Minimally Invasive Common Bile Duct Stone Management in Gastric Bypass Patients: Laparoscopic Common Bile Duct Exploration with Disposable Bronchoscope.

BACKGROUND: Bariatric surgery patients may develop common bile duct stones, and the alterations in their anatomy present challenges in treating this condition. Methods such as laparoscopic bile duct exploration is impractical in many healthcare facilities, due to the absence of a choledochoscope. This study assesses the feasibility of laparoscopic exploration of the common bile duct using a disposable bronchoscope in these individuals. METHOD: The study involved 32 participants who had undergone gastric bypass surgery. These participants presented with both bile duct stones and bile ducts exceeding 8 mm in diameter, diagnosed through either MRCP or cholangiography conducted during the surgery. Stone extraction was carried out through either choledotomy or transcystic routes using a disposable bronchoscope and endoscopic baskets. RESULTS: The patients' ages ranged from 27 to 66 years, with a mean bile duct diameter of 11.6 mm (SD 3.1 mm). A 100% stone clearance rate was achieved for all patients. None of the patients required conversion to open surgery. No T-tubes were placed. One patient developed biloma and intra-abdominal abscesses, which were successfully treated with a percutaneous drain over the course of a week. No mortalities were recorded during the course of this study. CONCLUSION: Our study results demonstrate that laparoscopic bile duct exploration is both feasible and safe in patients who have undergone gastric bypass surgery. The utilization of a disposable bronchoscope emerges as a practical and cost-effective alternative to a choledochoscope in this procedure.

Incidence of Electrolyte Imbalances Following Traumatic Rhabdomyolysis: A Systematic Review and Meta-Analysis.

Rhabdomyolysis, a medical condition caused by the destruction of striated muscle fibers, can have many etiologies, with the most common one being traumatic etiologies, that is, crushing injuries, heavy exertion, and being trapped under rubbles, and so forth. Rhabdomyolysis causes many complications, including acute kidney injury and different electrolyte imbalances, which later can cause cardiac dysrhythmia and even death as a result. This systematic review and meta-analysis investigate the incidence of imbalances of four important electrolytes among patients diagnosed with traumatic rhabdomyolysis. PubMed, Scopus, Web of Science, and Embase databases were searched for any article related to traumatic rhabdomyolysis using keywords related to the topic of our study, excluding case studies and case series. Relevant data were extracted from the included articles, and finally, a meta-analysis was performed on them to calculate the pooled incidence of each electrolyte imbalance. Collectively, 32 articles were included in our study (through the database and citation checking). The following were the pooled incidence of each electrolyte imbalance: hyperkalemia, 31% (95%CI 22%-41%); hypokalemia, 10% (95%CI 4%-17%); hypernatremia, 3% (95%CI 0%-8%); hyponatremia, 23% (95%CI 7%-44%); hypercalcemia, 0% (95%CI 0%-1%); hypocalcemia, 57% (95%CI: 22%-88%); hyperphosphatemia, 33% (95%CI 11%-59%); hypophosphatemia, 4% (95%CI 0%-16%). According to the meta-analyses, the rate of hyperkalemia, hyponatremia, hypocalcemia, and hyperphosphatemia is higher than their counterpart in patients diagnosed with traumatic rhabdomyolysis.

SSTE: Syllable-Specific Temporal Encoding to FORCE-learn audio sequences with an associative memory approach.

The circuitry and pathways in the brains of humans and other species have long inspired researchers and system designers to develop accurate and efficient systems capable of solving real-world problems and responding in real-time. We propose the Syllable-Specific Temporal Encoding (SSTE) to learn vocal sequences in a reservoir of Izhikevich neurons, by forming associations between exclusive input activities and their corresponding syllables in the sequence. Our model converts the audio signals to cochleograms using the CAR-FAC model to simulate a brain-like auditory learning and memorization process. The reservoir is trained using a hardware-friendly approach to FORCE learning. Reservoir computing could yield associative memory dynamics with far less computational complexity compared to RNNs. The SSTE-based learning enables competent accuracy and stable recall of spatiotemporal sequences with fewer reservoir inputs compared with existing encodings in the literature for similar purpose, offering resource savings. The encoding points to syllable onsets and allows recalling from a desired point in the sequence, making it particularly suitable for recalling subsets of long vocal sequences. The SSTE demonstrates the capability of learning new signals without forgetting previously memorized sequences and displays robustness against occasional noise, a characteristic of real-world scenarios. The components of this model are configured to improve resource consumption and computational intensity, addressing some of the cost-efficiency issues that might arise in future implementations aiming for compactness and real-time, low-power operation. Overall, this model proposes a brain-inspired pattern generation network for vocal sequences that can be extended with other bio-inspired computations to explore their potentials for brain-like auditory perception. Future designs could inspire from this model to implement embedded devices that learn vocal sequences and recall them as needed in real-time. Such systems could acquire language and speech, operate as artificial assistants, and transcribe text to speech, in the presence of natural noise and corruption on audio data.

The design of an Obstetric Telephone Triage Guideline (OTTG): a mixed method study.

BACKGROUND: Clarifying the dimensions and characteristics of obstetric telephone triage is important in improving the quality of services in the health system because researchers can evaluate the effectiveness of treatment, care and diagnostic measures in the form of obstetric telephone triage by developing a guideline. Therefore, this study aimed to design an Obstetric Telephone Triage Guideline (OTTG) using a mixed-method study. METHODS: The present study was carried out using an exploratory sequential mixed method study in two qualitative and quantitative phases. An inductive-deductive approach was also used to determine the concept of obstetric telephone triage. In this respect, a qualitative study and a literature review were used in the inductive and deductive stages, respectively. Moreover, the validity of the developed guideline was confirmed based on experts' opinions and results of the AGREE II tool. RESULTS: The guideline included the items for evaluating the severity of obstetric symptoms at five levels including "critical", "urgent", "less urgent", "no urgent", and "recommendations". The validity of the guideline was approved at 96%, 95%, 97%, 95%, 93%, and 100% for six dimensions of AGREE II including scope and purpose, stakeholder involvement, the rigor of development, clarity of presentation, applicability, and editorial independence, respectively. CONCLUSION: The OTTG is a clinically comprehensive, easy-to-use, practical, and valid tool. This guideline is a standardized tool for evaluating the severity of symptoms and determining the urgency for obstetrics triage services. By using this integrated and uniform guideline, personal biases can be avoided, leading to improved performance and ensuring that patients are not overlooked. Additionally, the use of OTTG promotes independent decision-making and reduces errors in triage decision-making.

Prevalence and Predictive Factors of Rhabdomyolysis in COVID-19 Patients: A Cross-sectional Study.

Introduction: The aim of the present prospective observational study was to demonstrate the prevalence and predictive factors of rhabdomyolysis in coronavirus disease 2019 (COVID-19) patients. Methods: The study was performed on reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients admitted to the emergency department between March 2020 and March 2021. Peak creatinine phosphokinase (CPK) levels were used to define rhabdomyolysis. A CPK level equal to or more than 1000 IU/L was defined as the presence of moderate to severe rhabdomyolysis. We developed a COVID-19-related Rhabdomyolysis Prognostic rule (CORP rule) using the independent predictors of rhabdomyolysis in COVID-19 patients. Results: Five hundred and six confirmed COVID-19 patients (mean age 58.36 ± 17.83 years, 56.32% male) were studied. Rhabdomyolysis occurred in 44 (8.69%) cases throughout their hospitalization. Male gender (odds ratio [OR] = 2.78, 95% confidence interval [CI]: 1.28, 6.00), hyponatremia (OR = 2.46, 95% CI: 1.08, 5.59), myalgia (OR = 3.04, 95% CI: 1.41, 6.61), D-dimer >1000 (OR = 2.84, 95% CI: 1.27, 6.37), and elevated aspartate aminotransferase level (three times higher than normal range) (OR = 3.14, 95% CI: 1.52, 6.47) were the significant preliminary predictors of rhabdomyolysis. The area under the curve of the CORP rule was 0.75 (95% CI: 0.69, 0.81), indicating the fair performance of it in the prognosis of rhabdomyolysis following COVID-19 infection. The best cutoff of the CORP rule was 3, which had a sensitivity of 72.9% and a specificity of 72.7%. Conclusion: This prospective study showed that 8.69% of patients developed rhabdomyolysis following COVID-19 infection. The CORP rule with optimal cutoff can correctly classify 72.8% of COVID-19 patients at risk of developing rhabdomyolysis.

The effect of significant weight loss after bariatric surgery on echocardiographic indices: an observational study focusing on left ventricular deformation by 2D speckle echocardiography and right ventricular size.

BACKGROUND: Obesity is a known risk factor for atherosclerosis and cardiac disease. HYPOTHESIS: This study evaluated the effect of significant weight loss following bariatric surgery on myocardial deformation indices and right ventricular size (RV). This was a prospective cohort study. Morbid obese patients scheduled for bariatric surgery from July 2017 to February 2018 at Firoozgar Hospital were included in our study and referred for transthoracic echocardiography at Rajaie Cardiovascular Medical and Research Center. RESULTS: Thirty-four patients entered the study. The absolute value of global longitudinal strain (GLS) at baseline, 3, and 6 months after surgery was 17.42 ± 2.94%, 18.24 ± 3.09%, and 19.52 ± 2.78%, respectively, with a statistically significant difference from baseline to after six months (P value < 0.001). The absolute value of global circumferential strain (GCS) at baseline, 3, and 6 months after surgery was 20.14 ± 4.22%, 23.32 ± 4.66%, and 24.53 ± 4.52%, respectively, with statistically significant changes (P value < 0.001) from baseline to three months and from baseline to six months and no significant difference from three months to six months. A significant decrease was reported in mechanical dispersion of circumferential strain (38.05 ± 23.81-23.37 ± 20.86 ms, P value = 0.006) 6 months after surgery. Right ventricular size three- and six-month post-surgery showed a significant decrease relative to baseline echocardiography. CONCLUSIONS: Bariatric surgery could enhance cardiac function, as proven by 2D speckle echocardiography. Changes in RV size may be related to weight loss and should be considered when assessing patients who have undergone bariatric surgery.

Effect of Postoperative Kinesio Taping on Knee Edema, Pain, and Range of Motion After Total Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Clinical Trials.

BACKGROUND: Kinesio taping (KT) has been shown to be clinically effective in a wide range of musculoskeletal disorders. Despite evidence supporting KT, there still needs to be more certainty regarding its clinical worthiness in managing postoperative conditions. This study aims to assess the effect of postoperative KT on knee edema, pain, and range of motion (ROM) when added to routine physiotherapy after knee surgery. METHODS: In this systematic review and meta-analysis, MEDLINE, Embase, Scopus, Web of Science, and CENTRAL databases were searched from their inception to July 2023. Randomized controlled trials (RCTs) comparing routine physiotherapy with and without KT were included. Random-effect models were used to calculate the standardized mean difference (SMD), confidence interval, and heterogeneity (I2). RESULTS: Sixteen RCTs on 842 operated knees were included. KT reduced knee edema in first week (SMD, -0.59, p < 0.001), 14th postoperative day (POD) (SMD, -0.78, p < 0.001), and 28 to 42 days postop (SMD, -0.66, p < 0.001). The KT demonstrated significant pain improvement in second week (SMD, -0.87, p < 0.001) and the fourth week (SMD, -0.53, p < 0.001). The KT groups demonstrated ROM improvement within second week (SMD, 0.69, p = 0.010) and in the 28th POD (SMD, 0.89, p = 0.009). Subgroup analysis demonstrated minimal heterogeneity in anterior cruciate ligament reconstruction (ACLR) cases. However, it did not show significant superiority regarding ankle, calf, or thigh edema and Lysholm scale. CONCLUSION: This study suggests that adding KT to routine postoperative physiotherapy reduces pain and knee edema after total knee arthroplasty or ACLR. Low to very low certainty of evidence for all outcomes and the limited number of studies emphasize the need for more high-quality primary studies to explore the optimal method of KT application and its effectiveness in specific knee surgeries. LEVEL OF EVIDENCE: Level I. See Instructions for Authors for a complete description of levels of evidence.

Uric acid in predicting the traumatic rhabdomyolysis induced acute kidney injury; a systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review and meta-analysis was to assess the value of uric acid in predicting acute kidney injury caused by traumatic rhabdomyolysis. METHODS: The search was conducted in MEDLINE, Scopus, Embase and Web of Science until November 1, 2023. Based on the inclusion and exclusion criteria, the articles were included by two independent researchers. Data regarding study design, patient characteristics, number of patients with and without AKI, mean and SD of uric acid and prognostic characteristics of uric acid were extracted from relevant studies. STATA version 17.0 was used to compute pooled measures of standardized mean differences, odds ratios, and diagnostic accuracy. I2 and chi-square tests were used to assess heterogeneity between studies. RESULTS: We found 689 non-redundant studies, 44 of them were potentially relevant. Six articles met the inclusion criteria and were included in the review. The results of the meta-analysis confirmed that there was a significant correlation between serum uric acid levels and the occurrence of AKI (SMD = 1.61, 95% CI = 0.69 to 2.54, I2 = 96.94%; p value = 0.001). There were no significant publication biases. CONCLUSION: According to this meta-analysis, uric acid levels could be considered as a predictor of acute kidney injury following traumatic rhabdomyolysis.

Comparison of the Onset of Action, Maintenance, and Recovery of Three Weight-based Dosing of Cisatracurium in Patients with Morbid Obesity in Laparoscopic Bariatric Surgery: A Randomized Clinical Trial.

Background: For patients with morbid obesity, different cisatracurium dosage regimens are recommended. This study aimed to compare the onset of action, the sufficiency of neuromuscular blockade during infusion, and the recovery of the three distinct cisatracurium dosage scalars in patients with morbid obesity undergoing laparoscopic bariatric surgery. Methods: In this randomized clinical trial, 55 patients were scheduled for bariatric surgery at Firoozgar Hospital from March 2020 to August 2021. Using a block randomization method, they were randomly divided into three groups, based on total body weight (TBW group), fat-free mass (FFM group), or ideal body weight (IBW group), to receive a bolus of cisatracurium 0.2 mg/Kg, followed by an infusion of 2 µg/Kg, to maintain a train-of-four (TOF) count≤2. Data were analyzed using SPSS software. P<0.05 was considered statistically significant. Results: The mean time (seconds) to reach TOF0 in the TBW group was significantly shorter (201.89, 95%CI=192.99-210.79; P=0.004) than the IBW group (233.53, 95%CI=218.71-248.34; P=0.01). However, this difference was not statistically significant between TBW and FFM groups (220.83, 95%CI=199.73-241.94; P=0.81) or between FFM and the IBW groups (P=0.23). The rescue dose and increments of cisatracurium infusion were not required in the TBW group, whereas their probability was 4.81 times higher in the IBW group than the FFM group. Furthermore, the TBW and FFM groups had higher mean surgical condition scores than the IBW group (P<0.001, and P=0.006, respectively). Conclusion: Cisatracurium loading and infusion dosing based on FFM provide a comparable onset of action and surgical field condition to the TBW-based dosing with a shorter recovery time. However, IBW-based dosing of cisatracurium was insufficient for laparoscopic bariatric surgery.Trial Registration Number: IRCT20151107024909N9.A preprint of this study was published at . doi: .

Clinical decision rules in predicting computed tomography scan findings and need for neurosurgical intervention in mild traumatic brain injury: a prospective observational study.

PURPOSE: In this study, we will compare the diagnostic values of head CT decision rules in predicting the findings of CT scans in a prospective multicenter study in university emergency departments in Iran. METHODS: The primary outcome was any traumatic lesion findings in brain CT scans, and the secondary outcomes were death, the need for mechanical ventilation, and neurosurgical intervention. Decision rules including the Canadian CT Head Rule (CCHR), New Orleans Criteria (NOC), National Institute for Health and Clinical Excellence (NICE), National Emergency X-Radiography Utilization Study (NEXUS), and Neurotraumatology Committee of the World Federation of Neurosurgical Societies (NCWFNS) were compared for the main outcomes. RESULTS: In total, 434 mild TBI patients were enrolled in the study. The NCWFNS had the highest sensitivity (91.14%) and the lowest specificity (39.42%) for predicting abnormal finding in CT scan compared to other models. While the NICE obtained the lowest sensitivity (79.75%), it was associated with the highest specificity (66.67%). All model performances were improved when administered to predict neurosurgical intervention among patients with GCS 13-15. NEXUS (AUC 0.862, 95% CI 0.799-0.924) and NCWFNS (AUC 0.813, 95% CI 0.723-0.903) had the best performance among all evaluated models. CONCLUSION: The NCWFNS and the NEXUS decision rules performed better than the CCHR and NICE guidelines for predicting any lesion in the CT imaging and neurosurgical intervention among patients with mTBI with GCS 13-15. For a subset of mTBI patients with GCS 15, the NOC criteria have higher sensitivity for abnormal CT imaging, but lower specificity and more requested CTs.

Muscimol as a treatment for nerve injury-related neuropathic pain: a systematic review and meta-analysis of preclinical studies.

Background: : Muscimol's quick onset and GABAergic properties make it a promising candidate for the treatment of pain. This systematic review and meta-analysis of preclinical studies aimed at summarizing the evidence regarding the efficacy of muscimol administration in the amelioration of nerve injury-related neuropathic pain. Methods: : Two independent researchers performed the screening process in Medline, Embase, Scopus and Web of Science extracting data were extracted into a checklist designed according to the PRISMA guideline. A standardized mean difference (SMD [95% confidence interval]) was calculated for each. To assess the heterogeneity between studies, I2 and chi-square tests were utilized. In the case of heterogeneity, meta-regression and subgroup analyses were performed to identify the potential source. Results: : Twenty-two articles met the inclusion criteria. Pooled data analysis showed that the administration of muscimol during the peak effect causes a significant reduction in mechanical allodynia (SMD = 1.78 [1.45-2.11]; P < 0.0001; I2 = 72.70%), mechanical hyperalgesia (SMD = 1.62 [1.28-1.96]; P < 0.0001; I2 = 40.66%), and thermal hyperalgesia (SMD = 2.59 [1.79-3.39]; P < 0.0001; I2 = 80.33%). This significant amendment of pain was observed at a declining rate from 15 minutes to at least 180 minutes post-treatment in mechanical allodynia and mechanical hyperalgesia, and up to 30 minutes in thermal hyperalgesia (P < 0 .0001). Conclusions: : Muscimol is effective in the amelioration of mechanical allodynia, mechanical hyperalgesia, and thermal hyperalgesia, exerting its analgesic effects 15 minutes after administration for up to at least 3 hours.

Prevalence of Compartment Syndrome and Disseminated Intravascular Coagulation following Rhabdomyolysis; a Systematic Review and Meta-Analysis.

Abstract. Introduction: Rhabdomyolysis (RM) may cause some complications such as compartment syndrome and disseminated intravascular coagulation (DIC), which can affect its prognosis. This systematic review and meta-analysis aimed to investigate the prevalence of the mentioned complications following RM. Methods: Medline, Embase, and Scopus databases were searched using keywords related to compartment syndrome, DIC, and rhabdomyolysis with appropriate combination. Cohort and cross-sectional studies that conducted research on the prevalence of compartment syndrome and DIC in patients with RM were included in the present study. The desired data were extracted from the included studies and meta-analysis was conducted on them to calculate pooled prevalence of these complications. Results: Twenty articles were included in our systematic review. The rate of compartment syndrome reported in these studies ranged from 0 to 30.7%. Our meta-analysis revealed the pooled prevalence of 4% (95% confidence interval (CI): 2.20 to 7.40) for compartment syndrome in these studies. The pooled prevalence of this complication was 7.1% (95% CI: 2.90 to 16.00) among patients with severe RM and 4.4% (95% CI: 1.80 to 10.00) in traumatic RM. The rate of DIC reported in the included studies ranged from 0 to 40.47%. Our meta-analysis showed the pooled prevalence of 8.3% (95% CI: 03.90 to 16.50) for this complication among RM patients. Conclusion: We reported the rates of compartment syndrome and DIC in RM patients based on rhabdomyolysis etiologies through an epidemiologic systematic review and meta-analysis. The rate of compartment syndrome was slightly higher in patients with severe RM and its rate in patients with traumatic RM was close to the overall rate of compartment syndrome.

Impact of Obesity and Bariatric Surgery on Metabolic Enzymes and P-Glycoprotein Activity Using the Geneva Cocktail Approach.

The inter-individual variability of CYP450s enzyme activity may be reduced by comparing the effects of bariatric surgery on CYP-mediated drug elimination in comparable patients before and after surgery. The current research will use a low-dose phenotyping cocktail to simultaneously evaluate the activities of six CYP isoforms and P-gp. The results showed that following weight reduction after surgery, the activity of all enzymes increased compared to the obese period, which was statistically significant in the case of CYP3A, CYP2B6, CYP2C9, and CYP1A2. Furthermore, the activity of P-gp after surgery decreased without reaching a statistical significance (p-value > 0.05). Obese individuals had decreased CYP3A and CYP2D6 activity compared with the control group, although only CYP3A was statistically important. In addition, there was a trend toward increased activity for CYP1A2, CYP2B6, CYP2C9, and CYP2C19 in obese patients compared to the control group, without reaching statistical insignificance (p-value ≥ 0.05). After six months (at least), all enzymes and the P-gp pump activity were significantly higher than the control group except for CYP2D6. Ultimately, a greater comprehension of phenoconversion can aid in altering the patient's treatment. Further studies are required to confirm the changes in the metabolic ratios of probes after bariatric surgery to demonstrate the findings' clinical application. As a result, the effects of inflammation-induced phenoconversion on medication metabolism may differ greatly across persons and drug CYP pathways. It is essential to apply these results to the clinic to recommend dose adjustments.

Frequency of posttrauma complications during hospital admission and their association with Injury Severity Score.

OBJECTIVE: Multiple trauma is associated with a remarkable risk of in-hospital complications, which harm healthcare services and patients. This study aimed to assess the incidence of posttrauma complications, their relationship with poor outcomes, and the effect of the Injury Severity Score (ISS) on their occurrence. METHODS: This retrospective cohort study was conducted at a pair of trauma centers, between January 2020 and December 2022. All hospitalized adult patients with multiple trauma were included in this study. Multivariable logistic regression was used to identify factors related to posttrauma complications. RESULTS: Among 727 multiple trauma patients, 90 (12.4%) developed in-hospital complications. The most frequent complications were pneumonia (4.8%), atelectasis (3.7%), and superficial surgical site infection (2.5%). According to multivariable logistic regression, ISS, the length of stay in the intensive care unit (ICU), the length of stay in the hospital, and mortality were significantly associated with complications. The complication rate increased by 17% with every single-unit increase in ISS (adjusted odds ratio [OR], 1.17; 95% confidence interval [CI], 1.00-1.38). Per every 1-day increase in the ICU or hospital stay, the complication rate increased by 65% (adjusted OR, 1.65; 95% CI, 1.00-2.73) and 20% (adjusted OR, 1.20; 95% CI, 1.03-1.41), respectively. Posttrauma complications were also significantly more common in patients with mortality (adjusted OR, 163.30; 95% CI, 3.04-8,779.32). In multiple trauma patients with a higher ISS, the frequency, severity, and number of complications were significantly increased. CONCLUSION: In-hospital complications in multiple trauma patients are frequent and associated with poor outcomes and mortality. ISS is an important factor associated with posttrauma complications.

Prevalence of Hypertension among Children Based on the New American Academy of Pediatrics Clinical Practice Guidelines.

Background: In 2017, the American Academy of Pediatrics (AAP) updated clinical practice guidelines for the diagnosis and management of hypertension in children. The present study aimed to assess the prevalence of hypertension in Iranian children based on the latest guidelines. Methods: Data on 7301 student participants (3589 boys and 3712 girls) aged between 7-12 yr were assessed. The data were extracted from the fifth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN V) school-based study conducted in the 30 provinces of Iran in 2015. Blood pressure (BP) was classified as normal, elevated BP, and stage 1 and 2 hypertension using weighted analysis and the 2017 AAP guidelines. All analyses were performed in STATA 14.0 statistical software, with findings presented in terms of prevalence. Results: The overall prevalence of high BP in Iranian children was 14.7%. In addition, 15.1% of boys had high BP, with 9.4% and 1.7% of them with stage 1 and 2 hypertension, respectively. Moreover, 14.3% of girls had high BP, of which 10% had stage 1 and 1.3% with stage 2 hypertension. For elevated hypertension, it was observed in 4% of boys and 3% of girls. Conclusion: Using the 2017 AAP guidelines demonstrated a higher prevalence of hypertension in children (14.7%) in Iran. The prevalence of hypertension in boys was slightly higher compared to girls.

Value of NEXUS chest rules in assessment of traumatic chest injuries; a systematic review and a meta-analysis.

BACKGROUND: Although many studies have evaluated the diagnostic value of the National Emergency X-ray Utilization Studies (NEXUS) chest rules in assessment of traumatic chest injuries, there still is no consensus on this subject matter. Therefore, this systematic review and meta-analysis aims to review the current existing literature in order to evaluate the diagnostic value of NEXUS chest rules for assessment of traumatic chest injuries. METHOD: Databases of Medline, Embase, Scopus and Web of Science were searched until August 20th, 2022. Two independent reviewers screened the articles related to the diagnostic value of NEXUS chest radiography, NEXUS chest CT-all and NEXUS chest-Major. RESULTS: Data of 6 studies, on 23,741 patients, were included in this review. Since only one article assessed the value of NEXUS chest CT scan, the meta-analysis was performed only on NEXUS chest radiography rule. Pooled analysis on the results of 5 articles showed that the AUC of NEXUS chest radiography rule in assessment of traumatic chest injuries was 0.98 (95% CI: 0.96 to 0.99), with a sensitivity and specificity of 0.99 (95% CI: 0.98 to 0.99) and 0.32 (95% CI: 0.17 to 0.52), respectively. Positive and negative likelihood ratio of NEXUS chest radiography rule were 1.46 (95% CI: 1.12 to 1.90) and 0.04 (95% CI: 0.03 to 0.06). Overall diagnostic odds ratio was calculated to be 36.67 (95% CI: 19.17 to 70.16). CONCLUSION: Our findings indicate that NEXUS chest radiography rule is a sensitive decision rule for assessment of traumatic chest injuries, but its specificity was found to be low. However, few articles have investigated the diagnostic value of NEXUS chest rules, especially the NEXUS chest CT scan, and more studies need to be done in order to strengthen the currently provided results.

Compression of Deep Neural Networks based on quantized tensor decomposition to implement on reconfigurable hardware platforms.

Deep Neural Networks (DNNs) have been vastly and successfully employed in various artificial intelligence and machine learning applications (e.g., image processing and natural language processing). As DNNs become deeper and enclose more filters per layer, they incur high computational costs and large memory consumption to preserve their large number of parameters. Moreover, present processing platforms (e.g., CPU, GPU, and FPGA) have not enough internal memory, and hence external memory storage is needed. Hence deploying DNNs on mobile applications is difficult, considering the limited storage space, computation power, energy supply, and real-time processing requirements. In this work, using a method based on tensor decomposition, network parameters were compressed, thereby reducing access to external memory. This compression method decomposes the network layers' weight tensor into a limited number of principal vectors such that (i) almost all the initial parameters can be retrieved, (ii) the network structure did not change, and (iii) the network quality after reproducing the parameters was almost similar to the original network in terms of detection accuracy. To optimize the realization of this method on FPGA, the tensor decomposition algorithm was modified while its convergence was not affected, and the reproduction of network parameters on FPGA was straightforward. The proposed algorithm reduced the parameters of ResNet50, VGG16, and VGG19 networks trained with Cifar10 and Cifar100 by almost 10 times.

Assessing the value of serum and urinary interleukins for diagnosis of acute kidney injury in children and adolescents: A systematic review and meta-analysis.

INTRODUCTION: Several studies have questioned the diagnostic utility of interleukins (IL) in detecting acute kidney injury (AKI) in pediatric population. Therefore, the present systematic review and meta-analysis aims to assess the diagnostic value of ILs in pediatric AKI patients. METHOD: Two independent researchers screened records acquired through searching in Medline, Embase, Scopus, and Web of Science, until the end of 2020. Articles evaluating serum and urinary levels of ILs in AKI patients were included in this study. Data were extracted and analyzed using STATA software. RESULTS: Twenty-one studies were included. Analyses showed that AUC, sensitivity, specificity and diagnostic odds ratio of urinary IL-18 for diagnosing AKI were 0.77 (95% CI: 0.74, 0.81), 0.64 (95% CI: 0.32, 0.87), 0.75 (95% CI: 0.62, 0.85) and 6 (95% CI: 1, 23), respectively. Those values were 0.79 (95% CI: 0.75, 0.83), 0.58 (95% CI: 0.37, 0.76), 0.87 (95% CI: 0.66, 0.96), and 9 (95% CI: 4, 20) for serum IL-6, and 0.72 (95% CI: 0.68, 0.76), 0.53 (95% CI: 0.34, 0.72), 0.79 (95% CI: 0.60, 0.91) and 4 (95% CI: 2, 8) for serum IL-8, respectively. Urinary levels of ILs 6, 8 and 10 were not significantly different between AKI patients and the non-AKI control group. Serum levels of ILs 10 and 18 were not adequately evaluated in the studies. CONCLUSION: IL-18 urinary levels and IL-6 and IL-8 serum levels are significantly higher in AKI patients compared to the non-AKI group. However, their low sensitivity and specificity in detecting AKI questions their diagnostic value.

Contrast-enhanced voiding urosonography, a possible candidate for the diagnosis of vesicoureteral reflux in children and adolescents; a systematic review and meta-analysis.

INTRODUCTION: The diagnostic value of contrast-enhanced voiding urosonography (ceVUS) in the diagnosis of vesicoureteral reflux (VUR) is still a subject of dispute. OBJECTIVE: Assessing the diagnostic value of ceVUS in VUR, performing a systematic review and meta-analysis. METHODS: An extensive search on Medline, Embase, Scopus and Web of Science databases was conducted by the end of 2020. The inclusion criteria were studies on the diagnostic value of ceVUS for VUR. Two independent researchers summarized the included articles and the findings were reported as area under the curve (AUC), sensitivity and specificity with a 95% confidence interval (95% CI). RESULTS: Finally, the data of 36 articles were included in the present meta-analysis (2768 children). The VUS assessment showed that 1297 of the cases were true positives, 3661 were true negatives, 398 were false positives and 169 were false negatives. The AUC, sensitivity and specificity of ceVUS with the first-generation contrast agent in the diagnosis of VUR in children and adolescents were obtained as 0.97 (95% CI: 0.95, 0.98), 0.92 (95% CI: 0.86, 0.96) and 0.94 (95% CI: 0.95, 0.98), respectively. Moreover, AUC, sensitivity and specificity of ceVUS with the second-generation contrast agent were 0.97 (95% CI: 0.95, 0.98), 0.93 (95% CI: 0.86, 0.97) and 0.91 (95% CI: 0.86, 0.95). CONCLUSION: The findings of the present study showed that diagnostic value of ceVUS with both first-generation and second-generation contrast agents for VUR, is in an excellent range. Although it seems that ceVUS may be applied as a radiation-free alternative to imaging techniques such as VCUG, the presence of 3% of false negatives in this test is a limitation. Since the lack of punctual management of VUR is associated with serious renal complications in children, future studies are recommended to be focused on the evaluation of the Benefit-risk evaluation of ceVUS.