AI in ECG: Validating an ambulatory semiology labeller and predictor.

OBJECTIVES: Early prediction of epileptic seizures can help reduce morbidity and mortality. In this work, we explore using electrocardiographic (ECG) signal as input to a seizure prediction system and note that the performance can be improved by using selected signal processing techniques. METHODS: We used frequency domain analysis with a deep neural network backend for all our experiments in this work. We further analysed the effect of the proposed system for different seizure semiologies and prediction horizons. We explored refining the signal using signal processing to enhance the system's performance. RESULTS: Our final system using the Temple University Hospital's Seizure (TUHSZ) corpus gave an overall prediction accuracy of 84.02 %, sensitivity of 87.59 %, specificity of 81.9 %, and an area under the receiver operating characteristic curve (AUROC) of 0.9112. Notably, these results surpassed the state-of-the-art outcomes reported using the TUHSZ database; all findings are statistically significant. We also validated our study using the Siena scalp EEG database. Using the frequency domain data, our baseline system gave a performance of 75.17 %, 79.17 %, 70.04 % and 0.82 for prediction accuracy, sensitivity, specificity and AUROC, respectively. After selecting the optimal frequency band of 0.8-15 Hz, we obtained a performance of 80.49 %, 89.51 %, 75.23 % and 0.89 for prediction accuracy, sensitivity, specificity and AUROC, respectively which is an improvement of 5.32 %, 10.34 %, 5.19 % and 0.08 for prediction accuracy, sensitivity, specificity and AUROC, respectively. CONCLUSIONS: The seizure information in ECG is concentrated in a narrow frequency band. Identifying and selecting that band can help improve the performance of seizure detection and prediction. SIGNIFICANCE: EEG is susceptible to artefacts and is not preferred in a low-cost ambulatory device. ECG can be used in wearable devices (like chest bands) and is feasible for developing a low-cost ambulatory device for seizure prediction. Early seizure prediction can provide patients and clinicians with the required alert to take necessary precautions and prevent a fatality, significantly improving the patient's quality of life.

Urogenital dysfunction following neurotrauma.

PURPOSE OF REVIEW: Trauma affecting the nervous system can have widespread consequences, depending on the location and severity of injury. The sensorimotor and cognitive deficits due to neurotrauma have been studied extensively. Although the overall mortality due to neurotrauma has reduced, the disability and morbidity due to neurotrauma has not significantly reduced and focus on urogenital disturbances in these patients has been limited. This article reviews the limited evidence and scientific literature on this topic. RECENT FINDINGS: Lower urinary tract symptoms are commonly reported in patients with neurotrauma, both acutely and over the long term. Multiple medical and surgical approaches are available for managing bladder dysfunction in these patients. Sexual dysfunction and changes in sexual behaviour are reported by patients with neurotrauma and are usually multifactorial. Treatment options for sexual dysfunction are available and their management requires a holistic approach. SUMMARY: Urogenital dysfunction contributes significantly to the overall functional outcome and impaired quality of life in patients with neurotrauma. A better understanding of the mechanisms behind the urogenital abnormalities is needed for efficient management and treatment.

An Experimental Study on Esthetic Preference and Satisfaction of Lip Position with Various Facial Divergences among the South Indian Population.

Aim: The aim of this study was to establish the most and least pleasing lip position and to evaluate esthetic preference in profile view among the South Indian population with diverse facial divergence. Materials and Methods: Photographs of 12 participants with an average lip position were taken, and original lip position (Image C) was altered by ± 2 mm and ± 4 mm from the original position of upper and lower lips using Adobe Photoshop 7.0 version. Image A and Image B comprised photographs with retrusive lips of 4 mm and 2 mm, respectively, and Image D and Image E comprised photographs with protrusive lips of 2 mm and 4 mm, respectively. The altered photographs were evaluated for pleasing lip positions by 300 examiners which comprised 102 orthodontists, 107 general dentists, and 91 laypersons. Results: A questionnaire was conducted through Google Forms, and the examiners favored Image C with an average lip position as the most desired lip position, whereas Image E with 4-mm lip protrusion and Image A with 4-mm lip retrusion were the least desired irrespective of gender or facial divergence. Conclusion: Importance to establish appropriate soft-tissue esthetics is the primary concern of an orthodontic treatment.

Assessing the Validity and Reliability of Tooth Widths and Bolton Ratios Obtained from Digital Models and Plaster Models.

Aim: The aim of the study is to compare and evaluate the validity and reliability of tooth widths and Bolton ratios measured from digital models obtained from intraoral scanners and plaster models derived from alginate and polyvinyl siloxane impression materials. Materials and Methods: Alginate and polyvinylsiloxane impression was taken for 40 subjects, orthokal stone was poured and grouped as Group I and Group II, respectively. Intraoral scanning was done using Trios Pod 3shape for the same patients, digital models were obtained and grouped as Group III. OrthoAnalyzer software was used for obtaining measurements in digital models and Aerospace Vernier calipers in plaster models. The validity and reliability of the three groups were quantified and compared. Results: Validity measurements showed significant differences between tooth widths and Bolton ratios obtained from digital models and plaster models indicating higher accuracy for plaster models whereas reliability coefficients were excellent for digital models indicating better reproducibility of values. Conclusion: The study shows significant differences in accuracy on measuring with vernier calipers and Orthoanalyzer software showing plaster models are still better than digital models for measuring tooth widths and bolton ratios.

Computation and Collation of Torque Expression in 0.018 Inch and 0.022 Inch Preadjusted Bracket Slots on Passive Insertion of Full-Size Archwire: A Finite Element Study.

Aim: To quantify and compare the prescribed torque expressed in preadjusted edgewise 0.018-inch and 0.022-inch bracket slot on passive insertion of full-size archwire using finite element method. Materials and Methods: Geometric model of the maxillary arch created with dimensions of the brackets and archwires scanned using microcomputed tomography were converted to finite element model using HYPERMESH V 12.0 software. Material properties were assigned and boundary conditioning was given. 0.017 × 0.025 inch, 0.018 × 0.025 inch, 0.019 × 0.025 inch, 0.021 × 0.025 inch stainless steel wires were inserted and ligated using 0.010 inch stainless steel wire. The amount of torque in each wire was quantified and compared. Results: 0.018 × 0.025-inch stainless steel archwire in 0.018-inch slot expressed more torque than 0.017 × 0.025-inch wire; in 0.022-inch slot 0.021 × 0.025-inch wire showed more torque. Torque expression in 0.018-inch slot was more than 0.022-inch slot. Torque expressed was less than the prescribed value in both bracket slots.

Assessment and Evaluation of Soft Tissue Measurements between Various Mandibular Divergences in the South Indian Population: A Cephalometric Study.

Aim: The aim of this study is to evaluate the association between the mandibular divergent patterns and soft tissue chin (STC) thickness measured at different chin levels in nongrowing patients. Methodology: Pretreatment lateral cephalograms of 400 adult patients were segregated into four groups based on mandibular divergence pattern defined by the mandibular plane to cranial base angle (average 32° ± 5°), Group I with low angle (below 27°), Group II with medium low angle (28°-32°), Group III with medium high angle (33°-36°), and Group IV with high angle (above 37°). STC thickness was measured between Pog-Pog' (pogonion), Gn-Gn' (gnathion), and Me-Me' (menton), thickness and height of the upper and lower lips were also measured. Statistical analysis was done using one-way analysis of variance followed by post hoc Tukey analysis. Results: A significant difference in the STC thickness at Pog, Gn, and Me was observed among all four groups with hyperdivergent patterns, showing decreased STC thickness than the hypodivergent mandibular pattern. Thickness of the upper and lower lips was greater in hypodivergent mandible, whereas height of the lips was greater in hyperdivergent mandible.

Biomarkers in orthodontic tooth movement.

Tooth movement by orthodontic treatment is characterized by remodeling changes in the periodontal ligament, alveolar bone, and gingiva. A reflection of these phenomenons can be found in the gingival crevicular fluid (GCF) of moving teeth, with significant elevations in the concentrations of its components like, cytokines, neurotransmitters, growth Factors, and a arachidonic acid metabolites. GCF arises at the gingival margin and can be described as a transudate or an exudate. Several studies have focused on the composition of GCF and the changes that occur during orthodontic tooth movement (OTM). GCF component analysis is a non-invasive method for studying the cellular response of the underlying periodontium. Clinically, GCF can be easily collected using platinum loops, filter paper strips, gingival washings, and micropipettes. A number of GCF biomarkers involve in bone remodeling during OTM. The data suggest that knowledge of all the biomarkers present in the GCF that can be used to mark the changes in tooth that is undergoing orthodontic treatment may be of clinical usefulness leading to proper choice of mechanical stress to improve and to shorten treatment time and avoid side effects.

Digital model as an alternative to plaster model in assessment of space analysis.

INTRODUCTION: Digital three-dimensional models are widely used for orthodontic diagnosis. The purpose of this study was to appraise the accuracy of digital models obtained from computer-aided design/computer-aided manufacturing (CAD/CAM) and cone-beam computed tomography (CBCT) for tooth-width measurements and the Bolton analysis. MATERIALS AND METHODS: Digital models (CAD/CAM, CBCT) and plaster model were made for each of 50 subjects. Tooth-width measurements on the digital models (CAD/CAM, CBCT) were compared with those on the corresponding plaster models. The anterior and overall Bolton ratios were calculated for each participant and for each method. The paired t-test was applied to determine the validity. RESULTS: Tooth-width measurements, anterior, and overall Bolton ratio of digital models of CAD/CAM and CBCT did not differ significantly from those on the plaster models. CONCLUSION: Hence, both CBCT and CAD/CAM are trustable and promising technique that can replace plaster models due to its overwhelming advantages.

Towards enhancing the performance of multi-parameter patient monitors.

Multi-parameter patient monitors (MPMs) have become increasingly important in providing quality healthcare to patients. It is well known in the medical community that there exists an intrinsic relationship between different vital parameters in a healthy person, these include heart rate, blood pressure, respiration rate and oxygen saturation. For example, an increase in blood pressure would lead to a decrease in the heart rate, and vice versa. Although it is likely to improve the performance of MPM systems, this fact is not explored in engineering research. In this work, experiments show that deriving additional features to capture the intrinsic relationship between the vital parameters, the alarm accuracy (sensitivity), no-alarm accuracy (specificity) and the overall performance of MPMs can be improved. The geometric mean of the product of all the vital parameters taken in pairs of two was used to capture the intrinsic relationship between the different parameters. An improvement of 10.55% for sensitivity, 0.32% for specificity and an overall performance improvement of 1.03% was obtained, compared to the baseline system using classification and regression tree with the four vital parameters.

Dissociative fugue in the elderly.

Dissociative fugue is a rarely reported diagnostic entity. It is one of the least understood and yet clinically one of the most fascinating disorders in Mental Health. Here, we describe a case of fugue in a 62-year-old housewife who was brought to our hospital with pockets of memory loss. This case illustrates the need for timely referrals, which could channelize valuable professional time and help avoid expensive and unnecessary investigations.

Juvenile Behçet's disease: highlighting neuropsychiatric manifestations and putative genetic mechanisms.

Behçet's disease is a multisystem inflammatory disorder of unknown etiology. We report a 12-year-old boy who presented with features of raised intracranial tension and seizures and was found to have cerebral venous sinus thrombosis on evaluation. Behçet's disease was diagnosed based on occurrence of recurrent oral and genital ulcers in the past and characteristic skin lesions subsequently. He also showed significant personality changes including multiple attempts of deliberate self-harm. Pedigree analysis revealed that six family members spanning three generations had recurrent oral ulcers and three members satisfied the criteria for Behçet's disease. Clinical features varied amongst the family members and there was suggestion of genetic anticipation. The index case was carrying HLA-B37/B7 and the mother was carrying B37/B40. Our report sheds light on the genetics of Behçet's disease. Unusual features were early age of onset, cerebral venous sinus thrombosis, significant personality changes and strong family history with phenotypic heterogeneity.

Expression of the Gas7 gene and Oct4 in embryonic stem cells of mice.

Oct4 is a stem cell expression marker, and persistence of its expression retains pluripotency in embryonic stem (ES) cells. Our results indicate a pattern of gradual decrease in Oct4 expression, which is prominent in the blastocyst and markedly reduced in the gastrula and neurula. The presence of POU transcription factor-like domain in Gas7 prompted us to look for its expression in the early embryonic cells. We have observed high expression of the Gas7 protein in blastocysts that gradually decreased in the neurula stages. The localization of Gas7 was initially seen throughout the blastocyst, but was later confined to dorsal ectodermal regions of the neurula, conforming with its role in neuronal differentiation. Our data reveal that Gas7 might play a role in cellular migration and cell protection in the ES cells of mouse embryo.