Gold Standard Approach Research Articles

Probing Neurophysiological Processes Related to Self-Referential Processing to Predict Improvement for Depressed Adolescents Receiving Cognitive Behavioral Therapy

BACKGROUNDCognitive Behavior Therapy (CBT) is a gold standard approach for treating major depressive disorder (MDD) among adolescents. However, nearly half of adolescents receiving CBT do not improve. In order to personalize treatment, it is essential to identify objective markers that predict treatment responsiveness. Toward addressing this aim, this study investigated neurophysiological processes related to self-referential processing that predicted CBT response among depressed, female adolescents. METHODSAt baseline, female adolescents ages 13-18-years-old (N=80) completed a comprehensive clinical assessment, and a self-referential encoding task was administered while electroencephalogram (EEG) data were recorded. Baseline EEG data were utilized to identify oscillatory differences between healthy (HC, n=38) and depressed (MDD, n=42) adolescents. Following the baseline assessment, depressed youth received up to 12-weeks of CBT. Baseline differences in EEG oscillations between healthy and depressed youth were used to guide CBT prediction analysis. Cluster-based event-related spectral perturbation analysis (ERSP) probed theta and alpha event-related synchronization/desynchronization (ERS/ERD) response to negative and positive words. RESULTSBaseline analyses showed that, relative to the healthy adolescents, depressed youth exhibited higher levels of frontal theta ERS and a greater posterior alpha ERD. Multilevel modeling identified primary neural pre-treatment predictors of treatment response: greater theta ERS in the right prefrontal cortex (PFC) after the onset of negative words and lower alpha ERD in both the right PFC and posterior cingulate cortex (PCC). ERS and ERD associations with treatment response remained significant, with baseline depressive and anxiety symptoms included as covariates in all analyses. CONCLUSIONSConsistent with prior research, results highlighted that relative to healthy youth, depressed adolescents are characterized by prominent theta synchronization and alpha desynchronization over PFC and PCC, respectively. Cluster-based ERSP analysis also identified key mechanisms underlying depression-related self-referential processing that predicted improved symptoms during the CBT course. Ultimately, a better characterization of the neural underpinnings of adolescent depression and its treatment may lead to more personalized interventions.

Thoracoabdominal approach to large adrenal tumors – when laparoscopic adrenalectomy is not enough: a retrospective four-year study

Introduction: Laparoscopic adrenalectomy is considered to be the gold standard approach in the field of adrenal surgery. This technique offers advantages of great importance compared to variant laparotomy techniques. Notwithstanding, a technique that needs to be mentioned is the thoracoabdominal approach which facilitates the anatomic exposure of the retroperitoneum, adrenal gland, and great vessels and is strongly recommended for the surgery of large, malignant adrenal tumors. Aim: The objective of this study is to evaluate the effectiveness and outcomes of the thoracoabdominal approach in adrenal surgery for large adrenal tumors. By presenting our results and experiences, we aim to highlight the advantages of this technique in providing optimal anatomic exposure of the retroperitoneum, adrenal gland, and great vessels, and to establish its role as a viable alternative to laparoscopic adrenalectomy in complex cases. Materials and methods: We reviewed retrospectively the data of our patients admitted to our Surgical Department and treated surgically with the thoracoabdominal incision, performed by a single surgeon at our tertiary care center, over the period 01/01/20-31/12/23. Results: All patients had large retroperitoneal masses of varying complexity, requiring maximal surgical exposure. Seventeen patients in total underwent operation with the indication of unilateral adrenal tumor. Five of those patients underwent a laparoscopic tumor resection, while 12 patients were treated by thoracoabdominal approach. Our study group included 7 women (58%) and 5 men (42%), with average age 57 years. The mean maximum tumor diameter was 10.8 cm. Conclusion: The advantages of the thoracoabdominal approach regarding the exposure of the operative field in challenging cases, together with the low incidence of complications noted in our experience, render this technique an excellent alternative if indicated.

Coupling solid phase microextraction to integrated optical sensors with microfluidic open interface

Increasing number of regulations today is very demanding, so many fields need to rely to screening techniques to separate samples whose content need to be confirmed with that field's gold standard approach. Therefore, the development of simple and fast approaches is very much needed. This manuscript presents the development of a microfluidic open interface integrated with ultraviolet-visible (UV–Vis) absorption detection for rapid screening applications. The system was designed as a rapid sensor readout for compounds enriched by solid-phase microextraction devices. Two azo dyes from a liquid water enhancer solution served as model analytes. These two dyes were extracted with the solid phase microextraction fiber and introduced to the system for analysis. Experimental results demonstrated that the system could effectively detect dyes with absorbance at 403 nm, indicating its potential for quantitating analytes with UV–Vis chromophores. Although this sensing method exhibits limited selectivity, it offers a cost-effective, straightforward approach to rapid screening that can be conveniently miniaturized for on-site applications. Further advances could focus on integrating low-cost sensors with specific responses in place of the UV–Vis unit, as well as simplification and miniaturization of the system to improve on-site analysis. Additionally, incorporating autosampler systems could enable high-throughput determinations, broadening the method's applicability. The developed solid phase microextraction method reliably samples and enriches small molecules from complex systems, delivering clean extracts to the selective sensor for readout without interference from the investigated sample matrix.

Comparison between early and late weight bearing after anterior cruciate ligament reconstruction surgery.

The anterior cruciate ligament (ACL) is a strip of dense connective tissue that runs from the femur to the tibia with a relatively poor blood supply. It prevents the femoral condyles from rolling posteriorly. ACL is commonly injured in any knee trauma, ranging from a little sprain to a total rupture. The arthroscope is the gold standard approach for identifying ACL tears, which may be treated conservatively or surgically. To assess the efficiency of immediate and delayed weight bearing after arthroscopic ACL reconstruction. Cohort longitudinal study carried through 6years from 2017 to 2023 et al.-kindy Teaching, Ulamaa, and Almuktar hospitals 186 patients, the patients were divided randomly into 2 groups, group A (n = 93) with immediate (after 10days) weight bearing and group B (n = 93) with delayed (after 1month) weight bearing following ACL reconstruction. any patients with chondral lesions, aged less than 19 or more than 40years, knee osteoarthritis, ligament damage, and deformity in lower extremities were excluded. Patients from both groups A and B had complete ACL tears and underwent arthroscopic ACL reconstruction follow-up for 6months duration regarding stiffness, infection, giving up pain, swelling, and quadriceps muscle atrophy. In group A, there were 93 patients,70 male and 23 female, and meniscal injury was 89 patients. While in group B (93 patients) 57 male and 36 female, meniscal injury in group B was 91. There is a statistically significant difference regarding knee swelling. (80.6% in group A, and 10.8% in group B), and knee pain in which (79.6% in group A patients and only 7.5% in group B). There is no significant value between the two groups about the knee getting given up, infection, stiffness, and quadriceps muscle atrophy. Delay weight bearing after ACL reconstruction makes the patients less prone to knee pain and effusion but more prone to quadriceps muscle atrophy.

Novel Method of Measuring Pelvic Floor Muscle Motion May Improve Accessibility of Pelvic Floor Muscle Coordination Training.

Pelvic floor muscle ultrasound is an important clinical tool for improving motor coordination and even strength. Although the gold standard approach involves transperineal probe placement, this is not always feasible with sensitive populations, requires privacy owing to probe placement, and additional sonography training. This article introduces a novel transabdominal method for measuring pelvic floor muscle motion that incorporates a reference point within the bladder. The hypothesis is that the novel measurement will correlate positively with transperineal measurements. A total of 55 women (15 nulliparous, 40 parous; 20 continent, 35 incontinent) performed pelvic floor muscle contraction and strain. Transabdominal ultrasound measured bladder diagonal length (BDL) and transperineal ultrasound measured bladder neck height (BNH), levator plate length (LPL), and levator plate angle (LPA). Spearman's test measured the correlation between the measurement outcomes and an independent t test compared outcomes based on parity and stress urinary incontinence symptom status. Spearman's correlation showed moderate positive correlations between the pelvic floor measurements for both tasks, which reduced slightly when grouping by parity and symptom status. Group differences were significant for BDL during the muscle contraction, factoring in SUI symptoms (p = 0.019) and parity status (p = 0.005) and LPL during contraction, factoring in parity status (p = 0.033). BDL correlates with BNH, LPL, and LPA with slightly reduced correlation when factoring in parity and continence status. The advantages of the method include accessibility for sensitive populations, nontraditional positions due to the anatomical reference point, functional locations due to limited privacy needs, and minimal training required for pelvic floor therapists to incorporate into rehabilitation.

Endoscopic Ultrasound-Guided Drainage of Pelvic Fluid Collections with Lumen-Apposing Metal Stents

Introduction: A pelvic abscess is a potential life-threatening condition that should be managed conservatively whenever possible. Currently, computed tomography or ultrasound-guided percutaneous drainage is still the gold standard approach for pelvic fluid collections (PFCs) requiring intervention. More recently, endoscopic ultrasound (EUS) drainage using lumen-apposing metal stents (LAMSs) has been used off-label in PFCs with similar efficacy, a favorable safety profile, better quality of life, and generally a shorter duration of treatment when compared to the gold standard treatment. Methods: An observational retrospective analysis of 6 patients who underwent EUS-guided PFC drainage with LAMS at our institution was conducted. Records were reviewed to identify etiology, size of the collection, number of endoscopic procedures required until complete resolution, stent indwelling time, concomitant surgical or percutaneous associated procedures, successful removal and resolution. Results: The 6 patients included had an average age of 69 years old and 5 (83.3%) were male. The average size of the PFCs was 72.5 mm. All patients (100%) had successful drainage following LAMS placement, though 1 patient had an early recurrence. The mean stent indwelling time in our study was 6.7 days. An additional percutaneous or surgical drainage intervention was not required in any of the participants. Also, no adverse events related to the procedure were reported during the follow-up period. Conclusion: EUS-guided drainage of PFCs with LAMS is a safe and minimally invasive technique, which allows rapid PFC resolution, with no need for percutaneous or surgical drainage interventions.

A rapid review of nutrition and exercise approaches to managing unintentional weight loss, muscle loss, and malnutrition in cancer.

This narrative review summarizes the evidence for nutrition, exercise, and multimodal interventions to maintain weight and muscle mass and prevent malnutrition from meta-analysis, systematic reviews, and randomized controlled trials published within the last 5 years, and in comparison to future research priority areas identified by international guidelines. Dietary counseling with oral nutrition support (ONS), escalated to enteral nutrition if weight loss continues, is the gold standard treatment approach to maintaining weight and preventing malnutrition. Recent ONS trials with dietary counseling show promising findings for weight maintenance, extending the literature to include studies in chemoradiotherapy, however, change in body composition is rarely evaluated. Emerging trials have evaluated the impact of isolated nutrients, amino acids, and their derivatives (ie, β-hydroxy β-methylbutyrate) on muscle mass albeit with mixed effects. There is insufficient evidence evaluating the effect of exercise interventions on unintentional weight loss, muscle mass, and malnutrition, however, our knowledge of the impact of multimodal nutrition and exercise interventions is advancing. Prehabilitation interventions may attenuate weight and muscle loss after surgery, particularly for patients having gastrointestinal and colorectal surgery. Multimodal trials that commence during treatment show mixed effects on weight and muscle mass when measured. This review highlights that the evidence for preventing unintentional weight loss and malnutrition from cancer treatment is strong within nutrition. Multimodal interventions are emerging as effective interventions to prevent unintentional weight loss. Promising interventions are demonstrating improvements in muscle mass, however further exploration through studies designed to determine the effect on muscle is required.

Video-assisted retroperitoneal debridement for necrotizing pancreatitis: a single center experience in Colombia.

Acute pancreatitis (AP) is a common and potentially lethal disease. Approximately 10-20% of the patients progress to necrotizing pancreatitis (NP). The step-up approach is the gold standard approach to managing an infected necrotizing pancreatitis with acceptable morbidity and mortality rates. Video-assisted retroperitoneal debridement (VARD) has been described as a safe and feasible approach with high success rates. Multiple studies in the American, European, and Asian populations evaluating the outcomes of VARD have been published; nevertheless, outcomes in the Latin American population are unknown. This study aims to describe a single-center experience of VARD for necrotizing pancreatitis in Colombia with a long-term follow-up. A prospective cohort study was conducted between 2016 and 2024. All patients over 18 years old who underwent VARD for necrotizing pancreatitis were included. Demographic, clinical variables, and postoperative outcomes at 30-day follow-up were described. A total of 12 patients were included. The mean age was 55.9 years old (SD 13.73). The median follow-up was 365 days (P25 60; P75 547). Bile origin was the most frequent cause of pancreatitis in 90.1% of the patients. The mean time between diagnosis and surgical management was 78.5 days (SD 22.93). The mean size of the collection was 10.5cm (SD 3.51). There was no evidence of intraoperative complications. The mean in-hospital length of stay was 65.18 days (SD 26.46). One patient died in a 30-day follow-up. One patient presented an incisional hernia one year after surgery, and there was no evidence of endocrine insufficiency at the follow-up. According to our data, the VARD procedure presents similar outcomes to those reported in the literature; a standardized procedure following the STEP-UP procedure minimizes the requirement of postoperative drainages. Long-term follow-up should be performed to rule out pancreatic insufficiency.

Disparate impact of risk assessment instruments: A systematic review.

One concern about the use of risk assessment instruments in legal decisions is the potential for disparate impact by race or ethnicity. This means that one racial or ethnic group will experience harsher legal outcomes than another because of higher or biased risk estimates. We conducted a systematic review of the literature to synthesize research examining the real-world impact of juvenile and adult risk instruments on racial/ethnic disparities in legal decision making. Given the nature of research synthesis, we did not test formal hypotheses. Our systematic literature search as of July 2023 identified 21 articles that investigated the disparate impact of 13 risk assessment instruments on various legal outcomes. Most of these instruments were actuarial pretrial screening instruments. Our narrative synthesis indicated that there is not strong evidence of risk instruments contributing to greater system disparity. Ten articles indicated that adopting risk instruments did not create (or exacerbate preexisting) disparities, and eight articles found that instrument use reduced disparities in legal decision making. Three articles reported evidence of disparate impact of risk instruments; only one of these studies received a strong study quality assessment score. We observed a scarcity of high-quality articles that employed what we deem to be the gold standard approach for examining the disparate impact of risk instruments (i.e., pretest-posttest design). The evidence signals that risk instruments can contribute to reductions in disparities across multiple stages of legal decision making. Yet study quality remains low, and most research has been conducted on decisions during the pretrial stage. More rigorous research on disparate impact across diverse legal decision points and approaches to risk assessment is needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A CRISPR mediated point‐of‐care assay for the detection of mucosal calprotectin in an animal model of ulcerative colitis

AbstractInflammatory bowel disease (IBD) is a chronic disorder associated with inflammation in the gastrointestinal tract, leading to a range of debilitating symptoms. Fecal calprotectin is an established biomarker for ulcerative colitis (UC), one of the main IBD diseases, which provides indications of the presence and severity of inflammation in the digestive tract. Enzyme‐Linked Immunosorbent Assay (ELISA) as a gold standard approach for fecal calprotectin detection is time‐consuming and impractical in point‐of‐care settings. Moreover, obtaining fecal samples from patients is challenging and inhibits longitudinal monitoring. To address these specific problems, we have developed a novel approach for detecting calprotectin which leverages clustered regularly interspaced short palindromic repeats (CRISPR)/Cas technology. We successfully developed a portable tube‐based CRISPR/Cas assay for point‐of‐care testing of calprotectin. This assay showed a detection range from 1 to 10,000 ng/ml (over 4 log units), using both fluorescent and colorimetric analytical techniques. The established assay was further validated through measurements in mucosal samples obtained in an anesthetised preclinical rodent model of UC, with 2–3 times higher calprotectin concentration detected in UC rat samples compared to that of healthy control animals. This point‐of‐care test may provide a rapid, precise, and user‐friendly approach for the diagnosis and monitoring of IBD through mucosal sample testing.

Urinary Leakage after Robot-Assisted Radical Prostatectomy: Is Always Predictive of Functional Results?

Introduction: The aim of the study was to evaluate if and when the presence of radiological urinary leakages of vesico-urethral anastomosis, after robotic radical prostatectomy, could provoke urethral strictures or affect continence recovery. Methods: We enrolled 216 patients, undergoing robot-assisted radical prostatectomy between January 2020 and December 2022 in three high-volume referenced centres for robotic surgery. Before removal of the bladder catheter, all patients underwent a cystourethrography in which the presence/absence of leakage was assessed at level of vesico-urethral anastomosis. Based on degree of severity of urinary leakage on cystourethrography, patients were classified as no leakage or grade 0, grade 1 with transversal diameter ≤1 cm, and grade 2 with transversal diameter ≥1 cm. At follow-up, urethral stenosis formation and urinary continence recovery were assessed; furthermore, post-operative 12-month functional outcome was determined using EORTC-QLQ-PR25 questionnaire. Results: Radiological urinary leakage was found in 30 patients with grade 1 and 33 patients with grade 2, for a total of 63 patients. Only 1 patient (1.5%), grade 2 urinary leakage, developed significant urethral stricture and required endoscopic urethrotomy after 6 months. Analysing the differences in those who removed the bladder catheter after 7–9 days and those who kept it longer, we found no statistically significant differences regarding recovery of continence (p = 0.23) or about urinary symptoms (p = 0.94). Conclusions: RARP remains gold-standard approach for treatment of localized prostate cancer and the superiority of this technique is safe in preventing urethral strictures and continence recovery, even in presence of significant anastomotic urinary leakage.

Does Differentially Private Synthetic Data Lead to Synthetic Discoveries?

Synthetic data have been proposed as a solution for sharing anonymized versions of sensitive biomedical datasets. Ideally, synthetic data should preserve the structure and statistical properties of the original data, while protecting the privacy of the individual subjects. Differential Privacy (DP) is currently considered the gold standard approach for balancing this trade-off. The aim of this study is to investigate how trustworthy are group differences discovered by independent sample tests from DP-synthetic data. The evaluation is carried out in terms of the tests' Type I and Type II errors. With the former, we can quantify the tests' validity, i.e., whether the probability of false discoveries is indeed below the significance level, and the latter indicates the tests' power in making real discoveries. We evaluate the Mann-Whitney U test, Student's t-test, chi-squared test, and median test on DP-synthetic data. The private synthetic datasets are generated from real-world data, including a prostate cancer dataset (n = 500) and a cardiovascular dataset (n = 70,000), as well as on bivariate and multivariate simulated data. Five different DP-synthetic data generation methods are evaluated, including two basic DP histogram release methods and MWEM, Private-PGM, and DP GAN algorithms. A large portion of the evaluation results expressed dramatically inflated Type I errors, especially at levels of ϵ ≤ 1. This result calls for caution when releasing and analyzing DP-synthetic data: low p-values may be obtained in statistical tests simply as a byproduct of the noise added to protect privacy. A DP Smoothed Histogram-based synthetic data generation method was shown to produce valid Type I error for all privacy levels tested but required a large original dataset size and a modest privacy budget (ϵ ≥ 5) in order to have reasonable Type II error levels.

A narrative review on the use of autologous platelet concentrates during alveolar bone augmentation: Horizontal (simultaneous/staged) & vertical (simultaneous/staged).

This review aimed to answer the general question of whether autologous platelet concentrates (APCs, an autologous blood-derivative) can improve the outcome of alveolar bone augmentation. Three clinical scenarios were assessed: horizontal/vertical bone augmentation in combination with implant placement (simultaneous approach), horizontal bone augmentation in a staged approach, and vertical bone augmentation in a staged approach. An electronic literature search strategy was conducted for each review from the outset to July 1st, 2023. The titles and abstracts (when available) of all identified studies were screened and imported into a database. If articles appeared to meet the inclusion criteria or their title and abstract had insufficient data, the full text was obtained to make the final decision. All studies that met the inclusion criteria underwent data extraction. Moreover, the references of the identified papers were screened for additional studies. After title and abstract screening and selection criteria application, 14 clinical studies were included for the qualitative analysis: seven for horizontal/vertical bone augmentation in a simultaneous approach, five for horizontal bone augmentation in a staged approach, and two for vertical bone augmentation in a staged approach. There is scarce literature regarding the added value of APCs in bone augmentation, and most studies had small sample sizes, a lack of standardized protocols, and different outcome variables, which makes comparisons between studies difficult. Out of the 14 studies, four were well-designed randomized clinical trials, where we could find better results for the APCs groups. Most studies, particularly comparative and well-designed studies, demonstrated beneficial and promising results of using APCs in alveolar bone augmentation. However, before high-level evidence-based conclusions can be drawn, more randomized clinical trials must compare the benefits of adding APCs to the gold-standard approach.

An Updated Comprehensive Review of Existing Transcatheter Aortic Valve Replacement Access.

For the past 20years, transcatheter aortic valve replacement (TAVR) has been the treatment of choice for symptomatic aortic stenosis. The transfemoral (TF) access is considered the gold standard approach for TAVR. However, TF-TAVR cannot be performed in some patients; thus, alternative accesses are required. Our review paper generalises the TAVR accesses currently available, including the transapical, transaortic, trans-subclavian/axillary, transcarotid, transcaval, and suprasternal approaches. Their advantages and disadvantages have been analysed. Since there is no standard recommendation for an alternative approach, access selection depends on the expertise of the local cardiac team, patient characteristics, and access properties. Each TAVR centre is recommended to master a minimum of one non-TF access alternative. Of note, more evidence is required to delve into the clinical outcomes of each approach, at both early and long-term (Figure 1).

The safety and efficacy of endoscopic approaches for the management of Zenker’s diverticulum: a multicentre retrospective study

IntroductionMinimally invasive endoscopic options are safe and effective alternatives to surgery for the treatment of symptomatic Zenker’s diverticulum (ZD). However, there is no consensus on the gold-standard approach. We compared the safety and efficacy of Zenker’s peroral endoscopic myotomy (Z-POEM), flexible diverticulotomy (FD), and rigid diverticulotomy (RD) for the management of ZD.MethodsPatients undergoing treatment for ZD at three UK tertiary referral centres were identified and analysed between 2013 and 2023. Patient demographics, procedural details, clinical success, and 30-day adverse events (AE) were recorded. The primary outcomes were technical and clinical success defined as a fall in Dakkak and Bennett dysphagia score to ≤ 1 without re-intervention.ResultsThere was no difference in baseline characteristics amongst 126 patients undergoing intervention (50 RD, 31 FD, 45 Z-POEM). Technical success for RD, FD, and Z-POEM was 80%, 100%, and 100%, respectively (p < 0.001). Over a mean follow-up of 11.0 months (95% CI 8.2–13.9), clinical success amongst those treated was 85.3% (RD), 74.1% (FD), and 83.7% (Z-POEM; p = 0.48) with recurrence in 17.2% (RD), 20.0% (FD), and 8.3% (Z-POEM; p = 0.50). AEs were equivalent between groups (p = 0.98). During this time, 11 patients underwent surgical myotomy with low clinical success (36.4%) and high morbidity.ConclusionEndoscopic options for the treatment of ZD show equivalent rates of success, but failed RD often led to open myotomy with worse outcomes. Flexible endoscopic modalities are both safe and highly effective treatments that may be considered first-line in experienced centres and should be offered before surgery.Graphical abstract

Comparison of Titanium versus Resorbable Intramedullary Nailing in Pediatric Forearm Fractures.

Pediatric forearm fractures, particularly involving the shaft or diaphysis, are common injuries typically resulting from accidental trauma during various activities. Traditional treatment involves closed reduction and casting; however, surgical intervention may be necessary in certain cases. The gold standard surgical approach utilizes elastic stable intramedullary nailing (ESIN), but a newer technique uses bioabsorbable intramedullary nails made of poly(lactic-co-glycolic acid) (PLGA). This study aims to compare the outcomes of these two surgical methods in pediatric diaphyseal forearm fractures. We retrospectively reviewed 86 patients who underwent operative treatment due to the diaphyseal fractures of the forearm in the Surgical Division, Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary between 2018 and September 2022. The mean age was 9.48 (ranging from 4 to 17). A total of 41 patients underwent surgery with PLGA implants (RESIN technique), while 45 patients were treated with titanium elastic nails (ESIN technique). Various factors including patient demographics, injury mechanisms, fracture characteristics, and complications were assessed. Both groups showed similar gender distribution, with a majority of fractures occurring in boys (the male-female ratio was 31:10 in the PLGA group, while in the titanium elastic nailing (TEN) group, this ratio was 29:16, with no statistical difference between the groups (p > 0.005). The average age of the patients treated with PLGA implants (8.439 years) was lower compared to those treated with titanium nails (10.422 years). A statistically significant difference was found regarding the average age of the two groups (p = 0.0085). Left-sided injuries were more prevalent in both groups (59% of the cases in the PLGA group and 69% in the TEN group, with no statistically significant difference, p = 0.716), and fractures typically involved both the radius and ulna. This represents 93% of the cases in the PLGA group and 80% in the TEN group. Regarding the involvement of bones, we also did not find a statistically significant difference (p = 0.123). The mechanisms of injury predominantly involved indirect force, such as falls (30 cases in the PLGA group and 27 cases in the TEN group), and no statistically significant difference was found (p = 0.139) regarding the mechanism of the injury. Complication rates were lower in the PLGA group (7%) compared to the titanium group (20%). The treatment of pediatric diaphyseal forearm fractures using PLGA implants appears to be a viable alternative to traditional titanium implants. Advantages include no need for secondary surgery and associated cost savings and reduced complication rate and stress associated with anesthesia and surgery. Prospective randomized trials are warranted to further validate these findings and explore long-term outcomes.

Detecting and Predicting Cognitive Decline in Individuals with Traumatic Brain Injury: A Longitudinal Telephone-Based Study.

Traumatic brain injuries (TBIs) can lead to long-lasting cognitive impairments, and some survivors experience cognitive decline post-recovery. Early detection of decline is important for care planning, and understanding risk factors for decline can elucidate targets for prevention. While neuropsychological testing is the gold standard approach to characterizing cognitive function, there is a need for brief, scalable tools that are capable of detecting clinically significant changes in post-TBI cognition. This study examines whether a clinically significant change can be detected using the Brief Test of Adult Cognition by Telephone (BTACT) in a sample of individuals with chronic TBI and investigates whether potentially modifiable factors are associated with cognitive decline. Ninety participants aged 40 or older with complicated mild-to-severe TBI participated in two telephone-based study visits ∼1 year apart. Demographic, head trauma exposure, comorbid medical conditions, physical, and psychosocial functioning data were collected via self-report. The BTACT, a brief measure of global cognitive function, was used to assess cognitive performance across six domains. A reliable change index for quantifying clinically significant changes in BTACT performance was calculated. Results revealed cognitive decline in 10-27% of participants across various cognitive domains. More specifically, only depressive symptoms, including depressed affect and anhedonia, were significantly associated with cognitive decline after correcting for multiple comparisons using false discovery rate (FDR). Other factors such as the number of blows to the head, male gender, dyspnea, increased anxiety symptoms, seizures, illicit drug use, and fewer cardiovascular comorbidities should be considered hypothesis generating. Importantly, age was not a significant predictor of cognitive decline, which challenges the assumption that cognitive decline is solely related to the natural aging process. It suggests that there are unique factors associated with TBI that impact cognitive function, and these factors can affect individuals across the lifespan. The BTACT is a brief and sensitive tool for identifying clinically meaningful changes in cognitive function over a relatively brief period (i.e., 1 year) in a sample of individuals in the chronic stages of TBI (i.e., x̄ = 6.7 years post-TBI). Thus, the BTACT may be useful in surveillance efforts aimed at understanding and detecting decline, particularly in situations where in-person cognitive screening is impractical or unfeasible. We also identified potentially modifiable targets for the prevention of post-TBI cognitive decline. These findings can offer insights into treatment goals and preventive strategies for individuals at risk for cognitive decline, as well as help to facilitate early identification efforts.

A data augmentation procedure to improve detection of spike ripples in brain voltage recordings

Epilepsy is a major neurological disorder characterized by recurrent, spontaneous seizures. For patients with drug-resistant epilepsy, treatments include neurostimulation or surgical removal of the epileptogenic zone (EZ), the brain region responsible for seizure generation. Precise targeting of the EZ requires reliable biomarkers. Spike ripples - high-frequency oscillations that co-occur with large amplitude epileptic discharges - have gained prominence as a candidate biomarker. However, spike ripple detection remains a challenge. The gold-standard approach requires an expert manually visualize and interpret brain voltage recordings, which limits reproducibility and high-throughput analysis. Addressing these limitations requires more objective, efficient, and automated methods for spike ripple detection, including approaches that utilize deep neural networks. Despite advancements, dataset heterogeneity and scarcity severely limit machine learning performance. Our study explores long-short term memory (LSTM) neural network architectures for spike ripple detection, leveraging data augmentation to improve classifier performance. We highlight the potential of combining training on augmented and in vivo data for enhanced spike ripple detection and ultimately improving diagnostic accuracy in epilepsy treatment.

Bilirubin measurements in neonates: uniform neonatal treatment can only be achieved by improved standardization.

Measurement of total bilirubin (TBil) concentration in serum is the gold standard approach for diagnosing neonatal unconjugated hyperbilirubinemia. It is of utmost importance that the measured TBil concentration is sufficiently accurate to prevent under treatment, unnecessary escalation of care, or overtreatment. However, it is widely recognized that TBil measurements urgently require improvement in neonatal clinical chemistry. External quality assessment (EQA) programs for TBil assess for differences between laboratories and provide supporting evidence of significant differences between various methods, manufacturers and measurement platforms. At the same time, many countries have adopted or only slightly adapted the neonatal hyperbilirubinemia management guidelines from the USA or UK, often without addressing differences in the methodology of TBil measurements. In this report, we provide an overview of the components of bilirubin that are measured by laboratory platforms, the availability of current reference measurement procedures and reference materials, and therole of EQA surveys in this context. Furthermore, the current status of agreement in neonatal bilirubin against clinical decision thresholds is reviewed. We advocate for enhancements in accuracy and comparability of neonatal TBil measurements, propose a path forward to accomplish this, and reflect on the position of the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC) Working Group Neonatal Bilirubin (WG-NB) in this matter.

Urinary Extracellular Vesicles as a Readily Available Biomarker Source: A Simplified Stratification Method.

Urine, a common source of biological markers in biomedical research and clinical diagnosis, has recently generated a new wave of interest. It has recently become a focus of study due to the presence of its content of extracellular vesicles (EVs). These uEVs have been found to reflect physiological and pathological conditions in kidney, urothelial, and prostate tissue and can illustrate further molecular processes, leading to a rapid expansion of research in this field In this work, we present the advantages of an immunoaffinity-based method for uEVs' isolation with respect to the gold standard purification approach performed by differential ultracentrifugation [in terms of purity and antigen presence. The immunoaffinity method was made feasible by combining specific antibodies with a functionalized polymethacrylate polymer. Flow cytometry indicated a significant fluorescence shift, validating the presence of the markers (CD9, CD63, CD81) and confirming the effectiveness of the isolation method. Microscopy evaluations have shown that the morphology of the vesicles remained intact and corresponded to the expected shapes and dimensions of uEVs. The described protocol is inexpensive, fast, easy to process, has good reproducibility, and can be applied to further biological samples.