Augmentation Research Articles

O-251 Generative artificial intelligence substantially enhances the accuracy of embryo selection models

Abstract Study question Can generative artificial intelligence (AI) produce high-fidelity human embryo images to improve AI-based embryo selection models? Summary answer Generative AI models exhibit the capability to generate high-fidelity human embryo images and can substantially improve the performance of AI models through extensive training data. What is known already The integration of AI into in vitro fertilization (IVF) procedures holds the potential to enhance objectivity and automate embryo selection for transfer. However, the effectiveness of AI is limited by data scarcity and ethical concerns related to patient data privacy. Generative Adversarial Networks (GAN) have emerged as a promising approach to alleviate data limitations by generating synthetic data that closely approximate real images. However, the advantage of applying GAN in IVF embryo images is yet to be determined. Study design, size, duration Embryo images were retrieved as training data from time-lapse microscopy (TLM) videos (n = 328). Embryo key morphokinetic variables including blastomere division from 1-cell stage to 9 (and more) cells-stage, compaction of morula, and blastocyst formation were manually annotated by six embryologists. A style-based GAN was fine-tuned as the generative model and a residual network as the morphokinetic classification model. Participants/materials, setting, methods We configured generative models with data augmentation (AUG) and pretrained weights (Pretrained-T/R) to test their refinement to synthetic image quality. We analyzed quantitative metrics including Fréchet Inception Distance (FID) and Kernel Inception Distance (KID) to assess the quality and fidelity of the generated images. Subsequently, we evaluated qualitative performance through a visual Turing test. Then, we compared the performance of a classifier by training real images alone and by integrating real images with generated data. Main results and the role of chance During the training process, we observed consistent improvement in image quality that was measured by FID and KID scores. The AUG+Pretrained-R model showed the highest performance of the evaluated five configurations with FID and KID scores of 15.2 and 0.004 following 5,000 training iterations. Subsequently, we carried out a visual Turing test, such that a total of 60 individuals including IVF embryologists (Group I, n = 25), IVF laboratory technicians (Group II, n = 15), and non-experts (Group III, n = 20) evaluated the synthetic blastocyst-stage embryo images. Group I displayed accuracy of 55.7% (±6.2), sensitivity of 65.9% (±14.1), and specificity of 45.1% (±17.8). Group II showed accuracy of 54.2% (±4.7), sensitivity of 65.9% (±17.6), and specificity of 42.0% (±19.6). Group III had the accuracy of 50.1% (±3.8), sensitivity of 49.3% (±6.3), and specificity was 50.9% (±10.4). Statistical analysis indicated significant differences in accuracy (Kruskal-Wallis test, P=1.2x10-3) and sensitivity (Kruskal-Wallis test, P=1.6x10-4) among the three groups. In the embryonic stage classification model, integrated with generated data outperformed the model using real data solely, with an increase of validation accuracy from 72.6% to 90.6%. The classifier was tested on external TLM video data (n = 100) where the area under the curve was 0.92. Limitations, reasons for caution Further research is needed to involve a more extensive and diverse dataset, e.g. video generation, and more detailed annotations including polar body appearance, pronuclei appearance and disappearance, and blastocyst expansion and hatching. Wider implications of the findings Generative AI offers potential in generating high-fidelity human embryo images. This approach ensures sufficient training datasets while addressing class imbalances for robust AI-based methods, ultimately transforming embryo selection and enhancing IVF outcomes. A set of 5,000 generated images (1024x1024-pixel) at each embryonic developmental stage was open-source for future AI studies. Trial registration number not applicable

Generative artificial intelligence to produce high-fidelity blastocyst-stage embryo images.

Can generative artificial intelligence (AI) models produce high-fidelity images of human blastocysts? Generative AI models exhibit the capability to generate high-fidelity human blastocyst images, thereby providing substantial training datasets crucial for the development of robust AI models. The integration of AI into IVF procedures holds the potential to enhance objectivity and automate embryo selection for transfer. However, the effectiveness of AI is limited by data scarcity and ethical concerns related to patient data privacy. Generative adversarial networks (GAN) have emerged as a promising approach to alleviate data limitations by generating synthetic data that closely approximate real images. Blastocyst images were included as training data from a public dataset of time-lapse microscopy (TLM) videos (n = 136). A style-based GAN was fine-tuned as the generative model. We curated a total of 972 blastocyst images as training data, where frames were captured within the time window of 110-120 h post-insemination at 1-h intervals from TLM videos. We configured the style-based GAN model with data augmentation (AUG) and pretrained weights (Pretrained-T: with translation equivariance; Pretrained-R: with translation and rotation equivariance) to compare their optimization on image synthesis. We then applied quantitative metrics including Fréchet Inception Distance (FID) and Kernel Inception Distance (KID) to assess the quality and fidelity of the generated images. Subsequently, we evaluated qualitative performance by measuring the intelligence behavior of the model through the visual Turing test. To this end, 60 individuals with diverse backgrounds and expertise in clinical embryology and IVF evaluated the quality of synthetic embryo images. During the training process, we observed consistent improvement of image quality that was measured by FID and KID scores. Pretrained and AUG + Pretrained initiated with remarkably lower FID and KID values compared to both Baseline and AUG + Baseline models. Following 5000 training iterations, the AUG + Pretrained-R model showed the highest performance of the evaluated five configurations with FID and KID scores of 15.2 and 0.004, respectively. Subsequently, we carried out the visual Turing test, such that IVF embryologists, IVF laboratory technicians, and non-experts evaluated the synthetic blastocyst-stage embryo images and obtained similar performance in specificity with marginal differences in accuracy and sensitivity. In this study, we primarily focused the training data on blastocyst images as IVF embryos are primarily assessed in blastocyst stage. However, generation of an array of images in different preimplantation stages offers further insights into the development of preimplantation embryos and IVF success. In addition, we resized training images to a resolution of 256 × 256 pixels to moderate the computational costs of training the style-based GAN models. Further research is needed to involve a more extensive and diverse dataset from the formation of the zygote to the blastocyst stage, e.g. video generation, and the use of improved image resolution to facilitate the development of comprehensive AI algorithms and to produce higher-quality images. Generative AI models hold promising potential in generating high-fidelity human blastocyst images, which allows the development of robust AI models as it can provide sufficient training datasets while safeguarding patient data privacy. Additionally, this may help to produce sufficient embryo imaging training data with different (rare) abnormal features, such as embryonic arrest, tripolar cell division to avoid class imbalances and reach to even datasets. Thus, generative models may offer a compelling opportunity to transform embryo selection procedures and substantially enhance IVF outcomes. This study was supported by a Horizon 2020 innovation grant (ERIN, grant no. EU952516) and a Horizon Europe grant (NESTOR, grant no. 101120075) of the European Commission to A.S. and M.Z.E., the Estonian Research Council (grant no. PRG1076) to A.S., and the EVA (Erfelijkheid Voortplanting & Aanleg) specialty program (grant no. KP111513) of Maastricht University Medical Centre (MUMC+) to M.Z.E. Not applicable.

Semi-supervised Active Learning for Video Action Detection

In this work, we focus on label efficient learning for video action detection. We develop a novel semi-supervised active learning approach which utilizes both labeled as well as un- labeled data along with informative sample selection for ac- tion detection. Video action detection requires spatio-temporal localization along with classification, which poses several challenges for both active learning (informative sample se- lection) as well as semi-supervised learning (pseudo label generation). First, we propose NoiseAug, a simple augmenta- tion strategy which effectively selects informative samples for video action detection. Next, we propose fft-attention, a novel technique based on high-pass filtering which enables effective utilization of pseudo label for SSL in video action detection by emphasizing on relevant activity region within a video. We evaluate the proposed approach on three different bench- mark datasets, UCF-101-24, JHMDB-21, and Youtube-VOS. First, we demonstrate its effectiveness on video action detec- tion where the proposed approach outperforms prior works in semi-supervised and weakly-supervised learning along with several baseline approaches in both UCF101-24 and JHMDB- 21. Next, we also show its effectiveness on Youtube-VOS for video object segmentation demonstrating its generalization capability for other dense prediction tasks in videos.

An approach to the diagnosis of lumbar disc herniation using deep learning models.

Background: In magnetic resonance imaging (MRI), lumbar disc herniation (LDH) detection is challenging due to the various shapes, sizes, angles, and regions associated with bulges, protrusions, extrusions, and sequestrations. Lumbar abnormalities in MRI can be detected automatically by using deep learning methods. As deep learning models gain recognition, they may assist in diagnosing LDH with MRI images and provide initial interpretation in clinical settings. YOU ONLY LOOK ONCE (YOLO) model series are often used to train deep learning algorithms for real-time biomedical image detection and prediction. This study aims to confirm which YOLO models (YOLOv5, YOLOv6, and YOLOv7) perform well in detecting LDH in different regions of the lumbar intervertebral disc. Materials and methods: The methodology involves several steps, including converting DICOM images to JPEG, reviewing and selecting MRI slices for labeling and augmentation using ROBOFLOW, and constructing YOLOv5x, YOLOv6, and YOLOv7 models based on the dataset. The training dataset was combined with the radiologist's labeling and annotation, and then the deep learning models were trained using the training/validation dataset. Results: Our result showed that the 550-dataset with augmentation (AUG) or without augmentation (non-AUG) in YOLOv5x generates satisfactory training performance in LDH detection. The AUG dataset overall performance provides slightly higher accuracy than the non-AUG. YOLOv5x showed the highest performance with 89.30% mAP compared to YOLOv6, and YOLOv7. Also, YOLOv5x in non-AUG dataset showed the balance LDH region detections in L2-L3, L3-L4, L4-L5, and L5-S1 with above 90%. And this illustrates the competitiveness of using non-AUG dataset to detect LDH. Conclusion: Using YOLOv5x and the 550 augmented dataset, LDH can be detected with promising both in non-AUG and AUG dataset. By utilizing the most appropriate YOLO model, clinicians have a greater chance of diagnosing LDH early and preventing adverse effects for their patients.

Antidepressant Strategies for Treatment of Acute Depressive Episodes Among Veterans.

The 2016 VA/DoD Clinical Practice Guideline for Management of Major Depressive Disorder offers consensus-based recommendations when response to the initial antidepressant medication is suboptimal; however, little is known about "real-world" pharmacological strategies used by providers treating depression in the Veterans Affairs Health Care System (VAHCS). We extracted pharmacy and administrative records of patients diagnosed with a depressive disorder and treated at the Minneapolis VAHCS between January 1, 2010 and May 11, 2021. Patients with bipolar disorder, psychosis-spectrum, or dementia diagnoses were excluded. An algorithm was developed to identify antidepressant strategies: monotherapy (MONO); optimization (OPM); switching (SWT); combination (COM); and augmentation (AUG). Additional data extracted included demographics, service utilization, other psychiatric diagnoses, and clinical risk for hospitalization and mortality. The sample consisted of 1298 patients, 11.3% of whom were female. The mean age of the sample was 51 years. Half of the patients received MONO, with 40% of those patients receiving inadequate doses. OPM was the most common next-step strategy. SWT and COM/AUG were used for 15.9% and 2.6% of patients, respectively. Overall, patients who received COM/AUG were younger. OPM, SWT, and COM/AUG occurred more frequently in psychiatric services settings and required a greater number of outpatient visits. The association between antidepressant strategies and risk of mortality became nonsignificant after accounting for age. Most of the veterans with acute depression were treated with a single antidepressant, while COM and AUG were rarely used. The age of the patient, and not necessarily greater medical risks, appeared to be a major factor in decisions about antidepressant strategies. Future studies should evaluate whether implementation of underutilized COM and AUG strategies early in the course of depression treatment are feasible.

The Vascularization Course of Labral Autograft and Its Effect on Tissue Healing: Acetabular Labral Augmentation Versus Labral Reconstruction in a Porcine Model

Background: The preservation of the native labral vascularization is assumed to be the potential advantage of acetabular labral augmentation, the effect of which remains unknown. Purpose: To identify the vascular distribution within the labral autograft and its effect on the healing process between labral augmentation (AUG) and reconstruction (RECON) in a porcine model. Study Design: Controlled laboratory study. Methods: A total of 36 pigs randomly underwent unilateral labral augmentation or reconstruction (AUG group, n = 18; RECON group, n = 18). The pigs were randomly sacrificed at 6, 12, and 24 weeks postoperatively. The labral autografts were harvested for macroscopic evaluation and histologic assessment. The labral autograft was zoned into 2 halves to observe the vascular distribution: the capsular half (zone I) and the articular half (zone II). Each zone was divided into 2 parts: the peripheral part (IA and IIA) and the part attached to the acetabulum (IB and IIB). Results: At 6 weeks, there existed more vascular ingrowth in zone I, whereas zone IIB appeared nearly avascular in both groups. At 12 weeks, the area with the greatest vascularity was zone II in the RECON group and zone IA in the AUG group. The vascularity was concentrated at zones IA and IIA in both groups at 24 weeks. The labral autografts were hypertrophic with sufficient filling of the labral defect in both groups at 6 weeks. At 12 weeks, an insufficient volume of the articular half was observed in 3 of 6 labral autografts in the RECON group, while all autografts remained well integrated with the chondrolabral junction in the AUG group. At 24 weeks, unsatisfactory merging of the labral autograft with the cartilage at the articular side was found in 2 of 6 labral autografts in the RECON group, which was not observed in the AUG group despite the sufficient volume of autografts labrum in both groups. Conclusion: Slow vascular ingrowth within the articular half might account for the poor healing of the reconstructed labral autograft. Labral augmentation provides the possibility of better tissue healing because of the preservation of the original chondrolabral junction compared with labral reconstruction. Clinical Relevance: Labral augmentation might be a feasible alternative to labral reconstruction under the condition of viable labral remnants.

The comparison of losartan and ramipril on the incidence of hyperkalaemia among hypertensive patients with chronic kidney disease

Background and Aims: The Joint National Committee 8th guideline recommends the initiation of renin angiotensin aldosterone system (RAAS)-linked drugs for hypertensive patients with chronic kidney disease (CKD). Losartan, an angiotensin receptor blocker (ARB), and ramipril, angiotensin converting enzyme (ACE) inhibitors, are widely utilized antihypertensive agents with sound efficacy and safety. The study compared the hyperkalemia incidences in CKD patients exposed to losartan and ramipril. Methods: A prospective observational study was conducted for 12 months in the nephrology outpatient setting of a private tertiary care referral hospital in the Malabar region of Kerala. CKD patients with hypertension who were on ACE inhibitors or ARB therapy constituted our study population. Their demographic details, serum creatinine and potassium and urine protein were documented for three consecutive patient consultations. Results: There were an equal number of samples (n=186) in each of the losartan and ramipril administered groups. Losartan and ramipril doses preferred by the nephrologist were 1.25, 25, 50 & 100 mg and 0.625, 1.2, 2.5, 5 and 10 mg, respectively. The Mann-Whitney U test showed statistical significance (p≥0.05) between RAAS-related drugs and patients’ total daily doses. We noticed more frequency of hyperkalemia in the losartan group (n=11, 5.9%) than in the ramipril group (n=4, 2.2%). Initially, the mean serum potassium was low in the ACE inhibitor (4.35±0.55) subset, and then there was augmentation in the second (4.46±0.52) and third (4.52±0.55) patient consultations. The repeated measures ANOVA tests depicted the samples to be different (p<0.05) in the serum potassium measurements within the losartan group (p-=0.018) and ramipril group (p<0.001). Conclusion: Losartan gave favorable clinical effects in CKD patients with regards to serum creatinine and potassium. However, the frequency in reduction of proteinuria was profound in ramipril understudies.

Multifeature Fusion-Based Hand Gesture Sensing and Recognition System

With the development of the radar sensing technology, hand gesture sensing and recognition has attracted much attention. This letter adopts a frequency-modulated continuous wave (FMCW) radar to achieve short-range hand gesture sensing and recognition. Specifically, the range, Doppler, and angle parameters of hand gestures are measured by fast Fourier transformation (FFT) and multiple signal classification (MUSIC) algorithm, respectively. The mixup (MP) algorithm combined with augmentation (AU) algorithm using a weight factor is applied to expand the hand gesture data. Then, a complementary multidimensional feature fusion network-based hand gesture recognition (CMFF-HGR) is designed to extract the features and achieve HGR. Finally, a series of experiments are carried out to verify the effectiveness of the proposed approach, and the results show that the recognition accuracy is higher than the existing alternatives with low computational complexity.

Birds of a Feather Flock Together: Disadvantageous Decision Making in Augmented Restless Legs Syndrome Patients with and without Impulse Control Disorders.

Background: Augmentation (AUG) in patients with restless legs syndrome (RLS) can be associated with impulse control disorder (ICD) symptoms, such as compulsive sexual behavior, gambling disorder or compulsive shopping. In this study, we wanted to assess whether RLS patients with AUG differ in decision making from those patients who have augmentation and in addition ICD symptoms (AUG + ICD) in a post hoc analysis of a patient cohort assessed in a previous study. Methods: In total, 40 RLS patients with augmentation (19 AUG + ICD, 21 AUG without ICDs) were included. RLS diagnosis, severity, and diagnosis of augmentation were made by sleep disorder specialists. ICD symptoms were assessed using semi-structured interviews. All patients performed the beads task, which is an information sampling task where participants must decide from which of the two cups colored beads were drawn. Results were compared to 21 healthy controls (HC). Results: There was no difference in information sampling or irrational decision making between AUG and AUG + ICD patients (p = 0.67 and p = 1.00, respectively). Both patient groups drew less beads and made more irrational decisions than HC (all p-values < 0.03, respectively). Conclusions: Our results suggest that augmentation itself is associated with poorer decision making even in the absence of ICD symptoms. Further studies are necessary to explore whether rapid and hasty decision making are a harbinger of augmentation in RLS.

Dynamic augmentation of scattering cross‐section by a conducting polycylinder coated with varactor‐loaded metasurface

Dynamic augmentation of scattering cross‐section by a conducting polycylinder coated with varactor‐loaded metasurface

Redesigning irrigated almond and pistachio cultivation: implications of a shift towards sustainable intensification

The global warming is increasing the variability of rainfall and temperature, peculiarly, in arid and semiarid environments worlwide. Alterations in precipitation patterns and evapotranspiration in these areas will provoke an augmentation in the water requirements for crops, therefore, a collapse in the water resources systems is contemplated. This work presents the deficit irrigation as an adaptation tool for water shortage in reducing the vulnerability of woody-fruit crops in the Mediteraean area. In this context, almond (Prunus dulcis Mill.) and pistachio (Pistacia vera L.) are traditional Mediterranean crops well-adapted to rainfed conditions with highly producer potential under irrigation, therefore, both fruit crops are convenient alternative due to its congenital response to water-stress. In general, moderate deficit irrigation technique enables to save about 30% of irrigation water at yield reductions below 20%. That is, the application of deficit irrigation could be recommended especially in those areas where the full water requeriments for crops are not available due to environmental constrains. In addition, the success of deficit irrigation is based on relevant knowledge of crop phenological development and its physiological reaction to water stress. Thus, the implementation of properly redesign of irrigated fruit plantations under climate change is vital, in order to mitigate the impact on yield, increase water-use efficiency, and preserve or improve the production quality.

A Study on the Improvement of Domestic Navigation Safety System: Focused on the Implementation of Korea Augmentation Satellite System

A Study on the Improvement of Domestic Navigation Safety System: Focused on the Implementation of Korea Augmentation Satellite System

Twisted Tape Insert Effect on Heat Transfer Enhancement Placed in Smooth Tube: A Review

Today heat exchangers are commonly used with twisted-tape inserts to improve convective heat transfer in various industries such as thermal power plants, chemical processing plants, air conditioning equipment, refrigerators, petrochemical, biomedical, and food processing plants. By using the twisted tape patch, the fluid flow swirls together, interrupting a thermal boundary layer on the surface of the pipeline. Heat exchanger thermal efficiency can be enhanced by heat transfer increase techniques. Tape insert is one of the techniques of passive heat transfer augmentation and used in the utmost application of heat transfer, for example, food processes for air conditioning and refrigeration systems. Thus, various techniques of enhancement were reviewed.

Augmentation in Healthcare Utilization of Patients with Opioid Use Disorder After Methadone Maintenance Treatment: A Retrospective Nationwide Study.

The health benefits of entering methadone maintenance treatment (MMT) for opioid-dependent persons may not be merely limited to therapy of opioid use disorder. We aimed to compare the healthcare utilization of MMT patients before and after MMT. A retrospective analysis was performed using the Taiwan Illicit Drug Issue Database and the National Health Insurance Research Database (NHIRD) between 2014 and 2016. We included 1255 newly enrolled MMT patients in 2015 and randomly selected 5020 patients from NHIRD matched by age and gender as the comparison group. Changes in healthcare utilization 1year before and 1year after the date of the index date (MMT initiation) were compared within and between MMT and comparison groups. During the 1-year period following MMT, the hospitalization length was considerably decreased, while the number of outpatient visits, emergency department (ED) visits, and ED expenditure significantly increased in MMT patients. Multivariable linear regression with the difference-in-difference approach revealed that all the categories of healthcare utilization increased, except for a minor increase of outpatient expenditure and a slight decrease of hospitalization length for the MMT group relative to the comparison group. Increases in utilization of the departments of psychiatry and infectious diseases of the MMT patients were considerable. MMT is associated with increased healthcare utilization, and departments of psychiatry and infectious diseases play substantial roles. Policy-makers should warrant access for all who need healthcare by ensuring the availability of the treatment for drug dependence.

Simultaneous Excision of an Antral Pseudocyst and Maxillary Sinus Augmentation.

Case letters - No abstract.

Caffeic acid protects mice pancreatic islets from oxidative stress induced by multi-walled carbon nanotubes (MWCNTs).

Increasing applications of carbon nanotubes (CNTs) indicate the necessity to examine their toxicity. According to previous studies, CNTs caused oxidative stress that impaired β-cell functions and reduced insulin secretion. Our previous study indicated that single-walled carbon nanotubes (SWCNTs) could induce oxidative stress in pancreatic islets. However, there is no study on the effects of multi-walled carbon nanotubes (MWCNTs) on islets and β-cells. Therefore, the present study aims to evaluate effects of MWCNTs on the oxidative stress of islets and the protective effects of caffeic acid (CA) as an antioxidant. The effects of MWCNTs and CA on islets were investigated using MTT assay, reactive oxygen species (ROS), malondialdehyde (MDA), activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), the content of glutathione (GSH) and mitochondrial membrane potential (MMP) and insulin secretion measurements. The lower viability of islet cells was dose-dependent due to the exposure to MWCNTs according to the MTT assay. Further studies revealed that MWCNTs decreased insulin secretion and MMP, induced ROS creation, increased the MDA level, and decreased activities of SOD, GSH-Px, CAT, and content of GSH. Furthermore, the pretreatment of islets with CA returned the changes. These findings indicated that MWCNTs might induce the oxidative stress of pancreatic islets occurring diabetes and protective CA effects that were mediated by the augmentation of the antioxidant defense system of islets. Our research suggested the necessity of conducting further studies on effects of MWCNTs and CA on the diabetes.

Radiography study on osteotome sinus floor elevation with placed implant simultaneously with no graft augmentation

OBJECTIVE To investigate the change of endo-sinus bone height and bone volume in osteotome sinus floor elevation (OSFE) without bone graft but placing implants simultaneously by using cone beam computed tomography (CBCT) and three dimensional analysis, and to find the impacting factors on endo-sinus bone augmentation. METHODS OSFE was performed in 38 edentulous patients with missing teeth at posterior maxillary region, and 44 implants were placed and referred for OSFE using no graft materials. CBCT was performed pre-surgery and 9－68 months post-surgery when the patients encountered another implant surgery. The gained bone height at mesial, distal, buccal and palatal sites around the implant in sinus were measured, volumetric measurements of the endo-sinus gained bone volume (ESGBV) in the elevated region were calculated by Mimics software. Univariate analysis and multiple linear regression were performed to investigate the impacting factors on the gained bone height and ESGBV. Marginal bone loss was recorded according to the periapical radiography after implant restoration. RESULTS The mean residual bone height (RBH) pre-surgery was (3.41±1.23) mm, the mean protruded length (PL) into sinus of implant post-surgery was (3.41±1.28) mm, the mean endo-sinus gained bone height was (2.44±1.23) mm at distal sites, (2.88±1.20) mm at mesial sites, (2.83±1.22) mm at buccal sites and (2.96±1.16) mm at palatal sites, the mean endo-sinus gained bone height at distal sites was significantly lower than the other three sites (P < 0.05). The average endo-sinus gained bone height was (2.78±1.13) mm. The mean ESGBV was (122.15± 73.27) mm3. Univariate analysis showed the more RBH, the less bone height gained in sinus, which existed at buccal, lingual, mesial and distal sites (P < 0.001), and the more RBH, the smaller ESGBV gained (P=0.012). The ESGBV was significantly higher in the subjects whose bone generation period was more than 24 months than those whose bone generation period less than 24 months (P=0.034). The more PL, the more bone height and ESGBV gained (P=0.008). Multivariate analysis showed after adjusting factors of gender, age, smoking, width of sinus floor, thickness of sinus membrane pre-surgery, diameter and length of the implant, PL and bone generation period was positively correlated with mean endo-sinus gained bone height and ESGBV, while RBH negatively correlated with mean endo-sinus gained bone height. During the follow-up, the mean marginal bone loss was 0 (0－1.41) mm and all the implants loaded successfully. CONCLUSION OSFE without bone graft but with placed implant simultaneously can increase endo-sinus gained bone height and ESGBV. RBH, PL and bone generation period are the significant factors impacting endo-sinus bone augmentation.

El humor en los dominicanos como pretexto del trauma cultural de la colonización

En este articulo de reflexión se plantea que el humor en los dominicanos se ha convertido en una defensa patológica que permanece como una barrera que impide integrar las experiencias traumáticas, como fue la colonización. El enfoque es cualitativo con un diseño documental de tipo bibliográfico y argumentativo. La colonización significó un acontecimiento traumático que alteró la vida de los pueblos originarios con experiencias colectivas de abuso, muertes, malos tratos, trabajo forzado, hambrunas, epidemias, guerras, suicidios, un sistema esclavista despiadado y la pérdida cultural. La colonización se manifiesta como una herida enmascarada del trauma cultural que se afronta desde lo inconsciente a través de la figura del Trickster personaje universal que representa lo cómico. El Trickster dominicano, como figura daimónica, se polariza en la sombra, convirtiéndose en persecutor por medio del humor agresivo, que se manifiesta como una defensa inconsciente que pretende menospreciar y ridiculizar al otro. Este humor agresivo, espasmódico y seco es una forma de control compulsivo que se conoce como relajo. Es un Trickster que expresa la invisibilización de los grupos originarios, la desdicha de la herencia española, la tristeza del negro esclavo y todo el sufrimiento a posteriori de la colonización en una mezcla racial y cultural parcialmente incorporada. El relajo del dominicano es una defensa inconsciente, que mantiene la estructura del trauma, por tanto, la fragmentación polarizada del self individual y colectivo, que no se integra a la vida consciente por lo tanto perdura como una continua disculpa del trauma histórico y cultural de la colonización.

Biological augmentation strategies in rotator cuff repair.

Rotator cuff tears (RCT) are a common problem encountered by orthopaedic surgeons. The incidence of re-tears (up to 94%) following surgical repair of RCTs renders the management of RCTs challenging. This higher re-tear rate has been attributed to the failure of healing at the tendon-bone junction. Biological augmentation methods such as growth factors, stem cell therapies, and biomaterials have been developed to promote the healing at the tendon-bone junction. Growth factors and stem cell therapies have been intensively studied in mid to large RCTs. Biomaterials have been generally utilized for large or massive RCTs. However, these newly generated biological augmentation strategies are mostly studied in animal models. The efficacy and safety of the biological augmentation methods in humans need further investigation. In this review, we aimed to highlight the most recent advancements in RCT surgical repair with biological augmentation.

Exploring the Impact of Blended, Flipped, and Traditional Teaching Strategies for Teaching Grammar on Iranian EFL Learners' through English Newspaper Articles

Following the recent developments in educational technology-integrated learning, interest in the true implementation of flipped and blended classrooms as innovative approaches has become increasingly popular among language education authorities. This research aimed at comparing flipped, blended, and traditional teaching (T-learning) contexts on Iranian EFL learners’ grammar learning. To this end, 60 intermediate EFL students out of 80, based on their performance in an Oxford Placement Test (OPT), were selected and divided into three groups, including two comparative and one control group, 20 in each. At the beginning of the study, the three groups participated in a pretest to assess their initial ability of grammar knowledge. To integrate technology into their instruction, both comparative groups received the same treatment and materials based on the Substitution, Augmentation, Modification, and Redefinition (SAMR) model. The blended comparative group received instruction in both on-line and T-learning contexts, while the flipped comparative group received instruction in an online context. The control group received instruction in a T-learning context. After the treatment sessions, they participated in a post-test. The findings showed that reading interesting English newspaper articles, both in the blended and flipped classrooms had a statistically significant effect on developing EFL learners' grammar knowledge. The findings of the study may be beneficial for EFL teachers and material developers to reconsider the role of educational technology (Ed Tech) tools to support classroom-based learning.