Visual Score Research Articles

Artificial intelligence-driven volumetric CT outcome score in cystic fibrosis: longitudinal and multicenter validation with/without modulators treatment.

Holistic segmentation of CT structural alterations with 3D deep learning has recently been described in cystic fibrosis (CF), allowing the measurement of normalized volumes of airway abnormalities (NOVAA-CT) as an automated quantitative outcome. Clinical validations are needed, including longitudinal and multicenter evaluations. The validation study was retrospective between 2010 and 2023. CF patients undergoing Elexacaftor/Tezacaftor/Ivacaftor (ETI) or corticosteroids for allergic broncho-pulmonary aspergillosis (ABPA) composed the monocenter ETI and ABPA groups, respectively. Patients from six geographically distinct institutions composed a multicenter external group. All patients had completed CT and pulmonary function test (PFT), with a second assessment at 1 year in case of ETI or ABPA treatment. NOVAA-CT quantified bronchiectasis, peribronchial thickening, bronchial mucus, bronchiolar mucus, collapse/consolidation, and their overall total abnormal volume (TAV). Two observers evaluated the visual Bhalla score. A total of 139 CF patients (median age, 15 years [interquartile range: 13-25]) were evaluated. All correlations between NOVAA-CT to both PFT and Bhalla score were significant in the ETI (n = 60), ABPA (n = 20), and External groups (n = 59), such as the normalized TAV (ρ ≥ 0.76; p < 0.001). In both ETI and ABPA groups, there were significant longitudinal improvements in peribronchial thickening, bronchial mucus, bronchiolar mucus and collapse/consolidation (p ≤ 0.001). An additional reversibility in bronchiectasis volume was quantified with ETI (p < 0.001). Intraclass correlation coefficient of reproducibility was > 0.99. NOVAA-CT automated scoring demonstrates validity, reliability and responsiveness for monitoring CF severity over an entire lung and quantifies therapeutic effects on lung structure at CT, such as the volumetric reversibility of airway abnormalities with ETI. Normalized volume of airway abnormalities at CT automated 3D outcome enables objective, reproducible, and holistic monitoring of cystic fibrosis severity over an entire lung for management and endpoints during therapeutic trials. Visual scoring methods lack sensitivity and reproducibility to assess longitudinal bronchial changes in cystic fibrosis (CF). AI-driven volumetric CT scoring correlates longitudinally to disease severity and reliably improves with Elexacaftor/Tezacaftor/Ivacaftor or corticosteroid treatments. AI-driven volumetric CT scoring enables reproducible monitoring of lung disease severity in CF and quantifies longitudinal structural therapeutic effects.

Comparison of the modified Mallampati classification score versus the best visible Mallampati score in the prediction of difficult tracheal intubation: a single-centre prospective observational study.

The modified Mallampati classification is part of the preoperative airway risk assessment. Inconsistency in the way it is examined may contribute to heterogeneity in its diagnostic performance. The best visible Mallampati score could reduce interobserver heterogeneity but its diagnostic characteristics remain unknown. During preoperative anesthesia consultation of adult patients with a senior anesthesiologist, we compared the modified Mallampati classification score vs the best visible Mallampati score using cervical extension, tongue in, and phonation. The primary outcome was the diagnostic characteristic of the modified Mallampati classification score vs the best visible Mallampati score as predictors of difficult orotracheal intubation (more than two direct laryngoscopies or need for an alternate device). We performed a multivariable analysis to identify independent predictors of difficult orotracheal intubation in the tested cohort. Difficult orotracheal intubation occurred in 77/3,243 (2.4%) patients. A best visible Mallampati score was obtained in 1,596 (49.2%) patients. Sensitivity and specificity of the modified Mallampati classification score for predicting difficult orotracheal intubation were 0.56 (95% confidence interval [CI], 0.44 to 0.66) and 0.69 (95% CI, 0.68 to 0.71), respectively. By comparison, the best visible Mallampati score was less sensitive (difference, -0.30; 95% CI, -0.19 to -0.30; P < 0.001) but more specific (difference, 0.24; 95% CI, 0.22 to -0.25; P < 0.001). In patients with difficult orotracheal intubation, 53% were incorrectly reclassified as low risk by the best visible Mallampati score. Compared with the modified Mallampati classification score, the best visible Mallampati score decreased sensitivity for predicting difficult orotracheal intubation and falsely classified half of the patients with difficult orotracheal intubation. Taking the risks associated with difficult airways into account, our findings indicate that a careful examination of the modified Mallampati classification is required during the global preoperative airway examination. ClinicalTrials.gov ( NCT02788253 ); 9 February 2016.

Genetic Dissection of ToLCNDV Resistance in Resistant Sources of Cucumis melo.

Tomato leaf curl New Delhi virus (ToLCNDV) is a begomovirus causing significant melon (Cucumis melo) crop losses globally. This study aims to map the ToLCNDV resistance in the PI 414723 melon accession, previously identified and characterized through phenotypic studies, thereby exploring shared genomic regions with the established resistant source WM-7. In the present study, WM-7 and PI 414723 were crossed with the susceptible accessions 'Rochet' and 'Blanco' respectively, to generate F1 hybrids. These hybrids were self-pollinated to generate the populations for mapping the ToLCNDV resistance region and designing markers for marker-assisted selection. Disease evaluation included visual symptom scoring, viral-load quantification and tissue printing. Genotyping-by-sequencing and SNP markers were used for quantitative trait loci (QTL) mapping. For genetic analysis, qPCR and bulked segregant RNA-seq (BSR-seq) were performed. Gene expression was assessed using RNA-seq, and qRT-PCR was used for confirmation. The research narrows the candidate region for resistance in WM-7 and identifies overlapping QTLs on chromosome 11 in PI 414723, found in the region of the DNA primase large subunit. BSR-seq and expression analyses highlight potential regulatory roles of chromosome 2 in conferring resistance. Differential expression was confirmed for six genes in the candidate region on chromosome 2. This study confirms the existence of common resistance genes in PI 414723 and WM-7.

The effects of telemedicine on Rotator cuff-related shoulder function and pain symptoms: a meta-analysis of randomized clinical trials

BackgroundThe effectiveness of telemedicine in aiding rehabilitation exercises among patients with rotator cuff (RC) disorders remains unknown. Therefore, this meta-analysis aimed to assess the effectiveness of telemedicine in patients with RC disorders.MethodsRandomized clinical trials (RCTs) on the effectiveness of telemedicine in patients with RC disorders were summarized through a meta-analysis. A systematic search for these RCTs was conducted in PubMed, Cochrane, Embase, and Web of Science databases up to July 2024. Statistical analysis was performed using Stata 16. Publication bias was estimated with the funnel plot and Egger’s test.ResultsTen studies involving 497 participants (telemedicine group = 248 and conventional group = 249) were enrolled, with follow-up durations ranging from 8 weeks to 48 weeks. Functional outcomes measured by the Constant-Murley score were markedly improved after treatment in the telemedicine group compared to the conventional group. Moreover, compared to conventional treatment, telemedicine significantly improved shoulder function evaluated by Quick Disabilities of the Arm, Shoulder, and Hand Score, relieved pain assessed by visual analog scale pain score, and improved range of motion after treatment and in the final follow-up period.ConclusionTelemedicine has demonstrated potential in alleviating pain and enhancing shoulder function and motion in patients with RC injuries. It may be a feasible intervention for rehabilitation exercises. Further research with a large sample size and standardized treatment is warranted to validate these findings.

Long-term neurodevelopmental outcomes following liver transplantation for metabolic disease-a single centre experience.

This study describes the neurodevelopmental outcome of children with urea cycle disorders (UCD) and organic acidemias (OA) preliver transplant (LT), 1-year, and 3-years post-LT. We performed a retrospective chart review of children with OA or UCD transplanted between January 2014 and December 2021. Standardized motor and cognitive assessment scores were collected from children who had ≥1 motor/cognitive assessment at any timepoint. Pre-LT brain magnetic resonance imaging (MRI) was graded. Associations between demographic/medical variables and neurodevelopmental outcomes were explored. Twenty-six children (64% male) underwent LT at a median age of 1.4 (interquartile range 0.71, 3.84) years. Fifteen (58%) had a UCD diagnosis, 14 (54%) required dialysis for hyperammonemia, and 10 (42%) had seizures typically around diagnosis. The proportion of children with gross motor scores >1 standard deviation (SD) below the mean increased across timepoints, and ≥50% demonstrated general intellect scores >2 SD below the mean at each timepoint. The following significant associations were noted: UCD diagnoses with lower general intellect scores (p = 0.019); arginosuccinate lyase deficiency diagnosis with lower visual motor scores at 3-years post-LT (p = 0.035); a history of seizures pre-LT with lower general intellect (>2SD below the mean) at 3-years post-LT (p = 0.020); dialysis pre-LT with lower motor scores (>1 SD below the mean) at 1-year post-LT (p = 0.039); pre-emptive LT with higher general intellect scores at 3-years post-LT (p = 0.001). MRI gradings were not associated with developmental scores. In our single centre study, children with UCD or OA had a higher prevalence of developmental impairment post-LT compared to population norms. Earlier screening, pre-emptive transplant, and rehabilitation may optimize long-term outcomes.

Explore the safety and efficiency of mild myopia retention in patients with myopia and presbyopia

Objective: To explore the corrective effects of a personalized corneal refractive surgery design that retains mild myopia in patients over 40 years old with refractive errors and presbyopia. Methods: A retrospective case series study was conducted, including 60 patients (120 eyes) over 40 years old who underwent corneal refractive surgery at Peking Union Medical College Hospital l from January 2023 to December 2023. The patients were divided into two groups based on their preference: Group A (retained mild myopia) and Group B (fully corrected), with 30 patients (60 eyes) in each group. Preoperative and postoperative visual acuity, subjective refraction, slit-lamp examination, corneal topography, and intraocular pressure were assessed at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. The effectiveness and safety indices were calculated based on visual acuity before and after surgery. The National Eye Institute Refractive Quality of Life questionnaire was used to evaluate patient satisfaction and postoperative visual symptoms. Results: There were no significant differences in preoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), corneal thickness, and intraocular pressure between the two groups (all P>0.05). At the final follow-up, the proportions of eyes with UDVA≥0.8 and≥1.0 were 93.3% (56/60) and 60.0% (36/60) in Group A, and 100% (60/60) and 83.3% (50/60) in Group B, respectively. The SE was significantly different between Group A [(-0.35±0.52) D] and Group B [(-0.07±0.55) D] (P<0.05). Near visual acuity was better in Group A than in Group B (P<0.05). The effectiveness indices were 0.96±0.23 and 0.99±0.12, and the safety indices were 1.02±0.11 and 1.02±0.07 for Groups A and B, respectively. Both groups had high overall satisfaction, but Group A had higher scores for near vision, reading, and computer screen viewing. Conclusion: The personalized corneal refractive surgery design that retains mild myopia provides good corrective effects for patients over 40 years old with refractive errors, improving patient satisfaction and quality of life.

Synthesizing High b-Value Diffusion-Weighted Imaging of Gastric Cancer Using an Improved Vision Transformer CycleGAN.

Diffusion-weighted imaging (DWI), a pivotal component of multiparametric magnetic resonance imaging (mpMRI), plays a pivotal role in the detection, diagnosis, and evaluation of gastric cancer. Despite its potential, DWI is often marred by substantial anatomical distortions and sensitivity artifacts, which can hinder its practical utility. Presently, enhancing DWI's image quality necessitates reliance on cutting-edge hardware and extended scanning durations. The development of a rapid technique that optimally balances shortened acquisition time with improved image quality would have substantial clinical relevance. This study aims to construct and evaluate the unsupervised learning framework called attention dual contrast vision transformer cyclegan (ADCVCGAN) for enhancing image quality and reducing scanning time in gastric DWI. The ADCVCGAN framework, proposed in this study, employs high b-value DWI (b = 1200 s/mm2) as a reference for generating synthetic b-value DWI (s-DWI) from acquired lower b-value DWI (a-DWI, b = 800 s/mm2). Specifically, ADCVCGAN incorporates an attention mechanism CBAM module into the CycleGAN generator to enhance feature extraction from the input a-DWI in both the channel and spatial dimensions. Subsequently, a vision transformer module, based on the U-net framework, is introduced to refine detailed features, aiming to produce s-DWI with image quality comparable to that of b-DWI. Finally, images from the source domain are added as negative samples to the discriminator, encouraging the discriminator to steer the generator towards synthesizing images distant from the source domain in the latent space, with the goal of generating more realistic s-DWI. The image quality of the s-DWI is quantitatively assessed using metrics such as the peak signal-to-noise ratio (PSNR), structural similarity index (SSIM), feature similarity index (FSIM), mean squared error (MSE), weighted peak signal-to-noise ratio (WPSNR), and weighted mean squared error (WMSE). Subjective evaluations of different DWI images were conducted using the Wilcoxon signed-rank test. The reproducibility and consistency of b-ADC and s-ADC, calculated from b-DWI and s-DWI, respectively, were assessed using the intraclass correlation coefficient (ICC). A statistical significance level of p < 0.05 was considered. The s-DWI generated by the unsupervised learning framework ADCVCGAN scored significantly higher than a-DWI in quantitative metrics such as PSNR, SSIM, FSIM, MSE, WPSNR, and WMSE, with statistical significance (p < 0.001). This performance is comparable to the optimal level achieved by the latest synthetic algorithms. Subjective scores for lesion visibility, image anatomical details, image distortion, and overall image quality were significantly higher for s-DWI and b-DWI compared to a-DWI (p < 0.001). At the same time, there was no significant difference between the scores of s-DWI and b-DWI (p > 0.05). The consistency of b-ADC and s-ADC readings was comparable among different readers (ICC: b-ADC 0.87-0.90; s-ADC 0.88-0.89, respectively). The repeatability of b-ADC and s-ADC readings by the same reader was also comparable (Reader1 ICC: b-ADC 0.85-0.86, s-ADC 0.85-0.93; Reader2 ICC: b-ADC 0.86-0.87, s-ADC 0.89-0.92, respectively). ADCVCGAN shows excellent promise in generating gastric cancer DWI images. It effectively reduces scanning time, improves image quality, and ensures the authenticity of s-DWI images and their s-ADC values, thus providing a basis for assisting clinical decision making.

Deep Inspiration breath Hold facilitates surgical cavity registration on cone beam imaging for Partial breast irradiation

Background and purposeThe quality of the Cone Beam Computed Tomography (CBCT) images used for patient set-up is essential to avoid geographical miss when narrower margins or shorter fractionation are used for example in Accelerated Partial Breast Irradiation (APBI). This study evaluates deep inspiration breath hold (DIBH) with skin guided radiotherapy as a tool for image improvement reducing motion artifacts. Materials and methodsDaily CBCT images of left and right breast cancer patients with well-defined surgical cavity on CT simulation were used for this study. Only left sided CBCT were acquired with DIBH. Trained and experienced radiation therapists were asked to evaluate the image quality using a cavity visualization score (CVS), an image quality Likert score, and to perform registration shifts. Images were anonymized and therapists were blinded to the use of DIBH. ResultsImages from 21 patients, with 15 CBCT each, were evaluated by 6 radiation therapists, generating 4,015 evaluation points. Statistically significant improvements were observed in CVS and image quality (p < 0.001) with DIBH. Also, the rate of surgical cavity identification increased to 76 % with DIBH compared to 56 % without (p < 0.001). DIBH significantly reduced the inter-observer variability in registration shift corrections (p < 0.001) ConclusionUtilizing DIBH for motion control improves both the image quality and the surgical cavity identification. This results in a decrease in registration variability, which is important for APBI accuracy.

Image analysis for bright-field HER2 in situ hybridization: validation for clinical use.

The aim of the present study was to develop and validate a quantitative image analysis (IA) algorithm to aid pathologists in assessing bright-field HER2 in situ hybridization (ISH) tests in solid cancers. A cohort of 80 sequential cases (40 HER2-negative and 40 HER2-positive) were evaluated for HER2 gene amplification with bright-field ISH. We developed an IA algorithm using the ISH Module from HALO software to automatically quantify HER2 and CEP17 copy numbers per cell as well as the HER2/CEP17 ratio. We observed a high correlation of HER2/CEP17 ratio, an average of HER2 and CEP17 copy number per cell between visual and IA quantification (Pearson's correlation coefficient of 0.842, 0.916, and 0.765, respectively). IA was able to count from 124 cells to 47,044 cells (median of 5565 cells). The margin of error for the visual quantification of the HER2/CEP17 ratio and of the average of HER2 copy number per cell decreased from a median of 0.23 to 0.02 and from a median of 0.49 to 0.04, respectively, in IA. Curve estimation regression models showed that a minimum of 469 or 953 invasive cancer cells per case is needed to reach an average margin of error below 0.1 for the HER2/CEP17 ratio or for the average of HER2 copy number per cell, respectively. Lastly, on average, a case took 212.1s to execute the IA, which means that it evaluates about 130 cells/s and requires 6.7s/mm2. The concordance of the IA software with the visual scoring was 95%, with a sensitivity of 90% and a specificity of 100%. All four discordant cases were able to achieve concordant results after the region of interest adjustment. In conclusion, this validation study underscores the usefulness of IA in HER2 ISH testing, displaying excellent concordance with visual scoring and significantly reducing margins of error.

Correlation between the Visual Prostate Symptom Score and International Prostate Symptom Score in Patients with Symptomatic Benign Prostatic Hyperplasia

Background: Benign prostatic hyperplasia affects about 210 million males as of 2010 (6% of the population). BPH is the most common disease of men above 50 years of age. BPH is a major cause of morbidity in the ageing men. Lower urinary tract symptoms, are a collective term for the symptoms of disrupted voiding in males, which has long been associated with BPH. Materials and Methods: Study was descriptive cross-sectional study conducted in Department of Urology, Nobel medical college, Biratnagar, Nepal over a period from January 2022 to December 2022. The entire Patient with visiting urology clinic of the provisionally diagnosed as BEP was enrolled in the study with approval of institutional review committee. Results: We enrolled a cohort of 75 patients who had been diagnosed with BEP. The mean age was 51.31 years. The mean prostate size among these individuals was measured to be 45.63 grams, and their mean Prostate-Specific Antigen level was determined to be 3.57.We observed a moderate positive correlation (r = 0.536) with statistical significance (p &lt; 0.01) between VPSS total and IPSS total. Out of total, 35 (47%) completed VPSS alone without any assistance while filling IPSS only 9 (12%) could complete one. Median time for completing VPSS versus IPSS was 60sec and 300 sec respectively. Conclusion: In assessment of symptom severity visual prostate symptom score is equally effective as International prostate symptom score in cases of benign prostatic hyperplasia presenting with Lower urinary tract symptoms. All parameters of visual prostate symptom score is significantly correlated with International prostate symptom score.

Research on visual experience evaluation of fortress heritage landscape by integrating SBE–SD method and eye movement analysis

Urbanization has led to homogenizing heritage site landscapes, and the protective measures have become disconnected from public needs. Additionally, the complex and diverse overall characteristics of heritage sites and the uneven distribution of values across different areas are related to the lack of landscape experience assessment. The “subjective + objective” cognitive evaluation and visual perception framework that adopts the Scenic Beauty Estimation Procedure-Semantic Differential (SBE–SD) method and eye-tracking analysis can compensate for the limitations of a single evaluation method by integrating quantitative and qualitative analysis. This research takes the Yi’an Fortress in Zhangpu County, Fujian Province, as the object and examines the visual experiences of different areas and types of landscapes within the Yi’an Fortress. The findings reveal several key insights: (1) Significant differences were found in the landscape experiences of different areas within the heritage site. The visual experience score of the core building area of Yi’an Fortress is (1.01) > the heritage entrance area (0.897) > the residential area (0.841) > the natural ecological area (0.784), indicating that the natural ecological area should be the focus of future protection and development efforts, with a particular emphasis on enhancing the ‘landscape aesthetic’ and ‘landscape cultural’ aspects. (2) The landscape experience scores can be used to understand the reasons for the differences in participants’ experiences of different landscapes. The architectural heritage landscape of the Yi’an Fortress scored highest in the experience evaluation due to its superior performance in terms of ‘landscape form’ factors. The cultural decorative landscape scored next, while the garden greening landscape scored the lowest, due to their poorer performance in terms of ‘landscape form’ and ‘landscape aesthetics’. (3) The eye-tracking data was consistent with the results of the subjective evaluation, validating the “subjective + objective” cognitive evaluation and visual perception framework, employing the SBE–SD method and eye-tracking analysis is a scientific and effective method for assessing the visual experience of heritage landscapes. These results provide a scientific basis for the heritage planners and managers of the Yi’an fortress to improve the landscape environment, better meet public needs, and preserve the unique character of this vital cultural resource. Furthermore, this study offers a new research method and approach for the protection of other heritage landscapes.

Ultrasound assessment of short peripheral catheter failure.

Short peripheral catheters (SPCs) are affected by a high complication rate that leads to catheter failure. Currently, the Visual Infusion Phlebitis score (VIP) is the most used tool to verify the presence of inflammatory complications (phlebitis and thrombophlebitis). However, ultrasound signs (US) may be an attractive alternative. This study aims to evaluate the sensitivity and specificity of US and VIP score = 1 in identifying and recognizing early signs of SPC failure. The time to positivity for US and VIP scores was assessed as a secondary outcome. An observational prospective study was conducted. In each patient, US (subcutaneous edema; fibroblastic sleeve; thrombophlebitis) and VIP of the exit site were performed every 24 h until 96 h after insertion. Compared to catheter failure, Sensitivity, Specificity, and Predictive values in both US and VIP were calculated. Two hundred patients were enrolled. The presence of ultrasonic pattern suggestive of edema at 72 h (p = 0.018), fibroblastic sleeve at 24, 48, 72, and 96 h (p < 0.001), thrombosis at 48 (p < 0.001) and 72 h (p = 0.005), and at least one of an abovementioned US at all checkpoints (p < 0.001) were highly significant predictors of complications. Both US and VIP effectively detect inflammatory events; however, the US showed better sensitivity in overall checkpoints and earlier predictive ability than VIP (1.9 vs 0.47 days). An ultrasound inflammatory pattern is correlated with SPC failure. An ultrasound protocol-requiring minimal training-is more effective than VIP in recognizing early signs of device failure.

An Update to the Stochastically Perturbed Parameterization Scheme of HarmonEPS

Abstract High-resolution, limited-area forecasting is strongly affected by errors in the initial atmospheric state, lateral boundary conditions (LBCs), and physical parameterizations used by numerical weather prediction (NWP) models. These errors need to be accounted for through the introduction of uncertainty in an ensemble prediction system (EPS). One approach to account for model error is to use a stochastically perturbed parameterizations (SPPs) scheme. A first version of the SPP scheme of HARMONIE EPS (HarmonEPS) has been tested, with promising improvements in ensemble spread. However, it introduced systematic biases and deteriorated skill scores for some variables. Here, we investigate the performance of an updated version of the HarmonEPS SPP scheme, which includes (i) the use of uniform distributions, (ii) the correlation of stochastic patterns between key SPP parameters, and (iii) the introduction of four additional parameters, in the microphysics and mass-flux schemes. Two five-parameter SPP-based setups are compared against initial and LBC perturbations setups for five forecast periods: (i) 22–28 March 2019, (ii) 6–12 July 2020, (iii) 20–26 February 2021, (iv) 13–26 January 2021, and (v) 20 May–2 June 2021. We find that SPP-based experiments show better probabilistic metrics for near-surface and cloud-related variables than the non-SPP experiments. The SPP-based ensembles show increased spatial spread (as indicated by dFSS), while maintaining similar spatial skill (as indicated by eFSS) with the non-SPP experiment. In addition, the systematic bias in the ensemble members of the previous SPP iteration has been alleviated with the use of uniform distributions. Finally, the use of microphysical and mass-flux perturbations improves the ensemble scores for cloud-related variables, precipitation, and visibility. Significance Statement Ensemble prediction systems are essential for weather forecasting. Their skill depends on the representation of uncertainties arising from errors in the initial atmospheric state and model physics. In this study, we present an update to the stochastically perturbed parameterizations scheme, which represents uncertainty arising from model errors, of the limited-area HARMONIE ensemble prediction system. The update to the scheme includes the introduction of uniform distributions and correlated perturbations for the perturbed parameters, as well as the addition of four new perturbed parameters. Overall, this revision removes systematic biases in ensemble members, which were present in the previous iteration of the scheme, and shows increased ensemble spread (up to 70%) and reduced model errors (up to 5%) for near-surface and cloud-related variables.

Effect of light walking combined with arthroscopic surgery on bone mineral density in patients with foot and ankle osteoarthritis

ObjectiveTo observe the effect of light walking combined with arthroscopic surgery on the efficacy and Bone Mineral Density (BMD) of patients with ankle arthritis. Methods 180 patients with ankle arthritis were retrospectively selected, who were divided into a control group (Group A) and an experimental group (Group B) according to treatment methods, with 90 patients in each group. Group A was treated with conventional open surgery and Group B was treated with light walking combined with arthroscopic surgery. The two groups were compared before and after treatment on scales such as the AOFAS ankle hindfoot score. Meanwhile, the patients' BMD and levels of inflammatory factors such as tumor cell necrosis factor-α (TNF-α) were compared before and after treatment. Results The Kofoed and AOFAS scale scores were higher for mild walking combined with arthroscopic surgery than for conventional treatment (P < 0.05), and their pain visual analogue VAS scores were lower than for conventional treatment (P < 0.05). In Group B, the postoperative BMD increase was significantly higher (P < 0.05). The R-value between PDGF bone growth factor and BMD was 0.957 and the R-value between VEGF growth factor and BMD was 0.903. The R-value between patient age and BMD was −0.936 and the R-value between patient BMI and BMD was −0.913. The treatment efficiency in Group B was 96.7 %. Conclusion The results prove that light walking combined with arthroscopic surgery is suitable for the surgical treatment of patients with ankle arthritis because it has a better therapeutic effect and makes patients' BMD level improved.

High Preoperative Pain Score is a Predictor of Cheilectomy Failure in Hallux Rigidus

Hallux rigidus (HR) is a prevalent arthritic condition in the foot. Cheilectomy is a common joint-preserving procedure for HR, involving the removal of prominent osteophytes to relieve impingement of the 1st MTPJ. This study aims to identify factors associated with the failure of cheilectomy in the treatment of HR. A retrospective review of a prospectively collected database from 2007 to 2021 identified all cheilectomy cases. The minimum follow-up was 2 years. Preoperative demographic data, patient-reported outcome measures (PROMs) and foot radiographs were collected. PROMs were reassessed in post-operative reviews, and cases were categorized as successes or failures. Failure was defined by meeting at least one of the following criteria at the latest review: 1) Visual analog pain score (VAS) more than or equal to 4, 2) undergoing subsequent revision procedures, or 3) reporting poor or terrible satisfaction with the surgery. The analysis involved 66 patients, with 19 failure and 47 success cases. Both groups showed similar age, BMI, and gender profiles. Preoperative radiographic parameters were comparable between groups. However, preoperative VAS was significantly higher in the failure group: 7.16 vs. 5.23 (P = 0.0029). Logistic regression confirmed preoperative VAS as a predictor of non-response (P = 0.023). Receiver Operating Characteristic analysis established an optimal cut-off VAS score of 7.0. Patients with a preoperative VAS score of more than 7 had an odds ratio of 5.11 (P = 0.0055) for failure. A higher preoperative VAS score is significantly associated with cheilectomy failure in HR treatment, suggesting a cutoff score of 7.0.

Experience With Immediate Internal Fixation Combined With Primary Wound Closure in Gustilo–Anderson Type IIIA Open Ankle Fractures

Open ankle fractures, especially Gustilo–Anderson type III fractures are challenging to manage with controversy over the “best” or “superior” treatment strategy. This study aimed to evaluate the treatment outcome of immediate internal fixation combined with primary wound closure in the management of Gustilo–Anderson type III open ankle fractures. We retrospectively assessed the outcomes of thirty-two patients treated using immediate internal fixation combined with primary wound closure with a minimum follow-up of twenty-four months. At the median follow-up of 38 months, the mean American Orthopaedic Foot and Ankle Society scale score was 87.22 ± 4.05. The physical component summary score of Short-Form 36 Health Status Survey was 66.63 ± 11.42 and the mental component summary score was 67.31 ± 7.20. Range of motion of Ankle/Foot injured side was 64.56 ± 4.30 degrees, and Range of motion of Ankle/Foot uninjured side was 72.31 ± 3.12 degrees. Visual analog pain scale score was 1.5 ± 0.88 at rest and 3.09 ± 1.17 during activity. According to American Orthopaedic Foot and Ankle Society scale score, the rate of excellent and good outcomes was 90.6%. Postoperative complications were documented, comprising 2 (6.4%) cases of infection, 5 (15.6%) cases of wound skin necrosis, 1 (3.2%) case of postoperative ankle traumatic arthritis, and 1 (3.2%) case requiring reoperation due to suboptimal fibula fracture reduction. The study results demonstrated that immediate internal fixation combined with primary wound closure for Gustilo–Anderson type III open ankle fractures achieve good functional outcomes and lower complication rates.

The Figure-of-Eight Ligament Reconstruction in Thumb Carpometacarpal Instability: Surgical Technique and Clinical Outcomes

This study reviewed the results of the figure-of-eight ligament reconstruction, a technique used in the surgical management of thumb carpometacarpal (CMC) instability. This technique establishes joint stability through forces originating within the CMC joint, providing volar and dorsal support. We evaluated the outcomes of 15 patients with nontraumatic, nonarthritic thumb CMC instability treated with the figure-of-eight ligament reconstruction technique. This technique involves routing a graft of the palmaris longus tendon through the base of the first metacarpal and trapezium bone in a figure-of-eight fashion. Preoperative visual analog scale (0-100) for pain and Michigan Hand Outcomes Questionnaire total scores were compared with 3- and 12-month postoperative scores. Secondary outcomes included strength, range of motion, patient satisfaction, return to work, and complications. A significant improvement between intake and 12 months after surgery was observed for both Michigan Hand Outcomes Questionnaire total scores (53, SD 3 vs 70, SD 4) and visual analog scale pain scores (63, SD 4 vs 36, SD 7). Additionally, after surgery, restored thumb CMC joint stability was reported for all patients. Strength and range of motion improved between intake and 12 months after surgery. The median return to work was 6 weeks. Nine (60%) patients rated their satisfaction as "excellent" or "good," and 11 (73%) patients said that they would undergo the surgery again. The figure-of-eight ligament reconstruction significantly improves pain and function in patients with thumb CMC instability while restoring joint stability and preserving range of motion, making it a suitable technique. Therapeutic IV.

Clinical Efficacy of a Novel Titania Nanoparticle-Reinforced Bonding Agent in Reducing Post-Restorative Sensitivity: A randomized clinical trial.

To evaluate the clinical efficacy of novel titania-nanoparticle reinforced bonding agent on post-restorative sensitivity in patients. This triple-blinded, randomized clinical trial included participants (n = 60) having Class- I and II cavitations with a minimum cavity depth of 3mm at Department of Operative Dentistry & Endodontics, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad from January 5, 2023, to June 20, 2023. They were randomly assigned into two groups A and B (n = 30). After informed consent, restorative intervention was accomplished using an etch-and-rinse adhesive strategy. In Group-A, titania-nanoparticle-incorporated bonding agent was used for composite restoration, while in Group-B, bonding agent without nanoparticles was used. The primary outcome was assessed using Visual Analogue Scale mean score. Participants were instructed to rate their sensitivity status at follow-ups: 24 hours, one week, and one month. Mann-Whitney U test was employed to compare sensitivity between the two groups. According to results of this trial, a significant difference was observed between two groups after 24 hours (p = 0.004) and one week (p = 0.002). However, no discernible difference was observed after one month (p = 0.643). Post-restorative sensitivity in patients with composite restorations was reduced using titania-reinforced bonding agents as compared to bonding agents without nanoparticles. This shows that inclusion of titania nanoparticles into adhesive dentistry could be beneficial in resolving post-restorative sensitivity occurring with composite restorations.

Can cereal-based oral contrast agents-assisted ultrasound become an alternative to non-contrast magnetic resonance imaging (MRI) in radiological follow-up for pancreatic cystic lesions?

Pancreatic cystic lesions (PCLs) are recommended to be examined by magnetic resonance imaging (MRI), yet MRI still has limitations, such as high costs, the risk of triggering claustrophobia, and relatively low availability compared with ultrasound. Oral contrast agents-assisted ultrasound has been used to examine the gallbladder and stomach, but whether oral contrast agents could improve the accuracy of transabdominal ultrasound (TAUS) for PCLs and could be a potential alternative to non-contrast MRI for PCL follow-up has not been studied. This study aimed to explore the value of cereal-based oral contrast agents in improving the accuracy of PCLs during TAUS. This is a prospective cohort study. Patients with PCL who were admitted to our center between January 2023 and January 2024 were enrolled, and TAUS was performed before and after taking cereal-based oral contrast agents. The imaging quality of the PCL was measured by structural visualization scores. The structural visualization scores of oral contrast agent-assisted ultrasound and non-contrast MRI were also compared. A total of 27 patients with PCLs were enrolled, and 30 PCLs were detected. The sonolucency of the PCL improved after oral contrast agent administration. Before taking the agent, only 30% of patients had satisfactory sonolucency; after taking the oral contrast agent, the corresponding proportion reached 80% (P=0.002). The structural visualization score of the PCL determined by oral contrast agent-assisted TAUS was higher than that determined without the aid of an agent [1 (0-6) vs. 1 (0-3), P=0.001], which was mainly reflected in the increase in the number of visible septa after taking the agent. No significant difference was detected between the structural visualization score of the PCL examined by oral contrast agent-assisted TAUS and that examined by non-contrast MRI and the correlation between the 2 types of scores were satisfactory [1 (0-6) vs. 2 (0-7), P=0.070, Spearman correlation factor r=0.880]. This study used a structured scoring system to confirm that cereal-based oral contrast agents could improve the ultrasound quality of PCLs, and the correlation between the quality of oral contrast agent-assisted ultrasound and non-contrast MRI findings on PCLs was satisfactory. Further research to improve visualization of PCLs on TAUS using oral contrast agents could result in TAUS being a potential alternative to MRI in the follow-up of PCLs in resource-limited situations.

Reflections of stress: Ozone damage in broadleaf saplings can be identified from hyperspectral leaf reflectance

Tropospheric ozone (O3) causes widespread damage to vegetation; however, monitoring of O3 induced damage is often reliant on manual leaf inspection. Reflectance spectroscopy of vegetation can identify and detect unique spectral signatures of different abiotic and biotic stressors. In this study, we tested the use of hyperspectral leaf reflectance to detect O3 stress in alder, beech, birch, crab apple, and oak saplings exposed to five long-term O3 regimes (ranging from daily target maxima of 30 ppb O3 to 110 ppb). Hyperspectral reflectance varied significantly between O3 treatments, both in whole spectra analysis and when simplified to representative components. O3 damage had a multivariate impact on leaf reflectance, underpinned by changes in pigment balance, water content and structural composition. Vegetation indices derived from reflectance which characterised the visible green peak were able to differentiate between O3 treatments. Iterative normalised difference spectral indices across the hyperspectral wavelength range were correlated to visual damage scores to identify significant wavelengths for O3 damage detection. We propose a new Ozone Damage Index (OzDI), which characterises the reflectance peak in the shortwave infrared region and outperformed existing vegetation indices in terms of correlation to O3 treatment. These results demonstrate the potential application of hyperspectral reflectance as a high throughput method of O3 damage detection in a range of common broadleaf.species.