Medical Research Articles

Brain magnetic resonance image (MRI) segmentation using multimodal optimization

AbstractOne of the highly focused areas in the medical science community is segmenting tumors from brain magnetic resonance imaging (MRI). The diagnosis of malignant tumors at an early stage is necessary to provide treatment for patients. The patient’s prognosis will improve if it is detected early. Medical experts use a manual method of segmentation when making a diagnosis of brain tumors. This study proposes a new approach to simplify and automate this process. In recent research, multi-level segmentation has been widely used in medical image analysis, and the effectiveness and precision of the segmentation method are directly tied to the number of segments used. However, choosing the appropriate number of segments is often left up to the user and is challenging for many segmentation algorithms. The proposed method is a modified version of the 3D Histogram-based segmentation method, which can automatically determine an appropriate number of segments. The general algorithm contains three main steps: The first step is to use a Gaussian filter to smooth the 3D RGB histogram of an image. This eliminates unreliable and non-dominating histogram peaks that are too close together. Next, a multimodal particle swarm optimization method identifies the histogram’s peaks. In the end, pixels are placed in the cluster that best fits their characteristics based on the non-Euclidean distance. The proposed algorithm has been applied to a Cancer Imaging Archive (TCIA) and brain MRI Images for brain Tumor detection dataset. The results of the proposed method are compared with those of three clustering methods: FCM, FCM_FWCW, and FCM_FW. In the comparative analysis of the three algorithms across various MRI slices. Our algorithm consistently demonstrates superior performance. It achieves the top mean rank in all three metrics, indicating its robustness and effectiveness in clustering. The proposed method is effective in experiments, proving its capacity to find the proper clusters.

Bias in artificial intelligence for medical imaging: fundamentals, detection, avoidance, mitigation, challenges, ethics, and prospects.

Although artificial intelligence (AI) methods hold promise for medical imaging-based prediction tasks, their integration into medical practice may present a double-edged sword due to bias (i.e., systematic errors). AI algorithms have the potential to mitigate cognitive biases in human interpretation, but extensive research has highlighted the tendency of AI systems to internalize biases within their model. This fact, whether intentional or not, may ultimately lead to unintentional consequences in the clinical setting, potentially compromising patient outcomes. This concern is particularly important in medical imaging, where AI has been more progressively and widely embraced than any other medical field. A comprehensive understanding of bias at each stage of the AI pipeline is therefore essential to contribute to developing AI solutions that are not only less biased but also widely applicable. This international collaborative review effort aims to increase awareness within the medical imaging community about the importance of proactively identifying and addressing AI bias to prevent its negative consequences from being realized later. The authors began with the fundamentals of bias by explaining its different definitions and delineating various potential sources. Strategies for detecting and identifying bias were then outlined, followed by a review of techniques for its avoidance and mitigation. Moreover, ethical dimensions, challenges encountered, and prospects were discussed.

Premature ovarian insufficiency: knowledge, attitudes, and quality of care offered by gynecologists.

Premature ovarian insufficiency (POI) affects up to 3% of the global female population, influencing metabolic, cardiovascular, and reproductive health. Medical expertise in diagnosis, effects, and treatment strategies, particularly for gynecologists, is crucial for ensuring improved healthcare for women. The objective of this study is to assess the state of medical knowledge regarding the diagnosis, treatment, and follow-up of POI among Brazilian gynecologists. A cross-sectional study was conducted using online questionnaires administered to 16,000 members of the Brazilian Federation of Gynecology and Obstetrics. In total, 460 questionnaires were received from gynecologists who had an average age of 44.49 ± 12.57 years and 19.37 ± 12.95 years of professional experience. Fifty-three percent of gynecologists diagnosed POI correctly, and 49% requested karyotype analysis, while fewer than 10% identified all POI etiologies. Over 90% of gynecologists understood the long-term consequences of POI for bone and cardiovascular health. Despite being a consequence of hypoestrogenism, hormone therapy was recommended only by 20% of doctors, with no more than 50% of them prescribing appropriate doses for young women. Regarding self-perception, 60% of gynecologists declared deficient knowledge regarding how to offer care and guidance to women, with hormone therapy being reported as the most important reason (47%). Current concepts and guidelines for POI are not adequately understood or applied in Brazilian clinical practice, leading to suboptimal care.

Clinician Knowledge of Chagas Disease After an Educational Intervention

This survey study describes the self-reported medical knowledge among physicians before and after attending a lecture on Chagas disease.

Thinking Style Preferences of Chinese and Western Physicians: A Mixed-Methods Study

IntroductionTraditional Chinese medicine (TCM) and Western medicine (WM) stem from distinct cultural and regional contexts, with the primary difference in their approaches to clinical reasoning.This study aims to investigate the cognitive preferences of TCM and WM physicians in clinical diagnosis and treatment, providing valuable insights for the advancement of TCM. MethodsWe implemented a two-phase mixed methods approach comprising questionnaires and semi-structured interviews. The Thinking Style Inventory (TSI) was used to evaluate the thinking styles of physicians through convenience sampling. Additionally, a total of six physicians (three practicing TCM and three WM) were selected by purposive sampling and open-ended responses regarding self-cognition and influencing factors were analyzed using thematic analysis. ResultsA total of 150 surveys and six interviews consistently indicated a preference among both TCM and WM physicians for Legislative, Executive, Hierarchical, Liberal, and External styles. In contrast, TCM physicians exhibited a tendency towards Legislative and Liberal styles, whereas WM physicians leaned towards Executive and Judicial styles. Thematic analysis of the interviews revealed four themes: self-understanding, thinking characteristics, influencing factors, and style changes. ConclusionOur study identified that within TCM and WM, a blend of shared characteristics and distinct individuality in thinking styles existed, exhibiting variations in the growth processes of physicians. Both TCM and WM physicians attributed the formation of their thinking styles to factors such as education, internship experience, Chinese social culture and personal disposition. Furthermore, empirical research methods emerged as effective tools for studying clinical reasoning in healthcare contexts.

Patterns in health care use and intensity for diagnosed and undiagnosed cognitive impairment in the older australian community: Implications for primary care management

ObjectivesWhile the economic burden imposed by dementia is well-documented, findings are mixed on health care use for those with mild cognitive impairment (MCI). Our objective was to analyse annual, non-hospital medical and pharmaceutical use patterns for older people with undiagnosed MCI and diagnosed dementia, living in the Australian community. MethodsWe analysed panel data from a community sample, the Sydney Memory and Ageing Study (Australia), linked to administrative data on health care use, using two-part models to estimate the probability of using health care and the annual costs incurred by study participants. ResultsPeople with MCI, unaware of their diagnoses, were significantly less likely to incur annual pathology and diagnostic imaging costs relative to cognitively normal individuals. This effect was concentrated in individuals with MCI who had non-amnestic symptoms, lived alone, or had limited carer support. Compared to cognitively normal individuals, people with MCI were predicted to have slightly lower annual costs for broad medical care categories related to the management and diagnosis of cognitive impairment, and people with dementia, substantially higher professional attendances, and pharmaceutical costs. These findings were consistent across estimation models adjusting for attrition over the study. Policy implicationsDiagnosis and symptom management in primary care may enable individuals with MCI to improve their quality of life and prevent more costly future health care use. However, our study found potential gaps in medical service use for people with undiagnosed MCI in the community, especially when they had less support or did not have memory symptoms. Primary care services may need to better diagnose and target these individuals.

Research progress on pathogenesis of chronic fatigue syndrome and treatment of traditional Chinese and Western medicine

Chronic Fatigue Syndrome (CFS) is a complex and perplexing medical disorder primarily characterized by persistent and debilitating fatigue, often accompanied by a constellation of symptoms, including weakness, dyspnea, arthromyalgia, sore throat, and disrupted sleep patterns. CFS is defined by its persistent or recurrent manifestation for a minimum duration of six months, marked by an enduring and unrelenting fatigue that remains refractory to rest. In recent decades, this condition has garnered significant attention within the medical community. While the precise etiology of CFS remains elusive, it is postulated to be multifactorial. CFS is potentially associated with various contributory factors such as infections, chronic stress, genetic predisposition, immune dysregulation, and psychosocial influences. The pathophysiological underpinnings of CFS encompass viral infections, immune system dysregulation, neuroendocrine aberrations, heightened oxidative stress, and perturbations in gut microbiota. Presently, clinical management predominantly relies on pharmaceutical interventions or singular therapeutic modalities, offering alleviation of specific symptoms but exhibiting inherent limitations. Traditional Chinese Medicine (TCM) interventions have emerged as a promising paradigm, demonstrating notable efficacy through their multimodal, multi-target, multi-pathway approach, and holistic regulatory mechanisms. These interventions effectively address the lacunae in contemporary medical interventions. This comprehensive review synthesizes recent advancements in the understanding of the etiological factors, pathophysiological mechanisms, and interventional strategies for CFS, drawing from a corpus of domestic and international literature. Its aim is to furnish valuable insights for clinicians actively involved in diagnosing and treating CFS, as well as for pharmaceutical researchers delving into innovative drug development pathways. Moreover, it seeks to address the intricate challenges confronted by clinical practitioners in managing this incapacitating condition.

Antipyretic and Anti-inflammatory Effects of Sanchen Pediatric Antipyretic Paste

Objective:: This study aimed to investigate the antipyretic and anti-inflammatory effects and mechanisms of Sanchen Pediatric antipyretic Paste (SPAP). Methods:: Rats were randomly divided into 7 groups: negative control group, positive control group, positive treatment group, SPAP high-dose, medium-dose and low-dose groups, and blank substrate group. Except normal control group, rats in other groups were subcutaneously injected with 10% dry yeast suspension (10mL/kg) on the back to establish a fever model, and the normal group was given the same volume of saline. At the 4 h and 7 h after modeling, each treatment group was subjected to corresponding SPAP intervention. Anal temperature was measured every one hour after modeling for 10 consecutive times. The average temperature-rise curve, maximum temperature and body temperature response index (TRI) were calculated to evaluate the efficacy of SPAP. After the last temperature measurement, abdominal aortic blood was collected, and serum was separated from blood. The levels of IL-6, TNF-α and CRP in serum were determined by enzyme-linked immunosorbent assay. Results:: The body temperature of the positive control group was significantly increased (p < 0.01) 4 hours after model establishment, and that of the SPAP groups significantly decreased (p < 0.01) after 5 hours of the model establishment. The levels of Serum IL-6, TNF-α and CRP were significantly decreased (p < 0.01) in a dose-dependent manner. Conclusion:: SPAP has an obvious antipyretic effect on fever caused by dry yeast in rats. One of its antipyretic mechanisms may be associated with inhibiting inflammatory reactions by reducing the production or accelerating the degradation of endogenous thermogenic cytokines, such as IL-6, TNF- α, and CRP.

The Effect of Primary Language on Access to Specialized Orthopaedic Care

BackgroundLanguage barriers can negatively impact the quality of care for non-English speaking patients. Lack of access to healthcare providers who speak multiple languages or interpreters in medical offices can result in delayed appointment times, delayed treatment, and increased complications. Access to shoulder surgeons with subspecialty training is limited and this has been established which may further exacerbate the problem with access for these patients. The purpose of this study was to determine the effect of primary language spoken on access to specialty shoulder care in South Florida. MethodsThree populous, diverse counties in South Florida were selected for data collection. Sixty-nine orthopedic offices were identified by Google search and selected via random number generator. Investigators used the Secret Shopper methodology to contact each office to schedule an appointment for a shoulder arthroplasty (SA) for a family member who spoke exclusively English or Spanish using a blocked phone number. The ability to schedule a new patient appointment with a fellowship-trained shoulder specialist, the waiting period for the scheduled appointment and interpretation services for Spanish-speaking patients were collected. ResultsOf the 69 offices called, 35 met inclusion criteria. There were no significant differences in wait times for shoulder arthroplasty based on primary language spoken. There was no difference in wait time to see a shoulder specialist between Spanish (13.7 days) and English-speaking patients (12.9 days) (p=0.835)). Wait times with a non-fellowship-trained orthopedic surgeon between Spanish and English-speaking patients was also not different (9.5 days and 11.96 days, respectively (p=0.522). Similarly, no difference existed in phone call duration (p=0.56), median income and wait times for a general orthopedic surgeon, with r=-0.26 (p=0.105), or a shoulder specialist, with r =-0.19 (p=0.22). Of the clinics accepting patients, 74.3% (n=26/35) offered Spanish interpretation with 42.3% (n=11/26) providing a multilingual physician, 26.9% (n=7/26) a translating service, 23.1% (n=6/26) had a staff member capable of translation, and 7.7% (n=2/26) had an available professional interpreter. ConclusionWhile access to orthopedic specialty care may be similar for Spanish-speaking and English-speaking patients in South Florida, over 25% of clinics lack multilingual physicians or qualified interpreter access. This can negatively impact surgical decision-making, postoperative care and outcomes after shoulder surgery. It is essential the orthopedic community advocates for the proper resources to optimally assist surgeons and provide quality care for Spanish-speaking orthopedic patients.

“The Knight in the Panther’s Skin” by Shota Rustaveli: Salutogenic Aspects

The article provides a discussion of the specific salutogenic aspects of medical knowledge in Shota Rustaveli’s “The Knight in the Panther’s Skin” – a distinguished piece of Georgian literature. Consideration of specific passages from the poem and corresponding commentary demonstrates the author’s medical knowledge, as he stresses the significance of positive emotions, a healthy environment, and mood on human health, thus having a therapeutic effect.. Regarding the knowledge reflected in similar scientific literature, which is significant for the history of Georgian medicine, the work offers a more specific and, in some cases, newer vision of the salutogenic aspects in “The Knight in the Panther’s Skin”. Along with the author’s knowledge, we emphasise the fact that during that period, there was a logical link between the medical-biological thinking of the era known as the “Golden Age”. This connection represents a natural expression of the level of the scientific sphere, simultaneously with cultural and political progress in the country. In addition to providing an overview of specific medical areas in “The Knight in the Panther’s Skin”, the article will explore the scientific and other literature of the era and a later period, where similar approaches are described. The issues discussed in the article, regarding their nature and different aspects, could be of interest for studying the history of medicine of that specific era.

Racial Disparities in Outcomes After Foot and Ankle Surgery: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis delved into the impact of race and ethnicity on outcomes following foot and ankle surgery, an area garnering increasing attention within the medical community. Despite significant literature on post-surgical clinical and functional outcomes, limited research has explored the influence of racial and ethnic factors on post-operative outcomes. In this study, data from 33 relevant studies, involving a total of 557,734 patients, were analyzed to assess outcomes across different racial and ethnic groups. Notably, only six studies met the criteria for inclusion in the final meta-analysis due to variations in outcome reporting. Findings revealed disparities in functional scores, pain levels, and resource utilization among different racial and ethnic cohorts. Specifically, non-White and minority patients exhibited higher rates of foot and ankle fractures and lower extremity surgeries, worse functional outcomes, increased pain, longer hospital stays, and a greater incidence of complications compared to their White counterparts. However, some studies presented contradictory results, emphasizing the necessity for further investigation to elucidate these discrepancies fully. This research underscores the importance of considering racial and ethnic factors in foot and ankle surgery outcomes and highlights the need for targeted interventions to address existing disparities.

Metachromatic leukodystrophy in infant presenting as acute febrile illness: a case report

Introduction and Importance: Metachromatic leukodystrophy (MLD) is a rare genetic disorder affecting the central and peripheral nervous systems. It results from ARSA enzyme deficiency, causing sulfatide accumulation and myelin damage. Early diagnosis is crucial, and this case highlights the diagnostic challenges and rapid health deterioration associated with MLD. Case Presentation: A 14-month-old male, initially presenting with fever and crying during micturition, experienced a devastating health decline. Previously, he had achieved developmental milestones but rapidly lost motor and cognitive skills. Extensive investigations led to an MLD diagnosis, complicated by severe malnutrition. Despite medical interventions, his condition worsened, leading to cardiopulmonary arrest and a tragic end. Clinical Discussion: MLD is an exceedingly rare genetic disease with systemic effects, as illustrated by severe metabolic acidosis in this case. Early diagnosis, through comprehensive investigations like MRI, is critical, but MLD’s rapid progression poses challenges in management. Therapeutic options remain limited, emphasizing the importance of a multidisciplinary approach. Conclusion: This case emphasizes the insidious nature of MLD, highlighting the need for considering rare genetic conditions in unexplained neurological regression. It underscores the urgency of improved awareness, early diagnosis, and comprehensive care for individuals affected by such devastating disorders. Despite the challenges, the medical community’s dedication to providing care and support remains unwavering.

Identifying Community-Based Entrustable Professional Activities for Medical Students Through a Modified Delphi Process.

Recognition of the need for medical education to train physicians who are skilled at supporting population health and work beyond traditional health care settings is growing. Entrustable professional activities (EPAs) for medical students typically have centered around activities taking place in the clinical workplace; however, EPAs that involve working with community members in community contexts have not been clearly established. We used a three-stage online modified-Delphi method to identify community-based EPAs for University of Wisconsin School of Medicine and Public Health medical students. We recruited key stakeholders to participate and asked them, based on their experience, to generate a list of community-based tasks that they believed graduates should be trusted to perform. Subsequently, using a five-point anchored Likert scale (1=strongly disagree to 5=strongly agree), we asked participants to rate their level of agreement with each identified task becoming an EPA. An a priori definition of consensus was established. Twenty-two tasks reached consensus as potential community-based EPAs. The tasks with the highest mean ratings were "addressing trust issues with the medical community amongst the local population" (mean=4.71), "meeting with community members around a health topic" (mean=4.64), "identifying opportunities for disease prevention" (mean=4.64), and "identifying policies that impact community outcomes" (mean=4.57). The identified community-based tasks can support the augmentation of existing community-based curriculum and help identify areas for novel curriculum and assessment development. Lessons learned from this local effort could be helpful to other programs seeking to establish and refine community-based curricula.

Analysis of the structure of the information field of perception of risk factors for non-communicable diseases

When studying the attitude of the population to saving their own health, the question of the connection between abstract knowledge about the harm caused to health by risk factors and a real understanding of the harm caused by these factors to their own health remains poorly understood.The purpose of this work is to analyze the structure of the information field of the population’s attitude to the impact of FR on health.Materials and methods. The material for the analysis was the results of a sociological survey in three pilot regions of the Russian Federation – Tula Region, Stavropol Territory and the Republic of Crimea. The questionnaire consisted of 33 questions concerning risk factors and their impact on the human body and a block of questions concerning sources of medical information and trust in them. The sample size was 1,718 respondents. The following methods were used: descriptive statistics and the sociological method of questioning. Statistical data processing and reweighing were carried out in the statistical data processing package SPSS22.0. In general, the sampling error in the study does not exceed 1.99% for a confidence level of p<0.1.Results. The study showed that abstract knowledge about the harm of a particular FR in almost all FR is quite high, since it is precisely on them that the efforts of the medical community have been directed in recent decades. Moreover, the highest values are expected to have such factors as tobacco use, alcohol consumption, elevated blood sugar (glucose) and high blood pressure. The level of knowledge of the harm of FR, to which the medical community paid less attention, was expected to be lower. The lowest value is such a FR as a low iodine content in salt, which is consumed in food. An assessment of the relationship of variables such as abstract knowledge of harm about FR and understanding of their harm to one’s body using a two-way T-criterion showed that these variables are completely independent of each other at the significance level p<0.001. This result made us look more closely at the factor structure of the studied field of reality and put forward the assumption of independence of knowledge about the harm caused to the human body by FR and behavioral patterns in relation to FR. As a result of factor analysis of 73 variables, 9 factors were identified: the first and most powerful factor (10.33%) – knowledge of the effect of FR on one’s own health; the second most powerful factor (8.71%) – knowledge of the harm of FR; the third highlighted factor (5.46%) – trust in information sources, which included both trust in the media and trust in TV presenters, popular personalities and trust in the leaders of the region and the city; the fourth highlighted factor (4.67%) is the gender characteristics of the control of the FR by the population; the fifth highlighted factor (4.59%) is the sources of information about the FR; the sixth highlighted factor (4.30%) – age–related features of FR control; the seventh highlighted factor (3.32%) – the use of gadgets to control FR and exercise; the eighth highlighted factor (3.00%) – trust in health workers as a source of information; the ninth highlighted factor (2.59%) – smoking and alcohol consumption.Conclusion. The assessment of the effect of FR on the respondents’ own health in the framework of the conducted study turned out to be significantly lower than abstract knowledge about the harmful effects of these FR. The analysis of the factor structure of the studied field confirmed the validity of such a division of knowledge based on ideas about its various forms – «knowledge in itself» and «knowledge for oneself». The analysis made it possible to formulate a number of conditions for improving the effectiveness of preventive work with the population, including to increase the impact of population prevention: it is necessary to more actively involve the most important sources for the population – medical workers, scientific medical workers and health managers; more fully take into account the gender and age characteristics of audiences in preventive measures; the use of mass media should be preceded by an analysis of the level of trust in them from the target audience; the information messages themselves must first be checked for memorability. Preventive measures should change the personal meanings of specific people in relation to FR and HLS, and not be limited to stating general knowledge about them. The study also allows us to determine the directions for further research of the population’s attitude to the FR and their own health as an interdisciplinary task with the necessary involvement of specialists in medical and general psychology, personality psychology and motivation psychology, as well as sociologists.

Establishment of Primary Cell Cultures from Canine Oral Melanomas via Fine-Needle Aspiration: A Novel Tool for Tumorigenesis and Cancer Progression Studies.

Oral melanomas are the most common oral malignancies in dogs and are characterized by an aggressive nature, invasiveness, and poor prognosis. With biological and genetic similarities to human oral melanomas, they serve as a valuable spontaneous comparative model. Primary cell cultures are widely used in human medicine and, more recently, in veterinary medicine to study tumorigenesis, cancer progression, and innovative therapeutic approaches. This study aims to establish two- and three-dimensional primary cell lines from oral canine melanomas using fine-needle aspiration as a minimally invasive sampling method. For this study, samples were collected from six dogs, represented by four primary oral melanomas and five lymph nodal metastases. The cells were digested to obtain single-cell suspensions, seeded in flasks, or processed with Matrigel® to form organoids. The cell cultures were characterized through flow cytometry using antibodies against Melan-A, PNL2, and Sox-10. This technique offers a minimally invasive means to obtain cell samples, particularly beneficial for patients that are ineligible for surgical procedures, and enables the establishment of in vitro models crucial for comparative studies in mucosal melanoma oncology. To the best of our knowledge, this is the first work establishing neoplastic primary cell cultures via fine-needle aspiration in dogs.

Rationale of using magnetically sensitive biomaterials in bone tissue therapy: a review

INTRODUCTION. Currently, new biomaterials are being intensively developed to improve the efficiency of repair of damage to hard and soft tissues. New approaches and methods for functionalizing biomaterials have been proposed. One such method is the use of magnetic nanoparticles. This approach is new and still little studied, however, the annual increase in the number of publications on this topic indicates the promise of studying the osteogenic effect of magnetic nanoparticles. AIM. To summarize the results of current research devoted to studying the effect of magnetically sensitive biomaterials on the functional activity of cells involved in the reparation of bone tissue damage. MATERIALS AND METHODS. A literature review was conducted using the databases PubMed and Scopus. Keywords used to conduct the search: electromagnetic field, magnetic nanoparticles, biomaterials, osteoinduction, bone regeneration. Request dates: February-March 2024, publication period 2000–2024 years. MAIN CONTENT. New approaches and methods for functionalizing biomaterials have been proposed. One such approach is the use of magnetic nanoparticles (MNPs). Traditionally, in medicine, MNPs are used as a contrast agent to improve the visualization of cancer tumors; in addition, MNPs can act as a matrix in targeted drug delivery systems and in hyperthermic therapy of cancer tumors. New experimental data show that the use of MNPs as a magnetically sensitive component in biomaterials is a promising way to stimulate the repair of bone defects and fractures. It has been shown that biomaterials modified by nanoparticles stimulate osteogenic differentiation of stem cells, increase proliferative activity and secretion of extracellular matrix proteins by bone cells. CONCLUSION. Integration of MNPs with organic and synthetic polymers, and other biomimetic constructs is a promising direction for creating osteogenic biomaterials for medical use, including those aimed at increasing the efficiency of regeneration of bone defects. The use of magnetically sensitive biomaterials makes it possible to create “smart” tissue-engineered structures controlled by external electromagnetic stimulus.

Assessing Genotoxicity of Bovine Pericardium in Guided Tissue Regeneration: Bacterial Reverse Mutation Assay With Exogenous Metabolic Activation.

Introduction Guided tissue regeneration (GTR) is integral to periodontal therapy, facilitating the repair of osseous defects. Due to the widespread use of bovine pericardium (BP) in GTR, a thorough investigation into its genotoxicity is essential for patient safety and treatment efficacy. This study aimed to evaluate the genotoxic effects of local BP in GTR for periodontal osseous defects. Materials and methods The Bacterial Reverse Mutation Assay (Ames test) was used to assess the genotoxic potential of local BP. An exogenous metabolic activation system was employed to evaluate the direct effects of the material on bacterial cells. Results The study investigated the mutagenic effects of local BP across multiple strains of Salmonella typhimurium, utilizing concentrations ranging from 0.3125 mg/plate to 5 mg/plate. While some variability was observed in revertant counts, the generally low SDs suggest a consistent response to the test substance. The maximum revertant count for each strain did not significantly exceed the mean values, indicating the absence of notable outliers or exceptionally high revertant counts at any specific concentration. Based on the data and toxicity assessment criteria, there is insufficient evidence to suggest that the experimental material induces genotoxic effects in the tested bacterial strains under the provided experimental conditions. Conclusion This study assessed the mutagenic potential of local BP membranes used in GTR with the Ames test. Results showed no evidence of mutagenicity, as revertant counts did not exceed twice the negative control in all bacterial strains with exogenous metabolic activation. This suggests that bovine pericardium membranes are safe for medical use under the test conditions. The study highlights the biocompatibility and non-mutagenic nature of BP membranes in GTR for periodontal therapy.

Emerging Role of Artificial Intelligence in Academic Pulmonary Medicine.

Emerging Role of Artificial Intelligence in Academic Pulmonary Medicine.

Some Perceptions Differ, Match Outcomes Do Not: A Multisite Retrospective Cross-Sectional Comparison of Virtual vs. In-Person Recruitment.

Virtual interviewing for residency provides considerable savings. Its impact on match outcomes remains unclear. Evaluate the impact of virtual residency recruitment on program and applicant assessment and match outcomes. Cross-sectional survey, September 2020-July 2021 PARTICIPANTS: Faculty interviewers and 2019 and 2020 PGY-1 classes at three academic internal medicine residencies. Survey items rating effectiveness of interview format, preference for future interview format, and perceived impact on diversity. A total of 247/436 faculty (57%) interviewers responded. Faculty perceived that in-person interviews enhanced applicant assessment (3.23 ± 0.38, p < 0.01) and recruitment of the most qualified applicants (p < 0.01) but did not impact recruitment of a racially or gender diverse class (3.03 ± 0.99, p = 0.95 and 3.09 ± 0.76, p = 0.14 respectively). They also did not demonstrate a preference for future interview formats. A total of 259/364 matched applicants responded, corresponding to a 76% response rate in the in-person cohort and a 66% response rate for virtual. Trainees were equally likely to match at their top choice when interviewing virtually vs. in-person (p = 0.56), and racial/ethnic and gender composition of the incoming class also did not differ (p = 0.81 and p = 0.19 respectively). Trainees perceived many aspects of the institution were better assessed in-person, though the impact varied according to assessment domain. Trainees who interviewed in-person preferred in-person formats. Of those who interviewed virtually, 47% preferred virtual and 54% preferred in-person. There were no predictors of virtual preference for future interview formats. Faculty and applicants who experienced virtual recruitment had no preference for future recruitment format. Virtual recruitment had no impact on the racial/gender diversity of matched classes or on applicants matching at their top-ranked institution. Institutions should consider the potential non-inferiority of virtual interviews with financial and other benefits when making decisions about future interview formats.

Recent advances in measuring the effects of diet on gastrointestinal physiology: Probing the "leaky gut" and application of real-time ultrasound.

There is a large pool of ideas in both mainstream and non-mainstream medicine on how diet can be manipulated in order to treat or prevent illnesses. Despite this, our understanding of how specific changes in diet influence the structure and function of the gastrointestinal tract is limited. This review aims to describe two areas that might provide key information on the integrity and function of the gastrointestinal tract. First, demystifying the "leaky gut syndrome" requires rational application and interpretation of tests of intestinal barrier function. Multiple ways of measuring barrier function have been described, but the inherent difficulties in translation from animal studies to humans have created misinterpretations and misconceptions. The intrinsic nature of intestinal barrier function is dynamic. This is seldom considered in studies of intestinal barrier assessment. To adequately understand the effects of dietary interventions on intestinal barrier function, background barrier function in different regions of the gut and the dynamic responses to stressors (such as psychological stress) should be assessed as a minimum. Second, intestinal ultrasound, which is now established in the assessment and monitoring of inflammatory bowel disease, has hitherto been poorly evaluated in assessing real-time intestinal function and novel aspects of structure in patients with disorders of gut-brain interaction. In conclusion, a more complete functional and structural profile that these investigations enable should permit a greater understanding of the effects of dietary manipulation on the gastrointestinal tract and provide clinically relevant information that, amongst other advantages, might permit opportunities for personalized health care delivery.