bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of a visual-based analytics tool to predict outcomes of polytrauma patients: The IBM WATSON trauma pathway explorer
Authors: Niggli C , Pape H -C , Mica L 
Published: May 2021

Abstract

Objective
Big data-based artificial intelligence (AI) is on the way to develop into a part of daily clinical life and its reasonable application could help to improve disease or injury outcomes. A visual polytrauma analytics tool based on IBM WATSON was developed and described in a previous publication. The present article relates to the validation of the IBM WATSON Trauma Pathway Explorer.

Methods
A retrospective prediction model validation in a level I trauma center including 107 patients with an Injury Severity Score (ISS) ≥16 and age ≥16 was performed. Age, ISS, temperature and the presence of head injury were the predictors used to validate the following three outcomes: SIRS and sepsis within 21 days since admission of the patient, as well as early death within 72 hours since admission. The area under the receiver operating characteristic (ROC) curve was used to determine predictive quality. Calibration plots showed the graphical goodness of fit. The Brier score assessed the overall performance of the two models.

Results
The area under the curve (AUC) is 0.77 (95% CI: 0.679-0.851) for SIRS, 0.71 (95% CI: 0.578-0.831) for sepsis and 0.90 (95% CI: 0.786-987) for early death. The Brier scores are as follows: early death 0.06, sepsis 0.12 and SIRS 0.15.

Conclusion
The validation has shown that the predictive performance of WATSON for SIRS and early death corresponds to the clinical outcome in nearly 80% of cases and 90% of cases, respectively. The concordance for sepsis was modest with over 70% of cases. This visual analytics tool for polytrauma patients can be used to obtain valid predictions for SIRS, sepsis and early death. Here, we can present a possible working variant of AI in trauma surgery.
Transcarotid artery revascularization (TCAR) – first experience
Authors: Akifi S , Blackham K A , Gürke L , Wolff T 
Published: May 2021

Abstract

Objective
In transcarotid artery revascularization (TCAR) the carotid stent used to treat carotid artery stenosis is introduced via a cut-down to the common carotid artery (CCA). Stent placement is performed during flow reversal using an external shunt to the femoral vein. The advantages compared to transfemoral carotid stenting are that the risks of embolization from the aortic arch and origin of the arch vessels are avoided and that clamping of the common carotid artery allows complete flow-reversal during stent placement. TCAR was developed in 2015 and is extensively used predominately in the USA. To our knowledge, TCAR has until now not been used in Switzerland. We present our first experience with TCAR.

Methods
Retrospective analysis of consecutive patients.

Results
We treated 4 patients with TCAR from Dec 2019 to May 2020. All patients were male, median age was 66y. All had high-grade internal carotid artery (ICA) stenosis (3 asymptomatic, 1 symptomatic). All procedures were performed in a hybrid operation room. Technical success was achieved in 3 patients. In these patients there was no peri-interventional stroke or TIA and duplex sonography 6 months postoperatively showed a patent stent without restenosis. In the fourth patient previous attempted transfemoral stenting for symptomatic ICA-stenosis had failed because of a very tortuous CCA. During TCAR, puncture of the CCA was difficult because of atherosclerotic thickening of the vessel wall, furthermore the tip of the guidewire for insertion of the dedicated sheath into the CCA needed to be placed in the CCA rather than in the external carotid artery (ECA) because of ECA occlusion. This led to inadvertent crossing of the stenosis with the guide wire. The procedure was abolished and converted to a conventional carotid endarterectomy. The patient had a perioperative minor stroke with signs of embolization into branches of the medial cerebral artery. He underwent transfemoral intracranial thrombectomy and eventually recovered with only minor deficits.

Conclusion
Our first experience with TCAR confirmed that patient selection is important: A combination of atherosclerotic disease of the CCA and occlusion of the ECA, both in themselves only relative contraindications to TCAR, led to technical failure and perioperative stroke. With good patient selection TCAR could be performed safely.
Protected and unprotected radiation exposure to the eye lens of vascular surgeons during endovascular procedures in hybrid operating rooms
Authors: Jungi S , Schweizer V , Ante M , Attigah N , Geisbüsch P , Hödlmoser H , Böckler D 
Published: May 2021

Abstract

Objective
Radiation induced cataract has been observed at lower threshold doses than expected. Therefore, the annual limit for equivalent dose to the eye lens has been reduced from 150 to 20 mSv. We aimed to evaluate radiation exposure to the eye lens of vascular surgeons working in a hybrid operating room before and after a dose reduction program was established.

Methods
Prospective non-randomized trial with a historic control group. From April – October 2019, radiation exposure to the operator was measured during all endovascular procedures performed in the hybrid operating room using BeOSL Hp(3) eye lens dosimeters placed outside the 0.75mm lead equivalent glasses on the side of the radiation source and behind the lead glasses. Measured values were compared to data from a prospective study performed at the same center in the years of 2012 and 2013 before a dose reduction program had been implemented.

Results
A total of 181 consecutive patients underwent an endovascular procedure in the hybrid operating room. The mean unprotected eye lens dose of the main operator was 0.119 mSv for EVAR (n = 30), 0.118 mSv for TEVAR (n = 23), 0.312 mSv for more complex aortic procedures (F/BrEVAR; n = 15) and 0.046 mSv for peripheral interventions.
Compared to the control period, EVAR had 75% lower, TEVAR 79% lower and more complex aortic procedures 55% lower radiation exposure unprotected eye lens of the operator. The 0.75 mm lead equivalent glasses led to a median reduction of the exposure to the eye lens by the factor 3.43. Behind the lead glasses at the level of the eye lens, radiation exposure exceeding the detection limit of 0.042 mSv was measured only in 22 of 181 cases. There was a significant correlation between DAP between both protected and unprotected eye lens dose (p &lt; 0.0001, r2 = 0.512 and 0.282). DAP correlated significantly with patients’ body mass index, operating time, fluoroscopy time and digital subtraction angiography time.

Conclusion
The dose reduction program at our institution has led to a relevant reduction of the radiation dose to the head and the eye lens of the main operator in endovascular procedures. With optimum radiation protection measures including a ceiling-mounted shield and 0.75 mm lead equivalent glasses, more than 440 EVARs, 280 TEVARs or 128 FEVARs could be performed per year until the dose limit for the eye lens of 20 mSv would be reached.
Room staff radiation dose in a vascular surgery hybrid operating room and evaluation of a real-time radiation dosimeter
Authors: Jungi S , Schweizer V , Ante M , Geisbüsch P , Böckler D 
Published: May 2021

Abstract

Objective
Real-time radiation dosimeter have been shown to decrease radiation exposure of the staff. This effect is mainly explained by increased awareness of the radiation due to direct radiation exposure feedback to the operator. We aimed to measure the radiation exposure of all staff members working in a hybrid operating room and wanted to compare the equivalent doses of real-time radiation dosimeters with thermoluminescence dosimeters.

Methods
Prospective non-randomized comparative trial. From April – October 2019, all staff members working in a hybrid operating room were equipped with real-time radiation dosimeters (Unfors RaySafe i3). The table positions of all staff members were documented. In addition, the first operator was equipped with a thermoluminescence Hp(3) eye lens dosimeter (TLD) placed outside the lead glasses to validate the real-time radiation dosimeter.

Results
The median dose of the operator / the first assistant was 73.6 µSv / 21.8 µSv for EVAR (n = 30); 57.25 µSv / 18.2 µSv for TEVAR (n = 23); 207.0 µSv / 76.65 µSv for more complex aortic procedures (f/bEVAR etc.; n = 15); 14.85 µSv / 8.5 µSv for occlusive disease of the iliac arteries (n = 27) and 6.1 µSv / 3.4 µSv for occlusive disease of the peripheral arteries (n = 53). The anesthesiologist’s median dose was 0.3 µSv, with highest values in f/bEVAR (3.9µSv). The scrub nurse’s median dose was 2 µSv with highest values in f/bEVAR (24 µSv). The position of any staff member at the left arm for transbrachial cannulation in f/bEVAR was associated with higher median equivalent radiation doses compared to the right femoral position (272.5 vs. 207 µSv for the operator (p=ns), 175.3 vs. 27.8 µSv for the first assistant (p = 0.027) and 45.55 vs. 8.0 µSv for the scrub nurse (p = 0.14)). The equivalent doses of the TLD and RaySafe did not correlate well using simple lineal regression analysis (r2 0.1713, p = 0.0014).

Conclusion
With the RaySafe real-time radiation dosimeter, table positions with increased radiation exposure can be identified. This allows for improvement in shielding at these positions, possibly leading to lower radiation exposure of the staff.
Patient-specific computational fluid dynamic simulation for assessing hemodynamic changes following branched endovascular aneurysm repair: A pilot study
Authors: Tran K , Deslarzes C , Marsden A , Lee J , Déglise S 
Published: May 2021

Abstract

Objective
This pilot study assessed the hypothesis that patient-specific computational fluid dynamic (CFD) modelling can detect aortic branch hemodynamic changes following branched endovascular aneurysm repair (bEVAR).

Methods
Patients who underwent bEVAR with the Jotec E-xtra Design for thoracoabdominal aortic aneurysms were retrospectively selected. Using open-source SimVascular software, pre- and post-operative aortic finite element volume meshes were constructed from CT imaging. Pulsatile in-flow conditions were derived and adjusted for patient-specific clinical variables. Outlet boundary conditions consisted of Windkessel models approximated from physiologic flow splits. Rigid wall flow simulations were then performed on pre- and post-operative models with equivalent boundary conditions. Computations were performed with an incompressible Navier-Stokes flow solver on a 72-core cluster.

Results
Pre- and post-operative flow simulations were performed on 10 patients undergoing bEVAR with a total of 40 target vessels (10 celiac, 20 superior mesenteric, 20 renal stents). Compared to pre-operative values, bEVAR was associated with a decrease in peak renal artery pressure (116.8 ± 11.5 vs 112.8 ± 11.6 mmHg, p&lt;.001) and flow rate (13.7 ± 2.3 vs 12.9 ± 2.4 ml/s, p&lt;.001). No post-operative differences were observed in pressure or flow rates in the celiac or mesenteric arteries (p=.10-.55). Representative perfusion waveforms from a single patient are shown in Figure 1. bEVAR resulted in a significant increase in aortic (1.4 ± 0.5 vs 4.3 ± 2.9 dynes/cm2, p=.009) and renal artery (24.3 ± 7.1 vs 35.4 ± 12.4 dynes/cm2, p=.23) wall shear stress; however, these values remained within the physiologic range. In certain graft configurations, 3D visualization of blood flow streamlines revealed areas of turbulent flow at the origin of external branches which were associated with decreased target artery perfusion (Figure 2).

Conclusion
Changes in para-visceral aortic geometry after bEVAR is associated with a decrease in computationally estimated renal perfusion, without significant changes to celiac or mesenteric hemodynamics. Further CFD simulation-based studies are needed to assess whether changes in branch configuration or hemodynamics after bEVAR can predict loss of branch patency.
Outcome after acute und subacute TEVAR in uncomplicated type B aortic dissection
Authors: Jungi S , Mylonas S , Ante M , Ahmad W , Meisenbacher K , Brunkwall J , Böckler D 
Published: May 2021

Abstract

Objective
In the past years, a paradigm shift from best medical therapy to early thoracic endovascular aortic repair (TEVAR) has been observed in the treatment of uncomplicated type B aortic dissection (uTBAD). We aimed to analyze outcomes after TEVAR in the acute and subacute phase of uTBAD, focusing on aortic remodeling.

Methods
Retrospective analysis of consecutive patients who underwent TEVAR for acute or subacute uTBAD in two tertiary referral centers from 2008 – 2017. Two assessors per center reviewed computed tomography scans of each patient at presentation, at one year and at the last follow-up using post-processing software.

Results
Forty-nine patients were treated with TEVAR for uTBAD. The indication for TEVAR was the presence of multiple morphologic predictors of adverse aortic outcome. The most common predictors were a false lumen diameter of &gt; = 22mm in 76% of patients, a primary entry tear of &gt; = 10mm in 69% and a total aortic diameter of &gt; = 40mm in 67%. There were no in-hospital deaths and no deaths at 1 year. The median follow-up was 40.6 months. Three-year cumulative survival was 94 % (46/49). Fourteen secondary interventions were performed in 10 patients (20 %) after a median of 4.2 months. TEVAR lead to remodeling of the descending thoracic aorta with a median reduction of the total aortic diameter of 4.5 mm within one year and stable diameters after three years. The median maximum false lumen diameter diminished from 26 mm to 15 mm in one year (at 3 years: 14.8 mm).

Conclusion
In this cohort of selected patients with uTBAD and multiple morphologic predictors of worse aortic outcome, elective acute or subacute TEVAR was associated with a low mortality and positive aortic remodeling in the mid-term follow-up.
Chest wall stabilization and rib fixation using a nitinol screwless system in selected patients after blunt trauma: Long-term results in a single-center experience
Authors: Hojski A , Xhambazi A , Wiese M , Subotic D , Bachmann H , Lardinois D 
Published: May 2021

Abstract

Objective
First experience with rib fixation by use of nitinol in terms of reliability, morbidity, influence on pain control and quality of life in a large series of selected patients after blunt chest trauma.

Methods
Data of all patients who underwent rib fixation by use of nitinol were retrospectively analyzed in terms of indications, morbidity and in-hospital mortality. Standard clinical and radiological follow-up was performed at 1, 3, 6, 12 months after discharge. Short-, mid- and long-term pain status and health related quality of life (HRQOL) were assessed using visual analogous scale (VAS) and short form 12 (SF-12) questionnaire.

Results
From September 2017 until April 2019, 70 patients underwent rib fixation by use of the nitinol device, consisting of dislocated and painful fractures (67.1%), pseudarthrosis (15.7%), emergencies with hemodynamical instability (8.6%), and flail chest (8.6%). Morbidity was 21.4% without wound infection; in-hospital mortality was 2.9%. Fracture of the material occurred in 5.7% of the patients during the first year but removal of the material was not necessary. Analysis of the pain score showed a decrease of the pain with a statistical significance for the whole collective and in the group with series of dislocated fractures (p &lt; 0.001, linear mixed-effects models). Assessment of HRQOL revealed a significant improvement of the physical and mental score for the mid- and long-term analysis.

Conclusion
Our results suggest that rib fixation with nitinol device is reliable, associated with an acceptable morbidity, and significantly decreases pain and improves health related quality of life.
Platelet-induced cell signaling during liver regeneration
Authors: Balaphas A , Meyer J , Perozzo R , Zeisser Labouebe M , Berndt S , Turzi A , Fontana P , Scapozza L , Gonelle-Gispert C , Bühler L 
Published: May 2021

Abstract

Objective
To investigate the mechanisms driving the interaction of platelets with liver sinusoidal endothelial cells (LSEC) during liver regeneration.

Methods
Platelets were tracked in vivo in mice by intravital confocal microscopy after partial hepatectomy. In vitro, we isolated highly pure mouse LSEC and analyzed their interactions with platelets, hepatic stellate cells (HSC), Kupffer cells and hepatocytes.

Results
Recruited platelets adhered to LSEC in vivo within the remnant liver segments following partial hepatectomy and were necessary for the interleukin 6 (IL-6) burst that occurred afterwards. In vitro, platelets were activated after incubation with LSEC and released transforming growth factor β1 (TGF-β1), which stimulated LSEC to secrete IL-6 (fold increase of 9.8±0.73 relative to baseline). Antibody-mediated neutralization of TGF-B1 or its downstream SMAD signalling pathway prevented the effects of activated platelets on LSEC.
We also demonstrated that IL-6 released by LSEC stimulates HSC to produce hepatocyte growth factor (HGF) a main mitogen for hepatocytes.

Conclusion
Our results suggest that after hepatectomy, platelets initiate liver regeneration by interacting with LSEC and stimulate IL-6 release, which in turn stimulates HSC to produce HGF.
A Conversation between Confucian Ethics and the NASW Code of Ethics in the Chinese context
Authors: He Longtao , Xu Jianbin 
Published: May 2021

AbstractRecent years have witnessed a growing scholarly interest in the development of professional ethics of social work in China. Confucian ethics is believed to be able to contribute to such development. This article explores Confucian ethics and its interaction with western ethics that underpins the United States’ National Association of Social Workers Code of Ethics. Particularly, it compares the two cultural contexts, western versus eastern, in terms of the ethical deliberation of two elements of Confucian ethics: Chinese people are embedded in a framework of complex relationality, and practical situations take precedence over abstract moral rules (action/practice-oriented situationality). This exploration can provide insight into the Chinese moral context of social work practice and the complex issues associated with formulating Chinese ethical guidelines for such a discipline adapted from the west as social work.
Multisensory Processing Can Compensate for Top-Down Attention Deficits in Schizophrenia
Authors: Moran James K , Keil Julian , Masurovsky Alexander , Gutwinski Stefan , Montag Christiane , Senkowski Daniel 
Published: May 2021

AbstractStudies on schizophrenia (SCZ) and aberrant multisensory integration (MSI) show conflicting results, which are potentially confounded by attention deficits in SCZ. To test this, we examined the interplay between MSI and intersensory attention (IA) in healthy controls (HCs) (N = 27) and in SCZ (N = 27). Evoked brain potentials to unisensory-visual (V), unisensory-tactile (T), or spatiotemporally aligned bisensory VT stimuli were measured with high-density electroencephalography, while participants attended blockwise to either visual or tactile inputs. Behaviorally, IA effects in SCZ, relative to HC, were diminished for unisensory stimuli, but not for bisensory stimuli. At the neural level, we observed reduced IA effects for bisensory stimuli over mediofrontal scalp regions (230–320 ms) in SCZ. The analysis of MSI, using the additive approach, revealed multiple phases of integration over occipital and frontal scalp regions (240–364 ms), which did not differ between HC and SCZ. Furthermore, IA and MSI effects were both positively related to the behavioral performance in SCZ, indicating that IA and MSI mutually facilitate bisensory stimulus processing. Multisensory processing could facilitate stimulus processing and compensate for top-down attention deficits in SCZ. Differences in attentional demands, which may be differentially compensated by multisensory processing, could account for previous conflicting findings on MSI in SCZ.
Action-locked Neural Responses in Auditory Cortex to Self-generated Sounds
Authors: Reznik Daniel , Guttman Noa , Buaron Batel , Zion-Golumbic Elana , Mukamel Roy 
Published: May 2021

AbstractSensory perception is a product of interactions between the internal state of an organism and the physical attributes of a stimulus. It has been shown across the animal kingdom that perception and sensory-evoked physiological responses are modulated depending on whether or not the stimulus is the consequence of voluntary actions. These phenomena are often attributed to motor signals sent to relevant sensory regions that convey information about upcoming sensory consequences. However, the neurophysiological signature of action-locked modulations in sensory cortex, and their relationship with perception, is still unclear. In the current study, we recorded neurophysiological (using Magnetoencephalography) and behavioral responses from 16 healthy subjects performing an auditory detection task of faint tones. Tones were either generated by subjects’ voluntary button presses or occurred predictably following a visual cue. By introducing a constant temporal delay between button press/cue and tone delivery, and applying source-level analysis, we decoupled action-locked and auditory-locked activity in auditory cortex. We show action-locked evoked-responses in auditory cortex following sound-triggering actions and preceding sound onset. Such evoked-responses were not found for button-presses that were not coupled with sounds, or sounds delivered following a predictive visual cue. Our results provide evidence for efferent signals in human auditory cortex that are locked to voluntary actions coupled with future auditory consequences.
High Plasmid Gene Protein 3 (Pgp3) Chlamydia trachomatis Seropositivity, Pelvic Inflammatory Disease, and Infertility Among Women, National Health and Nutrition Examination Survey, United States, 2013–2016
Authors: Anyalechi Gloria E , Hong Jaeyoung , Danavall Damien C , Martin Diana L , Gwyn Sarah E , Horner Patrick J , Raphael Brian H , Kirkcaldy Robert D , Kersh Ellen N , Bernstein Kyle T 
Published: May 2021

Abstract

Background
Chlamydia trachomatis causes pelvic inflammatory disease (PID) and tubal infertility. Plasmid gene protein 3 antibody (Pgp3Ab) detects prior chlamydial infections. We evaluated for an association of high chlamydial seropositivity with sequelae using a Pgp3Ab multiplex bead array (Pgp3AbMBA).

Methods
We performed chlamydia Pgp3AbMBA on sera from women 18-39 years old participating in the 2013–2016 National Health and Nutrition Examination Survey (NHANES) with urine chlamydia nucleic acid amplification test results. High chlamydial seropositivity was defined as a median fluorescence intensity (MFI ≥ 50 000; low-positive was MFI &gt; 551–&lt;50 000. Weighted US population high-positive, low-positive, and negative Pgp3Ab chlamydia seroprevalence and 95% confidence intervals (CI) were compared for women with chlamydial infection, self-reported PID, and infertility.

Results
Of 2339 women aged 18–39 years, 1725 (73.7%) had sera, and 1425 were sexually experienced. Overall, 104 women had high positive Pgp3Ab (5.4% [95% CI 4.0–7.0] of US women); 407 had lowpositive Pgp3Ab (25.1% [95% CI 21.5–29.0]), and 914 had negative Pgp3Ab (69.5% [95% CI 65.5–73.4]). Among women with high Pgp3Ab, infertility prevalence was 2.0 (95% CI 1.1–3.7) times higher than among Pgp3Ab-negative women (19.6% [95% CI 10.5–31.7] versus 9.9% [95% CI 7.7–12.4]). For women with low Pgp3Ab, PID prevalence was 7.9% (95% CI 4.6–12.6) compared to 2.3% (95% CI 1.4–3.6) in negative Pgp3Ab.

Conclusions
High chlamydial Pgp3Ab seropositivity was associated with infertility although small sample size limited evaluation of an association of high seropositivity with PID. In infertile women, Pgp3Ab may be a marker of prior chlamydial infection.