Automated Identification of Different Severity Levels of Diabetic Retinopathy Using a Handheld Fundus Camera and Single-Image Protocol.

Purpose: To evaluate the performance of artificial intelligence (AI) systems embedded in a mobile, handheld retinal camera, with a single retinal image protocol, in detecting both diabetic retinopathy (DR) and more-than-mild diabetic retinopathy (mtmDR). Design: Multicenter cross-sectional diagnostic study, conducted at 3 diabetes care and eye care facilities. Participants: A total of 327 individuals with diabetes mellitus (type 1 or type 2) underwent a retinal imaging protocol enabling expert reading and automated analysis. Methods: Participants underwent fundus photographs using a portable retinal camera (Phelcom Eyer). The captured images were automatically analyzed by deep learning algorithms retinal alteration score (RAS) and diabetic retinopathy alteration score (DRAS), consisting of convolutional neural networks trained on EyePACS data sets and fine-tuned using data sets of portable device fundus images. The ground truth was the classification of DR corresponding to adjudicated expert reading, performed by 3 certified ophthalmologists. Main Outcome Measures: Primary outcome measures included the sensitivity and specificity of the AI system in detecting DR and/or mtmDR using a single-field, macula-centered fundus photograph for each eye, compared with a rigorous clinical reference standard comprising the reading center grading of 2-field imaging protocol using the International Classification of Diabetic Retinopathy severity scale. Results: Of 327 analyzed patients (mean age, 57.0 ± 16.8 years; mean diabetes duration, 16.3 ± 9.7 years), 307 completed the study protocol. Sensitivity and specificity of the AI system were high in detecting any DR with DRAS (sensitivity, 90.48% [95% confidence interval (CI), 84.99%-94.46%]; specificity, 90.65% [95% CI, 84.54%-94.93%]) and mtmDR with the combination of RAS and DRAS (sensitivity, 90.23% [95% CI, 83.87%-94.69%]; specificity, 85.06% [95% CI, 78.88%-90.00%]). The area under the receiver operating characteristic curve was 0.95 for any DR and 0.89 for mtmDR. Conclusions: This study showed a high accuracy for the detection of DR in different levels of severity with a single retinal photo per eye in an all-in-one solution, composed of a portable retinal camera powered by AI. Such a strategy holds great potential for increasing coverage rates of screening programs, contributing to prevention of avoidable blindness. Financial Disclosures: F.K.M. is a medical consultant for Phelcom Technologies. J.A.S. is Chief Executive Officer and proprietary of Phelcom Technologies. D.L. is Chief Technology Officer and proprietary of Phelcom Technologies. P.V.P. is an employee at Phelcom Technologies.

Modeling the influence of propionic acid concentration and pH on the kinetics of Salmonella Typhimurium.

Salmonella Typhimurium is a foodborne pathogen often found in the poultry production chain. Antibiotics have been used to reduce S. Typhimurium contamination in poultry aviaries and improve chicken growth. However, antibiotics were banned in several countries. Alternatively, organic acids, such as propionic acid (PA), can control pathogens. This study determined the PA minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and mathematically modeled S. Typhimurium growth/inactivation kinetics under the influence of PA at different pH values (4.5, 5.5, and 6.5) which are within the pH range of the chicken gastrointestinal tract. The PA MIC against S. Typhimurium was pH-dependent, resulting in 5.0, 3.5 and 9.0 mM undissociated PA at pH 4.5, 5.5, and 6.5, respectively. The Baranyi and Roberts and the Weibull model fit growth and inactivation data well, respectively. Secondary models were proposed. The validated model predicted 3-log reduction of S. Typhimurium in 3 h at 68.2 mM of undissociated PA and pH 4.5. The models presented a good capacity to describe the kinetics of S. Typhimurium subjected to PA, representing a useful tool to predict PA antibacterial action depending on the pH.

Chemical Method for Recovery and Regeneration of Graphene Oxide.

Graphene oxide (GO) has been developed as a very effective medium for filtration and removal of microbial contaminants in fuel. GO is capable of filtering out microorganisms without needing micrometer and submicrometer pores for filtration. Our previous studies showed that microorganisms are attracted by GO and bind irreversibly to GO without promoting bacterial growth. Therefore, GO was tested as a filter medium to remove microorganisms in fuel. The characterization results showed that GO removed microbes in diesel fuel with >99% efficiency. However, the synthesis of GO using Hummers' method is labor intensive and a time-consuming. We present in this paper an economical, less labor intensive and a simple chemical approach to recover GO after it has been used as a filtration medium for the removal of microorganisms in fuels. In the GO recovery process, microbial and fuel contaminated GO is washed with hexane to remove any fuel from the GO sample. The hexane-washed GO is further washed with acetone and mixed with ethanol to kill and remove any microorganisms. After washing with ethanol, the GO sample is sonicated in water to remove impurities and re-establish the oxygen functionalities. The final recovered-GO (rec-GO) is obtained after removing water by rotary evaporation. The chemical characterization of rec-GO showed that rec-GO is similar in both chemical and physical properties compared to freshly synthesized-GO (as-syn-GO). Rec-GO was shown to perform similarly to as-syn-GO in filtration of biocontaminated fuel. We estimate that our rec-GO is at least 90% cheaper than high quality commercially available GO.

Assessing the efficacy of palliative radiation treatment schemes for locally advanced squamous cell carcinoma of the head and neck: a meta-analysis.

Background: The objective to assess the outcomes from different palliative radiotherapy (RT) schedules in incurable head and neck cancer (HNC), to evaluate if there is a relationship between RT dose, technique, and fractionation with tumor response in contrast to the occurrence of adverse effects. Materials and methods: Eligible studies were identified on Medline, Embase, the Cochrane Library, and annual meetings proceedings through June 2020. Following PRISMA and MOOSE guidelines, a cumulative meta-analysis of studies for overall response rate (ORR), overall survival (OS), progression-free survival (PFS), pain/dysphagia relief, and toxicity was performed. A meta-regression analysis was done to assess if there is a connection between RT dose, schedule, and technique with ORR. Results: Twenty-eight studies with 1,986 patients treated with palliative RT due to incurable HNC were included. The median OS was 6.5 months [95% confidence interval (CI): 5.6-7.4], and PFS was 3.6 months (95% CI: 2.7-4.3). The ORR, pain and dysphagia relief rates were 72% (95% CI: 0.6-0.8), 83% (95% CI: 52-100%), and 75% (95% CI: 52-100%), respectively. Conventional radiotherapy (2D-RT) or conformational radiotherapy (3D-RT) use were significantly associated with a higher acute toxicity rate (grade ≥ 3) than intensity-modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). On meta-regression analyses, the total biological effective doses (BED) of RT (p = 0.001), BED > 60 Gy10 (p = 0.001), short course (p = 0.01) and SBRT (p = 0.02) were associated with a superior ORR. Conclusions: Palliative RT achieves tumor response and symptom relief in incurable HNC patients. Short course RT of BED > 60 Gy using IMRT could improve its therapeutic ratio. SBRT should be considered when available.

Acute physiological responses to eccentric cycling: a systematic review and meta-analysis.

INTRODUCTION: Eccentric cycling (ECCCYC) has attracted considerable interest due to its potential applicability for exercise treatment/training of patients with poor exercise tolerance as well as healthy and trained individuals. Conversely, little is known about the acute physiological responses to this exercise modality, thus challenging its proper prescription. This study aimed to provide precise estimates of the acute physiological responses to ECCCYC in comparison to traditional concentric cycling (CONCYC). EVIDENCE ACQUISITION: Searches were performed until November 2021 using the PubMed, Embase, and ScienceDirect databases. Studies that examined individuals' cardiorespiratory, metabolic, and perceptual responses to ECCCYC and CONCYC sessions were included. Bayesian multilevel meta-analysis models were used to estimate the population mean difference between acute physiological responses from ECCCYC and CONCYC bouts. Twenty-one studies were included in this review. EVIDENCE SYNTHESIS: The meta-analyses showed that ECCCYC induced lower cardiorespiratory (i.e., V̇O2, V̇E, and HR), metabolic (i.e., [BLa]), and perceptual (i.e., RPE) responses than CONCYC performed at the same absolute power output, while greater cardiovascular strain (i.e., greater increases in HR, Q, MAP, [norepinephrine], and lower SV) was detected when compared to CONCYC performed at the same V̇O2. CONCLUSIONS: The prescription of ECCCYC based on workloads used in the CONCYC sessions may be considered safe and, therefore, feasible for the rehabilitation of individuals with poor exercise tolerance. However, the prescription of ECCCYC based on the V̇O2 obtained during CONCYC sessions should be conducted with caution, especially in clinical settings, since there is a high probability of additional cardiovascular overload in this condition.

Optical Coherence Tomography Angiographic Evaluation of Macular Vessel Density in Diabetic Macular Edema After Intravitreal Dexamethasone Implants: A Prospective Interventional Trial.

BACKGROUND AND OBJECTIVE: The goal of this study was to assess macular vascular density evolution, macular thickness, and functional outcomes after intravitreal dexamethasone implants for diabetic macular edema. PATIENTS AND METHODS: Vascular density was evaluated with optical coherence tomography (OCT) angiography in 21 eyes. Macular thickness was evaluated with structural OCT. Visual acuity and contrast sensitivity were evaluated before and after treatment, and these functional outcomes were analyzed for association with anatomic outcomes. Macular vessel density in the superficial capillary plexus was evaluated with OCT angiography and quantified in areas with no fluid, allowing a more accurate measurement and eliminating the segmentation bias in areas with intra-retinal fluid. Such a methodology was possible by positioning the scans only in areas with no fluid before and after the implant. The absence of fluid in these areas was confirmed by three experienced evaluators using both the B-scan and the en face. Visual acuity and contrast sensitivity were evaluated before and after treatment, and these functional outcomes were analyzed for association with anatomic outcomes. RESULTS: At 30, 60, and 90 days after implantation, there was improvement in macular perfusion in areas without fluid after intravitreal dexamethasone implantation, accompanied by reduced macular thickness and improved visual acuity (P < .001). However, there was no improvement in contrast sensitivity after treatment. CONCLUSIONS: Improved macular perfusion after treatment with intravitreal dexamethasone implantation may be associated with modulation of leukostasis, when the release of cytokines leads to capillary endothelial damage and obstruction of the micro-vasculature, leading to impaired capillary perfusion and ischemic damage. Despite the anatomical and functional findings demonstrated, further studies are needed to prove the relationship between the inflammatory mechanisms of diabetic macular edema and its relationship with macular perfusion and functional aspects. [Ophthalmic Surg Lasers Imaging Retina 2023;54(3):174-182.].

Prevalence and risk factors for pseudarthrosis in humeral shaft fractures treated by minimally invasive plate osteosynthesis: A 10-year review.

Introduction: Fractures of the humeral shaft account for about 3% to 5% of all fractures. Although conservative treatment remains the first choice, there are a number of surgical indications. Minimally invasive plate osteosynthesis shows good functional results. However, complications have been reported, such as non-union. Objective: To assess the prevalence and risk factors for non-union after treatment of humeral shaft fractures using minimally invasive plate osteosynthesis. Materials and methods: This retrospective study was carried out in patients treated by minimally invasive plate osteosynthesis between 2009 and 2019. Demographic data and variables related to the fracture that could influence bone healing were analysed. The unpaired t-test and Mann-Whitney test were used for the statistical analyses. Categorical variables were analysed using the chi-square test or Fisher's exact test. Results: The study population showed a male predominance (53 of 75, 70.7%). The average time for fracture healing was 19.8 ± 15.3 weeks. Seven patients developed non-union. Only the presence of an open fracture increased the likelihood of non-union. Conclusions: The prevalence of non-union in patients treated by minimally invasive plate osteosynthesis was 9.3%. Patients with open fractures were six times more likely to progress to non-union. Fracture characteristics (Arbeitsgemeinschaft für Osteosynthesefragen classification, fracture location and plate working length) did not influence progression to non-union.

Is Functional Overreaching or Acute Fatigue the Key to the Effects of Concentrated Block Training in Running?

ABSTRACT: Borszcz, FK, Vieira, MT, Tramontin, AF, Visentainer, LH, and Costa, VP. Is functional overreaching or acute fatigue the key to the effects of concentrated block training in running? J Strength Cond Res 36(12): 3485-3496, 2022-This study examined the effects of 5 consecutive days of high- and moderate-intensity training on performance and physiological measures in moderately trained individuals. The relationship of the training organization with the state of overreaching and acute fatigue was investigated. Twenty-four male soldiers (age, 19.3 ± 0.4 years; V̇o2peak, 58.7 ± 3.8 ml·kg-1·min-1) were assigned to 2 training groups for 5 consecutive days of either high- or moderate-intensity training. The subjects underwent incremental and 12-minute time trial tests before, immediately after, 1 and 2 weeks after training. The high- and moderate-intensity sessions were 30 minutes in duration and performed at fixed velocities of 13.3 and 10 km·h-1 (near second and first ventilatory thresholds), respectively. Acute fatigue and overreaching criteria were set as concomitant nonimpairment and impairment, respectively, in the incremental peak velocity and 12-minute time trial performances at posttest immediately after the training block. Data analyses were completed using hierarchical Bayesian's models. In subjects who wer trained at moderate intensity, no performance impairment occurred (i.e., acute fatigue); for the high-intensity training, 5 subjects showed impairment in performance and were classified as overreached. Only in subjects who were acutely fatigued, clear beneficial effects were observed in incremental test peak velocity and 12-minute time trial performances. In moderately trained runners, a block of 5 consecutive days of moderate-intensity training was demonstrated to be a useful strategy for the improvement of performance. However, high-intensity training does not seem to be a safe strategy because of the observations of overreaching and inferior probabilities of performance improvements.

Síndrome de burnout en cirujanos generales en tiempos de la pandemia COVID-19

Objetivo: Evaluar el síndrome de burnout (SB) en cirujanos generales. Material y Método: Se realizó un estudio de corte transversal en nuestro centro hospitalario, en agosto de 2021. La muestra estuvo formada por 56 profesionales de la salud que incluyeron a residentes y especialistas en cirugia general quienes prestaron servicio en el contexto de la COVID-19. Resultados: La prevalencia del burnout fue del 71%, la edad media fue de 34 años y los residentes fueron los más afectados (62,5%). La distribución por sexo fue de 82,5% en masculinos y 17,5% en el sexo femenino. Del total de evaluados, 23 son casados y 17 solteros, predominando los cirujanos con hijos (60%). Discusión: Entre los pocos estudios publicados sobre el SB en trabajadores de la salud en tiempos de COVID-19 se ubican como posibles factores predisponentes: a las privaciones de sueño, el riesgo biológico ocupacional intrínseco, la cuarentena obligada a la que tienen que someterse los trabajadores de la salud fuera de casa y los dilemas éticos en la toma de decisiones de atención a pacientes. Sin embargo, un estudio ha mostrado que los estresores vinculados al SB más importantes son la falta de equipo de protección personal, el miedo al contagio de COVID-19 y el miedo de contagiar a los familiares. Conclusión: Existe una alta prevalencia del SB en cirujanos generales en el contexto de la pandemia COVID-19. Los más afectados fueron residentes jóvenes de sexo masculino, casados, con hijos y con bajos ingresos económicos.

Objective: To evaluate the burnout syndrome (BS) in general surgeons. Material and Method: A cross-sectional study was carried out in our hospital in August 2021. The sample consisted of 56 health professionals that included residents and specialists in general surgery who provided service in the context of COVID-19 Results: The prevalence of burnout was 71%, the mean age was 34 years and the residents were the most affected (62.5%). Sex was 82.5% in males and 17.5% in females. Of the total evaluated, 23 are married and 17 are single, with a predominance of surgeons with children (60%). Discussion: Among the few studies published on BS in health workers in times of COVID-19, the following are located as possible predisposing factors: sleep deprivation, intrinsic occupational biological risk, the forced quarantine that patients have to undergo. out-of-home health workers and ethical dilemmas in patient care decision-making. However, a study has shown that the most important stressors linked to BS are the lack of personal protective equipment, the fear of contagion of COVID-19 and the fear of infecting family members. Conclusion: There is a high prevalence of BS in general surgeons in the context of the COVID-19 pandemic. The most affected were young male residents, married, with children and with low income.

Physiological and Perceptual Responses in Spinal Cord Injury Handcyclists During an Endurance Interval Training: The Role of Critical Speed.

OBJECTIVE: This study sought to determine the physiological (oxygen uptake, heart rate, and blood lactate concentration) and perceptual (rating of perceived exertion) responses during an endurance interval training at the critical speed in elite handcyclists with spinal cord injury. DESIGN: Eight handcyclists performed an incremental test, three tests to exhaustion at a constant speed to determine critical speed, and the endurance interval training. The endurance interval training consisted of 6 × 5 mins at the individualized critical speed, with passive recovery of 50 secs. All testing was performed using their own handcycles on an oversized motorized treadmill. Physiological and perceptual responses were assessed during the incremental and endurance interval training tests. RESULTS: There was no significant difference in average oxygen uptake from the first to the sixth repetition. The mean ∆[La-]10_last between the 10th to the 30th minute of the exercise was -0.36 mmol·l-1, and no difference was detected from the first to the sixth repetition. The heart rate also remained stable during endurance interval training, whereas rating of perceived exertion increased significantly throughout the session. CONCLUSIONS: Repetitions of 5 mins at the critical speed in elite handcyclists are associated with cardiorespiratory and lactate steady state, whereas the perceived exertion increased systematically.

The Impact of Pre-Exercise Carbohydrate Meal on the Effects of Yerba Mate Drink on Metabolism, Performance, and Antioxidant Status in Trained Male Cyclists.

INTRODUCTION: The consumption of yerba mate (YM), a source of antioxidants, in a fasted state increases fatty acid oxidation (FATox) during low-moderate-intensity exercise and improves performance in high-intensity exercise. However, the impact of a pre-exercise carbohydrate (CHO) meal on YM effects during exercise is unknown. OBJECTIVE: We investigated the effects of yerba mate drink (YMD) consumed in the fasted state (YMD-F) or after a CHO meal (YMD-CHO) on measurements of metabolism, performance, and blood oxidative stress markers in cycling exercise. METHODS: In a randomized, repeated-measures, crossover design, eight trained male cyclists ingested (i) YMD-CHO, (ii) YMD-F, or (iii) control-water and CHO meal (Control-CHO). The YMD (an infusion of 5 g of ultrarefined leaves in 250 mL of water) was taken for 7 days and 40 min before exercise. CHO meal (1 g/kg body mass) was consumed 60 min before exercise. The cycling protocol included a 40-min low-intensity (~ 53% V̇O2peak) constant load test (CLT); a 20-min time trial (TT); and 4 × 10-s all-out sprints. Blood samples and respiratory gases were collected before, during, and/or after tests. RESULTS: During CLT, YMD-CHO increased FATox ~ 13% vs. YMD-F (P = 0.041) and ~ 27% vs. Control-CHO (P < 0.001). During TT, YMD-CHO increased FATox ~ 160% vs. YMD-F (P < 0.001) and ~ 150% vs. Control-CHO (P < 0.001). Power output during TT improved ~ 3% (P = 0.022) in YMD-CHO vs. Control-CHO and was strongly correlated with changes in serum total antioxidant capacity (r = -0.87) and oxidative stress index (r = 0.76) at post-exercise in YMD-CHO. Performance in sprints was not affected by YMD. CONCLUSION: CHO intake did not negate the effect of YMD on FATox or TT performance. Instead, a synergism between the two dietary strategies may be present. Clinical Trial Registration NCT04642144. November 18, 2020. Retrospectively registered.

Near-infrared spectroscopy-derived muscle V̇O2${\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ kinetics after moderate running exercise in healthy males: reliability and associations with parameters of aerobic fitness.

NEW FINDINGS: What is the central question of this study? What is the reliability of near-infrared spectroscopy-derived muscle oxygen uptake ( mV̇O2${\rm{m}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ ) kinetics following running exercise and what is the relationship between the time constant of mV̇O2${\rm{m}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ off-kinetics and parameters of aerobic fitness? What is the main finding and its importance? The time constant of mV̇O2${\rm{m}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ kinetics in gastrocnemius following moderate running exercise presents good to excellent reliability. In addition, it was well correlated with parameters of aerobic fitness, such as maximal speed of an incremental test, ventilatory threshold and pulmonary V̇O2${\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ on-kinetics. Therefore, near-infrared spectroscopy-derived muscle oxidative capacity together with other physiological measurements may allow a concomitant local and systemic analysis of the components of the oxidative system. ABSTRACT: Near-infrared spectroscopy-derived muscle oxygen uptake ( mV̇O2${\rm{m}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ ) kinetics following single-joint exercise has been used to assess muscle oxidative capacity. However, little evidence is available on the use of this technique following whole-body exercise. Therefore, this study aimed to assess the reliability of the NIRS-derived mV̇O2${\rm{m}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ kinetics following running exercise and to investigate the relationship between the time constant of mV̇O2${\rm{m}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ off-kinetics ( τmV̇O2$\tau {\rm{m}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ ) and parameters of aerobic fitness. After an incremental test to determine V̇O2max${\dot{V}_{{{\rm{O}}_{\rm{2}}}{\rm{max}}}}$ , first (VT1 ) and second (VT2 ) ventilatory thresholds, and maximal speed (Smax ), 13 males (age = 21 ± 4 years; V̇O2max${\dot{V}_{{{\rm{O}}_{\rm{2}}}{\rm{max}}}}$  = 55.9 ± 3.4 ml kg-1  min-1 ) performed three sets (two on the first day and one on a subsequent day) of two repetitions of 6-min running exercise at 90%VT1 . The pulmonary V̇O2${\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ ( pV̇O2${\rm{p}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ ) on-kinetics and mV̇O2${\rm{m}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ off-kinetics in gastrocnemius were assessed. τmV̇O2$\tau {\rm{m}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ presented no systematic change and satisfactory reliability (the standard error of the measurement (SEM) and intraclass correlation coefficient of 4.21 s and 0.49 for between transitions; and 2.65 s and 0.74 averaging τmV̇O2$\tau {\rm{m}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ within each time set), with no difference (P > 0.3) between the within- (SEM = 2.92 s) and between-day variability (SEM = 2.78 s and 2.19 s between first vs. third set, and second vs. third set, respectively). τmV̇O2$\tau {\rm{m}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ (28.5 ± 4.17 s) correlated significantly (P < 0.05) with Smax (r = -0.66), VT1 (r = -0.64) and time constant of the p V̇O2${\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ on-kinetics (r = 0.69). These findings indicate that NIRS-derived mV̇O2${\rm{m}}{\dot{V}_{{{\rm{O}}_{\rm{2}}}}}$ kinetics in the gastrocnemius following moderate running exercise is a useful and reliable parameter to assess muscle oxidative capacity.

Once daily (OD) versus twice-daily (BID) chemoradiation for limited stage small cell lung cancer (LS-SCLC): A meta-analysis of randomized clinical trials.

OBJECTIVES: Assess Once daily (OD) chemoradiation effectiveness for LS-SCLC compared with twice daily (BID) chemoradiation. METHODS AND MATERIALS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, eligible randomized clinical trials (RCT) comparing OD and BID were identified on electronic databases. A meta-analysis was performed to compare overall survival (OS), progression-free survival (PFS), and toxicity. A metaregression analysis was conducted to explore the influence of fractionation, biological effective dose (BED), the proportion of patients treated with prophylactic cranial irradiation (PCI), elective nodal irradiation (ENI), and the start of radiotherapy (week 1 or week 4). RESULTS: Five RCTs with a total of 1941 patients (OD vs. BID) were included. The relative risk (RR) for OS and PFS was 0.97 (CI95% 0.8-1.1, p = 0.731) and 0.90 (CI95% 0.7-1.1, p = 0.20) at 3-years. In the metaregression analysis, hypofractionated radiotherapy schedules were associated with an improvement in overall survival (p = 0.03). The start of radiotherapy (W1 or W4), BED, and ENI had no significant effect on OS and PFS. The complete response rate partial response and overall response rate for BID vs OD were 40% vs. 33% (p = 0.97), 50% vs. 57% (p = 0.94), and 89% vs. 93% (p = 0.99). The rate of completed planned RT 96% vs. 94% (p = 0.66), and the % of ≥4 chemotherapy cycles received 74% vs. 74% (p = 0.99), did not differ between OD and BID. The local and distant failure rates were not significantly different between OD and BID 40% vs. 33% (p = 0.88) and 36% vs. 36% (p = 0.99). No difference in grade 2 or grade 3 pneumonitis and esophagitis was observed among the groups (p = NS). CONCLUSION: For LS-SCLC, OD conventional chemoradiation results in similar outcomes to BID chemoradiation. In contrast, hypofractionated radiotherapy was associated with a better OS and PFS than BID. Additional randomized phase III trials exploring hypofractionation with systemic therapy are warranted to validate our findings.

Ergogenic Effects of Photobiomodulation on Performance in the 30-Second Wingate Test: A Randomized, Double-Blind, Placebo-Controlled, Crossover Study.

ABSTRACT: Molina Correa, JC, Padoin, S, Varoni, PR, Demarchi, MC, Flores, LJ, Nampo, FK, and de Paula Ramos, S. Ergogenic effects of photobiomodulation on performance in the 30-second Wingate test: A randomized, double-blind, placebo-controlled, crossover study. J Strength Cond Res 36(7): 1901-1908, 2022-The purpose of this study was to evaluate the ergogenic effects of red light (630 nm) photobiomodulation on anaerobic capacity in the Wingate test. Sixteen healthy and physically active male volunteers (21.71 ± 2.49 years of age, body mass index between 18.5 and 24.9 kg/m2) participated in this randomized, double-blind, placebo-controlled, crossover study. The subjects performed 3 Wingate test sessions, with a 48-hour interval between tests. In the first session (baseline session, BS), a Wingate test was performed to evaluate the initial performance. Subjects were paired by performance in the BS and allocated through a draw to receive either the phototherapy (630 nm, 4.6 J/cm2, 6 J per point, 16 points, light-emitting diode [LED] session) or placebo intervention (PLA session) in the second test session. In the third test session, a crossover intervention was performed. The repeated-measures analysis of variance test, followed by Bonferroni post hoc test or Friedman test with Dunn's post hoc test (p < 0.05) and Cohen's d statistic were used for comparisons. The LED session with phototherapy promoted an increase in performance in peak power (p < 0.05), relative power (p < 0.05), RPMpeak (p < 0.05), and peak velocity (p < 0.05), as well as total displacement (p < 0.01) compared with PLA. The mean power (p < 0.05), relative power (p < 0.05), RPMmean (p < 0.01), and mean velocity (p < 0.01) were higher in the LED session than those of BS. We concluded that phototherapy improves performance in Wingate anaerobic exercise, possibly due to large effects on the anaerobic alactic metabolism.

Dynamically Weighted Balanced Loss: Class Imbalanced Learning and Confidence Calibration of Deep Neural Networks.

Imbalanced class distribution is an inherent problem in many real-world classification tasks where the minority class is the class of interest. Many conventional statistical and machine learning classification algorithms are subject to frequency bias, and learning discriminating boundaries between the minority and majority classes could be challenging. To address the class distribution imbalance in deep learning, we propose a class rebalancing strategy based on a class-balanced dynamically weighted loss function where weights are assigned based on the class frequency and predicted probability of ground-truth class. The ability of dynamic weighting scheme to self-adapt its weights depending on the prediction scores allows the model to adjust for instances with varying levels of difficulty resulting in gradient updates driven by hard minority class samples. We further show that the proposed loss function is classification calibrated. Experiments conducted on highly imbalanced data across different applications of cyber intrusion detection (CICIDS2017 data set) and medical imaging (ISIC2019 data set) show robust generalization. Theoretical results supported by superior empirical performance provide justification for the validity of the proposed dynamically weighted balanced (DWB) loss function.

A Case Report on Life-Threatening Lower Gastrointestinal Bleeding: A Rare Presentation of Mucinous Adenocarcinoma of the Appendix.

INTRODUCTION: A life-threatening lower gastrointestinal bleeding from mucinous adenocarcinoma of the appendix is a rare occurrence. Diagnosing and management of such a condition are challenging. Case Presentation. A 73-year-old male with a history of type 2 diabetes mellitus and hypertension presented with intermittent per rectal bleeding for two weeks, which progressed to the passage of a large number of blood clots and fresh blood. He had features of class III shock on admission. An endoscopic evaluation followed initial resuscitation to locate the source of bleeding. Colonoscopy revealed a large blood clot at the opening of the appendicular orifice with no active bleeding. Oesophagoduodenoscopy, contrast-enhanced CT abdomen, and CT angiogram findings were unremarkable. Due to repeated episodes of rebleeding leading to haemodynamic instability, an exploratory laparotomy was performed. A retrocaecal appendix was noticed with a macroscopically suspicious-looking dilated tip adhered to the posterior caecal wall. Right hemicolectomy was performed as the lesion was suspicious and to stop bleeding from the site. Ileocolic side-to-side hand-sewn anastomosis was performed using 3/0 polyglactin. Postoperatively, per rectal bleeding was settled. Microscopy revealed appendiceal mucinous adenocarcinoma with AJCC staging of pT3NoMx. The patient was discharged on postoperative day seven and referred to oncological management. He was offered six cycles of chemotherapy with capecitabine and oxaliplatin. At the six-month follow-up visit, the patient had no features of recurrence clinically. CONCLUSION: Mucinous adenocarcinoma of the appendix can rarely present as life-threatening lower GI bleeding. Prompt resuscitation, endoscopic evaluation, and operative management with right hemicolectomy and chemotherapy provided a good outcome.

Phloroglucinol and dieckol isolated from Ecklonia cava suppress impaired diabetic angiogenesis; A study of in-vitro and in-vivo.

Abnormalities in angiogenesis that are associated with diabetes may contribute to vascular complications and result in disabilities and death. Furthermore, an imbalance in angiogenesis in different tissues, including the retina and kidney, can play a role in the pathogenesis of diabetic microvascular complications. Phlorotannins, such as phloroglucinol (PG) and dieckol (DK), which are found in Ecklonia cava exhibit antioxidant and anti-inflammatory activities that improve endothelial function in hypertension. However, reports on the effects of these compounds on diabetes-induced angiogenesis in vivo and in vitro are scarce. In this study, we assessed the antiangiogenic effects of PG and DK on endothelial cells treated with a high concentration of glucose to mimic angiogenesis. In addition, we sought to determine the effects of these compounds on cell proliferation, cell migration, and capillary formation. In silico docking of PG and DK into VEGFR-2 revealed their potential as therapeutic agents against angiogenesis. Further, both compounds were identified to inhibit the formation of the retinal vessel in transgenic zebrafish (flk:EGFP) embryos under high glucose conditions. These findings suggested that PG and DK derived from E. cava are potential inhibitors of angiogenesis in diabetic vascular complications and could, therefore, be used to develop angiogenic agents.

Real-life outcomes of subthreshold laser therapy for diabetic macular edema.

BACKGROUND: Diabetic macular edema (DME) is a major cause of visual impairment and its treatment is a public health challenge. Even though anti-angiogenic drugs are the gold-standard treatment, they are not ideal and subthreshold laser (SL) remains a viable and promising therapy in selected cases. The aim of this study was to evaluate its efficacy in a real-life setting. METHODS: Retrospective case series of 56 eyes of 36 patients with center-involving DME treated with SL monotherapy. Treatment was performed in a single session with the EasyRet® photocoagulator with the following parameters: 5% duty cycle, 200-ms pulse duration, 160-µm spot size and 50% power of the barely visible threshold. A high-density pattern was then applied to the whole edematous area, using multispot mode. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were obtained at baseline and around 3 months after treatment. RESULTS: Fifty-six eyes of 36 patients were included (39% women, mean age 64.8 years old); mean time between treatment day and follow-up visit was 14 ± 6 weeks. BCVA (Snellen converted to logMAR) was 0.59 ± 0.32 and 0.43 ± 0.25 at baseline and follow-up, respectively (p = 0.002). Thirty-two percent had prior panretinal photocoagulation (p = 0.011). Mean laser power was 555 ± 150 mW and number of spots was 1,109 ± 580. Intraretinal and subretinal fluid (SRF) was seen in 96 and 41% of eyes at baseline and improved in 35 and 74% of those after treatment, respectively. Quantitative analysis of central macular thickness (CMT) change was performed in a subset of 23 eyes, 43% of which exhibited > 10% CMT reduction post-treatment. CONCLUSIONS: Subthreshold laser therapy is known to have RPE function as its main target, modulating the activation of heat-shock proteins and normalizing cytokine expression. In the present study, the DME cases associated with SRF had the best anatomical response, while intraretinal edema responded poorly to laser monotherapy. BCVA and macular thickness exhibited a mild response, suggesting the need for combined treatment in most patients. Given the effect on SRF reabsorption, subthreshold laser therapy could be a viable treatment option in selected cases.

Obstetric Paralysis: Evaluation of the Sever-L'Episcopo Technique Modified by Hoffer.

Evaluate the results of a series of 28 cases of high obstetric paralysis treated with the Sever-L'Episcopo technique modified by Hoffer, between 2003 and 2016. Children (mean age, four years and seven months) with adduction contracture and internal rotation of the shoulder without secondary bone deformities (Mallet class II) underwent lengthening of the pectoralis major muscle and tenotomy of the subscapularis muscle associated with transfer of the latissimus dorsi and teres major muscle to the infraspinatus muscle, moving to the function of external rotators and elevators. The mean follow-up was three years and 10 months. At the end of the study, 24 patients achieved excellent functional assessment scores, mainly of the abduction and external rotation, passing from Mallet class II to class IV. Four patients still demonstrated some degree of global movement limitation, passing from class II to class III. Regardless of the final functional gain, all patients were able to perform tasks that were previously difficult. The data from this study suggest that Hoffer's surgery is an effective method in the treatment of the sequelae of high obstetric paralysis without secondary bone deformities.