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BACKGROUND: Left ventricular assist devices (LVAD) represent an important therapeutic option for patients progressing to end-stage heart failure. Women have been historically underrepresented in LVAD studies, and have been reported to have worse outcomes despite technological optimisation. We aimed to systematically explore the evidence on sex disparities in the use and outcomes of LVAD implantation. METHODS: A systematic database search with meta-analysis was conducted of comparative original articles of men versus women undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to July 2022. Primary outcomes were stroke (haemorrhagic and ischaemic) and early/overall mortality. Secondary outcomes were LVAD thrombosis, right VAD implantation, major bleeding, kidney dysfunction, and device/driveline infection. RESULTS: Our search yielded 137 relevant studies, including 22 meeting the inclusion criteria with a total of 53 227 patients (24.2% women). Overall mortality was higher in women (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.05-1.62, p = 0.02), as was overall stroke (OR 1.32, 95%CI 1.06-1.66, p = 0.01), including ischemic (OR 1.80, 95%CI 1.22-2.64, p = 0.003) and haemorrhagic (OR 1.72, 95%CI 1.09-2.70, p = 0.02). Women had more frequent right VAD implantation (OR 2.11, 95%CI 1.24-3.57, p = 0.006) and major bleeding (OR 1.40, 95%CI 1.06-1.85, p = 0.02). Kidney dysfunction, LVAD thrombosis, and device/driveline infections were comparable between sexes. CONCLUSIONS: Our analysis suggests that women face a greater risk of adverse events and mortality post-LVAD implantation. Although the mechanisms remain unclear, the difference in outcomes is thought to be multifactorial. Further research, that includes comprehensive pre-operative characteristics and post-operative outcomes, is encouraged.

INTRODUCTION Automated CT scan segmentation (labelling of pixels according to tissue type) is now possible. This technique is being adapted to achieve three-dimensional (3D) segmentation of computed tomography (CT) scans, opposed to single L3-slice alone. This systematic review evaluates feasibility and accuracy of automated segmentation of 3D CT scans for volumetric body composition (BC) analysis, as well as current limitations and pitfalls clinicians and researchers should be aware of. METHODS OVID Medline, Embase and grey literature databases up to October 2021 were searched. Original studies investigating automated SM, visceral and subcutaneous AT segmentation from CT were included. RESULTS Seven of 92 studies met inclusion criteria. Variation existed in expertise and numbers of humans performing ground-truth segmentations used to train algorithms. There was heterogeneity in patient characteristics, pathology and CT phases that segmentation algorithms were developed upon. Reporting of anatomical CT coverage varied, with confusing terminology. Six studies covered volumetric regional slabs rather than the whole body. One study stated the use of whole-body CT but it was not clear whether this truly meant head-to-fingertip-to-toe. Two studies used conventional computer algorithms. The latter five used deep learning (DL), an artificial intelligence technique where algorithms are similarly organised to brain neuronal pathways. Six of seven reported excellent segmentation performance (Dice similarity coefficients > 0.9 per tissue). Internal testing on unseen scans was performed for only four of seven algorithms, whilst only three were tested externally. Trained DL algorithms achieved full CT segmentation in 12 to 75 seconds versus 25 minutes for non-DL techniques. CONCLUSION Deep learning enables opportunistic, rapid, and automated volumetric BC analysis of CT performed for clinical indications. However, most CT scans do not cover head-to-fingertip-to-toe; further research must validate using common CT regions to estimate true whole-body BC, with direct comparison to single lumbar slice. Due to successes of DL, we expect progressive numbers of algorithms to materialize in addition to the seven discussed in this paper. Researchers and clinicians in the field of BC must therefore be aware of pitfalls. High Dice similarity coefficients do not inform the degree to which BC tissues may be under- or overestimated, and nor does it inform on algorithm precision. Consensus is needed fto define accuracy and precision standards for ground-truth labelling. Creation of a large international, multicentre common CT dataset with BC ground-truth labels from multiple experts could be a robust solution.

BACKGROUND: This review aims to systematically evaluate the currently available evidence investigating the use of artificial intelligence (AI) and machine learning (ML) in the field of cardiac transplantation. Furthermore, based on the challenges identified we aim to provide a series of recommendations and a knowledge base for future research in the field of ML and heart transplantation. METHODS: A systematic database search was conducted of original articles that explored the use of ML and/or AI in heart transplantation in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to November 2021. RESULTS: Our search yielded 237 articles, of which 13 studies were included in this review, featuring 463 850 patients. Three main areas of application were identified: (1) ML for predictive modeling of heart transplantation mortality outcomes; (2) ML in graft failure outcomes; (3) ML to aid imaging in heart transplantation. The results of the included studies suggest that AI and ML are more accurate in predicting graft failure and mortality than traditional scoring systems and conventional regression analysis. Major predictors of graft failure and mortality identified in ML models were: length of hospital stay, immunosuppressive regimen, recipient's age, congenital heart disease, and organ ischemia time. Other potential benefits include analyzing initial lab investigations and imaging, assisting a patient with medication adherence, and creating positive behavioral changes to minimize further cardiovascular risk. CONCLUSION: ML demonstrated promising applications for improving heart transplantation outcomes and patient-centered care, nevertheless, there remain important limitations relating to implementing AI into everyday surgical practices.

Aims The decision on the appropriate type of anesthesia for pelvic floor repair depends on a variety of factors including patients' age, performance status, comorbidities, cost-effectiveness and personal preferences. We aim to review the literature on urogynecological procedures performed under local anesthesia (LA). Methods A systematic search of four electronic databases was conducted for articles published up to May 2020. Studies reporting outcomes of women who underwent pelvic floor reconstructive surgery under LA with or without sedation, were considered eligible. Results Nineteen studies (14 noncomparative and 5 comparative), including 1626 cases of urogynecological procedures under LA were recruited. Meta-analysis revealed significantly lower mean pain scores in LA group compared to general-regional anesthesia one (GA/RA) at both 4-6 h and 8-18 h postoperatively (160 patients; mean difference [MD], -1.70; 95% confidence interval [CI]: -3.12, -0.28; p = 0.02 and 160 patients; MD, -0.72; 95% CI: -1.17, 0.27; p = 0.002, respectively). Pain scores at >24 h did not differ among the two groups (160 patients; MD, -0.28; 95% CI: -0.60-0.05; p = 0.10). Intra- and postoperatively morphine use was not different among patients who received LA and GA during prolapse surgery while nausea rates were significantly lower in LA group compared to RA group 8 h postoperatively. Conclusions LA with or without sedation represents a safe and efficient alternative anesthetic technique for urogynecological procedures with improved pain scores in up to 18 h postoperatively especially in patients who underwent surgery for SUI. LA is feasible and could be offered to patients undergoing pelvic floor surgery allowing a prompt postoperative recovery.

Immediately after the removal of orthodontic appliances, the teeth might start to drift away from their corrected position in an attempt to reach a new equilibrium. Medications and biologic factors could potentially modulate these processes. The objective of the present systematic review is to systematically investigate and appraise the quality of the evidence regarding the effect of various medications and biologic factors on the rate of relapse following active tooth movement. Search without restrictions in eight databases and hand searching until April 2020 were conducted. Studies performed on animal models investigating the effects of medication and biologic factors on the rate of relapse following orthodontic tooth movement were considered. Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed. Seventeen studies were finally identified, mostly at either high or unclear risk of bias. Ketorolac did not show any significant effects on relapse, while the administration of tetracycline, atorvastatin, psoralen and raloxifene decreased it. Overall, the same result was observed with bisphosphonates with the exception of low dosage of risedronate, which did not have an effect. Osteoprotegerin and strontium resulted in reduced relapse, but not in the immediate post-administration period. Inconsistent or conflicting effects were noted after the use of simvastatin and relaxin. The quality of the available evidence was considered at best as low. It can be concluded that specific medications and biologic factors may have an effect on the rate of relapse following tooth movement. The orthodontist should be knowledgeable about the substances potentially affecting retention.

Background Manual evaluation of blood cell counts on stained blood films is a common procedure in resource-limited laboratories of farm animal clinics. Moreover, settings for sheep blood cell counts are not provided on most veterinary hematology analyzers. Objectives We aimed to (a) compare the results of white blood cell (WBC) counts evaluated microscopically on ovine blood smears with those obtained by the ADVIA 120 hematology analyzer and validate appropriate correction factors for the manual technique; and (b) assess the two suggested factors to calculate platelet counts on blood smears in sheep. Methods The blood samples of 57 sheep were used to generate a regression equation between the average WBC count per field and the WBC count determined using the ADVIA 120 analyzer. Thirty-one new ovine samples were used to assess the agreement between the calculated WBC counts based on a generated equation and those obtained by the analyzer using the Passing-Bablok test and Bland-Altman plots. Similarly, agreements between platelet counts using two different factors for platelet calculation were assessed using the Bland-Altman plot. Results The average bias of calculated WBC counts was 0.4%, with precision and accuracy being over 95%. Regarding calculated platelet counts, Bland-Altman plots revealed a bias of 26.4% and 1.4% when the average number of platelets per field was multiplied by 15 000 and 20 000, respectively. Conclusions Microscopic WBC counting in ovine blood is a reliable alternative to automated analyses using the generated equation. A better agreement between the two methods was observed when a factor of 20 000 was used to calculate platelet counts in ovine blood smears.

Urinalysis is not routinely used in bovine medicine, and there is no evidence as to whether urine protein-to-creatinine ratio (UPC) could be used for the diagnosis of renal diseases in cattle.The goal of the study was to determine alterations in UPCs observed with different subclinical renal diseases in clinically healthy cattle and to investigate whether UPC can efficiently differentiate cattle with and without subclinical renal pathology.Kidney and urine samples from 57 clinically healthy adult dairy (44) and beef (13) cattle were collected after slaughter. Urinary protein and creatinine concentrations were measured in an automatic analyzer, and urinary-specific gravity (USG) was measured using a temperature compensated refractometer. Kidney samples underwent histopathologic examination, and the cattle were classified as NL (no renal lesion) and L (lesions detected even in one kidney). Based on USG, the cattle were divided into the Normal USG (≥1.020) and Low USG (1.020) groups. The cattle with either histopathologic lesions or low specific gravities were considered to have renal disease.Renal lesions were detected in 37 cattle. UPC values were significantly affected (P .05) by USG values, and not by the type of lesion detected, breed, or age, and their interactions (P .05). The analysis revealed that a UPC of ≥0.19 provided an optimal cut-off point for the differentiation between normal animals and those with renal disease with 66.0% sensitivity and 90% specificity.The UPC calculation is a useful tool for the differentiation of normal cattle and those with renal disease. A UPC of less than 0.19 is associated with the absence of renal damage, whereas higher values raise suspicion for renal disease.

To assess potential impacts on receiving systems, associated with storm water contaminants, laboratory 10-d amphipod (Eohaustorius estuarius) survival toxicity tests were performed using intact sediment cores collected from Paleta Creek (San Diego Bay, CA, USA) on 5 occasions between 2015 and 2017. The approach included deposition-associated sediment particles collected from sediment traps placed at each of 4 locations during the 2015 to 2016 wet seasons. The bioassays demonstrated wet season toxicity, especially closest to the creek mouth, and greater mortality associated with particles deposited in the wet season compared with dry season samples. Grain size analysis of sediment trap material indicated coarser sediment at the mouth of the creek and finer sediment in the outer depositional areas. Contaminant concentrations of metals (Cd, Cu, Hg, Ni, Pb, and Zn) and organic compounds (polycyclic aromatic hydrocarbons [PAHs], polychlorinated biphenyls [PCBs], and pesticides) were quantified to assess possible causes of toxicity. Contaminant concentrations were determined in the top 5 cm of sediment and porewater (using passive samplers). Whereas metals, PAHs, and PCBs were rarely detected at sufficient concentrations to elicit a response, pyrethroid pesticides were highly correlated with amphipod toxicity. Summing individual pyrethroid constituents using a toxic unit approach suggested that toxicity to E. estuarius could be associated with pyrethroids. This unique test design allowed delineation of spatial and temporal differences in toxicity, suggesting that storm water discharge from Paleta Creek may be the source of seasonal toxicity. Environ Toxicol Chem 2019;39:229-239. © 2019 SETAC.

OBJECTIVES To assess in vivo colour alterations of teeth following removal of fixed orthodontic appliances during retention. SETTING AND SAMPLE POPULATION The Department of Orthodontics at the Aristotle University of Thessaloniki. Forty-eight patients after orthodontic treatment. MATERIAL AND METHODS Debonding and cleaning procedures after orthodontic treatment were performed using two different carbide burs attached to a low or high-speed handpiece, respectively, in a non-blinded cohort study with split-mouth design. Spectrophotometric colour data of teeth were recorded: (a) after debonding, (b) three months later, prior to and following finishing with Soflex discs, and (c) after 1 year. The CIE Lab colour parameters were measured for each tooth, and the corresponding ΔE differences were calculated. The effect on colour was assessed with 3-way mixed ANOVA and Bonferroni's comparisons test (a

Two key interfaces in flexible perovskite solar cells (f-PSCs) are mechanically reinforced simultaneously: one between the electron-transport layer (ETL) and the 3D metal-halide perovskite (MHP) thin film using self-assembled monolayer (SAM), and the other between the 3D-MHP thin film and the hole-transport layer (HTL) using an in situ grown low-dimensional (LD) MHP capping layer. The interfacial mechanical properties are measured and modeled. This rational interface engineering results in the enhancement of not only the mechanical properties of both interfaces but also their optoelectronic properties holistically. As a result, the new class of dual-interface-reinforced f-PSCs has an unprecedented combination of the following three important performance parameters: high power-conversion efficiency (PCE) of 21.03% (with reduced hysteresis), improved operational stability of 1000 h T

The differential diagnosis of a sudden protrusion of a large vaginal mass includes a uterine or vaginal vault prolapse, a pedunculated uterine leiomyoma or leiomyosarcoma, a uterine stromal tumor or a giant polyp.

Wild pig (Sus scrofa) populations in the United States are expanding and increasing in distribution and abundance and are known to reservoir a variety of pathogens that can have economic and agricultural impacts. We examined wild pigs for exposure to Brucella spp. and Francisella tularensis from Oklahoma and Texas to determine their potential role as a regional reservoir for these pathogens since wild pigs co‐occur with livestock, especially on rangelands in this region. Antibodies to Brucella spp. and F. tularensis were found in every location sampled and during multiple years. Overall, wild pigs had a 12.5% prevalence of Brucella spp. and a 14.8% prevalence of F. tularensis in this study. Wild pig prevalence of Brucella spp. was 43 times higher in southcentral Oklahoma compared to previously published results. Understanding and monitoring regional disease prevalence rates in wild pigs are necessary, especially on rangelands managing for livestock that may be susceptible to these diseases.

Biallelic mutations in AP5Z1 are known to cause a rare, autosomal recessive, complex form of hereditary spastic paraplegia (HSP) referred to as SPG48 (MIM#613647)[1]. To date, only 11 SPG48 cases have been reported. The clinical spectrum of SPG48 is complex and heterogeneous, presenting with neuropathy, ataxia, dystonia and parkinsonism in addition to the spastic paraplegia (SP). AP5Z1 codes for the ζsubunit of the AP-5 complex, implicated in vesicular-mediated intracellular sorting and trafficking of cargo proteins[1] and functional studies demonstrate accumulation of multilamellar structures(endolysosomes) in SPG48 skin fibroblasts[2].