Subjective Scores Research Articles

The effect of different timings of protein supplementation on variable outcomes in hemodialysis patients: a randomized clinical trial.

Oral nutritional supplements (ONS) are commonly prescribed to provide protein and energy to hemodialysis (HD) patients. There is a debate about the appropriate timing to administer ONS. We aimed to study the effect of different timings of ONS on variable outcomes in HD patients. This research is a prospective, randomized, multicentric clinical trial (RCT) that included 120 patients on regular HD. Patients were allocated to receive ONS (25 gm protein powder/HD session) for 8weeks either predialytic (1h before the start of the session), intradialytic (2h after the start of the session), or interdialytic (on non-dialysis days). Laboratory parameters, blood pressure (BP), dialysis adequacy, and nutritional parameters were assessed during the study. At study end, BP at the end of HD dropped significantly in the intradialytic group compared to the other groups (p < 0.001). Serum albumin improved significantly in the predialytic (p < 0.001) and intradialytic (p = 0.039) groups. The mean subjective global assessment score increased significantly in the interdialytic group (p = 0.040). The Kt/V and urea reduction ratio decreased significantly only in the intradialytic group (p value < 0.001 and 0.001). Serum sodium, potassium, phosphorus, cholesterol, triglycerides, and adverse events did not significantly differ between the different groups. Predialytic ONS supplementation is a favorable option due to improved serum albumin with minimal effects on hemodynamics and dialysis adequacy compared to intradialytic and interdialytic supplementation. ClinicalTrials.gov NCT05953636. First registration date: 1/07/2023.

Benefits of Cochlear Implantation and Hearing Preservation for Children With Preoperative Functional Hearing: A Prospective Clinical Trial.

This study was designed to (1) compare preactivation and postactivation performance with a cochlear implant for children with functional preoperative low-frequency hearing, (2) compare outcomes of electric-acoustic stimulation (EAS) versus electric-only stimulation (ES) for children with versus without hearing preservation to understand the benefits of low-frequency acoustic cues, and (3) to investigate the relationship between postoperative acoustic hearing thresholds and performance. This was a prospective, 12-month between-subjects trial including 24 pediatric cochlear implant recipients with preoperative low-frequency functional hearing. Participant ages ranged from 5 to 17 years old. They were recruited at their device activation and fit with EAS or ES based on their postoperative thresholds. Group outcomes were compared for single-word recognition, masked sentence recognition, perceived hearing abilities, speech production, receptive language, expressive language, and prosodic identification. Children experienced improvements in word recognition, subjective hearing, speech production, and expressive language with EAS or ES as compared with their preoperative abilities. Children using EAS performed better on a prosodic identification task and had higher subjective hearing scores postactivation as compared with children using ES. There was a significant relationship between postoperative thresholds at 125 Hz and prosodic identification. The results of this study support cochlear implantation for children with normal-to-moderate low-frequency hearing thresholds and severe-to-profound high-frequency hearing loss. They also highlight the benefits of postoperative hearing preservation for language development.

The 10-Year Outcomes of Single- versus Double-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Single-bundle (SB) and double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) have been compared for years, and long-term outcomes of the two techniques remain inconclusive. We compared the 10-year outcomes of SB and DB reconstruction, in terms of subjective scores, knee stability, graft failure, and osteoarthritis (OA). We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for relevant studies, without restrictions on study design, language, or publication date. The risk of bias and methodological quality were assessed using the Cochrane risk of bias tools (RoB 2 and ROBINS-I) and the Modified Coleman Methodology Score (MCMS), respectively. Reconstructions scoring at least 8 on the Anatomic ACLR Scoring Checklist (AARSC) were considered anatomic. The results were narratively summarized and graphically represented using tables and forest plots. Our search included six studies (two randomized control trials [RCTs] and four cohort studies [CSs]), comprising 222 SB and 214 DB reconstruction patients, with an average follow-up of 11.4 years. Of these, four studies achieved a methodological rating of "good" or above. Bias risk was evaluated as "some concerns" in the RCTs and "serious" in the CSs. Six, four, four, and two studies reported on subjective scores, knee stability, graft failure, and OA, respectively. Except for one study that reported a higher Lysholm score (p = 0.007) in the DB group, no group differences in subjective scores were identified. According to one study, the DB group performed better on the Lachman test (p = 0.02) and the KT-2000 arthrometer (p = 0.024 and 0.034 for pulling and back pushing, respectively). Three studies revealed higher negative rates of the pivot shift test in the DB group. The incidence of graft failure and OA were not statistically significant between the SB and DB groups. The existing evidence does not conclusively determine whether DB reconstruction provides long-term advantages over SB reconstruction. Future research with larger sample sizes and higher levels of evidence is warranted.

Two-stage revision anterior cruciate ligament reconstruction reduces failure risk but leads to lesser clinical outcomes than single-stage revision after primary anterior cruciate ligament graft failure: a retrospective cohort study

BackgroundThere are no studies that compare the outcomes and complications of single-versus two-stage revision anterior cruciate ligament reconstruction (ACLR) after primary ACLR failure. This purpose of this study is to examine clinical and functional outcomes and complications associated with single and two-stage revision ACLR after primary ACLR failure.MethodsAll patients who underwent single or two-stage revision ACLR after primary ACLR failure between 2012 and 2021 with a minimum of a 2 year follow-up were included. Patients were excluded if they were not treated at our single academic institution, had inadequate follow-up, or had incomplete medical records. Revision intraoperative data, concomitant injuries, and complications were collected by chart review. Return to sport, numerical pain rating scale (NPRS) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Veteran Rands 12-item health survey (VR-12 scores) were collected.ResultsThe final analysis included 176 patients. A total of 147 (83.5%) had a single-stage revision ACLR (87 male, 60 female), and 29 (16.5%) had a two-stage revision ACLR (13 male, 16 female). Two-stage revision ACLR was significantly associated with anterior knee pain [odds ratio (OR) 4.36; 95% confidence interval (CI) 1.5 to 12.65; P = 0.007] but with lower failure rates (OR 0.12, 95% CI 0.02 to 0.9; P = 0.04). On multivariate analysis, a two-stage revision ACLR reduced the risk of graft failure by 85% (OR 0.15; 95% CI 0.02 to 1.17; P = 0.07). Two-stage revision ACLR was significantly associated with a lower KOOS pain score (OR −11.7; 95% CI −22.35 to −1.04; P = 0.031), KOOS symptoms score (OR −17.11; 95% CI −28.85 to −5.36; P = 0.004), KOOS Activities of Daily Living (ADL) score (OR −11.15; 95% CI −21.71 to −0.59; P = 0.039) and Veterans RAND 12-Item Health Survey (VR-12) physical component score (OR −9.99; 95% CI −15.77 to −4.22; P = 0.001).ConclusionsThe clinical outcomes and subjective patient scores significantly differed between the single-stage and two-stage revision ACLR after primary ACLR failure. Patients with a two-stage revision ACLR had a significantly reduced risk of revision graft failure but higher rates of postoperative anterior knee pain, lower pain scores, and lesser knee functional scores than single-stage revision patients.Study designRetrospective cohort study; level of evidence, 3

Clinical and magnetic resonance imaging outcome after proximal hamstring tendon repair at mean 3 years follow-up

PurposeThe purpose of this study was to assess clinical and radiological outcome in patients after proximal hamstring tendon repair. We hypothesized that there is a significant correlation among subjective clinical outcome and interlimb asymmetries in muscle strength, fatty infiltration, and hamstring volume.MethodsThis retrospective monocentric case series included patients with surgical repair after proximal hamstring tendon rupture. Clinical outcome was assessed utilizing: Healthy Days Core Module (CDC HRQOL-4), numeric pain rating scale (NRS), modified Harris Hip Score (mHHS), Tegner Activity Scale (TAS), return to pre-injury activity level (RTPA), and patient satisfaction score. Postoperative hamstring strength was measured using a handheld dynamometer and radiological outcome was determined by postoperative magnetic resonance imaging (MRI).ResultsTwenty-seven patients with a mean age of 51.2 (± 12.6) years were available for follow-up at a mean of 41.11 (± 18.4) months. Patients state a mean of 10.6 (± 11.5) days in the unhealthy days (UHD) index and 88.9% show “good health” in the simple summary score (SSS). Mean subjective outcome scores were as follows: NRS 1.1 (± 2.4), mHHS 90.3 (± 14.8) and TAS 5.7 (± 2.2). A total of 59.3% RTPA and 88.9% state to be somewhat or very satisfied with their surgery. Mean interlimb strength ratio was 0.88 (± 0.21). MRI demonstrated a fully restored muscle–tendon unit, significantly greater fatty infiltration in the injured hamstrings (p = 0.009, d = 0.558), and a mean interlimb hamstring volume ratio of 0.94 (± 0.11). With respect to the 10% benchmark, patients had no significant asymmetries in muscle strength (p = 0.677, d = 0.084) or hamstring volume (p = 0.102, d = − 0.34). Correlation analysis revealed moderate correlation among asymmetries in strength and volume (p = 0.073, r = 0.373). In patients with the operated side inferior to the healthy side (n = 15), there was strong correlation among asymmetries in strength and volume (p = 0.002, r = 0.725). Statistically significant correlation was found between interlimb muscle volume atrophy and increase in fatty infiltration (p = 0.015, r = 0.481).ConclusionProximal hamstring repair results in good clinical outcome with satisfactory recovery of hamstring strength and volume. Interlimb asymmetries, in terms of muscle strength, fatty infiltration, and hamstring volume do not correlate with clinical outcome.Study TypeRetrospective cohort study; Level of evidence, 3.

Influence of Extra-Articular Augmentation on Clinical Outcomes and Survival in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Pseudorandomized Study

Background and Objectives: Up to 27% of anterior cruciate ligament (ACL) reconstruction cases result in a residual positive pivot shift sign, indicating anteroposterior and rotational instability. This instability can compromise returning to sports and increase the risk of further injuries. The biomechanical role of the anterolateral ligament (ALL) in controlling internal knee rotation is well known. However, there are no clinical trials comparing isolated ACL repairs to those combined with ALL reconstruction. Our objective is to compare the results of these techniques, with a primary focus on assessing knee stability and graft survival, to provide evidence for optimizing surgical approaches, particularly for athletes and physically active individuals. Materials and Methods: An observational study using paired score matching as a method of pseudo-randomization was conducted. Subjects were divided into an ACL group and an ACL+ALL group. Demographic and clinical variables were collected, as well as those related to complications and survival. Results: A total of 236 patients were included, which was reduced to 74 ACL and 37 ACL+ALL after pseudo-randomization, resulting in preoperatively comparable groups. During follow-up, differences in favor of ALL reinforcement were found on the pivot shift test (p = 0.007). No differences were found with regard to the Lachman test (p = 0.201), the International Knee Documentation Committee (IKDC) knee score (p = 0.169), the IKDC subjective score (p = 0.095), intensity of pain (p = 0.928), or complications (p = 0.529). Nor were differences found in the limb symmetry index; the single hop test (p = 0.710); the triple hop test (p = 0.653); the crossover hop test (p = 0.682); the 6 meter timed hop test (p = 0.360); the normalized Y-balance test (YBT) (p = 0.459 anterior; p = 0.898 posterolateral; and p = 0.211 posteromedial directions); or the limb symmetry index of the composite YBT (p = 0.488). There were no differences either with respect to return to sports practice (p = 0.723) or survival (p = 0.798). Conclusions: Patients treated by means of the ACL+ALL technique obtained higher rotational stability, as measured by the pivot shift test, than those subjected to an isolated ACL repair. No differences were found with respect to Lachman test, complications, IKDC, pain, or survival.

Interposition Arthroplasty with Meniscal Allograft for the Treatment of Sternoclavicular Joint Pathology; The SC Calamari Technique.

Painful degeneration of the sternoclavicular joint refractory to nonoperative treatment has historically been managed with resection of the degenerative segment of the medial clavicle. Although this has produced good results with improvement in symptoms, recurrent pain necessitating revision surgery is not an infrequently encountered outcome. To reduce the occurrence of recurrent postoperative pain, a novel technique to reconstruct the intra-articular disc at the time of medial clavicle resection was developed. 10 patients whom underwent medial clavicle excision and interposition arthroplasty with a lateral meniscus allograft were retrospectively reviewed. Functional results were based on VAS pain scores and subjective shoulder scores. VAS pain score improved from 7.5 (5-10) preoperatively to 1.2 (0-2; p = .005, W-value = 0) postoperatively, with an average improvement of 6.3. The mean preoperative SSV score improved from 54.5 (25-70) preoperatively to 88.5% (80-95%; p = .005; W-value = 0) postoperatively, with a mean increase of 34 percentage points. No patients experienced a complication and or recurrence of pain at most recent follow-up. Minimal excision of the medial clavicle and interposition arthroplasty with lateral meniscal allograft successfully reduces pain and restores stability and function for the treatment of painful degeneration of the SC joint.

Dual Functions of Androgen Receptor Overexpression in Triple-Negative Breast Cancer: A Complex Prognostic Marker

A subset of triple-negative breast cancer (TNBC) expresses the androgen receptor (AR), but thresholds for AR positivity and its clinical significance vary. We hypothesize that objective assessment outperforms subjective methods, and that high AR negatively impacts prognosis. In a population-based TNBC cohort (n = 198) with long follow-up (4–383 months), AR expression was evaluated via subjective scoring (AR-Manual) and automated digital image analysis (AR-DIA). A 10% cut-off value via AR-DIA was the strongest negative prognostic threshold for distant metastases (p = 0.008). High AR-DIA correlated with lower grade (p = 0.014), and lower proliferation (p = 0.004) but also with larger tumors (p = 0.047), distant metastasis (p = 0.052), and lymph node (LN) positivity (p &lt; 0.001), highlighting its dual roles. Multivariate analysis revealed interaction between LN status and AR-DIA (p &lt; 0.001) as the strongest prognostic factor, followed by fibrotic focus (FF; p = 0.009), mitotic activity index (MAI; p = 0.018), and stromal tumor-infiltrating lymphocytes (sTILs; p = 0.041). AR-DIA had no additional prognostic value in favorable subgroups but was significant in unfavorable subgroups. In high AR-DIA patients with unfavorable characteristics, ACT did not improve survival, and patients may benefit from AR-targeted therapy. Overall, the DIA method provides reproducibility, high AR-DIA (≥10%) shows opposing survival effects in different TNBC subgroups, and AR evaluation is crucial for prognosis and AR-targeted therapies.

Vibration Energy Color Doppler Imaging (VECDI) in Evaluating the Effect of Screw Fixation on Sacroiliac Joint Stiffness: A Prospective Pilot Study

BackgroundThe sacroiliac joints (SIJ) are specialized articulations in the pelvis that allow load transfer between the upper and lower body. Traumatic pelvic disruption often requires surgical fixation of at least one of these joints. Subsequent SIJ pain is associated with asymmetries in joint laxity or stiffness. This pilot study examines SIJ stiffness in patients with intact sacroiliac screw fixation after posterior pelvic ring injuries. This information will prove valuable to informing surgeons about technique efficacy in SIJ injury stabilization.Questions/purposesThis pilot study examined SIJ stiffness in patients with intact sacroiliac screw fixation to: (1) establish vibration energy color Doppler imaging (VECDI) SIJ intra-rater reliability; (2) measure SIJ stiffness in subjects following surgical fixation using VECDI; (3) compare stiffness data between post-surgical and healthy control subjects; (4) evaluate the relationship between stiffness data and pain and disability scores.Methods13 reliability and 19 experimental subjects were tested using VECDI. Subjects were placed into a side-lying position on top of a shaker apparatus that transmitted vibration energy to the pelvic ring while color Doppler images were taken from the bilateral posterior SIJ. One investigator performed SIJ measurements on healthy subjects to establish reliability and then evaluated post SIJ fixation stiffness in experimental subjects at four-weeks (T1) and eight-weeks (T2). Visual analog scales were used to collect subjective pain scores at each time point.ResultsHealthy subject VECDI values suggested good intra-rater reliability (ICC = 0.819; CI 95% = 0.405–0.945). No significant differences in SIJ stiffness (ΔTU) were observed between healthy and experimental subjects at both time points (p > .05). Pearson correlation coefficients highlighted relationships between current pain at T1 and T2 (p = .004, r = .879), and Oswestry Disability Index (ODI) values at T1 and T2 (p = .003, r = .890).ConclusionsAsymmetric laxity through the SIJ can be associated with pain resulting from either trauma or inherent physiologic variations. Prior to this study, the mainstay of evaluation was subjective indexes, such as the ODI. Here we propose VECDI as a potentially objective tool in SIJ assessment. Following surgical fixation necessitated by trauma, fixation using SI screws demonstrated similar stiffness values through the SIJ at four- and eight-weeks post-operatively when compared to healthy controls. Direct inferences regarding VECDI’s exact sensitivity to SIJ dysfunction cannot be concluded from our investigation due to small sample sizes. Future investigations should include a larger sample size to enhance our understanding of stiffness measurements obtained using VECDI, validate the technique, and determine the time-course of healing from SIJ surgical stabilization.

Deep learning-based image domain reconstruction enhances image quality and pulmonary nodule detection in ultralow-dose CT with adaptive statistical iterative reconstruction-V.

To evaluate the image quality and lung nodule detectability of ultralow-dose CT (ULDCT) with adaptive statistical iterative reconstruction-V (ASiR-V) post-processed using a deep learning image reconstruction (DLIR)-based image domain compared to low-dose CT (LDCT) and ULDCT without DLIR. A total of 210 patients undergoing lung cancer screening underwent LDCT (mean ± SD, 0.81 ± 0.28 mSv) and ULDCT (0.17 ± 0.03 mSv) scans. ULDCT images were reconstructed with ASiR-V (ULDCT-ASiR-V) and post-processed using DLIR (ULDCT-DLIR). The quality of the three CT images was analyzed. Three radiologists detected and measured pulmonary nodules on all CT images, with LDCT results serving as references. Nodule conspicuity was assessed using a five-point Likert scale, followed by further statistical analyses. A total of 463 nodules were detected using LDCT. The image noise of ULDCT-DLIR decreased by 60% compared to that of ULDCT-ASiR-V and was lower than that of LDCT (p < 0.001). The subjective image quality scores for ULDCT-DLIR (4.4 [4.1, 4.6]) were also higher than those for ULDCT-ASiR-V (3.6 [3.1, 3.9]) (p < 0.001). The overall nodule detection rates for ULDCT-ASiR-V and ULDCT-DLIR were 82.1% (380/463) and 87.0% (403/463), respectively (p < 0.001). The percentage difference between diameters > 1 mm was 2.9% (ULDCT-ASiR-V vs. LDCT) and 0.5% (ULDCT-DLIR vs. LDCT) (p = 0.009). Scores of nodule imaging sharpness on ULDCT-DLIR (4.0 ± 0.68) were significantly higher than those on ULDCT-ASiR-V (3.2 ± 0.50) (p < 0.001). DLIR-based image domain improves image quality, nodule detection rate, nodule imaging sharpness, and nodule measurement accuracy of ASiR-V on ULDCT. Question Deep learning post-processing is simple and cheap compared with raw data processing, but its performance is not clear on ultralow-dose CT. Findings Deep learning post-processing enhanced image quality and improved the nodule detection rate and accuracy of nodule measurement of ultralow-dose CT. Clinical relevance Deep learning post-processing improves the practicability of ultralow-dose CT and makes it possible for patients with less radiation exposure during lung cancer screening.

TARREAN: A Novel Transformer with a Gate Recurrent Unit for Stylized Music Generation

Music generation by AI algorithms like Transformer is currently a research hotspot. Existing methods often suffer from issues related to coherence and high computational costs. To address these problems, we propose a novel Transformer-based model that incorporates a gate recurrent unit with root mean square norm restriction (TARREAN). This model improves the temporal coherence of music by utilizing the gate recurrent unit (GRU), which enhances the model’s ability to capture the dependencies between sequential elements. Additionally, we apply masked multi-head attention to prevent the model from accessing future information during training, preserving the causal structure of music sequences. To reduce computational overhead, we introduce root mean square layer normalization (RMS Norm), which smooths gradients and simplifies the calculations, thereby improving training efficiency. The music sequences are encoded using a compound word method, converting them into discrete symbol-event combinations for input into the TARREAN model. The proposed method effectively mitigates discontinuity issues in generated music and enhances generation quality. We evaluated the model using the Essen Associative Code and Folk Song Database, which contains 20,000 folk melodies from Germany, Poland, and China. The results show that our model produces music that is more aligned with human preferences, as indicated by subjective evaluation scores. The TARREAN model achieved a satisfaction score of 4.34, significantly higher than the 3.79 score of the Transformer-XL + REMI model. Objective evaluation also demonstrated a 15% improvement in temporal coherence compared to traditional methods. Both objective and subjective experimental results demonstrate that TARREAN can significantly improve generation coherence and reduce computational costs.

Emotional analysis of operating room nurses in acute care hospitals in Japan: insights using ChatGPT

AimThis study aimed to explore the emotions of operating room nurses in Japan towards perioperative nursing using generative AI and human analysis, and to identify factors contributing to burnout and turnover.MethodsA single-center cross-sectional study was conducted from February 2023 to February 2024, involving semi-structured interviews with 10 operating room nurses from a national hospital in Japan. Interview transcripts were analyzed using generative AI (ChatGPT-4o) and human researchers for thematic, emotional, and subjectivity analysis. A comparison between AI and human analysis was performed, and data visualization techniques, including keyword co-occurrence networks and cluster analysis, were employed to identify patterns and relationships.ResultsKey themes such as patient care, surgical safety, and nursing skills were identified through thematic analysis. Emotional analysis revealed a range of tones, with AI providing an efficient overview and human researchers capturing nuanced emotional insights. High subjectivity scores indicated deeply personal reflections. Keyword co-occurrence networks and cluster analysis highlighted connections between themes and distinct emotional experiences.ConclusionsCombining generative AI with human expertise offered nuanced insights into the emotions of operating room nurses. The findings emphasize the importance of emotional support, effective communication, and safety protocols in improving nurse well-being and job satisfaction. This hybrid approach can help address emotional challenges, reduce burnout, and enhance retention rates. Future research with larger and more diverse samples is needed to validate these findings and explore the broader applications of AI in healthcare.

Knee injury and osteoarthritis outcome score and knee society score for the minimal clinically important differences after cruciate-retaining total knee arthroplasty: Two-year follow up.

This study investigated changes in the Knee Injury and Osteoarthritis Outcome Score (KOOS), 2011 Knee Society Score (KSS), and minimal clinically important differences (MCIDs) of these scores preoperatively to 2years after total knee arthroplasty (TKA). This single-center retrospective study included 168 patients who underwent primary cruciate-retaining (CR) TKA using the subvastus approach. The KOOS and KSS were assessed preoperatively and during the 3-month, 6-month, 1-year, and 2-year follow ups. The MCIDs of the KOOS and KSS were calculated using distribution-based methods with standard deviation. All patient-reported outcome measures improved considerably from preoperatively to 3months postoperatively. KOOS pain and symptom scores considerably improved at approximately 2years postoperatively, with KOOS activities of daily living (ADL) and sports/recreation subscale scores showing rapid improvement within 3months, followed by smaller gains. MCID thresholds for KOOS subscales were as follows: pain, 14.3-15.3; symptoms, 14.1-15.6; ADL, 15.2-16.0; sport/recreation, 11.7-11.8; and quality of life, 13.6-14.4. KSS objective knee indicators and satisfaction improved considerably approximately 2years postoperatively; however, scores on the expectation and functional activity subscales did not improve after 1year. MCID thresholds for KSS subscales were as follows: objective knee indicators, 4.6-4.7; satisfaction, 4.9-5.0; expectation, 2.4; and functional activities, 12.0-12.3. Improvements in the KSS objective knee indicators and KOOS subjective pain and symptom scores were similar over the 2-year follow up. These findings may help better understand the expected outcomes of CR-type TKA, especially in severe osteoarthritis cases, thereby informing patient counseling.

Gender Differences in Self-Assessment Among Clerkship Medical Students Despite Equivalent Academic and Clinical Performance.

The authors aimed to determine if medical students' self-assessment of abilities and performance differed by gender during the psychiatry clerkship and if these differences were reflected objectively in test scores or clinical evaluations from educators. Data from mid-clerkship self-assessments completed during the psychiatry core clerkship were reviewed from two classes of medical students. Students rated their performance on 14 items across five domains: knowledge/clinical reasoning, differential diagnosis, data presentation, studying skills, and teamwork as "below," "at," or "above expected level." Ratings were coded numerically, and statistical analysis was performed using Student's T-test. National Board of Medical Examiners (NBME) Subject Exam scores and clinical evaluations served as measures of actual performance. Female students (n = 123) rated their performance significantly below male peers (n = 114) in medical knowledge (female - 0.05 vs male 0.13), clinical reasoning (- 0.02 vs 0.06), differential diagnosis (- 0.09 vs 0.00), balancing work and studying (- 0.02 vs 0.11), keeping up with clerkship assignments (0.03 vs 0.13), understanding role on the team (0.11 vs 0.23), interacting with other team members (0.15 vs 0.31), and functioning as part of the team (0.13 vs 0.25). Clinical evaluation scores and NBME Subject Exam scores showed no significant difference (evaluation scores 138.1 vs 136.0; NBME scores 163.8 vs 162.2) in performance between students. Female medical students tend to underrate their performance compared to male peers in clinical knowledge, studying skills, and teamwork, despite equivalent academic and clinical performance. This study highlights gender disparities in self-assessment during medical training.

. Serum Neuroprotection , nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and superoxide dismutase (SOD) Levels in Neonates with Hypoxic-ischemic Encephalopathy

Abstract: Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the main causes of brain injury and death in infants. This article aimed to investigate the effects of mild hypothermia therapy on neuroprotection and cytokine levels in neonates with HIE. 132 children with HIE in the Northwest Women's and Children's Hospital between January 2022 and April 2023 were enrolled as the study subjects, and they were grouped by the method of random number table, controls using conventional treatment intervention, mild hypothermia group adopting mild hypothermia therapy based on conventional treatment. The levels of cytokines and neonatal behavioral neurological assessment (NBNA) were compared before and following remedy. As against controls, in mild hypothermia therapy-treated subjects, the levels of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and superoxide dismutase (SOD) were clearly raised; the levels of malondialdehyde (MDA), interleukin (IL-18), and Caspase-3 were clearly decreased, and the NBNA score of mild hypothermia therapy-treated subjects was clearly raised; the recovery time of neurological function was clearly shortened (all P &lt;0.05). Mild hypothermia therapy has an obvious neuroprotective outcome on neonates with HIE, possibly by regulating the levels of cytokines.

Strawberry Desiccation and Gloss in Refrigerated Storage Depend on the Interaction between Cultivar and Time after Harvest

The objectives of this study were to characterize strawberry cultivars grown under two production systems for gloss at harvest as a proxy for freshness and assess cultivar differences regarding the loss of gloss and changes in desiccation scores during refrigerated postharvest storage. Nine strawberry cultivars were grown in an annual plasticulture system for 3 years, harvested twice weekly, and packaged for refrigerated storage. Four of these cultivars also were grown in a low tunnel production system and harvested, packaged, and evaluated similarly. In both cases, berry gloss was measured at harvest and again after 1 and 2 weeks of refrigerated storage. Subjective desiccation scores were assigned to the berries during refrigerated storage. For both traits, effects were primarily determined by the interaction between the cultivar and time of measurement relative to harvest. For either gloss or desiccation, there was no evidence of differences in cultivar rankings based on the production system or packaging event. Cordial and Sweet Charlie were among cultivars that did not show loss of gloss or changes in desiccation scores during storage; therefore, they would not be good choices for studies that test alternative postharvest storage protocols. Keepsake and USDA Lumina were among the glossiest cultivars and those with the highest gloss levels and desiccation scores after both 1 week and 2 weeks of refrigerated storage. The variability of these traits among cultivars indicate that improvement can be made when developing new cultivars.

Esthetic and Colorimetric Assessment of Peri-implant Soft Tissue Augmented with the Strip Gingival Graft Harvested Either from the Buccal Soft Tissue or the Palate: A Retrospective Study.

It is well known that keratinized mucosa (KM) plays a crucial role for maintaining peri implant health and esthetic outcomes. The Strip Gingival Graft (SGG) technique, which involved an apically positioned flap (APF), in combination with an autogenous SGG and a xenogeneic collagen matrix (XCM), demonstrated its efficacy in re-establishing an adequate amount of KM width at implant sites. Nevertheless, it is still unclear whether harvesting the SGG from the palate (pSGG) or from the buccal aspect of natural dentition (bSGG) affects the esthetic outcomes at the augmented implant sites. Therefore, the objective of the present study was to compare the esthetic outcomes of dental implants augmented with either bSGG &#43; XCM or pSGG &#43; XCM. The present study was designed as a single-center retrospective study, assessing the esthetic and colorimetric outcomes of peri-implant KM augmentation with either pSGG &#43; XCM or bSGG &#43; XCM in cohort of 49 subjects. The two groups were compared in terms of colorimetric outcomes, assessed on clinical photograph using specific software able to identify and quantify the predominant color within the peri implant soft tissue. Colorimetric comparisons with adjacent untreated sites were also investigated. In addition, the Pink Esthetic Score (PES) and the Subjective Esthetic Score (SEE) were performed to further assess the esthetic outcomes of pSGG &#43; XCM and bSGG &#43; XCM. The colorimetric analysis did not show statistically significant differences among sites augmented with pSGG &#43; XCM, sites augmented with bSGG &#43; XCM, and untreated sites. Implants treated with bSGG &#43; XCM showed significantly greater PES (in terms of shape of the mesial and distal papilla, level of the soft tissue margin, soft tissue contour, anatomy of the alveolar process, and final PES) and SEE compared to implants augmented with pSGG &#43; XCM. The present study demonstrated that implant sites augmented with APF with either pSGG &#43; XCM or bSGG &#43; XCM did not show different colorimetric outcomes compared to adjacent untreated sites, while bSGG &#43; XCM obtained superior professional and subjective esthetic scores compared to pSGG &#43; XCM.

Long‐term Outcomes of PRP Injections for Post‐viral Olfactory Loss: A Prospective Cohort Study

ABSTRACTBackgroundPlatelet‐rich plasma (PRP) injections have previously been shown to benefit coronavirus disease 2019 (COVID‐19)‐induced smell loss. It is unknown if that benefit is stable over time. The aim of this study was to assess outcomes at 1‐year post‐intervention.MethodsProspective cohort study. Sixteen patients (10 PRP and six placebo) from the original PRP randomized placebo‐controlled clinical trial, and a further 16 patients from smell clinic who were a year out from initial treatment (six PRP patients and 10 non‐PRP) were enrolled. University of Pennsylvania Smell Identification Tests (UPSITs) and visual analog scale (VAS) subjective scores were compared to initial scores.ResultsThere was no difference between groups with respect to age, gender, race, duration of smell loss prior to intervention, smoking or diabetes status, Charlson comorbidity index, presence of phantosmia or parosmia, or baseline UPSIT score. The PRP group had a significantly higher change in UPSIT score at 1 year (p = 0.001), a higher number of patients who met the minimal clinically important difference for the UPSIT (87.5% vs. 31.2%, p = 0.004), and a significantly greater change in VAS at 1 year (p = 0.001), compared to those who did not receive injections. On multivariate logistic regression analysis, no factors appeared to have a significant effect on these findings.ConclusionPRP injections into the olfactory cleft now have long‐term data suggesting benefit in both subjective and psychophysical measures of smell, and improvements in both realms at 1 year are significantly higher than in those who do not receive the injections.

Neighborhood social contact and cohesion mediate the relationship between subjectively perceived artificial light at night and mental wellbeing

Artificial Light at Night (ALAN) may improve health by promoting increased social activity. However, this hypothesis still lacks empirical evidence. In this study, we conducted an online survey to investigate the relationship between both subjective and objective measures of artificial light at night (ALAN) and mental wellbeing among 646 adults across 27 provinces in China. Additionally, we explored the potential mediating role of social contact and social cohesion within neighborhoods. Objective ALAN data were obtained through remote sensing technologies, while subjective ALAN exposure, social contact, and social cohesion were assessed via pre-established survey instruments. We found a non-linear relationship between subjective ALAN and mental wellbeing: subjective ALAN scores within the range of 6–11 (out of a total of 11) were positively correlated with mental wellbeing. This association was largely explained by neighborhood social contact and social cohesion, particularly among men. These results underscore the bright side of ALAN and provide a mechanism for understanding the health benefits of ALAN.

Prevalence of Body Dysmorphic Disorder (BDD) among Orthodontic Patients Compared to Community Population in Eastern Mediterranean Region

Background and Objectives Many orthodontists may recognize that some of their clinic's patients may have one or more abnormal physical or psychological conditions, such as Body Dysmorphic Disorder (BDD). The aims of this study were to screen and identify the prevalence of BDD among orthodontic patients using the COPS-BDD questionnaire. Additionally, the study aimed to compare the prevalence of BDD between orthodontic patients and the normal population (community group) in the Eastern Mediterranean region. Material and Methods Two groups of participants aged between 18-25 years old were recruited: a) Community group consisting of dental clinic visitors for operative procedures (n=503 participants), and b) Orthodontic patients' group comprising individuals seeking orthodontic treatment at orthodontic offices (n=500 participants). Results According to questionnaire guidelines, 7.36% and 11.2% of participants from the community group and orthodontic patients' group, respectively, were likely to have BDD with higher probability. Meanwhile, 16.7% and 12.4% of participants from these groups were still likely to have BDD but with lower probability. Females scored higher than males in both groups. In both groups, BDD was more common among females, with younger individuals showing higher likelihood of BDD. No significant differences in the mean scores of BDD subjects were observed when comparing the study groups. While there were no significant variations in the prevalence of BDD between both groups, the scores of questionnaire items suggested that subjects in the orthodontic patients' group received significantly higher scores than those in the community group, indicating a greater tendency to have BDD. Conclusion Body Dysmorphic Disorder (BDD) is a notable psychological condition that should be carefully investigated and addressed by orthodontists. It is recommended that BDD be routinely considered as part of the decision-making process in orthodontic offices.