Miracle-dz/UniFAR-FTUs huggingface dataset:
Three-Dimensional Analysis of the Cement Mantle in Total Hip Arthroplasty

Cemented fixation of the femoral stem is the gold standard for patients older than 60 years. The importance of reliably achieving an adequate cement mantle has been shown in many studies. Currently, inspection and grading of plain radiographs is the accepted method for study of the cement mantle. However, the reliability of plain radiographs for this purpose has been questioned. In addition, the interobserver agreement of current grading systems has been shown to be limited. A new in vitro method of cement mantle analysis is described. Plastic replicas of six contemporary stems were implanted into femurs from cadavers. The specimens were imaged with a computed tomography scanner. Detailed, computer-assisted analysis of mantle thickness was done. Comparisons were made between designs. A subset was compared with standard radiographs. Plain radiographs overestimated thickness and underestimated the deficiencies. There was significant variability in the mantle produced by the different designs. Commonly used designs had deficiencies in their mantles by standard criteria despite proper surgical technique. The importance of being fully acquainted with the particular implant one uses is emphasized by these results. This is a valuable technique for investigation of the effects on the cement mantle of implant design, surgical technique, and patient anatomy.
Predictors of posttraumatic deep vein thrombosis (DVT): hospital practice versus patient factors-an analysis of the National Trauma Data Bank (NTDB).

OBJECTIVE Trauma centers that perform more duplex ultrasounds report more deep vein thromboses (DVT). However, it is uncertain if this is due to variations in hospital practices or patient characteristics and case mix. We hypothesize that admission to trauma centers that use duplex ultrasound more frequently, independently predicts DVT reporting for individual patients, controlling for patient-level risk factors. METHODS We analyzed patients from trauma centers reporting at least one vascular ultrasound and one DVT to the National Trauma Data Bank (v6.2). Because National Trauma Data Bank contains no data on hospital duplex surveillance practice, we defined "screening" trauma centers as those performing ultrasound on more than 2% of patients. The primary outcome measure was DVT diagnosis. Multiple logistic regression was performed, using patient-level risk factor covariates as well as hospital duplex rate to compare patients at "screening" versus "non-screening" trauma centers. Sensitivity analysis was performed by varying duplex rate cutoff, outcome measure, and patient population. RESULTS Approximately half of 492,496 patients were admitted to "screening" trauma centers. Unadjusted DVT rate was threefold higher in "screening" trauma center patients (1.18% vs. 0.35%, p < 0.001). Age > or = 40 years, extremity injury, head injury, ventilator days > or = 3, venous injury and major surgery were independently associated with DVT diagnosis. "Screening" trauma center admission was independently associated with a higher likelihood of DVT reporting (odds ratio, 2.16; 95% confidence interval, 1.07-4.34). No qualitative differences were identified on sensitivity analyses. CONCLUSIONS Trauma center ultrasound practice is an independent predictor of DVT diagnosis for individual patients, controlling for patient-level risk factors. Elevated DVT rates at these centers are due to surveillance bias. In the absence of standardized surveillance, hospital DVT rate is an inappropriate quality of care measure after trauma.
Brain-actuated gait trainer with visual and proprioceptive feedback

Objective. Brain-machine interfaces (BMIs) have been proposed in closed-loop applications for neuromodulation and neurorehabilitation. This study describes the impact of different feedback modalities on the performance of an EEG-based BMI that decodes motor imagery (MI) of leg flexion and extension. Approach. We executed experiments in a lower-limb gait trainer (the legoPress) where nine able-bodied subjects participated in three consecutive sessions based on a crossover design. A random forest classifier was trained from the offline session and tested online with visual and proprioceptive feedback, respectively. Post-hoc classification was conducted to assess the impact of feedback modalities and learning effect (an improvement over time) on the simulated trial-based performance. Finally, we performed feature analysis to investigate the discriminant power and brain pattern modulations across the subjects. Main results. (i) For real-time classification, the average accuracy was 62.33±4.95% and 63.89±6.41% for the two online sessions. The results were significantly higher than chance level, demonstrating the feasibility to distinguish between MI of leg extension and flexion. (ii) For post-hoc classification, the performance with proprioceptive feedback (69.45±9.95%) was significantly better than with visual feedback (62.89±9.20%), while there was no significant learning effect. (iii) We reported individual discriminate features and brain patterns associated to each feedback modality, which exhibited differences between the two modalities although no general conclusion can be drawn. Significance. The study reported a closed-loop brain-controlled gait trainer, as a proof of concept for neurorehabilitation devices. We reported the feasibility of decoding lower-limb movement in an intuitive and natural way. As far as we know, this is the first online study discussing the role of feedback modalities in lower-limb MI decoding. Our results suggest that proprioceptive feedback has an advantage over visual feedback, which could be used to improve robot-assisted strategies for motor training and functional recovery.
A review and experimental study on the application of classifiers and evolutionary algorithms in EEG-based brain–machine interface systems

Objective. Considering the importance and the near-future development of noninvasive brain–machine interface (BMI) systems, this paper presents a comprehensive theoretical–experimental survey on the classification and evolutionary methods for BMI-based systems in which EEG signals are used. Approach. The paper is divided into two main parts. In the first part, a wide range of different types of the base and combinatorial classifiers including boosting and bagging classifiers and evolutionary algorithms are reviewed and investigated. In the second part, these classifiers and evolutionary algorithms are assessed and compared based on two types of relatively widely used BMI systems, sensory motor rhythm-BMI and event-related potentials-BMI. Moreover, in the second part, some of the improved evolutionary algorithms as well as bi-objective algorithms are experimentally assessed and compared. Main results. In this study two databases are used, and cross-validation accuracy (CVA) and stability to data volume (SDV) are considered as the evaluation criteria for the classifiers. According to the experimental results on both databases, regarding the base classifiers, linear discriminant analysis and support vector machines with respect to CVA evaluation metric, and naive Bayes with respect to SDV demonstrated the best performances. Among the combinatorial classifiers, four classifiers, Bagg-DT (bagging decision tree), LogitBoost, and GentleBoost with respect to CVA, and Bagging-LR (bagging logistic regression) and AdaBoost (adaptive boosting) with respect to SDV had the best performances. Finally, regarding the evolutionary algorithms, single-objective invasive weed optimization (IWO) and bi-objective nondominated sorting IWO algorithms demonstrated the best performances. Significance. We present a general survey on the base and the combinatorial classification methods for EEG signals (sensory motor rhythm and event-related potentials) as well as their optimization methods through the evolutionary algorithms. In addition, experimental and statistical significance tests are carried out to study the applicability and effectiveness of the reviewed methods.
Process-specific analysis in episodic memory retrieval using fast optical signals and hemodynamic signals in the right prefrontal cortex

Objective. Memory is formed by the interaction of various brain functions at the item and task level. Revealing individual and combined effects of item- and task-related processes on retrieving episodic memory is an unsolved problem because of limitations in existing neuroimaging techniques. To investigate these issues, we analyze fast and slow optical signals measured from a custom-built continuous wave functional near-infrared spectroscopy (CW-fNIRS) system. Approach. In our work, we visually encode the words to the subjects and let them recall the words after a short rest. The hemodynamic responses evoked by the episodic memory are compared with those evoked by the semantic memory in retrieval blocks. In the fast optical signal, we compare the effects of old and new items (previously seen and not seen) to investigate the item-related process in episodic memory. The Kalman filter is simultaneously applied to slow and fast optical signals in different time windows. Main results. A significant task-related HbR decrease was observed in the episodic memory retrieval blocks. Mean amplitude and peak latency of a fast optical signal are dependent upon item types and reaction time, respectively. Moreover, task-related hemodynamic and item-related fast optical responses are correlated in the right prefrontal cortex. Significance. We demonstrate that episodic memory is retrieved from the right frontal area by a functional connectivity between the maintained mental state through retrieval and item-related transient activity. To the best of our knowledge, this demonstration of functional NIRS research is the first to examine the relationship between item- and task-related memory processes in the prefrontal area using single modality.
Preinjury warfarin worsens outcome in elderly patients who fall from standing.

INTRODUCTION Fall from standing (FFS) has become one of the most common mechanisms of injury for admission to the trauma center in the elderly population. Many of these patients present anticoagulated with warfarin. This two-center study was designed to examine the effects of preinjury warfarin use on outcome in the elderly. METHODS A retrospective review of prospectively collected registry data at two Level I trauma centers was conducted from 2003 to 2006. The study population included patients age > or = 65 admitted to the trauma center after an FFS. These centers are relatively close geographically and have similar patient demographics. Data collected included: age, Injury Severity Score, Abbreviated Injury Score (AIS) for head, mortality, admission Glasgow Coma Score, and admission international normalized ratio (INR). Patients were divided into two groups based on the preinjury condition of warfarin use. Statistical differences were determined by unpaired t test for continuous variables and chi and odds ratios (ORs) for dichotomous variables. RESULTS Of the 27,812 patients admitted to these two trauma centers over this time period, 2,791 (10.0%) were of age > or = 65 and admitted after an FFS. INR was 2.8 +/- 1.1 in warfarin group (+warf). The number of patients with AIS head 4 and 5 was similar between groups (-warf 22.1%, +warf 25.9%). Overall, preinjury warfarin use had a negative effect on the in-hospital mortality rate, +warf 8.6% and -warf 5.7% (OR 1.54, 1.09-2.19, p = 0.015). There was no difference in mortality between groups in patients with an AIS head < 4. The negative impact of preinjury warfarin use on mortality was most pronounced in patients with an AIS head 4 and 5 who presented awake (Glasgow Coma Score 14 and 15), +warf 13.5% and -warf 6.4% (OR 2.30, 95% confidence interval 1.12-4.70, p = 0.019). CONCLUSION Preinjury warfarin use has an adverse effect on outcome (mortality) in elderly FFS patients. Importantly, this effect is most prominent in patients admitted awake with significant findings on computed tomography scan. This argues for rapid emergency department triage to computed tomography scan and rapid INR correction in this population.
Superior arm-movement decoding from cortex with a new, unsupervised-learning algorithm

Objective. The aim of this work is to improve the state of the art for motor-control with a brain–machine interface (BMI). BMIs use neurological recording devices and decoding algorithms to transform brain activity directly into real-time control of a machine, archetypically a robotic arm or a cursor. The standard procedure treats neural activity—vectors of spike counts in small temporal windows—as noisy observations of the kinematic state (position, velocity, acceleration) of the fingertip. Inferring the state from the observations then takes the form of a dynamical filter, typically some variant on Kalman’s (KF). The KF, however, although fairly robust in practice, is optimal only when the relationships between variables are linear and the noise is Gaussian, conditions usually violated in practice. Approach. To overcome these limitations we introduce a new filter, the ‘recurrent exponential-family harmonium’ (rEFH), that models the spike counts explicitly as Poisson-distributed, and allows for arbitrary nonlinear dynamics and observation models. Furthermore, the model underlying the filter is acquired through unsupervised learning, which allows temporal correlations in spike counts to be explained by latent dynamics that do not necessarily correspond to the kinematic state of the fingertip. Main results. We test the rEFH on offline reconstruction of the kinematics of reaches in the plane. The rEFH outperforms the standard, as well as three other state-of-the-art, decoders, across three monkeys, two different tasks, most kinematic variables, and a range of bin widths, amounts of training data, and numbers of neurons. Significance. Our algorithm establishes a new state of the art for offline decoding of reaches—in particular, for fingertip velocities, the variable used for control in most online decoders.
Early tracheostomy in intensive care unit: a retrospective study of 506 cases of video-guided Ciaglia Blue Rhino tracheostomies.

BACKGROUND Percutaneous dilatational tracheostomy (PDT) is a common procedure in critically ill patients, but the correct timing is still controversial. This study was designed to establish whether an early timing in video-guided Ciaglia Blue Rhino PDT affects the duration of mechanical ventilation (MV) and the length of stay (LOS) in intensive care unit (ICU). Secondary clinical outcomes were the overall hospitalization duration and the mortality rate. METHODS A retrospective, single-center study of 2,210 patients admitted to the ICU of the Emergency Department of the Careggi Teaching Hospital (Florence, Italy) between 2002 and 2007. Among the 506 patients who underwent PDT, 256 and 250 patients were retrospectively assigned to the early tracheostomy (ET) or late tracheostomy (LT) group according to whether the procedure was performed before (ET) or after (LT) 3 days of MV (median time of procedure execution). RESULTS The two groups of patients showed comparable demographic and clinical characteristics. The video-guided PDT procedures were performed without major complications in all cases. The average timing of tracheostomy in the ET group was 1.9 +/- 0.9 days, whereas in LT group resulted 6.8 +/- 3.8 days (mean +/- SD). Total hospital LOS and mortality rate were not different between the two groups. However, the duration of MV days and of ICU LOS group were significantly shorter in the ET group (13.3 +/- 9.6 and 16.9 +/- 13.0 days, respectively; p = 0.0001) than in the LT group (16.7 +/- 8.3 days and 20.8 +/- 9.2 days, respectively; p < 0.0001). Stratified analysis by the three major ICU admission diagnosis confirmed that both traumatized and nontraumatized (medical and postsurgical) ET patients had a shorter MV duration and ICU LOS as compared with LT patients. CONCLUSIONS Video-guided Ciaglia Blue Rhino PDT is safe and easy to perform in ICU. No difference in overall hospital LOS, incidence of pneumonia, and mortality rate between the ET and LT groups was found. However, in both traumatized and nontraumatized patients, shortened duration of ICU LOS and MV in the ET group (<or=3 days) indicates this procedure as a useful approach for patients and healthcare system.
Farewell to life on land – thoracic strength as a new indicator to determine paleoecology in secondary aquatic mammals

Habitat shifts from land to water have occurred independently in several mammal lineages. However, because we do not know completely about the relationship between skeletal morphology and function, both reliable life reconstructions of each extinct taxon and the timing of those shifts in locomotor strategies are yet to be fully understood. We estimated the strengths of rib cages against vertical compression in 26 extant and four extinct mammal specimens including cetartiodactyls, paenungulates, and carnivorans, representing 11 terrestrial, six semi‐aquatic, and nine obligate aquatic taxa. Our analyses of extant taxa showed that strengths were high among terrestrial/semi‐aquatic mammals, whose rib cages are subjected to vertical compression during the support on land, whereas strengths were low among obligate aquatic mammals, whose rib cages are not subjected to antigravity force in the water. We therefore propose rib strength as a new index to estimate the ability of an animal to be supported on land while being supported by either the forelimbs or thoracic region. According to our analyses of extinct taxa, this ability to be supported on land was rejected for a basal cetacean (Cetartiodactyla: Ambulocetus) and two desmostylians (Paenungulata: Paleoparadoxia and Neoparadoxia). However, this ability was not rejected for one desmostylian species (Desmostylus). Further study of the ribs of extant/extinct semi‐aquatic taxa may help in understanding the ecological shifts in these groups.
Innervation of taste buds revealed with Brainbow‐labeling in mouse

Nerve fibers that surround and innervate the taste bud were visualized with inherent fluorescence using Brainbow transgenic mice that were generated by mating the founder line L with nestin‐cre mice. Multicolor fluorescence revealed perigemmal fibers as branched within the non‐taste epithelium and ending in clusters of multiple rounded swellings surrounding the taste pore. Brainbow‐labeling also revealed the morphology and branching pattern of single intragemmal fibers. These taste bud fibers frequently innervated both the peripheral bud, where immature gemmal cells are located, and the central bud, where mature, differentiated cells are located. The fibers typically bore preterminal and terminal swellings, growth cones with filopodia, swellings, and rounded retraction bulbs. These results establish an anatomical substrate for taste nerve fibers to contact and remodel among receptor cells at all stages of their differentiation, an interpretation that was supported by staining with GAP‐43, a marker for growing fibers and growth cones.
Is the "seat belt sign" associated with serious abdominal injuries in pediatric trauma?

BACKGROUND The "seat belt sign" (SBS) has been reported to be highly associated with intra-abdominal injury. This study defines its predictive value in identifying injuries in a large pediatric trauma population. METHODS At a level I pediatric trauma center, we performed a retrospective review of trauma flow sheets for all motor vehicle crash victims (ages, 0-20) requiring trauma team activation during 2005 and 2006. All patients with an abdominal SBS recorded were included in the analysis. RESULTS Of 331 patients (mean age, 9.96 years), an SBS was present in 54 (16%) of these children. Abdominal injury was identified by computed tomography scan or intraoperatively in 12 (22%) of these children. Three (6%) children with SBS required operative intervention. Two had a bowel injuries and one had a negative laparoscopy. SBS and abdominal tenderness were reported in 30 (56%) patients; 8 (15%) of whom sustained abdominal injury. Of the 277 (84%) children without SBS, 36 (13%) had abdominal injuries. Four (11%) of these had a positive laparotomy with three having a bowel injuries. The relative risk of an abdominal injury given an SBS was 1.7 (CI 0.96-2.69; p = 0.078). Four (1.4%) children without SBS died of head injuries compared with zero with SBS. The SBS had a sensitivity of 25% and a specificity of 85%. CONCLUSIONS The SBS was not significantly associated with abdominal injury in our population. Patients without SBS had a higher Injury Severity Score and accounted for all of the deaths. SBS may not be as predictive of abdominal injury as previously reported.
On the prenatal initiation of T cell development in the opossum Monodelphis domestica

Thymus‐dependent lymphocytes (T cells) are a critical cell lineage in the adaptive immune system of all jawed vertebrates. In eutherian mammals the initiation of T cell development takes place prenatally and the offspring of many species are born relatively immuno‐competent. Marsupials, in contrast, are born in a comparatively altricial state and with a less well developed immune system. As such, marsupials are valuable models for studying the peri‐ and postnatal initiation of immune system development in mammals. Previous results supported a lack of prenatal T cell development in a variety of marsupial species. In the gray short‐tailed opossum, Monodelphis domestica, however, there was evidence that αβT cells were present on postnatal day 1 and likely initiated development prenatally. Demonstrated here is the presence of CD3ε+ lymphocytes in late‐stage embryos at a site in the upper thoracic cavity, the site of an early developing thymus. CD3ε+ cells were evident as early as 48 h prior to parturition. In day 14 embryos, where there is clear organogenesis, CD3ε+ cells were only found at the site of the early thymus, consistent with no extra‐thymic sites of T cell development in the opossum. These observations are the first evidence of prenatal T cell lineage commitment in any marsupial.