bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic-assisted left thoracoabdominal esophagectomy (LLTA): an innovative approach for locally advanced tumors of the gastroesophageal junction
Authors: Reyhani A , Zylstra J , Davies A R , Gossage J A 
Published: March 2020

ABSTRACT

Purpose
To report a novel approach for locally advanced tumors located at the gastroesophageal junction (GEJ) using a laparoscopic abdominal phase and open left thoracotomy with the patient in a single right lateral decubitus position.

Background
The standard open left thoracoabdominal approach offers excellent exposure and access to the GEJ and lower esophagus. It also involves a single position for the procedure, shortening the operation time. The disadvantages are a large incision, division of the costochondral junction, and a low-level thoracotomy. The laparoscopic-assisted left thoracoabdominal esophagectomy (LLTA) is performed with the patient in the same right lateral decubitus position, but initially rolled away from the operator at 45° allowing laparoscopic gastric mobilization and lymphadenectomy. The patient is then tilted back to the lateral position for the thoracic phase. An anterolateral left thoracotomy is performed through the higher fifth intercostal space allowing a high intrathoracic anastomosis, just below the aortic arch. No disruption of the costochondral junction is made.

Methods
Consecutive patients selectively treated for locally advanced GEJ tumors with an LLTA approach between 2013 and 2019 were analyzed and compared to national standards (NOGCA).

Results
This series of 74 consecutive patients had a mean age of 63 years. The median operation time was 235 minutes. The median inpatient stay was 10 days (NOGCA 9 [11–17]). The tumors were predominantly adenocarcinoma (95%) and located at the GEJ (92%). The majority were locally advanced T3 or T4 tumors. Postoperative morbidity was low, Clavien–Dindo (C–D) 0 in 52.7% patients, C–D1 (1.4%), C–D2 (31.1%), C–D3a (5.4%), C–D4a (9.5%), and C–D5 (1.4%). The median number of total lymph nodes (LN) excised was 28 (NOGCA &gt;15); LN % yield ≥18 was 90% (NOGCA 82.5%). Positive nodes were located at the lesser-curve (40%), paraesophageal (32.4%), and subcarinal regions (2.7%). Positive circumferential resection margins (&lt;1 mm) were present in 28.4% of resected specimens (NOGCA 25.1%). This is reflective of the high proportion T3/T4 tumors selected for this approach. Hospital and 30-day mortality was 1.4% (NOGCA 2.7%). Recurrence after LLTA was 25.7% (local 5.4%, systemic 17.6%, mixed 2.7%) at a median of 311 days (62–1,158).

Conclusion
This series demonstrates a novel, safe, and reproducible approach for locally advanced cancer of the GEJ. It offers a better exposure of the hiatus than the right-sided approach and avoids division of the costochondral junction and low thoracotomy seen with the open left thoracoabdominal approach.
Non-CpG methylation biases bisulphite PCR towards low or unmethylated mitochondrial DNA: recommendations for the field
Authors: Morris Margaret J , Hesson Luke B , Youngson Neil A 
Published: March 2020

Abstract
Mitochondrial DNA (mtDNA) is a circular genome of 16 kb that is present in multiple copies in mitochondria. mtDNA codes for genes that contribute to mitochondrial structure and function. A long-standing question has asked whether mtDNA is epigenetically regulated similarly to the nuclear genome. Recently published data suggest that unlike the nuclear genome where CpG methylation is the norm, mtDNA is methylated predominantly at non-CpG cytosines. This raises important methodological considerations for future investigations. In particular, existing bisulphite PCR techniques may be unsuitable due to primers being biased towards amplification from unmethylated mtDNA. Here, we describe how this may have led to previous studies underestimating the level of mtDNA methylation and reiterate methodological strategies for its accurate assessment.
DeepPod: a convolutional neural network based quantification of fruit number in Arabidopsis
Authors: Hamidinekoo Azam , Garzón-Martínez Gina A , Ghahremani Morteza , Corke Fiona M K , Zwiggelaar Reyer , Doonan John H , Lu Chuan 
Published: March 2020

Abstract

Background
High-throughput phenotyping based on non-destructive imaging has great potential in plant biology and breeding programs. However, efficient feature extraction and quantification from image data remains a bottleneck that needs to be addressed. Advances in sensor technology have led to the increasing use of imaging to monitor and measure a range of plants including the model Arabidopsis thaliana. These extensive datasets contain diverse trait information, but feature extraction is often still implemented using approaches requiring substantial manual input.

Results
The computational detection and segmentation of individual fruits from images is a challenging task, for which we have developed DeepPod, a patch-based 2-phase deep learning framework. The associated manual annotation task is simple and cost-effective without the need for detailed segmentation or bounding boxes. Convolutional neural networks (CNNs) are used for classifying different parts of the plant inflorescence, including the tip, base, and body of the siliques and the stem inflorescence. In a post-processing step, different parts of the same silique are joined together for silique detection and localization, whilst taking into account possible overlapping among the siliques. The proposed framework is further validated on a separate test dataset of 2,408 images. Comparisons of the CNN-based prediction with manual counting (R2 = 0.90) showed the desired capability of methods for estimating silique number.

Conclusions
The DeepPod framework provides a rapid and accurate estimate of fruit number in a model system widely used by biologists to investigate many fundemental processes underlying growth and reproduction
A novel method for detecting morphologically similar crops and weeds based on the combination of contour masks and filtered Local Binary Pattern operators
Authors: Le Vi Nguyen Thanh , Ahderom Selam , Apopei Beniamin , Alameh Kamal 
Published: March 2020

Abstract

Background
Weeds are a major cause of low agricultural productivity. Some weeds have morphological features similar to crops, making them difficult to discriminate.

Results
We propose a novel method using a combination of filtered features extracted by combined Local Binary Pattern operators and features extracted by plant-leaf contour masks to improve the discrimination rate between broadleaf plants. Opening and closing morphological operators were applied to filter noise in plant images. The images at 4 stages of growth were collected using a testbed system. Mask-based local binary pattern features were combined with filtered features and a coefficient k. The classification of crops and weeds was achieved using support vector machine with radial basis function kernel. By investigating optimal parameters, this method reached a classification accuracy of 98.63% with 4 classes in the “bccr-segset” dataset published online in comparison with an accuracy of 91.85% attained by a previously reported method.

Conclusions
The proposed method enhances the identification of crops and weeds with similar appearance and demonstrates its capabilities in real-time weed detection.
T4 Nursing Matters! Better Nurse Staffing and Work Environments Associated with Lower Burn Patient Mortality
Authors: Bettencourt Amanda P , Aiken Linda H , Sloane Douglas , McHugh Matthew 
Published: March 2020

Abstract

Introduction
The complexity of modern burn care requires an integrated team of clinicians working together to achieve the best possible outcome for each survivor. Nurses are central to many aspects of a burn survivor’s care including physiologic monitoring, fluid resuscitation, pain management, infection prevention, complex wound care, and rehabilitation. Previous research suggests that hospital nursing resources such as staffing, education, and the quality of the work environment relate to overall patient mortality, but the relationship between those resources and burn mortality has not been previously examined. Due to their unique and complex care needs, burn patients are likely highly sensitive to nursing resources.

Methods
This study examined whether patient-to-nurse ratios, nurse education, and features of the clinical work environment are associated with burn patient in-hospital mortality. A multivariable regression model using a linked, cross-sectional claims database of 14,064 adult (&gt;18 yrs.) burn patients admitted to 653 hospitals was employed. Mortality was risk-adjusted for age, burn size, the presence of mechanical ventilation, co-morbidities, and hospital characteristics such as burn patient volume, technological capabilities, and teaching status. Nursing resources were independently reported by 29,586 bedside nurses working in the study hospitals. The work environment was assessed using the National Quality Forum-endorsed Practice Environment Scale. Nursing resources differ in the high vs. low-volume hospitals, so the final model includes an interaction term for each nursing resource and hospital burn patient volume.

Results
In the risk-adjusted main-effects model, the patient’s age, burn size, presence of mechanical ventilation, comorbidities, and hospital burn patient volume were all significantly associated with in-hospital mortality. The full model including interaction terms suggests that in high burn patient volume hospitals (&gt;100 patients / yr.) each additional patient added to a nurse’s workload is associated with 30% higher odds of mortality (p&lt; 0.05, 95% CI [1.02, 1.94]), and improvements in the nurse work environment are associated with 28% lower odds of mortality (p&lt; 0.05, 95%CI [0.07, 0.99]).

Conclusions
Nurse staffing and the nurse work environment significantly relate to burn patient mortality in high-volume burn hospitals where the most complex burn patients often receive care.

Applicability of Research to Practice
Nursing resources are critical to the survival of the most complex burn patients, and are a significant, yet previously unmeasured variable in the evaluation of burn outcomes. To promote optimal recovery for burn survivors, attention to nurse staffing and the work environment is warranted. Future evaluations of burn patient outcomes should account for hospital nursing resources.
6 Complete Blood Count and Derived Indices: Evolution Pattern and Prognostic Value in Adult Burned Patients
Authors: Aramendi Ignacio , Moreno Laura , Cabrera Julio R , Angulo Martin , dos Santos Gimena , Gastón Burghi 
Published: March 2020

Abstract

Introduction
Thermal injuries represent a major health problem. Biomarkers capable of predicting burned patients outcomes are missing. Certain parameters of complete blood count (CBC) such as red cell distribution width (RDW) and mean platelet volume (MPV), as well as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and RDW-to-platelet ratio (RPR) have been associated with inflammatory status and outcome in diverse medical conditions. The aim of this study was to describe the evolution pattern of these parameters in adult burned patients.

Methods
Adult burned patients admitted to the National Burn Center of a University Hospital between May 2017 and March 2018 were included. Patients characteristics and outcomes were recorded, as well as CBC parameters on days 1, 3, 5 and 7 after thermal injury.

Results
Eighty-eight patients were included. Total body surface area burned was 14 [7–23] %, and mortality was 15%. Non-survivors presented higher RDW (days 3, 5 and 7; P &lt; 0.01) and MPV (days 3 and 7; P &lt; 0.01). NLR decreased after admission in all patients (P &lt; 0.01), but was higher in non-survivors compared to survivors on days 1 and 7 (P &lt; 0.01). On day 3, PLR was higher in survivors than in non-survivors (P &lt; 0.05). In deceased patients, RPR was significantly higher on days 3, 5 and 7 (P &lt; 0.01). There was a significant correlation between NLR on admission and burn extension and severity. Kaplan-Meier analysis revealed that NLR, PLR and RPR could identify patients with increased mortality.

Conclusions
Basic CBC parameters and derived indices could be useful as biomarkers to determine prognosis in adults with thermal injuries.

Applicability of Research to Practice
The study allowed us to identify basic CBC parameters and indices that behave differently in survivors and non-survivors. Interestingly, the CBC profile that differentiates survivors and non-survivors varies at each time point. A particular combination of CBC parameters might be used as a prognostic indicator depending on evolution time since thermal injury.
23 Triage and Transfer to a Regional Burn Center - Impact of a Mobile Phone App
Authors: Carmichael Heather , Dyamenahalli Kiran U , Duffy Patrick , Wagner Anne L Lambert , Wiktor Arek J 
Published: March 2020

Abstract

Introduction
The ABA designs referral criteria to guide providers in recommending appropriate patients for treatment at specialized burn centers. However, patients are typically triaged at local facilities where providers may not have expertise to assess burn injuries properly. Addition of a visual component to a consultation call can improve local triage decisions, including estimations of total burn surface area (TBSA). In 2016, our regional burn center implemented a mobile phone app, which allows a referring provider to send photos of the wound along with basic demographic data to the burn specialist in a HIPPA-compliant manner, facilitating the consultation. Our hypothesis is that use of the burn app can improve triage decisions, particularly in cases of intermediate TBSA (1–10%).

Methods
This is a retrospective review of all consults to our ABA-verified burn center from a single Level II trauma center (TC) approximately 70 miles from our institution. Data were integrated from our call center, burn registry, electronic medical record and the mobile app. Burns were classified as large (&gt;10% TBSA), intermediate (1–10% TBSA), or small (&lt; 1%). Patients were triaged to either a) immediate transfer via ground ambulance or helicopter, b) transfer via private vehicle, c) outpatient follow up at the burn center, or d) local facility/primary care management. Patients were considered to be “down-triaged” if they required transfer but could transfer via private vehicle, or if they could be managed locally.

Results
During the study period, 135 patient consultations were made by the TC for thermal or cold injuries. 82 patients (61%) were referred using the app. Most patients (n=56, 41%) presented with small burns of the hands, feet or face. Overall, 53 patients (39%) were transferred to the burn center. The majority required ambulance transfer (n=44). 60 patients (44%) were recommended for outpatient follow up, but only 43% (n=26) followed up. When the subset of intermediate burns was considered (n=54), the mobile app allowed for successful “down-triage” of 12 patients (30%) referred through the app. No patient referred without the app could be “down-triaged” (p=0.02).

Conclusions
A mobile app can be used to successfully triage patients with intermediate size burn injuries to a lower acuity of follow up and transfer mode. However, less than half of patients triaged to outpatient follow up were actually seen at the burn center.

Applicability of Research to Practice
Telemedicine can be used to assist in triage decisions and appropriate referral to a regional burn center. This technology could be optimized to assist in outpatient follow up.
53 Regulation of Glycolysis and the Warburg Effect in Keloids
Authors: Vinaik Roohi , Barayan Dalia , Jeschke Marc G 
Published: March 2020

Abstract

Introduction
Hypertrophic and keloid scarring are considered as major determinants for long-term outcomes and quality of life for burn survivors. Keloid development is predicated on prolonged local inflammation and altered glucose metabolism. Owing to its tumor-like dependence on glucose, we hypothesized that keloids would display the bioenergetics of cancer cells; namely, increased glucose uptake via Glut1 and upregulation of key glycolytic enzymes. Furthermore, burn patients who develop keloids potentially demonstrate early evidence of the aforementioned features compared to non-keloid patients. Therefore, elevated Glut1 expression could serve as a marker for keloid development in burn patients.

Methods
We enrolled 27 control burn patients with 39% ± 4% total body surface area (TBSA) burns. The keloid burn group included 9 burn patients with 47% ± 9% TBSA burns. Skin was obtained for histology, gene and protein expression at 0–17 days post-burn.

Results
Keloids have higher Glut1 expression compared to normal and burn skin (7.72 vs. 0.15, p&lt; 0.001; 7.72 vs. 2.35, p&lt; 0.05). Keloids also exhibit enhanced expression of critical glycolytic enzymes compared to burn skin at 7–10 days post-burn (HK2: 4.14 vs. 2.36, p&lt; 0.001; PFK1: 6.51 vs. 3.83, p&lt; 0.001; PFK2: 5.35 vs. 1.27, p&lt; 0.001; PDK1: 5.50 vs. 4.31, p&lt; 0.05; PKM2: 7.58 vs. 2.98, p&lt; 0.001). A Glut1 time-course analysis in burn skin from non-keloid patients indicated a significant elevation at 7–10 days post-burn compared to normal skin (3.22 vs. 0.20, p&lt; 0.01). Skin from keloid burn patients prior to development of keloids demonstrate higher Glut1 expression compared to skin from non-keloid controls when matched by days post-burn (40.5 vs. 0.58 at 0–2 days, p&lt; 0.05).

Conclusions
Patients who develop post-burn keloids exhibit early risk factors prior to the development of keloids (e.g. elevated skin Glut1). Keloids have an augmented reliance on glycolysis compared to burn skin. Therefore, early identification and targeting glycolysis in susceptible patients is key.

Applicability of Research to Practice
Upregulation of glycolytic enzymes and transporters such as Glut1 may serve as keloid predictive markers. Identification of at-risk patients allows for a tailored treatment regimen that targets dysregulated glycolysis in these patients. Pharmaceutical agents like shikonin suppress multiple glycolytic steps, serving as an effective means to interfere with the proliferative capacity of keloids. Potentially, local shikonin administration could serve as a therapy in select patients exhibiting keloid risk factors.
65 Fourteen Years of Worldwide Teleconsultation Support for Burn Patient Care
Authors: Cancio Leopoldo C 
Published: March 2020

Abstract

Introduction
The onset of hostilities in 2003 in Iraq generated large numbers of burned combat casualties and civilians, but most U.S. deployed providers are inexperienced in burn care. To help address this gap, the U.S. military established a Burn Teleconsultation (BTC) program in 2005. The BTC was one of 21 specialty TC programs. We reviewed this experience.

Methods
TC was a store-and-forward system based on e mail. BTC was one of the earliest TC programs established (Jan 2005). Users accessed BTC by sending an e mail (often with photos) to burntrauma.consult.army@mail.mil. This reached a group of Burn Center providers, as well as the overall TC program manager (PM). The PM ensured a timely response and documented resolution. BTC was publicized in numerous educational and other materials. Other TCs included Dermatology (Derm, Apr 2004), Ophthalmology (Jul 2004), and Infectious Diseases (ID, Jan 2005).

Results
TC program as a whole. The TC program was active for 176 months. 3766 providers requested TCs; 14763 TCs were completed; and at least 333 patient evacuations were prevented and 775 were facilitated. The median response time (RT) was 2 hours, 57 min. RT was &lt; = 1 hour in 26.3% of cases, and &lt; = 24 hours in 96.4%. Leading programs were Derm (5616 patients, 38.0%), Orthopedics (1428, 9.7%), and ID (1103, 7.5%). TC was transitioned to another platform in Jan 2019.
BTC program. BTC provided 197 (1.3%) TCs. Peak years were among the peak war years: fiscal years 2006 (24 patients), 2008 (32), and 2009 (34). Location of the requesting provider included Iraq (95 consultations, 48.2%), Afghanistan (56, 28.4%), and the continental US (20, 10.2%). The affiliation of the patient was predominantly non-combatant (76 patients, 38.6%), U.S. Army (37, 18.7%), and U.S. Marine Corps (12, 6.1%). The median RT was faster than for the overall TC program at 1 hour, 25 min. RT was &lt; = 1 hour in 45.4% of cases, and &lt; =24 hours in 98.3%.

Conclusions
TC took advantage of the availability of e mail to most deployed providers; it did not depend on wide-band video-teleconferencing, which was not available. Like the leading TC program (Derm), BTC relied on digital photos to enhance communication. BTC achieved a faster RT than the TC as a whole, making it appropriate for rapid, if non-immediate, consultation. The fact that non-combatants constituted the largest group of BTC patients represents the role of civilians with burns on the battlefield. It argues for more training in burn care, to include care well past initial resuscitation, for those who deploy.

Applicability of Research to Practice
Asynchronous teleconsultation should be considered for non-emergent burn care support.