bluuebunny/crossref_metadata_2025 huggingface dataset:
Ketamine’s rapid and sustained antidepressant effects are driven by distinct mechanisms
Authors: Rawat Radhika , Tunc-Ozcan Elif , Dunlop Sara , Tsai Yung-Hsu , Li Fangze , Bertossi Ryan , Peng Chian-Yu , Kessler John A.
Published: February 2024

Administration of multiple subanesthetic doses of ketamine increases the duration of antidepressant effects relative to a single ketamine dose, but the mechanisms mediating this sustained effect are unclear. Here, we demonstrate that ketamine’s rapid and sustained effects on affective behavior are mediated by separate and temporally distinct mechanisms. The rapid effects of a single dose of ketamine result from increased activity of immature neurons in the hippocampal dentate gyrus without an increase in neurogenesis. Treatment with six doses of ketamine over two weeks doubled the duration of behavioral effects after the final ketamine injection. However, unlike ketamine’s rapid effects, this more sustained behavioral effect did not correlate with increased immature neuron activity but instead correlated with increased numbers of calretinin-positive and doublecortin-positive immature neurons. This increase in neurogenesis was associated with a decrease in bone morphogenetic protein (BMP) signaling, a known inhibitor of neurogenesis. Injection of a BMP4-expressing lentivirus into the dentate gyrus maintained BMP signaling in the niche and blocked the sustained – but not the rapid – behavioral effects of ketamine, indicating that decreased BMP signaling is necessary for ketamine’s sustained effects. Thus, although the rapid effects of ketamine result from increased activity of immature neurons in the dentate gyrus without requiring an increase in neurogenesis, ketamine’s sustained effects require a decrease in BMP signaling and increased neurogenesis along with increased neuron activity. Understanding ketamine’s dual mechanisms of action should help with the development of new rapid-acting therapies that also have safe, reliable, and sustained effects.
Urologie in der Oberpfalz – Was uns Archäologie, historische Forschung und Geschichtsschreibung verraten
Authors: Otto W.
Published: February 2024

Seit dem Jahr 1924 gibt es in Deutschland die Möglichkeit, eine Facharztanerkennung für Urologie zu erwerben. Bereits im ausgehenden Kaiserreich und der Weimarer Republik entstanden erste Klinikabteilungen zur Behandlung urologischer Krankheitsbilder. Der Beginn fachärztlicher Versorgung im bayerischen Regierungsbezirk Oberpfalz, in Teilen bis in die zweite Hälfte des vergangenen Jahrhunderts hinein als „Armenhaus“ Deutschlands bekannt, liegt aber deutlich später. Dennoch lässt sich hier die Linie „urologischer“ Tätigkeit in sehr viel weiter zurückliegende Epochen zurückverfolgen. Dabei muss es als naturgemäß hingenommen werden, dass die Nachweislage in längst vergangenen Zeiten schwach ausgeprägt ist. Zumal bei einem Thema wie der Krankenbehandlung und Gesundheitserhaltung, das uns Heutigen nicht nur als Wissenschaft, sondern auch ganz individuell oft als zentraler Lebensschwerpunkt gilt, in der Geschichte aber oft genug nur in der Seuchenbekämpfung und in anekdotischen Beschreibungen ihren Ausdruck fand. Ein Umstand, der beim Blick in die Geschichte der Urologie freilich die ein oder andere interessante Quelle erhoffen lässt. So möchte der vorliegende Beitrag nicht nur die Entwicklungsgeschichte der Urologie in zeithistorischer Prägung bis in unsere Tage in einem ländlich geprägten Raum nachzeichnen, sondern auch auf die Behandlung urologischer Krankheitsbilder in diesem Gebiet seit der Spätantike eingehen – und dazu einladen, an anderen Erinnerungsorten der Urologie ähnlich zu verfahren.
Wave scattering problems in exterior domains with the method of fundamental solutions
Authors: Alves Carlos J. S. , Antunes Pedro R. S.
Published: February 2024

The method of fundamental solutions has been mainly applied to wave scattering problems in bounded domains and to our knowledge there have not been works addressing density results for general shapes, or addressing the calculation of the complex resonance frequencies that occur in exterior problems. We prove density and convergence of the fundamental solutions approximation in the context of wave scattering problems, with and without a priori knowledge of the frequency, which is of particular importance to detect resonance frequencies for trapping domains. We also present several numerical results that illustrate the good performance of the method in the calculation of complex resonance frequencies for trapping and non trapping domains in 2D and 3D.
The acute effects of cannabis, with and without cannabidiol, on attentional bias to cannabis related cues: a randomised, double-blind, placebo-controlled, cross-over study
Authors: Hall Daniel , Lawn Will , Ofori Shelan , Trinci Katie , Borissova Anya , Mokrysz Claire , Petrilli Kat , Bloomfield Michael A. P. , Wall Matthew B. , Freeman Tom P. , Curran H. Valerie
Published: February 2024

Rationale

Attentional bias to drug-related stimuli is hypothesised to contribute towards addiction. However, the acute effects of Δ9-tetrahydrocannabinol (THC) on attentional bias to cannabis cues, the differential response in adults and adolescents, and the moderating effect of cannabidiol (CBD) are unknown.

Objectives

Our study investigated (1) the acute effects of vaporised cannabis on attentional bias to cannabis-related images in adults and adolescents and (2) the moderating influences of age and CBD.

Methods

We conducted a randomised, double-blind, placebo-controlled, cross-over study where three weight-adjusted vaporised cannabis preparations: ‘THC’ (8 mg THC for a 75-kg person), ‘THC + CBD’ (8 mg THC and 24 mg CBD for a 75-kg person) and PLA (matched placebo). Cannabis was administered on 3 separate days to 48 participants, who used cannabis 0.5–3 days/week: 24 adolescents (12 females, aged 16–17) and 24 adults (12 females, aged 26–29). Participants completed a visual probe task with cannabis cues. Our primary outcome was attentional bias to cannabis stimuli, measured using the differential reaction time to a cannabis vs. neutral probe, on 200-ms trials.

Results

In contrast to hypotheses, attention was directed away from cannabis cues on placebo, and there was a main effect of the drug (F(2,92) = 3.865, p = 0.024, η2p = 0.077), indicating THC administration eliminated this bias. There was no significant impact of CBD nor an age-by-drug interaction.

Conclusions

Acute THC intoxication eliminated attentional bias away from cannabis cues. There was no evidence of differential response in adolescents compared to adults and no evidence that a moderate vaporised dose of CBD altered the impact of cannabis on attentional bias.

Trial registration

This study was listed with the US National Library of Medicine and registered on ClinicalTrials.gov, URL: Do Adolescents and Adults Differ in Their Acute Response to Cannabis?—Full Text View—ClinicalTrials.gov, registration number: NCT04851392.
Repeated Δ-9-Tetrahydrocannabinol administration dose dependently increases stablished schedule-induced drinking
Authors: Fuentes-Verdugo Esmeralda , Pellón Ricardo , Miguéns Miguel
Published: February 2024

Rationale

Schedule-induced drinking (SID) reproduces an excessive and repetitive behavioural pattern that has led to propose this procedure as an animal model to study compulsive behaviours. Although it is known that cannabis can cause several adverse effects, in recent years there has been great interest in the medical application of cannabis derivatives for obsessive-compulsive related disorders.

Objectives

The present study investigated the effects of repeated THC administration on rates of previously acquired SID, as well as the possible alteration of its temporal distribution along inter-food intervals.

Methods

Male Wistar rats acquired SID under a 30 min fixed-time 30-sec food delivery schedule (from 30 to 43 sessions to reach a stable level). Thereafter, 5 or 10 mg/kg daily i.p. injections of THC or vehicle were repeatedly administered for 7 days to evaluate the effects on SID.

Results

Repeated THC administration at a dose of 5 mg/kg resulted in an increase on licking. Surprisingly, no effects on SID were observed with the 10 mg/kg dose. However, magazine entries were reduced with both THC doses. THC also modified the temporal distributions of licking and magazine entries during inter-food intervals.

Conclusions

The present results show that repeated THC administration may (i) increase induced licking at moderate doses, (ii) reduce magazine entries, and (iii) affect the temporal pattern of SID. These findings suggest that THC does not appear to be beneficial to reduce compulsive behaviour in this animal model, while another collateral effect of THC —such as a greater habitual-like behaviour— needs to be considered.
Distinguishing reflex from non-reflex responses elicited by transcutaneous spinal stimulation targeting the lumbosacral cord in healthy individuals
Authors: Gordineer Elizabeth A. , Stokic Dobrivoje S. , Krenn Matthias J.
Published: February 2024

Transcutaneous spinal stimulation (TSS) studies rely on the depolarization of afferent fibers to provide input to the spinal cord; however, this has not been routinely ascertained. Thus, we aimed to characterize the types of responses evoked by TSS and establish paired-pulse ratio cutoffs that distinguish posterior root reflexes, evoked by stimulation of afferent nerve fibers, from motor responses, evoked by stimulation of efferent nerve fibers. Twelve neurologically intact participants (six women) underwent unipolar TSS (cathode over T11-12 spinal processes, anode paraumbilically) while resting supine. In six participants, unipolar TSS was repeated 2–3 months later and also compared to a bipolar TSS configuration (cathode 2.5 cm below T11-12, anode 5 cm above cathode). EMG signals were recorded from 16 leg muscles. A paired-pulse paradigm was applied at interstimulus intervals (ISIs) of 25, 50, 100, 200, and 400 ms. Responses were categorized by three assessors into reflexes, motor responses, or their combination (mixed responses) based on the visual presence/absence of paired-pulse suppression across ISIs. The paired-pulse ratio that best discriminated between response types was derived for each ISI. These cutoffs were validated by repeating unipolar TSS 2–3 months later and with bipolar TSS. Unipolar TSS evoked only reflexes (90%) and mixed responses (10%), which were mainly recorded in the quadriceps muscles (25–42%). Paired-pulse ratios of 0.51 (25-ms ISI) and 0.47 (50-ms ISI) best distinguished reflexes from mixed responses (100% sensitivity, > 99.2% specificity). These cutoffs performed well in the repeated unipolar TSS session (100% sensitivity, > 89% specificity). Bipolar TSS exclusively elicited reflexes which were all correctly classified. These results can be utilized in future studies to ensure that the input to the spinal cord originates from the depolarization of large afferents. This knowledge can be applied to improve the design of future neurophysiological studies and increase the fidelity of neuromodulation interventions.
Most Probable Flows for Kunita SDEs
Authors: Grong Erlend , Sommer Stefan
Published: February 2024

We identify most probable flows for Kunita Brownian motions, i.e. stochastic flows with Eulerian noise and deterministic drifts. Such stochastic processes appear for example in fluid dynamics and shape analysis modelling coarse scale deterministic dynamics together with fine-grained noise. We treat this infinite dimensional problem by equipping the underlying domain with a Riemannian metric originating from the noise. The resulting most probable flows are compared with the non-perturbed deterministic flow, both analytically and experimentally by integrating the equations with various choice of noise structures.
Effect of Sarcopenia on the Increase in Liver Volume and Function After Portal Vein Embolization
Authors: Arntz Pieter J. W. , Olthof Pim B. , Korenblik Remon , Heil Jan , Kazemier Geert , van Delden Otto M. , Bennink Roelof J. , Damink Steven W. M. Olde , van Dam Ronald M. , Schadde Erik , Erdmann Joris I.
Published: February 2024

Purpose

Sarcopenia is associated with a decreased kinetic growth rate (KGR) of the future liver remnant (FLR) after portal vein embolization (PVE). However, little is known on the increase in FLR function (FLRF) after PVE. This study evaluated the effect of sarcopenia on the functional growth rate (FGR) after PVE measured with hepatobiliary scintigraphy (HBS).

Methods

All patients who underwent PVE at the Amsterdam UMC between January 2005 and August 2017 were analyzed. Functional imaging by HBS was used to determine FGR. Liver volumetry was performed using multiphase contrast computed tomography (CT). Muscle area measurement to determine sarcopenia was taken at the third lumbar level (L3).

Results

Out of the 95 included patients, 9 were excluded due to unavailable data. 70/86 (81%) patients were sarcopenic. In the multivariate logistic regression analysis, sarcopenia (p = 0.009) and FLR volume (FRLV) before PVE (p = 0.021) were the only factors correlated with KGR, while no correlation was found with FGR. 90-day mortality was similar across the sarcopenic and non-sarcopenic group (4/53 [8%] versus 1/11 [9%]; p = 1.000). The resection rates were also comparable (53/70 [75%] versus 11/16 [69%]; p = 0.542).

Conclusion

FGR after PVE as measured by HBS appears to be preserved in sarcopenic patients. This is in contrast to KGR after PVE as measured by liver volumetry which is decreased in sarcopenic patients.

Level of Evidence

Level 3b, cohort and case control studies.
ESR Essentials: Imaging in colorectal cancer—practice recommendations by ESGAR
Authors: Caruso Damiano , Polici Michela , Bellini Davide , Laghi Andrea
Published: February 2024

Colorectal cancer (CRC) is a significant global health concern. Diagnostic imaging, using different modalities, has a pivotal role in CRC, from early detection (i.e., screening) to follow-up. The role of imaging in CRC screening depends on each country’s approach: if an organized screening program is in place, the role of CT colonography (CTC) is limited to the study of either individuals with a positive stool test unwilling/unable to undergo colonoscopy (CC) or in patients with incomplete CC. Although CC is the most common modality to diagnose CRC, CRC can be also incidentally detected during a routine abdominal imaging examination or at the emergency room in patients presenting with intestinal occlusion/subocclusion or perforation. Staging is a crucial aspect of CRC management, guiding treatment decisions and providing valuable prognostic information. An accurate local staging is mandatory in both rectal and colon cancer to drive the appropriate therapeutic workflow. Important limitations of US, CT, and MR in N-staging can be partially solved by FDG PET/CT. Distant staging is usually managed by CT, with MR and FDG PET/CT which can be used as problem-solving techniques. Follow-up is performed according to the general recommendations of the oncological societies.

Clinical relevance statement

It is essential to summarize each phase of colorectal cancer workup, differentiating the management for colon and rectal cancer supported by the main international guidelines and literature data, with the aim to inform the community on the best practice imaging in colorectal cancer.

Key Points

• Colorectal cancer is a prevalent disease that lends itself to imaging at each stage of detection and management.

• Various imaging modalities can be used as adjuncts to, or in place of, direct visualization methods of screening and are necessary for evaluating metastatic disease.

• Reevaluation of follow-up strategies should be considered depending on patients’ individual risk of recurrence.
Astroglial calcium signaling and homeostasis in tuberous sclerosis complex
Authors: Romagnolo Alessia , Dematteis Giulia , Scheper Mirte , Luinenburg Mark J. , Mühlebner Angelika , Van Hecke Wim , Manfredi Marcello , De Giorgis Veronica , Reano Simone , Filigheddu Nicoletta , Bortolotto Valeria , Tapella Laura , Anink Jasper J. , François Liesbeth , Dedeurwaerdere Stefanie , Mills James D. , Genazzani Armando A. , Lim Dmitry , Aronica Eleonora
Published: February 2024

Tuberous Sclerosis Complex (TSC) is a multisystem genetic disorder characterized by the development of benign tumors in various organs, including the brain, and is often accompanied by epilepsy, neurodevelopmental comorbidities including intellectual disability and autism. A key hallmark of TSC is the hyperactivation of the mechanistic target of rapamycin (mTOR) signaling pathway, which induces alterations in cortical development and metabolic processes in astrocytes, among other cellular functions. These changes could modulate seizure susceptibility, contributing to the progression of epilepsy and its associated comorbidities. Epilepsy is characterized by dysregulation of calcium (Ca2+) channels and intracellular Ca2+ dynamics. These factors contribute to hyperexcitability, disrupted synaptogenesis, and altered synchronization of neuronal networks, all of which contribute to seizure activity. This study investigates the intricate interplay between altered Ca2+ dynamics, mTOR pathway dysregulation, and cellular metabolism in astrocytes. The transcriptional profile of TSC patients revealed significant alterations in pathways associated with cellular respiration, ER and mitochondria, and Ca2+ regulation. TSC astrocytes exhibited lack of responsiveness to various stimuli, compromised oxygen consumption rate and reserve respiratory capacity underscoring their reduced capacity to react to environmental changes or cellular stress. Furthermore, our study revealed significant reduction of store operated calcium entry (SOCE) along with strong decrease of basal mitochondrial Ca2+ concentration and Ca2+ influx in TSC astrocytes. In addition, we observed alteration in mitochondrial membrane potential, characterized by increased depolarization in TSC astrocytes. Lastly, we provide initial evidence of structural abnormalities in mitochondria within TSC patient-derived astrocytes, suggesting a potential link between disrupted Ca2+ signaling and mitochondrial dysfunction. Our findings underscore the complexity of the relationship between Ca2+ signaling, mitochondria dynamics, apoptosis, and mTOR hyperactivation. Further exploration is required to shed light on the pathophysiology of TSC and on TSC associated neuropsychiatric disorders offering further potential avenues for therapeutic development.
High serum levels of leucine-rich α-2 glycoprotein 1 (LRG-1) are associated with poor survival in patients with early breast cancer
Authors: Göbel Andy , Rachner Tilman D. , Hoffmann Oliver , Klotz Daniel Martin , Kasimir-Bauer Sabine , Kimmig Rainer , Hofbauer Lorenz C. , Bittner Ann-Kathrin
Published: February 2024

Background

Leucine-rich α-2 glycoprotein 1 (LRG-1) is a secreted glycoprotein that is mainly produced in the liver. Elevated levels of LRG-1 are found in a multitude of pathological conditions including eye diseases, diabetes, infections, autoimmune diseases, and cancer. In patients with early breast cancer (BC), high intratumoral LRG-1 protein expression levels are associated with reduced survival. In this study, we assessed serum levels of LRG-1 in patients with early BC and investigated its correlation with the presence of disseminated tumor cells (DTCs) in the bone marrow and survival outcomes.

Methods

Serum LRG-1 levels of 509 BC patients were determined using ELISA and DTCs were assessed by immunocytochemistry using the pan-cytokeratin antibody A45-B/B3. We stratified LRG-1 levels according to selected clinical parameters. Using the log-rank (Mantel–Cox) test and multivariate Cox regression analysis, Kaplan–Meier survival curves and prognostic relevance were assessed.

Results

Mean serum levels of LRG-1 were 29.70 ± 8.67 µg/ml. Age was positively correlated with LRG-1 expression (r = 0.19; p < 0.0001) and significantly higher LRG-1 levels were found in patients over 60 years compared to younger ones (30.49 ± 8.63 µg/ml vs. 28.85 ± 8.63 µg/ml; p = 0.011) and in postmenopausal patients compared to premenopausal patients (30.15 ± 8.34 µg/ml vs. 26.936.94 µg/ml; p = 0.002). Patients with no DTCs showed significantly elevated LRG-1 levels compared to the DTC-positive group (30.51 ± 8.69 µg/ml vs. 28.51 ± 8.54 µg/ml; p = 0.004). Overall and BC-specific survival was significantly lower in patients with high serum LRG-1 levels (above a cut-off of 33.63 µg/ml) compared to patients with lower LRG-1 levels during a mean follow-up of 8.5 years (24.8% vs. 11.1% BC-specific death; p = 0.0003; odds ratio 2.63, 95%CI: 1.56—4.36). Multivariate analyses revealed that LRG-1 is an independent prognostic marker for BC-specific survival (p = 0.001; hazard ratio 2.61).

Conclusions

This study highlights the potential of LRG-1 as an independent prognostic biomarker in patients with early BC.
Male sexual and reproductive health in multiple sclerosis: a scoping review
Authors: Toljan Karlo , Briggs Farren B. S.
Published: February 2024

Background

Multiple sclerosis (MS) is a chronic neuroinflammatory disease with highest incidence during the period of optimal reproductive health. This scoping review aimed to identify and summarize available data on sexual/reproductive health in males with MS (MwMS).

Methods

This review was based on PRISMA extension for Scoping Review. PubMed database was searched for keyword “multiple sclerosis” alongside keywords “sexual health”, “reproductive health”, “family planning”, “male fertility”, “male infertility”, “sexual dysfunction”, and “erectile dysfunction”, iteratively using the “AND” logical operator. Descriptive analysis was performed on the included articles.

Results

Thirty-four studies were included, and four topics emerged: sexual dysfunction, erectile dysfunction, fertility, and family planning. Sexual dysfunction is common in MwMS (35–72%), yet only a minority of MwMS discuss their sexual health with their treatment teams. Both MS disability and depression were associated with sexual dysfunction in MwMS, with erectile dysfunction and decreased libido as the most prevalent aspects of sexual dysfunction. Positively, phosphodiesterase-5 inhibitors appear effective for treating erectile dysfunction and improving sexual quality of life in MwMS. There may also be a relationship between MS and male infertility, though changes in sexual behavior may underlie this association. Finally, a prominent knowledge gap was observed for disease-modifying therapy use and family planning in MwMS.

Conclusion

Sexual dysfunction is common, impacted by MS severity, and associates with decreased quality of life in MwMS. Communication barriers regarding sexual and reproductive health appear to exist between MwMS and providers, as do literature gaps related to MS therapeutics and sexual/reproductive health.
An automated process for bulk downloading optical coherence tomography scans
Authors: Cnaany Yaacov , Lender Rivkah , Chowers Itay , Tiosano Liran , Shwartz Yahel , Levy Jaime
Published: February 2024

Objective

To develop an automated method for efficiently downloading a large number of optical coherence tomography (OCT) scans obtained using the Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) platform.

Methods

The electronic medical records and OCT scans were extracted for all patients with age-related macular degeneration treated at the Hadassah University Hospital Retina Clinic between 2010 and 2021. A macro was created using Visual Basic for Applications (VBA) and Microsoft Excel to automate the export process and anonymize the OCT scans in accordance with hospital policy. OCT scans were extracted as proprietary Heidelberg E2E files.

Results

The VBA macro was used to export a total of 94,789 E2E files from 2807 patient records, with an average processing time of 4.32 min per volume scan (SD: 3.57 min). The entire export process took a total of approximately 202 h to complete over a period of 24 days. In a smaller sample, using the macro to download the scans was significantly faster than manually downloading the scans, averaging 3.88 vs. 11.08 min/file, respectively (t = 8.59, p < 0.001). Finally, we found that exporting the files during both off-clinic and working hours resulted in significantly faster processing times compared to exporting the files solely during working hours (t = 5.77, p < 0.001).

Conclusions

This study demonstrates the feasibility of using VBA and Excel to automate the process for bulk downloading data from a specific medical imaging platform. The specific steps and techniques will likely vary depending on the software used and hospital constraints and should be determined for each application.
Short-term outcomes of treatment switch to faricimab in patients with aflibercept-resistant neovascular age-related macular degeneration
Authors: Schneider Miklos , Bjerager Jakob , Hodzic-Hadzibegovic Delila , Klefter Oliver Niels , Subhi Yousif , Hajari Javad
Published: February 2024

Purpose

To report short-term outcomes of treatment switch to faricimab in real-world patients with aflibercept-resistant neovascular age-related macular degeneration (AMD).

Methods

Single-center, retrospective cohort study with chart-review using electronic injection database, electronic medical records, and optical coherence tomography (OCT) data from May to September 2023.

Results

A total of 50 eyes of 46 patients were analyzed. Faricimab treatment led to absence of fluid in 32% of the eyes and a reduction of fluid in 84% of the eyes. There was a statistically significant decrease in central retinal thickness (CRT) and pigment epithelial detachment (PED) height in those that responded to the switch (median difference: − 31 μm, IQR: 55, p < 0.0001 and median difference: − 21 μm, IQR: 36, p < 0.0001, respectively) and a statistically significant increase in CRT (median difference: + 19 μm, IQR: 20, p = 0.0143) and no change in PED height (median difference: + 22 μm, IQR: 64, p = 0.1508) in those that did not.

Best-corrected visual acuity (BCVA) showed marginal decrease with low statistical significance. No ocular or systemic safety events were observed.

Conclusions

Our findings suggest that switching to faricimab is generally safe and effective in patients with neovascular AMD who are otherwise difficult to treat and have residual fluid despite frequent injections with aflibercept. We observed a high rate of morphological response to the treatment switch, improvement of anatomical parameters with about one-third of patients having dry macula following a single injection, and a marginal change in BCVA. Sustainability of these results requires further investigation.

Study registration

ClinicalTrials.gov registration number: NCT06124677. Date of registration: 09/11/2023, retrospectively registered.
Inter-arm bone mass and size asymmetries in children tennis players are maturity status specific: a 9-month study on the effects of training time across pubertal change and somatic growth
Authors: Palaiothodorou Dimitria , Vagenas George
Published: February 2024

Purpose

Bone growth with exercise is best assessed by tennis-induced inter-arm asymmetries. Yet, the effects of training and maturation across puberty were unclear. This study explored arm bone growth across 9 months of training in 46 tennis players 7–14 years (25 boys, 21 girls).

Methods

Bone mineral content (BMC) and bone area (BA) were measured from DXA scans. Pubertal status was assessed by Tanner stage (TS) and somatic growth by maturity offset (MO). Children were grouped as pre- (TS I–I), early (TS I–II), and mid/late pubertal (TS II–III).

Results

Training time (TT) change in the three groups was 160–170, 190–230, and 200–220 h, respectively. Bone asymmetries were large in all groups (d > 0.8, P < 0.001): 5–18 g (9–21%) and 9–17 g (17–23%) in girls and boys, respectively, for BMC, and 5–15 cm2 (6–13%) and 9–15 cm2 (12–15%) in girls and boys (10–13%), respectively, for BA. BMC and BA change asymmetry peaked at pre-puberty in girls (56%, 46%) and at early puberty in boys (57%, 43%). Asymmetry gains varied with baseline asymmetry (41%) and change in TT (38%) and TS (17%) in BMC, and with baseline asymmetry (58%) and change in MO (17%) and TS (12%) in BA.

Conclusion

All bone asymmetries were substantial. Tennis-induced bone gains were higher at pre- to early puberty in girls and at early to mid/late puberty in boys. Training enhanced mostly bone mass and maturity status enhanced mostly bone size; sex was not bone-change modeling impactful. Implications are discussed considering certain limitations.
The test–retest reliability of physiological and perceptual responses during treadmill load carriage
Authors: Vickery-Howe Danielle M. , Dascombe Ben J. , Clarke Anthea C. , Drain Jace R. , Huynh Minh , Middleton Kane J.
Published: February 2024

Purpose

Understanding the test–retest reliability of physiological responses to load carriage influences the interpretation of those results. The aim of this study was to determine the test–retest reliability of physiological measures during loaded treadmill walking at 5.5 km h−1using the MetaMax 3B.

Methods

Fifteen Australian Army soldiers (9 male, 6 female) repeated two 12-min bouts of treadmill walking at 5.5 km h−1in both a 7.2 kg Control condition (MetaMax 3B, replica rifle) and a 23.2 kg Patrol condition (Control condition plus vest) across three sessions, separated by one week. Expired respiratory gases and heart rate were continuously collected, with the final 3 min of data analysed. Ratings of Perceived Exertion and Omnibus-Resistance Exercise Scale were taken following each trial. Reliability was quantified by coefficient of variation (CV), intra-class correlation coefficients (ICC), smallest worthwhile change (SWC), and standard error of the measurement.

Results

Metabolic and cardiovascular variables were highly reliable (≤ 5% CV; excellent-moderate ICC), while the respiratory variables demonstrated moderate reliability (< 8% CV; good-moderate ICC) across both conditions. Perceptual ratings had poorer reliability during the Control condition (12–45% CV; poor ICC) than the Patrol condition (7–16% CV; good ICC).

Conclusions

The test–retest reliability of metabolic and cardiovascular variables was high and relatively consistent during load carriage. Respiratory responses demonstrated moderate test–retest reliability; however, as the SWC differed with load carriage tasks, such data should be interpreted independently across loads. Perceptual measures demonstrated poor to moderate reliability during load carriage, and it is recommended that they only be employed as secondary measures.

Graphical abstract
Congenital diaphragmatic hernia: automatic lung and liver MRI segmentation with nnU-Net, reproducibility of pyradiomics features, and a machine learning application for the classification of liver herniation
Authors: Conte Luana , Amodeo Ilaria , De Nunzio Giorgio , Raffaeli Genny , Borzani Irene , Persico Nicola , Griggio Alice , Como Giuseppe , Cascio Donato , Colnaghi Mariarosa , Mosca Fabio , Cavallaro Giacomo
Published: February 2024

Prenatal assessment of lung size and liver position is essential to stratify congenital diaphragmatic hernia (CDH) fetuses in risk categories, guiding counseling, and patient management. Manual segmentation on fetal MRI provides a quantitative estimation of total lung volume and liver herniation. However, it is time-consuming and operator-dependent. In this study, we utilized a publicly available deep learning (DL) segmentation system (nnU-Net) to automatically contour CDH-affected fetal lungs and liver on MRI sections. Concordance between automatic and manual segmentation was assessed by calculating the Jaccard coefficient. Pyradiomics standard features were then extracted from both manually and automatically segmented regions. The reproducibility of features between the two groups was evaluated through the Wilcoxon rank-sum test and intraclass correlation coefficients (ICCs). We finally tested the reliability of the automatic-segmentation approach by building a ML classifier system for the prediction of liver herniation based on support vector machines (SVM) and trained on shape features computed both in the manual and nnU-Net-segmented organs. We compared the area under the classifier receiver operating characteristic curve (AUC) in the two cases. Pyradiomics features calculated in the manual ROIs were partly reproducible by the same features calculated in nnU-Net segmented ROIs and, when used in the ML procedure, to predict liver herniation (both AUC around 0.85).

          Conclusion: Our results suggest that automatic MRI segmentation is feasible, with good reproducibility of pyradiomics features, and that a ML system for liver herniation prediction offers good reliability.

          Trial registration: https://clinicaltrials.gov/ct2/show/NCT04609163?term=NCT04609163&draw=2&rank=1; Clinical Trial Identification no. NCT04609163.

What is Known:• Magnetic resonance imaging (MRI) is crucial for prenatal congenital diaphragmatic hernia (CDH) assessment. It enables the quantification of the total lung volume and the extent of liver herniation, which are essential for stratifying the severity of CDH, guiding counseling, and patient management.• The manual segmentation of MRI scans is a time-consuming process that is heavily reliant upon the skill set of the operator.

What is New:• MRI lung and liver automatic segmentation using the deep learning nnU-Net system is feasible, with good Jaccard coefficient values and satisfactory reproducibility of pyradiomics features compared to manual results.• A feasible ML system for predicting liver herniation could improve prenatal assessments and CDH patient management.
Score prediction of anastomotic leak in colorectal surgery: a systematic review
Authors: Litchinko Alexis , Buchs Nicolas , Balaphas Alexandre , Toso Christian , Liot Emilie , Meurette Guillaume , Ris Frédéric , Meyer Jeremy
Published: February 2024

Objective

Predicting the risk of anastomotic leak (AL) is of importance when defining the optimal surgical strategy in colorectal surgery. Our objective was to perform a systematic review of existing scores in the field.

Methods

We followed the PRISMA checklist (S1 Checklist). Medline, Cochrane Central and Embase were searched for observational studies reporting on scores predicting AL after the creation of a colorectal anastomosis. Studies reporting only validation of existing scores and/or scores based on post-operative variables were excluded. PRISMA 2020 recommendations were followed. Qualitative analysis was performed.

Results

Eight hundred articles were identified. Seven hundred and ninety-one articles were excluded after title/abstract and full-text screening, leaving nine studies for analysis. Scores notably included the Colon Leakage Score, the modified Colon Leakage Score, the REAL score, www.anastomoticleak.com and the PROCOLE score. Four studies (44.4%) included more than 1.000 patients and one extracted data from existing studies (meta-analysis of risk factors). Scores included the following pre-operative variables: age (44.4%), sex (77.8%), ASA score (66.6%), BMI (33.3%), diabetes (22.2%), respiratory comorbidity (22.2%), cardiovascular comorbidity (11.1%), liver comorbidity (11.1%), weight loss (11.1%), smoking (33.3%), alcohol consumption (33.3%), steroid consumption (33.3%), neo-adjuvant treatment (44.9%), anticoagulation (11.1%), hematocrit concentration (22.2%), total proteins concentration (11.1%), white blood cell count (11.1%), albumin concentration (11.1%), distance from the anal verge (77.8%), number of hospital beds (11.1%), pre-operative bowel preparation (11.1%) and indication for surgery (11.1%). Scores included the following peri-operative variables: emergency surgery (22.2%), surgical approach (22.2%), duration of surgery (66.6%), blood loss/transfusion (55.6%), additional procedure (33.3%), operative complication (22.2%), wound contamination class (1.11%), mechanical anastomosis (1.11%) and experience of the surgeon (11.1%). Five studies (55.6%) reported the area under the curve (AUC) of the scores, and four (44.4%) included a validation set.

Conclusion

Existing scores are heterogeneous in the identification of pre-operative variables allowing predicting AL. A majority of scores was established from small cohorts of patients which, considering the low incidence of AL, might lead to miss potential predictors of AL. AUC is seldom reported. We recommend that new scores to predict the risk of AL in colorectal surgery to be based on large cohorts of patients, to include a validation set and to report the AUC.
Adaptive temperature scaling for Robust calibration of deep neural networks
Authors: Balanya Sergio A. , Maroñas Juan , Ramos Daniel
Published: February 2024

In this paper, we study the post-hoc calibration of modern neural networks, a problem that has drawn a lot of attention in recent years. Despite the plethora of calibration methods proposed, there is no consensus yet on the inherent complexity of the task and, while some authors claim that simple functions solve the problem, others suggest that more expressive models are needed to capture misscalibration. As a first approach, we focus on the task of confidence scaling, specifically on post-hoc methods that generalize Temperature Scaling, which we refer to as the Adaptive Temperature Scaling family. We begin by demonstrating that while complex models like neural networks provide an advantage when there is ample data, they fail in scenarios where it is limited, notably common in fields like medical diagnosis. We then show how under this ideal data conditions the more expressive methods learn a relationship between the entropy of a prediction and its level of overconfidence, and based on this observation, we propose Entropy-based Temperature Scaling, a simple method that scales the confidence of a prediction according to this relationship. Results show that our method obtains state-of-the-art performance and is robust against data scarcity. Moreover, our proposed model enables a deeper understanding of the calibration process by the interpretation of the entropy as a measure of uncertainty in the network outputs.
Parametric RSigELU: a new trainable activation function for deep learning
Authors: Kiliçarslan Serhat , Celik Mete
Published: February 2024

Activation functions are used to extract meaningful relationships from real-world problems with the help of deep learning models. Thus, the development of activation functions which affect deep learning models’ performances is of great interest to researchers. In the literature, mostly, nonlinear activation functions are preferred since linear activation functions limit the learning performances of the deep learning models. Non-linear activation functions can be classified as fixed-parameter and trainable activation functions based on whether the activation function parameter is fixed (i.e., user-given) or modified during the training process of deep learning models. The parameters of the fixed-parameter activation functions should be specified before the deep learning model training process. However, it takes too much time to determine appropriate function parameter values and can cause the slow convergence of the deep learning model. In contrast, trainable activation functions whose parameters are updated in each iteration of deep learning models training process achieve faster and better convergence by obtaining the most suitable parameter values for the datasets and deep learning architectures. This study proposes parametric RSigELU (P+RSigELU) trainable activation functions, such as P+RSigELU Single (P+RSigELUS) and P+RSigELU Double (P+RSigELUD), to improve the performance of fixed-parameter activation function of RSigELU. The performances of the proposed trainable activation functions were evaluated on the benchmark datasets of MNIST, CIFAR-10, and CIFAR-100 datasets. Results show that the proposed activation functions outperforms PReLU, PELU, ALISA, P+FELU, PSigmoid, and GELU activation functions found in the literature. To access the codes of the activation function; https://github.com/serhatklc/P-RsigELU-Activation-Function.
Intradiscal vacuum phenomenon matches lumbar spine degeneration patterns in an ageing population
Authors: Cawley Derek T. , Simpkin Andrew , Abrahim Elizabeth , Doyle Thomas , Elsheikh Nada , Fallon John , Habash Mohammed , Phua Rou Jiing , Langille Jaimie , Matini Elvis , McNamee Conor , Mohamed Fayhaa , Gabhann Cliona Nic , Noorani Ali , Oh Jieun , O’Reilly Padraig , O’Sullivan David , Devitt Aiden
Published: February 2024

Purpose

Intra-Discal Vacuum phenomenon (IDVP) is well-recognised, yet poorly visualised and poorly understood radiological finding in disc degeneration, particularly with regard to its role in spinal alignment. CT analysis of the lumbar spine in an aging population aims to identify patterns associated with IDVP including lumbopelvic morphology and associated spinal diagnoses.

Methods

An analysis was performed of an over-60s population sample of 2020 unrelated abdominal CT scans, without acute spinal presentations. Spinal analysis included sagittal lumbopelvic reconstructions to assess for IDVP and pelvic incidence (PI). Subjects with degenerative pathologies, including previous vertebral fractures, auto-fusion, transitional vertebrae, and listhesis, were also selected out and analysed separately.

Results

The prevalence of lumbar spine IDVP was 50.3% (955/1898) and increased with age (125 exclusions). This increased in severity towards the lumbosacral junction (L1L2 8.3%, L2L3 10.9%, L3L4 11.5%, L4L5 23.9%, and L5S1 46.3%). A lower PI yielded a higher incidence of IDVP, particularly at L5S1 (p < 0.01). A total of 292 patients had IDVP with additional degenerative pathologies, which were more likely to occur at the level of isthmic spondylolisthesis, adjacent to a previous fracture or suprajacent to a lumbosacral transitional vertebra (p < 0.05).

Conclusions

This study identified the prevalence and severity of IDVP in an aging population. Sagittal patterns that influence the pattern of IVDP, such as pelvic incidence and degenerative pathologies, provide novel insights into the function of aging spines.
Impaired dual-task gait in Parkinson’s disease is associated with brain morphology changes
Authors: Krupička Radim , Malá Christiane , Neťuková Slávka , Hubená Tereza , Havlík Filip , Bezdicek Ondrej , Dušek Petr , Růžička Evžen
Published: February 2024

In Parkinson’s disease (PD), impaired gait and cognition affect daily activities, particularly in the more advanced stages of the disease. This study investigated the relationship between gait parameters, cognitive performance, and brain morphology in patients with early untreated PD. 64 drug-naive PD patients and 47 healthy controls (HC) participated in the study. Single- and dual-task gait (counting task) were examined using an expanded Timed Up & Go Test measured on a GaitRite walkway. Measurements included gait speed, stride length, and cadence. A brain morphometry analysis was performed on T1-weighted magnetic resonance (MR) images. In PD patients compared to HC, gait analysis revealed reduced speed (p < 0.001) and stride length (p < 0.001) in single-task gait, as well as greater dual-task cost (DTC) for speed (p = 0.007), stride length (p = 0.014) and cadence (p = 0.029). Based on the DTC measures in HC, PD patients were further divided into two subgroups with normal DTC (PD-nDTC) and abnormally increased DTC (PD-iDTC). For PD-nDTC, voxel-based morphometric correlation analysis revealed a positive correlation between a cluster in the left primary motor cortex and stride-length DTC (r = 0.57, p = 0.027). For PD-iDTC, a negative correlation was found between a cluster in the right lingual gyrus and the DTC for gait cadence (r=-0.35, pFWE = 0.018). No significant correlations were found in HC. The associations found between brain morphometry and gait performance with a concurrent cognitive task may represent the substrate for gait and cognitive impairment occurring since the early stages of PD.
Effect of realistic distributed loads on the bi-stable behavior of a pre-stressed aileron
Authors: Corsi Giovanni , Battista Francesco , Gualtieri Paolo , Vidoli Stefano
Published: February 2024

We study both experimentally and numerically the aeroelastic response of a pre-stressed curved aileron in a high Reynolds number flow undisturbed at infinity. The structure is designed to have a peculiar nonlinear behavior. Specifically, the aileron has only one stable equilibrium when the external forces are vanishing, but it is bistable when distributed aerodynamic loads are applied. Hence, for sufficiently high fluid velocities, another equilibrium branch is possible. We test a prototype of such an aileron in a wind tunnel. A sudden change (snap) of the shell configuration is observed when the fluid velocity exceeds a critical threshold: the snapped configuration is characterized by sensibly lower drag. However, when the velocity is reduced to zero, the structure recovers its initial shape. A similar nonlinear behavior can have important applications for drag-reduction strategies since the transition between a bluff body-like and a slender body-like behavior is controlled by the free-stream fluid velocity and does not require any external actuation.
Double the data rate in underwater acoustic communication using OFDM based on subcarrier power modulation
Authors: Alraie Hussam , Alahmad Raji , Ishii Kazuo
Published: February 2024

Underwater communication is one of the most important and difficult challenges facing researchers due to the high attenuation of the signal, communication with the surface because of the harsh medium of water, and data transmission performance degradation as a result of various effects. Underwater acoustic communication (UWA) has a low data rate, which describes the disadvantage of this type of communication. In addition, it has a low bandwidth range and high latency but has a long transmission range as an advantage. Multicarrier wireless transmission systems increase the data rate by sending the data using more than one carrier. We proposed a noncoherent orthogonal frequency division multiplexing (OFDM) method to increase the data rate in UWA communication systems. In addition, doubling the data rate in the OFDM using Subcarrier Power Modulation (OFDM-SPM) system can save half of the bandwidth. The MATLAB simulation program was used to implement the system in the underwater acoustic environment to increase its throughput. The proposed design uses Differential Phase Shift Keying (DPSK) with power control, and the data stream is transmitted through two-dimensional modulation schemes, the DPSK, and the power level of each subcarrier in the OFDM system with cyclic prefix (CP). The underwater channel was designed using a Rician fading multipath with a spreading loss formula as a function of distance and frequency. We designed an equalizer at the receiver side to recover the original signal as a function of three parameters which are: the channel effect as a rate between transmitting and receiving symbols, the Rician channel response, and the UWA spreading loss. OFDM-Subcarrier Power Modulation (OFDM-SPM) using the proposed equalizer performed better than the theoretical OFDM-SPM in the Rayleigh channel. The designed equalizer increased the performance of the OFDM-SPM system by 25% which helped to enhance the system’s throughput and doubled the data rate compared with the OFDM system, doubling the data rate using OFDM-SPM had been validated in laboratory experiments in the Time domain.