Muscle oxygenation and pain in different types of temporomandibular disorders.

OBJECTIVES: Studies exploring variations in peripheral muscle oxygenation and pressure pain thresholds (PPT) of masticatory muscles in individuals with Temporomandibular Disorders (TMDs) are limited. The purpose of this study was to compare variations in peripheral oxygenation of the masseter muscle; PPT of the masseter and temporal muscles and correlate peripheral muscle oxygenation and PPT of the masseter muscle in individuals with different types of TMDs. MATERIALS AND METHODS: Cross-sectional study involving 116 participants classified into three groups: muscle group (MG, n = 32), joint group (JG, n = 30) and muscle-joint group (MJG, n = 54). Individuals aged 26.97 ± 6.93, 68.97% female, 31,03% males were included. All participants were evaluated using the Diagnostic Criteria for Temporomandibular Disorders, Near-infrared spectroscopy (NIRS) for peripheral muscle oxygenation and pressure algometer for PPT. RESULTS: There was no difference in masseter muscle oxygenation among groups. In the masseter muscle, a weakly positive correlation was observed between PPT and variation in tissue saturation index in the MG (rho = 0.365) and JG (rho = 0.317). In addition, the MJG expressed lower PPT (p = 0.004) than JG, demonstrating that MJG had more pain in this muscle. CONCLUSIONS: MJG have lower PPT in the masseter muscle. Although the PPT is dependent on the type of TMDs, the correlation between PPT and oxygenation is weak. All TMDs groups evaluated (MG, JG, MJG) showed hemodynamic similarities of the masseter muscle. CLINICAL RELEVANCE: Understanding pain thresholds and the hemodynamic behavior of the masticatory muscles contributes to a more assertive physiotherapeutic assessment in TMDs, serving as a basis for careful and individualized interventions.

Interactive effects of ammonium sulfate and lead on alfalfa in rare earth tailings: Physiological responses and toxicity thresholds.

Ion-adsorption rare earth ore contains significant levels of leaching agents and heavy metals, leading to substantial co-contamination. This presents significant challenges for ecological rehabilitation, yet there is limited understanding of the toxicity thresholds associated with the co-contamination of ammonium sulfate (AS) and lead (Pb) on pioneer plants. Here, we investigated the toxicity thresholds of various aspects of alfalfa, including growth, ultrastructural changes, metabolism, antioxidant system response, and Pb accumulation. The results indicated that the co-contamination of AS-Pb decreased the dry weight of shoot and root by 26 %-77 % and 18 %-92 %, respectively, leading to irregular root cell morphology and nucleus disintegration. The high concentration and combined exposures to AS and Pb induced oxidative stress on alfalfa, which stimulated the defense of the antioxidative system and resulted in an increase in proline levels and a decrease in soluble sugars. Structural equation modeling analysis and integrated biomarker response elucidated that the soluble sugars, proline, and POD were the key physiological indicators of alfalfa under stresses and indicated that co-exposure induced more severe oxidative stress in alfalfa. The toxicity thresholds under single exposure were 496 (EC5), 566 (EC10), 719 (EC25), 940 (EC50) mg kg-1 for AS and 505 (EC5), 539 (EC10), 605 (EC25), 678 (EC50) mg kg-1 for Pb. This study showed that AS-Pb pollution notably influenced plant growth performance and had negative impacts on the growth processes, metabolite levels, and the antioxidant system in plants. Our findings contribute to a theoretical foundation and research necessity for evaluating ecological risks in mining areas and assessing the suitability of ecological restoration strategies.

Sex-specific troponin and creatine kinase thresholds after coronary bypass surgery.

BACKGROUND: The impact of sex-differences on the release of cardiac biomarkers after coronary artery bypass grafting (CABG) remains unknown. The aim of our study was to (a) investigate the impact of sex-differences in cardiac biomarker release after CABG and (b) determine sex-specific thresholds for high-sensitivity troponin (hs-cTn) and creatine kinase-MB (CK-MB) associated with 30-day major adverse cardiovascular event (MACE) and mortality. METHODS: A consecutive cohort of 3687 patients (female: n= 643 (17.4%); male: 3044 (82.6%) undergoing CABG from 2008-2021 in two tertiary university centers with serial postoperative cTn and CK-MB measurement was analyzed. The composite primary outcome was MACE at 30 days. Secondary endpoints were 30-day mortality and five-year mortality and MACE. Sex-specific thresholds for cTn and CK-MB were determined. RESULTS: Lower levels of cTn were found in women after CABG (69.18 vs. 77.57 xURL; p<0.001). Optimal threshold value for cTn was calculated at 94.36 times the URL for female and 206.07 times the URL for male patients to predict 30-day MACE. Female patients missed by a general threshold had increased risk for MACE or death within 30 days (cTn: MACE: OR 3.78 CI: 1.03-13.08; p=0.035; death: OR 4.98; CI: 1.20.-20.61; p=0.027; CK-MB: MACE: OR 10.04; CI: 2.07-48.75; p<0.001; death: OR 13.59; CI: 2.66-69.47; p=0.002). CONCLUSIONS: We provide evidence for sex-specific differences in the outcome and biomarker release after CABG. Sex-specific cut-offs are necessary for the diagnosis of perioperative myocardial injury to improve outcomes of women after CABG.

Factors contributing to the minimum water column stability and timing of the winter turnover in the Ogouchi reservoir.

Turnover in lakes and reservoirs causes circulation in the water column from the bottom to the surface when the water column stability becomes low. Previous studies commonly mentioned that turnover occurs when stratification indices become small, but the threshold is rarely discussed. While turnover phenomena have been extensively studied by evaluating changes in bottom dissolved oxygen (DO), the relationship between the disappearance of hypoxia and water temperature indices has not been determined. This study focused on the factors influencing the minimum thermal gradient (TG) and Schmidt Stability Index (SSI), and the timing of turnover events using DO as an indicator of mixing in the Ogouchi reservoir from 1992 to 2001. The results showed that the occurrence of minimum TG and SSI is mainly driven by inflow retention time and average maximum wind speed. Moreover, minimum air temperature and outflow retention time have few contributions to minimum SSI. It was found that 7 out of 10 years exhibited full winter turnover, while the remaining years showed incomplete mixing with persistent hypoxia at the reservoir bottom. This study identifies four cases based on onset thresholds of 0.0035 °C m-1 for TG and 30 J m-2 for SSI to explain turnover event: Case 1: an ideal state with stratification indices below the threshold, resulting in the disappearance of hypoxia; Case 2: indices above the threshold sustain hypoxia; Case 3: an irregular state where the indices exceed the threshold, yet hypoxia disappears; and Case 4: an unexpected persistence of hypoxia despite being below the threshold. The majority of the years (70 percent) were explained by thresholds. The multiple regression analysis indicated the importance of wind speed on the turnover event. Therefore, the effect of wind shear was analyzed for 30 percent of the years that cannot be explained by thresholds (cases 3 and 4). Case 3 shows turnover occurrence due to strong accumulated wind shear, despite exceeding thresholds. Conversely, Case 4 reveals weak wind shear preventing bottom water upwelling, even below thresholds. In conclusion, the precise TG and SSI thresholds for the onset of turnover event were determined using DO data. The thresholds explained the occurrence and non-occurrence of turnover event in most of the years and wind speed clarified unexplained cases by thresholds. The presented method successfully evaluated the timing of turnover and can be applicable elsewhere.

The role of Allee effects for Gaussian and Lévy dispersals in an environmental niche.

In the study of biological populations, the Allee effect detects a critical density below which the population is severely endangered and at risk of extinction. This effect supersedes the classical logistic model, in which low densities are favorable due to lack of competition, and includes situations related to deficit of genetic pools, inbreeding depression, mate limitations, unavailability of collaborative strategies due to lack of conspecifics, etc. The goal of this paper is to provide a detailed mathematical analysis of the Allee effect. After recalling the ordinary differential equation related to the Allee effect, we will consider the situation of a diffusive population. The dispersal of this population is quite general and can include the classical Brownian motion, as well as a Lévy flight pattern, and also a "mixed" situation in which some individuals perform classical random walks and others adopt Lévy flights (which is also a case observed in nature). We study the existence and nonexistence of stationary solutions, which are an indication of the survival chance of a population at the equilibrium. We also analyze the associated evolution problem, in view of monotonicity in time of the total population, energy consideration, and long-time asymptotics. Furthermore, we also consider the case of an "inverse" Allee effect, in which low density populations may access additional benefits.

A study on the effects of visual condition on postural stability in adults with and without chronic low back pain.

This study was conducted to compare postural stability during repeated unilateral standing tasks between adults with and without chronic low back pain (LBP) while considering visual input. The study involved 26 participants with LBP and 39 control participants. Each participant performed three trials of standing tasks on the dominant limb using a stable platform. The Falls Efficacy Scale was utilized to assess fall-related self-efficacy and fear of falling due to potential physical frailty. The center of pressure (COP) sway excursion was analyzed at 10 mm and 20 mm thresholds for the time-in-boundary (TIB). The results indicated a significant fear of falling difference in the LBP group compared to the control group (t = 3.27, p = 0.001). The LBP group demonstrated a significant interaction between visual condition and TIB (F = 8.45, p = 0.01), particularly in the LBP group, which demonstrated a notable decrease in TIB at 10 mm (54.02 % compared to the control group's 70.40 %) and 20 mm (70.93 % compared to the control group's 85.92 %) thresholds during the second trial and at 10 mm (59.73 % compared to the control group's 73.84 %) during the third trial in the eyes open condition. Overall, visual condition demonstrated significant interactions on thresholds (F = 15.80, p = 0.001, η2p = 0.21) as well as trials  ×  thresholds (F = 4.21, p = 0.04, η2p = 0.07). These findings indicate a potential adaptation in postural control among the LBP group with visual feedback. Further research is warranted to explore group differences when considering visual conditions and sway excursion thresholds.

Assessment of the eutrophication status at Mediterranean sub-basin scale, within the European Marine Strategy Framework Directive.

The aim of this work is to define harmonized reference conditions and assessment thresholds for selected criteria elements of the Marine Strategy Framework Directive (MSFD) Descriptor 5 (Eutrophication) in the Eastern Mediterranean Sea and to test if a tool for integrated assessment of the status of marine systems can be used as a common methodological approach. In this frame, we tested two statistical approaches in order to set threshold values for four criteria of Descriptor 5: nutrients, chlorophyll a, transparency and dissolved oxygen in the bottom waters. It is noteworthy that this work revealed the need to apply common procedures in data treatment and assessment evaluation. This is the first attempt to set common methods for the assessment of eutrophication in the Eastern Mediterranean, which is essential in marine environments, especially those shared by several countries. To this end, we have applied common criteria and metrics and established thresholds "Good" and "Moderate" for nutrients, chlorophyll a, transparency and dissolved oxygen in the bottom waters for the different Water Types of the Adriatic and Aegean Seas (I, II, IIIW, IIIE), based on datasets provided by Italy, Slovenia, Croatia and Greece. The selected criteria elements were common for all countries, providing a unified approach to GES assessment of two case study areas: the Adriatic Sea and the Saronikos Gulf. Dissolved Inorganic Nitrogen (DIN) threshold values of 15.6, 6.85, 1.61 and 2.11 µmol L-1 were set for the Water Types I, II, IIIW and IIIE, respectively. We also tested if an aggregation tool for GES assessment, such as Nested Environmental status Assessment Tool (NEAT), could be used as a common methodological approach. The comparison of NEAT with TRIX showed good comparability. In this end, NEAT can be used as a useful and much needed assessment tool for assessing eutrophication status of the marine.

Estimating thresholds of natural vegetation for the protection of water quality in South African catchments.

Many of South Africa's current water quality problems have been attributed to diffuse pollution derived from poorly regulated land use/land cover (LULC) transformations. To mitigate these impacts, the preservation of an adequate amount of natural vegetation within catchment areas is an important management strategy. However, it is not clear how much natural vegetation cover is required to provide adequate levels of protection, nor at which scale(s) this strategy would be most effective. To investigate the possibility of estimating minimum thresholds of natural vegetation required to protect water resources, regression analysis was used to model relationships between water quality (measured using Nemerow's Pollution Index) and metrics of natural vegetation at multiple scales across a sample of sub-catchments located along the western, southern, and south-eastern coast of South Africa. With conspicuous outliers removed, the models were able to explain up to 82 % of the variability in the relationship between land use and water quality. Moreover, a statistically significant, nonlinear, and inverse relationship was found between proportions of natural vegetation cover and pollution levels. This relationship was strongest when measured (1) across the whole catchment and (2) within a 200 m riparian buffer zone. The models further indicated that approximately 80 to 90 % natural vegetation cover was necessary at these scales to maintain water quality at ecologically acceptable levels. Additional nonlinear thresholds estimated using breakpoint analysis suggested that if proportions of natural vegetation fall below 45 % (across the whole catchment) and 60 % (within a 200 m riparian buffer zone) a dramatic increase in pollution levels can be expected. The estimated thresholds are recommended as guidelines that can be used to inform integrated land and water resources management strategies aimed at protecting water quality in the study area. Likewise, the methods described are recommended for the estimation of similar thresholds in other regions.

Meaning and prediction of 'excess mortality': a comparison of Covid-19 and pre-Covid-19 mortality data in 31 Eurostat countries from 1965 to 2021.

Determining 'excess mortality' makes it possible to compare the burden of disasters between countries and over time, and thus also to evaluate the success of mitigation measures. However, the debate on coronavirus disease 2019 (Covid-19) has exposed that calculations of excess mortalities vary considerably depending on the method and its specification. Moreover, it is often unclear what exactly is meant by 'excess mortality'. We define excess mortality as the excess over the number of deaths that would have been expected counter-factually, that is without the catastrophic event in question. Based on this definition, we use a very parsimonious calculation method, namely the linear extrapolation of death figures from previous years to determine the excess mortality during the Covid-19 pandemic. But unlike most other literature on this topic, we first evaluated and optimized the specification of our method using a larger historical data set in order to identify and minimize estimation errors and biases. The result shows that excess mortality rates in the literature are often inflated. Moreover, they would have exhibited considerable excess mortalities in the period before Covid-19, if this value had already been of public interest at that time. Three conclusions can be drawn from this study and its findings: (i) All calculation methods for current figures should first be evaluated against past figures. (ii) To avoid alarm fatigue, thresholds should be introduced which would differentiate between 'usual fluctuations' and 'remarkable excess'. (iii) Statistical offices could provide more realistic estimates.

Framework for developing cost-effectiveness analysis threshold: the case of Egypt.

BACKGROUND: Cost-effectiveness analyses rarely offer useful insights to policy decisions unless their results are compared against a benchmark threshold. The cost-effectiveness threshold (CET) represents the maximum acceptable monetary value for achieving a unit of health gain. This study aimed to identify CET values on a global scale, provide an overview of using multiple CETs, and propose a country-specific CET framework specifically tailored for Egypt. The proposed framework aims to consider the globally identified CETs, analyze global trends, and consider the local structure of Egypt's healthcare system. METHODS: We conducted a literature review to identify CET values, with a particular focus on understanding the basis of differentiation when multiple thresholds are present. CETs of different countries were reviewed from secondary sources. Additionally, we assembled an expert panel to develop a national CET framework in Egypt and propose an initial design. This was followed by a multistakeholder workshop, bringing together representatives of different governmental bodies to vote on the threshold value and finalize the recommended framework. RESULTS: The average CET, expressed as a percentage of the gross domestic product (GDP) per capita across all countries, was 135%, with a range of 21 to 300%. Interestingly, while the absolute value of CET increased with a country's income level, the average CET/GDP per capita showed an inverse relationship. Some countries applied multiple thresholds based on disease severity or rarity. In the case of Egypt, the consensus workshop recommended a threshold ranging from one to three times the GDP per capita, taking into account the incremental relative quality-adjusted life years (QALY) gain. For orphan medicines, a CET multiplier between 1.5 and 3.0, based on the disease rarity, was recommended. A two-times multiplier was proposed for the private reimbursement threshold compared to the public threshold. CONCLUSION: The CET values in most countries appear to be closely related to the GDP per capita. Higher-income countries tend to use a lower threshold as a percentage of their GDP per capita, contrasted with lower-income countries. In Egypt, experts opted for a multiple CET framework to assess the value of health technologies in terms of reimbursement and pricing.

Instrumental Monitoring of a Slow-Moving Landslide in Piedmont (Northwest Italy) for the Definition of Rainfall Thresholds.

The prediction and prevention of landslide hazard is a challenging topic involving the assessment and quantitative evaluation of several elements: geological and geomorphological setting, rainfalls, and ground motion. This paper presents the multi-approach investigation of the Nevissano landslide (Asti Province, Piedmont, NW Italy). It shows a continuous and slow movement, alongside few paroxysmal events, the last recorded in 2016. The geological and geomorphological models were defined through a field survey. An inventory of the landslide's movements and rainfall records in the period 2000-2016 was performed, respectively, through archive investigations and the application of "Moving Sum of Daily Rainfall" method, allowing for the definition of rain thresholds for the landslide activation (105 mm and 193 mm, respectively, in 3 and 30 days prior to the event). The displacements over the last 8 years (2016-2023) were monitored through an innovative in-continuum monitoring inclinometric system and Earth Observation (EO) data (i.e., relying on Interferometric Synthetic Aperture Radar, or InSAR data): it gave the opportunity to validate the rainfall thresholds previously defined. This study aims to provide information to public authorities for the appropriate management of the site. Moreover, the proposed workflow could be adopted as a guideline for investigating similar situations.

Assessing the influence of autumnal temperature fluctuations on cold hardiness in different grapevine cultivars: variations across vine age and bud positions.

The dynamic fluctuations in autumn temperatures, particularly the marked diurnal variations and the subsequent precipitous drops are key and a pivotal role in viticulture, as they critically influence the acclimation process of grapevines to cold, thereby directly impacting their survival and productivity in cold-climate regions. In this comprehensive study, we investigated the cold hardiness of four grapevine cultivars: 'Itasca', 'Frontenac', 'La Crescent', and 'Marquette', focusing on how these cultivars and their individual buds (1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, and 9th) respond to fluctuating weather and low temperatures typical of autumn [-1.1°C (30°F) -9.4°C (15°F) and -17.8°C (0°F)]. Our results illuminated the striking variability in cold hardiness that was manifest not only among the different cultivars but also within individual buds on the same vine, underscoring the critical influence of bud position on a vine for cold hardiness. 'Frontenac' showed greater cold hardiness at critical temperatures at which 10%, and 50% of the dormant buds were lethally affected by cold (LT10 and LT50) compared to 'Itasca' and 'La Crescent', with 'Marquette' exhibiting intermediate values. However, in cultivars such as 'Itasca' and 'Marquette', certain buds demonstrated a pronounced hardiness when faced with colder temperatures, while others exhibited a heightened sensitivity, thereby revealing a nuanced interplay between bud position and a vine's ability to withstand cold stress. Our study revealed a notable divergence from traditional viticulture understanding; apical buds demonstrated greater cold hardiness than basal buds and opened new paths for research into grapevine physiology. Our results also indicated a significant trend wherein older vines across all studied cultivars displayed enhanced cold hardiness, particularly pronounced at the critical LT50 and the critical temperature at which 90% of the dormant buds were lethally affected by cold (LT90) thresholds, in comparison to younger vines. Moreover, our findings shed light on the impact of autumn's diurnal temperature variations and the subsequent drop in temperatures on vine cold hardiness, thus highlighted the complex interplay between environmental temperature dynamics and dormant bud hardiness. In conclusion, our study showed that the cold damage observed in grapevines in North Dakota was not a result of extreme temperature fluctuations in the fall. This was confirmed by testing the vines after they had reached various threshold temperatures through differential thermal analysis (DTA) and optical differential nucleation and expansion analysis (ODNEAL) methodologies, particularly before the onset of severe pre-winter cold conditions. These comprehensive findings highlighted the complexity of the vine's response to climatic conditions and viticultural management, pointing to the need for specific strategies in vineyard management and cultivar selection to optimize bud hardiness and productivity in the face of various environmental challenges, especially in cold climate viticulture.

A genome-wide association study reveals a polygenic architecture of speech-in-noise deficits in individuals with self-reported normal hearing.

Speech-in-noise (SIN) perception is a primary complaint of individuals with audiometric hearing loss. SIN performance varies drastically, even among individuals with normal hearing. The present genome-wide association study (GWAS) investigated the genetic basis of SIN deficits in individuals with self-reported normal hearing in quiet situations. GWAS was performed on 279,911 individuals from the UB Biobank cohort, with 58,847 reporting SIN deficits despite reporting normal hearing in quiet. GWAS identified 996 single nucleotide polymorphisms (SNPs), achieving significance (p < 5*10-8) across four genomic loci. 720 SNPs across 21 loci achieved suggestive significance (p < 10-6). GWAS signals were enriched in brain tissues, such as the anterior cingulate cortex, dorsolateral prefrontal cortex, entorhinal cortex, frontal cortex, hippocampus, and inferior temporal cortex. Cochlear cell types revealed no significant association with SIN deficits. SIN deficits were associated with various health traits, including neuropsychiatric, sensory, cognitive, metabolic, cardiovascular, and inflammatory conditions. A replication analysis was conducted on 242 healthy young adults. Self-reported speech perception, hearing thresholds (0.25-16 kHz), and distortion product otoacoustic emissions (1-16 kHz) were utilized for the replication analysis. 73 SNPs were replicated with a self-reported speech perception measure. 211 SNPs were replicated with at least one and 66 with at least two audiological measures. 12 SNPs near or within MAPT, GRM3, and HLA-DQA1 were replicated for all audiological measures. The present study highlighted a polygenic architecture underlying SIN deficits in individuals with self-reported normal hearing.

Assessing the feasibility of test-and-cull and test-and-segregation approaches for the control of high-prevalence bovine tuberculosis in Ethiopian intensive dairy farms.

Bovine tuberculosis (bTB) is endemic and has a substantial impact on the livestock sector in Ethiopia and other low and middle-income countries (LMICs). With a national emphasis on dairy farm intensification to boost milk production and spur economic growth, the incidence of bTB is anticipated to rise. However, Ethiopia, like other LMICs, lacks a comprehensive national bTB control strategy due to the economic and social infeasibility of traditional test-and-cull (TC) approaches. To inform the development of such a strategy, we evaluated the effectiveness and feasibility of TC and test-and-segregation (TSg) strategies for bTB control on Ethiopian dairy farms. A TC approach was used at Farm A [N = 62; comparative cervical test (CCT) > 4 mm, starting prevalence 11.3%] while TSg was implemented at Farm B (N = 45; CCT > 4 mm, prevalence 22.2%), with testing intervals of 2-4 months. Both strategies achieved a reduction in bTB prevalence to 0%, requiring seven rounds of TC over 18 months at Farm A, and five rounds of TSg over 12 months at Farm B's negative herd. The results show that adopting more sensitive thresholds [CCT > 0 mm or single cervical test (SCT) > 2 mm] during later rounds was pivotal in identifying and managing previously undetected infections, emphasizing the critical need for optimized diagnostic thresholds. Cost analysis revealed that TC was approximately twice as expensive as TSg, primarily due to testing, labor, and cow losses in TC, versus construction of new facilities and additional labor for TSg. This underscores the economic and logistical challenges of bTB management in resource-limited settings. Taken together, our study highlights an urgent need for the exploration of alternative approaches including TSg and or vaccination to mitigate within herd transmission and enable implementation of bTB control in regions where TC is not feasible.

Basing intubation of acutely hypoxemic patients on physiologic principles.

The decision to intubate a patient with acute hypoxemic respiratory failure who is not in apparent respiratory distress is one of the most difficult clinical decisions faced by intensivists. A conservative approach exposes patients to the dangers of hypoxemia, while a liberal approach exposes them to the dangers of inserting an endotracheal tube and invasive mechanical ventilation. To assist intensivists in this decision, investigators have used various thresholds of peripheral or arterial oxygen saturation, partial pressure of oxygen, partial pressure of oxygen-to-fraction of inspired oxygen ratio, and arterial oxygen content. In this review we will discuss how each of these oxygenation indices provides inaccurate information about the volume of oxygen transported in the arterial blood (convective oxygen delivery) or the pressure gradient driving oxygen from the capillaries to the cells (diffusive oxygen delivery). The decision to intubate hypoxemic patients is further complicated by our nescience of the critical point below which global and cerebral oxygen supply become delivery-dependent in the individual patient. Accordingly, intubation requires a nuanced understanding of oxygenation indexes. In this review, we will also discuss our approach to intubation based on clinical observations and physiologic principles. Specifically, we consider intubation when hypoxemic patients, who are neither in apparent respiratory distress nor in shock, become cognitively impaired suggesting emergent cerebral hypoxia. When deciding to intubate, we also consider additional factors including estimates of cardiac function, peripheral perfusion, arterial oxygen content and its determinants. It is not possible, however, to pick an oxygenation breakpoint below which the benefits of mechanical ventilation decidedly outweigh its hazards. It is futile to imagine that decision making about instituting mechanical ventilation in an individual patient can be condensed into an algorithm with absolute numbers at each nodal point. In sum, an algorithm cannot replace the presence of a physician well skilled in the art of clinical evaluation who has a deep understanding of pathophysiologic principles.

DRPSO:A multi-strategy fusion particle swarm optimization algorithm with a replacement mechanisms for colon cancer pathology image segmentation.

Colon adenocarcinoma (COAD) is a type of colon cancers with a high mortality rate. Its early symptoms are not obvious, and its late stage is accompanied by various complications that seriously endanger patients' lives. To assist in the early diagnosis of COAD and improve the detection efficiency of COAD, this paper proposes a multi-level threshold image segmentation (MIS) method based on an enhanced particle swarm algorithm for segmenting COAD images. Firstly, this paper proposes a multi-strategy fusion particle swarm optimization algorithm (DRPSO) with a replacement mechanism. The non-linear inertia weight and sine-cosine learning factors in DRPSO help balance the exploration and exploitation phases of the algorithm. The population reorganization strategy incorporating MGO enhances population diversity and effectively prevents the algorithm from stagnating prematurely. The mutation-based final replacement mechanism enhances the algorithm's ability to escape local optima and helps the algorithm to obtain highly accurate solutions. In addition, comparison experiments on the CEC2020 and CEC2022 test sets show that DRPSO outperforms other state-of-the-art algorithms in terms of convergence accuracy and speed. Secondly, by combining the non-local mean 2D histogram and 2D Renyi entropy, this paper proposes a DRPSO algorithm based MIS method, which is successfully applied to the segments the COAD pathology image problem. The results of segmentation experiments show that the above method obtains relatively higher quality segmented images with superior performance metrics: PSNR = 23.556, SSIM = 0.825, and FSIM = 0.922. In conclusion, the MIS method based on the DRPSO algorithm shows great potential in assisting COAD diagnosis and in pathology image segmentation.

Impact of low-level exposure to antibiotics on bile acid homeostasis in adults: Implication for human safety thresholds.

Bile acid homeostasis is critical to human health. Low-level exposure to antibiotics has been suggested to potentially disrupt bile acid homeostasis by affecting gut microbiota, but relevant data are still lacking in humans, especially for the level below human safety threshold. We conducted a cross-sectional study in 4247 Chinese adults by measuring 34 parent antibiotics and their metabolites from six common categories (i.e., tetracyclines, qinolones, macrolides, sulfonamides, phenicols, and lincosamides) and ten representative bile acids in fasting morning urine using liquid chromatography coupled to mass spectrometry. Daily exposure dose of antibiotics was estimated from urinary concentrations of parent antibiotics and their metabolites. Urinary bile acids and their ratios were used to reflect bile acid homeostasis. The estimated daily exposure doses (EDED) of five antibiotic categories with a high detection frequency (i.e., tetracyclines, qinolones, macrolides, sulfonamides, and phenicols) were significantly associated with urinary concentrations of bile acids and decreased bile acid ratios in all adults and the subset of 3898 adults with a cumulative ratio of antibiotic EDED to human safety threshold of less than one. Compared to a negative detection of antibiotics, the lowest EDED quartiles of five antibiotic categories and four individual antibiotics with a high detection frequency (i.e., ciprofloxacin, ofloxacin, trimethoprim, and florfenicol) in the adults with a positive detection of antibiotics had a decrease of bile acid ratio between 6.6% and 76.6%. Except for macrolides (1.2×102 ng/kg/day), the medians of the lowest EDED quartile of antibiotic categories and individual antibiotics ranged from 0.32 ng/kg/day to 10 ng/kg/day, which were well below human safety thresholds. These results suggested that low-level antibiotic exposure could disrupt bile acid homeostasis in adults and existing human safety thresholds may be inadequate in safeguarding against the potential adverse health effects of low-level exposure to antibiotics.

Experimental validation of a PNS-optimized whole-body gradient coil.

PURPOSE: Peripheral nerve stimulation (PNS) limits the usability of state-of-the-art whole-body and head-only MRI gradient coils. We used detailed electromagnetic and neurodynamic modeling to set an explicit PNS constraint during the design of a whole-body gradient coil and constructed it to compare the predicted and experimentally measured PNS thresholds to those of a matched design without PNS constraints. METHODS: We designed, constructed, and tested two actively shielded whole-body Y-axis gradient coil winding patterns: YG1 is a conventional symmetric design without PNS-optimization, whereas YG2's design used an additional constraint on the allowable PNS threshold in the head-imaging landmark, yielding an asymmetric winding pattern. We measured PNS thresholds in 18 healthy subjects at five landmark positions (head, cardiac, abdominal, pelvic, and knee). RESULTS: The PNS-optimized design YG2 achieved 46% higher average experimental thresholds for a head-imaging landmark than YG1 while incurring a 15% inductance penalty. For cardiac, pelvic, and knee imaging landmarks, the PNS thresholds increased between +22% and +35%. For abdominal imaging, PNS thresholds did not change significantly between YG1 and YG2 (-3.6%). The agreement between predicted and experimental PNS thresholds was within 11.4% normalized root mean square error for both coils and all landmarks. The PNS model also produced plausible predictions of the stimulation sites when compared to the sites of perception reported by the subjects. CONCLUSION: The PNS-optimization improved the PNS thresholds for the target scan landmark as well as most other studied landmarks, potentially yielding a significant improvement in image encoding performance that can be safely used in humans.

The historical origins of modern international normalized ratio targets.

Prothrombin time (PT) and its derivative international normalized ratio (INR) are frequently ordered to assess the coagulation system. Plasma transfusion to treat incidentally abnormal PT/INR is a common practice with low biological plausibility and without credible evidence, yet INR targets appear in major clinical guidelines and account for the majority of plasma use at many institutions. In this article, we review the historical origins of INR targets. We recount historical milestones in the development of the PT, discovery of vitamin K antagonists (VKAs), motivation for INR standardization, and justification for INR targets in patients receiving VKA therapy. Next, we summarize evidence for INR testing to assess bleeding risk in patients not on VKA therapy and plasma transfusion for treating mildly abnormal INR to prevent bleeding in these patients. We conclude with a discussion of the parallels in misunderstanding of historic PT and present-day INR testing with lessons from the past that might help rationalize plasma transfusion in the future.

Identifying influence factors and thresholds of the next day's pollen concentration in different seasons using interpretable machine learning.

The prevalence of pollen allergies is a pressing global issue, with projections suggesting that half of the world's population will be affected by 2050 according to the estimation of the World Health Organization (WHO). Accurately forecasting pollen allergy risks requires identifying key factors and their thresholds for aerosol pollen. To address this, we developed a technical framework combining advanced machine learning and SHapley Additive exPlanations (SHAP) technology, focusing on Beijing. By analyzing meteorological data and vegetation phenology, we identified the factors influencing next-day's pollen concentration (NDP) in Beijing and their thresholds. Our results highlight vegetation phenology data from Synthetic Aperture Radar (SAR), temperature, wind speed, and atmospheric pressure as crucial factors in spring. In contrast, the Normalized Difference Vegetation Index (NDVI), air temperature, and wind speed are significant in autumn. Leveraging SHAP technology, we established season-specific thresholds for these factors. Our study not only confirms previous research but also unveils seasonal variations in the relationship between radar-derived vegetation phenology data and NDP. Additionally, we observe seasonal fluctuations in the influence patterns and threshold values of daily air temperatures on NDP. These insights are pivotal for improving pollen concentration prediction accuracy and managing allergic risks effectively.