We evaluated the effect of compression leggings with micromassage in association with physical activity on women with lipedema, not previously treated and without recent changes in body weight. The treatment resulted in an improvement in all subjective parameters, in spontaneous and evoked pain, in the volume of the limbs, in the absence of significant changes in body weight, and regardless of the duration of use, age, years of illness, the clinical stage, and body mass index (BMI). Evoked pain did not improve in areas affected by untreated lipedema; foot circumferences did not increase. We found a significant reduction in the thickness of subcutaneous adipose tissue (SAT) and skin evaluated in multiple points of the lower limb. Micromassage compression leggings are proposed as an integral part of conservative treatment. A method is proposed for the clinical evaluation of evoked pain, called the Progressive Pain Check (PPC), which allows for the calculation of a numerical score called the Ricolfi-Patton Score (RPS) and for the ultrasound evaluation of tissues. The method is simple and repeatable and allows for completion of the clinical evaluation of the patient at diagnosis and for an evaluation of the effects of various treatments, even applied to just one side of the body.

High shear wet granulation (HSWG) is widely used in tablet manufacturing mainly because of its advantages in improving flowability, powder handling, process run time, size distribution, and preventing segregation. In line process analytical technology measurements are essential in capturing detailed particle dynamics and presenting real-time data to uncover the complexity of the HSWG process and ultimately for process control. This study presents an opportunity to predict the properties of the granules and tablets through torque measurement of the granulation bowl and the force exerted on a novel force probe within the powder bed. Inline force measurements are found to be more sensitive than torque measurements to the granulation process. The characteristic force profiles present the overall fingerprint of the high shear wet granulation, in which the evolution of the granule formation can improve our understanding of the granulation process. This provides rich information relating to the properties of the granules, identification of the even distribution of the binder liquid, and potential granulation end point. Data were obtained from an experimental high shear mixer across a range of key process parameters using a face-centred surface response design of experiment (DoE). A closed-form analytical model was developed from the DOE matrix using the discovery of evolutionary equations. The model is able to provide a strong predictive indication of the expected tablet tensile strength based only on the data in-line. The use of a closed form mathematical equation carries notable advantages over other AI methodologies such as artificial neural networks, notably improved interpretability/interrogability, and minimal inference costs, thus allowing the model to be used for real-time decision making and process control. The capability of accurately predicting, in real time, the required compaction force required to achieve the desired tablet tensile strength from upstream data carries the potential to ensure compression machine settings rapidly reach and are maintained at optimal values, thus maximising efficiency and minimising waste.

BACKGROUND: Vocal biomarkers, derived from acoustic analysis of vocal characteristics, offer noninvasive avenues for medical screening, diagnostics, and monitoring. Previous research demonstrated the feasibility of predicting type 2 diabetes mellitus through acoustic analysis of smartphone-recorded speech. Building upon this work, this study explores the impact of audio data compression on acoustic vocal biomarker development, which is critical for broader applicability in health care.
OBJECTIVE: The objective of this research is to analyze how common audio compression algorithms (MP3, M4A, and WMA) applied by 3 different conversion tools at 2 bitrates affect features crucial for vocal biomarker detection.
METHODS: The impact of audio data compression on acoustic vocal biomarker development was investigated using uncompressed voice samples converted into MP3, M4A, and WMA formats at 2 bitrates (320 and 128 kbps) with MediaHuman (MH) Audio Converter, WonderShare (WS) UniConverter, and Fast Forward Moving Picture Experts Group (FFmpeg). The data set comprised recordings from 505 participants, totaling 17,298 audio files, collected using a smartphone. Participants recorded a fixed English sentence up to 6 times daily for up to 14 days. Feature extraction, including pitch, jitter, intensity, and Mel-frequency cepstral coefficients (MFCCs), was conducted using Python and Parselmouth. The Wilcoxon signed rank test and the Bonferroni correction for multiple comparisons were used for statistical analysis.
RESULTS: In this study, 36,970 audio files were initially recorded from 505 participants, with 17,298 recordings meeting the fixed sentence criteria after screening. Differences between the audio conversion software, MH, WS, and FFmpeg, were notable, impacting compression outcomes such as constant or variable bitrates. Analysis encompassed diverse data compression formats and a wide array of voice features and MFCCs. Wilcoxon signed rank tests yielded P values, with those below the Bonferroni-corrected significance level indicating significant alterations due to compression. The results indicated feature-specific impacts of compression across formats and bitrates. MH-converted files exhibited greater resilience compared to WS-converted files. Bitrate also influenced feature stability, with 38 cases affected uniquely by a single bitrate. Notably, voice features showed greater stability than MFCCs across conversion methods.
CONCLUSIONS: Compression effects were found to be feature specific, with MH and FFmpeg showing greater resilience. Some features were consistently affected, emphasizing the importance of understanding feature resilience for diagnostic applications. Considering the implementation of vocal biomarkers in health care, finding features that remain consistent through compression for data storage or transmission purposes is valuable. Focused on specific features and formats, future research could broaden the scope to include diverse features, real-time compression algorithms, and various recording methods. This study enhances our understanding of audio compression\'s influence on voice features and MFCCs, providing insights for developing applications across fields. The research underscores the significance of feature stability in working with compressed audio data, laying a foundation for informed voice data use in evolving technological landscapes.

UNASSIGNED: Digital radiography (DR) is a common and widely available examination. However, spinal DR cannot detect bone marrow edema, therefore, determining vertebral compression fractures (VCFs), especially fresh VCFs, remains challenging for clinicians.
UNASSIGNED: We trained, validated, and externally tested the deep residual network (DRN) model that automated the detection and identification of fresh VCFs from spinal DR images. A total of 1,747 participants from five institutions were enrolled in this study and divided into the training cohort, validation cohort and external test cohorts (YHDH and BMUH cohorts). We evaluated the performance of DRN model based on the area under the receiver operating characteristic curve (AUC), feature attention maps, sensitivity, specificity, and accuracy. We compared it with five other deep learning models and validated and tested the model internally and externally and explored whether it remains highly accurate for an external test cohort. In addition, the influence of old VCFs on the performance of the DRN model was assessed.
UNASSIGNED: The AUC was 0.99, 0.89, and 0.88 in the validation, YHDH, and BMUH cohorts, respectively, for the DRN model for detecting and discriminating fresh VCFs. The accuracies were 81.45% and 72.90%, sensitivities were 84.75% and 91.43%, and specificities were 80.25% and 63.89% in the YHDH and BMUH cohorts, respectively. The DRN model generated correct activation on the fresh VCFs and accurate peak responses on the area of the target vertebral body parts and demonstrated better feature representation learning and classification performance. The AUC was 0.90 (95% confidence interval [CI] 0.84-0.95) and 0.84 (95% CI 0.72-0.93) in the non-old VCFs and old VCFs groups, respectively, in the YHDH cohort (p = 0.067). The AUC was 0.89 (95% CI 0.84-0.94) and 0.85 (95% CI 0.72-0.95) in the non-old VCFs and old VCFs groups, respectively, in the BMUH cohort (p = 0.051).
UNASSIGNED: In present study, we developed the DRN model for automated diagnosis and identification of fresh VCFs from spinal DR images. The DRN model can provide interpretable attention maps to support the excellent prediction results, which is the key that most clinicians care about when using the model to assist decision-making.

Background The carpal tunnel is a groove that spans the palm as a \'U.\' The ulnar and radial sides of the wrist are made up of the scaphoid tubercle and trapezium while the palmar aspect is made up of carpal bones. Our study aimed to see whether there were differences in carpal tunnel size between men and women. Material and methods The study was conducted on 65 healthy adults, 13 (20%) were males and 52 (80%) were females (both non-pregnant and pregnant). Inclusion criteria were healthy adults and bilaterally symmetrical limbs. Exclusion criteria were chronic disease, diabetes, hypertension, immunological disorders, any visible abnormalities, and a history of upper extremity pain on either side. A high-resolution ultrasound machine with a linear transducer was used to perform an ultrasound scan of the carpal tunnel. The anteroposterior dimension was measured at the midline, or along the axis of the middle finger, and the transverse diameter was measured at the midpoint of the flexor retinaculum. The cross-sectional area of the tunnel was measured at its largest diameter within the carpal tunnel. All the dimensions were measured in centimeters. Results The mean transverse diameter of the right side was 1.824 ± 0.223 cm (p-value 0.002) and of the left side was 1.742 ± 0.197 cm (p-value 0.004). The mean cross-sectional area of the carpal tunnel on the right side was 1.417 ± 0.379 cm2 (p-value 0.008) and on the left side was 1.306 ± 0.303 cm2 (p-value 0.004), respectively. Age, sex, weight, and BMI were discussed. The carpal tunnels of females were found to be comparatively squarer and smaller than those of males. Conclusion The transverse diameter and cross-sectional area of the carpal tunnel and their correlation with carpal tunnel syndrome are predicted by age, sex, weight, and BMI. Both sexes had the same wrist ratio.

BACKGROUND: Degenerative cervical myelopathy (DCM), a progressive spinal cord injury caused by spinal cord compression from degenerative pathology, often presents with neck pain, sensorimotor dysfunction in the upper or lower limbs, gait disturbance, and bladder or bowel dysfunction. Its symptomatology is very heterogeneous, making early detection as well as the measurement or understanding of the underlying factors and their consequences challenging. Increasingly, evidence suggests that DCM may consist of subgroups of the disease, which are yet to be defined.
OBJECTIVE: This study aimed to explore whether machine learning can identify clinically meaningful groups of patients based solely on clinical features.
METHODS: A survey was conducted wherein participants were asked to specify the clinical features they had experienced, their principal presenting complaint, and time to diagnosis as well as demographic information, including disease severity, age, and sex. K-means clustering was used to divide respondents into clusters according to their clinical features using the Euclidean distance measure and the Hartigan-Wong algorithm. The clinical significance of groups was subsequently explored by comparing their time to presentation, time with disease severity, and other demographics.
RESULTS: After a review of both ancillary and cluster data, it was determined by consensus that the optimal number of DCM response groups was 3. In Cluster 1, there were 40 respondents, and the ratio of male to female participants was 13:21. In Cluster 2, there were 92 respondents, with a male to female participant ratio of 27:65. Cluster 3 had 57 respondents, with a male to female participant ratio of 9:48. A total of 6 people did not report biological sex in Cluster 1. The mean age in this Cluster was 56.2 (SD 10.5) years; in Cluster 2, it was 54.7 (SD 9.63) years; and in Cluster 3, it was 51.8 (SD 8.4) years. Patients across clusters significantly differed in the total number of clinical features reported, with more clinical features in Cluster 3 and the least clinical features in Cluster 1 (Kruskal-Wallis rank sum test: χ22=159.46; P<.001). There was no relationship between the pattern of clinical features and severity. There were also no differences between clusters regarding time since diagnosis and time with DCM.
CONCLUSIONS: Using machine learning and patient-reported experience, 3 groups of patients with DCM were defined, which were different in the number of clinical features but not in the severity of DCM or time with DCM. Although a clearer biological basis for the clusters may have been missed, the findings are consistent with the emerging observation that DCM is a heterogeneous disease, difficult to diagnose or stratify. There is a place for machine learning methods to efficiently assist with pattern recognition. However, the challenge lies in creating quality data sets necessary to derive benefit from such approaches.

BACKGROUND: To compare the clinical outcomes of compressive buttress screw (CBS) fixation, a novel screw fixation strategy, to off-axial screw fixation (off-axial partial threaded cannulated screw, OPTCS) for vertical femoral neck fractures (FNFs) in young adults.
METHODS: A total of 146 adults younger than 55 years old with high-energy Pauwels type III FNFs were randomized to receive CBS fixation or OPTCS fixation. Primary outcomes were complication rates, including fixation failure, fracture nonunion, and avascular necrosis of the femoral head (ANFH) at 24 months after treatment. Fixation loosening, femoral neck shortening and varus collapse, patient function and quality of life using the Harris hip score (HHS), and EuroQol-5 dimensional-5 levels (EQ-5D-5L) questionnaire (including EQ-5D-5L and EQ-VAS) were assessed as secondary outcomes at 24 months.
RESULTS: CBS and OPTCS fixation groups were similar with regard to demographics at baseline. At 24 months, patients in the CBS fixation cohort had a significantly lower rate of fixation failure (10.5% vs. 25.0%, p = 0.041) and fracture nonunion (1.8% vs. 18.3%, p = 0.003) compared with patients who received OPTCS fixation. There was no difference in rate of ANFH (7.0% vs. 11.7%, p = 0.389) between groups. Additionally, patients managed with CBS fixation showed significantly less fixation loosening (19.3% vs. 58.3%, p < 0.001), less severe femoral neck shortening and varus collapse (10.5% vs. 25.0%, p = 0.007), higher HHS (93 vs. 83, p = 0.001) and more excellent grade (68.4% vs. 36.7%, p = 0.008), higher EQ-5D-5L (0.814 vs, 0.581, p < 0.001) and EQ-VAS (85 vs. 80, p = 0.002).
CONCLUSIONS: CBS screw fixation confers significantly lower complication rate in addition to higher functional and quality of life outcomes for young adults with high-energy FNF compared with OPTCS fixation.
BACKGROUND: This prospective, randomized controlled trial was approved by the institutional review board of our center, Ethics Committee of Shanghai sixth people\'s Hospital, and registered at www.chictr.org.cn (Approval Number: ChiCTR1900026283; Registered 29 September 2019-Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=43164 ).

Dredging of lake sediment is a method to remove accumulated phosphorus and nitrogen in lakes and thereby reducing the risk of eutrophication. After dredging, the sediment is dewatered to reduce the volume. It is important to get a high dry matter content and ensure that the filtrate does not contain harmful compounds so it can be returned to the lake. A pilot-scale belt filter and flexible intermediate bulk containers (FIBC) were used for dewatering lake sediment with the sediment treated with a synthetic polymer or three different biopolymers. The goal of the study was to retain the phosphorus in the filter cake while returning the filtrate to the lake with a minimal phosphorus content. Results showed dry matter content of up to 16 % in the dewatered sediment and the sediment retained 96-99 % of the phosphorus. Furthermore, nitrogen was reduced by 27-71 % in the filtrate water. Toxicity tests found low ecotoxicity for most biopolymer filtrates, whereas synthetic polymer showed the highest potential ecotoxicity. Consequently, biopolymers provided satisfactory results, proving more environmentally friendly despite requiring longer filtration time.

UNASSIGNED: Cine-magnetic resonance imaging (MRI) is currently used in real-time tumor tracking during magnetic resonance (MR)-guided radiotherapy. As a type of MRI specified for motion tracking, a few minutes\' acquisition results in thousands of 2-dimensional (2D) images. For MR-guided radiotherapy consisting of multiple treatment fractions, the large number of cine-MRI images would be disproportionate to the tight clinical data storage available. To alleviate this issue, the feasibility of compression of cine-MRI via video encoders was investigated in this study.
UNASSIGNED: The cine-MRI images were first sorted into 3 sequences according to their plane orientations. Then, each sequence was reordered according to their acquisition times [time-based (TB)] or content similarities [similarity-based (SB)]. As a result, 3 sequences were obtained for 3 plan orientations. Next, the obtained sequences were processed by a video encoder and the corresponding 3 video files were achieved. We employed 3 popular video encoders: Motion JPEG (M-JPEG), Advanced Video Coding (AVC), and High Efficiency Video Coding (HEVC). The performances of the sequence reordering methods and video encoders were evaluated based on a total of 150 image sets.
UNASSIGNED: The mean correlation quantities for SB sequences were higher than those for TB sequences by 3% (sagittal), 2% (coronal), and 1% (transverse), respectively. The average compression ratio (CR) yielded by the SB sequences was higher than that achieved by the TB sequences. Comparing with M-JPEG, the CRs obtained by AVC and HEVC were increased by 58% and 62% (sagittal), 16% and 23% (coronal), and 48% and 56% (transverse), respectively. Among the 3 video encoders, the highest CRs and restoration accuracy were achieved by HEVC.
UNASSIGNED: HEVC with inter-frame coding is more effective in reducing the redundant information in consecutive images. It is feasible to implement the video encoder for high-performance cine-MRI compression.

UNASSIGNED: Clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP) occurs in 20%-40% of patients and remains a leading cause of morbidity and increased healthcare cost in this patient group. Recently, several studies suggested decreased risk of CR-POPF with the use of peri-firing compression (PFC) technique. The aim of this report was to conduct a systematic review to get an overview of the current knowledge on the use of PFC in DP. In addition, our experience with PFC was presented.
UNASSIGNED: The systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Also, 19 patients undergoing DP with the use of PFC at Oslo University Hospital were studied. The primary endpoint was incidence of CR-POPF.
UNASSIGNED: Seven articles reporting a total of 771 patients were ultimately included in the systematic review. Only two of these were case-control studies examining outcomes in patients with and without PFC, while the rest were case series. These were heterogeneous in terms of staplers used, cartridge selection policy, and PFC technique. Both case-control studies reported significantly reduced CR- POPF incidence with PFC. Eight (21%) of our patients developed CR-POPF after DP with PFC. Only one patient developed CR-POPF among those with pancreatic transection site thickness ⩽1.5 cm.
UNASSIGNED: Evidence on potential benefits of PFC in DP is limited in quantity and quality. Our findings suggest that the use of PFC does not lead to reduction in the incidence of CR-POPF. Yet, there might be a benefit from PFC when dealing with a thin pancreas.