bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute zonal occult outer retinopathy complex disease: Lessons learned about choroid, photoreceptors, and retinal function
Authors: Pellegrini Francesco , Cirone Daniele , De Simone Luca , Marullo Michele , Cimino Luca 
Published: January 2021

Purpose: Retinal photoreceptors layer integrity is considered essential to visual function. We report a case of acute zonal occult outer retinopathy (AZOOR) complex disease (namely AIBSE: acute idiopathic blind spot enlargement) in which apparently a full anatomic regeneration is not needed for a complete functional recovery. Methods: Case report with multimodal imaging. Reports: Visual field recovery in the presence of photoreceptors layer disruption studied by means of Optical Coherence Tomography. Choroid and photoreceptors layer thickness thinned progressively during recovery. Conclusion: This case suggests that anatomical retinal integrity as shown by OCT does not always correspond to visual function. Our case highlights that a complete visual recovery can occur even when structural abnormalities are still observable.
Artificial intelligence accurately identifies total hip arthroplasty implants: a tool for revision surgery
Authors: Murphy Michael , Killen Cameron , Burnham Robert , Sarvari Fahad , Wu Karen , Brown Nicholas 
Published: January 2021

Background: A critical part in preoperative planning for revision arthroplasty surgery involves the identification of the failed implant. Using a predictive artificial neural network (ANN) model, the objectives of this study were: (1) to develop a machine-learning algorithm using operative big data to identify an implant from a radiograph; and (2) to compare algorithms that optimise accuracy in a timely fashion. Methods: Using 2116 postoperative anteroposterior (AP) hip radiographs of total hip arthroplasties from 2002 to 2019, 10 artificial neural networks were modeled and trained to classify the radiograph according to the femoral stem implanted. Stem brand and model was confirmed with 1594 operative reports. Model performance was determined by classification accuracy toward a random 706 AP hip radiographs, and again on a consecutive series of 324 radiographs prospectively collected over 2019. Results: The Dense-Net 201 architecture outperformed all others with 100.00% accuracy in training data, 95.15% accuracy on validation data, and 91.16% accuracy in the unique prospective series of patients. This outperformed all other models on the validation ( p < 0.0001) and novel series ( p < 0.0001). The convolutional neural network also displayed the probability (confidence) of the femoral stem classification for any input radiograph. This neural network averaged a runtime of 0.96 (SD 0.02) seconds for an iPhone 6 to calculate from a given radiograph when converted to an application. Conclusions: Neural networks offer a useful adjunct to the surgeon in preoperative identification of the prior implant.
Ultrasound-guided supraclavicular nerve block for implantable port catheters: Does it show a significant difference in pain control?
Authors: Çelebioğlu Emre Can , Bilgiç Mehmet Sadık 
Published: January 2021

Background: Nerve blocks have been used for decades at head and neck region interventions and recently introduced as an alternative option for subcutaneous port implantation. This study aimed to compare two different local anesthesia techniques used during subcutaneous port implantation. Methods: This retrospective study was conducted with 107 patients who were categorized into two groups according to the local anesthesia techniques used during port implantations. Group 1 underwent local infiltration anesthesia and Group 2 received an ultrasound-guided supraclavicular nerve block. In both groups, prilocaine 2% was used for skin anesthesia and no other systemic anesthetic drugs or additional local anesthetics were administered during port implantation. Local anesthetic doses were 400 mg in Group 1 and 200 mg in Group 2. The time required for adequate cutaneous anesthesia, procedure time, complication rate and visual analog scale (VAS) score were recorded for each patient. Results: Groups 1 and 2 contained 58 and 49 patients respectively. Both groups showed similar demographic distributions of patients ( p > 0.05). Mean procedure times and the time required for adequate cutaneous anesthesia were longer in Group 2 ( p < 0.05). Group 2 also showed 12 immediate complications, although they were temporary and recovered without any intervention under surveillance. Mean VAS scores during port implantation were similar in both groups [Group 1: 1.17(±0.60), Group 2: 1.1(±0.62)] ( p > 0.05). Conclusions: The VAS scores did not differ significantly between groups. Although a supraclavicular nerve block may require lower local anesthetic doses for similar cutaneous anesthesia, it is associated with higher immediate complication rates due to unintended blockade of the peripheral nerves. Thus, if the nerve block is preferred over local infiltration anesthesia during port implantation, to prevent life-threatening complications, caution needed especially for the patients with contralateral vocal cord or diaphragm paralysis.
Delayed Bladder Perforation Related to Immediate Single Dose Intravesical Doxorubicin Instillation After TURBT: A Case Report and Literature Review
Authors: Alrabadi Adel , Abuhamad Mohannad , Mansi Hammam , Alhamss Sohaib , Bustami Nadwa , Al Demour Saddam , Al-Abbadi Mousa A 
Published: January 2021

Introduction: Intravesical chemotherapy instillation immediately after tumor resection is a well-known practice in the management of non-muscle invasive bladder cancer. Despite being largely well tolerated in most cases, it is not devoid of severe and life-threatening complications. Case Presentation: We present an unusual case of bladder perforation that happened 2 weeks after bladder tumor resection. The patient had received single dose intra-vesical instillation of doxorubicin after TUR-BT. Conservative managements failed to achieve bladder healing; as a result, open surgical repair was performed. To the best of our knowledge, this is the first reported case of bladder perforation after intra-vesical doxorubicin instillation. Conclusion: The occurrence of such a rare serious complication in a mostly safe intervention must be taken into consideration. A high index of suspicion, timely management, and proceeding to more invasive surgical treatments when necessary are cornerstones in the management and preserving the bladder.
Vascular comorbidity is associated with lower brain volumes and lower neuroperformance in a large multiple sclerosis cohort
Authors: Fitzgerald Kathryn C , Damian Anne , Conway Devon , Mowry Ellen M 
Published: January 2021

Objective: The objective of this study is to assess the association between vascular comorbidity burden with clinical and imaging features of disease burden in a large population of people with multiple sclerosis (MS). Methods: We included participants from the MS Partners Advancing Technology Health Solutions (MS PATHS) cohort. We evaluated if vascular comorbidities (diabetes, hypertension, and dyslipidemia) or a composite sum of comorbidities was associated with MS characteristics, including objective neurologic function assessments and quantitative brain magnetic resonance imaging (MRI) measurements in propensity score–weighted models. Results: In total, 11,506 participants (6409 (55%) with brain MRI) were included. Individuals with 2+ vascular comorbidities had slower walking speed (standard deviation (SD) = −0.49; 95% confidence interval (CI) = −0.78, −0.19; p = 0.001), slower manual dexterity (SD = −0.41; 95% CI = −0.57, −0.26; p < 0.0001), and fewer correct scores on cognitive processing speed (SD = −0.11; 95% CI = −0.20, −0.02; p = 0.02) versus those with no comorbidities. Those with 2+ had lower brain parenchymal (−0.41%, 95% CI = −0.64, −0.17) and gray matter fractions (−0.30%, 95% CI = −0.49, −0.10), including reduced cortical (−10.10 mL, 95% CI = −15.42, −4.78) and deep (−0.44 mL, 95% CI = −0.84, −0.04) gray matter volumes versus those with no comorbidity. Conclusion: Increased vascular comorbidity burden was associated with clinical and imaging markers of neurologic dysfunction and neurodegeneration in MS. Strategies to optimize comorbidity management in people with MS are warranted.
A cost-minimisation analysis comparing alternative telemedicine screening approaches for retinopathy of prematurity
Authors: Kim Emmanuel , Nguyen Kim-Huong , Donovan Tim , Edirippulige Sisira , Armfield Nigel R 
Published: January 2021

Introduction Screening for retinopathy of prematurity (ROP) is an important procedure in the prevention of blindness in high-risk preterm infants. In the regionalised healthcare system of Queensland (Australia), outside of the major centres, some preterm infants are cared for in special care nurseries (SCNs). When necessary, infants in these nurseries who are at risk of ROP are transferred to a tertiary hospital for screening by paediatric ophthalmologists. The transport of preterm infants for eye examinations adds risk and incurs significant costs to the health system. Using a cost-minimisation approach, we aimed to compare the costs of the current ROP screening practice with two alternative telemedicine approaches. Methods We constructed a decision analytic model to estimate costs from a health service perspective with a five-year analysis horizon; activity data from a tertiary ROP screening service were used to inform the models. The three models assessed were: (a) a digital retinal photography (DRP)-equipped travelling nurse, (b) equipping SCNs with DRP, and providing training to local nurses, and (c) current practice of infant transfer. In all cases, the tertiary centre provides specialist ophthalmologic review. Results Of the three models, we estimated the most expensive option to be equipping SCNs with DRP and providing training to local nurses (AUD$4114/infant). We found that the current practice of transferring infants was the second most expensive (AUD$1021/infant). The most economical model was the specialist nurse travelling to each SCN with a portable DRP (AUD$363/infant). A sensitivity analysis, which assessed uncertainty and variability around the cost estimates, found that the ranking for the expected costs of the alternative models of care did not change. Discussion This is the first economic and cost-minimisation analysis in Australia to compare the costs of the current screening programme with two alternative telemedicine approaches for screening ROP. Telemedicine programmes that facilitate non-physician screening may improve the cost efficiency of the health system while maintaining the health outcomes for children, and reducing the risk associated with infant transport.
Home-based music therapy for children with developmental disorders during the COVID-19 pandemic
Authors: Bompard Sarah , Liuzzi Tommaso , Staccioli Susanna , D’Arienzo Fiammetta , Khosravi Sahereh , Giuliani Roberto , Castelli Enrico 
Published: January 2021

Introduction During the COVID-19 pandemic, children with neurodevelopmental disabilities could not attend their usual rehabilitation therapies, with a consequent reduced support of developmental process and risk of worsening of their clinical conditions. Methods We prospectively enrolled 14 children with developmental delay, who had already tried a personalised music therapy (Euterpe method). We included them in a 12-day programme of home-based music therapy. The children and their parents were investigated using the Sleep Disturbance Scale for Children and the Parent Stress Index-Short Form. Results Fourteen children started the intervention, while only 12 children completed all the planned home sessions and assessments. We observed a significant improvement in children’s sleep quality and a reduction of parental distress. Discussion The significant improvements in parental distress and sleep quality must be considered important achievements for the quality of life of a child and their family. Home-based music therapy can provide a feasible approach to improving sleep and parent’s stress for children with developmental disorders.
Health-system equity, egalitarian democracy and COVID-19 outcomes: An empirical analysis
Authors: Vadlamannati Krishna Chaitanya , Cooray Arusha , de Soysa Indra 
Published: January 2021

Aims: The COVID-19 pandemic has led to a spate of studies showing a close connection between inequitable access to health care, welfare services and adverse outcomes from the pandemic. Others have argued that democratic governments have generally failed relative to more autocratic ones, simply because autocrats can make the hard choices required for stemming the spread of viruses. We address this question by asking whether more ‘egalitarian’ forms of democracy matter, given that they contain more equitable health-care access and societal infrastructure, such as social capital and trust. Methods: We use standard regression techniques, including instrumental variables analysis addressing endogeneity on COVID-19 testing and deaths data as of the end of May and beginning of September. We use novel data from the Varieties of Democracy Project on health-system equity and egalitarian democracy. Results: Our results suggest that more equitable access to health care increases testing rates and lowers the death rate from COVID-19. Broader egalitarian governance, measured as egalitarian democracy, however, shows the opposite effect. Thus, factors associated with health-care capacity to reach and treat matter more than broader societal factors associated with social capital and trust. The results are robust to alternative testing procedures, including instrumental variable technique for addressing potential endogeneity. Conclusions: Despite a great deal of public health focus on how equitable governance helps fight the adverse effects of so-called neoliberal pandemics, we find that broadly egalitarian factors have had the opposite effect on fighting COVID-19, especially when an equitable health system has been taken into account. Fighting disease, thus, might be more about the capacity of health systems rather than societal factors, such as trust in government and social capital.
Improved damage detection in Pelton turbines using optimized condition indicators and data-driven techniques
Authors: Zhao Weiqiang , Egusquiza Mònica , Estevez Aida , Presas Alexandre , Valero Carme , Valentín David , Egusquiza Eduard 
Published: January 2021

The health condition of hydraulic turbines is one of the most critical factors for the operation safety and financial benefits of a hydro power plant. After the massive entrance of intermittent renewable energies, hydropower units have to regulate their output much more frequently for the balancing of the power grid. Under these conditions, the components of the machine have to withstand harsher excitation forces, which are more likely to produce damage and eventual failure in the turbines. To ensure the reliability of these machines, improved condition monitoring techniques are increasingly demanded. In this article, the feasibility of upgrading condition monitoring of Pelton turbines using novel vibration indicators and data-driven techniques is discussed. The new indicators are selected after performing a detailed analysis of the dynamic behavior of the turbine using numerical models and field measurements. After that, factor analysis is carried out in order to assess which are the most informative indicators and to reduce the dimension of the input data. For the validation of the proposed method, monitoring data from an actual Pelton turbine that suffered from an important fatigue failure due to a crack propagation on the buckets have been used. The novel condition indicators as well as classical indicators based on the spectrum and harmonics levels have been obtained while the machine was in good operation, during different stages of damage and after repair. All of these have been used to train an artificial neural network model in order to predict the evolution of the crack until failure occurs. The results show that using the improved monitoring methodology enhances the ability to predict the appearance of damage in comparison to typical condition indicators.
Apolipoprotein A1 and Low-Density Lipoprotein as Risk Factors for Intraocular Metastases in Postmenopausal Breast Cancer
Authors: Li Biao , Liu Yao , Yuan Qing , Lin Qi , Shi Wen-Qing , Zhu Pei-Wen , Min You-Lan , Ge Qian-Min , Shao Yi 
Published: January 2021

Background: The outcomes of patients with postmenopausal breast cancer(PBC) can be improved through the early detection of intraocular metastases(IOMs). In this study, we investigated patients with PBC, and compared those with IOMs with those with non-intraocular metastases(NIOMs) in terms of blood lipid levels, and then differentiated the risk factors associated with IOMs. Methods: Student’s t-test and a chi-square test were used to discriminate between the IOMs and NIOMs groups. After establishing a Poisson regression model to analyze risk factors, we plotted receiver operating characteristic curves(ROC) to assess the quality of risk factors predicting IOMs. Results: The incidence of IOMs in PBC was 1.16%. There was no significant difference in terms of histopathology between the 2 groups. The levels of total cholesterol (TC), apolipoprotein A1(APOA1) and low-density lipoprotein(LDL) in IOMs were significantly lower than in NIOMs groups. Poisson regression suggested that low levels of APOA1 and LDL were risk factors for IOMs (P = 0.002 and P < 0.001, respectively). ROC curve analysis demonstrated that the cut-off values of APOA1 and LDL were 1.025 g/L and 2.415 mmol/L. The highest prediction accuracy for IOMs involved the combination of APOA1 and LDL (AUC = 0.881, P < 0.001). Conclusion: Our research demonstrates that low levels of APOA1 and LDL efficiently predict IOMs in PBC as risk factors, and the combination of APOA1 and LDL was more predictive than single factors.
Minimally Invasive Left Ventricular Assist Device Insertion Facilitates Subsequent Heart Transplant
Authors: Rabin Joseph , Ziegler Luke A. , Cipriano Sarah , Madathil Ronson J. , Feller Erika D. , Sorensen Erik N. , Griffith Bartley P. , Kaczorowski David J. 
Published: January 2021

Objective We have observed that minimally invasive left ventricular assist device (LVAD) insertion leads to more facile re-entry and easier cardiac transplantation. We hypothesize minimally invasive LVAD implantation results in improved outcomes at the time of subsequent heart transplant. Methods All adults undergoing cardiac transplantation between October 2015 and March 2019 at our institution were retrospectively reviewed. Those bridged to transplantation with a HeartWare HVAD were identified and divided into 2 cohorts based upon the surgical approach: those who underwent HVAD placement by conventional sternotomy versus minimally invasive insertion via lateral thoracotomy and hemisternotomy (LTHS). Patient demographics, as well as perioperative transplant outcomes, including survival, length of stay (LOS), blood utilization, ischemic time, bypass time, and postoperative extracorporeal membrane oxygenation (ECMO) were compared between cohorts. Results Forty-two patients were bridged to heart transplant with a HVAD implanted via either sternotomy ( n = 22) or LTHS technique ( n = 20). Demographics were similar between groups. There was 1 predischarge death in the sternotomy group and none in the LTHS group. Body surface area, cardiopulmonary bypass time, ischemic time, ECMO utilization, and reoperation for bleeding were similar. Red blood cell units transfused were significantly lower in the LTHS cohort (3.0 [1.0-5.0] vs 6.0 [2.5-10.0] P = 0.046). The LTHS cohort had a significantly shorter hospital LOS (12.0 [11.0-28.0] vs 22.5 [15.7-41.7] P = 0.022) with a trend toward shorter intensive care unit LOS (6.0 [5.0-10.5] vs 11.0 [6.0-21.5] days P = 0.057). Conclusions Minimally invasive HVAD implantation improves outcomes at subsequent heart transplantation, resulting in shorter LOS and less red cell transfusion. Larger multi-institutional studies are necessary to validate these findings.
Age and discharge modified Rankin score are associated with 90-Day functional outcome after basilar artery occlusion treated with endovascular therapy
Authors: Karamchandani Rahul R , Strong Dale , Rhoten Jeremy B , Prasad Tanushree , Selig Jacob , Defilipp Gary , Asimos Andrew W 
Published: January 2021

Introduction Prognostic factors for functional outcome after basilar artery occlusion (BAO) treated with modern endovascular therapy (EVT) are sparse. We investigated the association between clinical characteristics, readily available imaging variables, and outcome in BAO patients treated with EVT. Methods Retrospective analysis from a large healthcare system’s prospectively collected code stroke registry of acute BAO patients treated with EVT between January 2017–January 2020. The primary outcome measure was a favorable 90-day modified Rankin score (mRS) of 0-2. Results 65 patients (median age 67 years, 57% male, median NIHSS 16) met the study inclusion criteria. Thrombolysis in Cerebral Infarction (TICI) 2 b-3 revascularization was achieved in 57/65 patients (88%) with a median time to revascularization of 445 minutes [IQR 302-840]. Ninety-day good outcome was seen in 35% (23/65) of patients. In a univariate analysis, age, history of ischemic stroke, baseline NIHSS, BAO site, and discharge mRS were associated with significant differences between the good and poor outcome groups. A multivariable logistic regression analysis demonstrated an independent association with 90-day good outcome and younger age (per 1-year, OR 0.79, 95% CI 0.64, 0.98) and good discharge mRS (0-2) (OR > 999.99, 95% CI 13.26, > 999.99). Conclusions Patients presenting with an acute BAO treated with modern EVT have a good 90-day outcome in over one-third of cases. Age and discharge mRS are independently associated with good 90-day outcome. Additional studies may focus on factors that can enhance discharge function after BAO, a novel prognostic indicator for favorable 90-day outcome in our study.