Automatic foot ulcer segmentation using conditional generative adversarial network (AFSegGAN): A wound management system.

Effective wound care is essential to prevent further complications, promote healing, and reduce the risk of infection and other health issues. Chronic wounds, particularly in older adults, patients with disabilities, and those with pressure, venous, or diabetic foot ulcers, cause significant morbidity and mortality. Due to the positive trend in the number of individuals with chronic wounds, particularly among the growing elderly and diabetes populations, it is imperative to develop novel technologies and practices for the best practice clinical management of chronic wounds to minimize the potential health and economic burdens on society. As wound care is managed in hospitals and community care, it is crucial to have quantitative metrics like wound boundary and morphological features. The traditional visual inspection technique is purely subjective and error-prone, and digitization provides an appealing alternative. Various deep-learning models have earned confidence; however, their accuracy primarily relies on the image quality, the dataset size to learn the features, and experts' annotation. This work aims to develop a wound management system that automates wound segmentation using a conditional generative adversarial network (cGAN) and estimate the wound morphological parameters. AFSegGAN was developed and validated on the MICCAI 2021-foot ulcer segmentation dataset. In addition, we use adversarial loss and patch-level comparison at the discriminator network to improve the segmentation performance and balance the GAN network training. Our model outperformed state-of-the-art methods with a Dice score of 93.11% and IoU of 99.07%. The proposed wound management system demonstrates its abilities in wound segmentation and parameter estimation, thereby reducing healthcare workers' efforts to diagnose or manage wounds and facilitating remote healthcare.

Effect of Percentage Reduction in Action Potential Duration of M-cells on Re-entry in Short QT Syndrome.

Increase in transmural dispersion of repolarisation along with a diminished QT interval have been known to aid in the development of arrhythmia during KCNQ1-linked short QT syndrome type 2 (SQTS2). However, the percentage by which action potential duration (APD) shortens in the different cell types that make up the ventricular wall are not fully understood. In this study, the percentage of APD shortening of M-cells was varied to determine the conditions under which re-entry occurs during SQTS2. A 2D transmural section of the heart with anisotropic properties is considered. Slight modifications to the TP06 equations are used to simulate the electrophysiology of the endocardial (endo), midmyocardial (M) and epicardial (epi) cells. A discrete network of 250×100 cells are interconnected using gap junction conductances and from this, a pseudo ECG is generated. On pacing the tissue with premature beats in the midst of normal pacing pulses and on including SQTS, it is observed that re-entry is sustained for a longer duration when the APD shortening in M-cells is more compared to the epi or endo cells while the percentage reduction in APD of M-cells is about 5% to 7% lesser than that in epi and endo cells. Further, when the percentage reduction in APD of M-cells is similar to epi or endo cells, no re-entry is generated. This analysis highlights the key role of percentage reduction in APD of M-cells compared to epi and endo cells in maintaining the re-entrant waves.

Evaluation of cytotoxicity levels of poly vinyl ether silicone, polyether, and poly vinyl siloxane impression materials: An in vitro study.

AIM: To assess the cytotoxicity level of newly introduced poly vinyl ether silicone (PVES) compared to poly vinyl siloxane (PVS) and polyether (PE) elastomeric impression materials. SETTINGS AND DESIGN: Comparative -Invitro study design. MATERIALS AND METHODS: Mouse cell line NIH/3T3 was grown in Dulbecco's modified Eagle's medium. Samples of three elastomers were dissolved in dimethyl sulfoxide and were tested at various concentrations. Twenty-four well plates with NIH/3T3 cells with different concentrations of elastomeric solutions were incubated at 37°C. 3-(4,5-dimethylthiazol-2-yl)-2-5-diphenyltetrazolium bromide assay was performed on day 1, 3, and 7, with a time interval of 15 min, 30 min, 60 min, and 24th h to estimate the cytotoxicity for all three elastomers. STATISTICAL ANALYSIS USED: Kruskal-Wallis ANOVA test and the period effect within the subjects, repeated-measure ANOVA was done using the Greenhouse-Geisser correction method. RESULTS: The mean cell viability (survival rate) of NIH 3T3 cells at the concentrations tested was measured. A repeated-measure Kruskal-Wallis ANOVA determined the mean survival concentration on day 1, 3, and 7. PVES showed significant decrease in the survival rate on day 1 than PVS and PE, while PVS and PE had significant decrease in the survival rates of cells on day 3 and 7 which were statistically significant (P < 0.001). CONCLUSION: PVES shows early cytotoxic signs as compared to PVS and PE, and cell viability for PVS was the highest among all. When making impression with PVES and PE, it is always better to evaluate the impression and gingival sulcus carefully with magnification to prevent adverse reaction, if any material is left inadvertently for longer period of time.

Post coital hemoperitoneum: The pain of love.

Acute abdominal pain in women of reproductive age is common and frequent cause for visit to emergency department which warrants emergent evaluation. We present the case of a 23-year-old nulliparous women presenting with post-coital haemoperitoneum secondary to a ruptured corpus luteum cyst. This is a rare case demonstrating the need to elicit sexual history in patients presenting with an acute abdomen in emergency department.

Final-impression techniques and materials for making complete and removable partial dentures.

BACKGROUND: Edentulism is relatively common and is often treated with the provision of complete or partial removable dentures. Clinicians make final impressions of complete dentures (CD) and removable partial dentures (RPD) using different techniques and materials. Applying the correct impression technique and material, based on an individual's oral condition, improves the quality of the prosthesis, which may improve quality of life. OBJECTIVES: To assess the effects of different final-impression techniques and materials used to make complete dentures, for retention, stability, comfort, and quality of life in completely edentulous people.To assess the effects of different final-impression techniques and materials used to make removable partial dentures, for stability, comfort, overextension, and quality of life in partially edentulous people. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 November 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Register of Studies, to 22 November 2017), MEDLINE Ovid (1946 to 22 November 2017), and Embase Ovid (21 December 2015 to 22 November 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases, however the search of Embase was restricted by date due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing different final-impression techniques and materials for treating people with complete dentures (CD) and removable partial dentures (RPD). For CD, we included trials that compared different materials or different techniques or both. In RPD for tooth-supported conditions, we included trials comparing the same material and different techniques, or different materials and the same technique. In tooth- and tissue-supported RPD, we included trials comparing the same material and different dual-impression techniques, and different materials with different dual-impression techniques. DATA COLLECTION AND ANALYSIS: Two review authors independently, and in duplicate, screened studies for eligibility, extracted data, and assessed the risk of bias for each included trial. We expressed results as risk ratios (RR) for dichotomous outcomes, and as mean differences (MD) or standardised mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CI), using the random-effects model. We constructed 'Summary of findings' tables for the main comparisons and outcomes (participant-reported oral health-related quality of life, quality of the denture, and denture border adjustments). MAIN RESULTS: We included nine studies in this review. Eight studies involved 485 participants with CD. We assessed six of the studies to be at high risk of bias, and two to be at low risk of bias. We judged one study on RPD with 72 randomised participants to be at high risk of bias.Overall, the quality of the evidence for each comparison and outcome was either low or very low, therefore, results should be interpreted with caution, as future research is likely to change the findings.Complete denturesTwo studies compared the same material and different techniques (one study contributed data to a secondary outcome only); two studies compared the same technique and different materials; and four studies compared different materials and techniques.One study (10 participants) evaluated two stage-two step, Biofunctional Prosthetic system (BPS) using additional silicone elastomer compared to conventional methods, and found no evidence of a clear difference for oral health-related quality of life, or quality of the dentures (denture satisfaction). The study reported that BPS required fewer adjustments. We assessed the quality of the evidence as very low.One study (27 participants) compared selective pressure final-impression technique using wax versus polysulfide elastomeric (rubber) material. The study did not measure quality of life or dentures, and found no evidence of a clear difference between interventions in the need for adjustments (RR 0.81, 95% CI 0.38 to 1.70). We assessed the quality of the evidence as very low.One study compared two stage-two step final impression with alginate versus silicone elastomer. Oral health-related quality of life measured by the OHIP-EDENT seemed to be better with silicone (MD 7.20, 95% CI 2.71 to 11.69; 144 participants). The study found no clear differences in participant-reported quality of the denture (comfort) after a two-week 'confirmation' period, but reported that silicone was better for stability and chewing efficiency. We assessed the quality of the evidence as low.Three studies compared single-stage impressions with alginate versus two stage-two step with elastomer (silicone, polysulfide, or polyether) impressions. There was no evidence of a clear difference in the OHIP-EDENT at one month (MD 0.05, 95% CI -2.37 to 2.47; two studies, 98 participants). There was no evidence of a clear difference in participant-rated general satisfaction with dentures at six months (MD 0.00, 95% CI -8.23 to 8.23; one study, 105 participants). We assessed the quality of the evidence as very low.One study compared single-stage alginate versus two stage-two step using zinc-oxide eugenol, and found no evidence of a clear difference in OHIP-EDENT (MD 0.50, 95% CI -2.67 to 3.67; 39 participants), or general satisfaction (RR 3.15, 95% CI 0.14 to 72.88; 39 participants) at six months. We assessed the quality of the evidence as very low.Removable partial denturesOne study randomised 72 participants and compared altered-cast technique versus one-piece cast technique. The study did not measure quality of life, but reported that most participants were satisfied with the dentures and there was no evidence of any clear difference between groups for general satisfaction at one-year follow-up (low-quality evidence). There was no evidence of a clear difference in number of intaglio adjustments at one year (RR 1.43, 95% CI 0.61 to 3.34) (very low-quality evidence). AUTHORS' CONCLUSIONS: We conclude that there is no clear evidence that one technique or material has a substantial advantage over another for making complete dentures and removable partial dentures. Available evidence for the relative benefits of different denture fabrication techniques and final-impression materials is limited and is of low or very low quality. More high-quality RCTs are required.

Assessment of shoulder and low back muscle activity of male kitchen workers using surface electromyography.

OBJECTIVES: This study aims to assess muscle fatigue for kitchen workers during various tasks in a kitchen. MATERIAL AND METHODS: This study consists of 2 phases: a) surface electromyography (EMG) to determine muscle fatigue of trapezius and erector spinae muscles bilaterally for 12 healthy male volunteers during 30 min of Indian flatbread (chapati) preparation, b) self-administered questionnaire study after 30 min preparation to determine the impact on performance. RESULTS: Surface EMG results show that the right trapezius muscle had significantly higher fatigue during kneading, rolling and roasting tasks. Similarly, right erector spinae muscle showed significantly higher fatigue during rolling and roasting tasks. CONCLUSIONS: Both phases of the study conclude that, even though the dynamic postural adjustment may reduce fatigue during the work schedule; the combination of risk factors like the repetitive task, forceful exertion and prolonged standing during working results in a high risk of developing muscle fatigue. Int J Occup Med Environ Health 2018;31(1):81-90.

Spectro-Temporal Electrocardiogram Analysis for Noise-Robust Heart Rate and Heart Rate Variability Measurement.

The last few years has seen a proliferation of wearable electrocardiogram (ECG) devices in the market with applications in fitness tracking, patient monitoring, athletic performance assessment, stress and fatigue detection, and biometrics, to name a few. The majority of these applications rely on the computation of the heart rate (HR) and the so-called heart rate variability (HRV) index via time-, frequency-, or non-linear-domain approaches. Wearable/portable devices, however, are highly susceptible to artifacts, particularly those resultant from movement. These artifacts can hamper HR/HRV measurement, thus pose a serious threat to cardiac monitoring applications. While current solutions rely on ECG enhancement as a pre-processing step prior to HR/HRV calculation, existing artifact removal algorithms still perform poorly under extremely noisy scenarios. To overcome this limitation, we take an alternate approach and propose the use of a spectro-temporal ECG signal representation that we show separates cardiac components from artifacts. More specifically, by quantifying the rate-of-change of ECG spectral components over time, we show that heart rate estimates can be reliably obtained even in extremely noisy signals, thus bypassing the need for ECG enhancement. With such HR measurements in hands, we then propose a new noise-robust HRV index termed MD-HRV (modulation-domain HRV) computed as the standard deviation of the obtained HR values. Experiments with synthetic ECG signals corrupted at various different signal-to-noise levels, as well as recorded noisy signals show the proposed measure outperforming several HRV benchmark parameters computed post wavelet-based enhancement. These findings suggest that the proposed HR measures and derived MD-HRV metric are well-suited for ambulant cardiac monitoring applications, particularly those involving intense movement (e.g., elite athletic training).

Prevalence of work-related musculoskeletal injuries among South Indian hand screen-printing workers.

BACKGROUND: Hand screen-printing (HSP) plays a predominant role in textile industries in developing countries. Workers from HSP industry were mostly affected by musculoskeletal injury due to monotonous, and prolonged work nature and poor workplace environment. OBJECTIVE: The present study aims to investigate the prevalence of work-related musculoskeletal disorder (MSD) symptoms and risk factors associated among the HSP industry workers. METHODS: Cochran's sample size for categorical data was used to select 385 HSP workers of 1000 samples from various provinces of Tamil Nadu, INDIA. Modified Nordic based questionnaire was used to assess the musculoskeletal injuries and risk factors among HSP workers. RESULTS: The statistical analysis revealed that 62.5% workers are prone to MSD symptoms with lower back (75.1%), shoulder (66.2%), knees (58.7%), and ankle/feet (55.6%). Age, experience, marital status, stress in the job were the risk factors which significantly (p < 0.05) associated with the reported MSDs. Further, this study result infers that the subjects with higher age and experience are exposed higher levels of MSD prevalence of 85.5% and 92.0% respectively in past 12 months than other groups. Among the different work categories in HSP task, the workers reported with the maximum discomfort during printing work (63.1%) with Odds ratio as 10.38 and 95% CI is 6.18-17.4. than the material handling and drying task. CONCLUSIONS: Study results infer that HSP workers are prone to lower back and shoulder pain followed by knees and ankle feet regions. Socio-demographic factors, awkward posture and repetitive movements contribute to cause MSD among hand screen-printing workers.

Electroencephalography Amplitude Modulation Analysis for Automated Affective Tagging of Music Video Clips.

The quantity of music content is rapidly increasing and automated affective tagging of music video clips can enable the development of intelligent retrieval, music recommendation, automatic playlist generators, and music browsing interfaces tuned to the users' current desires, preferences, or affective states. To achieve this goal, the field of affective computing has emerged, in particular the development of so-called affective brain-computer interfaces, which measure the user's affective state directly from measured brain waves using non-invasive tools, such as electroencephalography (EEG). Typically, conventional features extracted from the EEG signal have been used, such as frequency subband powers and/or inter-hemispheric power asymmetry indices. More recently, the coupling between EEG and peripheral physiological signals, such as the galvanic skin response (GSR), have also been proposed. Here, we show the importance of EEG amplitude modulations and propose several new features that measure the amplitude-amplitude cross-frequency coupling per EEG electrode, as well as linear and non-linear connections between multiple electrode pairs. When tested on a publicly available dataset of music video clips tagged with subjective affective ratings, support vector classifiers trained on the proposed features were shown to outperform those trained on conventional benchmark EEG features by as much as 6, 20, 8, and 7% for arousal, valence, dominance and liking, respectively. Moreover, fusion of the proposed features with EEG-GSR coupling features showed to be particularly useful for arousal (feature-level fusion) and liking (decision-level fusion) prediction. Together, these findings show the importance of the proposed features to characterize human affective states during music clip watching.

Evaluation of Crestal Bone Loss Around Implants Placed at Equicrestal and Subcrestal Levels Before Loading: A Prospective Clinical Study.

INTRODUCTION: Depth of placement of implant shoulder in relation to the crestal bone positively influence bone remodelling and preservation but the role of placement depth on bone loss before loading is not very clear. AIM: To assess the effect of placement depth alone on the crestal bone loss around implant placed at subcrestal and equicrestal level before prosthetic loading. MATERIALS AND METHODS: Patients reporting to the Department of Prosthodontics with the complaint of missing teeth were enrolled in the study after analysing inclusion and exclusion criteria. A total of 24 implants were planned to be placed into two groups as Group E (n=12) and Group S (n=12). Follow up radiographs after implant placement and after six months were analysed for the amount of bone loss. RESULTS: On six months follow up crestal bone levels of Group E were apical to Group S. Bone loss comparison between groups after six months follow up, revealed almost same mean bone loss. CONCLUSION: The implants placed at subcrestal and equicrestal level did not show difference in crestal bone loss before prosthetic loading.

Intervention for replacing missing teeth: Partially absent dentition-Evidence summary of Cochrane review.

Cochrane reviews are systematic reviews with meta analysis published by the Cochrane collaboration, in the Cochrane Database of Systematic Reviews (CDSR). These reviews provide the clinicians with the highest level of evidence as they use a highly structured and transparent systematic review model to address a specific research question. The management of partially absent dentition is routinely under taken by general dentist and Prosthodontist but clinical practice guidelines based on evidence to this common problem is yet to be summarized. This Cochrane systematic review aims to address the effect of different prosthesis for the treatment of partially absent dentition in the terms of, Long-term success, function, morbidity, and patient satisfaction. All randomized controlled trials were searched till March 18, 2011, based on the inclusion and exclusion criteria, 21 trials were included and 32 trials were excluded and, it was critically appraised using the Cochrane methodology for interventions. The summary of evidence from the study concludes that there is insufficient evidence to state the effectiveness of removable and fixed prosthesis in partially edentulous subjects in the following four outcomes. There were insufficient trials to perform a meta-analysis and sensitivity analysis. This evidence-based summary emphasizes and reinforces the need to reassess the quality of research currently pursued in our profession, to address the need to provide higher level of evidence for common conditions like partial edentulousness. The included studies are basically not from our population too, hence the urgency to address this critical issue.

Evaluation of marginal fit and internal adaptation of zirconia copings fabricated by two CAD - CAM systems: An in vitro study.

STATEMENT OF PROBLEM: Three main factors which determine the success of an All-ceramic restoration are esthetic value, resistance to fracture and third being the marginal fit. Marginal fit and internal adaptation are crucial factors in increasing the longevity of the restoration. Newer and economical CAD CAM systems have been introduced claiming better marginal fit and adaptation of All ceramic crowns. CAD CAM systems involves scanning of the die or the tooth preparation and milling of the restoration, which may have variations among the systems available. AIM OF THE STUDY: Our study intended to check the marginal fit and internal adaptation of commonly used CAD CAM systems namely CERAMILL and CEREC -In Lab MC XL. MATERIALS AND METHODS: Two groups of typodont teeth (n = 10) were prepared using a standardized protocol to receive All ceramic copings. 10 samples of Group A were used for fabrication of copings using CERAMILL system and 10 samples of Group B were used for fabrication of copings using CEREC -In Lab MC XL system. They were then luted with glass ionomer cement under mild finger pressure. Samples were embedded in resin and sliced longitudinally. They were then viewed under stereomicroscope and readings were measured along 15 points using ImageScope software. The P value was set at 0.05 at 95% confidence interval with 80% power. The data were checked for normality and unpaired t-test was used to evaluate the results of the two groups. RESULTS: The overall internal adaptation was 61.5 ± 5.2 µm for CERAMILL and 56.9 ± 5.7 µm for CEREC -In Lab MC XL (P < 0.05). The marginal fit for CERAMILL was 83 µm and for CEREC -In Lab MC XL was 68 µm (P < 0.05). CONCLUSION: The marginal adaptation of CEREC -In Lab MC XL (68 µm) was found to be superior to CERAMILL (83 µm) (P < 0.05). Both the CEREC -In Lab MC XL and CERAMILL copings demonstrated internal adaptation and marginal fit within acceptable discrepancy range. When corroborating both the internal adaptation and marginal fit, CEREC -In Lab MC XL was found to be better than CERAMILL.

Interventions for replacing missing teeth: Antibiotics in dental implant placement to prevent complications: Evidence summary of Cochrane review.

The failure of dental implant can occurs at the preoperative planning stage, at the surgical stage, and at the postoperative stage. The success of this treatment can be increased if the clinical implant practice guidelines are prepared based on the recommendations from the highest level of research evidence (i.e.,) from systematic review of randomized controlled trials (RCTs) with meta-analysis. The Cochrane reviews of interventions are basically systematic reviews of RCTs with meta-analysis but follow a systematic methodological approach following the guidelines from Cochrane handbook for Systematic Reviews of Intervention. They give the current best evidence as they are updated every 2 years which is being the minimum period for an update. This evidence summary recommends the use of antibiotics, single dose of 2 g of amoxicillin 1 h prior to implant surgery to prevent implant failure, based on the body of evidence from the Cochrane review that was first published in 2003, 2008, and then updated twice in 2010 and 2013. The included studies are not from our population for the research question asked in this updated Cochrane review; hence, the need to do primary research in our population to support the available evidence is mandatory.

Intervention for replacing missing teeth: Alveolar ridge preservation techniques for dental implant site development - evidence summary of Cochrane review.

The Cochrane reviews have transparent reporting of the methodology to clarify the reader the methods used for writing the review; hence, each review becomes a large volume of scientific literature. This evidence summary of the Cochrane review published in 2015 for the question, what are the clinical effects (preservation of both width and height of bone, esthetic outcomes, complications, and failure of implant) for different alveolar ridge preservation techniques (ARP) and materials used in patients planning implant placement following extraction after 6 months follow-up. This review provides evidence for efficacy of different ARP techniques, materials, and superiority of one over the other. It also tries to settle the controversy of timing of placement of implant after grafting. Of the 8 included studies from 50, two trials provide moderate evidence for xenografts versus extraction favoring xenografts in preserving the width and height of bone by 1.97 mm (2.48-1.46) and 2.60 mm (3.43-1.76), respectively in pooled estimates of meta-analysis. Using different material, five-trial were found; of which, two trials provide moderate evidence for alloplast versus xenografts favoring alloplast in preserving the width by 0.44 mm (0.90-0.02) and low-grade evidence for height of bone by 0.35 mm (0.86-0.16) in pooled estimates of meta-analysis. There is a paucity of randomized controlled trial to address other primary and secondary outcomes addressed in this review.