bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variables associated with 30‐day postoperative complications in lower extremity free flap reconstruction identified in the ACS‐NSQIP database
Authors: Veith Jacob , Donato Daniel , Holoyda Kathleen , Simpson Andrew , Agarwal Jayant 
Published: August 2019

AbstractBackgroundLower extremity free flaps are a common way to treat both traumatic and oncologic lower extremity wounds. These patients often suffer postoperative complications. We sought to use the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP) database to identify variables associated with postoperative complications.MethodsPatients who had free flap procedure and a primary diagnosis code for lower extremity pathology were identified in the NSQIP database from 2006 to 2017. NSQIP includes data on preoperative, intraoperative, and postoperative variables, including information up to 30 postoperative days. Current procedural terminology (CPT) codes for free flaps and international classification of diseases (ICD) 9 and 10 codes for lower extremity pathology were used for our cohort. We examined overall and major complication rates. Major complications were defined as reoperation, readmission, organ space infection, or death. Univariate and multivariate analyses were used to identify associations with complications.ResultsFour hundred and eighty‐three patients underwent lower extremity free flaps. Overall complication rate was 31.6% and major complication rate was 14.9%. Prolonged operative time (OR = 2.81, CI:1.76–4.48, p < .001), preoperative steroid use (OR = 3.04, CI:1.12–8.29, p = .030), and preoperative anemia (OR = 4.10, CI:2.00–8.41, p < .001) were independently associated with any complication. Diabetes (OR = 2.56, CI:1.24–5.29, p = .011) and prolonged operative time (OR = 3.75, CI:2.17–6.47, p < .001) were independently associated with major complications.ConclusionsIn lower extremity flap reconstruction, associations with overall complications include prolonged operative time, steroid use, and anemia. Associations with major complications included diabetes and prolonged operative time. These associations can be used to guide interventions on patients identified to have greater risk of complications.
An x‐band waveguide orthomode transducer with integrated filters
Authors: Gao Yang , Shang Xiaobang , Wang Yi , Lancaster Michael J. 
Published: August 2019

AbstractThis letter presents a novel waveguide orthomode transducer (OMT) with integrated filters. Resonator‐based bandpass filters are used for the two channels forming a duplexing OMT. As an example, a two‐channel duplexing OMT is designed with channels at 9.9‐10.1 GHz and 10.9‐11.1 GHz. A good filter response with 20 dB return loss is achieved for both the channels. The upper and lower bands are isolated to −80 dB due to the filtering elements and a transmission zero. This new multifunction compact filter‐OMT design leads to the size reduction and improved inter‐band isolation. A CNC machined waveguide OMT is demonstrated and its performance is verified with excellent agreement between the electromagnetic wave (EM) simulation and measured results.
A new approach to automatic fetal brain extraction from MRI using a variational level set method
Authors: Pishghadam Morteza , Kazemi Kamran , Nekooei Sirous , Seilanian‐Toosi Farrokh , Hoseini‐Ghahfarokhi Mojtaba , Zabihzadeh Mansour , Fatemi Ali 
Published: August 2019

Background and purposeAppropriate images extracted from the MRI of mothers’ wombs can be of great help in the medical diagnosis of fetal abnormalities. As maternal tissue may appear in such images, affecting visualization of myelination of the fetal brain, it is not possible to use methods routinely used for extraction of adult brains for fetal brains. The aim of the present study was to use a variational level set approach to extract fetal brain from T2‐weighted MR images of the womb.MethodsCoronal T2‐weighted images were acquired using fast MRI protocols (to avoid artifacts). The database includes 105 MR images from eight subjects. After correcting the inhomogeneity of the images, the fetal eyes were located, and from that information, the location of the fetus brain was automatically determined. Then, the variational level set was used for fetus brain extraction. The results were analyzed by a clinical specialist (radiologist) and the similarity (Dice and Jaccard coefficients), sensitivity and specificity were calculated.Results and conclusionsThe means of the statistical analysis for the Dice and Jaccard coefficients, sensitivity and specificity, were 99.56%, 96.89%, 95.71%, and 97.96%, respectively. Thus, extraction of fetal brain from MR images was confirmed, both statistically and visually through cross‐validation.
Embryo presence regulates NODAL/LEFTY2 system in the rat oviduct in vivo
Authors: Argañaraz Martin E. , Zampini Renato , Apichela Silvana A. , Barraza Daniela E. , Angiono Georgina , Lombardo Daniel 
Published: August 2019

AbstractTo gain further insight in the mechanisms of the embryo–maternal dialog in the oviduct, expression of members of the transforming growth factor‐β superfamily, NODAL, its inhibitor, LEFTY2, and their coreceptor, CFC1, were studied in the oviduct of 3‐day post copula (3 dpc) females with and without embryos (E and NE), pseudopregnant rats (SP3), and in 3‐day embryos. Nodal transcripts in SP3 oviducts showed a steady‐state relative abundance when compared with proestrus stage and the 3 dpc. In contrast, Lefty2 and Cfc1 relative abundance levels in proestrus and 3 dpc were higher. When comparing E with NE oviducts, Nodal and Lefty2 expression levels decreased, while Cfc1 expression increased in the presence of embryos. Nodal messenger RNA (mRNA) was observed in the embryo, but Lefty2 and Cfc1 transcripts were not found. In addition, an increase in Lefty2 expression coincided with increased levels of matrix metalloproteinases 9 mRNA and protein in the oviduct and in the oviductal fluid, respectively. These observations have shed new light on the relevance of the NODAL/LEFTY2 pathway in the oviduct during early embryo development and the role of the embryo in modulating this pathway.
Mixing Effects in Continuous Free‐Radical Solution Copolymerization Tank Reactors: II—Investigation of Micromixing Effects
Authors: Oechsler Bruno F. , Poblete Israel B. S. , Melo Príamo A. , Pinto José C. 
Published: August 2019

AbstractThe effect of micromixing on the dynamic behavior of continuous solution copolymerization tank reactors is evaluated both experimentally and theoretically. For this purpose, copolymerization reactions of styrene and divinylbenzene are carried out in a lab‐scale polymerization system, composed of two tank reactors in series, to provide experimental data of conversion and molar masses for analysis of micromixing effects. Besides, a detailed micromixing model, based on a dynamic population balance approach, is developed and solved with the method of characteristics, to investigate the micromixing effects on the dynamic behavior of conversion and molar masses in copolymerization reactions. Particularly, results show for the first time that micromixing effects can be important to explain the dynamic behavior of polymerization reactions performed in bulk, but are not sufficient to explain the whole set of available experimental data, which are much more sensitive to modification of residence time distributions and macromixing.
Quantitative brain relaxation atlases for personalized detection and characterization of brain pathology
Authors: Piredda Gian Franco , Hilbert Tom , Granziera Cristina , Bonnier Guillaume , Meuli Reto , Molinari Filippo , Thiran Jean‐Philippe , Kober Tobias 
Published: August 2019

PurposeTo exploit the improved comparability and hardware independency of quantitative MRI, databases of MR physical parameters in healthy tissue are required, to which tissue properties of patients can be compared. In this work, normative values for longitudinal and transverse relaxation times in the brain were established and tested in single‐subject comparisons for detection of abnormal relaxation times.MethodsRelaxometry maps of the brain were acquired from 52 healthy volunteers. After spatially normalizing the volumes into a common space, T1 and T2 inter‐subject variability within the healthy cohort was modeled voxel‐wise. A method for a single‐subject comparison against the atlases was developed by computing z‐scores with respect to the established healthy norms. The comparison was applied to two multiple sclerosis and one clinically isolated syndrome cases for a proof of concept.ResultsThe established atlases exhibit a low variation in white matter structures (median RMSE of models equal to 32 ms for T1 and 4 ms for T2), indicating that relaxation times are in a narrow range for normal tissues. The proposed method for single‐subject comparison detected relaxation time deviations from healthy norms in the example patient data sets. Relaxation times were found to be increased in brain lesions (mean z‐scores >5). Moreover, subtle and confluent differences (z‐scores ~2–4) were observed in clinically plausible regions (between lesions, corpus callosum).ConclusionsBrain T1 and T2 quantitative norms were derived voxel‐wise with low variability in healthy tissue. Example patient deviation maps demonstrated good sensitivity of the atlases for detecting relaxation time alterations.
Fast myocardial T1 mapping using cardiac motion correction
Authors: Becker Kirsten M. , Blaszczyk Edyta , Funk Stephanie , Nuesslein André , Schulz‐Menger Jeanette , Schaeffter Tobias , Kolbitsch Christoph 
Published: August 2019

PurposeTo improve the efficiency of native and postcontrast high‐resolution cardiac T1 mapping by utilizing cardiac motion correction.MethodsCommon cardiac T1 mapping techniques only acquire data in a small part of the cardiac cycle, leading to inefficient data sampling. Here, we present an approach in which 80% of each cardiac cycle is used for T1 mapping by integration of cardiac motion correction. Golden angle radial data was acquired continuously for 8 s with in‐plane resolution of 1.3 × 1.3 mm2. Cine images were reconstructed for nonrigid cardiac motion estimation. Images at different TIs were reconstructed from the same data, and motion correction was performed prior to T1 mapping. Native T1 mapping was evaluated in healthy subjects. Furthermore, the technique was applied for postcontrast T1 mapping in 5 patients with suspected fibrosis.ResultsCine images with high contrast were obtained, leading to robust cardiac motion estimation. Motion‐corrected T1 maps showed myocardial T1 times similar to cardiac‐triggered T1 maps obtained from the same data (1288 ± 49 ms and 1259 ± 55 ms, respectively) but with a 34% improved precision (spatial variation: 57.0 ± 12.5 ms and 94.8 ± 15.4 ms, respectively, P < 0.0001) due to the increased amount of data. In postcontrast T1 maps, focal fibrosis could be confirmed with late contrast‐enhancement images.ConclusionThe proposed approach provides high‐resolution T1 maps within 8 s. Data acquisition efficiency for T1 mapping was improved by a factor of 5 by integration of cardiac motion correction, resulting in precise T1 maps.
Measuring extracellular volume fraction by MRI: First verification of values given by clinical sequences
Authors: Nordlund David , Xanthis Christos , Bidhult Sebastian , Jablonowski Robert , Kanski Mikael , Kopic Sascha , Carlsson Marcus , Engblom Henrik , Aletras Anthony H. , Arheden Håkan 
Published: August 2019

PurposeTo verify MR measurements of myocardial extracellular volume fraction (ECV) based on clinically applicable T1‐mapping sequences against ECV measurements by radioisotope tracer in pigs and to relate the results to those obtained in volunteers.MethodsBetween May 2016 and March 2017, 8 volunteers (25 ± 4 years, 3 female) and 8 pigs (4 female) underwent ECV assessment with SASHA, MOLLI5(3b)3, MOLLI5(3s)3, and MOLLI5s(3s)3s. Myocardial ECV was measured independently in pigs using a radioisotope tracer method.ResultsIn pigs, ECV in normal myocardium was not different between radioisotope (average ± standard deviation; 19 ± 2%) and SASHA (21 ± 2%; P = 0.086). ECV was higher by MOLLI5(3b)3 (26 ± 2%), MOLLI5(3s)3 (25 ± 2%), and MOLLI5s(3s)3s (25 ± 2%) compared with SASHA or radioisotope (P ≤ 0.001 for all). ECV in volunteers was higher by MOLLI5(3b)3 (26 ± 3%) and MOLLI5(3s)3 (26 ± 3%) than by SASHA (22 ± 3%; P = 0.022 and P = 0.033). No difference was found between MOLLI5s(3s)3s (25 ± 3%) and SASHA (P = 0.225). Native T1 of blood and myocardium as well as postcontrast T1 of myocardium was consistently lower using MOLLI compared with SASHA. ECV increased over time as measured by MOLLI5(3b)3 and MOLLI5(3s)3 for pigs (0.08% and 0.07%/min; P = 0.004 and P = 0.013) and by MOLLI5s(3s)3s for volunteers (0.07%/min; P = 0.032) but did not increase as measured by SASHA.ConclusionClinically available MOLLI and SASHA techniques can be used to accurately estimate ECV in normal myocardium where MOLLI‐sequences show minor overestimation driven by underestimation of postcontrast T1 when compared with SASHA. The timing of imaging after contrast administration affected the measurement of ECV using some variants of the MOLLI sequence.
Making strides toward achieving the Triple Aim in the treatment of chronic low back pain with a biopsychosocial guided approach
Authors: Gliedt Jordan A. , Mardian Aram S. 
Published: August 2019

AbstractThe Triple Aim is an effort to bring attention to improving the patient experience, improving population health and reducing healthcare costs. Chronic pain, particularly chronic low back pain, is a common disabling condition with high costs and burdens to society. The biopsychosocial model may provide a framework in which chronic low back pain may be viewed to guide new and emerging clinical care models to achieve the Triple Aim in this field of care.
Energy Expenditure and Protein Requirements Following Burn Injury
Authors: Wise Amy K. , Hromatka Kathleen A. , Miller Keith R. 
Published: August 2019

AbstractSevere burn injuries have long been known to have a profound effect on metabolic equilibrium that can persist after resolution of the cutaneous injuries. Following burn injury, metabolism is a dynamic state resulting in the need for frequent interval reassessment over the course of the care continuum. The acute phase of injury transitions to chronic alterations in macronutrient utilization characterized by futile energy cycling and disproportionate catabolism of skeletal muscle. Protein supplementation appears to be preferentially distributed to the burn wound rather than the skeletal muscle pool. Accurate assessment of caloric and protein requirements is extremely difficult in these patients but is an essential step in efforts to attenuate functional impairment. Indirect calorimetry should be utilized to determine caloric requirements, but trophic feeding strategies are preferred in the initial resuscitative phase to prevent overfeeding while maintaining enteric and immune function. Controversy persists regarding optimal protein targets, and weight‐based estimates remain the norm. Exogenous protein and caloric provision performed in isolation is insufficient to optimize outcomes and should be incorporated within a multidisciplinary approach to include muscle loading and pharmaceutical adjuncts.
IL‐10 from plasmacytoid dendritic cells promotes angiogenesis in the early stage of endometriosis
Authors: Suen Jau‐Ling , Chang Yu , Shiu Yu‐Shiang , Hsu Chia‐Yi , Sharma Pooja , Chiu Chien‐Chih , Chen Yi‐Ju , Hour Tzyh‐Chyuan , Tsai Eing‐Mei 
Published: August 2019

AbstractAn elevated level of IL‐10 has been considered a critical factor for the development of endometriosis; however, its detailed mechanism and causal relationship remain unclear. This study explored the cellular source and angiogenic activity of local IL‐10 during the early stage of endometriosis. Using a surgical murine model, we found that localised treatment with exogenous recombinant IL‐10 on the day of surgery significantly enhanced endometriotic lesion growth and angiogenesis, whereas blocking local IL‐10 activity using mAbs significantly suppressed those effects. Adoptive transfer of Il10+/+ plasmacytoid dendritic cells into mice significantly enhanced lesion development, whereas Il10−/− plasmacytoid dendritic cells significantly inhibited lesion development. Furthermore, in vitro angiogenesis analyses demonstrated that the IL‐10 and IL‐10 receptor pathway stimulated the migratory and tube formation ability of HUVECs as well as ectopic endometrial mesenchymal stem cells through, at least in part, a VEGF‐dependent pathway. We also found that recombinant IL‐10 directly stimulated angiogenesis, based on a Matrigel plug assay as well as a zebrafish model. Pathological results from human endometrioma tissues showed the increased infiltration of CD123+ plasmacytoid dendritic cells and higher percentages of cells that express the IL‐10 receptor and CD31 as compared with the corresponding normal counterparts. Taken together, these results show that IL‐10 secreted from local plasmacytoid dendritic cells promotes endometriosis development through pathological angiogenesis during the early disease stage. This study provides a scientific basis for a potential therapeutic strategy targeting the IL‐10—IL‐10 receptor pathway in the endometriotic milieu. © 2019 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
High occurrence of sleep problems in survivors of a childhood brain tumor with neurocognitive complaints: The association with psychosocial and behavioral executive functioning
Authors: van Kooten Jojanneke A.M.C. , Maurice‐Stam Heleen , Schouten Antoinette Y.N. , van Vuurden Dannis G. , Granzen Bernd , Gidding Corrie , de Ruiter Marieke A. , van Litsenburg Raphaële R.L. , Grootenhuis Martha A. 
Published: August 2019

AbstractBackgroundSurvivors of childhood brain tumors are prone to sleep and neurocognitive problems. Effective interventions to improve neurocognitive functioning are largely lacking. In general, sleep problems are negatively related to neurocognitive functioning, but this relationship is unclear in survivors of childhood brain tumors. Therefore, the occurrence of sleep problems, potential risk factors, and the relation between sleep and executive functioning were evaluated.ProcedureBaseline data of a randomized controlled trial on the effectiveness of neurofeedback were used. Childhood brain tumor survivors 8‐18 years of age with parent‐reported neurocognitive complaints ≥2 years after treatment were eligible. Parents completed the Sleep Disturbance Scale for Children. Executive functioning was assessed by parents and teachers (Behavior Rating Inventory of Executive Functioning). Multiple linear regression analyses were used to examine sociodemographic and medical characteristics and emotional difficulties and hyperactivity/inattention (Strength and Difficulties Questionnaire) as potential risk factors for sleep problems, and to assess the association between sleep and executive functioning.ResultsForty‐eight percent of survivors (n = 82, 7.0 ± 3.6 years post diagnosis, age 13.8 ± 3.2 years) had sleep problems and scored significantly worse than the norm on the subscales Initiating and Maintaining Sleep, Excessive Somnolence, and the total scale (effect sizes 0.58‐0.92). Emotional problems and/or hyperactivity/inattention were independent potential risk factors. Sleep problems were associated with worse parent‐reported executive functioning.ConclusionsSleep problems occur among half of childhood brain tumor survivors with neurocognitive problems, and are associated with worse executive functioning. Future studies should focus on the development of sleep interventions for this population, to improve sleep as well as executive functioning.
Postmarket surveillance of arthroplasty device components using machine learning methods
Authors: Cafri Guy , Graves Stephen E. , Sedrakyan Art , Fan Juanjuan , Calhoun Peter , de Steiger Richard N. , Cuthbert Alana , Lorimer Michelle , Paxton Elizabeth W. 
Published: August 2019

AbstractPurposeWhile joint arthroplasty is generally a safe and effective procedure, there are concerns that some devices are at increased risk of failure. Early identification of total hip arthroplasty devices with increased risk of failure can be challenging because devices consist of multiple components, hundreds of distinct components are currently used in surgery, and any estimated effect needs to address confounding due to device and patient factors. The purpose of this study was to assess the effectiveness of machine learning approaches at identifying recalled components listed by the US Food and Drug Administration using data from a US total joint arthroplasty registry.MethodsAn open cohort study was conducted using data (January 1, 2001, to December 31, 2015) from 74 520 implantations and 348 unique components in the Kaiser Permanente Total Joint Replacement Registry. Exposures of interest were device components used in elective primary total hip arthroplasty. The outcome was time to first revision surgery, defined as exchange, removal, or addition of any component. Machine learning methods included regularized/unregularized Cox models and random survival forest.ResultsAmong the recalled components detected were ASR acetabular shell/large femoral head, Durom acetabular shell/Metasul large femoral head, and Rejuvenate modular neck stem. The three components not identified were characterized by small numbers of devices recorded in the registry.ConclusionsThe novel approaches to signal detection may improve postmarket surveillance of frequently used arthroplasty devices, which in turn will improve public health.
Cognitive functioning following brain irradiation as part of cancer treatment: Characterizing better cognitive performance
Authors: Wong Shan S. , Case L. Douglas , Avis Nancy E. , Cummings Tiffany L. , Cramer Christina K. , Rapp Stephen R. 
Published: August 2019

AbstractObjectiveAlthough brain radiation therapy (RT) impacts cognitive function, little is known about the subset of survivors with minimal cognitive deficits. This study compares the characteristics of patients receiving brain irradiation as part of cancer treatment with minimal cognitive deficits to those with poorer cognitive functioning.MethodsAdults at least 6 months postbrain RT (N = 198) completed cognitive measures of attention, memory, and executive functions. Cognitive functioning was categorized into better‐ and poorer‐performing groups, with better‐performing survivors scoring no worse than 1.5 standard deviations below the published normative mean on all cognitive measures. Logistic regression was used to identify variables associated with better‐performing group membership.ResultsApproximately 25% of the sample met the criteria for the better‐performing group. In unadjusted analyses, RT type (whole brain irradiation and partial brain irradiation), sedating medications, and fatigue were independently associated with cognition. Sociodemographic and other clinical characteristics were not significant. In adjusted analyses, only fatigue remained significantly associated with group membership (OR = 1.05, 95% CI = 1.01‐1.09, P = .009).ConclusionsThere is a subgroup of survivors with minimal long‐term cognitive deficits despite undergoing a full course of brain RT as part of cancer treatment. Lower fatigue had the strongest association with better cognitive performance. Interventions targeting cancer‐related fatigue may help buffer the neurotoxic effects of brain RT.