Traditional Examination Methods Research Articles

Multisensory Extended Reality Applications Offer Benefits for Volumetric Biomedical Image Analysis in Research and Medicine.

3D data from high-resolution volumetric imaging is a central resource for diagnosis and treatment in modern medicine. While the fast development of AI enhances imaging and analysis, commonly used visualization methods lag far behind. Recent research used extended reality (XR) for perceiving 3D images with visual depth perception and touch but used restrictive haptic devices. While unrestricted touch benefits volumetric data examination, implementing natural haptic interaction with XR is challenging. The research question is whether a multisensory XR application with intuitive haptic interaction adds value and should be pursued. In a study, 24 experts for biomedical images in research and medicine explored 3D medical shapes with 3 applications: a multisensory virtual reality (VR) prototype using haptic gloves, a simple VR prototype using controllers, and a standard PC application. Results of standardized questionnaires showed no significant differences between all application types regarding usability and no significant difference between both VR applications regarding presence. Participants agreed to statements that VR visualizations provide better depth information, using the hands instead of controllers simplifies data exploration, the multisensory VR prototype allows intuitive data exploration, and it is beneficial over traditional data examination methods. While most participants mentioned manual interaction as the best aspect, they also found it the most improvable. We conclude that a multisensory XR application with improved manual interaction adds value for volumetric biomedical data examination. We will proceed with our open-source research project ISH3DE(Intuitive Stereoptic Haptic 3D Data Exploration) to serve medical education, therapeutic decisions, surgery preparations, or research data analysis.

A Label-Free Colorimetric AuNP-Aptasensor for the Rapid Detection of Vibrio cholerae O139.

Waterborne pathogens pose a significant threat to public health, emphasizing the continuous necessity for advancing robust detection techniques, particularly in preventing outbreaks associated with these pathogens. This study focuses on cholera, an infectious disease caused by Vibrio cholerae, serogroups O1 and O139, often transmitted through contaminated water and food, raising significant public health concerns in areas with poor sanitation and limited access to clean water. We developed a colorimetric biosensor using aptamer-functionalized gold nanoparticles to identify Vibrio cholerae O139 and address this issue. The detection mechanism relies on the color change of gold nanoparticles (AuNPs) from red to blue-purple induced by NaCl after the pathogen incubation and aptamer-target binding. Initial steps involved synthesizing and characterizing AuNPs, then exploring the impact of aptamer and NaCl concentrations on AuNP agglomeration. Optimization procedures for aptamer concentration and salt addition identified the optimal conditions for detection as 120 pM aptamers and 1 M NaCl. The aptasensor demonstrated a robust linear relationship, detecting V. cholerae concentrations from 103 to 108 CFU/mL, with a limit of detection (LOD) of 587 CFU/mL. Specificity tests and accurate sample analyses confirmed the efficiency of the AuNPs aptasensor, showcasing its reliability and speed compared to traditional culture examination methods. Moreover, we extended the aptasensor to a paper-based sensing platform with similar detection principles. The change in color upon target binding was captured with a smartphone and analyzed using image processing software. The paper-based device detected the target in less than 2 min, demonstrating its convenience for on-field applications.

A New Approach for Organizing Online Examination

The “Examination Form” research paper explores the transformative potential of digital technology in reshaping the landscape of educational assessments. This paper delves into the development and implementation of an online examination system that aims to streamline the process of conducting exams, thereby enhancing efficiency and integrity in educational institutions. The online examination system provides a platform for educators to create, manage, and grade exams with ease, accommodating various question types such as multiple-choice, short-answer, and essay questions. It offers students the flexibility to take exams from any location, ensuring a user-friendly and secure examination experience. The system incorporates robust security measures to maintain the integrity of the examination process and prevent unauthorized access. The paper further discusses how real-time analytics provided by the system can aid administrators in tracking performance trends and identifying areas for improvement. These insights can contribute to refining teaching methodologies in education. The “Examination Form” research paper underscores the pivotal role of digital innovation in bridging the gap between traditional examination methods and the evolving needs of the modern educational ecosystem. It highlights how such a system can alleviate administrative burdens, promote academic integrity, and provide valuable pedagogical insights. This research contributes to the ongoing discourse on digital transformation in education, particularly in the realm of assessment systems.

ЭФФЕКТИВНОСТЬ ПРИМЕНЕНИЯ АУТОФЛУОРЕСЦЕНТНОЙ СТОМАТОСКОПИИ КАК ОСНОВНОГО МЕТОДА РАННЕЙ ДИАГНОСТИКИ ПРЕДРАКОВЫХ ЗАБОЛЕВАНИЙ СЛИЗИСТОЙ ОБОЛОЧКИ РТА (ОБЗОР ЛИТЕРАТУРЫ)

Importance Currently, the prevalence of various diseases of the oral mucosa in the world has increased significantly (from 15.2% to 49.1%). Oncological pathology should be attributed to a separate group of diseases. In order to actively identify precancerous processes of the oral cavity, along with traditional methods of examination of the maxillofacial region, oncoscreening of the mucous membrane and organs of the oral cavity is mandatory. One of the possible methods of oncoscreening is autofluorescence stomatoscopy. Objectives To clarify the effectiveness of autofluorescence stomatoscopy as the main method of early diagnosis of precancerous diseases of the oral mucosa, its advantages and disadvantages. Methods In the process of investigating the effectiveness of autofluorescence stomatoscopy, methods of qualitative analysis and synthesis of available scientific literature on autofluorescence stomatoscopy were used. Conclusions It is concluded that the use of autofluorescence stomatoscopy for the early diagnosis of precancerous diseases of the oral mucosa remains controversial. Some clinicians believe that the introduction of autofluorescence stomatoscopy into the practice of a dentist as an additional method of oncoscreening of the oral mucosa is not only relevant, but also necessary; and the analysis of the light glow corresponds to the results of a biopsy. However, other researchers have concluded that the AFS-method will not replace the gold standard of histological examination, due to the low specificity of the method, the study can lead to overdiagnosis, and it can only be used by experienced clinicians to find the boundaries of precancerous lesions of the oral cavity for taking a biopsy in an altered mucous membrane.

Evaluation of the implementation of the objective structured clinical examination in health sciences education from a low-income context in Tunisia: A cross-sectional study.

Objective structured clinical examination (OSCE) is well-established and designed to evaluate students' clinical competence and practical skills in a standardized and objective manner. While OSCEs are widespread in higher-income countries, their implementation in low-resource settings presents unique challenges that warrant further investigation. This study aims to evaluate the perception of the health sciences students and their educators regarding deploying OSCEs within the School of Health Sciences and Techniques of Sousse (SHSTS) in Tunisia and their efficacity in healthcare education compared to traditional practical examination methods. This cross-sectional study was conducted in June 2022, focusing on final-year Health Sciences students at the SHSTS in Tunisia. The study participants were students and their educators involved in the OSCEs from June 6th to June 11th, 2022. Anonymous paper-based 5-point Likert scale satisfaction surveys were distributed to the students and their educators, with a separate set of questions for each. Spearman, Mann-Whitney U and Krusakll-Wallis tests were utilized to test the differences in satisfaction with the OSCEs among the students and educators. The Wilcoxon Rank test was utilized to examine the differences in students' assessment scores in the OSCEs and the traditional practical examination methods. The satisfaction scores were high among health sciences educators and above average for students, with means of 3.82 ± 1.29 and 3.15 ± 0.56, respectively. The bivariate and multivariate analyzes indicated a significant difference in the satisfaction between the students' specialities. Further, a significant difference in their assessment scores distribution in the practical examinations and OSCEs was also demonstrated, with better performance in the OSCEs. Our study provides evidence of the relatively high level of satisfaction with the OSCEs and better performance compared to the traditional practical examinations. These findings advocate for the efficacy of OSCEs in low-income countries and the need to sustain them.

Modified Adaptive CNN for Deep Learning based Histopathological Image Analysis for Cancer Diagnosis

This research on cancer diagnosis is motivated by the need for more accurate and efficient diagnostic tools in the field of oncology. Traditional methods of histopathological examination are time-consuming and can be subject to human error. The adoption of deep learning techniques, particularly Convolutional Neural Networks (CNNs), presents an opportunity to significantly improve the precision and speed of cancer diagnosis through automated analysis of tissue samples. This research addresses current challenges, including variability in samples and limited dataset diversity, with the goal of enhancing the reliability and applicability of the developed models. The ultimate aim is to contribute to the advancement of diagnostic methodologies, providing clinicians with more reliable tools for early and accurate cancer detection and ultimately improving patient outcomes and treatment strategies. Using a modified adaptive CNN algorithm, trained on extensive pathology image datasets, the approach enhances the precision and speed of cancer cell detection in tissue samples. By utilizing these artificial intelligence tools, the diagnostic process becomes not only more accurate but also significantly expeditious. Despite the promising strides, certain challenges persist. Variability in tissue samples, limited availability of diverse datasets, and interpretability of deep learning models pose hurdles to widespread adoption. To address these challenges, this research focuses on developing robust models that can generalize well across diverse datasets. Additionally, efforts are being made to create more comprehensive and diverse datasets to improve model training. Results show accuracy exceeding 97%, sensitivity and specificity at 97% and 95%, F1 score reaching 96%, and precision at 96%.

Modified Adaptive CNN for Deep Learning based Histopathological Image Analysis for Cancer Diagnosis

This research on cancer diagnosis is motivated by the need for more accurate and efficient diagnostic tools in the field of oncology. Traditional methods of histopathological examination are time-consuming and can be subject to human error. The adoption of deep learning techniques, particularly Convolutional Neural Networks (CNNs), presents an opportunity to significantly improve the precision and speed of cancer diagnosis through automated analysis of tissue samples. This research addresses current challenges, including variability in samples and limited dataset diversity, with the goal of enhancing the reliability and applicability of the developed models. The ultimate aim is to contribute to the advancement of diagnostic methodologies, providing clinicians with more reliable tools for early and accurate cancer detection and ultimately improving patient outcomes and treatment strategies. Using a modified adaptive CNN algorithm, trained on extensive pathology image datasets, the approach enhances the precision and speed of cancer cell detection in tissue samples. By utilizing these artificial intelligence tools, the diagnostic process becomes not only more accurate but also significantly expeditious. Despite the promising strides, certain challenges persist. Variability in tissue samples, limited availability of diverse datasets, and interpretability of deep learning models pose hurdles to widespread adoption. To address these challenges, this research focuses on developing robust models that can generalize well across diverse datasets. Additionally, efforts are being made to create more comprehensive and diverse datasets to improve model training. Results show accuracy exceeding 97%, sensitivity and specificity at 97% and 95%, F1 score reaching 96%, and precision at 96%.

Momentum informed muon scattering tomography for monitoring spent nuclear fuels in dry storage cask

Development of an effective monitoring method for spent nuclear fuel (SNF) in a dry storage cask (DSC) is important to meet the increasing demand for dry storage investigations. The DSC investigation should provide information about the quantity of stored SNF, and quality assurance of materials should be possible without opening the cask. However, traditional nondestructive examination (NDE) methods such as x-rays are difficult to deploy for DSC investigation because a typical DSC is intentionally designed to shield against radiation. To address this challenge, cosmic ray muons (CRMs) are used as an alternative NDE radiation probe because they can easily penetrate an entire DSC system; however, a wide application of muons is often hindered due to the naturally low CRM flux (~104 muons/m2/min). This paper introduces a newly proposed imaging algorithm, momentum-informed muon scattering tomography (MMST), and presents how a limitation of the current muon scattering tomography technique has been addressed by measuring muon momentum. To demonstrate its functionality, a commercial DSC with 24 pressurized light water reactor fuel assemblies (FAs) and the MMST system were designed in GEANT4. Three noticeable improvements were observed for MMST system as a DSC investigation tool: (1) a signal stabilization, (2) an enhanced capability to differentiate various materials, and (3) statistically increased precision to identify and locate missing FAs. The results show that MMST improves the investigation accuracy from 79 to 98% when one FA is missing and 51% to 88% when one-half FA is missing. The advancement of the NDE technique using CRM for DSC verification is expected to resolve long-standing problems in increasing demand for DSC inspections and nuclear security.

Assessing the Accuracy and Reliability of Cone-Beam Computed Tomography (CBCT) in Diagnosing Grade II and III Furcation Involvement Compared to Traditional Clinical Examination Methods.

Introduction Chronic periodontal diseases can lead to bone defects and tooth loss, making accurate diagnosis essential for treatment. Various methods are used for diagnosing furcation involvement, with clinical examination and cone-beam computed tomography (CBCT) being the most effective. CBCTproduces reliable images with submillimeter resolution, revealing marginal bone contours and furcation defects. Limited studies show that CBCTis more precise than clinical detection for diagnosing furcation involvement. Therefore, CBCTtechnology can be considered as an adjunct method for furcation involvement detection. This study tests the accuracy and efficiency of CBCTand clinical examination in detecting furcation involvement. Material and methods The study included 25 patients (68 molars) with generalized periodontitis of stage II to IV, Grade B and C. Inclusion criteria required at least two intrabony defects with probing depth > 6mm in both jaws and criteria of periodontitis in at least 30% of the teeth present. Results The study compared clinical examination and CBCTreadings for measuring maxillary and mandibular teeth furcation involvement. The results show significant differences between clinical and CBCT measurements of maxillary teeth furcation involvement, particularly in specific areas and types of furcation involvement. In contrast, there were significant differences between clinical and CBCTreadings for only a few measurements of mandibular teeth furcation involvement. Therefore, the study suggests that CBCTimaging may be beneficial for accurate diagnosis and treatment planning in cases of furcation involvement in maxillary teeth. Conclusion CBCTimaging is a reliable adjunct method for detecting furcation involvement in maxillary teeth, while clinical examination alone may not be sufficient. Therefore, the use of CBCTtechnology should be considered in cases where accurate detection of furcation involvement is necessary for successful treatment outcomes. However, further studies with larger sample sizes are needed to confirm these findings.

Al-Based Detection of Dental Caries: Comparative Analysis with Clinical Examination

ABSTRACT Dental caries pose a significant public health concern, affecting a vast population globally. Traditional clinical examination methods, although reliable, can be subject to human error and time-consuming. Artificial intelligence (AI) technologies have emerged as promising tools to enhance diagnostic accuracy and efficiency. This study explores the potential of AI in revolutionizing dental caries detection. Materials and Methods: A cohort of 50 patients with varying degrees of dental caries participated in this comparative analysis. Clinical examination by dental professionals served as the gold standard for caries detection. AI algorithms were trained using dental images, and their performance was evaluated against the clinical examination results. Results: The AI-based detection system demonstrated a sensitivity of 92% and a specificity of 85% in identifying dental caries, with an overall accuracy of 88%. The clinical examination yielded a sensitivity of 86% and a specificity of 90%, resulting in an overall accuracy of 88%. Statistical analysis indicated no significant difference between AI-based detection and clinical examination (P > 0.05). Conclusion: AI technology exhibits promise as an adjunctive tool for dental practitioners, potentially reducing diagnostic errors and improving efficiency. Integrating AI into routine dental practice may aid in early caries detection and promote better oral health outcomes.

Diagnostic criteria of death cause from low temperature in air and water established by traditional expert examination methods

To clarify and supplement the complex of differential diagnostic macro- and microscopic signs of a fatal acute general cold trauma received when person is in the air and water. The conclusions of forensic medical experts on the bodies of people who died from hypothermia in the air and in water (by 150 observations) were analyzed. Methods of descriptive statistics, calculation of the frequency ratio of signs' occurrence were used. The article provides quantitative assessment of occurrence (detection) rate of diagnostically significant signs established with the help of traditional methods of expert examination. A new classification of diagnostic death signs from hypothermia taking into account their differential diagnostic significance and reflecting the conditions of a person's stay in the air and water in the pre-mortem and post-mortem periods, as well as terminal period mechanisms is proposed. The established complexes of signs provide an objective basis for determining death cause in non-obvious conditions when cold exposure is expected to be one of the most damaging factors.

APPLICATION OF MINI-INVASIVE ECHO-CONTROLLED PERCUTANEOUS INTERVENTIONS IN PATIENTS WITH A COMPLICATED COURSE OF ACUTE PANCREATITIS

Background. Mini-invasive percutaneous echo-controlled puncture drainage interventions have certain limitations in case of location of local complications of acute pancreatitis of the right and central-right type due to the high risk of iatrogenic injuries as a result of possible uncontrolled advancement of the working part of the device.
 Aim: to improve the results of surgical treatment of patients with acute pancreatitis through the introduction of improved techniques of miniinvasive percutaneous echo-controlled interventions in complicated course of the disease.
 Materials and methods. The study was based on the results of examination of 187 patients with severe acute pancreatitis, who were divided into two groups: a comparison group – patients who used traditional methods of examination and treatment (n=92) and the main group – patients who used improved surgical tactics (n =95). To assess the effectiveness of surgical tactics in the studied groups, a comparative analysis of the applied methods, the frequency of postoperative complications, mortality, and the duration of hospitalization was carried out.
 Results. The introduction of improved miniinvasive percutaneous echo-controlled surgical interventions expanded the possibilities of their use, including in the localization of infected local complications of the right and central-right type, and probably increased their effectiveness by 41.8% (p=0.02). A comparative analysis of the duration of inpatient treatment in the studied groups revealed a probable reduction in the terms of hospitalization of patients in the main group by 14.7 days (р=0.0008), of which in the intensive care unit – by 4.7 days (р<0.0001).
 Conclusion. The use of improved methods of diagnosis and treatment in patients of the main group made it possible to reliably reduce the frequency of postoperative complications by 28% (p=0.003) and overall postoperative mortality by 27.7% (p=0.005).

High frequency acoustic microscopy imaging of pellet cladding interface in nuclear fuel rods

In Pressurized Water Reactors (PWRs), fuel rods play a crucial role in generating nuclear energy. These rods consist of ceramic pellets, such as UO2 or (U,Pu)O2, enclosed in a zircaloy cladding tube, leaving an initial gap between the pellets and the cladding. As the reactor operates and the fuel undergoes irradiation, both the ceramic pellets and the zircaloy cladding experience transformations, causing the gap between them to gradually close. This phenomenon has a significant impact on the thermomechanical behavior of the fuel rod.Understanding the nature of the bonding that occurs during irradiation is essential for ensuring the safe and efficient operation of the reactor. To investigate the evolution of the contact state between the fuel pellets and the cladding during irradiation, a detailed analysis of the pellet-cladding interface after irradiation is necessary. However, traditional examination methods might be destructive or incapable of providing the desired level of precision and resolution.The Institute of Electronic and Systems at the University of Montpellier (IES – UMR CNRS 5214), in collaboration with the Alternative Energies and Atomic Energy Commission (CEA) and Electricité de France (EDF), has developed a specialized high-frequency acoustic microscope for imaging and non-destructively inspecting the pellet/cladding interface. The design of the acoustic microscope takes into account the complexity of the fuel rod's structure and the challenges associated with imaging the pellet/cladding interface by utilizing high-frequency ultrasound.In this paper, we present the ability of this acoustic microscope to acquire 2D images with controlled displacements of the sample rod along both its axial and circumferential directions thanks to a card with a high sampling frequency reaching 2 GHz. This capability is crucial because the geometrical, chemical, and mechanical properties of the fuel pellet-cladding contact are not uniform in these directions. By obtaining detailed acoustic images, we can identify specific regions where the fuel pellets and the cladding were in contact during irradiation. In this research, a resolution study is carried out to validate the microscope's ability to investigate the fuel rod and achieve the desired resolutions.Testing on real samples requires a specific configuration of the microscope, which must be adapted to the irradiation conditions. This is why, before proceeding to this stage, it is necessary to carry out tests on representative samples to validate the achievement of the desired resolution. So we’re also presenting the first acoustic images obtained on the zircaloy alloy claddings.

Automated detection of abnormal respiratory sound from electronic stethoscope and mobile phone using MobileNetV2

Auscultation, a traditional clinical examination method using a stethoscope to quickly assess airway abnormalities, remains valuable due to its real-time, non-invasive, and easy-to-perform nature. Recent advancements in computerized respiratory sound analysis (CRSA) have provided a quantifiable approach for recording, editing, and comparing respiratory sounds, also enabling the training of artificial intelligence models to fully excavate the potential of auscultation. However, existing sound analysis models often require complex computations, leading to prolonged processing times and high calculation and memory requirements. Moreover, the limited diversity and scope of available databases limits reproducibility and robustness, mainly relying on small sample datasets primarily collected from Caucasians. In order to overcome these limitations, we developed a new Chinese adult respiratory sound database, LD-DF RSdb, using an electronic stethoscope and mobile phone. By enrolling 145 participants, 9,584 high quality recordings were collected, containing 6,435 normal sounds, 2,782 crackles, 208 wheezes, and 159 combined sounds. Subsequently, we utilized a lightweight neural network architecture, MobileNetV2, for automated categorization of the four types of respiratory sounds, achieving an appreciable overall performance with an AUC of 0.8923. This study demonstrates the feasibility and potential of using mobile phones, electronic stethoscopes, and MobileNetV2 in CRSA. The proposed method offers a convenient and promising approach to enhance overall respiratory disease management and may help address healthcare resource disparities.

Imaging features of concurrent scirrhous hepatocellular carcinoma and primary clear cell carcinoma of the liver: A case report and literature review

Multiple lesions commonly appear in the liver of patients with hepatocellular carcinoma (HCC), and the prognosis is associated with the subtype. However, simultaneous occurrence of scirrhous HCC (SHCC) and primary clear cell carcinoma of the liver (PCCCL) has not been reported to date. The diagnosis of SHCC and PCCCL is uncommon using the traditional imaging examination methods such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging. We herein summarize the imaging features of SHCC and PCCCL to provide a reference for accurate preoperative diagnosis and appropriate treatment. A 55-year-old male was diagnosed with two hepatic tumors by the US examination. On the 2nd day after the US examination, he was diagnosed with HCC with intrahepatic metastasis by enhanced CT examination. His alpha-fetoprotein level was 3272 ng/mL (reference range, 0–7 ng/mL). Two weeks after enhanced CT examination, the patient underwent hepatectomy and cholecystectomy. Pathological examination showed that the tumor in liver segments 2 and 3 was SHCC and that the tumor in liver segment 4 was PCCCL. One year postoperatively, digital subtraction angiography showed no obvious tumor staining. Five years postoperatively, enhanced CT examination showed no recurrence or metastasis. Radiologists usually diagnose multiple tumors in the liver as malignant tumors with intrahepatic metastasis. Simultaneous occurrence of SHCC and PCCCL in the liver is occasionally found. The US imaging features, CT enhancement types, and location of the tumors can help radiologists to accurately diagnose SHCC and PCCCL, allowing clinicians to choose appropriate treatment.

Assessment of the Chronic Process in the Liver under Study Conditions Using Conventional and in-Depth Laboratory Studies

The presented article describes the work carried out on white rats in an experiment on the occurrence of severe liver pathologies, as in humans. When assessing the pathological process in the liver, in-depth laboratory studies were mainly carried out in combination with traditional examination methods. Thus, in the conducted studies, a substance with hepatotoxic properties of heliotrin, when administered according to a subtoxic dose scheme, caused severe functional and morphological changes in the liver. It was found that the change in normal and deep laboratory blood parameters characterizing inflammatory processes in the liver corresponds to morphological data.

Effect of Nitrendipine and Amlodipine on Cognitive Functions of Patients with Arterial Hypertension

Background: Arterial hypertension (AH) is one of the main factors causing a high risk of cardiovascular complications and mortality. The existence of a relationship between high blood pressure (BP) and the risk of developing central nervous system pathology, primarily stroke, and cognitive impairment, has been shown. The purpose of this study was a comparative assessment of the effect of 12-month antihypertensive therapy (AHT) with the inclusion of nitrendipine (NIT) or amlodipine (AML) on cognitive functions (CF) in hypertensive patients. Methods and Results: The study included 111 patients of both genders aged 30-75 years with AH Grades 1-3 (ESC/ESH, 2018). All patients underwent the following examinations: assessment of traditional risk factors, physical examination, clinical and biochemical laboratory methods, 12-lead ECG, echocardiography, pulse contour analysis, and 24-hour ambulatory blood pressure monitoring, neuropsychological tests (Mini-Cog test, Montreal Cognitive Assessment (MoCA) test, Hospital Anxiety and Depression Scale (HADS), and self-assessment questionnaire for memory, attention, thinking, ability to cope with one's affairs, and ability to make decisions). After the screening stage, all patients were discontinued from previous therapy and assigned to the 2 regimes of AHT. Group 1 included 58 AH patients who received NIT as monotherapy or as part of combination AHT; Group 2 included 53 patients who received AML as monotherapy or as part of combination AHT. Correlation analysis between the parameters of DBPP and the MoCA test revealed a weak but statistically significant negative correlation between the total MoCA score and the average 24-h SBP (rs=-0.33, P=0.015). In addition, there was a weak but statistically significant negative correlation between the total MoCA score and the daytime SBP variability and daytime DBP variability (rs=-0.40 and rs=-0.35, respectively, P=0.000 in both cases). A weak but statistically significant negative correlation was found between the total Mini-Cog score and PWV and PPc (rs=-0.24, P=0.01 and rs=-0.27, P=0.007, respectively). Analysis of the office BP indicators showed high antihypertensive efficacy of 12-month therapy in both groups, regardless of the therapy regimens. A comparative analysis of the effect of AHT with the inclusion of NIT or AML on CF in AH patients showed the advantages of combined AHT with the inclusion of NIT. Amlodipine treatment did not significantly affect any test score. Thus, in Group 1, after 12 months of therapy, there was an increase in the total Mini-Cog score from 3.8±1.08 points to 4.55±0.75 points (P<0.001), while in Group 2, there was a non-significant decrease in this score from 4.26±0.98 points to 3.92±0.95 points (P>0.05). There was also an increase in the total MoCA score in Group 1 from 23.3±2.8 points to 25.08±2.6 points (P<0.001), while in Group 2, there was a non-significant decrease in this score from 24.06±2.73 points to 23.07±2.7 points (P>0.05). It should be noted that only in Group 1 did we find a significant improvement in CF, such as abstraction, delayed recall, memory, and attention, as well as a significant improvement in work-coping and decision-making. In Group 1, the HADS Depression score decreased from 4.6±3.7 points to 3.32±2.95 points (P<0.05), HADS Anxiety score decreased from 7.01±5.37 points to 4.95±3.75 points (P<0.02). At the same time, in Group 2, in contrast, the HADS Depression score and the HADS Anxiety score did not significantly change. Conclusion: A weak but statistically significant negative correlation was found between the total MoCA score and the daytime SBP/DBP variability in AH patients. A weak but statistically significant negative correlation was found between the total Mini-Cog score and pulse wave velocity and central pulse pressure. A pronounced antihypertensive efficacy of 12-month combination therapy was noted, with the inclusion of both NIT and AML. The NIT-based treatment contributed to a significant increase in the total Mini-Cog score and the total MoCA score and a substantial improvement in CF. Abstraction, delayed recall, memory, attention, work-coping, and decision-making significantly improved, compared to AML-based treatment. The presented data allow a differentiated approach to tactics for treating AH patients with severe cognitive impairment.

Point-of-Care Ultrasound in Airway Evaluation and Management: A Comprehensive Review.

Airway management is a common and critical procedure in acute settings, such as the Emergency Department (ED) or Intensive Care Unit (ICU) of hospitals. Many of the traditional physical examination methods have limitations in airway assessment. Point-of-care ultrasound (POCUS) has emerged as a promising tool for airway management due to its familiarity, accessibility, safety, and non-invasive nature. It can assist physicians in identifying relevant anatomy of the upper airway with objective measurements of airway parameters, and it can guide airway interventions with dynamic real-time images. To date, ultrasound has been considered highly accurate for assessment of the difficult airway, confirmation of proper endotracheal intubation, prediction of post-extubation laryngeal edema, and preparation for cricothyrotomy by identifying the cricothyroid membrane. This review aims to provide a comprehensive overview of the key evidence on the use of ultrasound in airway management. Databases including PubMed and Embase were systematically searched. A search strategy using a combination of the term "ultrasound" combined with several search terms, i.e., "probe", "anatomy", "difficult airway", "endotracheal intubation", "laryngeal edema", and "cricothyrotomy" was performed. In conclusion, POCUS is a valuable tool with multiple applications ranging from pre- and post-intubation management. Clinicians should consider using POCUS in conjunction with traditional exam techniques to manage the airway more efficiently in the acute setting.

The Use Of Specific Expertise While Research On Documents Made In The Form Of Plastic Cards

Abstract. The article highlights issues related to the rising circulation of documents made on the basis of plastic cards in Ukraine and the increase in offenses involving their use. Timely application of specific expertise, the necessity of which is determined by the specificity of the objects, is of particular importance in the investigation of offenses characterized by forgery of plastic cards. Supplementing the methodology for plastic card research using specific expertise should be used in combination with possibilities of traditional forensic examination.
 The article covers questioned document examination that is most often used in proceedings in which research objects are forged plastic cards. Emphasis is made on the characteristics of plastic cards and their protection against forgery as the main research objects. It is emphasized that means of card security, often referred to as security elements, include the following: graphic record, embossing, barcodes, magnetic stripe coding, chip, and laser recording.
 The analysis of forensic examinations conducted during the pre-trial proceedings concerning forged vehicle registration certificates and driver’s licenses is provided. The article details peculiarities of forgery production and stresses issues that cannot be solved with the help of traditional forensic examination methods. The application of specific expertise is possible within advisory activities concerning identification of potential violations involving forged plastic cards.
 The author has concluded that there is a need to conduct multidisciplinary expert research on plastic cards. This research would determine: whether the card submitted for study has been forged and how the forgery has been executed; whether the card has been produced by the issuing enterprise; and whether the examined card has been made from the same materials and on the same technological equipment as other cards from the same batch, etc.
 Diverse methods of committing violations using plastic cards, use of modern technical means by the offenders, and the insufficient informational support of investigators and forensic experts during a pre-trial proceeding lead to low effectiveness in revealing such types of offences.

Assessment of the Methods of Testing Clinical Competence of Nursing Students in Nigeria

The study assessed the Objective Structured Clinical Examination (OSCE) and Traditional Practical Examination (TPE) methods of testing Nursing Students’ Clinical competence in Nigeria by examining the strengths and weaknesses of OSCE and TPE as perceived by Nurse Educators and Nursing Students in Osun State, Nigeria. Descriptive research design of the survey type was used in the study. The population of the study comprised Seven Hundred and Fifteen (715) Nursing Students and Seventy-Five (75) Nurse Educators in Private and Public Nursing Institutions in Osun State, Nigeria. A sample of Three Hundred and Eighteen (318) participants was used which consisted of Two Hundred and Eighty-Eight (288) Nursing Students and Thirty (30) Nurse Educators drawn from Public and Private Nursing Institutions in Osun State, Nigeria using a multi-stage sampling procedure. Two research instruments were used to collect data for the study which were: Questionnaire on Students’ Assessment (QSA) administered to the students, and Questionnaires on Teachers’ Assessment (QTA) administered to the Nurse Educators. Validity of the instruments was ensured using expert judgment while the reliability of the instruments was estimated using the Cronbach Alpha reliability method. The reliability coefficients of QSA and QTA were 0.87 and 0.84 respectively. Two Research questions were raised, and two hypotheses were formulated for the study. Frequency counts and percentages were used to answer the research questions while the hypotheses were tested using a student’s t-test at 0.05 level of significance. The findings of the study indicated that the students perceived that OSCE has more strengths than TPE while Nursing Educators were of the view that the two methods complement each other. Based on the findings of the study, it is concluded that each of the methods has its weaknesses and strengths, and therefore, it is recommended that the two methods should be jointly used in training and testing Nursing students’ clinical competence in Nigeria.