Caregivers experience lower back pain due to patient transfer. Foot position is an important and adjustable posture for reducing lumbar loads during patient transfer. Specifically, a suitable foot position provides the use of the lower limbs instead of the lumbar region in patient handling. Thus, we have developed a monitoring and feedback system for foot positioning using wearable sensors to instruct suitable foot positions. However, existing measurement methods require multiple specific wearable sensors. In addition, the existing method has not been evaluated in patient transfer, including twisting and lowering. Thus, the objective of this study was to develop and evaluate a measurement method using only a smartphone-installed inertial sensor for foot position during patient transfer, including twisting and lowering. The smartphone attached to the trunk measures the acceleration, angular velocity, and geomagnetic field. The proposed method recognizes anteroposterior and mediolateral foot positions by machine learning using inertial data. The proposed method was tested using simulated patient transfer motions, including horizontal rotation. The results showed that the proposed method could recognize the two foot positions with more than 90% accuracy. These results indicate that the proposed method can be applied to wearable monitoring and feedback systems to prevent lower back pain caused by patient transfer. Full article

Cannabis sativa L. (hemp) is a herbaceous plant rich in cannabinoids with a long history of use in pain treatment. The most well-characterized cannabinoids, cannabidiol (CBD) and Δ9-tetrahydrocannabinol (Δ9-THC), garnered much attention in chemotherapy-induced peripheral neuropathy (CIPN) treatment. However, few studies have investigated the biological benefits and mechanism of hemp extract on CIPN. In the present study, hemp extract (JG) rich in cannabinoids was extracted by supercritical fluid carbon dioxide extraction (SFCE). The antinociceptive efficacy was evaluated using a paclitaxel-induced peripheral neuropathy (PIPN) rat model based on behavioral tests. Further omics-based approaches were applied to explore the potential mechanisms. The results showed that JG decreased mechanical allodynia, thermal hyperalgesia, and inflammatory cytokines in PIPN rats significantly. Transcriptome analysis identified seven key genes significantly regulated by JG in PIPN model rats, mainly related to the neuroactive ligand–receptor interaction pathway, PPAR signaling pathway, and cAMP signaling pathway. In metabolomic analysis, a total of 39 significantly altered metabolites were identified, mainly correlated with pentose and glucuronate interconversions and the glycerophospholipid metabolism pathway. Gut microbiota analysis suggested that increased community Lachnoclostridium and Lachnospiraceae_UCG-006 in PIPN rats can be reversed significantly by JG. In conclusion, hemp extract exhibited antinociceptive effects on PIPN. The analgesic mechanism was probably related to the regulation of inflammation, neuroactive ligand–receptor interaction pathway, sphingolipid metabolism, etc. This study provides novel insights into the functional interactions of Cannabis sativa L. extract on PIPN. Full article

This study employs a multidisciplinary methodology across natural and social sciences to examine relationships between biodiversity loss at sea and urban consumption with a focus on sea cucumber and dried seafood markets in New York City (NYC). The study identified 34 dried seafood retailers across three NYC Chinatown boroughs: Manhattan, Brooklyn, and Queens. Samples of sea cucumber were collected with Chinese-language labels indicating the commodity was from South America, a region of conservation concern. Comparison samples were taken from sea cucumbers labeled from Mexico and Japan. A mitochondrial DNA barcoding method was used to examine the taxonomic origin of 103 samples. Sequence data were successfully obtained from 74 of the samples, 8 of which were classified as brown sea cucumber (Isostichopus fuscus), an endangered species for which harvest is banned in several locations. Semi-structured interviews with dried seafood retailers and consumers (n = 64), moreover, revealed associations between consuming sea cucumber and enhancing human health and limited knowledge of product origins. Collectively, the findings reveal socio-ecological dynamics wherein endangered species on the market coupled with geographic market labeling practices and varying degrees of retailer and consumer knowledge negatively bear on marine biodiversity. Furthermore, given that brown sea cucumbers are abundant on the market, there is a need for developing genetic markers that can trace geographic origin to determine if species were legally harvested. These results indicate that more robust market labeling, training, genetic research, and public outreach are required to advance One Health in urban seafood markets. Full article

Additive manufacturing (AM) is an advanced manufacturing method that produces objects by sequential layering. Material extrusion AM (MEAM) with continuous-fibre reinforcement is becoming more widely used in naval structures, which are exposed to the marine environment. However, the water diffusion process and the effect of water ageing on the mechanical performance of AM materials are not yet well understood because of their complex internal structure, caused by defects generated during manufacturing. Current research on diffusion is mostly based on experimental methods for conventionally manufactured materials without considering AM-induced defects. The objective of this study is to explore how the defects inherent to MEAM affect water diffusion in a composite material by the capillary effect. Results from a numerical study of capillary flow in MEAM polymer are applied as a boundary condition in the subsequent finite-element analysis. The study illustrates that flow in the capillary reaches the steady state quicker compared to the saturation time in the matrix, predicted by Fick’s diffusion equation. It is demonstrated that the capillary effect can significantly affect the water diffusion in MEAM parts and reduce the saturation time to one-third compared to the case without accounting for this effect. Full article

The figure of the child is one that, at least in the Westernised imagination, is entangled with notions of innocence, naivety, and freedom. But what of the child who is unfree, who has been stripped of innocence, and for whom naivety is a danger? One expression of this iteration of the figure of the child is the child soldier, which has been a centralising figure in various narratives set during and concerned with African experiences of warfare. This paper is concerned with the figure of the child soldier as it is staged in both Edward Zwick’s Blood Diamond (2006) and Cary Joji Fukunaga’s filmic adaptation of Uzodinma Iweala’s novel, Beasts of No Nation (2015). In turning to Ashis Nandy’s articulation of the tension held within “the child” as being both emblematic of a fantasy of childhood produced by adult nostalgia—hopeful, joyous and free—and always potentially dangerous, this paper pivots the notions of soldiering and slaving on and around the child as a figure. In doing so, the paper asks what it might mean to think of the condition of being a child soldier as being akin to that of being a child slave, weaponised for political and economic ends. Full article

Impaired neuronal plasticity and cognitive decline are cardinal features of Alzheimer’s disease and related Tauopathies. Aberrantly modified Tau protein and neurotransmitter imbalance, predominantly involving acetylcholine, have been linked to these symptoms. In Drosophila, we have shown that dTau loss specifically enhances associative long-term olfactory memory, impairs foot shock habituation, and deregulates proteins involved in the regulation of neurotransmitter levels, particularly acetylcholine. Interestingly, upon choline treatment, the habituation and memory performance of mutants are restored to that of control flies. Based on these surprising results, we decided to use our well-established genetic model to understand how habituation deficits and memory performance correlate with different aspects of choline physiology as an essential component of the neurotransmitter acetylcholine, the lipid phosphatidylcholine, and the osmoregulator betaine. The results revealed that the two observed phenotypes are reversed by different choline metabolites, implying that they are governed by different underlying mechanisms. This work can contribute to a broader knowledge about the physiologic function of Tau, which may be translated into understanding the mechanisms of Tauopathies. Full article

Success in integrating artificial intelligence (AI) in anesthesia depends on collaboration with anesthesiologists, respecting their expertise, and understanding their opinions. The aim of this study was to illustrate the confidence in AI integration in perioperative anesthetic care among Jordanian anesthesiologists and anesthesia residents working at tertiary teaching hospitals. This cross-sectional study was conducted via self-administered online questionnaire and includes 118 responses from 44 anesthesiologists and 74 anesthesia residents. We used a five-point Likert scale to investigate the confidence in AI’s role in different aspects of the perioperative period. A significant difference was found between anesthesiologists and anesthesia residents in confidence in the role of AI in operating room logistics and management, with an average score of 3.6 ± 1.3 among residents compared to 2.9 ± 1.4 among specialists (p = 0.012). The role of AI in event prediction under anesthesia scored 3.5 ± 1.4 among residents compared to 2.9 ± 1.4 among specialists (p = 0.032) and the role of AI in decision-making in anesthetic complications 3.3 ± 1.4 among residents and 2.8 ± 1.4 among specialists (p = 0.034). Also, 65 (55.1%) were concerned that the integration of AI will lead to less human–human interaction, while 81 (68.6%) believed that AI-based technology will lead to more adherence to guidelines. In conclusion, AI has the potential to be a revolutionary tool in anesthesia, and hesitancy towards increased dependency on this technology is decreasing with newer generations of practitioners. Full article

Introduction: Metformin, a commonly used oral antihyperglycemic drug, poses a rare risk related to the development of metformin-associated lactic acidosis (MALA). The Extracorporeal Treatments in Poisoning (EXTRIP) group recommended intermittent haemodialysis (IHD) as a primary elimination therapy in case of severe metformin poisoning. However, in haemodynamically unstable patients, our previous observations suggested that continuous venovenous haemofiltration (CVVH) might be more effective. This retrospective cohort study aimed to contribute evidence on the use of IHD and CVVH in patients with severe MALA, particularly in haemodynamically unstable patients. Methods: Data from January 2015 to December 2020 were collected from the Leuven University Hospital. Two separate search methods, based on hospital activity records and laboratory criteria, were used to identify patients with MALA. Patients diagnosed with MALA, receiving extracorporeal treatment within 24 h of admission, were included. Patients were categorized into the IHD and CVVH groups. Patient characteristics, treatment details, and outcomes were analysed. Results: Among 358,148 patient records, 35 MALA cases were identified. IHD was chosen as the initial elimination technique in 13 cases, whereas 22 patients were first commenced on CVVH. Patients treated with CVVH were sicker, had more comorbidities and had higher ventilation and vasopressor requirements. CVVH group had longer vasopressor use, longer ICU stays, and higher in-hospital mortality. Discussion: CVVH rather than IHD seems to be the preferred elimination technique in the more critically ill patients with MALA. Due to its retrospective design, this study failed to identify the superior elimination technique in terms of efficacy. Poorer outcomes in the CVVH group are likely attributed to the severity of illness rather than the inferiority of the elimination therapy. We acknowledge the diagnostic challenges regarding MALA. Using metformin assays could be beneficial in managing these patients. Conclusions: This study suggests clinicians’ preference for CVVH in severe cases of MALA with haemodynamic instability. Full article

Background: The primary cause of medium- to long-term complications in reverse shoulder arthroplasty (RSA) is the failure of the glenoid component. The purpose of this study was to evaluate both the achievement of planning through computer-assisted navigation and the clinical outcomes at a minimum follow-up (FU) of 12 months. Methods: From December 2019 to December 2022, 57 Equinoxe RSAs with computer-assisted navigation were performed. The average age was 72.8 ± 6.6 years. Using the Orthoblue software, the version and inclination of the glenoid were evaluated from a preoperative CT scan, and planning was performed. Intraoperative navigation data were evaluated, and the clinical outcomes were assessed at a minimum follow-up of 12 months. Results: The average follow-up was 30.7 ± 13.5 months. The planning was reproduced in all implants. No errors in the computer-assisted navigation system were detected. No intraoperative or postoperative complications were recorded. At the final FU, the average active anterior elevation was 143° ± 36°, external rotation was 34° ± 5°, QuickDASH score was 19 ± 16 points, and constant score was 77 ± 18. Conclusions: Computer-assisted navigation is a reliable system for positioning prosthetic implants on challenging glenoids. A longer follow-up period is necessary to confirm the reduction in postoperative complications and the increase in survival compared to traditional RSA. Full article

Surveys of the Italian population typically assess general sexual behaviors (e.g., oral, vaginal and anal intercourse). However, little is known about other sexual behavior such as rough sexual behaviors, choking and slapping. Thus, an online cross-sectional survey of 4618 Italian participants was conducted. In the past month, the most prevalent sexual behaviors were solo masturbation (93.6%), partner masturbation (80.0%), oral sex (71.4% received, 75.9% performed), penile–vaginal intercourse (75.7%) and anal intercourse (12.5% received, 7.1% performed). Regarding rough sexual behaviors, the most common behaviors performed were spanking (23.3% received, 55.5% performed), choking (13.2% receive, 60.0% performed), slapping (30.1% received, 20.9% performed) and name calling (44.5% received, 37.0% performed). Our results suggest a gender difference where men and transgender/non-binary individuals perform more rough sexual behaviors compared to women. Moreover, regarding the role of consent in behaviors such as choking and slapping, our results highlight the importance of sexual and affective education to implement sexual assertiveness. In conclusion, this study adds knowledge to the limited literature on this topic, especially with respect to the Italian population. Full article

Introduction: Intraocular surgeries are conventionally contraindicated for patients with active retinoblastoma (Rb) due to the potential risk of tumor dissemination. However, surgery is occasionally necessary to preserve vision in patients with a single eye when the eye is complicated by rhegmatogenous retinal detachment (RRD). Objective: This study aims to evaluate the outcomes of surgical repair for RRD in pediatric patients with active Rb utilizing a non-drainage scleral buckling approach. Results: This cohort included six eyes from six patients who harbored active Rb and presented with RRD; one had a concurrent tractional component. All eyes (100%) had active intraocular Rb and were undergoing active therapy (systemic chemotherapy, cryotherapy, and thermal laser therapy) when RRD developed. RRD consistently manifested at the site of recent cryotherapy in all cases. RRD repair in the affected eyes was performed by scleral buckling without subretinal fluid drainage. Five of the six eyes (83%) achieved complete retinal reattachment. One eye (17%) with a tractional component exhibited partial reattachment and was eventually enucleated due to persistent active disease. At a median follow-up of 15 months (range 12–180 months) after scleral buckling, all five eyes had persistent retinal attachment, and no case developed orbital or distant metastasis. Conclusions: Our study demonstrates that nondrainage scleral buckling is an effective and safe method for the surgical repair of RRD in eyes harboring active Rb, as most cases achieved persistent complete retinal reattachment without the risk of tumor spread. Full article

Human papillomavirus (HPV), an oncogenic DNA virus, is the most common sexually transmitted virus and significant public health concern globally. Despite the substantial prevalence of HPV infection among men, routine testing remains elusive due to the lack of approved HPV tests and the complexity of detection methods. Various studies have explored the link between HPV and genitourinary cancers, revealing different associations influenced by geographic variation, histological subtype and methodological differences. These findings underscore the importance of further research to elucidate the role of HPV in male urogenital cancers. This comprehensive review delves into the intricate relationship between HPV and male genitourinary cancers, shedding light on the virus’s oncogenic mechanisms and its reported prevalence. A deeper understanding of HPV’s implications for male health is essential for advancing public health initiatives and reducing the burden of urogenital cancers worldwide. Full article

Eddy current inspection has been extensively employed in non-destructive testing of various conductive materials. The coil probe, as a mainstream sensor in the eddy current detection system, inevitably encounters interference from external signals while transmitting its own signal. Therefore, developing techniques to extract valuable signals from noisy ones is crucial for ensuring accurate detection. Carbon fiber composites not only possess significantly lower electrical conductivity compared to conventional metallic materials but also exhibit notable anisotropy. To address this issue, we designed an ‘8’ coil probe set where the excitation coil does not electromagnetically interfere with the detection coil. However, practical applications that require portability and miniaturization pose challenges when utilizing this coil probe set to identify carbon content or defects due to the typically weak output signal. To address this issue, this paper proposes a design that combines the ‘8’ structure of the planar coil probe with the principle of phase-locked amplification to create a dual-phase sensitive phase-locked amplification detection circuit. These specific design ideas were tested using a weak signal, which passed through the preamplifier, secondary amplifier, and band-pass filter comprising the target channel for signal amplification and noise filtering. The effective signal amplitude is proportional to the inverse phase difference between the direct current (DC) signal and inversely proportional to the amplitude of the signal. Finally, the DC signal was passed through an analog-to-digital converter (ADC). The analog-to-digital converter (A/D) is used to collect and calculate the DC signal, enabling the detection of weak electrical signals. Simulation experiments demonstrated that the signal detection circuit has an amplitude error below 0.2% and a phase error below 0.5%. The phase-locked amplification circuit designed in this paper can effectively extract the tiny impedance change signals of the planar coil sensor probe with high sensitivity and good robustness. Full article

The north region of Brazil is characterized by significant vulnerabilities, notably surpassing national poverty indicators. These disparities exacerbated the impact of respiratory illnesses on the healthcare system during the COVID-19 pandemic, particularly in areas with limited healthcare resources, inadequate infrastructure, and barriers to healthcare access. The crisis was further influenced by multiple lineages that emerged as significant virus variants associated with increased transmissibility. Within this context, our ecological study focused on analyzing the epidemiological evolution of COVID-19 in the state of Acre. We constructed time-series trends in incidence, lethality, and mortality from March 2020 to December 2022 using the Prais–Winsten regression model. Our findings revealed that in 2020, there was an increasing trend in incidence, while mortality and lethality continued to decrease (p < 0.05). In the following year, both incidence and mortality decreased, while lethality increased at a rate of 1.02% per day. By the end of 2022, trends remained stationary across all rates. These results underscore the importance of ongoing surveillance and adaptive public health measures to bolster the resilience of healthcare systems in remote and vulnerable regions. Indeed, continuous monitoring of the most predominant SARS-CoV-2 lineages and their dynamics is imperative. Such proactive actions are essential for addressing emerging challenges and ensuring effective responses to adverse situations. Full article

The early and accurate detection of Distributed Denial of Service (DDoS) attacks is a fundamental area of research to safeguard the integrity and functionality of organizations’ digital ecosystems. Despite the growing importance of neural networks in recent years, the use of classical techniques remains relevant due to their interpretability, speed, resource efficiency, and satisfactory performance. This article presents the results of a comparative analysis of six machine learning techniques, namely, Random Forest (RF), Decision Tree (DT), AdaBoost (ADA), Extreme Gradient Boosting (XGB), Multilayer Perceptron (MLP), and Dense Neural Network (DNN), for classifying DDoS attacks. The CICDDoS2019 dataset was used, which underwent data preprocessing to remove outliers, and 22 features were selected using the Pearson correlation coefficient. The RF classifier achieved the best accuracy rate (99.97%), outperforming other classifiers and even previously published neural network-based techniques. These findings underscore the feasibility and effectiveness of machine learning algorithms in the field of DDoS attack detection, reaffirming their relevance as a valuable tool in advanced cyber defense. Full article

To assess the correlation between vitamin D status and body composition variables in adult women of childbearing age, a cross-sectional study was conducted involving women aged 20–49 years. The participants were categorized based on their vitamin D status and further divided according to body mass index (BMI). Anthropometric and biochemical data were collected to compute body composition indices, specifically body fat and muscle mass. The sample included 124 women, with 63.70% exhibiting vitamin D inadequacy. Women with inadequate vitamin D status demonstrated a higher waist-to-height ratio (WHtR) and body adiposity index (BAI), along with a lower BMI-adjusted muscle mass index (SMI _BMI), compared to those with adequate levels of vitamin D (p = 0.021; p = 0.019; and p = 0.039, respectively). A positive correlation was observed between circulating concentrations of 25(OH)D and SMI _BMI, while a negative correlation existed between circulating concentrations of 25(OH)D and waist circumference (WC), WHtR, conicity index (CI), fat mass index (FMI), body fat percentage (% BF), and fat-to-muscle ratio (FMR). These findings suggest that inadequate vitamin D status may impact muscle tissue and contribute to higher body adiposity, including visceral adiposity. It is recommended that these variables be incorporated into clinical practice, with a particular emphasis on WHtR and SMI _BMI, to mitigate potential metabolic consequences associated with vitamin D inadequacy. Full article

The research used polyethersulfone (PES) as a membrane material, polyvinylpyrrolidone (PVP) k30 and polyethylene glycol 400 (PEG 400) as water-soluble additives, and dimethylacetamide (DMAc) as a solvent to prepare hollow-fiber ultrafiltration membranes through a nonsolvent-induced phase separation (NIPS) process. The hydrophilic nature of PVP-k30 and PEG caused them to accumulate on the membrane surface during phase separation. The morphology, chemical composition, surface charge, and pore size of the PES membranes were evaluated by SEM, FTIR, zeta potential, and dextran filtration experiments. The paper also investigated how different spinning solution compositions affected membrane morphology and performance. The separation efficiency of membranes with four different morphologies was tested in single-protein and double-protein mixed solutions. The protein separation effectiveness of the membrane was studied through molecular weight cutoff, zeta potential, and static protein adsorption tests. In addition, the operating pressure and pH value were adjusted to improve ultrafiltration process conditions. The PES membrane with an intact sponge-like structure showed the highest separation factor of 11, making it a prime candidate membrane for the separation of bovine serum albumin (BSA) and lysozyme (LYS). The membrane had a minimal static protein adsorption capacity of 48 mg/cm² and had excellent anti-fouling properties. When pH = 4, the BSA retention rate was 93% and the LYS retention rate was 23%. Furthermore, it exhibited excellent stability over a pH range of 1–13, confirming its suitability for protein separation applications. Full article

This review delves into the groundbreaking impact of induced pluripotent stem cells (iPSCs) and three-dimensional organoid models in propelling forward neuropathology research. With a focus on neurodegenerative diseases, neuromotor disorders, and related conditions, iPSCs provide a platform for personalized disease modeling, holding significant potential for regenerative therapy and drug discovery. The adaptability of iPSCs, along with associated methodologies, enables the generation of various types of neural cell differentiations and their integration into three-dimensional organoid models, effectively replicating complex tissue structures in vitro. Key advancements in organoid and iPSC generation protocols, alongside the careful selection of donor cell types, are emphasized as critical steps in harnessing these technologies to mitigate tumorigenic risks and other hurdles. Encouragingly, iPSCs show promising outcomes in regenerative therapies, as evidenced by their successful application in animal models. Full article

Mangrove ecosystems are crucial for biodiversity and coastal protection but face threats from climate change and human activities. This review assesses the productivity of the Matang Mangrove Forest Reserve (MMFR) in Malaysia, which is recognised as one of the best-managed mangrove forests, while also addressing challenges such as deforestation and climate change-induced factors. This review explores the concept of productivity in mangrove forests, highlighting their role in carbon sequestration and discussing litterfall measurements as fundamental metrics for assessing primary productivity. An analysis of historical changes in MMFR’s biomass and productivity revealed fluctuations influenced by logging, reforestation, and climatic conditions. Trends in MMFR productivity indicate a concerning decline attributed to anthropogenic activities such as aquaculture and industrial projects. A regression analysis conducted on Rhizophora apiculata data with age as the predictor and AGB as the response variable indicated a positive trend (slope = 3.61, R-squared = 0.686), suggesting a quantitative increase in AGB with age. Further analysis revealed a significant negative trend in MMFR’s overall productivity over years (coefficient = −3.974, p < 0.05) with a strong inverse relationship (rho = −0.818, p < 0.05), indicating declining AGB trends. Despite these challenges, this review underscores the significance of sustainable management practices, effective conservation efforts, and community engagement in maintaining mangrove ecosystem health and productivity. In conclusion, sharing management lessons from MMFR can contribute to global conservation and sustainable mangrove forest management efforts, fostering resilience in these vital ecosystems. Full article

Nowadays the phenomenon of hearing voices represents a very fertile and discussed field of research. In psychological and psychiatric fields, the phenomenon has been described as a normal phenomenon, but also as a prodromal stage and as a symptom of psychosis. Through a qualitative research methodology, the aim was to explore how family medicine physicians configure the phenomenon and its clinical and interactive implications. The present research involved 35 family medicine physicians as figures of primary importance in the approach toward people who start to hear voices. Semi-structured interviews have been used and they have been analyzed by the method of discourse analysis. The results show a remarkable difficulty in understanding the phenomenon in all its complexity and the tendency to consider it a symptom or a prodromal stage of psychopathology. Increasing the knowledge of doctors on the subject is necessary so that their evaluation and choice of intervention match the needs of each patient. We also discuss the importance of promoting the knowledge of the potential meanings taken on by the voices in the context of the personal and family background of the individual hearer, and of collaboration with other relevant professionals and services. Full article

Radical enactivism supports radical embodied cognition (REC), which is the idea that basic or fundamental cognition (perception and action) does not need to be understood in representational, contentful terms. REC departs from the idea that the mind can be naturalized through biological functions, but rejects the idea that mental content, which is understood as having a representational nature, can be naturalized. For REC, the natural origins of content (or NOC) is a program based on the following hypothesis: first, we depart from basic cognitive processes that are target-based and guided by an Ur-intentionality or directedness toward the world, and then sociality enters in the picture when language appears into the scene, allowing for establishing full-blown semantic content in which that content is about worldly states of affairs. Here, I am going to focus on the phenomenon of directedness since there are blind spots in this picture: as many authors claim, REC takes Ur-intentionality as the starting point, but there is simply no explanation to date of how this directedness or Ur-intentionality is established. Therefore, how could we account for Ur-intentionality? How does this kind of intentionality emerge? We believe that we can answer this question if we invoke the best scientific evidence from ecological perceptual learning especially in regard to the role of the environment and the information for perceiving affordances in our learning processes. This allows us to offer an answer to the question of how the most basic form of cognition (Ur-intentionality or directedness) emerges in nature. Full article

The differential diagnosis of solid pancreatic lesions (SPLs) using B-mode endoscopic ultrasonography (EUS) is challenging. Detective flow imaging (DFI) offers the potential for detecting low-flow vessels in the pancreas, thus enhancing diagnostic accuracy. This retrospective study aimed to investigate DFI-EUS findings of SPLs and analyze their differential diagnostic accuracy for pancreatic cancer. We included 104 patients with pathologically confirmed SPLs who underwent EUS between April 2021 and June 2023. Expert endosonographers, blinded to the patients’ clinical data, evaluated images obtained through B-mode, eFLOW, and DFI-EUS. The frame rate and vessel detection sensitivity were compared between eFLOW and DFI, and the diagnostic criteria for pancreatic cancer were established. The visualization rate for vessels in SPLs was significantly higher with DFI-EUS (96%) compared to eFLOW (27%). Additionally, DFI showed a superior frame rate, sensitivity (99%), and accuracy (88%) for detecting pancreatic cancer, although with a modest specificity (43%). On DFI-EUS, characteristics such as hypovascularity, peritumoral vessel distribution, or spotty vessel form were suggestive of pancreatic cancer. DFI-EUS significantly improved the visualization of vascular structures within the SPLs, highlighting its efficacy as a diagnostic modality for pancreatic cancer. Full article