bluuebunny/crossref_metadata_2025 huggingface dataset:
Contributions from the 2016 Literature on Clinical Decision Support
Authors: Koutkias V. , Bouaud J.
Published: September 2017

Objectives: To summarize recent research and select the best papers published in 2016 in the field of computerized clinical decision support for the Decision Support section of the IMIA yearbook.

Methods: A literature review was performed by searching two bibliographic databases for papers related to clinical decision support systems (CDSSs). The aim was to identify a list of candidate best papers from the retrieved papers that were then peer-reviewed by external reviewers. A consensus meeting of the IMIA editorial team finally selected the best papers on the basis of all reviews and section editor evaluation.

Results: Among the 1,145 retrieved papers, the entire review process resulted in the selection of four best papers. The first paper describes machine learning models used to predict breast cancer multidisciplinary team decisions and compares them with two predictors based on guideline knowledge. The second paper introduces a linked-data approach for publication, discovery, and interoperability of CDSSs. The third paper assessed the variation in high-priority drug-drug interaction (DDI) alerts across 14 Electronic Health Record systems, operating in different institutions in the US. The fourth paper proposes a generic framework for modeling multiple concurrent guidelines and detecting their recommendation interactions using semantic web technologies.

Conclusions: The process of identifying and selecting best papers in the domain of CDSSs demonstrated that the research in this field is very active concerning diverse dimensions, such as the types of CDSSs, e.g. guideline-based, machine-learning-based, knowledge-fusion-based, etc., and addresses challenging areas, such as the concurrent application of multiple guidelines for comorbid patients, the resolution of interoperability issues, and the evaluation of CDSSs. Nevertheless, this process also showed that CDSSs are not yet fully part of the digitalized healthcare ecosystem. Many challenges remain to be faced with regard to the evidence of their output, the dissemination of their technologies, as well as their adoption for better and safer healthcare delivery.
Knowledge Representation and Management, It’s Time to Integrate!
Authors: Dhombres F. , Charlet J.
Published: September 2017

Objectives: To select, present, and summarize the best papers published in 2016 in the field of Knowledge Representation and Management (KRM).

Methods: A comprehensive and standardized review of the medical informatics literature was performed based on a PubMed query.

Results: Among the 1,421 retrieved papers, the review process resulted in the selection of four best papers focused on the integration of heterogeneous data via the development and the alignment of terminological resources. In the first article, the authors provide a curated and standardized version of the publicly available US FDA Adverse Event Reporting System. Such a resource will improve the quality of the underlying data, and enable standardized analyses using common vocabularies. The second article describes a project developed in order to facilitate heterogeneous data integration in the i2b2 framework. The originality is to allow users integrate the data described in different terminologies and to build a new repository, with a unique model able to support the representation of the various data. The third paper is dedicated to model the association between multiple phenotypic traits described within the Human Phenotype Ontology (HPO) and the corresponding
genotype in the specific context of rare diseases (rare variants). Finally, the fourth paper presents solutions to annotation-ontology mapping in genome-scale data. Of particular interest in this work is the Experimental Factor Ontology (EFO) and its generic association model, the Ontology of Biomedical AssociatioN (OBAN).

Conclusion: Ontologies have started to show their efficiency to integrate medical data for various tasks in medical informatics: electronic health records data management, clinical research, and knowledge-based systems development.
Findings from the Section on Bioinformatics and Translational Informatics
Authors: Dauchel H. , Lecroq T.
Published: September 2017

Objective: To summarize excellent current research and propose a selection of best papers published in 2016 in the field of Bioinformatics and Translational Informatics with applications in the health domain and clinical care.

Methods: We provide a synopsis of the articles selected for the IMIA Yearbook 2017, from which we attempt to derive a synthetic overview of current and future activities in the field. As in 2016, a first step of selection was performed by querying MEDLINE with a list of MeSH descriptors completed by a list of terms adapted to the section coverage. Each section editor evaluated separately the set of 951 articles returned and evaluation results were merged for retaining 15 candidate best papers for peer-review.

Results: The selection and evaluation process of papers published in the Bioinformatics and Translational Informatics field yielded four excellent articles focusing this year on the secondary use and massive integration of multi-omics data for cancer genomics and non-cancer complex diseases. Papers present methods to study the functional impact of genetic variations, either at the level of the transcription or at the levels of pathway and network.

Conclusions: Current research activities in Bioinformatics and Translational Informatics with applications in the health domain continue to explore new algorithms and statistical models to manage, integrate, and interpret large-scale genomic datasets. As addressed by some of the selected papers, future trends would include the question of the international collaborative sharing of clinical and omics data, and the implementation of intelligent systems to enhance routine medical genomics.
Making Sense of Big Textual Data for Health Care: Findings from the Section on Clinical Natural Language Processing
Authors: Névéol A. , Zweigenbaum P.
Published: September 2017

Objectives: To summarize recent research and present a selection of the best papers published in 2016 in the field of clinical Natural Language Processing (NLP).

Method: A survey of the literature was performed by the two section editors of the IMIA Yearbook NLP section. Bibliographic databases were searched for papers with a focus on NLP efforts applied to clinical texts or aimed at a clinical outcome. Papers were automatically ranked and then manually reviewed based on titles and abstracts. A shortlist of candidate best papers was first selected by the section editors before being peer-reviewed by independent external reviewers.

Results: The five clinical NLP best papers provide a contribution that ranges from emerging original foundational methods to transitioning solid established research results to a practical clinical setting. They offer a framework for abbreviation disambiguation and coreference resolution, a classification method to identify clinically useful sentences, an analysis of counseling conversations to improve support to patients with mental disorder and grounding of gradable adjectives.

Conclusions: Clinical NLP continued to thrive in 2016, with an increasing number of contributions towards applications compared to fundamental methods. Fundamental work addresses increasingly complex problems such as lexical semantics, coreference resolution, and discourse analysis. Research results translate into freely available tools, mainly for English.
Public Health and Epidemiology Informatics
Authors: Thiébaut R. , Thiessard F.
Published: September 2017

Objectives: To summarize current research in the field of Public Health and Epidemiology Informatics. Methods: The complete 2016 literature concerning public health and epidemiology informatics has been searched in PubMed and Web of Science, and the returned references were reviewed by the two section editors to select 14 candidate best papers. These papers were then peer-reviewed by external reviewers to allow the editorial team an enlightened selection of the best papers. Results: Among the 829 references retrieved from PubMed and Web of Science, three were finally selected as best papers. The first one compares Google, Twitter, and Wikipedia as tools for Influenza surveillance. The second paper presents a Geographic Knowledge-Based Model for mapping suitable areas for Rift Valley fever transmission in Eastern Africa. The last paper evaluates the factors associated with the visit of Facebook pages devoted to Public Health Communication.

Conclusions: Surveillance is still a productive topic in public health informatics but other very important topics in public health are appearing.
Clinical Data Reuse or Secondary Use: Current Status and Potential Future Progress
Authors: Meystre S. M. , Lovis C. , Bürkle T. , Tognola G. , Budrionis A. , Lehmann C. U.
Published: September 2017

Objective: To perform a review of recent research in clinical data reuse or secondary use, and envision future advances in this field.

Methods: The review is based on a large literature search in MEDLINE (through PubMed), conference proceedings, and the ACM Digital Library, focusing only on research published between 2005 and early 2016. Each selected publication was reviewed by the authors, and a structured analysis and summarization of its content was developed.

Results: The initial search produced 359 publications, reduced after a manual examination of abstracts and full publications. The following aspects of clinical data reuse are discussed: motivations and challenges, privacy and ethical concerns, data integration and interoperability, data models and terminologies, unstructured data reuse, structured data mining, clinical practice and research integration, and examples of clinical data reuse (quality measurement and learning healthcare systems).

Conclusion: Reuse of clinical data is a fast-growing field recognized as essential to realize the potentials for high quality healthcare, improved healthcare management, reduced healthcare costs, population health management, and effective clinical research.
Evaluation Considerations for Secondary Uses of Clinical Data: Principles for an Evidence-based Approach to Policy and Implementation of Secondary Analysis
Authors: Scott P. J. , Rigby M. , Ammenwerth E. , McNair J. , Georgiou A. , Hyppönen H. , de Keizer N. , Magrabi F. , Nykänen P. , Gude W. T. , Hackl W.
Published: September 2017

Objectives: To set the scientific context and then suggest principles for an evidence-based approach to secondary uses of clinical data, covering both evaluation of the secondary uses of data and evaluation of health systems and services based upon secondary uses of data.

Method: Working Group review of selected literature and policy approaches.

Results: We present important considerations in the evaluation of secondary uses of clinical data from the angles of governance and trust, theory, semantics, and policy. We make the case for a multi-level and multi-factorial approach to the evaluation of secondary uses of clinical data and describe a methodological framework for best practice. We emphasise the importance of evaluating the governance of secondary uses of health data in maintaining trust, which is essential for such uses. We also offer examples of the re-use of routine health data to demonstrate how it can support evaluation of clinical performance and optimize health IT system design.

Conclusions: Great expectations are resting upon “Big Data” and innovative analytics. However, to build and maintain public trust, improve data reliability, and assure the validity of analytic inferences, there must be independent and transparent evaluation. A mature and evidence-based approach needs not merely data science, but must be guided by the broader concerns of applied health informatics.
Historical Roots of International Biomedical and Health Informatics: The Road to IFIP-TC4 and IMIA through Cybernetic Medicine and the Elsinore Meetings
Authors: Kulikowski C. A.
Published: September 2017

Background: It is 50 years since the International Federation of Information Processing (IFIP) Societies approved the formation of a new Technical Committee (TC) 4 on Medical Information Processing under the leadership of Professor Francois Grémy, which was the direct precursor of the International Medical Informatics Association (IMIA).

Objectives: The goals of this paper are to give a very brief overview of early international developments leading to informatics in medicine, with the origins of the applications of computers to medicine in the USA and Europe, and two meetings - of the International Society of Cybernetic Medicine, and the Elsinore Meetings on Hospital Information Systems—that took place in 1966. These set the stage for the formation of IFIP-TC4 the following year, with later sponsorship of the first MEDINFO in 1974, setting the path for the evolution to IMIA.

Methods: This paper reviews and analyzes some of the earliest research and publications, together with two critical contrasting meetings in 1966 involving international activities in what evolved into biomedical and health informatics in terms of their probable influence on the formation of IFIP-TC4.

Conclusion: The formation of IFIP-TC 4 in 1967 by Francois Grémy arose out of his concerns for merging, at an international level, the diverse strands from the more abstract work on cybernetic medicine and its basis in biophysical and neural modeling, with the more concrete and health-oriented medical information processing that was developing at the time for hospitals and clinical decision-making.
Economic Comparison of Hand-Sutured and Coupler-Assisted Microvascular Anastomoses
Authors: Head Linden , McKay Douglas
Published: September 2017

Background Compared with hand-sewn anastomoses, microvascular anastomotic coupling devices (MACDs) provide equivalent flap survival and reduced operative time. To date, an economic analysis of MACDs has not been reported. The objective of this study was to evaluate the economics of a venous anastomosis performed using a coupling device compared with a hand-sewn anastomosis.

Methods Economics were modeled for a single free tissue transfer (FTT) requiring one venous anastomosis performed with either hand-sewn sutures or with a coupler-assisted anastomosis using the GEM COUPLER. Fixed and variable costs incurred with each anastomotic technique were identified with an activity-based cost analysis. Price lists were retrieved from suppliers to quantify disposable costs and capital expenditures. Two literature reviews were executed to identify microsurgical operating room (OR) costs and operating time reductions with coupler-assisted anastomoses.

Results For each venous anastomosis, the use of the anastomotic coupler increased disposable costs by $284.40 compared with a hand-sutured anastomosis. Total fixed and variable OR costs were $30.82 per minute. Operating time was reduced by a mean of 16.9 minutes with a coupler-assisted anastomosis, decreasing OR costs by $519.29. Total savings of $234.89 were generated for each coupler-assisted anastomosis, recuperating the device's capital expenditure after 13 uses.

Conclusion Compared with a hand-sewn venous anastomosis, an MACD produces savings with each case and quickly recoups the device's capital expenditure. Despite its limitations and simplicity, this study provides a practical economic analysis that can help inform purchasing decisions, particularly for smaller volume centers where the economic rationale may be less clear.
Combined Direct and Indirect Cerebral Revascularization Using Local and Flow-Through Flaps
Authors: Azadgoli Beina , Leland Hyuma , Wolfswinkel Erik , Bakhsheshian Joshua , Russin Jonathan , Carey Joseph
Published: September 2017

Background Extracranial–intracranial bypass is indicated in ischemic disease such as moyamoya, certain intracranial aneurysms, and other complex neurovascular diseases. In this article, we present our series of local and flow-through flaps for cerebral revascularization as an additional tool to provide direct and indirect revascularization and/or soft tissue coverage.

Methods A retrospective review of a prospectively maintained database was performed identifying nine patients. Ten direct arterial bypass procedures with nine indirect revascularization and/or soft tissue reconstruction were performed.

Results Indications for arterial bypass included intracranial aneurysm (n = 2) and moyamoya disease (n = 8). Indications for soft tissue transfer included infected cranioplasty (one) and indirect cerebral revascularization (eight). Four flow-through flaps and five pedicled flaps were used including a flow-through radial forearm fasciocutaneous flap (one), flow-through radial forearm fascial flaps (three), and pedicled temporoparietal fascial (TPF) flaps with distal end anastomosis (five). The superficial temporal vessels (seven) and facial vessels (two) were used as the vascular inflow. Arterial bypass was established into the middle cerebral artery (six) and anterior communicating artery (three). There were no intraoperative complications. All flaps survived with no donor-site complications. In one case of flow-through TPF flap, the direct graft failed, but the indirect flap remained vascularized.

Conclusion Local and flow-through flaps can improve combined direct and indirect revascularization and provide soft tissue reconstruction. Minimal morbidity has been encountered in early outcomes though long-term results remain under investigation for these combined neurosurgery and plastic surgery procedures.

Level of Evidence The level of evidence is IV.
Fracturas e pseudartroses da apofise do unciforme – 10 casos
Authors: Botelheiro J. C. , Silverio S. , Irisarri C.
Published: September 2017

Se presentan 10 casos de fractura y pseudartrosis de la apofisis del hueso ganchoso. 9 han sido operados – excisión de la apofisis por vía palmar. 3, diagnosticados precozmente, habían sido inmovilizados pero no se obtuvo consolidación en ninguno de ellos, pero uno se quedo sin dolor. 7 fueron diagnosticados como pseudartrosis dolorosas o fracturas con varias semanas de evolución. De los 9 pacientes operados 8 quedaron asintomáticos. Así, la excisión quirúrgica nos parece el tratamiento de elección para las pseudartrosis y fracturas dolorosas de la apofisis del hueso ganchoso.
Contrast-Enhanced Ultrasound for Guidance of Percutaneous Liver Interventions in Neoplastic Hepatic Disease
Authors: Partovi Sasan , Nakamoto Dean , Lu Ziang , Yu Alice , Patel Indravadan , Ahmed Yasmine , Azar Nami , Kessner Rivka
Published: September 2017

Contrast-enhanced ultrasound (CEUS) is an evolving technique for the detection and characterization of focal liver lesions. Currently, it is recommended mainly for inconclusive cases and for patients with contraindications to computed tomography (CT)/magnetic resonance imaging. For percutaneous liver interventions, image guidance is of utmost importance to detect the target lesion. Primarily, ultrasound guidance is used for liver biopsies and ablations. CT is reserved for challenging cases, for example, when the target or the surrounding structures are not well identified with standard B-mode ultrasound. Instead of CT guidance, CEUS has gained increasing interest for percutaneous liver interventions. CEUS has the advantage of superior target visualization, real-time imaging guidance of probe or needle advancement without exposure to radiation.
Tethered Cord and Anorectal Malformations: A Case Series
Authors: Canazza Lorena , Meroni Milena , Selvaggio Giorgio , Parazzini Cecilia , Valentini Laura , Riccipetitoni Giovanna , Destro Francesca
Published: September 2017

Introduction The clinical manifestation of a stretched low-lying cone (LLC) is represented by the tethered cord syndrome (TCS) with cutaneous, urologic, neurologic, and orthopaedic dysfunctions. TC is frequently found in patients with anorectal malformations (ARMs). The aim of our article is to report a series of patients affected by LLC and ARMs and evaluate their management and long-term follow-up results.

Materials and Methods We performed a retrospective analysis over a period of 15 years including patients with ARM and TC and excluding those with severe polymalformations. We collected information related to the types of malformations and demographic data. We analyzed their management (perinatal protocol, radiological investigations, surgery, and multidisciplinary follow-up). QOL was assessed through the International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY).

Results Thirty-three patients among 210 ARM cases had TC (16%). Eleven of them underwent neurosurgery. One patient had retethering; out of 11 patients, 4 remained stable and 6 improved after surgery (UDS normalization and resolution of symptoms). At a mean follow-up of 10 years, four patients were on clean intermittent catheterization and five on the Peristeen transanal irrigation. The majority of patients were defined as 3 (from 1-bad to 5-excellent) for their physical and mental state.

Conclusion The use of MRI is considered to complete the ARM screening in detecting TC. The multidisciplinary approach is crucial and helps in defining the management of patients. In fact, it is not clear how the features of ARM and TC affect each other. The selection of cases for surgery should take into account the critical elements.
Parameters Associated with Adverse Fetal Outcomes in Parvovirus B19 Congenital Infection
Authors: Agra Isabela Karine Rodrigues , Amorim Filho Antonio Gomes , Lin Lawrence Hsu , Biancolin Sckarlet Ernandes , Francisco Rossana Pulcineli Vieira , Brizot Maria de Lourdes
Published: September 2017

Objective To investigate the clinical and sonographic parameters associated with adverse fetal outcomes in patients with congenital parvovirus B19 infection managed by intrauterine transfusion.

Methods This was a single-center retrospective study conducted from January 2005 to December 2016 that assessed patients with singleton pregnancies with fetal parvovirus infection confirmed by a polymerase chain reaction of the amniotic fluid or fetal blood samples who underwent at least one intrauterine transfusion. The maternal characteristics, sonographic findings and parameters related to intrauterine transfusion were compared between the two groups (recovery/non-recovery), who were categorized based on fetal response after in-utero transfusions. Progression to fetal death or delivery without fetal recovery after the transfusions was considered non-recovery and categorized as an adverse outcome.

Results The final analysis included ten singleton pregnancies: seven of which were categorized into the recovery group and three of which into the non-recovery group. The baseline characteristics were similar between the groups. All fetuses were hydropic at the time of diagnosis. No significant differences related to sonographic or intrauterine transfusion parameters were identified between the groups; however, the non-recovery group tended to have an increased number of sonographic markers and lower fetal hemoglobin and platelet levels before the transfusion.

Conclusion We were unable to firmly establish the clinical or sonographic parameters associated with adverse fetal outcomes in patients with parvovirus infection managed with intrauterine transfusions; however, edema, placental thickening and oligohydramnios may indicate greater fetal compromise and, subsequently, adverse outcomes. However, further studies are necessary, mainly due to the small number of cases analyzed in the present study.
Intra-arterial Thrombectomy with Stent Retriever for Acute Ischemic Stroke – a Retrospective, Single-centered Study from Brazil
Authors: Gatto Luana , Zétola Viviane , Demartini Junior Zeferino , Nascimento Fábio , Koppe Gelson
Published: September 2017

Objective To report our initial experience with intra-arterial thrombectomy (IAT) with stent retriever for acute ischemic stroke.

Methods We conducted a retrospective review of patients with acute ischemic stroke who underwent IAT from September 2010 to August 2016.

Results Forty-one patients were included; mean age was 57 years (range: 29–85), and 54% were women. There were 32 anterior circulation occlusions, and 11 posterior circulation occlusions. The mean value of the National Institutes of Health Stroke Scale (NIHSS) upon admission (available in 9/41 patients) was 14 (range: 6–20). Nineteen patients had favorable outcomes (modified Rankin Scale [mRS]: 0–2 at 6 months), and 22 had unfavorable outcomes (mRS: 3–6 at 6 months). The mortality rate was 37% (15/41). Favorable outcomes were associated with revascularization within the first 360 minutes of the onset of symptoms (p = 0.000001), and satisfactory revascularization (thrombolysis in cerebral infarction [TICI] scale: 2b or 3) (p = 0.0018).

Conclusion It is of paramount importance to educate stroke teams on the benefits of IAT for acute ischemic stroke and the population on identifying stroke and seeking immediate care following symptom onset.
High Glucose Level Induces Cardiovascular Dysplasia During Early Embryo Development
Authors: Jin Yi-mei , Zhao Shu-zhu , Zhang Zhao-long , Chen Yao , Cheng Xin , Chuai Manli , Liu Guo-sheng , Lee Kenneth Ka Ho , Yang Xuesong
Published: September 2017

The incidence of gestational diabetes mellitus (GDM) has increased dramatically amongst multiethnic population. However, how gestational diabetes mellitus damages the developing embryo is still unknown. In this study, we used yolk sac membrane (YSM) model to investigate angiogenesis in the developing chick embryo. We determined that in the presence of high glucose, it retarded the growth and extension of the embryonic vascular plexus and it also reduced the density of the vasculature in yolk sac membrane model. Using the same strategy, we used the chorioallantoic membrane (CAM) as a model to investigate the influence of high glucose on the vasculature. We established that high glucose inhibited development of the blood vessel plexus and the blood vessels formed had a narrower diameter than control vessels. Concurrent with the abnormal angiogenesis, we also examined how it impacted cardiogenesis. We determined the myocardium in the right ventricle and left atrium were significantly thicker than the control and also there was a reduction in glycogen content in cardiomyocytes. The high glucose also induced excess reactive oxygen species (ROS) production in the cardiomyocytes. We postulated that it was the excess reactive oxygen species that damaged the cardiomyocytes resulting in cardiac hyperplasia.
Palivizumab: The Effects of Prophylactic Immunization on the Occurrence of Infections Caused by the Respiratory Syncytial Virus
Authors: Raguz Marjana , Brzica Jerko , Grgic Ivana
Published: September 2017

Aim The aim of this research is to analyze the characteristics of children immunized during immunization season, and their readmission to hospital due to infections of the respiratory tract in the period from 2008 to 2016.

Method The retrospective cohort study included 101 children. The test group consists of infants who met the strict criteria for immunization. The national guidance was determined on the basis of earlier research and recommendations by the AAP. All the children who had been readmitted for hospitalization were quickly tested for RSV.

Results Of this total, 47 children were preterm children (46.5%), 43 (42.5%) were children with CHD, and 11 (11%) exhibited other individual risk factors (gestational age 33–34 weeks, neurological disorders, respiratory anomalies, multi-organ anomalies). 25 (24%) patients of the immunized study population readmitted the ward due to respiratory infections. Of these, 50% were under the age of 6 months and were treated for less than a week on average. Upon readmission, a quick test to diagnose for RSV infections was conducted, which was negative for all of the previously immunized children.

Conclusion Palivizumab represents an effective prevention to avoid RSV infections, that significantly contributes to mortality for children at risk, especially in developing countries.
Quantenphysik und Wirklichkeit
Authors: Winter Norbert
Published: September 2017

Homöopathie und Wissenschaft scheinen für viele unvereinbar zu sein, zu widersprüchlich erscheinen die Postulate der Homöopathie und die Prämissen der Wissenschaft. Aber vielleicht liegt das Problem gar nicht in den Grundannahmen der Homöopathie – sondern in falsch rezipierten Grundannahmen der Wissenschaft. Deshalb soll an dieser Stelle der vielleicht herausforderndste Teil in unserem heutigen Wissenschaftsverständnis, die Quantenphysik, in ihren wesentlichen Aspekten beleuchtet werden.

Daran schließt sich unmittelbar die Frage an, inwieweit diese Phänomene relevant für unsere Alltagswirklichkeit sind – und inwieweit die Einsicht in quantenphysikalische Phänomene Auswirkungen auf das Weltbild der beteiligten Physiker hat.
Eingeschränktes Axilla-Staging bei klinisch und sonografisch nodal-negativen Patientinnen mit frühem invasiven Mammakarzinom (c/iT1–2) im Rahmen der brusterhaltenden Therapie: erste Erkenntnisse nach Start der Intergroup-Sentinel-Mamma-(INSEMA-)Studie
Authors: Reimer Toralf , Stachs A. , Nekljudova V. , Loibl S. , Hartmann S. , Wolter K. , Hildebrandt G. , Gerber B.
Published: September 2017

Der axilläre Nodalstatus wird beim frühen Mammakarzinom immer noch als wichtiger Prognosefaktor und Indikator für eine (neo-)adjuvante System- und postoperative Strahlentherapie der Lymphabflusswege (LAW) gesehen. Die im September 2015 gestartete INSEMA-Studie untersucht, ob beim frühen Mammakarzinom (c/iT1 – 2 c/iN0) auf die operative Bestimmung des Nodalstatus im Rahmen der brusterhaltenden Therapie (BET) verzichtet werden kann, ohne dass die onkologische Sicherheit beeinträchtigt wird. Nach Einschluss von 1001 Patientinnen war die Akzeptanz des komplexen Studiendesigns bei Patientinnen und Prüfärzten gegeben, sodass die Rekrutierung für die erste Randomisierung (axilläre Sentinel-Lymphknoten-Biopsie [SLNB]: ja oder nein) im Rahmen der Fallzahlprognose liegt. Die 2. Randomisierung (SLNB allein versus Komplettierung der Axilladissektion bei 1 oder 2 Makrometastasen in der SLNB) rekrutiert dagegen aus 3 Gründen weniger als erwartet: a) Der Nachweis von 1 bis 2 Makrometastasen nach der SLNB im INSEMA-Kollektiv ist mit 13 % geringer als erwartet; b) etwa 20 % der Patientinnen lehnten die 2. Randomisierung ab; c) der Einstieg der österreichischen Prüfzentren, die ausschließlich für die 2. Randomisierung rekrutieren, erfolgt zeitlich verzögert. Die Unkenntnis des Nodalstatus bei Verzicht auf die SLNB bringt eine neue Herausforderung für die postoperative Tumorkonferenz. Insbesondere die Indikation zur Chemotherapie bei Luminal-like-Tumoren und zur Bestrahlung der LAW (ohne Axilla) muss nun an den tumorbiologischen Parametern ausgerichtet werden. Einige wichtige Fragen können durch die INSEMA-Studie nicht beantwortet werden. Unklar bleibt beispielsweise, ob Patientinnen ohne SLNB eine alleinige Teilbrustbestrahlung in Low-Risk-Situationen angeboten werden kann bzw. ob auch bei Patientinnen mit einer Mastektomieindikation auf die SLNB im Stadium T1 – 2 verzichtet werden kann.
Music in Obstetrics: An Intervention Option to Reduce Tension, Pain and Stress
Authors: Wulff Verena , Hepp Philip , Fehm Tanja , Schaal Nora
Published: September 2017

In recent years, the effect of music interventions and music therapy has experienced increased attention in the literature. It has been shown that music has positive effects on cognitive and physical performance, such as concentration and endurance, as well as on psychological parameters, such as anxiety and relaxation. Studies within the context of medicine in particular are increasingly indicating that music may be used as an intervention for relief against anxiety, stress and pain. Music is therefore seen in actual practice as a supplement to conventional pharmacological and non-pharmacological forms of treatment – and the trend is rising. Studies involving music interventions in the field of obstetrics have shown, amongst other things, that music improves the ability to relax during pregnancy and can reduce anxiety. It was also discovered that during childbirth music interventions resulted in a reduction of pain and stress. Music also has the effect of reducing stress, pain and anxiety in expectant mothers during deliveries by caesarean section. This review intends to provide an overview of the literature on music interventions in the field of obstetrics and to give a resume on the current state of research around the topic of music in relation to pregnancy, spontaneous deliveries and caesarean sections. Furthermore, the relevance of music for everyday obstetrics will be illustrated.
Role of Glutamatergic System in Obsessive-Compulsive Disorder with Possible Therapeutic Implications
Authors: Vlček Přemysl , Polák Jakub , Brunovský Martin , Horáček Jiří
Published: September 2017

Obsessive-compulsive disorder (OCD) is a chronic psychiatric illness and 1 of the most common anxiety disorders with the prevalence of 3%. Although its pathogenesis remains unclear, the traditional model focused on alternations in the serotonin system. Selective serotonin reuptake inhibitors provide the most effective treatment; however, as much as 40–60% of patients do not respond to antidepressants therapy. Thus, attention has shifted towards other neurotransmitter systems and related neuroanatomical structures. Recently, there is extensive evidence showing a key role of glutamate pathways abnormalities within the cortico-striatal-thalamo-cortical circuitry and temporal lobes in OCD pathogenesis. In this review, we link together the existent neuroanatomical, neurophysiological, and neuropsychological evidence to argue for potential benefits of adjuvant treatment with glutamatergic agents, especially memantine. By a targeted de-excitation effect on the glutamatergic system in the temporal lobes and connected brain regions, memantine might further alleviate OCD symptoms. This effect should be even more pronounced in certain subtypes of patients with specific cognitive deficits and maladaptive compensatory memory processes (e.g., checkers).
Design and Evaluation of Chronomodulated Drug Delivery of Tramadol Hydrochloride
Authors: Alekya Thota , Narendar Dudhipala , Mahipal Donthi , Arjun Narala , Nagaraj Banala
Published: September 2017

Rheumatoid arthritis is an auto immune disease which requires chronotherapy as it occurs during early morning. Tramadol hydrochloride (TH) is an analgesic drug, used to treat rheumatoid arthritis. The aim of the present investigation was to develop chronomodulated drug delivery system of tramadol hydrochloride such that it releases the drug early in the morning, during which the symptoms of rheumatoid arthritis worsen. To develop chronomodulated drug delivery system of TH, initially core tablets of TH were prepared using three different supradisintegrants followed by coating with pH dependent polymer of Eudragit S100. The prepared core tablets are evaluated for physical parameters and an optimal system was identified. Further, coating composition of Eudragit S100 was optimized and coating tablets of TH was prepared. The prepared coated tablets were evaluated for weight variation, hardness, drug content and in vitro release studies in 0.1N HCl, pH 6.8 phosphate buffer and pH 7.4 phosphate buffer. Formulation with 7.5% of coating solution (ES2) had shown a significant drug release after a lag time of 3 h (in pH 6.8 medium), 6 h (in pH 6.8 medium) and 8 h (in pH 7.4 medium), respectively. DSC studies revealed that no interaction between core and coated materials with drug was observed. Thus, chronomodulated drug delivery system of TH was formulated and assuming that if a tablet is administered around 9 pm to 10 pm, the drug release starts after a lag time of 6 h i. e., around 3am to 4 am.
Percutaneous Treatment of Malignant Liver Lesions: Evaluation of Success Using Contrast- Enhanced Ultrasound (CEUS) and Perfusion Software
Authors: Wiesinger Isabel , Wiggermann Philipp , Zausig Nicola , Beyer Lukas , Salzberger Bernd , Stroszczynski Christian , Jung Ernst
Published: September 2017

Aim Using new perfusion software for evaluation of the success of percutaneous treatments of malignant liver tumors with CEUS.

Materials and Methods Retrospective analysis of 88 patients (74 male, 14 female; 30 – 84 years) with 165 malignant liver lesions. The lesions were 57 metastases and 108 HCCs. The success of interventional treatment (IRE n = 47; RFA n = 38; MWA n = 44; TACE n = 36) was evaluated by CEUS and perfusion software (VueBox®). CEUS was performed after injection of 1 – 2.4 ml of sulfur hexafluoride microbubbles (SonoVue®) using a 1 – 5 MHz convex probe. DICOM loops up to 1 min. in the ablation area were stored digitally in the PACS. Regions of interest (ROI) were manually placed in the center, the margins of the lesions as well as in the surrounding tissue. Using VueBox® peak, time to peak (TTP), mean transit time (mTT), rise time (RT), the wash-in and wash-out rate were calculated for the regions, in order to evaluate the success of the percutaneous treatment after the ablation in comparison to the ceCT/ceMRI up to 6 months after the treatment.

Results There were significant differences in all cases between the center compared to the margins for the main perfusion parameters (peak, mTT, RT) (p < 0.001). Peak, wash-in and wash-out ratios were further analyzed with the type of lesion and the method of ablation. All parameters were significantly different between lesions treated successfully vs. lesions with recurrence.

Conclusion A combination of CEUS with perfusion imaging enables critical assessment of successful treatment after percutaneous interventional procedures for a malignant liver lesion.
A Markov state modeling analysis of sliding dynamics of a 2D model
Authors: Teruzzi M. , Pellegrini F. , Laio A. , Tosatti E.
Published: September 2017

Non-equilibrium Markov State Modeling (MSM) has recently been proposed by Pellegrini et al. [Phys. Rev. E 94, 053001 (2016)] as a possible route to construct a physical theory of sliding friction from a long steady state atomistic simulation: the approach builds a small set of collective variables, which obey a transition-matrix-based equation of motion, faithfully describing the slow motions of the system. A crucial question is whether this approach can be extended from the original 1D small size demo to larger and more realistic size systems, without an inordinate increase of the number and complexity of the collective variables. Here we present a direct application of the MSM scheme to the sliding of an island made of over 1000 harmonically bound particles over a 2D periodic potential. Based on a totally unprejudiced phase space metric and without requiring any special doctoring, we find that here too the scheme allows extracting a very small number of slow variables, necessary and sufficient to describe the dynamics of island sliding.
Double modulation pyrometry: A radiometric method to measure surface temperatures of directly irradiated samples
Authors: Potamias Dimitrios , Alxneit Ivo , Wokaun Alexander
Published: September 2017

The design, implementation, calibration, and assessment of double modulation pyrometry to measure surface temperatures of radiatively heated samples in our 1 kW imaging furnace is presented. The method requires that the intensity of the external radiation can be modulated. This was achieved by a rotating blade mounted parallel to the optical axis of the imaging furnace. Double modulation pyrometry independently measures the external radiation reflected by the sample as well as the sum of thermal and reflected radiation and extracts the thermal emission as the difference of these signals. Thus a two-step calibration is required: First, the relative gains of the measured signals are equalized and then a temperature calibration is performed. For the latter, we transfer the calibration from a calibrated solar blind pyrometer that operates at a different wavelength. We demonstrate that the worst case systematic error associated with this procedure is about 300 K but becomes negligible if a reasonable estimate of the sample’s emissivity is used. An analysis of the influence of the uncertainties in the calibration coefficients reveals that one (out of the five) coefficient contributes almost 50% to the final temperature error. On a low emission sample like platinum, the lower detection limit is around 1700 K and the accuracy typically about 20 K. Note that these moderate specifications are specific for the use of double modulation pyrometry at the imaging furnace. It is mainly caused by the difficulty to achieve and maintain good overlap of the hot zone with a diameter of about 3 mm Full Width at Half Height and the measurement spot both of which are of similar size.
Continuous point-like high-temperature laser discharge produced by terahertz free electron laser
Authors: Kubarev V. V. , Getmanov Ya. V. , Shevchenko O. A.
Published: September 2017

A continuous point-like laser discharge of record high temperature has been produced in argon at atmospheric pressure with focusing of the radiation of the Novosibirsk terahertz free electron laser (NovoFEL). According to spectral measurements, the temperature in the center of the millimeter-sized plasma sphere was 28000 K at a plasma density of 1.5×1017 cm-3 and an average NovoFEL power of 200 W at a wavelength of 130 μm (2.3 THz).
Translation-rotation decoupling of tracers of locally favorable structures in glass-forming liquids
Authors: Park Yoonjae , Kim Jeongmin , Sung Bong June
Published: September 2017

Particles in glass-forming liquids may form domains of locally favorable structures (LFSs) upon supercooling. Whether and how the LFS domains would relate to the slow relaxation of the glass-forming liquids have been issues of interest. In this study, we employ tracers of which structures resemble the LFS domains in Wahnström and Kob-Andersen (KA) glass-forming liquids and investigate the translation-rotation decoupling of the tracers. We find that the tracer structure affects how the translation and the rotation of tracers decouple and that information on the local mobility around the LFS domains may be gleaned from the tracer dynamics. According to the Stokes-Einstein relation and the Debye-Stokes-Einstein relation, the ratio of the translational (DT) and rotational (DR) diffusion coefficients is expected to be a constant over a range of T/η, where η and T denote the medium viscosity and temperature, respectively. In supercooled liquids and glasses, however, DT and DR decouple due to dynamic heterogeneity, thus DT/DR not being constant any more. In Wahnström glass-forming liquids, icosahedron LFS domains are the most long-lived ones and the mobility of neighbor particles around the icosahedron LFS domain is suppressed. We find from our simulations that the icosahedron tracers, similar in size and shape to the icosahedron LFS domains, experience drastic translation-rotation decoupling upon cooling. The local mobility of liquid particles around the icosahedron tracers is also suppressed significantly. On the other hand, tracers of FCC and HCP structures do not show translation-rotation decoupling in the Wahnström liquid. In KA glass-forming liquids, bicapped square antiprism LFS domains are the most long-lived LFS domains but are not correlated significantly with the local mobility. We find from our simulations that DT and DR of bicapped square antiprism tracers, also similar in size and shape to the bicapped square antiprism LFS domains, do not decouple significantly similarly to tracers of other structures, thus reflecting that the local mobility would not be associated strongly with LFS domains in the KA liquid.
Sizing and placement of battery-coupled distributed photovoltaic generations
Authors: Ali Abid , Mohd Nor Nursyarizal , Ibrahim Taib , Fakhizan Romlie Mohd
Published: September 2017

The rate of integration of distributed generation (DG) using renewable sources is increasing in distribution networks because of their technical and economic advantages. However, mismatches in the timing of electricity demand and generation in distribution networks have restricted the penetration of non-dispatchable DGs such as photovoltaic (PV) plants. Such a problem associated with the integration of DGs in distribution networks could be eliminated using the proper application of battery energy storage systems. In this paper, optimal planning of battery-coupled distributed photovoltaic generators (BCDPGs) in distribution networks is presented. The optimal planning determines the size and location of BCDPGs and schedules the charging and discharging of the batteries, while minimizing the total energy losses subject to technical constraints. To estimate the output from PV modules, 15-year solar irradiance data is modeled using the beta probability density function. Mixed-integer optimization using a genetic algorithm is employed for solving the optimization problem. The numerical studies on a 33-node distribution network show the advantages of the proposed methodology. The results obtained through this study show the capability of the proposed method to optimally allocate BCDPGs to largely improve the quality of supply of power from non-dispatchable DGs in terms of reducing energy losses, improving bus voltages, and increasing penetration levels of renewable energy. The proposed approach can also be useful when applied to realistic networks for proper sizing and operations of battery-coupled photovoltaic plants.
Intrinsically shunted Josephson junctions for electronics applications
Authors: Belogolovskii M. , Zhitlukhina E. , Lacquaniti V. , De Leo N. , Fretto M. , Sosso A.
Published: September 2017

Conventional Josephson metal-insulator-metal devices are inherently underdamped and exhibit hysteretic current-voltage response due to a very high subgap resistance compared to that in the normal state. At the same time, overdamped junctions with single-valued characteristics are needed for most superconducting digital applications. The usual way to overcome the hysteretic behavior is to place an external low-resistance normal-metal shunt in parallel with each junction. Unfortunately, such solution results in a considerable complication of the circuitry design and introduces parasitic inductance through the junction. This paper provides a concise overview of some generic approaches that have been proposed in order to realize internal shunting in Josephson heterostructures with a barrier that itself contains the desired resistive component. The main attention is paid to self-shunted devices with local weak-link transmission probabilities that are so strongly disordered in the interface plane that transmission probabilities are tiny for the main part of the transition region between two super-conducting electrodes, while a small part of the interface is well transparent. We discuss the possibility of realizing a universal bimodal distribution function and emphasize advantages of such junctions that can be considered as a new class of self-shunted Josephson devices promising for practical applications in superconducting electronics operating at 4.2 K.
Reentrance phenomenon in superconductor/ferromagnet nanostructures and their application in superconducting spin valves for superconducting electronics
Authors: Sidorenko A. S.
Published: September 2017

In superconductor/ferromagnet layered structures, a Fulde–Ferrell–Larkin–Ovchinnikov-like inhomogeneous superconducting pairing give rise. The singlet and zero-projection triplet components of the pairing oscillate in space, and the presence of interfaces causes interference phenomena. As the result of the interference, the super-conducting critical temperature Tc oscillates as a function of the ferromagnetic layer thicknesses or, even more spectacular, reentrant superconductivity appears. Two ferromagnetic layers can be combined with a superconducting layer into a superconducting spin valve. Proper design and choice of the material parameters give possibility to control superconducting Tc manipulating with magnetic configurations in the system. The conditions to get large spin-valve effect, i.e., a large shift in the critical temperature, are reviewed in the article.