Consistency of convolutional neural networks in dermoscopic melanoma recognition: A prospective real-world study about the pitfalls of augmented intelligence.

BACKGROUND: Deep-learning convolutional neural networks (CNNs) have outperformed even experienced dermatologists in dermoscopic melanoma detection under controlled conditions. It remains unexplored how real-world dermoscopic image transformations affect CNN robustness. OBJECTIVES: To investigate the consistency of melanoma risk assessment by two commercially available CNNs to help formulate recommendations for current clinical use. METHODS: A comparative cohort study was conducted from January to July 2022 at the Department of Dermatology, University Hospital Basel. Five dermoscopic images of 116 different lesions on the torso of 66 patients were captured consecutively by the same operator without deliberate rotation. Classification was performed by two CNNs (CNN-1/CNN-2). Lesions were divided into four subgroups based on their initial risk scoring and clinical dignity assessment. Reliability was assessed by variation and intraclass correlation coefficients. Excisions were performed for melanoma suspicion or two consecutively elevated CNN risk scores, and benign lesions were confirmed by expert consensus (n = 3). RESULTS: 117 repeated image series of 116 melanocytic lesions (2 melanomas, 16 dysplastic naevi, 29 naevi, 1 solar lentigo, 1 suspicious and 67 benign) were classified. CNN-1 demonstrated superior measurement repeatability for clinically benign lesions with an initial malignant risk score (mean variation coefficient (mvc): CNN-1: 49.5(±34.3)%; CNN-2: 71.4(±22.5)%; p = 0.03), while CNN-2 outperformed for clinically benign lesions with benign scoring (mvc: CNN-1: 49.7(±22.7)%; CNN-2: 23.8(±29.3)%; p = 0.002). Both systems exhibited lowest score consistency for lesions with an initial malignant risk score and benign assessment. In this context, averaging three initial risk scores achieved highest sensitivity of dignity assessment (CNN-1: 94%; CNN-2: 89%). Intraclass correlation coefficients indicated 'moderate'-to-'good' reliability for both systems (CNN-1: 0.80, 95% CI:0.71-0.87, p < 0.001; CNN-2: 0.67, 95% CI:0.55-0.77, p < 0.001). CONCLUSIONS: Potential user-induced image changes can significantly influence CNN classification. For clinical application, we recommend using the average of three initial risk scores. Furthermore, we advocate for CNN robustness optimization by cross-validation with repeated image sets. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04605822).

EPA Consensus Project Paper: Accuracy of Photogrammetry Devices, Intraoral Scanners, and Conventional Techniques for the Full-Arch Implant Impressions: A Systematic Review.

PURPOSE: The objective of this systematic review was to evaluate and compare the accuracy of digital impression techniques and conventional methods for full-arch implant impressions. METHODS: An electronic literature search in the databases Medline (Pubmed), Web of Science, and Embase was performed to identify in vitro and in vivo publications (between 2016 and 2022) directly comparing digital and conventional abutment-level impression techniques. All selected articles passed through the data extraction procedure according to defined parameters in inclusion and exclusion criteria. Measurements on linear, angular and/or surface deviations were performed in all selected articles. RESULTS: Nine studies met the inclusion criteria and were selected for this systematic review. 3 articles were clinical studies and 6 studies were in vitro. Accuracy difference mean values of the trueness up to 162+/-77µm between digital and conventional techniques were reported in the clinical studies and up to 43µm in laboratory studies. Methodological heterogeneity was observed in both, in vivo and in vitro studies. CONCLUSIONS: Intraoral scanning and photogrammetric method showed comparable accuracy for registering implant positions in the full-arch edentulous cases. A tolerable implant prosthesis misfit threshold and objective misfit assessment criteria (for linear and angular deviations) should be verified in clinical studies.

Physiological stretching induces a differential extracellular matrix gene expression response in acetabular labrum cells.

The acetabular labrum is a fibrocartilaginous ring surrounding the acetabulum and is important for hip stability and contact pressure dissipation through a sealing function. Injury of the labrum may contribute to hip-joint degeneration and development of secondary osteoarthritis. Understanding how extracellular matrix (ECM) production and remodelling is regulated is of key importance for successful tissue restoration. The present study hypothesised that physiological stretching enhanced the metabolic activity and altered the ECM gene expression in labrum cells. Primary bovine labrum cells were physiologically stretched for up to 5 d. 24 h after the last stretch cycle, changes in metabolic activity were measured using the PrestoBlue™ HS Cell Viability Reagent and ECM gene expression was examined using the quantitative polymerase chain reaction method. Targets of interest were further investigated using immunofluorescence and enzyme-linked immunosorbent assay. Metabolic activity was not affected by the stretching (0.9746 ± 0.0614, p > 0.05). Physiological stretching upregulated decorin (DCN) (1.8548 ± 0.4883, p = 0.002) as well as proteoglycan 4 (PRG4) (1.7714 ± 0.6600, p = 0.029) and downregulated biglycan (BGN) (0.7018 + 0.1567, p = 0.008), cartilage oligomeric matrix protein (COMP) (0.5747 ± 0.2650, p = 0.029), fibronectin (FN1) (0.5832 ± 0.0996, p < 0.001) and spondin 1 (SPON1) (0.6282 ± 0.3624, p = 0.044) gene expression. No difference in PRG4 and DCN abundance or release could be measured. The here identified mechanosensitive targets are known to play relevant roles in tissue organisation. Therefore, physiological stretching might play a role in labrum tissue homeostasis and regeneration.

Towards redox-switchable organocatalysts based on bidentate halogen bond donors.

Redox-active bidentate halogen bond donors based on halopyridinium groups as halogen-bond donating units were synthesized and their structures were elucidated by X-ray diffraction analyses and DFT calculations. Via reversible twofold reduction, these dicationic species can be transformed to neutral compounds which should be much weaker Lewis acids. The corresponding electrochemical data were obtained, and CV as well as UV-vis and NMR techniques were also used to determine binding constants of these halogen bond donors to halides. While all titrations agree on the relative order of binding strengths (with chloride being bound strongest), there are marked deviations in the overall affinity constants which are discussed. In contrast to earlier azo-bridge analogues, the ethylene-linked variants presented herein do not oxidize halides, and thus the novel halogen bond donors could also be used as Lewis acidic organocatalysts in a halide abstraction benchmark reaction, yielding a performance similar to bis(haloimidazolium)-derived catalysts.

Fragmentation of propionitrile (CH3CH2CN) by low energy electrons.

Propionitrile (CH3CH2CN, PN) is a molecule relevant for interstellar chemistry. There is credible evidence that anions, molecules, and radicals that may originate from PN could also be involved in the formation of more complex organic compounds. In the present investigation, dissociative electron attachment to CH3CH2CN has been studied in a crossed electron-molecular beam experiment in the electron energy range of about 0-15 eV. In the experiment, seven anionic species were detected: C3H4N-, C3H3N-, C3H2N-, C2H2N-, C2HN-, C2N-, and CN-. The anion formation is most efficient for CN- and anions originating from the dehydrogenation of the parent molecule. A discussion of possible reaction channels for all measured negative ions is provided. The experimental results are compared with calculations of thermochemical thresholds of the detected anions.

Comparison of novel approaches for expedited pathogen identification and antimicrobial susceptibility testing against routine blood culture diagnostics.

Blood stream infections pose a major challenge for clinicians as the immediate application of an appropriate antibiotic treatment is the vital factor to safe the patients' lives. This preliminary study compares three different systems promising fast pathogen identification and susceptibility testing in comparison to conventional blood culture (BC): (i) the rapid antimicrobial susceptibility testing protocol according to EUCAST in combination with the Sepsityper® kit (sRAST), (ii) the direct inoculation method on the VITEK® 2 system (dVIT) and (iii) testing with the Accelerate Pheno® system (AccPh). All methods were assessed in terms of accuracy, time to result and usability. Twenty-three BC samples obtained from patients suffering from proven sepsis were analysed in detail. Pathogen identification was successful in 95·6, 91·3 and 91·3% in sRAST, dVIT and AccPh, respectively. Categorical agreement in antimicrobial susceptibility testing was 89·5, 96 and 96·6%, respectively. Time to result from sample entry to reporting ranged from an average of 4·6 h for sRAST and 6·9 h for AccPh to 10·6 h for dVIT. These results imply a significant shortening of reporting times at considerably high agreement rates for these new diagnostic approaches.

EFhd2/Swiprosin-1 is a common genetic determinator for sensation-seeking/low anxiety and alcohol addiction.

In many societies, the majority of adults regularly consume alcohol. However, only a small proportion develops alcohol addiction. Individuals at risk often show a high sensation-seeking/low-anxiety behavioural phenotype. Here we asked which role EF hand domain containing 2 (EFhd2; Swiprosin-1) plays in the control of alcohol addiction-associated behaviours. EFhd2 knockout (KO) mice drink more alcohol than controls and spontaneously escalate their consumption. This coincided with a sensation-seeking and low-anxiety phenotype. A reversal of the behavioural phenotype with ß-carboline, an anxiogenic inverse benzodiazepine receptor agonist, normalized alcohol preference in EFhd2 KO mice, demonstrating an EFhd2-driven relationship between personality traits and alcohol preference. These findings were confirmed in a human sample where we observed a positive association of the EFhd2 single-nucleotide polymorphism rs112146896 with lifetime drinking and a negative association with anxiety in healthy adolescents. The lack of EFhd2 reduced extracellular dopamine levels in the brain, but enhanced responses to alcohol. In confirmation, gene expression analysis revealed reduced tyrosine hydroxylase expression and the regulation of genes involved in cortex development, Eomes and Pax6, in EFhd2 KO cortices. These findings were corroborated in Xenopus tadpoles by EFhd2 knockdown. Magnetic resonance imaging (MRI) in mice showed that a lack of EFhd2 reduces cortical volume in adults. Moreover, human MRI confirmed the negative association between lifetime alcohol drinking and superior frontal gyrus volume. We propose that EFhd2 is a conserved resilience factor against alcohol consumption and its escalation, working through Pax6/Eomes. Reduced EFhd2 function induces high-risk personality traits of sensation-seeking/low anxiety associated with enhanced alcohol consumption, which may be related to cortex function.

Identification of large variation in the photosynthetic induction response among 37 soybean [Glycine max (L.) Merr.] genotypes that is not correlated with steady-state photosynthetic capacity.

Irradiance continuously fluctuates during the day in the field. The speed of the induction response of photosynthesis in high light affects the cumulative carbon gain of the plant and could impact growth and yield. The photosynthetic induction response and its relationship with the photosynthetic capacity under steady-state conditions (P max) were evaluated in 37 diverse soybean [Glycine max (L.) Merr.] genotypes. The induction response of leaf photosynthesis showed large variation among the soybean genotypes. After 5 min illumination with strong light, genotype NAM23 had the highest leaf photosynthetic rate of 33.8 µmol CO2 m-2 s-1, while genotype NAM12 showed the lowest rate at 4.7 µmol CO2 m-2 s-1. Cumulative CO2 fixation (CCF) during the first 5 min of high light exposure ranged from 5.5 mmol CO2 m-2 for NAM23 to 0.81 mmol CO2 m-2 for NAM12. The difference in the induction response among genotypes was consistent throughout the growth season. However, there was no significant correlation between CCF and P max among genotypes suggesting that different mechanisms regulate P max and the induction response. The observed variation in the induction response was mainly attributed to ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) activation, but soybean lines differing in the induction response did not differ in the leaf content of Rubisco activase α- and ß-proteins. Future studies will be focused on identifying molecular determinants of the photosynthetic induction response and determining whether this trait could be an important breeding target to achieve improved growth of soybeans in the field.

Amb a 1 isoforms: Unequal siblings with distinct immunological features.

BACKGROUND: Ragweed pollen represents a major allergy risk factor. Ragweed extracts contain five different isoforms of the major allergen Amb a 1. However, the immunological characteristics of Amb a 1 isoforms are not fully investigated. Here, we compared the physicochemical and immunological properties of three most important Amb a 1 isoforms. METHODS: After purification, the isoforms were physicochemically characterized, tested for antibody binding and induction of human T-cell proliferative responses. Their immunological properties were further evaluated in vitro and in vivo in a mouse model. RESULTS: Amb a 1 isoforms exhibited distinct patterns of IgE binding and immunogenicity. Compared to Amb a 1.02 or 03 isoforms, Amb a 1.01 showed higher IgE-binding activity. Isoforms 01 and 03 were the most potent stimulators of patients' T cells. In a mouse model of immunization, Amb a 1.01 induced higher levels of IgG and IgE antibodies when compared to isoforms 02 and 03. Interestingly, ragweed-sensitized patients also displayed an IgG response to Amb a 1 isoforms. However, unlike therapy-induced antibodies, sensitization-induced IgG did not show IgE-blocking activity. CONCLUSION: The present study showed that naturally occurring isoforms of Amb a 1 possess different immunogenic and sensitizing properties. These findings should be considered when selecting sequences for molecule-based diagnosis and therapy for ragweed allergy. Due to its high IgE-binding activity, isoform Amb a 1.01 should be included in diagnostic tests. In contrast, due to their limited B- and T-cell cross-reactivity patterns, a combination of different isoforms might be a more attractive strategy for ragweed immunotherapy.

Prenatal and adult androgen activities in alcohol dependence.

OBJECTIVE: Alcohol dependence is more prevalent in men than in women. The evidence for how prenatal and adult androgens influence alcohol dependence is limited. We investigated the effects of prenatal and adult androgen activity on alcohol dependence. Moreover, we studied how the behaviours of pregnant women affect their children's prenatal androgen load. METHOD: We quantified prenatal androgen markers (e.g., second-to-fourth finger length ratio [2D : 4D]) and blood androgens in 200 early-abstinent alcohol-dependent in-patients and 240 controls (2013-2015, including a 12-month follow-up). We also surveyed 134 women during pregnancy (2005-2007) and measured the 2D : 4D of their children (2013-2016). RESULTS: The prenatal androgen loads were higher in the male alcohol-dependent patients compared to the controls (lower 2D : 4D, P = 0.004) and correlated positively with the patients' liver transaminase activities (P < 0.001) and alcohol withdrawal severity (P = 0.019). Higher prenatal androgen loads and increasing androgen levels during withdrawal predicted earlier and more frequent 12-month hospital readmission in alcohol-dependent patients (P < 0.005). Moreover, stress levels (P = 0.002), alcohol (P = 0.010) and tobacco consumption (P = 0.017), and lifetime stressors (P = 0.019) of women during pregnancy related positively to their children's prenatal androgen loads (lower 2D : 4D). CONCLUSION: Androgen activities in alcohol-dependent patients and behaviours of pregnant women represent novel preventive and therapeutic targets of alcohol dependence.

Determining crystal phase purity in c-BP through X-ray absorption spectroscopy.

We employ X-ray absorption near-edge spectroscopy at the boron K-edge and the phosphorus L2,3-edge to study the structural properties of cubic boron phosphide (c-BP) samples. The X-ray absorption spectra are modeled from first-principles within the density functional theory framework using the excited electron core-hole (XCH) approach. A simple structural model of a perfect c-BP crystal accurately reproduces the P L2,3-edge, however it fails to describe the broad and gradual onset of the B K-edge. Simulations of the spectroscopic signatures in boron 1s excitations of intrinsic point defects and the hexagonal BP crystal phase show that these additions to the structural model cannot reproduce the broad pre-edge of the experimental spectrum. Calculated formation enthalpies show that, during the growth of c-BP, it is possible that amorphous boron phases can be grown in conjunction with the desired boron phosphide crystalline phase. In combination with experimental and theoretically obtained X-ray absorption spectra of an amorphous boron structure, which have a similar broad absorption onset in the B K-edge spectrum as the cubic boron phosphide samples, we provide evidence for the presence of amorphous boron clusters in the synthesized c-BP samples.

Locomotion characteristics of dairy cows walking on pasture and the effect of artificial flooring systems on locomotion comfort.

The locomotion comfort of dairy cows depends on the floor of the walking alleys. Optimal locomotion comfort is given when cows walk on pasture, allowing freedom from discomfort and pain and the expression of normal behavior. This study examined the characteristics of locomotion behavior on pasture (gold standard with optimal locomotion comfort) and compared it with behaviors of cows walking on mastic asphalt or solid rubber mats before and after a routine claw trimming session. Our hypotheses were (1) that gait variables were different on pasture versus mastic asphalt and on mastic asphalt versus rubber, and (2) that claw trimming had an effect on gait variables of cows walking on mastic asphalt. Twenty-four dairy cows kept in a tiestall facility were enrolled in this experimental trial. The pedogram was measured using 2 standalone 3-dimensional accelerometers (400 Hz), attached to the metatarsus of both hind limbs. The extracted pedogram variables included temporal events (kinematic outcome = gait cycle and stance-phase and swing-phase durations) and peaks (kinetic outcome = foot load, toe-off). The cows were further video-recorded to calculate walking speed and stride length. Locomotion score was performed on mastic asphalt to enroll only nonlame cows (locomotion score <3). For comparison between different floor types, repeated-measures ANOVA was performed with the cow as a subject variable, session time of measurement as within-subject variable, and flooring type as a fixed effect. Three separate analyses were performed: pasture versus mastic asphalt (analysis I), solid rubber versus mastic asphalt (analysis II), and the effect of claw trimming on the kinematic and kinetic variables on mastic asphalt (analysis III). All tested gait variables were significantly different between pasture and mastic asphalt floor. The optimal characteristics of locomotion comfort on pasture included shorter duration of gait cycle, longer stance-phase duration, shorter swing-phase duration, higher walking speed, longer stride length, and higher peaks of foot load and toe-off. However, gait variables of cows walking on rubber mats did not show any significant difference compared with the mastic asphalt floor; only stride length tended to be longer on rubber mats. In addition, the stance- and swing-phase durations significantly improved shortly after trimming. The left-right differences of the stance- and swing-phase durations tended to decrease after claw trimming when cows walked on asphalt floor. The results of this study show that solid rubber flooring does not result in significant improvement of the evaluated variables of locomotion comfort compared with mastic asphalt.

Dissociative electron attachment to the radiosensitizing chemotherapeutic agent hydroxyurea.

Dissociative electron attachment to hydroxyurea was studied in the gas phase for electron energies ranging from zero to 9 eV in order to probe its radiosensitizing capabilities. The experiments were carried out using a hemispherical electron monochromator coupled with a quadrupole mass spectrometer. Diversified fragmentation of hydroxyurea was observed upon low energy electron attachment and here we highlight the major dissociation channels. Moreover, thermodynamic thresholds for various fragmentation reactions are reported to support the discussion of the experimental findings. The dominant dissociation channel, which was observed over a broad range of energies, is associated with formation of NCO(-), water, and the amidogen (NH2) radical. The second and third most dominant dissociation channels are associated with formation of NCNH(-) and NHCONH2 (-), respectively, which are both directly related to formation of the highly reactive hydroxyl radical. Other ions observed with significant abundance in the mass spectra were NH2 (-)/O(-), OH(-), CN(-), HNOH(-), NCONH2 (-), and ONHCONH2 (-).

Insights into numerical cognition: considering eye-fixations in number processing and arithmetic.

Considering eye-fixation behavior is standard in reading research to investigate underlying cognitive processes. However, in numerical cognition research eye-tracking is used less often and less systematically. Nevertheless, we identified over 40 studies on this topic from the last 40 years with an increase of eye-tracking studies on numerical cognition during the last decade. Here, we review and discuss these empirical studies to evaluate the added value of eye-tracking for the investigation of number processing. Our literature review revealed that the way eye-fixation behavior is considered in numerical cognition research ranges from investigating basic perceptual aspects of processing non-symbolic and symbolic numbers, over assessing the common representational space of numbers and space, to evaluating the influence of characteristics of the base-10 place-value structure of Arabic numbers and executive control on number processing. Apart from basic results such as reading times of numbers increasing with their magnitude, studies revealed that number processing can influence domain-general processes such as attention shifting-but also the other way round. Domain-general processes such as cognitive control were found to affect number processing. In summary, eye-fixation behavior allows for new insights into both domain-specific and domain-general processes involved in number processing. Based thereon, a processing model of the temporal dynamics of numerical cognition is postulated, which distinguishes an early stage of stimulus-driven bottom-up processing from later more top-down controlled stages. Furthermore, perspectives for eye-tracking research in numerical cognition are discussed to emphasize the potential of this methodology for advancing our understanding of numerical cognition.

Subwavelength single layer absorption resonance antireflection coatings.

We present theoretically derived design rules for an absorbing resonance antireflection coating for the spectral range of 100 - 400 nm, applied here on top of a molybdenum-silicon multilayer mirror (Mo/Si MLM) as commonly used in extreme ultraviolet lithography. The design rules for optimal suppression are found to be strongly dependent on the thickness and optical constants of the coating. For wavelengths below λ ∼ 230 nm, absorbing thin films can be used to generate an additional phase shift and complement the propagational phase shift, enabling full suppression already with film thicknesses far below the quarter-wave limit. Above λ ∼ 230 nm, minimal absorption (k < 0.2) is necessary for low reflectance and the minimum required layer thickness increases with increasing wavelength slowly converging towards the quarter-wave limit.As a proof of principle, SixCyNz thin films were deposited that exhibit optical constants close to the design rules for suppression around 285 nm. The thin films were deposited by electron beam co-deposition of silicon and carbon, with N+ ion implantation during growth and analyzed with variable angle spectroscopic ellipsometry to characterize the optical constants. We report a reduction of reflectance at λ = 285 nm, from 58% to 0.3% for a Mo/Si MLM coated with a 20 nm thin film of Si0.52C0.16N0.29.

Echoes of the electroweak phase transition: discovering a second Higgs doublet through A0→ZH0.

The existence of a second Higgs doublet in nature could lead to a cosmological first-order electroweak phase transition and explain the origin of the matter-antimatter asymmetry in the Universe. We obtain the spectrum and properties of the new scalars H0, A0, and H(±) that signal such a phase transition and show that the observation of the decay A0→ZH0 at LHC would be a "smoking gun" signature of these scenarios. We analyze the LHC search prospects for this decay in the ℓℓbb and ℓℓW(+)W(-) final states, arguing that current data may be sensitive to this signature in the former channel as well as there being great potential for a discovery in either channel at the very early stages of the 14 TeV run.

Cognitive control in number magnitude processing: evidence from eye-tracking.

The unit-decade compatibility effect describes longer response times and higher error rates for incompatible (e.g., 37_52) than compatible (e.g., 42_57) number comparisons. Recent research indicated that the effect depends on the percentage of same-decade filler items. In the present study, we further examined this relationship by recording participants' eye-fixation behaviour. In four conditions, participants had to compare item sets with different filler item types (i.e., same-decade and same-unit filler items) and different numbers of same-decade filler items (i.e., 25, 50, and 75%). We found a weaker unit-decade compatibility effect with most fixations on tens in the condition with same-unit filler items. Moreover, the compatibility effect increased with the percentage of same-decade filler items which was accompanied by less fixations on tens and more fixations on units. Thus, our study provides first eye-tracking evidence for the influence of cognitive control in number processing.

[Five case reports on granulosa cell tumors in cattle with practical information on diagnosis and possible progression]. / Fünf Fallberichte zum Granulosazelltumor beim Rind mit praktischen Hinweisen zur Diagnostik und zum möglichen Verlauf.

INTRODUCTION: Five cases of ovarian tumors (granulosa cell tumors) in cattle are presented from the patient load of the Vetsuisse University of Zurich and Bern. The aim of this work was to demonstrate the variable development of the illness and to indicate diagnostic and therapeutic possibilities to the practicing veterinarians. Case 1 shows bilateral appearance and the development of malignancy and metastases. The main symptoms in case 2 were the development of the mammary gland in a juvenile animal and the behavior modification due to a hormonal imbalance. The cases 3, 4 and 5 underwent surgery, case 4 restarted reproductive activity resulting in five subsequent pregnancies. The initial presumption is a result of a gynecological including ultrasonographic examination and can be verified by the analysis of Müllerian Inhibiting Hormone in serum. The decision to perform surgery should be done rapidly, as normal fertility can be achieved if the tumor is located unilaterally. Tumor growth and potential malignancy can provoke fatal health issues and also make it impossible to use meat of these animals for consumption.

INTRODUCTION: Cinq cas de tumeurs ovariennes (tumeurs des cellules de la granulosa) chez les bovins sont présentés à partir de la patientèle de l'Université Vetsuisse de Zurich et de Berne. Le but de ce travail était de montrer l'évolution variable de la maladie et d'indiquer les possibilités diagnostiques et thérapeutiques aux vétérinaires praticiens. Le cas 1 montre la possibilité d'une apparition bilatérale avec développement d'une tumeur maligne et de métastases. Les principaux symptômes du cas 2 étaient le développement de la glande mammaire chez un animal juvénile et la modification du comportement due à un déséquilibre hormonal. Les cas 3, 4 et 5 ont subi une intervention chirurgicale, le cas 4 a repris une activité de reproduction avec cinq gestations ultérieures. La présomption initiale résulte d'un examen gynécologique et peut être vérifiée par l'analyse de l'hormone anti-müllérienne dans le sérum. La décision d'opérer doit être prise rapidement, car une intervention chirurgicale pour enlever l'ovaire atteint peut, dans l'idéal, permettre une reprise de l'activité de reproduction. La croissance de la tumeur et la malignité potentielle peuvent provoquer des problèmes de santé fatals et rendre la viande de ces animaux impropre à la consommation.

PEMOCS: Evaluating the effects of a concept-guided, PErsonalised, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-study protocol for a randomised controlled trial.

BACKGROUND: Many stroke survivors remain with residual cognitive and motor impairments despite receiving timely acute and sub-acute rehabilitation. This indicates that rehabilitation following stroke should be continuous to meet the needs of individual stroke patients. Both cognitive and motor functions are essential for mastering daily life and, therefore, should be aimed at with rehabilitation. Exergames, motor-cognitive exercises performed using video games, are an auspicious method to train both motor and cognitive functions and at the same time may foster the long-term motivation for training. This study aims to assess the effect of concept-guided, personalised, motor-cognitive exergame training on cognitive and motor functions in chronic stroke survivors. METHODS: This study is a single-blinded, randomised controlled trial. Assessments are performed at baseline, after a 12-week intervention, and at a 24-weeks follow-up. Chronic stroke patients (≥ 18 years old, ≥ 6 months post-stroke) able to stand for 3 min, independently walk 10 m, follow a two-stage command, and without other neurological diseases apart from cognitive deficits or dementia are included. Participants in the intervention group perform the exergame training twice per week for 30 (beginning) up to 40 (end) minutes additionally to their usual care programme. Participants in the control group receive usual care without additional intervention(s). Global cognitive functioning (total Montreal Cognitive Assessment (MoCA) score) is the primary outcome. Secondary outcomes include health-related quality of life, specific cognitive functions, single- and dual-task mobility, and spatiotemporal gait parameters. The target sample size for this trial is 38 participants. Linear mixed models with the post-outcome scores as dependent variables and group and time as fixed effects will be performed for analysis. DISCUSSION: Superior improvements in global cognitive functioning and in the abovementioned secondary outcomes in the intervention group compared to the control group are hypothesised. The results of this study may guide future design of long-term rehabilitation interventions after stroke. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05524727). Registered on September 1, 2022.