bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep Learning Application in Spinal Implant Identification
Authors: Yang Hee-Seok , Kim Kwang-Ryeol , Kim Sungjun , Park Jeong-Yoon 
Published: February 2021

Study Design.
Retrospective observational study.

Objective.
To demonstrate the clinical usefulness of deep learning by identifying previous spinal implants through application of deep learning.

Summary of Background Data.
Deep learning has recently been actively applied to medical images. However, despite many attempts to apply deep learning to medical images, the application has rarely been successful. We aimed to demonstrate the effectiveness and usefulness of deep learning in the medical field. The goal of this study was to demonstrate the clinical usefulness of deep learning by identifying previous spinal implants through application of deep learning.

Methods.
For deep learning algorithm development, radiographs were retrospectively obtained from clinical cases in which the patients had lumbar spine one-segment instrument surgery. A total of 2894 lumbar spine anteroposterior (AP: 1446 cases) and lateral (1448 cases) radiographs were collected. Labeling work was conducted for five different implants. We conducted experiments using three deep learning algorithms. The traditional deep neural network model built by coding the transfer learning algorithm, Google AutoML, and Apple Create ML. Recall (sensitivity) and precision (specificity) were measured after training.

Results.
Overall, each model performed well in identifying each pedicle screw implant. In conventional transfer learning, AP radiography showed 97.0% precision and 96.7% recall. Lateral radiography showed 98.7% precision and 98.2% recall. In Google AutoML, AP radiography showed 91.4% precision and 87.4% recall; lateral radiography showed 97.9% precision and 98.4% recall. In Apple Create ML, AP radiography showed 76.0% precision and 73.0% recall; lateral radiography showed 89.0% precision and 87.0% recall. In all deep learning algorithms, precision and recall were higher in lateral than in AP radiography.

Conclusion.
The deep learning application is effective for spinal implant identification. This demonstrates that clinicians can use ML-based deep learning applications to improve clinical practice and patient care.

Level of Evidence: 3
Spine Surgery HCAHPS Patient Satisfaction Survey Results Inversely Correlate with Survey Response Time
Authors: Kebaish Kareem J. , Mercier Michael R. , Duy Phan Q. , Malpani Rohil , Galivanche Anoop R. , Grauer Jonathan N. 
Published: February 2021

Study Design.
Retrospective review.

Objective.
The aim of this study was to understand the potential correlation of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey response time on reported satisfaction following spine surgery hospitalization.

Summary of Background Data.
With increasing emphasis on patient satisfaction metrics, such as HCAHPS, hospital reputations, and reimbursements are being affected by the results of such surveys. HCAHPS is a 32-question survey about patient experience in the hospital and after discharge.

Methods.
HCAHPS surveys were routinely sent to all patients admitted after spine surgery at an academic medical center between January 2013 and August 2017. Survey data, survey return time, patient demographics, and 30-day postoperative outcomes were gathered for all spine surgery patients who returned the survey. Multivariate regression analysis controlling for age, sex, BMI, functional status, American Society of Anesthesiologists class, education, and race was used to determine whether there were differences in rates of “Top Box” response between different time ranges of survey return.

Results.
In total, 1495 consecutive spinal surgery patients who returned their HCAHPS survey were identified. Of these, 31.51% returned their surveys within 21 days, 48.09% returned them between 22 to 42 days, 13.58% returned them between 43 to 64 days, and 6.82% returned them ≥65 days after distribution. Multivariate regression demonstrated no statistical differences in reported satisfaction between surveys returned between days 0 to 21 and days 22 to 42. However, there were significantly lower scores reported by surveys returned on days 43 to 64 and 65 plus days.

Conclusion.
Centers for Medicare and Medicaid Services only considers HCAHPS surveys returned within the first 42 days. It appears that the survey responses are similar over this time period. Beyond this time, lower scores are reported. Further attention to this less satisfied, later HCAHPS survey returning group seems warranted.

Level of Evidence: 2
Circular RNA Expression Profile in Patients with Lumbar Spinal Stenosis Associated with Hypertrophied Ligamentum Flavum
Authors: Chen Jianwei , Yu Xiaosheng , Qiu Manle , Feng Fan , Liu Zude , Zhong Guibin 
Published: February 2021

Study Design.
Sequencing and experimental analysis of the expression profile of circular RNAs (circRNAs) in hypertrophic ligamentum flavum (LFH).

Objectives.
The aim of this study was to identify differentially expressed circRNAs between LFH and nonhypertrophic ligamentum flavum tissues from lumbar spinal stenosis (LSS) patients.

Summary of Background Data.
Hypertrophy of the ligamentum flavum (LF) can cause LSS. circRNAs are important in various diseases. However, no circRNA expression patterns related to LF hypertrophy have been reported.

Methods.
A total of 33 patients with LSS participated in this study. LF tissue samples were obtained when patients underwent decompressive laminectomy during surgery. The expression profile of circRNAs was analyzed by transcriptome high-throughput sequencing and validated with quantitative real-time polymerase chain reaction (PCR). Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed for the differentially expressed circRNA-associated genes and related pathways. The connections between circRNAs and microRNAs were explored using Cytoscape. The role of hsa_circ_0052318 on LF cell fibrosis was assessed by analyzing the expression of collagen I and collagen III.

Results.
The results showed that 2439 circRNAs of 4025 were differentially expressed between the LFH and nonhypertrophic ligamentum flavum tissues, including 1276 upregulated and 1163 downregulated circRNAs. The Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses revealed that these differentially expressed circRNAs functioned in biological processes, cellular components, and molecular functions. Autophagy and mammalian target of rapamycin were the top two signaling pathways affected by these circRNAs. Five circRNAs (hsa_circ_0021604, hsa_circ_0025489, hsa_circ_0002599, hsa_circ_0052318, and hsa_circ_0003609) were confirmed by quantitative real-time PCR. The network indicated a strong relationship between circRNAs and miRNAs. Furthermore, hsa_circ_0052318 overexpression decreased mRNA and protein expression of collagen I and III in LF cells from LFH tissues.

Conclusion.
This study identified circRNA expression profiles characteristic of hypertrophied LF in LSS patients, and demonstrated that hsa_circ_0052318 may play an important role in the pathogenesis of LF hypertrophy.

Level of Evidence: N/A
Is Reading Performance Impaired in Glaucoma Patients With Preserved Central Vision?
Authors: Ikeda Mariana C. , Bando Andre H. , Hamada Koiti U. , Nakamura Vinicius P.L. , Prata Tiago S. , Paranhos Augusto , Tatham Andrew J. , Gracitelli Carolina P.B. 
Published: February 2021

Precis:
Although this sample with glaucoma had preserved central vision, they presented worse reading performance compared with similarly aged controls.

Objective:
To determine whether patients with glaucoma with preserved central vision have impaired reading performance compared with healthy controls.

Methods:
A cross-sectional study of 35 patients with glaucoma and 32 similarly aged controls with visual acuity better than 0.4 logMAR in both eyes. Each participant had a detailed ophthalmological examination followed by a 5-chart reading performance test using a Portuguese version of the Minnesota Low Vision Reading Test (MNREAD). Correlation between reading performance (reading speed) and ocular parameters was investigated.

Results:
Participants had an average age of 63.0±12.6 years. In the glaucoma group, mean deviation in the better and worse eyes was −6.29±6.36 and −11.08±0.23 dB, respectively. There was no significant difference in age, sex, rage, education, visual acuity, or systemic comorbidities between groups. Participants with glaucoma had significantly slower reading speeds, with an average of 83.2±25.12 compared with 102.29±29.57 words per minute in controls (P=0.006). Reading speed was slower for all 5 charts. Odds of glaucoma increased by 1.29 (95% confidence interval, 1.07-1.56; P=0.009) for each 10 words per minute decrease in average reading speed, with this relationship maintained after accounting for age, schooling, and visual acuity.

Conclusions:
Patients with mild to moderate glaucoma had worse reading performance compared with similarly aged controls, despite both having preserved central vision.
Effects of Wearing the Elevation Training Mask During Low-intensity Cycling Exercise on Intraocular Pressure
Authors: Vera Jesús , Jiménez Raimundo , Redondo Beatríz , Perez-Castilla Alejandro , García-Ramos Amador 
Published: February 2021

Précis:
Low-intensity aerobic exercise is recommended to reduce intraocular pressure (IOP) levels. However, this effect depends on several factors. We found that using an elevation training mask (ETM) during low-intensity aerobic exercise causes an IOP rise.

Purpose:
The aim was to assess the influence of wearing an ETM on IOP during low-intensity endurance training.

Methods:
Sixteen physically active young adults (age=23.9±2.9 y) cycled during 30 minutes at 10% of maximal power production with and without an ETM in 2 different days and randomized order. A rebound tonometer was used to measure IOP at baseline, after a warm-up of 5 minutes, during cycling (6, 12, 18, 24, and 30 min), and recovery (5 and 10 min) by rebound tonometry.

Results:
The use of an ETM significantly affects the IOP behaviour during exercise (P<0.001, ηp²=0.66). In the ETM condition, there was an IOP increment during exercise (P<0.001, ηp²=0.28) whereas an IOP-lowering effect was observed in the control condition (P<0.001, ηp²=0.41). Post hoc comparisons showed that there were greater IOP values during exercise in the ETM condition in comparison to the control condition (average IOP difference=3.7±2.2 mm Hg; corrected P<0.01, and the Cohen d’s >1.10, in all cases).

Conclusion:
Low-intensity endurance exercise causes an increment in IOP when it is performed wearing an ETM and a decrease in IOP when the air flow is not restricted (control condition). Therefore, the ETM should be discouraged during low-intensity endurance exercise for individuals who need to reduce IOP levels (eg, glaucoma patients or those at risk). However, the external validity of these results needs to be addressed in future studies with the inclusion of glaucoma patients.
Image Quality Improvement of Dynamic Contrast-Enhanced Gradient Echo Magnetic Resonance Imaging by Iterative Denoising and Edge Enhancement
Authors: Gassenmaier Sebastian , Herrmann Judith , Nickel Dominik , Kannengiesser Stephan , Afat Saif , Seith Ferdinand , Hoffmann Rüdiger , Othman Ahmed E. 
Published: February 2021

Objectives
The aim of this study was to investigate the impact of a novel edge enhancement and iterative denoising algorithm in 1.5-T T1-weighted dynamic contrast-enhanced (DCE) gradient echo (GRE) magnetic resonance imaging of the abdomen on image quality, noise levels, diagnostic confidence, and lesion detectability.

Materials and Methods
Fifty patients who underwent a clinically indicated magnetic resonance imaging with DCE imaging of the abdomen between June and August 2020 were included in this retrospective, monocentric, institutional review board–approved study. For DCE imaging, a series of 3 volume interpolated breath-hold examinations (VIBEs) was performed. The raw data of all DCE imaging studies were processed twice, once using standard reconstruction (DCES) and again using an edge enhancement and iterative denoising approach (DCEDE). All imaging studies were randomly reviewed by 2 radiologists independently regarding noise levels, arterial contrast, sharpness of vessels, overall image quality, and diagnostic confidence using a Likert scale ranging from 1 to 4, with 4 being the best. Furthermore, lesion detectability was evaluated using the same ranking system.

Results
All 50 imaging studies were successfully reconstructed with both methods. Interreader agreement (Cohen κ) was substantial to perfect for both readers. Arterial contrast and sharpness of vessels were rated superior by both readers with a median of 4 in DCEDE versus a median of 3 in DCES (P < 0.001). Furthermore, noise levels as well as overall image quality were rated higher with a median of 4 in DCEDE compared with a median of 3 in DCES (P < 0.001). Lesion detectability was evaluated to be superior in DCEDE with a median of 4 versus DCES with a median of 3 (P < 0.001). Consequently, diagnostic confidence was also rated to be superior in DCEDE with a median of 4 versus DCES with a median of 3 (P < 0.001).

Conclusions
Iterative denoising and edge enhancement are feasible in DCE imaging of the abdomen providing superior arterial contrast, noise levels, and overall image quality. Furthermore, lesion detectability and diagnostic confidence were significantly improved using this novel reconstruction method. Further reduction of acquisition time might be possible via reduction of increased noise levels using this presented method.
Topical Timolol Combined Intralesional Injection of Diprospan in the Treatment of Elevated Localized Mixed Infantile Hemangiomas and a Discussion for Proper Timing for Injection
Authors: Zhang Jing-Yue , Lan Shi-Jie , Liu Meng , Yang Tian-Ye , Liu Shan-Shan , Rong Li 
Published: February 2021

Background:
Although infantile hemangiomas (IHs) are usually self-limiting, residual elevated appearance may remain. Topical beta-blockers are effective in superficial IHs management, while intralesionally injected diprospan is effective at treating deep, localized IHs. A single application of topical timolol or injected diprospan has obvious limitations. Therefore, for elevated, localized mixed IHs, we applied topical timolol combined with intralesionally injected diprospan, using their respective advantages to maximize benefits.

Purpose:
To evaluate the clinical efficacy and safety of topical timolol combined with intralesionally injected diprospan for the treatment of elevated, localized mixed IHs and identify the optimal injection time.

Methods:
Infants with elevated, localized mixed IHs in the proliferative phase were treated with injected diprospan combined with topical timolol between March 2018 and March 2020. The injection was administered only when the tumor surface was higher than that of the surrounding tissue. The patients were asked to return every 4 weeks for a treatment response evaluation, and complications were recorded.

Results:
Thirty-six patients with elevated, localized mixed IHs (thickness >3 mm on Doppler ultrasound) were recruited. The mean age at treatment initiation was 3.58 ± 1.50 months (range: 1.00–6.00 months). The follow-up period ranged from 9 to 24 months. Considering the size of the IH at the end of treatment, regression was observed in 31 (86.1%) cases, stabilization was observed in 5 (13.9%) cases, and no treatment failure was observed. All the IHs improved in color and height after treatment.

Conclusion:
Topical timolol combined with intralesionally injected diprospan is an effective and safe treatment for elevated, localized mixed IH. The injection is needed only when we forecast the elevated tissue may remain after regression.
Determining the Level of Importance of Variables in Predicting Kidney Transplant Survival Based on a Novel Ranking Method
Authors: Taherkhani Nasrin , Sepehri Mohammad Mehdi , Khasha Roghaye , Shafaghi Shadi 
Published: February 2021

Background.
Kidney transplantation is the best alternative treatment for end-stage renal disease. To optimal use of donated kidneys, graft predicted survival can be used as a factor to allocate kidneys. The performance of prediction techniques is highly dependent on the correct selection of predictors. Hence, the main objective of this research is to propose a novel method for ranking the effective variables for predicting the kidney transplant survival.

Methods.
Five classification models were used to classify kidney recipients in long- and short-term survival classes. Synthetic minority oversampling and random undersampling were used to overcome the imbalanced class problem. In dealing with missing values, 2 approaches were used (eliminating and imputing them). All variables were categorized into 4 levels. The ranking was evaluated using the sensitivity analysis approach.

Results.
Thirty-four of the 41 variables were identified as important variables, of which, 5 variables were categorized in very important level (“Recipient creatinine at discharge,” “Recipient dialysis time,” “Donor history of diabetes,” “Donor kidney biopsy,” and “Donor cause of death”), 17 variables in important level, and 12 variables in the low important level.

Conclusions.
In this study, we identify new variables that have not been addressed in any of the previous studies (eg, AGE_DIF and MATCH_GEN). On the other hand, in kidney allocation systems, 2 main criteria are considered: equity and utility. One of the utility subcriteria is the graft survival. Our study findings can be used in the design of systems to predict the graft survival.
Neural versus alternative integrative systems: molecular insights into origins of neurotransmitters
Authors: Moroz Leonid L. , Romanova Daria Y. , Kohn Andrea B. 
Published: February 2021

Transmitter signalling is the universal chemical language of any nervous system, but little is known about its early evolution. Here, we summarize data about the distribution and functions of neurotransmitter systems in basal metazoans as well as outline hypotheses of their origins. We explore the scenario that neurons arose from genetically different populations of secretory cells capable of volume chemical transmission and integration of behaviours without canonical synapses. The closest representation of this primordial organization is currently found in Placozoa, disk-like animals with the simplest known cell composition but complex behaviours. We propose that injury-related signalling was the evolutionary predecessor for integrative functions of early transmitters such as nitric oxide, ATP, protons, glutamate and small peptides. By contrast, acetylcholine, dopamine, noradrenaline, octopamine, serotonin and histamine were recruited as canonical neurotransmitters relatively later in animal evolution, only in bilaterians. Ligand-gated ion channels often preceded the establishment of novel neurotransmitter systems. Moreover, lineage-specific diversification of neurotransmitter receptors occurred in parallel within Cnidaria and several bilaterian lineages, including acoels. In summary, ancestral diversification of secretory signal molecules provides unique chemical microenvironments for behaviour-driven innovations that pave the way to complex brain functions and elementary cognition.This article is part of the theme issue ‘Basal cognition: multicellularity, neurons and the cognitive lens'.
OX2: Understanding the pattern of symptoms for pancreatic neuroendocrine neoplasms (PNENs) to improve the early diagnosis of pancreatic cancer: analysis of the QResearch database
Authors:   Investigators, Liao Weiqi , Clift Ashley , Patone Martina , Coupland Carol , Hippisley-Cox Julia 
Published: February 2021

AbstractThis article is the study protocol and statistical analysis plan for the project. This study is set up to identify and quantify “red flag” symptoms associated with the diagnosis of Pancreatic Neuroendocrine Neoplasm (PNEN) and compare these with the symptoms associated with Pancreatic Ductal Adenocarcinoma (PDAC). The results of this study will inform the evidence base for the refinement of the QCancer (Pancreas) tools, which have been integrated into the UK NHS primary care computer systems, to improve the early recognition of PNEN.
Neuromotor Prosthetic to Treat Stroke-Related Paresis
Authors: Serruya Mijail D. , Napoli Alessandro , Satterthwaite Nicholas , Kardine Joseph , McCoy Joseph , Grampurohit Namrata , Talekar Kiran , Middleton Devon , Mohamed Feroze , Kogan Michael , Sharan Ashwini , Wu Chengyuan , Rosenwasser Robert 
Published: February 2021

AbstractBackgroundFunctional recovery of independent arm movement typically plateaus within six months following a stroke, leaving chronic motor deficits. This feasibility study tested whether a wearable, powered exoskeletal orthosis, driven by a percutaneous, implanted brain–computer interface (BCI), using the activity of neurons in the precentral gyrus in the affected cortical hemisphere, could restore voluntary upper extremity function in a person with chronic hemiparetic subsequent to a cerebral hemispheric stroke of subcortical gray and white matter and cortical gray matter.MethodsOne person with chronic hemiparetic stroke with upper-limb motor impairment used a powered elbow-wrist-hand orthosis that opened and closed the affected hand using cortical activity, recorded from four 64-channel microelectrode arrays implanted in the ipsilesional precentral gyrus, based on decoding of spiking patterns and high frequency field potentials generated by imagined hand movements using technology and decoding methods used for people with other causes of paralysis. The system was evaluated in a home setting daily for 12 weeks.ResultsRobust single unit activity, modulating with attempted or imagined movement, was present throughout the precentral gyrus areas. The participant was able to acquire voluntary control over a hand-orthosis BCI, with a score of 10 points on the Action Research Arm Test (out of 53) using the BCI, compared to 0 without any device, and 5 using myoelectric control. Orthosis-powered hand-opening was faster with BCI control compared to myoelectric control, on a standardized object-movement task.ConclusionsThe findings demonstrate the therapeutic potential of an implantable BCI system coupled to a brace to “electrically bypass” the stroke and promote neurally driven limb function. The participant’s ability to rapidly acquire voluntary control over otherwise paralyzed hand opening, more than 18 months after a subcortical stroke, lays the foundation for a fully implanted movement restoration system.