Negative Test Research Articles

An evaluation of the knowledge, attitudes and treatment approaches of general dental practitioners in Ireland in the management of traumatic dental injuries.

Traumatic Dental Injuries (TDIs) are a common oral health problem worldwide. Prompt and accurate diagnosis and treatment maximises the chances of favourable outcomes. This study aimed to evaluate the knowledge and attitudes of Irish Dentists regarding the management of TDIs based on different trauma scenarios. Following ethical approval, a cross-sectional, 22-item self-administered questionnaire was distributed electronically to members of the Irish Dental Association between January and March 2024. A total of 245 complete responses were obtained, representing a 17% response rate. The results demonstrated a correlation between self-reported knowledge and number of correct answers. Overall 80% of respondents chose the correct storage medium for avulsed teeth. The majority of dentists aged > 46 years were unaware of the updated IADT guidelines. A large proportion of dentists showed inadequate knowledge with regard to the management of intruded permanent teeth (65%) and the endodontic management of an immature avulsed permanent tooth (50%). Management of intruded teeth and knowledge of root fractures was not as good as other injury types. The majority of respondents (85%) correctly answered that a tooth with negative sensibility tests following subluxation does not require endodontic treatment immediately. The survey had an acceptable response rate and demonstrated overall good knowledge in the management of TDIs. However, there was still confusion over management of certain scenarios which could have negative repercussions for patients entering an unnecessary restorative cycle. There is a need to improve practitioner confidence and experience in the management of certain TDIs and improve awareness of the IADT guideline as a resource, especially in dentists with more years of experience.

Evaluation of a Pharmacist-Led Methicillin-Resistant Staphylococcus aureus Nasal PCR Testing Protocol

Background/Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) can cause cases of community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia, and nasal colonization with this pathogen increases the risk of infection. Due to its high negative predictive value, multiple studies support using the MRSA nasal polymerase chain reaction (PCR) test to discontinue antimicrobials that target MRSA in the setting of a negative test result. The purpose of this project was to assess the utility of a protocol to allow pharmacists the ability to order MRSA nasal PCR screenings in hospitalized patients with pneumonia. Results: The pre-protocol group included a random sample of 100 patients, and the post-protocol group included 625 patients. Vancomycin DOTs when pharmacists ordered PCRs were significantly lower compared to the pre-protocol group (p < 0.5; 95% CI, 0.46–2.24). The average length of stay and readmission rates at 30 days were significantly lower in the post-protocol group compared to the pre-protocol group (p < 0.05 and p = 0.02, respectively), but there was no significant difference in mortality (p = 0.33). Methods: A protocol was implemented at our institution that allowed pharmacists to order an MRSA nasal PCR test in patients with pneumonia. This retrospective chart review compared a cohort of patients who received vancomycin from before implementation of the protocol to patients who received vancomycin after the protocol’s implementation. The primary endpoint was vancomycin days of therapy (DOTs) between the pre-protocol group and the post-protocol group. Other endpoints assessed included the length of hospitalization, readmission rates, and mortality. Conclusions: Pharmacists ordering MRSA nasal PCR tests significantly reduced vancomycin DOTs, average length of stay, and 30-day readmission rates, contributing to positive outcomes in patients with pneumonia.

Rifaximin-Alpha Increases Lactase Activity in Patients with Irritable Bowel Syndrome Without Constipation and Small Intestinal Bacterial Overgrowth.

Irritable bowel syndrome symptoms are associated with diverse pathophysiological mechanisms including small intestinal bacterial overgrowth and food intolerance. Small intestinal bacterial overgrowth leads to the decreased activity of several digestive enzymes, including lactase. To assess the efficacy of rifaximin-alpha on the symptoms and lactase activity of patients with irritable bowel syndrome without constipation. This was a prospective, pilot study. The recruited patients had irritable bowel syndrome without constipation (Rome IV criteria), a positive lactulose-Hydrogen Breath Test for small intestinal bacterial overgrowth, low urinary D-Xylose levels measured using the Lactest® test, and self-reported lactose intolerance. In addition, lactose HBT was performed. All patients received 400mg rifaximin-alpha every 8h for 2weeks. Four weeks after the intervention, lactose and lactulose HBT were performed, and the symptoms and urinary D-Xylose levels were evaluated. After treatment with rifaximin-alpha, 60% of the patients reported improvement in abdominal pain, 44% in bloating, 36% in flatulence, 60% in borborygmi, and 72% in stool consistency. A negative lactulose-Hydrogen Breath Test result for SIBO was documented in 32% of patients, and lactose maldigestion by lactose-Hydrogen Breath Test was reduced from 88 to 52% of the studied subjects. The median D-Xylose levels before and after treatment were 7.6 (IQR 4.34-13.7)mg/dL vs. 10.4 (IQR 7.1-17.3)mg/dL, p = 0.002. Rifaximin-alpha caused symptomatic improvement, reduced lactose maldigestion, and reduced positive Hydrogen Breath Test results for small intestinal bacterial overgrowth in patients with irritable bowel syndrome without constipation.

Factors predicting the mathematics anxiety of adolescents: a structural equation modeling approach

IntroductionMathematics anxiety (MA) is a distinct negative emotional state or trait that individuals experience when confronted with mathematical problems in everyday life and academic contexts. This study aims to identify the key predictors of MA among secondary-level students in Bangladesh.MethodsUtilizing a quantitative cross-sectional research design, data were collected from 486 students across 89 institutions. Later, the data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM).ResultsThe findings revealed that math related negative past experiences (β = 0.241, t = 4.914, p < 0.001) and a perceived lack of teacher support (β = 0.234, t = 5.440, p < 0.001) significantly contribute to students’ low self-efficacy in mathematics. This low self-efficacy is further influenced by negative attitudes and test anxiety, ultimately leading to increased MA (β = 0.694, t = 22.695, p < 0.001). Additionally, cognitive challenges, particularly working memory difficulties, directly affect MA (β = 0.110, t = 2.659, p = 0.008). The study also found that negative attitudes (β = 0.347, t = 9.063, p < 0.001) and test anxiety (β = 0.251, t = 5.913, p < 0.001) independently exacerbate MA. Moreover, a lack of motivation in learning mathematics is directly influenced by this elevated level of MA (β = 0.384, t = 9.939, p < 0.001).DiscussionTaken together, the study proposes several key recommendations and policy implications to inform the development of synchronized policies by educational authorities aimed at combatting, reducing MA among secondary-level students in Bangladesh and similar contexts.

What Is the Accuracy of 16S PCR Followed by Sanger Sequencing or Next-generation Sequencing in Native Vertebral Osteomyelitis? A Systematic Review and Meta-analysis.

Identifying a microorganism in patients with native vertebral osteomyelitis presents diagnostic challenges. Microorganism identification through culture-based methods is constrained by prolonged processing times and sensitivity limitations. Despite the availability of molecular diagnostic techniques for identifying microorganisms in native vertebral osteomyelitis, there is considerable variability in reported sensitivity and specificity across studies, leading to uncertainty in their clinical utility. What are the sensitivity, specificity, and diagnostic odds ratios for 16S broad-range PCR followed by Sanger sequencing (16S) and metagenomic next-generation sequencing (NGS) for detecting bacteria in native vertebral osteomyelitis? On June 29, 2023, we searched Cochrane, Embase, Medline, and Scopus for results from January 1970 to June 2023. Included studies involved adult patients with suspected native vertebral osteomyelitis undergoing molecular diagnostics-16S bacterial broad-range PCR followed by Sanger sequencing and shotgun or targeted metagenomic NGS-for bacteria detection. Studies involving nonnative vertebral osteomyelitis and cases of brucellar, tubercular, or fungal etiology were excluded. The reference standard for the diagnosis of native vertebral osteomyelitis was a composite clinical- and investigator-defined native vertebral osteomyelitis diagnosis. Diagnostic performance was assessed using a bivariate random-effects model. Risk of bias and diagnostic applicability were evaluated using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. After a manual screening of 3403 studies, 10 studies (5 on 16S, 5 on NGS) were included in the present analysis, from which 391 patients were included from a total of 958 patients overall. Quality assessment via QUADAS-2 criteria showed moderate risk of bias and good applicability. 16S showed 78% (95% confidence interval [CI] 95% CI 31% to 96%) sensitivity and 94% (95% CI 73% to 99%) specificity, whereas NGS demonstrated 82% (95% CI 63% to 93%) sensitivity and 71% (95% CI 37% to 91%) specificity. In addition, the diagnostic ORs were 59 (95% CI 9 to 388) and 11 (95% CI 4 to 35) for 16S and NGS, respectively. Summary receiver operating characteristic curves showed high test performance for 16S (area under the curve for 16S 95% [95% CI 93% to 97%] and for NGS 89% [95% CI 86% to 92%]). Certainty in estimates was moderate because of sample size limitations. This meta-analysis found moderate-to-high diagnostic performance of molecular methods on direct patient specimens for the diagnosis of native vertebral osteomyelitis. When used as a complementary test to microbiological analyses, a positive 16S result rules in the diagnosis of native vertebral osteomyelitis, while further studies are needed to understand the role of NGS in the diagnosis of native vertebral osteomyelitis. When available, these tests should be used in addition to conventional microbiology, especially in complex cases with extensively negative standard microbiological test results, to detect fastidious bacteria or to confirm the causative bacteria when their isolation and pathogenicity are unclear. A large sample size is needed in future research to understand the use of these techniques as standalone tests for diagnosis. Level III, diagnostic study.

Revisiting microgenderome: detecting and cataloguing sexually unique and enriched species in human microbiomes

BackgroundMicrogenderome or arguably more accurately microsexome refers to studies on sexual dimorphism of human microbiomes aimed at investigating bidirectional interactions between human microbiomes, sex hormones, and immune systems. It is important because of its implications to disease susceptibility and therapy, in which men and women demonstrate divergence in many diseases especially autoimmune diseases. In a previous report [1], we presented analyses of several key ecological aspects of microgenderome by leveraging the large datasets of the HMP (human microbiome project) but failed to offer species-level composition differences such as sexually unique species (US) and enriched species (ES). Existing approaches, for such tasks, including differential species relative abundance analysis and differential network analysis, possess certain limitations given that virtually all rely on species abundance alone or are univariate, while ignoring species distribution information across samples. Obviously, it is both species abundance and distribution that shape/drive the structure and dynamics of human microbiomes, and both should be equally responsible for the universal heterogeneity of microbiomes including the sexual dimorphism.ResultsHere, we fill the gap by taking advantages of a recently developed computational algorithm, species specificity, and specificity diversity (SSD) framework (refer to the companion article) to reanalyze the HMP and complementary seminovaginal microbiome datasets. The SSD framework can randomly search and catalogue the sexually specific unique/enriched species with statistical rigor, guided by species specificity (a synthetic metric of abundance and distribution) and specificity diversity (SD). The SSD framework reveals that men seem to have more unique species than women in their gut and reproductive system microbiomes, but women seem to have more unique species than men in the airway, oral, and skin microbiomes, which is likely due to sexual dimorphism in the hormone and immune systems. We further investigate co-dependency and heterogeneity of those sexually unique/enriched species across 15 body sites, with core/periphery network analyses.ConclusionsThis study not only produced sexually unique/enriched species in the human microbiomes and analyzed their codependency and heterogeneity but also further validated the robustness of the SSD framework presented in the companion article, by performing all negative control tests based on the HMP gut microbiome samples.

An automated blood test for glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) to predict the absence of intracranial lesions on head CT in adult patients with mild traumatic brain injury: BRAINI, a multicentre observational study in Europe

Following mild traumatic brain injury (mTBI), elevated concentrations of brain-specific blood proteins glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) may be indicative of intracranial lesions normally detected by head CT scans. We sought to validate the performance of this combination of biomarkers at predetermined cutoff values with an automated immunoassay to predict which patients did not have intracranial lesions. This prospective, observational study was conducted in France and Spain at 16 emergency departments. Adult patients with mTBI were eligible if they had a head CT scan and gave a 10-ml blood sample within 12h of injury. GFAP and UCH-L1 serum concentrations were measured and analysed, in less than an hour time, according to predefined cutoff values of 22pg/ml and 327pg/ml, respectively. Serum concentrations of S100B protein were concomitantly determined in a subset of patients. The primary outcome measures were the sensitivity and negative predictive value (NPV) of the combined GFAP-UCH-L1 test to rule out intracranial lesions on head CT scans. gov (NCT04032509). Between August 2019 and June 2021, 1508 patients were recruited, and 1438 were included in the main analysis. Median age was 69 years (IQR 44-83). Most patients (74%) presented 3h after trauma. 179 (12.4%) patients were positive for intracranial lesions by CT. The sensitivity of the combined test was 98.3% (95% CI 95.0-99.7) and the specificity 24.9 (95% CI 22.6-27.4), with a NPV of 99.1% (95% CI 97.1-99.8). Three patients with a positive CT scan had negative biomarker test results. S100B had a sensitivity of 83.0% (95% CI 76.2-88.2) and a NPV of 94.2% (95% CI 91.6-96.0). Patients with higher biomarker values more frequently had poorer recovery at 3 months after injury. Testing for GFAP and UCH-L1, using validated cutoffs obtained with a new, fast automated immunoassay platform, accurately predicted the absence of intracranial lesions on head CT following mTBI. This study is co-funded by the European Institute of Innovation and Technology (EIT) Health, a body of the European Union (Grant nº19474). Biomarkers tests were funded by bioMérieux.

Molecular investigation of Coxiella burnetii, Brucella spp., Ehrlichia spp., and Borrelia spp. among patients suspected of having Crimean-Congo Hemorrhagic Fever in Iran

ObjectivesCrimean-Congo Hemorrhagic Fever (CCHF) is a tick-borne zoonotic viral disease that could be a public health concern. The overlapping of clinical symptoms of some acute bacterial febrile diseases with CCHF is of importance for clinical diagnosis. This study aimed to molecularly examination of Brucella, Coxiella burnetii, Borrelia, and Ehrlichia infections among individuals suspected of CCHF in Iran. MethodsIn this study, 260 serum samples of suspected cases of CCHF with definitively negative laboratory test results for CCHF virus infection, were examined for Brucella spp., Coxiella burnetii, Borrelia spp., and Ehrlichia spp. by Real-time PCR. ResultsAccording to the results, 3.46% and 3.07% of the patients were positive for brucellosis and Q fever, respectively. Notably, no cases of borreliosis or ehrlichiosis were detected. Among the positive cases for brucellosis (N= 9), three cases were identified as Brucella abortus infection. Individuals under the age of 43 displayed a significantly higher positivity rate for Q fever (p < 0.01). Furthermore, patients presenting with chills had a 5.81-fold increased likelihood of being infected with Q fever (95% CI: 1.39–24.26) compared to those without chills. Notably, no other variables demonstrated a statistically significant association with Q fever infection. Discussion and ConclusionsThe results of this study showed that bacterial infections such as Q fever and brucellosis should be considered as differential diagnoses of CCHF. It is recommended that other bacterial infections that can cause early clinical symptoms similar to CCHF should also be taken into consideration in future studies and serological and molecular investigations of these infections should be tested on a wide scale.

Study on the physical mechanical properties and freeze-thaw resistance of energy storage concrete with artificial phase change aggregate

As the main material for major infrastructure in cold regions, the mechanical properties and freeze-thaw resistance of concrete have become key scientific issues affecting the safety and normal operation and maintenance of infrastructure in cold regions. Energy storage concrete with phase change materials (PCM) has high thermal storage performance, which is beneficial to improving the frost resistance of concrete. In our preliminary research work, the artificial phase change aggregate (APCA) containing PCM with high latent heat, good mechanical properties and frost resistance were made and tested. The APCA was added to the concrete and replaced with natural coarse aggregate in different proportions, resulting in several energy storage concrete schemes with different APCA contents. The water absorption characteristics, microstructure and pore characteristics of energy storage concrete with different APCA contents were tested and analyzed through negative pressure saturation test, SEM and MIP. The effects of APCA replacement on the composition, mechanical properties, failure morphology characteristics and frost resistance durability of energy storage concrete at various ages were analyzed through XRD test, strength test and freeze-thaw cycle test. The results showed that replacing natural coarse aggregates with APCA changed the pore characteristics of concrete, reduced its saturation water absorption rate, but did not change the composition of hydration products at various ages of concrete. Replacing with an appropriate amount of APCA in concrete is beneficial for reducing the total porosity, the number of more-harmful pores and harmful pores. APCA reduce the compressive strength and splitting tensile strength of energy storage concrete at various ages. The early splitting strength of energy storage concrete increases rapidly, while the later growth is relatively slow. APCA are beneficial for suppressing the expansion of pores and cracks under freeze-thaw action of concrete. APCA is helpful to improve the freeze–thaw resistance of the energy storage concrete. After 100 freeze-thaw cycles, their strength is still 96% of the 28 day strength, and their compressive strength is about 35 MPa. This study provides a reliable experimental and theoretical basis for improving the freezing resistance of concrete in cold area.

Efficacy of Pyloshot in combination with standard four-drug antimicrobial treatment for Helicobacter pylori eradication: A randomized clinical trial.

The treatment for Helicobacter pylori is considered to be a combination of several strict regimens, with patients' dissatisfaction and poor compliance. Probiotics are effective in patients' antibiotic regimens. This study investigated the efficacy of the Pyloshot probiotic in combination with standard four-drug therapy in patients with H. pylori infection. This is an interventional study. The study population consisted of patients with H. pylori infection who were selected using the convenience sampling method and were randomly divided into two groups: (i) A or standard four-drug therapy (amoxicillin-clarithromycin-bismuth-pantoprazole) plus two placebo capsules (80 cases). (ii) B or Pyloshot group (standard four-drug therapy plus 2 Pyloshot probiotic capsules) (90 cases). Patients were followed up for 1 month after treatment completion. Eradication of H. pylori was also assessed using the stool antigen test. Data were analyzed using SPSS (v.26) statistical software. Based on the results from the present study, the number of negative stool antigen tests in group A was less than that in group B, and no statistically significant relationship was found between H. pylori eradication (based on stool antigen test) and the studied groups (P = 0.20). There was a statistically significant relationship between vomiting (P = 0.03), diarrhea (P = 0.04), constipation (P = 0.01), and headache (P = 0.04); vomiting and constipation were most frequent in the control group. Based on the results of the present study, there was no significant difference between the effectiveness of treatment with Pyloshot probiotic and the standard four-drug therapy in patients with H. pylori infection. However, the incidence of side effects was lower in the group treated with Pyloshot.

The Diagnostic Value of Metagenomic Next-generation Sequencing in Suspected Pulmonary Tuberculosis Patients with Scarce Sputum or Negative Sputum Etiological Test Results

The Diagnostic Value of Metagenomic Next-generation Sequencing in Suspected Pulmonary Tuberculosis Patients with Scarce Sputum or Negative Sputum Etiological Test Results

Genetic machinery which accompanies metaplasticity operates differentially in experimental model of autism

AbstractThe present study investigated metaplasticity‐related mRNA expressions in valproic acid (VPA)‐rats, focusing on the PI3K/AKT pathway. Wistar dams were treated with a single intraperitoneal injection of 600 mg/kg VPA or saline on embryonic day E12.5 or an equal volume of saline solution. Three behavioral tests were conducted on these males' offspring: grid‐walking test, negative geotaxis test, and three‐chamber social interaction test. Metaplasticity was induced in 60‐day‐old male progeny by giving high‐frequency stimulation for 5 minutes following low‐frequency stimulation to the perforant pathway. For the baseline stimulation protocol (n = 6), stimulation was delivered to the dentate gyrus at the previously determined stimulation intensity (0.33 Hz 0.175 msec 30 s) for 75 min. The percent change of slope of field excitatory postsynaptic potential (fEPSP) and amplitude of population spike were calculated 55–60 min after induction protocol. The mRNA levels of PI3K, PTEN, AKT, GSK‐3β, and MAPT were measured in the hippocampus by using quantitative rt‐PCR. We found that offspring of VPA‐treated rats showed significantly impaired sensorimotor coordination, decreased sociability, impaired preference for social novelty, and reduced input–output curve of fEPSP slope, compared to control animals. Despite a similar metaplastic response, mRNA levels of genes of interest were similar but considerably down‐regulated after induction in offspring of VPA‐treated dams. Our study provides evidence that the induced expression of autism‐related genes has evolved to enable an adaptation mechanism during metaplastic control of long‐term potentiation.

Lasting liver injury following COVID-19 infection characterized by ultrasound shear wave elastography

ObjectiveTo assess for lasting hepatic injury using ultrasound shear wave elastography (SWE) in patients following COVID-19 infection. MethodsIn this retrospective cohort study, patients with SWE exams between January 2019 and 2022 were categorized into three groups: 1) post-COVID-19 subjects with positive COVID-19 PCR assay, 2) random sample of contemporaneous unexposed patients with only negative prior COVID-19 PCR tests, and 3) random sample of pre-pandemic patients to address possible undiagnosed COVID-19 infection in the contemporaneous group. The average difference in median Young’s modulus between post-COVID-19 patients and controls was calculated using a linear regression model after controlling for confounders. Results130 patients (mean age ± SD, 56 years ± 13; 66 women) were evaluated, including 30 patients after COVID-19 infection (mean age ± SD, 53 years ± 11; 15 women), 50 contemporaneous unexposed patients (mean age ± SD, 55 years ± 13; 27 men), and 50 pre-pandemic patients (mean age ± SD, 58 years ± 13; 28 women). SWE scans were performed on General Electric LOGIQ E9 or E10 an average of 44 (range, 12-81) weeks after COVID-19 infection. COVID-19 infection was associated with an average increase in median Young’s modulus of 1.5 kPa (95% CI [0.44, 2.355], p=0.006) after controlling for age, sex, obesity, history of chronic liver disease, and time period. Post-COVID-19 patients had higher liver stiffness compared to contemporaneous controls (median = 7.58 vs 5.99 kPa, p=0.001) but not pre-pandemic controls (median = 7.00 kPa, p=0.51). ConclusionsCOVID-19 infection is associated with increased liver stiffness, which may reflect lasting hepatic injury such as ongoing inflammation or the development of fibrosis. US SWE may serve as a noninvasive tool for long-term liver health monitoring after COVID-19 infection.

Antibodies to Anaplasma phagocytophilum in Patients with Human Granulocytic Anaplasmosis Confirmed by Both Polymerase Chain Reaction and Culture

Background/AimsSera from patients from a single medical institution in New York State with human granulocytic anaplasmosis established by a positive polymerase chain reaction test (PCR) for Anaplasma phagocytophilum were used to assess the performance of serologic testing. All cases were also confirmed by culture in order to eliminate any false positive PCR samples. MethodsA nested PCR was performed targeting the heat shock operon of A. phagocytophilum. Culture was done using the HL-60 promyelocytic cell line. Serologic testing was performed to detect IgG/A/M using an indirect immunofluorescence assay that incorporated a human isolate of A. phagocytophilum as the source of the antigen. ResultsFrom 1997-2009, 38 human granulocytic anaplasmosis patients were evaluated. On the baseline serum sample 21 (55.3%; 95% CI: 38.3% to 71.4%) had a positive serologic test; 7 samples (33.1%) were positive at a titer of 80-320 and 14 samples (66.7%) at a titer of at least 640. Sixteen (94.1%) of the 17 with a negative baseline test had follow-up testing performed. All 16 tested positive on a convalescent phase serum sample obtained from 6 to 45 days later. ConclusionPCR testing is the most commonly used direct diagnostic test to diagnose human granulocytic anaplasmosis. Our findings demonstrate that only approximately 55% of the PCR and culture positive cases were also seropositive on blood samples obtained at the same time point, indicating that serologic testing performed at the time of presentation has limited sensitivity. However, all of the 16 evaluable seronegative patients developed antibodies to A. phagocytophilum during convalescence.

Enhancing mortality prediction in patients with spontaneous intracerebral hemorrhage: Radiomics and supervised machine learning on non-contrast computed tomography

PurposeThis study aims to develop a Radiomics-based Supervised Machine-Learning model to predict mortality in patients with spontaneous intracerebral hemorrhage (sICH). MethodsRetrospective analysis of a prospectively collected clinical registry of patients with sICH consecutively admitted at a single academic comprehensive stroke center between January-2016 and April-2018. We conducted an in-depth analysis of 105 radiomic features extracted from 105 patients. Following the identification and handling of missing values, radiomics values were scaled to 0-1 to train different classifiers. The sample was split into 80-20% training-test and validation cohort in a stratified fashion. Random Forest(RF), K-Nearest Neighbor(KNN), and Support Vector Machine(SVM) classifiers were evaluated, along with several feature selection methods and hyperparameter optimization strategies, to classify the binary outcome of mortality or survival during hospital admission. A tenfold stratified cross-validation method was used to train the models, and average metrics were calculated. ResultsRF, KNN, and SVM, with the "DropOut+SelectKBest" feature selection strategy and no hyperparameter optimization, demonstrated the best performances with the least number of radiomic features and the most simplified models, achieving a sensitivity range between 0.90 and 0.95 and AUC range from 0.97 to 1 on the validation dataset. Regarding the confusion matrix, the SVM model did not predict any false negative test (negative predicted value 1). ConclusionRadiomics-based Supervised Machine Learning models can predictmortality during admission in patients with sICH. SVM with the "DropOut+SelectKBest"feature selection strategy and no hyperparameter optimization was the best simplifiedmodel to detect mortality during admission in patients with sICH.

A case of silicosis with Mycobacterium avium infection relapsed with lymphadenitis 1 year after the completion of initial treatment.

A 71-year-old man with silicosis was treated for Mycobacterium avium infection. Antimycobacterial treatment for M. avium was terminated 1 year after a negative test result for the bacteria on sputum examination. One year following the treatment, the patient developed pneumonitis. In the sputum culture, growth of M. avium was not detected. Pneumonitis did not improve despite sufficient antibacterial therapy. Chest computed tomography scan revealed aggravated shadows of pneumonitis and swelling of supraclavicular lymph nodes. A lymph node biopsy was performed, and polymerase chain reaction testing revealed M. avium infection. We diagnosed the patient with pneumonitis and lymphadenitis due to recurrent M. avium infection. Antimycobacterial treatment with rifampicin, ethambutol, clarithromycin, and amikacin was initiated. Pneumonitis and the general status of the patient improved following the treatment. Lymphadenitis is rare in adults in the absence of any immunodeficiency condition. We speculate that silicosis is a risk factor for mycobacterial infection recurrence.

English As A Foreign Language (EFL) Classroom Anxiety, Risk-Taking Behavior and Willingness to Communicate Among Chinese College Students

This study investigates the relationship between risk-taking behavior, foreign language (EFL) classroom anxiety, and willingness to communicate (WTC) among Chinese college students (n=410). Effective communication is crucial for language acquisition, and fostering WTC is essential. However, factors like anxiety can hinder this. The study explores how risk-taking and anxiety influence WTC in freshmen and sophomore students from liberal arts and science backgrounds. Quantitative data was collected through surveys in Hebei Province, China. Results showed students experience negative evaluation, communication, and test anxiety. Their WTC in listening, speaking, reading, and writing was average, and risk-taking behavior was low. Importantly, a significant negative correlation emerged between risk-taking and anxiety, and a positive correlation between risk-taking and WTC. Based on these findings, the study proposes an action plan for improving English language learning. This plan offers practical suggestions for teachers, focusing on cultivating a risk-taking spirit, encouraging classroom participation, and reducing student anxiety. By implementing these strategies, teachers can enhance students’ WTC and promote the social and communicative aspects of language learning.

Demographic risk factors and injury severity scores in Substance-use behaviour related traffic crashes

Alcohol and drugs, including Tetrahydrocannabinol (THC), significantly impact roadway safety by impairing cognitive functions, coordination, and reaction times, leading to increased crash risk and severity. This study examines the prevalence of alcohol and drugs among 4,586 injured roadway users (drivers, riders, and passengers) in the U.S. from 2019 to 2021, utilizing an XGBoost model to identify key variables associated with Injury Severity Score (ISS) in substance-related traffic crashes, and highlighting influential factors such as injury location, demographic characteristics (age, race), safety compliance, and alcohol and drug presence. These risk factors were further analyzed through Cluster Correspondence Analysis (CCA) to reveal patterns and trends affecting injury severity across different demographic and behavioral groups. The findings reveal that 55.8% of the injured tested positive for substances, with cannabinoids being the most common, followed by alcohol, stimulants, and opioids. This study identified six core crash clusters, each with distinct characteristics, including older drivers, impaired young drivers, specific driver ethnicities, and motorcyclists. Key findings from clusters indicate that older drivers, despite high safety compliance and negative substance tests, faced crash risks potentially due to age-related limitations. Impaired young adult crashes arecharacterized by risky behavior, including alcohol and THC use combined with low safety compliance, while motorcyclists with high substance involvement and inconsistent helmet use, are identified as a high-risk group, frequently experiencing severe leg injuries. These insights underscore the need for comprehensive traffic safety policies targeting substance use and promoting effective safety measures to mitigate crash risks and improve road safety.

Efficacy of Rifaximin and Probiotics in the Treatment of Small Intestinal Bacterial Overgrowth When Used Concomitantly or Sequentially

Background: With the prevalence of small intestinal bacterial overgrowth (SIBO) on the rise, treatment has become of paramount importance for patients suffering from this disease. Antibiotics used to treat SIBO include rifaximin, ciprofloxacin, metronidazole, and neomycin. Probiotics reinforce the small intestine's internal microbiota and help cure many diseases. Aim: In this study, we aimed to evaluate the efficacy of rifaximin together with a multi-strain probiotic in patients with SIBO. In a multi-center open-labeled prospective study, recruited patients were randomized into two groups treated with rifaximin as a base and probiotics that varied in the timing of initiation (concomitantly; group A or sequentially; group B) for treating the clinical manifestations of the disease. The primary endpoint evaluated the clinical response to treatment, and the secondary endpoint evaluated the eradication rates. Results: Eradication rates revealed that 69.8% of the patients in group A and 74.8% of the patients in group B were successfully treated and returned with negative lactulose hydrogen breath test results. Clinical response rates were divided into partial and complete responders; partial responders were reported in 23.3% and 26.6% of patients in groups A and B, respectively, and complete responders were reported in 62.7% and 59.5% of patients in groups A and B, respectively. Overall, partial or complete responders' combined rate comprised 86% and 86.2% in groups A and B, respectively. There were no reported side effects by patients treated with rifaximin and the multi-strain probiotic for both protocols. Conclusion: The addition of probiotics, both concomitantly or sequentially, to the treatment regimen acts synergistically with rifaximin to improve outcomes. According to our study, there were no statistical differences between the two regimens. In conclusion, the extension of probiotics in the sequential regimen provided a more prolonged clinical response rate.

Screening and surveillance practices for Multiple Endocrine Neoplasia type 1-related Neuroendocrine Tumours in European Neuroendocrine Tumor Society Centers of Excellence (ENETS CoE)-An ENETS MEN1 task force questionnaire study.

Multiple Endocrine Neoplasia type 1 (MEN1) Clinical Practice Guidelines (2012) are predominantly based on expert opinion due to limited available evidence at the time, leaving room for interpretation and variation in practices. Evidence on the natural course of MEN1-related neuroendocrine tumours (NET) and the value of screening programs has increased and new imaging techniques have emerged. The aim of this study is to provide insight in the current practices of screening and surveillance for MEN1-related NETs in ENETS Centers of Excellence (CoEs). A clinical practice questionnaire was distributed among all 65 ENETS CoEs. Response rate was 91% (59/65). In 14% of CoEs <10 patients, in 50% 10-49, in 31% 50-100 and in 3 centres (5%) >100 patients with MEN1 are seen. Practices with regard to screening and surveillance of NETs were markedly heterogeneous. Differences between countries were noted in the use of gut hormones for biochemical screening and the choice for imaging modality for screening/surveillance of pancreatic NETs (PanNETs). Magnetic resonance imaging (MRI) is the preferred modality for screening and surveillance of PanNETs, whereas this is computed tomography (CT) for thoracic NETs. Practices regarding screening for thoracic NETs were more homogeneous among larger volume CoEs, with longer screening intervals. The majority of CoEs tailored the surveillance of small pancreatic and lung NETs to observed growth rate. 68% of CoEs advise patients with clinical MEN1 with negative genetic testing to undergo periodic screening like mutation-positive patients. In conclusion, there is still marked heterogeneity in practice, although there are also common trends. Differences were sometimes associated with volume or country, but often no association was found. This underscores the need for clear and evidence-based practice recommendations.