Normal Values Research Articles

Long-term photogrammetric outcomes of midface advancement in Apert syndrome: are we nearing normal?

The aesthetic goals of midface surgery in Apert syndrome are to correct the multi-planar midface deficiency and normalize facial ratios. This study characterizes the long-term photogrammetric outcomes of midface advancement in Apert syndrome. Patients with Apert syndrome who underwent midface distraction from 2000 to 2023 were retrospectively reviewed. Soft tissue measurements were applied to preoperative (T0), short-term postoperative (T1), and long-term postoperative (T2) photographs. Long-term changes were compared between subcranial and transcranial procedures, segmental and non-segmental osteotomies, and individual techniques. Frontal facial dimensions at time T2 were compared to age- and sex-matched normal controls from the NIMH-ChEFS face database. Twenty patients had postoperative follow-up of T1 = 0.6 ± 0.4 and T2 = 4.7 ± 1.1years and were compared to 40 normal controls. From time T0 to T2, middle facial third height increased (26.1 ± 3.0% to 27.8 ± 2.6%, p = 0.026), canthal tilt improved (- 7.6° ± 3.7° to - 3.9° ± 4.4°, p < 0.001), and facial convexity increased (182.9° ± 6.2° to 167.9° ± 8.6°, p < 0.001). From time T1 to T2, facial convexity flattened (159.4° ± 10.1° to 167.9° ± 8.6°, p < 0.001). Compared to controls, patients at time T2 had shorter middle facial third height (27.8 ± 2.6% vs. 32.0 ± 1.9%, p < 0.001) and reverse canthal tilt (- 3.9° ± 4.4° vs. 5.4° ± 2.6°, p < 0.001). A tailored treatment approach to the Apert midface yields varying degrees of resolution of central midfacial shortening, canthal tilt, and facial concavity at 5years postoperatively. A slight reduction in facial convexity over time, likely reflecting pseudorelapse in the setting of sagittal overcorrection, should be anticipated. Greater utilization of segmental osteotomies may bring facial third ratios and canthal tilt closer to normal morphometric values.

Possible effects of lumbar stabilization surgery on sagittal alignment, disability and quality of life

BackgroundIn order to restore the individual's health in lumbar stabilization surgeries, it is aimed to bring the sagittal alignment closer to normal values, to eliminate the findings, and thus to increase the quality of life of the individual by reducing the disability level. The aim of this study is to measure the effects of lumbar region stabilization surgeries performed in our clinic on some angular values in the spine, disability and quality of life. Preoperative (preop) and postoperative (postop) radiographs of 30 individuals over the age of 40 who applied to our clinic with various lumbar region complaints and underwent lumbar stabilization surgery between the years 2020–2022 were taken. Lumbar lordosis, pelvic tilt, sacral slope and pelvic inclination angles were measured from the images obtained. The Visual Analog Scale was used to measure the pain of individuals, the Oswestry Disability Index to measure the disability level, and the Nottingham Health Profile questionnaire to measure the quality of life. Preop and postop data were analyzed with the SPSS 23.0 program and p < 0.05 was considered significant.ResultsThe lumbar lordosis angles of individuals who underwent lumbar stabilization surgery approached normal values and the difference between preop–postop lumbar lordosis angle averages was significant (p < 0.05); It was observed that the harmony between the lumbar lordosis and pelvic inclination angles increased, the pain decreased and the difference between preop–postop pain values was significant (p < 0.05), disability levels decreased and quality of life increased.ConclusionsThe decrease in the level of disability and the increase in the quality of life seen in individuals who underwent lumbar stabilization surgery were associated with the decrease in pain; The changes in angular values are considered to be clinically significant.

Admission Point-of-Care Testing for the Clinical Care of Children with Cerebral Malaria.

Point-of-care testing (PoCT), an alternative to laboratory-based testing, may be useful in the clinical care of critically ill children in resource-limited settings. We evaluated the clinical utility of PoCT in the care of 193 Malawian children treated for World Health Organization-defined cerebral malaria (CM) between March 2019 and May 2023. We assessed the frequency of abnormal PoCT results and the clinical interventions performed in response to these abnormalities. We determined the association between abnormal PoCT results and patient outcomes. Overall, 52.1% of all PoCT results were abnormal. Of the children with abnormal results, clinical interventions occurred in 16.9%. Interventions most commonly followed abnormal results for PoCT glucose (100.0% of the patients had treatment for hypoglycemia), potassium (32.1%), lactate (22.0%), and creatinine (16.3%). Patients with hypoglycemia, hyperlactatemia, and hypocalcemia had a higher mortality risk than children with normal values. Future studies are needed to determine whether obtaining laboratory values using PoCT and the clinical response to these interventions modify outcomes in critically ill African children with CM.

The nasal cavity of the bearded seal: An effective and robust organ for retaining body heat and water

We report the effects of varying physiological and other properties on the heat and water exchange in the maxilloturbinate structure (MT) of the bearded seal (Erignathus barbatus or Eb) in realistic environments, using a computational fluid dynamics (CFD) model. We find that the water retention in percent is very high (about 90 %) and relatively unaffected by either cold (−30 °C) or warm (10 °C) conditions. The retention of heat is also high, around 80 % . Based on a consideration of entropy production by the maxilloturbinate system, we show that anatomical and physiological properties of the seal provide good conditions for heat and water exchange at the mucus lining in the seal’s nasal cavity. At normal values of tidal volume and maxilloturbinate (MT) length, the air temperature in the MT reaches the body temperature before the air has left the MT channels. This confers a safety factor which is expected to be helpful in exercise, when ventilation increases.

Phase 1 Trials of Gatralimab, a Next-Generation Humanized Anti-CD52 Monoclonal Antibody, in Participants with Progressive Multiple Sclerosis.

Lymphocyte depletion via anti-CD52 monoclonal antibody (mAb) therapy is an effective treatment strategy for relapsing-remitting multiple sclerosis (MS) but is associated with infusion/injection-associated reactions (IARs) and autoimmune-related adverse events (AEs). Gatralimab is a next-generation humanized anti-CD52 mAb. Two first-in-human trials were conducted in participants with progressive MS to assess the pharmacodynamics, pharmacokinetics, and safety of gatralimab administered via subcutaneous (SC) and intravenous (IV) routes, and to determine the effect of different comedication regimes on IARs to SC gatralimab. A Phase 1 trial (NCT02282826) included double-blind, placebo-controlled sequential ascending single IV (1, 3.5, and 12mg) and SC (12, 36, and 60mg) dose groups. A Phase 1b trial (NCT02977533) involved five groups who received SC gatralimab (36, 48, or 60mg) and different comedications. A long-term safety (LTS) study (NCT02313285) examined safety and pharmacodynamics over 4years. Gatralimab produced depletion of lymphocytes (dose-dependently) and CD4+ regulatory T cells, with partial repopulation to normal values by approximately 12months. Peak serum gatralimab concentrations followed dose-proportionality and were delayed by 6.0-7.5days following SC administration. Treatment-emergent AEs, including IARs, were reported for most participants but were generally of mild or moderate severity, and treatment-emergent serious AEs were mostly MS-related. Methylprednisolone and antihistamine comedications were associated with reduced incidence of fevers and skin and subcutaneous tissue AEs, respectively. During the LTS study, one participant (3.0%) experienced an autoimmune-related AE (Basedow's disease), and subsequently died from pulmonary sepsis deemed unrelated to gatralimab by the investigator. These data show that gatralimab achieves the desired pharmacodynamic effect of lymphocyte depletion followed by repopulation, and has an acceptable safety profile, including low risk of non-MS autoimmunity. Although gatralimab is no longer in development for MS, insights from these trials may inform the development of comedication regimes of future anti-CD52 mAbs and subcutaneous formulations of other lymphocyte-depleting mAbs. NCT02282826, NCT02977533, NCT02313285.

Precision Imaging in Neurodegeneration: The Superiority of Diffusion Tensor Imaging Over Conventional MRI in Differentiating Parkinson's Disease From Atypical Parkinsonian Syndromes.

Background Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by the degeneration of dopaminergic neurons in the substantia nigra, leading to motor and non-motor symptoms. Atypical parkinsonian syndromes (APS), including progressive supranuclear palsy (PSP) and essential tremor (ET), present with overlapping clinical features, making differential diagnosis challenging. Conventional MRI has limitations in distinguishing PD from APS, necessitating advanced imaging techniques like diffusion tensor imaging (DTI) for more accurate diagnosis. Objectives This retrospective study aimed to evaluate the diagnostic accuracy of DTIin diagnosing PDand APS, particularly assessing its ability to differentiate these conditions from each other compared to conventional MRI. Additionally, the study sought to determine if DTI could diagnose PD in cases where conventional MRI results were normal, thereby highlighting the potential role of DTI in enhancing diagnostic precision in neurodegenerative disorders. Methodology The study included 30 patients with clinically diagnosed PD or APS who underwent both conventional MRI and DTI. Data were collected retrospectively. Imaging was performed using a Philips Multiva 1.5-Tesla MRI scanner (Philips, Amsterdam, Netherlands). DTI sequences were analyzed for fractional anisotropy (FA)values in the substantia nigra, superior cerebellar peduncle, middle cerebellar peduncle, transverse pontine fibers, and dentate nucleus. The FA values were compared with established normal values, and the findings from DTI were correlated with clinical diagnoses and conventional MRI results. Results Among the 30 patients, 53.3% were clinically diagnosed with PDand 46.7% with APS, including PSP and ET. Conventional MRI findings were normal in 46.7% of cases, indicating its limitations in detecting early or subtle changes in neurodegenerative disorders. In contrast, DTI identified abnormalities in 83.3% of cases, demonstrating its superior diagnostic sensitivity. DTI detected significant FA value reductions in the substantia nigra in PD patients (mean FA: 0.440), which is consistent with the degeneration of dopaminergic neurons characteristic of PD. In PSP patients, the superior cerebellar peduncle showed marked FA reductions (mean FA: 0.523), correlating with the clinical features of PSP, such as bradykinesia and postural instability. ET was identified by reduced FA values in the superior cerebellar peduncle and dentate nucleus, distinguishing it from other forms of parkinsonism. DTI was particularly effective in cases where conventional MRI results were inconclusive or normal, identifying early-stage PD and differentiating it from APS with greater accuracy. The study demonstrated a sensitivity of 95.8% and specificity of 93.8% for DTI in differentiating PD from APS compared to conventional MRI. Conclusion This study highlights DTI as a superior imaging modality for the early diagnosis and differentiation of parkinsonian disorders, particularly when conventional MRI results are inconclusive. DTI's ability to detect significant microstructural changes in specific brain regions, evidenced by FA value reductions, enhances diagnostic accuracy. Incorporating DTI into routine clinical practice is essential for accurate differentiation between PD and APS, facilitating better patient management.

Target Fitting Method for Spherical Point Clouds Based on Projection Filtering and K-Means Clustered Voxelization.

Industrial computed tomography (CT) is widely used in the measurement field owing to its advantages such as non-contact and high precision. To obtain accurate size parameters, fitting parameters can be obtained rapidly by processing volume data in the form of point clouds. However, due to factors such as artifacts in the CT reconstruction process, many abnormal interference points exist in the point clouds obtained after segmentation. The classic least squares algorithm is easily affected by these points, resulting in significant deviation of the solution of linear equations from the normal value and poor robustness, while the random sample consensus (RANSAC) approach has insufficient fitting accuracy within a limited timeframe and the number of iterations. To address these shortcomings, we propose a spherical point cloud fitting algorithm based on projection filtering and K-Means clustering (PK-RANSAC), which strategically integrates and enhances these two methods to achieve excellent accuracy and robustness. The proposed method first uses RANSAC for rough parameter estimation, then corrects the deviation of the spherical center coordinates through two-dimensional projection, and finally obtains the spherical center point set by sampling and performing K-Means clustering. The largest cluster is weighted to obtain accurate fitting parameters. We conducted a comparative experiment using a three-dimensional ball-plate standard. The sphere center fitting deviation of PK-RANSAC was 1.91 μm, which is significantly better than RANSAC's value of 25.41 μm. The experimental results demonstrate that PK-RANSAC has higher accuracy and stronger robustness for fitting geometric parameters.

Is lipoprotein(a) measurement important for cardiovascular risk stratification in children and adolescents?

BackgroundElevated lipoprotein (Lp(a)) levels are associated with increased risk of atherosclerotic processes and cardiovascular events in adults. The amount of Lp(a) is mainly genetically determined. Therefore, it is important to identify individuals with elevated Lp(a) as early as possible, particularly if other cardiovascular risk factors are present. The purpose of the study was to investigate whether, in a population of children and adolescents already followed for the presence of one or more cardiovascular risk factors (elevated blood pressure (BP), and/or excess body weight, and/or dyslipidemia), the measurement of Lp(a) can be useful for better stratifying their risk profile.MethodsIn a sample of 195 children and adolescents, height, body weight, waist circumference and systolic (SBP) and diastolic (DBP) BP were measured. Body Mass Index (BMI) and SBP and DBP z-scores were calculated. Plasma Lp(a), total cholesterol, high-density lipoprotein (HDL), triglycerides, glucose, insulin, uric acid and creatinine were assessed. Low-density lipoprotein (LDL) cholesterol was calculated with the Friedewald formula. High Lp(a) was defined as ≥ 75 nmol/L and high LDL cholesterol as ≥ 3.37 mmol/L.ResultsOur sample of children and adolescents (54.4% males, mean age 11.5 years) had median LDL cholesterol and Lp(a) values equal to 2.54 (interquartile range, IQR: 2.07–3.06) mmol/L and 22 (IQR: 7.8–68.6) nmol/L respectively. 13.8% of children had LDL cholesterol ≥ 3.37 mmol/L and 22.6 Lp(a) values ≥ 75 nmol/L. Lp(a) values were higher in children of normal weight than in those with excess weight (p = 0.007), but the difference disappeared if normal weight children referred for dyslipidemia only were excluded from the analysis (p = 0.210). 69.4% of children had normal Lp(a) and LDL cholesterol values and only 6.2% showed both elevated Lp(a) and LDL cholesterol levels. However, 16.6% of the sample, despite having normal LDL cholesterol, had elevated Lp(a) values. Multivariable analyses showed a significant association of LDL cholesterol both with Lp(a) values, and with the presence of elevated Lp(a) levels. For each mmol/L increase in LDL cholesterol the risk of having an elevated Lp(a) value increased by 73%. There was an inverse correlation between BMI z-score and Lp(a). Neither BP z-scores, nor other biochemical parameters were associated with Lp(a).ConclusionsIn our population more than one out of five children had elevated Lp(a) values, and in about 17% of children elevated Lp(a) values were present in the absence of increased LDL cholesterol. Our results suggest that Lp(a) measurement can be useful to better define the cardiovascular risk profile in children and adolescents already followed for the presence of other cardiovascular risk factors such as elevated BP, excess body weight and high LDL cholesterol.

Age and sex-related differences in T1 and T2 mapping. 1.5 magnetic resonance referent values

Introduction: Parametric mapping is a non-invasive method to quantify tissue changes in the myocardium by measuring T1, T2 and T2* relaxation times and extracellular volume, requiring a pre-established range of normal values. Purpose: To establish reference values for native T1 and T2 myocardial relaxation times in healthy subjects on 1.5 T magnetic resonance imaging and to assess changes in their values according to left ventricular segments, age, sex, heart rate, and myocardial thickness. Material and Methods: A prospective 1.5 T magnetic resonance imaging study was performed with the voluntary participation of 50 healthy individuals in different age groups. Image analysis was performed by a radiologist with 5 years of experience in the field of CMRT and further coordinated with a radiologist with more than 20 years of expe-rience in the field. Siemens ARGUS integrated software was used to calculate the volumes and function of both cameras. Global and segmental T1 and T2 values were measured in the shortaxis midlevel section by manually delineating the region of interest. Myocardial thickness of the mid septum was measured for each patient. Results: The distribution of volunteers was 25 men and 25 women. Significantly higher global T1 values were observed in women (1027.7 &amp;plusmn; 25.4 ms) compared to men (992.9 &amp;plusmn; 24.4 ms), at p &lt; 0.001. The same correlation was observed in individual segments, with a significant difference between genders. Examination of the correlation between T1 and other parameters demonstrated a negative linear relationship only with myocardial thickness. Global T2 in women (48.6 &amp;plusmn; 2.49 ms) was also significantly higher than in men (44.6 &amp;plusmn; 2.06 ms), with an observed difference of 3.95, p &lt; 0.001. Global T2 showed a very strong negative correlation with myocardial thickness (r = -0.769; p &lt; 0.001). There was no sig-nificant correlation between T2 times and heart rate and age of patients. Conclusion: A statistically significant difference in native T1 and T2 values by sex was demonstrated. The use of sex-specific reference values to distinguish healthy from pathologically affected myocardium is recommended.

Hubungan Dukungan Keluarga dengan Kepatuhan Diet pada Penderita Hipertensi di Wilayah Kerja Puskesmas Gondangrejo Kabupaten Karanganyar

Background: The World Healt Organization (WHO) has determined that in 2022 there will be approximately 972 million people with hypertension worldwide. The incidence of hypertension tends to increase due to the lack of public knowledge about hypertension. Family support may improve dietary adherence in hypertensive patients. Support provided is form of emotional support, appreciation, informational, instrumental. Dietary adherence of hypertensive patients important determining the stability and normal value of blood pressure for the change from non-compliant behavior to compliant behavior. Objective: To analyze the relationship between family support and hypertensive dietary adherence in hypertensive patients in the Working Area of Gondangrejo Health Center, Karanganyar Regency. Methods: This study used quantitative method with zero observational analysis, sampling using the Qouta Sampling technique with sample of 91 respondents. Data analysis using Chi-square. Results: The statistical test research obtained p value of 0.183 &gt; 0.05 so that there was no relationship between family support and dietary adherence in hypertensive patients in the working area of Gondangrejo Health Center, Karanganyar Regency. Conclusion: There is no relationship between family support and dietary adherence in hypertensive patients in the working area of the Gondangrejo Health Center, Karanganyar Regency.

The attitudes and knowledge of family physicians regarding malnutrition in the elderly: a call for action

BackgroundMalnutrition in the elderly places a significant burden on healthcare, social, and aged-care systems, yet it often remains undiagnosed and untreated. This study aims to evaluate family physicians' knowledge and attitudes towards the diagnosis and treatment of malnutrition in the elderly.MethodsBased on a literature review, an online questionnaire was developed, comprised of seven knowledge-related items and eight attitude-related questions regarding malnutrition in elderly populations. We also assessed the feasibility of including two malnutrition screening questions in regular clinic visits for individuals aged ≥ 70 years.ResultsSurveys were completed by 126 physicians (35% response rate), mean age 47.2 ± 12.6 years; 15.6 ± 12.5 years of practice; 67% females; and 92% board-certified family physicians. Moreover, 77.6% agreed that diagnosing malnutrition is important in patients with decreased appetite. Most respondents demonstrated knowledge of nutritional screening principles (63.5%) and recognized that even obese elderly individuals could be malnourished (83.2%). There was partial agreement (60%) that normal BMI values in the elderly differ from those in younger populations. Almost complete agreement was seen for incorporating two nutritional status questions in medical visits (91%), with physicians expressing willingness to receive training in malnutrition identification and screening tools. Despite challenges such as time constraints and limited knowledge, participants were open to conducting biannual malnutrition risk screening for elderly patients.ConclusionWe recommend malnutrition screening in primary care followed by malnutrition diagnosis and referral of malnourished patients to the proper intervention.

Nerve ultrasound in CANVAS-spectrum disease: Reduced nerve size distinguishes genetically confirmed CANVAS from other axonal polyneuropathies.

Ultrasound nerve cross-sectional area (CSA) of patients affected with axonal neuropathy usually shows normal value. Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) seems to represent an exception, showing smaller CSA, but previous reports did not test for biallelic RFC1 gene repeat expansions. We compared nerve CSA from CANVAS patients (tested positive for biallelic RFC1 gene repeat expansions) with the CSA from a group of patients with chronic idiopathic axonal polyneuropathy (CIAP) who tested negative for RFC1 gene repeat expansions, hereditary axonal neuropathy (Charcot-Marie-Tooth type 2, CMT2), and Friedreich ataxia (FRDA). We enrolled 15 CANVAS patients (eight men, mean age 66.3 ± 11.5 years, mean disease duration 9.3 ± 4.1 years), affected with sensory axonal neuronopathy. Controls consisted of 13 CIAP (mean age 68.5 ± 12.8 years, seven men), seven CMT2 (mean age 47.9 ± 18.1 years, four men), 12 FRDA (mean age 33.7 ± 8.8, five men). Nerve ultrasound was performed at median, ulnar, sciatic, sural, and tibial nerves and brachial plexus, bilaterally. The nerve CSA from CANVAS patients was significantly smaller than the one from the other cohorts at several sites with significant and high accuracy at Receiver-operating characteristic (ROC) curve analyses. RFC1 AAGGG pentanucleotide expansion, disease duration, and disability did not correlate with CSA at any site, after Bonferroni correction. Decreased sonographic nerve sizes, in arms and legs, in patients with sensory neuropathy and normal motor conduction studies could point to CANVAS-spectrum disease and help guide appropriate genetic testing.

Three-Dimensional Transthoracic Echocardiography for Semiautomated Analysis of the Tricuspid Annulus: Validation and Normal Values

The expansion of tricuspid valve (TV) interventions has underscored the need for accurate and reproducible three-dimensional (3D) transthoracic echocardiographic (TTE) tools for evaluating the tricuspid annulus and for 3D normal values of this structure. The aims of this study were to develop new semi-automated software for 3D TTE analysis of the tricuspid annulus, compare its accuracy and reproducibility against those of multiplanar reconstruction (MPR) reference, and determine normative values. Three-dimensional TTE images of 113 patients with variable degrees of tricuspid regurgitation were analyzed using the new semiautomated software and conventional MPR methodology (as the reference standard), each by three independent readers. For each measured parameter, intertechnique agreement was assessed using linear regression and Bland-Altman analyses, and interreader variability using intraclass correlation coefficients and coefficients of variation. Additionally, 3D TTE data sets of 789 subjects from the WASE (World Alliance Societies of Echocardiography) study were analyzed using this new software to determine normal values for each tricuspid annular (TA) parameter. Semiautomated measurements showed excellent agreement with MPR reference values for all TA measurements: high correlations (all r values >0.8) and minimal biases. All measurements were more reproducible than with MPR: higher intraclass correlation coefficients (0.94-0.96 vs 0.82-0.90) and lower coefficients of variation (5%-12% vs 8%-18%). Sex- and age-related differences were identified in 3D normal values of most TA parameters. Dynamic analysis showed that TA parameters vary throughout the cardiac cycle, reaching minimal values at end-systole and maximum values in late diastole. Novel software for semiautomated analysis of TA geometry and dynamics provides accurate and reproducible measurements. Normal values of TA dimensions, parsed by sex and age, are reported.

The effect of lavender oil use on pain and comfort level in intramuscular injection administration: A single blind randomized controlled study

ContextThe fact that the concept of quality in health care services has come to the fore and that evidence-based practices have become widespread made such concepts as patient satisfaction and comfort important and priority parameters in determining the quality of health services. ObjectivesThe aim of the study is to determine the effects of using lavender oil in intramuscular injection on injection pain, comfort level, blood pressure, pulse rate and respiratory rate. MethodsThe study was designed as a prospective, single-blind randomized controlled trial. The research was conducted in accordance with the CONSORT Checklist guide. In our study, a total of 160 individuals were included in the sample, 80 of whom were control and 80 were intervention. Structured Information Form, Visual Analog Scale and Comfort Scale were used to collect the data of the research. Mann Whitney U, Kruskal Wallis test and Wilcoxon test were used to evaluate the data. ResultsIt was determined that the mean pain scores of the individuals who received intramuscular injection by applying lavender oil were statistically significantly lower than the individuals in the control group. Again, the comfort score averages of the individuals who were applied lavender oil were found to be statistically significantly higher than the control group. It was determined that the blood pressure, pulse rate and respiratory rate before the injection of the individuals in the control group increased statistically significantly according to the post-injection measurements, while the blood pressure, pulse rate and respiratory rate in the lavender oil group decreased significantly after the injection and remained within their normal values. ConclusionAs a result, it was determined that the application of lavender oil in intramuscular injection had a positive and significant effect on the blood pressure, pulse rate and respiratory rate of the individuals on the injection pain and comfort level.

Repeatability of the Calibration Protocol for Emg Evaluation of the Occlusion With the Teethan Device

Abstract Objective The aim of the study was to investigate the repeatability of the calibration protocol performed by the Teethan® device (Teethan S.p.A. Italy) for surface electromyography (sEMG) when biting on cotton rolls to eliminate the effect of occlusal contacts. Materials and methods Thirty-three fully dentate subjects aged 13-43 years (mean 21.33 years) of which 15 men and 18 women were enrolled in the study All subjects had a good state of dental and periodontal health without temporomandibular disorders (TMDs). Each examined participant performed two distinct maximal voluntary clenches on cotton rolls: the first one for calibration of the device and the second one for recording of the signals. The results were presented as the indices: Percentage overlapping coefficient (POC), Barycenter (BAR), Torsion (TORS), Impact (IMPACT), Global index and Asymmetry (ASIM). Results All the examined indices showed good repeatability during the test, compared with the normal values, determined by the manufacturer of the device. Some of the recorded indices were insignificantly lower than the norm (POC TA, POC MM, BAR and TORS). Global index and IMPACT were within the reference values and showed highest repeatability in this study. Conclusion Instrument calibration is an important prerequisite for exact testing. The indices, recorded by this device are rather repeatable, with Global index and Impact found to be the most repeatable ones. The values of the measured indices show that the process of calibration is highly reliable.

Deep Learning-based 12-Lead Electrocardiogram for Low Left Ventricular Ejection Fraction Detection in Patients

BackgroundReduced left ventricular ejection fraction (LVEF) initiates heart failure, and promptly identifying low ejection fraction is crucial for managing progression and averting mortality. This study developed an artificial intelligence-enabled electrocardiogram (AI-ECG) algorithm to identify patients with low ejection fraction and predict LVEF values. MethodsThe ECG data were used as input, and the algorithm generated the probability of the patient suffering a low ejection fraction as well as estimating the LVEF value. A 5-year follow-up study on a group of individuals who initially had normal LVEF values was also performed. Furthermore, external validation of the algorithm performance was conducted using the Medical Information Mart for Intensive Care (MIMIC-IV) database. ResultsThe algorithm's performance on the test set yielded an area under the curve (AUC) of 0.965 for detecting LVEF ≤ 50%. The algorithm had an accuracy of 92.8%, sensitivity of 88.8%, and specificity of 92.9%. For LVEF regression, the method showed a mean absolute error (MAE) of 5.28 (95% CI: 5.23 - 5.33) for the testing set. Additionally, the algorithm obtained an AUC value of 0.848 and an MAE value of 9.56 during external validation. Patients with false-positive results had a significantly greater likelihood of developing a low ejection fraction compared to patients who received true negative results (26.2% vs. 2.0%, P < 0.0001). ConclusionsThe AI-ECG algorithm is capable of identifying low ejection fraction in patients with high accuracy. The AI-ECG algorithm is an efficient, prompt, and cost-effective screening tool for early heart failure.

Short-term and long-term results of odontoid screw fixation in patients with Type II and rostral Type III dens fractures

ObjectivesTo evaluate both the short-term and long-term outcomes of odontoid screw fixation (OSF), identifying potential risk factors for implant-related complications in patients with odontoid fractures. MethodsThis is a retrospective observational cohort study. Inclusion criteria were as follows: 1) Type II fractures and rostral Type III fractures, according to the Anderson and D’Alonzo classification; 2) patients older than 15 years. Exclusion criteria were: 1) other Type III injuries; 2) osteoporosis confirmed by densitometry or a CT bone density score below 100 Hounsfield units; 3) odontoid fractures related to tumors or aneurysmal bone cysts. ResultsIn total, 56 patients were considered for the analysis of short-term results, and 26 patients were evaluated for long-term outcomes. No significant differences were observed in the preoperative imaging data and intraoperative features of OSF between patients with Type II and rostral Type III fractures. The mean operative duration was 63.9 ± 20.9 min, and the mean intraoperative blood loss was 22.1 ± 22.9 ml.Screw cut-out was identified in four patients with rostral Type III fractures (p = 0.04). The rate of screw cut-out was found to correlate with the degree of dens fragment displacement. The bone fusion rate was 95.7%. CT scans identified stable pseudarthrosis in two cases. We observed C2–C3 ankylosis in all cases following partial disc resection. One third of patients with screws placed through the anterior lip of C2 showed no C2–C3 ankylosis. A strong trend towards lateral joint ankylosis formation in patients with a median lateral mass dislocation of 11.9 mm was observed. Most SF-36 scores either matched or exceeded the corresponding normal median values in the published reference database. ConclusionsOSF is a reliable treatment method of Type II and rostral Type III odontoid fractures with fragment displacement of 4 mm or less. The minimally invasive OSF through the anterior-inferior lip of C2, using monocortical screw placement and cannulated instruments, without rigid intraoperative head immobilization, is sufficient to achieve favorable clinical and fusion results. This technique reduces the risk of ankylosis in the C2–C3 segment. OSF restore the quality of life for patients with odontoid fractures to levels comparable to those of the general population norm.

Fetal Outcome Evaluation in High-risk Term Pregnancy Using Biophysical Profile at a Tertiary Hospital in Anambra State, Nigeria

Introduction: A high-risk pregnancy is defined as a pregnancy in which there is a significant probability of an adverse maternal or fetal outcome that is more than the incidence of that outcome in the general population. Aim: To determine the usefulness of biophysical profile evaluation in women with high-risk term pregnancies. Methods: Biophysical profile (BPP) parameters were used to evaluate 160 high-risk women with term pregnancies. Results: All the participants had normal amniotic fluid index values [AFI] of 8.1-24.0cm. Most of the participants 115 (71.9%) showed good BPP scores. Outcome at delivery was as follows; fetal distress [presence 8.9%, absence 91.1%], stillbirth = none, admission into the intensive care unit (ICU) [Yes 2.0%, No 88%], meconium staining [Yes 8.2%, Clear 91.8%], birth weight [&lt; 2.5kg = 5.7%, &gt; 2.5kg = 94.3%]. APGAR score at 1 minute [&lt;7 = 5.1%, &gt;7 = 94.9%] while at 5 minutes [&lt;7 = 3.2%, &gt; 7= 96.8%]. The commonest mode of delivery was vaginal 84 (52.8%). The association between gross body movement, fetal breathing movement, and fetal outcome was not statistically significant p &gt; 0.05. Conclusion: BPP parameters were found to be associated with fetal outcomes.

Impact of Abnormal Ankle Brachial Index on Sepsis Survival: One-Year Prospective Study Results.

Lower extremity peripheral artery disease (LE-PAD) has been linked to unfavorable cardiovascular outcomes. The impact of potentially undiagnosed LE-PAD, suspected by abnormal ankle-brachial index (ABI), on the survival of sepsis patients admitted to the intensive care unit (ICU) remains uncertain. We conducted a prospective cohort study and recruited adult patients admitted to the ICU with a primary diagnosis of sepsis (defined by a quick Sepsis-Related Organ Failure Assessment score of ≥ 2) between November 23, 2017 and July 22, 2018. ABI measurements were obtained within 24 hours of admission. The study compared the 30-day and 1-year all-cause mortality rates as well as the incidence of major adverse cardiovascular events (MACEs) between the groups with normal and abnormal ABI values. Of the 102 sepsis patients admitted to the ICU, 38 (37%) were diagnosed with LE-PAD based on their ABI measurements. The overall 30-day mortality rate was 30.0% in patients with LE-PAD and 25.8% in those with normal ABI (p = 0.56). At 1 year, the overall mortality rate was 52.6% in the patients with abnormal ABI and 40.6% in those with normal ABI (p = 0.24). Additionally, the incidence of MACEs was significantly higher in the patients with abnormal ABI compared to those with normal ABI at 1-year follow-up (21.1% vs. 3.1%, respectively; p = 0.003). The patients with abnormal ABI had a higher incidence of MACEs within one year following hospital discharge. Future studies are needed to improve cardiovascular outcomes among sepsis survivors (ClinicalTrials.gov number, NCT03372330).

Vertical gravity gradient in volcano monitoring – In situ measured or theoretical? (Campi Flegrei study)

We analyse the vertical gravity gradient (VGG) properties at calderas using the Campi Flegrei (CF) site in Italy. In situ observed VGG values can depart significantly from the theoretical (normal) value of −308.6 μGal/m, particularly in areas of rugged relief. It is assumed that in sufficiently flat areas, the effect of geology, i.e., of the subsurface density heterogeneities, on VGG could prevail over the effect of terrain (topography), which can subsequently be neglected. With respect to the CF caldera, which is often considered as ‘reasonably flat area’, according to our findings the effect of topography on VGG is usually underestimated, while the effect of deeper geology is overestimated. We model the effect of the near topography on VGG at CF and subsequently verify the results of modelling by in situ observations to support our predictions. The results show that, in terms of VGG, the topographic relief plays a more significant role than the assumed geological sources even at ‘flat’ calderas such as CF. For a better understanding, in addition to CF, we analyse the effect of deeper geological sources on VGG also in the territory of Slovakia using a detailed gravimetric database of Slovakia. As a result, we question the use of in situ observed VGG values when processing and interpreting observed time-lapse gravity changes in volcanic areas accompanied by surface deformation.