Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved

PURPOSE

Management of massive rotator cuff tears (MRCTs) remains debated, and various arthroscopic and open techniques have been described for their management. Nevertheless, the optimal strategy remains unclear. The present study evaluated the clinical results in patients managed arthroscopically for MRCTs augmented with the long head biceps tendon (LHBT) at a minimum 1-year follow-up, considering different type of tears, demographic data and number of torn tendons.

METHODS

Patients treated in a secondary referral centre from January 2021 to April 2022 were enroled prospectively. Inclusion criteria were pain, inability to fully elevate the affected shoulder, irreparable tears and active and motivated patients. All patients were managed within 2 months from diagnosis in a single centre by the same surgeons. Preoperative shoulder radiographs and magnetic resonance imaging (MRI) were collected, and clinical assessment was also performed using the Numerical analogue scale (NAS), Constant score (CS) American Shoulder and Elbow Surgeons Shoulder Score (ASES). Tissue retraction and tendon fatty infiltration were evaluated using Patte and Fuchs scale, respectively. Clinical assessment was performed using the same scales at 3-6 months and 1-year follow-up.

RESULTS

A total of 55 patients (31 female and 24 male) with a mean age of 60 ± 7.1 years were enroled for a mean follow-up of 18.2 ± 4.3 months. The mean preoperative NAS was 7.8 ± 0.6, CS was 20.5 ± 7.6 and ASES was 22.6 ± 9.2, increasing, respectively, to 0.3 ± 0.6, 91.5 ± 6.9 and 94.2 ± 6.7. No adverse side effects (infection, rejection, allergy) were reported during the study period. All patients were evaluated after surgery at 3 and 6 months and 1 year with statistically significant improvement for each score at the first and last follow-up (p < 0.05).

CONCLUSIONS

The use of LHBT augmentation in patients with MRCTs in appropriately selected patients is safe and effective and can lead to pain relief and acceptable clinical outcomes. Furthermore, its use carries low donor site morbidity and is cost effective. Comparative studies, including randomised controlled trials, with other proposed techniques are needed to confirm these findings.

LEVEL OF EVIDENCE

Level IV.

Emotion coaching skills as an augmentation to family-based therapy for adolescents with anorexia nervosa: A pilot effectiveness study with families with high expressed emotion

OBJECTIVE

To examine the feasibility and acceptability of augmenting family-based treatment (FBT) for adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) with a parent emotion coaching intervention (EC) focused on reducing parent expressed emotion.

METHOD

In this pilot effectiveness trial, families of adolescents with AN/AAN exhibiting high expressed emotion received standard FBT with either (1) EC group or (2) support group (an attention control condition focused on psychoeducation).

RESULTS

Forty-one adolescents with AN or AAN were recruited (88% female, Mage  = 14.9 ± 1.6 years, 95% White: Non-Hispanic, 1% White: Hispanic, 1% Bi-racial: Asian). Most study adolescents were diagnosed with AN (59%) while 41% were diagnosed with AAN. Participating parents were predominantly mothers (95%). Recruitment and retention rates were moderately high (76% and 71%, respectively). High acceptability and feasibility ratings were obtained from parents and interventionists with 100% reporting the EC intervention was "beneficial"-"very beneficial." The FBT + EC group demonstrated higher parental warmth scores at post-treatment compared to the control group (standardized effect size difference, d = 1.58), which was maintained at 3-month follow-up. Finally, at post-treatment, the FBT + EC group demonstrated higher rates of full remission from AN/AAN (40%) compared to FBT + support (27%), and were nine times more likely to be weight restored by 3-month follow-up.

DISCUSSION

Augmenting FBT with emotion coaching for parents with high expressed emotion is acceptable, feasible, and demonstrates preliminary effectiveness.

PUBLIC SIGNIFICANCE

Family based treatment for AN/AAN is the recommended treatment for youth but families with high criticism/low warmth are less likely to respond to this treatment. Adding a parent emotion coaching group (EC) where parents learn to talk to their adolescents about tough emotions is feasible and well-liked by families.

The physiology and pharmacology of oxytocin in labor and in the peripartum period

Oxytocin is a reproductive hormone implicated in the process of parturition and widely used during labor. Oxytocin is produced within the supraoptic nucleus and paraventricular nucleus of the hypothalamus and released from the posterior pituitary lobe into the circulation. Oxytocin is released in pulses with increasing frequency and amplitude in the first and second stages of labor, with a few pulses released in the third stage of labor. During labor, the fetus exerts pressure on the cervix of the uterus, which activates a feedforward reflex-the Ferguson reflex-which releases oxytocin. When myometrial contractions activate sympathetic nerves, it decreases oxytocin release. When oxytocin binds to specific myometrial oxytocin receptors, it induces myometrial contractions. High levels of circulating estrogen at term make the receptors more sensitive. In addition, oxytocin stimulates prostaglandin synthesis and release in the decidua and chorioamniotic membranes by activating a specific type of oxytocin receptor. Prostaglandins contribute to cervical ripening and uterine contractility in labor. The oxytocin system in the brain has been implicated in decreasing maternal levels of fear, pain, and stress, and oxytocin release and function during labor are stimulated by a social support. Moreover, studies suggest, but have not yet proven, that labor may be associated with long-term, behavioral and physiological adaptations in the mother and infant, possibly involving epigenetic modulation of oxytocin production and release and the oxytocin receptor. In addition, infusions of synthetic oxytocin are used to induce and augment labor. Oxytocin may be administered according to different dose regimens at increasing rates from 1 to 3 mIU/min to a maximal rate of 36 mIU/min at 15- to 40-minute intervals. The total amount of synthetic oxytocin given during labor can be 5 to 10 IU, but lower and higher amounts of oxytocin may also be given. High-dose infusions of oxytocin may shorten the duration of labor by up to 2 hours compared with no infusion of oxytocin; however, it does not lower the frequency of cesarean delivery. When synthetic oxytocin is administered, the plasma concentration of oxytocin increases in a dose-dependent way: at infusion rates of 20 to 30 mIU/min, plasma oxytocin concentration increases approximately 2- to 3-fold above the basal level. Synthetic oxytocin administered at recommended dose levels is not likely to cross the placenta or maternal blood-brain barrier. Synthetic oxytocin should be administered with caution as high levels may induce tachystole and uterine overstimulation, with potentially negative consequences for the fetus and possibly the mother. Of note, 5 to 10 IU of synthetic oxytocin is often routinely given as an intravenous or intramuscular bolus administration after delivery to induce uterine contractility, which, in turn, induces uterine separation of the placenta and prevents postpartum hemorrhage. Furthermore, it promotes the expulsion of the placenta.

Oxytocin: physiology, pharmacology, and clinical application for labor management

Oxytocin is a peptide hormone that plays a key role in regulating the female reproductive system, including during labor and lactation. It is produced primarily in the hypothalamus and secreted by the posterior pituitary gland. Oxytocin can also be administered as a medication to initiate or augment uterine contractions. To study the effectiveness and safety of oxytocin, previous studies have randomized patients to low- and high-dose oxytocin infusion protocols either alone or as part of an active management of labor strategy along with other interventions. These randomized trials demonstrated that active management of labor and high-dose oxytocin regimens can shorten the length of labor and reduce the incidence of clinical chorioamnionitis. The safety of high-dose oxytocin regimens is also supported by no associated differences in fetal heart rate abnormalities, postpartum hemorrhage, low Apgar scores, neonatal intensive care unit admissions, and umbilical artery acidemia. Most studies reported no differences in the cesarean delivery rates with active management of labor or high-dose oxytocin regimens, thereby further validating its safety. Oxytocin does not have a predictable dose response, thus the pharmacologic effects and the amplitude and frequency of uterine contractions are used as physiological parameters for oxytocin infusion titration to achieve adequate contractions at appropriate intervals. Used in error, oxytocin can cause patient harm, highlighting the importance of precise administration using infusion pumps, institutional safety checklists, and trained nursing staff to closely monitor uterine activity and fetal heart rate changes. In this review, we summarize the physiology, pharmacology, infusion regimens, and associated risks of oxytocin.

The use of antipsychotics in obsessive compulsive disorder

Obsessive-compulsive disorder (OCD) is a chronic disease with a prevalence in the general population of around 2%-3%, generally accompanied by a severe impairment of functioning and quality of life. A consistent subgroup of patients may not achieve adequate symptom remission with first-line treatments (i.e., cognitive behavioral therapy, selective serotonin reuptake inhibitors [SSRIs]). The most validated option for treatment-resistant cases relies on the augmentative use of antipsychotics to SSRIs, preferably of the 'second generation'. Indeed, dopamine appears to be crucially involved in OCD neuropathology due to its implication in systems relating to goal-directed behaviour and maladaptive habits. Nevertheless, the mechanism of action of antipsychotics in OCD symptom improvement is still unclear. Risperidone, aripiprazole, and haloperidol seem to be the most useful medications, whereas 'first generation' antipsychotics may be indicated in case of comorbidity with tics and/or Tourette Syndrome. Antipsychotic augmentation may be also related to side-effects, particularly in the long term (e.g., alteration in metabolic profile, sedation, extrapyramidal symptoms). The present mini-review sought to provide the most updated evidence on augmentative antipsychotic use in treatment-resistant patients with OCD, providing a road map for clinicians in daily practice and shedding light on avenues for further research.

A Comparative Study of Preprocessing and Model Compression Techniques in Deep Learning for Forest Sound Classification

Deep-learning models play a significant role in modern software solutions, with the capabilities of handling complex tasks, improving accuracy, automating processes, and adapting to diverse domains, eventually contributing to advancements in various industries. This study provides a comparative study on deep-learning techniques that can also be deployed on resource-constrained edge devices. As a novel contribution, we analyze the performance of seven Convolutional Neural Network models in the context of data augmentation, feature extraction, and model compression using acoustic data. The results show that the best performers can achieve an optimal trade-off between model accuracy and size when compressed with weight and filter pruning followed by 8-bit quantization. In adherence to the study workflow utilizing the forest sound dataset, MobileNet-v3-small and ACDNet achieved accuracies of 87.95% and 85.64%, respectively, while maintaining compact sizes of 243 KB and 484 KB, respectively. Henceforth, this study concludes that CNNs can be optimized and compressed to be deployed in resource-constrained edge devices for classifying forest environment sounds.

Is antipsychotic augmentation associated with improved functioning in patients on clozapine?

OBJECTIVE

We aimed at exploring the relationship between functional outcomes in patients on clozapine augmented with antipsychotics in treatment-resistant schizophrenia using standard outcome measures Health of Nation Outcome Scales (HoNOS) and Life Skills Profile (LSP-16).

METHOD

In a cross-sectional study of 83 patients on clozapine treated in a psychiatric rehabilitation hospital, the association between the primary outcome measure, LSP-16 including its subscales, and treatment with antipsychotic augmentation (AA) were analysed using linear regression.

RESULT

The presence of moderate-to-severe positive symptoms on the HoNOS 6 dichotomised item measure was the only statistically significant predictor of functional impairment as determined by total LSP-16 score.The group of patients with ongoing positive symptoms (partial responders) were characterised by higher total LSP-16 scores, higher numbers of AA agents, and higher chlorpromazine equivalence. There was an inverse linear relationship between chlorpromazine equivalence of AA and total score of LSP-16 scale in the group of partial responders.

CONCLUSION

Augmentation with other antipsychotic agents was associated with higher functioning in a cross-sectional study of patients with schizophrenia with poor response of positive symptoms to clozapine. This might be an important clinical factor to consider when prescribing antipsychotics to patients with clozapine-resistant schizophrenia.

Biomechanical Characteristics of Ulnar Collateral Ligament Injuries Treated With and Without Augmentation: A Network Meta-analysis of Controlled Laboratory Studies

BACKGROUND

Treatment of ulnar collateral ligament (UCL) tears with suture tape augmentation has gained interest given preliminary reports of favorable biomechanical characteristics. No study to date has quantitatively assessed the biomechanical effects of multiple augmentation techniques relative to the native UCL.

PURPOSE

To perform a systematic review and meta-analysis of controlled laboratory studies to assess and comparatively rank biomechanical effects of UCL repair or reconstruction with or without augmentation.

STUDY DESIGN

Systematic review and meta-analysis; Level of evidence, 4.

METHODS

PubMed, OVID/Medline, and Cochrane databases were queried in January 2023. A frequentist network meta-analytic approach was used to perform mixed-treatment comparisons of UCL repair and reconstruction techniques with and without augmentation, with the native UCL as the reference condition. Pooled treatment estimates were quantified under the random-effects assumption. Competing treatments were ranked in the network meta-analysis by using point estimates and standard errors to calculate P scores (greater P score indicates superiority of treatment for given outcome).

RESULTS

Ten studies involving 206 elbow specimens in which a distal UCL tear was simulated were included. UCL reconstruction with suture tape augmentation (AugRecon) restored load to failure to a statistically noninferior magnitude (mean difference [MD], -1.99 N·m; 95% CI, -10.2 to 6.2 N·m; P = .63) compared with the native UCL. UCL reconstruction (Recon) (MD, -12.7 N·m; P < .001) and UCL repair with suture tape augmentation (AugRepair) (MD, -14.8 N·m; P < .001) were both statistically inferior to the native UCL. The AugRecon condition conferred greater load to failure compared with Recon (P < .001) and AugRepair (P = .002) conditions. AugRecon conferred greater torsional stiffness relative to all other conditions and was not statistically different from the native UCL (MD, 0.32 N·m/deg; 95% CI, -0.30 to 0.95 N·m/deg; P = .31). Medial ulnohumeral gapping was not statistically different for the AugRepair (MD, 0.30 mm; 95% CI, -1.22 to 1.82 mm; P = .70), AugRecon (MD, 0.57 mm; 95% CI, -0.70 to 1.84 mm; P = .38), or Recon (MD, 1.02 mm; 95% CI, -0.02 to 2.05 mm; P = .055) conditions compared with the native UCL. P-score analysis indicated that AugRecon was the most effective treatment for increasing ultimate load to failure and torsional stiffness, whereas AugRepair was the most effective for minimizing medial gapping.

CONCLUSION

AugRecon restored load to failure and torsional stiffness most similar to the parameters of the native UCL, whereas Recon and AugRepair did not restore the same advantageous properties at time zero. Medial ulnohumeral gapping during a valgus load was minimized by all 3 treatments. Based on network interactions, AugRecon was the superior treatment approach for restoring important biomechanical features of the UCL at time zero that are jeopardized during a complete distal tear.

Antipsychotics in child and adolescent patients with major depressive disorder: A retrospective analysis of prescribing patterns

Introduction

Depression rates in children/adolescents in the United States have increased in the last 10 years. Fluoxetine and escitalopram are the only 2 antidepressants approved for the treatment of major depression disorder (MDD) in children/adolescents. In adults, some antipsychotics are approved for augmented treatment of MDD. However, there is limited research on antipsychotic augmentation in child/adolescent MDD.

Methods

This retrospective chart review evaluated antipsychotic prescribing for MDD in hospitalized patients aged 4 to 17 years to determine the frequency of prescribing antipsychotics for MDD and what factors influence the addition of an antipsychotic. For inclusion, patients were diagnosed with MDD and not on an antidepressant or antipsychotic before admission. Binomial logistic regression was used to analyze variables with prescribed antipsychotics as the dependent variable.

Results

There were 6.8% of patients prescribed an antipsychotic. Binomial logistic regression analysis found that increased age (odds ratio [OR] 1.28; 95% CI = 1.045, 1.568; P = .017) and multiple admissions within 1 year (OR 3.277; 95% CI = 2.283, 4.705; P < .001) were associated with the use of antipsychotics in patients with MDD. Posttraumatic stress disorder and disruptive mood dysregulation disorder were also associated with the use of antipsychotics.

Discussion

Careful consideration should be taken when using off-label antipsychotics in children due to limited studies on efficacy. Future research is warranted to assess the efficacy and safety of these agents in children and adolescents.

Ulnar Collateral Ligament Repair With Suture Tape Augmentation: Can You Overtighten?

BACKGROUND

There has been a renewed interest and, recently, wider implementation of ulnar collateral ligament (UCL) repair in throwing athletes because of improvement in ligament repair technology and corresponding outcome data.

PURPOSE

To compare the biomechanical parameters and failure mode between 2 brace-tightening techniques for UCL repair.

STUDY DESIGN

Controlled laboratory study.

METHODS

Eleven matched pairs of cadaveric arms were procured. One limb from each pair underwent UCL repair with suture tape augmentation with either (1) attempted restoration of physiologic ligament tension or (2) maximal tension. Each specimen was subjected to 10 cycles of subfailure valgus torque at 90º of flexion in the intact state after UCL avulsion and then after UCL repair. Specimens were then torqued to failure. Articular contact mechanics, linear gap distance, angular displacement, failure torque, failure stiffness, and suture tape pull-through length were recorded. Two-way analysis of variance and paired t tests were used to test for statistical differences.

RESULTS

There was a significant effect (P = .01) of tightening on joint contact area. There was a significant decrease in gap distance (P = .03) and angular displacement (P = .004) from the torn condition to the repaired condition for the maximum tension group, without a significant difference in gap distance from the intact condition. Failure torque and stiffness were not significantly different between groups, although there was a significant difference (P = .001) in the overall suture tape pull-through length.

CONCLUSION

Although there are potential physiologic changes at time zero-including significant decreases in contact area, normalized gap distance, and normalized angular displacement with maximal tension repair-examination of failure biomechanics suggests that these effects may be mitigated over time within the construct by suture tape pull-through at the tape-anchor interface. Neither method of UCL repair with suture tape augmentation resulted in overconstraint of the elbow joint compared with the native ligament biomechanics.

CLINICAL RELEVANCE

As more long-term outcome data from UCL repair with suture tape augmentation emerge, there will be wider implementation with various techniques to tension the suture tape. Examining the potential biomechanical sequelae of the UCL repair construct applied under maximal tension will help further refine recommendations for surgeons who utilize this technique for UCL repair.

Percutaneous short segmental fixation combined with bone cement augmentation for stage III Kümmell's disease without nerve deformity

The objective of this study was to evaluate the safety and efficacy of percutaneous pedicle screw fixation combined with bone cement augmentation in the management of stage III Kümmell disease without nerve deformity. A retrospective analysis was conducted on 17 patients diagnosed with stage III Kümmell disease without nerve deformity, who underwent treatment with percutaneous pedicle screw fixation combined with bone cement augmentation between April 2019 and 2022. Preoperative, postoperative, and final follow-up clinical outcome measures were collected, including Visual Analog Scale scores and Oswestry Disability Index scores. Additionally, lateral radiography was used to measure the Cobb angle and height of the anterior border of the affected vertebral body. Operative time, volume of injected bone cement, intraoperative cement leakage, and other complications were recorded. All patients underwent successful surgery, resulting in significant reductions in Visual Analog Scale scores, Oswestry Disability Index scores, and Cobb angle postoperatively; meanwhile there was a significant increase in height of the anterior border of the affected vertebral body. No major complications occurred during the follow-up period. In conclusion, percutaneous pedicle screw short-segment fixation combined with bone cement augmentation appears to be an effective surgical option for treating stage III Kümmell disease without nerve deformities.

Comparison of Clinical Outcomes Between Modern Augmented ACL Repair and Autograft ACL Reconstruction: A Systematic Review and Meta-analysis of Studies With Minimum 2-Year Follow-up

Background

Anterior cruciate ligament (ACL) reconstruction has been the gold standard for primary ACL rupture since the 1990s. In the past decade, ACL repair has received renewed attention and increased research.

Purpose

To compare the clinical outcomes of modern augmented ACL repair versus autograft reconstruction for ACL ruptures.

Study Design

Systematic review; Level of evidence, 3.

Methods

A search of the PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library databases was conducted for prospective or retrospective comparative studies published between January 1, 2010, and January 3, 2023, with a minimum 2-year follow-up. Two independent reviewers performed data extraction and methodological quality assessment. Sensitivity analysis was performed to maintain the stability of results.

Results

Nine studies were included (minimum follow-up period, 24-60 months). The total sample size was 833 patients (augmented repair group: 358 patients; autograft ACL reconstruction group: 475 patients). There were 4 randomized controlled trials (level 1), 1 prospective comparative study (level 2), 2 retrospective comparative studies (level 3), and 2 case-control studies (level 3). The augmented ACL repair group attained significantly higher Lysholm score (weighted mean difference [WMD] = 1.57; 95% confidence interval [CI], 0.14-3.01; P = .03) and hamstring strength (WMD = 36.69; 95% CI, 29.07-44.31; P < .01) but had higher rates of hardware removal (odds ratio [OR] = 6.30; 95% CI, 2.44-16.23; P = .0001), reoperation (OR = 1.87; 95% CI, 1.33-2.62; P = .0003), and failure (OR = 1.58; 95% CI, 1.03-2.43; P = .0003) compared with the autograft ACL reconstruction group. No significant differences were observed between the repair and reconstruction groups regarding postoperative International Knee Documentation Committee scores, Tegner scores, knee laxity, satisfaction, ACL revisions, complications, and reoperation rather than revision.

Conclusion

Augmented ACL repair was associated with higher rates of reoperation, hardware removal, and failure compared with autograft ACL reconstruction in studies with minimum 2-year follow-up data. However, augmented ACL repair had higher Lysholm scores and hamstring strength versus autograft ACL reconstruction.

Technical note: acetabular augmentation with customisable cementless all-polyethylene insert

Acetabular augmentation is a challenge for complex primary and revision hip surgery. Several methods exist to recreate a supportive, hemispherical acetabulum where a defect exists, however, these can be complex, expensive, time consuming, and limited by available size and shape. We present a simple, inexpensive, quick and customisable method of acetabular augmentation using cementless polyethylene with titanium coating. The first case is presented with follow-up up to 8 years.

Technique and Outcomes of Posterior Cruciate Ligament Repair With Augmentation

Background

Posterior cruciate ligament (PCL) injuries to the knee are uncommon, and ideal surgical management of these injuries is unclear. Current surgical techniques include PCL reconstruction with remnant debridement, remnant-preserving techniques, and primary PCL repair. Augmentation of PCL repairs and reconstructions has been proposed to protect repairs or grafts in the postoperative period.

Purpose

To describe PCL repair with the hamstring autograft augmentation technique and examine our preliminary midterm outcomes from a sequential cohort of patients.

Study Design

Case series; Level of evidence, 4.

Methods

The authors identified patients at their institution who underwent remnant-preserving primary PCL repair with hamstring autograft augmentation for both isolated tears and tears associated with multiligament knee injury (MLKI). Patient-reported outcomes were evaluated at a minimum 2-year follow-up using the International Knee Documentation Committee (IKDC) subjective knee form, the 12-item Short Form Survey, and a custom return-to-play questionnaire. Patient-reported outcomes data were summarized, and the predictors of outcomes from the descriptive data and clinical measures were further examined.

Results

A total of 23 patients with a mean follow-up of 5.3 years met the inclusion criteria. Of these patients, 87% were associated with MLKI. The mean IKDC score was 87.7. Approximately 83% of patients were able to successfully return to their sport or occupation. Among 19 athletes, only 2 reported being unable to return to their preinjury level of sport because of limitations from their PCL surgery. Patient-reported outcome scores and return to sport or occupation did not have a statistically significant association with age, sex, body mass index, time from injury to surgery, or follow-up time.

Conclusion

Outcomes of our cohort with remnant-preserving primary PCL repairs with hamstring autograft augmentation demonstrated comparable clinical outcomes to previously published PCL data. The advantages of remnant preservation, primary repair, and augmentation with an independent hamstring autograft reconstruction are combined within this technique.

Effect of severity of depression on augmentation of antidepressant medication in young adults with depression

BACKGROUND

Antipsychotics (AP) have been used to augment antidepressant (AD) medication in treatment-resistant depression. In this study we examined factors (including severity of depression and initial antidepressant) affecting AP augmentation, as well as which APs were initiated as augmentation in young adults.

METHODS

Data were extracted from Finnish nationwide registers. Of persons aged 18-29 years diagnosed with a depression during 2004-2017 we focused on incident AD users (who initiated AD 6 months before and after the diagnosis) whose severity level of depression was recorded (N = 21,966). AP augmentation was studied during 1 year after diagnosis of depression. Persons diagnosed with severe depression with psychotic features (n = 1486) were excluded from main analyses and analyzed separately.

RESULTS

Overall, 8.4% of new antidepressant users initiated AP augmentation. Risk of augmentation increased with severity of depression as 3.9%, 5.8%, and 14.0% of persons with mild, moderate, and severe depression, respectively, initiated augmentation. Male sex, comorbid anxiety and personality disorders, substance abuse and selfharm/suicide attempt were positively associated with augmentation. Compared to citalopram, use of tricyclic antidepressant, paroxetine and venlafaxine were associated with increased risk of augmentation, while use of bupropion was associated with a decreased risk. Quetiapine and risperidone were the most common APs used in augmentation. Among persons with severe depression with psychotic features, use of sertraline was associated with AP augmentation, whereas use of fluoxetine decreased risk of augmentation.

CONCLUSIONS

Use of APs as augmentation of AD therapy was common in severe depression. Comorbidities had only a small effect to augmentation, but selection of initial AD was more closely associated to risk of augmentation. Interestingly, use of bupropion decreased risk of augmentation, which warrants further studies, as well as the decrease in risk of augmentation when fluoxetine in case of psychotic depression was used.

A Rare Cause of Breast Swelling in Lactating Women: Aquafilling® Gel Injection

Aquafilling® gel has been used in recent years as an alternative method to breast augmentation surgery. In this case report, we aimed to discuss radiological imaging findings and complications of Aquafilling® gel injection. Case: A 34-year-old lactating female patient presented with swelling and pain in the left breast. Ultrasonography showed massive septate fluid collections with dense content in both breasts and between the pectoral muscle fibers. On mammography, both breasts appeared dense with large mass opacities. On magnetic resonance imaging, extensive fluid-signal cystic areas were observed. Peripheral enhancement around the fluid in the left breast was present in the contrast-enhanced series. We learned from her anamnesis that Aquafilling® was applied to both breasts 5 years ago. Ultrasonography-guided sampling was performed from the cystic areas in the left breast and cytological examination revealed basophilic Aquafilling® material surrounded by diffuse inflammatory infiltrates. Breast augmentation history should be questioned in suspicious cases because Aquafilling® gel injection and its complications can present with a wide variety of symptoms and may mimic various other conditions on radiological imaging, such as cancer, abscess, granulomatous mastitis, and parasite infections.

Optimizing treatment allocation in randomized clinical trials by leveraging baseline covariates

We consider the problem of optimizing treatment allocation for statistical efficiency in randomized clinical trials. Optimal allocation has been studied previously for simple treatment effect estimators such as the sample mean difference, which are not fully efficient in the presence of baseline covariates. More efficient estimators can be obtained by incorporating covariate information, and modern machine learning methods make it increasingly feasible to approach full efficiency. Accordingly, we derive the optimal allocation ratio by maximizing the design efficiency of a randomized trial, assuming that an efficient estimator will be used for analysis. We then expand the scope of optimization by considering covariate-dependent randomization (CDR), which has some flavor of an observational study but provides the same level of scientific rigor as a standard randomized trial. We describe treatment effect estimators that are consistent, asymptotically normal, and (nearly) efficient under CDR, and derive the optimal propensity score by maximizing the design efficiency of a CDR trial (under the assumption that an efficient estimator will be used for analysis). Our optimality results translate into optimal designs that improve upon standard practice. Real-world examples and simulation results demonstrate that the proposed designs can produce substantial efficiency improvements in realistic settings.

Outcomes of Anterior Cruciate Ligament Reconstruction With Independently Tensioned Suture Tape Augmentation at 5-Year Follow-up

BACKGROUND

Reconstruction using autograft remains the gold standard surgical treatment for anterior cruciate ligament (ACL) injuries. However, up to 10% to 15% of patients will suffer a graft failure in the future. Cadaveric studies have demonstrated that the addition of suture tape augmentation to ACL autograft constructs can increase graft strength and reduce elongation under cyclical loading.

PURPOSE/HYPOTHESIS

This study aimed to investigate the clinical outcomes and rerupture rates after ACL reconstruction (ACLR) with suture tape augmentation. We hypothesized that augmentation with suture tape would lead to lower rerupture rates.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Patients undergoing primary ACLR using hamstring or patellar tendon autografts augmented with suture tape between 2015 and 2019 were recruited prospectively. Patients with multiligament injuries or a concomitant lateral extra-articular procedure were excluded. Patients were observed in person for 6 months, and patient-reported outcome measures (PROMs) were collected at 2 and 5 years postoperatively. All patients were contacted, and records were reviewed to determine the incidence of graft failure. PROMs collected were as follows: Knee injury and Osteoarthritis Outcome Score (KOOS), Veterans RAND 12-Item Health Survey (VR-12), Tegner and Marx activity scores, and visual analog scale for pain (VAS).

RESULTS

A total of 97 patients, with a mean age of 34.7 (±13.4) years, were included (76% men; 52 hamstring and 45 patellar tendon grafts). The mean graft diameter was 8 (±1) mm. There was 1 rerupture (1.1%) out of the 90 patients who were contactable at a mean of 5 years postoperatively. Median KOOS scores at 2 years were as follows: Pain, 94; Symptoms, 86; Activities of Daily Living, 99; Sport and Recreation, 82; and Quality of Life, 81. The postoperative scores were significantly higher than the preoperative scores (P < .001). The VR-12 Physical score improved from 43 preoperatively to 55 at 2 years and remained at 56 at 5 years. The VAS pain, Tegner, and Marx scores were 0, 6, and 9, respectively, at 2 years postoperatively. There was no difference in PROMs between graft types.

CONCLUSION

This study demonstrates encouraging results of suture tape augmentation of autograft ACLR for both hamstring and patellar tendon grafts. The failure rate of 1.1% at a mean follow-up of 5 years is lower than published rates for reconstruction, and PROMs results are satisfactory. The technique is safe to use and may permit a return to the preinjury sporting level with a lower chance of reinjury.

Clozapine augmentation with long-acting antipsychotic injections: A case series and systematic review

BACKGROUND

Up to 30% of patients with a diagnosis of treatment-resistant psychosis remain symptomatic despite an optimal trial with the gold standard treatment, clozapine. Emerging evidence suggests the clinical utility of long-acting injections (LAI) in such clinical scenarios. In this study, we aimed to describe clozapine augmentation with LAIs in an inner London hospital and explore the literature on the clinical effectiveness of this treatment modality.

METHODS

Patients prescribed clozapine, who were commenced on a LAI between 2007 and 2023 by the United Kingdom's largest mental health trust, were identified from electronic patient records. First, routine clinical data were used to describe the use, effectiveness, and safety of this augmentation strategy. Second, we conducted a literature search up to 1st June 2023 to identify published studies describing clinical outcomes after clozapine augmentation with a LAI. Clinical outcomes were collated and presented in a table, including hospitalisation rates and quantitative clinical assessments using validated scales.

RESULTS

Of the 1248 patients prescribed clozapine in SLaM, three patients (0.2%) received augmentation with the following LAIs: olanzapine embonate, paliperidone palmitate and pipotiazine palmitate. This treatment strategy was clinically effective and generally well tolerated in all three cases. Twelve published studies between 2010 and 2022 were included in the review. Eight distinct LAIs were reported (4 first and 4 second generation antipsychotics), with risperidone and paliperidone most widely studied. All the identified studies were observational including mirror-image studies, case series and case reports. Duration of follow up varied from 3 months to 3 years. There was evidence that the use of LAIs with clozapine can significantly reduce clinical symptoms, hospitalisation rates and bed days. No serious adverse effects were reported.

CONCLUSION

This preliminary evidence suggests clinical utility of LAIs in alleviating residual symptoms and subsequently reducing hospitalisation rates in patients optimised on clozapine treatment. The current study warrants further investigations including a randomised controlled study to establish the clinical efficacy, tolerability, and place in therapy of this treatment modality.

Spinal cord stimulation in severe pharmacoresistant restless legs syndrome-two case reports

Restless legs syndrome is a prevalent, sleep-related sensorimotor disorder with relevant impact on the patients' quality of life. For patients suffering from severe, pharmacoresistant restless legs syndrome, few therapeutic options remain to alleviate symptoms. In this case series, two patients with severe, pharmacoresistant restless legs syndrome were treated with epidural spinal cord stimulation and repeatedly assessed with polysomnography, including sleep structure and periodic limb movements as objective biomarkers not subject to placebo effects, during a 6-month follow-up period. One of the patients experienced excellent short- and long-term efficacy on subjective symptom severity (International RLS Study group rating scale 1 vs. 34 points at 3 months) and objective sleep parameters such as sleep architecture and periodic limb movements during sleep, while the second patient only reported short-term benefits from spinal cord stimulation. Ultimately, both patients opted for removal of the device for inefficacy. Based on the complex pathophysiology of restless legs syndrome and presumed mechanism of action of spinal cord stimulation in chronic pain disorders, we provide a detailed hypothesis on the possible modulating effect of spinal cord stimulation on the key symptoms of restless legs syndrome. Apart from describing a new therapeutic option for pharmacoresistant restless legs syndrome, our findings might also provide further insights into the pathophysiology of the syndrome.

Artifact Augmentation for Enhanced Tissue Detection in Microscope Scanner Systems

As the field of routine pathology transitions into the digital realm, there is a surging demand for the full automation of microscope scanners, aiming to expedite the process of digitizing tissue samples, and consequently, enhancing the efficiency of case diagnoses. The key to achieving seamless automatic imaging lies in the precise detection and segmentation of tissue sample regions on the glass slides. State-of-the-art approaches for this task lean heavily on deep learning techniques, particularly U-Net convolutional neural networks. However, since samples can be highly diverse and prepared in various ways, it is almost impossible to be fully prepared for and cover every scenario with training data. We propose a data augmentation step that allows artificially modifying the training data by extending some artifact features of the available data to the rest of the dataset. This procedure can be used to generate images that can be considered synthetic. These artifacts could include felt pen markings, speckles of dirt, residual bubbles in covering glue, or stains. The proposed approach achieved a 1-6% improvement for these samples according to the F1 Score metric.

Improving Monocular Facial Presentation-Attack-Detection Robustness with Synthetic Noise Augmentations

We present a synthetic augmentation approach towards improving monocular face presentation-attack-detection (PAD) robustness to real-world noise additions. Face PAD algorithms secure authentication systems against spoofing attacks, such as pictures, videos, and 2D-inspired masks. Best-in-class PAD methods typically use 3D imagery, but these can be expensive. To reduce application cost, there is a growing field investigating monocular algorithms that detect facial artifacts. These approaches work well in laboratory conditions, but can be sensitive to the imaging environment (e.g., sensor noise, dynamic lighting, etc.). The ideal solution for noise robustness is training under all expected conditions; however, this is time consuming and expensive. Instead, we propose that physics-informed noise-augmentations can pragmatically achieve robustness. Our toolbox contains twelve sensor and lighting effect generators. We demonstrate that our toolbox generates more robust PAD features than popular augmentation methods in noisy test-evaluations. We also observe that the toolbox improves accuracy on clean test data, suggesting that it inherently helps discern spoof artifacts from imaging artifacts. We validate this hypothesis through an ablation study, where we remove liveliness pairs (e.g., live or spoof imagery only for participants) to identify how much real data can be replaced with synthetic augmentations. We demonstrate that using these noise augmentations allows us to achieve better test accuracy while only requiring 30% of participants to be fully imaged under all conditions. These findings indicate that synthetic noise augmentations are a great way to improve PAD, addressing noise robustness while simplifying data collection.

Boosting the performance of pretrained CNN architecture on dermoscopic pigmented skin lesion classification

BACKGROUND

Pigmented skin lesions (PSLs) pose medical and esthetic challenges for those affected. PSLs can cause skin cancers, particularly melanoma, which can be life-threatening. Detecting and treating melanoma early can reduce mortality rates. Dermoscopic imaging offers a noninvasive and cost-effective technique for examining PSLs. However, the lack of standardized colors, image capture settings, and artifacts makes accurate analysis challenging. Computer-aided diagnosis (CAD) using deep learning models, such as convolutional neural networks (CNNs), has shown promise by automatically extracting features from medical images. Nevertheless, enhancing the CNN models' performance remains challenging, notably concerning sensitivity.

MATERIALS AND METHODS

In this study, we aim to enhance the classification performance of selected pretrained CNNs. We use the 2019 ISIC dataset, which presents eight disease classes. To achieve this goal, two methods are applied: resolution of the dataset imbalance challenge through augmentation and optimization of the training hyperparameters via Bayesian tuning.

RESULTS

The performance improvement was observed for all tested pretrained CNNs. The Inception-V3 model achieved the best performance compared to similar results, with an accuracy of 96.40% and an AUC of 0.98.

CONCLUSION

According to the study, classification performance was significantly enhanced by augmentation and Bayesian hyperparameter tuning.

Indirect adjusted comparison of 6-month clinical outcomes between esketamine nasal spray and other real-world polypharmacy treatment strategies for treatment resistant depression: results from the ICEBERG study

Background

The efficacy of esketamine nasal spray (NS) as a rapid-acting agent for treatment resistant depression (TRD) was demonstrated in comparisons with placebo, when both were given in addition to a newly initiated selective serotonin reuptake inhibitor (SSRI)/serotonin norepinephrine reuptake inhibitor (SNRI). How esketamine NS compares with commonly used real-world (RW) polypharmacy treatment strategies is not known.

Method

ICEBERG was an adjusted indirect treatment comparison that analysed data from SUSTAIN-2 (NCT02497287; clinicaltrials.gov), a long-term, open-label study of esketamine NS plus SSRI/SNRI, and the European Observational TRD Cohort (EOTC; NCT03373253; clinicaltrials.gov), an observational study of routine clinical practice. Data were compared between patients receiving esketamine NS (SUSTAIN-2) and those from the EOTC treated with polypharmacy treatment strategies, either combination or augmentation. Analyses were adjusted for potential confounders, using rescaled average treatment effect among treated estimates. Threshold analyses were conducted to assess potential impact of unmeasured confounders on the robustness of analyses where esketamine NS was found to be significantly superior. Sensitivity analyses were used to understand the impact of analysis method selection and data handling.

Results

Esketamine NS treatment resulted in a higher probability of 6-month response (49.7% [95% confidence interval (CI) 45.6-53.9]) and remission (33.6% [95% CI 29.7-37.6]) versus RW polypharmacy (26.8% [95% CI 21.0-32.5] and 19.4%, [95% CI 14.2-24.6], respectively). Relative risk calculations showed esketamine NS was 1.859 (95% CI 1.474-2.345; p < 0.0001) times as likely to result in response and 1.735 (1.297-2.322; p = 0.0002) times as likely to result in remission versus RW polypharmacy at 6 months. Threshold and extensive sensitivity analyses supported that analyses of esketamine NS superiority were robust.

Conclusion

ICEBERG supports esketamine NS being superior to current RW individualized polypharmacy strategies, including augmentation, with benefits extending beyond acute use, to improved chance of 6-month response and remission. While unobserved confounding factors may certainly impact results of an indirect comparison, threshold analysis supported a low likelihood of this affecting the conclusions.To view an animated summary of this publication, please click on the Supplementary video.

Breast Ultrasound Images Augmentation and Segmentation Using GAN with Identity Block and Modified U-Net 3

One of the most prevalent diseases affecting women in recent years is breast cancer. Early breast cancer detection can help in the treatment, lower the infection risk, and worsen the results. This paper presents a hybrid approach for augmentation and segmenting breast cancer. The framework contains two main stages: augmentation and segmentation of ultrasound images. The augmentation of the ultrasounds is applied using generative adversarial networks (GAN) with nonlinear identity block, label smoothing, and a new loss function. The segmentation of the ultrasounds applied a modified U-Net 3+. The hybrid approach achieves efficient results in the segmentation and augmentation steps compared with the other available methods for the same task. The modified version of the GAN with the nonlinear identity block overcomes different types of modified GAN in the ultrasound augmentation process, such as speckle GAN, UltraGAN, and deep convolutional GAN. The modified U-Net 3+ also overcomes the different architectures of U-Nets in the segmentation process. The GAN with nonlinear identity blocks achieved an inception score of 14.32 and a Fréchet inception distance of 41.86 in the augmenting process. The GAN with identity achieves a smaller value in Fréchet inception distance (FID) and a bigger value in inception score; these results prove the model's efficiency compared with other versions of GAN in the augmentation process. The modified U-Net 3+ architecture achieved a Dice Score of 95.49% and an Accuracy of 95.67%.

Case report: An OSAS patient with comorbid RLS/PLMS - a closer look at the causes of PAP intolerance

Since 2017, hypoglossal nerve stimulation has been included in the S3-guidelines on restorative sleep/sleep disorders as an alternative treatment for patients with obstructive sleep related breathing disorders who cannot tolerate conventional PAP-therapy. Under certain conditions, some of these patients have the option to have a tongue pacemaker implanted during a surgical procedure to regain a restful night's sleep. However, in some cases it does not solve the problem. In this case report, we present a patient who continued to have restless sleep despite implantation of a hypoglossus nerve stimulator. We provide a closer look at the underlying causes of PAP intolerance and emphasize the importance of a combined pneumological and neurological approach to sleep medicine in sleep-specific therapy evaluation.

Graph Clustering with High-Order Contrastive Learning

Graph clustering is a fundamental and challenging task in unsupervised learning. It has achieved great progress due to contrastive learning. However, we find that there are two problems that need to be addressed: (1) The augmentations in most graph contrastive clustering methods are manual, which can result in semantic drift. (2) Contrastive learning is usually implemented on the feature level, ignoring the structure level, which can lead to sub-optimal performance. In this work, we propose a method termed Graph Clustering with High-Order Contrastive Learning (GCHCL) to solve these problems. First, we construct two views by Laplacian smoothing raw features with different normalizations and design a structure alignment loss to force these two views to be mapped into the same space. Second, we build a contrastive similarity matrix with two structure-based similarity matrices and force it to align with an identity matrix. In this way, our designed contrastive learning encompasses a larger neighborhood, enabling our model to learn clustering-friendly embeddings without the need for an extra clustering module. In addition, our model can be trained on a large dataset. Extensive experiments on five datasets validate the effectiveness of our model. For example, compared to the second-best baselines on four small and medium datasets, our model achieved an average improvement of 3% in accuracy. For the largest dataset, our model achieved an accuracy score of 81.92%, whereas the compared baselines encountered out-of-memory issues.

Aripiprazole, a Novel Option in the Management of Restless Legs Syndrome (RLS) Patients with Augmentation and/or Severe RLS Symptoms: A Report of 4 Cases

Purpose

Restless Legs Syndrome (RLS) is a sensorimotor disorder associated with an unpleasant urge to move the limbs, relieved with movement, occurring in the evenings and with prolonged rest/inactivity. Treatment with dopamine agonists is effective for up to 60-90% of affected individuals. However, augmentation, ie, the paradoxical worsening of RLS symptoms after prolonged RLS treatment, is frequently reported, typically after 3-10 years of treatment. Here, we present 4 patients with RLS who were successfully treated with dopamine agonists but later developed augmentation. A trial of aripiprazole, a dopamine receptor partial agonist (DRPA), was initiated for treatment of augmentation symptoms.

Patients and Methods

Four patients treated for RLS with dopamine agonists developed augmentation. In each instance, augmentation symptoms did not respond adequately to a variety of medications including α2δ drugs, opioids or other agents. A trial of aripiprazole was initiated for each patient, and effects were evaluated.

Results

All four patients with severe RLS and augmentation with dopamine agonists achieved symptom control with aripiprazole. Patients endorsed 90-100% efficacy with aripiprazole by subjective self-report after failures with other agents. Further evaluation with the International Restless Legs Syndrome Study Group RLS Rating Scale (IRLS-SGRS) showed that benefits (from moderate to very severe, to mild to moderate severity) were largely maintained for 1-2 years. Aripiprazole doses to control augmentation symptoms were low (1-4 mg). No significant side effects were reported.

Conclusion

Aripiprazole may have utility for augmentation in RLS. We speculate that the partial agonist and antagonist properties of aripiprazole may limit potential for dopamine hyposensitization to progress to cause augmentation. Further research is needed to see if aripiprazole and/or other DRPAs are a viable long-term treatment option for patients experiencing augmentation and/or severe RLS with dopamine agonist therapy.

Hyaluronic Acid: Exploring Its Versatile Applications in Dentistry

Hyaluronic acid (HA) a polysaccharide present in many areas of the body like the synovium of synovial joints, and connective tissues which have high regenerative and biocompatible properties has been an area of interest since recent times in dentistry. Several research papers and review articles were studied in the Pubmed database to formulate this review article. The main aim of this article is to demonstrate various applications of HA in different branches of dentistry. The PubMed database was searched for keywords "Hyaluronic acid AND periodontics," "Hyaluronic acid AND oral and maxillofacial surgery," "Hyaluronic acid AND oral medicine," "Hyaluronic acid AND orthodontics," "Hyaluronic acid AND endodontics," and "Hyaluronic acid AND aesthetic dentistry" which resulted in six, 296, 83, 86, 40, and 49 articles, respectively. The most relevant and informative articles were selected and studied for this review article. This review article will also help people to gain knowledge about the future aspects of the use of HA in dentistry and also motivate clinicians and new-generation dentists to inculcate the HA's use in their respective practice in dentistry.

Salvage Treatments for Poor Voice Outcomes Following Autologous Fat Injection Laryngoplasty

OBJECTIVE

Fat injection laryngoplasty (FIL) is a common procedure used to correct glottic insufficiency. Nevertheless, few studies have discussed potential treatments for cases with poor voice recovery after FIL.

METHODS

Eighteen patients with unfavorable vocal outcomes from FIL were analyzed. Each of these patients presented persistent dysphonia for more than 2 months following FIL, together with bulging vocal folds and poor mucosal wave. We applied microsurgery as the standard treatment to remove excessive fat. Vocal fold steroid injection (VFSI) was administered to patients that were hesitant or declined to undergo microsurgery. Voice outcomes were evaluated using the Voice Handicap Index-10 (VHI-10), grade-roughness-breathiness (GRB) scores, and smoothed cepstral peak prominence (CPPs).

RESULTS

Six patients underwent microsurgery directly, 6 patients received only VFSIs as a salvage treatment, and the remaining 6 patients received 1 to 3 courses of VFSIs before the decision to undergo microsurgery. Pathology reports were available for 10 patients, and contained 5 instances of adipose tissues, 3 of fat necrosis, 1 of chronic inflammation, and 1 of fibrosis. Seventeen patients reported satisfactory or improved outcomes. We found remarkable improvements in VHI-10, GRB, and CPPs (all P < .05) after salvage treatments for FIL. Subgroup analyses showed comparable voice outcomes for patients undergoing direct microsurgery, VFSI alone, and VFSI followed by microsurgery (P > .05).

CONCLUSIONS

This study demonstrated that fat overinjection and/or fibrotic change in the injected vocal folds may cause poor voice outcomes after FIL. Both microsurgery and VFSI could be applied as salvage treatments with good voice recovery profiles.

LEVEL OF EVIDENCE

Level 4.

Proximal Femur Endoprosthesis Augmentation with Polymethylmethacrylate and Condylar Plate: A Case Series

Introduction

Aseptic and septic loosening by mechanical failure is one of the main causes of proximal femur endoprosthesis failure with different clinical consequences such as pain, inflammation, progressive loosening of muscular volume, and strength with functional limitation. We present a case series of four patients with aseptic and septic loosening of femur endoprosthesis that was treated with a novel technique that combines different methods to achieve primary stability.

Case Report

Four patients with an average age of 49.5 years (35-70 years), two women and two men, were referred to the Orthopedic Surgery Department of the San Ignacio University Hospital of Bogota. Two of them with a history of oncological disease, ruling out a tumor relapse through local images and extension examinations; another patient with a history of firearm injury to the left thigh with multiple secondary complications, which required various reconstructive procedures; and the oldest patient with a history of total hip replacement. The main complaint of the four patients was thigh pain not caused by trauma and initial assessment radiographs of all of them showed signs of loosening of the prosthetic material, with septic etiology in two of the patients and aseptic etiology in the other two. Therefore, they were scheduled for revision surgery of prosthetic components. These patients recover functional status and resolved pain in the early post-operative period and during long-term follow-up. Only one of the patients, time after the surgical procedure, required removal of the osteosynthesis material due to persistent bone infectious process.

Conclusion

Septic and aseptic loosening is one of the most common complications of proximal femur endoprosthesis, resulting in significant pain and functional decline in patients. We present a novel surgical technique that allows primary stabilization of the construct that allows early rehabilitation, improvement of functionality, and no signs of new loosening.

Soft Tissue Management Around the Dental Implant: A Comprehensive Review

In the modern world, there is an increasing concern among people regarding dental esthetics. Edentulism can impact one's appearance, affect the regular bite, and can even affect mental well-being. There are various options to replace the missing teeth, such as removable dentures, fixed crown and bridge prostheses, and resin-retained bridges. Various factors are evaluated before giving a suitable prosthesis for missing teeth. Implant installation is highly desired by patients as it has a high success and long-term survival rate when used to replace lost teeth. However, several difficulties relating to errors in treatment planning, surgery, soft tissue, and hard tissue care, and infections may compromise the efficacy of implant therapy. An increasing body of research indicates that long-term clinical stability and esthetics may be significantly impacted by the stability of the soft tissues around osseointegrated dental implants. Consequently, when implant therapy is planned, the dental surgeon has to have the necessary expertise to appropriately handle any possible causes of difficulties in addition to being able to carry out the necessary actions to maintain or develop stable soft tissue. Various augmentation procedures can be done for the correction of any deformity or inadequacy of soft tissues. Osseointegration is a fundamental part of the success of the implant treatment. It is the formation of a biological and functional connection between the bone and the implant increasing the stability of implant prosthesis. After the treatment, the patient should be counseled for regular and proper oral hygiene practices suitable for the implant. A proper follow-up has to be done after implant treatment in regular intervals. Any postoperative soft tissue complications, such as peri-implantitis or peri-implant mucositis, should be addressed immediately, and appropriate treatment has to be given. This article reviews about the procedures before and after the implant placement to prevent or treat soft tissue complications, ultimately leading to the success of the implant.

Disturbances of the stomatognathic system and possibilities of its correction in patients with craniofacial morphea

Morphea en coup de sabre and progressive hemifacial atrophy are extremely rare connective tissue disorders causing facial deformity. In extreme cases, morphological disorders are accompanied by symptoms of a clear impairment of the stomatognathic system. The aetiology of the above-mentioned diseases is still unknown. Properly planned therapy in the field of maxillofacial orthopaedics makes it possible to correct the asymmetric pattern of hard tissue growth and thus enable rehabilitation. The task of augmentation techniques is the volumetric supplementation of tissue defects resulting from atrophic processes. The degree of destruction and the extent of changes determine the method of correction. Mild and moderate defects are treated mainly with biomaterials and autologous adipose tissue. The severe course of hemifacial atrophy and morphea en coup de sabre and the associated significant tissue atrophy necessitate the search for more complex methods of treatment. In this paper, we summarize the disturbances of the stomatognathic system in patients with craniofacial morphea, together with an analysis of current treatment options.

Bone reconstruction of extensive maxillomandibular defects in adults

Reconstruction of significant maxillomandibular defects is a challenge that has been much discussed over the last few decades. Fundamental principles were developed decades ago (bone bed viability, graft immobilization). Clinical decision-making criteria are highly relevant, including local/systemic factors and incision designs, the choice of material, grafting technique, and donor site morbidity. Stabilizing particulated grafts for defined defects-that is, via meshes or shells-might allow significant horizontal and vertical augmentation; the alternatives are onlay and inlay techniques. More significant defects might require extra orally harvested autologous bone blocks. The anterior iliac crest is often used for nonvascularized augmentation, whereas more extensive defects often require microvascular reconstruction. In those cases, the free fibula flap has become the standard of care. The development of alternatives is still ongoing (i.e., alloplastic reconstruction, zygomatic implants, obturators, distraction osteogenesis). Especially for these complex procedures, three-dimensional planning tools enable facilitated planning and a surgical workflow.

Indications and surgical technique for distraction osteogenesis of the alveolar bone for augmentation prior to insertion of dental implants

When bone is limited, short, ultra-short, or narrow implants help to restore oral rehabilitation with an acceptable long-term outcome. This becomes more difficult with severe vertical bone loss. Guided bone regeneration, onlay block transplantation, or sandwich osteotomy have been established to build up these defects. The alternative to the alveolar distraction osteogenesis (ADO) has only been established in some centers, with a standardized protocol. On the one hand, ADO is a biological procedure that allows almost a "restitutio ad integrum" when building up hard and soft tissue. On the other hand, there are clear indications, limitations, and complications of the procedure in the literature. In addition to the literature, concept of Tissue Regeneration by Alveolar Callusdistraction Cologne (TRACC), which has been practiced successfully for over two decades, will be presented for different indications.

Exploring the causes of augmentation in restless legs syndrome

Long-term drug treatment for Restless Legs Syndrome (RLS) patients can frequently result in augmentation, which is the deterioration of symptoms with an increased drug dose. The cause of augmentation, especially derived from dopamine therapy, remains elusive. Here, we review recent research and clinical progress on the possible mechanism underlying RLS augmentation. Dysfunction of the dopamine system highly possibly plays a role in the development of RLS augmentation, as dopamine agonists improve desensitization of dopamine receptors, disturb receptor interactions within or outside the dopamine receptor family, and interfere with the natural regulation of dopamine synthesis and release in the neural system. Iron deficiency is also indicated to contribute to RLS augmentation, as low iron levels can affect the function of the dopamine system. Furthermore, genetic risk factors, such as variations in the BTBD9 and MEIS1 genes, have been linked to an increased risk of RLS initiation and augmentation. Additionally, circadian rhythm, which controls the sleep-wake cycle, may also contribute to the worsening of RLS symptoms and the development of augmentation. Recently, Vitamin D deficiency has been suggested to be involved in RLS augmentation. Based on these findings, we propose that the progressive reduction of selective receptors, influenced by various pathological factors, reverses the overcompensation of the dopamine intensity promoted by short-term, low-dose dopaminergic therapy in the development of augmentation. More research is needed to uncover a deeper understanding of the mechanisms underlying the RLS symptom and to develop effective RLS augmentation treatments.

Comparative efficacy and safety of 4 atypical antipsychotics augmentation treatment for major depressive disorder in adults: A systematic review and network meta-analysis

BACKGROUND

Atypical antipsychotic (AAP) augmentation is an alternative strategy for patients with major depressive disorder (MDD) who had an inadequate response to antidepressant therapy (ADT). We aimed to compare and rank the efficacy and safety of 4 AAPs in the adjuvant treatment of MDD.

METHODS

We searched randomized controlled trials (RCTs) published and unpublished from the date of databases and clinical trial websites inception to April 30, 2023. The evidence risk of bias (RoB) and certainty are assessed using the Cochrane bias risk tool and grading of recommendations assessment, development, and evaluation (GRADE) framework, respectively. Using network meta-analysis, we estimated summary risk ratios (RRs) or standardized mean difference (SMD) based on the random effects model.

RESULTS

56 eligible studies comprising 11448 participants were included. In terms of primary efficacy outcome, compared with placebo (PBO), all AAPs had significant efficacy (SMD = -0.40; 95% CI, -0.68 to -0.12 for quetiapine (QTP); -0.35, -0.59 to -0.11 for olanzapine (OLA); -0.28, -0.47 to -0.09 for aripiprazole (ARI) and -0.25, -0.42 to -0.07 for brexpiprazole (BRE), respectively). In terms of acceptability, no significant difference was found, either agents versus agents or agents versus PBO. In terms of tolerability, compared with the PBO, QTP (RR = 0.24; 95% CI,0.11-0.53), OLA (0.30,0.10-0.55), ARI (0.39,0.22-0.69), and BRE (0.37,0.18-0.75) were significantly less well tolerated. 8 (14.2%) of 56 trials were assessed as low RoB, 38 (67.9%) trials had moderate RoB, and 10 (17.9%) had high RoB; By the GRADE, the certainty of most evidence was low or very low.

CONCLUSION

Adjuvant AAPs had significant efficacy compared with PBO, but treatment decisions must be made to balance the risks and benefits.

An approach to the diagnosis of lumbar disc herniation using deep learning models

Background: In magnetic resonance imaging (MRI), lumbar disc herniation (LDH) detection is challenging due to the various shapes, sizes, angles, and regions associated with bulges, protrusions, extrusions, and sequestrations. Lumbar abnormalities in MRI can be detected automatically by using deep learning methods. As deep learning models gain recognition, they may assist in diagnosing LDH with MRI images and provide initial interpretation in clinical settings. YOU ONLY LOOK ONCE (YOLO) model series are often used to train deep learning algorithms for real-time biomedical image detection and prediction. This study aims to confirm which YOLO models (YOLOv5, YOLOv6, and YOLOv7) perform well in detecting LDH in different regions of the lumbar intervertebral disc. Materials and methods: The methodology involves several steps, including converting DICOM images to JPEG, reviewing and selecting MRI slices for labeling and augmentation using ROBOFLOW, and constructing YOLOv5x, YOLOv6, and YOLOv7 models based on the dataset. The training dataset was combined with the radiologist's labeling and annotation, and then the deep learning models were trained using the training/validation dataset. Results: Our result showed that the 550-dataset with augmentation (AUG) or without augmentation (non-AUG) in YOLOv5x generates satisfactory training performance in LDH detection. The AUG dataset overall performance provides slightly higher accuracy than the non-AUG. YOLOv5x showed the highest performance with 89.30% mAP compared to YOLOv6, and YOLOv7. Also, YOLOv5x in non-AUG dataset showed the balance LDH region detections in L2-L3, L3-L4, L4-L5, and L5-S1 with above 90%. And this illustrates the competitiveness of using non-AUG dataset to detect LDH. Conclusion: Using YOLOv5x and the 550 augmented dataset, LDH can be detected with promising both in non-AUG and AUG dataset. By utilizing the most appropriate YOLO model, clinicians have a greater chance of diagnosing LDH early and preventing adverse effects for their patients.

Pectoralis Major Muscle Morbidity After Submuscular Silicone-based Breast Reconstruction: A Systematic Review

Silicone implants or tissue expanders placed under the pectoralis major (PM) muscle are often used for breast reconstruction. However, the disruption of PM insertions, which is often an inevitable part of the surgical procedure, is known to cause PM morbidity and, subsequently, problems with the use of the ipsilateral arm. In this systematic review, we present current knowledge regarding the effect of submuscular silicone-based breast reconstruction on the function of PM and the ipsilateral arm. A search of the relevant English literature was performed through PubMed and ten eligible studies were identified. Articles reporting breast augmentation were accepted as the techniques of implant insertion are similar to reconstruction. Questionnaires reporting the status of the arm, analysis of the range of motion of the shoulder with 3-D video, isometric or isokinetic dynamometry, ultrasound shear-wave elastography, volumetric MRI, electromyography and light and electron microscopy of the PM fibers were used for the assessment of PM and arm status. The insertion of implants under the PM, especially when combined with dissection of some of its insertions, seems to be associated with measurable abnormal microscopic, imaging, and dynamometric findings. However, the intact part of the muscle and possibly other nearby muscular structures are able to compensate for the lost part of PM. Thus, the insertion of implants fully or partially under the PM seems to have no or little effect on the function of the ipsilateral upper limb in daily life.

Combined Biologic Augmentation Strategies with Collagen Patch Graft, Microfractures, and Platelet Concentrate Injections Improve Functional and Structural Outcomes of Arthroscopic Revision Rotator Cuff Repair

BACKGROUND

Arthroscopic revision rotator cuff repair (ARRCR) is challenging. Biologic strategies seem to be promising. The aim was to evaluate the effectiveness of the combination of microfractures of the greater tuberosity, augmentation with collagen patch graft, and platelet concentrate injections in ARRCR.

METHODS

A retrospective comparative study was conducted on patients that underwent ARRCR with a minimum follow-up of two years. Patients in the augmentation group underwent ARRCR combined with microfractures, collagen patch graft, and postoperative subacromial injections of platelet concentrate. A standard rotator cuff repair was performed in the control group.

PRIMARY OUTCOME

Constant-Murley score (CMS).

SECONDARY OUTCOMES

disease-specific, health-related quality of life using the Disabilities of the Arm, Shoulder, and Hand (DASH) score; assessment of tendon integrity with magnetic resonance at least six months after surgery. Significance was set at p < 0.05.

RESULTS

Forty patients were included. Mean follow-up was 36.2 ± 8.7 months. The mean CMS was greater in the augmentation group (p = 0.022). No differences could be found for DASH score. Healing failure rate was higher in the control group (p = 0.002).

CONCLUSION

Biologic augmentation of ARRCR using a combination of microfractures, collagen patch graft, and subacromial injections of platelet concentrate is an effective strategy in improving tendon healing rate.

LEVEL OF EVIDENCE

retrospective cohort study, level III.

Comparison of Intracervical Foley's Catheter With Vaginal Misoprostol Versus Intravaginal Misoprostol Alone for Cervical Ripening and Induction of Labor

Introduction Induction of labor implies stimulation of contractions before the spontaneous onset of labor, with or without membranes. Augmentation refers to the enhancement of spontaneous contractions that are considered inadequate because of failed cervical and fetal descent. This study compared the effectiveness of intracervical Foley catheter insertion and vaginal misoprostol versus only vaginal misoprostol in the induction of labor and other outcomes relted to it. Methods The present study was a randomized controlled trial that included 148 women divided into two groups: (i) Group A, which received intracervical Foley catheter insertion and vaginal misoprostol (25 µg), and (ii) Group B, which received intravaginal administration of tablet misoprostol (25 µg) alone. We compared the median time from the time of induction to vaginal delivery, incidence of cesarean delivery, chorioamnionitis, puerperal infection, uterine tachysystole, neonatal information at delivery, and discharge status (i.e., birth weight, neonatal intensive care unit (NICU) admission, and neonatal death) between groups. Results We found that the rates of puerperal infection (n=36; 48.6%) and meconium-stained amniotic fluid (n=45; 60.8%) were higher in Group B than in Group A (n=20; 27.0% and n=25; 33.8%, respectively), which were statistically significant differences (p=0.0066 and p=0.0009, respectively). In addition, NICU admission was higher in Group B (n=47; 63.5%) than in Group A (n=30; 40.5%), which was a statistically significant difference (p=0.0051). Conclusion An intracervical Foley catheter with 25 µg of misoprostol was more effective for induction of labor than 25 µg of intravaginal misoprostol alone every six hours for a maximum of four doses in terms of induction to delivery interval, meconium-stained amniotic fluid, mode of delivery, intrapartum complications, and puerperal infection.

Evaluation of Augmentation Methods in Classifying Autism Spectrum Disorders from fMRI Data with 3D Convolutional Neural Networks

Classifying subjects as healthy or diseased using neuroimaging data has gained a lot of attention during the last 10 years, and recently, different deep learning approaches have been used. Despite this fact, there has not been any investigation regarding how 3D augmentation can help to create larger datasets, required to train deep networks with millions of parameters. In this study, deep learning was applied to derivatives from resting state functional MRI data, to investigate how different 3D augmentation techniques affect the test accuracy. Specifically, resting state derivatives from 1112 subjects in ABIDE (Autism Brain Imaging Data Exchange) preprocessed were used to train a 3D convolutional neural network (CNN) to classify each subject according to presence or absence of autism spectrum disorder. The results show that augmentation only provide minor improvements to the test accuracy.

SeizFt: Interpretable Machine Learning for Seizure Detection Using Wearables

This work presents SeizFt-a novel seizure detection framework that utilizes machine learning to automatically detect seizures using wearable SensorDot EEG data. Inspired by interpretable sleep staging, our novel approach employs a unique combination of data augmentation, meaningful feature extraction, and an ensemble of decision trees to improve resilience to variations in EEG and to increase the capacity to generalize to unseen data. Fourier Transform (FT) Surrogates were utilized to increase sample size and improve the class balance between labeled non-seizure and seizure epochs. To enhance model stability and accuracy, SeizFt utilizes an ensemble of decision trees through the CatBoost classifier to classify each second of EEG recording as seizure or non-seizure. The SeizIt1 dataset was used for training, and the SeizIt2 dataset for validation and testing. Model performance for seizure detection was evaluated using two primary metrics: sensitivity using the any-overlap method (OVLP) and False Alarm (FA) rate using epoch-based scoring (EPOCH). Notably, SeizFt placed first among an array of state-of-the-art seizure detection algorithms as part of the Seizure Detection Grand Challenge at the 2023 International Conference on Acoustics, Speech, and Signal Processing (ICASSP). SeizFt outperformed state-of-the-art black-box models in accurate seizure detection and minimized false alarms, obtaining a total score of 40.15, combining OVLP and EPOCH across two tasks and representing an improvement of ~30% from the next best approach. The interpretability of SeizFt is a key advantage, as it fosters trust and accountability among healthcare professionals. The most predictive seizure detection features extracted from SeizFt were: delta wave, interquartile range, standard deviation, total absolute power, theta wave, the ratio of delta to theta, binned entropy, Hjorth complexity, delta + theta, and Higuchi fractal dimension. In conclusion, the successful application of SeizFt to wearable SensorDot data suggests its potential for real-time, continuous monitoring to improve personalized medicine for epilepsy.

Treatment of Insertional Achilles Tendinosis With Polyurethane Urea-Based Matrix Augmentation

INTRODUCTION

Surgical treatment for insertional Achilles tendinosis (IAT) sometimes requires tendon repair augmentation. The purpose of this study is to evaluate the efficacy of polycaprolactone-based polyurethane urea (PUUR) matrix augmentation in the treatment of IAT.

METHODS

A retrospective review was performed in surgically treated IAT. Repairs were augmented with a PUUR matrix. Factors evaluated included date of full weightbearing, patient satisfaction, Visual Analog Scale (VAS) pain score, strength, and ankle motion. The Wilcoxon signed-rank test was used to compare baseline and final follow-up VAS scores.

RESULTS

A total of 18 cases were included in the study. The mean patient age was 54.61 ± 8.25 (40-75) years with a mean follow-up of 163.61 ± 57.81 (92-314) days. Patient satisfaction was obtained on 15 of 18 patients, with 14 patients satisfied with their outcome. Mean VAS for pain significantly decreased from 6.19 ± 1.97 (2.5-9) to 0.83 ± 1.54 (0-5) postoperatively, which was statistically significant (P < .01).

CONCLUSION

Achilles tendon augmentation with the PUUR matrix is a viable option in the treatment of IAT. Its use in this condition has minimal morbidity and can be an alternative to other forms of augmentation.

LEVELS OF EVIDENCE

Level IV: Retrospective case series.

Bone tissue 3D bioprinting in regenerative dentistry through the perspective of the diamond concept of healing: A narrative review

Three-dimensional bioprinting technology appears to be a promising solution for the treatment and reconstruction of a wide range of maxillofacial bone defects. In this review, the authors discuss different bioprinting solutions and options in the context of the 4 factors of bone healing: structures or scaffolds, osteogenic cells, growth factors, and stabilization (diamond concept of healing), as well as the influence of a 5th factor - vascularization. Bone is a complex tissue; hence, bone bioprinting may require different technical approaches and mixed methods. Ultraviolet (UV) crosslinkable hydrogels, such as gelatin methacryloyl (GelMA), are among the most promising bioinks; they are enhanced by hydroxyapatite or 1-2.5 mm beta-tricalcium phosphate (β-TCP) granules and porous scaffolds with recommended pore sizes greater than 300 μm. The advantages of mesenchymal stem cells (MSCs) are their significant availability, low tumorigenicity, and great potential for differentiation into osteoblasts or endothelial cells (ECs). Although growth factors require advanced delivery systems, they provide excellent improvement in the functionality of printed tissues. A proper vasculature system supplies cells with oxygen and nutrients, removes waste products, promotes osteogenesis, prevents ischemic necrosis, and improves the mechanical properties of bone. With all of these aspects perfectly balanced and working in synergy, the clinical use of bioprinting is only a matter of time.

Neurotechnology and ethics guidelines for human enhancement: The case of the hippocampal cognitive prosthesis

Neurotechnologies offer both therapeutic and enhancement potential. In this article, we demonstrate how ethics guidelines can help with critical reflection on their potential for enhancement. We do this through the case of the hippocampal cognitive prosthesis. This prothesis developed in the US, has primarily therapeutic ends, with scope for enhancement. This technology raises several ethical issues, including as related to identity and memory, autonomy and authenticity. In the first section, we outline what we mean by enhancement, and introduce neurotechnologies generally and the hippocampal cognitive prosthesis specifically, with an introduction to generally relevant ethical issues. In the second section, we outline ethical issues pertinent to the hippocampal cognitive prosthesis and explore how ethics guidelines can help to promote essential critical reflection on a technology like this. Through all this, our emphasis is to balance between technological optimism and caution, especially where technologies have enhancement potential.

Broström Repair With and Without Augmentation: Comparison of Outcomes at Median Follow-up of 5 Years

BACKGROUND

An augmented Broström repair with nonabsorbable suture tape has demonstrated strength and stiffness more similar to the native anterior talofibular ligament (ATFL) compared to Broström repair alone at the time of repair in cadaveric models for the treatment of lateral ankle instability. The study purpose was to compare minimum 2-year patient-reported outcomes (PROs) following treatment of ATFL injuries with Broström repair with vs without suture tape augmentation.

METHODS

Between 2009 and 2018, patients >18 years old who underwent primary surgical treatment for an ATFL injury with either a Broström repair alone (BR Cohort) or Broström repair with suture tape augmentation (BR-ST Cohort) were identified. Demographic data and PROs, including Foot and Ankle Ability Measure (FAAM) with activities of daily living (ADL) and sport subscales, 12-Item Short Form Health Survey (SF-12), Tegner Activity Scale, and patient satisfaction with surgical outcome, were compared between groups, and proportional odds ordinal logistic regression was used.

RESULTS

Ninety-one of 102 eligible patients were available for follow-up at median 5 years. The BR cohort had 50 of 53 patients (94%) completed follow-up at a median of 7 years. The BR-ST cohort had 41 of 49 (84%) complete follow-up at a median of 5 years. There was no significant difference in median postoperative FAAM ADL (98% vs 98%, P = .67), FAAM sport (88% vs 91%, P = .43), SF-12 PCS (55 vs 54, P = .93), Tegner score (5 vs 5, P = .64), or patient satisfaction (9 vs 9, P = .82). There was significantly higher SF-12 MCS (55.7 vs 57.6, P = .02) in the BR-ST group. Eight patients underwent subsequent ipsilateral ankle surgery, of which one patient (BR-ST group) was revised for recurrent lateral ankle instability.

CONCLUSION

At median 5 years, patients treated for ATFL injury of the lateral ankle with Broström repair with suture tape augmentation demonstrated similar patient-reported outcomes to those treated with Broström repair alone.

LEVEL OF EVIDENCE

Level II, retrospective cohort study.

Effects of an Artificial Intelligence Platform for Behavioral Interventions on Depression and Anxiety Symptoms: Randomized Clinical Trial

BACKGROUND

The need for scalable delivery of mental health care services that are efficient and effective is now a major public health priority. Artificial intelligence (AI) tools have the potential to improve behavioral health care services by helping clinicians collect objective data on patients' progress, streamline their workflow, and automate administrative tasks.

OBJECTIVE

The aim of this study was to determine the feasibility, acceptability, and preliminary efficacy of an AI platform for behavioral health in facilitating better clinical outcomes for patients receiving outpatient therapy.

METHODS

The study was conducted at a community-based clinic in the United States. Participants were 47 adults referred for outpatient, individual cognitive behavioral therapy for a main diagnosis of a depressive or anxiety disorder. The platform provided by Eleos Health was compared to treatment-as-usual (TAU) approach during the first 2 months of therapy. This AI platform summarizes and transcribes the therapy session, provides feedback to therapists on the use of evidence-based practices, and integrates these data with routine standardized questionnaires completed by patients. The information is also used to draft the session's progress note. Patients were randomized to receive either therapy provided with the support of an AI platform developed by Eleos Health or TAU at the same clinic. Data analysis was carried out based on intention-to-treat approach from December 2022 to January 2023. The primary outcomes included the feasibility and acceptability of the AI platform. Secondary outcomes included changes in depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) scores as well as treatment attendance, satisfaction, and perceived helpfulness.

RESULTS

A total of 72 patients were approached, of whom 47 (67%) agreed to participate. Participants were adults (34/47, 72% women and 13/47, 28% men; mean age 30.64, SD 11.02 years), 23 randomized to the AI platform group, and 24 to TAU. Participants in the AI group attended, on average, 67% (mean 5.24, SD 2.31) more sessions compared to those in TAU (mean 3.14, SD 1.99). Depression and anxiety symptoms were reduced by 34% and 29% in the AI platform group versus 20% and 8% for TAU, respectively, with large effect sizes for the therapy delivered with the support of the AI platform. No group difference was found in 2-month treatment satisfaction and perceived helpfulness. Further, therapists using the AI platform submitted their progress notes, on average, 55 hours earlier than therapists in the TAU group (t=-0.73; P<.001).

CONCLUSIONS

In this randomized controlled trial, therapy provided with the support of Eleos Health demonstrated superior depression and anxiety outcomes as well as patient retention, compared with TAU. These findings suggest that complementing the mental health services provided in community-based clinics with an AI platform specializing in behavioral treatment was more effective in reducing key symptoms than standard therapy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05745103; https://classic.clinicaltrials.gov/ct2/show/NCT05745103.

Exploring crossmodal correspondences for future research in human movement augmentation

"Crossmodal correspondences" are the consistent mappings between perceptual dimensions or stimuli from different sensory domains, which have been widely observed in the general population and investigated by experimental psychologists in recent years. At the same time, the emerging field of human movement augmentation (i.e., the enhancement of an individual's motor abilities by means of artificial devices) has been struggling with the question of how to relay supplementary information concerning the state of the artificial device and its interaction with the environment to the user, which may help the latter to control the device more effectively. To date, this challenge has not been explicitly addressed by capitalizing on our emerging knowledge concerning crossmodal correspondences, despite these being tightly related to multisensory integration. In this perspective paper, we introduce some of the latest research findings on the crossmodal correspondences and their potential role in human augmentation. We then consider three ways in which the former might impact the latter, and the feasibility of this process. First, crossmodal correspondences, given the documented effect on attentional processing, might facilitate the integration of device status information (e.g., concerning position) coming from different sensory modalities (e.g., haptic and visual), thus increasing their usefulness for motor control and embodiment. Second, by capitalizing on their widespread and seemingly spontaneous nature, crossmodal correspondences might be exploited to reduce the cognitive burden caused by additional sensory inputs and the time required for the human brain to adapt the representation of the body to the presence of the artificial device. Third, to accomplish the first two points, the benefits of crossmodal correspondences should be maintained even after sensory substitution, a strategy commonly used when implementing supplementary feedback.

Sensory augmentation for a rapid motor task in a multisensory environment

BACKGROUND

Sensory substitution and augmentation systems (SSASy) seek to either replace or enhance existing sensory skills by providing a new route to access information about the world. Tests of such systems have largely been limited to untimed, unisensory tasks.

OBJECTIVE

To test the use of a SSASy for rapid, ballistic motor actions in a multisensory environment.

METHODS

Participants played a stripped-down version of air hockey in virtual reality with motion controls (Oculus Touch). They were trained to use a simple SASSy (novel audio cue) for the puck's location. They were tested on ability to strike an oncoming puck with the SASSy, degraded vision, or both.

RESULTS

Participants coordinated vision and the SSASy to strike the target with their hand more consistently than with the best single cue alone, t(13) = 9.16, p <.001, Cohen's d = 2.448.

CONCLUSIONS

People can adapt flexibly to using a SSASy in tasks that require tightly timed, precise, and rapid body movements. SSASys can augment and coordinate with existing sensorimotor skills rather than being limited to replacement use cases - in particular, there is potential scope for treating moderate vision loss. These findings point to the potential for augmenting human abilities, not only for static perceptual judgments, but in rapid and demanding perceptual-motor tasks.