bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of an electronic medical record-based appointment order on outpatient cardiology follow-up after hospital discharge
Authors: Telukuntla Kartik S. , Huded Chetan P. , Shao Mingyuan , Sobol Tim , Abdallah Mouin , Kravitz Kathleen , Hulseman Michael , Barzilai Benico , Starling Randall C. , Svensson Lars G. , Nissen Steven E. , Khot Umesh N. 
Published: May 2021

AbstractOutpatient follow-up after hospital discharge improves continuity of care and reduces readmissions, but rates of follow-up remain low. It is not known whether electronic medical record (EMR)-based tools improve follow-up. The aim of this study was to determine if an EMR-based order to secure cardiology follow-up appointments at hospital discharge would improve follow-up rates and hospital readmission rates. A pre-post interventional study was conducted and evaluated 39,209 cardiovascular medicine discharges within an academic center between 2012 and 2017. Follow-up rates and readmission rates were compared during 2 years prior to EMR-order implementation (pre-order era 2012–2013, n = 12,852) and 4 years after implementation (EMR-order era 2014–2017, n = 26,357). The primary endpoint was 90-day cardiovascular follow-up rates within our health system. In the overall cohort, the mean age of patients was 69.3 years [SD 14.7] and 60.7% (n = 23,827) were male. In the pre-order era, 90-day follow-up was 56.7 ± 0.4% (7286 of 12,852) and increased to 67.9 ± 0.3% (17,888 of 26,357, P < 0.001) in the EMR-order era. The use of the EMR follow-up order was independently associated with increased outpatient follow-up within 90 days after adjusting for patient demographics and payor status (OR 3.28, 95% CI 3.10–3.47, P < 0.001). The 30-day readmission rate in the pre-order era was 12.8% (1642 of 12,852) compared with 13.7% (3601 of 26,357, P = 0.016) in the EMR-order era. An EMR-based appointment order for follow-up appointment scheduling was associated with increased cardiovascular medicine follow-up, but was not associated with an observed reduction in 30-day readmission rates.
Melatonin delays ovarian aging in mice by slowing down the exhaustion of ovarian reserve
Authors: Yang Chan , Liu Qinghua , Chen Yingjun , Wang Xiaodong , Ran Zaohong , Fang Fang , Xiong Jiajun , Liu Guoshi , Li Xiang , Yang Liguo , He Changjiu 
Published: May 2021

AbstractStudies have shown that melatonin (MLT) can delay ovarian aging, but the mechanism has not been fully elucidated. Here we show that granulosa cells isolated from mice follicles can synthesize MLT; the addition of MLT in ovary culture system inhibited follicle activation and growth; In vivo experiments indicated that injections of MLT to mice during the follicle activation phase can reduce the number of activated follicles by inhibiting the PI3K-AKT-FOXO3 pathway; during the early follicle growth phase, MLT administration suppressed follicle growth and atresia, and multiple pathways involved in folliculogenesis, including PI3K-AKT, were suppressed; MLT deficiency in mice increased follicle activation and atresia, and eventually accelerated age-related fertility decline; finally, we demonstrated that prolonged high-dose MLT intake had no obvious adverse effect. This study presents more insight into the roles of MLT in reproductive regulation that endogenous MLT delays ovarian aging by inhibiting follicle activation, growth and atresia.
Accurate but fragile passive non-line-of-sight recognition
Authors: Wang Yangyang , Zhang Yaqin , Huang Meiyu , Chen Zhao , Jia Yi , Weng Yudong , Xiao Lin , Xiang Xueshuang 
Published: May 2021

AbstractNon-line-of-sight (NLOS) imaging is attractive for its potential applications in autonomous vehicles, robotic vision, and biomedical imaging. NLOS imaging can be realized through reconstruction or recognition. Recognition is preferred in some practical scenarios because it can classify hidden objects directly and quickly. Current NLOS recognition is mostly realized by exploiting active laser illumination. However, passive NLOS recognition, which is essential for its simplified hardware system and good stealthiness, has not been explored. Here, we use a passive imaging setting that consists of a standard digital camera and an occluder to achieve a NLOS recognition system by deep learning. The proposed passive NLOS recognition system demonstrates high accuracy with the datasets of handwritten digits, hand gestures, human postures, and fashion products (81.58 % to 98.26%) using less than 1 second per image in a dark room. Beyond, good performance can be maintained under more complex lighting conditions and practical tests. Moreover, we conversely conduct white-box attacks on the NLOS recognition algorithm to study its security. An attack success rate of approximately 36% is achieved at a relatively low cost, which demonstrates that the existing passive NLOS recognition remains somewhat vulnerable to small perturbations.
Deep Q‐network implementation for simulated autonomous vehicle control
Authors: Quek Yang Thee , Koh Li Ling , Koh Ngiap Tiam , Tso Wai Ann , Woo Wai Lok 
Published: May 2021

AbstractDeep reinforcement learning is poised to be a revolutionised step towards newer possibilities in solving navigation and autonomous vehicle control tasks. Deep Q‐network (DQN) is one of the more popular methods of deep reinforcement learning that allows the agent that controls the vehicle to learn through its mistakes based on its actions and interactions with the environment. This paper presents the implementation of DQN to an autonomous self‐driving vehicle control in two different simulated environments; first environment is in Python which is a simple 2D environment and then advanced to Unity software separately which is a 3D environment. Based on the scores and pixel inputs, the agent in the vehicle learns and adapts to its surrounding. It develops the best solution strategy to direct itself in the environment where its task is to manoeuvre the vehicle from point to point on a simulated highway scenario. The implemented DQN technique approximates the action value function with convolutional neural network. This evaluates the Q‐function for the Q‐learning architecture and updates the action value function. This paper shows that DQN is an effective learning method for the agent of an autonomous vehicle. In both simulated environments, the autonomous vehicle gradually learnt the manoeuvre operations and progressively gained the ability to successfully navigate itself and avoid obstacles without prior information of the surrounding.
Accurate prediction of radio wave propagation in an environment of dielectric ground and obstacles based on the principle of domain decomposition
Authors: Li An‐qi , Yin Cheng‐you , Gan Yong‐ji , Wu Wei 
Published: May 2021

AbstractTo study the problem of radio wave propagation in an environment of dielectric ground and obstacles, especially in low‐lossy obstacles, to consider the propagation inside the obstacle, a new method is proposed to solve the two‐way parabolic equation based on the principle of domain decomposition. First, a mathematical model of parabolic equations for reflection and refraction in an environment with obstacles is established. Then, the area of the obstacle is decomposed into two different subdomains; the discrete mixed Fourier transform is used to calculate the field value in the upper subdomain from the top of the obstacle to the absorption boundary, the finite difference method is used to calculate the field value of the lower subdomain inside the obstacle, and the field strengths and phases of the two subdomains coordinate with the boundary conditions. In the process of calculation, we emphatically consider the multiple reflection and transmission paths inside obstacles to make the algorithm results more accurate. In addition, we verified the stability and convergence of the method. Finally, the simulation results show that the proposed method and the method of moments have good consistency, so the algorithm has the characteristics of strong applicability and fast calculation speed, which provide a novel and reliable method to research the wave propagation problem in a modified environment of obstacles.
Interdisziplinäre Aspekte der oralen Antikoagulation mit NOAKs bei Vorhofflimmern
Authors: Dürschmied Daniel , Goette Andreas , Hardt Roland , Kleinschnitz Christoph , Kämmerer Wolfgang , Lembens Christoph , Schmitt Wilhelm , Bode Christoph 
Published: May 2021

ZusammenfassungDie Schlaganfallprophylaxe mit nicht von Vitamin K abhängigen oralen Antikoagulanzien (NOAKs) bei Patienten mit nichtvalvulärem Vorhofflimmern (nvVHF) hat heute einen festen Platz in der klinischen Routine. Die Definition des nvVHF umfasst die Abwesenheit einer mechanischen Herzklappe und ein nicht mit einer mittel- oder hochgradigen Mitralklappenstenose einhergehendes Vorhofflimmern. Das Management der oralen Antikoagulation (OAK) erfordert eine starke Interdisziplinarität. Nicht zuletzt aus diesem Grund sind in der Praxis immer wieder Unsicherheiten zu beobachten, die für den einzelnen Patienten weitreichende Folgen haben können. Deshalb hat sich ein Gremium aus Vertretern von Allgemeinmedizin, Geriatrie, Kardiologie, Nephrologie und Neurologie versammelt, um praxisrelevante Aspekte aus den verschiedenen Disziplinen zu identifizieren und gemeinsam praktische Handreichungen zu erarbeiten, die die Therapiesicherheit für die Patienten im Alltag verbessern sollen (Übersicht siehe Abb. 1).
Apps auf Rezept in der Arztpraxis, aber wie? Fallbasierter Problemaufriss medizinethischer Implikationen bei der Nutzung von DiGA
Authors: Kuhn Eva , Rogge Annette , Schreyer KorbinianFelix , Buyx Alena 
Published: May 2021

Zusammenfassung
Ziel der Studie Mit dem Digitale-Versorgung-Gesetz (DVG) können Ärzt/innen seit dem 19.12.2019 Digitale Gesundheitsanwendungen (DiGAs) verschreiben und Patient / innen haben Anspruch auf eine solche Versorgung. Nachfolgend soll geklärt werden, was niedergelassene Ärzt/ innen bei der Einbindung von DiGAs in die Versorgung berücksichtigen sollten und welche ethische Verantwortung ihnen dabei zukommt.
Methodik Mittels adaptierter prinzipienorientierter Fallanalyse werden drei fiktive, aber praxisnahe Kasuistiken beleuchtet. Das argumentativ-analytische Vorgehen basiert auf den vier medizinethischen Prinzipien Autonomie, Fürsorge, Nichtschaden und Gerechtigkeit nach Beauchamp und Childress sowie der Musterberufsordnung für die in Deutschland tätigen Ärztinnen und Ärzte (MBO-Ä).
Ergebnisse Bei der Verschreibung von DiGAs sollte das ärztliche Aufklärungsgespräch um die besonderen Risiken, die sich aus solchen Anwendungen ergeben, erweitert werden. Es ist insbesondere auf die digitale Gesundheitskompetenz von Patient/innen zu achten. Des Weiteren sollten DiGAs nicht den persönlichen Kontakt ersetzen, sondern allenfalls eine Ergänzung und Unterstützung leitliniengerechter Behandlung bieten. Um Patient/innen zu einem selbstständigeren Gebrauch zu befähigen, wird eine ‚Applikationsanamnese‘ empfohlen.
Schlussfolgerung Die Prinzipienethik nach Beauchamp und Childress sowie die MBO-Ä sind auch für den Umgang mit DiGAs in der Patientenversorgung instruktiv. Die vorgestellten Dos und Don’ts sollten kontinuierlich um weitere Leitplanken ergänzt werden, die Ärzt / innen Orientierung bieten, wie sie DiGAs verantwortlich in der Patientenversorgung einbinden können.
The Predictive Value of Decisive and Soft Ultrasound Criteria for Ectopic Pregnancy Identification in 321 Preoperative Cases
Authors: Pape Janna , Bajka Anahita , Strutas Deivis , Burkhardt Tilo , Imesch Patrick , Fink Daniel , Samartzis Eleftherios Pierre , Bajka Michael 
Published: May 2021

Abstract
Purpose To define the predictive value of morphological types (MTs) and further criteria in diagnosing ectopic pregnancy (ECP) by transvaginal sonography (TVS) prior to operative confirmation and treatment.
Materials and Methods Retrospective cohort analysis of 321 consecutive patients with suspected ECP who were advised to undergo operation.
Results ECP was investigated by TVS in all 321 patients. Application of the five selected MTs (blob sign, bagel sign, yolk sac, embryo, heart action) resulted in 85 % of cases receiving a conclusive diagnosis and 12 % receiving a presumed ECP diagnosis. 3 % remained nondiagnostic due to large or multiple ovarian cysts, large myoma, extended hemoperitoneum, or severe pain. ECP diagnosis was confirmed intraoperatively in 97 % of cases and was otherwise (3 %) immediately followed by curettage (CUR). The assessment of free fluid by TVS was achieved in most cases and correlated significantly with free blood. In the majority of cases, free blood was not bound to transmural ECP rupture. Histology confirmed the ECP diagnosis directly or by exclusion in 99 % of cases. Three cases of tubal ECP were diagnosed by TVS but not confirmed by LSC (1 %) and, finally, histology from CUR proved miscarriage (false-positive rate 1 %).
Conclusion We confirm the high accuracy of TVS diagnosis of ECP relying on five clearly different MTs, independent of its location. The blob and bagel sign emerged as important types (75 % of all ECPs). Histology from CUR was needed when ECP could not be visualized in LSC. Assessment of free fluid was essential and accurate in predicting free blood.
Intra-Articular Corticosteroid or Hyaluronic Acid Injections Are Not Associated with Periprosthetic Joint Infection Risk following Total Knee Arthroplasty
Authors: Kurtz Steven M. , Mont Michael A. , Chen Antonia F. , Valle Craig Della , Sodhi Nipun , Lau Edmund , Ong Kevin L. 
Published: May 2021

AbstractThis study evaluated whether the preoperative use and timing of the use of hyaluronic acid (HA) and/or corticosteroid (CS) injections were associated with an increased risk of periprosthetic joint infections (PJIs) following primary total knee arthroplasty (TKA). We tested the hypothesis that preoperative injection of HA or CS within 3 months prior to primary TKA was associated with an increased risk of PJI by specifically evaluating the association between PJI risk and (1) injection type; (2) timing; (3) patient demographic factors; and (4) surgery-related factors, such as surgeon injection volume, knee arthroscopy (pre- and postoperative), and hospital length of stay. The 5% Medicare part B claims database was queried for patients who received CS and/or HA injections. Cox proportional hazards regressions evaluated the risk of PJIs after TKA, adjusting for patient and clinical factors, as well as propensity scores. The unadjusted incidence of PJI at 2-year post-TKA was 0.75% for the CS group, 0.89% for the HA group, 0.96% for both CS and HA group, and 0.75% for those who did not use HA or CS in the 12 months before TKA. For patients who used HA and/or CS within 3 months prior to TKA, the unadjusted incidence of PJI at 2-year post-TKA was 0.75% for the CS group, 1.07% for the HA group, and 1.00% for both CS and HA group, compared with 0.77% for those who did not use HA or CS. The number of injections performed per year was inconsistently associated with PJI risk. Overall, we found that intra-articular injections given within the 4-month period prior to TKA were not associated with elevated PJI risk (evaluated at 1, 3, 12, and 24 months after the index TKA) within the elderly Medicare patient population.
Delayed Surgery, Low Presurgery Activity, and Poor Preoperative IKDC Scores Are Correlated with Lower Rates of Return to Sports after ACL Reconstruction in an Asian Population
Authors: Lim Dominic G.W. , Chou Andrew C.C. , Chang Paul C.C. , Tan Edwin T.S. , Lie Denny T.T. 
Published: May 2021

AbstractThere is limited literature regarding the early postsurgical outcomes of anterior cruciate ligament (ACL) reconstruction in Asian populations, particularly in the rates of return to sports. We aimed to quantify early clinical outcomes for ACL reconstruction, determine the predictive value of surgeon- and patient-reported outcomes on the rate of return to sports in the early postoperative period, and identify factors predictive of return to sports. We analyzed the data of 55 patients who underwent ACL reconstruction at our tertiary medical center from 2015 to 2016. All patients underwent transportal ACL reconstruction and a standardized post-ACL reconstruction rehabilitation protocol. Patients with concurrent meniscal injury and repair were included. Patients were evaluated at the 3-month, 6-month, 1-year, and 2-year postoperative periods. Surgeon- and patient-reported outcome scores were collected at each follow-up through a systematic questionnaire designed to determine the patient's level of return to sport and reasons for not returning. Surgeon- and patient-reported outcome measures improved significantly over the 2-year postoperative period (p < 0.001). Overall rate of return to sports was 58.2%. The International Knee Documentation Committee (IKDC) subjective (p = 0.02), symptomatic (p = 0.001), composite (p = 0.005), Tegner (p < 0.001) and Lysholm (p = 0.049) scores at 2-year follow-up were significantly worse in patients who failed to return to sports. Earliest difference in scores manifested at 3-month postsurgery (p = 0.011). IKDC grade-D patients were 18.1 times less likely to return to sports (p = 0.035). Delayed surgery (p = 0.01) and presurgery inactivity (p = 0.023) were negatively predictive of return to sports. The rate of return to sport is consistent with the literature analyzing other ethnic populations. Both surgeon- and patient-reported outcome scores at 2-year postsurgery exhibited significant differences between those who did and did not return to sports. Patients should be advised to seek surgical treatment as soon as possible and stay active preoperatively to maximize return to sports.
Combination Immunotherapy for Hepatocellular Carcinoma: Where Are We Currently?
Authors: Uson Junior Pedro Luiz Serrano , Nagalo Bolni Marius , Ahn Daniel H. , Bekaii-Saab Tanios , Borad Mitesh J. 
Published: May 2021

AbstractThe past decade has seen a rise in the availability of breakthrough therapeutic strategies for treatment of hepatocellular carcinoma (HCC). A tumor microenvironment in HCC is regulated by various immunotolerance mechanisms; therefore, therapeutic strategies aiming at disrupting tumor immune tolerance are becoming attractive curative options in HCC. Immune checkpoint inhibitors have demonstrated impressive effectiveness in HCC, including in sorafenib-unresponsive patients. Synergistic approaches with checkpoint inhibitors (anti-PD-1/PD-L1 and CTLA-4) and antiangiogenic drugs are burgeoning as first-line treatment therapeutic modalities in HCC.
Potential of HBx Gene for Hepatocarcinogenesis in Noncirrhotic Liver
Authors: Sekiba Kazuma , Otsuka Motoyuki , Koike Kazuhiko 
Published: May 2021

AbstractCurrent treatments for hepatitis B virus (HBV) using nucleos(t)ide analogs cannot eliminate the risk of hepatocellular carcinoma (HCC) development. As HBV-associated HCC can develop even in the absence of liver cirrhosis, HBV is regarded to possess direct oncogenic potential. HBV regulatory protein X (HBx) has been identified as a primary mediator of HBV-mediated hepatocarcinogenesis. A fragment of the HBV genome that contains the coding region of HBx is commonly integrated into the host genome, resulting in the production of aberrant proteins and subsequent hepatocarcinogenesis. Besides, HBx interferes with the host DNA or deoxyribonucleic acid damage repair pathways, signal transduction, epigenetic regulation of gene expression, and cancer immunity, thereby promoting carcinogenesis in the noncirrhotic liver. However, numerous molecules and pathways have been implicated in the development of HBx-associated HCC, suggesting that the mechanisms underlying HBx-mediated hepatocarcinogenesis remain to be elucidated.
Spinal Dermoid and Epidermoid Cyst: An Institutional Experience and Clinical Insight into the Neural Tube Closure Models
Authors: Maurya Ved P. , Singh Yashveer , Srivastava Arun K. , Das Kuntal K. , Bhaisora Kamlesh S. , Sardhara Jayesh , Behari Sanjay 
Published: May 2021

Abstract

Objectives The spinal dermoid and epidermoid cysts (SDECs) are rare entities comprising less than 1% of pediatric intraspinal tumors. The present study aims to extrapolate the clinicoradiological data, in order to identify the most plausible neural tube closure model in human and provide a retrospective representation from our clinical experience.

Materials and Methods We collected the details of all histologically proven, newly diagnosed primary SDECs who underwent excision over the past 20 years. Secondary or recurrent lesions and other spinal cord tumors were excluded. Surgical and follow-up details of these patients as well as those with associated spinal dysraphism were reviewed. Clinical and radiological follow-up revealed the recurrence in these inborn spinal cord disorders.

Results A total of 73 patients were included retrospectively, having a mean age of 22.4 ± 13.3 years, and 41 (56.2%) cases fell in the first two decades of life. Twenty-four (32.9%) dermoid and 49 (67.1%) epidermoid cysts comprised the study population and 20 of them had associated spinal dysraphism. The distribution of SDECs was the most common in lumbosacral region (n = 30) which was 10 times more common than in the sacral region (n = 3). Bladder dysfunction 50 (68.5%) and pain 48 (65.7%) were the most common presenting complaints. During follow-up visits, 40/48 (83.3%) cases showed sensory improvement while 11/16 (68.7%) regained normal bowel function. There was no surgical mortality with recurrence seen in eight till the last follow-up.

Conclusions The protracted clinical course of the spinal inclusion cysts mandates a long-term follow-up. The results of our study support the multisite closure model and attempt to provide a retrospective reflection of neural tube closure model in humans by using SDECs as the surrogate marker of neural tube closure defect.
Computed Tomographic Morphometry of Lumbar Spine in Indian Population
Authors: Singh Vivek , Prasad Surya Nandan , Neyaz Zafar , Bhargava Nishant , Yadav Uttam , Srivastav Arun Kumar , Mishra Prabhakar , Phadke Rajendra Vishnu 
Published: May 2021

Abstract
Purpose Several studies have been conducted to determine morphometry of lumbar vertebrae, mostly in western population and data on other populations is relatively sparse. Most of these studies have been carried out using fresh cadavers or osteological collections and several of them having limitations such as a small sample size and lack of demographic information. We conducted morphometric analysis of the lumbar vertebrae in a relatively large number of Indian patients using computed tomography scan. Vertebral body and pedicle dimensions of lumbar spinal elements were documented in Indian population and compared with other studies from the subcontinent as well as from other parts of the world. The morphometric data thus compiled may help in the development of new spinal implants for transpedicular screw fixations.
Methods An observational study was conducted and a total of 302 patients were evaluated. Thin section computed tomographic images of the 12th thoracic vertebra (D12) to 1st sacral vertebra (S1) were acquired and various dimensions of vertebral body and pedicle were recorded and analyzed.
Results Generally, the lumbar vertebral and pedicle dimensions were found to be greater in male patients. Comparison of dimensions in different populations revealed statistically significant differences in pedicle dimensions between Indian population and others.
Conclusion Morphometric analysis of lumbar vertebrae using computed tomography scan provides measurements of different vertebral dimensions. This will help in development of spinal implants in future to meet the specific needs of the studied population.