Grading System Research Articles

External Validation of the ISGPS Complexity Grading System for Minimally Invasive Pancreatoduodenectomy: Insights from the IGOMIPS registry.

To validate the ISGPS complexity grading system for minimally invasive pancreaticoduodenectomy (MIPD). Although concerns about patient safety persist, MIPD is gaining popularity. The ISGPS recently introduced a difficulty grading system to improve patient selection by aligning procedural complexity with surgeon and center expertise. Data from MIPD cases reported in the IGOMIPS registry (October 2019-February 2024) were analyzed, with severe postoperative complications as the primary outcome. Logistic regression was used to identify risk factors for complications. Of the 771 MIPD cases, 426 (55.3%) were analyzed. A pancreatic duct size ≤3mm was the only significant risk factor for severe complications (OR=2.22, P=0.0001). Most cases (n=255; 59.9%) were classified as grade C complexity, whereas 22 (5.1%) were classified as grade A. Severe postoperative complications increased with complexity (grade A, 31.8%; grade B, 36.3%; grade C, 48.6%; P=0.0091). For grade A complexity, the outcomes were consistent across surgeons and centers. Grade B outcomes were similar between grade B and C centers but superior to grade A centers. In grade C cases, outcomes were comparable between grade A and B centers, with improvements at grade C centers. Grade A ISGPS experience correlated strongly with mismatches between planned and performed procedures (grade A, 15.0%; grade B, 3.0%; grade C, 3.1%; P<0.0001), including total pancreatectomy (grade A, 11.5%; grade B, 1.2%; grade C, 3.1%; P=0.0005). The ISGPS complexity grading system effectively predicted MIPD outcomes, supporting better patient selection and alignment of complexity with surgical expertise.

Efficacy of piracetam in children with breath-holding spells: a systematic review and meta-analysis.

A number of randomized-controlled trials (RCTs) have been conducted comparing the efficacy of piracetam with placebo and other medications in children with breath-holding spells (BHS). However, no systematic review has yet collated all this evidence. All RCTs comparing the efficacy and/or safety of piracetam with placebo or other medications in children with BHS were included. The pooled estimates were compared for the number of participants with a favorable response, the change in monthly frequency of BHS, compliance, and adverse effects in both groups. The ROB 2.0 tool was used to assess the risk of bias, and the GRADE system was used to determine the certainty of the collated evidence. We included 5 RCTs (437 participants) in the review. Piracetam group had significantly more participants with favorable responses at 1, 2 and 3months after randomization, as compared to placebo group (RR: 6.5 (95% CI-1.8-23.2), I2 = 75%, p = 0.004, RR: 4.7 (95% CI-3.3-6.7), I2 = 49%, p < 0.0001, RR: 5.4 (95% CI-3.4-8.5), I2 = 0%, p < 0.0001 respectively). Number of participants with complete response or total cessation of attacks was more in thepiracetam group compared to placebo (RR: 5.7 (95% CI-1.4-23.2), I2 = 88%, p = 0.01). Change in theaverage number of BHS was significantly more in thepiracetam group, as compared to theplacebo group (mean difference-4.9 (95% CI-0.7-9.0), I2 = 99%, p = 0.02). Number of participants with treatment-emergent adverse effects were comparable in both piracetam and placebo groups (RR: 1.9 (95% CI-0.5-7.6), I2 = 0%, p = 0.33). Conclusion: Oral piracetam is efficacious and safe in children with BHS, and its efficacy may further increase by co-administration of oral docosahexaenoic acid. What is known? • Breath-holding spells (BHS) are a common pediatric condition, affecting 0.1% to 4.6% of otherwise healthy children. • Several studies have investigated the efficacy of piracetam in reducing the frequency and severity of BHS, with mixed results. What is new? • Oral piracetam is efficacious and safe in children with BHS. • Its efficacy is further increased by co-administration of oral docosahexaenoic acid.

A Cross-Sectional Institutional Survey of Depression, Suicidal Ideation, and Stigma in Medical Students

Background: Due to high rates of depression and suicidal ideation among medical students, interventions, such as Pass/Fail grading systems and peer-mentorship, have been implemented, but their effects not reported. The purpose of this study was to explore variations in depression severity among medical students and to better understand the related stigma in healthcare over the past decade, with the aim of enhancing medical education. Methods: A cross-sectional survey was conducted on REDCap across students at the University of Illinois College of Medicine. The severity of depression was measured by the PHQ-9. Stigma was assessed utilizing Likert scale responses. Demographics of students who are most likely to experience depression were collected. Additionally, clinical diagnoses of depression, treatment modalities, and alcohol use were compared. Results: There were 178 respondents with a 15% response rate. Thirty-nine (22%) respondents were classified in the moderate-to-severe depression group. Thirteen students, all female, endorsed suicidal ideation. A majority of respondents reported that depressed medical students would provide inferior patient care (n=71, 58%), their application to residency would be less competitive (n=76, 54%), they would feel embarrassed (n=88, 61%), and that it would be risky to reveal they have depression on a residency application (n=153, 94%). Conclusions: Depression, suicidal ideation, and stigmatization remain prevalent in medical students and may have worsened since 2010. New, multi-faceted approaches such as giving medical students the choice of mental health providers, providing clear information about documentation, and implementing personal, well-being goals are needed to reduce depression and stigma experienced by medical students.

Circulating irisin levels in patients with MAFLD: an updated systematic review and meta-analysis

ObjectiveCurrent research suggests that irisin is closely linked to the pathogenesis and progression of metabolic dysfunction-associated fatty liver disease (MAFLD). This systematic review and meta-analysis updates our previous meta-analysis and further explores the relevance between circulating irisin levels and MAFLD.MethodsNine databases (PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, Weipu, CBM, Clinicaltrials.gov and gray literature) were retrieved as of 1st August, 2024. The standardized mean difference (SMD) and 95% confidence interval (CI) represent pooled effect size. We used the Newcastle–Ottawa Scale to evaluate the quality of articles and the certainty of evidence assessed by GRADE system. All statistical analyses were performed using RevMan 5.3 and Stata 12(Stata Corporation, yi TX).ResultsFifteen case-control studies were included. Circulating irisin levels in the MAFLD group were markedly lower than those in the healthy group (SMD=-1.04 [-1.93, -0.14]). Subgroup analyses by race, age, severity and T2DM revealed that circulating irisin levels were lower in the MAFLD group compared to those in the healthy controls in the Asian population (SMD=-1.38 [-2.44, -0.31], P&amp;lt;0.05) and in those above 50 years old (SMD=-2.23 [-3.64, -0.81], P&amp;lt;0.05) and higher in the mild MAFLD groups than those in moderate to severe MAFLD groups (SMD = 11.68 [9.05, 14.31], P&amp;lt;0.05). And the circulating irisin levels in MAFLD patients with T2DM were significantly lower than those in healthy group (SMD = -2.90 [-4.49, -1.30]). ELISA kits from different companies also presented different relationships.ConclusionsThere were significantly lower circulating irisin levels in the MAFLD group than in the healthy control group. Although these results differed from our previous results, there is no denying that circulating irisin levels are closely associated with the advancement of MAFLD.

Albumin–Bilirubin Grade as a Valuable Predictor of Recurrence and Prognosis in Patients with Hepatocellular Carcinoma Following Radiofrequency Ablation

Background/Objectives: Radiofrequency ablation (RFA) is an important local treatment for hepatocellular carcinoma (HCC). This study aimed to evaluate the characteristics of tumor recurrence after RFA and analyze predictors of tumor recurrence and survival in patients with HCC. Methods: We retrospectively reviewed data from treatment-naïve patients with HCC who underwent RFA for HCC treatment between 2008 and 2017 at four tertiary hospitals in South Korea. Results: A total of 636 patients with HCC treated with RFA were enrolled in the study. The mean age was 66.3 ± 10.4 years, with 75.0% of patients being male. Most patients (96.7%) had underlying liver cirrhosis, and viral hepatitis (types B and C) accounted for most cases. The average maximum tumor size was 2.2 ± 0.9 cm, with 84.3% of tumors being single lesions. During the follow-up period, 331 patients experienced recurrence, with 95.5% of cases being intrahepatic and one-fifth occurring at the RFA site. Most patients underwent RFA or transarterial chemoembolization as subsequent therapy for recurrence. Multivariate analysis revealed that age, the albumin–bilirubin (ALBI) grade, and Child–Pugh class B status were independent factors associated with tumor recurrence. Only the ALBI grade was significantly associated with mortality. Additionally, the ALBI grade differentiated between recurrence-free survival and overall survival in the Kaplan–Meier survival curve. Conclusions: The ALBI grade was independently associated with tumor recurrence and prognosis in patients with HCC following RFA. This grading system can help clinicians identify high-risk patients, optimize treatment strategies, and enhance patient care.

Research on the Accuracy of Machine Learning-Based AI Grading Systems in Handling High School Math Function Problems: A Comparative Study of MathGPTPro and Zuoyebang

As artificial intelligence (AI) technology becomes more prevalent in education, AI automatic grading systems have emerged as essential tools for enhancing homework grading efficiency and alleviating teachers' workloads. The two leading platforms, Zuoyebang and MathGPTPro, are widely utilized in mathematics education. This study employs an experimental research method to compare the performance of these platforms in automatically grading function solution problems. The sample consists of 30 questions from the Function Solution Problems section of China's National College Entrance Examination. The focus will be on four key dimensions: logical steps, final answers, expression symbols, and analysis feedback to assess accuracy rates. A t-test will then examine differences in their handling of complex solution steps. The results show that MathGPTPro can achieve higher accuracy in complex reasoning, and its AI system has more potential to be applied to homework correction and math learning. However, there are still problems of inaccurate identification and wrong judgment in the process of Zuoyebang step recognition. This study offers insights into the application of AI automatic grading systems in education and suggests areas for system optimization.

A comparison of the effects of ticagrelor and clopidogrel in patients with acute ST-segment elevation myocardial infarction: a systematic review and meta-analysis of randomized clinical trials

BackgroundRupture of unstable coronary atherosclerotic plaque leads to acute ST-segment elevation myocardial infarction (STEMI). Dual anti-platelet therapy is one of the main treatments, and the combination of Aspirin and Clopidogrel is recognized as the standard oral regimen in most cases. Ticagrelor is a new generation of P2Y12 receptor inhibitors. We aimed to compare the effect of Ticagrelor and Clopidogrel in the treatment of patients post-STEMI.MethodsThis study investigated Pub Med, Scopus, Google Scholar Web of Science, and Embase Cochrane Library clinical trials.gov databases. Heterogeneity between studies was assessed using the I2 index and the Q statistic. The random effects model was used to combine studies and the Funnel plot and Egger’s test were used to assess the publication bias.ResultsEleven studies were included in this meta-analysis. 5274 patients in the Ticagrelor and 5,295 patients in the Clopidogrel groups were examined. The mean age of the patients was 58.84 years (2.70) and 59.92 years (3.19) in the Ticagrelor and Clopidogrel groups, respectively. Based on the results of the meta-analysis, compared to Clopidogrel, Ticagrelor had decreased the outcomes of mortality, recurrent myocardial infarction, stroke, and Major Adverse Cardiovascular Events (MACE). However, the post-myocardial infarction bleeding according to Bleeding Academic Research Consortium (BARC) criteria and reperfusion state regarding thrombolysis in myocardial infarction (TIMI) Flow Grading system showed no differences in both groups. However, these effects were not statistically significant.ConclusionsTicagrelor decreased the chance of mortality, re-infarction, stroke, and MACE in post-STEMI patients compared to clopidogrel. But there was no difference in the chance of major bleedings (BARC ≥ 3) and improvement in TIMI grade flow between these two drugs. However, none of these findings were statistically significant, and more studies are needed to reach definitive results.

Invasion of the Cavernous Sinus Medial Wall by Pituitary Adenomas: Intraoperative Evaluation and the Clinical Efficacy of the Cavernous Sinus Medial Wall Resection in the Treatment of Somatotroph Adenomas.

Pituitary adenomas are common benign intracranial tumors. This study aimed to explore the relevant factors influencing the cavernous sinus medial wall invasion by Pituitary adenomas based on intraoperative evaluation. Meanwhile, the authors introduced a safe technique for the resection of the medial wall of the cavernous sinus and conducted a preliminary evaluation of the efficacy of this technique. The clinical data of 108 patients with pituitary adenomas who underwent surgery at our institution were collected. Binary logistic regression analysis was utilized to identify independent predictors of medial wall invasion. Furthermore, the authors performed medial wall resection on 12 cases of somatotroph adenomas with medial wall invasion to initially assess the surgical efficacy of this technique for somatotroph adenomas. Multivariate Logistic regression analysis showed that tumor Knosp grade and somatotroph adenomas were independent predictors of medial wall invasion (P<0.05). For somatotroph adenomas, medial wall resection resulted in a high biochemical remission rate (83%), and all patients were free of recurrence at the last follow-up. Higher knosp grade and somatotroph adenomas will increase the risk of medial wall invasion of the cavernous sinus. Relying solely on the Knosp grade system to evaluate tumor invasion of the medial wall without differentiating between tumor subtypes is inaccurate. Invasion of the medial wall may be a cause of low biochemical remission rates and recurrence after surgery for somatotroph adenomas. The technique of medial wall resection is safe and effective, and holds significant importance in the treatment of somatotroph adenomas.

Implementation of a Specifications Grading System in Four Upper Division Chemistry Courses

Implementation of a Specifications Grading System in Four Upper Division Chemistry Courses

Case report: Giant meningioma of the left hemisphere

Meningiomas are some of the most prevalent primary brain tumors in adults, and are typically non-neuroglial in nature. A variety of symptoms may be observed, including headaches, fluctuations in mental status, ataxia, muscle weakness, nausea and vomiting, seizures, visual changes, speech disorders, and sensory abnormalities. The World Health Organization (WHO) has a grading system for meningiomas based on histological criteria, which is as follows: Grade 1 meningiomas are considered benign; Grade 2 meningiomas have a moderately aggressive nature and usually present with histological atypia; and Grade 3 meningiomas exhibit aggressive malignant behavior. Grade 3 meningiomas are distinguished by aberrant and accelerated cellular proliferation, which increases the probability of invasion and recurrence within the central nervous system relative to the other grades. Malignant meningiomas are further classified by tumor size. For example, WHO grade 3 meningiomas with diameter &amp;gt;5 cm are designated giant meningiomas. Giant meningiomas are complicated by their potential for compression of the brain tissue, which can lead to increased intracranial pressure and hemodynamic changes. In many cases, these changes induce vasogenic edema in the adjacent brain tissue. This article details a rare case of rapidly growing atypical giant meningioma that progressed to an anterior-posterior diameter of 13 cm within 3 years, occupying the majority of the left hemisphere of the brain and encroaching upon the right intracranial structures. Through recent advances in medical diagnostics and heightened public awareness of health issues, cases with such large meningiomas have become exceedingly rare. Fortunately, the tumor in the present case was successfully resected using advanced surgical techniques that employed microscopy in conjunction with sodium fluorescein, resulting in complete removal of the tumor and restoration of the patient’s muscle strength postoperatively. The value of fluorescence-guided surgery in this type of procedure is support in the present case report.

Interventions for recurrent embryo implantation failure: An umbrella review.

Recurrent implantation failure (RIF) has a multifactorial etiology. An umbrella review was undertaken to evaluate the multiple proposed interventions. To summarize and assess the strength of evidence of interventions for RIF from published systematic reviews (SR) of randomized clinical trials (RCTs). After prospective registration (PROSPERO CRD42023414255), a systematic search was conducted in the Cochrane Library, Scopus and Medline from inception until March 2024. SRs of RCTs, with or without meta-analyses (MA), were included if they reported clinical pregnancy rates (CPR) or live birth rates (LBR). The methodological quality of the included SRs was appraised independently in duplicate using the AMSTAR 2 tool. For each intervention, the MAs of RCTs with statistically significant improvements were counted as a percentage of the total assessing the strength of evidence using the GRADE system. A total of 47 SRs were included: 32 reviews covered immunomodulatory interventions, 10 (68 RCTs) covered uterine and endometrial interventions, one covered antibiotics, and four (69 RCTs) addressed mixed approaches, including laboratory interventions. AMSTAR 2 appraised 41 (88%) SRs as critically low or low, and 6 (12%) as moderate or high in quality. The SRs often had a level of overlap of RCTs (median 33.3%), inconsistent definitions of RIF, and varied comparisons for the interventions. Considering the significant meta-analytic evidence of high-moderate GRADE strength: Granulocyte colony-stimulating factor (G-CSF) showed improvement in CPR in 9/13 (69.2%) MAs and LBR in 1/7 (14%); intralipid infusion showed improvement in CPR in 4/6 (57.14%) MAs and LBR in 3/4 (75%); peripheral blood mononuclear cells (PBMC) showed improvement in CPR in 4/8 (50%) MAs and LBR 3/5 (60%); platelet-rich plasma (PRP) intervention showed improvement in CPR in 6/10 (60%) MAs and LBR in 1/5 (20%); human chorionic gonadotropins showed improvement in CPR in 3/3 (100%) MAs; growth hormone showed improvement in CPR in 1/1 (100%) MA; low molecular weight heparin showed improvement in CPR in 1/1 (100%) MAs and LBR in 1/2 (50%); hysteroscopy showed improvement in CPR in 1/2 (50%) MAs; and, intentional endometrial injury showed improvement in CPR in 3/4 (75%) MAs and LBR in 2/3 (66.66%). Evidence syntheses of RCTs evaluating interventions for RIF suggest a consistent direction, with high to moderate strength, indicating that immunomodulatory treatments, including G-CSF, PBMC, PRP, intralipid infusion, and intentional endometrial injury are likely to be effective. However, this conclusion should be interpreted with caution due to the generally low methodological quality of the included studies and the clinical heterogeneity observed in most SRs.

Timing of Treatment Initiation and Effect on Facial Synkinesis Outcomes-A Retrospective Study.

Background: While facial neuromuscular retraining and chemodenervation are effective treatments for facial synkinesis, it is unclear if clinical outcomes are affected by the timing or sequence of treatment initiation. Objective: To compare outcomes between patients with facial synkinesis based on timing of treatment initiation with facial neuromuscular retraining and/or chemodenervation as measured by the Sunnybrook Facial Grading System. Methods: Retrospective review of patients with facial synkinesis. Patient data recorded include demographics, clinical information, and Sunnybrook scores. t-Tests, analysis of variance, and logistic regression were used for analysis. Results: A total of 78 adult patients were included in our study (73% female; median age 50 years with a range of 18-78 years). Median patient follow-up was 16 months (range of 1-56 months). Patients were divided into three groups based on time between paralysis onset and treatment initiation: <12 months, 12-36 months, and >36 months. The use of facial neuromuscular retraining and chemodenervation improved Sunnybrook scores for all patients. The time between paralysis onset to treatment initiation was not associated with a difference in Sunnybrook scores. Conclusion: The duration of facial palsy prior to initiation of facial neuromuscular retraining and/or chemodenervation was not associated with a difference in synkinesis outcomes as determined by Sunnybrook scores.

Quantitative assessment of cervical disc degeneration using disc signal intensity index.

The assessment of disc degeneration remains a significant challenge in clinical research. Pfirrmann grade is a frequently used classification for lumbar disc degeneration on MRI. However, there has been no gold standard for cervical spine disc degeneration. Recently, we introduced the Disc Signal Intensity Index (DSI2) as a quantitative disc assessment for the lumbar spine, which is easily measurable in the cervical spine. The aim of this study was to apply DSI2 in the cervical intervertebral disc and investigate the factors associated with the cervical disc degeneration. Cross-sectional study using retrospectively collected data. Cervical MRIs from a database of patients undergoing ACDF between 2015 and 2018 were retrospectively reviewed. Demographic variables included age, sex, body mass index (BMI), race, smoking status, and comorbidities such as diabetes, chronic kidney disease, and coronary artery disease. DSI2 measurements were performed on midsagittal T2-weighted MRI images by determining the intensity within regions of interest (ROI). One ROI was set in the cerebrospinal fluid (CSF) and three ROIs were set per disc at the anterior, middle, and posterior third. The mean of the three measurements per disc was then divided by that of the CSF to calculate the DSI2 score. Multivariable linear regression analyses with mixed model were conducted to determine the potential contributing factors for disc degeneration. A total of 149 patients and 770 discs were included in the final analysis. Ninety-three patients (37.6%) were female and the mean (SD) age was 55.6 (11.7) years. The distribution of DSI2 scores among the different Pfirrmann grades was as follows: Grade 1: 0.259±NA; Grade 2: 0.226±0.090; Grade 3: 0.175±0.070; Grade 4: 0.136±0.060; Grade 5: 0.131±0.050. Multivariable linear mixed-effect regression analysis, setting with DSI2 as the objective variable, demonstrated that age (β= -0.130, p< 0.05), BMI (β= -2.06, p< 0.05), Modic changes (Type1 β= -2.70, p<0.01) were independent contributors to disc degeneration. The segments C4/5 and C7/T1 were less prone to disc degeneration (C4/5: β=1.37, p<0.001; C7/T1: β= 2.63, p<0.001) and the history of diabetes (β=5.31, p<0.01) was associated with high DSI2.(p<0.01) CONCLUSIONS: The present study provides valuable insights for identifying risk factors in degenerative cervical conditions utilizing the DSI2. The DSI2 method emerges as a promising alternative for future disc research, excelling in the detection of subtle progressions of degeneration and distinguishing itself from the subjective Pfirrmann grading system.

Factors Affecting Liver Function Abnormalities After Laparoscopic Esophageal Hiatal Hernia Repair.

In this study, we investigated the factors related to abnormal liver function in patients undergoing laparoscopic esophageal hiatal hernia repair. The clinical data of 347 patients who underwent elective laparoscopic esophageal hiatal hernia repair at Beijing Chao-yang Hospital of Capital Medical University between January 2018 and November 2023 were retrospectively collected. The patients comprised 131 males and 216 females, ranging in age from 24 to 87 years, and were assessed using the ASA grading system between grades I and III. The patients were divided into 2 groups based on the presence or absence of liver function abnormalities on the first day after surgery: a normal liver function group (NLA group) and an abnormal liver function group (LA group). Patients with elevation in any of the following indicators were included in the LA group: alanine aminotransferase >40U/L, glutamine aminotransferase >40U/L, γ-glutamyltransferase >49U/L, alkaline phosphatase >135U/L, total bilirubin >17.1μmol/L, or direct bilirubin >6.8μmol/L. The clinical data of the 2 groups of patients were compared, and only the indicators with a P-value <0.15 were included in a binary logistic regression model analysis. There were 238 patients (68.6%) who developed liver function abnormalities on the first postoperative day. In comparison to the NLA group, the LA group had a significantly higher proportion of patients with esophageal hiatal hernia type II, type III, and type IV, hypotension, and high PETCO2. Furthermore, the LA group had a significantly lower proportion of patients receiving blood transfusions. The maximum length and maximum cross-sectional area of the esophageal hiatal hernia were also significantly larger in the LA group. In addition, the operation time was significantly longer in the LA group. (all P-values are <0.15). The binary logistic regression analysis revealed that prolonged operation time (OR=1.017, 95% CI: 1.007-1.028) was the only risk factor associated with postoperative liver function abnormalities. The sole risk factor for postoperative liver function abnormalities was prolonged surgical time.

Boron-Doped Nano Hydroxyapatite Grafts for Bone Regeneration in Rat Mandibular Defects.

The aim of this study was to evaluate the potential effects of boron-doped nano hydroxyapatite grafts on craniofacial bone regeneration in critical bone defects in the mandibular corpus of rats, in terms of scintigraphic and histopathological aspects. Forty Wistar albino rats, with an average weight of 200-220g, aged 16-18weeks, and all male, were used in the study. The rats were randomly assigned to five groups, each containing 8 rats, as follows: group C1 (no procedure applied to the mandible), group C2 (surgical defect created in the mandible but no treatment applied), group nHA (nano hydroxyapatite applied to the surgical defect area), group nHA + B1 (nano hydroxyapatite + 1% boron applied to the surgical defect area), and group nHA + B2 (nano hydroxyapatite + 2% boron applied to the surgical defect area). A standard 4 × 4mm full-thickness transosseous bone defect was created in the mandibular corpus of all rats, except for those in group C1. The bone defect in the rats in group C2 was left to heal naturally. Nano hydroxyapatite (nHA), nano hydroxyapatite + 1% boron, and nano hydroxyapatite + 2% boron were applied to the surgical defect areas of the other three groups, respectively. Bone scintigraphy was performed on all rats on days 0 (following the surgical procedure) and 28 of the experimental period. At the end of the 28th day, the animals were sacrificed, and tissue samples were collected for histological examination. A standard grading system was used to evaluate fracture healing. When the groups were compared in terms of bone healing histopathological scores, a statistically significant difference was observed between group C1 and the other groups (p < 0.005). In the statistical evaluation made according to the histopathological mean scores, the least improvement was observed in group C2. No statistically significant difference was observed between group nHA and group nHA + B1 and group C2 and between group nHA and group nHA + B1 in terms of bone healing scores (p > 0.005). A statistically significant difference was found between group nHA + B2 and group C2 (p = 0.026). Although there was no statistically significant difference in histopathological scores, the mean score closest to group C1 was observed in group nHA + B2. A statistically significant difference was observed between the groups in the scintigraphic evaluation performed on the 28th day of the experimental procedure, and the difference was between group C1 and group nHA + B1 and between group nHA and group nHA + B1 (p = 0.004; p = 0.028, p < 0.005). In the comparison of the values obtained on days 0 and 28 within the group, a statistically significant change was observed in group nHA + B1 and group nHA + B2 (p < 0.005). When the results of the present study were evaluated, it was thought that the boron-doped nHA graft biomaterials may have positive effects on bone healing. Providing a different perspective for the development of an alternative new treatment modality that can be locally applied in the treatment of fractures a serious and common health problem can be interpreted as an important outcome of the present study. We believe that this study will serve as a preliminary study for more comprehensive future studies on this subject.

Automated Conveyor System of Sorting and Grading for Red Chili Pepper (Capsicum annum L.) using Image Processing and Artificial Neural Network

This research aims to design an automatic sorting and grading tool driven by color sensor processed through image processing and artificial neural networks (ANN). The research stage consists of data collection in a Mini Studio, image processing using ImageJ, and image classification with ANN. The automatic sorting process begins with items entering the belt, where they are processed in four phases: (1) separating good and rejects chili, (2) separating red from green chili, (3) distinguishing large and small red peppers, and (4) separating large and small green peppers. Automatic sorting and grading were based on image data processed using ANN. The best activation function was tansig-logsig-purelin with MAPE 1.220, RMSE 0.010, and R² = 1 during training. During testing, the MAPE 0.158, RMSE 1.790, and R² = 0.963. The criteria produced grade 1 (red, 10-15 cm), grade 2 (green, 10-15 cm), grade 3 (red, 5-9.99 cm), and reject grade. The quality of large red chilies is used as a reference for market pricing: grade 1 (IDR 60,000/kg), grade 2 (IDR 40,000/kg), and grade 3 (IDR 25.000 – 35,000). Assessing quality based on color with an automatic conveyor can reduce sorting and grading time by 70% compared to conventional methods. Keywords: ANN, Color, Grading, Image Processing, Sorting.

3D Assessment of Mandibular Margin Morphological Change after BTX-A Injection for Masseter Hypertrophy: A Retrospective Study.

Some facial morphological changes may occur in some patients after botulinum toxin A (BTX-A) injection for the treatment of masseteric hypertrophy. The aim of this study was to investigate the morphological changes that occurred on mandibular margin. This retrospective analysis included 43 patients (86 lateral cases) who received BTX-A injections for masseter hypertrophy. To assess the morphological changes in the mandibular margin after treatment, the sharpness of the mandibular margin was evaluated before and after the injections using an established grading system. Additionally, 3D scanning technology was used to measure both the therapeutic effect of the BTX-A injections and the extent of soft tissue sagging in the mandibular margin area. Grading: The grade of mandibular margin sharpness change occurred in 41 lateral cases post-procedurally. Based on the measurement results, statistically significant differences were observed before, 1 month, and 3 months post-procedurally in subjects' positive lower face width representing the therapeutic effect of BTX-A injection and the extent of sagging soft tissue at sagittal section B and section C (p < 0.05), but not in section A (A: outer canthus, B: midpoint of the eyelid margin, and C: inner canthus) (p > 0.05). After receiving a BTX-A injection for masseteric hypertrophy, the mandibular margin may develop an unclear mandibular margin and sagging soft tissue in mandibular margin area. EBM Level: IV LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Efficacy of a Postbiotic Formulation Combined WithMicroneedling for Mild-to-Moderate Acne: A Self-Control Study.

Acne vulgaris significantly affects young individuals globally, with its onset associated with an increased prevalence of C acnes, a naturally occurring skin bacterium. In light of the rising concerns regarding antibiotic resistance and the potential for adverse effects, pharmacological interventions may not consistently represent the most suitable option. Nonpharmacological approaches, such as microneedling, offer promising alternative treatment modalities. Furthermore, the integration of postbiotics in skincare formulations for acne management has gained traction recently. Nonetheless, there remains a lack of sufficient evidence to establish the efficacy and safety of postbiotics when combined with microneedling. To assess the clinical effectiveness of a postbiotic formulation combined with microneedling in mild-to-moderate facial acne vulgaris. Twenty Chinese patients were enrolled, all received one treatment and were monitored 4 weeks posttreatment. The evaluation assessed symptom improvement, treatment safety, and patient satisfaction. The global acne grading system (GAGS) score decreased more than half based on the baseline. Clinical photographs following treatment revealed improved the skin lesions and brightened skin tone. Statistics from VISIA showed excellent improvement in speckle, pore, red region, and porphyrin. No significant adverse reactions have been reported during the treatment period. Additionally, more than 85% were very satisfied or satisfied with the outcome. Our results showed that the postbiotic formulation combined with microneedling may benefit the restoration of the skin barrier and the equilibrium of skin microbiota. This approach may help mitigate inflammation and address skin lesions, presenting a promising therapeutic avenue for the prevention and management of acne vulgaris.

The clinical effect of flow-diverting stent for treatment of unruptured internal carotid artery small- and medium-sized wide-neck aneurysms

Objective: To study the feasibility of domestic flow diverter(TFD) for the treatment of unruptured internal carotid artery small- and medium-sized wide-neck aneurysms. Methods: This is a retrospective case series study.The study retrospectively evaluated consecutive 54 patients with unruptured intracranial small- and medium-sized wide-neck aneurysms treated with TFD in the Department of Cerebrovascular Disease,the Second Affiliated Hospital of Kunming Medical University between October 2019 and January 2024. There were 11 males and 43 females, and the age of patients was (54.9±9.6) years (range:36 to 74 years). There were 63 aneurysms in 54 patients,6 of which were tandem multiple small aneurysms. One case had saccular aneurysms of bilateral internal carotid artery. The maximum diameter of aneurysm was (4.1±0.8) mm (range: 1.5 to 10.0 mm).The ratio of the maximum diameter of the aneurysm to the neck width diameter was 1.3±0.4 (range:0.4 to 2.4). The surgical and follow-up data were collected. The aneurysm embolization rate at the immediate operation and follow-up,and the complications were analyzed. The degree of aneurysm embolization was evaluated using the O'Kelly-Marotta (OKM) grading system,with OKM grade D as complete occlusion and grade C and above (C1,C2,C3 and D) as successful occlusion. Clinical outcomes of all patients were evaluated by modified Rankin scale(mRS). Results: For 63 aneurysms, 48 aneurysms were treated with TFD alone,and 15 aneurysms were treated with a combination of TFD and coiling. The immediate postoperative successful occlusion rate was 14.3% (9/63) and the complete occlusion rate was 3.2% (2/63). Follow-up results were obtained for all of the patients. The follow-up time (M(IQR)) was 124 (182) days (range: 85 to 754 days). The time to aneurysm successful occlusion was 140.5 (151.5) days (range: 85 to 308 days). At final follow-up,the successful aneurysm occlusion rate was 68.3% (43/63) and the complete occlusion rate was 58.7% (37/63). The complete occlusion rate of the TFD group was 50.0% (24/48) and the TFD+coiling group was 13/15. All patients had no aneurysm rupture,ischemic complications and no recurrence of the aneurysm needed to retreatment during the intraoperative and follow-up period. A total of 3 mild haemorrhagic complications which were related to dual-antiplatelet agents. Twelve patients had asymptomatic mild-moderate stent stenosis. TFD covered 66 branch vessels totally. Only 6 branches were affected by the time of the last follow-up and none of the patients had relevant ischaemic symptoms. All of 54 patients were evaluated as mRS score<2 points at the last follow-up. Conclusion: Using TFD to treat internal carotid artery unruptured small and medium-sized wide-neck aneurysms can simplify the surgical procedure with low complication rate, which is a clinically optional treatment approach.

Mitigating the costs of failure: NSFAS challenges and the need for an undergraduate grade reform in South African universities

This paper examines the financial and psychological impacts of the current grade system in South African universities, particularly on students funded by the National Student Financial Aid Scheme (NSFAS). The system, designed to enhance the quality of education by ensuring students grasp core concepts before advancing, often extends the duration of study for student. This extension leads to significant financial burdens, including additional tuition fees, accommodation costs, and subsistence expenses. The rigid structure of grading can prevent students from progressing in their programs, as failing a core module often disqualifies them from taking multiple subsequent modules. The literature review highlights international practices and the unique socio-economic context of South Africa. Findings reveal that the system contributes to high dropout rates, increased student debt, and psychological distress. This paper argues for a reform in the grading system, suggesting a cap at 40% pass, instead of 50% pass for progression at undergraduate level, which would alleviate some of these pressures. Discussions focus on the potential benefits of such a reform, including reduced financial strain on NSFAS, improved student retention, and better mental health outcomes. The conclusion reiterates the necessity of policy changes to create a more equitable and sustainable higher education system. By addressing these challenges, South African universities can ensure that more students complete their degrees in a timely manner, benefiting both the students and the broader economy.