible Boolean logic. The probabilistic bit (or p-bit, the base unit of probabilistic computing) is a naturally fluctuating entity that requires tunable stochasticity; by coupling low-barrier stochastic magnetic tunnel junctions (MTJs) with a transistor circuit, a compact implementation is achieved. In this work, by combining stochastic MTJs with 2D-MoS2 field-effect transistors (FETs), we demonstrate an on-chip realization of a p-bit building block displaying voltage-controllable stochasticity. Supported by circuit simulations, we analyze the three transistor-one magnetic tunnel junction (3T-1MTJ) p-bit design, evaluating how the characteristics of each component influence the overall p-bit output. While the current approach has not reached the level of maturity required to compete with CMOS-compatible MTJ technology, the design rules presented in this work are valuable for future experimental implementations of scaled on-chip p-bit networks with reduced footprint.

Fibromuscular dysplasia is an abnormal cell growth of the arterial wall that usually affects the renal and carotid arteries. It may lead to stenosis, tortuosity, aneurysm, or dissection of the artery and can potentially compromise the circulation from ensuing total occlusion and infarction of the recipient area. We report a case of a young male who presented with severe acute abdominal pain in the right side of the abdomen associated with nausea, vomiting, and constipation. Computed tomography of the abdomen with intravenous contrast showed acute renal infarction of a focal area at the lower pole of the right kidney, subsequent computed angiography showed dissection of a segmental branch of the right renal artery associated with fibromuscular dysplasia and beading appearance of the right renal artery. The renal function test and urinalysis were both normal. The patient was treated with unfractionated heparin infusion, with the resolution of abdominal pain, he was subsequently discharged home uneventfully on oral aspirin.

Introduction: The ribonuclease (RNase) A superfamily encodes cationic antimicrobial proteins with potent microbicidal activity toward uropathogenic bacteria. Ribonuclease 6 (RNase6) is an evolutionarily conserved, leukocyte-derived antimicrobial peptide with potent microbicidal activity toward uropathogenic Escherichia coli (UPEC), the most common cause of bacterial urinary tract infections (UTIs). In this study, we generated Rnase6-deficient mice to investigate the hypothesis that endogenous RNase 6 limits host susceptibility to UTI. Methods: We generated a Rnase6EGFP knock-in allele to identify cellular sources of Rnase6 and determine the consequences of homozygous Rnase6 deletion on antimicrobial activity and UTI susceptibility. Results: We identified monocytes and macrophages as the primary cellular sources of Rnase6 in bladders and kidneys of Rnase6EGFP/+ mice. Rnase6 deficiency (i.e., Rnase6EGFP/EGFP) resulted in increased upper urinary tract UPEC burden during experimental UTI, compared to Rnase6+/+ controls. UPEC displayed increased intracellular survival in Rnase6-deficient macrophages. Conclusion: Our findings establish that RNase6 prevents pyelonephritis by promoting intracellular UPEC killing in monocytes and macrophages and reinforce the overarching contributions of endogenous antimicrobial RNase A proteins to host UTI defense.

Abstract Asian soybean rust (ASR), caused by Phakopsora pachyrhizi, is a devastating disease that is present in all major soybean-producing regions. The limited availability of resistant germplasm has resulted in a scarcity of commercial soybean cultivars that are resistant to the disease. To date, only the Chinese soybean landrace SX6907 has demonstrated an immune response to ASR. In this study, we present the isolation and characterization of Rpp6907-7 and Rpp6907-4, a gene pair that confer broad-spectrum resistance to ASR. Rpp6907-7 and Rpp6907-4 encode atypic nucleotide-binding leucine-rich repeat (NLR) proteins that are found to be required for NLR-mediated immunity. Genetic analysis shows that only Rpp6907-7 confers resistance, while Rpp6907-4 regulates Rpp6907-7 signaling activity by acting as a repressor in the absence of recognized effectors. Our work highlights the potential value of using Rpp6907 in developing resistant soybean cultivars.