External Validation of the Effect of the Combined Use of Object Detection for the Classification of the C-Shaped Canal Configuration of the Mandibular Second Molar in Panoramic Radiographs: A Multicenter Study.

INTRODUCTION: The purposes of this study were to evaluate the effect of the combined use of object detection for the classification of the C-shaped canal anatomy of the mandibular second molar in panoramic radiographs and to perform an external validation on a multicenter dataset. METHODS: The panoramic radiographs of 805 patients were collected from 4 institutes across two countries. The CBCT data of the same patients were used as "Ground-truth". Five datasets were generated: one for training and validation, and 4 as external validation datasets. Workflow 1 used manual cropping to prepare the image patches of mandibular second molars, and then classification was performed using EfficientNet. Workflow 2 used two combined methods with a preceding object detection (YOLOv7) performed for automated image patch formation, followed by classification using EfficientNet. Workflow 3 directly classified the root canal anatomy from the panoramic radiographs using the YOLOv7 prediction outcomes. The classification performance of the 3 workflows was evaluated and compared across 4 external validation datasets. RESULTS: For Workflows 1, 2, and 3, the area under the receiver operating characteristic curve (AUC) values were 0.863, 0.861, and 0.876, respectively, for the AGU dataset; 0.935, 0.945, and 0.863, respectively, for the ASU dataset; 0.854, 0.857, and 0.849, respectively, for the ODU dataset; and 0.821, 0.797, and 0.831, respectively, for the ODU low-resolution dataset. No significant differences existed between the AUC values of Workflows 1, 2, and 3 across the 4 datasets. CONCLUSIONS: The deep learning systems of the 3 workflows achieved significant accuracy in predicting the C-shaped canal in mandibular second molars across all test datasets.

Generative adversarial networks in dental imaging: a systematic review.

OBJECTIVES: This systematic review on generative adversarial network (GAN) architectures for dental image analysis provides a comprehensive overview to readers regarding current GAN trends in dental imagery and potential future applications. METHODS: Electronic databases (PubMed/MEDLINE, Scopus, Embase, and Cochrane Library) were searched to identify studies involving GANs for dental image analysis. Eighteen full-text articles describing the applications of GANs in dental imagery were reviewed. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. RESULTS: GANs were used for various imaging modalities, including two-dimensional and three-dimensional images. In dental imaging, GANs were utilized for tasks such as artifact reduction, denoising, and super-resolution, domain transfer, image generation for augmentation, outcome prediction, and identification. The generated images were incorporated into tasks such as landmark detection, object detection and classification. Because of heterogeneity among the studies, a meta-analysis could not be conducted. Most studies (72%) had a low risk of bias in all four domains. However, only three (17%) studies had a low risk of applicability concerns. CONCLUSIONS: This extensive analysis of GANs in dental imaging highlighted their broad application potential within the dental field. Future studies should address limitations related to the stability, repeatability, and overall interpretability of GAN architectures. By overcoming these challenges, the applicability of GANs in dentistry can be enhanced, ultimately benefiting the dental field in its use of GANs and artificial intelligence.

circNFIB decreases synthesis of arachidonic acid and inhibits breast tumor growth and metastasis.

We identified circNFIB (hsa_circ_0086376) as a down-regulated circRNA in breast cancer but its effect is unclear. We aimed to explore the roles of circNFIB in breast cancer. The expression levels of circNFIB in breast cancer tissues and cells were detected. Both in vitro and in vivo experiments were used to assess the effects and mechanisms of circNFIB. circNFIB was down-regulated in 29 breast cancer tissues compared to adjacent normal tissues. circNFIB is a highly conserved circRNA and mainly located in cytoplasm of breast cancer cells. In vitro experiments showed that overexpression of circNFIB inhibited proliferation and invasion of breast cancer cells, whereas knockdown of circNFIB induced proliferation and invasion. Animal experiments indicated that circNFIB inhibited tumor growth and metastasis in vivo. Bioinformatics analysis showed that circNFIB contained an open reading frame (ORF) spanning its spliced junction, an internal ribosome entry site (IRES) and a N6-methyladenosine (m6A) site, suggesting circNFIB had the potential to encode a 56 amino acid (aa) protein, which was then confirmed by experiments. Metabonomics analysis results indicated that circNFIB may inhibit synthesis of arachidonic acid (AA) by regulating phospholipase. EIF4A3 and U2AF65 may regulate circNFIB expression by binding to the flanking sequence of circNFIB. In conclusion, circNFIB is a down-regulated circRNA in breast cancer tissues and encodes a 56 aa protein. circNFIB down-regulates AA in breast cancer cells, thus decreasing AA metabolites. Based on reported evidences of AA metabolites on cancer, we speculated that circNFIB may inhibit breast tumor growth and metastasis partly by inhibiting AA.

Evaluating the performance of generative adversarial network-synthesized periapical images in classifying C-shaped root canals.

This study evaluated the performance of generative adversarial network (GAN)-synthesized periapical images for classifying C-shaped root canals, which are challenging to diagnose because of their complex morphology. GANs have emerged as a promising technique for generating realistic images, offering a potential solution for data augmentation in scenarios with limited training datasets. Periapical images were synthesized using the StyleGAN2-ADA framework, and their quality was evaluated based on the average Frechet inception distance (FID) and the visual Turing test. The average FID was found to be 35.353 (± 4.386) for synthesized C-shaped canal images and 25.471 (± 2.779) for non C-shaped canal images. The visual Turing test conducted by two radiologists on 100 randomly selected images revealed that distinguishing between real and synthetic images was difficult. These results indicate that GAN-synthesized images exhibit satisfactory visual quality. The classification performance of the neural network, when augmented with GAN data, showed improvements compared with using real data alone, and could be advantageous in addressing data conditions with class imbalance. GAN-generated images have proven to be an effective data augmentation method, addressing the limitations of limited training data and computational resources in diagnosing dental anomalies.

Effects of Screen Time on Problematic Behavior in Children During the COVID-19 Pandemic in South Korea.

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has led to a decrease in face-to-face classes worldwide, affecting the mental health of children and their parents. The global pandemic has increased children's overall use of electronic media. This study analyzed the effect of children's screen time on problematic behaviors during the COVID-19 pandemic. Methods: A total of 186 parents from Suwon, South Korea, were recruited to participate in an online survey. The mean age of the children was 10.14 years old, and 44.1% were females. The questionnaire included questions on children's screen time, problematic behaviors, and parental stress. Children's behavioral problems were evaluated using the Behavior Problem Index, whereas the Parental Stress Scale was used to estimate parental stress. Results: The mean smartphone usage frequency of the children was 5.35 days per week, and the mean smartphone screen time was 3.52 hours per day. Smartphone screen time (Z=4.49, p <0.001) and usage frequency (Z=2.75, p=0.006) were significantly correlated with children's behavioral problem scores. The indirect effect of parental stress on this relationship was also statistically significant (p=0.049, p=0.045, respectively). Conclusion: This study suggests that children's smartphone screen time has affected problematic behaviors during the COVID-19 pandemic. Furthermore, parental stress is related to the relationship between children's screen time and problematic behaviors.

Hyperthermia promotes M1 polarization of macrophages via exosome-mediated HSPB8 transfer in triple negative breast cancer.

PURPOSE: To investigate the mechanism underlying the modulation of M1 macrophage polarization by exosomes released from hyperthermia-treated triple-negative breast cancer (TNBC) cells. MATERIALS AND METHODS: In this study, the effects of hyperthermia on TNBC cells were examined using cell counting kit-8, apoptosis, and cell cycle assays. Transmission electron microscopy was used to identify the structure of exosomes, while bicinchoninic acid and nanoparticle tracking analysis were used to detect particle size and amounts of exosomes released after hyperthermia. The polarization of macrophages incubated with exosomes derived by hyperthermia-pretreated TNBC cells were assessed by RT-qPCR and flow cytometry analysis. Next, RNA sequencing was performed to determine the targeting molecules changed in hyperthermia-treated TNBC cells in vitro. Finally, the mechanism underlying the modulation of macrophage polarization by exosomes derived from hyperthermia-treated TNBC cells was examined by using RT-qPCR, immunofluorescence and flow cytometry analysis. RESULTS: Hyperthermia markedly reduced cell viability in TNBC cells and promoted the secretion of TNBC cell-derived exosomes. The hub genes of hyperthermia-treated TNBC cells were significantly correlated with macrophage infiltration. Additionally, hyperthermia-treated TNBC cell-derived exosomes promoted M1 macrophage polarization. Furthermore, the expression levels of heat shock proteins, including HSPA1A, HSPA1B, HSPA6, and HSPB8, were significantly upregulated upon hyperthermia treatment, with HSPB8 exhibiting the highest upregulation. Moreover, hyperthermia can induce M1 macrophage polarization by promoting exosome-mediated HSPB8 transfer. CONCLUSION: This study demonstrated a novel mechanism that hyperthermia can induce M1 polarization of macrophages via exosome-mediated HSPB8 transfer. These results will help with future development of an optimized hyperthermia treatment regime for clinical application, especially for combination treatment with immunotherapy.

Computerized Version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (KSADS-COMP): Development and Validation of the Korean Clinician-Administered Version.

OBJECTIVE: The purpose of the present study was to develop and validate the Korean version of the clinician-administered KSADSCOMP, which is the recently updated, web-based computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia for school-age children (KSADS). METHODS: A total of 71 participants (mean age=12.04±3.86 years, female=29.57%) participated in the study. A child-adolescent psychiatrist established a diagnosis for the participant after a thorough psychiatric interview with the participant and the parent. Researchers who were blind to the diagnoses administered the clinician-administered KSADS-COMP to the parents and participants. The gold-standard diagnoses made by child-adolescent psychiatrists were compared to the current diagnoses generated by the clinician-administered KSADS-COMP. Percent agreement, Cohen's Kappa, Gwet's first-order agreement coefficient (AC1), sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: Gwet's AC1, our preferred measure of agreement, showed excellent range between 0.78 and 1. Sensitivity, specificity, positive predicted value and negative predictive value also showed high scores. CONCLUSION: The current study demonstrated excellent criterion validity of the Korean version of the clinician-administered KSADSCOMP, though the small sample size could be a limitation. The current study was the first study to examine the criterion validity of the KSADS-COMP. Due to its readily usable format and efficient and accurate diagnostic process, widely-use of KSADS-COMP is expected.

Evaluation of dental status using a questionnaire before administration of general anesthesia for the prevention of dental injuries.

Background: Dental evaluation and protection are important for preventing traumatic dental injuries when patients are under general anesthesia. The objective of the present study was to develop a questionnaire based on dentition-related risk factors that could serve as a valuable tool for dental evaluation and documentation. Methods: We developed a questionnaire for dental evaluation before administration of general anesthesia, investigated the association between patient-and-dentist responses and mouthguard fabrication, and assessed response agreement between 100 patients. Results: Protective mouthguards were fabricated for 27 patients who were identified as having a high risk of dental injury. There was a strong association between dentists' responses and mouthguard fabrication, depending on the general oral health status, use of ceramic prosthesis, presence of masticatory pain related to periodontal diseases, gingival edema, and implants (P < 0.05). Response agreement between patients and dentists for items related to dental pain, loss of dental pulp vitality, root canal therapy, dental trauma, aesthetic prosthesis, tooth mobility, and implant prosthesis was high (Cohen's kappa coefficient κ ≥ 0.6). Conclusions: A high agreement was observed between patient-dentist responses and a strong association with mouthguard fabrication for items pertaining to ceramic prosthesis, masticatory pain, and dental implants. Patients with a "yes" response to these items are recommended to undergo a dental evaluation and use a dental protective device while under general anesthesia.

Safety outcomes of selective serotonin reuptake inhibitors in adolescent attention-deficit/hyperactivity disorder with comorbid depression: the ASSURE study.

BACKGROUND: Attention deficit-hyperactivity disorder (ADHD) is related to depressive disorder, and adolescents with both present poor outcomes. However, evidence for the safety of concomitantly using a methylphenidate (MPH) and a selective serotonin reuptake inhibitor (SSRI) among adolescent ADHD patients is limited, a literature gap aimed to address through this investigation. METHODS: We conducted a new-user cohort study using a nationwide claims database in South Korea. We identified a study population as adolescents who were diagnosed both ADHD and depressive disorder. MPH-only users were compared with patients who prescribed both a SSRI and a MPH. Fluoxetine and escitalopram users were also compared to find a preferable treatment option. Thirteen outcomes including neuropsychiatric, gastrointestinal, and other events were assessed, taking respiratory tract infection as a negative control outcome. We matched the study groups using a propensity score and used the Cox proportional hazard model to calculate the hazard ratio. Subgroup and sensitivity analyses were conducted in various epidemiologic settings. RESULTS: The risks of all the outcomes between the MPH-only and SSRI groups were not significantly different. Regarding SSRI ingredients, the risk of tic disorder was significantly lower in the fluoxetine group than the escitalopram group [HR 0.43 (0.25-0.71)]. However, there was no significant difference in other outcomes between the fluoxetine and escitalopram groups. CONCLUSION: The concomitant use of MPHs and SSRIs showed generally safe profiles in adolescent ADHD patients with depression. Most of the differences between fluoxetine and escitalopram, except those concerning tic disorder, were not significant.

Validation of the Korean self-administered computerized versions of the kiddie schedule for affective disorders and schizophrenia for school-age children (KSADS-COMP).

The purpose of the present study was to examine the validity of the Korean version of the parent and youth self-administered versions of the KSADS-COMP (The Kiddie Schedule for Affective Disorders and Schizophrenia for school-age children). To assess the criterion validity of the KSADS-COMP, diagnoses made by the selfadministered KSADS-COMP were compared to the gold-standard diagnoses made by the child-adolescent psychiatrists in 41 participants (mean age=14.93 ± 2.16 years, female=41.46 %). Gwet's first order agreement coefficient (AC1) concordance ratings showed moderate to good range. The present study shows promising validity of the Korean self-administered versions of the KSADS-COMP in Korean youths.

Long-term methylphenidate use for children and adolescents with attention deficit hyperactivity disorder and risk for depression, conduct disorder, and psychotic disorder: a nationwide longitudinal cohort study in South Korea.

BACKGROUND: Methylphenidate (MPH) is the most frequently prescribed medication for the treatment of attention deficit hyperactivity disorder (ADHD). However, the safety of its long-term use remain unclear. In particular, real-world evidence of long-term MPH treatment regarding the risk of depression, conduct disorders, and psychotic disorders in children and adolescents is needed. This study aimed to compare the risks of depression, conduct disorder, and psychotic disorder between long- and short-term MPH treatments in children and adolescents. METHODS: This population-based cohort study used a nationwide claims database of all patients with ADHD in South Korea. Patients aged less than 18 years who were prescribed MPH were included in the study. Long- and short-term MPH were defined as > 1 year, and < 1 year, respectively. Overall, the risk of developing depressive disorder, conduct disorder and oppositional defiant disorder (ODD), and psychotic disorder were investigated. A 1:2 propensity score matching was used to balance the cohorts, and the Cox proportional hazards model was used to evaluate the safety of MPH. RESULTS: We identified 1309 long-term and 2199 short-term MPH users. Long-term MPH use was associated with a significantly lower risk of depressive (hazard ratio [HR], 0.70 [95% confidence interval [CI] 0.55-0.88]) and conduct disorders and ODD (HR, 0.52 [95% CI 0.38-0.73]) than short-term MPH use. Psychotic disorder was not significantly associated with long-term MPH use (hazard ratio [HR], 0.83 [95% confidence interval [CI] 0.52-1.32]). CONCLUSIONS: Our findings suggest that long-term MPH use may be associated with a decreased risk of depression, conduct disorders and ODD. Moreover, the long-term use of MPH does not increase the risk of psychotic disorders. Long-term MPH administration may be considered as a favourable treatment strategy for children and adolescents with ADHD regarding depressive, conduct, and psychotic disorders.

Expression profile and prognostic values of SMC family members in HCC.

OBJECTIVE: The structural maintenance of chromosome (SMC) gene family, including 6 proteins, is involved in a wide range of biological functions in different human cancers. Nevertheless, there is little research on the expression patterns, potential functions and prognostic value of SMC genes in hepatocellular carcinoma (HCC). Based on publicly available databases and integrative bioinformatics analysis, we tried to determine the value of SMC gene expression in predicting the risk of developing HCC. METHODS: The expression and copy number variations data of SMC family members were obtained from TCGA (The Cancer Genome Atlas). We identified the prognostic values of SMC family members and their clinical features. GSEA (Gene Set Enrichment Analysis) was conducted to detect the mechanism underlying the involvement of SMC family members in liver cancer. We used Tumor Immune Estimation Resource database to explore the associations between TIICs (Tumor Immune Infiltrating Cells) and the SMC family members. RESULTS: Our analysis proved that downregulation of SMC family members was common modification in HCC patients. In HCC, the expression of SMC1A, SMC2, SMC3, SMC4, SMC6 were upregulated. Upregulation of SMC2, SMC3, and SMC4, along with the clinical stage of HCC, were associated with a poor prognosis according to the results of univariate and multivariate Cox proportional hazards regression analysis. SMC2, SMC3, and SMC4 are also related to tumor purity and immune infiltration levels of HCC. The GSEA results proved that SMC family members take part in numerous biological processes underlying tumorigenesis. CONCLUSION: In this study, we comprehensively analyzed the expression of SMC family members in patients with HCC. This can provide insights for further investigation of the SMC members as potential therapeutic targets in HCC and suggest that the use of SMC inhibitor targeting SMC2, SMC3, and SMC4 can be a practical strategy for the therapy of HCC.

Identification of TIMP2 as a Prognostic Biomarker and Its Correlation with Tumor Immune Microenvironment: A Comprehensive Pan-Cancer Analysis.

Background: Tissue inhibitor of metalloproteinase-2 (TIMP2), an endogenous inhibitor of matrix metalloproteinases, has been disclosed to participate in the development and carcinogenesis of multiple malignancies. However, the prognosis of TIMP2 in different cancers and its correlation with tumor microenvironment and immunity have not been clarified. Methods: In this study, we conducted a comprehensive bioinformatics analysis to evaluate the prognostic and therapeutic value of TIMP2 in cancer patients by utilizing a series of databases, including Oncomine, GEPIA, cBioPortal, GeneMANIA, Metascape, and Sangerbox online tool. The expression of TIMP2 in different cancers was analyzed by Oncomine, TCGA, and GTEx databases, and mutation status of TIMP2 in cancers was then verified using the cBioPortal database. The protein-protein interaction (PPI) network of the TIMP family was exhibited by GeneMANIA. The prognosis of TIMP2 in cancers was performed though the GEPIA database and Cox regression. Additionally, the correlations between TIMP2 expression and immunity (immune cells, gene markers of immune cells, TMB, MSI, and neoantigen) were explored using Sangerbox online tool. Results: The transcriptional level of TIMP2 in most cancerous tissues was significantly elevated. Survival analysis revealed that an elevated expression of TIMP2 is associated with unfavorable survival outcome in multiple cancers. Enrichment analysis demonstrated the possible mechanisms of TIMPs and their associated genes mainly involved in pathways including extracellular matrix (ECM) regulators, degradation of ECM and ECM disassembly, and several other signaling pathways. Conclusions: Our findings systematically dissected that TIMP2 is a potential prognostic maker in various cancers and use the inhibitor of TIMP2, which may be an effective strategy for cancer therapy to improve the poor cancer survival and prognostic accuracy, but concrete mechanisms need to be validated by subsequent experiments.

CircRNA expression profiles of breast cancer and construction of a circRNA-miRNA-mRNA network.

CircRNAs are a group of endogenous small noncoding RNAs that are involved in multiple diseases including cancers. At present, the functions of circRNAs in breast cancer need to be further explored. In this study, 3 pairs of breast cancer and paracancer tissues with axillary lymph node metastasis were collected for circRNA high-throughput sequencing. We have identified 17,966 distinct circRNA candidates. Significant differential expressions were found in 136 circRNAs in breast cancer tissues relative to the matched paracancer tissues. We aslo identified differentially expressed 156 miRNAs and 1105 mRNAs in breast cancer tissues and normal breast tissues from public databases. Then we constructed a regulatory ceRNA network. 12 mRNAs were associated with prognosis of breast cancer. We also constructed a circRNAs-mediated subnetwork which might be related to prognosis of breast cancer. This article provides a better understanding of circRNAs-mediated ceRNA regulatory network by which circRNAs compete for endogenous RNAs in breast cancer.

Effects of Frequent Smartphone Use on Sleep Problems in Children under 7 Years of Age in Korea: A 4-Year Longitudinal Study.

The use of electronic screen devices has a negative effect on sleep. The purpose of this study is to longitudinally examine the effects of various screen use on sleep problems in children under 7 years of age. A total of 314 caregivers of children aged 4−7 years from three cities in Korea were recruited and responded to a self-administered questionnaire from 2017 to 2020. As a result of the analysis of the mixed model designed as a two-leveled structure, the use frequency of smartphones significantly predicted children's sleep problems (ß = 0.328, p < 0.001) compared to that of TV, PC, and tablet PC. In addition, the frequency of smartphone screen use showed a weak but significant correlation with bedtime resistance (r = 0.067, p = 0.009), sleep duration (r = 0.089, p <0.001), nighttime awakening (r = 0.066, p = 0.010), and daytime sleepiness (r = 0.102, p < 0.001). The results of this study suggest that screen time education in Korea should focus on smartphones above all else.

Lower-Income Predicts Increased Smartphone Use and Problematic Behaviors Among Schoolchildren During COVID-19 Related School Modification: A Longitudinal Study.

BACKGROUND: As the coronavirus disease 2019 (COVID-19) has continued for a couple of years, the long-term effects of the pandemic and the subsequent school curriculum modification on the mental health of children and parents need to be investigated. To clarify the changes that can occur during one school year and to predict the risk factors for vulnerable groups, this study identified parameters relative to children's screen time, their problematic behavior, and parental depression. METHODS: A total of 186 participants were analyzed who were parents of elementary schoolchildren in South Korea. These parents were required to complete a web-based questionnaire twice. The questionnaires were conducted in June 2020 and September 2021. Participants' general demographics including family income, children's screen time, sleep patterns, problematic behavior, and parental depression were assessed via the parental questionnaire that included various measurement tools. RESULTS: Children's body mass index (BMI) increased significantly in 2021 (18.94 ± 3.75 vs. 18.14 ± 3.30, P < 0.001). Smartphone frequency of use per week (5.35 vs. 4.54, P < 0.001) and screen time per day (3.52 vs. 3.16, P < 0.001) significantly increased during the period of the COVID-19 pandemic. The television screen time (2.88 vs. 3.26, P < 0.001), frequency of viewing (3.77 vs. 4.77, P < 0.001), and children's problematic behaviors significantly decreased (9.15 vs. 11.85, P < 0.001). A lower income household was a key predictor of increased smartphone frequency (B = 1.840, 95% confidence interval [CI], 0.923-2.757, P < 0.001) and smartphone screen time (B = 1.992, 95% CI, 1.458-2.525, P < 0.001). The results showed that the lower income household (B = 5.624, 95% CI, 2.927-8.320, P < 0.001) and a child's psychiatric treatment history (B = 7.579, 95% CI, 5.666-9.492, P < 0.001) was the most significant predictor of problematic behaviors of children and parental depression (B = 3.476, 95% CI, 1.628-5.325, P < 0.001; B = 3.138, 95% CI, 1.827-4.450, P < 0.001). CONCLUSION: This study suggested that children's smartphone screen time and BMI increased during COVID-19 because of the school curriculum modification following school closures in South Korea. The increased children's problematic behaviors and parental depression were predicted by lower-income households and the previous psychiatric history of children. These results indicate that multiple social support systems to the vulnerable group are needed during the ongoing pandemic and that a modified school setting is required.

Inconsistent Media Mediation and Problematic Smartphone Use in Preschoolers: Maternal Conflict Resolution Styles as Moderators.

Previous studies suggest that inconsistent parenting leads to undesired consequences, such as a child's defiant reactance or parent-child conflicts. In light of this, we examined whether mothers' inconsistent smartphone mediation strategies would influence their children's problematic smartphone use during early childhood. Furthermore, given that harsh parenting often escalates a child's behavioral problems, we focused on parent-child conflict resolution tactics as moderators. One hundred fifty-four mothers (ages 25-48 years; M = 35.58 years) of preschoolers (ages 42-77 months) reported their media mediation and parent-child conflict resolution tactics and their child's problematic smartphone use. We found that the positive association between the mother's inconsistent mediation and their child's problematic smartphone use was more pronounced when mothers relied on negative parent-child resolution tactics-i.e., psychological aggression and physical assault. Our findings provide vital theoretical and empirical insights into mother-child relational characteristics for the child's problematic smartphone use.

Exosomal microRNAs shuttling between tumor cells and macrophages: cellular interactions and novel therapeutic strategies.

Extracellular vesicles secreted by tumor microenvironment (TME) cells are vital players in tumor progression through transferring nucleic acids and proteins. Macrophages are the main immune cells in TME and tumor associated macrophages (TAM) express M2 phenotype, which induce tumor proliferation, angiogenesis, invasion, metastasis and immune elimination, resulting in the subsequent evolution of malignancies. There are a high number of studies confirmed that tumor cells and TAM interact with each other through extracellular vesicles in various cancers, like pancreatic ductal adenocarcinoma, gastric cancer, breast cancer, ovarian cancer, colon cancer, glioblastoma, hepatocellular cancer, and lung cancer. Herein, this review summarizes the current knowledge on mechanisms of communications between tumor cells and TAM via extracellular vesicles, mainly about microRNAs, and targeting these events might represent a novel approach in the clinical implications of this knowledge into successful anti-cancer strategies.

Development and Validation of a Visually Explainable Deep Learning Model for Classification of C-shaped Canals of the Mandibular Second Molars in Periapical and Panoramic Dental Radiographs.

INTRODUCTION: The purpose of this study was to develop and validate a visually explainable deep learning model for the classification of C-shaped canals of the mandibular second molars in dental radiographs. METHODS: The periapical and panoramic images of 1000 mandibular second molars were collected from 372 patients. The diagnostic performance of the deep learning system using periapical and panoramic radiographs was investigated in respect to its ability to determine whether the second mandibular molar showed a C-shaped canal configuration. The assessment of the canal configuration of cone-beam computed tomographic volumes from 372 patients (740 mandibular second molars) was used as a gold standard. RESULTS: The deep convolutional neural network algorithm model showed high accuracy in predicting the C-shaped canal variation among mandibular second molars in both periapical and panoramic images. The model demonstrated best results when using image patches including only the root portion of the tooth and when using both periapical and panoramic images for training (area under the curve [AUC] = 0.99). The model's diagnostic performance using only the root portion of the tooth (AUC: periapical = 0.98 and panoramic = 0.95) was similar to a specialist (AUC: periapical = 0.95 and panoramic = 0.96) and better than a novice general clinician (AUC: periapical = 0.89 and panoramic = 0.91). Both the specialist and general clinician showed better diagnostic performance when reading panoramic radiographs compared with periapical images. CONCLUSIONS: With further optimization of the test data using a larger data set and improvements made in the model, a deep learning system may be expected to effectively diagnose C-shaped canals and aid clinicians in practice and education.