Purpose: Urodynamic studies (UDS) are the gold standard for evaluating pediatric lower urinary tract dysfunction (LUTD). However, previous studies have shown that the interpretation of cystometric findings may vary according to the observer’s level of experience and the criteria used for evaluation. This study aimed to investigate interobserver differences in the reporting of cystometric parameters in children with spina bifida. Methods: Patients who underwent UDS between 2020 and 2025 for neurogenic LUTD secondary to spina bifida were retrospectively reviewed. Studies that did not reach 80% agreement for compliance with good urodynamic practice standards were excluded. Detrusor overactivity (DOA) and bladder compliance were independently evaluated by 4 pediatric urologists and 3 urologists experienced in neuro-urology. Agreement was assessed using Fleiss’ kappa test. Results: A total of 100 children, including 53 females and 47 males, were included; the median age was 6.5 (range, 1–17) years. Agreement of at least 80% was reached in 86% of evaluations for DOA and 82% of evaluations for compliance. Based on the ratings of 7 observers, the Fleiss’ kappa value was 0.60 for DOA, indicating moderate agreement, and 0.46 for bladder compliance, indicating weak agreement. Conclusions This study demonstrated substantial interobserver variation in the interpretation of UDS, even among experienced centers and observers. Because UDS are essential for the diagnosis, treatment, and follow-up of patients with spina bifida, standardized criteria are needed to improve interobserver consistency in this patient group. Multicenter prospective studies involving observers with varying levels of experience are warranted to improve concordance in UDS reporting.

Background: The purpose of the present study was to determine how long superior screws alone or in combination with posterior placement of metaglene screws protruding and penetrating into the scapular spine in reverse total shoulder arthroplasty affect the strength of thescapular spine in a fresh cadaveric scapular model. Methods: Seven fresh cadaver scapulas were allocated to the control group (short posterior and superior screws) and seven scapulars to thestudy group (spine base fixation with a four long screws, three with both long superior and long posterior screws). Results: The failure load was lower in the spine fixation group (long screw, 869 N vs. short screw, 1,123 N); however, this difference did notreach statistical significance (p>0.05). All outside-in long superior or superior plus posterior screws failed due to scapular spine base fracture; failures in the short screw group were due to acromion fracture. An additional posterior outside-in screw failed to significantly decrease the failure load of the acromion spine. Conclusions The present study highlights the significance of preventing a cortical breach or an outside-in configuration when a superioror posterior screw is inserted into the scapular spine base.

Background: The purpose of the present study was to determine how long superior screws alone or in combination with posterior placement of metaglene screws protruding and penetrating into the scapular spine in reverse total shoulder arthroplasty affect the strength of thescapular spine in a fresh cadaveric scapular model. Methods: Seven fresh cadaver scapulas were allocated to the control group (short posterior and superior screws) and seven scapulars to thestudy group (spine base fixation with a four long screws, three with both long superior and long posterior screws). Results: The failure load was lower in the spine fixation group (long screw, 869 N vs. short screw, 1,123 N); however, this difference did notreach statistical significance (p>0.05). All outside-in long superior or superior plus posterior screws failed due to scapular spine base fracture; failures in the short screw group were due to acromion fracture. An additional posterior outside-in screw failed to significantly decrease the failure load of the acromion spine. Conclusions The present study highlights the significance of preventing a cortical breach or an outside-in configuration when a superioror posterior screw is inserted into the scapular spine base.

PURPOSE: To determine the potential protective and therapeutic effects and action mechanism of ruscogenin on cerulein-induced acute pancreatitis (AP) model in rats. METHODS: Overall, 32 rats were attenuated to the sham (2-mL/kg/day isotonic solution for 4 weeks), control (20-µg/kg cerulein-induced AP for 12 hours), prophylaxis groups (cerulein-induced AP following 3-mL/kg/day ruscogenin for 4 weeks) and treatment (3-mL/kg/day ruscogenin following cerulein-induced AP for 12 hours). Blood samples were collected for biochemical analysis of nitric oxide synthase 1 (NOS1/neuronal NOS), malondialdehyde (MDA) and intercellular adhesion molecule 1 (ICAM-1). After sacrification, pancreas tissues were collected and prepared for light microscopic (hematoxylin and eosin), immunohistochemical (nuclear factor kappa B) and biochemical analysis (tumor necrosis factor-alpha [TNF-α], interleukin-6 and 1β [IL-6 and IL-1β], CRP, high-sensitivity CRP [hs-CRP] amylase, lipase, and ICAM-1). Ultrastructural analysis was performed by transmission electron microscopy. RESULTS: The protective and therapeutic actions of ruscogenin were accomplished by improvements in histopathology, by decreasing blood cytokine levels of CRP, hs-CRP levels, TNF-α, IL-6, IL-1β, ICAM-1, by reducing the pancreatic enzymes amylase and lipase in blood, and by suppressing the expression of nuclear factor kappa B, ICAM-1, and NOS-1, but not MDA in pancreatic tissues. Ruscogenin also improved cerulein-induced ultrastructural degenerations in endocrine and exocrine cells, especially in treatment group. CONCLUSION: The present findings have demonstrated the beneficial protective and therapeutical effects of ruscogenin, nominating it as a highly promising supplementary agent to be considered in the treatment of AP, and even as a protective agent against the damages induced by disease.
Amylases ; Animals ; Ceruletide ; Intercellular Adhesion Molecule-1 ; Interleukin-6 ; Lipase ; Malondialdehyde ; Microscopy, Electron, Transmission ; Necrosis ; NF-kappa B ; Nitric Oxide Synthase ; Pancreas ; Pancreatitis ; Rats ; Therapeutic Uses

PURPOSE: Radiation proctitis (RP) is inflammation and damage to the rectum, manifested secondary to ionizing radiation utilized for treatment. In this study, we evaluated the anti-inflammatory therapeutical and protective effects of ruscogenin in a model of acute RP. METHODS: Thirty-two Sprague-Dawley rats were divided into 4 groups (n = 8) as sham, control, treatment, and prophylaxis groups. Prophylaxis group and treatment group were dosed ruscogenin by oral gavage for 14 days pre- and postradiation. At the end of the 28th day, all subjects were sacrificed. RESULTS: Histopathological analysis showed a significant increase in cryptitis abscess, cryptitis and reactive atypia, and depth of lymphocytic infiltration of the control group, compared to the other groups (P < 0.05), while treatment and prophylaxis groups showed significant decreases (P < 0.05). Immunohistochemical analysis indicated that immunoreactivity were significantly higher in control group (P < 0.05, P < 0.001, and P < 0.01, respectively), but vice versa for treatment and prophylaxis groups. There was not any significant difference for fibroblast growth factor 2 immunoreactivity. The epithelium of control rectums indicated an increase in TNF-α immunoreactivity while other groups had significant decrease (P < 0.01). Electron microscopical findings were parallel to light microscopy. CONCLUSION: In this study, ruscogenin was observed to be effective on prophylaxis or treatment of acute RP. Although there are various reports on the treatment of the rectum damaged by acute RP in the literature, this could be the first study since there is no research indicating the ultrastructural effect of ruscogenin.
Abscess ; Animals ; Epithelium ; Fibroblast Growth Factor 2 ; Inflammation ; Microscopy ; Models, Animal* ; Proctitis* ; Radiation, Ionizing ; Rats* ; Rats, Sprague-Dawley ; Rectum ; Therapeutic Uses*

BACKGROUND AND OBJECTIVES: We have intended to investigate the influence of the timing of invasive procedures on all-cause mortality, recurrent myocardial infarction (MI), re-hospitalization due to cardiac causes and left ventricular function over a 3-month period among patients with Non-ST-elevation myocardial infarction (NSTEMI). SUBJECTS AND METHODS: A total of 131 NSTEMI patients with moderate-high Thrombolysis in Myocardial Infarction risk scores, who had been admitted to our department between July 2011-December 2011 were included in our study. They had been randomized into 2 groups according to the timing of the percutaneous coronary intervention (PCI). Patient undergoing PCI in the first 24 hours of hospitalization were named the "Early Invasive Group" and those undergoing PCI between 24-72 hours of hospitalization were named the "Delayed Invasive Group". All patients were followed up for 3 months. RESULTS: Third month left ventricular ejection fraction (LVEF) values were higher in the early invasive group (59.9+/-6.0% vs. 54.1+/-8.7%; p<0.001). Recurrent MI rates were lower in the early invasive group (2.9% vs. 14.5%; p=0.016). Similarly, hospitalization rates due to cardiac events were lower in the early invasive group (8.7% vs. 30.6%; p=0.001). All cause mortality appeared to be lower in the early invasive group, although not to a statistically significant degree (0% vs. 4.8%; p=0.065). CONCLUSION: The early invasive strategy appears to be more effective for the reduction of recurrent MI, re-hospitalization due to cardiac events, and the preservation of 3rd month LVEF in patients with moderate-high risk NSTEMI when compared to a delayed invasive strategy.
Hospitalization ; Humans ; Mortality ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Prognosis ; Stroke Volume ; Ventricular Function, Left

OBJECTIVE: The purpose of this study was to develop a new method for automated lung nodule detection in serial section CT images with using the characteristics of the 3D appearance of the nodules that distinguish themselves from the vessels. MATERIALS AND METHODS: Lung nodules were detected in four steps. First, to reduce the number of region of interests (ROIs) and the computation time, the lung regions of the CTs were segmented using Genetic Cellular Neural Networks (G-CNN). Then, for each lung region, ROIs were specified with using the 8 directional search; +1 or -1 values were assigned to each voxel. The 3D ROI image was obtained by combining all the 2-Dimensional (2D) ROI images. A 3D template was created to find the nodule-like structures on the 3D ROI image. Convolution of the 3D ROI image with the proposed template strengthens the shapes that are similar to those of the template and it weakens the other ones. Finally, fuzzy rule based thresholding was applied and the ROI's were found. To test the system's efficiency, we used 16 cases with a total of 425 slices, which were taken from the Lung Image Database Consortium (LIDC) dataset. RESULTS: The computer aided diagnosis (CAD) system achieved 100% sensitivity with 13.375 FPs per case when the nodule thickness was greater than or equal to 5.625 mm. CONCLUSION: Our results indicate that the detection performance of our algorithm is satisfactory, and this may well improve the performance of computer-aided detection of lung nodules.
Algorithms ; Automation ; *Diagnosis, Computer-Assisted ; False Positive Reactions ; Fuzzy Logic ; Humans ; Imaging, Three-Dimensional ; Lung Neoplasms/*radiography ; *Neural Networks (Computer) ; Radiographic Image Interpretation, Computer-Assisted ; Sensitivity and Specificity ; *Tomography, X-Ray Computed

OBJECTIVE: The purpose of this study was to develop a new method for automated mass detection in digital mammographic images using templates. MATERIALS AND METHODS: Masses were detected using a two steps process. First, the pixels in the mammogram images were scanned in 8 directions, and regions of interest (ROI) were identified using various thresholds. Then, a mass template was used to categorize the ROI as true masses or non-masses based on their morphologies. Each pixel of a ROI was scanned with a mass template to determine whether there was a shape (part of a ROI) similar to the mass in the template. The similarity was controlled using two thresholds. If a shape was detected, then the coordinates of the shape were recorded as part of a true mass. To test the system's efficiency, we applied this process to 52 mammogram images from the Mammographic Image Analysis Society (MIAS) database. RESULTS: Three hundred and thirty-two ROI were identified using the ROI specification methods. These ROI were classified using three templates whose diameters were 10, 20 and 30 pixels. The results of this experiment showed that using the templates with these diameters achieved sensitivities of 93%, 90% and 81% with 1.3, 0.7 and 0.33 false positives per image respectively. CONCLUSION: These results indicate that the detection performance of this template based algorithm is satisfactory, and may improve the performance of computer-aided analysis of mammographic images and early diagnosis of mammographic masses.
Sensitivity and Specificity ; Radiographic Image Enhancement ; Mammography/*methods ; Humans ; False Positive Reactions ; Automation ; Algorithms