Prospective Comparison Study Research Articles

Electrical cardiometry for non-invasive cardiac output monitoring: a method comparison study in patients after coronary artery bypass graft surgery.

Cardiac output can be estimated non-invasively by electrical cardiometry with the ICON® monitor (Osypka Medical GmbH, Berlin, Germany). Conflicting results have been reported regarding the cardiac output measurement performance of electrical cardiometry. In this prospective method comparison study, we compared cardiac output measured using electrical cardiometry (EC-CO; test method) with cardiac output measured using intermittent pulmonary artery thermodilution (PATD-CO; reference method) in patients after coronary artery bypass graft (CABG) surgery. We calculated the mean of the differences with 95%-limits of agreement (95%-LOA) and their corresponding 95%-confidence intervals (95%-CI) using Bland-Altman analysis and calculated the percentage error. We also analyzed trending using four-quadrant plot analysis. We analyzed 157 paired cardiac output measurements of 41 patients. Mean ± standard deviation PATD-CO was 5.1 ± 1.3L/min and mean EC-CO was 5.3 ± 1.3L/min. The mean of the differences ± SD between PATD-CO and EC-CO was -0.2 (95%-CI -0.5 to 0.2) ± 1.2L/min with a lower 95%-LOA of -2.6 (95%-CI -3.1 to -2.0) L/min and an upper 95%-LOA of 2.3 (95%-CI 1.6 to 2.9)L/min. The percentage error was 47% (95%-CI, 37 to 56%). The concordance rate for cardiac output changes was 48%. In this study, the agreement between EC-CO and PATD-CO was not clinically acceptable in patients after CABG surgery. The trending ability of EC-CO was poor.

Body posture can modulate liver stiffness measured by transient elastography: a prospective observational study

BackgroundNon-invasive measurement of liver stiffness (LS), traditionally performed in the supine position, has been established to assess liver fibrosis. However, fibrosis degree is not the sole determinant of LS, necessitating the identification of relevant confounders. One often-overlooked factor is body posture, and it remains unclear whether normal daily postures interfere with LS irrespective of fibrosis. A prospective two-group comparison study was conducted to investigate the relationship between posture and LS.MethodsSixty-two adults participated, divided into two groups: patients with chronic liver disease and healthy controls. Both groups were assessed using transient elastography (TE) under the supine, seated, and standing postures. Randomization was applied to the order of the two upright postures. A two-way mixed ANOVA was conducted to assess the posture-dependence of LS and its variations between two groups.ResultsResults showed that posture differentially affected LS depending on the presence of liver fibrosis. In 31 healthy individuals (baseline LS range: 3.5–6.8 kPa), a transition from the supine (5.0 ± 1.0 kPa) to seated (5.7 ± 1.4 kPa; p = 0.036) or standing (6.2 ± 1.7 kPa; p = 0.002) positions increased LS, indicating liver stiffening. Conversely, in 31 patients with varying fibrosis stages (baseline LS range: 8.8–38.2 kPa), posture decreased LS from the supine (15.9 ± 7.3 kPa) to seated (13.8 ± 6.2 kPa; p < 0.001) or standing (13.9 ± 6.2 kPa; p = 0.001) positions. No significant difference in LS was observed between the seated and standing positions in both groups (control group: 5.7 vs. 6.2 kPa, p = 0.305; patient group: 13.8 vs. 13.9 kPa, p = 1). Additionally, different postures did not elicit significant changes in the success rate (supine, 98.6 ± 4%; seated, 97.6 ± 6%; standing, 99.1 ± 3%; p = 0.258) and IQR/median value (supine, 25 ± 8%; seated, 29 ± 15%; standing, 29 ± 12%; p = 0.117), implying no impact on both measurement feasibility and reliability.ConclusionsWe demonstrated, for the first time, the feasibility of utilizing upright postures as an alternative measurement protocol for TE. We further unravel a previously unrecognized role of transitioning between different postures to assist the diagnosis of cirrhosis. The findings suggested that daily physiological activity of postural changes suffices to alter LS. Therefore, body positioning should be standardized and carefully considered when interpreting LS.

Comparison of different types of ultrasound probes for lung ultrasound in neonates-A prospective randomized comparison study.

To determine the effect of different types of probes for lung ultrasound in neonates. Prospective, blinded, randomized, comparative study between 2020 and 2022. Single-center study at a third level neonatal unit. Hemodynamically stable infants with either nasal continuous positive airway pressure, high flow nasal cannula or without respiratory support. Lung ultrasound using either an echo or microconvex probe. As control, the linear probe was used. Primary outcome measure was neonatologist performed lung ultrasound (NPLUS) score. Secondary outcome measures were number of B-Lines, thickness of the pleural line and subjective image quality. Furthermore, correlation between NPLUS results and clinical data was assessed. A total of 1584 video loops from 66 patients, with a mean corrected gestational age of 33.8 weeks (SD 4.23) and weight of 1950g (SD 910), respectively, were analyzed. NPLUS score was estimated lower with the echo- and microconvex probe compared to the linear probe, with a coefficient of -2.95 (p < 0.001) and -1.09 (p = 0.19), respectively. Correlation between the pulse oximetric saturation/fraction of inspired oxygen ratio and NPLUS score was moderately strong and best using the microconvex probe (Spearman's rho = -0.63, p<0.001). Our results not only confirm the current recommendations, but also demonstrate the extent of the varying results when different probes are used. The differences we discovered call for caution in interpreting scores, especially in the context of guiding therapies and communicating prognoses. Finally, the correlation between NPLUS score and clinical parameters contributes to validating the use of this diagnostic tool.

Single-Center Prospective Study of Cross-Clamp vs Balloon Occlusion in Robotic Mitral Surgery

BackgroundTransthoracic aortic cross-clamp and endoaortic balloon occlusion have both been shown to have comparable safety profiles for aortic occlusion. Because most surgeons use only one technique, we sought to compare the outcomes when a homogeneous group of surgeons changed their occlusion technique from aortic cross-clamp to balloon occlusion. MethodsWe changed our technique from aortic cross-clamp to balloon occlusion in November 2022. This allowed us to conduct a prospective treatment comparison study in the same group of surgeons. Propensity score matching was used to match cases (balloon occlusion) 1:3 to controls (aortic cross-clamp) based on age, sex, body mass index, concomitant maze procedure, and tricuspid valve repair. ResultsTotal of 411 patients underwent robotic mitral surgery from 2020 through 2023. Propensity score matching was used to match 56 balloon occlusion patients to 168 aortic cross-clamp patients. The 224 patients were a median age of 65 years (interquartile range, 55.6-70.0 years), and 119 (53%) were men. All valves were successfully repaired. Balloon occlusion had a shorter median cardiopulmonary bypass (CPB) time compared with aortic cross-clamp (84.0 vs 94.5 minutes, P = .006). Median cross-clamp time (64.0 vs 64.0 minutes, P = .483) and total surgery time (5.9 vs 6.1 hours, P = .495) did not differ between groups. There were no in-hospital deaths. There were 5 surgeons who performed various combinations of console and bedside roles. CPB, cross-clamp, and surgery durations were not significantly affected by the different surgeon combinations. ConclusionsCompared with aortic cross-clamp, balloon occlusion has similar perioperative and early postoperative outcomes. Additionally, it likely introduces a 10-minute reduction in total CPB time.

A prospective comparison study utilizing patient-reported outcomes of taxane-related peripheral neuropathy between nab-paclitaxel and standard paclitaxel in patients with breast cancer.

Patients with histologically confirmed breast cancer who were scheduled to receive standard weekly paclitaxel (80mg/m2) or tri-weekly nab-paclitaxel (260mg/m2) at institutions in our multicenter group were eligible for this study. Sensory and motor PN were evaluated every 3weeks until PN improved for up to one year using patient-reported outcome. Between February 2011 and April 2013, 115 patients were enrolled, including 57 and 58 in the paclitaxel and nab-paclitaxel groups, respectively. The incidence of moderate or severe sensory PN was not significantly different between the two groups (p = 0.40). The incidence of moderate or higher motor PN was more frequent in the nab-paclitaxel group than in the paclitaxel group (p = 0.048). The median period for demonstrating PN were shorter in the nab-paclitaxel group than in the paclitaxel group (sensory, p = 0.003; motor, p = 0.001). The recovery of motor PN was slower in the nab-paclitaxel group than in the paclitaxel group (p = 0.035), while the recovery period of sensory PN was not statistically different. Nab-paclitaxel induced sensory PN sooner than paclitaxel, and no difference was observed in the severity and recovery duration between the two agents. Motor PN was more severe, started sooner, and improved over a longer period in the nab-paclitaxel-treated patients than in the paclitaxel-treated patients.

Health-Related Quality of Life (HRQoL) and Its Associated Factors Among Post-COVID-19 Patients at Three Months in a Tertiary Hospital of Bangladesh

COVID-19 is a burning issue brought on by the SARS-COV2 coronavirus. Many SARS-COV-2 survivors continue to experience a variety of symptoms, which negatively impact their standard of living. A total of 103 post-COVID patients participated in a prospective comparison study from July 2021 to December 2021 to assess the individual’s health-related quality of life (HRQoL) and the elements that contribute to it. A control group with age and gender that matched 110 seemingly healthy individuals was also included for comparison. At three months, the EuroQol 5-dimensional 3-levels (EQ-5D-3L) questionnaire, which encompasses a brief expressive system questionnaire and an EQ-VAS visual analogue scale, was collected in a predesigned datasheet. The EQ index score was used to reflect all HRQoL data, which was then contrasted to a set of matched controls for ages and sexes. At three months, the mean EQ-5D index and EQ-VAS scores were lower than those of age and gender that matched the control group, at 0.810±0.208 and 73.240±11.36, respectively. Regarding dimensions of the questionnaire, mobility, self-care, usual activities, pain/discomfort, and depression/anxiety were assessed at three months follow-up. The mobility and usual activity parameters showed a statistically evident difference (p-value = 0.001) compared to the control group.

Advantages of single-site laparoscopic orchiopexy for palpable undescended testes in children: a prospective comparison study

PurposeTo evaluate the feasibility of single-site laparoscopic orchiopexy for palpable undescended testes in children.MethodsWe prospectively studied patients with undescended testes between July 2021 and June 2022. In total, 223 patients were included in our study: 105 underwent single-site laparoscopic orchiopexy and 118 underwent conventional laparoscopic orchiopexy. During single-site laparoscopic orchiopexy, 3 ports were inserted within the umbilicus.ResultsNo differences were observed between the groups in terms of age and laterality. For unilateral undescended testes, the operating time was longer in the single site group than in the conventional group at the early stages (55.31 ± 12.04 min vs. 48.14 ± 14.39 min, P = 0.007), but it was similar to the conventional group at the later stages (48.82 ± 13.49 min vs. 48.14 ± 14.39 min, P = 0.78). Testicular ascent occurred in one patient from each group. There was no significant difference in the success rate between the single-site group and the conventional group (99.0% vs. 99.2%, P = 0.93). In the single-site group, no visible abdominal scarring was observed, while in the conventional group, there were two noticeable scars on the abdomen.ConclusionSingle-site laparoscopic orchiopexy offers superior cosmetic results and comparable success rates compared to conventional laparoscopic orchiopexy for palpable undescended testes.

Effects of psychedelic microdosing versus conventional ADHD medication use on emotion regulation, empathy, and ADHD symptoms in adults with severe ADHD symptoms: A naturalistic prospective comparison study.

Adults with attention-deficit hyperactivity disorder (ADHD) often struggle with emotion regulation (ER), impacting their empathic skills and relationships. ADHD medication might not be as effective for ER issues as for ADHD symptoms. Microdosing (MD) psychedelics has shown promise for ADHD treatment and previous studies reported social-emotional benefits. Two online prospective studies investigated MD effects on ER and empathy in adults with severe ADHD symptoms across three assessments: baseline, two-, and four-week post-initiation. Study 1 examined adults initiating MD on their own (n = 233, n = 64, and n = 44) and found positive effects on ER (cognitive reappraisal and expressive suppression) and aspects of empathy (perspective-taking and personal distress). Study 2, including a control group and an ADHD symptom scale, compared individuals only MD (n = 180, n = 50, and n = 38) to individuals using conventional ADHD medication (n = 37, n = 27, and n = 28). After 4 weeks, ADHD symptoms were lower in the MD group. Only improvements in expressive suppression persisted after adding the control group. This study indicates the positive effects of MD psychedelics on ADHD symptoms and ER in adults with severe ADHD symptoms while lacking evidence for effects on empathy.

Comparison of myopic astigmatic correction after cross-assisted SMILE, FS-LASIK, and transPRK.

To compare astigmatic correction among cross-assisted small-incision lenticule extraction (SMILE), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and transepithelial photorefractive keratectomy (transPRK). The Eye Hospital of Wenzhou Medical University, Zhejiang, China. Prospective comparison study. 154 right eyes of 154 patients with astigmatism of -1.00 to -2.75 diopters (D) were included in this study. 64 eyes, 42 eyes, and 48 eyes were receiving SMILE, FS-LASIK, and transPRK, respectively. The SMILE group used cross-axial alignment for head positioning for astigmatism correction. In the FS-LASIK and transPRK groups, static and dynamic cyclotorsion control were used. Changes in ocular parameters and vector analysis were assessed at 6 months postoperatively. The safety and efficacy indices were comparable among the 3 groups at 6 months postoperatively. Residual astigmatism was smallest in the SMILE group (-0.23 ± 0.25 D) compared with that in FS-LASIK (-0.40 ± 0.28 D, P = .009) and transPRK groups (-0.42 ± 0.32 D, P = .001). 53 (82.8%), 36 (85.7%), and 37 (77.1%) eyes achieved an angle of error within ±5 degrees, respectively ( P = .55). Notably, vector analysis showed that the difference vector, the magnitude of the error, and its absolute value were significantly smaller in the SMILE group than those in the other groups ( P < .05). In addition, the higher-order aberrations, especially coma, were significantly induced postoperatively in each group ( P < .001). Residual astigmatism magnitude was smallest by cross-assisted SMILE, followed by FS-LASIK and transPRK, and the astigmatism axial correction was comparable among groups.

Point-of-care haemoglobin accuracy and transfusion outcomes in non-cardiac surgery at a Canadian tertiary academic hospital: protocol for the PREMISE observational study

IntroductionTransfusions in surgery can be life-saving interventions, but inappropriate transfusions may lack clinical benefit and cause harm. Transfusion decision-making in surgery is complex and frequently informed by haemoglobin (Hgb) measurement...

Whole tumor based texture analysis of magnetic resonance diffusion imaging for colorectal liver metastases: A prospective study for diffusion model comparison and early response biomarker

PurposeTo evaluate and compare the diagnostic value of diffusion-related texture analysis parameters obtained from various magnetic resonance diffusion models as early predictors of the clinical response to chemotherapy in patients with colorectal liver metastases (CRLM). MethodsPatients (n = 145) with CRLM were prospectively and consecutively enrolled and scanned using diffusion-weighted imaging (DWI)-magnetic resonance imaging (MRI)/intravoxel incoherent motion (IVIM)/diffusion kurtosis imaging (DKI) before (baseline) and two–three weeks after (follow-up) commencing chemotherapy. Therapy response was evaluated based on the Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1). The histogram and texture parameters of each diffusion-related parametric map were analysed between the responding and non-responding groups, screened using LASSO, and fitted with binary logistic regression models. The diagnostic efficacy of each model in the early prediction of CRLM was analysed, and the corresponding receiver operating characteristic (ROC) curve was drawn. The area under the curve (AUC) and 95% confidence intervals (CI) were calculated. ResultsOf the 145 analysed patients, 69 were in the responding group and 76 were in the non-responding group. Among all models, the difference value based on the histogram and texture features of the DKI-derived parameters performed best for the early prediction of CRLM treatment efficacy. The AUC of the DKI model in the validation set reached 0.795 (95% CI 0.652–0.938). Among the IVIM-derived parameters, the difference model based on D and D* performed best, and the AUC in the validation set reached 0.737 (95% CI 0.586–0.889). Finally, in the DWI sequence, the model comprising baseline features performed the best, with an AUC of 0.699 (95% CI 0.537–0.86) in the validation set. ConclusionsBaseline DWI parameters and follow-up changes in IVIM and DKI parameters predicted the chemotherapeutic response in patients with CRLM. In addition, as very early predictors, DKI-derived parameters were more effective than DWI- and IVIM-related parameters, in which changes in D-parameters performed best.

Improvement in Growth in Adolescents with Average Height Using A Massage Chair: A Prospective Single Arm Pre-Post and National Standard Data Comparison Study

Background: This study aimed to examine the changes in height, weight, and bone age between pre- and post-intervention when using a BEG-100 massage chair daily.Methods: Thirty-five children aged 11 years who were close to the average height (145-155 cm) were included in the study. There were 34 participants who used the BEG-100 massage chair for 24 weeks. Daily intervention consisted of 20 minutes of lower body massage and 10 minutes of whole-body massage. Height, weight, and adverse events were checked every five visits, while a hand X-ray was used before and after massages. The height percentile and height standard deviation score (SDS) were calculated using the 2017 Korean growth chart. The bone age and predicted adult height using radiographs were computed using the Tanner-Whitehouse method. The paired t-test or Wilcoxon signed-rank test was used according to normality of data to determine statistical significance.Results: A total of 31 children were included in the final analysis. The height percentile and height SDS significantly increased after BEG-100 massage chair use (2.39; &lt;i&gt;p&lt;/i&gt; = 0.032, and 0.07; &lt;i&gt;p&lt;/i&gt; = 0.036, respectively). However, these changes were not significant in children whose baseline height was shorter than the average. There were no significant differences in bone age, height for bone age, predicted adult height, or sitting height/height ratio. None of the participants complained of adverse events.Conclusion: The height percentile and SDS of teenagers increased after use of massage chair therefore, it is necessary to perform larger randomized controlled clinical studies. Trial registration: KCT0004673.

A prospective comparison study of subcutaneous and intramuscular testosterone injections in transgender male adolescents.

This prospective study compares testosterone injection type and effects on biochemical changes, clinical effects, and quality of life amongst transgender and gender diverse (TGD) adolescents assigned female at birth (AFAB) over the first 6months of subcutaneous (SQ) vs. intramuscular (IM) testosterone injections as part of their gender affirming care. Subjects were testosterone-naïve transgender adolescents, AFAB, ages 14-18 years old. Subjects were either randomized to injection type or selected a preferred injection type. At enrollment, subjects completed baseline labs and PedsQL™ quality of life questionnaire. At 3month and 6month follow up, subjects completed peak and trough testosterone levels, PedsQL™, masculinizing effects, and medication experience questionnaires. Twenty-six subjects participated with a median age 15.5 years. By 6-month follow up, trough testosterone levels were comparable between the two groups. Peak testosterone levels were higher in the IM group at 3-month follow up. Mild adverse effects were rare (12 %, all in SQ subjects) and limited to skin reaction only. Self-reported masculinization effects and quality of life were not statistically different between injection groups. A total of 92 % of participants was self-injecting by 3-month follow up. In this prospective study, clinical and biochemical effects are similar between SQ and IM testosterone injections for transgender adolescents. Subjects expressed preference for both injection types. Both SQ and IM injection modalities are safe and effective for TGD youth initiating testosterone and both options should be offered to patients.

Analysis and results of pharmacomechanical thrombectomy with AngioJet in acute arterial occlusions: a prospective comparison study among the number of cycles and outcomes

Analysis and results of pharmacomechanical thrombectomy with AngioJet in acute arterial occlusions: a prospective comparison study among the number of cycles and outcomes

Prospective Dosimetric Comparison Study Between Volumetric Modulated Arc Therapy and Intracavitary Brachytherapy for Cervical Cancer

Although volumetric modulated arc therapy (VMAT) boost can achieve highly conformal dose distributions for cervical cancer, VMAT has the disadvantage of requiring set-up and organ motion margins. This study prospectively recruited patients with the cervical cancer and compared VMAT plan with intracavitary brachytherapy (ICBT) plan. All patients treated with ICBT for locally advanced cervical cancer between April 2020 and September 2022 were enrolled. Patients had whole-pelvis radiotherapy, followed by CT scans with and without the tandem and ovoid in the same session (for the planning of ICBT and VMAT, respectively). ICBT planning characterizes the high-risk clinical target volume (HR-CTV) as the target volume and the bladder, rectum, sigmoid colon and small bowel loop as the organ at risk (OAR). VMAT planning defines the HR-CTV + 3 mm as the target volume and bladder, rectum + 3 mm (planning organ at risk volume (PRV) rectum), sigmoid colon + 3 mm (PRV sigmoid) and bowel bag as the OAR to account for set-up and organ motion. ICBT and VMAT plans were optimized for maximal dose received by at least 90% (D90%) of the target volume without impairing the dose constraints for the OARs. The prescribed dose (PD) was 26 Gy in 4 fractions. The dose constraints were determined as 25.2 Gy for D2 ml in the bladder and 20 Gy for D2 ml in the other OARs. The D90% and D100% of the target volume and D2 ml of OARs were compared between 2 plans using paired two-tailed Student's t test. Seventeen patients were enrolled. Dose and volume parameters for the 2 plans are shown in Table 1. Of the 17 patients, D90% of the target volume received 100% PD in 4 cases with ICBT plans, in 6 cases for VMAT plans, and in 2 cases with both methods. For D90% of the target volume, ICBT plans were greater than VMAT plans in 4 cases, with a maximum difference of 5.6 Gy (ICBT: 26.0 Gy, SBRT: 20.4 Gy). VMAT plans were higher than ICBT plans in 11 cases, with a maximum difference of 10.3 Gy (ICBT: 14.5 Gy, SBRT: 24.8 Gy). The dose-limiting OARs to attain D90% of target volume were bladder in 12 cases and small bowel loop in 1 case for ICBT plans, while PRV rectum in 11 cases, PRV sigmoid in 4 cases and bowel bag in 1 case for VMAT plans. This prospective study with 17 ICBT-eligible patients revealed D90% of the target volume demonstrated no substantial difference between VMAT and ICBT plans, while D100% showed a significant increase in VMAT plan compared to ICBT plan. Even with a set-up and organ motion margins on the HR-CTV and OARs, VMAT may have a dosimetric advantage over ICBT if the target geometry is complicated and close to the OARs.

Distraksi Virtual Reality (VR) terhadap Tingkat Nyeri dan Cemas Anak Usia Sekolah yang Dilakukan Tindakan Invasif

This study aims to discover that healthcare technology has innovated in the quality and delivery of care to patients to motivate the promotion of safe, comfortable, and cost-effective care. The method used is a literature review from several online database searches using a research design in the form of a literature review. The results showed that from the six articles reviewed, several themes were obtained, namely 1) Virtual Reality for Pediatric Needle Procedural Pain: Two Randomized Clinical Trials, 2) A Systematic Review and Meta-analysis of virtual reality in Pediatrics: Effects on Pain and Anxiety, carried out meta-analysis, 3) Virtual reality distraction during pediatric intravenous line placement in the emergency department: A prospective randomized comparison study, 4). Virtual reality for pain and anxiety management in children, 5). Effect of an Immersive Virtual Reality Intervention on Pain and Anxiety Associated With Peripheral Intravenous Catheter Placement in the Pediatric Setting A Randomized Clinical Trial, 6). Effectiveness of virtual reality on pain and anxiety management in cancer patients, Literature review. So thus, the involvement of all parties is needed to improve distraction techniques using Virtual Reality during intervention so that it is hoped that it can reduce the pain scale in children according to standard care in every hospital that gets invasive procedures. In conclusion, the Virtual Reality distraction technique has or is very influential on the condition of the child to be carried out or to receive medical procedures.&#x0D; &#x0D; Keywords: School Children, Hospitalization, Pain and Cas Levels, Virtual Reality

Recipient site creation for hair transplantation: A prospective half-side comparison study of hole versus slit

Follicular unit strip surgery and FUE (follicular unit extraction) are techniques used for donor harvesting in hair transplantation. For recipient site creation, the slit technique is now commonly used. The hole technique is an alternative technique in which holes are created in the tissue at the recipient site. This study compared these techniques in order to evaluate the effectiveness of the hole technique. Mean time for recipient site creation was significantly shorter with the hole technique than with the slit technique (95.5 s vs. 121 s; p = 0.021). This can be explained by better visibility of the holes compared with slits. This study focused on recipient site creation and found that the hole technique was a rapid and effective for recipient site creation.

Efficacy of Smartphone-Based Telescreening for Retinopathy of Prematurity With and Without Artificial Intelligence in India

Retinopathy of prematurity (ROP) telemedicine screening programs have been found to be effective, but they rely on widefield digital fundus imaging (WDFI) cameras, which are expensive, making them less accessible in low- to middle-income countries. Cheaper, smartphone-based fundus imaging (SBFI) systems have been described, but these have a narrower field of view (FOV) and have not been tested in a real-world, operational telemedicine setting. To assess the efficacy of SBFI systems compared with WDFI when used by technicians for ROP screening with both artificial intelligence (AI) and human graders. This prospective cross-sectional comparison study took place as a single-center ROP teleophthalmology program in India from January 2021 to April 2022. Premature infants who met normal ROP screening criteria and enrolled in the teleophthalmology screening program were included. Those who had already been treated for ROP were excluded. All participants had WDFI images and from 1 of 2 SBFI devices, the Make-In-India (MII) Retcam or Keeler Monocular Indirect Ophthalmoscope (MIO) devices. Two masked readers evaluated zone, stage, plus, and vascular severity scores (VSS, from 1-9) in all images. Smartphone images were then stratified by patient into training (70%), validation (10%), and test (20%) data sets and used to train a ResNet18 deep learning architecture for binary classification of normal vs preplus or plus disease, which was then used for patient-level predictions of referral warranted (RW)- and treatment requiring (TR)-ROP. Sensitivity and specificity of detection of RW-ROP, and TR-ROP by both human graders and an AI system and area under the receiver operating characteristic curve (AUC) of grader-assigned VSS. Sensitivity and specificity were compared between the 2 SBFI systems using Pearson χ2testing. A total of 156 infants (312 eyes; mean [SD] gestational age, 33.0 [3.0] weeks; 75 [48%] female) were included with paired examinations. Sensitivity and specificity were not found to be statistically different between the 2 SBFI systems. Human graders were effective with SBFI at detecting TR-ROP with a sensitivity of 100% and specificity of 83.49%. The AUCs with grader-assigned VSS only were 0.95 (95% CI, 0.91-0.99) and 0.96 (95% CI, 0.93-0.99) for RW-ROP and TR-ROP, respectively. For the AI system, the sensitivity of detecting TR-ROP sensitivity was 100% with specificity of 58.6%, and RW-ROP sensitivity was 80.0% with specificity of 59.3%. In this cross-sectional study, 2 different SBFI systems used by technicians in an ROP screening program were highly sensitive for TR-ROP. SBFI systems with AI may be a cost-effective method to improve the global capacity for ROP screening.

General anesthesia and femoral nerve block versus spinal anesthesia for cemented hip arthroplasty in elderly patients: A randomized controlled trial

ABSTRACT BACKGROUND Traumatic femoral fractures are a prevalent orthopaedic issue in elderly adults. General anaesthesia (GA) vs. spinal anaesthesia are still being discussed as the best anaesthetic method for cemented hip arthroplasty (SA). This study compared the impact of spinal anaesthesia versus general anaesthesia in combination with femoral nerve block on the mean arterial blood pressure (MAP) in patients having cemented hip arthroplasty operations. AIM OF THE STUDY To compare the impact of spinal anaesthesia on elderly patients undergoing cemented hip arthroplasty operations versus general anaesthesia in combination with femoral nerve block on mean arterial blood pressure. PATIENTS AND METHODS The study was registered at Pan African-Clinical Trial Registry.org with ID of (PACTR 202,111,575,647,784). At Ain Shams University Hospital, 60 patients receiving total hip arthroplasty were separated into two equal groups, each comprising 30 patients, for the purpose of this prospective randomised comparison study. Patients in Group (A) underwent spinal anaesthesia, while Group (B) received general anaesthesia together with an ultrasound-guided femoral nerve block. RESULTS This study showed that GA was associated with more stable readings of mean arterial blood pressure (MAP) after anesthesia induction and post cement implantation than SA (p-value = 0.04 and 0.038 respectively). CONCLUSION Patients who received general anesthesia (GA) had more stable hemodynamic parameters especially the mean arterial blood pressure (MAP) than those who received spinal anesthesia (SA).

Flat Magnetic Stimulation for Stress Urinary Incontinence: A Prospective Comparison Study

Flat Magnetic Stimulation (FMS) is characterized by a stimulation generated by electromagnetic fields with a homogenous profile. One possible application is the treatment of stress urinary incontinence (SUI). We aimed to compare the objective, subjective, quality of life, and instrumental outcomes in women with SUI not eligible for surgery undergoing either FMS or pelvic floor muscle training (PFMT). This was a prospective interventional study. After proper counseling, patients with isolated SUI were divided according to their treatment of choice into FMS and PFMT groups. At baseline and after treatment, patients completed the International Consultation on Incontinence Questionnaire-Short Form, the Female Sexual Function Index, and the Incontinence Impact Questionnaire, and volumetric measurement of the urethral rhabdosphincter (RS) was performed. The Patient Global Impression of Improvement questionnaire and stress test defined subjective and objective cure rates, respectively. We observed improvements in urinary-related quality of life scores and an increase in RS volume after FMS compared to baseline. All these outcomes were significantly better compared to women who underwent PFMT. Our study demonstrated that FMS is a safe and effective conservative option for SUI management in terms of objective and subjective cure rates.