Proposing an ensemble learning model based on neural network and fuzzy system for keratoconus diagnosis based on Pentacam measurements

International Ophthalmology - The present study was done to evaluate efficiency of an ensemble learning structure for automatic keratoconus diagnosis and to categorize eyes into four different...     

Combined turnover vastus lateralis and lateral gastrocnemius flaps as a salvage option for soft tissue reconstruction of the knee

Infection with subsequent wound breakdown and soft tissue deficit represents the most devastating complication after total knee arthroplasty. Although microsurgical reconstruction is increasingly being performed in this setting, several factors may preclude its use. We present a case of a 52-year-old female patient who presented with a complex right anterior knee wound resulting from a complicated clinical course following total knee arthroplasty. Initial reconstructive efforts included coverage with a superiorly based fasciocutaneous thigh flap as well as a medial gastrocnemius flap. Persistence of infection and necrosis of the distal aspect of the fasciocutaneous flap eventually required salvage by means of a vastus lateralis turnover muscle flap augmented by a lateral gastrocnemius muscle flap. The combination of these two fairly straightforward muscle flaps provided stable wound coverage with well-vascularized tissue without the use of sophisticated microsurgical expertise. Level of Evidence: V, therapeutic study     

The objective CORE score allows early rule out in acute chest pain patients

Abstract

Objectives. Chest pain is a common complaint in the emergency department (ED), and it is a challenge to identify low-risk chest pain patients eligible for early discharge. We aimed to develop a simple objective decision rule to exclude 30-day major adverse cardiac events (MACE) in ED chest pain patients.

Design. We analyzed prospectively included patients presenting with chest pain. Low risk patients were identified with the clinical objective rule-out evaluation (CORE). CORE was based on high sensitivity cardiac troponin T (hs-cTnT) tests at ED presentation (0?h) and 2?h later together with a simplified risk score consisting of four objective variables: age ≥65 years and a history of arterial disease, hypertension or diabetes. For the patient to be classified as low risk in the CORE rule, hs-cTnT had to be ≤14?ng/L both at 0 and 2?h, and the sum of the risk score had to be 0. The primary outcome was MACE within 30 days.

Results. Among the 751 patients in the final analysis, 90 (11.9%) had a MACE. CORE identified 248 (33%) of patients as low risk with a sensitivity of 98.9% (CI 93.1–99.9) and a negative predictive value of 99.6% (95% CI 97.4–100) for 30-day MACE. Adding the ED physician’s interpretation of the ECG to CORE did not improve diagnostic performance.

Conclusion. A simple objective decision rule (CORE) identified one-third of all patients as having a very low 30-day risk of MACE. These patients may potentially be discharged without additional investigations for acute coronary syndrome.     

Trend in dental research output in Iran over a period of 20 years (1990–2009)

Introduction: The number of scientific papers is a conventional metric for the measurement of a country’s research performance in a particular area. Objective: To evaluate the trend in Iranian publications of dental research results in peer-reviewed international scientific journals over the period 1999–2009, using national and international databases, and to compare the results with other countries. Methods: The search process was performed by two independent persons in PubMed and Iranian Medline (IranMedex). Data extraction included the year of publication, total number of dental papers in each year, total number of Iranian dental papers in each year and number of papers with a high level of evidence; these were compared with those in other Asian countries. Results: The total number of dental articles indexed in PubMed during the studied period was 207,689, with 671 being written by researchers who stated their affiliation as Iran. Although the proportion of Iranian dental articles to all published dental articles was 0.01% in 1990, this increased to 1.4% in 2009. Of all clinical trials indexed in PubMed from 1990 to 2009, only 0.62% had an author from Iran. The collaboration rate of authors ranged between 1 and 10. Turkey and Iran had a larger number of dental research publications compared with other Asian countries assessed in this study. Conclusion: During the last two decades, there has been a considerable increase in the number of dental papers by Iranian researchers indexed in the PubMed database.Key words: Dental, research, Iran     

Posttraumatic reduction of edema with aquaporin-4 RNA interference improves acute and chronic functional recovery

Traumatic brain injury (TBI) is common in young children and adolescents and is associated with long-term disability and mortality. The neuropathologic sequelae that result from juvenile TBI are a complex cascade of events that include edema formation and brain swelling. Brain aquaporin-4 (AQP4) has a key role in edema formation. Thus, development of novel treatments targeting AQP4 to reduce edema could lessen the neuropathologic sequelae. We hypothesized that inhibiting AQP4 expression by injection of small-interfering RNA (siRNA) targeting AQP4 (siAQP4) after juvenile TBI would decrease edema formation, neuroinflammation, neuronal cell death, and improve neurologic outcomes. The siAQP4 or a RNA-induced silencing complex (RISC)-free control siRNA (siGLO) was injected lateral to the trauma site after controlled cortical impact in postnatal day 17 rats. Magnetic resonance imaging, neurologic testing, and immunohistochemistry were performed to assess outcomes. Pups treated with siAQP4 showed acute (3 days after injury) improvements in motor function and in spatial memory at long term (60 days after injury) compared with siGLO-treated animals. These improvements were associated with decreased edema formation, increased microglial activation, decreased blood–brain barrier disruption, reduced astrogliosis and neuronal cell death. The effectiveness of our treatment paradigm was associated with a 30% decrease in AQP4 expression at the injection site.     

Comparison of the accuracy of the London atlas and Smith method in dental age estimation in 5–15.99-year-old Iranians using the panoramic view

International Journal of Legal Medicine - Tooth development is widely used for age estimation and staging physical maturity. It is of great importance in dental age estimation in forensic...     

Hepatic Hemodynamic Changes Following Stepwise Liver Resection

Aim

Extended liver resection has increased during the last decades. However, hepatic hemodynamic changes after resection and the consequent complications like post hepatectomy liver failure are still a challenging issue. The aim of this study was to systematically evaluate the role of stepwise liver resection on hepatic hemodynamic changes.

Methods

To evaluate this effect we performed 25, 50, and 75 % sequential liver resections in 10 pigs. Before and after each resection, the hepatic artery flow and portal vein flow in relation to the remnant liver volume (RLV) as well as hepatic vascular pressures were measured and compared between the groups.

Results

Following sequential liver resection, the hepatic artery flow /100 g decreases and the portal vein flow increases up to 17 and 167 % following extended liver resection (75 %), respectively. Also, during stepwise liver resection, the portal vein pressure increases gradually up to 33 % following extended hepatectomy (75 %).

Conclusion

Sequential decrease in the RLV decreases the hepatic artery flow /100 g and increases the portal vein flow /100 g and portal vein pressure. As the consequence, the liver goes under more poor-oxygenated blood supply and higher pressure. This may be one of the most important mechanisms of the post hepatectomy liver failure in case of extended liver resection.