The field of immunology is rapidly progressing, with new monogenic disorders being discovered every year. The heterogeneity of clinical manifestations and the genetic background of immunodeficiencies brought about the new definition of inborn errors of immunity (IEI), which was adopted by the International Union of Immunological Societies (IUIS) in 2019. This term reflects a considerable change in the viewpoint of immunologists, with a deeper recognition of the non-infectious manifestations of IEI and their atypical presentations. In this current intriguing context, this Special Issue offers an overview of some of the most updated concepts in immunology, ranging from the discussion of some peculiar aspects of well-known entities to the presentation of recently discovered diseases. The Special Issue includes six original research papers and seven review papers submitted from different countries.As the first contribution to this Special Issue, we provided a review on the autoimmune manifestations of IEI, with a specific focus on the various molecular mechanisms involved in autoimmunity and potential targeted therapeutic strategies . This woFollowing this, other interesting elements can be derived from the review paper by Pieniawska-Śmiech et al., in which some of the most relevant non-infectious presentations of IEI are discussed . SpecifiThe atypical presentation of IEI is also the main focus of the paper by Morawska et al., which explores the spectrum of atopic manifestations in patients with selective IgA deficiency (sIgAD). This review gives specific attention to the epidemiological and clinical features of the atopic diseases associated with sIgAD and discusses the most relevant diagnostic aspects . SimilarThe other papers in this Special Issue have a major focus on the molecular mechanisms responsible for IEI. Concerning this, the review paper by Romano et al. discusses the role of epigenetic alterations associated with IEI . This paThe review paper by Mertowska et al.  deeply dThe paper by Votto et al.  deals wiAnother paper analyzing a rare and poorly recognized entity is the cohort study by Alberio et al. , in whicFinally, the wide spectrum of antibody deficiencies is the main focus of four research papers and a review paper. The study by Więsik-Szewczyk et al.  analyzesFinally, the paper by Sgrulletti et al.  focuses To conclude, the present Special Issue represents an overview of the current immunological scenario, and deals with different innovative concepts and clinical and research approaches. Indeed, the expanding availability of immunological and genetic testing offers the opportunity to identify new disease entities and elucidate the function of new genes involved in the development and regulation of the immune response. In this continuously evolving field, both researchers and clinicians need to be constantly updated on the most relevant innovations, and with this Special Issue we hope to have contributed to this extremely relevant topic.


The transition to intelligent transportation systems (ITSs) is necessary to improve traffic flow in urban areas and reduce traffic congestion. Traffic modeling simplifies the understanding of the traffic paradigm and helps researchers to estimate traffic behavior and identify appropriate solutions for traffic control. One of the most used traffic models is the car-following model, which aims to control the movement of a vehicle based on the behavior of the vehicle ahead while ensuring collision avoidance. Differences between the simulated and observed model are present because the modeling process is affected by uncertainties. Furthermore, the measurement of traffic parameters also introduces uncertainties through measurement errors. To ensure that a simulation model fully replicates the observed model, it is necessary to have a calibration process that applies the appropriate compensation values to the simulation model parameters to reduce the differences compared to the observed model parameters. Fuzzy inference techniques proved their ability to solve uncertainties in continuous-time models. This article aims to provide a comparative analysis of the application of Mamdani and Takagi–Sugeno fuzzy inference systems (FISs) in the calibration of a continuous-time car-following model by proposing a methodology that allows for parallel data processing and the determination of the simulated model output resulting from the application of both fuzzy techniques. Evaluation of their impact on the follower vehicle considers the running distance and the dynamic safety distance based on the observed behavior of the leader vehicle. In this way, the identification of the appropriate compensation values to be applied to the input of the simulated model has a great impact on the development of autonomous driving solutions, where the real-time processing of sensor data has a crucial impact on establishing the car-following strategy while ensuring collision avoidance. This research performs a simulation experiment in Simulink  and considers traffic data collected by inductive loops as parameters of the observed model. To emphasize the role of Mamdani and Takagi–Sugeno FISs, a noise injection is applied to the model parameters with the help of a band-limited white-noise Simulink block to simulate sensor measurement errors and errors introduced by the simulation process. A discussion based on performance evaluation follows the simulation experiment, and even though both techniques can be successfully applied in the calibration of the car-following models, the Takagi–Sugeno FIS provides more accurate compensation values, which leads to a closer behavior to the observed model. The importance of traffic simulation models has increased in recent years with the growing interest in driver assistance systems and autonomous driving systems. The development and calibration of such complex systems can greatly benefit from the use of simulations to reduce time and costs. Among other traffic simulation models, the continuous-time car-following model is particularly useful in the design and fine-tuning of various advanced driver assistance systems (ADASs) such as adaptive cruise control  and coopThis paper aims to evaluate the performance of two well-known fuzzy inference techniques, Mamdani  and TakaThe justification behind conducting this research also results from a literature search and analysis on the main scientific databases, such as ISI Web of Science (WoS), Scopus, and Google Scholar. The search was carried out between 2 June and 5 September. Performs a literature search on the main scientific databases such as ISI WoS, Scopus, and Google Scholar and evaluates the results obtained based on their relevance to the comparative analysis of the application of Mamdani and Takagi–Sugeno FISs in the calibration of car-following models;Performs a literature review in two directions, one considering the approaches based on the application of the two fuzzy inference techniques in the calibration of car-following models, and another focusing on similar comparative investigations of these techniques in other fields of research;Proposes an original methodology to perform the comparison of Mamdani and Takagi–Sugeno FISs in the case of the calibration of car-following models by adapting their characteristics according to the needs of the modeling of this concept;Implements a three-parallel-simulation model in Simulink  to reproduce the behavior of the observed car-following model and to calculate the compensation values to be applied to the input of the simulation model so that it replicates the behavior of the observed model; for this last purpose, two calibration models are implemented corresponding to the two fuzzy inference techniques;Validates the proposed methods for the calibration of the car-following model using real-world traffic data and provides a comparative evaluation in terms of the performance of the Mamdani and Takagi–Sugeno FISs in the context of the calibration of the car-following models;Identifies the limitations of this study and provides recommendations for future research.This research addresses a scientific literature gap related to a comparative analysis of the behavior of a car-following calibration system in the case of using Mamdani and Takagi–Sugeno FISs. To achieve this goal, this article has the following scientific contributions:This discussion of related work follows two directions. The first analyzes the applicability of fuzzy techniques in the implementation of the calibration process of car-following models, as identified during the literature analysis of the papers found according to the approach described in Bennajeh and Ben Said  proposedHowever, the use of fuzzy-based solutions showed promising results in addressing the uncertainties in autonomous driving systems capable of ensuring collision avoidance. Pérez et al.  developeSimilar comparative studies were conducted in various fields, such as optical  and wireAn increased number of articles that conducted comparisons between the fuzzy techniques analyzed in this study was observed in the field of power engineering. Phunpeng and Kerdphol  concludeHowever, the studies performed are not limited to the comparison of these two fuzzy techniques: they also investigated possible directions of optimization that can benefit in both cases. Bagis and Konar  applied The existing literature also offers some comparisons between Mamdani and Takagi–Sugeno FISs related to intelligent transportation systems (ITSs), except for the topic of car-following calibration. Saleh et al.  performeThis research applies the methodology illustrated in A simulated car-following model has as main components a subsystem designed for parameters handling and a subsystem responsible for the control strategy of the vehicle behind  based on the observed behavior of the vehicle moving ahead , while ensuring collision avoidance . In thist for both cases of inference engines. The validation system compares the dynamic characteristics of the observed system at time t with the simulated values obtained at time t after applying the compensation values according to the output of the calibration system for both cases of inference engines. As shown in The calibration system uses In the following subsections, this article presents in detail the characteristics of each of the systems involved in this research. Furthermore, an experimental case study based on real traffic data is chosen to validate this research. All the following information allows other researchers to replicate this study and facilitates future developments.The representation of traffic phenomena at microscopic level ensures a better granularity in identifying the root cause of traffic congestion and simplifies the identification of appropriate measures to improve the traffic control systems. According to Yin et al. , this roS [The state-space representation of the car-following model in continuous time and without time delay in Equation  uses thestance S ,34.(1)xS applies the average length of the vehicle for passenger cars ZThe surface diagram describing the three-dimensional relationship between the inputs y to cover the needs for the visualization of the simulated behavior of the car-following model in the presence of Mamdani and Takagi–Sugeno FISs, respectively. This allows for an easier comparison to the observed model, which is considered as the ideal model . Consequently, The simulation experiment uses Simulink  to implement the car-following model . Compareuently, x and FV  and complies with the definition of membership functions previously presented in this methodology. This implementation uses the notation s  so that it can comply with the fuzzy theory that uses the notation with easily interpreted significance [Transport Delay immediately after the output of the Fuzzy Logic Controller blocks aims to cover the processing and response time of these units and, consequently, to ensure that the proposed calibration model fits to real-time processing.The detailed view of the calibration subsystem . The devificance  and is aThe validation of the calibration models uses real traffic data from the local center for traffic monitoring and control in Timișoara city, Romania. The input data consist of velocity profiles  for the Performance analysis considers the calibration time of Mamdani and Takagi–Sugeno FISs as the main method of evaluation; this metric is also observable based on a visual analysis of the obtained results.i-th recordings of observed and simulated values from a total of N recorded data.To obtain a better overview in terms of performance, this research also uses the same methodology as in other similar studies ,44,45,46y is available in The calculation of these metrics for the running distance The simulation results  show thaThe Takagi–Sugeno FIS behaves better than the Mamdani FIS in identifying the time-varying appropriate compensation values that, applied to the simulated running distance of the FV  ,24,47. AHowever, there are differences in terms of computational efficiency; the existence of perturbations and higher scale-down simulated values of the FV running distance before the system achieves the calibrated state are explained by the existing literature. The Mamdani FIS identifies fuzzy output values through the aggregation of multiple fuzzy rule outputs ,24,26,27y to validate the application of Mamdani and Takagi–Sugeno FISs in the calibration of a continuous-time car-following model. Similar to the evaluation of these metrics in the case of running distance S in the calculation of y has no effect on influencing the performance of the two fuzzy techniques because it applies to all the time-varying processed parameters and is a constant value that is provided by the car-following strategy and cannot be measured.Thus, even if both fuzzy techniques can be successfully applied for the calibration of car-following models, the Takagi–Sugeno FIS is characterized by more accurate results, the computational efficiency being ensured by the use of constant crisp values in the definition of the membership functions and the application of the weighted average technique in the determination of the FIS output.This article addresses a gap in the scientific literature consisting of the absence of a comparative analysis between the application of Mamdani and Takagi–Sugeno FISs for the calibration of car-following models. The proposed methodology for performing this comparison consists of defining the membership functions of both FISs considering the standard safety distance that should be applied in the FV control strategy to avoid collisions during travel. Although the input membership functions and the fuzzy rules are the same, the differences arise from the definition of the output membership functions .A simulation experiment performed in Simulink  shows that both FISs succeeded in calibrating the car-following model. However, the Takagi–Sugeno FIS obtains better results in terms of performance according to the evaluation of performance metrics represented by MAE and RMSE, widely used for evaluation in related work. The impact of the computation errors that lead to scaled-down values of the running distance of the FV is also observable in both cases, but the differences are smaller in the case of the Takagi–Sugeno FIS.Furthermore, the Takagi–Sugeno FIS is suitable for use in the calibration process of car-following models based on the stability process of the identification of the time-varying compensation values, whereas the approach using the Mamdani FIS is affected by perturbations. The source of these perturbations is strongly connected to the definition of output membership functions: the higher surface of values covered in the case of the Mamdani FIS can introduce erroneous compensation values, while the Takagi–Sugeno FIS offers a more stable behavior because of the definition of output membership functions as crisp constant values.However, this research also has some limitations that can be addressed in future research. This results from the intervals chosen for the membership functions and also from the type of function chosen. The particularity of the continuous-time car-following model used in this research can influence the behavior of the calibration method and can impact the performance of the FIS. The weaknesses of this research are also related to the use of simulated fault injection to represent the errors from the measurement of sensor data and those introduced by the simulation process, the configuration of the Simulink Band-Limited White Noise block also having influence on the calibration process.Future research can perform comparative evaluations of these two fuzzy techniques in the presence of additional control mechanisms such as genetic algorithms or neural networks. Also, it is worth analyzing how Mamdani and Takagi–Sugeno FISs behave for the calibration of traffic models at upper levels of modeling, such as mesoscopic and macroscopic.Future research can also address the limitations of this research described at the end of The use of fault injection mechanisms can be replaced by approximated values of the possible measurement errors calculated according to the worst-case scenario by subtracting the values corresponding to the tolerance associated with the sensors used for traffic data acquisition. Currently, the data used in this research are provided by the local traffic management center, and the obtained data do not have details related to the data sheets of the inductive loops placed in the city for traffic monitoring.Another way to collect data for the simulation is to use specific simulators and human subjects. In addition to recording the traffic profiles from the simulator, the emotional behavior of the human subject can also be recorded. The use of tools such as eye-tracking, galvanic skin response analysis, or heart rate analysis facilitates the classification of driver behavior that can be introduced as a third input variable of the FIS. This is essential for adopting the appropriate car-following strategy in the case of autonomous vehicles due to the possible interaction with human-driven vehicles on the road.


Despite multiple attempts to understand its molecular mechanisms, cancer continues to pose a significant challenge to both the general population and healthcare workers. Multiple studies have highlighted the important role of microorganisms in almost all aspects of cancer . The fatYi-Hui and George show the important aspects for the prediction of colorectal cancer (CRC) using 16S rRNA or shotgun metagenomics data through a specific algorithms approach. The approach presented in the article demonstrates the key CRC-related taxa including predominant levels of Bacteroides fragilis (B. fragilis). The importance of identifying specific microbiota constituents such as of B. fragilis may be helpful to reveal the microbial signatures through molecular techniques which may provide valuable information for the disease pathology. In addition, the outcome of the study will open avenues for the management of CRC.One of the most common and deadliest types of cancer is colorectal cancer (CRC). Narabayashi et al. explore the involvement of the adaptor molecule RBM4 in the recruitment of DNMT. The study also shows the role of gut microbiota in the TLR4 gene methylation in the colonic epithelial cells (CEC) line through increasing RBM14 expression. RBM14 is an adaptor molecule controlling the recruitment of DNMT that bind to specific target genes. Furthermore, compared to cells from germ-free mice, the results of this study report the overexpression of RBM14 in conventional mice colonic epithelial cells. Collectively, the results show that the gut microbiota mediates TLR4 methylation in colonic epithelial cells through RBM14 upregulation. These results indicate that the intestinal microbiota helps in intestinal homeostasis through epigenetic regulation, corroborating recently published work (DNA methyltransferase (DNMT) is an important enzyme which controls the process of DNA methylation. hed work . Sarfraz et al. discusses the very important aspect of metabolic regulation by nutrition and microbiota. Metabolic regulation by microbiota and nutrition is an important aspect for physiological regulation in multiple diseases including cancer. This article discusses the disparities among microbiota composition and provides the relationship between diet and microbiota with a focus on using this association to harness microbiota modulation through diet for physiological benefits. The article demonstrates various host and exogenous factors which alter the composition of gut microbiota. The article also emphasizes the role of lifestyle and diet on microbiota composition. Moreover, the work shows the important information of the gut microbiome on dietary interventions and the possible effect of nutrition including feeding pattern  and circadian patterns which may affect the host metabolism and resultant intestinal microbial population. Host metabolism plays an important role in the progression of cancer and therefore the information presented in the article provides a valuable addition to the field by shedding light on the metabolic regulation by microbiota through diet. The consumed polysaccharides from a diet play a crucial role in the modulation of intestinal microbiota and their functions. The microbial metabolites such as short-chain fatty acids (SCFAs) have the potential to alter the physiology of the host, and act as prominent factors to promote certain immunological disorders and metabolic disorders including cancer and obesity. Hence, personalized nutrition may be used for the management and cure of various immune diseases, metabolic disorders, neurological disorders, and cancer.The article by Approximate 90% of most of oral cancers belong to types of oral squamous cell carcinoma (OSCC).Saproo et al. present a brief research report on the saliva samples of OSCC patients and normal controls. The report presents findings about the differential gene expression analysis of salivary RNAs from OSCC patients. The findings also illustrate potential salivary indicators of OSCC and their relationship to different aspects of carcinogenesis. Notably, the study also explores microbial dysbiosis among OSCC patients and their relationship with tumor-promoting pathways. Though few other studies present microbiota dysbiosis among OSCC patients, the study involving the detection of the integrated landscape for OSCC specific salivary RNA from an Indian population provides a valuable addition to the field. The study found that Prevotella is significantly enriched in OSCC and indicated that differently abundant microbial taxa are also involved in pathways associated with carcinogenesis. The role of the Prevotella genus in inflammation has been presented in several diseases (diseases . The difOverall, the articles gathered in the current research provide a valuable source for understanding the different perspectives about microbiota-mediated cancer and their implications in the development, diagnosis, and management of various cancer types. The high throughput host-microbiota interaction data is generated by current methods and gathered in several databases. The articles included in the current Research Topic create a thought-provoking space and update the knowledge status for microbiota involvement in cancer, which in turn may be helpful for their utilization in the diagnosis, therapy, and management of different types of cancer.


This report presents the first case of painful anterior shoulder snapping due to a thickened, fibrotic bursa snapping between the subscapularis and the short head of the bicep during external and internal rotation of the humerus. A 46-year-old presented with a 10-month history of on-and-off anterolateral right shoulder pain and snapping. Direct treatment to the anterior suspected lesions partially and temporarily relieved the pain but did not reduce the snapping. Further musculoskeletal examination and dynamic ultrasound scanning showed dysfunction in the scapulothoracic movement and defects of the muscles that interact with the infraspinatus aponeurotic fascia. An ultrasound-guided diagnostic injection to the suspected lesions in the infraspinatus fascia and its muscles attachments improved the scapulothoracic movement, and the snapping and pain were eliminated immediately after the injection, which further shows that the defects in the infraspinatus fascia may be the root cause of the painful anterolateral snapping. The importance of the infraspinatus fascia and its related muscle in maintaining the harmony of the scapulothoracic movement and flexibility of the shoulder is considerable.


PLOS ONE Editors retract this article [After this article was published, similarities were noted between this article and submissions by other research groups which call into question the validity and provenance of the reported results, and the adherence of this article to the PLOS Authorship policy. Further editorial assessment identified concerns regarding the integrity of the peer review process. In light of these issues, the  article .HR did not agree with the retraction.


Road dust cotains tire wear particles (TWPs) and a large amount of mineral particles (MPs). Given that tire tread in vehicles is mainly comprised of natural rubber (NR), isoprene and dipentene could be the main pyrogenic products stemmed from the thermolysis of NR. This offers a great chance to quantify the exact mass of TWP in road dust. As such, this study focused on the influence of MPs on the trends in thermolytic behaviors of NR using the resistive furnace (furnance) and Curie point pyrolyzers. This study confirmed that a reliable correlation in line with the formation of isoprene and dipentene could not be realized using the furnace type of a pyrolyzer. This means that employing the furnace type of a pyrolyzer in quantitification of TWPs could not be a viable and approproiate option due to the diverted thermolytic trends of NR due to differences in the heat transfer and adsoprtion of the pyrogenic products triggered by MPs. In the Curie point type of a pyrolyzer, the production rates of isoprene and dipentene were linearly responded to the mass of NR. The ferromagnetic substance in MPs could lead to the thermolytic trend change of NR. Thus, adopting the Curie point type of a pyrolyzer could be a viable option for quantification of TWPs in road dust when the effects of ferromagnetic substance are well neutralized.


The journal retracts the 2022 article cited above.Following publication, concerns were raised regarding the contributions of the authors of the article. Our investigation, conducted in accordance with Frontiers policies, confirmed a serious breach of our authorship policies and of publication ethics; the article is therefore retracted.This retraction was approved by the Chief Editors of Frontiers in Bioengineering & Biotechnology and the Chief Executive Editor of Frontiers. The authors have not responded to correspondence regarding this retraction.


Goal: Conventionally, a surgeon's skill is assessed through visual observation by experts and by tracking patient outcomes. These techniques are very subjective and demands enormous time and effort. Hence, the aim of this study is to construct a framework for automated objective assessment of micro-neurosurgical skill. Methods: A mask region-based convolution neural network (RCNN) is trained to identify and localize instances of surgical instruments from the recorded neurosurgery videos. Then the tool motion and tool handling metrics are computed by tracking the detected instrument locations through time. Microscope adjustment patterns are also investigated via the proposed time based metrics.Results: This study highlights the metrics that could potentially emphasize the variance in expertise between a veteran and a novice. These variations include an expert exhibiting a lower velocity, lower acceleration, lower jerks, reduced path length, higher normalized angular displacement, increased bi-manual handling, shorter idle time and smaller inter tool-tip distances while handling tools accompanied with frequent microscope adjustments and reduced maximum and median intervals between adjustments when compared to a novice. Conclusions: The developed vision based framework has proven to be a reliable method to assess the degree of surgical skill objectively and offer prompt and precise feedback to the neurosurgeons. I.Central Nervous System is incredibly complicated with various interconnections that involve all other major organs and glands Checklist based surgical skill assessments like Structured Assessment of Technical Skills (OSATS), Operative Performance Rating System (OPRS), Multiple Objective Measures of Skill (MOMS) are prone to evaluator bias and offer limited feedback to the trainee residents besides demanding huge time and effort from the experts 1)To automate the assessment of micro-neurosurgical skills in the recorded neurosurgery videos through the introduction of metrics to apprehend the surgeons' tool and microscope handling characteristics.2)To perform statistical analysis to measure the reliability of metrics in grading surgeons' skill. The related works in automated surgical skill assessment is furnished in the Section The objective of this study isII.The surgical competence is a blended outcome of knowledge, technical skills, decision making and team-handling skills of the surgeon. The competencies are commonly assessed either based on the observational approach through rating checklists or by patient outcome measures In recent years, the interest has shifted towards automated analysis of instrument and hand movement from the recorded videos as an effective alternative to access the psychomotor skills. III.A.The dataset comprises of video recordings of a neurosurgeon performing variety of neurosurgeries like removal of gliomas, colloidal cyst and craniopharyngioma over real patients ranging from the year 2011 to 2017 in the Department of Neurosurgery, National Institute of Mental Health and Sciences (NIMHANS), India. All surgeries were carried out with the aid of Leica OH5 or Leica OH6 neurosurgery microscopes. And the video recordings of the surgery were acquired at the rate of 25 frames per second with the frame resolution of 640 × 480. The authors have taken approval from the NIMHANS ethics committee on B.An automated framework to segment microsurgical instruments and to characterize operating patterns using the instruments is presented in the Section IV.The operating maneuvers of a neurosurgeon are accredited as a combination of intuitive (subconscious) to analytical (conscious) actions A.Instance segmentation of the surgical tools is the key to skill analysis. The Mask-RCNN is employed in the proposed model for instance segmentation of surgical tools from the neurosurgical videos. The Mask RCNN model is built on top of the Faster RCNN with the inclusion of small fully convolutional Neural network (FCN) applied to each region-of-interest (RoI) and predict the object mask for each instance in parallel to the existing branch for bounding box recognition Micro-surgical tools have similar form factor and shape resulting in higher chances of misclassification. The false positive outputs are discarded by thresholding the confidence scores. Incorrect detections and mislabelled instances which are inherent consequences with the usage of frame based segmentation models over videos were handled efficiently with a robust and efficient post-processing (REPP) technique conceived by Sabater et al. B.Each predicted mask instances of surgical instruments are binarized by thresholding. The binary image of the surgical instrument is then subjected to medial axis skeletonization to extract the skeleton pixels through which no minimal path from any inner point to the shape boundary exists For angle estimation, a minimum area rotated rectangle is determined for each instances of surgical instruments as shown in the Fig. C.The Suturing segments from 10 different neurosurgeries performed by a neurosurgeon from the year 2011 to 2017 are analysed to decipher the parameters that could elicit distinctive and notable improvements in the surgical skill over time. Five video segments from the year 2011 to 2013 and five segments from the year 2017 are analysed to objectively compare the improvement in dexterity with the transformation of the surgeon into a veteran. All instruments in the surgery were hand-held and no robotic assistance was utilized to reduce resting tremor. From each video recording, the frames are extracted at the rate of 12 per second. Then the extracted frame sequences are subjected to Mask RCNN model followed by post-processing to segment the desired surgical tools. The 2-Dimensional coordinates of the segmented tool's tip and the orientation of the tools are then computed as described in the Section V.The advent of microscope into the operating room by Nylen in 1921 revolutionized the surgical practices In the operating microscopes, when the focusing aid is active, the focusing lasers are triggered. Hence, any microscope adjustments is indirectly inferred from the presence of the two red colored laser spots on the image. Detecting and tracking of the laser dots in the recorded videos helps to analyze the adjustment patterns.A.Yolov5 which belongs the family of single-stage deep learning framework for object detection was employed to detect the laser spots. Yolov5 employs CSPDarknet53 as backbone for feature extraction which feeds into a path aggregation network (PANet) for feature fusion and followed by the YOLO head to generate predictions B.Neurosurgeons are required to be very adept in handling microscope as almost all surgeries of brain and spine inclusive of all complex delicate procedures are carried out with the aid of microscope. With the aid of operating microscopes, there is minimal chance of disturbance to the neighbouring regions of abnormality even in intricate neuro-procedures thereby resulting in improved patient outcomes.In micro-neurosurgery, the perceived image space under the magnification offered by microscope is different from the actual. The major challenge to the neurosurgeon is to get trained to assimilate tactile feedback from the instruments and the visual information from the microscope and to automatically compensate for the perceptual mismatch from experience VI.Efficient handling of tools and operating microscope are salient traits of an experienced neurosurgeon. This study aims to establish the useful metrics that assesses the improvements in micro-neurosurgical skills of a neurosurgeon over the years of practice. Mann-Whitney U test is employed to study the difference in the metrics between the two range of years as it does not rely on distributional assumptions.Multiple tools like Needle Holder, Straight Microscissors, Dural Tooth Forceps and Suction have a role during suturing. This is very pertinent to examine the optimal multi-tool handling, tool switching, task planning and sequencing ability of a surgeon and hence analysis of suturing segment is opted in this study. The tool handling metrics are evaluated and compared between the suturing segments of ten neurosurgery videos of a neurosurgeon recorded between the years 2011 to 2013, and 2017. The initial step for computing tool-based metrics involves detecting and localizing the different micro-neurosurgical tools using Mask-RCNN. Then the tip of the surgical tool is tracked to compute the tool-handling metrics. The parameters are sensitive enough to discriminate various levels of expertise of a neurosurgeon as summarized in the Table The first fifty minute duration of eight recorded neurosurgeries performed by a neurosurgeon over the years 2011–2012 and 2016–2017 are analysed to study the operating microscope adjustment patterns and summarized in the Table VII.This study detailed a framework for automated objective assessment of micro-neurosurgical skills and this is the first reported study on assessment of real-life neurosurgery rather than a bench-top task. The proposed video based methodology is designed to assist residents to measure and compare the tool handling and microscope handling characteristics with explainable standardized metrics. And to the best of our knowledge, this is the first time operating microscope adjustment features have been reported in micro-surgical skill analysis. The proposed technique has potential to offer real-time feedback and shows promise as a reliable and valid method to track performance over time and to accomplish meaningful comparison. This pilot study has proven that it is feasible to completely automate the hassle process of surgical skill assessment in residents and is definitely a valuable contribution in the direction of automated surgical skill assessment. Our ongoing research and the future direction in this field is to establish a structured grading system for surgeons to assess micro-neurosurgical proficiency's in an uniform scale.


The herpes zoster oticus results from the reactivation of the varicella zoster virus, a DNA virus of the Herpesviridae family with strictly human-to-human contamination, affecting the geniculate ganglion of the facial nerve. The manifestations of shingles and post-herpes signs are associated with psychiatric manifestations such as anxiety, insomnia and depressive disorder. Shingles and depressive disorder share common features, such as decreased cellular immunity and a high prevalence in the elderlyIs there a correlation between the intensity of depression and the comorbidity of herpes zoster and depression? Is there an explanation for this association? Can adequate therapy of the infection prevent the occurrence of the depressive disorder? Does the existence of this comorbidity affect the response to antidepressants?case report and litteraturecase reportWe will try to answer these questions in this work while illustrating by the case of a patient having been touched by this comorbidity and while being based on what was published in literature.None Declared


Regarding last years, in German psychiatry the effects of the changed statutory framework conditions for the use of physical restraints  and the COVID-19 pandemic on the treatment in emergency psychiatry were discussed.Against these background, changes in the severity of disease and regarding the use of coercive measures in our emergency psychiatry are to be analysed.An internal retrospective study in the emergency psychiatry  was performed.- The socio-demographic patient data (exception: gender) and the distribution of the main diagnoses groups remained stable. There was a reduction in the treatment volume by 4% in the pandemic period compared to 2019.- Both in 2019 and 2021, significant increases regarding the number of patient characteristics of the intensive treatment according to the OPS code 9-61  were measured.- During pandemic period 2021, a significantly rise in the percentage of involuntarily committed treatment cases [10] imposed.- Following changed framework conditions, there were decreases in the total duration of physical restraint and the number of restraint events per restrained treatment case [10] ratio of five-point/ seven-point restraint events reduced significantly and continuously.The amendments in statutory framework for the use of physical restraints made personnel more aware of the issue and consequently led to changes in restraint practice at our emergency psychiatric unit. These effects were partially cancelled by the increases in the severity of diseases during the pandemic.None Declared


The journal retracts the 2021 article cited above.Following publication, concerns were raised regarding the contributions of the authors of the article. Our investigation, conducted in accordance with Frontiers policies, confirmed a serious breach of our authorship policies and of publication ethics; the article is therefore retracted.This retraction was approved by the Chief Editors of Frontiers in Immunology and the Chief Executive Editor of Frontiers. The authors do not agree to this retraction.


The journal and Chief Editors retract the 29 November 2021 article cited above.Following publication, concerns were raised regarding abnormal similarities with the contents of other articles published by unrelated research groups. A subsequent investigation, which was conducted in accordance with Frontiers’ policies, raised strong concerns over the authorship of the articles, resulting in a loss of confidence in the findings presented in the article.The authors have not responded to this retraction.This retraction was approved by the Chief Editors of Frontiers in Endocrinology and the Chief Executive Editor of Frontiers.


An experimental study has been carried out to assess the effectiveness of infrared thermography in wrinkle detection in composite GFRP (Glass Fiber Reinforced Plastic) structures by infrared active thermography. Wrinkles in composite GFRP plates with different weave patterns (twill and satin) have been manufactured with the use of the vacuum bagging method. The different localization of defects in laminates has been taken into account. Transmission and reflection measurement techniques of active thermography have been verified and compared. The section of a turbine blade with a vertical axis of rotation containing post-manufacturing wrinkles has been prepared to verify active thermography measurement techniques in the real structure. In the turbine blade section, the influence of a gelcoat surface on the effectiveness of thermography damage detection has also been taken into account. Straightforward thermal parameters applied in structural health monitoring systems allow an effective damage detection method to be built. The transmission IRT setup allows not only for damage detection and localization in composite structures but also for accurate damage identification. The reflection IRT setup is convenient for damage detection systems coupled with nondestructive testing software. In considered cases, the type of fabric weave has negligible influence on the quality of damage detection results. The engineering application of composite structures as an alternative to typical metallic materials is often limited because of the great number of possible failure forms. The design process of the composite parts is inseparably connected with the selection and optimization of the manufacturing method. The failure form in composite materials can occur not only as a consequence of the boundary and loading conditions but also during the manufacturing process. The structures exposed to environmental factors are especially prone to durability reduction and different failure forms evolution during normal service life ,2. Thus,Several nondestructive damage detection methods are applied to this failure form in different types of composite structures . The curThe wrinkle detection in CFRP structures by the total focusing method (TFM) has been investigated by Ma et al. . A compaThe development and trends in nondestructive testing and evaluation for wind turbine composite blades have been presented by Yang et al.  and SongIn this paper, the wrinkle characterization in the GFRP structures by infrared thermography has been taken into account. First of all, the two types of glass woven weave—twill and satin have been applied in the vacuum-assisted production of plates with wrinkles to verify the influence of the material type on the results of thermographic inspections. The different subsurface wrinkle localization has been prepared to include the aspects of the defect position to the accuracy of the infrared inspections. The section of the turbine blade with a vertical axis of rotation containing post-manufacturing wrinkles has been prepared to verify the proposed active thermography measurement technique in the real structure. One part of this model has been manufactured with the use of a gel coat finishing surface containing the surface defect to validate the accuracy of the active thermographic measurement techniques in the case of wrinkle detection with disturbing factors. The transmission and reflection thermographic measurement techniques have been verified in the analyzed models and the real wind turbine blade.Vacuum bagging is a practical method for both large-scale and small-scale applications, such as wind turbine blades, boats, car components, or some hobby projects. This technique has been used to fabricate GFRP samples with wrinkles based on satin and twill fiberglass fabric configurations and epoxy resin. The applied setup of the flat vacuum bagging technique is shown in The manufactured plates have been scanned with the use of a 3D laser scanner REVscan and measured with the use of GOM Inspect software 2022 SP1. The Creaform REVscan  is a self-positioning, handheld scanner for inspection, quality control, and reverse engineering measurements. The scanner allows to digitize 18,000 points per second with an accuracy of up to 50 µm. The size of the wrinkles measured concerning the composite surface has been demonstrated in In the next step, vacuum-assisted production was applied to manufacture a section of the real structure of a turbine blade with a vertical axis of rotation containing post-manufacturing wrinkles. The wrinkles appeared during the fabrication of the blade model in the closed mold. The analyzed wind blade model is presented in Thermography is the process of detection, registration, processing, and visualizing the infrared radiation emitted by non-contact measurements by imaging devices. Active thermography employs an external heat source generating internal heat flow and an increase in temperature to induce relevant thermal contrast between areas of interest.The reflection and transmission thermographic methods have been tested to check the possibility, accuracy, and effectiveness of wrinkle detection. The experimental setup schema for the case of two halogen lamps has been demonstrated in The transient thermal analysis has been applied with the use of one 1500 W halogen lamp. The time of the analysis was equal to 300 s, and the time of heating was 30 s. It means that the thermal response of the analyzed structures was monitored both in the heating and cooling process. The measurements were conducted with a frame rate of 9 Hz. The analyzed specimens with wrinkles have been analyzed with the use of one halogen lamp in the transmission and reflection IRT measurement configurations. It should be emphasized that during analyses, manufactured wrinkles were always oriented on the opposite side with respect to the IR camera. It means that convexity was invisible from the observer’s point of view. The IR camera monitored only the flat side of specimens—see microimages in c distribution versus time. The thermal contrast was computed as the difference between the temperature of the reference area and the temperature of the defective area. In active thermography, the defective areas are detected as areas having a lower temperature. In the transmission setup, the highest thermal contrast of more than 4 °C has been observed for the wrinkle in the fourth layer (point P2). The wrinkle in the seventh layer presented a little lower value of Tc. The wrinkle on the top layer also revealed the visible difference between the defective and the intact area. The thermographic results of the reflection IRT setup presented in c. The wrinkles have been detected; however, only the slight difference between the position of the wrinkles has been revealed. Here, the highest thermal contrast is lower than in the transmission setup. In the reflection mode, the indication of wrinkle position on the temperature profile is not so clear as in the transmission mode. The temperature profile revealed the wrinkle in the seventh layer (above point P1), and in the fourth layer (above point P2), but the wrinkle on the top layer (above point P3) was not so obvious—The main goal of this work was concerned with the effectiveness of thermography in the case of wrinkle detection in GFRP multilayered composite structures. Firstly, the influence of material type and the depth of the defects in the composite plates on the thermal response has been studied. The two types of glass woven weave, namely twill and satin, having subsurface wrinkles with different localization, have been prepared. In the 8-layer composite plates, the manually induced wrinkles were placed in the fourth and seventh layers. In the case of the twill sample, another wrinkle was made on the top layer caused by folding the vacuum bag when the air was pumped out—c value is observed for the deeper wrinkle in the fourth layer where the maximum value is lower than 3 °C—For satin plate thermograms, point P1 indicates the seventh layer wrinkle, whereas point P2 shows the fourth layer wrinkle—The comparison between temperature distribution vs. time of the transmission and reflection thermographic setup revealed diverse heating and cooling behavior of plates. The possibility of heating the plates was lower in the case of the reflection mode. In this case, the achieved maximum temperature during the 30 s of heating was about 10 °C lower for the twill plate and about 6 °C lower for the satin plate. Additionally, the heating charts obtained from the applied IRT setups are different. In the transmission mode, after heating, the natural cooling of samples is slow, with smooth characteristics of temperature decay, whereas, in the reflection mode, the temperature after heating decreases quickly in the first part of the cooling, and next, the speed of cooling is much lower.For the assumed 8-layered plates made of GFRP, the manufactured twill sample possesses lower thickness and higher fiber volume fraction compared with the satin sample.The section of a turbine blade with a vertical axis of rotation containing post-manufacturing wrinkles has been investigated with the use of both transmission and reflection IRT setup configurations. The measurements were conducted with an IR camera frame rate of 30 Hz setting the heating time at 20 s and the whole time of analysis at 50 s. The temperature profile measured at the gel coat-covered part of the section was lower than for the structure without a finishing surface. However, characteristics of the profile concerning detected wrinkles have been very similar. The heating source localized at the top of the analyzed structure  caused nHowever, the internal stiffening rods disturbed the wrinkle localization, and the defect analysis was cumbersome. Therefore, the correct analysis should consider the information on the internal structure of the section regardless of the heating source localization.The results demonstrate the capability of infrared thermography wrinkle detection in different structures made of GFRP composites. Different measurement techniques have been analyzed to verify the effectiveness and accuracy of the damage detection process.Two different glass fiber weaves of the fabric have been analyzed in this research. The influence of the weave type on damage detection results has been negligible. The qualitative assessment of the wrinkle detection based on obtained thermographic results was similar for both materials. From the measurement point of view, it should be noted that the greater thickness of the specimen made of satin fabric results in the lower temperature achieved during the heating process. However, the thermal contrast measured as a difference between temperatures in reference areas and defective points is similar for both glass fabrics—From the structural health monitoring and inspection point of view, it means that it is not necessary to adapt the methodology of the thermographic inspection to the type of fabric because the effectiveness of the damage detection process is similar.The methodology of the thermographic inspection determines the effectiveness and quality of the damage detection results. The transmission IRT setup allows us to accurately determine the state of the analyzed structures. The straightforward thermal contrast parameter can be applied here also in the automated damage detection monitoring systems based on the active thermography measurement because the difference between healthy and defective structures is substantial and easy to interpret. The thermal contrast measured in the time domain requires the reference characteristics and may be applied to the mass-produced items’ quality control. The detailed analysis of the intensity of thermal contrast gives accurate information about the position, orientation, and dimension of internal defects. The thermal profile analysis allows satisfying results without the reference structure because each deviation from the temperature level may result from structural defects. Moreover, the detailed and local analysis of the defective areas can be also applied not only in the qualitative damage detection and localization systems but also for quantitative assessment of the damage size, orientation, and localization between laminate layers. The results of the reflection IRT setup depend on the localization and the size of the wrinkle concerning the heat source. The thermographic results of the composite plates with wrinkles demonstrate the problems with the damage assessment in this measurement technique. It should be reminded that the subsurface wrinkles were oriented on the opposite side to the IR camera and the heating source. The measured parameters, namely temperature and thermal contrast in the time domain and the temperature profile, have not allowed for an unambiguous interpretation in the damage detection context. In this case, the inspection of the composite part should be supported by the visual analysis of the temperature distribution during the heating and cooling process and the results presented by the specialized software for thermal image analysis. On the other hand, the analysis of the manufactured section of the wind turbine blade proved that the reflection measurement technique allows for obtaining satisfying results, especially in situations where the transmission configuration is not possible to apply or introduces many complications associated with the geometry of the analyzed structures. The thermographic results of the wing section partially covered by the gelcoat demonstrated lower temperatures achieved in the structures with the additional surface.In general, the additional layers applied on composites reduce the thermal flow during the active thermography inspection, which may decrease the effectiveness and accuracy of a damage detection system. However, in the analyzed case, the gel coat has not disturbed the quality of the damage detection process. The verification of the covered composite structures requires special attention and testing of the inspection parameters  because, from a safety and reliability point of view, the crucial issue is to avoid missing substantial defects during thermographic research.The difference between reference point temperature and temperature on the detected wrinkles was similar in both parts of the section. The temperature profile also indicates a similar temperature disturbance caused by the wrinkle. Moreover, the gelcoat surface defects do not influence the damage detection of internal wrinkles. The damage in the gel coat, which may be identified by visual inspection, does not interfere with the wrinkles in the thermographic inspection, which is especially important from the practical application point of view. The thermographic inspection and quality control of the composite structures revealed internal defects, even if the visual inspection only identified surface damages. It is worth pointing out that the uniform heating process in active thermography is essential in the damage detection process, and it is difficult to achieve in complicated shapes of structures. The transmission IRT setup in the case of the real structure analysis demonstrates the typical problems in the real construction analysis. The internal stiffening elements of the structure may disturb the results and influence misinterpretation in the damage detection and localization context. Regardless of the localization of the heating source (inside or outside the structure), the correct interpretation of the thermographic results requires knowledge about the internal structure of the analyzed part.The presented results deal with wrinkle detection in GFRP structures by active thermography inspection in different measurement setup configurations. To summarize obtained results, the following conclusions can be formulated.The type of fabric weave has negligible influence on the results of the thermographic inspection. Despite the different thicknesses of the analyzed specimens resulting in different temperatures in the heating process, the thermal contrast indicating the defective areas is similar;Straightforward thermal parameters can be applied in structural health monitoring systems. The transmission IRT setup allows for damage detection and localization in composite structures. Detailed analysis of the heating source and IR camera localization and the observed temperature relation between reference and defective areas may also be applied to assess the damage size, orientation, and localization in the laminate layers;The reflection IRT setup is convenient for damage detection systems supported by the nondestructive testing software allowing for visual verification of the thermographic results;In our case, the gelcoat finishing surface has no substantial influence on the effectiveness of the damage detection process. However, additional coatings reduce the thermal flow during the active thermography inspection; thus, the testing of thermographic parameters is necessary to confirm the accuracy of conducted tests.Further research will focus on the application of active thermography in transmission and reflection configurations in the real blades of wind turbines with the horizontal axis of rotation .The quality control of horizontal axis wind turbine blades allows for the validation of presented results and the assessment of the active thermography of real constructions.


Implant-supported removable prostheses (ISrP) improve the quality of life, especially in patients who underwent mandibular reconstruction, but few studies have focused on the effect of ISrP in the fibular mandible on the function of the temporomandibular joint. The purpose of this pilot case series was to determine the usefulness of four-dimensional computed tomography (4DCT) images for the evaluation of differences in condylar movements with and without ISrP. Three patients who underwent ISrP following segmental mandibulectomy and free-flap reconstruction were evaluated. The participants were instructed to masticate a cookie during the 4DCT scan. The distance between the most anterior and posterior positions of the condyles on the sagittal view of the 4DCT images during the chewing of the cookies was measured and compared with and without ISrP. 4DCT revealed changes in the distances of condylar protrusion with and without wearing ISrP, but there were no obvious differences among the three patients. The 4DCT motion analysis was useful for the evaluation of the effect of wearing ISrP on condylar movements during mastication in patients with mandibular reconstruction and may become a useful objective evaluation method for the functional evaluation of ISrP. It is believed that dental rehabilitation with osseointegrated implants in patients who underwent jaw bone resection and reconstruction improves oral function, oral diet achievement, and oral health-related quality of life , 2. ImplRecently, it was reported that four-dimensional computed tomography (4DCT) can visualize the changes in mandibular movement in reconstructed mandibles , 6. The Three patients who underwent segmental mandibulectomy and simultaneous reconstruction with a free fibular osteocutaneous flap at Kobe University Hospital were enrolled in this study. Additionally, 4DCT examinations were performed as routine postoperative follow-up imaging to monitor tumor recurrence or osteoradionecrosis. The 4DCT examination was performed with an Aquilion ONE  at the Kobe University Hospital . All images were acquired axially with a 320-detector row CT scanner to allow for multiple phases of unenhanced 3D volume acquisition with 16 cm coverage. The patient's forehead was fixed with tape to prevent bodily movement. They were instructed to chew a cookie during the scan. CT scans were performed with and without ISrP. The gantry was angled to limit radiation to the eyes, and the inferior aspect of the field of view was tailored to minimize radiation to the thyroid. The exposure doses in all study participants were within the notification values recommended by the American Association of Physicists in Medicine (AAPM) Working Group on Standardization of CT Nomenclature and Protocols for 4DCT. For image post-processing, a volume rendering (VR) image was generated using a commercial software .The maximum distance between the most anterior and posterior positions of the posterior portion of the condyle during mastication was measured using sagittal multiplanar reconstruction (MPR) images. The number of strokes during the scanning was counted. The percentage of the larger protrusion  was also calculated. All measurements were performed by one oral and maxillofacial surgeon (author J.Y.) in a blinded manner. The patient provided written informed consent to participate in this study after receiving a full explanation of the purpose and structure of the study, which had already been approved by the Medical Ethics Committee of Kobe University (No. B200052). This article was previously posted to the medRxiv preprint server on April 27, 2020.Participants' characteristics are presented in Table Figure The number of strokes during scanning and the percentage of larger protrusive distances above the mean values are listed in Table No remarkable changes in condylar protrusion with or without ISrP were found among the three patients. Patient one had a history of segmental mandibulectomy, neck dissection, and fibula flap reconstruction for gingival cancer and did not undergo radiation therapy. Patient three had a history of concomitant chemoradiotherapy for oropharyngeal cancer and subsequent segmental mandibulectomy and fibula flap reconstruction for mandibular osteoradionecrosis. Although the surgical invasion of patient three was the lowest among the three patients, it was affected by irradiation. We found a similar condylar protrusion of the reconstructed side with and without ISrP in patients one and three, whereas the ranges of condylar protrusion of the non-reconstructed side were smaller in patients with ISrP than in those without ISrP in patients two and three. The number of missing teeth and the extent of the segments were similar in patients one and three, but larger in patient two than in patients one and three. Condylar movements during mastication are probably affected by the area and the number of missing teeth, irradiation, and the extent of defects of the mandible and the surrounding soft tissue, such as the masticatory muscle.ISrP in the reconstructed mandibles contributes to the improvement of patients' quality of life, whereas there is no strong evidence to support the effect of ISrP because of the lack of objective evaluation methods of function . This piThe influence of the loss of posterior teeth on the condyle has been a controversial issue. It was previously reported that prosthetic rehabilitation significantly changed the condylar position in women with good general health . In thisThere are some important studies that have evaluated the effects of ISrP. Roumanas et al.  analyzedFinally, there were some limitations in the current pilot report. First, this report included only three patients whose primary diseases, treatment history, and extent of mandibular defects were heterogeneous because the number of patients who underwent mandibulectomy and osseous reconstruction and subsequently completed ISrP was very limited . Second,Although 4DCT could visualize changes in the distances of condylar protrusion with and without wearing ISrP, there were no obvious differences among the three patients. Further investigations are necessary to clarify the usefulness of the 4DCT motion analysis for the evaluation of condylar movements during mastication in patients wearing ISrP.


A significant increase has been observed globally in multi-centre trainee-led trauma & orthopaedic (T&O) research collaborative projects with more emphasis have been on tackling important research questions since the start of the COCID-19 pandemic. The objective of our analysis was to determine the number of trainee-led research collaborative projects in T&O in the United Kingdom that were started during the COVID-19 pandemic.A retrospective analysis was conducted to determine how many trainee-led national collaborative projects in T&O were conducted since the start of the COVID-19 pandemic lockdown (March 2020 to June 2021) and the number of projects identified were compared to the previous year (2019). Any regional collaborative projects, projects that were started before the onset of COVID and projects of other surgical specialities were not included in the study.There were no projects identified in 2019 while in the Covid pandemic lockdown we identified 10 trainee-led collaborative trauma & orthopaedic projects with six of them being published with level of evidence from three to four.Covid was unprecedented and has placed considerable trials across healthcare. Our study highlights an increase in multi-centre trainee-led collaborative projects within the UK and it underlines the feasibility of such projects especially with the advent of social media and Redcap® which facilitate recruitment of new studies and data. During the previous year, there has been an upsurge of trainee-led Orthopaedic research collaborative projects globally. The concept of Trainee Led Collaborative projects is not a new concept in the UK and one such project was a two-year study in the 1980s looking at measles which was conducted by the Royal College of Surgeons of General Practitioners trainees.The recent pandemic has been a driving force for an increase in the number of collaborative projects in the United Kingdom. There has also been an increase in the enthusiasm of the trainees to get involved in research and to collectively answer important clinical questions. The National Research Collaborative (NRC) was established which acts as an umbrella organisation which facilitates multiple collaborative groups and networks and aims to promote participation among various specialities, including general surgery and Trauma and Orthopaedics. To promote this, the NRC has guides that aim to help set up projects that are collaborative focusing on the key operational and organizational principles.The value and importance of the recent rise of successful Orthopaedic trainee Led research projects in the past year are always discussed with arguments both for and against.In this study, we aim to evaluate the number of trauma & orthopaedic trainee-led research collaborative projects that took part since the start of the COVID-19 pandemic in the UK, exploring the value and feasibility of such collaboratives in driving forwards clinical academia.A systematic search was done online using key phrases ‘trainee research’, ‘trainee-led collaborative’ and ‘Orthopaedic trainee-led research collaborative’. Websites such as Association of Surgeons in training (ASIT), Twitter, British Orthopaedic Training Association (BOTA) and British Orthopaedic Association (BOA) were also checked for any trainee-led collaborative projects that were posted.The timeline for data collection had been from March 2020 to January 2021, essentially the Covid Lockdown period in the United Kingdom.All of the projects identified in this study were done in the United Kingdom.Any regional collaborative projects, projects that were started before the COVID-19 and projects that involved other surgical specialities were excluded from the study.The number of projects identified was also compared to that published in 2019.All conference abstracts and proceedings were also excluded from the analysis.All of the publications were identified from website listings of collaboratives and searches done on PubMed using the project names.All of the publications which were PubMed-indexed were included in the study.Using the Health Research Authority decision tool, this study was not deemed to need ethical approval.Ten trainee-led collaborative trauma & orthopaedic projects were included in the analysis with six being published in peer reviewed journals. The level of evidence ranged between three and four. There were five audits and five cohort studies. The patients that were included in the studies ranged from 927 to 140,231 with Supraman Collaborative study with the lowest number of recruited patients.Comparing to 2019, we were not able to identify any trainee-led collaborative projects. Collectively 2249 centres participated in collaboratives projects with the maximum number of centres participating in one study was 1674 and lowest number was 38 centres. Almost all of the collaboratives recruited centres by the use of social media, twitter, or by networking in conferences and the use of the British Orthopaedic Trainee Association.The data collection method used most was by using REDCAP (Research Electronic Data Capture), which is a web application which manages databases and online surveys in a secure encrypted manner, and confidential excel sheets were also used .st 2020) and collected using a secure online database (Redcap). Conclusion of the study was as there was a higher mortality in patients after seven week delay with ongoing symptoms compared to those patients who were asymptomatic and whose symptoms had resolved. This research resulted in four PubMed cited publications in various high impact journals.11COVID Surg Collaborative Surg Week was a cohort study which was international, multicentre, and prospective in nature and included patients undergoing any type of surgery. This was initiated by the NIHR Global health research unit on Global surgery, Birmingham UK and the aim of the study was to get more data as to update clinical practice during the Covid Pandemic regarding the importance of identification of symptomatic vs. asymptomatic SARS-COV-2 preoperatively along with the determination of the optimal timing of surgery following an infection. One Hundred forty thousand two hundred and thirty one patients were included in the study with 1674 hospitals in 116 countries. Data was collected up to four blocks of seven consecutive days  and 1st February to 14th March 2021 (prospective). Collection of data was done on a Excel spreadsheet and analysis of the data was done against the BOA standard (Full weight bearing for activities of daily living). Hospital-by-hospital variation was calculated for fracture location and description, type of operation, seniority of operating surgeon and duration of restricted weight bearing. Nineteen thousand one hundred fifty three patients were included in the study with 81 hospitals taking place with 430 collaborators. The Conclusion of the study was that there was a large difference noted in the overall percentage of Neck of femur fractures vs non neck of femur fractures fragility fracture patients that were allowed to fully weight bear after surgery. Outside of the femur, the most common fracture locations for non-Neck of femur fragility fractures are foot and ankle fractures and proximal tibia fractures. This audit was published with a proposal for further research to enable surgeons to feel confident to make non-Neck of femur fragility fractures to become Fully weight bear after surgery.Chlorhexidine Gluconate versus Povidone-Iodine Skin Antisepsis Prior to Upper limb Surgery (CIPHUR) was a prospective National service evaluation. The aim was to compare local practise of antiseptic use and compare them to the standards outlined by NICE which recommended using alcoholic Chlorhexidine gluconate (CHG) for preoperative skin preparation to reduce the risk of Surgical site infections. The inclusion criteria were any adult or children identified prior to any form of surgery distal to the shoulder joint while the exclusion criteria were any active infection at the time of upper limb surgery. The audit included 2,454 patients and collaborators from 92 centres participated and data was recruited via Excel sheets. The Systematic review and network meta- analysis of antiseptic in clean surgery and the national survey of clinical practice and clinician opinion was done and is pending publication.(Patient related outcome measures) practice within elective orthopaedics. 38 enrolled trusts across nine regions participated in the national audit. The conclusion of the audit was that standardization of PROMS practice is required across all orthopaedic procedures as there is limited consensus and wide variation in their usage. However, the integration of PROMS within Best Practise Tariff has encouraged PROMs uptake and consistency. The audit has not been published yet.Evaluating the Measures in patient reported outcomes, values and experiences (emprove) was a national collaborative audit of elective orthopaedic clinical practise conducted by the south west orthopaedic division (SWORD). The audit was against national society standards with the aim to assess concordance with standards and define the configuration of current PROMS st of January 2019 of December 2019. Exclusion criteria were open fractures, undisplaced fractures, if there was a separate acute but distinct fracture present on the ipsilateral upper limb or if primary surgical intervention occurred over three weeks from the time of injury. Data collection was done via Redcap. Nine hundred twenty seven patients were identified as undergoing surgical intervention for a displaced supracondylar elbow fracture across 42 hospitals. The conclusion of the study was that the majority of displaced supracondylar fractures of the elbow are operated on during daytime hours, with most being performed the day after injury. Varying surgical techniques are utilised across the United Kingdom. Overall, two wires in a cross configuration were most commonly utilised with the wires left percutaneous. However, Paediatric Orthopaedic specialists appear to prefer lateral only fixation. A very low rate of deep infection and revision surgery for displacement was noted in both crossed and lateral only fixation patients. A manuscript has been prepared and sent to a journal for consideration of publication.Supracondylar fracture management was a retrospective trainee led national evaluation which was designed and led by members of the South West Orthopaedic Research division (SWORD). The primary objective was to identify the surgical practice and post-operative care being provided for displaced supracondylar elbow fractures across the United Kingdom. Secondary objectives included the identification of patient characteristics, common mechanisms of injury, fracture types undergoing surgical intervention, and significant post-operative complications associated with the management of these injuries. Recruitment was done across the United Kingdom through promotion of Twitter. Inclusion criteria were patients that were less than 16 years of age with a displaced supracondylar fracture of the elbow of any time confirmed on X-ray that required acute surgical intervention between the 1It was a cross sectional study which was survey based conducted in 87 centres in the UK from November 2020 to April 2021. The aim of the study was to investigate the availability of radiological imaging (MRI) directly from the Emergency Department and minor injury units and whether pathways were made for suspected scaphoid fractures. Recruitment was done via previous projects, social media (twitter) and clinician contacts. All centres that regularly treated acute wrist trauma were included in the study. The study showed that only a fraction of hospitals across the UK offers MRI directly from minor injury units and emergency departments when suspecting a scaphoid fracture. The results of the study have been published in the Bone and joint journal on the Nov. 29, 2021.13st January to June 30th 2019. The main objective was to determine the outcomes and management of complex ankle fractures in the United Kingdom and compare them to the BOAST guidelines for the management of complex ankle fractures. All adult patients with complex ankle fractures (Ao43/44) which were open or closed were included in the study. These complex fractures included patient with diabetes with or without neuropathy, rheumatoid arthritis, alcoholism, polytrauma and cognitive impairment. Fifty-six centres participated in the study and data from 1360 patients were collected. The study concluded that 9% of patients were managed with a Hind foot nail and were also noted to have the most complications. Only 21% of patients were allowed to weight bear fully after the procedure despite BOAST guidance. The Results have not been published.Hindfoot ankle reconstruction Nail trail (HARNT) was a national collaborative study in affiliation with British Orthopaedic Trainee Association and data was collected retrospectively between 1Evaluation of practice patellofenoral instability collaborative was a BASK trainee collaborative retrospective national audit that was performed over a five years period. The Audit was to evaluate which procedures and in which combination are being used to surgically manage patellofemoral instability in the United Kingdom and these were compared to the British Orthopaedic Association surgical management of recurrent patellar instability.Data was collected by the help of coding departments and theatre records and were analysed and on excel sheets. Fifty sites across the United Kingdom participated with 3,639. The study showed that the surgical management of Patellofemoral instability varies across the country but as new national guidelines are implemented a re-audit of practice should be done. This has not been published.Pansurg Predict was an International Observational Cohort study which was retrospective and prospective in nature. This study was sponsored primarily by Imperial College London with the primary aim to measure the risk associated with patients presenting to hospital with a surgical pathology during the pandemic. Secondary aim was to create a dynamic risk prediction model. Collaborators were recruited via social media, Twitter and Data collection was done by REDCAP.th March 2020, 5th April 2020, 20th May 2020 and 26th June 2020.Data was collected retrospectively and prospectively and the data was collected in such a way that it coincided with the publications by the Royal Colleges of Surgeons Guidance for surgeons working during COVID-19 pandemic on 20th March 2020 to30th August 2020 were included in the study. There were 55 Participating centres from 18 countries.All patients who presented to hospitals with an acute orthopaedic pathology during 9The study showed that the capacity of the operating room declined by 63.6% along with a decline of surgical staff by 27.2%. The results were published in the Annals of Surgery on 2021.14This was a national, multicentre observational cohort study with an aim to assess the safety of upper extremity surgery and to assess the 30 days mortality of patients. The secondary objectives were any complications related and unrelated to SARS COV-2 and any hospital safety processes that were in place. Data collection was between 01/04/2020 to 14/04/2020. The collaborators were recruited by social media and data was collected on a standardised encrypted excel spreadsheet. About 74 centres participated in the study with 1093 patients being recruited into the study. The study showed that Complications related to Sars-cov-2 were 0.18% for upper limb surgery with zero deaths when patients were operated on the same day as admission.The study also suggested that surgery should not be delayed whilst waiting for the results of the Sars-Cov-2 test for any upper limb day case surgery. The study was published in the BMJ quality and safety Journal on April 2021.15There is little literature available highlighting the importance of Trainee led collaborative research projects and no scientific analysis such as our study has been carried out in the past. Our analysis provides the current direction and activity within the UK trainee collaborative movement however even though larger studies with multiple centres and high recruitment of patients are being undertaken we have noted that only six studies have contributed to the literature by publishing in peer review journals.Our Analysis is suggestive of an increased ambition of the various groups in the UK with more prospective/retrospective national studies. Multiple regional orthopaedic trainee organizations such as British Orthopaedic Training Association (BOTA), south west orthopaedic division (SWORD) have taken an initiative to ensure more multi-collaborative projects are started. These Trainee bodies are pivotal in promoting such collaborations in the United Kingdom and encourages the expansion of such collaboration in other specialties. Our study also highlights an expanding footprint in literature by these UK trainee collaborative research projects which are of respectable quality directly impacting clinical practise.16The main contributory factors of the increase in UK trainee led collaborative projects are a highly ambitious trainee body within a postgraduate surgical training system boosted by the COVID Pandemic. We feel that the surge of such collaborative projects especially during the pandemic are due to the fact that the junior doctors understood the importance of being involved in high yield research and contributing to and improving the current evidence-based practise of common pathologies. We feel Covid was a trigger for junior doctors to get involved in more research and maybe this was due to the fact that there was less operating due to the COVID pandemic. An increased enthusiasm has also been noticed after the Royal College of Surgeons Clinical Trials Initiative have established a wide network of trial centrals across the United Kingdom.17Our analysis also notes the importance of social media for recruitment and programs such as Twitter. These have been instrumental for the success of such multicentre collaborative projects as due to the pandemic there was less chances of networking in conferences, courses, workshops, and other events.REDCAP is growing in popularity in the multicentre collaborative projects as it is a centralized online database. They provide an accessible, secure and affordable approach to database and statistician access and this ensures the long-term success of the trainee collaborative movement.However, the most core aspect of the future success of more Multicentre collaborative projects of trainee led collaborative projects is ensuring the enthusiasm of the Trainees is maintained through open participation and ensuring fair recognition of the involvement of trainees. In all of projects included in the study the method of recognition has been the use of a collaborator status in peer reviewed journals.The introduction of Collaborative Trainee led Research projects is essential across the world for trainees as they can develop and sharpen their research methodologies and especially in countries, like Pakistan, where trainees are not satisfied with their development of research skills.20The limitations of this study stem from the small sample size and the lack of representation from other countries. However, we feel that after this research is published and the advantages seen, there will be an increase of impact caused by Trainee led collaborative projects in Europe and worldwide.Orthopaedic Surgical trainees in the United Kingdom have been instrumental in the development of an innovative and valuable model for healthcare research despite COVID 19 having placed significant challenges. This is proven by the fact that there has been a significant increase in such collaborative Orthopaedic Trainee led projects in the United Kingdom in the Covid Lockdown.TK: Designed, Collected, analysed data, write up of paper.RK: Analysis and review of paperUA: Supervisor, final check and responsible and accountable for the accuracy or integrity of the work.


The journal retracts the 2021 article cited above.Following publication, concerns were raised regarding the contributions of the authors of the article. Our investigation, conducted in accordance with Frontiers policies, confirmed a serious breach of our authorship policies and of publication ethics; the article is therefore retracted.This retraction was approved by the Chief Editors of Frontiers in Public Health and the Chief Executive Editor of Frontiers. The authors have not responded to correspondence regarding this retraction.


Over the last decades, the non-linearity of natural objects has been shown to be suitable to the application of fractal analysis. By extending the principles of fractal geometry to the study of biology and to the human body, fractal physiology is receiving considerable research attention. The human body, including its most complex structure, i.e., the brain, is characterized by recursive systems and complex networks. Today it is well proven that the structural organization of the brain, the architecture of neural and vascular networks, and the dynamics of functional activity, amongst others, have fractal properties . AdvanceChanges of objectively observed fractal characteristics are markers of age-related alterations, including the ones seen in normal and pathological aging and mental disorders as well. A change in the structural complexity, quantified by means of the fractal dimension, amongst other parameters, and of the dynamic patterns of activity of the brain and retina occur in diseases of various etiologies, including neurodegenerative disorders, brain tumors, cerebrovascular diseases, visual system’s disorders, and cognitive impairment during stress, chronic anxiety or depression. Moreover, the patterns of physiological and psychological responses to fractal stimulation therapy open the way for the formation of new therapeutic strategies.This Issue is dedicated to computational fractal-based methodologies in medicine and applications of the achievements of fractal physiology in the diagnosis of the brain and retina disorders. An objective assessment of the fractal complexity of the structural and functional organization of the brain can provide new tools useful for differential diagnosis, novel prognostic tests to assess the brain and retina disorders and criteria to monitor the effectiveness of the therapeutic interventions.Rowland et al. raises the issue whether pathological states of neurons might affect this fractal branching optimization. Using confocal microscopy to obtain images of CA1 pyramidal neurons and constructing 3-dimensional models of the dendritic arbors, the authors found that control rats exposed to an enriched habitat and training in spatial memory showed higher dendrites branching complexity and connectivity compared to other conditions. Rats with or without anterior thalamic nuclei lesions both optimized the connectivity in respect to the material cost of competing connections. The authors used an improved technique on characterization of fractal dimension of dendritic pattern. The fractal dimension values to optimize these connections did not differ between rats’ groups with or without lesions, perhaps due to small morphological differences induced by these injuries. However, the results show that successful application of this method to characterize the dendritic pattern can become a promising diagnostic tool to help detect the neuronal pathological states that affect fractal optimization.Fractal dimension of the neuronal dendrites’ arborization was recently shown to be related to functional constraints - the need and ability of dendrites to compete to make connections to other neurons . AnterioSánchez and Martín-Landrove employed a method based on dynamic quantum clustering to perform contrast enhanced MRI of brain tumors and describe different morphological parameters including fractal dimension and lacunarity, growth dynamics exponents, regularity measures, and parameters derived from multifractal analysis. The tumor surface regularity, one-dimensional and bi-dimensional fluctuations of the tumor interface were analyzed by Detrended Fluctuation Analysis. Tumor interface fractal dimension, local roughness exponent and surface regularity were shown to be parameters that can discriminate between gliomas and meningiomas/schwannomas.The tumor interface has an irregular geometry due to the complex dynamics of the tumor growth process, including the tumor cells proliferation of and the invasion of surrounding tissues. Fractal analysis is commonly used to characterize the complexity the tumor surface  and to mDick and colleagues analyzed the degree of multifractality of EEG time series obtained in healthy subjects and patients with mental disorders (paranoid schizophrenia and depression) using the method of maximum modulus of the wavelet transform and multifractal detrended fluctuation analysis. The main differences between the multifractal properties of brain activity in healthy people and those with mental disorders were in the width of the multifractality spectrum and its location associated with the correlation or anticorrelation dynamics of the values of successive time series. Schizophrenia was characterized by a greater degree of multifractality compared to depression. These data suggest that the degree of multifractality can be included in a diagnosis tool as the test for the differential diagnosis and further study of mental disorders.Currently, the attention of many researchers is attracted by the study of EEG in brain diseases , and theRacz and coauthors introduced an extension of irregular-resampling auto-spectral analysis to the bivariate case - multiple-resampling cross-spectral analysis (MRCSA) to separate the fractal component of the cross-spectral spectrum of long-range coupled signals. The authors showed the applicability of MRCSA to EEG recordings by analyzing fractal connectivity at rest and under the condition of word generation.More and more attention is now paid to the study of fractal functional connectivity in the brain. The effects of scale-dependent interactions make it difficult to analyze it. The assessment of the extent of the narrowband oscillatory components in combination with broadband fractal, which are presented in empirical data  is of great importance given that the fractal and oscillatory signal components may reflect different underlying processes . For betThe versatile applications of fractal analysis to the neurosciences, using the accumulated empirical data and existing theoretical models make it possible to identify promising future applications in the clinical setting and open new promising areas of research.


The guttural pouch of the horse is a diverticulum of the auditory tube and has a complex anatomical structure. Disease of the guttural pouch can lead to neurological signs and hemorrhage due to its close relation to major vessels and some cranial nerves. Endoscopy allows direct visualization of the pouch and is considered to be the gold standard for its evaluation. Nevertheless, diagnostic imaging can bring useful additional information and this review article describes the value of each technique and the main imaging findings to be expected in the diagnosis of guttural pouch disease.The most common diseases of the guttural pouch are empyema, tympany, mycosis and temporohyoid osteoarthropathy. The challenge in diagnosis of guttural pouch diseases lies in the complex anatomy of the guttural pouch and adjacent associated structures. Diagnostic imaging is a good complement to endoscopy for the diagnosis of some guttural pouch diseases, especially to make a full assessment of the lesions involving the pouch and surrounding structures. This review article describes the value of each diagnostic imaging technique in the diagnosis of guttural pouch disease and the corresponding imaging findings. Radiography is generally used as the first line to complement endoscopic findings, and can give useful additional information although it is limited by superimposition. Ultrasonographic examination of the guttural pouch is of limited value due to the presence of gas in the guttural pouch but can eventually be used to detect fluid within the pouch or can help to evaluate the soft tissues located lateral and ventral to the guttural pouch. Cross-sectional imaging, especially CT, is increasingly available and appears to be the best technique to fully assess the surrounding soft tissues and to precisely identify lesions of the temporohyoid apparatus, temporal bone and skull base that are associated with guttural pouch disease. The guttural pouch is a diverticulum of the auditory tube that connects the pharynx to the middle ear bilaterally. This diverticulum has a complex anatomical structure, consisting of a cavity divided by the stylohyoid bone into a small lateral recess and a larger medial recess . The gutRadiography is generally the first-line imaging modality to be used to complement endoscopy for the diagnosis of guttural pouch diseases . Air-filUltrasonography of the region of the guttural pouches is of limited value due to the presence of air in the guttural pouch and the vertical ramus of the mandible, and the consequent inability to image through them . Due to Cross-sectional imaging, especially CT, is becoming increasingly available for imaging horse heads, particularly with the development of standing CT, allowing the elimination of general anesthesia and reduced costs . The majEmpyema is the most common disease of the guttural pouch and can be caused by upper airway infection or drainage of abscesses of the retropharyngeal lymph nodes into the ipsilateral pouch ,3,8,10. Guttural pouch tympany is a condition of young horses that is a result of trapped air within the guttural pouch due to an excessive amount of tissue at the pharyngeal orifice that allows air to enter the guttural pouch during deglutition but prevents it from exiting . It causBleeding within the guttural pouches is most frequently due to guttural pouch mycosis or injury of the rectus capitis and longus capitis muscles that attach to the skull base . Other rBasilar skull trauma with injury and avulsion of the rectus capitis and longus capitis muscles occurs when the horse falls over backward ,15,16. STemporohyoid osteoarthropathy is a disorder characterized by osseous proliferation of the temporohyoid joint that can lead to neurological disorders, especially facial nerve deficit ,18,19. TMRI may also be useful in select cases to diagnose temporohyoid osteoarthropathy ,9,17, alThe most common cause of a mass effect involving the guttural pouch is adenomegaly of the retropharyngeal lymph nodes secondary to guttural pouch empyema . HematomEven if endoscopy of the guttural pouch remains the gold standard for identifying most guttural pouch diseases, diagnostic imaging, especially radiographic and CT examinations, and occasionally ultrasound, can be very useful to complement clinical examination and endoscopic evaluation for the diagnosis of some diseases of the guttural pouch in order to precisely determine the prognosis and adapt the treatment.