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Adaptive Optics Ophthalmoscopy Reveals Subclinical Arteritis and Periphlebitis After Intravitreal Brolucizumab Injection
No full textChanges in delayed sleep patterns and related clinical factors in a social restriction environment
No full textWe aimed to investigate which factors, including socioenvironmental factors and emotional regulation, were associated with pronounced delayed sleep patterns during the COVID-19 social restriction. We evaluated 744 adults aged 20-65 y using a web-based survey with a self-reported questionnaire in May 2022. Based on the survey, we estimated the mid-sleep time on free days corrected for oversleeping on free days (MSFsc) and social jet lag (SJL). We determined delayed sleep patterns using DeltaMSFsc, which was defined as the difference between MSFsc during the pre- and mid-pandemic. The high-risk group for delayed sleep patterns (H-DSP) group was younger with evening person and had more severe insomnia, depression with rumination, and smartphone addiction (p < 0.05). Logistic regression revealed that stronger tendencies to express emotions and rumination were independent risk factors associated with a pronounced pattern of delayed sleep during the pandemic. In the H-DPS group, SJL increased even more during the pandemic. In socially restricted environments, emotion regulation significantly affects the severity of delayed sleep patterns, and people with H-DSP also had more disrupted circadian rhythms. Therefore, active education of sleep hygiene and emotional support with psychological interventions are needed in socially restricted environments
A novel machine learning model for screening the risk of obstructive sleep apnea using craniofacial photography with questionnaires
No full textSTUDY OBJECTIVES: Undiagnosed or untreated moderate-to-severe obstructive sleep apnea (OSA) increases cardiovascular risks and mortality. Early and efficient detection is critical, given its high prevalence. We aimed to develop a practical and efficient approach for OSA screening, using simple facial photography and sleep questionnaires. METHODS: We retrospectively included 748 participants who completed polysomnography, sleep questionnaires (STOP-BANG), and facial photographs at a university hospital between 2012 and 2023. Owing to class imbalance, we randomly undersampled the participants, categorized into the moderate/severe or no/mild OSA group, based on an apnea-hypopnea index of 15 events/h. Using a validated convolutional neural network, we extracted the OSA probability scores from photographs, which were used as the input for the questionnaires. Four machine learning models were employed to classify the moderate/severe vs no/mild groups and evaluated in the test dataset. RESULTS: We analyzed 426 participants (213 each in the moderate/severe and no/mild groups). The mean (standard deviation) age was 44.6 (14.7) years; 80.8% were men. Logistic regression achieved the highest performance: the area under the receiver operator curve was 97.2%, and accuracy was 91.9%. Adding OSA probability, retrieved from facial photographs, to the questionnaires improved performance, compared with using questionnaires or photographs alone (the area under the receiver operating characteristic curve 97.2% using both, 85.7% for photographs alone, and 64% and 79.1% for questionnaire threshold STOP-BANG scores of 3 and 4, respectively). CONCLUSIONS: Using simple facial photographs and sleep questionnaires, a 2-stage approach (convolutional neural network + machine learning) accurately classified OSA into moderate/severe vs no/mild OSA groups. This method may facilitate optimal OSA treatment and avoid unnecessary costly evaluations. CITATION: Park J-Y, Shin H-R, Kim MH, et al. A novel machine learning model for screening the risk of obstructive sleep apnea using craniofacial photography with questionnaires. J Clin Sleep Med. 2025;21(5):843-854
Hashimoto’s encephalopathy with diffuse leukoencephalopathy: serial MRI and gait analysis
No full textSelecting Anterior Segmental Osteotomy Versus Orthodontic Camouflage Treatment: Importance of the Incisor–Mandibular Plane Angle
No full textBackground: Temporary anchorage devices (TADs) have reduced the need for anterior segmental osteotomy (ASO) in Class I patients; however, ASO remains relevant in Class II patients. As previous studies were conducted before the usage of TADs, updated guidelines are required to determine the relationship between surgery and orthodontic treatment. We aimed to evaluate the hard tissue changes following ASO versus non-ASO (NASO) orthodontic treatment utilizing TADs with premolar extraction. Methods: This retrospective clinical study involved 67 patients diagnosed with skeletal Class II malocclusion. The patients were categorized into the ASO (n = 31) and NASO (n = 36) groups. Cephalometric analyses were conducted to compare initial and final records to assess the treatment effects. Results: Pre- and post-treatment changes in the ASO and NASO groups exhibited significant differences in ΔSNA, ΔSNB, ΔANB, ΔA to N-perp, ΔB to N-perp, ΔPog to N-perp, and ΔA to FH (p < 0.05). Both groups demonstrated normalized ANB, indicating significant skeletal improvement in Class II malocclusion. Specifically, the change in FMIA (ΔL1 to FH [°]) was 4.98° greater in the NASO group than in the ASO group (p < 0.05). Conclusions: Considering the IMPA change, NASO was recommended for treatment choice when a reduction of more than 10° was achievable
Innovating Pelvic Fracture Surgery: Development and Evaluation of a New Surgical Table for Enhanced C-Arm Imaging and Operational Efficiency
No full textBackground: Pelvic fractures require precise reduction and stabilization, necessitating high-quality C-arm imaging and accurate patient positioning. Standard operating tables often obstruct optimal C-arm maneuverability. To address this, we developed a new auxiliary surgical table that integrates with existing tables and evaluated its clinical utility compared to a specialized carbon surgical table. Methods: Between March 2018 and June 2023, we conducted a retrospective study involving 162 patients (97 men and 65 women; average age 45.7 years) who underwent percutaneous sacroiliac screw fixation for pelvic fractures. Ninety patients were treated using the newly developed table, and seventy-two patients were treated using the carbon table. The new table, measuring 200 cm in length, 50 cm in width, and 2 cm in thickness, was constructed from waterproof plywood and designed to be securely attached to existing operating tables. We compared surgical preparation times, economic costs, and intraoperative imaging feasibility between the two groups. Results: Use of the new table significantly reduced the surgical preparation time by an average of 21 min and saved approximately $43,000 in cost compared to the carbon table. Subjective assessments indicated no notable difference in intraoperative C-arm image quality between the two groups. The new table allowed free C-arm rotation by overcoming the mechanical limitations of conventional tables. Conclusions: The new auxiliary table demonstrated clinical feasibility and economic advantages without compromising intraoperative imaging quality, offering a practical and cost-effective alternative for pelvic fracture surgeries
Differential impact of maternal and paternal metabolic syndrome on offspring’s cardiometabolic risk factors
No full textParental metabolic syndrome (MetS) is associated with increased cardiometabolic risk in offspring, yet the distinct impacts of maternal versus paternal MetS remain poorly understood. Evidence on sex-specific susceptibility during adolescence is particularly limited, despite this being a critical period for the development of chronic metabolic conditions. Using a comprehensive dataset of 5,245 patients selected from a nationally representative database, we examined the differential association of maternal and paternal MetS with cardiometabolic outcomes in adolescent offspring and their variation by offspring sex. Overall, paternal MetS was associated with higher triglyceride and lower HDL cholesterol in male offspring. In contrast, maternal MetS was linked to higher triglyceride levels in both sexes, with additional associations with elevated systolic blood pressure and lower HDL cholesterol only in males. The odds of MetS and its components were most elevated in male adolescents in both paternal and maternal MetS. In conclusion, paternal MetS appeared to exert a stronger influence, particularly in male adolescents. Our findings suggest that both parental and offspring sexes modify the intergenerational transmission of metabolic risk; it is crucial to consider both parental and offspring sexes for effective screening and the prevention of MetS
Nano Crack-based Angular Potentiometers for Deployable and Small-scale Origami Robots
No full textOrigami robots can be fabricated at various scales and transform flat two-dimensional sheets into complex three-dimensional structures. To date, the potential of origami robots in developing versatile robotic systems has been demonstrated through various folding patterns and actuation mechanisms. However, limitations in angle sensing - such as restricted range, direction, and scale - challenge the development of proprioceptive capabilities, hindering their ability to perform tasks. Here, we introduce a nano crack-based angular potentiometer (NanoCAP) capable of detecting a wide range of motion in origami robot joints. NanoCAP provides resistance changes resulting from the opening and closing of cracks under tension and compression. Furthermore, NanoCAP can be fabricated at a small scale, enabling integration into miniaturized origami robots. We validated the proprioceptive capabilities of NanoCAP by measuring angles independent of joint rotation direction, range, and robot size. Demonstrate includes an origami robot manipulator providing real-time posture feedback while transforming from a fully folded flat state to deployment, and a miniature origami gripper capable of detecting subtle angular changes due to external stimuli (e.g., contact with objects)
Artificial Delayed-phase Technetium-99m MIBI Scintigraphy From Early-phase Scintigraphy Improves Identification of Hyperfunctioning Parathyroid Lesions in Patients With Hyperparathyroidism
No full textPURPOSE: The aim of this study was to generate and validate artificial delayed-phase technetium-99m methoxyisobutylisonitrile scintigraphy (aMIBI) images from early-phase technetium-99m methoxyisobutylisonitrile scintigraphy (eMIBI) images. PATIENTS AND METHODS: This retrospective study included patients with hyperparathyroidism who underwent dual-phase technetium-99m methoxyisobutylisonitrile (MIBI) scintigraphy at 2 centers. The patients were divided into a training set (n = 980), an internal test set (n = 100), and an external test set (n = 253). The generation of aMIBI images from eMIBI images was performed using an unpaired image-to-image translation method. Receiver operating characteristic curves and the area under the curves (AUCs) were used to evaluate the diagnostic performance of aMIBI and eMIBI images in identifying hyperfunctioning parathyroid lesions in both the internal and external test sets. In addition, an artificial intelligence (AI)-assisted diagnostic model combining aMIBI and clinical data was evaluated. RESULTS: The AUCs of aMIBI images were significantly higher than those of eMIBI images (internal test set: 0.944 vs 0.658, P < 0.001; external test set: 0.900 vs 0.761, P < 0.001). The performance of the AI-assisted diagnostic models combining aMIBI images and clinical data was significantly better than those of the aMIBI-only models in both the internal (AUC: 0.974 vs 0.944, P = 0.020) and external (AUC: 0.953 vs 0.900, P < 0.001) test sets. CONCLUSIONS: The diagnostic performance of aMIBI images in identifying hyperfunctioning parathyroid lesions was significantly superior to that of eMIBI images in patients with hyperparathyroidism. Models combining aMIBI images with clinical information enhanced the diagnostic performance even further
Effects of subjective stress levels on learning effectiveness in high-fidelity simulation among healthcare workers
No full textBACKGROUND: Appropriate stress reportedly influences memory gains. However, stress levels may vary across individuals and may lead to changes in vital signs as a physiological response induced by endogenous hormone secretion. The aim of this study was to evaluate the impact of high-fidelity simulation (HFS) training on cognitive performance using Perceived Stress Scale (PSS) scores as a subjective stress indicator and vital sign measurements as an objective stress indicator during Neonatal Resuscitation Program training. MATERIALS AND METHODS: This study was conducted as a single-blind randomized controlled study with a pre-post design for health care workers, including paediatric residents and nurses in charge of neonatal care. The trainees' vital signs and PSS scores were measured and determined before, during, and after each training session, and the results were analysed. RESULTS: A comparison of vital signs between groups after each training session revealed significant changes in heart rate (HR), and the PSS score significantly increased after practical training (2nd HR; 78.4 +/- 9.0 vs. 87.7 +/- 8.7, p = 0.05; 3rd HR 83.1 +/- 9.0 vs. 76.7 +/- 8.1, p = 0.041: 2nd PSS 15.1 +/- 3.3 vs. 18.2 +/- 4.8, p = 0.040), but there was no difference between the groups in terms of the final confirmed test result or PSS score (3rd result 66.3 +/- 24.4 vs. 72.7 +/- 12.7, p = 0.360; 3rd PSS 17.2 +/- 4.9 vs. 16.1 +/- 4.8, p = 0.510). When comparing vital signs, test scores, and PSS scores before and after HFS, regardless of the training sequence, no statistically significant changes were observed in the HR or respiratory rate (RR). However, body temperature (BT; 36.5 +/- 0.3 vs. 36.7 +/- 0.3, p < 0.001), mean blood pressure (BP; 81.9 +/- 11.8 vs. 84.8 +/- 10.2, p = 0.030), test scores (51.0 +/- 26.2 vs. 56.6 +/- 23.2, p < 0.001), and PSS scores (15.8 +/- 3.8 vs. 17.7 +/- 4.8, p = 0.036) significantly increased, whereas SpO(2) significantly decreased (99.3 +/- 0.8 vs. 98.8 +/- 1.4, p = 0.017). Multiple regression analysis was conducted to assess the relationship between PSS variability and final test score improvements. This revealed a significant relationship, as described by the following equation: final score difference = 34.997 + 1.637 x PSS variability (p = 0.006). CONCLUSION: The results of the analysis revealed a statistically significant relationship between the variability in subjective stress levels (PSS variability) and the improvement in final scores. This finding suggests that the greater the variability of subjective stress levels is, the greater the improvement in final scores is. Further research is needed to explore these relationships across different populations and training scenarios