bluuebunny/crossref_metadata_2025 huggingface dataset:
Driving Outcomes and Improving Documentation with Long-Wave Infrared Thermography in a Long-term Acute Care Hospital
Authors: Holster Mindy
Published: February 2023

OBJECTIVE

Hospital-acquired pressure injuries (HAPIs) have been increasing nationally, and unfortunately, long-term acute care hospitals (LTACHs) continue to report the highest prevalence and incidence.
1,2
To help reduce HAPI rates and to increase healing rates of all pressure injuries (PIs), including those that are present on admission, a 23-bed LTACH implemented a HAPI prevention and treatment protocol using new technology as a tool for patient skin assessments.

METHODS

A 75-day evaluation using long-wave infrared thermography (LWIT) was conducted for all patients admitted to the facility in conjunction with new PI treatment and prevention bundles that were created by the skin care team. Every PI was imaged using LWIT, which provided a photographic image of the PI, as well as a thermal image of the subcutaneous tissue underneath. This enabled staff to implement treatment and prevention measures as soon as possible.

RESULTS

After the 75-day evaluation, the LTACH decided to make LWIT a permanent tool in their HAPI treatment and prevention program. For 10 months, the LTACH sustained a zero HAPI rate using the new treatment and prevention program including LWIT.

CONCLUSIONS

The LTACH demonstrated that LWIT technology was an invaluable tool in the prevention and treatment of PIs. The use of LWIT has become common practice in this facility. The LTACH facility maintained a zero HAPI rate for 10 months after implementation of LWIT.
Safety, Efficacy, and Clinical Outcomes of Dexmedetomidine for Sedation in Traumatic Brain Injury: A Scoping Review
Authors: Hatfield Jordan , Soto Alexandria L. , Kelly-Hedrick Margot , Kaplan Samantha , Komisarow Jordan M. , Ohnuma Tetsu , Krishnamoorthy Vijay
Published: February 2023

Dexmedetomidine is a promising alternative sedative agent for moderate-severe Traumatic brain injury (TBI) patients. Although the data are limited, the posited benefits of dexmedetomidine in this population are a reduction in secondary brain injury compared with current standard sedative regimens. In this scoping review, we critically appraised the literature to examine the effects of dexmedetomidine in patients with moderate-severe TBI to examine the safety, efficacy, and cerebral and systemic physiological outcomes within this population. We sought to identify gaps in the literature and generate directions for future research. Two researchers and a librarian queried PubMed, Embase, Scopus, and APA PsycINFO databases. Of 920 studies imported for screening, 11 were identified for inclusion in the review. The primary outcomes in the included studied were cerebral physiology, systemic hemodynamics, sedation levels and delirium, and the presence of paroxysmal sympathetic hyperactivity. Dexmedetomidine dosing ranged from 0.2 to 1 ug/kg/h, with 3 studies using initial boluses of 0.8 to 1.0 ug/kg over 10 minutes. Dexmedetomidine used independently or as an adjunct seems to exhibit a similar hemodynamic safety profile compared with standard sedation regimens, albeit with transient episodes of bradycardia and hypotension, decrease episodes of agitation and may serve to alleviate symptoms of sympathetic hyperactivity. This scoping review suggests that dexmedetomidine is a safe and efficacious sedation strategy in patients with TBI. Given its rapid onset of action and anxiolytic properties, dexmedetomidine may serve as a feasible sedative for TBI patients.
Patella Fracture Fixation With Novel Wagon Wheel Construct Versus Tension-Band Construct: A Technical Trick
Authors: Cancio-Bello Alexandra M. , Owen Aaron R. , Kuttner Nicolas P. , Hidden Krystin A. , Cross William W. , Yuan Brandon J. , Sems Stephen A.
Published: February 2023

Internal fixation of patella fractures remains technically challenging. Cannulated screws with an anterior tension band have been associated with high rates of implant prominence, and fracture comminution can make appropriate application of a tension band impractical. We present the results of a novel technique using a transtendinous/transligamentous mini-fragment plate positioned peripherally around the patella with radially directed screws: termed the wagon-wheel (WW) construct. Compared with a cohort of fractures treated with cannulated screws with an anterior tension band, there was no difference in final range of motion and rate of nonunion. The WW construct had a significantly decreased incidence of symptomatic implants (5% vs. 32%, P = 0.02), rate of reoperation (9% vs. 38%, P = 0.018), dependency on gait aids (10% vs. 38%, P = 0.031), and a faster time to union (HR: 2.2; 95% CI, 1.28–3.95, P = 0.005). In summary, the WW was designed with the goal of obtaining peripheral plate fixation to maximize fragment-specific fixation while minimizing implant prominence. Patients treated with the WW demonstrated reduced rates of implant prominence and reoperation.
Is High Body Mass Index Protective or Detrimental in Surgical Fixation of Hip Fractures?: A Spline Regression Analysis of 22,388 Patients
Authors: Emara Ahmed K. , Oyem Precious C. , Ferre Alexandra , Churchill Jessica , Grits Daniel , Ng Mitchell , Pan Xuankang , Nagy Matthew , Obiri-Yeboah Derrick , Molloy Robert M. , Piuzzi Nicolas S.
Published: February 2023

Objective:

We aimed to characterize the association between BMI as a continuous variable and 30-day postoperative outcomes following hip fracture surgery through (1) 30-day readmission and reoperation; (2) local wound-related; and (3) systemic complications.

Methods:

The National Surgical Quality Improvement Program database (January 2016–December 2019) was queried for patients undergoing hip fracture open reduction and internal fixation. Baseline patient demographics, comorbidities, and patient outcomes were recorded. Multivariable regression models accounted for baseline demographics, comorbidities, and fracture patterns. Significant associations were analyzed using spline regression models to evaluate the continuous association between BMI and the aforementioned outcomes.

Results:

Spline models demonstrated a U-shaped curve for the odds of 30-day readmission and 30-day reoperation with nadirs at the BMI of 27.5 and 22.0 kg/m2. The odd ratios of superficial infection, deep infection, any wound complication, and inability to weight bear on POD 1 rose progressively starting at a BMI of 25.6, 35.5, 25.6, and 32.7 kg/m2 respectively. Odds of 30-day mortality, transfusion, pneumonia, and delirium were greatest at the lowest recorded BMI (11.9 kg/m2).

Conclusion:

BMI has a U-shaped association with 30-day readmission and reoperation. Conversely, the highest risk of mortality and systemic complications (transfusion, pneumonia, and delirium) were within the lower BMI range, with diminishing risk as BMI increased. Local wound complications and systemic sepsis exhibited a third unique pattern with progressive rise in odds as BMI increased. The odds of any complications demonstrated a U-shaped pattern with a nadir in the overweight to obese I categories, suggesting that patients may be at lowest risk within this range.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Deep Learning–Based Recurrent Delirium Prediction in Critically Ill Patients
Authors: Lucini Filipe R. , Stelfox Henry T. , Lee Joon
Published: February 2023

OBJECTIVES:

To predict impending delirium in ICU patients using recurrent deep learning.

DESIGN:

Retrospective cohort study.

SETTING:

Fifteen medical-surgical ICUs across Alberta, Canada, between January 1, 2014, and January 24, 2020.

PATIENTS:

Forty-three thousand five hundred ten ICU admissions from 38,426 patients.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We used ICU and administrative health data to train deep learning models to predict delirium episodes in the next two 12-hour periods (0–12 and 12–24 hr), starting at 24 hours after ICU admission, and to generate new predictions every 12 hours. We used a comprehensive set of 3,643 features, capturing patient history, early ICU admission information (first 24 hr), and the temporal dynamics of various clinical variables throughout the ICU admission. Our deep learning architecture consisted of a feature embedding, a recurrent, and a prediction module. Our best model based on gated recurrent units yielded a sensitivity of 0.810, a specificity of 0.848, a precision (positive predictive value) of 0.704, and an area under the receiver operating characteristic curve (AUROC) of 0.909 in the hold-out test set for the 0–12-hour prediction horizon. For the 12–24-hour prediction horizon, the same model achieved a sensitivity of 0.791, a specificity of 0.807, a precision of 0.637, and an AUROC of 0.895 in the test set.

CONCLUSIONS:

Our delirium prediction model achieved strong performance by applying deep learning to a dataset that is at least one order of magnitude larger than those used in previous studies. Another novel aspect of our study is the temporal nature of our features and predictions. Our model enables accurate prediction of impending delirium in the ICU, which can potentially lead to early intervention, more efficient allocation of ICU resources, and improved patient outcomes.
Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the ICU: An Observational Study From the OUTCOMEREA Database, 1997–2018
Authors: Galerneau Louis-Marie , Bailly Sébastien , Terzi Nicolas , Ruckly Stéphane , Garrouste-Orgeas Maité , Cohen Yves , Hong Tuan Ha Vivien , Gainnier Marc , Siami Shidasp , Dupuis Claire , Darmon Michael , Forel Jean-Marie , Rigault Guillaume , Adrie Christophe , Goldgran-Toledano Dany , Laurent Virginie , de Montmollin Etienne , Argaud Laurent , Reignier Jean , Pepin Jean-Louis , Timsit Jean-François ,   on behalf of the OUTCOMEREA Network
Published: February 2023

OBJECTIVES:

Our aim was to describe changes in the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) by ICUs and patient outcomes.

DESIGN:

We extracted data from the OutcomeRea database concerning patients admitted for AECOPD between 1997 and 2018. We analyzed trends in the use of ventilatory support, corticosteroid therapy, antibiotic therapy, and patient survival.

SETTING:

ICUs at 32 French sites.

PATIENTS:

One thousand eight hundred sixteen patients in the database had a diagnosis of AECOPD.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Over time, there was a reduction in the prescription of corticosteroids and antibiotics. In a time-series analysis, these changes in practice were not linked with ICU mortality. The proportion of patients treated with invasive mechanical ventilation (IMV) also gradually declined (from 51% between 1997 and 2002 to 35% between 2013 and 2018) with an association between decrease in IMV use and reduction in ICU mortality in a time series analysis. Rates of noninvasive ventilation (NIV) failure decreased with an increase in NIV use to support weaning from IMV. There was a reduction in the median ICU length of stay (from 8 d in 1997–2002 to 4 d in 2013–2018) and in the median total duration of hospitalization (from 23 d in 1997–2002 to 14 d in 2013–2018). We observed an improvement in prognosis, with decreases in overall hospital mortality (from 24% between 1997 and 2002 to 15% between 2013 and 2018), ICU mortality (from 14% between 1997 and 2002 to 10% between 2013 and 2018), and 90-day mortality (from 41% between 1997 and 2002 to 22% between 2013 and 2018).

CONCLUSIONS:

The length of stay and mortality of patients with AECOPD admitted to ICUs has decreased over the last 20 years, with a wider use of NIV and a reduction in antibiotic and corticosteroid prescriptions.
A new era: Comparing wired to wireless endoscopy
Authors: Niu Di , Yang Cheng , Liang Chaozhao
Published: February 2023

Minimally invasive operations represented by laparoscopy have generated a revolution in the field of surgery over recent decades. There are various wired connections of standard endoscopic systems that have some drawbacks to the operators and operative room such as reducing mobility and occupying much space. Emerging technologies are directing endoscopy toward an ultra-high definition, wireless design, with a small volume, and improved ergonomics. This narrative review discusses the application of mobile technology and ordinary cameras in endoscopy and some wireless designs. However, further technical tests and large-scale clinical validation are required for these wireless endoscopes.
A rare triple concurrence of ureteric calculus and renal cell carcinoma in a horseshoe kidney
Authors: Munien Kale , Winston Joshua , Davies Nicholas
Published: February 2023

Horseshoe kidney is a rare anatomical variant with low clinical morbidity. However, the characteristic shape of horseshoe kidney causes significant anomalies within the vascular and collecting systems. This complicates the diagnosis and management of coexisting pathologies within the kidneys. Here, we report a rare case of concurrent diagnoses of ipsilateral ureteric calculus and renal cell carcinoma within a horseshoe kidney and describe the subsequent management rationale based on the current literature.
Management of urolithiasis in pregnancy
Authors: Chan Kimberley , Shakir Taner , El-Taji Omar , Patel Amit , Bycroft John , Lim Chou Phay , Vasdev Nikhil
Published: February 2023

Urolithiasis is the most common cause of nonobstetric abdominal pain, resulting in 1.7 admissions per 1000 deliveries. Urolithiasis most commonly occurs in the second and third trimesters, with an incidence between 1:125 and 1:2000. Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in pathological outcomes. The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging. In addition, a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery. Affected pregnancies are conservatively managed; however, 1 in 4 requires surgical intervention. Indications for surgical interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy. Therefore, a multidisciplinary approach is required to optimize patient care.

The diagnosis and management of urolithiasis in pregnancy are complex. We reviewed the role, safety, advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.
Optimizing Anticoagulation Management in Atrial Fibrillation: Beyond the Guidelines. How and for Whom?
Authors: Papakonstantinou Panteleimon E. , Tsioufis Konstantinos
Published: February 2023

Anticoagulation therapy (AT) is the cornerstone of atrial fibrillation (AF) treatment for thromboembolic event prevention. The AF burden, however, is of predictive relevance and may be used as a foundation for therapeutic decisions in individuals with paroxysmal or persistent AF. Remote rhythm monitoring devices can provide early detection of the arrhythmia, long-term rhythm monitoring, and the development of anticoagulation strategies based on AF recurrence profile and the total burden of the arrhythmia. Although the exact thromboembolic cut-off value for the AF burden has not yet been established, targeted anticoagulation treatments in the new oral anticoagulants era have shown encouraging outcomes. The combined evaluation of AF burden and patient thromboembolic risk reported in some studies supports the concept of tailored anticoagulation management, at least in a subset of patients with low AF burden and intermediate thromboembolic risk, for whom the guidelines recommend that AT should be individualized based on net clinical benefit and patient values and preferences. Although it is still premature to derive firm conclusions or algorithms diverging from the current guidelines, the combination of a patient's AF burden, thromboembolic risk, and bleeding risk can lead in the future to an individualized management of patients with a congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65–74 years sex category (female) (CHA2DS2-VASc) score of 1 (2 for female patients), in whom the guidelines do not strictly recommend long-term AT. In this study, we provide an algorithm regarding the individualized implementation of anticoagulation strategies in AF in different patients' thromboembolic risk profiles, based on the available data on the so far tailored anticoagulation strategies in AF.
Measuring Serum Vedolizumab and Vedolizumab Antibodies: Comparison of Commercial Assays with the Vedolizumab Clinical Development Assay
Authors: Vande Casteele Niels , Yang Lili , Dobler Iwona , Agboton Christian , McRorie Osborn Teresa , Suri Ajit , Lindner Dirk , Smithson Glennda M.
Published: February 2023

Background:

Vedolizumab (VDZ) is an anti-α4β7 integrin monoclonal antibody approved for inflammatory bowel disease treatment. VDZ serum and antidrug antibody (ADA) concentrations may be used for treatment optimization. In this article, the results of 5 commercial assays (Grifols, Immundiagnostik, Progenika, Sanquin, and Theradiag) measuring VDZ concentration and ADA were compared with those of the reference assays used in VDZ clinical studies. Our findings will assist clinicians in interpreting commercial assay results in the context of VDZ clinical trial data.

Methods:

VDZ-treated patient samples were used to evaluate the agreement between commercial assays and the reference VDZ serum concentration assay, based on linear regression, Bland–Altman, and qualitative agreement analyses. VDZ ADAs were detected using qualitative assays. Specificity, selectivity, accuracy, and precision were assessed using serum samples from healthy donors or patients with IBD (VDZ serum concentration <0.5 mcg/mL) spiked with VDZ, with/without other biologics (identical sample sets per assay).

Results:

All assays were specific and selective for VDZ. Overall, the commercial assay results for VDZ-spiked samples correlated well with those of the reference serum concentration assay (R2 ≥ 0.98). Compared with the Immundiagnostik and Theradiag assays, the Grifols, Sanquin, and Progenika assays had the best reference assay agreement (based on regression analysis, Bland–Altman plots, and qualitative agreement [Cohen's kappa ≥0.92]). All immunogenicity assays detected VDZ ADAs; only the reference assay detected VDZ ADAs in the presence of 15 mcg/mL VDZ, advising caution with commercial ADA assays if VDZ is present.

Conclusions:

All 5 commercial assays are suitable for VDZ therapeutic monitoring and ADA testing. However, the absolute values from the reference assays and the different commercial assays were not comparable, indicating that the same assay must be used for repeated monitoring of VDZ serum concentrations.
Elbasvir/grazoprevir in children aged 3–18 years with chronic HCV genotype 1 or 4 infection: a pharmacokinetic modeling study
Authors: Gonzalez-Peralta Regino P. , Wirth Stefan , Squires Robert H. , Mutschler Frauke , Lang Thomas , Pawlowska Malgorzata , Sluzewski Wojciech , Majda-Stanislawska Ewa , Fischler Bjorn , Balistreri William F. , Jonas Maureen M. , Blondet Niviann , Rosenthal Philip , Alkhouri Naim , Romero Rene , Grandhi Anjana , Castronuovo Patricia , Caro Luzelena , Du Lihong , Rosenbloom Daniel I.S. , Haber Barbara A.
Published: February 2023

Background:

Approximately 3.5 million children and adolescents worldwide are chronically infected with HCV. This study uses pharmacokinetic modeling to identify pediatric doses of elbasvir/grazoprevir (EBR/GZR) that achieve plasma concentrations similar to those seen in adults receiving the approved fixed-dose combination regimen of EBR/GZR.

Patients and Methods:

We conducted a nonrandomized, single-arm, multicenter, open-label phase 2b trial in children and adolescents aged 3 to <18 years with chronic HCV genotype 1 or 4 infection (NCT03379506). Pharmacokinetic data were used to bridge efficacy and safety data from adults to children in a stepwise (oldest to youngest) manner. A total of 57 participants were enrolled: cohort 1 (aged 12 to <18 y), n=22; cohort 2 (aged 7 to <12 y), n=17; and cohort 3 (aged 3 to <7 y), n=18.

Results:

Steady-state plasma exposures were achieved by week 4 for EBR and GZR in all cohorts and daily dosing achieved geometric mean steady-state area under the concentration-time curve at 0–24 hours that fell within comparability bounds established for adults. All participants achieved sustained virologic response 12 weeks after completing treatment (ie, undetectable HCV RNA 12 wk following completion of treatment). Headache (n=4), fatigue (n=4), and nausea (n=2) were the most common treatment-related adverse events (all mild or moderate); no participant discontinued because of an adverse event.

Conclusions:

Pediatric EBR/GZR pharmacokinetic models were successfully developed based on complex adult population pharmacokinetic models. At appropriate age-related doses, EBR/GZR is safe and effective in pediatric and adolescent participants with HCV infection.
Genetics of aortic valve disease
Authors: Ackah Ruth L. , Yasuhara Jun , Garg Vidu
Published: February 2023

Purpose of review

Aortic valve disease is a leading global cause of morbidity and mortality, posing an increasing burden on society. Advances in next-generation technologies and disease models over the last decade have further delineated the genetic and molecular factors that might be exploited in development of therapeutics for affected patients. This review describes several advances in the molecular and genetic understanding of AVD, focusing on bicuspid aortic valve (BAV) and calcific aortic valve disease (CAVD).

Recent findings

Genomic studies have identified a myriad of genes implicated in the development of BAV, including NOTCH1, SMAD6 and ADAMTS19, along with members of the GATA and ROBO gene families. Similarly, several genes associated with the initiation and progression of CAVD, including NOTCH1, LPA, PALMD, IL6 and FADS1/2, serve as the launching point for emerging clinical trials.

These new insights into the genetic contributors of AVD have offered new avenues for translational disease investigation, bridging molecular discoveries to emergent pharmacotherapeutic options. Future studies aimed at uncovering new genetic associations and further defining implicated molecular pathways are fuelling the new wave of drug discovery.
Genetics of atrial fibrillation
Authors: Lee David S.M. , Damrauer Scott M. , Levin Michael G.
Published: February 2023

Purpose of review

Atrial fibrillation is the most common cardiac arrhythmia worldwide. There is considerable interest in better understanding the molecular genetics and biology of atrial fibrillation to inform the development of new therapies and improve clinical management. This review summarizes recent advances in our understanding of the genetic basis of atrial fibrillation and new efforts to utilize genetics to inform clinical management.

Recent findings

Genome-wide association studies in diverse populations have increased the number of genetic loci associated with atrial fibrillation and its specific subtypes. Large-scale biobanks with deep phenotyping have provided invaluable data to study the impact of both common and rare variants on atrial fibrillation, susceptibility, and prognosis. Polygenic risk scores help improve individual atrial fibrillation risk stratification and prognostication.

Our understanding of atrial fibrillation genetics is rapidly improving with larger and more diverse genome-wide association studies. Translating genetic discoveries into molecular pathways and new therapeutic targets remains a bottleneck in the development of new therapies for atrial fibrillation. Genetic risk scores have shown early promise in improving atrial fibrillation risk stratification; however, their broader utility for the general population remains unclear.
An Electrocoagulation Fixation Technique for One-Piece Intraocular Lens Scleral Flapless Fixation With Sutures Without Knots
Authors: Si Shancheng , Zhang Jianhui
Published: February 2023

Purpose:

To present an electrocoagulation fixation technique for one-piece intraocular lens (IOL) scleral flapless fixation with sutures without knots.

Methods:

First of all, after repeated tests and comparisons, we chose 8-0 polypropylene suture as the material for electrocoagulation fixation of one-piece IOL haptics because of its proper elasticity and size. A transscleral tunnel puncture at the pars plana was performed using an arc-shaped needle with 8-0 polypropylene suture. The suture was subsequently guided out of the corneal incision by a 1-mL syringe needle and then guided by the needle into the inferior haptics of the IOL. The suture was cut off and heated into a shape of a probe with a spherical tip using a monopolar coagulation device to prevent slippage from the haptics.

Results:

In the end, 10 eyes underwent our new surgical procedures, and the average operation time was 42.5 ± 12.4 minutes. At the 6-month follow-up, seven of 10 eyes achieved significant vision improvement and nine of 10 kept the implanted one-piece IOL stable in the ciliary sulcus. No serious intraoperative/postoperative complications were observed.

Conclusion:

The electrocoagulation fixation was a safe and effective alternative technique for previously implanted one-piece IOL scleral flapless fixation with sutures without knots.
New simulation software to predict postoperative corneal stiffness before laser vision correction
Authors: Francis Mathew , Shetty Rohit , Padmanabhan Prema , Vinciguerra Riccardo , Vinciguerra Paolo , Lippera Myrta , Matalia Himanshu , Khamar Pooja , Chinnappaiah Nandini , Mukundan Deepa , Nuijts Rudy M.M.A. , Sinha Roy Abhijit
Published: February 2023

Purpose:

To develop a new virtual surgery simulation platform to predict postoperative corneal stiffness (Kcmean) after laser vision correction (LVC) surgery.

Setting:

Narayana Nethralaya Eye Hospital and Sankara Nethralaya, India; Humanitas Clinical and Research Center, Italy.

Design:

Retrospective observational case series.

Methods:

529 eyes from 529 patients from 3 eye centers and 10 post–small-incision lenticule extraction (SMILE) ectasia eyes were included. The software (called AcuSimX) derived the anisotropic, fibril, and extracellular matrix biomechanical properties (using finite element calculation) of the cornea using the preoperative Corvis-ST, Pentacam measurement, and inverse finite element method assuming published healthy collagen fibril orientations. Then, the software-computed postoperative Kcmean was adjusted with an artificial intelligence (AI) model (Orange AI) for measurement uncertainties. A decision tree was developed to classify ectasia from normal eyes using the software-computed and preoperative parameters.

Results:

In the training cohort (n = 371 eyes from 371 patients), the mean absolute error and intraclass correlation coefficient were 6.24 N/m and 0.84 (95% CI, 0.80-0.87), respectively. Similarly, in the test cohort (n = 158 eyes from 158 patients), these were 6.47 N/m and 0.84 (0.78-0.89), respectively. In the 10 ectasia eyes, the measured in vivo (74.01 [70.01-78.01]) and software-computed (74.1 [69.03-79.17]) Kcmean were not statistically different (P = .96). Although no statistically significant differences in these values were observed between the stable and ectasia groups (P ≥ .14), the decision tree classification had an area under the receiver operating characteristic curve of 1.0.

Conclusions:

The new software provided an easy-to-use virtual surgery simulation platform for post-LVC corneal stiffness prediction by clinicians and was assessed in post-SMILE ectasia eyes. Further assessments with ectasia after surgeries are required.
Out-of-Hospital Pediatric Video Laryngoscopy With an Adult Device
Authors: Miller Matthew , Storey Heather , Andrew Jeffrey , Christian Edward , Hayes-Bradley Clare
Published: February 2023

Objectives

After introducing an adult video laryngoscope (VL) in our physician-paramedic prehospital and retrieval medical service, our quality assurance process identified this blade being used during pediatric intubations. We present a case series of pediatric intubations using this oversized adult VL alongside a contemporaneous group of direct laryngoscopy (DL) intubations.

Methods

We performed a retrospective review of intubated patients 15 years or younger in our electronic quality assurance registry from January 1, 2017, to December 31, 2020. Data collected were demographic details, intubation equipment, drug doses, the number of intubation attempts, and complications. Results are presented according to those intubated with C-MAC4 VL (Karl Storz) alongside age-appropriate DL sizes.

Results

Ninety-nine pediatric patients were intubated, 67 (67%) by CMAC4 and 32 (33%) by DL. Video laryngoscopy had a first-attempt success rate of 96% and DL 91%. A Cormach and Lehane view 1 or 2 was found in 66 VL (99%) and 29 DL patients (91%). Desaturation was reported in two VL and 1 DL patient.

Conclusions

Adult VL became the most common method of intubation in patients older than 1 year during the study period. An adult C-MAC4 VL could be considered for clinicians who prefer VL when a pediatric VL is unavailable or as a second-line device if a pediatric VL is not present when intubating children older than 1 year.
Commentary: A Radiologist's Guide to Peer-Reviewing Manuscripts
Authors: Ersahin Devrim , Catanzano Tara , Tamm Eric
Published: February 2023

Reviewers play an important role in the publishing of radiology articles. When done well, reviewers help editors identify which articles to accept and improve them through their recommendations. In this commentary, we provide a step-by-step guide to reviewing both original science and review articles.
Imaging Findings on Head Computed Tomography Scans in Victims of Intimate Partner Violence
Authors: Watane Gaurav V. , Tang Anji , Thomas Richard , Park Hyesun , Gujrathi Rahul , Gosangi Babina , Khurana Bharti
Published: February 2023

Objective

The aim of the study is to analyze the imaging findings and injury patterns seen on head computed tomography (CT) examinations performed on survivors of intimate partner violence (IPV).

Methods

An institutional review board–approved retrospective analysis of 668 patients reporting IPV to our institution's violence intervention and prevention program between January 2013 and June 2018 identified 40 unique patients with radiological findings visible on head CT. All injuries visible on head CT were analyzed based on the anatomic location and injury type. Demographics, IPV screening at the time of injury, concomitant, prior, and subsequent injuries to the index head injury were also recorded.

Results

Our study cohort had 36 women and 4 men with a mean age at presentation of 43 ± 13 years (mean ± SD), 91 unique injuries with 57 (62.6%) isolated soft tissue injuries, 4 (3.2%) fractures, 13 (14.3%) intra-axial, and 17 (18.7%) extra-axial injuries. Soft tissue injuries and intra-axial injuries occurred most commonly in the frontal region (45.6% and 38.5%), followed by the parietal region (22.8% and 23.1%), while most extra-axial injuries were subdural hematomas (41.2%). Left-sided injuries accounted for 49% (45/91) with 29/91 right-sided (32%) and 17/91 bilateral (19%) injuries. The IPV screening occurred in 44% of injury visits (22/50). Concomitant injuries were seen in 14/50 injury visits (28%), most commonly being in the lower extremity (6/14, 42.9% [% of visits with concomitant injuries]) followed by the upper extremity (5/14, 35.7%), while 52% of visits (26/50) were preceded by prior injuries and 68% of events (34/50) were followed by subsequent injuries.

Conclusions

Isolated soft tissue swelling is the most common manifestation of IPV on head CT scans with frontoparietal region being the most common site. Synchronous and metachronous injuries are frequent.
Optimal Virtual Monoenergetic Photon Energy (keV) for Photon-Counting-Detector Computed Tomography Angiography
Authors: Dunning Chelsea A. S. , Rajendran Kishore , Inoue Akitoshi , Rajiah Prabhakar , Weber Nikkole , Fletcher Joel G. , McCollough Cynthia H. , Leng Shuai
Published: February 2023

Objective

This study aimed to determine the optimal photon energy for virtual monoenergetic images (VMI) in computed tomography angiography (CTA) using photon-counting-detector (PCD) CT.

Methods

Under institutional review board approval, 10 patients (abdominal, n = 4; lower extremity, n = 3; head and neck, n = 3) were scanned on an investigational PCD-CT (Count Plus, Siemens Healthcare) at 120 or 140 kV. All images were iteratively reconstructed with Bv48 kernel and 2-mm slice thickness. Axial and coronal VMI maximum-intensity projections were created in the range 40 to 65 keV (5-keV steps). Contrast-to-noise ratio (CNR) was calculated for major arteries in each VMI series. Two radiologists blindly ranked each VMI series for overall image quality and visualization of small vessels and pathology. The median and SD of scores for each photon energy were calculated. In addition, readers identified any VMIs that distinguished itself from others in terms of vessel/pathology visualization or artifacts.

Results

Mean iodine CNR was highest in 40-keV VMIs for all evaluated arteries. Across readers, the 50-keV VMI had the highest combined score (2.00 ± 1.11). Among different body parts, the 45-keV VMI was ranked highest for the head-and-neck (1.75 ± 0.68) and lower extremity (2.00 ± 1.41) CTA. Meanwhile, 50- and 55-keV VMIs were ranked highest for abdominal (2.50 ± 1.35 and 2.50 ± 1.56) CTA. The 40-keV VMI received the highest score for iodine visualization in vessels, and the 65-keV VMI for reduced metal/calcium-blooming artifacts.

Conclusions

Quantitatively, VMIs at 40 keV had the highest CNR in major arterial vasculature using PCD-CTA. Based on radiologists' preference, the 45- and 50-keV VMIs were optimal for small body parts (eg, head and neck and lower extremity) and large body parts (eg, abdomen), respectively.
Comparisons of Hepatobiliary Phase Imaging Using Combinations of Parallel Imaging and Variable Degrees of Compressed Sensing With Use of Parallel Imaging Alone
Authors: Toshimori Wataru , Matsuda Megumi , Tsuda Takaharu , Takahashi Yoshiki , Mori Chihiro , Wakayama Tetsuya , Nozaki Atsushi , Hirooka Masashi , Koizumi Yohei , Hiasa Yoichi , Kido Teruhito
Published: February 2023

Objective

This study aimed to compare the image quality in the hepatobiliary phase images of gadoxetic acid–enhanced liver magnetic resonance imaging using parallel imaging (PI) and compressed sensing (CS) reconstruction, using variable CS factors with the standard method using the PI technique.

Methods

In this study, 64 patients who underwent gadoxetic acid–enhanced liver magnetic resonance imaging at 3.0 T were enrolled. Hepatobiliary phase images were acquired 6 times using liver acquisition with volume acceleration (LAVA) and CS reconstruction with 5 CS factors 1.4, 1.6, 1.8, 2.0, and 2.5 (LAVA-CS 1.4, 1.6, 1.8, 2.0, and 2.5) and standard LAVA (LAVA-noCS). For objective analysis, the signal intensity ratios (SIRs) of the liver-to-spleen (SIRliver/spleen), liver-to-portal vein (SIRliver/portal vein), and liver-to-fat (SIRliver/fat) were estimated. For subjective analysis, 2 radiologists independently evaluated the quality of all the images.

Results

The objective analysis demonstrated no significant difference in all evaluation parameters of all the images. Subjective analysis revealed that the scores of all evaluation items were higher for LAVA-noCS images than for LAVA-CS images, and only LAVA-CS 1.4 did not significantly differ from LAVA-noCS in all evaluation items (P = 1.00 in 2 readers).

Conclusions

A CS factor of 1.4 in the hepatobiliary phase image with combined PI and CS can reduce the scan time without degrading the image quality compared with the standard method.
Optic Neuritis After SARS-CoV-2 Vaccination
Authors: Shemer Asaf , Greenbaum Assaf , Toledano Amit , Biron Roy , Dubinsky-Pertzov Biana , Or Lior
Published: February 2023

Background:

To describe recent cases of optic neuritis in patients who received a vaccine for COVID-19.

Methods:

Retrospective case series of patients diagnosed with optic neuritis after a recent COVID-19 vaccination with BNT162b2 (Pfizer-BioNTech), in one university-affiliated tertiary hospital, from January 2021 to June 2021. Data were obtained from medical charts.

Results:

We describe 7 patients who developed optic neuritis after immunization with the BNT162b2 vaccine.

Conclusions:

A causal relationship cannot be deduced, and the importance of COVID-19 vaccination is not challenged. However, the authors encourage a prospective monitoring and reporting system for all patients receiving COVID-19 vaccines, to further assess the spectrum of adverse events in large databases.
The impact of anesthetic drugs on hemodynamic parameters and neurological outcomes following temporal middle cerebral artery occlusion in rats
Authors: Keshavarz Somaye , Nemati Marzieh , Saied Salehi Mohammad , Naseh Maryam
Published: February 2023

The induction of ischemic stroke in the experimental model requires general anesthesia. One of the factors that can be effective in the size of ischemic brain lesions and neurological outcomes is the type of anesthesia. So, the current study was designed to compare the impacts of the most important and widely used anesthetics including halothane, isoflurane, and chloral hydrate on the transient middle cerebral artery occlusion (MCAO) outcomes. Adult Male Sprague-Dawley rats were randomly divided into three groups as follows: (1) MCAO + halothane group, (2) MCAO + isoflurane group, and (3) MCAO + chloral hydrate group. After 24 h, the mortality rate, infarct size, tissue swelling, neurological function, hemodynamic, and arterial blood gas parameters were assessed. Our finding showed that 60 min MCAO rats anesthetized with chloral hydrate significantly increased mortality rate, infarct size, tissue swelling, and neurological deficits compared with halothane and isoflurane anesthetics after 24 h of MCAO. Also, chloral hydrate caused a significant decrease in mean arterial pressure and arterial pO2 compared to halothane and isoflurane anesthetics. On the basis of the current data, we concluded that chloral hydrate increased cerebral infarct volume and neurological outcomes and reduced hemodynamic and metabolic parameters compared with halothane and isoflurane-anesthetized rats temporal MCAO.
Effects of acute aerobic exercise on the motor inhibitory process in the go/no-go task in humans: a functional near-infrared spectroscopy study
Authors: Akatsuka Kosuke , Mitsuzono Ryouichi , Yamashiro Koya
Published: February 2023

Background and objectives

While many studies have reported the relationship between human cognitive functions and exercise, only a few have investigated the effect of mild-intensity exercise on the human motor inhibitory process. We employed the go/no-go task as a useful paradigm for studying the neural mechanisms involved in response execution and inhibition.

Method

Using functional near-infrared spectroscopy, we observed 17 subjects performing go/no-go tasks under a control condition and an exercise condition. Under the control condition, the subjects performed a go/no-go session before and after a 15 min rest. Under the exercise condition, the subjects performed a go/no-go session before and after a 10 min ergometer cycling session followed by a 5 min rest. We set the exercise intensity individually for each subject at 30% of their maximum heart rate as calculated by Karvonen’s formula.

Results

We recorded an increase oxygenated hemoglobin (oxy-Hb) in the go/no-go blocks compared to those in the go blocks and found that mild exercise significantly enhanced the peak amplitude of oxy-Hb. On the other hand, we observed no significant changes under the control condition.

Conclusion

This result suggests that mild exercise could trigger enhanced activation in the right frontal area, and cause a stronger inhibitory effect related to go/no-go tasks.
Combined measures of mimetic fidelity explain imperfect mimicry in a brood parasite–host system
Authors: Dixit Tanmay , Choi Gary P. T. , al-Mosleh Salem , Lund Jess , Troscianko Jolyon , Moya Collins , Mahadevan L. , Spottiswoode Claire N.
Published: February 2023

The persistence of imperfect mimicry in nature presents a challenge to mimicry theory. Some hypotheses for the existence of imperfect mimicry make differing predictions depending on how mimetic fidelity is measured. Here, we measure mimetic fidelity in a brood parasite–host system using both trait-based and response-based measures of mimetic fidelity. Cuckoo finches
Anomalospiza imberbis
lay imperfectly mimetic eggs that lack the fine scribbling characteristic of eggs of the tawny-flanked prinia
Prinia subflava
, a common host species. A trait-based discriminant analysis based on Minkowski functionals—that use geometric and topological morphometric methods related to egg pattern shape and coverage—reflects this consistent difference between host and parasite eggs. These methods could be applied to quantify other phenotypes including stripes and waved patterns. Furthermore, by painting scribbles onto cuckoo finch eggs and testing their rate of rejection compared to control eggs (i.e. a response-based approach to quantify mimetic fidelity), we show that prinias do not discriminate between eggs based on the absence of scribbles. Overall, our results support relaxed selection on cuckoo finches to mimic scribbles, since prinias do not respond differently to eggs with and without scribbles, despite the existence of this consistent trait difference.
A parametric blueprint for optimum cochlear outer hair cell design
Authors: Rabbitt Richard D. , Bidone Tamara C.
Published: February 2023

The present work examines the hypothesis that cochlear outer hair cell (OHC) properties vary in precise proportions along the tonotopic map to optimize electromechanical power conversion. We tested this hypothesis using a very simple model of a single isolated OHC driving a mechanical load. Results identify three non-dimensional ratios that are predicted to optimize power conversion: the ratio of the resistive-capacitive (RC) corner to the characteristic frequency (CF), the ratio of nonlinear to linear capacitance and the ratio of OHC stiffness to cochlear load stiffness. Optimum efficiency requires all three ratios to be universal constants, independent of CF and species. The same ratios are cardinal control parameters that maximize power output by positioning the OHC operating point on the edge of a dynamic instability. Results support the hypothesis that OHC properties evolved to optimize electro-mechanical power conversion. Identification of the RC corner frequency as a control parameter reveals a powerful mechanism used by medial olivocochlear efferent system to control OHC power output. Results indicate the upper-frequency limit of OHC power output is not constrained by the speed of the motor itself but instead is probably limited by the size of the nucleus and membrane surface area available for ion-channel expression.
Robert Hooke, Isaac Newton and the Royal Society: three unnoticed letters at the Staatsbibliothek zu Berlin
Authors: Vozar Thomas Matthew
Published: February 2023

This article brings attention to three manuscript letters by Robert Hooke and Isaac Newton in the Darmstaedter collection at the Staatsbibliothek zu Berlin, two of which are published here for the first time. Of principal interest is a 1678 letter from Hooke to Newton, which concerns the controversy with Anthony Lucas over Newton's prism experiments and Hooke's disinclination ‘to print transactions’ on behalf of the Royal Society. A second Hooke letter, written to the French
savant
Nicolas Toinard in 1680, sends some astronomical observations together with English mathematician Robert Wood's book on a proposed calendrical reform. While the text of the third item, a 1706 letter by Newton welcoming its addressee into the Royal Society, has long been available in draft form, the Darmstaedter manuscript allows the recipient to be identified as a Savoyard diplomat, the Comte de Briançon, who can further be recognized as the intended addressee of another Newton letter.
A biomechanical model for the relation between bite force and mandibular opening angle in arthropods
Authors: Püffel Frederik , Johnston Richard , Labonte David
Published: February 2023

Bite forces play a key role in animal ecology: they affect mating behaviour, fighting success, and the ability to feed. Although feeding habits of arthropods have a significant ecological and economical impact, we lack fundamental knowledge on how the morphology and physiology of their bite apparatus controls bite performance, and its variation with mandible gape. To address this gap, we derived a biomechanical model that characterizes the relationship between bite force and mandibular opening angle from first principles. We validate this model by comparing its geometric predictions with morphological measurements on the muscoloskeletal bite apparatus ofAtta cephalotesleaf-cutter ants, using computed tomography (CT) scans obtained at different mandible opening angles. We then demonstrate its deductive and inductive utility with three examplary use cases: Firstly, we extract the physiological properties of the leaf-cutter ant mandible closer muscle fromin vivobite force measurements. Secondly, we show that leaf-cutter ants are specialized to generate extraordinarily large bite forces, equivalent to about 2600 times their body weight. Thirdly, we discuss the relative importance of morphology and physiology in determining the magnitude and variation of bite force. We hope that a more detailed quantitative understanding of the link between morphology, physiology, and bite performance will facilitate future comparative studies on the insect bite apparatus, and help to advance our knowledge of the behaviour, ecology and evolution of arthropods.
Scent mark signal investment predicts fight dynamics in house mice
Authors: Miller Caitlin H. , Haxhillari Klaudio , Hillock Matthew F. , Reichard Tess M. , Sheehan Michael J.
Published: February 2023

Signals mediate competitive interactions by allowing rival assessment, yet are often energetically expensive to produce. One of the key mechanisms maintaining signal reliability is social costs. While the social costs of over-signalling are well known, the social costs of under-signalling are underexplored, particularly for dynamic signals. In this study, we investigate a dynamic and olfactory-mediated signalling system that is ubiquitous among mammals: scent marking. Male house mice territorially scent mark their environment with metabolically costly urine marks. Competitive male mice are thought to deposit abundant scent marks in the environment. However, we recently identified a cohort of low-marking males that win fights. We hypothesized that there may be social costs imposed on individuals who under-invest in signalling. Here we find that scent mark investment predicts fight dynamics. Winning males that produce fewer scent marks prior to a fight engage in more intense fights that take longer to resolve. This effect appears to be driven by an unwillingness among losers to acquiesce to weakly signalling winners. We, therefore, find evidence for rival assessment of scent marks as well as social costs to under-signalling. This supports existing hypotheses for the importance of social punishment in maintaining optimal signalling equilibria. Our results further highlight the possibility of diverse signalling strategies in house mice.