bluuebunny/crossref_metadata_2025_split huggingface dataset:
The usefulness of measuring the anion gap in diagnosing metformin-associated lactic acidosis: a case series
Authors: Ruiz-Ramos Jesus , Lozano-Polo Laura , Juanes-Borrego Ana , Agra-Montava Iván , Puig-Campmany Mireia , Mangues-Bafalluy María Antonia 
Published: January 2021

Abstract
Background
Metformin-associated lactic acidosis (MALA) is a widely documented adverse event of metformin. Despite being considered one of the main causes of metabolic acidosis, the association between an anion gap and MALA diagnosis is still uncertain.

Case presentation
Cases involving six Caucasian patients with suspected MALA who were admitted to the emergency department were analysed. All these patients presented with pH values < 7.35, lactate levels > 2 mmol/L, and estimated glomerular filtration < 30 mL/min. Metformin plasma concentrations were > 2.5 mg/L in all the patients. The highest metformin concentrations were not found in the patients with the highest lactate levels. The anion gap values ranged from 12.3 to 39.3, with only two patients exhibiting values > 14.

Conclusions
In patients with MALA, there is a significant variability in the anion gap values, which is not related to the level of metformin accumulation, and therefore, it is doubtful whether measuring anion gaps is useful as an approach for MALA diagnosis.
Intrusion detection in internet of things using supervised machine learning based on application and transport layer features using UNSW-NB15 data-set
Authors: Ahmad Muhammad , Riaz Qaiser , Zeeshan Muhammad , Tahir Hasan , Haider Syed Ali , Khan Muhammad Safeer 
Published: January 2021

AbstractInternet of Things (IoT) devices are well-connected; they generate and consume data which involves transmission of data back and forth among various devices. Ensuring security of the data is a critical challenge as far as IoT is concerned. Since IoT devices are inherently low-power and do not require a lot of compute power, a Network Intrusion Detection System is typically employed to detect and remove malicious packets from entering the network. In the same context, we propose feature clusters in terms of Flow, Message Queuing Telemetry Transport (MQTT) and Transmission Control Protocol (TCP) by using features in UNSW-NB15 data-set. We eliminate problems like over-fitting, curse of dimensionality and imbalance in the data-set. We apply supervised Machine Learning (ML) algorithms, i.e., Random Forest (RF), Support Vector Machine and Artificial Neural Networks on the clusters. Using RF, we, respectively, achieve 98.67% and 97.37% of accuracy in binary and multi-class classification. In clusters based techniques, we achieved 96.96%, 91.4% and 97.54% of classification accuracy by using RF on Flow & MQTT features, TCP features and top features from both clusters. Moreover, we show that the proposed feature clusters provide higher accuracy and requires lesser training time as compared to other state-of-the-art supervised ML-based approaches.
Design of intelligent diagnosis system for teaching quality based on wireless sensor network and data mining
Authors: Zhang Yanping , Huang Wanwei 
Published: January 2021

AbstractWith the popularization of computers and various mobile intelligent terminals, intelligent teaching systems based on learners are becoming more and more popular among learners. The above phenomenon has greatly affected and changed the current teaching quality diagnosis methods and models. However, the author found through investigation that the current intelligent teaching quality diagnosis still has different degrees of deficiencies in the design and implementation. In response to the above problems, this paper proposes a teaching quality intelligent diagnosis model based on the combination of wireless sensor networks and fuzzy comprehensive evaluation algorithms. First of all, this article is based on the wireless sensor network to link various levels of intelligent teaching systems, and constructs the information transmission structure of the teaching intelligent diagnosis system. Secondly, this article uses fuzzy comprehensive evaluation and convolutional neural network algorithms to evaluate and excavate intelligent teaching information. Finally, the model successfully passed the simulation test and simulation application, which can provide intelligent diagnosis of teaching quality for modern intelligent teaching system.
A new approach on the modelling, chaos control and synchronization of a fractional biological oscillator
Authors: Alshomrani Ali Saleh , Ullah Malik Zaka , Baleanu Dumitru 
Published: January 2021

AbstractThis research aims to discuss and control the chaotic behaviour of an autonomous fractional biological oscillator. Indeed, the concept of fractional calculus is used to include memory in the modelling formulation. In addition, we take into account a new auxiliary parameter in order to keep away from dimensional mismatching. Further, we explore the chaotic attractors of the considered model through its corresponding phase-portraits. Additionally, the stability and equilibrium point of the system are studied and investigated. Next, we design a feedback control scheme for the purpose of chaos control and stabilization. Afterwards, we introduce an efficient active control method to achieve synchronization between two chaotic fractional biological oscillators. The efficiency of the proposed stabilizing and synchronizing controllers is verified via theoretical analysis as well as simulations and numerical experiments.
Diffusion-weighted MRI improves response assessment after definitive radiotherapy in patients with NSCLC
Authors: Jagoda Philippe , Fleckenstein Jochen , Sonnhoff Mathias , Schneider Günther , Ruebe Christian , Buecker Arno , Stroeder Jonas 
Published: January 2021

Abstract
Background
Computed tomography (CT) is the standard procedure for follow-up of non-small-cell lung cancer (NSCLC) after radiochemotherapy. CT has difficulties differentiating between tumor, atelectasis and radiation induced lung toxicity (RILT). Diffusion-weighted imaging (DWI) may enable a more accurate detection of vital tumor tissue. The aim of this study was to determine the diagnostic value of MRI versus CT in the follow-up of NSCLC.

Methods
Twelve patients with NSCLC stages I-III scheduled for radiochemotherapy were enrolled in this prospective study. CT with i.v. contrast agent and non enhanced MRI were performed before and 3, 6 and 12 months after treatment. Standardized ROIs were used to determine the apparent diffusion weighted coefficient (ADC) within the tumor. Tumor size was assessed by the longest longitudinal diameter (LD) and tumor volume on DWI and CT. RILT was assessed on a 4-point-score in breath-triggered T2-TSE and CT.

Results
There was no significant difference regarding LD and tumor volume between MRI and CT (p ≥ 0.6221, respectively p ≥ 0.25). Evaluation of RILT showed a very high correlation between MRI and CT at 3 (r = 0.8750) and 12 months (r = 0.903). Assessment of the ADC values suggested that patients with a good tumor response have higher ADC values than non-responders.

Conclusions
DWI is equivalent to CT for tumor volume determination in patients with NSCLC during follow up. The extent of RILT can be reliably determined by MRI. DWI could become a beneficial method to assess tumor response more accurately. ADC values may be useful as a prognostic marker.
On the usage of average Hausdorff distance for segmentation performance assessment: hidden error when used for ranking
Authors: Aydin Orhun Utku , Taha Abdel Aziz , Hilbert Adam , Khalil Ahmed A. , Galinovic Ivana , Fiebach Jochen B. , Frey Dietmar , Madai Vince Istvan 
Published: January 2021

AbstractAverage Hausdorff distance is a widely used performance measure to calculate the distance between two point sets. In medical image segmentation, it is used to compare ground truth images with segmentations allowing their ranking. We identified, however, ranking errors of average Hausdorff distance making it less suitable for applications in segmentation performance assessment. To mitigate this error, we present a modified calculation of this performance measure that we have coined “balanced average Hausdorff distance”. To simulate segmentations for ranking, we manually created non-overlapping segmentation errors common in magnetic resonance angiography cerebral vessel segmentation as our use-case. Adding the created errors consecutively and randomly to the ground truth, we created sets of simulated segmentations with increasing number of errors. Each set of simulated segmentations was ranked using both performance measures. We calculated the Kendall rank correlation coefficient between the segmentation ranking and the number of errors in each simulated segmentation. The rankings produced by balanced average Hausdorff distance had a significantly higher median correlation (1.00) than those by average Hausdorff distance (0.89). In 200 total rankings, the former misranked 52 whilst the latter misranked 179 segmentations. Balanced average Hausdorff distance is more suitable for rankings and quality assessment of segmentations than average Hausdorff distance.
Can Community Health Workers Increase Palliative Care Use for African American Patients? A Pilot Study
Authors: Sedhom Ramy , Nudotor Richard , Freund Karen M. , Smith Thomas J. , Cooper Lisa A. , Owczarzak Jill T. , Johnston Fabian M. 
Published: January 2021

PURPOSE:African American patients with cancer underutilize advance care planning (ACP) and palliative care (PC). This feasibility study investigated whether community health workers (CHWs) could improve ACP and PC utilization for African American patients with advanced cancer.METHODS:African American patients diagnosed with an advanced solid organ cancer (stage IV or stage III disease with a palliative performance score < 60%) were enrolled. Patients completed baseline surveys that assessed symptom burden and distress at baseline and 3 months post-CHW intervention. The CHW intervention consisted of a comprehensive assessment of multiple PC domains and social determinants of health. CHWs provided tailored support and education on the basis of iterative assessment of patient needs. Intervention feasibility was determined by patient and caregiver retention rate above 50% at 3 months.RESULTS:Over a 12-month period, 24 patients were screened, of which 21 were deemed eligible. Twelve patients participated in the study. Patient retention was high at 3 months (75%) and 6 months (66%). Following the CHW intervention, symptom assessment as measured by Edmonton Symptom Assessment System improved from 33.8 at baseline to 18.8 ( P = .03). Psychological distress improved from 5.5 to 4.7 ( P = .36), and depressive symptoms from 42.2 to 33.6 ( P = .09), although this was not significant. ACP documentation improved from 25% at baseline to 75% at study completion. Sixty-seven percentage of patients were referred to PC, with 100% of three decedents using hospice.CONCLUSION:Utilization of CHWs to address PC domains and social determinants of health is feasible. Although study enrollment was identified as a potential barrier, most recruited patients were retained on study.
Plasma Cell-Free DNA to Differentiate Malignant from Benign Thyroid Nodules
Authors: Dutta Susmita , Tarafdar Soham , Mukhopadhyay Pradip , Bhattacharyya Nitai P , Ghosh Sujoy 
Published: January 2021

Abstract

Background
Molecular testing is increasingly used to identify malignancy in thyroid nodules (especially indeterminate category). Measurement of cell-free DNA (cfDNA) levels from plasma has been useful in diagnosis of cancers of other organs/tissues; herein we analyze cfDNA levels in patients with thyroid nodules to explore the possibility of establishing a cutoff for identification of malignancy.

Methods
Patients underwent ultrasonography (USG) and USG-guided fine needle aspiration as well as surgery, where indicated. Cell-free DNA was extracted from plasma and quantified. In initial analysis (determination of cutoff), cfDNA levels were compared between Bethesda 2 and Bethesda 5 &6 to establish a cutoff value that could differentiate malignant from benign nodules. In the subsequent analysis, the aforementioned cutoff was applied (validation of cutoff) to those with indeterminate nodules to check ability to predict malignancy.

Results
Fine needle aspiration (n = 119) yielded patients with Bethesda 2 (n = 69) Bethesda 5 & 6 (n = 13) who underwent histopathological confirmation. Cell-free DNA levels in these 2 groups were 22.85 ± 1.27 and 96.20 ± 8.31 (ng/mL) respectively. A cfDNA cutoff of 67.9 ng/mL, with area under the curve of 0.992 (95% CI, 0.97-1.0) with 100% sensitivity and 93% specificity was established to identify malignant lesions. Indeterminate group (Bethesda 3 & 4) underwent surgery (malignant n = 24), (benign n = 13), and using the previously identified cutoff for cfDNA, we were able to identify malignant lesions with a sensitivity of 100% and specificity of 92.3%. There was a very strong agreement between cfDNA-based classification with histopathology-based classification of benign and malignant nodules (Cohen’s kappa 0.94; P &lt; 0.001)

Conclusion
Plasma cfDNA estimation could help differentiate malignant from benign thyroid nodules.
Construct Validation of the American Board of Anesthesiology’s APPLIED Examination for Initial Certification
Authors: Wang Ting , Sun Huaping , Zhou Yan , Chen Dandan , Harman Ann E. , Isaak Robert S. , Peterson-Layne Cathleen , Macario Alex , Fahy Brenda G. , Warner David O. 
Published: January 2021

BACKGROUND:
The American Board of Anesthesiology administers the APPLIED Examination as a part of initial certification, which as of 2018 includes 2 components—the Standardized Oral Examination (SOE) and the Objective Structured Clinical Examination (OSCE). The goal of this study is to investigate the measurement construct(s) of the APPLIED Examination to assess whether the SOE and the OSCE measure distinct constructs (ie, factors).

METHODS:
Exploratory item factor analysis of candidates’ performance ratings was used to determine the number of constructs, and confirmatory item factor analysis to estimate factor loadings within each construct and correlation(s) between the constructs.

RESULTS:
In exploratory item factor analysis, the log-likelihood ratio test and Akaike information criterion index favored the 3-factor model, with factors reflecting the SOE, OSCE Communication and Professionalism, and OSCE Technical Skills. The Bayesian information criterion index favored the 2-factor model, with factors reflecting the SOE and the OSCE. In confirmatory item factor analysis, both models suggest moderate correlation between the SOE factor and the OSCE factor; the correlation was 0.49 (95% confidence interval [CI], 0.42-0.55) for the 3-factor model and 0.61 (95% CI, 0.54-0.64) for the 2-factor model. The factor loadings were lower for Technical Skills stations of the OSCE (ranging from 0.11 to 0.25) compared with those of the SOE and Communication and Professionalism stations of the OSCE (ranging from 0.36 to 0.50).

CONCLUSIONS:
The analyses provide evidence that the SOE and the OSCE measure distinct constructs, supporting the rationale for administering both components of the APPLIED Examination for initial certification in anesthesiology.
Trends in Peripheral Nerve Block Usage in Mastectomy and Lumpectomy: Analysis of a National Database From 2010 to 2018
Authors: Lam Stephanie , Qu Helena , Hannum Margaret , Tan Kay See , Afonso Anoushka , Tokita Hanae K. , McCormick Patrick J. 
Published: January 2021

BACKGROUND:
Compared to general anesthesia, regional anesthesia confers several benefits including improved pain control and decreased postoperative opioid consumption. While the benefits of peripheral nerve blocks (PNB) have been well studied, there are little epidemiological data on PNB usage in mastectomy and lumpectomy procedures. The primary objective of our study was to assess national trends of the annual proportion of PNB use in breast surgery from 2010 to 2018. We also identified factors associated with PNB use for breast surgery.

METHODS:
We identified lumpectomy and mastectomy surgical cases with and without PNB between 2010 and 2018 using the Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry (AQI NACOR). We modeled the nonlinear association between year of procedure and PNB use with segmented mixed-effects logistic regression clustered on facility identifier. The association between PNB use and year of procedure, age, sex, American Society of Anesthesiologists physical status (ASA PS), facility type, facility region, weekday, and tissue expander use was also modeled using mixed-effects logistic regression.

RESULTS:
Of the 189,854 surgical cases from 2010 to 2018 that met criteria, 86.2% were lumpectomy cases and 13.8% were mastectomy cases. The proportion of lumpectomy cases with PNB was <0.1% in 2010 and increased each subsequent year to 1.9% in 2018 (trend P < .0001). The proportion of mastectomy cases with PNB was 0.5% in 2010 and 13% in 2018 (trend P < .0001). The year 2014 was the breakpoint selected for segmented regression. Before 2014, the odds of PNB among the mastectomy cases was not significantly different from year to year. After 2014, the odds of PNB increased by 2.24-fold each year (95% confidence interval [CI], 2.00–2.49; P < .001); interaction test for pre-2014 versus post-2014 was P < .001. Similar trends were seen in the lumpectomy cases, where after 2014, the odds of PNB increased by 2.03-fold (95% CI, 1.81–2.27; P < .001); interaction test for pre-2014 versus post-2014 was P < .001. In the mastectomy cohort, year of procedure ≥2014, female sex, facility region, and tissue expander use were associated with higher odds of PNB. For lumpectomy cases, year of procedure ≥2014 and facility region were associated with higher odds of PNB use.

CONCLUSIONS:
We found increased annual utilization of PNB for mastectomy and lumpectomy since 2010, although absolute prevalence is low. PNB use was associated with year of procedure for both lumpectomy and mastectomy, particularly post-2014.
Free Hemoglobin Ratio as a Novel Biomarker of Acute Kidney Injury After On-Pump Cardiac Surgery: Secondary Analysis of a Randomized Controlled Trial
Authors: Hu Jie , Rezoagli Emanuele , Zadek Francesco , Bittner Edward A. , Lei Chong , Berra Lorenzo 
Published: January 2021

BACKGROUND:
Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a high risk of postoperative acute kidney injury (AKI). Due to limitations of current diagnostic strategies, we sought to determine whether free hemoglobin (fHb) ratio (ie, levels of fHb at the end of CPB divided by baseline fHb) could predict AKI after on-pump cardiac surgery.

METHODS:
This is a secondary analysis of a randomized controlled trial comparing the effect of nitric oxide (intervention) versus nitrogen (control) on AKI after cardiac surgery (NCT01802619). A total of 110 adult patients in the control arm were included. First, we determined whether fHb ratio was associated with AKI via multivariable analysis. Second, we verified whether fHb ratio could predict AKI and incorporation of fHb ratio could improve predictive performance at an early stage, compared with prediction using urinary biomarkers alone. We conducted restricted cubic spline in logistic regression for model development. We determined the predictive performance, including area under the receiver-operating-characteristics curve (AUC) and calibration (calibration plot and accuracy, ie, number of correct predictions divided by total number of predictions). We also used AUC test, likelihood ratio test, and net reclassification index (NRI) to compare the predictive performance between competing models (ie, fHb ratio versus neutrophil gelatinase–associated lipocalin [NGAL], N-acetyl-β-d-glucosaminidase [NAG], and kidney injury molecule-1 [KIM-1], respectively, and incorporation of fHb ratio with NGAL, NAG, and KIM-1 versus urinary biomarkers alone), if applicable.

RESULTS:
Data stratified by median fHb ratio showed that subjects with an fHb ratio >2.23 presented higher incidence of AKI (80.0% vs 49.1%; P = .001), more need of renal replacement therapy (10.9% vs 0%; P = .036), and higher in-hospital mortality (10.9% vs 0%; P = .036) than subjects with an fHb ratio ≤2.23. fHb ratio was associated with AKI after adjustment for preestablished factors. fHb ratio outperformed urinary biomarkers with the highest AUC of 0.704 (95% confidence interval [CI], 0.592-0.804) and accuracy of 0.714 (95% CI, 0.579-0.804). Incorporation of fHb ratio achieved better discrimination (AUC test, P = .012), calibration (likelihood ratio test, P < .001; accuracy, 0.740 [95% CI, 0.617-0.832] vs 0.632 [95% CI, 0.477-0.748]), and significant prediction increment (NRI, 0.638; 95% CI, 0.269-1.008; P < .001) at an early stage, compared with prediction using urinary biomarkers alone.

CONCLUSIONS:
Results from this exploratory, hypothesis-generating retrospective, observational study shows that fHb ratio at the end of CPB might be used as a novel, widely applicable biomarker for AKI. The use of fHb ratio might help for an early detection of AKI, compared with prediction based only on urinary biomarkers.
What Should Guide the Performance of Venous Resection During Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma with Venous Contact?
Authors: Navez Julie , Bouchart Christelle , Lorenzo Diane , Bali Maria Antonietta , Closset Jean , van Laethem Jean-Luc 
Published: January 2021

AbstractComplete surgical resection, most often associated with perioperative chemotherapy, is the only way to offer a chance of cure for patients with pancreatic cancer. One of the most important factors in determining survival outcome that can be influenced by the surgeon is the R0 resection. However, the proximity of mesenteric vessels in cephalic pancreatic tumors, especially the mesenterico-portal venous axis, results in an increased risk of vein involvement and/or the presence of malignant cells in the venous bed margin. A concomitant venous resection can be performed to decrease the risk of a positive margin. Given the additional technical difficulty that this implies, many surgeons seek a path between the tumor and the vein, hoping for the absence of tumor infiltration into the perivascular tissue on pathologic analysis, particularly in cases with administration of neoadjuvant therapy. The definition of optimal surgical margin remains a subject of debate, but at least 1 mm is an independent predictor of survival after pancreatic cancer surgical resection. Although preoperative radiologic assessment is essential for accurate planning of a pancreatic resection, intraoperative decision-making with regard to resection of the mesenterico-portal vein in tumors with a venous contact remains unclear and variable. Although venous histologic involvement and perivascular infiltration are not accurately predictable preoperatively, clinicians must examine the existing criteria and normograms to guide their surgical management according to the integration of new imaging techniques, preoperative chemotherapy use, tumor biology and molecular histopathology, and surgical techniques.
New Aqueous Solutions with Lower Viscosities than Water
Authors: Haraguchi Kazutoshi , Kimura Yuji 
Published: January 2021

Abstract
Liquid water exhibits many anomalous physical properties because of its unique structure and hydrogen bonding networks, which were mostly uncovered at the beginning of the 20th century. Because of its interesting properties and microstructures under various conditions and in aqueous solutions, understanding the behavior of water is important, but remains scientifically challenging. Regarding the viscosity of aqueous solutions, despite the discovery 147 years ago that very small amounts of certain salts decrease the viscosity of water slightly, there has been no significant progress to date. Herein, we report new aqueous solutions, with low additive fractions and much lower viscosities than pure water, which exhibit unique viscosity–composition curves. The findings should spark renewed interest in scientific research on water, which may greatly impact numerous industries.