For antinuclear antibody (ANA) screening, the gold standard method is an indirect immunofluorescence assay (IIFA) using HEp-2 cells, and a serial dilution test is needed to determine the endpoint titer. We aimed to evaluate the accuracy of the estimated endpoint titer (eEPT) by the NOVA View system, by comparing it with the EPT by the serial dilution method (dEPT). The endpoint titers of a total of 1518 ANA positive cases with five major patterns including speckled, homogeneous, centromere, nucleolar, and nuclear dots patterns were determined using both the estimation function and the serial dilution method by the NOVA View system. A significant correlation between the light intensity unit (LIU) values and dEPTs was identified in all five patterns with high ρ values, ranging from 0.666 to 0.832. However, the overall exact match rate between dEPT and eEPT was 22.1% (336/1518), with the ±one-titer match rate being highest in the centromere pattern (62.8%, 81/129), and lowest in the homogeneous pattern (37.6%, 200/532). This suggests that while LIU values correlate well with dEPT, there are discrepancies in numerical agreement. Most cases that did not show an exact match, showed one-to-three-titer overestimations by eEPT. Therefore, adjusting eEPT downward significantly improved the concordance rates with dEPTs. Further investigation for an appropriate cutoff of LIU values for determining eEPT should be performed for clinical application and contribution to the standardization of the ANA titer.

Systemic arterial hypertension is a common occurrence and can have serious adverse consequences in cats. Therefore, measuring blood pressure is very important. There are many indirect blood pressure measurement devices available. This study compared Doppler, oscillometric (petMAP Graphic II, SunTech Vet20, the Cardell Insight-X0000) and high-definition oscillometry devices for the non-invasive measurement of blood pressure in conscious cats.
In this prospective study, blood pressure was measured in 32 cats using the different devices according to the recommendations of the American College of Veterinary Internal Medicine Consensus Statement. Blood pressures (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP]), time to complete measurements, number of attempts needed, coefficient of variation (CV) between the blood pressure measurements of the different devices, ease of completing measurements and apparent stress level of the cat were assessed.
There was a significant difference between devices in the time taken to obtain blood pressure readings and the number of attempts necessary to obtain six reliable measurements. The CV of the Doppler device was significantly smaller than that of the rest of the devices, but there were no other differences between the devices. The mean SBP, DBP and MAP measured by the petMAP device were significantly higher than the measurements from the other devices. The perceived ease of measurement was not significantly different between the various machines. The perceived level of stress of measurement with the Doppler device was significantly higher compared with the other devices but did not lead to an increased SBP.
Using a Doppler device to measure blood pressure in conscious cats is fast, relatively easy and gives reliable results. A disadvantage is that the Doppler device can only measure SBP, while oscillometric devices also provide DBP and MAP. However, in veterinary medicine, systolic hypertension is considered the most relevant.

UNASSIGNED: This study aimed to compare the estimated and measured resting metabolic rates of patients with type 1 and type 2 diabetes mellitus in an outpatient clinical setting.
UNASSIGNED: Participants were categorized into three groups that included type 1 diabetes, type 2 diabetes, and individuals without diabetes. Bland-Altman analysis was used to identify the equation that most accurately predicted the measured resting metabolic rates. Multiple regression analysis was used to identify the factors affecting resting metabolic rates.
UNASSIGNED: Resting metabolic rates was observed to be higher in subjects with type 2 diabetes compared to that of the other groups. There was a proportional bias between predicted and measured resting metabolic rates. Type 1 diabetes, type 2 diabetes, male sex, body weight, waist circumference, and triglyceride level were factors that positively predicted resting metabolic rates, and age was a factor that negatively predicted it.
UNASSIGNED: Although there was a bias between estimated and measured RMR, the most accurate results were achieved with the Mifflin-St Jeor equation for women with type 1 diabetes, with the Owen equation for men with type 1 diabetes, with the Harris Benedict equation for women with type 2 diabetes, and with the Ikeda equation for men with type 2 diabetes as well as for women and men in the control group.

This study proposes the new condition monitoring concept of using features in the measured rotation, or \'pitch\' signal, of a crossing vehicle as an indicator of the presence of foundation scour in a bridge. The concept is explored through two-dimensional vehicle-bridge interaction modelling, with a reduction in stiffness under a pier used to represent the effects of scour. A train consisting of three 10-degree-of-freedom carriages cross the model on a profiled train track, each train varying slightly in terms of mass and velocity. An analysis of the pitch of the train carriages can clearly identify when scour is present. The concept is further tested in a scaled laboratory experiment consisting of a tractor-trailer crossing a four-span simply supported bridge on piers. The foundation support is represented by four springs under each pier, which can be replaced with springs of a reduced stiffness to mimic the effect of scour. The laboratory model also consistently shows a divergence in vehicle pitch between healthy and scoured bridge states.

Indirect immunofluorescence is usually restricted to 3-5 markers per preparation, limiting analysis of coexistence. A solution containing 2-mercaptoethanol and sodium dodecyl sulfate (2-ME/SDS) can elute indirect immunofluorescence labelling (i.e. primary antisera followed by fluorophore-conjugated secondary antisera) and has been used for sequential staining of sections. The aim of this study was to test whether 2-ME/SDS is effective for eluting indirect immunofluorescent staining (with primary antisera visualised by fluorophore-coupled secondary antisera) in wholemount preparations. We also analysed how 2-ME/SDS may work and used this understanding to devise additional uses for immunofluorescence in the nervous system. 2-ME/SDS appears to denature unfixed proteins (including antisera used as reagents) but has much less effect on antigenicity of formaldehyde-fixed epitopes. Moieties linked by strong biotin-streptavidin bonds are highly resistant to elution by 2-ME/SDS. Two primary antisera raised in the same species can be applied without spurious cross-reactivity, if a specific order of labelling is followed. The first primary antiserum is followed by a biotinylated secondary, then a tertiary of fluorophore-conjugated streptavidin. The preparation is then exposed to 2-ME/SDS, which has minimal impact on labelling by the first primary/secondary/tertiary combination. However, when this is followed by a second primary antiserum (raised in the same species), followed by a fluorophore-conjugated secondary antiserum, the intervening 2-ME/SDS exposure prevents cross-reactivity between primary and secondary antisera of the two layers. A third property of 2-ME/SDS is that it reduces lipofuscin autofluorescence, although it also raises background fluorescence and strongly enhances autofluorescence of erythrocytes. In summary, 2-ME/SDS is easy to use, cost-effective and does not require modified primary antisera. It can be used as the basis of a multi-layer immunohistochemistry protocol and allows 2 primary antisera raised in the same species to be used together.

METHODS: Retrospective analysis.
OBJECTIVE: To evaluate resolution of radiculopathy in one-level lumbar fusion with indirect or direct decompression techniques.
METHODS: Patients ≥18 years of age with preoperative radiculopathy undergoing single-level lumbar fusion with up to 2-year follow-up were grouped by indirect and direct decompression. Direct decompression (DD) group included ALIF and LLIF with posterior DD procedure as well as all TLIF. Indirect decompression (ID) group included ALIF and LLIF without posterior DD procedure. Propensity score matching was used to control for intergroup differences in age. Intergroup outcomes were compared using means comparison tests. Logistic regressions were used to correlate decompression type with symptom resolution over time. Significance set at P < .05.
RESULTS: 116 patients were included: 58 direct decompression (DD) (mean 53.9y, 67.2% female) and 58 indirect decompression (ID) (mean 54.6y, 61.4% female). DD patients experienced greater blood loss than ID. Additionally, DD patients were 4.7 times more likely than ID patients to experience full resolution of radiculopathy at 3 months post-op. By 6 months, DD patients demonstrated larger reductions in VAS score. With regard to motor function, DD patients had improved motor score associated with the L5 dermatome at 6 months relative to ID patients.
CONCLUSIONS: Direct decompression was associated with greater resolution of radiculopathy in the near post-operative term, with no differences at long term follow-up when compared with indirect decompression. In particularly debilitated patients, these findings may influence surgeons to perform a direct decompression to achieve more rapid resolution of radiculopathy symptoms.

OBJECTIVE: We describe how consideration of external evidence may play an important role in judging certainty in the process of establishing the certainty of the evidence. Our example is a network meta-analysis (NMA) addressing treatment for Ebola virus disease, which informed a World Health Organization guideline.
METHODS: Through Grading of Recommendations Assessment, Development, and Evaluations (GRADE) project group iterative online, in-person and email discussions, we developed this GRADE concept and obtained approval from the GRADE working group. Using the null as a threshold, we rated our certainty for network estimates in mortality, including consideration of evidence external to the NMA (i.e., did not meet eligibility criteria) and formal logical construction.
RESULTS: Based on the existing GRADE guidance, we rated the network estimate for one indirect comparison as low certainty. The formal logical construction that lead us reevaluate the certainty of the evidence is as follows: if A is superior to B, and B is not inferior to C, then A must be superior to C. After considering the logic and the external indirect evidence, we concluded at least moderate certainty for the comparison.
CONCLUSIONS: Systematic review authors and guideline developers should apply the fundamental logical construction for indirect comparisons and consider compelling external evidence in NMA certainty ratings.

We investigated the indirect puncture method using a novel arc puncture-guided device in percutaneous transforaminal puncture to improve puncture accuracy and reduce the fluoroscopy, puncture, and operation times.
We have designed a novel arc puncture-guided device consisting of a 90° arc block and a 30° arc block. Punctures were performed on 8 fresh goat lumbar spine specimens. A senior doctor performed indirect punctures on the left side of the L2-L3, L3-L4, and L4-L5 levels using the novel device (group A) and on the right side of the L2-L3, L3-L4, and L4-L5 levels using the conventional method (group B). We recorded the fluoroscopy, puncture, and operation times.
In group A, the first puncture could successfully reach the target after 1-3 punctures, and the one-time success rate of the second needle puncture was 91.67%. The total fluoroscopy time was 14.88 ± 0.99 minutes in group A and 16.08 ± 2.22 minutes in group B (P = 0.027). The puncture times were 3.00 ± 0.66 minutes in group A and 6.04 ± 2.13 minutes in group B (P < 0.01). The operation time was 273.75 ± 30.19 minutes in group A and 361.25 ± 69.57 minutes in group B (P < 0.01). The differences in fluoroscopy times, puncture times, and operation times between the 2 groups were statistically significantly (P < 0.05).
Indirect puncture using the novel arc puncture-guided device for percutaneous transforaminal puncture can significantly improve puncture accuracy and reduce the fluoroscopy, puncture, and operation times. Indirect puncture using the novel device in percutaneous transforaminal endoscopic discectomy is a potential and practical puncture method.

UNASSIGNED: Indirect calorimetry (IC) is the most precise approach for estimating calorie demand in critically ill patients. Despite this, owing to unaffordable devices, it is rarely used in practice. Predictive equations are the alternatives.
UNASSIGNED: To assess the accuracy of 14 predictive resting energy expenditure(REE) equations in ventilated Thai patients.
UNASSIGNED: We compared the accuracy and agreement of 14 equations. The equations included the American College of Chest Physicians(ACCP) equation, Harris-Benedict equation(HBE), 1.2×HBE, 1.5×HBE, Mifflin-St. Jeor(MSJ), Ireton-Jones 1992 and 2002, Penn State 2003(HBE and MSJ) and 2010, Swinamer 1990, Faisy, Brandi 1999, and 25 kcal/kg equation. An equation was ascertained as accurate if the calculated values fell within ±10% of the measured REEs. Spearman correlation coefficient, Bland-Altman method, and intraclass correlation coefficient were used to analysis.
UNASSIGNED: We obtained data from 24 ventilated patients undergoing REE measurement by IC. Fifty percent of them were male with a median age of 64.5 years, a median height of 160 cm, and a median body mass index of 22.95 kg/m2. The predictive precision of all equations was poor, with largely different accuracies from 6.7% to 48.1%. The most reliable equation was Penn State 2010. The ACCP, HBE, MSJ, and Penn State 2003(HBE) tended to underestimate calorie need. Contrastingly, the other equations tended to overestimate REEs. Despite a moderate degree of correlations, the Bland-Altman plots demonstrated clinically unacceptable discrepancies between measured REE and REE calculated by each equation.
UNASSIGNED: In ventilated Thai patients, there were no precise equations for determining REE.

UNASSIGNED: There is still no standard of care to manage thoracolumbar burst fractures. With all the recent advances, posterior approaches are still one of the mainstays of treatment. On the other hand, while spinal canal decompression in neurological impaired patients is an important goal of treatment, its technique remains controversial.This study compared the effects of direct laminectomy decompression against ligamentotaxis/indirect canal decompression on neurological and radiographic improvements.
UNASSIGNED: A prospective double-blind randomized clinical trial was conducted on 60 thoracolumbar burst-fracture patients meeting our inclusion and exclusion criteria. They were randomized into 2 treatment arms: (1) direct decompression using laminectomy and (2) indirect decompression using ligamentotaxis/distraction. Each patient was observed for 6 months, and their neurological and radiographical data were collected prospectively. Statistical analysis was done by the Student t test, Friedman test, Mann Whitney-U test, Wilcoxon ranked test, and 1-way analysis of variance.
UNASSIGNED: Among 60 patients enrolled in our study, each treatment arm had an improvement in Frankel scores but there was no difference between the groups at any given time. After 6 months of surgery, local sagittal kyphosis improved in both groups (from 32.2 to 7.43 and 29.93 to 8.77 for the indirect and direct groups, respectively), as well as anterior vertebral height ratio (from 57.73 to 70.7 and 62.17 to 66.27 for the indirect and direct group, respectively) and posterior vertebral height ratio (from 61.17 to 74.87 and 64 to 67.5 for the indirect and direct group, respectively). For between-group comparisons after 6 months, there was a significant difference only for posterior vertebral height ratio (P = 0.040).
UNASSIGNED: Posterior approaches with ligamentotaxis have shown to be safe and may present the same outcome as direct decompression techniques using wide laminectomy.