To describe the prespecified statistical analysis plan for the GASTRIC-PICU, a trial to evaluate the clinical and cost-effectiveness of no routine gastric residual volume (GRV) measurement to guide enteral feeding in mechanically ventilated children admitted to a pediatric intensive care. Multicenter, randomised, noninferiority, open-label trial with embedded economic evaluation. Twenty-three PICUs across England, Scotland, Northern Ireland, and Switzerland. Infants and children older than 38 weeks corrected gestational age to 16 years, accepted to a participating PICU, on mechanical ventilation and being fed enterally by the gastric route. Standard PICU feeding protocols, but without regular GRV measurement to guide feeding. The primary clinical outcome is an ordinal composite of survival and days free from mechanical ventilation at 30 days (noninferiority). The primary effect estimate will be the adjusted odds ratio from a proportional odds logistic regression model with two-sided 95% CI. If the lower limit is not less than 1/1.2, we will declare noninferiority. The coprimary nutritional outcome is the percentage of the child's estimated energy requirements achieved by 72 hours, which will be tested for superiority. The GASTRIC-PICU trial will assess the noninferiority of no routine GRV measurements compared with standard at least 6-hourly GRV measurements. Prespecified statistical and health economic analysis plans for the GASTRIC-PICU study have been developed before trial completion to minimize analytical bias.

Breast symmetry plays a key role in breast reconstructive surgery. In the healthy population, volume asymmetry is common. This study aimed to better understand how breast symmetry is perceived and to compare subjective estimation with objective measurements of breast symmetry in the healthy participants. A retrospective cross-sectional study included healthy participants who underwent VECTRA 3-dimentional breast imaging. Breast volume measurements were obtained using the VECTRA system. Five plastic surgeons and five laypersons assessed volume symmetry subjectively. Of 209 healthy participants, 100 were randomly selected for assessment. Mean left and right breast volumes were 636.8 cc and 664.8 cc, respectively, with a mean relative volume difference of 16.0% (SD 12.7). No clear threshold of relative breast volume difference was found in which the majority of plastic surgeons or laypersons defined breast asymmetry. Even with large volume differences quantified by 3D VECTRA measurement, breasts were perceived as symmetrical by both plastic surgeons and laypersons. Inter-observer agreement was poor for both groups (Fleiss' kappa: surgeons 0.23; laypersons 0.30). Agreement with 3D measurements regarding the larger breast was low (surgeons: accuracy 53.8%, Cohen's kappa 0.08; laypersons: accuracy 48.6%, Cohen's kappa -0.07). Subjective assessments of breast symmetry by both experts and laypersons poorly correlate with objective 3D imaging volume measurements. Symmetry perception likely extends beyond volume alone, influenced by factors such as breast shape, projection, and nipple position. While 3D imaging provides reliable volume measurements and preoperative consultations, it alone may not enhance patient satisfaction regarding perceived symmetry. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anti-hemorrhagic potential of phytoconstituents of Macrosphyra longistyla ethanol leaf extract in abnormal uterine bleeding induced by incomplete abortion in rats.

Comparison of automated subcortical segmentation methods: VolBrain vs. 3D Slicer in brain volumetry.

This study evaluates 3 artificial intelligence (AI) systems in detecting, characterizing, and classifying lung nodules on low-dose computed tomography (LDCT) scans of 100 subjects, assessing agreement with a reference standard and inter-vendor consistency. Performance of 3 commercially available AI platforms-AI 1, AI 2, and AI 3-was retrospectively analyzed against evaluations by 2 thoracic radiologists, with discordances resolved by consensus as reference standard. Agreements were assessed for nodule presence, type (solid, part-solid, ground-glass), and Lung-RADS category using Cohen Kappa. Agreement for continuous measurements (nodule diameter and volume) across AI systems was evaluated using intraclass correlation coefficients (ICC). Group comparisons for continuous variables were performed using the Kruskal-Wallis test, with Mann-Whitney U tests for post hoc pairwise comparisons. Categorical variables were compared using χ 2 tests. Bland-Altman analysis evaluated variability in diameter and volume measurements. The 3 AI systems detected 435, 152, and 70 nodules, respectively, whereas radiologists identified 126 nodules ( P <0.001). Sensitivity, specificity, and accuracy were 77.0%, 8.2%, and 25.7% for AI 1; 72.2%, 83.4%, and 80.6% for AI 2; and 42.9%, 95.7%, and 82.2% for AI 3. Agreement with the reference standard was perfect for AI 2 and almost perfect for AI 3, but absent for AI 1. Inter-AI agreement was substantial (κ=0.66 to 0.78), and diameter/volume measurements showed moderate to good reliability (ICC=0.57 to 0.87). Commercial AI systems show variable performance in nodule detection and classification, underscoring the need for users to understand each system's characteristics and interpret results within clinical context.

Satellite data provide valuable information on the variations in the surface area of inland waters. These observations are crucial for monitoring remote or poorly instrumented regions and offer complementary insights to in situ measurements. To further assess this capability, we analyzed the temporal variations of Serra del Corvo Lake – located at the border between the Basilicata and Puglia regions in southern Italy – using cloud-free Sentinel-2 imagery acquired from 2015 to 2025. The satellite-derived surface water extent time series were compared with daily in situ measurements of water volume and level, achieving very high correlation (R &gt; 0.98). This strong correlation supported the development of two predictive models, based on both linear and exponential regression method, which demonstrated satisfactory accuracy (R² consistently above 0.8 in both calibration and validation phases). These results highlight the high potential of satellitebased approaches to provide almost independent and reliable information on inland water dynamics.

In animal models, derangements in paternal one‑carbon metabolism, giving rise to elevated serum total homocysteine (tHcy) concentrations, can impair sperm DNA integrity and chromatin methylation signatures, with consequences for embryonic gene expression, (neuro)development and growth. We hypothesize that, in humans, elevated serum tHcy similarly impairs prenatal development. In a prospective periconception cohort, 881 pregnant women (<10weeks of gestation) and their partners were enrolled from 2010 to 2022. Inclusion required paternal serum tHcy measurement in the first trimester. First trimester crown-rump length (CRL) and embryonic volume (EV) measurements were assessed on longitudinal three-dimensional ultrasound scans using virtual reality. Estimates of second trimester fetal biometry and birth outcomes were extracted from medical records. Associations between paternal tHcy and prenatal growth trajectories were assessed using linear mixed and piecewise regression models, adjusting for confounders. Paternal tHcy concentrations were on average two-fold higher than those of female partners, with men more frequently exhibiting hyperhomocysteinemia. In piecewise regression models, paternal tHcy ≥15μmol/L compared to <15μmol/L was associated with decreased first trimester CRL (Δ slope coefficient -0.016, P=0.019). The association persisted for fetal transcerebellar diameter (Δ slope coefficient -0.060, P=0.002), abdominal circumference (Δ slope coefficient -0.393, P=0.022), femur length (Δ slope coefficient -0.115, P=0.005) and estimated fetal weight (Δ slope coefficient -2.703, P=0.003). No associations were found with birth weight or adverse birth outcomes. Paternal tHcy may serve as a potential biomarker for prenatal growth. In preconception care, the benefit of assessing paternal tHcy concentrations and promoting multivitamin use warrants further investigation.

From mild cognitive impairment to normal cognition in Parkinson's disease: The role of brain network architecture.

Comparative assessment of radiocarbon and balance method for determining biogenic and fossil CO2 emissions from waste-to-energy plants in Austria and China.

Almost all patients with mucopolysaccharidosis (MPS) develop respiratory dysfunction of varying severity during disease progression. While respiratory disease in MPS has traditionally been attributed to upper airway obstruction caused by glycosaminoglycan (GAG) accumulation in the trachea and bronchi, involvement of the intrapulmonary conducting airways and lung parenchyma remains poorly defined. Here, we characterised lung disease in a mouse model of MPS I using a combination of non-invasive X-ray Velocimetry (XV) functional lung imaging and gold-standard flexiVent respiratory mechanics testing, complemented by lung volume measurements and histological analysis. XV provides regional ventilation information across the entire lung during tidal breathing. MPS I mice demonstrated reduced mean specific ventilation (the average regional expansion of lung tissue across the respiratory cycle), driven predominantly by reduced ventilation in the inner (mediastinal-adjacent) lung regions, with evidence of spatially heterogeneous ventilation distribution. Lung mechanics testing showed increased conducting airway resistance, increased respiratory system compliance and reduced tissue elastance, consistent with impaired elastic recoil and expiratory flow limitation. Lung volume analysis revealed reduced opening pressure following degassing together with increased residual volume, functional residual capacity and vital capacity. Histological analysis demonstrated heterogeneous parenchymal architecture with regions of enlarged airspaces. Together, these findings demonstrate that respiratory dysfunction in MPS I is not limited to upper airway obstruction but also involves intrinsic abnormalities of the intrapulmonary conducting airways and lung parenchyma. This intrinsic pulmonary pathology likely contributes to obstructive lung disease and may underlie the susceptibility to respiratory failure observed in patients with MPS I.

Excellent agreement between automated deep learning-based and manual diffusion-weighted imaging infarct volume measurements in hyperacute stroke.

Background: Rounded shoulder posture is a common postural deviation characterized by anterior displacement of the shoulder girdle, scapular protraction, and forward positioning of the acromion relative to the vertical axis. It is frequently associated with prolonged sitting, smartphone use, and computer-based activities, leading to predictable muscular imbalances. Objective: To determine the relationship between rounded shoulder posture and pulmonary function parameters among undergraduate physical therapy students. Methodology: A cross-sectional study was conducted on 200 undergraduate physical therapy students aged 19–25 years from universities in the Malakand division. Participants were equally divided into two groups based on postural assessment: Group A (normal shoulder posture, n=100) and Group B (rounded shoulder posture, n=100). Pulmonary function was evaluated using spirometry, with measurements of forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), and peak expiratory flow rate (PEFR). Postgraduate students, faculty members, and administrative staff, and individuals with known systemic or metabolic disorders, a recent history of trauma or injury, or individuals with any physical disability or structural deformity were excluded from the study. An independent-samples t-test was used for group comparisons, with statistical significance set at p &lt; 0.05. Results: Significant differences were observed between groups across all pulmonary parameters. Students with rounded shoulder posture demonstrated lower mean FEV₁ (3.07±0.59 L vs. 3.26±0.29 L, p=0.003), FVC (3.40±0.57 L vs. 3.74±0.36 L, p&lt;0.001), and PEFR (5.68±0.69 L/s vs. 6.57±0.67 L/s, p&lt;0.001). Demographic variables were comparable, minimizing confounding effects. Conclusion: Rounded shoulder posture is significantly associated with reduced pulmonary function in young adults. These findings underscore the importance of early postural assessment, targeted corrective strategies, and preventive ergonomic education within academic environments to optimize respiratory health outcomes and long-term functional capacity.

Therapeutic hypothermia is the only clinically approved treatment for neonatal hypoxia-ischemia (NHI), although its efficacy remains partial. In preclinical research, hypothermia is widely used as a reference therapy; however, its protocol is highly variable across studies, limiting robust comparisons with emerging neuroprotective strategies. This study aimed to define an optimal and standardized hypothermia protocol in the Rice-Vannucci model, not to challenge clinical practice, but to establish a reliable benchmark for preclinical therapeutic development. NHI was induced in postnatal day 7 (P7) rat pups, followed by normothermia or hypothermia for 2, 3, or 5 hours. Short- and long-term outcomes were assessed using lesion volume measurements by MRI, neurological scoring, behavioral tests, and histological analyses. The impact of immediate hypothermia initiation was also examined. Across analyses, both 2- and 3-hour hypothermia durations provided greater neuroprotection than 5 hours-including brain lesion volume, motor and cognitive performances, and markers of neuronal preservation and neuroinflammation. However, for several parameters, 2 hours of hypothermia showed superior efficacy compared with 3 hours. Immediate initiation further modestly improved outcomes. A 2-hour hypothermia protocol represents the most robust and reproducible preclinical reference, enabling meaningful comparison with novel therapies in the Rice-Vannucci model. By establishing an optimized hypothermia protocol in the Vannucci model, this study offers a consistent and robust reference for preclinical evaluation of emerging therapies. It does not question clinical hypothermia protocols, but addresses variability in preclinical literature Optimizing the hypothermia reference protocol is mandatory to reliably identify new effective treatments in preclinical studies and to enhance their likelihood of successful and efficient clinical translation.

This study developed an automated deep learning-based system to quantify retinoschisis and detachment volume (RDV) in pathological myopia (PM) patients undergoing posterior scleral contraction (PSC). A prospective study included 51 PM patients (36 PSC-treated and 15 controls). Based on the myopic traction maculopathy staging system classification, PSC-treated patients were divided into retinoschisis (RS, Stage 2, n=21) and retinal detachment (RD, Stages 3-4, n=15), while controls were classified as Stage 1 (n=15). Swept-source optical coherence tomography (OCT) and angiography imaging was used to acquire retinal data, and a Mask R-CNN model was trained to segment and calculate RDV. The primary outcome measures were regional macular recovery rate, defined as the percentage reduction in RDV at 12 months postoperatively. Clinical parameters such as axial length (AL) and best-corrected visual acuity (BCVA) were analysed. The model achieved an Intersection over Union of 80.9%. RDV increased with more advanced stages of myopic traction maculopathy (MTM). As MTM stage advanced, RDV distribution shifted from predominantly parafoveal/perifoveal involvement to foveal involvement. Macular RDV increased progressively with MTM stage (control: 0.94 mm3, RS: 5.24 mm3, RD: 9.50 mm3; p<0.001). Postoperative AL decreased significantly and BCVA improved significantly (all p<0.001). Postoperative RDV decreased significantly, achieving macular and foveal recovery rates as 80.90% and 99.50%, respectively. AL reduction demonstrated the strongest correlation with foveal RDV changes (r=0.479, p=0.003). The Mask R-CNN-based RDV measurement provides a sensitive 3D biomarker for assessing PSC efficacy and monitoring MTM progression. The system offers objective, high-precision quantification of retinal structural changes, addressing limitations of manual OCT analysis. ChiCTR2200065561.

To determine the feasibility of anatomical neuroimaging studies using 0.55T MRI. MPRAGE images with 1mm isotropic resolution were acquired from a cohort of five healthy subjects using both 0.55T and 3T scanners, including repeat scans of each subject at each field strength. The 0.55T images were denoised to mitigate the effects of high resolution and low-field strength. All scans were analyzed using BrainSuite and FreeSurfer image analysis software, which performs operations including tissue classification, region segmentation/labeling, and thickness/volume measurements for different brain regions. Regional cortical thickness measurements and regional brain volume measurements were compared, and test-retest repeatability at each field strength was evaluated. For both image analysis software tools, we observed reasonably good correlations between field strengths for cortical thickness measures and regional brain volume measures. Test-retest repeatability analysis suggests that experimental variability was generally higher at 0.55T than at 3T, although the amount of difference was dependent on the specific measure being considered and the software tool that was used. While our sample size was small which limits the strength of the conclusions we can draw, this small-scale pilot study suggests the potential feasibility of certain types of anatomical neuroimaging studies at 0.55T (especially those involving volume measurements), assuming that appropriate adjustments are made to account for increased experimental variability at this field strength.

ABSTRACT Purpose To examine changes in macular ganglion cell layer (GCL) thickness over five years in a community-based birth cohort of children without ophthalmic disease. Methods This prospective study included 660 children without ophthalmic disease from the Copenhagen Child Cohort 2000 Eye Study. Optical coherence tomography (OCT) scans were analyzed for seven macular GCL thickness and volume measurements. Associations with age, sex, axial length, and OCT signal strength were evaluated. Additionally, GCL thickness was measured in eyes with optic disc drusen (ODD; n = 16) and compared with non-ODD eyes. Results From around age 11 to 16, macular GCL thickness in boys increased by approximately 1.6%, with statistical significance in six of seven predefined measurements. In girls, GCL thickness was stable or slightly decreased (−0.4%), with significance in four of seven measurements. Baseline axial length (AL) differed significantly between sexes (23.47/22.89 mm in boys/girls, p < 0.0001), as did axial growth between visits (ΔAL, 0.19/0.42 mm in boys/girls, p < 0.0001). No consistent associations were found between AL and GCL thickness or longitudinal changes thereof. After adjusting for potential confounders, four of seven GCL measurements increased significantly with age in boys, while no age-related changes were observed in girls. No significant differences were found in baseline GCL thickness or longitudinal change in GCL between eyes with or without ODD. Conclusions GCL thickness remained relatively stable between ages 11 and 16, with small but statistically significant differences between sexes.

The association between development of chronic airflow limitation and exposures in the aluminum industry is unknown. In a prospective study with nearly 10 years of annual measurements of forced expiratory volume in 1 s (FEV1) and forced vital Capacity (FVC) and concurrent estimates of exposure to dust, total fluorides (TotF) and polycyclic aromatic hydrocarbons (PAH) we investigated the relationship between each of these exposures and annual decline in FEV1 (dFEV1) and FVC (dFVC). Estimates of exposure to dust, TotF, and PAH were obtained from random samples of 8-h shifts using personal samplers at each of seven Norwegian aluminum plants. A total of 18,332 measurements were used to create a job-exposure matrix. The total number of available spirometries was 20,712 in 3872 workers. Data were analyzed using linear mixed modeling with inverse probability weights for dropouts. We found that dFEV1 and dFVC increased during follow-up with linear and quadratic components that were modified by PAH exposure. These linear and quadratic components were estimated at 2.5 mL/year (p = 0.019) and 4.2 mL/year2 (p < 0.001) for dFEV1, and -2.6 mL/year (p = 0.076) and 5.9 mL/year2 (p < 0.001) for dFVC, respectively, per quartile increase in PAH exposure. We found a significant effect modification of the relationship between dFEV1 and dFVC, and follow-up time by PAH exposure, indicating that PAH exposure accelerates the annual decline in FEV1 and FVC.

To evaluate three commercial AI software tools for pulmonary nodule detection and segmentation and to assess their impact on guideline-based management recommendations. A total of 740 CT and PET-CT studies from clinical routine were analyzed using three software tools (S1, S2, S3). We compared the total number of detected nodules and "actionable" nodules (per British Thoracic Society (BTS) definition). We further evaluated how measurement variations between tools affected hypothetical management according to Fleischner Society and BTS guidelines for incidental nodules. The tools differed significantly in the total number of detections (S1: 1336; S2: 1060; S3: 1536; p < 0.001) and wrong findings (S1: 965; S2: 720; S3: 1169; p < 0.001). However, the detection of actionable nodules was comparable across all tools (S1: 375; S2: 341; S3: 373; p = 0.73). While no statistically significant differences were found in mean diameter or volume measurements, small absolute variations led to significant differences in management. Specifically, S2 triggered significantly more 1-year follow-up recommendations than S3 under BTS guidelines (p < 0.001). No significant management differences were observed when applying Fleischner Society guidelines. While the three included AI tools show comparable performance in detecting actionable nodules, minor measurement variations significantly impact downstream management when using guidelines with narrow thresholds, such as the BTS criteria. Fleischner Society guidelines appear more robust to these inter-software variations. Question How do commercial software tools for pulmonary nodule detection perform in real-world settings and impact hypothetical management under BTS and Fleischner guidelines? Findings Detection of actionable nodules was comparable across all tools, but small absolute measurement variations triggered significantly more 1-year follow-up recommendations under BTS guidelines. Clinical relevance AI software can cause inconsistent BTS-based management due to narrow thresholds, while Fleischner criteria appear more stable. Frequent detection of benign lesions potentially poses a risk of overdiagnosis and overtreatment in standalone AI-based reporting.

Accurate segmentation and Three-Dimensional (3D) reconstruction of Spinal Cord Injury (SCI) lesions are essential for clinical diagnosis, surgical planning, and prognostic assessment. However, multimodal MRI-based SCI lesion analysis faces critical challenges, including blurred lesion boundaries, non-rigid registration errors between modalities, and frequent modality loss in real clinical scenarios. This study aims to develop a robust network to address these issues and improve the clinical applicability of automated SCI lesion analysis. A Cross-Modal Alignment and Uncertainty-Aware Network (CMUA-Net) was proposed. It integrated three core components: 1) a learnable CrossModal Attention Alignment Module (CMAM) to dynamically correct spatial misalignments of T1w, DTI-FA, and T2-star-weighted (T2*w) at the feature level using T2w as the semantic reference, avoiding traditional image-level registration interference; 2) a Multi-Scale Residual Dense Block (MS-RDB) to fuse convolutional features with multiple receptive fields, enhancing contextual modeling of small and diffuse lesions; 3) a Modality-Robust Training (MRT) strategy combining random modality masking and Monte Carlo dropout-based uncertainty-guided loss to improve adaptability to any modality combination. The network was validated on multimodal MRI data from 127 multicenter SCI patients. With quad-modal input, CMUA-Net achieved a Dice Similarity Coefficient (DSC) of 0.821 and a 95% Hausdorff Distance (HD) of 3.21 mm; even with only T2w input, the DSC remained 0.713. Its 3D reconstruction yielded a Fréchet Video Distance (FVD) of 18.7. The network outperformed baseline methods (Spinal Cord Toolbox, U-Net, nnU-Net, TransBTS) in all metrics (p < 0.01), and the R2 between its automated lesion volume measurement and manual physician measurements reached 0.998. CMUA-Net effectively resolves clinical challenges such as strong subjectivity in quantification, incomplete modalities, and manual dependence in modeling. Its high multi-center adaptability and stability in small-lesion segmentation make it suitable for cross-institutional promotion, providing reliable anatomical references for prognosis assessment, doctor-patient communication, and rehabilitation monitoring. CMUA-Net enables high-precision, robust SCI lesion segmentation and 3D reconstruction, and can automatically output lesion volume, 3D models, and key surgical parameters. It provides technical support for personalized SCI diagnosis and treatment, with significant clinical applicability and promotion value.

The aim of this study was to compare the effectiveness of diode laser and combined treatment protocols, applied in addition to mechanical debridement, in the treatment of peri-implantitis on clinical periodontal parameters and S100A8 levels in peri-implant sulcus fluid (PISF). A total of 39 patients diagnosed with peri-implantitis were divided into three groups based on the treatment protocols used: Mechanical Debridement, Diode Laser, and Combined Treatment. Probing depth, clinical attachment level, modified plaque index, gingival index, and PISF volume measurements were recorded at baseline and at weeks 4 and 12. S100A8 levels in PISF samples were measured by ELISA. During the 12-week follow-up period, statistically significant improvements in clinical parameters were observed in all groups compared with baseline (p < 0.05). In the intergroup comparison, the most significant decrease and statistical superiority in mPI and GI values were observed in the combined treatment group (p < 0.001). Although there was no statistically significant difference among the groups in probing depth and clinical attachment gain, the greatest numerical improvement was observed in the combined group. Despite clinical improvement, no significant change in total S100A8 levels was detected between groups or over time (p > 0.05). The combined use of mechanical debridement and a diode laser in the treatment of peri-implantitis is more effective at reducing clinical signs of inflammation than either method used alone. However, the lack of correlation between S100A8 levels and clinical improvement suggests that this biomarker may not be sensitive in short-term follow-up of treatment.