Influence of Service Conditions and Mix Design on the Physical-Mechanical Properties of Roller-Compacted Concrete for Pavement.

This research focuses on the behavior of roller-compacted concrete (RCC) used in pavements, which are prone to deterioration affecting their performance. These deteriorations result from various causes, including traffic load, errors during construction, mix design, and ambient conditions. Among these, ambient conditions could lead to a marked variable impact on material behavior and durability depending on the conditions associated with each region. Accordingly, this study aims to deepen the understanding of the effect, which a broader range of ambient conditions and different mix designs have on the physical and mechanical properties of RCC. Measurements such as the amount of water vapor per kilogram of air were used to apply the findings comprehensively. The RCC analysis encompassed experimentation with different compositions, altering the cement water ratio amount, and adding a superplasticizer. The impact of curing on the materials was evaluated before subjecting them to various humidity and temperature conditions. Laboratory tests were conducted to measure performance, including moisture, shrinkage, compressive strength, and the progression of flexural fracture resistance over curing periods of up to 90 days. The results revealed a logarithmic correlation between shrinkage and ambient humidity, which is the most determining factor in performance. Mix optimization through increased cement and reduced water enhanced the tensile strength of the material. Furthermore, the curing process was confirmed to increase resistance to shrinkage, especially in the long term, establishing it as a crucial element for the structural stability of RCC, which is relatively insensitive to variations in ambient conditions.

Prediction of the Physical-Mechanical Properties of Roller-Compacted Concrete Pavements under Different Service and Mix Conditions Based on Cement and Water Content.

Roller-compacted concrete (RCC) for pavements has experienced problems with its physical-mechanical performance over extended periods due to ambient and in situ curing conditions. Accordingly, this study aimed to present multiple regression equations for calculating the physical-mechanical properties of RCC for pavements under different service and mix conditions. For this purpose, the research included two cement and two water contents, one reduced with admixture, and four combinations of temperature and relative humidity. For model calibration and definition of the equations, cubic and beam samples were fabricated to carry out physical-mechanical tests, such as moisture content, shrinkage, and modulus of rupture. Laboratory-obtained data were studied with the Response Surface Methodology (RSM) to determine the best regression equations. The main findings determined that the behavior of a mixture of RCC at a prolonged ambient exposure time is possible because the surface models and the RSM were consistent with the different service and mix conditions. The models showed an accuracy of 98.99% in detecting shrinkage changes from 12 to 16% cement with 5.65% water in dry to wet ambient conditions. Similarly, moisture content and modulus of rupture had a 98.27 to 98.88% fit. Finally, the drying shrinkage, with mixes of 12% cement and water content variations with water-reducing admixture and superplasticizer effects, had an adjustment of 94.87%.

Inteligencia artificial y lenguaje médico (III) / Artificial intelligence and medical language (III)

A principios de enero de 2023, la revista Nature se hacía eco de un artículo3 subido a finales de diciembre, sin revisión, al servidor bioRxiv. Los autores pidieron a GePeTo que redactara sendos resúmenes de 50 artículos publicados en cinco revistas biomédicas punteras: The Journal of the American Medical Association (JAMA), The New England Journal of Medicine, The British Medical Journal (BMJ), The Lancet y Nature Medicine. Cuando pasaron un detector automático de plagio a estos resúmenes generados por GePeTo, el resultado fue de un 100% de originalidad. A continuación, presentaron estos 50 resúmenes creados con IA y los 50 resúmenes originales publicados en las revistas a un grupo de científicos con experiencia como revisores externos para importantes publicaciones, y les pidieron que trataran de adivinar cuáles eran humanos y cuáles generados por IA. Un chimpancé tecleando a ciegas (o lanzando al aire una moneda) obtendría una tasa esperable de aciertos del 50%. Los revisores humanos identificaron correctamente como obra de GePeTo apenas el 68% de los resúmenes generados, y reconocieron erróneamente como escritos por IA un 14% de los resúmenes originales publicados. No está nada mal, la verdad, para un bot con menos de un mes de vida; todo apunta a que en los años venideros lo irá haciendo cada vez mejor, y que a corto plazo los textos generados por IA serán indistinguibles de los textos humanos para el común de los lectores. (AU)

Treatment Outcomes with Standard of Care in Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Real-World Data Analysis.

INTRODUCTION: Despite new therapies for relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL), treatments with chemotherapy, single-agent rituximab/obinutuzumab, single-agent lenalidomide, or combinations of these agents continue to be commonly used. METHODS: This retrospective study utilized longitudinal data from 4226 real-world electronic health records to characterize outcomes in patients with R/R DLBCL. Eligible patients were diagnosed with DLBCL between January 2010 and March 2022 and had R/R disease treated with ≥ 1 prior systemic line of therapy (LOT), including ≥ 1 anti-CD20-containing regimen. RESULTS: A total of 573 patients treated with ≥ 1 prior LOT were included (31.2% and 13.4% with ≥ 2 and ≥ 3 prior LOTs, respectively). Median duration of follow-up was 7.7 months. Most patients (57.1%) were male; mean standard deviation (SD) age was 63 (14.7) years. Overall and complete response rates (95% confidence interval (CI) were 52% (48-56) and 23% (19-27). Median duration of response and duration of complete response were 3.5 and 18.4 months. Median progression-free and overall survival (95% CI) was 3.0 (2.8-3.3) and 12.9 (10.1-16.9) months, respectively. Patients with a higher number of prior LOTs, primary refractoriness, refractoriness to last LOT, refractoriness to last anti-CD20-containing regimen, and prior CAR T exposure had worse outcomes (i.e., challenging-to-treat R/R DLBCL) compared with those without these characteristics. CONCLUSIONS: Outcomes in patients with R/R DLBCL treated with chemotherapy, single-agent rituximab/obinutuzumab, single-agent lenalidomide, or combinations of these agents remain poor, especially for those with challenging-to-treat R/R DLBCL. These findings underscore the unmet need for new, safe, and effective therapies, especially for challenging-to-treat R/R DLBCL populations.

TopCoW: Benchmarking Topology-Aware Anatomical Segmentation of the Circle of Willis (CoW) for CTA and MRA.

The Circle of Willis (CoW) is an important network of arteries connecting major circulations of the brain. Its vascular architecture is believed to affect the risk, severity, and clinical outcome of serious neuro-vascular diseases. However, characterizing the highly variable CoW anatomy is still a manual and time-consuming expert task. The CoW is usually imaged by two angiographic imaging modalities, magnetic resonance angiography (MRA) and computed tomography angiography (CTA), but there exist limited public datasets with annotations on CoW anatomy, especially for CTA. Therefore we organized the TopCoW Challenge in 2023 with the release of an annotated CoW dataset. The TopCoW dataset was the first public dataset with voxel-level annotations for thirteen possible CoW vessel components, enabled by virtual-reality (VR) technology. It was also the first large dataset with paired MRA and CTA from the same patients. TopCoW challenge formalized the CoW characterization problem as a multiclass anatomical segmentation task with an emphasis on topological metrics. We invited submissions worldwide for the CoW segmentation task, which attracted over 140 registered participants from four continents. The top performing teams managed to segment many CoW components to Dice scores around 90%, but with lower scores for communicating arteries and rare variants. There were also topological mistakes for predictions with high Dice scores. Additional topological analysis revealed further areas for improvement in detecting certain CoW components and matching CoW variant topology accurately. TopCoW represented a first attempt at benchmarking the CoW anatomical segmentation task for MRA and CTA, both morphologically and topologically.

Assessing the Quality of YouTube's Incontinence Information after Cancer Surgery: An Innovative Graphical Analysis.

BACKGROUND: Prostate and colorectum cancers rank among the most common cancers, and incontinence is a significant postsurgical issue affecting the physical and psychological well-being of cancer survivors. Social media, particularly YouTube, has emerged as a vital source of health information. While YouTube offers valuable content, users must exercise caution due to potential misinformation. OBJECTIVE: This study aims to assess the quality of publicly available YouTube videos related to incontinence after pelvic cancer surgery. METHODS: A search on YouTube related to "Incontinence after cancer surgery" was performed, and 108 videos were analyzed. Multiple quality assessment tools (DISCERN, GQS, JAMA, PEMAT, and MQ-VET) and statistical analyses (descriptive statistics and intercorrelation tests) were used to evaluate the characteristics and popularity, educational value, quality, and reliability of these videos, relying on novel graphical representation techniques such as Sankey and Chord diagrams. RESULTS: Strong positive correlations were found among quality rating scales, emphasizing agreement. The performed graphical analysis reinforced the reliability and validity of quality assessments. CONCLUSIONS: This study found strong correlations among five quality scales, suggesting their effectiveness in assessing health information quality. The evaluation of YouTube videos consistently revealed "high" quality content. Considering the source is mandatory when assessing quality, healthcare and academic institutions are reliable sources. Caution is advised with ad-containing videos. Future research should focus on policy improvements and tools to aid patients in finding high-quality health content.

Exploring the Implications of Inter-Limb Asymmetries on Sprint, Agility, and Jump Performance in Young Highly-Trained Basketball Athletes: Is There a Relevant Threshold?

Background and Objectives: This study aimed to investigate the magnitude of vertical jump inter-limb asymmetries among young highly-trained basketball athletes and to analyze its impact on sport performance, specifically in sprints, agility, and vertical jumps. Materials and Methods: A unilateral countermovement jump (CMJ) was employed to determine Inter-limb Index Asymmetry (IAI) in 320 participants aged from 14 to 18 years, from the Valencia Basket youth academy. IAI was categorized into three groups: 0-9.9%, 10-14.9%, and >15%. The relationship between IAI and performance variables was analyzed through correlation studies (Pearson or Spearman's). The influence of IAI magnitude was assessed using ANOVA or Kruskal-Wallis analysis, with leg dominance as a covariable. SPSS Statistics version 26 was used for analysis. Results: Among all the participants, the mean IAI was 10.6%. Correlation studies revealed non-significant values (p < 0.05) between IAI and sport performance variables. The three IAI magnitude groups did not show statistically significant differences in sprint, agility, and jump outcomes. Leg dominance did not seem to influence performance outcomes, except for unilateral CMJ. Conclusions: The results obtained challenge the assumption that an IAI above 10% negatively affects sprint, agility, or jump performance in young basketball athletes. Notably, the magnitude of IAI did not influence sport performance parameters, suggesting that the 10-15% threshold from previous studies may not be applicable to this population. The study emphasizes the need to understand lower-limb asymmetries in the context of specific sport task performance, considering the potential evolution over time among affected young athletes.

Social inequalities in the use of physiotherapy in women diagnosed with breast cancer in Barcelona: DAMA cohort.

PURPOSE: This study aimed to analyze social inequalities in the use and access of physiotherapy service and its clinical and socio-economic determinants in women diagnosed with breast cancer in the hospital network of Barcelona. METHODS: Data from 2235 women belonging to the mixed (prospective and retrospective) DAMA Cohort were analyzed, including demographic, socio-economic, clinical, and breast cancer treatment outcomes. To determine the influence of such variables on access to physiotherapy, different Poisson regression models with robust variance (obtaining Prevalence Ratios and confidence intervals) were estimated. RESULTS: Although when experiencing different chronic and acute symptoms, only between 20 and 35% of women visited physiotherapist. Two out of 3 women reported to have received insufficient information about medical care and rehabilitation. Age of women, job occupation, education level, having a mutual or private insurance, as well as outcomes related to breast cancer, appear to be factors influencing the access to physiotherapy. CONCLUSIONS: Social and economic inequalities exist on the access to physiotherapy by women diagnosed with breast cancer, which is generally low, and may clearly impact on their functional recovery. Promoting strategies to reduce social bias, as well as improve communication and patient information regarding physiotherapy may be of interest for a better health care in breast cancer diagnosed women.

Effectiveness of strategies to improve adherence to physical therapy in patients with knee and hip osteoarthritis: a systematic review and meta-analysis.

PURPOSE: To determine the effectiveness of current strategies oriented to increase adherence to physical therapy in subjects with knee and hip osteoarthritis (OA). MATERIAL AND METHODS: A systematic review of electronic databases was conducted from inception until March 2023. Studies with experimental interventions using strategies to increase adherence to physical therapy programs in subjects with knee or hip OA were included. A meta-analysis compared the effects of such interventions with usual care for adherence-related measures (primary outcome), and functional and pain outcomes, using standardized mean differences (SMD) with a 95% confidence interval (CI). GRADE was used to determine the strength of the resultant evidence and the external validity of the findings. RESULTS: Fifteen articles, assessing 1,818 participants, were included. The interventions included cognitive-behavior strategies, telephone calls, internet-based interventions, communication technologies, and booster sessions. A meta-analysis revealed that the experimental interventions increased adherence over usual care with a moderate effect size of SMD = 0.39 (95%CI = 0.08-0.71) and moderate certainty in this evidence. CONCLUSION: Overall, this review supports that the strategies to promote adherence to physical therapy in individuals with knee and hip OA are effective. However, the positive impact on adherence rates does not always translate into improved clinical outcomes.

Strategies such us behavioral programs, phone reminders, telerehabilitation and equipment based on new technologies can be employed to enhance adherence to physical therapy among individuals with knee and hip osteoarthritis.These interventions may be also beneficial for improving self-reported functionality; however, their impact on performance-based function and pain appears to be limited.The potential for longer-duration interventions to enhance adherence in the long-term is a subject of speculation but requires further reinforcement through additional studies.

Risk Factors and Prevalence Associated With Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: A Tertiary Care Hospital Experience in Western Mexico.

Introduction Laparoscopic cholecystectomy (LC) is a common procedure used for the treatment of different pathologies caused by gallstones in the gallbladder, and one of the most common indications is acute cholecystitis. The definitive treatment for acute cholecystitis is surgery, and LC is the gold standard. Nevertheless, transoperative complications (like intraoperative bleeding, anatomical abnormalities of the gallbladder, etc.) of LC and some other preoperative factors (like dilatation of bile duct, increased gallbladder wall thickness, etc.) can cause or be a risk factor for conversion to open cholecystectomy (OC). The objective of this study was to determine the risk factors and prevalence associated with the conversion from LC to OC in patients with gallbladder pathology and the indication for LC. Materials and methods This was a prospective cohort study. We included patients of both sexes over 18 years of age with gallbladder disease. To determine the risk factors associated with conversion, we performed a bivariate analysis and then a multivariate analysis. Results The rate of conversion to OC was 4.54%. The preoperative factors associated with conversion, in the bivariate analysis, were common bile duct dilatation (p=0.008), emergency surgery (p=0.014), and smoking (p=0.001); the associated intraoperative variables were: laparoscopic surgery duration (p <0.0001), Calot triangle edema (p=0.033), incapacity to hold the gallbladder with atraumatic laparoscopic tweezers (p=0.036), and choledocholithiasis (p=0.042). Laparoscopic Surgery duration was the only factor with a significant association in the multivariate analysis (p=0.0036); we performed a receiver operating characteristic (ROC) curve analysis and found a cut-off point of 120 minutes for the duration of laparoscopic surgery with a sensitivity and a specificity of 67 and 88%, respectively. Conclusion The prevalence of conversion from LC to OC is similar to that reported in the international literature. The risk factors associated with conversion to OC, in this study, should be confirmed in future clinical studies, in this same population, with a larger sample size.

Patient, clinician, and performance-based measures provide different information about clinical symptoms in patients with severe knee osteoarthritis presenting with depressive symptoms: a cross-sectional study.

BACKGROUND AND PURPOSE: Clinical status of subjects with knee osteoarthritis (KOA) is influenced by a complex interaction of several biopsychosocial factors. The use of patient-reported measures (PROM) is considered the gold standard for their evaluation. However, considering that 1 in 5 subjects with KOA present with depressive symptoms, it is necessary to analyse how this psychological domain may influence the subjective perception of PROM. The objective was to study the impact that depressive symptoms have on functional outcome assessments, according to the degree of objectivity of diverse outcome measures. METHODS: Cross-sectional study. Subjects with severe KOA, verified with clinical and radiological symptoms, were assessed with patient-reported (Oxford Knee Score), clinician-reported (knee range of motion), and performance-based (Timed up and go test) measures. The existence of depressive symptoms was assessed with the Yesavage scale, and participants were classified for having no-, mild- or severe-symptoms. Linear correlations (r) and one-way analysis of variance compared groups (95% CI). RESULTS: 244 participants were analysed, of which 75 (30.7%) had depressive symptoms. These symptoms had an inverse moderate association with Oxford Knee Score (r = -0.387). However, the correlation with the Timed up and go test was low (r = 0.176), while there was no correlation with knee ROM (r = -0.087). CONCLUSIONS: This study supports that patient-reported questionnaires may offer biased information on the clinical status of patients with severe knee osteoarthritis who present with depressive symptoms. Consideration of such symptoms may be critical to ensure data collected to accurately reflect patients' capacities and perceptions.

Utilidad de la endoscopia intraoperatoria en cirugía esofagogástrica / The utility of intraoperative endoscopy in esophagogastric surgery

La endoscopia flexible (EF) es un procedimiento de gran utilidad para el manejo diagnóstico y terapéutico de lesiones del tracto digestivo superior. A pesar de que su uso intraoperatorio se ha extendido con el paso de los años, su empleo por parte de cirujanos es aún limitado en nuestro medio. Las oportunidades de capacitación en EF varían ampliamente entre instituciones, especialidades y países. La endoscopia intraoperatoria (EIO) presenta ciertas peculiaridades que aumentan su complejidad respecto a la EF estándar. La realización de EIO repercute positivamente en los resultados quirúrgicos aportándoles seguridad y calidad así como disminución de las complicaciones asociadas a estas técnicas. Debido a sus innumerables ventajas, su uso intraoperatorio por parte de cirujanos es actualmente un proyecto vigente en muchos países y forma parte de un futuro próximo en otros, extendiéndose su uso dentro de la especialidad de cirugía general gracias a la creación de proyectos de formación mejor estructurados. En este manuscrito se realiza una revisión y puesta al día de las indicaciones y utilidades de la endoscopia digestiva alta intraoperatoria en la cirugía esofagogástrica. (AU)

Flexible endoscopy (FE) plays a major role in the diagnosis and treatment of gastrointestinal disease. Although its intraoperative use has spread over the years, its use by surgeons is still limited in our setting. EF training opportunities are different among many institutions, specialties, and countries. Intraoperative endoscopy (IOE) presents peculiarities that increase its complexity compared to standard EF. IOE has a positive impact on surgical results, due to increased safety and quality, as well as a reduction in the complications. Due to its innumerable advantages, its intraoperative use by surgeons is currently a current project in many countries and is part of the near future in others because of the creation of better structured training projects. This manuscript reviews and updates the indications and uses of intraoperative upper gastrointestinal endoscopy in esophagogastric surgery. (AU)