A Spherical Cap Model of Epidural Hematomas.

Background Epidural hematomas (EDHs), which have a characteristic biconvex shape, are a type of post-traumatic intracranial mass. EDHs and other types of intracranial hematomas are often diagnosed with computed tomography (CT). The volumes of EDHs are important in treatment decisions and prognosis. Their volumes are usually estimated on CT using the "ABC" method, which is based on the ellipsoid shape rather than their biconvex shape. Objective To simulate the biconvex shape, we modeled the geometry of EDHs with two spherical caps. We aim to provide simpler estimation of EDH volumes in clinical settings, and eventually recommend a threshold for surgical evacuation. Methods Applying the relationship between the sphere radius, spherical cap height, and base circle radius, we derived formulas for the shape of an EDH, relating its largest diameter and location to the other two diameters. We also estimated EDH volumes using the spherical cap volume and conventional ABC formulas and then constructed a lookup table accordingly. Results Validation of the model was performed using 14 CT image sets from previously reported patients with EDHs. Our geometric model demonstrated accurate predictions. The model also allows reducing the number of parameters to be measured in the ABC method from three to one, the hematoma length, showcasing its potential as a reliable tool for clinical decision-making. Based on our model, an EDH longer than 7 cm would occupy more than 30 mL of the intracranial volume. Conclusion The proposed model offers a streamlined approach to estimating EDH volumes, reducing the complexity of parameters required for clinical assessments. We recommend a length of 7 cm as a threshold for surgical evacuation of EDHs. This acceleration in decision-making is crucial for managing critically injured patients with traumatic brain injuries. Further validation across diverse patient populations will enhance the generalizability and utility of this geometric modeling approach in clinical settings.

Clinical validation of a saliva-based matrix metalloproteinase-1 rapid strip test for detection of oral cavity cancer.

BACKGROUND: We previously identified matrix metalloproteinase-1 (MMP-1) as one of the most promising salivary biomarkers for oral squamous cell carcinoma (OSCC) and developed a sensitive ELISA for MMP-1 with good performance in detection of OSCC using a cohort of 1160 saliva samples. METHODS: A time-saving rapid strip test (RST) for MMP-1 was developed in this study and its diagnostic performance compared with ELISA using saliva samples from a new cohort of 603 subjects (171 healthy controls, 236 patients with oral potentially malignant disorders, and 196 OSCC patients). RESULTS: Salivary MMP-1 levels measured using RST and ELISA were highly comparable and both assays could effectively distinguish between OSCC and non-cancerous groups. Similar to ELISA, receiver operating characteristic curve analysis of the MMP-1 RST was effective in identifying patients with OSCC at different oral cavity sites and stages. CONCLUSIONS: Salivary MMP-1 can be sensitively detected using both RST and ELISA methods. Our newly developed point-of-care MMP-1 RST is a promising in vitro diagnostic device (IVD) that may serve as a novel auxiliary tool in the routine clinical detection and monitoring of OSCC.

Uncovering a dose-response relationship between positive fecal immunochemical test (FIT) and all-cause, cardiovascular and cancer-related mortality.

BACKGROUND: Fecal immunochemical test (FIT) is for colorectal cancer (CRC) screening. Its association with non-CRC mortality has been overlooked. Given the quantitative FIT values, its dose-response relationships with different causes of deaths and years of life shortened were assessed. METHODS: This retrospective study included 546,214 adults aged ≥ 20 who attended a health surveillance program from 1994 to 2017 and were followed up until the end of 2020. FIT ≥ 20 µg Hb/g was defined as positive. The Cox model was used to assess adjusted hazard ratios (aHR). RESULTS: Positive FIT was associated with increased all-cause mortality (aHR: 1.34, 95 % CI: 1.25-1.44) and all-cancer mortality (aHR: 1.71, 95 % CI: 1.55-1.89), with a reduction of life expectancy by 4 years. The association remained even with CRC excluded. With each 10 µg Hb/g increase in FIT above 20 µg Hb/g, life expectancy was reduced by one year, and mortality increased by 4 %. About 18.6 % of deaths with positive FIT were attributed to cardiovascular disease (CVD), followed by CRC (13.5 %) and upper gastrointestinal (GI) cancers (4.5 %). The all-cause mortality rate after excluding CRC for positive FIT was 3.56/1,000 person-year, comparable to the all-cause mortality rate of 3.69/1,000 person-year for hypertension. CONCLUSION: Positive FIT was associated with increased mortality in a dose-response manner and shortened life expectancy by 4 years, an overlooked risk comparable to hypertension, even with CRC excluded. After a negative colonoscopy, subjects with positive FIT should undergo a workup on CVD risk factors and look for other upper GI cancers.

Intelligent Performance Evaluation in Rowing Sport Using a Graph-Matching Network.

Rowing competitions require consistent rowing strokes among crew members to achieve optimal performance. However, existing motion analysis techniques often rely on wearable sensors, leading to challenges in sporter inconvenience. The aim of our work is to use a graph-matching network to analyze the similarity in rowers' rowing posture and further pair rowers to improve the performance of their rowing team. This study proposed a novel video-based performance analysis system to analyze paired rowers using a graph-matching network. The proposed system first detected human joint points, as acquired from the OpenPose system, and then the graph embedding model and graph-matching network model were applied to analyze similarities in rowing postures between paired rowers. When analyzing the postures of the paired rowers, the proposed system detected the same starting point of their rowing postures to achieve more accurate pairing results. Finally, variations in the similarities were displayed using the proposed time-period similarity processing. The experimental results show that the proposed time-period similarity processing of the 2D graph-embedding model (GEM) had the best pairing results.

Ultrasound-Guided Perineural Vitamin B12 Injection for Brachial Plexus Injury: A Preliminary Study.

Individuals with brachial plexus injury (BPI) require upper limb function restoration, but the treatment remains controversial. Vitamin B12 may aid in pain control and nerve regeneration. We present the technical aspects of ultrasound-guided perineural vitamin B12 injection for BPI. The demonstrative case is a 50-year-old man with BPI resulting from a traffic accident. Under ultrasound guidance, vitamin B12 was injected precisely into the brachial plexus compartment around the swollen neuroma of the C6 root. Motor and sensory functions of the left upper extremity improved over 6 months. Ultrasound-guided perineural vitamin B12 injection may be an efficient and personalized intervention in cases of post-ganglionic BPI that failed to improve in the first 3 months.

Iterated cross validation method for prediction of survival in diffuse large B-cell lymphoma for small size dataset.

Efforts have been made to improve the risk stratification model for patients with diffuse large B-cell lymphoma (DLBCL). This study aimed to evaluate the disease prognosis using machine learning models with iterated cross validation (CV) method. A total of 122 patients with pathologically confirmed DLBCL and receiving rituximab-containing chemotherapy were enrolled. Contributions of clinical, laboratory, and metabolic imaging parameters from fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans to the prognosis were evaluated using five regression models, namely logistic regression, random forest, support vector classifier (SVC), deep neural network (DNN), and fuzzy neural network models. Binary classification predictions for 3-year progression free survival (PFS) and 3-year overall survival (OS) were conducted. The 10-iterated fivefold CV with shuffling process was conducted to predict the capability of learning machines. The median PFS and OS were 41.0 and 43.6 months, respectively. Two indicators were found to be independent predictors for prognosis: international prognostic index and total metabolic tumor volume (MTVsum) from FDG PET/CT. For PFS, SVC and DNN (both with accuracy 71%) have the best predictive results, of which outperformed other algorithms. For OS, the DNN has the best predictive result (accuracy 76%). Using clinical and metabolic parameters as input variables, the machine learning methods with iterated CV method add the predictive values for PFS and OS evaluation in DLBCL patients.

Dynamic ultrasound for evaluating the adequacy of median nerve decompression following minimally invasive carpal tunnel release: technical innovation and case study.

Background: Minimally invasive carpal tunnel release has recently emerged as the primary surgical approach for recalcitrant carpal tunnel syndrome. A major concern related to surgical failure with this technique is the incomplete release of the flexor retinaculum. Case presentation: We developed a technique using dynamic ultrasound for evaluating the adequacy of median nerve decompression following minimally invasive carpal tunnel release. This novel imaging method was applied to two patients who showed significant symptom relief after the intervention. This case study also provides details of the dynamic ultrasound protocol and highlights the advantages of this technique. Conclusion: Dynamic ultrasound imaging can be used to confirm the completeness of carpal tunnel decompression. A large-scale prospective trial should be conducted to validate whether additional dynamic ultrasound examination can improve the outcome of minimally invasive carpal tunnel release.

Analysis of the clinical and radiological outcomes of percutaneous cervical nucleoplasty: A case-control study.

BACKGROUND: Percutaneous cervical nucleoplasty (PCN) is a simple, safe, and effective treatment for contained cervical herniated intervertebral disc (CHIVD). However, few studies have compared the actual benefits of PCN against conservative treatment (CT), either clinically or radiographically. PURPOSE: The present study sought to analyze and to compare the outcomes of symptomatic contained CHIVD treated with PCN or CT. METHODS: The present study was designed as a case-control comparative study. Patients who indicated for PCN after a failed CT for more than 6 months were recruited. After the exclusion of some patients who did not meet the selection criteria of the study, we finally enrolled 71 patients treated with PCN. In addition, another 21 patients who indicated for PCN but finally chose to receive CT continuously were also enrolled and categorized as the control group. All patients completed the 6-month follow-up. Pain levels and functional outcomes were evaluated pre- and post-operatively by assessing the visual analog scale (VAS), Oswestry Disability Index (ODI), and Neck Disability Index (NDI). Radiographic images of 72 of 104 intervened segments were collected to measure disc height and other cervical spinal alignments, such as range of motion, C2-7 Cobb's angle, and C2-7 sagittal vertical axis. RESULTS: Compared with the CT group, the PCN group showed significantly better outcomes on VAS, ODI, and NDI at the 1-month post-operative follow-up, which continued through at least the 6-month follow-up (P < 0.01 for VAS and P < 0.05 for ODI and NDI). The mean disc height significantly decreased, from 6.04 ± 0.85 mm to 5.76 ± 1.02 mm, 3 months after PCN treatment (P = 0.003). However, the degree of disc height decrease did not correlate with the changes of the substantial VAS improvement. CONCLUSIONS: To provide therapeutic benefits for symptomatic contained CHIVD patients after an invalid CT for 6 months, PCN seems to be a better option than CT. The reduced disc heights did not alter the clinical outcomes of PCN.

Biocompatibile nanofiber based membranes for high-efficiency filtration of nano-aerosols with low air resistance.

Particulate matter (PMs) from combustion emissions (traffic, power plant, and industries) and the novel coronavirus (COVID-19) pandemic have recently enhanced the development of personal protective equipment against airborne pathogens to protect humans' respiratory system. However, most commercial face masks still cannot simultaneously achieve breathability and high filtration of PMs, bacteria, and viruses. This study used the electrospinning method with polyimide (PI) and polyethersulfone (PES) solutions to form a nanofiber membrane with low-pressure loss and high biocompatibility for high-efficiency bacteria, viruses, and nano-aerosol removal. Conclusively, the optimized nano-sized PI/PES membrane (0.1625 m2/g basis weight) exhibited conspicuous performance for the highest filtration efficiency towards PM from 50 to 500 nm (99.74 %), good filter quality of nano-aerosol (3.27 Pa-1), exceptional interception ratio against 100-nm airborne COVID-19 (over 99 %), and non-toxic effect on the human body (107 % cell viability). The PI/PES nanofiber membrane required potential advantage to form a medical face mask because of its averaged 97 % BEF on Staphylococcus aureus filiation and ultra-low pressure loss of 0.98 Pa by referring ASTM F2101-01. The non-toxic PI/PES filters provide a new perspective on designing excellent performance for nano-aerosols from air pollution and airborne COVID-19 with easy and comfortable breathing under ultra-low air flow resistance.

Two-Dimensional Conjugated Mass Transfer of Carbon Dioxide Absorption in a Hollow-Fiber Gas-Liquid Membrane Contactor.

The absorption efficiencies of CO2 in hollow-fiber membrane contactors using an ethanolamine (MEA) solvent under both concurrent- and countercurrent-flow operations were investigated theoretically and experimentally. Two-dimensional mathematical modeling was developed by Happel's free surface model, and the resultant partial differential equations were solved analytically using the separated variables method with the use of an orthogonal expansion technique. A simplified expression of Sherwood number variations was reported by employing the relevant operations conditions and expressed in terms of the computed eigenvalues for predicting concentration distribution and absorption efficiency. It is emphasized that, in comparing various fiber packing configurations, both theoretical predictions and experimental results should be compared to find the absorption flux increment accomplished by the CO2/N2 stream passing through the fiber cells under the same mass flow rate. The value of the present mathematical treatment is evident to propose a simplified expression of the averaged Sherwood number variations, and provides the predictions of the absorption flux, absorption efficiency, average Sherwood number with the absorbent Graetz number, inlet CO2 concentration, and absorbent flow rates as parameters. The availability of such concise expressions, as developed directly from the analytical formulations, is the value of the present study. The experiments of the CO2 absorption using MEA with alumina (Al2O3) hollow fiber membranes are also set up to confirm the accuracy of the theoretical predictions. The accuracy derivations between the experimental results and theoretical predictions for concurrent- and countercurrent-flow operations are 4.10×10-2≤E≤1.50×10-2 and 1.40×10-2≤E≤9.0×10-1, respectively. The operations of the hollow-fiber membrane contactor implementing N = 7 fiber cells and N = 19 fiber cells offer an inexpensive method of improving absorption efficiency by increasing fiber numbers with consideration of device performance.

Association of Sugar-Sweetened Beverages and Cardiovascular Diseases Mortality in a Large Young Cohort of Nearly 300,000 Adults (Age 20-39).

(1) Background: The association of sugar-sweetened beverages (SSBs) with cardiovascular disease (CVD) mortality in younger adults (age 20−39) is rarely mentioned in the literature. Younger adults are less vulnerable to CVDs, but they tend to consume more SSBs. This prospective study aimed to assess the association between CVD mortality and SSBs in younger adults between 1994 and 2017. (2) Methods: The cohort enrolled 288,747 participants consisting of 139,413 men and 148,355 women, with a mean age 30.6 ± 4.8 years, from a health surveillance program. SSBs referred to any drink with real sugar added, such as fructose corn syrup or sucrose. One serving of SSB contains about 150 Kcal of sugar in 12 oz of drink. Cox models were used to estimate the mortality risk. (3) Results: There were 391 deaths from CVDs in the younger adults, and the positive association with CVD mortality started when SSB intake was ≥2 servings/day (HR: 1.59, 95% CI: 1.16−2.17). With mortalities from diabetes and kidney disease added to CVDs, the so-called expanded CVD mortality risk was 1.49 (95% CI: 1.11−2.01). By excluding CVD risk factors (hypertension, diabetes, and smoking), the CVD mortality risk increased to 2.48 (95% CI: 1.33−4.62). The dose−response relationship persisted (p < 0.05 for trend) in every model above. (4) Conclusions: Higher intake of SSBs (≥2 servings/day) was associated with increased CVD mortality in younger adults. The younger adults (age 20−39) with SSB intake ≥2 servings/day had a 50% increase in CVD mortality in our study, and the mortality risk increased up to 2.5 times for those without CVD risk factors. The dose−response relationship between the quantity of SSB intake and the mortality risk of CVD in younger adults discourages SSB intake for the prevention of CVD mortality.

"Sugar-Sweetened Beverages" Is an Independent Risk From Pancreatic Cancer: Based on Half a Million Asian Cohort Followed for 25 Years.

Although the link between sugar-sweetened beverages (SSB) and pancreatic cancer has been suggested for its insulin-stimulating connection, most epidemiological studies showed inconclusive relationship. Whether the result was limited by sample size is explored. This prospective study followed 491,929 adults, consisting of 235,427 men and 256,502 women (mean age: 39.9, standard deviation: 13.2), from a health surveillance program and there were 523 pancreatic cancer deaths between 1994 and 2017. The individual identification numbers of the cohort were matched with the National Death file for mortality, and Cox models were used to assess the risk. The amount of SSB intake was recorded based on the average consumption in the month before interview by a structured questionnaire. We classified the amount of SSB intake into 4 categories: 0-<0.5 serving/day, ≥0.5-<1 serving per day, ≥1-<2 servings per day, and ≥2 servings per day. One serving was defined as equivalent to 12 oz and contained 35 g added sugar. We used the age and the variables at cohort enrolment as the reported risks of pancreatic cancers. The cohort was divided into 3 age groups, 20-39, 40-59, and ≥60. We found young people (age <40) had higher prevalence and frequency of sugar-sweetened beverages than the elderly. Those consuming 2 servings/day had a 50% increase in pancreatic cancer mortality (HR = 1.55, 95% CI: 1.08-2.24) for the total cohort, but a 3-fold increase (HR: 3.09, 95% CI: 1.44-6.62) for the young. The risk started at 1 serving every other day, with a dose-response relationship. The association of SSB intake of ≥2 servings/day with pancreatic cancer mortality among the total cohort remained significant after excluding those who smoke or have diabetes (HR: 2.12, 97% CI: 1.26-3.57), are obese (HR: 1.57, 95% CI: 1.08-2.30), have hypertension (HR: 1.90, 95% CI: 1.20-3.00), or excluding who died within 3 years after enrollment (HR: 1.67, 95% CI: 1.15-2.45). Risks remained in the sensitivity analyses, implying its independent nature. We concluded that frequent drinking of SSB increased pancreatic cancer in adults, with highest risk among young people.

Ultrasound Guidance for Full Endoscopic Spinal Surgery: A Technical Note.

BACKGROUND: The use of intraoperative ultrasound (IOU) has proven to be useful in spinal surgery. In this study, we present the techniques of applying IOU in cervical, thoracic, and lumbar full-endoscopic spine surgery (FESS). METHODS: For applying IOU in cervical FESS, first, we localize the surgical level by identifying the unique shape of C6 and C7 under ultrasound and then identify the cervical level subsequently. For the anterior approach, the endoscope passes through the cervical fascia between the carotid sheath and trachea/esophagus, which can be identified under ultrasound, and for the posterior approach, the endoscope docks on the facet joint under ultrasound. For applying IOU in thoracic FESS, we localize the surgical level by counting the ribs. The endoscope is advanced to the neural foramen under ultrasound without entering the pleural cavity. For applying IOU in lumbar FESS, we identify the surgical level by counting the interlaminar window from the sacrum. The endoscopic sheath is advanced to the neural foramen under ultrasound without entering the peritoneal cavity. RESULTS: The use of IOU in FESS has the potential to reduce radiation exposure, reach a higher successful puncture rate, and decrease the operation time. Furthermore, IOU prevents radiolucent organs from damage during FESS. CONCLUSIONS: We present the techniques of applying IOU in cervical, thoracic, and lumbar endoscopic spine surgery and hope that this will be helpful for physicians to master the IOU techniques.

Risk of colonoscopy-related complications in a fecal immunochemical test-based population colorectal cancer screening program.

BACKGROUND: The likelihood of advanced or synchronous neoplasms is significantly higher in fecal immunochemical test (FIT)-positive individuals than in the general population. The magnitude of the colonoscopy-related complication rate in FIT-positive individuals remains unknown. This study aimed to elucidate the colonoscopy-related complication rate after a positive FIT result and compare it with the rate when colonoscopy was performed for other purposes. METHODS: Information regarding colonoscopy-related severe complications after a positive FIT result (FIT-colonoscopy) and ordinary colonoscopy during 2010-2014 was collected from the Taiwanese Colorectal Cancer Screening Program Database and National Health Insurance Research Database. Severe complications included significant bleeding, perforation, and cardiopulmonary events ≤ 14 days after colonoscopy. The number of events per 1000 procedures was used to quantify complication rates. Multivariate analysis was conducted to assess the association of various factors with severe complications associated with FIT-colonoscopy compared with ordinary colonoscopy. RESULTS: 319 114 FIT-colonoscopies (214 955 patients) were identified, 51 242 (16.1 %) of which included biopsy and 94 172 (29.5 %) included polypectomy. Overall, 2125 significant bleedings (6.7 ‰) and 277 perforations (0.9 ‰) occurred ≤ 14 days after FIT-colonoscopy. Polypectomy, antiplatelet use, and anticoagulant use were associated with higher risk of complications (adjusted odds ratio [aOR] 4.41, 95 % confidence interval [CI] 4.05-4.81); aOR 1.35, 95 %CI 1.12-1.53; aOR 1.88, 95 %CI 0.61-5.84, respectively). Compared with ordinary colonoscopy, FIT-colonoscopy involved significantly higher risk of significant bleeding (aOR 3.10, 95 %CI 2.90-3.32). CONCLUSIONS: FIT-colonoscopy was associated with a more than two-fold risk of significant bleeding, especially when polypectomy was performed.

Risk of aortic dissection or aneurysm in patients with gallstone disease: a retrospective cohort study in Taiwan.

OBJECTIVE: This nationwide population-based cohort study was to compare the risk of aortic dissection (AD) or aortic aneurysm (AN) between the subjects with and without gallstone disease (GD). We also compare the risk of AD/AN between the patients with GD with and without cholecystectomy. SETTING: This nationwide population-based cohort study. PARTICIPANTS: We extracted the hospitalisation database from the National Health Insurance Research Database of Taiwan and identified a total of 343 300 patients aged ≥20 years with GD newly diagnosed between 2000 and 2010 as the study cohort, including 191 111 with cholecystectomy and 152 189 without cholecystectomy, respectively. We randomly selected those without GD as the control cohort, by 1:1 propensity score matching with the study cohort based on age, sex, comorbidities and year of the index date for GD diagnosis. RESULTS: The incidence of AD/AN was 6.65/10 000 person-years for the GD cohort and 6.24/10 000 person-years for the non-GD cohort (adjusted HR (aHR)=1.11, 95% CI=1.09 to 1.13), respectively (p<0.001). Furthermore, the incidence of AD/AN in the patients with GD was 9.93/10 000 person-years for the non-cholecystectomy patients (aHR=1.24, 95% CI=1.22 to 1.26) and 4.63/10 000 person-years for the cholecystectomy patients (aHR=0.97, 95% CI=0.95 to 0.99), respectively (p<0.05). CONCLUSIONS: The GD cohort was associated with and greater risk of AD/AN than the non-GD cohort, but the risk of AD/AN in the patients with GD would decrease after cholecystectomy.

Risk Prediction of Barrett's Esophagus in a Taiwanese Health Examination Center Based on Regression Models.

Determining the target population for the screening of Barrett's esophagus (BE), a precancerous condition of esophageal adenocarcinoma, remains a challenge in Asia. The aim of our study was to develop risk prediction models for BE using logistic regression (LR) and artificial neural network (ANN) methods. Their predictive performances were compared. We retrospectively analyzed 9646 adults aged ≥20 years undergoing upper gastrointestinal endoscopy at a health examinations center in Taiwan. Evaluated by using 10-fold cross-validation, both models exhibited good discriminative power, with comparable area under curve (AUC) for the LR and ANN models (Both AUC were 0.702). Our risk prediction models for BE were developed from individuals with or without clinical indications of upper gastrointestinal endoscopy. The models have the potential to serve as a practical tool for identifying high-risk individuals of BE among the general population for endoscopic screening.

Surface-Functionalized Boron Nanoparticles with Reduced Oxide Content by Nonthermal Plasma Processing for Nanoenergetic Applications.

The development of an in situ nonthermal plasma technology improved the oxidation and energy release of boron nanoparticles. We reduced the native oxide layer on the surface of boron nanoparticles (70 nm) by treatment in a nonthermal hydrogen plasma, followed by the formation of a passivation barrier by argon plasma-enhanced chemical vapor deposition (PECVD) using perfluorodecalin (C10F18). Both processes occur near room temperature, thus avoiding aggregation and sintering of the nanoparticles. High-resolution transmission electron microscopy (HRTEM), high-angular annular dark-field imaging (HAADF)-scanning TEM (STEM)-energy dispersive spectroscopy (EDS), and X-ray photoelectron spectroscopy (XPS) demonstrated a significant reduction in surface oxide concentration due to hydrogen plasma treatment and the formation of a 2.5 nm thick passivation coating on the surface due to PECVD treatment. These results correlated with the thermal analysis results, which demonstrated a 19% increase in energy release and an increase in metallic boron content after 120 min of hydrogen plasma treatment and 15 min of PECVD of perfluorodecalin. The PECVD coating provided excellent passivation against air and humidity for 60 days. We conclude in situ nonthermal plasma reduction and passivation lead to the amelioration of energy release characteristics and the storage life of boron nanoparticles, benefits conducive for nanoenergetic applications.