bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimizing vortex-induced vibration suppression in π-shaped girders using wind tunnel testing and CFD analysis
Authors: Liu Jun , Xian Bo , Li Feng , Tian Liyong , Qiu Enxi , Ni Zhifu 
Published: November 2024

This investigation meticulously explores the vortex-induced vibration (VIV) characteristics in Π-shaped girders within long-span cable-stayed bridges, presenting novel VIV mitigation techniques. Employing detailed wind tunnel evaluations of a 1:50 scale model alongside computational fluid dynamics (CFD) analyses to model the two-dimensional flow around the girder, this study reveals the formation and shedding of vortices behind the railings and main steel girder, which significantly contribute to VIV in such structures. The introduction of horizontal splitter plates, one m in width, in conjunction with two-m-wide V-shaped guide vanes, was found to substantially reduce the VIV amplitude of the Π-shaped girder, minimizing vortex generation on the deck’s sides and dramatically reducing the maximum vertical VIV amplitude from 208.75 mm to only 5.56 mm. CFD simulations confirm the effectiveness of these measures in suppressing Karman vortex street formation, thereby significantly improving downstream airflow characteristics. These findings offer pivotal insights for the advancement of bridge design and the proactive management of VIV, showcasing the potential of integrated aerodynamic modifications to enhance structural resilience and performance.
Antifibrotic drug treatment of patients with idiopathic pulmonary fibrosis in Sweden: A registry-based observational study
Authors: Carlson Lisa , Kalafatis Dimitrios , Pesonen Ida , Magnusson Jesper M , Skold Magnus 
Published: November 2024

Objectives Idiopathic pulmonary fibrosis (IPF) is characterized by progressive fibrosis of the lung parenchyma, resulting in respiratory failure. This study analysed differences in patient characteristics and antifibrotic treatment strategies during the first years after IPF diagnosis. Methods Data from patients with IPF was extracted from the Swedish IPF registry. Patients were defined as treated (either as fully- or reduced treated) or non-treated with antifibrotic drugs. Differences in clinical parameters and side effects were defined. Results Among 532 patients, 371 received treatment with antifibrotic drugs. Treated patients were younger, had worse lung function, higher body mass index (BMI), higher Gender-Age-Physiology stage, and were more often on oxygen treatment. Non-treated patients displayed a stable BMI, whereas patients treated with antifibrotics declined in BMI during follow-up. More than half (56%) of treated patients had reduced antifibrotic treatment. Sixty per cent reported side effects, with diarrhoea, nausea, and skin rash as the most common. Conclusions Patients prescribed antifibrotic treatment had more advanced disease compared to patients not prescribed antifibrotics. A considerable proportion of the patients had reduced treatment, probably due to more side effects in this group. This indicates that individuals starting treatment at IPF diagnosis are considered to be in greater need of antifibrotic drug treatment by the prescriber, compared to individuals with less severe disease.
Dynamic Morphology of Dilated Ascending Aorta and its Implications for Proximal Landing During Thoracic Endovascular Aortic Repair
Authors: Skrypnik Denis , Bischoff Moritz S. , Meisenbacher Katrin , Hagedorn Matthias , Kilian Samuel , Rengier Fabian , Andre Florian , Böckler Dittmar , Steen Henning 
Published: November 2024

Introduction: To improve the outcomes of thoracic endovascular aortic repair (TEVAR), we investigated the dynamic morphology of dilated and nondilated ascending aortas (AAs) to determine whether an appropriate proximal landing zone for TEVAR exists if the middle AA is dilated. Materials and Methods: Patients with dilated (diameter 40–50 mm) and nondilated (<40 mm) AAs underwent electrocardiogram-gated computed tomography angiography of the entire AA in the systolic and diastolic phases. For each plane of each AA segment, the maximal and minimal diameters in systole and diastole were recorded. Results: A total of 105 patients were enrolled (54% male; median age: 80 years [IQR 78–85]). A total of 35 patients were included in the dilated AA group (DG), and 70 patients were included in the nondilated AA group (n-DG). The aortic planes of the AA segment at the sinotubular junction (STJ) showed a more oval-shaped morphology compared with the distal planes of the same segment (the differences between the maximum and minimum diameters were 8.9% to 9.4% and 4.8% to 5.6%, respectively). If the mid-ascending aorta was dilated, the aortic segment at the STJ showed a more pronounced reversed-funnel 3D morphology, with a 14% (IQR 11%–19%) difference in diameters between the proximal and distal segmental planes shown in the n-DG and 18% (IQR 16%–22%, p<0.001) in the DG. Conclusion: If the middle AA is dilated, it is considered unsuitable to perform TEVAR using conventional endografts without additional proximal fixation in the aortic segment at the STJ due to its pronounced reversed-funnel segmental morphology. By contrast, the aortic segment at the brachiocephalic trunk seems to be promising for performing TEVAR using an endograft of the appropriate size and conformability. Moreover, endograft sizing using the average aortic diameter instead of the maximal AA diameter in an oval-shaped aortic plane morphology should be considered. Clinical Impact If the middle ascending aorta is dilated, it is considered unsuitable to perform TEVAR with a proximal landing in the aortic segment at the sinotubular junction due to its pronounced reversed-funnel segmental morphology and high risk of type Ia endoleak and endograft migration. By contrast, the aortic segment at the brachiocephalic trunk seems to be promising for performing TEVAR due to its moderate funnel morphology using an endograft of appropriate size and conformability.
TIPS, a Trick for Transcaval TEVAR Access
Authors: Kuypers Toon , Houthoofd Sabrina , Maleux Geert 
Published: November 2024

Purpose: We described an alternative access for thoracic endovascular aortic repair (TEVAR) deployment using a transjugular intrahepatic portosystemic shunt (TIPS) needle for gaining transcaval access to the abdominal aorta. Case report: A 63-year-old man presented with a penetrating atherosclerotic ulcer in the descending aorta. Traditional transfemoral and transaxillary access were not possible. A transcaval access was established using a TIPS needle to puncture from the caval vein to the aorta. Next, the access was gradually upsized until a 22 french large-bore transcaval access was achieved. Afterwards the thoracic endograft was positioned and deployed accustomed. The infrarenal aortocaval fistula was closed with a covered stent. Conclusion: When classic TEVAR access is not possible, transcaval access is a valuable and minimally invasive alternative access. We prefer the use of a TIPS needle for gaining access and use a covered stent for closing the aortic access site when possible instead of using electrified wires nor a transseptal occluder device. Preoperative planning remains key. Clinical Impact We discribe a transcaval access with a TIPS needle and closing of the aortocaval fistula with a covered stent. We are one of fiew reports of transcaval puncturing instead of using an electrified wire and the first using a TIPS needle for gaining transcaval access. We hope this case and our comments help other surgeons, radiologists and patients when they are in need of a transcaval access and contribute to a successful procedure.
Factors Associated With Adverse Outcomes Among Patients Undergoing Endovascular Revascularization for Iliac Artery Lesions TASC II A and B: A Single-Center Study
Authors: Nut Lam Van , Tin Le Duc , Duc Hoang , Abdalla Abdelrahman Sherif , Kwaah Patrick A. , Le Trang T.B. , Vy Tran Thi Thuy , Le Thoa , Minh Anh Pham , Kim Que Do , Huy Nguyen Tien 
Published: November 2024

Purpose: This prospective study from October 2016 to September 2020 aimed to identify the factors associated with non-revascularization and mortality rates in patients who underwent endovascular interventions for Trans-Atlantic Inter-Society Consensus (TASC) II A/B iliac artery occlusions at the Department of Vascular Surgery. Methods: Patients with TASC II A/B iliac artery occlusions who underwent endovascular intervention, including balloon angioplasty and stent placement, were included. The primary outcomes were factors associated with non-revascularization and mortality rate. Results: A total of 133 patients were enrolled in this study. Univariable analysis revealed significant associations between non-revascularization and diabetes (hazard ratio [HR]=2.61, 95% confidence interval [CI], p=0.03), chronic kidney disease (HR=16.2, 95% CI, p=0.01), and severe calcifications (HR=8.56, 95% CI, p<0.001). Subsequent multivariable analysis confirmed the significance of these factors, showing HRs of 3.04 (95% CI, p=0.02), 13.12 (95% CI, p=0.03), and 8.62 (95% CI, p<0.001), respectively. The overall mortality rate observed was 20.3%. Severe calcifications emerged as a significant risk factor for mortality in both univariable (HR=2.47, 95% CI, p=0.02) and multivariable (HR=3.01, 95% CI, p<0.001) analyses. Conclusion: Severe calcifications correlate with non-revascularization and mortality, while comorbidities like diabetes mellitus and chronic kidney disease are also associated with non-revascularization. Recognizing these identified factors holds substantial promise in enhancing patient selection and procedural approaches, potentially bolstering the success rates of endovascular interventions. However, further research aimed at comprehending the underlying mechanisms and devising strategies to mitigate these risks is imperative for continued improvement in patient outcomes. Clinical Impact The study provides valuable insights into patient selection and procedural planning for endovascular interventions in TASC II A/B iliac artery occlusions. Identifying severe calcifications, diabetes, and chronic kidney disease as key risk factors for non-revascularization and mortality equips clinicians with essential predictive tools, potentially improving outcomes by tailoring treatment approaches. The innovation lies in highlighting the impact of comorbidities and calcification severity, offering a pathway to refine patient eligibility criteria and optimize procedural decisions. This underscores the importance of further research to develop strategies that mitigate these risk factors and enhance intervention success rates.
The Infected Diabetic Foot: Does Negative Pressure Wound Therapy with Irrigation Reduce Bioburden and Improve Wound Healing?
Authors: Suludere Mehmet A. , Malone Matthew , Siah Michael C. , Tarricone Arthur , Coye Tyler L. , Najafi Bijan , Lavery Lawrence A. 
Published: November 2024

The aim of this study was to compare the microbial loads of patients with diabetic foot infections treated with negative pressure wound therapy (NPWT) with and without irrigation with polyhexamethylene biguanide (NPWTi-P). This is a post hoc analysis of combined data of two randomized clinical trials. We evaluated people with diabetes treated with moderate and severe diabetic foot infections that required surgery. Tissue specimens were obtained after the initial surgery and following a second planned return to the operating room after 48–72 h of NPWT or NPWTi-P, prior to the second surgery. We used quantitative polymerase chain reaction (qPCR) to determine the total microbial loads (Log10 16S copies per gram of tissue). There was no difference in mean quantitative bacterial cultures among patients that received NPWT and NPWTi-P (before first surgery Log10: NPWT = 6.4 ± 1.8, NPWTi-P = 7.5 ± 1.7 vs before second surgery Log10: NPWT = 6.7 ± 1.8, NPWTi-P = 7.6 ± 1.9 p = .12). There was no difference in wound healing (59.5% vs 50.0%, p = .51) or time to heal (127 ± 109.3 vs 143 ± 95.9), p = .71). There were fewer re-infections in people that received traditional NPWT (28.6% vs 56.3%, p = .05). Level of Clinical Evidence: Level 1.
Endovascular abdominal aortic aneurysm repair (EVAR) outcomes of unibody and single/double docking limb endografts in Medicare beneficiaries between 2012 and 2018
Authors: Conrad Mark F. , Sood Ami , O’Brien Alex , Prasad Sapna , Zendejas Erik , Thompson Matt 
Published: November 2024

Objective The evaluation of perioperative and long term outcomes for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) using anatomic (unibody) and proximal neck fixated (docking limbs) endografts across consecutive time cohorts. Design This study compares the outcomes of EVAR in Medicare patients stratified by mode of fixation. Methods All patients who underwent EVAR between 2012 and 2018 were identified in the Medicare database. Anatomic fixation (AF) and proximal fixation (PF) grafts were differentiated using Current Procedural Terminology (CPT) codes. The AF population was divided into three-time cohorts based on iterative changes in graft design: Cohort 1: (01/01/2012–20/07/2014); Cohort 2: (21/07/2014–09/05/2016); and Cohort 3: (10/05/2016–31/12/2017). The PF cohort was similarly divided into these three periods. Outcomes were evaluated through 31/12/2020 and included all-cause mortality, aortic rupture, and aortic-related reintervention. Results 32,031 patients underwent EVAR during the study period; 4729 were AF and 27,302 were PF. There were more women ( p < .001) and patients with peripheral vascular disease (PVD) ( p < .001) in the AF group. There were no group differences in perioperative outcomes. In Cohort 1, there was a higher rate of reintervention (11.9% vs 7.6%; p < .001) and aortic rupture (5.3% vs 4.0%; p = .019) in the AF group compared to the PF group. In Cohort 2, reintervention, aortic rupture, and reintervention rates were similar between the two groups (p = NS). In Cohort 3, the reintervention and aortic rupture rates were similar between the two groups (p = NS). Conclusion The higher rates of aortic rupture and reintervention seen in the AF group in Cohort 1 when compared with the PF group did not persist in Cohorts 2 and 3. This suggests that improvements in graft design may have led to durability which is similar to that of PF grafts. However, late aneurysm related complications are inherent risks after EVAR and long-term surveillance remains necessary.
Staff satisfaction with reusable surgical drapes
Authors: Snow Hayden , Clarke Jessica , Taylor Kara , McGain Forbes 
Published: November 2024

Background: Reusable surgical textiles have substantial environmental benefits over single-use, disposable items. However, staff satisfaction with the performance of reusable textiles is unclear. During a trial period using reusable drapes, staff were surveyed regarding satisfaction with the products. Results: A total of 30 staff members responded to the survey. Overall, 90% of respondents were either satisfied/very satisfied (80%) or neutral (10%) when asked about their satisfaction with the reusable drapes, while 10% were unsatisfied/very unsatisfied; 87% of staff responded that reusable drapes were either as effective or more effective than disposable drapes. Reusable drapes showed very high levels of staff satisfaction in terms of durability (87%), fluid protection (70%) and provision of a sterile field (80%). There were no staff who did not support the ongoing use of reusable surgical drapes. Conclusion: There is extremely high staff satisfaction with reusable surgical drapes.
Short delay to initiate plasma exchange or immunoadsorption as synergistic therapies for patients in the acute phase of anti-NMDAR encephalitis
Authors: Su Miao , Wu Zichao , Luo Qiuyan , Feng Huiyu , Zhou Hongyan 
Published: November 2024

Background: Combined first-line therapies have been frequently adopted for patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Plasma exchange (PE) or immunoadsorption (IA) was used as an add-on option following initial immunotherapies, including high-dose steroids and intravenous immunoglobulin (IVIG). However, whether a shorter delay of PE or IA can improve the early recovery prognosis of patients with anti-NMDAR encephalitis remains largely unknown. Objective: To compare short-term clinical improvement between patients with early and late initiation of PE or IA in anti-NMDAR encephalitis. Design: A retrospective study was conducted for patients admitted with anti-NMDAR encephalitis between January 2015 and December 2023 ( n = 29), including 21 patients who received PE or IA as synergistic therapies. Methods: The clinical prognosis was compared between the early PE/IA group and the late PE/IA group in the research. Primary outcome included changes in the Clinical Assessment Scale for Autoimmune Encephalitis (∆CASE) at 90 and 120 days after encephalitis onset. Secondary outcomes included changes in the modified Rankin scale (∆mRS) after 90 and 120 days from encephalitis onset, and the length of intensive care unit (ICU) stay for patients with severe anti-NMDAR encephalitis. Results: The ∆CASE scores after 90 and 120 days from encephalitis onset revealed a significant difference between patients with early and late initiation of PE or IA ( p ⩽ 0.05). A significant difference in the ∆mRS was also found between patients with early and late initiation of PE or IA in severe encephalitis ( p ⩽ 0.05). No significant difference was found in the length of ICU admission ( p = 0.101). Conclusion: Our findings emphasize the importance of considering PE or IA as early as feasible for patients with anti-NMDAR encephalitis, even when steroids and IVIG are in use.
Fenthion flea-killer: Unpredictable and dangerous
Authors: Rahalkar Kshitij , Ng Mingwei , Tan Elizabeth Ming Jing , Tan Boon Kiat Kenneth , Yao Yi Ju , Anantham Devanand , Ponampalam R 
Published: November 2024

Introduction This case of fenthion poisoning demonstrates the delayed, protracted and yet unpredictable nature of cholinergic effects which are unique to fenthion toxicity. Case Presentation A 36-year-old female presented to the emergency department with drowsiness and vomiting, 8 hours after an unknown pesticide ingestion. She had some cholinergic symptoms (miosis, incontinence, emesis) suspicious of organophosphate toxicity but was initially well with no bronchorrhea or bradycardia. During her admission, she developed increasing salivation and bronchorrhea resulting in respiratory failure requiring intubation 27 h’ post-ingestion. Possible aspiration pneumonitis was initially considered given the delayed nature of deterioration. However, blood toxicology results confirmed fenthion poisoning. Atropine and pralidoxime boluses were administered followed by continuous infusion. She was extubated after initial improvement and stabilization – only to require reintubation for recurring respiratory failure and seizures on Days 4 and 5, each time following apparent recovery. She was eventually weaned off mechanical ventilation only on Day 31. Discussion and Conclusion This case illustrates the importance of physician awareness to potentially innocuous presentations of fenthion poisoning as symptoms at the onset may appear benign and falsely reassuring. Serious toxic manifestations may be significantly delayed over a prolonged, waxing-and-waning clinical course because of the compound’s high lipid solubility and metabolism into potent secondary compounds.
A systematic review and meta-analysis of carfilzomib-associated thrombocytopenia as an adverse event in patients with multiple myeloma
Authors: Smrdel Lara , Locatelli Igor , Zver Samo , Gobec Martina 
Published: November 2024

Background: Carfilzomib is a second-generation proteasome inhibitor (PI) used for combination therapy with dexamethasone and/or lenalidomide in patients with relapsed or refractory multiple myeloma. Reports indicate that PIs have a unique toxicity profile that includes thrombocytopenia as a hematologic adverse event; however, its occurrence has not yet been quantified systematically. Objectives: The main objective of our systematic review and meta-analysis is to investigate the incidence of thrombocytopenia in patients with multiple myeloma after treatment with carfilzomib. Design: Selection of studies and meta-analysis of trials was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources and methods: Two investigators performed an independent literature search of PubMed, Web of Science, SciFinder, the Cochrane Central Register of Controlled Trials, as well as the US and EU clinical trials registries. The cumulative incidence and overall relative risk were calculated with the random effect model using RevMan and R statistical software. Results: The analysis included a total of 9237 patients, 2516 patients in single-arm studies and 6721 patients in randomized controlled trials (RCTs). A total of 47 studies were included; among these, 14 were RCTs. Analysis of currently available data showed that treatment with carfilzomib may increase the incidence of all-grade thrombocytopenia, and this correlated with the dose used. With supportive therapy alone, the incidence is 26%. The addition of carfilzomib to the treatment results in a 37% increase in incidence, whereas with bortezomib, the increase is slightly lower at 34%. Surprisingly, when treatment with carfilzomib and bortezomib was compared, bortezomib was found to be more likely to exacerbate high-grade thrombocytopenia (7%) than carfilzomib (3%). Conclusion: Clarification of these associations suggests that clinicians should be aware of the potential risk of high-grade thrombocytopenia occurring and monitor patients closely to take appropriate measures. Trial registration: Registered in PROSPERO under the number CRD42022314378.
Parkinson's disease detection from EEG signal employing autoencoder and RBFNN-based hybrid deep learning framework utilizing power spectral density
Authors: Jibon Ferdaus Anam , Tasbir Alif , Talukder Md. Alamin , Uddin Md. Ashraf , Rabbi Fazla , Uddin Md. Salam , Alanazi Fars K. , Kazi Mohsin 
Published: November 2024

Objective Early detection of Parkinson's disease (PD) is essential for halting its progression, yet challenges remain in leveraging deep learning for accurate identification. This study aims to overcome these obstacles by introducing a hybrid deep learning approach that enhances PD detection through a combination of autoencoder (AE) and radial basis function neural network (RBFNN). Methods The proposed method analyzes the power spectral density (PSD) of preprocessed electroencephalography (EEG) signals, with artifacts removed, to assess energy distribution across EEG sub-bands. AEs are employed to extract features from reconstructed signals, which are subsequently classified by an RBFNN. The approach is validated on UC SanDiego's EEG dataset, consisting of 31 subjects and 93 minutes of recordings. Results The hybrid model demonstrates promising performance, achieving a classification accuracy of 99%. The improved accuracy is attributed to advanced feature selection techniques, robust data preprocessing, and the integration of AEs with RBFNN, setting a new benchmark in PD detection frameworks. Conclusion This study highlights the efficacy of the hybrid deep learning framework in detecting PD, particularly emphasizing the importance of using multiple EEG channels and advanced preprocessing techniques. The results underscore the potential of this approach for practical clinical applications, offering a reliable solution for early and accurate PD detection.