Lincoln Sign: A Rare Presentation of Medication-related Osteonecrosis of the Jaw.

A 52-year-old female patient with metastatic breast cancer receiving denosumab for 7 years presented with marked diffuse tracer uptake in the mandible on Tc-99m-methylene diphosphonate bone scintigraphy, resembling the Lincoln sign. A diagnosis of medication-related osteonecrosis of the jaw (MRONJ) was confirmed, leading to immediate discontinuation of denosumab. Conservative therapy, including limited debridement and oral rinses, was initiated. MRONJ, a potential complication of bone-modifying agents, is more prevalent in advanced malignancy cases. The Lincoln sign has not been previously reported in MRONJ, emphasizing its consideration in cancer patients undergoing bone-modifying agent treatment.

Vertical is Beneficial but volume is Irrelevant: Optimization of urban guide signs based on spatial representation of road networks.

Urban guide signs, a fundamental component of traffic sign systems, convey both directional and locational information. Previous studies mainly focused on the font or volume of information, while little attention was paid to the layout of text-based Chinese guide signs, which is an unregulated area but crucial in practical applications and related to people's travel safety. This study investigates the impact of text layout and information volume on the spatial representation of road networks through two experimental studies, examining the effects of different designs on path determination and global road network knowledge. The results indicate that the text layout of urban road guide signs significantly influences the formation of spatial representation of the road network. Specifically, vertical guide signs displaying road names on both sides proved more effective than horizontal ones. While the volume of road name information does not markedly affect the formation of spatial representation, the arrangement of road names does influence the determination of information volume, with vertical layouts facilitating the presentation of more information. It is anticipated that these design recommendations for road signs can effectively mitigate the incidence of road traffic accidents.

A lightweight network architecture for traffic sign recognition based on enhanced LeNet-5 network.

As an important part of the unmanned driving system, the detection and recognition of traffic sign need to have the characteristics of excellent recognition accuracy, fast execution speed and easy deployment. Researchers have applied the techniques of machine learning, deep learning and image processing to traffic sign recognition successfully. Considering the hardware conditions of the terminal equipment in the unmanned driving system, in this research work, the goal was to achieve a convolutional neural network (CNN) architecture that is lightweight and easily implemented for an embedded application and with excellent recognition accuracy and execution speed. As a classical CNN architecture, LeNet-5 network model was chosen to be improved, including image preprocessing, improving spatial pool convolutional neural network, optimizing neurons, optimizing activation function, etc. The test experiment of the improved network architecture was carried out on German Traffic Sign Recognition Benchmark (GTSRB) database. The experimental results show that the improved network architecture can obtain higher recognition accuracy in a short interference time, and the algorithm loss is significantly reduced with the progress of training. At the same time, compared with other lightweight network models, this network architecture gives a good recognition result, with a recognition accuracy of 97.53%. The network structure is simple, the algorithm complexity is low, and it is suitable for all kinds of terminal equipment, which can have a wider application in unmanned driving system.

Intelligent real-life key-pixel image detection system for early Arabic sign language learners.

Lack of an effective early sign language learning framework for a hard-of-hearing population can have traumatic consequences, causing social isolation and unfair treatment in workplaces. Alphabet and digit detection methods have been the basic framework for early sign language learning but are restricted by performance and accuracy, making it difficult to detect signs in real life. This article proposes an improved sign language detection method for early sign language learners based on the You Only Look Once version 8.0 (YOLOv8) algorithm, referred to as the intelligent sign language detection system (iSDS), which exploits the power of deep learning to detect sign language-distinct features. The iSDS method could overcome the false positive rates and improve the accuracy as well as the speed of sign language detection. The proposed iSDS framework for early sign language learners consists of three basic steps: (i) image pixel processing to extract features that are underrepresented in the frame, (ii) inter-dependence pixel-based feature extraction using YOLOv8, (iii) web-based signer independence validation. The proposed iSDS enables faster response times and reduces misinterpretation and inference delay time. The iSDS achieved state-of-the-art performance of over 97% for precision, recall, and F1-score with the best mAP of 87%. The proposed iSDS method has several potential applications, including continuous sign language detection systems and intelligent web-based sign recognition systems.

Cerebellar form of multiple system atrophy: A case report.

Multiple system atrophy is a form of synucleinopathy with an unknown etiology that causes progressive neurodegeneration. It may affect the cerebellum, autonomic nerves, and pyramidal and extrapyramidal systems. We present the case of a 51-year-old man who was hospitalized for recurrent balance problems and dizziness. Cranial magnetic resonance imaging showed the "hot cross bun" sign of the pons with major atrophy of the cerebellum. The cerebellar form of probable multiple system atrophy was the final diagnosis.

Teaching an Infant to Request Help.

Teaching an infant manual signs is beneficial as it promotes early communication, improves socialization, and can functionally replace behaviors such as crying and whining. Improving early communication also may reduce the probability of an infant engaging in dangerous behavior, like unsafe climbing. The purpose of this study was to extend Thompson et al. (Journal of Applied Behavior Analysis 40:15-23, 2007) by teaching an 8-month-old infant, who was noted to display developmental delays, to sign for "help" when preferred items were inaccessible. Similar to Thompson et al., delayed prompting and differential reinforcement was efficacious in teaching the infant to sign for "help," and the skill generalized to situations that were previously associated with unsafe climbing. However, undesirable generalization of signs for "help" when the infant could independently access the items was observed. Additional teaching was necessary to ensure signing for "help" occurred under appropriate antecedent control. Supplementary Information: The online version contains supplementary material available at 10.1007/s40616-023-00198-9.

Unusual Presentation of De Winter's Sign Due to Bezold-Jarisch Reflex in a Patient With Severe Aortic Valve Stenosis.

The de Winter electrocardiogram (ECG) pattern, marked by upsloping ST depression in leads V2-V6, ST elevation in lead aVR, and tall symmetric T waves, typically indicates left anterior descending artery (LAD) occlusion. Traditionally linked to LAD occlusion, it is rare in severe aortic stenosis and the Bezold-Jarisch reflex (BJR). We report an 83-year-old man with severe aortic stenosis who developed hypotension due to bleeding and exhibited the de Winter ECG pattern. This case highlights how severe aortic stenosis and BJR can lead to significant hemodynamic instability and ischemic ECG changes, resolving after hemodynamic stabilization.

Operative treatment of isolated epiphyseal fracture of the distal fibula: 1 case report and literature review.

Pediatric ankle injuries are common; ankle epiphyseal fractures are also common in children. But isolated distal epiphyseal fibular fractures of the distal fibula are clinically rare. We describe one unusual case of an adolescent with a completely displaced Salter-Harris type II distal fibular epiphyseal fracture. The attempt of closed reduction failed, and the patient required open reduction and internal fixation. The localized periosteum and the superior peroneal retinaculum were avulsed from the distal fibular metaphysis, with the peroneal tendons underneath exposed but no obvious subluxation. To the best of our knowledge, this combination of injuries has not been previously reported.

Functional Language in Children from a Public Cochlear Implant Program in a Developing Country.

Introduction The World Health Organization (WHO) estimates that ∼ 32 million children worldwide are affected by hearing loss (HL). Cochlear implant is the first-line treatment for severe to profound sensorineural HL. It is considered one of the most successful prostheses developed to date. Objective To evaluate the oral language development of pediatric patients with prelingual deafness implanted in a reference hospital for the treatment of HL in southern Brazil. Methods We conducted a retrospective cohort study with a review of medical records of patients undergoing cochlear implant surgery between January 2009 and December 2018. Language development was assessed by reviewing consultations with speech therapy professionals from the cochlear implant group. Results A total of 152 children were included in the study. The mean age at cochlear implant surgery was of 41 months (standard deviation [SD]: ± 15). The patients were divided into six groups considering the type of language most used in their daily lives. We found that 36% of children use oral language as their primary form of communication. In a subanalysis, we observed that patients with developed or developing oral language had undergone cochlear implant surgery earlier than patients using Brazilian Sign Language (Língua Brasileira de Sinais, LIBRAS, in Portuguese) or those without developed language. Conclusion The cochlear implant is a state-of-the-art technology that enables the re-establishment of the sense of hearing and the development of oral language. However, language development is a complex process known to present a critical period to properly occur. We still see many patients receiving late diagnosis and treatment, which implies a delay and, often, the impossibility of developing oral communication. Level of Evidence Level 3 (cohort study).

Super T2-FLAIR mismatch sign: a prognostic imaging biomarker for non-enhancing astrocytoma, IDH-mutant.

PURPOSE: The T2-FLAIR mismatch sign is a highly specific diagnostic imaging biomarker for astrocytoma, IDH-mutant. However, a definitive prognostic imaging biomarker has yet to be identified. This study investigated imaging prognostic markers, specifically analyzing T2-weighted and FLAIR images of this tumor. METHODS: We retrospectively analyzed 31 cases of non-enhancing astrocytoma, IDH-mutant treated at our institution, and 30 cases from The Cancer Genome Atlas (TCGA)/The Cancer Imaging Archive (TCIA). We defined "super T2-FLAIR mismatch sign" as having a significantly strong low signal comparable to cerebrospinal fluid at non-cystic lesions rather than just a pale FLAIR low-signal tumor lesion as in conventional T2-FLAIR mismatch sign. Cysts were defined as having a round or oval shape and were excluded from the criteria for the super T2-FLAIR mismatch sign. We evaluated the presence or absence of the T2-FLAIR mismatch sign and super T2-FLAIR mismatch sign using preoperative MRI and analyzed the progression-free survival (PFS) and overall survival (OS) by log-rank test. RESULTS: The T2-FLAIR mismatch sign was present in 17 cases (55%) in our institution and 9 cases (30%) within the TCGA-LGG dataset without any correlation with PFS or OS. However, the super T2-FLAIR mismatch sign was detected in 8 cases (26%) at our institution and 13 cases (43%) in the TCGA-LGG dataset. At our institution, patients displaying the super T2-FLAIR mismatch sign showed significantly extended PFS (122.7 vs. 35.9 months, p = 0.0491) and OS (not reached vs. 116.7 months, p = 0.0232). Similarly, in the TCGA-LGG dataset, those with the super T2-FLAIR mismatch sign exhibited notably longer OS (not reached vs. 44.0 months, p = 0.0177). CONCLUSION: The super T2-FLAIR mismatch is a promising prognostic imaging biomarker for non-enhancing astrocytoma, IDH-mutant.

An approach designed to fail deaf children and their parents and how to change it.

The matter of raising and educating deaf children has been caught up in percepts of development that are persistently inaccurate and at odds with scientific research. These percepts have negatively impacted the health and quality of life of deaf children and deaf people in general. The all too prevalent advice is to raise the child strictly orally and wait to see what happens. Only when the child is seriously behind is a completely accessible language - a sign language - introduced, and that is far too late for protecting cognitive health. The medical profession, along with others, needs to offer parents better advice and better supports so that neither the children nor their parents wait and watch as the oral-only method fails. All must take responsible action to assure an approach that succeeds.

Leakage sign is a reliable predictor of hematoma expansion in acute epidural hematoma.

BACKGROUND: Hematoma expansion in small/medium-sized acute epidural hematoma (AEDH) cases upon emergency admission is critical. Predicting hematoma expansion can lead to early surgical interventions, improving outcomes and eliminating the need to check for expansion via computed tomography (CT). This study aimed to identify the most reliable predictors of AEDH expansion. METHODS: We retrospectively collected data from patients with pure AEDH not requiring surgical treatment upon emergency admission from 2012-2022. We assessed clinical and laboratory data, time from injury to the first CT, and time to follow-up CT. Factors predictive of hematoma expansion on the second follow-up CT, including the leakage sign (LS), were analyzed. RESULTS: A total of 23 patients with pure AEDH without surgery at admission were included, and LS was positive in 18. Thirteen patients showed hematoma expansion. The hematoma expansion group showed a significantly higher rate of positive LS and lower mean platelet count than the group without hematoma expansion. LS's predictive value for AEDH expansion showed 100% sensitivity and 50% specificity. All patients with negative LS and normal platelet counts showed no hematoma expansion. Analyzing the time from injury to the first CT suggested that LS (+) within 120 min strongly predicted hematoma expansion. Reconstructed three-dimensional images of the leakage point on the skull revealed multiple mottled bleeding points on the dural surface. CONCLUSION: LS can predict hematoma expansion in patients with pure AEDH for whom emergency surgery is unnecessary at admission. The time from injury and platelet counts must also be considered.

Ultrasonography of the Superficial Temporal and Axillary Arteries in Giant Cell Arteritis diagnosis.

OBJECTIVES: Giant cell arteritis (GCA) is the main systemic vasculitis in individuals aged ≥ 50 years. Color Doppler ultrasound (CDS) has an established role in GCA diagnosis and management. This study aims to assess the clinical characteristics associated with a positive CDS evaluation and the impact of additional axillary artery examination on diagnostic sensitivity. MATERIAL AND METHODS: We conducted a retrospective analysis of patients undergoing CDS of the superficial temporal arteries, with or without axillary artery assessment, at our hospital, between 2009 and 2023. Patients meeting the new 2022 diagnostic criteria for GCA were included and their characteristics were analyzed according to the presence of the halo sign on CDS. RESULTS: Of the 135 included patients (54% female, mean age 75±8 years), the halo sign was observed in 57%, correlating with higher systemic symptom prevalence (61% vs 42%, p=0.035), lower hemoglobin (p<0.001), and higher erythrocyte sedimentation rate (p=0.028). The halo sign inversely related to prior corticosteroid therapy (p=0.033). Patients with axillary halo sign had fewer external carotid symptoms and a higher vertebral halo sign prevalence. Vertebral halo sign was associated with posterior circulation ischemic stroke (65%, p < 0.001). Axillary artery studies improved diagnostic sensitivity by 9%. CONCLUSION: In our study, the halo sign correlated with higher systemic symptoms and analytical abnormalities. Axillary artery examination enhanced CDS sensitivity, linked to severe outcomes like stroke. Prior corticosteroid therapy reduced CDS sensitivity. The correlation of clinical, laboratory, and ultrasound findings provides a more comprehensive understanding of GCA pathogenesis and evolution.

Outdoor noncontact respiratory measurements of unrestricted rhesus macaques (Macaca mulatta) using millimeter-wave radar.

Respiration is an invaluable signal that facilitates the real-time observation of physiological dynamics. In recent years, the advancement of noncontact measurement technology has gained momentum in capturing physiological activities in natural settings. This technology is anticipated to be found not only in humans but also in nonhuman primates. Currently, the predominant noncontact approach for nonhuman animals involves measuring vital signs through subtle variations in skin color. However, this approach is limited when addressing areas of the body covered with hair or when working in outdoor settings under fluctuating sunlight. To overcome this issue, we focused on noncontact respiratory measurements using millimeter-wave radar. Millimeter-wave radar systems, which employ millimeter waves that can penetrate animal fur and estimate respiration-derived periodic body motion, exhibit minimal susceptibility to sunlight interference. Thus, this method shows potential for conducting noncontact vital measurements in natural and outdoor settings. In this study, we validated a millimeter-wave radar methodology for capturing respiration in outdoor-housed rhesus macaques (Macaca mulatta). The radar was positioned beyond the captive enclosure and maintained at a distance >5 m from the target. Millimeter waves were transmitted to the target, and the reflected waves were used to estimate skin surface displacement associated with respiration. The results revealed periodic skin surface displacement, and the estimated respiratory rates weres within the reported range of respiratory rates for rhesus macaques. These results suggest the potential applicability of millimeter-wave radar for noncontact respiration monitoring in outdoor-living macaques without anesthesia or immobilization. The continued advancement of noncontact vital measurement technology will contribute to understanding primate mental and physical dynamics during their daily life.

Imaging of supratentorial ependymomas with radio-pathological correlation.

Aim: Supratentorial ependymoma (STE) is a rare tumor with distinct genetic alterations, whose imaging features have been scarcely studied. This study aims to review the computed tomography (CT) and magnetic resonance imaging (MRI) features of a cohort of histopathologically proven STE to identify the distinguishing features of STE, and look for specific signs of zinc finger translocation associated (ZFTA) fused STEs. Methods: Ethical clearance was obtained from the institutional ethics committee. The magnetic resonance (MR) images, CT images when available, clinical details, and pathological reports of 25 patients from a single institute with histopathologically proven STE were retrospectively reviewed. Imaging features, demographic details, pathological and molecular features, and type of surgical resection were described and tabulated. Relevant associations with imaging features were computed and tabulated. Results: The study showed that STEs are common in the pediatric population with no sex predilection. The periventricular location was the most common. A significant association between periventricular location and the presence of a cystic component (P value = 0.023) and the presence of the periwinkle sign/stellate sign (P value = 0.045) was found. Common features of ZFTA fused STEs included periventricular or intraventricular location, cystic component, necrosis, and the periwinkle sign. A significant association was found between ZFTA fusion and cystic component (P value = 0.048). Conclusions: This study attempts to identify the imaging features of STEs and their associations with molecular pathology and surgical outcome, and the distinguishing features of ZFTA fused STEs.

Lemmel Syndrome: Unveiling the Underrecognized Pancreatobiliary Diagnosis, Management Strategies, and Future Directions.

Lemmel syndrome, a rare condition, is characterized by biliary obstruction caused by a periampullary diverticulum (a pouch-like outgrowth of the duodenum near the ampulla of Vater). In our case, a 76-year-old male patient presented with epigastric pain and exhibited a cholestatic pattern on liver function tests. Imaging revealed dilated pancreatic and common bile ducts due to compression by a periampullary diverticulum (double duct sign: simultaneous dilation of the common bile duct and pancreatic duct). Upper endoscopy showed one medium-sized periampullary diverticulum. This case emphasizes the diagnostic process and the importance of considering Lemmel syndrome in differential diagnosis in elderly patients with biliary obstruction. We discuss the prevalence, diagnostic considerations, including imaging modalities, and treatment options, emphasizing the need for further research.

Scalp vein sign caused by intracranial dural arteriovenous fistula.

A 68-year-old man presented with a headache that had started 1 month earlier. The scalp vein dilatation was observed at presentation. The findings of computed tomography and magnetic resonance imaging raised suspicion of a dural arteriovenous fistula, leading to the definitive diagnosis by digital subtraction angiography. Scalp vein signs can be a useful clue to suspect intracranial abnormalities, including dural arteriovenous fistula.

Small Bowel Obstruction Associated With Ureterocutaneous Fistula After a Radical Cystectomy: A Case Report.

This is a case report of a man in his 60s who was diagnosed with a small bowel obstruction due to an internal hernia caused by a ureterocutaneous fistula. Internal hernia caused by the ureter following urinary diversion is rare, posing challenges in preoperative diagnosis and carrying the risk of intraoperative injury due to the resemblance of a ureterocutaneous fistula to an adhesive band. The presentation and surgical management are discussed in this case report.

A machine learning-driven web application for sign language learning.

Addressing the increasing demand for accessible sign language learning tools, this paper introduces an innovative Machine Learning-Driven Web Application dedicated to Sign Language Learning. This web application represents a significant advancement in sign language education. Unlike traditional approaches, the application's unique methodology involves assigning users different words to spell. Users are tasked with signing each letter of the word, earning a point upon correctly signing the entire word. The paper delves into the development, features, and the machine learning framework underlying the application. Developed using HTML, CSS, JavaScript, and Flask, the web application seamlessly accesses the user's webcam for a live video feed, displaying the model's predictions on-screen to facilitate interactive practice sessions. The primary aim is to provide a learning platform for those who are not familiar with sign language, offering them the opportunity to acquire this essential skill and fostering inclusivity in the digital age.