bluuebunny/crossref_metadata_2025 huggingface dataset:
Flow Index accurately identifies breaths with low or high inspiratory effort during pressure support ventilation
Authors: Albani Filippo , Fusina Federica , Ciabatti Gianni , Pisani Luigi , Lippolis Valeria , Franceschetti Maria Elena , Giovannini Alessia , di Mussi Rossella , Murgolo Francesco , Rosano Antonio , Grasso Salvatore , Natalini Giuseppe
Published: December 2021

Background

Flow Index, a numerical expression of the shape of the inspiratory flow-time waveform recorded during pressure support ventilation, is associated with patient inspiratory effort. The aim of this study was to assess the accuracy of Flow Index in detecting high or low inspiratory effort during pressure support ventilation and to establish cutoff values for the Flow index to identify these conditions. The secondary aim was to compare the performance of Flow index,of breathing pattern parameters and of airway occlusion pressure (P0.1) in detecting high or low inspiratory effort during pressure support ventilation.

Methods

Data from 24 subjects was included in the analysis, accounting for a total of 702 breaths. Breaths with high inspiratory effort were defined by a pressure developed by inspiratory muscles (Pmusc) greater than 10 cmH2O while breaths with low inspiratory effort were defined by a Pmusc lower than 5 cmH2O. The areas under the receiver operating characteristic curves of Flow Index and respiratory rate, tidal volume,respiratory rate over tidal volume and P0.1 were analyzed and compared to identify breaths with low or high inspiratory effort.

Results

Pmusc, P0.1, Pressure Time Product and Flow Index differed between breaths with high, low and intermediate inspiratory effort, while RR, RR/VT and VT/kg of IBW did not differ in a statistically significant way. A Flow index higher than 4.5 identified breaths with high inspiratory effort [AUC 0.89 (CI 95% 0.85–0.93)], a Flow Index lower than 2.6 identified breaths with low inspiratory effort [AUC 0.80 (CI 95% 0.76–0.83)].

Conclusions

Flow Index is accurate in detecting high and low spontaneous inspiratory effort during pressure support ventilation.
A benchmark of structural variation detection by long reads through a realistic simulated model
Authors: Dierckxsens Nicolas , Li Tong , Vermeesch Joris R. , Xie Zhi
Published: December 2021

Accurate simulations of structural variation distributions and sequencing data are crucial for the development and benchmarking of new tools. We develop Sim-it, a straightforward tool for the simulation of both structural variation and long-read data. These simulations from Sim-it reveal the strengths and weaknesses for current available structural variation callers and long-read sequencing platforms. With these findings, we develop a new method (combiSV) that can combine the results from structural variation callers into a superior call set with increased recall and precision, which is also observed for the latest structural variation benchmark set developed by the GIAB Consortium.
Efficacy of denosumab therapy for a 12-year-old female patient with Williams syndrome with osteoporosis and history of fractures: a case report
Authors: Uehara Masashi , Nakamura Yukio , Suzuki Takako , Sakai Noriko , Takahashi Jun
Published: December 2021

Background

A decrease in bone mineral density is common in patients with Williams syndrome. However, appropriate management for osteoporosis in Williams syndrome patients has not been established. We report the case of a 12-year-old female patient with Williams syndrome, who underwent denosumab treatment for osteoporosis.

Case presentation

A 12-year-old Japanese female patient with Williams syndrome was shown to have very low bone mineral density. Bone mineral density was evaluated before treatment and at 5, 9, 17, 23, and 29 months of treatment by dual-energy X-ray absorptiometry. After denosumab therapy for 29 months, lumbar and total hip bone mineral density values had increased by 51.6% and 37.6%, respectively. No new fractures occurred during the observation period.

Conclusions

To the best of our knowledge, this is the first experience with denosumab treatment in Williams syndrome patients with osteoporosis. Based on our findings, denosumab may be an effective treatment option for Williams syndrome patients with osteoporosis.
Machine learning concepts for correlated Big Data privacy
Authors: Biswas Sreemoyee , Khare Nilay , Agrawal Pragati , Jain Priyank
Published: December 2021

With data becoming a salient asset worldwide, dependence amongst data kept on growing. Hence the real-world datasets that one works upon in today’s time are highly correlated. Since the past few years, researchers have given attention to this aspect of data privacy and found a correlation among data. The existing data privacy guarantees cannot assure the expected data privacy algorithms. The privacy guarantees provided by existing algorithms were enough when there existed no relation between data in the datasets. Hence, by keeping the existence of data correlation into account, there is a dire need to reconsider the privacy algorithms. Some of the research has considered utilizing a well-known machine learning concept, i.e., Data Correlation Analysis, to understand the relationship between data in a better way. This concept has given some promising results as well. Though it is still concise, the researchers did a considerable amount of research on correlated data privacy. Researchers have provided solutions using probabilistic models, behavioral analysis, sensitivity analysis, information theory models, statistical correlation analysis, exhaustive combination analysis, temporal privacy leakages, and weighted hierarchical graphs. Nevertheless, researchers are doing work upon the real-world datasets that are often large (technologically termed big data) and house a high amount of data correlation. Firstly, the data correlation in big data must be studied. Researchers are exploring different analysis techniques to find the best suitable. Then, they might suggest a measure to guarantee privacy for correlated big data. This survey paper presents a detailed survey of the methods proposed by different researchers to deal with the problem of correlated data privacy and correlated big data privacy and highlights the future scope in this area. The quantitative analysis of the reviewed articles suggests that data correlation is a significant threat to data privacy. This threat further gets magnified with big data. While considering and analyzing data correlation, then parameters such as Maximum queries executed, Mean average error values show better results when compared with other methods. Hence, there is a grave need to understand and propose solutions for correlated big data privacy.
Development of an exercise programme for balance abilities in people with multiple sclerosis: a development of concept study using Rasch analysis
Authors: Sattelmayer Karl Martin , Chevalley Odile , Kool Jan , Wiskerke Evelyne , Denkinger Lina Nilsson , Giacomino Katia , Opsommer Emmanuelle , Hilfiker Roger
Published: December 2021

Background

People with multiple sclerosis (PwMS) frequently have impaired balance from an early stage of the disease. Balance difficulties can be divided into categories; although, to date, these lack scientific foundation. Impaired balance in PwMS can be addressed using specific and challenging exercises. Such exercises should provide an optimal challenge point; however, the difficulty of balance exercises is often unknown, making it difficult to target the exercises to an individual’s abilities.

The aims of this study were: to develop an exercise programme for PwMS relating the exercises to the balance problem categories; to establish the order of difficulty of exercises in each category and; to evaluate the content and structural validity of the exercise programme.

Methods

A “construct map” approach was used to design and develop an exercise programme for PwMS. Potentially relevant balance exercises were identified, then a framework was set up, comprising four dimensions (subsequently reduced to three dimensions) of balance exercises. The relevance, comprehensibility, and comprehensiveness of the exercise programme were rated by 13 physiotherapists, who also linked 19 key exercises to balance categories. A total of 65 PwMS performed the 19 balance exercises, rated their difficulty and commented on the relevance and comprehensibility of each exercise. A Rasch model was used to evaluate the relative difficulty of the exercises. To assess fit of the data to the Rasch model a rating scale model was used, which is a unidimensional latent trait model for polytomous item responses.

Results

Evaluation by the physiotherapists and PwMS indicated that the content validity of the exercise programme was adequate. Rasch analysis showed that the latent trait “balance exercises in PwMS” comprised three subdimensions (“stable BOS”, “sway” and “step and walk”). The 19 balance exercises showed adequate fit to the respective dimensions. The difficulties of the balance exercises were adequate to cover the ability spectrum of the PwMS.

Conclusion

A balance exercise programme for PwMS comprising three dimensions of balance exercises was developed. Difficulty estimates have been established for each of the exercises, which can be used for targeted balance training. Content and structural validity of the programme was adequate.
Broad external validation of a multivariable risk prediction model for gastrointestinal malignancy in iron deficiency anaemia
Authors: Almilaji Orouba , Webb Gwilym , Maynard Alec , Chapman Thomas P. , Shine Brian S. F. , Ellis Antony J. , Hebden John , Docherty Sharon , Williams Elizabeth J. , Snook Jonathon
Published: December 2021

Background

Using two large datasets from Dorset, we previously reported an internally validated multivariable risk model for predicting the risk of GI malignancy in IDA—the IDIOM score. The aim of this retrospective observational study was to validate the IDIOM model using two independent external datasets.

Methods

The external validation datasets were collected, in a secondary care setting, by different investigators from cohorts in Oxford and Sheffield derived under different circumstances, comprising 1117 and 474 patients with confirmed IDA respectively. The data were anonymised prior to analysis. The predictive performance of the original model was evaluated by estimating measures of calibration, discrimination and clinical utility using the validation datasets.

Results

The discrimination of the original model using the external validation data was 70% (95% CI 65, 75) for the Oxford dataset and 70% (95% CI 61, 79) for the Sheffield dataset. The analysis of mean, weak, flexible and across the risk groups’ calibration showed no tendency for under or over-estimated risks in the combined validation data. Decision curve analysis demonstrated the clinical value of the IDIOM model with a net benefit that is higher than ‘investigate all’ and ‘investigate no-one’ strategies up to a threshold of 18% in the combined validation data, using a risk cut-off of around 1.2% to categorise patients into the very low risk group showed that none of the patients stratified in this risk group proved to have GI cancer on investigation in the validation datasets.

Conclusion

This external validation exercise has shown promising results for the IDIOM model in predicting the risk of underlying GI malignancy in independent IDA datasets collected in different clinical settings.
Compatibility of entomopathogenic nematodes with insecticides against the cabbage white butterfly, Pieris rapae L. (Lepidoptera: Pieridae)
Authors: Aioub Ahmed A. A. , El-Ashry Ramadan M. , Hashem Ahmed S. , Elesawy Ahmed E. , Elsobki Ahmed E. A.
Published: December 2021

Background

Compatibility of entomopathogenic nematodes (EPNs) with insecticides is a crucial mainstay of integrated pest management (IPM) programs. This study was designed to evaluate the joint action of EPN species and insecticides when employed to deter 3rd and 4th larval instars of cabbage white butterfly, Pieris rapae L. (Lepidoptera: Pieridae) under laboratory conditions. EPNs [Steinernema carpocapsae (All strain), S. feltiae (Filipjev), Heterorhabditis bacteriophora (HP88), and H. bacteriophora (Ar-4)], at concentrations of 50, 100, and 125 IJs/larva, were tested with 3 insecticides (lambda-cyhalothrin, emamectin benzoate, and indoxacarb) at LC25 and LC50 values. Additionally, expression profiles of 2 detoxification genes (CYP6AE120 and PrGSTs1) when the 4th instar larvae were treated by H. bacteriophora (HP88) and lambda-cyhalothrin were examined.

Results

Data indicated that statistically significant mortality of 2 larval instars of P. rapae was observed in vitro among EPN species and pesticide concentrations. At concentration of 50 IJs/larva, LT50 values were 2.385 and 3.92 days for S. carpocapsae (All strain) and H. bacteriophora(Ar-4), respectively, on 3rd instar larvae; also, these values were 3.506 and 3.107 days for S. feltiae and H. bacteriophora (Ar-4), respectively, on 4th instar larvae Lambda-cyhalothrin was the most toxic insecticide, followed by emamectin benzoate and indoxacarb at LC25 and LC50, respectively. An additive effect was observed between EPN species with LC25 and LC50 of the tested insecticides, except for lambda-cyhalothrin at LC50 with H. bacteriophora (Ar-4), and indoxacarb, with all EPNs showing antagonistic effects on mortality of 3rd instar larvae after 3 days post-treatment. The interaction between the tested pesticides at LC25 and LC50 and EPN species, showed an additive effect, excluding lambda-cyhalothrin at LC25 with S. carpocapsae (All strain) and LC25 of indoxacarb with H. bacteriophora (Ar-4), which showed potentiation effects. The interaction of S. feltiae (Filipjev) with tested insecticides at LC50 exhibited an antagonistic effect on the mortality of 4th instar P. rapae larvae after 3 days post-treatment. The expression of both CYP6AE120 and PrGSTs1 was significantly up-regulated with lambda-cyhalothrin, followed by H. bacteriophora (HP88) compared to control.

Conclusions

The findings suggested that combining EPNs and the pesticide concentrations can be a practical strategy for managing P. rapae and could pave the way to using new control technologies in protecting organic farm vegetables from lepidopteran pests.
Distribution, diversity and abundance of some insects around a telecommunication mast in Ilorin, Kwara State, Nigeria
Authors: Adelaja Olukayode James , Ande Adeolu Taiwo , Abdulraheem Gafar Deji , Oluwakorode Isaac Ayanfe , Oladipo Olushola Abel , Oluwajobi Ayoola Olusegun
Published: December 2021

Background

The preponderant use of wireless telecommunication in the twenty-first century has enabled ease and efficient communication and a pervasive occurrence of electromagnetic fields (EMFs) that has significantly impacted the ecosystem. This study looks at the effect of radiations from wireless telecommunication EMF on the distribution, diversity and abundance of some insects in Nigeria. The study was undertaken in Ilorin, Kwara State, which is located in the Guinea Savannah belt of Nigeria. The chosen choice of study area was one with a telecommunication mast devoid of residential and human interference within a 10 km radius. Five sampling stations were selected around the mast and a control station. EMR intensity levels and pollinating insect number were monitored daily for 22 weeks using an acoustimeter and malaise traps. Collected insects were identified morphologically using appropriate keys.

Results

The mean electromagnetic radiation (EMR) intensity was significantly (P < 0.05) highest (1.58 ± 1.52 V/m) at sampling station B, and there was an increase in EMR intensity as the radius reduced around the mast. A total of 1878 insects were recovered from the study with the dominant species in terms of abundance of insects collected from the study being Musca domestica (0.39) followed by Apis mellifera (0.31) and Locusta migratoria (0.30), while the least dominant species Tetramorium caespitum (0.23).

Conclusions

Indeed, EMR intensity has an effect on the distribution, diversity and abundance of insects and there is a need to reduce the number of masts in use in the environment by encouraging telecommunication service providers to jointly use the same mast in an area for broadcast.
A deeper exploration of the relation between sulfonation degree and retanning performance of aromatic syntans
Authors: Sun Qingyong , Zeng Yunhang , Wang Ya-nan , Yu Yue , Shi Bi
Published: December 2021

It is well-known that the sulfonation degree (DS) of aromatic syntan is an important factor affecting its retanning performances. But the quantitative relation between DS and syntan property and the influencing mechanism of DS on syntan property are not clarified. In this work, five phenolic formaldehyde syntans (PFSs) with the same polymerization degree but varying DS were prepared to investigate the effect of DS on the properties of syntan and crust leather. It was found that the absolute value of zeta potential and the particle size of PFS decreased with increasing DS in aqueous solution. Molecular dynamic simulation results proved that the DS of PFS was a major contributor to electrostatic interaction and hydrogen bonding in the PFS–water system and greatly affected the aggregation and dispersion of PFS in aqueous solution. The PFS with a low DS was prone to aggregate to large particles in aqueous solution because of low intermolecular electrostatic repulsion and less hydrogen bonds and therefore can be used to increase the thickness and tightness of leather. The PFS with a high DS presented a small particle size with more anionic groups in aqueous solution, thereby sharply decreasing the positive charge of leather surface and facilitating the penetration of the post-tanning agents into the leather. These results might be scientifically valid for rational molecular design of syntans and more productive use of syntans in leather making.

Graphical Abstract
Sweet sorghum for phytoremediation and bioethanol production
Authors: Xiao Ming-Zhao , Sun Qian , Hong Si , Chen Wei-Jing , Pang Bo , Du Zhi-Yan , Yang Wen-Bin , Sun Zhuohua , Yuan Tong-Qi
Published: December 2021

As an energy crop, sweet sorghum (Sorghum bicolor (L.) Moench) receives increasing attention for phytoremediation and biofuels production due to its good stress tolerance and high biomass with low input requirements. Sweet sorghum possesses wide adaptability, which also has high tolerances to poor soil conditions and drought. Its rapid growth with the large storage of fermentable saccharides in the stalks offers considerable scope for bioethanol production. Additionally, sweet sorghum has heavy metal tolerance and the ability to remove cadmium (Cd) in particular. Therefore, sweet sorghum has great potential to build a sustainable phytoremediation system for Cd-polluted soil remediation and simultaneous ethanol production. To implement this strategy, further efforts are in demand for sweet sorghum in terms of screening superior varieties, improving phytoremediation capacity, and efficient bioethanol production. In this review, current research advances of sweet sorghum including agronomic requirements, phytoremediation of Cd pollution, bioethanol production, and breeding are discussed. Furthermore, crucial problems for future utilization of sweet sorghum stalks after phytoremediation are combed.

Graphical Abstract
Utility of transient elastography in evaluation and follow-up of Budd-Chiari syndrome patients after endovascular intervention
Authors: Ebada Hend Elsaied , Montasser Mohamed Fawzy , Barakat Eman Fathy , Abdelhakam Sara Mahmoud , Ghazy Mohamed Shaker , Elganzory Ahmed Talaat
Published: December 2021

Background

Liver stiffness measurement (LSM) using transient elastography (TE) is a common noninvasive method for assessing hepatic fibrosis. The purpose of this study was to show the utility of LSM in the evaluation and short-term follow-up of Budd-Chiarri syndrome (BCS) patients as well as to investigate the relationships between LSM, hepatic venous pressure, and liver fibrosis. We conducted a prospective cohort study in which 25 patients with a confirmed diagnosis of primary BCS underwent endovascular intervention for BCS treatment. All patients had pressure gradient changes across the stenosed hepatic veins/inferior vena cava (HV/IVC) measured before and after the procedure, a transvenous liver biopsy during the procedure, and LSM (using Transient Elastography 3 days before and 3 months after the intervention as a short-term follow-up). Comparisons and correlations were made between liver stiffness, hepatic venous pressure, and fibrosis.

Results

The HV/IVC pressure gradient measured immediately before and after the intervention had a direct proportionate correlation with the LS measured 3 days before and 3 months after the intervention (r = 0.41 & 0.44, p: 0.04 & 0.03, respectively). LSM drops significantly 3 months after intervention (from 51.62 ± 22 kPa to 28.80 ± 19.25 kPa (p: 0.001)). There is a significant improvement in LSM post-intervention among patients with moderate to severe fibrosis (METAVIR scores of ≥ F2 before intervention (p: 0.001).

Conclusions

LSM in BCS patients reflects congestion rather than fibrosis stage. TE can be used for the short-term monitoring of patients with BCS following the endovascular intervention as a noninvasive tool.
The oral-to-intravenous equianalgesic ratio of morphine based on plasma concentrations of morphine and metabolites in advanced cancer patients receiving chronic morphine treatment
Authors: Takahashi Masahiko , Ohara Takeshi , Yamanaka Hiroyuki , Shimada Akira , Nakaho Toshimichi , Yamamuro Makoto
Published: December 2021

To provide additional pharmacokinetic evidence for the oral-to-parenteral relative potency ratio of 1:2 to 1:3 for chronic morphine use in a palliative care setting, we determined the plasma concentrations of morphine and its major metabolites, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G), in hospitalized advanced cancer patients maintained on long-term oral or intravenous morphine. There were significant linear correlations between daily doses of morphine and plasma concentrations (molar base) of morphine, M3G and M6G for both routes of administration. The oral-to-intravenous relative ratios of the regression coefficients were 2.9 for morphine and 1.8 for morphine» / M6G. The morphine kinetic variables were not significantly influenced by any hepato-renal biochemical markers. These results support the commonly used oral-to-intravenous relative potency ratio of 1:2 to 1:3 in patients with cancer pain receiving chronic morphine treatment.
BRE12-158: A Postneoadjuvant, Randomized Phase II Trial of Personalized Therapy Versus Treatment of Physician's Choice for Patients With Residual Triple-Negative Breast Cancer
Authors: Schneider Bryan P. , Jiang Guanglong , Ballinger Tarah J. , Shen Fei , Chitambar Christopher , Nanda Rita , Falkson Carla , Lynce Filipa C. , Gallagher Christopher , Isaacs Claudine , Blaya Marcelo , Paplomata Elisavet , Walling Radhika , Daily Karen , Mahtani Reshma , Thompson Michael A. , Graham Robert , Cooper Maureen E. , Pavlick Dean C. , Albacker Lee A. , Gregg Jeffrey , Solzak Jeffrey P. , Chen Yu-Hsiang , Bales Casey L. , Cantor Erica , Hancock Bradley A. , Kassem Nawal , Helft Paul , O'Neil Bert , Storniolo Anna Maria V. , Badve Sunil , Miller Kathy D. , Radovich Milan
Published: December 2021

PURPOSE

Patients with triple-negative breast cancer (TNBC) with residual disease after neoadjuvant chemotherapy (NAC) have high risk of recurrence with prior data suggesting improved outcomes with capecitabine. Targeted agents have demonstrated activity across multiple cancer types. BRE12-158 was a phase II, multicenter trial that randomly allocated patients with TNBC with residual disease after NAC to genomically directed therapy versus treatment of physician choice (TPC).

PATIENTS AND METHODS

From March 2014 to December 2018, 193 patients were enrolled. Residual tumors were sequenced using a next-generation sequencing test. A molecular tumor board adjudicated all results. Patients were randomly allocated to four cycles of genomically directed therapy (arm A) versus TPC (arm B). Patients without a target were assigned to arm B. Primary end point was 2-year disease-free survival (DFS) among randomly assigned patients. Secondary/exploratory end points included distant disease-free survival, overall survival, toxicity assessment, time-based evolution of therapy, and drug-specific outcomes.

RESULTS

One hundred ninety-three patients were randomly allocated or were assigned to arm B. The estimated 2-year DFS for the randomized population only was 56.6% (95% CI, 0.45 to 0.70) for arm A versus 62.4% (95% CI, 0.52 to 0.75) for arm B. No difference was seen in DFS, distant disease-free survival, or overall survival for the entire or randomized populations. There was increased uptake of capecitabine for TPC over time. Patients randomly allocated later had less distant recurrences. Circulating tumor DNA status remained a significant predictor of outcome with some patients demonstrating clearance with postneoadjuvant therapy.

CONCLUSION

Genomically directed therapy was not superior to TPC for patients with residual TNBC after NAC. Capecitabine should remain the standard of care; however, the activity of other agents in this setting provides rationale for testing optimal combinations to improve outcomes. Circulating tumor DNA should be considered a standard covariate for trials in this setting.
Inequity in Adoption of Advanced Diabetes Technologies Among Medicare Fee-for-service Beneficiaries
Authors: Wherry Kael , Zhu Cyrus , Vigersky Robert A
Published: December 2021

Context

Health inequity is often associated with race-ethnicity.

Objective

To determine the prevalence of insulin pump therapy and continuous glucose monitoring (CGM) among Medicare beneficiaries with type 1 diabetes (T1D) by race-ethnicity, and to compare diabetes-related technology users with nonusers.

Design

The prevalence of technology use (pump, CGM) was determined by race-ethnicity for enrollees in coverage years (CY) 2017-2019 in the Medicare fee-for-service database. Using CY2019 data, technology users were compared with nonusers by race-ethnicity, sex, average age, Medicare eligibility criteria, and visit to an endocrinologist.

Setting

Community

Patients or Other Participants

Beneficiaries with T1D and at least 1 inpatient or 2 outpatient claims in a CY.

Intervention(s)

Pump or CGM therapy, visit to an endocrinologist.

Main Outcome Measure(s)

Diabetes-related technology use by race-ethnicity groups.

Results

Between 2017 and 2019, CGM and insulin pump use increased among all groups. Prevalence of insulin pump use was < 5% for Black and Other beneficiaries yet increased from 14% to 18% among White beneficiaries. In CY2019, 57% of White patients used a pump compared with 33.1% of Black and 30.3% of Other patients (P < 0.001). Black patients were more likely than White patients to be eligible because of disability/end-stage renal disease or to be Medicare/Medicaid eligible (both P < 0.001), whether using technology or not. Significant race-ethnicity differences (P < 0.001) existed between technology users and nonusers for all evaluated factors except visiting an endocrinologist.

Conclusions

Significant race-ethnicity associated differences existed in T1D management. The gap in diabetic technology adoption between Black and White beneficiaries grew between 2017 and 2019.
Convolutional Neural Network-Based Computer-Assisted Diagnosis of Hashimoto’s Thyroiditis on Ultrasound
Authors: Zhao Wanjun , Kang Qingbo , Qian Feiyan , Li Kang , Zhu Jingqiang , Ma Buyun
Published: December 2021

Purpose

This study investigates the efficiency of deep learning models in the automated diagnosis of Hashimoto’s thyroiditis (HT) using real-world ultrasound data from ultrasound examinations by computer-assisted diagnosis (CAD) with artificial intelligence.

Methods

We retrospectively collected ultrasound images from patients with and without HT from 2 hospitals in China between September 2008 and February 2018. Images were divided into a training set (80%) and a validation set (20%). We ensembled 9 convolutional neural networks (CNNs) as the final model (CAD-HT) for HT classification. The model’s diagnostic performance was validated and compared to 2 hospital validation sets. We also compared the accuracy of CAD-HT against seniors/junior radiologists. Subgroup analysis of CAD-HT performance for different thyroid hormone levels (hyperthyroidism, hypothyroidism, and euthyroidism) was also evaluated.

Results

39 280 ultrasound images from 21 118 patients were included in this study. The accuracy, sensitivity, and specificity of the HT-CAD model were 0.892, 0.890, and 0.895, respectively. HT-CAD performance between 2 hospitals was not significantly different. The HT-CAD model achieved a higher performance (P < 0.001) when compared to senior radiologists, with a nearly 9% accuracy improvement. HT-CAD had almost similar accuracy (range 0.87-0.894) for the 3 subgroups based on thyroid hormone level.

Conclusion

The HT-CAD strategy based on CNN significantly improved the radiologists’ diagnostic accuracy of HT. Our model demonstrates good performance and robustness in different hospitals and for different thyroid hormone levels.
Capillary Endothelial Insulin Transport: The Rate-limiting Step for Insulin-stimulated Glucose Uptake
Authors: Williams Ian M , Wasserman David H
Published: December 2021

The rate-limiting step for skeletal muscle glucose uptake is transport from microcirculation to muscle interstitium. Capillary endothelium poses a barrier that delays the onset of muscle insulin action. Defining physiological barriers that control insulin access to interstitial space is difficult because of technical challenges that confront study of microscopic events in an integrated physiological system. Two physiological variables determine muscle insulin access. These are the number of perfused capillaries and the permeability of capillary walls to insulin. Disease states associated with capillary rarefaction are closely linked to insulin resistance. Insulin permeability through highly resistant capillary walls of muscle poses a significant barrier to insulin access. Insulin may traverse the endothelium through narrow intercellular junctions or vesicular trafficking across the endothelial cell. Insulin is large compared with intercellular junctions, making this an unlikely route. Transport by endothelial vesicular trafficking is likely the primary route of transit. Studies in vivo show movement of insulin is not insulin receptor dependent. This aligns with single-cell transcriptomics that show the insulin receptor is not expressed in muscle capillaries. Work in cultured endothelial cell lines suggest that insulin receptor activation is necessary for endothelial insulin transit. Controversies remain in the understanding of transendothelial insulin transit to muscle. These controversies closely align with experimental approaches. Control of circulating insulin accessibility to skeletal muscle is an area that remains ripe for discovery. Factors that impede insulin access to muscle may contribute to disease and factors that accelerate access may be of therapeutic value for insulin resistance.
Postoperative Acute Kidney Injury Is Associated With Progression of Chronic Kidney Disease Independent of Severity
Authors: Privratsky Jamie R. , Krishnamoorthy Vijay , Raghunathan Karthik , Ohnuma Tetsu , Rasouli Mohammad R. , Long Thorir E. , Sigurdsson Martin I.
Published: December 2021

BACKGROUND:

Both postoperative acute kidney injury (AKI) and preoperative chronic kidney disease (CKD) are associated with significantly worse outcomes following surgery. The relationship of both of these conditions with each other and with CKD progression after surgery remains poorly studied. Our objective was to assess if there was an interaction between preoperative kidney function estimated by preoperative estimated glomerular filtration rate (eGFR)/CKD stage, postoperative AKI, and eGFR/CKD progression within 1 year of surgery. Our hypothesis was that AKI severity would be associated with a faster time to eGFR/CKD stage progression within 1 year of surgery in a graded-fashion, which would be exacerbated by preoperative kidney dysfunction.

METHODS:

This was a retrospective cohort study at Landspitali University Hospital in Iceland, which serves about 75% of the population. Participants included adults receiving their first major anesthetic between 2005 and 2018. Patients with CKD stage 5, undergoing major urologic procedures, or having missing creatinine values for follow-up of eGFR stage were excluded from analysis. The primary exposure was postoperative AKI stage within 7 days after surgery classified by the kidney disease improving global outcome (KDIGO) criteria. The primary outcome was time to progression of CKD by at least 1 eGFR/CKD stage within 1-year following surgery. Multivariable Cox proportional hazards models were used to estimate hazard of eGFR/CKD stage progression, including an interaction between AKI and preoperative CKD on eGFR/CKD stage progression.

RESULTS:

A total of 5548 patients were studied. In the multivariable model adjusting for baseline eGFR/CKD stage, when compared to patients without AKI, postoperative AKI stage 1 (hazard ratio [HR], 5.91; 95% confidence interval [CI], 4.34–8.05), stage 2 (HR, 3.86; 95% CI, 1.82–8.16), and stage 3 (HR, 3.61; 95% CI, 1.49–8.74) were all independently associated with faster time to eGFR/CKD stage progression within 1 year following surgery, though increasing AKI severity did not confer additional risk. The only significant interaction between the degree of AKI and the preexisting renal function was for stage 1 AKI, where the odds of 1-year eGFR/CKD stage progression actually decreased in patients with preoperative CKD categories 3a, 3b, and 4.

CONCLUSIONS:

KDIGO-AKI was independently associated with eGFR/CKD stage progression within the year following surgery after adjustment for baseline eGFR/CKD stage and without an interaction between worse preoperative kidney function and higher stage AKI. Our observations suggest that further studies are warranted to test whether CKD progression could be prevented by the adoption of perioperative kidney protective practices.
Temporal Summation Predicts De Novo Contralateral Pain After Cordotomy in Patients With Refractory Cancer Pain
Authors: Treister Roi , Honigman Liat , Berger Assaf , Cohen Ben , Asaad Israa , Kuperman Pora , Tellem Rotem , Hochberg Uri , Strauss Ido
Published: December 2021

BACKGROUND:

Percutaneous cervical cordotomy (PCC), which selectively interrupts ascending nociceptive pathways in the spinal cord, can mitigate severe refractory cancer pain. It has an impressive success rate, with most patients emerging pain-free. Aside from the usual complications of neurosurgical procedures, the risks of PCC include development of contralateral pain, which is less understood.

OBJECTIVE:

To evaluate whether sensory and pain sensitivity, as measured by quantitative sensory testing (QST), are associated with PCC clinical outcomes.

METHODS:

Fourteen palliative care cancer patients with severe chronic refractory pain limited mainly to one side of the body underwent comprehensive quantitative sensory testing assessment pre-PPC and post-PCC. They were also queried about maximal pain during the 24 h precordotomy (0-10 numerical pain scale).

RESULTS:

All 14 patients reported reduced pain postcordotomy, with 7 reporting complete resolution. Four patients reported de novo contralateral pain. Reduced sensitivity in sensory and pain thresholds to heat and mechanical stimuli was recorded on the operated side (P = .028). Sensitivity to mechanical pressure increased on the unaffected side (P = .023), whereas other sensory thresholds were unchanged. The presurgical temporal summation values predicted postoperative contralateral pain (r = 0.582, P = .037).

CONCLUSION:

The development of contralateral pain in patients postcordotomy for cancer pain might be due to central sensitization. Temporal summation could serve as a potential screening tool to identify those who are most likely at risk to develop contralateral pain. Analysis of PCC affords a unique opportunity to investigate how a specific lesion to the nociceptive system affects pain processes.
Predicting Clinically Relevant Patient-Reported Symptom Improvement After Carpal Tunnel Release: A Machine Learning Approach
Authors: Hoogendam Lisa , Bakx Jeanne A. C. , Souer J. Sebastiaan , Slijper Harm P. , Andrinopoulou Eleni-Rosalina , Selles Ruud W.
Published: December 2021

BACKGROUND:

Symptom improvement is an important goal when considering surgery for carpal tunnel syndrome. There is currently no prediction model available to predict symptom improvement for patients considering a carpal tunnel release (CTR).

OBJECTIVE:

To predict using a model the probability of clinically relevant symptom improvement at 6 mo after CTR.

METHODS:

We split a cohort of 2119 patients who underwent a mini-open CTR and completed the Boston Carpal Tunnel Questionnaire preoperatively and 6 mo postoperatively into training (75%) and validation (25%) data sets. Patients who improved more than the minimal clinically important difference of 0.8 at the Boston Carpal Tunnel Questionnaire–symptom severity scale were classified as “improved.” Logistic regression, random forests, and gradient boosting machines were considered to train prediction models. The best model was selected based on discriminative ability (area under the curve) and calibration in the validation data set. This model was further assessed in a holdout data set (N = 397).

RESULTS:

A gradient boosting machine with 5 predictors was chosen as optimal trade-off between discriminative ability and the number of predictors. In the holdout data set, this model had an area under the curve of 0.723, good calibration, sensitivity of 0.77, and specificity of 0.55. The positive predictive value was 0.50, and the negative predictive value was 0.81.

CONCLUSION:

We developed a prediction model for clinically relevant symptom improvement 6 mo after a CTR, which required 5 patient-reported predictors (18 questions) and has reasonable discriminative ability and good calibration. The model is available online and might help shared decision making when patients are considering a CTR.
Importance of Cobalt-60 Dose Rate and Biologically Effective Dose on Local Control for Intracranial Meningiomas Treated With Stereotactic Radiosurgery
Authors: Huo Michael , Rose Melanie , van Prooijen Monique , Cusimano Michael D. , Laperriere Normand , Heaton Robert , Gentili Fred , Payne David , Shultz David B. , Kongkham Paul , Kalia Suneil K. , Schwartz Michael , Bernstein Mark , Spears Julian , Zadeh Gelareh , Hodaie Mojgan , Tsang Derek S.
Published: December 2021

BACKGROUND:

Radiosurgery dose rate and biologically effective dose (BED) are associated with outcomes after stereotactic radiosurgery (SRS) for functional neurosurgical conditions and some benign tumors. It is not known if these factors affect the efficacy of SRS for meningioma.

OBJECTIVE:

To determine the association between cobalt-60 dose rate and BED on outcomes in patients with meningioma treated with SRS.

METHODS:

A single-institution cohort of 336 patients treated between 2005 and 2018 with cobalt-based SRS for 414 separate meningioma lesions was assembled. BED was calculated using an SRS-specific monoexponential model accounting for treatment time per lesion, assuming α/β = 2.47 Gy. Cumulative incidences of local failure (LF) were reported after considering the competing risk of death, on a per-lesion basis. Multivariable analysis of LF was performed using a proportional hazards model.

RESULTS:

The most common SRS dose was 12 Gy (n = 227); 140 lesions received 14 Gy. Five-year LF was 15.6% (95% confidence interval 10.4-21.9) and 4.3% (1.4-9.8) in patients who had a dose rate of <2.95 and ≥2.95 Gy/min, respectively (P= .0375). Among 354 grade I or unresected lesions treated with SRS, BED >50 Gy2.47was associated with a lower incidence of LF (P= .0030). Each 1 Gy/min increase in dose rate was associated with an adjusted hazard ratio of 0.53 (95% confidence interval, 0.29-0.97,P= .041) for LF. Prescription dose >12 Gy was not associated with a lower incidence of LF.

CONCLUSION:

Patients with meningiomas treated with lower dose rates experienced a higher incidence of LF than those treated with higher dose rates.
Examination of the Economic Burden of Frailty in Patients With Adult Spinal Deformity Undergoing Surgical Intervention
Authors: Passias Peter G. , Ahmad Waleed , Kummer Nicholas , Lafage Renaud , Lafage Virginie , Kebaish Khaled , Daniels Alan , Klineberg Eric , Soroceanu Alex , Gum Jeffrey , Line Breton , Hart Robert , Burton Douglas , Eastlack Robert , Jain Amit , Smith Justin S. , Ames Christopher P. , Shaffrey Christopher , Schwab Frank , Hostin Richard , Bess Shay
Published: December 2021

BACKGROUND:

With increasing interest in cost optimization, costs of adult spinal deformity (ASD) surgery intersections with frailty merit investigation.

OBJECTIVE:

To investigate costs associated with ASD and frailty.

METHODS:

Patients with ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5 cm, pelvic tilt ≥ 25°, or thoracic kyphosis ≥ 60°) with baseline and 2-yr radiographic data were included. Patients were severely frail (SF), frail (F), or not frail (NF). Utility data were converted from Oswestry Disability Index to Short-Form Six-Dimension. Quality-adjusted life years (QALYs) used 3% rate for decline to life expectancy. Costs were calculated using PearlDiver. Loss of work costs were based on SRS-22rQ9 and US Bureau of Labor Statistics. Accounting for complications, length of stay, revisions, and death, cost per QALY at 2 yr and life expectancy were calculated.

RESULTS:

Five hundred ninety-two patients with ASD were included (59.8 ± 14.0 yr, 80% F, body mass index: 27.7 ± 6.0 kg/m2, Adult Spinal Deformity-Frailty Index: 3.3 ± 1.6, and Charlson Comorbidity Index: 1.8 ± 1.7). The average blood loss was 1569.3 mL, and the operative time was 376.6 min, with 63% undergoing osteotomy and 54% decompression. 69.3% had a posterior-only approach, 30% combined, and 0.7% anterior-only. 4.7% were SF, 22.3% F, and 73.0% NF. At baseline, 104 were unemployed losing $971.38 weekly. After 1 yr, 62 remained unemployed losing $50 508.64 yearly. With propensity score matching for baseline SVA, cost of ASD surgery at 2 yr for F/SF was greater than that for NF ($81 347 vs $69 722). Cost per QALY was higher for F/SF at 2 yr than that for NF ($436 473 vs $430 437). At life expectancy, cost per QALY differences became comparable ($58 965 vs $58 149).

CONCLUSION:

Despite greater initial cost, F and SF patients show greater improvement. Cost per QALY for NF and F patients becomes similar at life expectancy.
Syringomyelia From Extramedullary Compression: Resolution After Microsurgical Resection of a High-Cervical Spine Schwannoma: 2-Dimensional Operative Video
Authors: Mooney Michael A. , Al-Mefty Ossama
Published: December 2021

Syringomyelia with compression at the foramen magnum is a well-studied subject with a pathophysiological hypothesis explaining syrinx development and treatment.
1,2
However, compression of the cervical cord, as in cervical spondylosis, can also lead to cavitation in the spinal cord.
3,4
Although the association of intramedullary spinal cord tumors with syringomyelia is well known,
5
the association of extramedullary tumors with syringomyelia is scarcely reported, and it is of unknown mechanism and uncertain outcomes regarding syrinx resolution.

Syringomyelia is reported to be associated with intramedullary spinal schwannoma.
6
However, spinal schwannomas are by and large extramedullary tumors that produce deficits through compressive radiculopathy or myelopathy. The association of extramedullary schwannomas with syringomyelia is extremely rare. In this article, we present a patient with an extramedullary high-cervical schwannoma causing significant syringomyelia who underwent microsurgical resection of the schwannoma, with subsequent total resolution of the syringomyelia. The patient consented for surgery.

Images from Lancet 1969 at 6:36 in video Reprinted from The Lancet, Vol. 294, Bernard Williams, The Distending Force in the Production of “Communicating Syringomyelia,” Pages 189-193, Copyright 1969, with permission from Elsevier.
Falcotentorial Meningioma Resection Through the Supracerebellar Infratentorial Approach: 2-Dimensional Operative Video
Authors: Ibn Essayed Walid , Al-Mefty Ossama
Published: December 2021

Meningiomas are a common pineal region tumor in adults.
1
They frequently reach large size with pending serious neurological consequences.
1
Although they are more common in women, their presence in men might raise concerns about a higher-grade meningioma. Accordingly, their treatment starts with surgical resection. Their origin is the falcotentorial junction involving the midbrain tectum and the vital deep venous system. The torcular, transverse sinuses, cerebellar veins, straight sinus, internal occipital veins, basal veins, and internal cerebral veins are encountered requiring a cautious fine intra-arachnoidal dissection under high magnification.
2
Multiple surgical approaches are described for pineal area tumors with the advantages and disadvantages of each guiding the selection of the approach.
3
We believe that the main deciding factor is the relationship of the vein of Galen and its tributaries to the tumor, simply choosing the route that encounters the tumor first and the vein last. We demonstrate the surgical nuances of removing a pineal area meningioma that displaced the vein of Galen superiorly, prompting the resection through a lateral infratentorial supracerebellar approach. We currently prefer the 3/4 concord position because it provides a superb direct exposure over one cerebellar hemisphere, with the cerebellum relaxed downward while the bridging veins are not severely stretched with gravity.
4
The sitting surgeon with resting arms in an ergonomic position is able to perform fine microsurgical dissection over extended time.
5
The patient was a 57-year-old man with a large falcotentorial meningioma. The patient consented to the surgery and publication of his images.