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Abstract All-optical communication systems are under continuous development to address different core elements of inconvenience. Here, we numerically investigate an all-optical modulator, realizing a highly efficient modulation depth of 22 dB and a low insertion loss of 0.32 dB. The tunable optical element of the proposed modulator is a layer of Al-doped Zinc Oxide (AZO), also known as an epsilon-near-zero transparent conductive oxide. Sandwiching the AZO layer between a carefully designed distributed Bragg reflector and a dielectric metasurface—i.e., composed of a two-dimensional periodic array of cubic Si—provides a guided-mode resonance at the OFF state of the modulator, preventing the incident signal reflection at λ = 1310 nm. We demonstrate the required pump fluence for switching between the ON/OFF states of the designed modulator is about a few milli-Joules per cm2. The unique properties of the AZO layer, along with the engineered dielectric metasurface above it, change the reflection from 1 to 93%, helping design better experimental configurations for the next-generation all-optical communication systems.

Introduction Large language models such as ChatGPT have gained popularity for their ability to generate comprehensive responses to human queries. In the field of medicine, ChatGPT has shown promise in applications ranging from diagnostics to decision-making. However, its performance in medical examinations and its comparison to random guessing have not been extensively studied.Methods This study aimed to evaluate the performance of ChatGPT in the preinternship examination, a comprehensive medical assessment for students in Iran. The examination consisted of 200 multiple-choice questions categorised into basic science evaluation, diagnosis and decision-making. GPT-4 was used, and the questions were translated to English. A statistical analysis was conducted to assess the performance of ChatGPT and also compare it with a random test group.Results The results showed that ChatGPT performed exceptionally well, with 68.5% of the questions answered correctly, significantly surpassing the pass mark of 45%. It exhibited superior performance in decision-making and successfully passed all specialties. Comparing ChatGPT to the random test group, ChatGPT’s performance was significantly higher, demonstrating its ability to provide more accurate responses and reasoning.Conclusion This study highlights the potential of ChatGPT in medical licensing examinations and its advantage over random guessing. However, it is important to note that ChatGPT still falls short of human physicians in terms of diagnostic accuracy and decision-making capabilities. Caution should be exercised when using ChatGPT, and its results should be verified by human experts to ensure patient safety and avoid potential errors in the medical field.

Coronavirus disease 2019 has presented itself with a variety of clinical signs and symptoms. One of these has been the accordance of spontaneous pneumothorax which in instances has caused rapid deterioration of patients. Furthermore pneumothorax may happen secondary to intubation and the resulting complications. Not enough is discussed regarding cases with COVID-19 related pneumothorax and proper management of these patients. The present article reports an elderly patient with spontaneous pneumothorax secondary to COVID-19 and reviews the existing literature.

Background. Historically, many organs from deceased donors with hepatitis C virus (HCV) were discarded. The advent of highly curative direct-acting antiviral (DAA) therapies motivated transplant centers to conduct trials of transplanting HCV-viremic organs (nucleic acid amplification test positive) into HCV-negative recipients, followed by DAA treatment. However, the factors that influence candidates’ decisions regarding acceptance of transplant with HCV-viremic organs are not well understood. Methods. To explore patient-level perceptions, influences, and experiences that inform candidate decision-making regarding transplant with organs from HCV-viremic donors, we conducted a qualitative semistructured interview study embedded within 3 clinical trials investigating the safety and efficacy of transplanting lungs and kidneys from HCV-viremic donors into HCV-negative recipients. The study was conducted from June 2019 to March 2021. Results. Among 44 HCV-negative patients listed for organ transplant who were approached for enrollment in the applicable clinical trial, 3 approaches to decision-making emerged: positivist, risk analyses, and instinctual response. Perceptions of risk contributed to conceptualizations of factors influencing decisions. Moreover, most participants relied on multiple decision-making approaches, either simultaneously or sequentially. Conclusions. Understanding how different decisional models influence patients’ choices regarding transplant with organs from HCV-viremic donors may promote shared decision-making among transplant patients and providers.

The coronavirus disease 2019 (COVID-19) is characterized by viral pneumonia with mild to moderate symptoms. Emerging studies suggest that some patients may experience uncommon complications, such as thrombotic or hemorrhagic episodes. Here we present a 59-year-old male patient who had a hemorrhage episode from a branch of the pulmonary arteries and was treated by interventional embolization. Our case report demonstrates the importance of early diagnosis of hemorrhagic complications of COVID-19 and the possible benefits of early vascular intervention.

A radiographic incidental finding (sometimes called an incidentaloma) is defined as a structure that is unintentionally found during an exam for an unrelated indication. The increased use of routine abdominal imaging is associated with a rising incidence in incidentalomas of the kidney [1]. In one meta-analysis, 75% of renal incidentalomas were benign [2]. However, the overall prevalence of incidental carcinomas is low at 0.2% [3]. With the growing uptake of POCUS, healthy volunteers for clinical demonstrations may find themselves with new findings despite a lack of symptoms [4]. Having an incidentaloma discovered during the course of a nephrology POCUS workshop is a unique experience. Herein we report our experiences of having incidentalomas discovered during the course of POCUS demonstrations.

Abstract Rosai‐Dorfman disease (RDD), as a lymphoproliferative disorder with unknown etiology, is commonly identified with systemic clinical manifestations in various organs. In this case study, RDD occurrence was reported with an exceedingly liver mass.

Introduction: COVID-19 might present with other seemingly unrelated manifestations; for instance, neurological symptoms. This study aimed to evaluate the neurologic manifestations and their correlated factors in COVID-19 patients. Methods: This retrospective observational study was conducted from March 17, 2020 to June 20, 2020 in a tertiary hospital in Iran. The study population consisted of adult patients with a positive result for COVID-19 real-time reverse transcriptase polymerase chain reaction (RT-PCR) using nasopharyngeal swabs. Both written and electronic data regarding baseline characteristic, laboratory findings, and neurological manifestations were evaluated and reported. Results: 727 COVID-19 patients with the mean age of 49.94 ± 17.49 years were studied (56.9% male). At least one neurological symptom was observed in 403 (55.4%) cases. Headache (29.0%), and smell (22.3%) and taste (22.0%) impairment were the most prevalent neurological symptoms, while seizure (1.1%) and stroke (2.3%) were the least common ones. Patients with neurological manifestations were significantly older (p = 0.04), had greater body mass index (BMI) (p = 0.02), longer first symptom to admission duration (p < 0.001) and were more frequently opium users (p = 0.03) compared to COVID-19 patients without neurological symptoms. O2 saturation was significantly lower in patients with neurological manifestations (p = 0.04). In addition, medians of neutrophil count (p = 0.006), neutrophil-lymphocyte ratio (NLR) (p = 0.02) and c-reactive protein (CRP) (p = 0.001) were significantly higher and the median of lymphocyte count (p = 0.03) was significantly lower in patients with neurological manifestations. Conclusion: The prevalence of neurological manifestations in the studied cases was high (55.4%). This prevalence was significantly higher in older age, grated BMI, longer lasting disease, and opium usage.

Background: Vertebroplasty is a procedure most commonly used for vertebral compression fractures. Although it is a relatively safe procedure, complications have been reported. Cement embolism is seen in 2.1%–26% of patients after percutaneous vertebroplasty. Case presentation: a 38-year-old male who was diagnosed with cushing's syndrome, underwent percutaneous vertebroplasty for his thoracic osteoporotic compression fractures. 24-hours following vertebroplasty, he presented to emergency department with acute-onset dyspnea and chest pain. Chest radiography showed an opaque linear lesion in left pulmonary artery which was suggestive of cement embolism. Pulmonary spiral CT-scan further confirmed the diagnosis. The patient's symptoms improved over time, and warfarin was started with close cardiopulmonary assessments for indicators of cement embolus removal. Conclusion: in patients with pulmonary cement embolism, conservative treatment may be recommended rather than a surgical removal except when the obstruction is extensive enough to cause hemodynamic changes. Given that all the related studies have suggested that pulmonary thromboembolism can occur as a complication due to bone cement leakage, discovering new cement alternatives and/or injection devices, seems beneficial. Keywords: Percutaneous vertebroplasty, Cement embolism, Complications, cushing's syndrome

Background and Aim: Mild cognitive impairment (MCI) is characterized by declined cognitive function greater than that expected for a person’s age. The clinical significance of this condition is its possible progression to dementia. MLC601 is a natural neuroprotective medication that has shown promising effects in Alzheimer disease. Accordingly, we conducted this randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of MLC601 in MCI patients. Methods: Seventy-two patients with a diagnosis of MCI were recruited. The included participants were randomly assigned to groups to receive either MLC601 or placebo. An evaluation of global cognitive function was performed at baseline as well as at 3-month and 6-month follow-up visits. Global cognitive function was assessed by Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) scores. Efficacy was evaluated by comparing global function scores between the 2 groups during the study period. Safety assessment included adverse events (AEs) and abnormal laboratory results. Results: Seventy patients completed the study, 34 in the MLC601 group and 36 in the placebo group. The mean changes (±SD) in cognition scores over 6 months in the MLC601 group were –2.26 (±3.42) for the MMSE and 3.82 (±6.16) for the ADAS-cog; in the placebo group, they were –2.66 (±3.43) for the MMSE and 4.41 (±6.66) for the ADAS-cog. The cognition changes based on both MMSE and ADAS-cog scores were statistically significant between the placebo and the MLC601 group (p < 0.001). Only 5 patients (14.7%) reported minor AEs in the MLC601 group, the most commonly reported of which were gastrointestinal, none of them leading to patient withdrawal. Conclusion: MLC601 has shown promising efficacy and acceptable AEs in MCI patients.

Background and Purpose: Cognitive impairment (CI) is one of the most notable disabilities of Parkinson’s disease that is associated with lower quality of life. Early detection of CI is therefore very important for these patients. The purpose of this study was to examine the relationship between cognitive function and the metabolic data from magnetic resonance spectroscopy (MRS) of the patient suffering with Parkinson’s disease. Methods: Totally, 45 patients with Parkinson’s disease were used in this study. Subjects were divided into three groups based on scales for outcome from Parkinson cognition (SCOPACOG) test. Patients were classified as non-cognitive impairment (NCI; n=15), mild cognitive impairment (MCI; n=15) and dementia (PDD; n=15). All subjects underwent MRI and 1 H-MRS techniques and metabolic changes such as NAA/Cr and NAA/Cho ratios, which were measured in the left hippocampal area of the brain. Results: The mean and standard deviation of the NAA/Cr ratio in the three cognitive groups (NCI, MCI, PDD) were (2.51±0.037), (2.50±0.033) and (2.47±0.025), respectively. ANOVA test showed a significant difference in the three groups. Furthermore, the Scheffé test showed a significant difference between patients in the MCI and PDD groups (p=0.01). There was no significant difference between the non-cognitive impairment and mild cognitive impairment groups (p=0.54). No significant difference was found in NAA/Cho ratio (p=091). Conclusion: A decreasing NAA/Cr ratio has influence on cognitive function and the development of severe cognitive dysfunction in Parkinson suffering patients. Furthermore, 1 H-MRS determinant can be useful to evaluate cognition in Parkinson patients.

Brain hemorrhages are rare complications of acute methanol poisoning. There is a debate on association of brain hemorrhage in methanol toxicity and application of systemic anticoagulation during hemodialysis (HD). A 70-year-old male presented to us with severe metabolic acidosis and a methanol level of 7.6 mg/dL. Ethanol and folinic acid were administered, and HD was performed. Brain computed tomography (CT) scan which was normal on presentation showed extensive bilateral subcortical supratentorial hypodensities on the 3rd day after commencing the treatment. However, the next CT scan performed 2 weeks later revealed expanding hemorrhagic transformation in previous hypodensities. Hemorrhagic changes could not be explained by patient's coagulation profile on the 3rd day. Anticoagulation agents such as heparin are used routinely during a dialysis session to prevent clot formation in dialysis circuits. This case is possibly questioning the role of heparin in hemorrhagic brain lesions of methanol intoxication.

Introduction: Recently, hepatoma-derived growth factor (HDGF) has been considered as a significantly important factor in determining the prognosis and estimating the probability of tumor cell invasions, recurrence, and lymph node metastasis in different cancers, including breast malignancies. Materials and Methods: Immunohistochemistry (IHC) study for HDGF was performed on paraffin-embedded blocks of patients with breast carcinoma in Modarres hospital, Tehran, Iran, since 1387–1390 (74 cases); three separate pathologists read the slides after complete IHC staining. Thereafter, necessary information was recorded from patient files, and eventually, findings were analyzed by SPSS program. Results: Expression of nuclear HDGF has significant statistical correlation with tumor grade according to Nottingham grading scheme; this correlation is also seen with nuclear pleomorphism of tumor cells and mitotic count. No correlation between age and tumor size with expression of HDGF is found. Lymph node metastasis is in inverse ratio to nuclear HDGF staining. Conclusion: Nuclear expression of HDGF in tumor cells is increased concordantly to tumor grade, which implies us to the role of this marker in determining the prognosis and choosing the most suitable treatment plan.

The presence of different autoimmune disorders in the same individual is called multiple autoimmune syndrome (MAS). One of these co-occurring conditions is autoimmune haemolytic anaemia (AIHA), which is characterized by the production of autoantibodies against red blood cells due to immune system malfunction and which results in severe tissue oxygenation disturbance. AIHA is not uncommon but occurs rarely in MAS; if it does, MAS is then classified as MAS type III. Herein, we describe a case of MAS type III including AIHA which was successfully treated with hydrocortisone with gradual resolution of symptoms.

Ankylosing Spondylitis (AS) is a chronic inflammatory disease of the skeleton manifested by back pain and progressive stiffness of the spine. In AS, the inflammation starts around the enthesis (the site of ligament insertion into bone) and typically affects young men with a peak age of onset of 20 to 30 years. Although classically thought as a spinal disease, it can involve other organs such as eyes, lungs, and heart. We present a 49-year-old man with pleural effusion and history of recent pericardial effusion but his fluid studies of pleura and pericardium did not lead us to a clear diagnosis. Then we noticed his thoracic kyphosis, severe restriction of lumbar movements and sacroiliac joint inflammation on MRI which are suggestive of AS. We started prednisolone 50 mg daily for one week and the pleural effusion resolved spontaneously after one week. Then, we tapered prednisolone and the patient remained well off any medication. Isolated pleural and or pericardial effusion may be seen in patients with AS without a simultaneous apical fibrobullous involvement of the lungs and it responds well to corticosteroid.

Background and purpose: Cognitive impairment (CI) is one of the causes of disabilities in multiple sclerosis patients (MS). Therefore, early detection and evaluation of cognitive performance is very important in patients with MS. The aim of the present study is to compare Montreal Cognitive Assessment (MoCA) test and Mini Mental Status Exam (MMSE) in Relapsing Remitting (RR) MS patients. Methods: Fifty RRMS patients who met inclusion and exclusion criteria were recruited in this study. MMSE and MoCA were administrated to all subjects. Also demographic data, disease duration and EDSS were recorded. The results of both tests were compared. Results: The mean score of MoCA and MMSE was 22.86±3.85 and 27.64±2, with a significant difference (p

Background and Purpose: The increased risk for cognitive defects in individuals affected by metabolic syndrome especially in those patients with cardiovascular disorders is now claimed. We aimed to assess the relationship between cognitive performance and the various components of metabolic syndrome. Methods: One hundred and eighteen consecutive individuals aged 30 to 86 years were included into this cross-sectional survey. The metabolic syndrome and its definitive components were defined according to the definition described in the Framingham Heart Study by NCEP ATP III criteria. The Montreal Cognitive Assessment (MOCA) questionnaire was employed to cognitive screening. Results: Those patients with metabolic syndrome had significantly lower mean MOCA score compare to the group without metabolic syndrome (19.11 ± 5.49 versus 21.28 ± 4.56, p = 0.021). Among all cognition sub domains, the mean attention score was significantly lower in the group with metabolic syndrome than in another group. In a multivariate linear regression model adjusting sex and age variables showed that the presence of metabolic syndrome could effectively predict cognitive impairment (beta = -2.202, SE = -0.214, p = 0.013). Conclusion: The presence of metabolic syndrome can be mainly related to damaging cognition especially impairing the power of attention.

Background and Purpose: Because of well-established role of obesity in brain lesions, progressing cognitive deficits in obese patients has been recently suggested. In current study and for the first time, we aimed to assess cognition status in Iranian obese people and to compare it with non-obese individuals. Methods: One hundred and eighteen consecutive patients with the different cardiovascular and metabolic primary complaints were assigned to obese group (n=25, 21.2%) and non-obese group (n=93, 78.8%). Cognitive status was assessed at initial visit using the Montreal Cognitive Assessment (MoCA) questionnaire. Results: Mean of total cognitive score in obese patients was 20.04±4.57 and in non-obese ones was 20.19±5.32 with no difference (p=0.886). In total, 8.0% of obese patients and 20.4% of non-obese patients had normal cognitive function (p=0.149). No significant difference was also found in different subdomains of cognitive ability between obese and non-obese groups. None of the cognitive domains had significant association with BMI as the considered indicator for defining obesity. Based on multivariate linear regression modeling, obesity could not predict cognitive deficit (beta=0.034, SE:1.10 p=0.973). Conclusion: Our survey could not demonstrate an association between obesity and cognitive impairment in a sample of Iranian patients.

Transradial coronary angiography has been known as an alternative to the transfemoral approach with fewer serious complications. Radial artery pseudoaneurysms present as a rare complication of transradial catheterization. Although some methods have been applied for the obliteration of pseudoaneurysms, the use of radial bands such as the TR Band® (Terumo Medical Corporation, Somerset, NJ) is a novel efficient technique only suggested by a few reports. We describe a 34-year-old man, who underwent transradial primary coronary angiography due to ST-elevation myocardial infarction. Two months later, he noticed a pulsatile mass on his hand where the catheterization was done. Ultrasonography proved the diagnosis of a pseudoaneurysm. Consequently, a TR Band® was applied to compress the mass. Interestingly, 24 hours later, ultrasonography confirmed a thrombosed pseudoaneurysm and the pulsatile mass had completely disappeared gradually without recurrence at 2 months’ follow-up. Hence, this case report aims to propose the TR Band® as an effective noninvasive method for the treatment of pseudoaneurysms following catheterization.

Leigh syndrome is a severe progressive neurodegenerative disorder with different clinical presentationsthat usually becomes apparent in the first year of life and rarely in late childhood and elderly years. It is causedby failure of mitochondrial respiratory chain and often results in regression of both mental and motor skills and might even lead to death. In some of the inherited neurodegenerative diseases like Alexander disease, head trauma is reported as a trigger for onset of the disease. We present a late onset Leigh syndrome in a 14-year-old girl whose symptoms were initiating following head trauma.

Leigh syndrome is a severe progressive neurodegenerative disorder with different clinical presentationsthat usually becomes apparent in the first year of life and rarely in late childhood and elderly years. It is causedby failure of mitochondrial respiratory chain and often results in regression of both mental and motor skills and might even lead to death. In some of the inherited neurodegenerative diseases like Alexander disease, head trauma is reported as a trigger for onset of the disease. We present a late onset Leigh syndrome in a 14-year-old girl whose symptoms were initiating following head trauma.

Cerebral stroke is a rare disease in children. Moyamoya (MM) is one of the infrequent cerebrovascular diseases with unknown etiology. We report an 8 year-old-boy with chief complain of sudden onset bilateral parietal lobe headache. He mentioned that his headache was first started about three weeks ago and was associated with visual disturbance. His mother declared that the boy developed gait problems few days later and only could walk with assistance. He was diagnosed with MM disease. After, medical treatment his symptoms were mildly improved and because of his family disagreement cerebral revascularization surgery was not performed.

To perform an accurate approach to the spine specially for fracture stabilization a 3D model of spine surgical region may improve this mechanism and it can help the surgeon to have a deeper glance to this scenario. The pre-op planning facility is another advantage of the patient spine specific model to take a chance of making guides to direct pedicle screws safely and increase the pathomechanics of volumes of interest stability factor parallel with its mobility restoration. There are some algorithms for making 3D-reconstruction from CT or MR data-set but the main goal of in-vivo component 3D making is right component extraction from its peripheral segments to achieve the best judgment especially about the surgical approach. Here is a cervical vertebral bodies segmentation and 3D-reconstruction of two cervical adjacent levels combined with the registration process that is shown the intervertebral degree regarding to range of motion percent.

Cardiovascular diseases are one of the most common diseases that cause a large number of deaths each year. Coronary Artery Disease (CAD) is the most common type of these diseases worldwide and is the main reason of heart attacks. Thus early diagnosis of CAD is very essential and is an important field of medical studies. Many methods are used to diagnose CAD so far. These methods reduce cost and deaths. But a few studies examined stenosis of each vessel separately. Determination of stenosed coronary artery when significant ECG abnormality exists is not a difficult task. Moreover, ECG abnormality is not common among CAD patients. The aim of this study is to find a way for specifying the lesioned vessel when there is not enough ECG changes and only based on risk factors, physical examination and Para clinic data. Therefore, a new data set was used which has no missing value and includes new and effective features like Function Class, Dyspnoea, Q Wave, ST Elevation, ST Depression and Tinversion. These data was collected from 303 random visitor of Tehran′s Shaheed Rajaei Cardiovascular, Medical and Research Centre, in 2011 fall and 2012 winter. They processed with C4.5, Naοve Bayes, and k-nearest neighbour (KNN) algorithms and their accuracy were measured by tenfold cross validation. In the best method the accuracy of diagnosis of stenosis of each vessel reached to 74.20 ± 5.51% for Left Anterior Descending (LAD), 63.76 ± 9.73% for Left Circumflex and 68.33 ± 6.90% for Right Coronary Artery. The effective features of stenosis of each vessel were found too.

Kennedy disease is a rare X-linked neurodegenerative disorder that affects patients in 30-50 years of age. It is caused by CAG-repeat in androgen receptor gen. There is no known effective treatment for Kennedy disease. We report a 60-year-old man who had fasciculations and proximal and distal muscle weakness. Physical examination showed involvement of the bulbar musculature accompanied by tongue atrophy and perioral muscle weakness. Furthermore, he had bilateral gynecomastia. Laboratory and imaging findings were normal, except electromyography that showed chronic proximal and distal denervation. Finally, the patient diagnosed with Kennedy disease according to clinical presentation and EMG abnormality that confirmed with genetic study.

A 64-year-old female with history of previous aortoiliac occlusion and aortoiliac bypass operation four months ago presented with dyspnea, ascites and leg edema. She has been suffering from bloody diarrhea since two weeks earlier. Laboratory data showed important eosinophilia and stool examination was positive for Strongyloides stercoralis. Patient had clinical signs of heart failure. A cardiac MRI revealed hypersignal subendocardium in favor of endomyocardial fibrosis. Hypereosinophilic syndrome is defined by persistent hypereosinophilia for more than 6 months. The association with different etiologies is known but the report of cardiac involvement due to S. stercoralis infection is not very common. Cardiac manifestation is characterized by a restrictive cardiomyopathy due to toxic damage produced by activated eosinophils.

Background: Cardiac resynchronization therapy (CRT) is an established treatment in patients with end-stage heart failure and wide QRS complex. However, about 30% of patients do not benefit from CRT (non-responder). Recent studies with tissue Doppler imaging yielded disappointing results in predicting CRT responders. Phase analysis was developed to allow assessment of LV dyssynchrony by gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (GMPS). Objectives: The aim of present study was to investigate the role of quantitative GMPS-derived LV dyssynchrony data to predict CRT responder. Patients and Methods: Thirty eligible patients for CRT implantation underwent GMPS and echocardiography. Response to CRT was evaluated six months after the device implantation. Clinical response to CRT was defined as 50 meters increase in 6-minute walking test (6-MWT) distance. Echocardiographic response to CRT was defined as ≥ 15% decrease in left ventricular end-systolic volume (LVESV). The lead position was considered concordant if it was positioned at the area of latest mechanical activation, and discordant if located outside the area of latest mechanical activation. Results: Clinical response to CRT was observed in 74% of patients. However, only 57% of patients were responder according to the echo criteria. There were statistically significant differences between CRT responders and non-responders for GMPS-derived variables, including phased histogram bandwidth (PHB), phase SD (PSD), and Entropy. Moreover, a cutoff value of 112° for PHB with a sensitivity of 72% and specificity of 70%, a cutoff value of 21° for PSD with a sensitivity of 90% and specificity of 74%, and a cutoff of 52% for Entropy with a sensitivity of 90% and a specificity of 80% were considered to discriminate responders and non-responders. CRT response was more likely in patients with concordant LV lead position compared to those with discordant LV lead position. Conclusions: GMPS-derived LV dyssynchrony variables can predict response to CRT with good sensitivity and specificity.

Limited ankle dorsiflexion range of motion is one of the most important risk factors for lower limb injury, which changes the biomechanics and the neuromuscular control of the lower limb muscles. This study aims to test the effectiveness of a comprehensive corrective exercise program (CCEP) on the range of motion, proprioception, dynamic balance, and muscle activation in female athletes with limited weight-bearing lunge ankle dorsiflexion range of motion. 30 female athletes aged 15 to 25 years with dorsiflexion under 34° were randomized to two groups. The intervention group (n = 15) received eight weeks of CCEP including soft tissue mobilization, joint mobilization, stretching, and strengthening, and the control (n = 15) group did not receive any intervention. range of motion, proprioception, dynamic balance, and muscle activation were assessed before and after the intervention. The training group showed clinically acceptable and statistically significant changes in ankle dorsiflexion range of motion (ES = 0.714), balance (ES = 0.423), and proprioception (ES = 0.253; P < 0.05). There were significant changes in the activity of the tibialis anterior and soleus muscles in the dynamic overhead squat test (descending and ascending phases) and the activity of the medial gastrocnemius in the descending phase decreased significantly (P < 0.05). No significant change was observed in the activity of the peroneus longus muscle (P > 0.05). The findings show that CCEP appears to be beneficial in increasing dorsiflexion range of motion, proprioception, balance, and decreasing ankle muscle activity among individuals with limited ankle dorsiflexion. Improving the dorsiflexion range of motion may be promising for reducing ankle sprain injury., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a life-threatening monogenic autoimmune disorder primarily caused by biallelic deleterious variants in the autoimmune regulator ( AIRE ) gene. We prospectively evaluated 104 patients with clinically diagnosed APECED syndrome and identified 17 patients (16%) from 14 kindreds lacking biallelic AIRE variants in exons or flanking intronic regions; 15 had Puerto Rican ancestry. Through whole-genome sequencing, we identified a deep intronic AIRE variant (c.1504-818 G>A) cosegregating with the disease in all 17 patients. We developed a culture system of AIRE -expressing primary patient monocyte-derived dendritic cells and demonstrated that c.1504-818 G>A creates a cryptic splice site and activates inclusion of a 109-base pair frame-shifting pseudoexon. We also found low-level AIRE expression in patient-derived lymphoblastoid cell lines (LCLs) and confirmed pseudoexon inclusion in independent extrathymic AIRE -expressing cell lines. Through protein modeling and transcriptomic analyses of AIRE -transfected human embryonic kidney 293 and thymic epithelial cell 4D6 cells, we showed that this variant alters the carboxyl terminus of the AIRE protein, abrogating its function. Last, we developed an antisense oligonucleotide (ASO) that reversed pseudoexon inclusion and restored the normal AIRE transcript sequence in LCLs. Thus, our findings revealed c.1504-818 G>A as a founder APECED-causing AIRE variant in the Puerto Rican population and uncovered pseudoexon inclusion as an ASO-reversible genetic mechanism underlying APECED.

Correctly identifying perturbed biological pathways is a critical step in uncovering basic disease mechanisms and developing much-needed therapeutic strategies. However, whether current tools are optimal for unbiased discovery of relevant pathways remains unclear. Here, we create "Benchmark" to critically evaluate existing tools and find that most function sub-optimally. We thus develop the "Pathway Ensemble Tool" (PET), which outperforms existing methods. Deploying PET, we identify prognostic pathways across 12 cancer types. PET-identified prognostic pathways offer additional insights, with genes within these pathways serving as reliable biomarkers for clinical outcomes. Additionally, normalizing these pathways using drug repurposing strategies represents therapeutic opportunities. For example, the top predicted repurposed drug for bladder cancer, a CDK2/9 inhibitor, represses cell growth in vitro and in vivo. We anticipate that using Benchmark and PET for unbiased pathway discovery will offer additional insights into disease mechanisms across a spectrum of diseases, enabling biomarker discovery and therapeutic strategies., (© 2024. The Author(s).)

Hyperspectral imaging has shown great promise for diagnostic applications, particularly in cancer surgery. However, non-bulk tissue-related spectral variations complicate the data analysis. Common techniques, such as standard normal variate normalization, often lead to a loss of amplitude and scattering information. This study investigates a novel approach to address these spectral variations in hyperspectral images of optical phantoms and excised human breast tissue. Our method separates surface and volume reflectance, hypothesizing that spectral variability arises from significant variations in surface reflectance across pixels. An illumination setup was developed to measure samples with a hyperspectral camera from different axial positions but with identical zenith angles. This configuration, combined with a novel data analysis approach, allows for the estimation and separation of surface reflectance for each direction and volume reflectance across all directions. Validated with optical phantoms, our method achieved an 83% reduction in spectral variability. Its functionality was further demonstrated in excised human breast tissue. Our method effectively addresses variations caused by surface reflectance or glare while conserving surface reflectance information, which may enhance sample analysis and evaluation. It benefits samples with unknown refractive index spectra and can be easily adapted and applied across a wide range of fields where hyperspectral imaging is used.

Background: Dynamic knee valgus (DKV) is a risk factor for non-contact anterior cruciate ligament (ACL) injuries. Understanding the changes in the electromyographic activity of the lower extremity muscles in individuals with DKV helps trainers design ACL injury prevention exercises. Therefore, the present meta-analysis aimed to investigate the muscle activation of the lower limb muscles in individuals with DKV during single-leg and overhead squats., Methods: Articles with titles, abstracts, and full texts were searched and screened independently by two reviewers in the Web of Science, Scopus, PubMed, and Google Scholar databases, without restrictions on publication date and in English using specified keywords from their inception to January 5, 2024. The quality of articles was evaluated using a modified version of the Downs and Black quality checklist. This meta-analysis used mean difference (MD) to compare the muscle activity patterns between individual with DKV and healthy individuals. Heterogeneity was detected using I-square (I 2 ) test., Results: In total, four papers with 130 participants were included in the study. Evidence showed a significant difference between the DKV group and the healthy group regarding the activities of the adductor magnus (MD: 6.25, P < 0.001), vastus medialis (MD: 13.23, P = 0.002), vastus lateralis (MD: 11.71, P = 0.004), biceps femoris (MD: 3.06, P = 0.003), and tibialis anterior muscles (MD: 8.21, P = 0.02). Additionally, muscle activity in the DKV group was higher than that in the healthy group., Conclusions: This meta-analysis reveals distinct muscle activation patterns in individuals with dynamic knee valgus (DKV), with increased activity in key muscles suggesting compensatory responses. These findings underscore the need for targeted rehabilitation to address muscle imbalances and improve knee stability., (© 2024. The Author(s).)

Multi-modality image registration is an important task in medical imaging because it allows for information from different domains to be correlated. Histopathology plays a crucial role in oncologic surgery as it is the gold standard for investigating tissue composition from surgically excised specimens. Research studies are increasingly focused on registering medical imaging modalities such as white light cameras, magnetic resonance imaging, computed tomography, and ultrasound to pathology images. The main challenge in registration tasks involving pathology images comes from addressing the considerable amount of deformation present. This work provides a framework for deep learning-based multi-modality registration of microscopic pathology images to another imaging modality. The proposed framework is validated on the registration of prostate ex-vivo white light camera snapshot images to pathology hematoxylin-eosin images of the same specimen. A pipeline is presented detailing data acquisition, protocol considerations, image dissimilarity, training experiments, and validation. A comprehensive analysis is done on the impact of pre-processing, data augmentation, loss functions, and regularization. This analysis is supplemented by clinically motivated evaluation metrics to avoid the pitfalls of only using ubiquitous image comparison metrics. Consequently, a robust training configuration capable of performing the desired registration task is found. Utilizing the proposed approach, we achieved a dice similarity coefficient of 0.96, a mutual information score of 0.54, a target registration error of 2.4 mm, and a regional dice similarity coefficient of 0.70.

The objective of the present study was to develop a novel molybdenum disulfide/iron oxide/gold nanorods (MoS 2 /Fe 3 O 4 /GNR) nanocomposite (MFG) with different concentrations of AgNO 3 solution (MFG1, MFG2, and MFG3) for topical doxorubicin (DOX) drug delivery. Then, these nanocomposites were synthesized and characterized by Fourier transform infrared (FTIR), Transmission electron microscopy (TEM), Dynamic light scattering (DLS), and Ultraviolet-visible (UV-Vis) spectroscopies to confirm their structural and optical properties. Cytotoxicity of samples on Hela cell was determined using MTT assay. Results indicated that nanocomposites possess little cytotoxicity without NIR laser irradiation. Also, the relative viabilities of Hela cells decreased when the concentration of AgNO 3 solution increased in this nanocomposite. Using NIR irradiation, the relative viabilities of Hela cells decreased when the concentration of samples increased. Acridine orange/propidium iodide (PI) staining, flow cytometry were recruited to evaluate the effect of these nanocomposites on apoptosis of Hela cells. Finally, results revealed when DOX loading increased in nanocomposite, then cell viability was decreased in it. Therefore, these properties make MFG3 nanocomposite a good candidate for photothermal therapy and drug loading., (© 2024. The Author(s).)

Background and Objective: A positive surgical margin (PSM) occurs in up to 32% of patients undergoing robot-assisted radical prostatectomy (RARP). Diffuse reflectance spectroscopy (DRS), which measures tissue composition according to its optical properties, can potentially be used for real-time PSM detection during RARP. Our objective was to assess the feasibility of DRS in distinguishing prostate cancer from benign tissue in RARP specimens., Methods: In a single-center prospective study, DRS measurements were taken ex vivo for RARP specimens from 59 patients with biopsy-proven prostate carcinoma. Discriminating features from the DRS spectra were used to create a machine learning-based classification algorithm. The data were split patient-wise into training (70%) and testing (30%) sets, with ten iterations to ensure algorithm robustness. The average sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) from ten classification iterations were calculated., Key Findings and Limitations: We collected 542 DRS measurements, of which 53% were tumor and 47% were healthy-tissue measurements. Twenty discriminating features from the DRS spectra were used as the input for a support vector machine model. This model achieved average sensitivity of 89%, specificity of 82%, accuracy of 85%, and AUC of 0.91 for the test set. Limitations include the binary label input for classification., Conclusions and Clinical Implications: DRS can potentially discriminate prostate cancer from benign tissue. Before implementing the technique in clinical practice, further research is needed to assess its performance on heterogeneous tissue volumes and measurements from the prostate surface., Patient Summary: We looked at the ability of a technique called diffuse reflectance spectroscopy to guide surgeons in discriminating prostate cancer tissue from benign prostate tissue in real time during prostate cancer surgery. Our study showed promising results in an experimental setting. Future research will focus on bringing this technique to clinical practice., (© 2024 The Author(s).)

Background: Pancreatic duct (PD) dilation could be presented in both benign and malignant diseases. Endoscopic ultrasonography (EUS) is a sensitive modality that provides both structural assessment and tissue sampling. This study aims to explore the importance of PD dilation as a potential indicator related to various pancreatobiliary pathologies identified via EUS., Methods: Among 3109 subjects who underwent EUS, 599 had evidence of dilated PD and met the inclusion criteria of this retrospective study. Also, the patients underwent EUS fine needle aspiration (EUS-FNA) to evaluate the etiology when required. All data were extracted from patients' medical records to perform statistical analysis., Results: The study sample revealed 64% being male with a median age was 65-years. Pancreatic adenocarcinoma was the most common etiology diagnosed in 236 patients (39.4%), followed by sphincter of Oddi dysfunction (SOD) in 13% of subjects. Ampullary carcinoma, common bile duct stone, and cholangiocarcinoma were found at 9.5%, 8.8%, and 6.8%, respectively. Abdominal pain was the most common symptom seen in 440 (73.4%) patients. Opium consumption was reported in 170 (28.4%) subjects. Opium consumption was significantly more prevalent in patients with SOD ( P <0.05)., Conclusion: We suggest that PD dilation could be associated with a wide range of pancreaticobiliary pathologies, especially pancreatic neoplasms. In this regard, PD dilation should be considered as a crucial indicator of pancreatic neoplasm despite it may be associated with no clear etiologies., Competing Interests: Competing Interests The authors declare no conflict of interest related to this work., (© 2024 Middle East Journal of Digestive Diseases.)

Objective: The objective of this study was to evaluate the effectiveness of Hibiscus sabdariffa L. extract (HS) as an adjunct to valsartan in the treatment of high blood pressure in patients with mild chronic kidney disease (CKD)., Materials and Methods: This trial was conducted in Gorgan, Iran. Seventy-two participants with CKD and high blood pressure were randomly assigned to either the HS group, receiving a 350 mg pill every 12 hr for 90 days along with 40 mg of valsartan every 12 hr, or the control group (40 mg valsartan + 12.5 mg hydrochlorothiazide). The primary objective was to assess the improvement of hypertension, while secondary objectives included the evaluation of proteinuria, albuminuria, kidney function, lipid profile, and electrolyte levels. Molecular docking analysis was performed to examine the mechanisms of action of the isolated components of HS., Results: Out of 80 initial participants, 72 were included in the analysis. Both groups showed a significant reduction in blood pressure (p<0.001). The HS group demonstrated a statistically significant decrease in lipid profile (p<0.001). There were no statistically significant differences between the groups regarding the reduction of renal markers. Molecular docking analysis revealed that the compounds present in HS, particularly its anthocyanins and flavonoids, exhibited greater angiotensin-converting enzyme (ACE) inhibitory potential than hydrochlorothiazide in both domains. Moreover, the compounds met the criteria for drug likeness and Lipinski rules., Conclusion: Adjunctive therapy with HS showed promising results in reducing hypertension and improving lipid profile in patients with CKD., Competing Interests: Mohammad Hadi Soleimani is the CEO of Giah Essence Phytopharmaceutical Co

The large-scale motions in 3D turbulent channel flows, known as Turbulent Superstructures (TSS), play an essential role in the dynamics of small-scale structures within the turbulent boundary layer. However, as of today, there is no common agreement on the spatial and temporal relationships between these multiscale structures. We propose a novel space-time visualization technique for analyzing the temporal evolution of these multiscale structures in their spatial context and, thus, to further shed light on the conceptually different explanations of their dynamics. Since the temporal dynamics of TSS are believed to influence the structures in the turbulent boundary layer, we propose a combination of a 2D space-time velocity plot with an orthogonal 2D plot of projected 3D flow structures, which can interactively span the time and the space axis. Besides flow structures indicating the fluid motion, we propose showing the variations in derived fields as an additional source of explanation. The relationships between the structures in different spatial and temporal scales can be more effectively resolved by using various filtering operations and image registration algorithms. To reduce the information loss due to the non-injective nature of projection, spatial information is encoded into transparency or color. Since the proposed visualization is heavily demanding computational resources and memory bandwidth to stream unsteady flow fields and instantly compute derived 3D flow structures, the implementation exploits data compression, parallel computation capabilities, and high memory bandwidth on recent GPUs via the CUDA compute library.

Humans use their arms in complex ways that often demand two-handed coordination. Neurological conditions limit this impressive feature of the human motor system. Understanding how neuromodulatory techniques may alter neural mechanisms of bimanual coordination is a vital step towards designing efficient rehabilitation interventions. By non-invasively activating the spinal cord, transcutaneous spinal cord stimulation (tSCS) promotes recovery of motor function after spinal cord injury. A multitude of research studies have attempted to capture the underlying neural mechanisms of these effects using a variety of electrophysiological tools, but the influence of tSCS on cortical rhythms recorded via electroencephalography remains poorly understood, especially during bimanual actions. We recruited 12 neurologically intact participants to investigate the effect of cervical tSCS on sensorimotor cortical oscillations. We examined changes in the movement kinematics during the application of tSCS as well as the cortical activation level and interhemispheric connectivity during the execution of unimanual and bimanual arm reaching movements that represent activities of daily life. Behavioral assessment of the movements showed improvement of movement time and error during a bimanual common-goal movement when tSCS was delivered, but no difference was found in the performance of unimanual and bimanual dual-goal movements with the application of tSCS. In the alpha band, spectral power was modulated with tSCS in the direction of synchronization in the primary motor cortex during unimanual and bimanual dual-goal movements and in the somatosensory cortex during unimanual movements. In the beta band, tSCS significantly increased spectral power in the primary motor and somatosensory cortices during the performance of bimanual common-goal and unimanual movements. A significant increase in interhemispheric connectivity in the primary motor cortex in the alpha band was only observed during unimanual tasks in the presence of tSCS. Our observations provide, for the first time, information regarding the supra-spinal effects of tSCS as a neuromodulatory technique applied to the spinal cord during the execution of bi- and unimanual arm movements. They also corroborate the suppressive effect of tSCS at the cortical level reported in previous studies. These findings may guide the design of improved rehabilitation interventions using tSCS for the recovery of upper-limb function in the future., (© 2024. The Author(s).)

Significance: The accurate correlation between optical measurements and pathology relies on precise image registration, often hindered by deformations in histology images. We investigate an automated multi-modal image registration method using deep learning to align breast specimen images with corresponding histology images., Aim: We aim to explore the effectiveness of an automated image registration technique based on deep learning principles for aligning breast specimen images with histology images acquired through different modalities, addressing challenges posed by intensity variations and structural differences., Approach: Unsupervised and supervised learning approaches, employing the VoxelMorph model, were examined using a dataset featuring manually registered images as ground truth., Results: Evaluation metrics, including Dice scores and mutual information, demonstrate that the unsupervised model exceeds the supervised (and manual) approaches significantly, achieving superior image alignment. The findings highlight the efficacy of automated registration in enhancing the validation of optical technologies by reducing human errors associated with manual registration processes., Conclusions: This automated registration technique offers promising potential to enhance the validation of optical technologies by minimizing human-induced errors and inconsistencies associated with manual image registration processes, thereby improving the accuracy of correlating optical measurements with pathology labels., (© 2024 The Authors.)

Background: Autoimmune polyendocrine syndrome type 1 (APS-1) is a life-threatening, autosomal recessive syndrome caused by autoimmune regulator (AIRE) deficiency. In APS-1, self-reactive T cells escape thymic negative selection, infiltrate organs, and drive autoimmune injury. The effector mechanisms governing T-cell-mediated damage in APS-1 remain poorly understood., Methods: We examined whether APS-1 could be classified as a disease mediated by interferon-γ. We first assessed patients with APS-1 who were participating in a prospective natural history study and evaluated mRNA and protein expression in blood and tissues. We then examined the pathogenic role of interferon-γ using Aire -/- Ifng -/- mice and Aire -/- mice treated with the Janus kinase (JAK) inhibitor ruxolitinib. On the basis of our findings, we used ruxolitinib to treat five patients with APS-1 and assessed clinical, immunologic, histologic, transcriptional, and autoantibody responses., Results: Patients with APS-1 had enhanced interferon-γ responses in blood and in all examined autoimmunity-affected tissues. Aire -/- mice had selectively increased interferon-γ production by T cells and enhanced interferon-γ, phosphorylated signal transducer and activator of transcription 1 (pSTAT1), and CXCL9 signals in multiple organs. Ifng ablation or ruxolitinib-induced JAK-STAT blockade in Aire -/- mice normalized interferon-γ responses and averted T-cell infiltration and damage in organs. Ruxolitinib treatment of five patients with APS-1 led to decreased levels of T-cell-derived interferon-γ, normalized interferon-γ and CXCL9 levels, and remission of alopecia, oral candidiasis, nail dystrophy, gastritis, enteritis, arthritis, Sjögren's-like syndrome, urticaria, and thyroiditis. No serious adverse effects from ruxolitinib were identified in these patients., Conclusions: Our findings indicate that APS-1, which is caused by AIRE deficiency, is characterized by excessive, multiorgan interferon-γ-mediated responses. JAK inhibition with ruxolitinib in five patients showed promising results. (Funded by the National Institute of Allergy and Infectious Diseases and others.)., (Copyright © 2024 Massachusetts Medical Society.)

This study aims to evaluate several defined specimen parameters that would allow to determine the surgical accuracy of breast-conserving surgeries (BCS) in a representative population of patients. These specimen parameters could be used to compare surgical accuracy when using novel technologies for intra-operative BCS guidance in the future. Different specimen parameters were determined among 100 BCS patients, including the ratio of specimen volume to tumor volume (resection ratio) with different optimal margin widths (0 mm, 1 mm, 2 mm, and 10 mm). Furthermore, the tumor eccentricity [maximum tumor-margin distance - minimum tumor-margin distance] and the relative tumor eccentricity [tumor eccentricity ÷ pathological tumor diameter] were determined. Different patient subgroups were compared using Wilcoxon rank sum tests. When using a surgical margin width of 0 mm, 1 mm, 2 mm, and 10 mm, on average, 19.16 (IQR 44.36), 9.94 (IQR 18.09), 6.06 (IQR 9.69) and 1.35 (IQR 1.78) times the ideal resection volume was excised, respectively. The median tumor eccentricity among the entire patient population was 11.29 mm (SD = 3.99) and the median relative tumor eccentricity was 0.66 (SD = 2.22). Resection ratios based on different optimal margin widths (0 mm, 1 mm, 2 mm, and 10 mm) and the (relative) tumor eccentricity could be valuable outcome measures to evaluate the surgical accuracy of novel technologies for intra-operative BCS guidance.

The burgeoning necessity to discover new methodologies for the synthesis of long-chain hydrocarbons and oxygenates, independent of traditional reliance on high-temperature, high-pressure, and fossil fuel-based carbon, is increasingly urgent. In this context, we introduce a nonthermal plasma-based strategy for the initiation and propagation of long-chain carbon growth from biogas constituents (CO 2 and CH 4 ). Utilizing a plasma reactor operating at atmospheric room temperature, our approach facilitates hydrocarbon chain growth up to C40 in the solid state (including oxygenated products), predominantly when CH 4 exceeds CO 2 in the feedstock. This synthesis is driven by the hydrogenation of CO 2 and/or amalgamation of CH x radicals. Global plasma chemistry modeling underscores the pivotal role of electron temperature and CH x radical genesis, contingent upon varying CO 2 /CH 4 ratios in the plasma system. Concomitant with long-chain hydrocarbon production, the system also yields gaseous products, primarily syngas (H 2 and CO), as well as liquid-phase alcohols and acids. Our finding demonstrates the feasibility of atmospheric room-temperature synthesis of long-chain hydrocarbons, with the potential for tuning the chain length based on the feed gas composition.

The biofilm formation in klebsiella pneumoniae isolates poses a significant problem as it can result in treatment failure and the development of chronic infections. These biofilms act as protective barriers, rendering the bacteria resistant to antibiotics. Additionally, persister cells, which make up a small fraction of the bacterial population, have the ability to enter a dormant state after treatment with high doses of antibiotics. These persister cells play a crucial role in the high level of biofilm-mediated tolerance to antibiotics. The present study aimed to investigate the impact of Zinc oxide (ZnO) and titanium dioxide (TiO 2 ) nanoparticles on the formation of biofilm and persister cells in K. pneumoniae. The minimum inhibitory concentration (MIC) of colistin in K. pneumoniae ATCC 13883 was determined using the microdilution method. The formation of persister cells was evaluated by introducing sub-MIC of colistin. Subsequently, the MIC of ZnO NPs and TiO 2 NPs in these persister cells was assessed using the microdilution method. Furthermore, the effects of nanoparticles on the expression levels of biofilm-associated genes were analyzed using real-time polymer chain reaction (PCR). The MIC values for colistin, ZnO, and TiO 2 were determined at 2, 12.5, and 6.25 μg/mL, respectively. In the presence of nanoparticles, biofilm formation decreased. Real-time PCR results showed the messenger RNA (mRNA) level of mrkH and fimH were decreased and the expression of luxS and mazF were increased. Biofilm formation of K. pneumoniae ATCC 1383 was inhibited in response to nanoparticles. According to the results of the present study use of nanoparticles may help control multidrug-resistant (MDR) infections in hospitalized patients., (© 2023 Wiley‐VCH GmbH.)

Significance: During breast-conserving surgeries, it is essential to evaluate the resection margins (edges of breast specimen) to determine whether the tumor has been removed completely. In current surgical practice, there are no methods available to aid in accurate real-time margin evaluation., Aim: In this study, we investigated the diagnostic accuracy of diffuse reflectance spectroscopy (DRS) combined with tissue classification models in discriminating tumorous tissue from healthy tissue up to 2 mm in depth on the actual resection margin of in vivo breast tissue., Approach: We collected an extensive dataset of DRS measurements on ex vivo breast tissue and in vivo breast tissue, which we used to develop different classification models for tissue classification. Next, these models were used in vivo to evaluate the performance of DRS for tissue discrimination during breast conserving surgery. We investigated which training strategy yielded optimum results for the classification model with the highest performance., Results: We achieved a Matthews correlation coefficient of 0.76, a sensitivity of 96.7% (95% CI 95.6% to 98.2%), a specificity of 90.6% (95% CI 86.3% to 97.9%) and an area under the curve of 0.98 by training the optimum model on a combination of ex vivo and in vivo DRS data., Conclusions: DRS allows real-time margin assessment with a high sensitivity and specificity during breast-conserving surgeries., (© 2024 The Authors.)

(1) Background: Hyperspectral imaging has emerged as a promising margin assessment technique for breast-conserving surgery. However, to be implicated intraoperatively, it should be both fast and capable of yielding high-quality images to provide accurate guidance and decision-making throughout the surgery. As there exists a trade-off between image quality and data acquisition time, higher resolution images come at the cost of longer acquisition times and vice versa. (2) Methods: Therefore, in this study, we introduce a deep learning spatial-spectral reconstruction framework to obtain a high-resolution hyperspectral image from a low-resolution hyperspectral image combined with a high-resolution RGB image as input. (3) Results: Using the framework, we demonstrate the ability to perform a fast data acquisition during surgery while maintaining a high image quality, even in complex scenarios where challenges arise, such as blur due to motion artifacts, dead pixels on the camera sensor, noise from the sensor's reduced sensitivity at spectral extremities, and specular reflections caused by smooth surface areas of the tissue. (4) Conclusion: This gives the opportunity to facilitate an accurate margin assessment through intraoperative hyperspectral imaging.

Background: Right atrial pressure plays a critical role as a hemodynamic parameter in diagnosing pulmonary hypertension and other cardiac diseases, as well as guiding the treatment and prognosis of various cardiac disorders. If there is no obstruction between the inferior or superior vena cava (SVC) as central veins and the right atrium, the pressures in these veins could be considered equal to the right atrial pressure. This study aimed to examine the correlation between echocardiographic methods for estimating right atrial pressure and invasive measurements of central venous pressure (CVP i ) in infants and children with congenital heart disease during the 48 h after cardiac surgery and to establish regression equations for echocardiographic estimation of central venous pressure (CVP e )., Results: We prospectively enrolled 43 infants and children, ranging in age from 6 months to 16 years, including 20 males and 23 females. We found a significant correlation between CVP i and the ratio of the maximal diameter of IVC to the maximal diameter of the descending aorta ratio (IVC max /DAO max ) (r = 0.529, P < 0.001), SVC S/D velocity ratio (SVC S/D ) (r = 0.462, P = 0.006), right atrial vertical diameter (RA VD ) (r = 0.409, P = 0.01), area (r = 0.384, P = 0.014), and tricuspid valve A wave acceleration rate (TV AAR ) (r = 0.315, P = 0.048). Multiple regression analysis yielded an equation for estimating central venous pressure using four parameters related to the IVC, SVC, tricuspid valve, and right atrium. The equation is as follows: estimated CVP = 4.36 + (2.35 × IVC max /DAO max ) + (1.06 × SVC S/D ) +  (0.059 × RA VD ) + (0.001 × TV AAR ). This equation is strongly correlated with CVP i (Pearson r = 0.698, P = 0.002)., Conclusions: The estimation of central venous pressure through a multi-parametric equation that included the ratio of the maximal diameter of the inferior vena cava to the maximal diameter of the descending aorta, the ratio of S to D velocity of the superior vena cava, the vertical diameter of the right atrium, and the acceleration rate of the A wave of the tricuspid valve demonstrated a robust correlation with invasively measured central venous pressure. To assess the accuracy of predicted pressures by this equation, further investigations are required to apply this innovative multi-parametric formula to a prospective population of pediatric patients with congenital heart disease., (© 2024. The Author(s).)