Sign Test Research Articles

SURG-36. ACCURACY OF THE ROSA ONE BRAIN ROBOTIC PLATFORM FOR THE PLACEMENT OF NEUROBLATE AND VISUALASE LASER INTERSTITIAL THERMAL THERAPY PROBES

Abstract Laser interstitial thermal therapy (LITT) is a minimally invasive treatment option for patients with intracranial lesions. The success of LITT is dependent on accurate placement of the laser probe in target tissue. Placement can be facilitated by various stereotactic methods, including the Robotic Surgical Assistant (ROSA) ONE Brain robotic platform. The aim of this study is to examine the accuracy of stereotactic probe placement utilizing the ROSA robot. Primary outcomes were entry distance, target distance, and entry angle error. Accuracy differences between two major LITT platforms, the Neuroblate (Monteris Medical) and Visualase Systems, were compared. A prospective institutional database was used to identify all patients who underwent LITT for intracranial tumors utilizing the ROSA robot between 2013-2023. The sign test was used to compare error values to test their difference from a null value of 0. Spearman correlation was used to assess the relationship between angle of error and trajectory length. Kuskal-Wallis test was used to compare errors and trajectory length between the two companies. Of the 105 patients who underwent LITT during the study period, 337 probes were placed. For Visualase probes, median entry distance (1.1mm, IQR=0.4-2.0), target distance (1.6mm, IQR =0.9-2.4), and entry angle error (1.5°, IQR=0.9-2.5), were significantly different than zero (p=<.0001). For Neuroblate probes, median entry distance (1.5mm, IQR=1.0-2.1), target distance (1.8mm, IQR=1.1-2.4), and entry angle error (1.8°, IQR=1.1-2.5) were significantly different than zero (p=<.0001). When comparing laser systems, there was a significant difference in median entry distance error with Neuroblate having a higher error (1.5mm, IQR=1.0-2.1) than Visualase (1.1mm IQR=0.4-2.0, p=0.0041). Stereotactic placement of LITT probes utilizing the ROSA robotic system was not able to achieve perfect alignment with the planned trajectory. When comparing the systems, Visualase probes were placed more accurately at the entry point than Neuroblate probes.

Examining the Interrelation Between Microcredit, Entrepreneurship and Women’s Empowerment: An Insight into the Effectiveness of Pradhan Mantri Mudra Yojana (PMMY)

The present research unleashes the interrelation between microcredit, entrepreneurship and women’s empowerment in the context of Pradhan Mantri Mudra Yojana (PMMY). In light of this, a structured questionnaire designed to capture the study’s features was given to woman respondents who were residents of the six administrative regions of Haryana in order to gather their responses. The study takes into account 360 respondents. Primary data were collected from July 2023 to March 2024. Logit and ologit regression models were used to evaluate how strongly the chosen variables related to women’s employability. Wilcoxon sign test, a non-parametric test, has been used to determine whether the well-being of the woman respondents differed between the two stages (pre and post Mudra loan). The outcomes of the study revealed that there is a positive interconnection between microcredit, entrepreneurship and women’s empowerment. Further, there has been a considerable increase in the respondents’ economic, social, political and psychological empowerment when compared to the pre- Mudra loan phase. Moreover, the results showed that credit assistance under PMMY schemes helps in job creation.

Intrathecal enalapril reduces adhesion formation in experimentally induced digital flexor tendon sheath injuries in horses.

The objectives of the study were to describe a standing percutaneous adhesion induction model in the digital flexor tendon sheath (DFTS) of horses and to evaluate the effect of intrathecal administration of the angiotensin-converting enzyme (ACE) inhibitor enalapril on tendon healing and adhesion formation. Randomized, blinded, controlled experimental study. Eight healthy horses. A collagenase-induced adhesion model was implemented in the deep digital flexor tendon (DDFT) of both forelimbs under standing ultrasonographic guidance. Daily intrathecal injections of 5 mg enalapril (the treatment condition) were administered to a randomly assigned forelimb for 5 days, with the contralateral limb receiving an equivalent volume of 0.9% NaCl (the control). Lameness and limb circumference were recorded weekly. Horses were euthanized after 8 weeks and evaluated for gross digital flexor tendon sheath (DFTS) adhesions. Tendons were collected for histopathologic scoring of DDFT healing. Paired data were analyzed using a one-sided alternative sign test and longitudinal regression. Multiple DFTS adhesions were formed in control limbs of all horses. The median number of gross DFTS adhesions in treated limbs was less than in control limbs (p = .0039). The average reduction in limb circumference and lameness scores over time occurred faster in treated versus control limbs (p < .025). There were no differences in DDFT histopathologic scores between groups. The standing percutaneous DFTS adhesion induction model demonstrated that intrathecal enalapril reduced DFTS adhesion formation, lameness scores, and limb circumference over time. Intrathecal enalapril administration may reduce morbidity in horses with naturally occurring tendon injuries.

Smaller is better? Compact vs. Conventional gamma camera for sentinel lymph node localization in patients with breast cancer.

Sentinel lymph node biopsy (SLNB) has been recognized as "the gold standard" for axillary staging in early breast cancer patients with clinically negative lymph nodes, resulting in significant morbidity decrease and quality of life improvement. This study aims to validate the performance of a newly developed handheld portable gamma camera (PGC) produced by Imagensys (Italy), in detecting and locating sentinel lymph nodes (SLNs) during the preoperative and intraoperative phases in breast cancer patients compared to conventional lymphoscintigraphy. Adult female patients with histologically confirmed breast cancer, candidates for surgery and SLNB, were prospectively enrolled in this open-label, pre-marketing clinical trial. All patients underwent pre- operative assessment using both the PGC and conventional lymphoscintigraphy. The performance of the two devices was compared using the Poisson regression model for incidence rate ratios (IRRs). The intrinsic sensitivity of the devices was compared using the Wilcoxon Ranked Sign Test. The utility of PGC during intra-operative procedures was also evaluated. The manoeuvrability of the devices was evaluated using operator-satisfaction questioner. Sixty-eight patients (median age 50 years, BMI 21.4) were enrolled, including two patients with bilateral breast cancer, who underwent SLNB on both axillae. The PGC demonstrated superior preoperative lymph node detection rate (IRR 8.01, 95% CI 6.11-10.50; p < 0.0001) and intrinsic device sensitivity (mean counts per second 409 ± 286 vs. 255 ± 1173 for conventional device, p = 0.0003) compared to the conventional gamma camera. Intra-operative assessment with PGC was performed in 62 patients and no additional lymph nodes were visualised. However, the conventional gamma camera demonstrated superior manoeuvrability (p < 0.0001). The PGC handheld gamma camera showed promising results for preoperative SLN assessment in patients with breast cancer. The limited manoeuvrability may be related to the operator's experience leading to higher inter-operator variability. Appropriate training and frequent use of nuclear medicine and surgical equipment could overcome this limitation.

The Use of Machine Learning Models and SHAP Interaction Values to Predict the Soil Swelling Index

Predicting the soil swelling index (CS) is crucial for geotechnical engineer to ensure the stability of civil engineering conceptions. Recently, ML models has sparked great interest from researchers in predicting the soil swelling index. However, due to the black-box nature of ML models, their prediction capabilities are still uninterpretable. This study aims to predict the soil swelling index using ML algorithms and interpret predictions. First, it employs the prediction capability of the Gaussian process regression (GPR) algorithm and compares it to the artificial neural network (ANN) for prediction the soil swelling index. Second, the SHAP algorithm as one recent explainable artificial intelligence (XAI) models is applied to interpret the predictions of the complex GPR and ANN models. The compiled experimental database covers 362 clayey samples gathered from different sites located in Northern Algeria. The modeling involved six input features, including the liquid limit (LL), plastic limit (PL), plasticity index (PI), water content (ωn), dry density (γd), and void ratio (e) to predict the soil swelling index. The findings based on statistical metrics showed a good performance of GPR with R2 = 0.78 and of ANN with R2 = 0.79. Comparative study based on Wilcoxon signed- rank test and sign test indicated that the ANN outperform better than GPR. Based on the interpretations obtained by SHAP algorithm, it is observed that the liquid limit (LL) and plastic limit (PL) are the two main input features that influence the CS, indicating, the higher content of LL and PL increase the model's output.

Problem-oriented stimulus of teaching foreign-language listening in a secondary school. Part 1

The problem for the research. Listening skills are important for a modern person in many areas of life: at work, at home, travelling the world, etc., when immersed in the social space of culture in the fullness of its spiritual meanings. However, in school teaching of foreign languages, there is a contradiction between the large reserve listening capabilities in achieving students’ personal, metasubject and subject educational results in a foreign language and the established practice of teaching this type of foreign-language speech activity, where there are many difficulties associated with students’ perception and understanding of foreign-language information by ear. Methods of investigation. 50 ninth-graders of secondary school named after S. S. Rakitina in Murashi, Kirov Region (Russian Federation) took part in pilot testing. To obtain personal learning results, the “Methodology for studying the motivation of teaching older adolescents” was used; metasubject – L. F. Tikhomirova’s “Exclude the word” method; subject (in the field of foreign-language listening) – the method for calculating the success rate of V. P. Bespalko and A. N. Shamov. The results were processed using the sign test. The findings of the study. The final control revealed an increase in the level of proficiency in personal learning outcomes in 40% of ninth-graders; metasubject – in 45%; subject – in 61%. The reliability of the presented results is confirmed by the use of mathematical statistics methods for personal, metasubject and subject results. The results of calculating the criterion of G-signs in the experimental group: Gemp. is above ≤ Gcr.: 0 ≤ 3 for personal, 0 ≤ 5 for metasubject and subject results (p &lt; 0.05). Conclusion. The purpose of the study is achieved: the article describes the characteristics and proves the effectiveness of using the problem-oriented stimulus in the process of teaching foreign-language listening in a secondary school (based on materials from the senior stage in secondary school). The theoretical foundation and testing of a set of exercises for teaching students foreign-language listening using the components of the problem-oriented stimulus led us to the conclusion that the presented exercises contribute to the formation of personal and metasubject universal educational actions of students, increases the level of their proficiency in the oral receptive type of foreign-language speech activity.

Effects of speech tracking method using hearing aids for hearing disorder in older people.

Speech tracking is defined as a complex act or task of listening in which the learner tracks the speech heard and repeats it as accurately as possible while paying attention to incoming contextual information. This ability involves auditory input, speech output, repetition, and divided attention. In this small-scale study, we aimed to use a speech-tracking method to train older adults with hearing loss and examine its effects on hearing loss from multiple perspectives, including hearing handicap, frailty, and neuropsychological testing. Auditory rehabilitation was provided to older patients who purchased hearing aids at the clinic and wanted to engage in rehabilitation. The Hearing Handicap Inventory for the Elderly, Nursing Home Hearing Handicap Index, speech-tracking rate, Token Test, Communication Activities of Daily Living, Kihon Checklist, Mini-Mental State Examination, Digit Symbol Substitution Test, symbol search, and word recall were used for assessments before and after rehabilitation using the speech-tracking method. Changes in scores of each assessment item and sub-item were examined using Wilcoxon's signed-rank test, and changes per question were examined using the sign test. The speech tracking rate (p<0.001), Token Test score (p<0.001), and Mini-Mental State Examination score (p=0.035) improved significantly after the training. Notably, the speech-tracking rate improved for 31 of the 33 participants, with a maximum increase of 19.6 phrases per minute. The combination of a hearing aid and the speech-tracking method improved auditory comprehension.

A ‘Tuba Drain’ incorporated in sink drains reduces counts of antibiotic-resistant bacterial species at the plughole; A blinded, randomised trial in 36 sinks in a hospital Outpatients with a low prevalence of sink colonisation by antibiotic-resistant species

Multi-resistant Gram-negative bacteria (GNB) survive in hospital drains in traps that contain water and may ascend into the sink because of splashes, or biofilm growth. To investigate whether the 'Tuba Drain' (TD) a long, bent, continually descending copper tube between the sink outlet and the trap prevents the ascent of bacteria. After initial laboratory tests confirmed that the TD prevented bacteria in the U-bend from splashing upwards into the sink outlet, TDs were assessed in a randomised, blinded trial in a hospital out-patients built in 2019. Sinks were paired into those with a similar clinical exposure and each member of each pair was randomised to receive either new, standard plumbing up to and including the trap (18 sinks) or the same new standard plumbing but including the TD inserted between the sink outlet and trap. Bacterial counts in swabs from the sink outlets were determined blindly before and monthly after the plumbing change for a year. GNBs that are associated with clinical infection and carriage of resistance genes, Pseudomonas aeruginosa, Acinetobacter baumanii, Stenotrophomonas maltophilia and all Enterobacteriales spp were the organisms of primary interest and termed target bacteria. The TDs fitted into the required spaces and functioned without problems. The geometric means (over months) of the counts of target bacteria in TD-plumbed sinks was lower than those in their paired controls p= 0.012 (sign test 2 tailed). Prevalence of target bacteria in sinks was low. TDs were effective for reducing target bacteria in sinks.

Using contrasts in horizontal P-wave reflectivity to map the base of the continental lithosphere: Results for the central and eastern U.S.

Vertical-incidence seismic reflection profiles generated from global phases for 16 earthquakes recorded by stations of the Transportable Array (TA) show distinctive patterns of P-wave reflectivity in the uppermost mantle beneath the central and eastern United States. The overall distribution of reflections identified objectively using the sign test statistic applied to bootstrapped stacks is consistent with a westward increase in depth of the lithosphere-asthenosphere boundary (LAB) from roughly 110 to 250 km that is marked within the lower lithosphere by piecewise continuous segments of elevated horizontal P-wave reflectivity. For some profiles, the onsets of zones of increased reflectivity closely match depths corresponding to the maximum negative S-wave velocity gradients found by surface-wave tomography, suggesting that P-wave reflectivity can be used to help characterize properties of the lower lithosphere. We suggest that the vertical change in horizontal reflectivity straddles the lithosphere-asthenosphere transition, encompassing a broad zone of layering caused by increased strain in the lower lithosphere as well as drag-induced flow in the asthenosphere. Some of the lines also show waveforms that fall within the depth range of arrivals identified as midlithospheric discontinuities (MLDs) in overlapping Sp receiver-function profiles. The reflection waveforms observed in the TA lines are mostly multicyclic with a mix of polarities indicating a layered transition, consistent with previous observations and model studies that show the breakup of single Sp waveforms into a series of less prominent, shorter-period P-wave reflections as the dominant frequency of incident energy is increased.

Late Phase Testicular Torsion in Pre-Geriatic Age: A Case Report

Background: Testicular torsion is a urological emergency caused by a twist of spermatic cord, which result in testicular tissue ischemia and requiring immediate surgery. The incidence occurred generally in children and adolescents, rarely found in adults. Severe Scrotal pain is the most common manifestation of testicular torsion. The definitive treatment for testicular torsion is surgery, either one of orchidopexy or orchidectomy. The prognosis of testicular torsion depends on the onset of symptoms and the decision time for surgery. Case Report: A 52-year-old man presented to emergency department with a history of gradual severe right-sided scrotal pain (visual analogue scale 8) radiated to the right groin in the last 3 day before admission. Previously, the patient's genitals were hit by the table. On physical examination, the testicles were found to be asymmetrical, swollen, redness, tenderness, and the testicle felt hard and immobilized, either the cremaster reflex or the Phren sign test were negative. The TWIST score was 6 (high risk for testicular torsion). Orchidopexy and orchidectomy were performed immediately without Scrotal Doppler Ultrasonography due to operational problems. Histopathology examination of the orchidectomy specimen impression showed an inflammation sign with exudative fluid presentation. Conclusion: Gradual Severe scrotal pain manifestations should be suspected as testicular torsion as soon as possible before it evolves into later phase. One of the causes of late phase testicular torsion is late admission to Hospital. Surgical emergency action should be taken considering theemergency state without waiting for ideal sonography

Prevalence of coronary microvascular disease in myocardial infarction with non-obstructive coronary artery disease

Abstract Background Six percent of patients presenting with acute myocardial infarction (MI) have MI with non-obstructed coronary artery disease (MINOCA). Coronary microvascular disease (CMD) is common in angina with non-obstructive coronary artery disease (ANOCA), but its prevalence and severity in MINOCA is undefined. Purpose Patients with CMD may have elevated risk of myocardial infarction despite no significant stenosis. We tested the hypothesis that patients with MINOCA have more significant burden of CMD than patients with ANOCA. Methods A retrospective case-control study was performed on patients who underwent invasive testing for signs of coronary ischemia and found to have non-obstructive disease (stenoses&amp;lt; 50%). Cases of MI were classified as MINOCA (n=87) and compared to patients with ANOCA (n=552). Patients with spontaneous coronary artery dissection, myocarditis, Takotsubo cardiomyopathy or prior atherothrombotic MI were excluded. Coronary catheterization was performed followed by invasive provocation testing with adenosine and acetylcholine using a Doppler flow wire. CMD was subdivided into endothelium-independent, defined as coronary flow reserve (CFR) &amp;lt; 2.5 with intra-coronary adenosine, and endothelium dependent, defined as &amp;lt; 50% increase in coronary blood flow with acetylcholine. Epicardial vasoconstriction &amp;gt; 90% with typical anginal symptoms was classified as epicardial vasospasm. Results There was no difference in age, sex or traditional coronary risk factors between the MINOCA and ANOCA groups (Table 1). Fifty (57%) of patients with MINOCA had type 2 MI secondary to supply-demand mismatch. Both MINOCA and suspected ANOCA patients had a high prevalence of CMD (71% vs 67%) and endothelium-independent CMD is more prevalent in MINOCA (64.5% vs 50.4%). Although odds of endothelium-dependent CMD were similar, the CFR within this group and CMD overall was worse in MINOCA patients (Figure 1). There was no difference in epicardial spasm. Conclusion Coronary microvascular disease and vasomotor dysfunction are common in patients with MINOCA, with a higher prevalence of endothelium-independent CMD and more severe CMD overall compared to patients with ANOCA. Treatment of CMD in patients with MINOCA may help reduce recurrence and warrants further investigation.

Health literacy of pregnant women in Hungary

Abstract Health literacy determines our state of health and through this our quality of life. The health behavior of women of reproductive age should be treated with priority, since the lifestyle of pregnant women shows a correlation with the occurrence of premature birth and intrauterine development, and also between fetal development and the occurrence of chronic diseases in adulthood. The aim of our research is to explore the factors influencing the health behavior of pregnant women, to analyze regional differences, and to identify the causes of regional differences and inequalities. During a prospective, cross-sectional study, the health behavior of pregnant women living in Hungary was assessed using a questionnaire. In the course of our research, we examined health literacy using two measuring instruments, the Chew questionnaire and The Newest Vital Sign test. A total of 2,000 questionnaires were distributed of which 1,655 evaluable questionnaires were returned, the willingness to answer was 75%. The most people considered their own health to be good or very good (59.7%). 59.5% of the respondents changed their health behavior because of their pregnancy, mainly for the sake of the health of the fetus. 18.1% of pregnant women most likely have insufficient, 15.0% probably limited and 48.1% most likely have adequate functional health literacy. Age, education, place of residence and financial situation of pregnant women show a significant correlation with health literacy. Our results confirmed that sociodemographic factors, especially age and education, significantly influence the health literacy, perceived health status and health behavior of pregnant women. The two health literacy questionnaires we use can be combined well with each other and complement each other. The results greatly contribute to the development of health literacy, and thus to the development of individual and community-level strategies for improving health behavior in the field of pregnant women’s care. Key messages • Health literacy of pregnant women in Hungary. • Health literacy in health promotion.

Refugees' integration and emotional distress over the course of 9 months.

High prevalence rates of mental disorders are reported in refugees due to experiencing substantial pre-, peri-, and post-migration stress. While long-term studies indicated that emotional distress of refugees either stagnates or ameliorates over time, long-term research on refugees' integration and its' interaction with emotional distress is limited. The examined long-term predictors for refugees' emotional distress and integration in this study were, amongst others, severe physical abuse in childhood, residence status and length of stay. The sample included 46 refugees, 91.3% male, mean age 20.8 years. Trained psychologists screened for emotional distress with the use of the Refugee Health Screener in a semi-structured interview. Integration progress was screened using the Integration Index with the subdimensions psychological, economic, political, social, linguistic and navigational integration. Longitudinal differences for emotional distress and integration sub-dimensions were evaluated by sign tests and t-tests. The longitudinal course of integration was evaluated with a Mixed ANOVA. Further, two hierarchical regression analyses were performed to analyze longitudinal predictors of emotional distress and integration. Overall, emotional distress decreased, and integration increased over time. In particular, the sub-dimensions of social, economic, and linguistic integration increased significantly over time. Two regression analyses determined significant predictors of (a) emotional distresst1 (adjusted R2 = 0.46): psychotherapy (ß = 0.35, p = 0.020), emotional distresst0 (ß = 0.34, p = 0.031), and integrationt0 (ß = -0.29, p = 0.043), and one significant predictor of (b) integrationt1 (adjusted R2 = 0.70): integrationt0 (ß = 0.89, p < 0.001). This is the first study to longitudinally examine the Integration Index with all subdimensions. Over the course of 9 months refugees' overall integration, and the sub-dimensions of social, economic, and linguistic integration increased. Whilst the emotional distress of initially highly distressed refugees ameliorated over the course of nine months, their symptom severity remained clinically significant. Results emphasize the importance of early integration for the long-term development of mental health and integration in refugees. Refugees' emotional distress and integration are intertwined and need to be addressed promptly after refugees' entry into the host country.

Bottleneck Effect Analysis in Indigenous Poonchi Chicken Located Near International Border of India and Pakistan

Background: Poonch is the remotest district of Jammu, India located near to line of control with Pakistan. Poonchi chicken is the first native poultry breed of Jammu region which is being characterized and registered with National Bureau of Animal Genetic Resources. Present study is the first study on genetic bottleneck assessment in Poonchi chicken population using recommended microsatellite markers. This study in Poonchi chicken would be of immense use in tracing evolutionary origin and formulating effective conservation strategies for genetic diversity within breeds. Methods: Blood samples were collected randomly from Poonch and Rajouri districts of Jammu for DNA extraction and analysis. Microsatellite markers selected for the analysis were ADL0268, MCW0206, MCW0081, ADL0278, MCW0069, MCW0248, MCW0111, MCW0222, MCW0016 and LEI0094. To evaluate the Poonchi chicken for mutation drift equilibrium, Bottleneck software was used. Infinite allele model (IAM), two phase model of mutation (TPM) and stepwise mutation model (SMM) tests were done. Mode shift test was also used as another method of qualitative test for allele frequency. Result: Total number of alleles observed were 72, with the total number alleles ranged from 6 to 9. The results of all three models (IAM, TPM, SMM) in Sign test depicted the heterozygosity was more in the expected number of loci in Poonchi chicken as 5.97 (P less than 0.05), 5.93 (P less than 0.05), 5.90 (P less than 0.05) respectively. Whereas for Wilcoxon rank test the IAM, TPM and SMM revealed significant values of (P less than 0.05) deviation indicating that all the loci deviate from mutation-drift equilibrium. Mode shift test graph obtained depicted a slight shift from normal L-shaped curve indicating recent bottleneck effect in Poonchi chicken. This might have resulted in the loss of number of effective alleles which suggests a need of planning and implementing an effective breeding policy in order to preserve and promote this native breed.

The Rate of Inflation: Implementation for Income of Household Business in Sampe Cita Village

The purpose of this study was to analyse access to capital and technology responsiveness at the inflation rate as a mediating variable on the income of household businesses in the Glugur Rimbun area (Case Study: Sampe Cita Village). The specific target of this study is to analyse the level of inflation rate as a mediating variable on the income of household businesses in the Glugur Rimbun area (Case Study: Sampe Cita Village). So that it can show the value of the influence of the inflation rate on the income of household businesses in the Glugur Rimbun area of Sampe Cita Village. The hypothesis in this study is the level of inflation rate as a mediating variable on the income of household businesses in the Glugur Rimbun area (Case Study: Sampe Cita Village). Access to capital and responsiveness to technology influence the income of household business owners in Sampe Cita Village, with the inflation rate serving as a mediating factor. This study will utilize quantitative data to assess how the inflation rate mediates the relationship between capital and technology access and the income of household entrepreneurs in the Glugur Rimbun area, specifically focusing on Sampe Cita Village. The data analysis used was quantitative analysis, which consisted of path analysis and sign test. The findings of this study indicate that, in sub-structure I, the variable for capital access has a direct positive impact on the business income of household entrepreneurs in Sampe Cita Village. Conversely, in sub-structure II, the technology response variable has an indirect negative effect on their business income, with the inflation variable serving as a mediator.

Ligament reconstruction for distal radioulnar joint instability with the biomechanical analysis: A case report.

The aim of the study is to evaluate the clinical effects and feasibility on chronic distal radioulnar unstable joint (DRUJ) under wrist arthroscope triangular fibrocartilage complex (TFCC) repair and reconstruction. The biomechanical characteristics of the recovery process after treatment were analyzed using finite element modeling. A patient with chronic DRUJ instability was treated with reconstruction of the distal radioulnar ligament using the Adams Berger method. Piano sign and forearm rotation tests were used to evaluate the function of the DRUJ. Grip power, range of motion, and visual analog scale scores were recorded at the last follow-up. Joint function was evaluated by the disability of the arm, shoulder, and hand score. A geometric model for the surgical repair of TFCC damage, meshing in finite element simulation, and stress distribution of the repaired ligament during forearm rotation were analyzed by finite element simulation. The diagnosis was confirmed as chronic DRUJ instability. The patient had no postoperative complications and was followed-up for 6 months. Stability was achieved in all patients. The results of the stress and forearm rotation tests are negative. At the last follow-up, the grip power, disability of the arm, shoulder, and hand score, visual analog scale score, and range of motion of the wrist were significantly improved compared with the preoperative values (P < .05). TFCC repair and reconstruction under wrist arthroscopy can effectively treat chronic DRUJ and improve wrist function. Our study established a three-dimensional finite element model of the entire DRUJ, which provided a digital visual platform for simulating the biomechanical features of the TFCC, DRUJ, and other structures in different states. This study demonstrated that the rotation angle of the wrist joint should be confined within 75° for a short period after surgery to avoid tearing the tendon as a result of excessive force. It also provides an intuitive simulation tool for the design of TFCC repair and the evaluation of curative effects.

CURDIS: A template for incremental curve discretization algorithms and its application to conics

We introduce CURDIS, a template for algorithms to discretize arcs of regular curves by incrementally producing a list of support pixels covering the arc. In this template, algorithms proceed by finding the tangent quadrant at each point of the arc and determining which side the curve exits the pixel according to a tailored criterion. These two elements can be adapted for any type of curve, leading to algorithms dedicated to the shape of specific curves. While the calculation of the tangent quadrant for various curves, such as lines, conics, or cubics, is simple, it is more complex to analyze how pixels are traversed by the curve. In the case of conic arcs, we found a criterion for determining the pixel exit side. This leads us to present a new algorithm, called CURDIS-C, specific to the discretization of conics, for which we provide all the details. Surprisingly, the criterion for conics requires between one and three sign tests and four additions per pixel, making the algorithm efficient for resource-constrained systems and feasible for fixed-point or integer arithmetic implementations. Our algorithm also perfectly handles the pathological cases in which the conic intersects a pixel twice or changes quadrants multiple times within this pixel, achieving this generality at the cost of potentially computing up to two square roots per arc. We illustrate the use of CURDIS for the discretization of different curves, such as ellipses, hyperbolas, and parabolas, even when they degenerate into lines or corners.

The Comparison of Psychological Factors and Executive Functions of Children with Attention Deficit Hyperactivity Disorder and Cognitive Disengagement Syndrome to ADHD and ADHD Comorbid with Oppositional Defiant Disorder

Objective: The study aims to examine family functionality, emotion regulation difficulties, preference for loneliness, social exclusion, internalizing and externalizing disorders, and executive functions in children with Attention Deficit Hyperactivity Disorder (ADHD) and Cognitive Disengagement Syndrome (CDS) and compare with ADHD, and ADHD+ Oppositional Defiant Disorder (ODD). Method: This study included 842 children aged 8–12 years. The subjects were categorized according to DSM-V as ADHD (n = 246), ADHD + ODD (n = 212), ADHD + CDS (n = 176), and Control group (n = 207). The solitude and social exclusion, difficulties in emotion dysregulation and Barkley SCT scales, Child Behavior Checklist, family assessment device, and Central Vital Signs (CNSVS) test were used. Results: According to the study, children with ADHD + CDS had higher rates of internalizing disorders. They also preferred being alone and experienced more difficulty communicating with their parents and solving problems within the family. Additionally, these children had difficulty recognizing and understanding the emotional reactions of others. The ADHD + ODD group presented a poorer performance on CNSVS domain tests except for the psychomotor speed test than other groups. Also, ADHD + CDS children had the lowest psychomotor speed scores and lower scores on reaction time and cognitive flexibility than pure ADHD children. Conclusion: This study will contribute to the etiology, treatment, and clinical discrimination of ADHD + CDS.

Reliability of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries: A Cross-Sectional Study with Interobserver Analysis

Introduction: Anterior cruciate ligament (ACL) injuries are known to have a high rate of occurrence among athletes. The growing prevalence of these injuries demands research in this field to determine clinically reliable diagnostic techniques. Aims: The goal of this study was to compare the diagnostic accuracy of the lever sign test with other frequently used manual tests, such as the anterior drawer and Lachman test, and to evaluate the sensitivity and specificity of the lever sign test in the diagnosis of ACL injuries. Study Design: The study was conducted for a period of 1 year, from November 2021 to November 2022, among 100 patients presenting to orthopedic outpatient department in a tertiary care center with complaints of acute knee pain after a trauma to the knee. Materials and Methods: A thorough history, physical examination, and three manual tests for diagnosing an ACL tear were performed by an intern, orthopedic resident, and consultant after obtaining consent. Arthroscopy of the injured knee was taken as the reference standard. Results: Of 100 patients, 53 were surgical and 67 were nonsurgical; the mean patient age was 33 years (range, 16 + 6.38 years). The overall accuracy of the lever sign test was 83% (85% sensitivity and 81% specificity); the accuracy was almost similar at arrival and under anesthesia (at arrival 86%, under anesthesia 80%), when performed by interns, postgraduates, and consultants. Conclusion: The lever sign test is easier to perform, equally efficacious, and reliable in diagnosing ACL injuries when compared to the other conventionally used manual tests.

Evaluation of the sedative properties of oral trazodone, gabapentin or their combination in healthy cats.

Sedation before veterinary visits is advocated to help reduce fear and anxiety in cats and facilitate safe handling. The aim of this study was to evaluate the effectiveness of trazodone, gabapentin and a trazodone/gabapentin combination for oral sedation in healthy feline patients before blood donation. A total of 21 cats were included in the study. Baseline sedation scores were obtained, and cats were randomly assigned to receive oral trazodone at 5 mg/kg (T), oral gabapentin at 10 mg/kg (G), their combination (TG) or placebo (control group). A sedation score was obtained 1 h after drug administration. A blood sample was obtained at the time of blood collection for quantification of drug plasma concentrations. Agreement between observers was tested with a Cohen's Kappa test. Sign tests to compare change within treatment and a Skilling-Mack rank ANOVA to test for differences between groups were performed to compare pre- and post-sedation scores as well as a magnitude of differences over time between the groups. A Spearman's rank correlation coefficient test was used to correlate sedation scores with drug plasma concentrations. Post-sedation final scores were significantly higher only in the T (P = 0.022) and TG groups (P <0.001). The magnitude of change between pre- and post-sedation scores was larger in the TG (P <0.0032) and T groups (P <0.038) compared with the control group. There were no other significant differences between the groups. There was no correlation between drug plasma concentrations and sedation scores in any of the groups. Administration of oral trazodone alone at 5 mg/kg or in combination with gabapentin at 10 mg/kg resulted in significant sedation in healthy cats with no evident side effects. The degree of sedation was more profound when both drugs were combined, but a gabapentin dose of 10 mg/kg alone failed to provide significant sedation in this population.