Single Expert Research Articles

Effect of β-1,3-1,6-D-glukan (polysaccharide peptide) from miselia ganoderma lucidum extract as antioxidant and antiinflammation towards left ventricular systolic function in cardiometabolic patients

Background: Cardiometabolic disease (CMD) describes a metabolic condition often associated with cardiovascular disease. It has been revealed that the Ganoderma lucidum polysaccharide peptide (GLPP) possesses anti-inflammatory and antioxidant qualities. Objective: This study aimed to find out how GLPP affected oxidative stress, inflammation, and left ventricular function in individuals with cardiometabolic syndrome. Methods: A multicenter double-blinded randomized controlled trial was carried out. Subjects with cardiometabolic syndrome received either GLPP or a placebo for ninety days. Before taking the initial treatment and one day following the last treatment intake, blood samples were taken from every participant. The enzyme-linked immunosorbent assay was used to evaluate the levels of serum tumor necrosis factor (TNF)-α, interleukin-6 (IL-6), malondialdehyde (MDA), and high-sensitivity-C-Reactive Protein (hs-CRP) while the colorimetric test was used to measure the levels of superoxide dismutase (SOD). Global longitudinal strain (GLS) and Left ventricle ejection fraction (LVEF) were measured by single echocardiographer expert validation. Results: The MDA level was decreased in the GLPP treatment group (mean 56.0 ± 71.4 ng/mL to 27.7 ± 12.0 ng/mL, p= 0.023) compared to the control group (mean 39.3 ± 29.2 ng/mL to 38.3 ± 17.7 ng/mL, p= 0.719). However, the SOD level remained constant in the GLPP treatment (mean 122.2 ± 176.1 U/mL to 93.0 ± 40.9 U/mL, p=0.925) instead of significantly declining in the control group (mean 102.0 ± 67.3 U/mL to 64.0 ± 52.0 U/mL, p=0.016). The marker of TNF-α and hsCRP were significantly decreased in all groups (both p<0.05), but IL-6 was only significantly decreased in the control group (mean 1149.3 ± 581.7 pg/mL to 744.8 ± 336.5 pg/mL, p=0.010). The GLS was significantly decreased in the GLPP treatment group (-16.1 ± 4.1 to -17.5 ± 4.8, p=0.048) but there was no difference in LVEF in both groups (p>0.05). Conclusion: Patients with cardiometabolic syndrome may benefit from GLPP treatment for 90 days in terms of reduced inflammation, oxidative stress, and improved systolic left ventricular performance. Keyword: cardiometabolic syndrome, echocardiography, ganoderma lucidum, inflammation, oxidative stress

A Quantitative Comparison Between Human and Artificial Intelligence in the Detection of Focal Cortical Dysplasia.

Artificial intelligence (AI) is thought to improve lesion detection. However, a lack of knowledge about human performance prevents a comparative evaluation of AI and an accurate assessment of its impact on clinical decision-making. The objective of this work is to quantitatively evaluate the ability of humans to detect focal cortical dysplasia (FCD), compare it to state-of-the-art AI, and determine how it may aid diagnostics. We prospectively recorded the performance of readers in detecting FCDs using single points and 3-dimensional bounding boxes. We acquired predictions of 3 AI models for the same dataset and compared these to readers. Finally, we analyzed pairwise combinations of readers and models. Twenty-eight readers, including 20 nonexpert and 5 expert physicians, reviewed 180 cases: 146 subjects with FCD (median age: 25, interquartile range: 18) and 34 healthy control subjects (median age: 43, interquartile range: 19). Nonexpert readers detected 47% (95% confidence interval [CI]: 46, 49) of FCDs, whereas experts detected 68% (95% CI: 65, 71). The 3 AI models detected 32%, 51%, and 72% of FCDs, respectively. The latter, however, also predicted more than 13 false-positive clusters per subject on average. Human performance was improved in the presence of a transmantle sign (P < 0.001) and cortical thickening (P < 0.001). In contrast, AI models were sensitive to abnormal gyration (P < 0.01) or gray-white matter blurring (P < 0.01). Compared with single experts, expert-expert pairs detected 13% (95% CI: 9, 18) more FCDs (P < 0.001). All AI models increased expert detection rates by up to 19% (95% CI: 15, 24) (P < 0.001). Nonexpert+AI pairs could still outperform single experts by up to 13% (95% CI: 10, 17). This study pioneers the comparative evaluation of humans and AI for FCD lesion detection. It shows that AI and human predictions differ, especially for certain MRI features of FCD, and, thus, how AI may complement the diagnostic workup.

Corneal Clarity after Phacoemulsification: Nuclear Management by Stop and Chop vs Divide and Conquer Methods

Background: Restoration of effective vision is the principal aim of all modalities of cataract surgery including Phacoemulsification. Energy level of ultrasonic power in Phacoemulsification and turbulence of fluid in the anterior chamber plays an important role in corneal endothelial cell loss influencing post-operative corneal clarity. Objectives: To compare post-operative corneal clarity after Phacoemulsification by two techniques of nuclear divisions: stop and chop with divide and conquer. Methodology: This prospective observational study was conducted at Shaheed Monsur Ali Medical College and Hospital, Uttara, Dhaka from January, 2023 to June, 2023. The study was carried out on 30 outdoor patients undergoing Phacoemulsification at SMAMCH and Mirpur Eye Hospital, Dhaka. The selected patients underwent detailed ocular and systemic examinations with relevant investigations and divided equally into two groups comprising of 15 in group A (stop and chop) and 15 in group B (divide and conquer). Phacoemulsification was done in all patients by a single expert surgeon. Patients were followed up after 1 week, 4 weeks and 12 weeks of surgery. Corneal endothelial cell count and central corneal thickness were assessed in each visit. Mean value of these mentioned parameters in follow-up periods were compared between two groups. Unpaired t test was done to assess the level of significance. Results: The mean age + standard deviation (SD) of the study subjects was 61.5+2 years, out of which 13(43.33%) were males and other 17(56.67%) females. Pre-operative value of mean endothelial cell count was 2620+70.20/mm2 in group A and 2625+71.10/mm2 in group B. Postoperative mean value + SD of endothelial cell count was 2420+68.90/mm2, 2345+66.64/mm2, 2310+66.04/mm2 respectively after 1 week, 4 weeks and 12 weeks of surgery in group A and 2410+69.54/mm2, 2340 +6587/mm2, 2310+64.45/mm2 in group B respectively. Mean value + SD of central corneal thickness was 545+40.50 micrometer, 535+40.02 micrometer and 532+39.85 micrometer respectively after 1 week, 4 weeks and 12 weeks after surgery in group A and 547+43.98 micrometer, 537+41.23 micrometer and 533+40.63 micrometer respectively in group B. Conclusion: Quantitative assessment and comparison of endothelial cell count and central corneal thickness shows that at end of the study, there was no remarkable difference in mean values of endothelial cell count and central corneal thickness between two methods. Journal of Monno Medical College December, 2023; 9 (2):37-40

Identifying risk factors for urologic complications in placenta accreta spectrum surgical management.

To describe urologic complications associated with the surgical management of placenta accreta spectrum and determine their risk factors. A retrospective study was conducted on all patients diagnosed with abnormal invasive placentation who underwent surgery and delivered between 2002 and 2023 at a single expert maternity centre. Intra-operative and post-operative complications were described, with a special focus on urologic intra-operative injuries, including vesical or ureteral injuries. Univariate and multivariate analyses were performed to determine risk factors of intra-operative urologic injuries associated with placenta accreta spectrum surgical management. Additionally, using the Clavien-Dindo classification, the effects of intra-operative urologic injury and ureteral stent placement on post-operative outcome were evaluated. A total of 216 patients were included, of which 47 (21.48%) had an intra-operative bladder and/or ureteral injury. Placenta percreta was associated with a higher rate of intra-operative urologic injury than placenta accreta (72.34% vs. 6.38%, p < 0.001). Multivariate analyses showed that patients who had placenta percreta and bladder invasion or emergency hysterectomy were associated with more intra-operative urologic injuries (OR = 8.07, 95% CI [2.44-26.75] and OR = 3.87, 95% CI [1.09-13.72], respectively). Patients with intra-operative urologic injuries had significantly more severe post-operative complications, which corresponds to a Clavien-Dindo score of 3 or more, at 90 days (21.28% vs. 5.92%, p = 0.004). Surgical management of placenta accreta spectrum is associated with significant urologic morbidity, with a major impact on post-operative outcomes. Urologic complications seem to be correlated with the depth of invasion and the emergency of the hysterectomy.

Ultrasound study of natural progression of ovarian endometrioma.

To determine the natural progression of ovarian endometrioma in women who are managed expectantly. This was a retrospective cohort study of 83 women with evidence of ovarian endometrioma who were managed expectantly between April 2007 and May 2022. The study was conducted in the Department of Women's Health, University College London Hospitals and The Gynecology Ultrasound Centre, London, UK. We searched our ultrasound clinic databases to identify women aged 18 years or older with evidence of ovarian endometrioma who were managed expectantly for ≥ 6 months. All women attended for a minimum of two ultrasound scans performed by a single expert ultrasound operator. In addition to patient demographics, we recorded the number, mean diameter and location of each cyst. The cyst growth rate was expressed as annual change in the mean diameter. A total of 1922 women who attended our gynecology clinic during the study period were found to have evidence of moderate or severe endometriosis on pelvic ultrasound examination. Of those, 83 women had evidence of ovarian endometrioma and were managed expectantly. The median age of women was 39 (range, 26-51) years at the initial visit. Each woman had at least two ultrasound scans performed by a single expert operator at a minimum interval of ≥ 6 months. Of 83 women diagnosed with endometrioma, 50 (60% (95% CI, 49-71%)) had a single cyst and the remainder had multiple cysts. The median number of endometriomas per patient was 1 (range, 1-5) and the median follow-up time was 634 (range, 187-2984) days. A total of 39/83 (47% (95% CI, 36-58%)) women experienced an overall reduction in size of cysts, in 18/83 (22% (95% CI, 13-32%)) the cysts increased in size and in 26/83 (31% (95% CI, 22-42%)) women, no meaningful change in size was observed. The median change in mean cyst diameter per woman during the study period was -2.7 (range, -57.7 to 39.3) mm, with a median annual regression rate of -1.7 (range, -24.6 to 42.0) mm/year/woman. Overall, when compared with the initial visit, cysts were significantly smaller at follow-up (median diameter, 22.3 (range, 6.7-77.0) mm vs 18.5 (range, 5.0-72.0) mm; P = 0.009). We did not identify any clinical characteristics that could reliably predict the chance of endometrioma progression. In the majority of women with an ultrasound diagnosis of ovarian endometrioma, the cysts do not increase in size significantly over time and they could be managed expectantly. This evidence may help clinicians when counseling asymptomatic or minimally symptomatic women about management of ovarian endometrioma. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Ocean Species Discoveries 1-12 - A primer for accelerating marine invertebrate taxonomy.

Discoveries of new species often depend on one or a few specimens, leading to delays as researchers wait for additional context, sometimes for decades. There is currently little professional incentive for a single expert to publish a stand-alone species description. Additionally, while many journals accept taxonomic descriptions, even specialist journals expect insights beyond the descriptive work itself. The combination of these factors exacerbates the issue that only a small fraction of marine species are known and new discoveries are described at a slow pace, while they face increasing threats from accelerating global change. To tackle this challenge, this first compilation of Ocean Species Discoveries (OSD) presents a new collaborative framework to accelerate the description and naming of marine invertebrate taxa that can be extended across all phyla. Through a mode of publication that can be speedy, taxonomy-focused and generate higher citation rates, OSD aims to create an attractive home for single species descriptions. This Senckenberg Ocean Species Alliance (SOSA) approach emphasises thorough, but compact species descriptions and diagnoses, with supporting illustrations and with molecular data when available. Even basic species descriptions carry key data for distributions and ecological interactions (e.g., host-parasite relationships) besides universally valid species names; these are essential for downstream uses, such as conservation assessments and communicating biodiversity to the broader public. This paper presents thirteen marine invertebrate taxa, comprising one new genus, eleven new species and one re-description and reinstatement, covering wide taxonomic, geographic, bathymetric and ecological ranges. The taxa addressed herein span three phyla (Mollusca, Arthropoda, Echinodermata), five classes, eight orders and twelve families. Apart from the new genus, an updated generic diagnosis is provided for four other genera. The newly-described species of the phylum Mollusca are Placiphorellamethanophila Vončina, sp. nov. (Polyplacophora, Mopaliidae), Lepetodrilusmarianae Chen, Watanabe & Tsuda, sp. nov. (Gastropoda, Lepetodrilidae), Shinkailepasgigas Chen, Watanabe & Tsuda, sp. nov. (Gastropoda, Phenacolepadidae) and Lyonsiellaillaesa Machado & Sigwart, sp. nov. (Bivalvia, Lyonsiellidae). The new taxa of the phylum Arthropoda are all members of the subphylum Crustacea: Lepechinellanaces Lörz & Engel, sp. nov. (Amphipoda, Lepechinellidae), Cuniculomaeragrata Tandberg & Jażdżewska, gen. et sp. nov. (Amphipoda, Maeridae), Pseudionellapumulaensis Williams & Landschoff, sp. nov. (Isopoda, Bopyridae), Mastigoniscusminimus Wenz, Knauber & Riehl, sp. nov. (Isopoda, Haploniscidae), Macrostylispapandreas Jonannsen, Riehl & Brandt, sp. nov. (Isopoda, Macrostylidae), Austroniscusindobathyasellus Kaiser, Kniesz & Kihara, sp. nov. (Isopoda, Nannoniscidae) and Apseudopsisdaria Esquete & Tato, sp. nov. (Tanaidacea, Apseudidae). In the phylum Echinodermata, the reinstated species is Psychropotesbuglossa E. Perrier, 1886 (Holothuroidea, Psychropotidae).The study areas span the North and Central Atlantic Ocean, the Indian Ocean and the North, East and West Pacific Ocean and depths from 5.2 m to 7081 m. Specimens of eleven free-living and one parasite species were collected from habitats ranging from an estuary to deep-sea trenches. The species were illustrated with photographs, line drawings, micro-computed tomography, confocal laser scanning microscopy and scanning electron microscopy images. Molecular data are included for nine species and four species include a molecular diagnosis in addition to their morphological diagnosis.The five new geographic and bathymetric distribution records comprise Lepechinellanaces Lörz & Engel, sp. nov., Cuniculomaeragrata Tandberg & Jażdżewska, sp. nov., Pseudionellapumulaensis Williams & Landschoff, sp. nov., Austroniscusindobathyasellus Kaiser, Kniesz & Kihara, sp. nov. and Psychropotesbuglossa E. Perrier, 1886, with the novelty spanning from the species to the family level. The new parasite record is Pseudionellapumulaensis Williams & Landschoff, sp. nov., found in association with the hermit crab Pagurusfraserorum Landschoff & Komai, 2018.

Two listeners detect slightly more birds than a single listener when interpreting acoustic recordings

ABSTRACT Acoustic recorders are increasingly important for monitoring bird populations and have potential to augment existing monitoring programs such as the North American Breeding Bird Survey (BBS). An advantage of acoustic recordings is that they can be reviewed multiple times by multiple experts, potentially yielding improved estimates of species abundance and community richness. Yet, few studies have examined how frequently successive listeners disagree on acoustic interpretations and how strongly estimates of species richness and abundance are altered when multiple experts review each recording. We assigned multiple expert listeners to interpret recordings at 690 BBS stops, and subsequently assigned second listeners to conduct a review of first listeners’ interpretations. We examined the extent to which listeners agreed with each other and quantified the effect of disagreements on resultant estimates of species occurrence, abundance, and stop-level richness. We also compared estimates from acoustic recordings to those obtained during simultaneous field surveys. Estimates were highly correlated for number of species per stop (r = 0.92) and detection probabilities of species (r = 0.97) based on first and second-listener data. Second listeners disagreed with ~9% of first listeners’ interpretations and added an average of ~15% additional species and 16% additional birds not reported by first listeners. Estimates based on acoustic recordings were also highly correlated with those obtained from field surveys, though listeners were unable to count flocks. A single expert reviewer can provide a reasonable approximation of the relative abundance and species composition of birds available for acoustic detection during BBSs. However, acoustic review by multiple listeners may still be important for species that are rare, difficult to identify, or of high conservation concern.

Eyedrop Instillation Technique by Medical Interns: Assessment and Impact of Video-Assisted Training

Abstract Aim: To assess the eyedrop instillation technique by medical interns, and to study the effect of video-assisted training. Methods: This was a hospital based prospective study performed on interns of teaching institute. First, interns were asked to instil the eye drops on volunteers which was video recorded. Interns were then given ‘video-assisted training’ (VAT) of correct technique and again reassessment was performed immediately, after one-week and one-month interval. All the recorded videos were evaluated by a single independent blinded expert and scored according to the scoring system devised by subject experts based on the available literature. The data were entered in Microsoft Office Excel and statistical analysis was performed. Results: The study showed that before training 43.80% had good practice with mean test score of 6.32 ± 1.63. Immediately after video-assisted training, there was significant improvement in technique of instilling eye drop with mean test score of 9.01 ± 0.62 (P &lt; 0.0001), after one week, the mean test score was 9.52 ± 0.71 (P &lt; 0.0001), and after one-month, mean test score was 9.56 ± 0.75 (P &lt; 0.0001). Each step of eyedrop instillation was compared before and after the VAT and the difference was found to be statistically significant (P value &lt; 0.05). Conclusion: In our current study, initially interns had practised incorrect technique of instillation of eyedrop. But after video-assisted training there has been notable improvement in the technique of instilling eyedrop. Periodic VAT might be helpful in ensuring them to follow the correct technique regularly.

Imitation Learning from a Single Demonstration Leveraging Vector Quantization for Robotic Harvesting

The ability of robots to tackle complex non-repetitive tasks will be key in bringing a new level of automation in agricultural applications still involving labor-intensive, menial, and physically demanding activities due to high cognitive requirements. Harvesting is one such example as it requires a combination of motions which can generally be broken down into a visual servoing and a manipulation phase, with the latter often being straightforward to pre-program. In this work, we focus on the task of fresh mushroom harvesting which is still conducted manually by human pickers due to its high complexity. A key challenge is to enable harvesting with low-cost hardware and mechanical systems, such as soft grippers which present additional challenges compared to their rigid counterparts. We devise an Imitation Learning model pipeline utilizing Vector Quantization to learn quantized embeddings directly from visual inputs. We test this approach in a realistic environment designed based on recordings of human experts harvesting real mushrooms. Our models can control a cartesian robot with a soft, pneumatically actuated gripper to successfully replicate the mushroom outrooting sequence. We achieve 100% success in picking mushrooms among distractors with less than 20 min of data collection comprising a single expert demonstration and auxiliary, non-expert, trajectories. The entire model pipeline requires less than 40 min of training on a single A4000 GPU and approx. 20 ms for inference on a standard laptop GPU.

Ferumoxtran-10-enhanced MRI for pre-operative metastatic lymph node detection in pancreatic, duodenal, or periampullary adenocarcinoma.

To assess 3-Tesla (3-T) ultra-small superparamagnetic iron oxide (USPIO)-enhanced MRI in detecting lymph node (LN) metastases for resectable adenocarcinomas of the pancreas, duodenum, or periampullary region in a node-to-node validation against histopathology. Twenty-seven consecutive patients with a resectable pancreatic, duodenal, or periampullary adenocarcinoma were enrolled in this prospective single expert centre study. Ferumoxtran-10-enhanced 3-T MRI was performed pre-surgery. LNs found on MRI were scored for suspicion of metastasis by two expert radiologists using a dedicated scoring system. Node-to-node matching from in vivo MRI to histopathology was performed using a post-operative ex vivo 7-T MRI of the resection specimen. Sensitivity and specificity were calculated using crosstabs. Eighteen out of 27 patients (median age 65 years, 11 men) were included in the final analysis (pre-surgery withdrawal n = 4, not resected because of unexpected metastases peroperatively n = 2, and excluded because of inadequate contrast-agent uptake n = 3). On MRI 453 LNs with a median size of 4.0 mm were detected, of which 58 (13%) were classified as suspicious. At histopathology 385 LNs with a median size of 5.0 mm were found, of which 45 (12%) were metastatic. For 55 LNs node-to-node matching was possible. Analysis of these 55 matched LNs, resulted in a sensitivity and specificity of 83% (95% CI: 36-100%) and 92% (95% CI: 80-98%), respectively. USPIO-enhanced MRI is a promising technique to preoperatively detect and localise LN metastases in patients with pancreatic, duodenal, or periampullary adenocarcinoma. Detection of (distant) LN metastases with USPIO-enhanced MRI could be used to determine a personalised treatment strategy that could involve neoadjuvant or palliative chemotherapy, guided resection of distant LNs, or targeted radiotherapy. The study was registered on clinicaltrials.gov NCT04311047. https://clinicaltrials.gov/ct2/show/NCT04311047?term=lymph+node&cond=Pancreatic+Cancer&cntry=NL&draw=2&rank=1 . LN metastases of pancreatic, duodenal, or periampullary adenocarcinoma cannot be reliably detected with current imaging. This technique detected LN metastases with a sensitivity and specificity of 83% and 92%, respectively. MRI with ferumoxtran-10 is a promising technique to improve preoperative staging in these cancers.

Tumor Board Practice and Current Approach of Oncologists in Türkiye

Objective: Interdisciplinary cooperation is essential in treating and following up cancer disease. The primary objective of multidisciplinary tumor councils (MDTCs) is to identify the most suitable and effective treatment strategies for cancer patients through the collective decision-making of experts in oncology. MDTC plays a key role in breaking traditional taboos, providing the most up-to-date approach to the patient, sharing responsibility and accountability, and encouraging interdisciplinary communication and collaboration. Material and Methods: In this study, the perspectives, expectations, and experiences of medical oncologists regarding tumor boards were evaluated. The survey consisted of 10 questions and was conducted as an online survey at the '7th National Immunotherapy and Oncology Congress'. This study was cross-sectional and online. While those who were actively working as medical oncologists and those who wanted to voluntarily participate in the survey were included in the study, those who were not medical oncologists, those who were not actively working, and those who worked in private clinics were not included in the study. Participants were asked various questions about multidisciplinary tumor boards. They were asked about the specialties they most needed on the boards, the other clinics participating in the boards, and the clinics they felt were essential. The necessity of genetic clinics and molecular boards in shaping the future of oncology through molecular assessments was also assessed. The impact of board decisions on patient treatment and management was investigated. Results: A total of 624 oncologists participated in the survey. The majority of the participants were young oncologists. Most participants worked in tertiary healthcare units, including university hospitals and training and research hospitals. Almost all of the participants stated that they did MDTC. The most frequent and regular councils are; thoracic cancers and gastrointestinal cancers. The most needed and hard to reach branch was the medical genetics department. Conclusion: Cancer treatment is a complex process that cannot be confined to a single expertise. Multidisciplinary tumor boards (MDTB) are one of the cornerstones of a comprehensive approach to cancer treatment. In multidisciplinary tumor boards, various topics such as medical treatment planning for patients, diagnosis, surgical and radiotherapy planning, side effect management, and palliative care can be examined. MDTB not only provides effective treatment for cancer patients from a broad perspective but also ensures rapid and comprehensive solutions in case of potential complications.

ProACT™ (Uromedica, Plymouth, USA) balloons for male urinary incontinence: A fourteen-year-old cohort

BackgroundMale urinary incontinence is attributed to SUI consecutive to benign prostate hypertrophy surgery, trauma, neurological diseases, or injury. Medical devices are developed to treat male urinary incontinence among them proACT® balloons. This technique was chosen in our center to achieve continence. Our study aims to evaluate safety and efficacy of proACT® balloons implanted in our center by measuring the rate of efficacy. MethodsWe performed a retrospective and single centre study. A single expert surgeon performed all surgeries. Seventy-one balloons were implanted in 57 male patients between 2007 and 2020. Primary endpoint was the efficacy time lapse of the balloons after surgery. The analysis was performed using Kaplan-Meier method. Factors, which could affect the efficacy of the balloons, were analysed using a Cox regression analysis. ResultsIn all, 45 balloons successfully cured stress urinary incontinence among the 57 men implanted resulting in a 63.38% success rate. Twenty-six balloons failed to treat stress urinary incontinence and were retrieved out of the 71 implanted. Ten balloons failed to treat urinary stress incontinence without organic cause, 6 balloons deflated, 5 balloons migrated out of the initial implantation site, 2 eroded, and 3 ended up infected. Fifty percent of the balloons were successful for a median time of 95 months. Univariate analysis did not reveal any predictive factor of failure. ConclusionsOur study showed 50% success rate at 95 months follow-up, therefore allowing a life expectancy of 7.9 years for the balloons. This safe mini-invasive technique ensured stress urinary incontinence in men. Level of evidence4.

Efficient Deweahter Mixture-of-Experts with Uncertainty-Aware Feature-Wise Linear Modulation

The Mixture-of-Experts (MoE) approach has demonstrated outstanding scalability in multi-task learning including low-level upstream tasks such as concurrent removal of multiple adverse weather effects. However, the conventional MoE architecture with parallel Feed Forward Network (FFN) experts leads to significant parameter and computational overheads that hinder its efficient deployment. In addition, the naive MoE linear router is suboptimal in assigning task-specific features to multiple experts which limits its further scalability. In this work, we propose an efficient MoE architecture with weight sharing across the experts. Inspired by the idea of linear feature modulation (FM), our architecture implicitly instantiates multiple experts via learnable activation modulations on a single shared expert block. The proposed Feature Modulated Expert (FME) serves as a building block for the novel Mixture-of-Feature-Modulation-Experts (MoFME) architecture, which can scale up the number of experts with low overhead. We further propose an Uncertainty-aware Router (UaR) to assign task-specific features to different FM modules with well-calibrated weights. This enables MoFME to effectively learn diverse expert functions for multiple tasks. The conducted experiments on the multi-deweather task show that our MoFME outperforms the state-of-the-art in the image restoration quality by 0.1-0.2 dB while saving more than 74% of parameters and 20% inference time over the conventional MoE counterpart. Experiments on the downstream segmentation and classification tasks further demonstrate the generalizability of MoFME to real open-world applications.

Impact of deep phenotyping: high diagnostic yield in a diverse pediatric population of 172 patients through clinical whole-genome sequencing at a single center.

Background: Pediatric patients with undiagnosed conditions, particularly those suspected of having Mendelian genetic disorders, pose a significant challenge in healthcare. This study investigates the diagnostic yield of whole-genome sequencing (WGS) in a pediatric cohort with diverse phenotypes, particularly focusing on the role of clinical expertise in interpreting WGS results. Methods: A retrospective cohort study was conducted at Acibadem University's Maslak Hospital in Istanbul, Turkey, involving pediatric patients (0-18years) who underwent diagnostic WGS testing. Clinical assessments, family histories, and previous laboratory and imaging studies were analyzed. Variants were classified and interpreted in conjunction with clinical findings. Results: The cohort comprised 172 pediatric patients, aged 0-5years (62.8%). International patients (28.5%) were from 20 different countries. WGS was used as a first-tier approach in 61.6% of patients. The diagnostic yield of WGS reached 61.0%, enhanced by reclassification of variants of uncertain significance (VUS) through reverse phenotyping by an experienced clinical geneticist. Consanguinity was 18.6% of the overall cohort. Dual diagnoses were carried out for 8.5% of solved patients. Discussion: Our study particularly advocates for the selection of WGS as a first-tier testing approach in infants and children with rare diseases, who were under 5years of age, thereby potentially shortening the duration of the diagnostic odyssey. The results also emphasize the critical role of a single clinical geneticist's expertise in deep phenotyping and reverse phenotyping, which contributed significantly to the high diagnostic yield.

Interdisciplinary public engagement: untapped potential?

Public engagement projects developed by university-based academics tend to focus on specific academic topics. Yet, the problems and topics that our audiences want to engage with are broad, challenging, and can't be explained or solved by a single academic subject or expertise. In this article, we capitalise on our experience working with academics at the University of Oxford, and a workshop for public engagement professionals that we co-organised with the National Coordinating Centre for Public Engagement, to advocate for a novel approach: interdisciplinary public engagement (public engagement projects that bring together academics from several academic disciplines). We consider the potential benefits and the challenges of this approach and provide examples of how it is starting to be explored.

Atrioventricular block secondary to transient causes and long-term recurrence after an index event.

Atrioventricular block (AVB) secondary to transient causes can recover with its correction. However, studies assessing predictors of recovery and long-term recurrence are lacking. Patients with advanced or complete AVB who had a reversible cause admitted in a single expert center were retrospectively studied. Patients with AVB secondary to acute coronary syndromes were excluded from analysis. In a population of 162 patients, the main factors associated with recovery of rhythm without a permanent pacemaker (PPM) implantation were the presence of chronic kidney disease (CKD) on dialysis (OR 7.6; CI 95% 1.2-47.5 (p=.03)); greater serum potassium levels (OR 2.3; CI 95% 1.28-4.0 (p<.01)), higher dosage of bradycardic drugs (OR 2.2; CI 95% 1.13-4.4 (p=.02)), the association between different bradycardic drugs (OR 9.0; CI 95% 2.02-40.3 (p<.01)) and between drug therapy and hyperkaliemia (OR 5.2; CI 95% 1.8-15.1 (p<.01)). There was an overall high burden of conductions abnormalities which did not correlate with recovery of rhythm (OR 0.5; CI 95% 0.19-1.5 (p=.23)). In 29 patients (17.9%) there was a correction of the AVB. During a maximum follow-up of 130 months, 24 patients (82.8%) had a recurrence which warranted a PPM. In the overall cohort only five patients (3%) had sustained recovery of rhythm. Recovery of AVB was mainly observed with higher doses of drug therapy, higher serum potassium levels or a combination of factors and regardless of baseline conduction abnormalities. The high rate of recurrence during follow-up warrants a close follow-up or PPM implantation at index admission.

Significant reduction in left testicular volume shown by ultrasonography in infertile patients with left-side grade 2-3 varicocele as compared to less than grade 2: An evidence for indication of varicocelectomy.

Testicular volume (TV) is known to be one of the main parameters for testicular function (TF). This study was conducted to re-evaluate the indications of a varicocelectomy based on a survey of preoperative TV results in left-side varicocele patients considered to reflect the detrimental effects of a varicocele on TF. TV results of infertile patients determined using ultrasonography by a single expert physician were retrospectively evaluated. Of 590 examined patients, 424 had no varicocele findings (Group A), while 148 had a left-side varicocele (Group B). Group B was subdivided based on varicocele grade into Group B0 (subclinical), B1 (grade 1), B2 (grade 2), and B3 (grade 3). Comparisons of left-side TV showed no significant differences for grade among Group A, B0, and B1, whereas that for Group B2 and B3 was significantly lower as compared with Group A (p < 0.01, 0.02, respectively). The median TV of Group B I (composed of Groups B0 and B1) was 9.8 cm3, while that of Group B II (Groups B2 and B3) was significantly lower at 8.4 cm3 (p < 0.05). In contrast, a comparison of right TV values identified no significant differences among the groups (p = 0.918). A varicocelectomy should be performed for patients with a grade 2 and 3 varicocele for ameliorating testicular function.

Transfer learning promotes acquisition of individual BCI skills.

Subject training is crucial for acquiring brain-computer interface (BCI) control. Typically, this requires collecting user-specific calibration data due to high inter-subject neural variability that limits the usability of generic decoders. However, calibration is cumbersome and may produce inadequate data for building decoders, especially with naïve subjects. Here, we show that a decoder trained on the data of a single expert is readily transferrable to inexperienced users via domain adaptation techniques allowing calibration-free BCI training. We introduce two real-time frameworks, (i) Generic Recentering (GR) through unsupervised adaptation and (ii) Personally Assisted Recentering (PAR) that extends GR by employing supervised recalibration of the decoder parameters. We evaluated our frameworks on 18 healthy naïve subjects over five online sessions, who operated a customary synchronous bar task with continuous feedback and a more challenging car racing game with asynchronous control and discrete feedback. We show that along with improved task-oriented BCI performance in both tasks, our frameworks promoted subjects' ability to acquire individual BCI skills, as the initial neurophysiological control features of an expert subject evolved and became subject specific. Furthermore, those features were task-specific and were learned in parallel as participants practiced the two tasks in every session. Contrary to previous findings implying that supervised methods lead to improved online BCI control, we observed that longitudinal training coupled with unsupervised domain matching (GR) achieved similar performance to supervised recalibration (PAR). Therefore, our presented frameworks facilitate calibration-free BCIs and have immediate implications for broader populations-such as patients with neurological pathologies-who might struggle to provide suitable initial calibration data.

On the organization of prosecutorial and supervisory support for the implementation of the national project “Ecological Well-Being”

The author examines the relations between the Prosecutor's Office of the Russian Federation and supervisory support in the field of implementation of a national project in the field of ecology. The subject of the research is the practice of the prosecutor's offices of the constituent entities of the Russian Federation and the Prosecutor General's Office of the Russian Federation, the case law of the Supreme Court of the Russian Federation, the legislation of the Russian Federation and organizational and administrative documents of the Prosecutor General of the Russian Federation, the works of scientists related to the topic of research. The methodological basis of the research includes the dialectical method; system method; methods of analysis, synthesis, analogy, deduction, induction, observation, modeling, historical, comparative legal, statistical and other methods. The author examines the organization of supervisory support for national projects, in particular, the problems that arise during work with sources of information about violations of laws, the organization of systemic information interaction with the objects being inspected, the distribution of responsibilities among prosecutors, the formation of departmental reporting, interaction with specialists (experts) during inspections, as well as during inspections at various stages of implementation of national projects. The work classifies typical violations and analyzes specific examples at various stages of national project implementation, such as: organizing and conducting procurement; implementation of government contracts; payment of government contracts and other expenditure of budget funds; organization and implementation of subsequent maintenance of purchased equipment and constructed facilities. The author also substantiates the need to create a single expert institution in the Russian Federation.

N32 Implementation of chromoendoscopy in colorectal cancer screening in patients with Inflammatory Bowel Disease

Abstract Background Patients with inflammatory bowel disease (IBD) have a higher risk of colorectal cancer (CRC), so we must implement the best available endoscopic technique to detect it early, decreasing the risk of CRC and death. There is low adherence to CRC screening by chromoendoscopy with dye in patients with IBD, despite the fact that national and international clinical practice guidelines consider this technique of choice based on the available evidence. Description Of The Initiative The standardization of a screening procedure, based on the evidence of endoscopy, allows any member of the team, doctor or nurse, to detect the need for the indication, improving screening in terms of follow-up interval and technique. Likewise, the inflammatory nurse will have to know the technique to be able to inform the patient and improve their adherence, preparation and resolve doubts. The main aim is early detection of dysplasia and CRC. The side aims are: ▪ To improve the implementation of chromoendoscopy as a technique for CRC screening. ▪ Improve patient adherence to colonoscopy. Methods The development of an endoscopic follow-up procedure according to risk factors in patients with ulcerative colitis and colonic Crohn's disease, in which chromoendoscopy is the technique of choice. The technique in our center is with 0.4% carmine indigo diffusion with catheter-diffuser, but it is possible to adapt other alternatives according to availability. The procedure establishes the follow-up interval at 1, 3 or 5 years depending on the low, medium or high risk, respectively, depending on the activity, extent and duration of the disease, presence of stenosis and pseudopolyps, primary sclerosing cholangitis and/or family history of CRC. Results In our center, 100% of screenings are performed by chromoendoscopy with dye, by a single expert endoscopist, scheduled with a longer examination time than a conventional colonoscopy and with optimization of bowel preparation. Conclusion CRC screening of patients with IBD should preferably be performed with chromoendoscopy with dye, establishing follow-up intervals depending on known risk factors, both clinical, endoscopic and histological, and this indication should be standardized in a procedure that is known to all members of the team.