Expert opinion on screening, diagnosis and management of diabetic peripheral neuropathy: a multidisciplinary approach.

The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed "screening and diagnostic" algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN.

[Cancer genomic panels for lymphoid malignancies].

Cancer precision medicine (genome-based individualized treatment for cancer patients) has already been introduced for solid tumors, and involves identifying driver genes in the development and progression of tumors and suggesting optimal treatments targeting those genes. So far, many patients have received this style of treatment. Meanwhile, preparations for cancer genomic medicine based on cancer gene panel testing are also underway for hematopoietic tumors. In this article, I would like to share fundamental information about the main genetic mutations in malignant lymphomas and their clinical significance, and discuss how this information should be utilized in cancer genomic medicine in the future.

Research priorities on microplastics in marine and coastal environments: An Australian perspective to advance global action.

Plastic and microplastic contamination in the environment receive global attention, with calls for the synthesis of scientific evidence to inform actionable strategies and policy-relevant practices. We provide a systematic literature review on microplastic research across Australian coastal environments in water, sediment and biota, highlighting the main research foci and gaps in information. At the same time, we conducted surveys and workshops to gather expert opinions from multiple stakeholders (including researchers, industry, and government) to identify critical research directions to meet stakeholder needs across sectors. Through this consultation and engagement process, we created a platform for knowledge exchange and identified three major priorities to support evidence-based policy, regulation, and management. These include a need for (i) method harmonisation in microplastic assessments, (ii) information on the presence, sources, and pathways of plastic pollution, and (iii) advancing our understanding of the risk of harm to individuals and ecosystems.

[The expert panel for Script Concordance Tests: A truly adequate reference?] / Le panel d'experts pour les tests de concordance de script : une référence réellement adéquate ?

The Script Concordance Tests (SCTs) are an examination modality introduced by decree in the French National Ranking Exam for medical students in 2024. Their objective is to evaluate clinical reasoning in situations of uncertainty. In practice, SCTs assess the impact of new information on the probability of a hypothesis formulated a priori based on an authentic clinical scenario. This approach resembles probabilistic (or Bayesian) reasoning. Due to the uncertainty associated with the explored clinical situation, SCTs do not compare the student's response to an expected one in a theoretical knowledge reference. Instead, the distribution of responses from a panel of experienced physicians is used to establish the question's scoring scale. Literature data suggest that physicians, even experienced ones, like most humans, often exhibit biased intuitive probabilistic reasoning. These biases raise questions about the relevance of using expert panel responses as scoring scales for SCTs.

Efficient musculoskeletal annotation using free-form deformation.

Traditionally, constructing training datasets for automatic muscle segmentation from medical images involved skilled operators, leading to high labor costs and limited scalability. To address this issue, we developed a tool that enables efficient annotation by non-experts and assessed its effectiveness for training an automatic segmentation network. Our system allows users to deform a template three-dimensional (3D) anatomical model to fit a target magnetic-resonance image using free-form deformation with independent control points for axial, sagittal, and coronal directions. This method simplifies the annotation process by allowing non-experts to intuitively adjust the model, enabling simultaneous annotation of all muscles in the template. We evaluated the quality of the tool-assisted segmentation performed by non-experts, which achieved a Dice coefficient greater than 0.75 compared to expert segmentation, without significant errors such as mislabeling adjacent muscles or omitting musculature. An automatic segmentation network trained with datasets created using this tool demonstrated performance comparable to or superior to that of networks trained with expert-generated datasets. This innovative tool significantly reduces the time and labor costs associated with dataset creation for automatic muscle segmentation, potentially revolutionizing medical image annotation and accelerating the development of deep learning-based segmentation networks in various clinical applications.

Vulnerability assessment for physical protection systems of cave temples: A fuzzy petri net approach.

Preservation of cultural relics is crucial for cultural sustainability, particularly in the case of cave temples, which are a unique and immovable part of our heritage, nested within mountains. These structures bear immense historical significance and possess considerable economic value, making them vulnerable to criminal activities, notably theft. Establishing a robust physical protection system (PPS) is imperative to safeguard these relics from potential damage. This paper proposes a novel approach for assessing the vulnerability of cave temples' PPS. Based on the fuzzy Petri net (FPN) principle, a comprehensive vulnerability assessment index system was developed within the PPS framework, considering the unique characteristics of cave temples. This study refines the formal definition of the FPN, enhancing its precision and effectiveness for vulnerability assessment. The practicality and effectiveness of the proposed method are verified through simulation experiments. An illustrative example is provided to demonstrate this approach.

Emerging Innovations in Preoperative Planning and Motion Analysis in Orthopedic Surgery.

In recent years, preoperative planning has undergone significant advancements, with a dual focus: improving the accuracy of implant placement and enhancing the prediction of functional outcomes. These breakthroughs have been made possible through the development of advanced processing methods for 3D preoperative images. These methods not only offer novel visualization techniques but can also be seamlessly integrated into computer-aided design models. Additionally, the refinement of motion capture systems has played a pivotal role in this progress. These "markerless" systems are more straightforward to implement and facilitate easier data analysis. Simultaneously, the emergence of machine learning algorithms, utilizing artificial intelligence, has enabled the amalgamation of anatomical and functional data, leading to highly personalized preoperative plans for patients. The shift in preoperative planning from 2D towards 3D, from static to dynamic, is closely linked to technological advances, which will be described in this instructional review. Finally, the concept of 4D planning, encompassing periarticular soft tissues, will be introduced as a forward-looking development in the field of orthopedic surgery.

[Expert consensus on enteral nutrition management for preterm infants in special situations (2024)]. / ç‰¹æ®Šæƒ å†µçš„æ—©äº§å„¿è‚ å† è¥å »ç®¡ç†ä¸“å®¶å ±è¯†ï¼ˆ2024年）.

Establishing enteral nutrition after the birth of preterm infants presents numerous challenges, particularly for those in special situations. Various disease factors and medical interventions impede the establishment of enteral feeding, leading to conflicts and controversies regarding feeding goals, feeding methods, and the challenges and solutions faced by these infants. A critical issue for clinical physicians is how to safely and promptly establish enteral nutrition to achieve full enteral feeding as quickly as possible. The consensus formulation working group, based on both domestic and overseas research, adopted the Grading of Recommendations Assessment, Development and Evaluation, and formed an expert consensus on enteral nutrition management for preterm infants in special situations. This consensus provides 14 recommendations for 9 common special situations, aiming to offer guidance on enteral nutrition management for preterm infants to improve their short and long-term outcomes. Citation:Chinese Journal of Contemporary Pediatrics, 2024, 26(7): 665-676.

Neuroprotective efficiency of celecoxib vesicular bilosomes for the management of lipopolysaccharide-induced Alzheimer in mice employing 23 full factorial design.

The aim of this study was to develop and evaluate bilosomes loaded with Celecoxib (CXB) for the efficient treatment of Alzheimer. The thin-film hydration approach was utilized in the formulation of CXB bilosomes (CXB-BLs). The study used a 23-factorial design to investigate the impact of several formulation variables. Three separate parameters were investigated: bile salt type (X1), medication amount (X2), and lipid-bile salt ratio (X3). The dependent responses included entrapment efficiency (Y1: EE %), particle size (Y2: PS), and zeta potential (Y3: ZP). The formulation factors were statistically optimized using the Design-Expert® program. The vesicles demonstrated remarkable CXB encapsulation efficiency, ranging from 94.16 ± 1.91 to 98.38 ± 0.85%. The vesicle sizes ranged from 241.8 ± 6.74 to 352 ± 2.34 nm. The produced formulations have high negative zeta potential values, indicating strong stability. Transmission electron microscopy (TEM) revealed that the optimized vesicles had a spherical form. CXB release from BLs was biphasic, with the release pattern following Higuchi's model. In vivo studies confirmed the efficiency of CXB-BLs in management of lipopolysaccharide-induced Alzheimer as CXB-BLs ameliorated cognitive dysfunction, decreased acetylcholinesterase (AChE), and inhibited neuro-inflammation and neuro-degeneration through reducing Toll-like receptor (TLR4), and Interleukin-1ß (IL-1ß) levels. The findings suggested that the created CXB-BLs could be a potential drug delivery strategy for Alzheimer's treatment.

Exploring treatment decision-making in chronic myeloid leukemia in chronic phase.

The introduction of tyrosine kinase inhibitors (TKIs) has transformed the treatment of chronic myeloid leukemia (CML). Each approved TKI has its own risk-benefit profile, and patients have choices across lines of therapy. Identifying the initial and subsequent treatment that will lead to the best possible outcome for individual patients is challenging. In this review, we summarize data for each approved TKI across lines of therapy in patients with CML in chronic phase, highlighting elements of each agent's safety and efficacy profile that may impact patient selection, and provide insights into individualized treatment sequencing decision-making aimed at optimizing patient outcomes.

How often do fingerprint examiners disagree in routine casework?

During routine casework, fingerprint examiners are required to make decisions pertaining to the sufficiency of friction ridge skin impressions. Prior experimental research has established that differences of opinion between examiners are expected, though it is uncertain if these findings are representative of the decisions made during casework. In this study, 5000 job-cards completed by fingerprint experts of the NSW Police Force were scrutinised to track the differences of opinion that occurred between examiners. Experts recorded 19,491 casework decisions, which resulted in 8964 reported identification and inconclusive determinations. Expert decision making was found to be unanimous in 94.8 % of these determinations; 4.6 % involved one expert-to-expert disagreement; and 0.5 % involved two expert-to-expert disagreements. Nil determinations featured more than two expert-to-expert disagreements. Expert-to-expert disagreements occurred in 3.7 % of all identification and inconclusive casework verification decisions. However, verifying experts were more likely to agree with a prior expert's identification decision, than a prior expert's inconclusive decision. The observed expert-to-expert identification disagreement rate was 2.0 %, whereas the observed expert-to-expert inconclusive disagreement rate was 12.5 %. Overall, most casework disagreements arose due to subjective differences concerning the suitability of friction ridge skin information for comparison or sufficiency for identification. Experts were more concordant in their decision-making with other experts than with trainees, and approximately three times more likely to disagree with a prior trainees' identification or inconclusive decision than a prior experts' identification or inconclusive decision. We assume these differences reflect trainees' developing proficiencies in assessing the suitability or sufficiency of friction ridge skin impression information. Differences of opinion in casework are expected, which exposes the subjective nature of fingerprint decision-making. Computer-based quality metric and likelihood ratio tools should be considered for use in casework to guide examiner evaluations and mitigate examiner disagreements.

Position paper on perioperative management and surgical risk in the patient with cirrhosis.

INTRODUCTION: Management of the patient with cirrhosis of the liver that requires surgical treatment has been relatively unexplored. In Mexico, there is currently no formal stance or expert recommendations to guide clinical decision-making in this context. AIMS: The present position paper reviews the existing evidence on risks, prognoses, precautions, special care, and specific management or procedures for patients with cirrhosis that require surgical interventions or invasive procedures. Our aim is to provide recommendations by an expert panel, based on the best published evidence, and consequently ensure timely, quality, efficient, and low-risk care for this specific group of patients. RESULTS: Twenty-seven recommendations were developed that address preoperative considerations, intraoperative settings, and postoperative follow-up and care. CONCLUSIONS: The assessment and care of patients with cirrhosis that require major surgical or invasive procedures should be overseen by a multidisciplinary team that includes the anesthesiologist, hepatologist, gastroenterologist, and clinical nutritionist. With respect to decompensated patients, a nephrology specialist may be required, given that kidney function is also a parameter involved in the prognosis of these patients.

Major Trauma Triage Tool Study (MATTS) expert consensus-derived injury assessment tool.

Introduction: Major trauma centre (MTC) care has been associated with improved outcomes for injured patients. English ambulance services and trauma networks currently use a range of triage tools to select patients for bypass to MTCs. A standardised national triage tool may improve triage accuracy, cost-effectiveness and the reproducibility of decision-making. Methods: We conducted an expert consensus process to derive and develop a major trauma triage tool for use in English trauma networks. A web-based Delphi survey was conducted to identify and confirm candidate triage tool predictors of major trauma. Facilitated roundtable consensus meetings were convened to confirm the proposed triage tool's purpose, target diagnostic threshold, scope, intended population and structure, as well as the individual triage tool predictors and cut points. Public and patient involvement (PPI) focus groups were held to ensure triage tool acceptability to service users. Results: The Delphi survey reached consensus on nine triage variables in two domains, from 109 candidate variables after three rounds. Following a review of the relevant evidence during the consensus meetings, iterative rounds of discussion achieved consensus on the following aspects of the triage tool: reference standard, scope, target diagnostic accuracy and intended population. A three-step tool comprising physiology, anatomical injury and clinical judgement domains, with triage variables assessed in parallel, was recommended. The triage tool was received favourably by PPI focus groups. Conclusions: This paper presents a new expert consensus derived major trauma triage tool with defined purpose, scope, intended population, structure, constituent variables, variable definitions and thresholds. Prospective evaluation is required to determine clinical and cost-effectiveness, acceptability and usability.

A segmentation-based algorithm for classification of benign and malignancy Thyroid nodules with multi-feature information.

The aim of this study is to propose a new diagnostic model based on "segmentation + classification" to improve the routine screening of Thyroid nodule ultrasonography by utilizing the key domain knowledge of medical diagnostic tasks. A Multi-scale segmentation network based on a pyramidal pooling structure of multi-parallel void spaces is proposed. First, in the segmentation network, the exact information of the underlying feature space is obtained by an Attention Gate. Second, the inflated convolutional part of Atrous Spatial Pyramid Pooling (ASPP) is cascaded for multiple downsampling. Finally, a three-branch classification network combined with expert knowledge is designed, drawing on doctors' clinical diagnosis experience, to extract features from the original image of the nodule, the regional image of the nodule, and the edge image of the nodule, respectively, and to improve the classification accuracy of the model by utilizing the Coordinate attention (CA) mechanism and cross-level feature fusion. The Multi-scale segmentation network achieves 94.27%, 93.90% and 88.85% of mean precision (mPA), Dice value (Dice) and mean joint intersection (MIoU), respectively, and the accuracy, specificity and sensitivity of the classification network reaches 86.07%, 81.34% and 90.19%, respectively. Comparison tests show that this method outperforms the U-Net, AGU-Net and DeepLab V3+ classical models as well as the nnU-Net, Swin UNetr and MedFormer models that have emerged in recent years. This algorithm, as an auxiliary diagnostic tool, can help physicians more accurately assess the benign or malignant nature of Thyroid nodules. It can provide objective quantitative indicators, reduce the bias of subjective judgment, and improve the consistency and accuracy of diagnosis. Codes and models are available at https://github.com/enheliang/Thyroid-Segmentation-Network.git.

Key Issues of Economic Evaluations for Health Technology Assessment in China: A Nationwide Expert Survey.

OBJECTIVES: Health technology assessment (HTA) is increasingly crucial in medicine price negotiations in China, yet prior appraisals revealed national discrepancies on key economic evaluation issues: willingness-to-pay (WTP) threshold, pricing models for multi-indication medicines, and comparator selection principles. This study aims to collect expert opinions on these issues for future HTA evaluations. METHODS: A nationwide anonymous web-based survey encompassing experts across academia, HTA, consultancy/contract research organization (CRO)/industry, service provider and payer. In 2023, a generic invitation containing a web link to the questionnaire was disseminated via WeChat using convenience and snowball sampling. Agreement rates for questionnaire views were analyzed using descriptive statistics. The relationship between participants' responses and demographics was examined using appropriate logistic models. RESULTS: 303 responses were received from experts in 34 cities. Key expert views include: a suggested base WTP threshold ranging from 0.5 to 1.5 times GDP (52.1% agreement); elevated thresholds for childhood diseases, rare diseases, end-of-life diseases, and first-in-class medicines (FICs) (>78.0% agreement); a single pricing model for multi-indication medicines (60.4% agreement); consideration of multiple medicines as comparators (79.9% agreement); and avoiding the use of centrally procured medicines as comparators for medicines with a time-to-market under three years (71.0% agreement). Participants who are service provider had lower odds of selecting higher thresholds (OR: 0.26; P<0.01) compared with responders from consultancy/CRO/industry. CONCLUSIONS: Expert views indicate the need for substantial changes in China's current HTA methods, highlighting the need for increased investment in HTA processes and expertise cultivation.

[Accelerating the elimination of hepatitis B virus infection: expert recommendations for expanding prevention and treatment].

In order to achieve the early goal of "eliminating viral hepatitis as a public health threat by 2030" as proposed by the World Health Organization, the relevant issues that have not yet reached consensus on the aspects of hepatitis B prevention and treatment, including population-wide screening, adult hepatitis B vaccination, the evaluation of quantitative values of hepatitis B virus DNA, the alanine aminotransferase threshold for initiating antiviral therapy, the treatment of patients in the "indeterminate phase," the treatment of patients with co-infections and comorbidities, and others. Thus, experts have formulated recommendations to further expand hepatitis B prevention and treatment, with the aim of accelerating the elimination of hepatitis B virus infection.

Forensic criteria, clinical and theoretical issues of the indication of court-ordered treatment: A comparative survey among experts in forensic psychiatry and sentencing judges in France.

Following the French law n° 98-468 of 17 June 1998 relative to the prevention of sexual offenses and the protection of minors, social and judicial follow-up and court-ordered treatment were introduced with the aim of reinforcing the prevention of recidivism. Court-ordered treatment is one of the possible obligatory measures provided for by social and judicial follow-up. However, there is no consensus between the different professionals concerning the criteria of indication and the final purpose of this measure. Most of the few available studies are retrospective. Only rare studies have assessed the influence of criminological factors on the indication of court-ordered treatment. We carried out a nation-wide qualitative comparative study in two populations, psychiatric experts and sentencing judges, by means of e-mail questionnaires. The aim was to determine the criteria for court-ordered treatment according to psychiatric experts and to sentencing judges, to identify the criteria that gave rise to differences in appreciation between these professionals, and to attempt to explain these differences. The secondary aim of the study was to determine the methods and tools used in expert practice to evaluate dangerousness and risk of recidivism. We obtained 20 responses in each of the two populations. The great majority of psychiatric experts and sentencing judges considered that court-ordered treatment was appropriate when the offender presented with psychiatric dangerousness, and so with an underlying mental disorder. When a subject had no identified mental disorder, the psychiatrists were divided in their opinion, whereas the majority of sentencing judges were in favor of court-ordered treatment. Opinions differed particularly significantly between the two populations in four circumstances: a subject with an antisocial/psychopathic personality disorder, a subject who denied the alleged acts, the influence of precarious social circumstances and the influence of instability in intimate relationships. The majority of experts used international classifications (DSM-5 and ICD-10) as a basis for their psychiatric diagnosis. Just under half of those surveyed used structured or semi-structured interview guides and only a few stated that they used standardized actuarial tools to assess risk of recidivism. The concepts of care, dangerousness and mental disorder are associated with multiple representations that certainly play a part in the disagreements between the different professionals. It is of prime importance to define these concepts more clearly in order to encourage the use of a common language and to clarify the indications and purpose of court-ordered treatment. We also hypothesize that disagreements between professionals regarding the criteria for court-ordered treatment may be related to certain difficulties raised by the management of the convicted person. The development of guidelines that could be used by all professionals would help to reduce some of these difficulties. Psychiatric experts remain attached to clinical evaluation. Their limited use of assessment tools may relate to the material constraints and time constraints involved. The issue at stake in court-ordered treatment and social and judicial follow-up is to promote cooperation between the various professionals by creating a space for exchange of ideas where the fundamental questions raised by these measures can be discussed, fears shared and knowledge pooled.

Digital Psychosocial Follow-up for Childhood Critical Illness Survivors: A Qualitative Interview Study on Health Professionals' Perspectives.

Background: Digital solutions have been reported to provide positive psychological and social outcomes to childhood critical illness survivors, a group with an increased risk for long-term adverse psychosocial effects. Objective: To explore health professionals' perspectives on the potential of digital psychosocial follow-up for childhood critical illness survivors. Methods: Using a qualitative approach, expert interviews with six health professionals working at a Norwegian hospital were conducted. Transcribed interviews were analyzed using Braun and Clarke's six-phase thematic analysis framework. Concurrent data collection and analysis using inductive coding was also employed, and a model of codes was constructed. Results: The interview yielded thirteen unique codes regarding the health professionals' perspectives on the potential for digital psychosocial follow-up for childhood critical illness survivors, organized in a model comprising the two main themes: Affecting Factors and Digital Usage. Demographic factors (the child's medical condition, age, gender, and residence) and environmental factors (the child's family and health professionals) tended to affect the current psychosocial follow-up. Hospital limitations concerning a lack of digital solutions, worse relationship building with video communication, and children's already high screen time reflected the current state of digital usage. However, ongoing digitalization, existing successful digital solutions, children's good digital skills, and an ongoing process of creating an artifact are also seen as opportunities for digital usage in future psychosocial follow-up for childhood critical illness survivors. Conclusions: Researchers can build further on these findings to investigate the potential of digital psychosocial follow-up for childhood critical illness survivors, and clinicians can use it as a starting point for improving psychosocial follow-up.

[Chinese Expert Consensus on Day Surgery Management of Lung Cancer (2024 Edition)].

To alleviate the medical burden of lung cancer surgery and facilitate the implementation of the national hierarchical diagnosis and treatment policy, it is imperative to establish a hierarchical diagnosis and treatment system for day surgery of lung cancer. Identifying key quality control checkpoints in day surgery of lung cancer is essential to enhance medical quality, ensure safety, and improve the efficiency of medical services. These efforts aim to uphold a safe and well-structured progression of day surgery practices in China. The Chinese Expert Consensus Group on Day Surgery Management of Lung Cancer has convened national experts in relevant fields and integrated the latest research findings from both domestic and international sources to craft the Chinese Expert Consensus on Day Surgery Management of Lung Cancer (2024 Edition). This consensus is founded on the principles of holistic management of lung cancer surgery and comprehensive patient care throughout their medical journey. It encompasses preoperative assessments, anesthesia protocols, surgical procedures, postoperative care, hospital-community collaboration initiatives, and emergency response strategies. The primary objective of this expert consensus is to furnish research assistance and clinical recommendations to advance the practice of day surgery for lung cancer patients in China.
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