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DPFL-Nets: Deep Pyramid Feature Learning Networks for Multiscale Change Detection

IEEE Trans Neural Netw Learn Syst. 2021 May 24;PP. doi: 10.1109/TNNLS.2021.3079627. Online ahead of print.

ABSTRACT

Due to the complementary properties of different types of sensors, change detection between heterogeneous images receives increasing attention from researchers. However, change detection cannot be handled by directly comparing two heterogeneous images since they demonstrate different image appearances and statistics. In this article, we propose a deep pyramid feature learning network (DPFL-Net) for change detection, especially between heterogeneous images. DPFL-Net can learn a series of hierarchical features in an unsupervised fashion, containing both spatial details and multiscale contextual information. The learned pyramid features from two input images make unchanged pixels matched exactly and changed ones dissimilar and after transformed into the same space for each scale successively. We further propose fusion blocks to aggregate multiscale difference images (DIs), generating an enhanced DI with strong separability. Based on the enhanced DI, unchanged areas are predicted and used to train DPFL-Net in the next iteration. In this article, pyramid features and unchanged areas are updated alternately, leading to an unsupervised change detection method. In the feature transformation process, local consistency is introduced to constrain the learned pyramid features, modeling the correlations between the neighboring pixels and reducing the false alarms. Experimental results demonstrate that the proposed approach achieves superior or at least comparable results to the existing state-of-the-art change detection methods in both homogeneous and heterogeneous cases.

PMID:34029198 | DOI:10.1109/TNNLS.2021.3079627

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Medicare reimbursement disparities persist for female otolaryngologists performing endoscopic sinonasal procedures

Int Forum Allergy Rhinol. 2021 May 24. doi: 10.1002/alr.22806. Online ahead of print.

NO ABSTRACT

PMID:34029005 | DOI:10.1002/alr.22806

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A safety and feasibility trial of (131) I-MIBG in newly diagnosed high-risk neuroblastoma: A Children’s Oncology Group study

Pediatr Blood Cancer. 2021 May 24:e29117. doi: 10.1002/pbc.29117. Online ahead of print.

ABSTRACT

INTRODUCTION: 131 I-meta-iodobenzylguanidine (131 I-MIBG) is effective in relapsed neuroblastoma. The Children’s Oncology Group (COG) conducted a pilot study (NCT01175356) to assess tolerability and feasibility of induction chemotherapy followed by 131 I MIBG therapy and myeloablative busulfan/melphalan (Bu/Mel) in patients with newly diagnosed high-risk neuroblastoma.

METHODS: Patients with MIBG-avid high-risk neuroblastoma were eligible. After the first two patients to receive protocol therapy developed severe sinusoidal obstruction syndrome (SOS), the trial was re-designed to include an 131 I-MIBG dose escalation (12, 15, and 18 mCi/kg), with a required 10-week gap before Bu/Mel administration. Patients who completed induction chemotherapy were evaluable for assessment of 131 I-MIBG feasibility; those who completed 131 I-MIBG therapy were evaluable for assessment of 131 I-MIBG + Bu/Mel feasibility.

RESULTS: Fifty-nine of 68 patients (86.8%) who completed induction chemotherapy received 131 I-MIBG. Thirty-seven of 45 patients (82.2%) evaluable for 131 I-MIBG + Bu/Mel received this combination. Among those who received 131 I-MIBG after revision of the study design, one patient per dose level developed severe SOS. Rates of moderate to severe SOS at 12, 15, and 18 mCi/kg were 33.3%, 23.5%, and 25.0%, respectively. There was one toxic death. The 131 I-MIBG and 131 I-MIBG+Bu/Mel feasibility rates at the 15 mCi/kg dose level designated for further study were 96.7% (95% CI: 83.3%-99.4%) and 81.0% (95% CI: 60.0%-92.3%).

CONCLUSION: This pilot trial demonstrated feasibility and tolerability of administering 131 I-MIBG followed by myeloablative therapy with Bu/Mel to newly diagnosed children with high-risk neuroblastoma in a cooperative group setting, laying the groundwork for a cooperative randomized trial (NCT03126916) testing the addition of 131 I-MIBG during induction therapy.

PMID:34028986 | DOI:10.1002/pbc.29117

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The effects of rotational setup errors in total body irradiation using helical tomotherapy

J Appl Clin Med Phys. 2021 May 24. doi: 10.1002/acm2.13271. Online ahead of print.

ABSTRACT

PURPOSE: Helical tomotherapy (HT) is a form of intensity-modulated radiation therapy that is employed in total body irradiation (TBI). Because TBI targets the whole body, accurate setup positioning at the edge of the treatment volume is made difficult by the whole-body rotational posture. The purpose of this study is to clarify the tolerance for rotational setup error (SE) in the vertical direction. In addition, we perform a retrospective analysis of actually irradiated dose distributions using previous patients’ irradiation data.

METHODS: To clarify the effects of rotational SE on the dose distribution, the planned CT images of 10 patients were rotated by 1-5° in the vertical (pitch) direction to create a pseudo-rotational SE image. Then, the effect of the magnitude of the rotational SE on the dose distribution was simulated. In addition, the irradiated dose to the patients was analyzed by obtaining recalculated dose distributions using megavoltage CT images acquired before treatment.

RESULTS: The simulation results showed that the average value of the lung volume receiving at least 10 Gy did not exceed the allowable value when the SE value was ≤2°. When the rotational SE was ≤3°, it was possible to maintain the clinical target volume dose heterogeneity within ±10% of the prescribed dose, which is acceptable according to the guidelines. A retrospective analysis of previous patients’ irradiation data showed their daily irradiation dose distribution. The dose to the clinical target volume was reduced by up to 3.4% as a result of the residual rotational SE. Although whole-course retrospective analyses showed a statistically significant increase in high-dose areas, the increase was only approximately 1.0%.

CONCLUSIONS: Dose errors induced by rotational SEs of ≤2° were acceptable in this study.

PMID:34028944 | DOI:10.1002/acm2.13271

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The Serum Anion Gap Revisited: A Verified Reference Interval for Contemporary Use

Intern Med J. 2021 May 24. doi: 10.1111/imj.15396. Online ahead of print.

ABSTRACT

BACKGROUND: The anion gap (AG) is often used to evaluate acid-base disorders. The reference interval for normal AG is used to differentiate between raised (gap) or normal AG (non-gap) acidosis. Historically accepted AG values may not be valid with the evolution of modern analytical techniques and the reference interval requires revalidation.

AIMS: To determine the reference interval for AG based on current laboratory techniques.

METHODS: During a health-screening exercise, 284 participants with no major illnesses volunteered surplus blood for analysis. The samples were tested in an internationally-accredited clinical laboratory. AG was calculated by (Na+ ) – (Cl ) – (HCO3 ) and AGK by (Na+ ) + (K+ ) – (Cl ) – (HCO3 ). The reference interval was determined at 2.5th-97.5th percentiles. Analysis was further undertaken for a sub-cohort of 156 individuals with no sub-optimal health indicators.

RESULTS: Median age was 35 years, BMI 23.4 kg/m2 and glomerular filtration rate 106 mL/min/1.73m2 . Median AG was 13 mmol/L and the reference interval for normal AG is 10-18 mmol/L with a 99% level of confidence. Statistically significant differences in AG were detected for sex, race, obesity and serum albumin but the difference was 1 mmol/L between subgroups. The reference interval was the same for the sub-cohort of 156 individuals. Median AGK was 17.7 mmol/L and reference interval was 14.6-22.5 mmol/L.

CONCLUSIONS: The AG reference interval of 10-18 mmol/L is valid for laboratories with similar reference intervals for electrolytes. Lower values expected with current laboratory techniques were not observed. The median AG of 13 mmol/L may be used to differentiate gap acidosis, non-gap acidosis or mixed acid-base disorders. This article is protected by copyright. All rights reserved.

PMID:34028972 | DOI:10.1111/imj.15396

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Comparison of the soft and hard peri-implant tissue dimensional changes around single immediate implants in the esthetic zone with socket shield technique versus using xenograft: A randomized controlled clinical trial

Clin Implant Dent Relat Res. 2021 May 24. doi: 10.1111/cid.13008. Online ahead of print.

ABSTRACT

OBJECTIVE: Compare the dimensional changes of the peri-implant soft and hard tissues clinically and radiographically around single immediate implants in the esthetic zone with socket shield technique versus filling the buccal gap with xenograft.

MATERIALS AND METHODS: Forty-two patients with a single non-restorable tooth in the esthetic zone replaced with an immediate implant were randomly assigned either to the socket shield technique (test) or to grafting the buccal gap with xenograft (control). The vertical and horizontal buccal bone resorption were measured 6-months following implant placement. The esthetic outcomes were evaluated by assessing the Pink Esthetic Score (PES) and the amount of midfacial mucosal alteration, in addition to patient satisfaction assessment through a Visual Analogue Scale (VAS) based questionnaire 1-year following implant restoration.

RESULTS: The present study showed that the socket shield group yielded significantly less vertical and horizontal buccal bone resorption of 0.35 (±0.62) mm and 0.29 (±0.34) mm compared to 1.71 (±1.02) mm and 1.45 (±0.72) mm in the xenograft group respectively. Also, there was a significantly greater midfacial mucosal recession in the xenograft group of 0.466 (±0.58) mm compared to midfacial mucosal coronal migration of 0.45 (±0.75) mm in the socket shield group. However, there was no statistically significant difference regarding the total PES and patient satisfaction in both treatment groups.

CONCLUSION: The socket shield technique can preserve hard and soft peri-implant tissues following immediate implant placement. (ClinicalTrials.gov Identifier: NCT03684356).

PMID:34028974 | DOI:10.1111/cid.13008

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Trueness of Intaglio Surface of Milled Digital Dentures Designed From Intraoral Scans

J Prosthodont. 2021 May 24. doi: 10.1111/jopr.13393. Online ahead of print.

ABSTRACT

PURPOSE: To asses trueness of the intaglio surface of milled dentures fabricated according to a fully digital protocol starting from intraoral scans in a clinical study by means of 3-dimensional (3D) digital analysis.

MATERIALS AND METHODS: Ten maxillary and 10 mandibular dentures, designed on intraoral scans and milled in-house, were studied. Intraoral scans were compared with the scans of intaglio surface of milled dentures. To this end, they were aligned, trimmed and used in a metrology software to measure their mean 3D distance, absolute mean deviation, and other parameters. Measured differences for all parameters were statistically investigated. Subgroup analysis for the maxillary and mandibular dentures was performed using independent samples t test or, in case of non-normal distribution, by means of Mann-Whitney test.

RESULTS: Using a mean of 24.9 ±2.8 measurement points/mm2 , a mean 3D distance of 0.0006 ±0.007 mm between intraoral scans and the scans of the intaglio surface of milled dentures was measured. The corresponding absolute mean deviation was 0.055 ±0.032 for maxillary dentures and 0.061 ±0.016 for mandibular dentures; such a difference between arches was statistically significant (P = .035).

CONCLUSIONS: Milled dentures fabricated using a fully digital protocol and intraoral scans have accurate intaglio surfaces. It is reasonable to assume that they may achieve an adequate fit. This article is protected by copyright. All rights reserved.

PMID:34028902 | DOI:10.1111/jopr.13393

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‘They were aware of who I was as a person’: Patients’ and health professionals’ experiences of using the PEGASUS intervention to facilitate decision-making around breast reconstruction

Eur J Cancer Care (Engl). 2021 May 24:e13464. doi: 10.1111/ecc.13464. Online ahead of print.

ABSTRACT

OBJECTIVE: Many women choose to have breast reconstruction after mastectomy; however, decision-making can be difficult and expectations are often unmet. The PEGASUS intervention (Patient Expectations and Goals: Assisting Shared Understanding of Surgery) was developed to support shared decision-making by helping women and healthcare professionals to clarify and discuss their individual expectations around surgery. This study aimed to explore patients’ and health professionals’ experiences of using the intervention and its implementation.

METHODS: Forty interviews were conducted with participants in a large scale, multi-site trial of the effectiveness of PEGASUS, from ‘intervention’ (n=16) and ‘usual care’ groups (n=11), and healthcare professionals (n=13). Data were analysed using thematic analysis.

RESULTS: ‘Usual care’ participants described feeling overwhelmed in decision-making (‘bombarded’), often using their own research to break down information (‘process of elimination’). In contrast, intervention group participants described PEGASUS providing focus (‘focus amongst the frenetic’), and increased connection with clinicians (‘more than a number’). Healthcare professionals described increased focus on patient priorities (‘shifting focus’), but stressed the need for whole team buy-in (‘collective commitment’).

CONCLUSIONS: The PEGASUS intervention offered a qualitatively different experience to individuals considering breast reconstruction, with potential to enhance patients’ and healthcare professionals’ feelings of shared decision-making and patient-centred care.

TRIAL REGISTRATION: ISRCTN 18000391 (https://doi.org/10.1186/ISRCTN18000391) 27/01/2016.

PMID:34028913 | DOI:10.1111/ecc.13464

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Symptom response to mobilization and outcomes in patients with subacromial pain syndrome: A cohort study

Physiother Res Int. 2021 May 24:e1914. doi: 10.1002/pri.1914. Online ahead of print.

ABSTRACT

OBJECTIVES: The objectives of this study were the following: (1) to determine if there was a difference in outcomes between immediate responders to glenohumeral mobilizations at the initial evaluation, 2-week, 4-week, and 6-month follow-up as compared to those that do not respond in participants with subacromial pain syndrome; (2) to see if there were statistically significant differences in outcomes within these groups between these time frames of interest, and (3) to see if symptom response at the initial evaluation was predictive of a favorable recovery.

METHODS: This was a prospective, single-group observational design. Clinicians pragmatically identified positive responders as improving at least two points on the Numeric Pain Rating Scale and/or a 20° improvement in shoulder active range of motion (AROM) following shoulder mobilization at the initial evaluation. Data were collected for the subjective and objective variables of interest at the initial evaluation, 2-week, 4-week, and 6-month follow-up.

RESULTS: The prevalence of responders at the initial evaluation was 99 (81.8%). There were no statistically significant between-group differences for the variables of interest except for the Global Rating of Change (GRoC; f = 2.79, p = 0.006). The shoulder abduction AROM between-group difference exceeded the minimal detectable change at 4 weeks. The pair-wise comparison showed statistically significant differences for the outcomes of interest at each time point except for the GRoC between 4 weeks and 6 months. There was a statistically significant correlation between responders at the initial evaluation and shoulder abduction AROM at the 4-week follow-up (rpb (112) = 0.27, p = 0.004).

CONCLUSION: Individuals with SAPS may benefit from shoulder mobilization independent of their within-session response to shoulder mobilization at the initial evaluation. Future research should seek to differentiate if these improvements are related to the within-session positive treatment response at the initial evaluation in individuals who are randomized to receive shoulder mobilization or not.

PMID:34028940 | DOI:10.1002/pri.1914

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Simultaneous confidence tubes for comparing several multivariate linear regression models

Biom J. 2021 May 24. doi: 10.1002/bimj.202000148. Online ahead of print.

ABSTRACT

Much of the research on multiple comparison and simultaneous inference in the past 60 years or so has been for the comparisons of several population means. Spurrier seems to have been the first to investigate multiple comparisons of several simple linear regression lines using simultaneous confidence bands. In this paper, we extend the work of Liu et al. for finite comparisons of several univariate linear regression models using simultaneous confidence bands to finite comparisons of several multivariate linear regression models using simultaneous confidence tubes. We show how simultaneous confidence tubes can be constructed to allow more informative inferences for the comparison of several multivariate linear regression models than the current approach of hypotheses testing. The methods are illustrated with examples.

PMID:34028832 | DOI:10.1002/bimj.202000148