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Purpose Trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustment for TBS has accelerated adoption. This position paper therefore presents a review of the updated scientific literature and provides expert consensus statements and corresponding operational guidelines for the use of TBS. Methods An Expert Working Group was convened by the ESCEO and a systematic review of the evidence undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: (1) fracture prediction in men and women; (2) initiating and monitoring treatment in postmenopausal osteoporosis; (3) fracture prediction in secondary osteoporosis; and (4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results A total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and anabolic agents. All expert consensus statements were voted as strongly recommended. Conclusion The addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, adding useful information for treatment decision-making and monitoring. The expert consensus statements provided in this paper can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis. An example of an operational approach is provided in the appendix. Summary This position paper presents an up-to-date review of the evidence base, synthesised through expert consensus statements, which informs the implementation of Trabecular Bone Score in clinical practice.

Theta burst stimulation (TBS) is a form of repetitive transcranial magnetic stimulation (rTMS) with unknown underlying mechanisms and highly variable responses across subjects. To investigate these issues, we developed a simple computational model. Our model consisted of two neurons linked by an excitatory synapse that incorporates two mechanisms: short-term plasticity (STP) and spike-timing-dependent plasticity (STDP). We applied a variable-amplitude current through I-clamp with a TBS time pattern to the pre- and post-synaptic neurons, simulating synaptic plasticity. We analyzed the results and provided an explanation for the effects of TBS, as well as the variability of responses to it. Our findings suggest that the interplay of STP and STDP mechanisms determines the direction of plasticity, which selectively affects synapses in extended neurons and underlies functional effects. Our model describes how the timing, number, and intensity of pulses delivered to neurons during rTMS contribute to induced plasticity. This not only successfully explains the different effects of intermittent TBS (iTBS) and continuous TBS (cTBS), but also predicts the results of other protocols such as 10 Hz rTMS. We propose that the variability in responses to TBS can be attributed to the variable span of neuronal thresholds across individuals and sessions. Our model suggests a biologically plausible mechanism for the diverse responses to TBS protocols and aligns with experimental data on iTBS and cTBS outcomes. This model could potentially aid in improving TBS and rTMS protocols and customizing treatments for patients, brain areas, and brain disorders.

Background The prognostic role of the fibrosis-4 (FIB-4) index relative to intrahepatic cholangiocarcinoma (ICC) after hepatectomy remains unclear. This study sought to characterize the impact of the FIB-4 index and tumor burden score (TBS) on recurrence and overall survival (OS). Methods ICC patients undergoing hepatectomy (2000–2020) were identified using a multi-institutional database. Patients were categorized as low (low TBS/low FIB-4 index), intermediate (low TBS/high FIB-4 index or high TBS/low FIB-4 index), and high (high TBS/high FIB-4 index). Results Among 1168 patients in different TBS and FIB-4 index cohorts, 3-year recurrence varied considerably. For instance, among the patients with low TBS, individuals with a high FIB-4 index had a greater risk of recurrence than patients with a low FIB-4 index (59.9 vs. 47.7%; P  = 0.01). Among patients with a high TBS, individuals with a high versus a low FIB-4 index had a higher incidence of recurrence (76.8 vs. 69.0%; P  = 0.04). A similar pattern was observed among patients with both a low FIB-4 index (low [47.7%] vs. high [69.0%] TBS) and a high FIB-4 index (low [59.9%] vs. high [76.8%] TBS; both P  < 0.001). Patients with a high [27.5%] versus a low [48.8%] TBS; P  < 0.001) and patients with a high [34.2%] versus a low [43.5%] FIB-4 index; P  = 0.01) had a worse OS. The multivariable analysis demonstrated an increasing risk of recurrence in the intermediate-index (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.20–2.16; P  = 0.001) and high-index (HR, 2.13; 95% CI 1.45–3.13; P  < 0.001) groups versus the low-index group. Conclusions Both tumor-related and non-tumorous characteristics should be used to predict risk of recurrence and survival more accurately among patients with ICC following hepatic resection.

The cerebellum is strongly implicated in learning new motor skills. Theta burst stimulation (TBS), a form of repetitive transcranial magnetic stimulation, can be used to influence cerebellar activity. Our aim was to explore the potential of cerebellar TBS in modulating visuo-motor adaptation, a form of motor learning, in young healthy subjects. Cerebellar TBS was applied immediately before the learning phase of a visuo-motor adaptation task (VAT), in two different experiments. Firstly, we evaluated the behavioral effects of continuous (cTBS), intermittent (iTBS) or sham TBS on the learning, re-adaptation and de-adaptation phases of VAT. Subsequently, we investigated the changes induced by iTBS or sham TBS on motor cortical activity related to each phase of VAT, as measured by concomitant TMS/EEG recordings. We found that cerebellar TBS induced a robust bidirectional modulation of the VAT performance. More specifically, cerebellar iTBS accelerated visuo-motor adaptation, by speeding up error reduction in response to a novel perturbation. This gain of function was still maintained when the novel acquired motor plan was tested during a subsequent phase of re-adaptation. On the other hand, cerebellar cTBS induced the opposite effect, slowing the rate of error reduction in both learning and re-adaptation phases. Additionally, TMS/EEG recordings showed that cerebellar iTBS induced specific changes of cortical activity in the interconnected motor networks. The improved performance was accompanied by an increase of TMS-evoked cortical activity and a generalized desynchronization of TMS-evoked cortical oscillations. Taken together, our behavioral and neurophysiological findings provide the first-time multimodal evidence of the potential efficacy of cerebellar TBS in improving motor learning, by promoting successful cerebellar-cortical reorganization. ∙The cerebellum is crucial in visuo-motor adaptation.∙Neural activity of the cerebellum can be modulated by means of theta burst stimulation (TBS).∙Cerebellar iTBS speeds up motor learning, modulating motor cortical activity.

Porous wind barriers (PWBs) are gradually applied to tunnel-bridge-tunnel infrastructures (TBTIs) along high-speed railway lines. Due to the remarkable aerodynamic effect of high-speed trains (HSTs), the windproof performance of a PWB at tunnel-bridge section (TBS) is particularly critical when a HST passes through the TBTI under crosswind. And it seems to be easily ignored by researchers. This study aims to determine the influence mechanism of the PWB in the TBS. A CFD dynamic model of air-train-PWB was built based on porous media theory, and its reliability is verified by model and field tests. The main results are as follows: the corresponding variation amplitudes of the train's aerodynamic load coefficients are reduced by 36-95% when a PWB is set in the TBS; adopting the same design parameters along the full-length PWB on the TBTI is unreasonable; the PWB height and porosity in the TBS must be increased and reduced more than 33%, respectively, to achieve equivalent windproof performance. The conclusions in this paper can provide a preliminary idea for the optimization design of the PWB on the TBTI.

This study evaluated tensile bond strength (TBS) between anterior acrylic teeth and denture bases made of high-impact heat-cured acrylic resin (HI PMMA) impregnated with zirconia nanoparticles. A total of 30 specimens (each specimen containing a set of six upper anterior teeth) were fabricated from HI PMMA denture base acrylic resin reinforced with different weight concentrations of zirconia nanoparticles: 0% (control), 1.5%, 3%, 5%, 7% and 10%. TBS was tested according to a British standard (BS EN ISO 22112: 2017). A one-way analysis of variance (ANOVA) was employed with a Tukey post-hoc test. TBS values between the anterior teeth (central and lateral incisors and canine) and HI-PMMA denture base groups containing 7 wt.% (261.5 ± 66.0 N, 172.5 ± 57.4 N and 271.9 ± 86.3 N) and 10 wt.% (332.1 ± 122.9 N, 165.4 ± 48.7 N and 301.6 ± 73.2 N) zirconia were significantly lower compared to the control group (645.4 ± 84.8 N, 306.1 ± 81.6 N and 496.7 ± 179.1 N) and the other nanocomposite groups. However, TBS values for HI PMMA with 1.5 wt.% (534.4 ± 115.3 N, 304.7 ± 86.4 N, 514.0 ± 143.2 N), 3 wt.% (685.7 ± 159.6 N, 281.1 ± 78.3 N, 462.6 ± 122.1 N) and 5 wt.% (514.5 ± 134.3 N, 229.8 ± 67.3 N, 387.2 ± 99.4 N) zirconia showed slightly lower values than that of the control group but these were not significant. Failure modes between the teeth and denture base nanocomposites were predominantly cohesive fractures, which were clinically acceptable according to the Standard. The addition of zirconia nanoparticles to HI PMMA denture base at high concentration (7 wt.% and 10 wt. %) significantly (p<0.05) reduced the bonding strength for all types of anterior teeth compared to the control group.

Air quality forecasting plays a pivotal role in environmental management, public health and urban planning. This research presents a comprehensive approach for forecasting the Air Quality Index (AQI). The proposed Time-Based-Spatial (TBS) forecasting framework is integrated with spatial and temporal information using machine learning techniques on data collected from a wide range of cities. The TBS employs Convolutional Neural Networks (CNNs) to capture spatial dependencies based on normalized latitude and longitude coordinates of the cities. Simultaneously, time series model, specifically the ARIMA (AutoRegressive Integrated Moving Average) was employed to capture temporal dependencies using pollutant concentration readings over time. The dataset included information such as date, time, pollutant concentrations and AQI was further preprocessed and divided into training and testing sets. The CNN was configured to utilize the normalized latitude and longitude grid, while the ARIMA model concurrently processed the pollutant concentrations. The model was trained on the training dataset, and a 6 hour forecast is generated for each test instance. The outcomes demonstrate the TBS model’s ability to accurately predict AQI values. The integration of CNNs and time series model allowed for an clearer and deeper understanding of geographical and pollutant concentration factors that contribute to air quality variations.

Purpose Bone is one of the main targets of hormones and endocrine diseases are frequent causes of secondary osteoporosis and fractures in real-world clinical practice. However, diagnosis of skeletal fragility and prediction of fractures in this setting could be a challenge, since the skeletal alterations induced by endocrine disorders are not generally captured by dual-energy X-ray absorptiometry (DXA) measurement of bone mineral density (BMD), that is the gold standard for diagnosis of osteoporosis in the general population. The aim of this paper is to review the existing evidence related to bone quality features in endocrine diseases, proposing assessment with new techniques in the future. Methods A comprehensive search within electronic databases was performed to collect reports of bone quality in primary hyperparathyroidism, hypoparathyroidism, hyperthyroidism, hypercortisolism, growth hormone deficiency, acromegaly, male hypogonadism and diabetes mellitus. Results Using invasive and non-invasive techniques, such as high-resolution peripheral quantitative computed tomography or DXA measurement of trabecular bone score (TBS), several studies consistently reported altered bone quality as predominant determinant of fragility fractures in subjects affected by chronic endocrine disorders. Conclusions Assessment of skeletal fragility in endocrine diseases might take advantage from the use of techniques to detect perturbation in bone architecture with the aim of best identifying patients at high risk of fractures.

Theta burst stimulation (TBS) is associated with the modulation of a range of clinical, cognitive, and behavioural outcomes, but specific neurobiological effects remain somewhat unclear. This systematic literature review investigated resting-state and task-based functional magnetic resonance imaging (fMRI) outcomes post-TBS in healthy human adults. Fifty studies that applied either continuous—or intermittent—(c/i) TBS, and adopted a pretest–posttest or sham-controlled design, were included. For resting-state outcomes following stimulation applied to motor, temporal, parietal, occipital, or cerebellar regions, functional connectivity generally decreased in response to cTBS and increased in response to iTBS, though there were some exceptions to this pattern of response. These findings are mostly consistent with the assumed long-term depression (LTD)/long-term potentiation (LTP)-like plasticity effects of cTBS and iTBS, respectively. Task-related outcomes following TBS were more variable. TBS applied to the prefrontal cortex, irrespective of task or state, also produced more variable responses, with no consistent patterns emerging. Individual participant and methodological factors are likely to contribute to the variability in responses to TBS. Future studies assessing the effects of TBS via fMRI must account for factors known to affect the TBS outcomes, both at the level of individual participants and of research methodology.

Temperature is a pivotal factor influencing the progression of the decomposition process of a human cadaver and thus its post-mortem changes. In cases of advanced decomposition, various problems arise in routine forensic work, such as difficulties in estimating the time or cause of death. To understand and evaluate the impact of temperature and other related factors on the progression of post-mortem changes between the post-mortem examination and autopsy, 135 dead bodies with different post-mortem intervals (PMI) and varying storage times between discovery and autopsy were examined. The Total Decomposition Score (TDS) and the Total Body Score (TBS) were used to assess and compare the post-mortem changes, while continuous temperature measurements were taken inside the body bags throughout the cooling phase. It was found that the most important factors leading to an increased progression of the post-mortem changes were a high initial body temperature, few post-mortem changes (low TDS/TBS scores) present at the beginning of the cooling period, insect infestation of a body, and a prolonged duration of the storage period. The establishment of uniform standards for the cooling of bodies in Germany, as well as the recognition and appropriate treatment of cases with an increased risk of rapid progression of the post-mortem changes during the cooling period, has the potential to improve the preservation of forensic evidence.