bluuebunny/crossref_metadata_2025_split huggingface dataset:
Automated Detection of Vestibular Schwannoma Growth Using a Two‐Dimensional U‐Net Convolutional Neural Network
Authors: George‐Jones Nicholas A. , Wang Kai , Wang Jing , Hunter Jacob B. 
Published: April 2020

Objectives/HypothesisTo determine if an automated vestibular schwannoma (VS) segmentation model has comparable performance to using the greatest linear dimension to detect growth.Study DesignCase‐control Study.MethodsPatients were selected from an internal database who had an initial gadolinium‐enhanced T1‐weighted magnetic resonance imaging scan and a follow‐up scan captured at least 5 months later. Two observers manually segmented the VS to compute volumes, and one observer's segmentations were used to train a convolutional neural network model to automatically segment the VS and determine the volume. The results of automatic segmentation were compared to the observer whose measurements were not used in model development to measure agreement. We then examined the sensitivity, specificity, and area under the receiver‐operating characteristic curve (AUC) to compare automated volumetric growth detection versus using the greatest linear dimension. Growth detection determined by the external observer's measurements served as the gold standard.ResultsA total of 65 patients and 130 scans were studied. The automated method of segmentation demonstrated excellent agreement with the observer whose measurements were not used for model development for the initial scan (interclass correlational coefficient [ICC] = 0.995; 95% confidence interval [CI]: 0.991‐0.997) and follow‐up scan (ICC = 0.960; 95% CI: 0.935–0.975). The automated method of segmentation demonstrated increased sensitivity (72.2% vs. 63.9%), specificity (79.3% vs. 69.0%), and AUC (0.822 vs. 0.701) compared to using the greatest linear dimension for growth detection.ConclusionsIn detecting VS growth, a convolutional neural network model outperformed using the greatest linear dimension, demonstrating a potential application of artificial intelligence methods to VS surveillance.Level of Evidence4 Laryngoscope, 131:E619–E624, 2021
Detailed analysis of the impact of surgeon and hospital volume in microsurgical breast reconstruction
Authors: Reid Chris M. , Parmeshwar Nisha , Brandel Michael G. , Crisera Christopher A. , Herrera Fernando A. , Suliman Ahmed S. 
Published: April 2020

AbstractBackgroundPrior investigations of microsurgical breast reconstruction have not distinguished the effects of surgeon versus hospital volume and failed to address the effect of patient clustering. Our data‐driven analysis aims to determine the impacts of surgeon and hospital volume on outcomes of microsurgical breast reconstruction.MethodsNationwide Inpatient Sample (NIS) data from 2008 to 2011 was analyzed for patients who underwent microsurgical breast reconstruction. Volume‐outcome relationships were analyzed with restricted cubic spline analysis. A multivariable mixed‐effects logistic regression was used to account for patient clustering effect.ResultsA total of 5,404 NIS patients met inclusion criteria. High‐volume (HV) surgeons had a 59% decrease in the risk of inpatient complications, which became non‐significant after clustering correction. For HV hospitals, there was a 47% decrease in the risk of inpatient complications (odds ratio = 0.53; 95% confidence intervals 0.30, 0.91; p = 0.021) that was statistically significant with the clustering adjustment. Neither the volume‐cost relationship for surgeons nor hospitals remained statistically significant after accounting for clustering.ConclusionsHospital volume plays a significant impact on outcomes in microsurgical breast reconstruction, while surgeon volume has comparatively not shown to be similarly impactful. The complexity of care related to microsurgical breast reconstruction warrants equally complex and engineered health systems.
The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures
Authors: Shetty Kanaka D. , Robbins Michael , Aragaki Dixie , Basu Aashna , Conlon Craig , Dworsky Michael , Benner Douglas , Seelam Rachana , Nuckols Teryl K. 
Published: April 2020

AbstractIntroductionThe quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health‐care expenditures.MethodsWe evaluated test quality among 338 adults with workers’ compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery. Using regression, we evaluated associations with symptoms and functional limitations (Boston Carpal Tunnel Questionnaire), overall health (12‐item Short Form Health Survey version 2), actual receipt of surgery, and expenditures.ResultsIn simulations, suboptimal quality tests rendered surgery inappropriate for 99 of 309 patients (+32 percentage points). In regression analyses, patients with the highest quality tests had larger declines in symptoms (−0.50 point; 95% confidence interval [CI], −0.89 to −0.12) and functional impairment (−0.42 point; 95% CI, −0.78 to −0.06) than patients with the lowest quality tests. Test quality was not associated with overall health, actual receipt of surgery, or expenditures.DiscussionTest quality is pivotal to determining surgical appropriateness and associated with meaningful differences in symptoms and function.
Histone acetyltransferase inhibition rescues differentiation of emerin‐deficient myogenic progenitors
Authors: Bossone Katherine A. , Ellis Joseph A. , Holaska James M. 
Published: April 2020

AbstractIntroductionEmery‐Dreifuss muscular dystrophy (EDMD) is a disease characterized by skeletal muscle wasting, major tendon contractures, and cardiac conduction defects. Mutations in the gene encoding emerin cause EDMD1. Our previous studies suggested that emerin activation of histone deacetylase 3 (HDAC3) to reduce histone 4‐lysine 5 (H4K5) acetylation (ac) is important for myogenic differentiation.MethodsPharmacological inhibitors (Nu9056, L002) of histone acetyltransferases targeting acetylated H4K5 were used to test whether increased acetylated H4K5 was responsible for the impaired differentiation seen in emerin‐deficient myogenic progenitors.ResultsNu9056 and L002 rescued impaired differentiation in emerin deficiency. SRT1720, which inhibits the nicotinamide adenine dinucleotide (NAD)+‐dependent deacetylase sirtuin 1 (SIRT1), failed to rescue myotube formation.DiscussionWe conclude that emerin regulation of HDAC3 activity to affect H4K5 acetylation dynamics is important for myogenic differentiation. Targeting H4K5ac dynamics represents a potential new strategy for ameliorating the skeletal muscle wasting seen in EDMD1.
Impact of Traumatic Brain Injury on Clinical Institute Withdrawal Assessment Use in Trauma Patients: A Descriptive Study
Authors: Carter William , Truong Phong , Sima Adam P , Hupe Jessica , Newman James , Ebadi Ali 
Published: April 2020

BackgroundAlcohol withdrawal syndrome (AWS) and traumatic brain injury (TBI) present with similar signs and symptoms, yet their treatment strategies differ greatly. AWS treatment includes the Clinical Institute Withdrawal Assessment (CIWA) protocol, which grades withdrawal signs and symptoms. A major purpose of CIWA is to guide the addition and titration of central nervous system (CNS) depressants, most commonly benzodiazepines. Conversely, best practice is to avoid these same CNS depressants in the setting of TBI. Thus, patients with TBI presenting with AWS risk may receive undesirable interventions that could worsen outcome.ObjectiveTo describe the relationship of TBI diagnosis with CIWA protocol scores and intervention implementation.DesignRetrospective cohort observational study.SettingSingle university‐based, level one trauma center.PatientsThree hundred seventy‐five patients with head trauma or AWS classification, identified through the trauma center's trauma registry.InterventionsCIWA protocol and related medication use.Main Outcome MeasuresFrequency of elevated CIWA score, length of CIWA administration, and medication administration incidence were abstracted from patients' medical records.ResultsThe percentage of elevated CIWA scores increased significantly with TBI severity, from 4.5%(0‐60) in the No TBI group, up to 12.5% (0‐36) in the Mild TBI group, 27.1% (0‐57) in the Moderate TBI group, and 50.0% (14‐77) in the Severe TBI group. Nominally, lorazepam use showed a similar pattern of escalation with TBI severity, but it did not reach statistical significance. Haloperidol use did significantly escalate with higher TBI severity. No group differences were observed for total lorazepam equivalents or length on the CIWA protocol.ConclusionsTBI diagnosis and higher TBI severity level correlate with higher CIWA scores, but neither increased nor decreased benzodiazepine usage was observed. Antipsychotic use did escalate with TBI diagnosis and severity. The risks versus benefits of minimizing benzodiazepines in patients with TBI who are at risk for AWS warrant future study.
Generic Construction of the Standard Model Gauge Group and Matter Representations in F‐theory
Authors: Taylor Washington , Turner Andrew P. 
Published: April 2020

AbstractWe describe general classes of 6D and 4D F‐theory models with gauge group . We prove that this set of constructions gives all possible consistent 6D supergravity theories with no tensor multiplets having this gauge group and the corresponding generic matter representations, which include those of the MSSM. We expect, though do not prove, that these models are similarly generic for 6D theories with tensor multiplets and for 4D supergravity theories. The largest class of these constructions come from deforming an underlying geometry with gauge symmetry .
Patient‐specific titanium onlay eminoplasty: A novel protocol for treatment of recurrent temporomandibular joint dislocation
Authors: Ihab Rania , Mounir Ragia , Mounir Mohamed 
Published: April 2020

AbstractPurposeThe present study aimed to introduce an accurate, less morbid and less time‐consuming approach that secures the stability of the condylar movement's range for treating recurrent TMJ dislocations.MethodsFive patients were treated by surgical implantation of bilateral patient‐specific titanium onlay eminoplasties; each implant was virtually designed using specific software and milled from grade V titanium blocks. Intraoperatively, each implant was fixed with three mini‐screws along the lateral aspect of the zygomatic arch.ResultsThe follow‐up period ranged from 6 months to 1 year, which targeted the assessment of the maximal incisal mouth opening (MIO). The mean preoperative maximal incisal mouth opening figured (47.8 mm) vs (33.2 mm) for that recorded postoperatively. One patient reported postoperative slight unilateral pain that was gradually diminished through the first postoperative month.ConclusionThe innovated patient‐specific titanium eminoplasty represents an accurate alternative for treatment of chronic recurrent TMJ dislocation.
A pre-investigational new drug study of lung spheroid cell therapy for treating pulmonary fibrosis
Authors: Cores Jhon , Dinh Phuong-Uyen C. , Hensley Taylor , Adler Kenneth B. , Lobo Leonard J. , Cheng Ke 
Published: April 2020

Abstract
Idiopathic pulmonary fibrosis is a lethal interstitial lung disease with unknown etiology, no cure, and few treatment options. Herein, a therapy option is presented that makes use of a heterogeneous population of lung cells, including progenitor cells and supporting cells lines, cultured in adherent and suspension conditions, the latter of which induces spontaneous spheroid formation. Within these spheroids, progenitor marker expression is augmented. The cells, called lung spheroid cells, are isolated from fibrotic lungs, expanded, and delivered in single cell suspensions into rat models of pulmonary fibrosis via tail-vein injections. Two bleomycin-induced fibrotic rat models are used; a syngeneic Wistar-Kyoto rat model, treated with syngeneic cells, and a xenogeneic nude rat model, treated with human cells. The first objective was to study the differences in fibrotic progression in the two rat models after bleomycin injury. Nude rat fibrosis formed quickly and extended for 30 days with no self-resolution. Wistar-Kyoto rat fibrosis was more gradual and began to decrease in severity between days 14 and 30. The second goal was to find the minimum effective dose of cells that demonstrated safe and effective therapeutic value. The resultant minimum effective therapeutic dose, acquired from the nude rat model, was 3 × 106 human cells. Histological analysis revealed no evidence of tumorigenicity, increased local immunological activity in the lungs, or an increase in liver enzyme production. These data demonstrate the safety and efficacy of lung spheroid cells in their application as therapeutic agents for pulmonary fibrosis, as well as their potential for clinical translation.

Significance statement This study helps set the stage for the transition of this cellular therapy paradigm from rodent models to clinical trials in a number of ways. The transbronchial acquisition of the lung spheroid cells is a minimally invasive strategy suitable for the clinic and preferable to thoracoscopic alternatives; the doses used in this study are scalable, manufacturable, and comparable to currently existing clinical trial efforts targeting other lung diseases; and the intravenous route of administration used is applicable to clinical trials, as it presents an easy, quick, and patient-friendly way to administer the treatment.
Esophageal atresia and tracheoesophageal fistula: prenatal sonographic manifestation from early to late pregnancy
Authors: Kassif E. , Weissbach T. , Kushnir A. , Shust‐Barequet S. , Elkan‐Miller T. , Mazkereth R. , Weissmann‐Brenner A. , Achiron R. , Weisz B. 
Published: April 2020

ABSTRACTObjectiveEsophageal atresia and/or tracheoesophageal fistula (EA/TEF) remains one of the most frequently missed congenital anomalies prenatally. The aim of our study was to elucidate the sonographic manifestation of EA/TEF throughout pregnancy.MethodsThis was a retrospective study of data obtained from a tertiary center over a 12‐year period. The prenatal ultrasound scans of fetuses with EA/TEF were assessed to determine the presence and timing of detection of three principal signs: small/absent stomach and worsening polyhydramnios, both of which were considered as ‘suspected’ EA/TEF, and esophageal pouch, which was considered as ‘detected’ EA/TEF. We assessed the yield of the early (14–16 weeks' gestation), routine mid‐trimester (19–26 weeks) and third‐trimester (≥ 27 weeks) anomaly scans in the prenatal diagnosis of EA/TEF.ResultsSeventy‐five cases of EA/TEF with available ultrasound images were included in the study. A small/absent stomach was detected on the early anomaly scan in 3.6% of fetuses scanned, without a definitive diagnosis. On the mid‐trimester scan, 19.4% of scanned cases were suspected and 4.3% were detected. On the third‐trimester anomaly scan, 43.9% of scanned cases were suspected and 33.9% were detected. An additional case with an esophageal pouch was detected on magnetic resonance imaging (MRI) in the mid‐trimester and a further two were detected on MRI in the third trimester. In total, 44.0% of cases of EA/TEF in our cohort were suspected, 33.3% were detected and 10.7% were suspected but, eventually, not detected prenatally.ConclusionsPrenatal diagnosis of EA/TEF on ultrasound is not feasible before the late second trimester. A small/absent stomach may be visualized as early as 15 weeks' gestation. Polyhydramnios does not develop before the mid‐trimester. An esophageal pouch can be detected as early as 22 weeks on a targeted scan in suspected cases. The detection rates of all three signs increase with advancing pregnancy, peaking in the third trimester. The early and mid‐trimester anomaly scans perform poorly as a screening and diagnostic test for EA/TEF. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
War trauma in Homer’s Iliad: a trauma registry perspective
Authors: Chicco Maria , Tebala Giovanni D. 
Published: April 2020

Abstract
Purpose
Homer’s Iliad reports detailed descriptions of war traumas, with precise anatomical references, so that the Iliad can be considered the first trauma registry. We aimed to analyse the Iliad from the perspective of a modern trauma registry: that is, to find historical and local prognostic factors through the epidemiological study of the reported traumas.

Methods
Two different editions of Homer’s Iliad—one in English and one in Italian—were thoroughly studied and epidemiological data were statistically analysed.

Results
148 reports of human traumas were analysed. The majority of traumas (73.6%) involved Trojan warriors, with spears being the most frequent wounding agent (71%). Overall mortality was 84.5% and was higher in the Trojan field (90.8% vs 61.5%). Despite the high mortality, median New Injury Severity Score (NISS) was low, probably due to high prevalence of penetrating mono-systemic trauma. Median NISS was higher in the Trojan group. Compared to the Achaeans, the Trojans had more torso injuries, whereas Achaeans had more injuries to limbs and superficial tissues. However, in both fields, head and neck were more frequently injured.

Conclusions
Homer’s Iliad gives us an interesting insight into war traumas during the siege of Troy. The reported higher mortality within the Trojan army can be explained not only by poetic reasons but also by different military skills.
Characterising the prognostic potential of HLA-DR during colorectal cancer development
Authors: Dunne Margaret R. , Phelan James J. , Michielsen Adriana J. , Maguire Aoife A. , Dunne Cara , Martin Petra , Noonan Sinead , Tosetto Miriam , Geraghty Robert , Fennelly David , Sheahan Kieran , Ryan Elizabeth J. , O’Sullivan Jacintha 
Published: April 2020

AbstractHLA-DR, an MHC class II molecule that mediates antigen presentation, is a favourable prognostic indicator in colorectal cancer (CRC). However, the dynamics and location of HLA-DR expression during CRC development are unclear. We aimed to define HLA-DR expression by immunohistochemistry in colorectal epithelium and stromal tissue at different stages of cancer development, assessing non-neoplastic colorectal adenocarcinoma–adjacent tissue, adenomas and carcinoma tissues, and to associate HLA-DR levels with clinical outcomes. Patients with higher than median HLA-DR expression survived at least twice as long as patients with lower expression. This association was significant for HLA-DR staining in the colorectal carcinoma epithelium (n = 152, p = 0.011, HR 1.9, 95% CI 1.15–3.15) and adjacent non-neoplastic epithelium (n = 152, p < 0.001, HR 2.7, 95% CI 1.59–4.66), but not stroma. In stage II cases, however, the prognostic value of HLA-DR expression was significant only in adjacent non-neoplastic tissues, for both epithelium (n = 63, p = 0.015, HR 3.6, 95% CI 1.279–10.25) and stroma (n = 63, p = 0.018, HR 5.07, 95% CI 1.32–19.49). HLA-DR was lower in carcinoma tissue compared to matched adenomas (n = 35), in epithelium (p < 0.01) and stroma (p < 0.001). HLA-DR was further reduced in late-stage carcinoma (n = 101) compared to early stage (n = 105), in epithelium (p < 0.001) and stroma (p < 0.01). HLA-DR expression was lower (p < 0.05) in the adjacent non-neoplastic epithelium of patients with cancer recurrence. We demonstrate a progressive loss of HLA-DR in epithelial and stromal tissue compartments during CRC development and show prognostic ability in carcinoma–adjacent non-neoplastic tissues, highlighting the importance of this molecule in the anti-cancer immune response. These findings may have wider implications for immunotherapeutic interventions.
Atmospheric River Signatures in Radiosonde Profiles and Reanalyses at the Dronning Maud Land Coast, East Antarctica
Authors: Gorodetskaya Irina V. , Silva Tiago , Schmithüsen Holger , Hirasawa Naohiko 
Published: April 2020

AbstractAtmospheric rivers (ARs) are an important component of the hydrological cycle linking moisture sources in lower latitudes to the Antarctic surface mass balance. We investigate AR signatures in the atmospheric vertical profiles at the Dronning Maud Land coast, East Antarctica, using regular and extra radiosonde measurements conducted during the Year of Polar Prediction Special Observing Period November 2018 to February 2019. Prominent AR events affecting the locations of Neumayer and Syowa cause a strong increase in specific humidity extending through the mid-troposphere and a strong low-level jet (LLJ). At Neumayer, the peak in the moisture inversion (up to 4 g kg−1) is observed between 800 and 900 hPa, while the LLJ (up to 32 m s−1) is concentrated below 900 hPa. At Syowa the increase in humidity is less pronounced and peaks near the surface, while there is a substantial increase in wind speed (up to 40 m s−1) between 825 and 925 hPa. Moisture transport (MT) within the vertical profile during the ARs attains a maximum of 100 g kg−1 m s−1 at both locations, and is captured by both ERA-Interim and ERA5 reanalysis data at Neumayer, but is strongly underestimated at Syowa. Composites of the enhanced MT events during 2009-19 show that these events represent an extreme state of the lower-tropospheric profile compared to its median values with respect to temperature, humidity, wind speed and, consequently, MT. High temporal- and vertical-resolution radiosonde observations are important for understanding the contribution of these rare events to the total MT towards Antarctica and improving their representation in models.
Partitioning uncertainty components of mean climate and climate change in a large ensemble of European regional climate model projections
Authors: Christensen Ole B. , Kjellström Erik 
Published: April 2020

AbstractA study of seasonal mean temperature, precipitation, and wind speed has been performed for a set of 19 global climate model (GCM) driven high-resolution regional climate model (RCM) simulations forming a complete 5 × 4 GCM × RCM matrix with only one missing simulation. Differences between single simulations and between groups of simulations forced by a specific GCM or a specific RCM are identified. With the help of an analysis of variance (ANOVA) we split the ensemble variance into linear GCM and RCM contributions and cross terms for both mean climate and climate change for the end of the current century according to the RCP8.5 emission scenario. The results document that the choice of GCM generally has a larger influence on the climate change signal than the choice of RCM, having a significant influence for roughly twice as many points in the area for the fields investigated (temperature, precipitation and wind speed). It is also clear that the RCM influence is generally concentrated close to the eastern and northern boundaries and in mountainous areas, i.e., in areas where the added surface detail of e.g. orography, snow and ice seen by the RCM is expected to have considerable influence on the climate, and in areas where the air in general has spent the most time within the regional domain. The analysis results in estimates of areas where the specific identity of either GCM or RCM is formally significant, hence obtaining an indication about regions, seasons, and fields where linear superpositions of GCM and RCM effects are good approximations to an actual simulation for both the mean fields analysed and their changes. In cases where linear superposition works well, the frequently encountered sparse GCM–RCM matrices may be filled with emulated results, leading to the possibility of giving more fair relative weight between model simulations than simple averaging of existing simulations. An important result of the present study is that properties of the specific GCM–RCM combination are generally important for the mean climate, but negligible for climate change for the seasonal-mean surface fields investigated here.