Delayed interval delivery and survivability of the second twin with and without emergency cerclage in dichorionic diamniotic pregnancy. A systematic review.

BACKGROUND: There are no systematic reviews analyzing cervical cerclage's role in improving the perinatal outcome of the second twin in dichorionic diamniotic (DCDA) pregnancies following a second trimester or very early preterm birth of the first twin. OBJECTIVE: The primary objective of this systematic review was to evaluate the effect of rescue cervical cerclage on delaying the delivery of the second twin after the delivery of the first twin in DCDA twin pregnancies. The secondary objective was to analyze the effect of rescue cervical cerclage on the perinatal outcome of the second twin in DCDA pregnancies compared to the non-cerclage group. METHODS: A literature search was performed using PubMed, Medline databases, and the Cochrane Library. The studies selected were limited to human subjects and published online by December 2023. Two sets of results in this systematic review are described; the first set includes the outcomes of pregnancies with a DCDA twin pregnancy from the cohort of case series. The meta-analysis was performed for the cohort, and a combined narrative report was provided for the second set of results for the case reports. RESULTS: A literature search resulted in 27 case series and 36 case reports. The case series analysis demonstrated that the mean gestation age of twin 2 at delivery with cervical cerclage (27.5 weeks) compared to those without cervical cerclage (24.4 weeks) was statistically significant (p < 0.001). Furthermore, analysis of the case series showed that twin 2 with cerclage had a statistically significant increase in latency period (days 44.7 vs 23.67) and birth weight (grams 3320 vs 2460) compared to the group without cerclage (p = -value was 0.001 and 0.01, respectively). It is difficult to draw any significant conclusion with complications of cervical cerclage; however, there were slightly more chorioamnionitis and respiratory distress syndrome in the cerclage group. The case report analysis showed no significant difference with or without cervical cerclage. CONCLUSIONS: From this review, it can be concluded that in DCDA twin pregnancies, cervical cerclage insertion after the extremely premature delivery or miscarriage of twin 1 may increase the gestational age at delivery, prolong the delivery interval, and increase the birth weight of twin 2. However, a large prospective multicenter randomized control trial should be performed to assess the benefit of cervical cerclage in DCDA twins to improve the delivery interval latency period and perinatal outcome of twin 2 after the delivery of twin 1.

Electron transfer enhanced catalytic activity of nitrogen doped reduced graphene oxide supported CuCo2O4 towards the fast reduction of 4-nitrophenol in water.

There has been a growing interest in the design and development of graphene based composite materials with superior performances for environmental catalytic applications. But in most of the studies the synthesis conditions require elevated temperatures and expensive working setups (high temperature furnaces, autoclaves, inert atmosphere conditions etc.). In this reported work, the nitrogen doped reduced graphene oxide supported CuCo2O4 (NG/CuCo2O4) composites were prepared through a simple one pot synthesis method under mild conditions (∼95 °C and air atmosphere) and successfully employed as catalysts for the reduction of toxic 4-nitrophenol (4NP). The characterization results revealed the successful formation of NG/CuCo2O4 composites with a possible charge transfer interaction between nitrogen doped reduced graphene oxide support of CuCo2O4. The NG/CuCo2O4 hybrids exhibited robust catalytic activity in 4NP reduction with an activity factor of 261.5 min-1 g-1. A 4NP conversion percentage which is as high as 99.5% was achieved within 11 min using the NG/CuCo2O4 catalyst. The detailed kinetic analysis confirmed the Langmuir-Hinshelwood model for the NG/CuCo2O4 catalysed 4NP reduction. The nitrogen doped reduced graphene oxide support modified the electronic levels of CuCo2O4 nanoparticles through electron transfer interactions and enhanced the catalytic activity of CuCo2O4 in NG/CuCo2O4 through improved adsorption of reactant ions and effective generation of active hydrogen species. The good reusability and stability along with profound activity of NG/CuCo2O4 catalyst makes it a promising material for wide scale catalytic applications.

A Meta-Analysis of the Global Stillbirth Rates during the COVID-19 Pandemic.

COVID-19 has been shown to have variable adverse effects on pregnancy. Reported data on stillbirth rates during the pandemic have, however, been inconsistent-some reporting a rise and others no change. Knowing the precise impact of COVID-19 on stillbirths should help with the planning and delivery of antenatal care. Our aim was, therefore, to undertake a meta-analysis to determine the impact of COVID-19 on the stillbirth rate. Databases searched included PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and Web of Science, with no language restriction. Publications with stillbirth data on women with COVID-19, comparing stillbirth rates in COVID-19 and non-COVID-19 women, as well as comparisons before and during the pandemic, were included. Two independent reviewers extracted data separately and then compared them to ensure the accuracy of extraction and synthesis. Where data were incomplete, authors were contacted for additional information, which was included if provided. The main outcome measures were (1) stillbirth (SB) rate in pregnant women with COVID-19, (2) stillbirth rates in pregnant women with and without COVID-19 during the same period, and (3) population stillbirth rates in pre-pandemic and pandemic periods. A total of 29 studies were included in the meta-analysis; from 17 of these, the SB rate was 7 per 1000 in women with COVID-19. This rate was much higher (34/1000) in low- and middle-income countries. The odds ratio of stillbirth in COVID-19 compared to non-COVID-19 pregnant women was 1.89. However, there was no significant difference in population SB between the pre-pandemic and pandemic periods. Stillbirths are an ongoing global concern, and there is evidence that the rate has increased during the COVID-19 pandemic, but mostly in low- and middle-income countries. A major factor for this is possibly access to healthcare during the pandemic. Attention should be focused on education and the provision of high-quality maternity care, such as face-to-face consultation (taking all the preventative precautions) or remote appointments where appropriate.

mmWave Zero Order Resonant Antenna with Patch-Like Radiation Fed by a Butler Matrix for Passive Beamforming.

A small zero-order resonant antenna based on the composite right-left-handed (CRLH) principle is designed and fabricated without metallic vias at 30 GHz to have patch-like radiation. The mirror images of two CRLH structures are connected to design the antenna without via holes. The equivalent circuit, parameter extraction, and dispersion diagram are studied to analyze the characteristics of the CRLH antenna. The antenna was fabricated and experimentally verified. The measured realized gain of the antenna is 5.35 dBi at 30 GHz. The designed antenna is free of spurious resonance over a band width of 10 GHz. A passive beamforming array is designed using the proposed CRLH antenna and the Butler matrix. A substrate integrated waveguide is used to implement the Butler matrix. The CRLH antennas are connected to four outputs of a 4×4 Butler matrix. The scanning angles are 12∘, -68∘, 64∘, and -11∘ for excitations from port 1 to port 4 of the 4×4 Butler matrix feeding the CRLH antenna.

Managing Labour in Women with COVID-19.

Since first reported in December 2019 in Wuhan, China, COVID-19 caused by Severe Acute Respiratory Syndrome (SARS) Corona virus2 (SARS CoV-2) quickly spread to become a pandemic that has caused significant morbidity and mortality. The rapidity of the spread of the virus and the high mortality at the outset threatened to overwhelm health systems worldwide, and, indeed, this significantly impacted maternal health, especially since there was minimal experience to draw from. Experience with Covid 19 has grown exponentially as the unique needs of pregnant and labouring women with COVID-19 infection have become more evident. Managing COVID-19 parturients requires a multidisciplinary team consisting of anaesthesiologists, obstetricians, neonatologists, nursing staff, critical care staff, infectious disease and infection control experts. There should be a clear policy on triaging patients depending on the severity of their condition and the stage of labour. Those at high risk of respiratory failure should be managed in a tertiary referral centre with facilities for intensive care and assisted respiration. Staff and patients in delivery suites and operating rooms should be protected by enforcing infection protection principles such as offering dedicated rooms and theatres to SARS CoV-2 positive patients and using personal protective equipment. All hospital staff must be trained in infection control measures which should be updated regularly. Breastfeeding and care of the new-born must be part of the healthcare package offered to COVID-19 parturient mothers.

Machine Learning Models for Enhanced Estimation of Soil Moisture Using Wideband Radar Sensor.

In this paper, machine learning models for an effective estimation of soil moisture content using a microwave short-range and wideband radar sensor are proposed. The soil moisture is measured as the volumetric water content using a short-range off-the-shelf radar sensor operating at 3-10 GHz. The radar captures the reflected signals that are post processed to determine the soil moisture which is mapped to the input features extracted from the reflected signals for the training of the machine learning models. In addition, the results are compared and analyzed with a contact-based Vernier soil sensor. Different machine learning models trained using neural network, support vector machine, linear regression and k-nearest neighbor are evaluated and presented in this work. The efficiency of the model is computed using root mean square error, co-efficient of determination and mean absolute error. The RMSE and MAE values of KNN, SVM and Linear Regression are 11.51 and 9.27, 15.20 and 12.74, 3.94 and 3.54, respectively. It is observed that the neural network gives the best results with an R2 value of 0.9894. This research work has been carried out with an intention to develop cost-effective solutions for common users such as agriculturists to monitor the soil moisture conditions with improved accuracy.

mm-Wave Radar-Based Vital Signs Monitoring and Arrhythmia Detection Using Machine Learning.

A non-contact, non-invasive monitoring system to measure and estimate the heart and breathing rate of humans using a frequency-modulated continuous wave (FMCW) mm-wave radar at 77 GHz is presented. A novel diagnostic system is proposed which extracts heartbeat phase signals from the FMCW radar (reconstructed using Fourier series analysis) to test a three-layer artificial neural network model to predict the presence of arrhythmia in individuals. The effect of person orientation, distance of measurement and movement was analyzed with respect to a reference device based on statistical measures that include number of outliers, mean, mean squared error (MSE), mean absolute error (MAE), median absolute error (medAE), skewness, standard deviation (SD) and R-squared values. The individual oriented in front of the radar outperformed almost all other orientations for most distances with an expected d = 90 cm and d = 120 cm. Furthermore, it was found that the heart rate that was measured while walking and the breathing rate which was measured for a motionless individual generated results with the lowest SD and MSE. An artificial neural network (ANN) was trained using the MIT-BIH database with a training accuracy of 93.9 % and an R2 value = 0.876. The diagnostic tool was tested on 15 subjects and achieved a mean test accuracy of 75%.

Objective features of sedentary time and light activity differentiate people with low back pain from healthy controls: a pilot study.

BACKGROUND CONTEXT: Physical inactivity has been described as both a cause and a consequence of low back pain (LBP) largely based on self-reported measures of daily activity. A better understanding of the connections between routine physical activity and LBP may improve LBP interventions. PURPOSE: In this study, we aim to objectively characterize the free-living physical activity of people with low back pain in comparison to healthy controls using accelerometers, and we aim to derive a set of LBP-specific physical activity minutes thresholds that may be used as targets for future physical activity interventions. STUDY DESIGN: Cross-sectional. PATIENT SAMPLE: A total of 22 low back pain patients and 155 controls. OUTCOME MEASURES: Accelerometry derived physical activity measures. METHODS: Twenty-two people with LBP were compared to 155 age and gender-matched healthy controls. All subjects wore an ActiGraph accelerometer on the right hip for 7 consecutive days. Accelerometry-based physical activity features (count-per-minute CPM) were derived using Freedson's intervals and physical performance intervals. A random forest machine learning classifier was trained to classify LBP status using a leave-one-out cross-validation procedure. An interpretation algorithm, the SHapley Additive exPlanations (SHAP) algorithm was subsequently applied to assess the feature importance and to establish LBP-specific physical activity thresholds. RESULTS: The LBP group reported mild to moderate disability (average ODI=18.5). The random forest classifier identified a set of 8 features (digital biomarkers) that achieved 88.1% accuracy for distinguishing LBP from controls. All of the top distinguishing features were related to differences in the sedentary and light activity ranges (<800 CPM), whereas moderate to vigorous physical activity was not discriminative. In addition, we identified and ranked physical activity thresholds that are associated with LBP prediction that can be used in future studies of physical activity interventions for LBP. CONCLUSIONS: We describe a set of physical activity features from accelerometry data associated with LBP. All of the discriminating features were derived from the sedentary and light activity range. We also identified specific activity intensity minutes thresholds that distinguished LBP subjects from healthy controls. Future examination on the digital markers and thresholds identified through this work can be used to improve physical activity interventions for LBP treatment and prevention by allowing the development of LBP-specific physical activity guidelines.

Pangolin-Inspired Stretchable, Microwave-Invisible Metascale.

Microwave-invisible devices are emerging as a valuable technology in various applications, including soft robotics, shape-morphing structures, and textural camouflages, especially in electronic countermeasures. Unfortunately, conventional microwave-absorbing metastructures and bulk absorbers are stretching confined, limiting their application in deformable or special-shaped targets. To overcome such limitations, a conceptually novel soft-rigid-connection strategy, inspired by the pangolin, is proposed. Pangolin-inspired metascale (PIMS), which is a kind of stretchable metamaterial consisting of an electromagnetic dissipative scale (EMD-scale) and elastomer, is rationally designed. Such a device exhibits robust microwave-absorbing capacity under the interference of 50% stretching. Besides, profiting from the covering effect and size-confined effect of EMD-scale, the out-of-plane indentation failure force of PIMS is at least 5 times larger than conventional device. As a proof of concept, the proposed device is conformally pasted on nondevelopable surfaces. For a spherical dome surface, the maximum radar cross-section (RCS) reduction of PIMS is 6.3 dB larger than that of a conventional device, while for a saddle surface, the bandwidth of 10 dB RCS reduction exhibits an increase of 83%. In short, this work provides a conceptually novel platform to develop stretchable, nondevelopable surface conformable functional devices.

Optimized Aluminum Reflector for Enhancement of UVC Cathodoluminescence Based-AlGaN Materials with Carbon Nanotube Field Emitters.

The far ultraviolet C (UVC) light sources based on carbon nanotube (CNT) field emitters as excitation sources have become promising light sources for sterilization, disinfection, and water purification. However, the low light extraction efficiency of UVC-CNT light sources still hinders the practical application of these structures. Herein, we report an optimized aluminum (Al) reflector to enhance the light extraction efficiency of UVC-CNT light sources. Optical analysis of UVC-CNT light sources covered by the Al reflectors with various thicknesses ranging from 30 to 150 nm was performed to realize the optimized reflector. The UVC-CNT light sources exhibit the highest light extraction efficiency when the Al reflector layer has an optimized thickness of 100 nm. For comparison, the cathodoluminescence (CL) spectra were recorded for UVC-CNT light sources with and without the optimized Al reflector. The measured light output power and the estimated power efficiency of the UVC-CNT light-source-tube with Al reflector were enhanced by about 27 times over the reference. This enhancement is mainly attributed to the outstanding reflection effect of the Al reflector.

Ebola infection in pregnancy, an ongoing challenge for both the global health expert and the pregnant woman-A review.

A new Ebola outbreak is currently ongoing in the Democratic Republic of Congo, after the most severe outbreak in West Africa in 2014-2016 was controlled. Ebola outbreaks are usually a significant cause of death among pregnant women. The clinical presentation of Ebola Virus infection in pregnancy often mimics common pregnancy related bleeding complications or febrile conditions common in pregnancy. The large amount of body fluids discharged during the management of these conditions make pregnancy a highly risky intervention for nosocomial infection transmission, especially to health workers. In this review, we discuss the Ebola virus, its pathogenesis, clinical features, diagnosis and the current supportive intensive medical and obstetric- specific practices to ensure safe management of Ebola positive pregnant women. We present how Ebola may be managed in highly resourced settings where experience is limited in the management of pregnancy complicated by Ebola infection and how wherever these patients are managed, postpartum contraceptive support is necessary because of lingering concerns about sexual transmission. Wider issues highlighted by the Ebola outbreaks included the demonstration of how weak health systems from prolonged lack of investment, in the face of highly infectious diseases like Ebola Virus infection, can pose a risk to the global community, bringing sharply into focus the need for essential collaboration between national health departments and international health organizations such as the World Health Organization.

Electronic intrapartum fetal monitoring: a systematic review of international clinical practice guidelines.

BACKGROUND: Electronic fetal monitoring or fetal assessment using a cardiotocograph is currently the most commonly employed tool for intrapartum surveillance. Furthermore, there are numerous guidelines informing best practice worldwide. OBJECTIVE: This systematic review aimed to compare and appraise all available practice guidelines on intrapartum electronic fetal monitoring to describe the similarities and variations in recommendations. STUDY DESIGN: A systematic protocol was developed per Preferred Reporting Item for Systematic Review and Meta-Analysis Protocols. A total of 4 independent reviewers were involved with independent searches and quality assessment using the Appraisal of Guidelines for Research and Evaluation Instrument for guideline quality reporting. RESULTS: Overall, 7 international practice guidelines were included in this systematic review. Appraisal of Guidelines for Research and Evaluation Instrument showed higher scores for scope and purpose and for clarity of presentation; however, the overall assessment varied between 25% and 89%. When individual characteristics of electronic fetal monitoring or cardiotocograph were compared, all guidelines and guidance were essentially trying to describe the characters similarly, with critical differences described in the full article. CONCLUSION: In the context of globalization, a uniform approach for defining terminology, classifying characters and similar interpretation of results is needed for electronic fetal monitoring. Therefore, we should consider a unified, simple, logistically approved, and acceptable guideline, which is probably accepted worldwide.

A meta-analysis of the prevalence of gestational diabetes in patients diagnosed with obstetrical cholestasis.

BACKGROUND: Gestational diabetes and obstetrical cholestasis are common clinical conditions seen in clinical practice. There is evidence suggesting a coexisting relationship that could have a potential clinical implication related to stillbirth outcomes. OBJECTIVE: This study aimed to determine the prevalence of gestational diabetes in women with obstetrical cholestasis. STUDY DESIGN: A predefined protocol with a literature search was used to obtain all possible articles. A systematic review and meta-analysis of observational studies with quantifiable data published since 2010 were performed. Articles were evaluated and included in the study with specified criteria for the risk of bias using the Newcastle-Ottawa Scale. A meta-analysis was performed using Meta-analysis of Observational Studies in Epidemiology specifications to determine the prevalence of gestational diabetes in women with obstetrical cholestasis. RESULTS: A total of 16,748 patients with obstetrical cholestasis from 21 studies were included. The prevalence of gestational diabetes in women with obstetrical cholestasis was 13.9% (20 studies analyzed). Gestational diabetes was more common in women with obstetrical cholestasis than in women without obstetrical cholestasis (odds ratio, 2.129; 95% confidence interval, 1.697-2.670;10 studies). Gestational diabetes is twice more common in women with severe cholestasis than in women with mild cholestasis (odds ratio, 2.168; 95% confidence interval, 1.429-3.289; 4 studies). CONCLUSION: There is an increase in the prevalence of gestational diabetes among women diagnosed with obstetrical cholestasis. Compared with women with mild cholestasis, the increased risk of gestational diabetes in women with severe cholestatis is more than doubled. This suggests that the 2 conditions may have some biological similarities that affect clinical outcomes.

Anaphylaxis to Pfizer/BioNTech mRNA COVID-19 Vaccine in a Patient With Clinically Confirmed PEG Allergy.

Although allergic responses to the mRNA COVID-19 vaccines are rare, recent reports have suggested that a small number of individuals with allergy to polyethylene glycol (PEG), a component of the mRNA lipid nanoshell, may be at increased risk of anaphylaxis following vaccination. In this report, we describe a case of a patient who received an mRNA COVID-19 vaccine, experienced anaphylaxis, and was subsequently confirmed to have anti-PEG allergy by skin prick testing. The patient had previously noticed urticaria after handling PEG powder for their occupation and had a history of severe allergic response to multiple other allergens. Importantly, as many as 70% of people possess detectable levels of anti-PEG antibodies, indicating that the detection of such antibodies does not imply high risk for an anaphylactic response to vaccination. However, in people with pre-existing anti-PEG antibodies, the administration of PEGylated liposomes may induce higher levels of antibodies, which may cause accelerated clearance of other PEGylated therapeutics a patient may be receiving. It is important to improve awareness of PEG allergy among patients and clinicians.

Bacterial vaginosis in pregnancy - a storm in the cup of tea.

Human vaginal microbiota is dominated by Lactobacillus spp both in the non-pregnant and pregnant state. Bacterial vaginosis (BV) is an imbalance of vaginal microbiota caused by a reduction in the normal lactobacillary bacteria, and a heavy over-growth of mixed anaerobic bacteria. Various clinical (Amsel's Criteria), laboratory (Nugent's score) and molecular diagnostic method (quantitative PCR) are used for diagnosis. BV in pregnancy is associated with increased risk of preterm birth, low birth weight, chorioamnionitis and postpartum endometritis, apart from bothersome vaginal discharge. Antibiotic treatment with metronidazole or clindamycin are effective in eradicating bacterial vaginosis and safe to use in pregnancy. Treatment of bacterial vaginosis has not been shown to improve obstetric outcomes in women at low risk of preterm birth, but may reduce the risk of preterm birth and low birth weight in women at increased risk of preterm birth. Routine screening and treatment is not recommended in low risk women. Test for cure should be performed after treatment. Further research is required on other treatment modalities such as probiotic therapy and microbiota transplantation.

Incidence of Extravascular Perivertebral Artery Contrast Flow During Cervical Transforaminal Epidural Injections.

BACKGROUND: During a cervical transforaminal epidural injection, injectate flows along the path of least resistance. Given the proximity of the vertebral artery to the intervertebral foramen, injected contrast may flow along the external wall of the artery. The incidence of this contrast flow pattern during cervical transforaminal epidural injections is unknown. PURPOSE: To determine the incidence of extravascular perivertebral artery contrast flow patterns during cervical transforaminal epidural injections. STUDY DESIGN/SETTING: Retrospective, observational, in vivo study. PATIENT SAMPLE: Patients receiving cervical transforaminal epidural injections at a single outpatient spine clinic. OUTCOME MEASURES: The presence or absence of extravascular perivertebral artery contrast flow. METHODS: The saved images from 100 consecutive patients were reviewed by two independent observers and classified with or without extravascular perivertebral artery contrast flow. The incidence was determined and kappa was used to examine inter-rater reliability. All disagreements were reviewed, and the final classification was determined by consensus. RESULTS: The inter-rater reliability was moderate, with a kappa value of 0.69. The incidence of extravascular perivertebral artery contrast flow patterns was 49% by consensus. No statistically significant differences in incidence were present when comparing three different final needle tip positions. CONCLUSIONS: During a cervical transforaminal epidural injection, an extravascular perivertebral artery contrast flow pattern is frequently encountered. This includes flow along the exiting nerve and then around the vertebral artery, as suggested by this study. Although this contrast pattern does not represent an intravascular injection into the vertebral artery, practitioners should remain cautious to exclude intravascular needle placement before injecting medication.

Stillbirth and associated perinatal outcomes in obstetric cholestasis: a systematic review and meta-analysis of observational studies.

BACKGROUND: Obstetric cholestasis is a condition occurring in pregnancy with suspected adverse perinatal outcomes. Stillbirth is a significant adverse event associated with obstetric cholestasis and considered for intervention in pregnancy. OBJECTIVES: There are multiple studies with epidemiological data with regards to the outcomes of obstetric cholestasis. Our hypothesis is to the test the association of stillbirth and related outcomes in obstetric cholestasis. SEARCH STRATEGY & SELECTION CRITERIA: Two independent reviewers did independent searches and selection with a standardized design as outlined in the PRISMA statement. ANALYSIS: The retrieved relevant literature was subjected to a rigorous quality assessment and followed by standardized interpretable results. RESULTS: The pooled estimate in this study showed that there was no significant difference in the stillbirth rates in the obstetric (OC) population when compared to the non-obstetric cholestasis (reference) population. However, there was an increased risk of preterm birth in the OC population compared to the reference population; however, the cesarean section and induction of labor results were directly related. DISCUSSION: This study provides an epidemiological data related to the perinatal outcomes associated with obstetric cholestasis, specifically stillbirth. This result is likely to produce a benchmark for current evidence-based practice and to assist future research in understanding the implication of associated stillbirth risk and related outcomes with OC.

The Rehabilitation Research Experience for Medical Students: A 10-Year Review.

The aim of this project was to evaluate the 10-yr outcomes from the Rehabilitation Research Experience for Medical Students. A target benchmark was one high-quality output per student. Students were required to devise a research project and work full time with a mentor at an approved sponsor site for 8 wks. Longitudinal surveys were used to collect data about research outputs, match results, and decisions about whether to pursue academic careers. From 2008 to 2017, 73 (48%) of 153 applicants were awarded summer externships. Residency match results included the following: physical medicine and rehabilitation (45%), internal medicine (17%), emergency medicine (8%), orthopedic surgery (6%), neurology (6%), psychiatry (6%), OBGYN (6%), pediatrics (4%), and anesthesia (2%). The Rehabilitation Research Experience for Medical Students was successful in exceeding the target benchmark for quality scholarly output, which included 73 oral presentations at the Association of Academic Physiatrists meeting, 63 published and 20 in-review articles directly related to summer research, 5 book chapters, and 51 published and 20 in-review articles that were indirectly related to summer research. A total of 77% reported that the Rehabilitation Research Experience for Medical Students positively influenced their decision to pursue research in their future career, and 70% endorsed interest in becoming a clinician scientist.

Antenatal magnesium sulfate for fetal neuroprotection: a critical appraisal and systematic review of clinical practice guidelines.

Background Magnesium sulfate is an accepted intervention for fetal neuroprotection. There are some perceived differences in the international recommendations on the use magnesium sulfate for fetal neuroprotection in preterm labor. Content This systematic review analyses the available clinical guidelines for the use of magnesium sulfate for fetal neuroprotection and compares the recommendations, and assesses the quality of guidelines. This provides the consensus, differences and explores the areas for future collaborative research. We searched databases of PUBMED, EMBASE, COCHRANE, Web of Science, LILACS; and included the national and the international clinical practice guidelines. We included seven guidelines out of 227 search results. We evaluated the methodological quality of guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II) tool and systematically extracted guideline characters, recommendation and supporting evidence base. Summary Five guidelines were of high quality and two were of moderate quality. One guideline achieved more than an 80% score in all the domains of AGREE II tool. All guidelines recommend use of magnesium sulfate for fetal neuroprotection. However, there are differences in other recommendations such as upper gestational age, dose, duration, repeating treatment and use of additional tocolytics. Outlook Future guidelines should include recommendations on all aspects of magnesium sulfate therapy for fetal neuroprotection. Future research and international collaboration should focus on areas where there are no international consensual recommendations.

Clinical Evaluation of a Multiparametric Deep Learning Model for Glioblastoma Segmentation Using Heterogeneous Magnetic Resonance Imaging Data From Clinical Routine.

OBJECTIVES: The aims of this study were, first, to evaluate a deep learning-based, automatic glioblastoma (GB) tumor segmentation algorithm on clinical routine data from multiple centers and compare the results to a ground truth, manual expert segmentation, and second, to evaluate the quality of the segmentation results across heterogeneous acquisition protocols of routinely acquired clinical magnetic resonance imaging (MRI) examinations from multiple centers. MATERIALS AND METHODS: The data consisted of preoperative MRI scans (T1, T2, FLAIR, and contrast-enhanced [CE] T1) of 64 patients with an initial diagnosis of primary GB, which were acquired in 15 institutions with varying protocols. All images underwent preprocessing (coregistration, skull stripping, resampling to isotropic resolution, normalization) and were fed into an independently trained deep learning model based on DeepMedic, a multilayer, multiscale convolutional neural network for detection and segmentation of tumor compartments. Automatic segmentation results for the whole tumor, necrosis, and CE tumor were compared with manual segmentations. RESULTS: Whole tumor and CE tumor compartments were correctly detected in 100% of the cases; necrosis was correctly detected in 91% of the cases. A high segmentation accuracy comparable to interrater variability was achieved for the whole tumor (mean dice similarity coefficient [DSC], 0.86 ± 0.09) and CE tumor (DSC, 0.78 ± 0.15). The DSC for tumor necrosis was 0.62 ± 0.30. We have observed robust segmentation quality over heterogeneous image acquisition protocols, for example, there were no correlations between resolution and segmentation accuracy of the single tumor compartments. Furthermore, no relevant correlation was found between quality of automatic segmentation and volume of interest properties (surface-to-volume ratio and volume). CONCLUSIONS: The proposed approach for automatic segmentation of GB proved to be robust on routine clinical data and showed on all tumor compartments a high automatic detection rate and a high accuracy, comparable to interrater variability. Further work on improvements of the segmentation accuracy for the necrosis compartments should be guided by the evaluation of the clinical relevance.Therefore, we propose this approach as a suitable building block for automatic tumor segmentation to support radiologists or neurosurgeons in the preoperative reading of GB MRI images and characterization of primary GB.