Objective Proof Research Articles

A Dedicated Multidisciplinary Growth and Feeding Clinic for Infants with Cleft Lip and/or Palate Demonstrates Need for Intervention

Objective A Growth and Feeding Clinic (GFC) focused on early intervention around feeding routines in patients with cleft lip and/or palate (CL/P) was implemented. Design This study assessed the effect of preoperative feeding interventions provided by the GFC. Setting Tertiary academic center. Methods This study evaluated patients with CL/P who were cared for by the GFC and a control group of patients with CL/P. Weight-for-age (WFA) Z-score of less than −2.00 was used as a cutoff to classify patients who were underweight during the preoperative period. Main Outcome Measure The number of underweight patients who were able to reach normal weight by the time of their cleft lip repair was used as the primary outcome measure. Results Within both the GFC and control groups, 25% of patients with CL/P were underweight as determined by WFA Z-score. GFC patients who were underweight received more clinic visits ( P < .001) and GFC interventions ( P < .001) compared to GFC patients who were normal weight. At the time of cleft lip surgery, 64.1% of GFC underweight patients were normal weight compared to 31.8% of control group underweight patients ( P = .0187). Conclusion This study showed that multidisciplinary care provided by the GFC was able to target preoperative nutritional interventions to the highest-risk patients, resulting in double the percentage of patients who were of normal weight at the time of their cleft lip repair. These results provide objective proof supporting the assertion that multidisciplinary team care of the infant with cleft leads to measurable improvement in outcomes.

Intracoronary electrocardiogram detects coronary microvascular dysfunction and ischemia in patients with no obstructive coronary arteries disease

Coronary microvascular dysfunction (CMD) is the leading cause of ischemia with no obstructive coronary arteries disease (INOCA) disease. Diagnosis of CMD relies on surrogate physiological indices without objective proof of ischemia. Intracoronary electrocardiogram (icECG) derived hyperemic indices may accurately and objectively detect CMD and reversible ischemia in related territory. INOCA patients with proven ischemia by myocardial perfusion scan (MPS) and completely normal coronary arteries underwent simultaneous intracoronary electrophysiological (icECG) and physiological (intracoronary Doppler) assessment in all 3 coronary arteries during rest and under adenosine induced hyperemia. Sixty vessels in 21 patients were included in the final analysis. All patients had at least one vessel with abnormal CFR. 41 vessels had CMD (CFR < 2.5), of which 26 had increased microvascular resistance (structural CMD, HMR > 1.9 mmHg.cm-1.s) and 15 vessels had CMD (CFR < 2.5) with normal microvascular resistance (functional CMD, HMR <= 1.9 mmHg.cm-1.s). Only one-third of the patients (n = 7) had impaired CFR < 2.5 in all 3 epicardial arteries. Absolute ST shift between hyperemia and rest (∆ST) has shown the best diagnostic performance for ischemia (cut-off 0.10 mV, sensitivity: 95%, specificity: 72%, accuracy: 80%, AUC: 0.860) outperforming physiological indices (CFR: 0.623 and HMR: 0.653 DeLong's test P = .0002). In INOCA patients, CMD involves coronary artery territories heterogeneously. icECG can accurately detect CMD causing perfusion abnormalities in patients with INOCA outperforming physiological CMD markers, by demonstrating actual ischemia instead of predicting the likelihood of inducible ischemia based on violated surrogate thresholds of blunted flow reserve or increased minimum microvascular resistance. In 21 INOCA patients with coronary microvascular dysfunction (CMD) and myocardial perfusion scan proved ischemia, hyperemic indices of intracoronary electrocardiogram (icECG) have accurately detected vessel-specific CMD and resulting perfusion abnormalities & ischemia, outperforming invasive hemodynamic indices. Absolute ST shift between hyperemia and rest (∆ST) has shown the best classification performance for ischemia in no Obstructive Coronary Arteries (AUC: 0.860) outperforming Doppler derived CMD indices (CFR: 0.623 and HMR: 0.653 DeLong's test P = .0002).icECG can be used to diagnose CMD causing perfusion defects by demonstrating actual reversible ischemia at vessel-level during the initial CAG session, obviating the need for further costly ischemia tests. GOV: NCT05471739.

Old People as a Special Category of Victims Nazi Crimes

Relevance. Currently, there is an increased interest in the tragedy of the civilian population in Russian society. This is reflected both in numerous scientific publications and in procedural actions. Belgorod, Voronezh, Oryol regional courts recognized the war crimes of the Nazis and their accomplices as genocide.Purpose: to consider, based on the materials of the Extraordinary State Commission of Federal and Regional Archives, a special category of victims of Nazi crimes – the elderly.Objectives: to determine the criteria of old age, to find out the number of victims of crimes – the elderly in the territories of the Voronezh, Kursk and Oryol regions, to consider various ways of killing the elderly and the elderly.Methodology. The basis of this scientific research is a complex of general dialectical method of scientific cognition, general scientific methods of analysis and synthesis, induction and deduction and private scientific methods of cognition.Results. The study became an objective proof of the extermination policy of the Nazis and their accomplices on the territory of the regions of the Central Chernozem region. Numerous archival documents confirming that the elderly population and the elderly were one of the mass victims of war crimes are cited.Conclusion. The elderly population and the elderly, due to their psycho-physiological characteristics, due to their inability or limitation to physical labor, were among the first to be destroyed. They were considered by the Nazi leadership as an extra, absolutely unnecessary ballast, which had to be disposed of.

Complexity-based graph convolutional neural network for epilepsy diagnosis in normal, acute, and chronic stages.

The automatic precision detection technology based on electroencephalography (EEG) is essential in epilepsy studies. It can provide objective proof for epilepsy diagnosis, treatment, and evaluation, thus helping doctors improve treatment efficiency. At present, the normal and acute phases of epilepsy can be well identified through EEG analysis, but distinguishing between the normal and chronic phases is still tricky. In this paper, five popular complexity indicators of EEG signal, including approximate entropy, sample entropy, permutation entropy, fuzzy entropy and Kolmogorov complexity, are computed from rat hippocampi to characterize the normal, acute, and chronic phases during epileptogenesis. Results of one-way ANOVA and principal component analysis both show that utilizing complexity features, we are able to easily identify differences between normal, acute, and chronic phases. We also propose an innovative framework for epilepsy detection based on graph convolutional neural network (GCNN) using multi-channel EEG complexity as input. Combining information of five complexity measures at eight channels, our GCNN model demonstrate superior ability in recognizing the normal, acute, and chronic phases. Experiments results show that our GCNN model reached the high prediction accuracy above 98% and F1 score above 97% among these three phases for each individual rat. Our research practice based on real data shows that EEG complexity characteristics are of great significance for recognizing different stages of epilepsy.

Misers: British Responses to Extreme Saving, 1700–1860 by Timothy Ablorn

The cultural representation of misers in the eighteenth and nineteenth centuries may be a niche interest, but Alborn’s Misers: British Responses to Extreme Saving, 1700–1860 offers a valuable contribution to general historiography in the age of digital research. Alborn traces how the perception of misers shifted across his selected period: Sermons and poems decried misers’ moral failings; ethicists and economists gave ambivalent acceptance; plays, operas, and novels made them social pariahs and punchlines; and nineteenth-century biographies and novels considered their pecuniary acumen. This exploration marks an important case study in the intersection between capitalism and popular literature and culture. Alborn accurately notes, however, that it does not “address either the formation or distribution of capital” in an economic sense (11). Instead, the book explores how British culture represented misers to themselves. Although this intervention adds important layers to the already thick description of capitalism’s cultural influence in the eighteenth and nineteenth centuries, Alborn’s book deserves both accolades and scrutiny for a methodology based on both a distant reading of genres and a close reading of individual texts to prove its claims.The scope of Alborn’s archive is staggering. The first four chapters are organized around genre. Although the organization of the latter three is more scattershot, all the chapters range across genres with the same alacrity. The variance comes from Alborn’s interest in “boundary-drawing: when did someone qualify as a miser …?” (11). Part of the cleverness of Alborn’s approach is that he allows the texts to create this boundary for him, rather than imposing a definition. But allowing a culture to unveil its structure is always a historiographically complex task. In a critique of her own book, Making a Social Body: British Cultural Formation, 1830–1864 (Chicago, 1994), Poovey challenges textual analysis as a proper basis for cultural history: “No amount of evidence of the kind [textual criticism] supplies … would be sufficient to prove” broad historical claims.1 In other words, if four sermons are inadequate to prove that British people thought misers morally corrupt in the early eighteenth century, would five suffice? Would fifty? What about 5,000?In a refreshingly honest metacritical move, Alborn describes his work in the digital archive. When he claims that sermons across Christian denominations followed a formulaic script that portrayed misers as “caricatures” rather than “sympathetic portraits of human beings,” Alborn includes a footnote that outlines his analysis of 335 religious publications (18, 36, fn 13). The notion of objective proof of cultural movements may be a self-defeating endeavor, but Alborn’s dense work in the archive demands that we confront what the digital record makes possible.Most interestingly, Alborn deliberately eschews quantitative analysis to analyze his library. Instead, he uses these texts “to add no end of nuance to the stories” that he discovers (9). He creates this nuance with rapid flight across texts and genres—both a strength and a potential area for critique. The depth of his research creates powerful integrity for his narrative. Yet his readings hurry through these texts, often quoting at length with little to no explication or providing a lengthy plot summary of a play or novel, as though they speak for themselves (115–118, 84). But this critical observation leads to a methodological challenge: If texts need interpretation to fit a narrative, the narrative might have more to say about contemporary methods than about a historical moment.Misers presents an ambitious historiography that straddles the scientific aspirations of distant reading and the hermeneutic dreams of close reading. As is often the case with innovation, Alborn’s work demonstrates the strengths and exposes the shortcomings of both methodologies. The result is a vast, rich archive that builds a foundation for both deeper investigation into particular texts or genres, as well as for a broader discussion of capitalism and culture.

Role of neuronavigation in the surgical management of brainstem gliomas.

NeuroNavigation (NN) is a widely used intraoperative imaging guidance technique in neurosurgical operations; however, its value in brainstem glioma (BSG) surgery is inadequately reported and lacks objective proof. This study aims to investigate the applicational value of NN in BSG surgery. A retrospective analysis was performed on 155 patients with brainstem gliomas who received craniotomy from May 2019 to January 2022 at Beijing Tiantan Hospital. Eighty-four (54.2%) patients received surgery with NN. Preoperative and postoperative cranial nerve dysfunctions, muscle strength, and Karnofsky (KPS) were evaluated. Patients' radiological features, tumor volume, and extent of resection (EOR) were obtained from conventional MRI data. Patients' follow-up data were also collected. Comparative analyses on these variables were made between the NN group and the non-NN group. The usage of NN is independently related to a higher EOR in diffuse intrinsic pontine glioma (DIPG) (p=0.005) and non-DIPG group (p<0.001). It was observed that fewer patients in the NN group suffered from deterioration of KPS (p=0.032) and cranial nerve function (p=0.017) in non-DIPG group, and deterioration of muscle strength (p=0.040) and cranial nerve function (p=0.038) in DIPG group. Moreover, the usage of NN is an independent protective factor for the deterioration of KPS (p=0.04) and cranial nerve function (p=0.026) in non-DIPG patients and the deterioration of muscle strength (p=0.009) in DIPG patients. Furthermore, higher EOR subgroups were found to be independently related to better prognoses in DIPG patients (p=0.008). NN has significant value in BSG surgery. With the assistance of NN, BSG surgery achieved higher EOR without deteriorating patients' functions. In addition, DIPG patients may benefit from the appropriate increase of EOR.

Quality of life: pre-and post-functional endoscopic sinus surgery in chronic rhinosinusitis

Background: Chronic sinusitis (CRS) includes all inflammatory diseases of the nose and paranasal sinuses with a minimum duration of 12 weeks. Physical examination (anterior rhinoscopy, endoscopy) and/or radiography, ideally from sinus computed tomography, can provide objective proof of the same. After failure of conservative treatment, functional endoscopic sinus surgery (FESS) is the preferred modality for chronic rhinosinusitis that has been frequently used over the past years. Methods: The present prospective study aimed to assess the quality of life (QOL), the nasal endoscopy scores- before and after FESS in 60 patients aged more than 18 years suffering from chronic rhinosinusitis. QOL was assessed using SNOT-20 questionnaire and endoscopy was quantified using Lund-Kennedy sinonasal endoscopy scoring system. Results: QOL scores were significantly higher (p&lt;0.001) before surgery (41.28±15.30) than after FESS (6.83±5.96) indicating improvement in QOL. Lund-Kennedy endoscopy scores of patients suffering from chronic rhinosinusitis before and after surgery was also significantly reduced (p&lt;0.001). Conclusions: This study concludes that there is significant improvement in the QOL and reduction in the severity of symptoms in patients suffering from chronic rhinosinusitis after FESS.

Residual Sleepiness Risk in Aircrew Members with -Obstructive Sleep Apnea Syndrome.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a major problem in aviation medicine because it is responsible for sleepiness and high cardiovascular risk, which could jeopardize flight safety. Residual sleepiness after the treatment is not a rare phenomenon and its management is not homogenous in aviation medicine. Thus, we decided to perform a study to describe this management and propose guidelines with the help of the literature.METHODS: This is a retrospective study including all aircrew members with a history of OSAS who visited our aeromedical center between 2011 and 2018. Residual sleepiness assessment was particularly studied.RESULTS: Our population was composed of 138 aircrew members (mean age 50.1 ± 9.6 yr, 76.8% civilians, 80.4% pilots); 65.4% of them had a severe OSAS with a mean Epworth Sleepiness Scale (ESS) at 8.5 ± 4.7 and a mean apnea hypopnea index of 36.2 ± 19.2/h. Of our population, 59.4% performed maintenance of wakefulness tests (MWT) and 10.1% had a residual excessive sleepiness. After the evaluation, 83.1% of our population was fit to fly.DISCUSSION: An evaluation of treatment efficiency is required in aircrew members with OSAS. Furthermore, it is important to have an objective proof of the absence of sleepiness. In this case, ESS is not sufficient and further evaluation is necessary. Many tests exist, but MWT are generally performed and the definition of a normal result in aeronautics is important. This evaluation should not be reserved to solo pilots only.Monin J, Rebiere E, Guiu G, Bisconte S, Perrier E, Manen O. Residual sleepiness risk in aircrew members with obstructive sleep apnea syndrome. Aerosp Med Hum Perform. 2023; 94(2):74-78.

What are the Effects of Project-based English Curriculum on the Development of Learners&amp;#39; Competencies? A Case Study of a Japanese University English Language Program

Japanese English education reform continues to falter, and the same is true of university English education. However, amidst these circumstances, transmission-oriented English education is gaining attention as a methodological approach to English language educational reform. Transmission-oriented English education, in which the authors are also engaged, is a model for reform that shifts the emphasis from the traditional reception-based approach in English education to a more communicative, active learning approach. However, while these educational practices have shown results in terms of excitement in the classroom and subjective satisfaction among learners, there is a lack of objective proof, and the accumulation of research to verify the results objectively is an urgent need. In this paper, we examine the results of the GTEC (Global Test of English Communication)-Academic and TOEIC (Test of English for International Communication), which objectively measure English proficiency, and the GPS (Global Proficiency Skills)-Academic, which objectively measures basic social competencies, in two different groups of participants to determine whether the presence or absence of transmission-oriented English education has contributed to the growth of abilities ranging from subsets of English skills to socially necessary competencies by utilizing statistical verification. One interesting result was that the experimental group that took transmission-oriented English education for one year scored significantly higher in English writing than the group that did not, and since there were no statistically significant differences in any of the other components of English proficiency, we concluded that this could be considered an outcome of transmission-oriented English education.

What is a Risk of Increased Traffic in Boka Bay?

Boka is undeniably one of the most beautiful destinations in the world. This may be a subjective opinion, however being included in UNESCO’s world heritage list may be an objective proof of such a statement. This is recognized by the Government, and nautical tourism has been set as one of the main development strategies for this area. The economic growth, on the other side brings problems that our limited sources can hardly cope with. Increased traffic i.e. number and size of vessels (boats/yachts/ships) that are visiting Boka Bay, enormous fuel quantities burnt by giant engines on mega cruisers, by-products of every day processes such as garbage and sewage cause many side effects that could be hidden. These are all risks that could create catastrophic consequences if not handled properly, and in long term, may turn one of the finest destinations into a place to be avoided. Navigation is a skill. Years of experience are required to become professional navigator. It is not a sport and it is risky to treat it like that. Risk management concept will be utilized for assessing mentioned risks and for establishing controls that will definitely reduce them. After short introduction of the concept, priority will be given to analysis of all factors that must be taken into account for successful risk assessment. Special attention will be paid for database that must be established for Boka Bay area. Next step in the process is identification of all hazards related to visits of different types of vessels. Setting the criteria and matrixes that are relevant for this special area is essential before final part of the research focused on risk assessment.

Recurrent IPDA Aneurysm from Celiac Occlusion Treated by a Flow Diverting Stent

AbstractInferior pancreaticoduodenal artery (IPDA) aneurysms have been associated with celiac axis stenosis and occlusion. Retrograde flow through the IPDA arcade has been hypothesized to cause enlargement of these vessels and lead to aneurysm formation. However, objective proof of this hypothesis is lacking, given the fact that celiac stenosis or occlusion and IPDA aneurysms are typically diagnosed concurrently and recurrent aneurysms have not been described. This report presents a patient with celiac axis stenosis and an IPDA aneurysm treated with median arcuate ligament lysis, celiac stenting, and aneurysmectomy. Seventeen years later, he developed a second IPDA aneurysm treated with a flow diverting stent.

Information Manipulation of Securities Market Crimes Revisited: From the Perspective of the Amendment XI to the Criminal Law

In 2020, the Amendment XI to the Criminal Law and the Latest Judicial Interpretation in 2019 by the Supreme Court and Supreme Procuratorate have made information manipulation a key target of regulation. Information manipulation is a new type of securities manipulation crime in which the perpetrator relies on the abuse of information advantage to induce investors to make decisions in order to indirectly influence the securities market. This behavior has some similarities with traditional trading manipulation, but there are still significant differences in the manipulation methods and the infringement of legal interests, and it is necessary to clarify the rules of its judicial application with typical cases. In addition, it is difficult to judge the subjective intent of information manipulation. Due to the complexity of the act, the previous path of subjective intentional determination has been difficult to apply, so it is necessary to try to establish the judicial presumption path of “objective proof of subjective”. This path is achieved by considering three elements: objective behavior, purposeful intent and complementary factors, which are used to judge the subjective intent of information manipulation.

Role of length of locking screws &amp; surgeon strength in precision of placing locking screws in In-vitro osteoporotic saw bone model

Locking compression plate technology needs perfect seating of the locking screw head in the corresponding recess in the plate hole for a stable construct. The purpose of this study is to quantify screw-plate angle. In this study, a total of 750 locking screws of different lengths were placed by six residents. The measured angles were compared with Repeated Measures ANOVA method. Significant differences were seen for 40mm, 50mm, 70mm and 80mm screw length (p &amp;#60; 0.05) to assess the deviation of angle in pre-training, post-training and final experiment. The placement of locking screws precisely can help avoid an easily preventable surgical risk factor for fixation failure. The evolution of Locking Compression Plate (LCP) technology has radically changed the practice of fracture fixation. This technology mandates meticulous detail in surgical technique in placing the locking screw. It demands perfect seating of the locking screw head in the corresponding recess in the plate hole. The purpose of this study is to quantify screw-plate angle i.e., off-axis screw trajectory and its change with an increase in the length of screw and strength of the surgeons.Six orthopaedic residents were selected. The surgeons were familiarized with the instrumentation. A total of 750 locking screws of different lengths were placed in a locking plate in osteoporotic saw bone models using a torque measuring screw driver. The deviation was assessed for 150 screws inserted in pre-training, post-training and the final test under the supervision of the senior author. Immediate feedback on the performance and objective proof of precision was given within an hour by measuring the angle of deviation on X-ray using InstaPACS.Collected data was entered in MS Excel sheet. Descriptive statistics were presented in mean ±SD for continuous variables and count with percentage for Categorical variables. Repeated Measures ANOVA was used to assess the difference in deviation of angle pre-training, post-training and final experiment with the length of the screw. IBM SPSS 25.0 software was used for data analysis. Surgeon grip strength and torque applied had no significant association with the angle of deviation. The surgeons exceeded 10 Newton meter torque in pretraining. This applied torque decreased after training in the post-training and final experiments. The length of the screw and angle of deviation were found to positively correlate in pre-training and final experiment. In this study, 40 out of 150 (26%) studied screw insertions were off-axis. Most of the deviations (29) were only one degree (19.33%). The remaining 11 were more than 2 degrees (6.67%). The maximum off-axis was 4.3 degrees. Significant differences were seen for 40mm, 50mm, 70mm and 80mm screw length (p &amp;#60; 0.05) in pre-training, post-training and the final experiment. : This study signifies that practice under supervision with immediate and objective feedback is a valuable learning tool. Real time feedback definitely improves the surgical confidence that will result in better patient outcome in placing locking screws. The placement of locking screws precisely can help avoid an easily preventable surgical risk factor for fixation failure.

OC18: Transspinal direct current stimulation for pain treatment. Objective proof of concept, initial clinical findings and BDNF polymorphism

Introduction Transspinal Direct Current Stimulation (tsDCS) has been reported to block pain signaling. To approach clinical usage, two studies were performed. In both, the effect of BDNF polymorphism (Val/Met) was investigated. Materials and methods Study I Nineteen healthy controls, the anode over the tenth thoracic vertebra, the cathode over the shoulder. tsDCS: 2.5 A for 20 minutes, double blinded cross over design. Laser Evoked Potentials (LEPs): Stimulation of the dorsum of the hand and foot respectively, recordings at baseline, immediately after- and 30 minutes after the tsDCS stimulation. Amplitude and latency of the N2 peak was assessed and the subjects rated pain intensity. BDNF polymorphism was investigated in DNA from buccal mucosa cells. Study II Patients with neuropathic pain due to polyneuropathy are recruited. tsDCS is given at three days with one day between, BDNF polymorphism investigated as above. Results Study I Group level: LEP amplitudes successively reduced over time. Placebo; latencies unaffected from upper-, slightly increased from lower extremities. Verum; transiently increased from upper-, accumulatively increased from lower extremities in proportion to experienced pain. Individual level: Large variations. BDNF polymorphism influences the effect of stimulation with less pain reduction in those with less active BDNF (Val/Val). Study II Fourteen patients have been investigated. The results will be presented at the conference. Conclusions Short term, anodal thoracic tsDCS affects transspinal pain signaling with large inter-individual differences. Individualized tsDCS may be a treatment option for neuropathic pain. The type of BDNF one carries, seem to influence the effect of stimulation.

Relationship Between Inflow Impairment and Skin Oxygen Availability to the Upper Limb During Standardized Arm Abduction in Patients With Suspected Thoracic Outlet Syndrome.

ObjectiveThoracic outlet syndrome (TOS) should be considered of arterial origin only if patients have clinical symptoms that are the result of documented symptomatic ischemia. Simultaneous recording of inflow impairment and forearm ischemia in patients with suspected TOS has never been reported to date. We hypothesized that ischemia would occur in cases of severely impaired inflow, resulting in a non-linear relationship between changes in pulse amplitude (PA) and the estimation of ischemia during provocative attitudinal upper limb positioning.DesignProspective single center interventional study.MaterialFifty-five patients with suspected thoracic outlet syndrome.MethodsWe measured the minimal decrease from rest of transcutaneous oximetry pressure (DROPm) as an estimation of oxygen deficit and arterial pulse photo-plethysmography to measure pulse amplitude changes from rest (PA-change) on both arms during the candlestick phase of a “Ca + Pra” maneuver. “Ca + Pra” is a modified Roos test allowing the estimation of maximal PA-change during the “Pra” phase. We compared the DROPm values between deciles of PA-changes with ANOVA. We then analyzed the relationship between mean PA-change and mean DROPm of each decile with linear and second-degree polynomial (non-linear) models. Results are reported as median [25/75 centiles]. Statistical significance was p < 0.05.ResultsDROPm values ranged −11.5 [−22.9/−7.2] and − 12.3 [−23.3/−7.4] mmHg and PA-change ranged 36.4 [4.6/63.8]% and 38.4 [−2.0/62.1]% in the right and left forearms, respectively. The coefficient of determination between median DROPm and median PA-change was r2 = 0.922 with a second-degree polynomial fitting, but only r2 = 0.847 with a linear approach.ConclusionOxygen availability was decreased in cases of severe but not moderate attitudinal inflow impairments. Undertaking simultaneous A-PPG and forearm oximetry during the “Ca + Pra” maneuver is an interesting approach for providing objective proof of ischemia in patients with symptoms of TOS suspected of arterial origin.

Influence of the combined application of physiotherapeutic factors on microhemodynamic parameters and the level of oxygenation of tissues of the peri-implant zone in inflammatory complications in patients with orthopedic constructions on dental implants

The article analyzes the role of microcirculatory disorders in the pathogenesis of inflammatory complications (peri-implantitis) in patients with orthopedic constructions on dental implants and substantiates the possibility of a complex course application of low-intensity infrared laser therapy and low-frequency electrostatic therapy. It was shown that the initial state of patients with peri-implantitis is characterized by significantly low values of the level of general perfusion and its intensity, as well as the predominance of shunt mechanisms that reduce the values of the nutritive link of blood flow. The cause of the revealed disorders is the low level of functioning of the vasodilation mechanisms, caused by inflammatory and destructive processes in the peri-implant tissues. The use of a complex of physiotherapeutic exposure was characterized by a more pronounced corrective effect on the parameters of microcirculation and oxidative metabolism in comparison with standard dental treatment. The observed dynamics of microcirculatory systems of tissues of the peri-implant zone under the conditions of the complex influence of physiotherapeutic factors is aimed at the formation of adaptive reactions of local hemodynamics to the local needs of soft and bone tissues experiencing an inflammatory process around the implant, as well as strengthening the mechanisms of long-term adaptation of trophic relations in tissue peri-implant microregions. Taking into account the pathogenetic significance of microhemodynamic disorders in the formation of clinical manifestations of peri-implantitis, the revealed activating effect of the technology of the combined use of a laser and low-frequency electrostatic therapy serves as an objective proof of its therapeutic efficacy.

Ohrgeräusche zutreffend begutachten: Möglichkeit, Plausibilität und Wahrscheinlichkeit

Tinnitus as a subjective, individual sensation defies objective proof. In the assessment situation, tinnitus must also be distinguished from physiological or spontaneous hearing sensations.With regard to the new German "Königsteiner Recommendation" and the verdicts of the last few years, against the background of the different concepts of causality in the statutory and private accident insurance, a stringent examination to determine whether there is a sufficiently high probability of an accident-related subjective ear noise is necessary in the assessment. In order to create a comprehensible and comparable basis, the proposal of a plausibility check with the recording of 5 criteria - appropriate event, immediacy, reproducibility on the basis of today's examination methods of tinnitus masking and matching, persistence and fixation and the recording with a non-suggestive question was subjected to a review.The review shows that the requirements for the respective standard of proof can be fulfilled with the given steps of proof. The simple possibility of the presence of ringing in the ears can be systematically led to the probability of the presence by means of the plausibility criteria, which include psychoacoustic procedures, as well as open questions. This creates the prerequisites for a comprehensible causal consideration between the event and the reported tinnitus according to current medical-scientific knowledge.

Recognition and differentiation of dural puncture click sensation: A subjective and objective prospective study of dural puncture forces using fine-gauge spinal needles.

We hypothesized that the click perceived when puncturing the dura-arachnoid with fine-gauge spinal needles can be subjectively identified, and investigated whether it may be distinguishable among different needle types. Subjective and objective evaluations were performed. First, physicians punctured the polyamide film or porcine dura mater (n = 70 and n = 20, respectively) with seven types of spinal needles and numerically evaluated the perceived click sensations. Using an 11-point numerical rating scale (from "0" for "no click sensation" to "10" for "the strongest click perceived") data, subjective differentiation among needle types was assessed. Second, in the objective part of the study, total forces elicited by polyamide film or porcine dura mater punctures with each needle were measured using a biomechanical testing device, and load-displacement curves evaluated. Third, the results of subjective and objective evaluations were compared. All participants recognized the click and could discriminate among needles of different tip shape. The load-displacement curves for polyamide film and porcine dura mater were similar and needle-specific. The subjective numerical rating scale values corresponded well with the objectively measured changes in total forces (R2 = 0.862 and R2 = 0.881 for polyamide film and porcine dura mater, respectively), indicating that an increase in the largest drop in total force value of 0.30 N or 0.21 N would produce an increase of numerical rating scale value of 1 for polyamide film and porcine dura mater, respectively. We provide an objective proof of the click sensation felt upon dural puncture using different fine-gauge spinal needles. Click recognition could be used as an additional indicator of successful spinal puncture.

Impact of Tinnitus Masking on Auditory Brainstem Response Results

Tinnitus- the perception of sound without external stimulation can also lead to disruption in the quality of life and has been over the years been benefitted by tinnitus masking. Hence this study to understand the effectiveness of tinnitus masking using the Auditory Brainstem Response (ABR) Test. The intention of this experimental research design is to determine whether tinnitus masking as treatment for tinnitus makes a significant difference in auditory evoked brainstem responses before and after masking for understanding the effectiveness of the treatment objectively and possible quantification of benefit measurement through ABR. 30 subjects with normal hearing and unilateral tinnitus were assessed using ABR before and after tinnitus masking. Data was collected and compared to evaluate pre-masking and post-masking values of Latency-Intensity function and Interpeak Latency differences. Data was analyzed using descriptive statistics, test of homogeneity of variances and Two-way ANOVA. Both latency-intensity functions and interpeak latency differences showed significant differences before and after tinnitus masking with significance values of Two-way ANOVA as .001, (Calculated at p < .05). Despite the patient's subjective feedback, objective proof of the patient's benefit is a necessity. Therefore, this study shows that ABR shows significant differences in patients treated with tinnitus masking. Further suggesting benefit quantification of tinnitus masking as a treatment to tinnitus suffering individuals and for further understanding the intricacies of changes in the central auditory pathway due to masking.

Copy Move Forgery Detection Techniques: A Comprehensive Survey of Challenges and Future Directions

Digital Image Forensics is a growing field of image processing that attempts to gain objective ‎proof ‎of the origin and veracity of a visual image. Copy-move forgery detection (CMFD) has ‎currently ‎become an active research topic in the passive/blind image forensics field. There has no ‎doubt that ‎conventional techniques and especially the keypoint based techniques have pushed the ‎CMFD ‎forward in the previous two decades. However, CMFD techniques in general and ‎conventional ‎techniques in particular suffer from several challenges. And thus, increasing approaches ‎are exploiting ‎deep learning for CMFD. In this survey, we cover the conventional and the ‎deep learning ‎based CMFD techniques from a new perspective. We classify the ‎CMFD techniques into several ‎classifications according to the detection methodology, the detection paradigm, and the detection ‎capability‎. We discuss the ‎challenges facing the CMFD techniques as well as the ways for solving ‎them. In addition, this survey covers the evaluation metrics‎ and datasets commonly utilized for ‎CMFD. Also, we are ‎debating and proposing certain plans for future research. This survey will be ‎helpful for the researchers’ ‎as it master the recent trends of CMFD and outline some future research ‎directions.‎