bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of gravitational curvatures for a tesseroid and spherical shell with arbitrary-order polynomial density
Authors: Deng Xiao-Le
Published: February 2023

In recent years, there are research trends from constant to variable density and low-order to high-order gravitational potential gradients in gravity field modeling. Under the research circumstances, this paper focuses on the variable density model for gravitational curvatures (or gravity curvatures, third-order derivatives of gravitational potential) of a tesseroid and spherical shell in the spatial domain of gravity field modeling. In this contribution, the general formula of the gravitational curvatures of a tesseroid with arbitrary-order polynomial density is derived. The general expressions for gravitational effects up to the gravitational curvatures of a spherical shell with arbitrary-order polynomial density are derived when the computation point is located above, inside, and below the spherical shell. When the computation point is located above the spherical shell, the general expressions for the mass of a spherical shell and the relation between the radial gravitational effects up to arbitrary-order and the mass of a spherical shell with arbitrary-order polynomial density are derived. The influence of the computation point’s height and latitude on gravitational curvatures with the polynomial density up to fourth-order is numerically investigated using tesseroids to discretize a spherical shell. Numerical results reveal that the near-zone problem exists for the fourth-order polynomial density of the gravitational curvatures, i.e., relative errors in $$\log _{10}$$

log
10

scale of gravitational curvatures are large than 0 below the height of about 50 km by a grid size of $$15'\times 15'$$

15
′

×

15
′

. The polar-singularity problem does not occur for the gravitational curvatures with polynomial density up to fourth-order because of the Cartesian integral kernels of the tesseroid. The density variation can be revealed in the absolute errors as the superposition effects of Laplace parameters of gravitational curvatures other than the relative errors. The derived expressions are examples of the high-order gravitational potential gradients of the mass body with variable density in the spatial domain, which will provide the theoretical basis for future applications of gravity field modeling in geodesy and geophysics.
Early effects of lurasidone treatment in a chronic mild stress model in male rats
Authors: Creutzberg Kerstin Camile , Begni Veronica , Marchisella Francesca , Papp Mariusz , Riva Marco Andrea
Published: February 2023

Rationale

Stress represents a major contributor to the development of mental illness. Accordingly, exposure of adult rats to chronic stress represents a valuable tool to investigate the ability of a pharmacological intervention to counteract the adverse effects produced by stress exposure.

Objectives

The aim of this study was to perform a time course analysis of the treatment with the antipsychotic drug lurasidone in normalizing the anhedonic phenotype in the chronic mild stress (CMS) model in order to identify early mechanisms that may contribute to its therapeutic activity.

Methods

Male Wistar rats were exposed to CMS or left undisturbed for 7 weeks. After two weeks of stress, both controls and CMS rats were randomly divided into two subgroups that received vehicle or lurasidone for five weeks. Weekly measures of sucrose intake were recorded to evaluate anhedonic behavior, and animals were sacrificed at different weeks of treatment for molecular analyses.

Results

We found that CMS-induced anhedonia was progressively improved by lurasidone treatment. Interestingly, after two weeks of lurasidone treatment, 50% of the animals showed a full recovery of the phenotype, which was associated with increased activation of the prefrontal and recruitment of parvalbumin-positive cells that may lead to a restoration of excitatory/inhibitory balance.

Conclusion

These results suggest that the capacity of lurasidone to normalize anhedonia at an early stage of treatment may depend on its ability to modulate the function of the prefrontal cortex.
Carbon dots as a versatile tool to monitor insulin aggregation
Authors: Zingale Gabriele Antonio , Distefano Alessia , Pandino Irene , Tuccitto Nunzio , Oliveri Valentina , Gaeta Massimiliano , D’Urso Alessandro , Arcoria Alfio , Grasso Giuseppe
Published: February 2023

The possibility to monitor peptide and protein aggregation is of paramount importance in the so-called conformational diseases, as the understanding of many physiological pathways, as well as pathological processes involved in the development of such diseases, depends very much on the actual possibility to monitor biomolecule oligomeric distribution and aggregation. In this work, we report a novel experimental method to monitor protein aggregation, based on the change of the fluorescent properties of carbon dots upon protein binding. The results obtained in the case of insulin with this newly proposed experimental approach are compared with those obtained with other common experimental techniques normally used for the same purpose (circular dichroism, DLS, PICUP and ThT fluorescence). The greatest advantage of the hereby presented methodology over all the other experimental methods considered is the possibility to monitor the initial stages of insulin aggregation under the different experimental conditions sampled and the absence of possible disturbances and/or molecular probes during the aggregation process.

Graphical abstract
Liquid chromatography and differential mobility spectrometry—data-independent mass spectrometry for comprehensive multidimensional separations in metabolomics
Authors: Ekmekciu Lysi , Hopfgartner Gérard
Published: February 2023

The benefits of combining drift time ion mobility (DTIMS) with liquid chromatography–high-resolution mass spectrometry (HRMS) have been reported for metabolomics but the use of differential time mobility spectrometry (DMS) is less obvious due to the need for rapid scanning of the DMS cell. Drift DTIMS provides additional precursor ion selectivity and collisional cross-section information but the separation resolution between analytes remains cell- and component-dependent. With DMS, the addition of 2-propanol modifier can improve the selectivity but on cost of analyte MS response. In the present work, we investigate the liquid chromatography–mass spectrometry (LC–MS) analysis of a mix of 50 analytes, representative for urine and plasma metabolites, using scanning DMS with the single modifiers cyclohexane (Ch), toluene (Tol), acetonitrile (ACN), ethanol (EtOH), and 2-propanol (IPA), and a binary modifier mixture (cyclohexane/2-propanol) with emphasis on selectivity and signal sensitivity. 1.5% IPA in the N2 stream was found to suppress the signal of 50% of the analytes which could be partially recovered with the use of IPA to 0.05% as a Ch/IPA mixture. The potential to use the separation voltage/compensation voltage/modifier (SV/CoV/Mod) feature as an additional analyte identifier for qualitative analysis is also presented and applied to a data-independent LCxDMS-SWATH-MS workflow for the analysis of endogenous metabolites and drugs of abuse in human urine samples from traffic control.

Graphical Abstract
Validation of simplified uptake measures against dynamic Patlak Ki for quantification of lesional 89Zr-Immuno-PET antibody uptake
Authors: Wijngaarden Jessica E. , Huisman Marc C. , Jauw Yvonne W. S. , van Dongen Guus A. M. S. , Greuter Henri N. J. M. , Schuit Robert C. , Cleveland Matthew , Gootjes Elske C. , Vugts Daniëlle J. , Menke-van der Houven van Oordt C. Willemien , Boellaard Ronald
Published: February 2023

Purpose

Positron emission tomography imaging of zirconium-89-labelled monoclonal antibodies (89Zr-Immuno-PET) allows for visualisation and quantification of antibody uptake in tumours in vivo. Patlak linearization provides distribution volume (VT) and nett influx rate (Ki) values, representing reversible and irreversible uptake, respectively. Standardised uptake value (SUV) and tumour-to-plasma/tumour-to-blood ratio (TPR/TBR) are often used, but their validity depends on the comparability of plasma kinetics and clearances. This study assesses the validity of SUV, TPR and TBR against Patlak Ki for quantifying irreversible 89Zr-Immuno-PET uptake in tumours.

Methods

Ten patients received 37 MBq 10 mg 89Zr-anti-EGFR with 500 mg/m2 unlabelled mAbs. Five patients received two doses of 37 MBq 89Zr-anti-HER3: 8–24 mg for the first administration and 24 mg–30 mg/kg for the second. Seven tumours from four patients showed 89Zr-anti-EGFR uptake, and 18 tumours from five patients showed 89Zr-anti-HER3 uptake. SUVpeak, TPRpeak and TBRpeak values were obtained from one to six days p.i. Patlak linearization was applied to tumour time activity curves and plasma samples to obtain Ki.

Results

For 89Zr-anti-EGFR, there was a small variability along the linear regression line between SUV (− 0.51–0.57), TPR (− 0.06‒0.11) and TBR (− 0.13‒0.16) on day 6 versus Ki. Similar doses of 89Zr-anti-HER3 showed similar variability for SUV (− 1.3‒1.0), TPR (− 1.1‒0.53) and TBR (− 1.5‒0.72) on day 5 versus Ki. However, for the second administration of 89Zr-anti-HER3 with a large variability in administered mass doses, SUV showed a larger variability (− 1.4‒2.3) along the regression line with Ki, which improved when using TPR (− 0.38–0.32) or TBR (− 0.56‒0.46).

Conclusion

SUV, TPR and TBR at late time points were valid for quantifying irreversible lesional 89Zr-Immuno-PET uptake when constant mass doses were administered. However, for variable mass doses, only TPR and TBR provided reliable values for irreversible uptake, but not SUV, because SUV does not take patient and mass dose-specific plasma clearance into account.
Associations between KIR/KIR-ligand genotypes and clinical outcome for patients with advanced solid tumors receiving BEMPEG plus nivolumab combination therapy in the PIVOT-02 trial
Authors: Feils A. S. , Erbe A. K. , Birstler J. , Kim K. , Hoch U. , Currie S. L. , Nguyen T. , Yu D. , Siefker-Radtke A. O. , Tannir N. , Tolaney S. M. , Diab A. , Sondel P. M.
Published: February 2023

Bempegaldesleukin (BEMPEG), a CD122-preferential IL2 pathway agonist, has been shown to induce proliferation and activation of NK cells. NK activation is dependent on the balance of inhibitory and excitatory signals transmitted by NK receptors, including Fc-gamma receptors (FCγRs) and killer immunoglobulin-like receptors (KIRs) along with their KIR-ligands. The repertoire of KIRs/KIR-ligands an individual inherits and the single-nucleotide polymorphisms (SNPs) of FCγRs can influence NK function and affect responses to immunotherapies. In this retrospective analysis of the single-arm PIVOT-02 trial, 200 patients with advanced solid tumors were genotyped for KIR/KIR-ligand gene status and FCγR SNP status and evaluated for associations with clinical outcome. Patients with inhibitory KIR2DL2 and its ligand (HLA-C1) observed significantly greater tumor shrinkage (TS, median change −13.0 vs. 0%) and increased PFS (5.5 vs. 3.3 months) and a trend toward improved OR (31.2 vs. 19.5%) compared to patients with the complementary genotype. Furthermore, patients with KIR2DL2 and its ligand together with inhibitory KIR3DL1 and its ligand (HLA-Bw4) had improved OR (36.5 vs. 19.6%), greater TS (median change −16.1 vs. 0%), and a trend toward prolonged PFS (8.4 vs. 3.6 months) as compared to patients with the complementary genotype. FCγR polymorphisms did not influence OR/PFS/TS.

These data show that clinical response to BEMPEG plus nivolumab treatment in the PIVOT-02 trial may be associated with the repertoire of KIR/KIR-ligands an individual inherits. Further investigation and validation of these results may enable KIR/KIR-ligand genotyping to be utilized prospectively for identifying patients likely to benefit from certain cancer immunotherapy regimens.
The 27-gene IO score is associated with efficacy of PD-1/L1 inhibitors independent of FGFR expression in a real-world metastatic urothelial carcinoma cohort
Authors: Nielsen Tyler J. , Varga Matthew G. , Cronister Catherine T. , Ring Brian Z. , Seitz Robert S. , Ross Douglas T. , Schweitzer Brock L. , McGregor Kimberly
Published: February 2023

Multiple targeted therapeutics have been approved by the FDA for mUC, including immune checkpoint inhibitors (ICIs) and more recently targeted agents for both FGFR and Nectin-4. FGFR3-aberrant and Nectin-4 expressing cells have been associated with an immunosuppressed phenotype. Given that less than half of all patients respond to these agents as monotherapies and less than 20% are eligible to receive salvage therapy, effective personalized treatment plans are critical. Typical biomarkers for ICIs such as PD-L1 and TMB have not been definitive in mUC, yet a biomarker-driven optimization of first-line therapy and subsequent sequencing have the potential to achieve higher and more durable response rates. The IO score is a 27-gene tumor immune microenvironment (TIME) classifier that has been associated with the clinical benefits of ICIs in multiple cancer types, including mUC. This study demonstrates that the IO score was associated with both progression-free survival (PFS) and overall survival (OS) in a real-world cohort of mUC patients treated with ICIs. Furthermore, the IO score was independent of and provided information incremental to TMB. Interestingly, the IO score predicted benefit in patients with high FGFR expression, despite conflicting data regarding response rates among the FGFR aberrant population. Taken together, these results demonstrate that the IO score assessment of the TIME is associated with a clinical benefit from ICI therapy and that this novel biomarker may inform therapeutic sequencing decisions in mUC, potentially improving outcomes for this notoriously difficult-to-treat disease.
Three-dimensional encoding of a gas–liquid interface by means of color-coded glare points
Authors: Dreisbach Maximilian , Blessing Sebastian , Brunn André , Michaux Frank , Stroh Alexander , Kriegseis Jochen
Published: February 2023

The present work introduces an extension of the shadowgraphy method by differently colored oblique light sources for the observation of the three-dimensional spatio-temporal dynamics of gas–liquid interfaces. The proposed expanded approach is tested and elaborated with the example of a droplet during impingement. Particularly, it is elaborated in a combined experimental/theoretical approach, how well glare points from differently colored oblique light sources can be used to encode additional 3D information of the droplet shape within a single shadowgraph image. Narrow-banded LEDs with distinct spectra and maxima in the visible light illuminate the droplet from different angles in red, green and blue light, respectively, while a high-speed RGB camera captures the images produced by each light source in the corresponding image channel, therefore creating three unique views of the droplet. In order to compensate for the mutual perturbation of the images resulting from cross-talk between the channels and the polychromatic light of the LEDs, a color correction is introduced, which is based on the transfer function between the light sources and the channels of the RGB camera. In experiments with the proposed measurement setup of a water droplet impinging onto a flat substrate it is successfully demonstrated that three unique and independent grayscale images can be reconstructed with this color correction function. The optimal illumination angles for the lateral light sources are determined experimentally, which lead to consistent glare points on the deforming gas–liquid interface throughout the dynamic process of the drop impact. An ellipsoidal droplet is considered to derive information on orientation and three-dimensional shape of a non-axisymmetrical droplet from the relative positions of the glare points and the shadowgraph contour. Thereby it is successfully demonstrated that the additional three-dimensional information encoded in the glare points can lay the groundwork for the volumetric reconstruction of the deforming gas–liquid interface during the impingement of a droplet.
Turán Problems for k-Geodetic Digraphs
Authors: Tuite James , Erskine Grahame , Salia Nika
Published: February 2023

A digraph G is k-geodetic if for any pair of (not necessarily distinct) vertices $$u,v \in V(G)$$

u
,
v
∈
V
(
G
)

there is at most one walk of length $$\le k$$

≤
k

from u to v in G. In this paper, we determine the largest possible size of a k-geodetic digraph with a given order. We then consider the more difficult problem of the largest size of a strongly-connected k-geodetic digraph with a given order, solving this problem for $$k = 2$$

k
=
2

and giving a construction which we conjecture to be extremal for larger k. We close with some results on generalised Turán problems for the number of directed cycles and paths in k-geodetic digraphs.
Dataset of Comparative Observations for Land Surface Processes over the Semi-Arid Alpine Grassland against Alpine Lakes in the Source Region of the Yellow River
Authors: Meng Xianhong , Lyu Shihua , Li Zhaoguo , Ao Yinhuan , Wen Lijuan , Shang Lunyu , Wang Shaoying , Deng Mingshan , Zhang Shaobo , Zhao Lin , Chen Hao , Ma Di , Li Suosuo , Shu Lele , An Yingying , Niu Hanlin
Published: February 2023

Thousands of lakes on the Tibetan Plateau (TP) play a critical role in the regional water cycle, weather, and climate. In recent years, the areas of TP lakes underwent drastic changes and have become a research hotspot. However, the characteristics of the lake-atmosphere interaction over the high-altitude lakes are still unclear, which inhibits model development and the accurate simulation of lake climate effects. The source region of the Yellow River (SRYR) has the largest outflow lake and freshwater lake on the TP and is one of the most densely distributed lakes on the TP. Since 2011, three observation sites have been set up in the Ngoring Lake basin in the SRYR to monitor the lake-atmosphere interaction and the differences among water-heat exchanges over the land and lake surfaces. This study presents an eight-year (2012–19), half-hourly, observation-based dataset related to lake–atmosphere interactions composed of three sites. The three sites represent the lake surface, the lakeside, and the land. The observations contain the basic meteorological elements, surface radiation, eddy covariance system, soil temperature, and moisture (for land). Information related to the sites and instruments, the continuity and completeness of data, and the differences among the observational results at different sites are described in this study. These data have been used in the previous study to reveal a few energy and water exchange characteristics of TP lakes and to validate and improve the lake and land surface model. The dataset is available at National Cryosphere Desert Data Center and Science Data Bank.
Stenting of branch pulmonary artery stenosis in children: initial experience and mid-term follow-up of the pul-stent
Authors: Xu Xinyi , Guo Ying , Huang Meirong , Fu Lijun , Li Fen , Zhang Haibo , Gao Wei , Liu Tingliang
Published: February 2023

Not all stents are suitable for children. For instance, premounted stents can be used in infants and small children but cannot dilate with age to accommodate adult-sized pulmonary arteries. Conversely, the Pul-Stent adapts to somatic growth. Thus, our hospital implemented the Pul-Stent in pediatric patients with branch pulmonary artery stenosis. This study summarizes our initial experience with Pul-Stents in this patient population, including the efficacy and safety. We implanted 37 Pul-Stents in 35 patients between August 2014 and June 2015. The patients’ mean age and weight at stent implantation were 6.7 ± 3.0 years and 20.9 ± 8.7 kg, respectively. Bench testing revealed that axial shortening of the Pul-Stent was minimal with further dilation, and the radial strength did not change. The stents were successfully deployed in all cases, except two with minor malpositioning. Primarily, 8–12 mm mounting balloons were used for the initial implantation, and a long sheath (8–10 F) was used for delivery. After stent implantation, the minimal lumen diameter in the stenosed segment increased by 50% in 97% (34/35) of patients. Furthermore, the pressure gradient across the stenosed segment decreased by 50% in 77% (23/30) of biventricular patients. One stent fracture and one stent restenosis were noted during the follow-up visits (mean follow-up time: 4.6 ± 1.7 years). Eighteen patients (51%) underwent repeat catheterization; ten had successful redilation. No aneurysms or stent fractures were observed. Our initial results indicate that the Pul-Stent is safe and effective in pediatric patients and can be further dilated over time to accommodate somatic growth. Moreover, the Pul-Stent has good compliance and adequate radial strength to treat pulmonary artery stenosis effectively.
Surgical approaches to colonic and rectal anastomosis: systematic review and meta-analysis
Authors: Oliveira Ana , Faria Susana , Gonçalves Nuno , Martins Albino , Leão Pedro
Published: February 2023

Purpose

Postoperative complications after a colonic and rectal surgery are of significant concern to the surgical community. Although there are different techniques to perform anastomosis (i.e., handsewn, stapled, or compression), there is still no consensus on which technique provides the least number of postoperative problems. The objective of this study is to compare the different anastomotic techniques regarding the occurrence or duration of postoperative outcomes such as anastomotic dehiscence, mortality, reoperation, bleeding and stricture (as primary outcomes), and wound infection, intra-abdominal abscess, duration of surgery, and hospital stay (as secondary outcomes).

Methods

Clinical trials published between January 1, 2010, and December 31, 2021, reporting anastomotic complications with any of the anastomotic technique were identified using the MEDLINE database. Only articles that clearly defined the anastomotic technique used, and report at least two of the outcomes defined were included.

Results

This meta-analysis included 16 studies whose differences were related to the need of reoperation (p < 0.01) and the duration of surgery (p = 0.02), while for the anastomotic dehiscence, mortality, bleeding, stricture, wound infection, intra-abdominal abscess, and hospital stay, no significant differences were found. Compression anastomosis reported the lowest reoperation rate (3.64%) and the handsewn anastomosis the highest (9.49%). Despite this, more time to perform the surgery was required in compression anastomosis (183.47 min), with the handsewn being the fastest technique (139.92 min).

Conclusions

The evidence found was not sufficient to demonstrate which technique is most suitable to perform colonic and rectal anastomosis, since the postoperative complications were similar between the handsewn, stapled, or compression techniques.
The use of a standard-length conical tapered stem in hip revision arthroplasty to address Paprosky type I–II femoral defects: a prospective study of 87 patients
Authors: Innocenti Matteo , Smulders Katrijn , Andreotti Mattia , Willems Jore H. , Van Hellemondt Gijs , Nijhof Marc W.
Published: February 2023

Introduction

Low-grade femoral defects in revision total hip arthroplasty (rTHA) might be preferably treated with a primary implant. Almost no previous study reported the use of standard-length conical tapered (SLCT) stems in these cases. We analyzed a series of cases using a SLCT stem in rTHA with Paprosky type I–II femoral defects. The purpose of the study was to determine clinical and radiographic outcomes in this series of rTHA.

Materials and methods

We prospectively followed 87 patients undergoing a femoral component rTHA: 53 Paprosky type I and 34 type II femoral defects. Patient-reported measures (Oxford Hip Score, EQ-5D, VAS pain during rest and activity) were administered at baseline, 1 and 2 years post-operatively. Radiographic subsidence overtime was scored. Kaplan–Meier curves were used to evaluate the subsidence over time, the complication-free survival, and the implant survivorship with reoperation and stem revision as endpoints.

Results

The mean follow-up was 72.5 (SD ± 23.9) months. All PROMs significatively improved over time. The average subsidence was 2.8 (SD ± 3.2), 3.6 (SD ± 4.4), and 4.0 (SD ± 4.9) mm at 4, 12, and 24 months respectively. 6 stems had subsidence > 10 mm. The survival without complication was 0.85 (95% CI 0.94–0.77), while the implant survival without reoperation was 0.83 (95% CI 0.95–0.72). The overall stem survival rate was 93.7% (95% CI 0.91–0.97) at 2 years.

Conclusion

The use of a SLCT stem in rTHA with Paprosky type I–II femoral defects demonstrated good survival with low subsidence rates during the first 2 years after surgery. Surgeons should consider the use of this primary prosthesis as a potential treatment during stem revision in cases with limited femoral bone loss.
Patients’ perspectives towards biologic dose reduction in psoriasis: a qualitative study
Authors: van der Schoot L. S. , Verhoef L. M. , van Ee I. , van Oort F. P. A. H. , Pieterse A. H. , Seyger M. M. B. , de Jong E. M. G. J. , van den Reek J. M. P. A.
Published: February 2023

Dose reduction of biologics for psoriasis could contribute to more efficient use of these expensive medicines. Evidence on opinions of patients with psoriasis regarding dose reduction is sparse. The objective of this study was therefore to explore patients’ perspectives towards dose reduction of biologics for psoriasis. A qualitative study was conducted, comprising semi-structured interviews with 15 patients with psoriasis with different characteristics and treatment experiences. Interviews were analyzed by inductive thematic analysis. Perceived benefits of biologic dose reduction according to patients were minimizing medication use, lowering risks of adverse effects and lowering societal healthcare costs. Patients reported to have experienced a large impact of their psoriasis, and expressed concerns about loss of disease control due to dose reduction. Fast access to flare treatment and adequate monitoring of disease activity were among reported preconditions. According to patients, they should have confidence in dose reduction effects and should be willing to change their effective treatment. Moreover, addressing information needs and involvement in decision-making were deemed important among patients. In conclusion, addressing patients’ concerns, fulfilling information needs, providing the possibility of resuming standard dose, and involving patients in decision-making are important according to patients with psoriasis when considering biologic dose reduction.
Comparison of three common tonsil surgery techniques: cold steel with hot hemostasis, monopolar and bipolar diathermy
Authors: Knubb Jenny Christina , Kaislavuo Jasmin Maria , Jegoroff Henri Sebastian , Piitulainen Jaakko Matias , Routila Johannes
Published: February 2023

Purpose

To analyze the risk of postoperative hemorrhage in tonsil surgery with different surgical methods, instruments, indications, and age groups. Monopolar diathermy compared to bipolar diathermy was of particular interest.

Methods

The data from tonsil surgery patients were retrospectively collected between 2012 and 2018 in the Hospital District of Southwest Finland. The surgical method, instruments, indication, sex and age and their association with a postoperative hemorrhage were analyzed.

Results

A total of 4434 patients were included. The postoperative hemorrhage rate for tonsillectomy was 6.3% and for tonsillotomy 2.2%. The most frequently used surgical instruments were monopolar diathermy (58.4%) cold steel with hot hemostasis (25.1%) and bipolar diathermy (6.4%) with the overall postoperative hemorrhage rates 6.1%, 5.9% and 8.1%, respectively. In tonsillectomy patients, the risk for a secondary hemorrhage was higher with bipolar diathermy compared to both monopolar diathermy (p = 0.039) and the cold steel with hot hemostasis technique (p = 0.029). However, between the monopolar and the cold steel with hot hemostasis groups, the difference was statistically non-significant (p = 0.646). Patients aged > 15 years had 2.6 times higher risk for postoperative hemorrhage. The risk of a secondary hemorrhage increased with tonsillitis as the indication, primary hemorrhage, tonsillectomy or tonsillotomy without adenoidectomy, and male sex in patients aged ≤ 15 years.

Conclusion

Bipolar diathermy increased the risk for secondary bleedings compared to both monopolar diathermy and the cold steel with hot hemostasis technique in tonsillectomy patients. Monopolar diathermy did not significantly differ from the cold steel with hot hemostasis group regarding the bleeding rates.
Assessing retinal hemorrhages with non-invasive post-mortem fundus photographs in sudden unexpected death in infancy
Authors: Ducloyer Jean-Baptiste , Scherpereel Cloé , Goronflot Thomas , Le Meur Guylène , Lebranchu Pierre , Jossic Frédérique , Scolan Virginie , Ducloyer Mathilde
Published: February 2023

Introduction

In the case of sudden unexpected death in infancy (SUDI), eye examination is systematic to detect retinal hemorrhages (RH) that are a crucial hallmark for abusive head trauma (AHT). The aim of this study is to assess the ability of non-invasive post-mortem fundus photographs (PMFP) to detect RH in case of SUDI.

Methods

Bicentric retrospective analysis of consecutive cases of SUDI under 2 years of age were managed by two French SUDI referral centers with PMFP by RetCam (Clarity Medical Systems USA). PMFP were reviewed randomly, twice, by three independent ophthalmologists blinded for clinical data.

Results

Thirty cases (60 eyes) were included. Median age was 3.5 months (interquartile [1.6; 6.0]). No child died of AHT. Image quality was sufficient to assert presence or absence of RH in 50 eyes (83%). Sufficient quality rate was significantly higher when the post-mortem interval was inferior to 18 h (91%, 42/46) as opposed to over 18 h (57%, 8/14, p=0.0096). RH were found in six eyes (10%), four children (13%), with excellent inter and intra-raters’ concordance (Cohen’s Kappa from 0.81 [0.56–1.00] to 1.00 [1.00–1.00]).

Conclusion

PMFP can detect RH in case of SUDI and is a relevant systematic screening test to be carried out as soon as the deceased child arrives in the hospital. It can decrease the need of eye removal for pathological examination, but further studies are needed to define the best decision algorithm.
Patterns of acute ischemic stroke and intracranial hemorrhage in patients with COVID-19
Authors: Jensen-Kondering Ulf , Maurer Christoph J. , Brudermann Hanna C. B. , Ernst Marielle , Sedaghat Sam , Margraf Nils G. , Bahmer Thomas , Jansen Olav , Nawabi Jawed , Vogt Estelle , Büttner Laura , Siebert Eberhard , Bartl Michael , Maus Volker , Werding Gregor , Schlamann Marc , Abdullayev Nuran , Bender Benjamin , Richter Vivien , Mengel Annerose , Göpel Siri , Berlis Ansgar , Grams Astrid , Ladenhauf Valentin , Gizewski Elke R. , Kindl Philipp , Schulze-Zachau Victor , Psychogios Marios , König Inke R. , Sondermann Stefan , Wallis Sönke , Brüggemann Norbert , Schramm Peter , Neumann Alexander
Published: February 2023

Background

Coronavirus disease 2019 (COVID-19) is an infection which can affect the central nervous system. In this study, we sought to investigate associations between neuroimaging findings with clinical, demographic, blood and cerebrospinal fluid (CSF) parameters, pre-existing conditions and the severity of acute COVID-19.

Materials and methods

Retrospective multicenter data retrieval from 10 university medical centers in Germany, Switzerland and Austria between February 2020 and September 2021. We included patients with COVID-19, acute neurological symptoms and cranial imaging. We collected demographics, neurological symptoms, COVID-19 severity, results of cranial imaging, blood and CSF parameters during the hospital stay.

Results

442 patients could be included. COVID-19 severity was mild in 124 (28.1%) patients (moderate n = 134/30.3%, severe n = 43/9.7%, critical n = 141/31.9%). 220 patients (49.8%) presented with respiratory symptoms, 167 (37.8%) presented with neurological symptoms first. Acute ischemic stroke (AIS) was detected in 70 (15.8%), intracranial hemorrhage (IH) in 48 (10.9%) patients. Typical risk factors were associated with AIS; extracorporeal membrane oxygenation therapy and invasive ventilation with IH. No association was found between the severity of COVID-19 or blood/CSF parameters and the occurrence of AIS or IH.

Discussion

AIS was the most common finding on cranial imaging. IH was more prevalent than expected but a less common finding than AIS. Patients with IH had a distinct clinical profile compared to patients with AIS. There was no association between AIS or IH and the severity of COVID-19. A considerable proportion of patients presented with neurological symptoms first. Laboratory parameters have limited value as a screening tool.
Evolution of the digital operating room: the place of video technology in surgery
Authors: Cheikh Youssef Samy , Haram Kaled , Noël Jonathan , Patel Vipul , Porter James , Dasgupta Prokar , Hachach-Haram Nadine
Published: February 2023

Purpose

The aim of this review was to collate current evidence wherein digitalisation, through the incorporation of video technology and artificial intelligence (AI), is being applied to the practice of surgery. Applications are vast, and the literature investigating the utility of surgical video and its synergy with AI has steadily increased over the last 2 decades. This type of technology is widespread in other industries, such as autonomy in transportation and manufacturing.

Methods

Articles were identified primarily using the PubMed and MEDLINE databases. The MeSH terms used were “surgical education”, “surgical video”, “video labelling”, “surgery”, “surgical workflow”, “telementoring”, “telemedicine”, “machine learning”, “deep learning” and “operating room”. Given the breadth of the subject and the scarcity of high-level data in certain areas, a narrative synthesis was selected over a meta-analysis or systematic review to allow for a focussed discussion of the topic.

Results

Three main themes were identified and analysed throughout this review, (1) the multifaceted utility of surgical video recording, (2) teleconferencing/telemedicine and (3) artificial intelligence in the operating room.

Conclusions

Evidence suggests the routine collection of intraoperative data will be beneficial in the advancement of surgery, by driving standardised, evidence-based surgical care and personalised training of future surgeons. However, many barriers stand in the way of widespread implementation, necessitating close collaboration between surgeons, data scientists, medicolegal personnel and hospital policy makers.
Complex nonlinear neural network prediction with IOWA layer
Authors: Hussain Walayat , Merigó Jóse M. , Gil-Lafuente Jaime , Gao Honghao
Published: February 2023

Neural network methods are widely used in business problems for prediction, clustering, and risk management to improving customer satisfaction and business outcome. The ability of a neural network to learn complex nonlinear relationship is due to its architecture that uses weight parameters to transform input data within the hidden layers. Such methods perform well in many situations where the ordering of inputs is simple. However, for a complex reordering of a decision-maker, the process is not enough to get an optimal prediction result. Moreover, existing machine learning algorithms cannot reduce computational complexity by reducing data size without losing any information. This paper proposes an induced ordered weighted averaging (IOWA) operator for the artificial neural network IOWA-ANN. The operator reorders the data according to the order-inducing variable. The proposed sorting mechanism in the neural network can handle a complex nonlinear relationship of a dataset, which results in reduced computational complexities. The proposed approach deals with the complexity of the neuron, collects the data and allows a degree of customisation of the structure. The application further extended to IGOWA and Quasi-IOWA operators. We present a numerical example in a financial decision-making process to demonstrate the approach's effectiveness in handling complex situations. This paper opens a new research area for various complex nonlinear predictions where the dataset is big enough, such as cloud QoS and IoT sensors data. The approach can be used with different machine learning, neural networks or hybrid fuzzy neural methods with other extensions of the OWA operator.
Associations between symptoms with healthcare utilization and death in advanced cancer patients
Authors: Farrell Megan M. , Jiang Cherry , Moss Gabriel , Daly Barbara , Weinstein Elizabeth , Kemmann Matthew , Gupta Mona , Lee Richard T.
Published: February 2023

Introduction

There is limited data about assessments that are associated with increased utilization of medical services among advanced oncology patients (AOPs). We aimed to identify factors related to healthcare utilization and death in AOP.

Methods

AOPs at a comprehensive cancer center were enrolled in a Center for Medicare and Medicaid Innovation program. Participants completed the Edmonton Symptom Assessment Scale (ESAS) and the Functional Assessment of Cancer Therapy–General (FACT-G) scale. We examined factors associated with palliative care (PC), acute care (AC), emergency room (ER), hospital admissions (HA), and death.

Results

In all, 817 AOPs were included in these analyses with a median age of 69. They were generally female (58.7%), white (61.4%), stage IV (51.6%), and represented common cancers (31.5% GI, 25.2% thoracic, 14.3% gynecologic). ESAS pain, anxiety, and total score were related to more PC visits (B=0.31, 95% CI [0.21, 0.40], p<0.001; B=0.24 [0.12, 0.36], p<0.001; and B=0.038 [0.02, 0.06], p=0.001, respectively). Total FACT-G score and physical subscale were related to total PC visits (B=−0.021 [−0.037, −0.006], p=0.008 and B=−0.181 [−0.246, −0.117], p<0.001, respectively). Lower FACT-G social subscale scores were related to more ER visits (B=−0.03 [−0.53, −0.004], p=0.024), while increased tiredness was associated with fewer AC visits (B=−0.039 [−0.073, −0.006], p=0.023). Higher total ESAS scores were related to death within 30 days (OR=0.87 [0.76, 0.98], p=0.027).

Conclusions

The ESAS and FACT-G assessments were linked to PC and AC visits and death. These assessments may be useful for identifying AOPs that would benefit from routine PC.
Blended online learning for oncologists to improve skills in shared decision making about palliative chemotherapy: a pre-posttest evaluation
Authors: Bos-van den Hoek D. W. , van Laarhoven H. W. M. , Ali R. , Bakker S. D. , Goosens A. , Hendriks M. P. , Pepels M. J. A. E. , Tange D. , de Vos F. Y. F. L. , van de Wouw A. J. , Smets E. M. A. , Henselmans I.
Published: February 2023

Purpose

To improve shared decision making (SDM) with advanced cancer patients, communication skills training for oncologists is needed. The purpose was to examine the effects of a blended online learning (i.e. e-learning and online training session) for oncologists about SDM in palliative oncological care and to compare this blended format with a more extensive, fully in-person face-to-face training format.

Methods

A one-group pre-posttest design was adopted. Before (T0) and after (T2) training, participants conducted simulated consultations (SPAs) and surveys; after the e-learning (T1), an additional survey was filled out. The primary outcome was observed SDM (OPTION12 and 4SDM). Secondary outcomes included observed SDM per stage, SPA duration and decision made as well as oncologists’ self-reported knowledge, clinical behavioural intentions, satisfaction with the communication and evaluation of the training. Additionally, outcomes of the blended learning were compared with those of the face-to-face training cohort. Analyses were conducted in SPSS by linear mixed models.

Results

Oncologists (n = 17) showed significantly higher SDM scores after the blended online learning. The individual stages of SDM and the number of times the decision was postponed as well as oncologists’ beliefs about capabilities, knowledge and satisfaction increased after the blended learning. Consultation duration was unchanged. The training was evaluated as satisfactory. When compared with the face-to-face training, the blended learning effects were smaller.

Conclusion

Blended online SDM training for oncologists was effective. However, the effects were smaller compared to face-to-face training. The availability of different training formats provides opportunities for tailoring training to the wishes and needs of learners.
Residual motion of different posterior instrumentation and interbody fusion constructs
Authors: Burkhard Marco D. , Spirig José M. , Wanivenhaus Florian , Cornaz Frédéric , Fasser Marie-Rosa , Widmer Jonas , Farshad Mazda
Published: February 2023

Purpose

To elucidate residual motion of cortical screw (CS) and pedicle screw (PS) constructs with unilateral posterior lumbar interbody fusion (ul-PLIF), bilateral PLIF (bl-PLIF), facet-sparing transforaminal lumbar interbody fusion (fs-TLIF), and facet-resecting TLIF (fr-TLIF).

Methods

A total of 35 human cadaver lumbar segments were instrumented with PS (n = 18) and CS (n = 17). Range of motion (ROM) and relative ROM changes were recorded in flexion/extension (FE), lateral bending (LB), axial rotation (AR), lateral shear (LS), anterior shear (AS), and axial compression (AC) in five instrumentational states: without interbody fusion (wo-IF), ul-PLIF, bl-PLIF, fs-TLIF, and fr-TLIF.

Results

Whereas FE, LB, AR, and AC noticeably differed between the instrumentational states, AS and LS were less prominently affected. Compared to wo-IF, ul-PLIF caused a significant increase in ROM with PS (FE + 42%, LB + 24%, AR + 34%, and AC + 77%), however, such changes were non-significant with CS. ROM was similar between wo-IF and all other interbody fusion techniques. Insertion of a second PLIF (bl-PLIF) significantly decreased ROM with CS (FE -17%, LB -26%, AR -20%, AC -51%) and PS (FE − 23%, LB − 14%, AR − 20%, AC − 45%,). Facet removal in TLIF significantly increased ROM with CS (FE + 6%, LB + 9%, AR + 17%, AC of + 23%) and PS (FE + 7%, AR + 12%, AC + 13%).

Conclusion

bl-PLIF and TLIF show similarly low residual motion in both PS and CS constructs, but ul-PLIF results in increased motion. The fs-TLIF technique is able to further decrease motion compared to fr-TLIF in both the CS and PS constructs.
Clinical evaluation of vertebral body replacement of carbon fiber–reinforced polyetheretherketone in patients with tumor manifestation of the thoracic and lumbar spine
Authors: Schwendner Maximilian , Ille Sebastian , Kirschke Jan S. , Bernhardt Denise , Combs Stephanie E. , Meyer Bernhard , Krieg Sandro M.
Published: February 2023

Purpose

Radiolucent anterior and posterior implants by carbon fiber–reinforced polyetheretherketone (CFR PEEK) aim to improve treatment of primary and secondary tumors of the spine during the last years. The aim of this study was to evaluate clinical and radiological outcomes after dorsoventral instrumentation using a CFR PEEK implant in a cohort of patients representing clinical reality.

Methods

A total of 25 patients with tumor manifestation of the thoracic and lumbar spine underwent vertebral body replacement (VBR) using an expandable CFR PEEK implant between January 2021 and January 2022. Patient outcome, complications, and radiographic follow-up were analyzed.

Results

A consecutive series aged 65.8 ± 14.7 (27.6–91.2) years were treated at 37 vertebrae of tumor manifestation, including two cases (8.0%) of primary tumor as well as 23 cases (92.0%) of spinal metastases. Overall, 26 cages covering a median of 1 level (1–4) were implanted. Duration of surgery was 134 ± 104 (65–576) min, with a blood loss of 792 ± 785 (100–4000) ml. No intraoperative cage revision was required. Surgical complications were reported in three (12.0%) cases including hemothorax in two cases (one intraoperative, one postoperative) and atrophic wound healing disorder in one case. In two cases (8.0%), revision surgery was performed (fracture of the adjacent tumorous vertebrae, progressive construct failure regarding cage subsidence). No implant failure was observed.

Conclusion

VBR using CFR PEEK cages represents a legitimate surgical strategy which opens a variety of improvements—especially in patients in need of postoperative radiotherapy of the spine and MRI-based follow-up examinations.
Favorable long-term health-related quality of life after surgery for lumbar disc herniation in young adult patients
Authors: Roiha Miika , Marjamaa Johan , Siironen Jari , Koskinen Seppo , Koski-Palkén Anniina
Published: February 2023

Background

Lumbar disc herniation is often managed conservatively; nevertheless, surgical intervention can be required. Majority of patients experience a drastic relief of symptoms after surgery, but previous studies have reported that their health-related quality of life remains inferior compared to the general population for several years. There may be a major cumulative loss of health-related quality of life for young patients as they have long expected life ahead of them.

Methods

A total of 526 eligible adult patients under the age of 40 underwent surgery for lumbar disc herniation from 1990 to 2005. Patients’ baseline characteristics were acquired by chart review to confirm eligibility to the study. Follow-up quality of life data was acquired by sending patients EQ-5D questionnaire at median 18 years after index surgery, and those 316 patients responding to the questionnaire (60%) were included in the study. Propensity score matching was utilized to match every study patient with two general population sample participants from a large Finnish population health study. Primary objective was to compare the quality of life to that of the control population. Secondary objective was to explore which patient characteristics lead to inferior outcome.

Results

The mean EQ-index for the patient cohort was 0.86, while it was 0.84 for the age and gender–matched general population sample (difference 0.02, 95% CI − 0.0004 to 0.049). Within the patient cohort, an increasing number of lifetime lumbar surgeries was associated with progressively deteriorating EQ-index scores (p = 0.049) and longer duration of symptoms prior to the surgery correlated with lower score (p = 0.013).

Conclusion

Patients who underwent surgery for lumbar disc herniation nearly two decades ago reported quality of life comparable to the age and gender–matched general population. However, patients who had undergone numerous lumbar surgeries had significantly worse outcome. Therefore, possible ways to prevent cumulation of lumbar surgeries could improve long-term health-related quality of life.