Search Results (12,461)

Background: Conventional echocardiography used to assess volumes of the left ventricle (LV) and left atrium (LA) along with mitral regurgitation grade is routine in studies before and after transcatheter edge-to-edge mitral valve repair (Mitral TEER). Previous studies focus on LV parameter changes and comparison of the functions before and a few months following Mitral TEER implantation, as well as LA reverse remodeling, by assessing LV volumes. However, less is known regarding LA strain changes in the early phase after the procedure. The objective of the study was to assess the effect of Mitral TEER on LA strain early after TEER procedure. Methods: The retrospective study included 44 patients who underwent Mitral TEER. LA strain and volumes were evaluated by speckle tracking echocardiography at the baseline and 24–48 h following the procedure. Demographic, echocardiographic, and clinical characteristics were obtained and statistically analyzed. Results: LA global longitudinal strain (GLS) reservoir improved significantly (from 12.2 ± 7 to 14.7 ± 6.4, p = 0.0079) after Mitral TEER. Significant improvements were also seen in LA volumes (LA maximal and minimal volume), which reduced by 17% and 22.5% respectively. LV GLS was significantly changed (from −9.8% to −12.8%, p < 0.0001) following Mitral TEER, whereas LV stroke volume was not significantly different between the baseline and post-Mitral TEER (p = 0.7798). Conclusions: After successful Mitral TEER, there was a very early improvement in LA function. Two-dimensional speckle tracking echocardiography may contribute to our understanding of LA functional changes immediately post-procedure. Full article

Recently, there has been a significant focus on developing various energy harvesting technologies to power remote electronic sensors, data loggers, and communication devices for smart grid systems. Among these technologies, magnetic energy harvesting stands out as one straightforward method to extract substantial power from current-carrying overhead lines. Due to the relatively small size of the harvester, the high currents in the distribution system quickly saturate its magnetic core. Consequently, the magnetic harvester operates in a highly nonlinear manner. The nonlinear nature of the downstream AC to DC converters further complicates the process, making precise analytical modeling a challenging task. In this paper, a clamped type overhead line magnetic energy harvester with a controlled active rectifier generating significant DC output power is investigated. A piecewise nonlinear analytical model of the magnetic harvester is derived and reported. The modeling approach is based on the application of the Froelich equation. The chosen approximation method allowed for a complete piecewise nonlinear analytical treatise of the harvester’s behavior. The main findings of this study include a closed-form solution that accounts for both the core and rectifiers’ nonlinearities and provides an accurate quantitative prediction of the harvester’s key parameters such as the transfer window width, optimal pulse location, average DC output current, and average output power. To facilitate the study, a nonlinear model of the core was developed in simulation software, based on parameters extracted from core experimental data. Furthermore, theoretical predictions were verified through comparison with a computer simulation and experimental results of a laboratory prototype harvester. Good agreement between the theoretical, simulation, and experimental results was found. Full article

The red spotting disease harms sea urchins to the extent of mass mortality in the ocean and echinocultures, accompanied by environmental damage and economic losses. The current study emphasizes the antimicrobial resistance of three isolated bacteria, closely related to Vibrio harveyi, Vibrio owensii, and Vibrio fortis, associated with red spotting in the cultured sea urchin Tripneustes gratilla. In vitro trials examined the susceptibility of these bacterial isolates to various antibiotics. In addition, using an in silico examination, we revealed the arsenal of antimicrobial resistance genes in available genomes of various pathogenic Vibrio associated with diseases in sea urchins, fish, shellfish, and corals. These two approaches enabled the discussion of the similarities and differences between aquatic pathogenic Vibrio and their antibiotic resistance. Among them, we revealed a core resistance to tetracyclines and penams by the in vitro examined strains. At the same time, the in silico study also supported this core resistance by the presence of the adeF and CRP genes in the bacterial genomes. Nevertheless, variability and specific resistance were evident at the species and strain levels in the Vibrio bacteria and genomes. The in vitro trials highlighted the diverse resistance of the Vibrio harveyi-like isolate to all examined antibiotics, while the other two isolates were found susceptible to nitrofurantoin and sulfamethoxazole. The resistance of the Vibrio harveyi-like isolate could not have been obtained in the genome of the proposed relative of Vibrio harveyi VHJR7 that lacks the oqxA and oqxB genes, which enables such a resistance. A unique sensitivity of the Vibrio fortis-like isolate to erythromycin is proposed when compared to other isolated Vibrio and Vibrio genomes that seem capable of resisting this drug. According to the results, we propose nitrofurantoin or sulfamethoxazole for treating two of the red-spotting-associated isolates (Vibrio fortis and Vibrio owensii-like), but not Vibrio harveyi-like. We assume that a shared resistance to some antibiotics by Vibrios is gained by a horizontal gene transfer while previous exposures of a bacterial strain to a specific drug may induce the development of a unique resistance. Finally, we discuss the novel knowledge on antibiotic resistance in Vibrio from the current research in light of the potential risks when using drugs for disease control in aquaculture. Full article

In this study, we introduce a novel approach that integrates interpretability techniques from both traditional machine learning (ML) and deep neural networks (DNN) to quantify feature importance using global and local interpretation methods. Our method bridges the gap between interpretable ML models and powerful deep learning (DL) architectures, providing comprehensive insights into the key drivers behind model predictions, especially in detecting outliers within medical data. We applied this method to analyze COVID-19 pandemic data from 2020, yielding intriguing insights. We used a dataset consisting of individuals who were tested for COVID-19 during the early stages of the pandemic in 2020. The dataset included self-reported symptoms and test results from a wide demographic, and our goal was to identify the most important symptoms that could help predict COVID-19 infection accurately. By applying interpretability techniques to both machine learning and deep learning models, we aimed to improve understanding of symptomatology and enhance early detection of COVID-19 cases. Notably, even though less than 1% of our cohort reported having a sore throat, this symptom emerged as a significant indicator of active COVID-19 infection, appearing 7 out of 9 times in the top four most important features across all methodologies. This suggests its potential as an early symptom marker. Studies have shown that individuals reporting sore throat may have a compromised immune system, where antibody generation is not functioning correctly. This aligns with our data, which indicates that 5% of patients with sore throats required hospitalization. Our analysis also revealed a concerning trend of diminished immune response post-COVID infection, increasing the likelihood of severe cases requiring hospitalization. This finding underscores the importance of monitoring patients post-recovery for potential complications and tailoring medical interventions accordingly. Our study also raises critical questions about the efficacy of COVID-19 vaccines in individuals presenting with sore throat as a symptom. The results suggest that booster shots might be necessary for this population to ensure adequate immunity, given the observed immune response patterns. The proposed method not only enhances our understanding of COVID-19 symptomatology but also demonstrates its broader utility in medical outlier detection. This research contributes valuable insights to ongoing efforts in creating interpretable models for COVID-19 management and vaccine optimization strategies. By leveraging feature importance and interpretability, these models empower physicians, healthcare workers, and researchers to understand complex relationships within medical data, facilitating more informed decision-making for patient care and public health initiatives. Full article

The Late Chalcolithic period in the southern Levant saw notable changes in almost every aspect of daily life. Some of the most significant shifts during this time seem to have been anchored in the subsistence economy and involved food and its cooking, processing, storage, serving, and handling with vessels and tools. The paper offers a comprehensive overview and analysis of one utensil that is likely to have been caught up in these developments—the Late Chalcolithic spoon. While spoons first appeared in the region during the Pottery Neolithic period, the Chalcolithic period witnessed a rise in their frequency and distribution. Nonetheless, they were few in number. While their functions remain unclear, we have presupposed their association with food and kitchenware and have explored them in this vein. This paper delves into their morphological characteristics and distribution and ponders their significance in light of other changes that occurred during the Late Chalcolithic period in the southern Levant. Full article

Objectives: To assess success rates and cost-effectiveness of adrenal venous sampling (AVS) after implementing point-of-care rapid cortisol (RC) testing conducted using a europium nanoparticle-based fluoro-immunoassay in patients with primary hyperaldosteronism. Methods: A retrospective review of AVS procedures was conducted at our medical center between January 2016 and June 2024. The primary objective was to compare the success rates of AVS before and after the implementation of the RC testing. Secondary outcomes included a cost–benefit analysis. Results: Of 55 AVS procedures, 19 were conducted using RC testing and 36 were in the historical control cohort. The success rates for right vein sampling were 79% and 67%, respectively. Overall, in six (31.5%) patients in the RC cohort, a low RC selectivity index (SI) value, calculated within 10 min, enabled determination of unsuccessful cannulation and need for resampling during the same AVS session. Repeated sampling resulted in successful procedures in two cases (10.5%) and unsuccessful AVS in four cases, nonetheless sparing the need for repeated AVS sessions in 31.5% of cases. Utilizing RC potentially spared 6 patients from repeated AVS sessions, and considering the additional expenses on the RC test, its use afforded cost savings of an average of $1288 per patient. Conclusions: We demonstrated the cost-effectiveness of utilizing RC measurement in sparing the need for repeated AVS sessions. RC measurement during AVS enabled identification of correct catheter placement in real time, allowing for prompt decisions regarding the need for additional sampling attempts, thereby reducing subsequent costs of repeated AVS sessions. Full article

Background: Myocardial infarction (MI) is a common emergency with high rates of morbidity and mortality. Current risk stratification scores for non-ST-elevation MI (NSTEMI) use subjective or delayed information. Heart rate variability was shown to correlate with prognosis following MI. This study aimed to evaluate ultra-short heart rate variability (usHRV) as a prognostic factor in NSTEMI patients. Methods: A retrospective analysis was performed on 183 NSTEMI patients admitted to Rambam Health Care Campus in 2014. usHRV measures, including the standard deviation of normal-to-normal intervals (SDNN) and root mean square of successive differences (RMSSD), were calculated. Logistic regression assessed whether clinical, laboratory, or usHRV parameters predicted severe in-hospital complications like heart failure (HF), atrial flutter/fibrillation (AFL/AF), ventricular tachycardia/fibrillation (VT/VF), and atrioventricular block (AVB). Both Cox and logistic regression were used for survival analysis. Results: Of 183 patients (71.6% male, mean age 67.1), 35 (19%) died within 2 years. In-hospital complications included 39 cases (21.3%) of HF, 3 cases (1.6%) of VT/VF, and 9 cases (4.9%) of AVB. Lower usHRV was significantly associated with higher mortality at 2 years and showed marginal significance at 90 days and 1 year. Increased usHRV was linked to a higher risk of in-hospital ventricular arrhythmia (VT/VF). Conclusions: Overall, this study is in agreement with previous research, showing a correlation between low usHRV and a higher mortality risk. However, the association between usHRV and the risk of VT/VF demands further investigation. More expansive prospective studies are needed to strengthen the observed associations. Full article

Background and Objectives: The aim of this study was to test whether there is a necessity for routine postoperative laboratory testing in patients undergoing primary elective unilateral total knee arthroplasty (TKA), with the administration of Tranexamic Acid (TXA) and without the use of tourniquet. Materials and Methods: This observational, retrospective cohort study was conducted at Meir Medical Center. The data were collected in 2018–2022. Patients were collected in a consecutive manner. There were no exclusion criteria for this study. The inclusion criteria were individuals who underwent elective TKA due to end-stage osteoarthritis (OA). We conducted a multivariable logistic regression analysis to determine the factors associated with postoperative hemoglobin (PoOHb) < 9 g/dL and the optimal cutoff to detect those patients postoperatively. Results: A total of 271 patients were included. The mean preoperative hemoglobin (PrOHb) was 13.02 ± 1.42 g/dL, and the mean PoOHb was 11.5 ± 1.34 g/dL. The mean decrease in Hbg levels following surgery was 1.52 ± 0.91 g/dL. In all, 271 patients had a PoOHb level ≥ 9 g/dL or above. A total of 16 patients received packed red blood cells following surgery. Patients with PoOHb < 9 g/dL had a significantly lower PrOHbg. In the current study, all 11 patients who had PoOHb < 9, 10 (90.9%) had PrOHb ≤ 1011.95 55 g/dL, compared to 25 (49.6%) of the 260 patients who had PoOHb ≥ 9. The odds ratio for having PrOHb ≤ 10.9511.55 g/dL if PoOHb < 9 g/dL was 206.6710.4 (95% CI 24.427.164 to 1749.01415.97). A cut-off of 11.2510.25 would have offered a sensitivity of 99% (specificity 93.5%). Conclusions: In conclusion, this study supports using selective post-TKR Hgb monitoring rather than adhering to routine practice. An association between postoperative anemia and the need for blood transfusion was found only when the preoperative baseline hemoglobin threshold was less than 10.95 g/dL. Full article

Background: In frozen embryo transfer (FET) cycles, optimal endometrial thickness on ovulation day is typically 7–8 mm before progesterone administration. Recent studies have highlighted the significant inverse correlation between ongoing pregnancy rates and changes in endometrial thickness during the secretory phase after progesterone exposure, particularly by the day of embryo transfer (ET). This study aims to investigate how changes in endometrial thickness from the end of the proliferative phase to ET impact FET outcomes. Methods: We conducted a prospective observational cohort study involving 247 FET cycles, divided into hormonally based (102) and ovulatory-based (145) groups. Patients were monitored through transvaginal ultrasound (TVS) and blood tests. On ET day, we assessed endometrial thickness and changes compared to the last day of the proliferative phase, defining endometrial compaction as a decrease in thickness. We analyzed data to identify factors predicting cycle outcomes. Results: The study reported chemical and clinical pregnancy rates of 47.4% and 38.1%, respectively. Endometrial compaction was observed in 37.2% (92/247) of cycles, with corresponding rates of 48.9%, 32.6%, and 29.5% for chemical, clinical, and ongoing pregnancies, compared to 46.4%, 41.3%, and 28.9% in cycles without compaction. These differences were not statistically significant, and patterns of endometrial thickness change were similar across different FET protocols and progesterone exposure durations. Conclusions: The main factors influencing cycle outcomes were maternal age, embryo transfer protocol, and endometrial thickness on ET day, with endometrial compaction showing no correlation with improved outcomes. Full article

Binocular vision may serve as a good model for research on awareness. Binocular summation (BS) can be defined as the superiority of binocular over monocular visual performance. Early studies of BS found an improvement of a factor of about 1.4 (empirically), leading to models suggesting a quadratic summation of the two monocular inputs (√2). Neural interaction modulates a target’s visibility within the same eye or between eyes (facilitation or suppression). Recent results indicated that at a closely flanked stimulus, BS is characterized by instability; it relies on the specific order in which the stimulus condition is displayed. Otherwise, BS is stable. These results were revealed in experiments where the tested eye was open, whereas the other eye was occluded (mono-optic glasses, blocked presentation); thus, the participants were aware of the tested eye. Therefore, in this study, we repeated the same experiments but utilized stereoscopic glasses (intermixed at random presentation) to control the monocular and binocular vision, thus potentially eliminating awareness of the tested condition. The stimuli consisted of a central vertically oriented Gabor target and high-contrast Gabor flankers positioned in two configurations (orthogonal or collinear) with target–flanker separations of either two or three wavelengths (λ), presented at four different presentation times (40, 80, 120, and 200 ms). The results indicate that when utilizing stereoscopic glasses and mixing the testing conditions, the BS is normal, raising the possibility that awareness may be involved. Full article

Background: Predicting whether extracorporeal membrane oxygenation (ECMO) treatment duration affects prognosis is important both medically and economically. Methods: We conducted a retrospective, multicenter study to better understand the outcomes of patients treated with veno-venous (VV) ECMO over a prolonged duration, analyzing data from the Israel ECMO registry. The study included all adult patients treated with VV-ECMO due to COVID-19-induced respiratory failure. The primary outcomes were survival rates up to 180 days from cannulation. Results: One hundred and eighty-eight patients were included in the study. The median age was 50 years (IQR 42, 50), and 69% were male. Patients were mechanically ventilated for a median of 2.5 days before cannulation (IQR 0.5, 5). The mean ECMO support duration was 29.9 days, with a maximal duration of 189.9 days. The survival rate for 180 days was 56%. We found no change in survival for patients on ECMO for 14, 28, or 56 days. Every day of mechanical ventilation before cannulation correlated with an 11% greater risk for prolonged ECMO treatment (p = 0.01). Conclusions: COVID-19-induced ARDS patients treated with VV-ECMO for prolonged duration had the same prognosis as those treated for short periods of time. The longer the duration of mechanical ventilation before ECMO cannulation, the higher the risk for prolonged ECMO treatment. Full article

Background: Glioblastoma multiforme is an aggressive malignancy with a dismal 5-year survival rate of 5–10%. Current therapeutic options are limited, due in part to drug exclusion by the blood–brain barrier (BBB). We have previously shown that high-amplitude repetitive transcranial magnetic stimulation (rTMS) in rats allowed the delivery across the BBB of an IGF signaling inhibitor—IGF-Trap. The objective of this study was to assess the therapeutic effect of IGF-Trap when delivered in conjunction with rTMS on the intracerebral growth of glioma. Results: We found that systemic administration of IGF-Trap without rTMS had a minimal effect on the growth of orthotopically injected glioma cells in rats and mice, compared to control animals injected with vehicle only or treated with sham rTMS. In rats treated with a combination of rTMS and IGF-Trap, we observed a growth retardation of C6 tumors for up to 14 days post-tumor cell injection, although tumors eventually progressed. In mice, tumors were detectable in all control groups by 14–17 days post-injection of glioma GL261 cells and progressed rapidly thereafter. In mice treated with rTMS prior to IGF-Trap administration, tumor growth was inhibited or delayed, although the tumors also eventually progressed. Conclusion: The results showed that rTMS could increase the anti-tumor effect of IGF-Trap during the early phases of tumor growth. Further optimization of the rTMS protocol is required to improve survival outcomes. Full article

Objectives: The present prospective study aimed to compare near-infrared light reflection (NIRI) and bitewing radiographs (BWR) images to detect proximal caries in primary teeth. Methods: 71 children underwent routine BWR, and scans were performed using an intra-oral scanner (iTero Element 5D, Align Technology, Tempe, AZ, USA), including a near-infrared light source (850 nm) and sensor. Five specialist pediatric dentists examined the NIRI and BWR images. Results: The average participant age was 7.8 years. A total of 1004 proximal surfaces of primary molars and canines were examined, 209 carious lesions were detected on BWR, and 227 on NIRI. Comparison between all carious lesions detected on BWR and NIRI: Sensitivity (53.6%); Specificity (85.5%); Positive Predictive Value (PPV) (49.3%); Negative Predictive Value (NPV) (87.5%). Comparison between carious lesions involving the DEJ detected on BWR and at any level in NIRI: Sensitivity (61%); Specificity (83.4%), PPV (36.6%); NPV (93.2%). Comparison between enamel-only carious lesions detected on BWR and all lesions detected using NIRI: Sensitivity (44.8%); Specificity (85.5%); PPV (20.7%); NPV (94.8%). Conclusions: No additional diagnostic information can be gleaned from BWR if initial caries lesions in the enamel are not detected by clinical examination or in images from a NIRI scanner, making BWR unnecessary. Full article

Background: Attention deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterised by deficits in attention, hyperactivity, and impulsivity. Current treatments, such as stimulant medication and behavioural therapy, ameliorate symptoms but do not address the core cognitive dysfunctions. This study aimed to investigate the effects of two computerised neurocognitive training programs, attention functions training and executive functions training, in children with ADHD. Methods: Eighty children with ADHD (ages 8–13) were randomly assigned to one of three groups: Attention functions training (AFT), targeting sustained, selective-spatial, orienting, and executive attention; executive functions training (EFT), focusing on working memory, cognitive flexibility, and problem solving; or a passive control group. Training sessions were administered in small groups twice a week for nine weeks. Participants underwent comprehensive assessments of attention (Continuous Performance Test, Conjunctive Visual Search Task), executive functions (Corsi Block-Tapping Tasks), nonverbal reasoning (Raven’s Colored Progressive Matrices), parent-rated behavioural symptoms, and arithmetic performance at baseline, post-intervention, and follow-up. Results: The AFT group demonstrated significant improvements in sustained and selective-spatial attention, nonverbal reasoning, inattentive symptoms, and arithmetic performance, and most improvements persisted at follow-up. The EFT group showed gains in nonverbal reasoning and inattentive symptoms, although no improvements were documented in working memory or in parent ratings of executive functions. Conclusions: The AFT program that addressed core attentional functions in children with ADHD produced robust cognitive and behavioural benefits, whereas the EFT program yielded behavioural benefits and a limited improvement in executive functions. Future research should explore different training protocols for broader gains in executive functions. These findings support the potential of theory-driven, structured neurocognitive training targeting basic cognitive functions as an effective small-group intervention for ADHD. Full article

From a detailed review of 90 experimental and clinical metabolomic investigations of obesity and metabolic dysfunction-associated steatotic liver disease (MASLD), we have developed metabolomic hallmarks for both obesity and MASLD. Obesity studies were conducted in mice, rats, and humans, with consensus biomarker groups in plasma/serum being essential and nonessential amino acids, energy metabolites, gut microbiota metabolites, acylcarnitines and lysophosphatidylcholines (LPC), which formed the basis of the six metabolomic hallmarks of obesity. Additionally, mice and rats shared elevated cholesterol, humans and rats shared elevated fatty acids, and humans and mice shared elevated VLDL/LDL, bile acids and phosphatidylcholines (PC). MASLD metabolomic studies had been performed in mice, rats, hamsters, cows, geese, blunt snout breams, zebrafish, and humans, with the biomarker groups in agreement between experimental and clinical investigations being energy metabolites, essential and nonessential amino acids, fatty acids, and bile acids, which lay the foundation of the five metabolomic hallmarks of MASLD. Furthermore, the experimental group had higher LPC/PC and cholesteryl esters, and the clinical group had elevated acylcarnitines, lysophosphatidylethanolamines/phosphatidylethanolamines (LPE/PE), triglycerides/diglycerides, and gut microbiota metabolites. These metabolomic hallmarks aid in the understanding of the metabolic role played by obesity in MASLD development, inform mechanistic studies into underlying disease pathogenesis, and are critical for new metabolite-inspired therapies. Full article