bluuebunny/crossref_metadata_2025_split huggingface dataset:
AI in Surgery: Navigating Trends and Managerial Implications Through Bibliometric and Text Mining Odyssey
Authors: Le Minh-Hieu , Le Thu-Thao , Tran Phung Phi 
Published: October 2024

Background: This research employs bibliometric and text-mining analysis to explore artificial intelligence (AI) advancements within surgical procedures. The growing significance of AI in healthcare underscores the need for healthcare managers to prioritize investments in this technology. Purpose: To assess the increasing impact of AI on surgical practices through a comprehensive analysis of scientific literature, providing insights that can guide managerial decision-making in adopting AI solutions. Research Design: The study analyzes over 6000 scientific articles published since 1990 to evaluate trends and contributions in the field, informing managers about the current landscape of AI in surgery. Study Sample: The research focuses on publications from various influential publishers across North America, Northern Asia, and Eastern & Western Europe, highlighting key markets for AI implementation in surgical settings. Data Collection and Analysis: A bibliometric approach was utilized to identify key contributors and influential journals. At the same time, text-mining techniques highlighted significant keywords related to AI in surgery, aiding managers in recognizing essential areas for further exploration and investment. Results: The year 2022 marked a significant upsurge in publications, indicating widespread AI integration in healthcare. The U.S. emerged as the foremost contributor, followed by China, the UK, Germany, Italy, the Netherlands, and India. Key journals, such as Annals of Surgery and Spine Journal, play a crucial role in disseminating research findings, serving as valuable resources for managers seeking to stay informed. Conclusions: The findings underscore AI’s pivotal role in enhancing diagnostic precision, predicting treatment outcomes, and improving operational efficiency in surgical practices. This progress represents a significant milestone in modern medical science, paving the way for intelligent healthcare solutions and further advancements in the field. Healthcare managers should leverage these insights to foster innovation and improve patient care standards.
Epigastric Ventral Hernia Repair Through Vaginal Natural Orifice Transluminal Endoscopic Surgery
Authors: N Vancanneyt , T Tollens , J Baekelandt 
Published: October 2024

Objective Ventral hernia repair is a commonly performed operation and can be executed by open or laparoscopic approach. The search for even less invasive techniques continues. Natural orifice transluminal endoscopic surgery (NOTES) is a known method of minimally invasive surgery. Methods We performed an epigastric ventral hernia repair through vaginal NOTES during a concurrent hysterectomy and bilateral salpingectomy. We used the access to do a synchronous hernia repair with mesh augmentation. The technique of repair was identical to the laparoscopic intraperitoneal onlay mesh repair (Lap. IPOM). Results We reported a sufficient hernia repair without intra-operative complications. Also, post-operatively, no problems were encountered. Follow-up after 4 weeks showed a good and strong hernia repair. The complaints of the patient were relieved. CT scan 10 months after operation showed no recurrence nor signs of mesh infection. Conclusions Ventral hernia repair through vaginal NOTES can be considered a possible new and minimal invasive (scarless) technique for ventral hernia repair but further investigations on a larger scale are needed to confirm feasibility & safety.
Performance assessment of the Surpass Evolve flow diverter for the treatment of intracranial aneurysms: A systematic review and meta-analysis
Authors: Rodriguez-Calienes Aaron , Vivanco-Suarez Juan , Castillo-Huerta Nicole M. , Espinoza-Martinez David , Morán-Mariños Cristian , Espiritu-Vilcapoma Ximena , Rivera-Angles Valeria , Ortega-Gutierrez Santiago 
Published: October 2024

Background The Surpass Evolve (SE) has emerged as a promising alternative treatment from the flow diverter series. The utilization of the SE has gradually increased, however, there is a scarcity of comprehensive data on the solidity of this technology in the endovascular treatment of intracranial aneurysms (IAs). This meta-analysis aimed to evaluate the safety and effectiveness of the SE flow diverter. Methods A systematic literature search from inception to April 2024 was conducted across five databases for studies involving IAs treated with the SE. The primary effectiveness outcome was the proportion of complete aneurysm occlusion at the final follow-up, and the primary safety outcome comprised a composite of early and delayed complications. Subgroup analyses based on aneurysm size, anatomical location, and rupture status were also conducted. Results Our analysis included nine studies with 645 patients and 722 IAs. Effectiveness outcomes revealed an overall complete aneurysm occlusion rate of 69% (95% confidence interval (CI) = 58%–78%; I2 = 72%) and a favorable aneurysm occlusion rate of 91% (95% CI = 82%–96%; I2 = 49%). Safety outcomes demonstrated an overall complications rate of 6% (95% CI = 3%–12%; I2 = 66%), with an early complications rate of 6% (95% CI = 4%–11%; I2 = 0%), and a delayed complications rate of 0% (95% CI = 0%–7%; I2 = 0%). Conclusions Our findings suggest a favorable outcome with a high rate of complete aneurysm occlusion at the last follow-up, with acceptable rates of neurological complications. Future research efforts should focus on larger, prospective studies with standardized outcome measures to further elucidate the clinical utility of the SE flow diverter in the management of IAs.
Emergent endovascular treatment versus medical treatment for acute large vessel occlusions with nondisabling symptoms
Authors: Onalan Aysenur , Gurkas Erdem , Balgetir Ferhat , Aytac Emrah , Akpinar Cetin Kursad , Cetin Hasan , Ciftaslan Asli , Kavak Genc Sule 
Published: October 2024

Objectives The aim of this study is to analyze the effectiveness and safety of medical treatment (MT) versus endovascular treatment (EVT) in acute large vessel occlusion patients with mild nondisabling stroke symptoms. Methods This study is a multicenter observational study in which data from patients at three stroke centers were prospectively obtained and retrospectively analyzed. Patients were included if they arrived for treatment within 6 h of stroke onset or last known well time and had a baseline National Institutes of Health Stroke Scale (NIHSS) score of ≤5. Primary outcome was modified Rankin Scale (mRS) score 0–2 at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH), discharge NIHSS score, 90-day all-cause mortality and length of stay. Clinical outcomes were compared through a multivariable logistic regression after adjusting for age, treatment type admission and discharge NIHSS score, admission Alberta Stroke Program Early CT (ASPECT) score and length of stay. Results Of the 82 patients included in the study, 42 were in the EVT group and 40 were in the MT group. The groups were similar in age (MT:66, EVT:64 age; p = .62), gender (MT:55%, EVT:54.8%; male) admission NIHSS score (MT:2, EVT:3 points; p = .26), ASPECT score (MT:10, EVT:9; p = .15). While discharge NIHSS score was found to be statistically significant between the groups (MT:1, EVT:2; p = .04). There was no difference between the two groups in terms of 90-day mRS scores (MT:1, EVT:1, p = .86) and mortality rates (MT:4, EVT:4; p = .94). In unadjusted analysis, sICH rates were similar between the MT and EVT groups (MT 5%, EVT 7.1%, p = .52). Neurological intensive care unit length of stay (MT:5 days, EVT:2 days p < .001), inpatient clinic length of stay (MT:3, EVT:2 days p = .041), and total length of stay (MT:9 days, EVT:4 days p < .001) were significantly longer in the MT group. Conclusions Our multicenter study demonstrated that MT with blood pressure augmentation and anticoagulation at hyperacute stage is an alternative option for emergency large vessel occlusion patients with nondisabling mild stroke symptoms.
Removing the straight jacket in practice approach: An investigation into coach learning and development in Australian female tennis
Authors: Moulds Kylie , Lascu Alexandra , Bai Alison , Davidson James 
Published: October 2024

Objectives Applying an ecological dynamics perspective with the Skilled Intentionality Framework, this study examined whether an integrated coach learning and development framework could be successfully implemented in Australian female tennis coaching. Methods Participants were all females: qualified coaches ( N = 4), coach developers ( N = 2) and athletes, aged 15–18 years ( N = 7). Participants completed an online survey, examining socio-demographics, playing/coaching history and learning outcomes. An ethnographic and action research approach utilising the Learning in Development Research Framework (LDRF) was undertaken over 20 weeks of coach learning and development. Coaches followed two female coach developers (one as the primary investigator) for a minimum of two hours per week (in situ learning), while the coaches worked directly with athletes. To identify influential factors, multiple data collection strategies were employed, including surveys, semi-structured interviews, observations, critical reflections and focus groups. Results Perceived program benefits (e.g., coach self-confidence and reassurance) and on-court/off-court support were verified within qualitative interview-derived data . Conclusion Findings identify the positive influence of an integrated coach learning and development framework on continued Australian female coaching career progression, highlighting coach development implications.
Efficacy and safety of perioperative, neoadjuvant, or adjuvant immunotherapy alone or in combination with chemotherapy in early-stage non-small cell lung cancer: a systematic review and meta-analysis of randomized clinical trials
Authors: Meng Yunchang , Zhang Qingfeng , Wu Ranpu , Li Huijuan , Wang Zhaofeng , Yao Yang , Li Xinjing , Chen Zhangxuan , Gong Yanzhuo , Liu Hongbing 
Published: October 2024

Background: Neoadjuvant (NE), adjuvant (AD), and perioperative (PE) immunotherapies have gained validation in early-stage non-small cell lung cancer (NSCLC) trials. However, a comprehensive assessment of their comparative efficacy and safety is lacking. Objectives: To compare the efficacy and safety of NE, AD, and PE immunotherapies in early-stage NSCLC. Design: A systematic review and network meta-analysis using a Bayesian framework. Data sources and methods: We searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) of immune checkpoint inhibitors plus chemotherapy (CT) for early-stage NSCLC. Hazard ratios (HRs) and odds ratios (ORs) for binary endpoints with 95% confidence intervals (CIs) were calculated. Results: We included 10 RCTs involving 5569 NSCLC patients, categorized as NE, PE, or AD immunotherapy. Indirect comparisons highlighted differences in efficacy between PE and AD immunotherapy, specifically in event-free survival (EFS)/disease-free survival (DFS) (HR = 0.72, 95% CI: 0.53–0.96). NE/PE immunotherapies improved pathologic complete response (pCR) (OR = 7.56, 95% CI: 5.24–10.92), major pathologic response (MPR) (OR = 5.46, 95% CI: 3.97–7.51), and EFS (HR = 0.58, 95% CI: 0.52–0.65), while AD immunotherapy enhanced DFS (HR = 0.78, 95% CI: 0.69–0.90). Overall survival (OS) benefits were seen only with PE immunotherapy (HR = 0.66, 95% CI: 0.55–0.81). PE treatment improved EFS across various subgroups (PD-L1 < 1%, IIIB, squamous, female, without MPR/pCR, epidermal growth factor receptor (EGFR) mutant-negative), except EGFR mutant-positive NSCLC (HR = 0.54, 95% CI: 0.21–1.43). AD (OR = 1.81, 95% CI: 1.20–2.73) and PE (OR = 1.28, 95% CI: 1.10–1.50) immunotherapies were associated with higher grade ⩾3 adverse events. Conclusion: In the three treatment modalities, PE immunotherapy appears to be more effective than AD immunotherapy, with PE showing significant advantages in certain subgroups that NE does not. NE and PE immunotherapy significantly improved pCR, MPR, and EFS, while AD immunotherapy significantly improved DFS in NSCLC patients compared to the control group. However, only PE immunotherapy significantly improved OS. Differences in efficacy between NE and PE across the entire population of resectable NSCLC remain to be explored in additional studies.
Effects of Parallax and Distortion in Total Ankle Arthroplasty
Authors: Brown Joseph R. , Hill Zachary P. , Groeschl Ross , Steginsky Brian , Mendicino Robert W. 
Published: October 2024

Background Surgeons rely on intraoperative fluoroscopy to assist in placement of implant components during total ankle arthroplasty (TAA). Parallax alters the direction of an object when viewed from two different points, resulting in image distortion. The purpose of this study was to evaluate parallax/distortion in intraoperative fluoroscopic images during TAA. Methods A retrospective review of all TAAs performed by two surgeons (R.W.M. and B.S.) from August 2019 to April 2023 were reviewed. Intraoperative fluoroscopic anteroposterior (AP) ankle views were evaluated for any obvious parallax image distortion. Cases with obvious parallax distortion were included for angular evaluation of AP intraoperative fluoroscopic and first postoperative plain films. The tibia was marked at 2-centimeter intervals to create zones from the proximal stem of the implant. The anatomical axis of the tibia (AAT) was drawn at the mid-diaphysis. The anatomic lateral distal tibial angle (aLDTA) and anatomic axis deviation (AAD) were measured for each zone. Results A total of 22 TAAs were performed during the study period. Four cases were excluded due to inadequate imaging, leaving a total of 18 TAAs for review. We found 6 of 18 (33.3%) cases had obvious parallax distortion. We found the average aLDTA was 90.9° (84°-101°). At the most proximal tibial zone, the average aLDTA was 94° (91°-101°). We found the average AAD was 4.7 (0.5-17.2) mm. The AAD ranged from 0.5 to 17.2 mm lateral to 0.8 to 8.2 mm medial. Postoperative plain film radiographs displayed a normal aLDTA and an AAT centered within the ankle joint. Conclusion Parallax can distort the appearance of the tibia on fluoroscopic images. Deviation from the normal aLDTA and anatomical axis should be anticipated. Surgeons should be aware of the potential impact of parallax and ways to mitigate these effects.
Pressure and cold pain threshold reference values in a pain-free older adult population
Authors: Waller R , Brown E , Lim J , Nadarajah R , Reardon E , Mikhailov A , Straker L , Beales D 
Published: October 2024

Background More sex-specific pain sensitivity normative values from population-based cohorts in pain-free older adults are required. The aims of this study were (1) to provide sex- and age-specific normative values of pressure and cold pain thresholds in older pain-free adults and (2) to examine the association of potential correlates of pain sensitivity with pain threshold values. Methods This study investigated sex-specific pressure (lumbar spine, tibialis anterior, neck and dorsal wrist) and cold (dorsal wrist) pain threshold estimates for older pain-free adults aged 41–70 years. This cross-sectional study used participants ( n = 212) from the Raine Study Gen1-26 year follow-up. The association of pain thresholds, with correlates including sex, test site, ethnicity, waist-hip ratio, smoking status, health-related quality of life, depression, anxiety and stress symptoms, sleep quality, socioeconomic status and physical activity levels, was examined. Results Values for pressure and cold pain thresholds for older pain-free adults are provided, grouped by vicennium, sex and test site (pressure). Statistically significant independent correlates of increased pressure pain sensitivity were test site, ethnicity and sex. Only lower waist/hip ratio was a statistically significant, independent correlate of increased cold pain sensitivity. Conclusions This study provides robust sex- and age-specific normative values for pressure pain threshold and cold pain threshold for an older adult pain-free population. Combined with existing values, these data provide an important resource in assisting interpretation of pain sensitivity in clinical pain disorders and provide insights into the complex association of pain sensitivity with correlates that can be used in research.
Integrating tabular data through image conversion for enhanced diagnosis: A novel intelligent decision support system for stratifying obstructive sleep apnoea patients using convolutional neural networks
Authors: Casal-Guisande Manuel , Fernández-Villar Alberto , Mosteiro-Añón Mar , Comesaña-Campos Alberto , Cerqueiro-Pequeño Jorge , Torres-Durán María 
Published: October 2024

Objective High-dimensional databases make it difficult to apply traditional learning algorithms to biomedical applications. Recent developments in computer technology have introduced deep learning (DL) as a potential solution to these difficulties. This study presents a novel intelligent decision support system based on a novel interpretation of data formalisation from tabular data in DL techniques. Once defined, it is used to diagnose the severity of obstructive sleep apnoea, distinguishing between moderate to severe and mild/no cases. Methods The study uses a complete database extract from electronic health records of 2472 patients, including anthropometric data, habits, medications, comorbidities, and patient-reported symptoms. The novelty of this methodology lies in the initial processing of the patients’ data, which is formalised into images. These images are then used as input to train a convolutional neural network (CNN), which acts as the inference engine of the system. Results The initial tests of the system were performed on a set of 247 samples from the Pulmonary Department of the Álvaro Cunqueiro Hospital in Vigo (Galicia, Spain), with an AUC value of ≈ 0.8. Conclusions This study demonstrates the benefits of an intelligent decision support system based on a novel data formalisation approach that allows the use of advanced DL techniques starting from tabular data. In this way, the ability of CNNs to recognise complex patterns using visual elements such as gradients and contrasts can be exploited. This approach effectively addresses the challenges of analysing large amounts of tabular data and reduces common problems such as bias and variance, resulting in improved diagnostic accuracy.
Are multiple coders needed for cause of death assignment: results from telephonic verbal autopsy interviews conducted in 2021 in South Africa
Authors: Neethling Ian , Morof Diane , Glass Tracy , Kallis Natasha , Rao Chalapati , Bradshaw Debbie , Groenewald Pam 
Published: October 2024

Introduction Verbal autopsy (VA) methods have emerged to estimate causes of death in populations lacking robust civil registration and vital statistics (CRVS) systems. Despite World Health Organization endorsement of routine VA use, cost and efficiency concerns persist. Telephonic verbal autopsies (teleVAs) can reduce cost. Physician coding offers a valuable approach, but the expertise required makes it resource-intensive, often involving multiple coders for consensus. Objective To assess inter-coder agreement for cause of death (CoD) in South African teleVAs using Kappa statistics, evaluating if agreement surpasses a 0.8 cut-off (very high) potentially allowing single coders. Methods A cross-sectional study employed telephonic VA interviews on non-facility deaths in Cape Town (December 2020–September 2021). Trained fieldworkers administered a standard VA questionnaire. Each case's VA responses were reviewed independently by two physicians, medically certifying the CoD. A panel was used to solve disagreements. Cohen’s kappa-statistic ( k-statistic) tested agreement levels. Results Decedents were aged between 18 and 98 years. In total, 228 teleVAs (16.6% response rate) were conducted. Physician coding agreement was good overall ( k-statistic: 0.63). Diabetes mellitus (47%) and other non-communicable disease (42%) had initial agreement between physician coders in less than 50% of cases in comparison to consensus totals. COVID-19 (89%) and acute cardiac disease (83%) showed initial agreement in more than 80% of cases compared to consensus totals. A chi-square test revealed a significant difference in the number of causes listed on death notification forms for cases with and without agreement in Part 1 (χ2 = 14.71, p < 0.01), but not in Part 2 (χ2 = 4.97, p = 0.17). Conclusion CoD agreement might not be high enough to infer that single coders can be used instead of multiple coders. Challenges with co-morbidities and specific CoDs with multiple sequelae highlight the need for further research and refinement of VA methodologies for reliable CoD determination in routine practice.
Influence of Age on Outcome Following Rib Fractures – A Case-Control Analysis
Authors: Ziegenhain Franziska , Mittlmeier Anne S. , Pape Hans-Christoph , Neuhaus Valentin , Canal Claudio 
Published: October 2024

Background Thoracic injuries are a very common entity throughout all age groups. With rising numbers of geriatric patients, characteristics of this patient group need to be better defined. The aim of this study was to investigate the impact of age on the outcome of thoracic trauma. In this project we provide a stratification of differentiated age groups regarding outcome parameter on rib fractures. Methods The study employed a retrospective design using data from patients who sustained thoracic trauma and received treatment at a level I trauma center over a 5-year period. Patients with the same pattern of injury and gender but different age (above and below 70 years) were matched. Results The mean age of the study population was 57 ± 19 years, 69% were male, 54% of patients had preexisting comorbidities. Hemothorax was present in 109 (16%), pneumothorax in 204 (31%) and lung contusions in 136 patients (21%). The overall complication rate was 36%, with a mortality rate of 10%. The matched pair analysis of 70 pairs revealed a higher prevalence of comorbidities in the older age group. They had significantly fewer pulmonary contusions and pneumothoraces than the younger patients and a shorter length of stay. However, the older age group had a significantly higher mortality rate. Conclusions Geriatric patients with rib fractures exhibit different patterns of intrathoracic injuries compared to their younger counterparts. Although numeric age may not be the most accurate predictor of adverse outcome, we found that higher age was associated with a clear trend towards an increased mortality rate. Our findings build a basis for further research to evaluate the outcome of age for instance with the tool of a rib fracture scoring system within stratified age groups in order to identify patients at major risk.