bluuebunny/crossref_metadata_2025_split huggingface dataset:
Automated 3D-Body Composition Analysis as a Predictor of Survival in Patients With Idiopathic Pulmonary Fibrosis
Authors: Salhöfer Luca , Bonella Francesco , Meetschen Mathias , Umutlu Lale , Forsting Michael , Schaarschmidt Benedikt Michael , Opitz Marcel Klaus , Kleesiek Jens , Hosch Rene , Koitka Sven , Parmar Vicky , Nensa Felix , Haubold Johannes 
Published: August 2024

Purpose:
Idiopathic pulmonary fibrosis (IPF) is the most common interstitial lung disease, with a median survival time of 2 to 5 years. The focus of this study is to establish a novel imaging biomarker.

Materials and Methods:
In this study, 79 patients (19% female) with a median age of 70 years were studied retrospectively. Fully automated body composition analysis (BCA) features (bone, muscle, total adipose tissue, intermuscular, and intramuscular adipose tissue) were combined into Sarcopenia, Fat, and Myosteatosis indices and compared between patients with a survival of more or less than 2 years. In addition, we divided the cohort at the median (high=≥ median, low=<median) of the respective BCA index and tested the impact on the overall survival using the Kaplan-Meier methodology, a log-rank test, and adjusted multivariate Cox-regression analysis.

Results:
A high Sarcopenia and Fat index and low Myosteatosis index were associated with longer median survival (35 vs. 16 mo for high vs. low Sarcopenia index, P=0.066; 44 vs. 14 mo for high vs. low Fat index, P<0.001; and 33 vs. 14 mo for low vs. high Myosteatosis index, P=0.0056) and better 5-year survival rates (34.0% vs. 23.6% for high vs. low Sarcopenia index; 47.3% vs. 9.2% for high vs. low Fat index; and 11.2% vs. 42.7% for high vs. low Myosteatosis index). Adjusted multivariate Cox regression showed a significant impact of the Fat (HR=0.71, P=0.01) and Myosteatosis (HR=1.12, P=0.005) on overall survival.

Conclusion:
The fully automated BCA provides biomarkers with a predictive value for the overall survival in patients with IPF.
CONTINUOUS KIDNEY REPLACEMENT THERAPY DOSAGE AND MORTALITY IN CRITICALLY ILL PATIENTS: A RETROSPECTIVE COHORT STUDY USING MARGINAL STRUCTURAL MODEL
Authors: Faria Maria Luiza Medeiros , Libório Alexandre Braga 
Published: August 2024

ABSTRACT

Background: Continuous kidney replacement therapy (CKRT) is a crucial intervention for hemodynamically unstable patients with acute kidney injury (AKI). Despite the recommendations to offer a CKRT dose of 20 to 25 mL/kg/h, the optimal CKRT dose remains uncertain, especially whether low-dose CKRT is associated with poor outcomes. This study investigated the association between low CKRT dosage and 90-day mortality using a marginal structural model (MSM). Methods: Using the MIMIC-IV database, adult patients who received CKRT for more than 24 h were included. Data on time-fixed and time-dependent variables were collected. Patients were categorized based on CKRT dose thresholds of 13 and 20 mL/kg/h. Results: Among the 1,329 patients, the 90-day mortality rate was 49.6%. The median age of the patients was 62 years (IQR: 52–72). Changes in CKRT dosing during treatment were frequent. Patients with a reduced delivered CKRT dose (<20 and <13 mL/kg/h) generally exhibited low values during the initial days of CKRT, with an increase in the delivered CKRT dose. After adjusting only for baseline variables (traditional Cox regression model), patients receiving CKRT doses <13 mL/kg/h had significantly greater 90-day mortality (HR: 1.70, 95% CI 1.16–2.49) than those receiving CKRT doses ≥13 mL/kg/h. However, after adjusting for time-dependent variables, the CKRT dose was not significantly associated with mortality at either the 13 or 20 mL/kg/h threshold. Additionally, there were no significant associations between the delivered CKRT dose and 90-day mortality within the range of 5 to 40 mL/kg/h. Conclusion: This study highlights the impact of methodological approaches on the association between CKRT dose and mortality and that with personalized adjustments, there may not be a lower limit of the unsafe CKRT dose. However, lower CKRT doses were initially associated with higher mortality, and adjusting for time-dependent variables nullified this association.
Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy and Liver Resection is a Treatment Option for Patients With Peritoneal and Liver Metastases From Colorectal Cancer
Authors: Dagenborg Vegar Johansen , Brudvik Kristoffer Watten , Lund-Andersen Christin , Torgunrud Annette , Lund-Iversen Marius , Flatmark Kjersti , Larsen Stein Gunnar , Yaqub Sheraz 
Published: August 2024

Objective:
To study outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) in patients also treated for colorectal liver metastases (CLM).

Background:
Colorectal cancer (CRC) frequently metastasizes to the liver and peritoneum and is associated with a poor prognosis. In selected patients, a benefit in overall survival (OS) was shown for both peritoneal metastases (PM-CRC) offered CRS-HIPEC, and CLM treated with surgical resection. However, the presence of CLM was considered a relative contraindication to CRS-HIPEC, causing a paucity of outcome data in this patient group.

Methods:
Patients with PM-CRC having CRS-HIPEC at a single national center between 2007 and 2023, with additional intervention for CLM, were included (previous curative treatment for extraperitoneal and extrahepatic metastases was allowed). Three groups were defined: CLM before CRS-HIPEC (pre-CRS-HIPEC), CLM resected simultaneously with CRS-HIPEC (sim-CRS-HIPEC), and CLM after CRS-HIPEC (post-CRS-HIPEC), aiming to retrospectively analyze outcomes.

Results:
Fifty-seven patients were included and classified as: pre-CRS-HIPEC (n = 11), sim-CRS-HIPEC (n = 29), and post-CRS-HIPEC (n = 17). Median Peritoneal Cancer Index (PCI) was 8; 13 patients had severe complications (Clavien-Dindo ≥3), and no 90-day mortality. Median OS was 48 months after CRS-HIPEC. PCI was a predictor of OS (hazard ratio: 1.11, P < 0.001). We observed no difference in short or long-term outcomes between intervention groups.

Discussion:
This study demonstrated that patients with CLM having CRS-HIPEC had comparable OS to reports on CRS-HIPEC only, likely explained by a low PCI. Simultaneous CLM resection did not increase the risk of severe complications.

Conclusions:
In this national cohort, CRS-HIPEC and CLM intervention offers long-term survival, suggesting that this treatment may be offered to selected patients with PM-CRC and CLM.
Dynamic Assessment of Drain Fluid Amylase Estimates the Risk of CR-POPF Following Pancreatoduodenectomy
Authors: AlMasri Samer , Kim Victoria M. , Hodges Jacob C. , Casciani Fabio , Lee Kenneth K. , Paniccia Alessandro , Vollmer Charles M. , Zureikat Amer H. 
Published: August 2024

Objective:
To evaluate whether drain fluid amylase levels on day-1 (DFA1) and day-3 (DFA3) can reliably estimate the risk of clinically relevant-postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) compared to either value alone or in combination with clinicopathologic variables.

Background:
CR-POPF is a major source of morbidity and mortality following PD. Current drain management algorithms are variable and are mostly dependent on DFA1, while the DFA3 is seldom utilized to guide clinical decision making.

Methods:
Between 2015-2020, patients who underwent PD at two high-volume pancreas centers and had intraoperative drain placement with measurement of DFA1 and DFA3 were retrospectively reviewed. Models to predict CR-POPF were constructed using DFA1, DFA3, fistula risk score (FRS) and other patient or treatment-related parameters. The fittest and more parsimonious model was used to construct a CR-POPF risk calculator.

Results:
Nine-hundred-twenty-three patients were included in the analysis. The FRS was high in 100(10.9%), intermediate in 524(57.3%), low in 211(23.1%) and negligible in 79(8.6%) patients. The overall rate of CR-POPF was 9.2%. Five logistic regression models were constructed using variables known to be implicated in CR-POPF. A model based solely on DFA1 and DFA3 with a cross-validated area under the curve of 0.846 was selected. A calculator using DFA1 and DFA3 was created based on this model to estimate the risk of CR-POPF.

Conclusions:
Risk of CR-POPF following pancreatoduodenectomy can be accurately estimated based on measurement of DFA1 and DFA3. Our CR-POPF kinetics calculator can facilitate postoperative risk stratification and guide drain management algorithms
Impact of Infrared Indocyanine Green Fluorescence Imaging-guided Laparoscopic Hepatectomy on Securing the Resection Margin for Colorectal Liver Metastasis
Authors: Kato Toru , Imamura Masafumi , Kyuno Daisuke , Kimura Yasutoshi , Kukita Kazuharu , Murakami Takeshi , Yoshida Eiji , Mizuguchi Toru , Takemasa Ichiro 
Published: August 2024

Background:
Laparoscopic hepatectomy for colorectal liver metastases (CRLM) is performed worldwide. However, owing to a lack of palpatory information and difficulties associated with accurate intraoperative ultrasonographic diagnosis, the tumor may be exposed at the hepatic transection margin. This study aimed to investigate the pathological significance of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG)-guided laparoscopic hepatectomy and determine its usefulness in securing the resection margin for CRLMs.

Methods:
Fifty-nine patients who underwent laparoscopic hepatectomy for CRLM using NIR fluorescence imaging between February 2017 and June 2021 at Sapporo Medical University Hospital were included. Generally, all patients received intravenous ICG (2.5 mg/body) as a fluorescence agent 1 to 2 days before surgery. During the surgical procedure, real-time NIR fluorescence imaging was repeatedly performed to assess the surgical margins.

Results:
Of the 94 tumors in 59 patients, laparoscopic NIR fluorescence imaging identified 56 tumors (59.6%) on the liver surface. Pathological analysis indicated clear margins in 96.6% (57/59) of patients. Examination of paraffin-embedded sections, which were successful in only 20 of 94 cases (21.3%), revealed that there were no tumor cells positive for NIR fluorescence, and the median distance of the continuous fluorescent signal from the tumor margin was 1.074 mm.

Conclusions:
We demonstrated a high R0 rate using NIR fluorescence-guided hepatectomy. This technique has the potential to improve intraoperative tumor identification and tumor margin assurance and reduce the rate of positive resection margins in patients with CRLMs.
Cyclic Alternating EEG Patterns: From Sleep to Encephalopathy
Authors: Misirocchi Francesco , Mutti Carlotta , Hirsch Lawrence J. , Parrino Liborio , Florindo Irene 
Published: August 2024

Summary:
In the 2021 version of the Standardized Critical Care EEG Terminology, the American Clinical Neurophysiology Society introduced new definitions, including for the cyclic alternating pattern of encephalopathy (CAPE). CAPE refers to changes in background EEG activity, with two patterns alternating spontaneously in a regular manner. CAPE shares remarkable similarities with the cyclic alternating pattern, a natural EEG phenomenon occurring in normal non–rapid eye movement sleep, considered the main electrophysiological biomarker of sleep instability. This review explores similarities and differences between cyclic alternating pattern and CAPE and, leveraging the existing expertise on cyclic alternating pattern, aims to extend knowledge on CAPE. A standardized assessment of CAPE features is key to ascertain its prevalence and clinical significance among critically ill patients and to encompass the impact of confounding factors such as anesthetic and sedative agents. Although the preservation of non–rapid eye movement sleep-related elements has a well-known prognostic value in the critical care setting, the clinical importance of cyclic oscillating patterns and the prognostic significance of CAPE remain to be elucidated.
Electroconvulsive Therapy in a Patient With Cerebral Aneurysm, Normal Pressure Hydrocephalus With Ventriculoperitoneal Shunt, and Severe Acquired Pyloric Stenosis
Authors: Jacob Titus , Grözinger Michael , Papenfuß Tim , Mai Matthias , Gahr Maximilian 
Published: August 2024

Abstract
Cerebral aneurysm (CA), normal pressure hydrocephalus (NPH) with ventriculoperitoneal shunt (VPS), and pyloric stenosis increase the risk of complications related to electroconvulsive therapy (ECT). Whereas there is some evidence for the safety of ECT in patients with CA and NPH with VPS, there is none in patients with pyloric stenosis that increases the risk of aspiration during short anesthesia. A 67-year-old female patient with a small and stable aneurysm of the right anterior cerebral artery, NPH with VPS, and severe pyloric stenosis (as a result of suicidal ingestion of pipe cleaner) suffering from therapy-resistant depression and chronic suicidal tendencies was treated successfully with 15 sessions of ECT. The following measures were taken to increase ECT-related safety and may help physicians in their decision-making process in similar cases: careful risk assessment based on presentation and discussion of the case in an academic multidisciplinary neurovascular team, glycerol trinitrate sublingual spray before short anesthesia and (after development of hypotension) switching to a pro re nata (PRN) medication with urapidil directly after electric stimulation in case of a relevant increase in blood pressure, examination of the VPS after five stimulations, oral administration of 30 mL of sodium citrate (0.3 molar) before ECT to increase the gastric pH, and establishment of a specific diet and fasting plan (generally only liquid oral food, discontinuation of oral food intake 20 hours, and administration of water only 14 hours before ECT).
Controlling a new plasma regime
Authors: Lennholm M. , Aleiferis S. , Bakes S. , Bardsley O. P. , van Berkel M. , Casson F. J. , Chaudry F. , Conway N. J. , Hender T. C. , Henderson S. S. , Kool B. , Lafferty M. , Meyer H. F. , Mitchell J. , Mitra A. , Osawa R. , Otin R. , Parrot A. , Thompson T. , Xia G. , the STEP Team  
Published: August 2024

Success of the UK’s Spherical Tokamak for Energy Production (STEP) programme requires a robust plasma control system. This system has to guide the plasma from initiation to the burning phase, maintain it there, produce the desired fusion power for the desired duration and then terminate the plasma safely. This has to be done in a challenging environment with limited sensors and without overloading plasma-facing components. The plasma parameters and the operational regime in the STEP prototype will be very different from tokamaks, which are presently in operation. During fusion burn, the plasma regime in STEP will be self-organizing, adding further complications to the plasma control system design. This article describes the work to date on the design of individual controllers for plasma shape and position, magneto hydrodynamic instabilities, heat load and fusion power. Having studied ‘normal’ operation, the article discusses the philosophy of how the system will handle exceptions, when things do not go exactly as planned.
This article is part of the theme issue ‘Delivering Fusion Energy – The Spherical Tokamak for Energy Production (STEP)’.
Staying positive: producing net power
Authors: Acres Jack , Antoniou Ioannis , Christie Finlay , Blackburn Daniel , Knight Samuel 
Published: August 2024

The Spherical Tokamak for Energy Production (STEP) prototype powerplant (SPP) will be a first-of-a-kind powerplant—its prime objective is to export electrical power, to the national power transmission system (‘grid’), above 100 MWe. As part of a wider issue, addressing the STEP concept design, this article seeks to explore how electrical power will be generated from a spherical tokamak heat source. Accordingly, the following key functions of the SPP power infrastructure are reviewed.

Cooling the tokamak
: cooling the tokamak while extracting useful thermal energy.

Generating power
: conversion of thermal energy to electrical energy (power generation).

Managing energy
: management of the site-wide distribution, storage and energy export.

In each of these areas, the design scope, challenges and solution spaces have been discussed. This has shaped the design of the SPP power infrastructure, which in turn has ensured a powerplant design focused on operability and performance. Furthermore, it has been demonstrated that the SPP will achieve its prime objective in generating net power, which is enabled by a unique power infrastructure. Confidence in the ability to generate net power will be refined as the design matures. Finally, this article recommends key opportunities that STEP could use to improve power generation and reduce the parasitic load of the SPP.
This article is part of the theme issue ‘Delivering Fusion Energy – The Spherical Tokamak for Energy Production (STEP)’.
Impacts of Disinfection Methods in a Granular Activated Carbon (GAC) Treatment System on Disinfected Drinking Water Toxicity and Antibiotic Resistance Induction Potential
Authors: Feng Yinmei , Lau Stephanie S. , Mitch William A. , Russell Caroline , Pope Greg , Gu April Z. 
Published: August 2024

AbstractAbstract FigureGraphic AbstractGranular activated carbon (GAC) treatment followed by chlorination (GAC/Cl2) and chlorination followed by chloramination (Cl2/NH2Cl) are two methods utilized by drinking water treatment facilities to mitigate the formation of disinfection byproducts (DBPs) in treated water. However, the effectiveness of these methods in reducing the overall toxicity of drinking water, driven by DBPs, remains largely unknown. In this study, we evaluate the total toxicity of water samples from a pilot-scale GAC system with post-chlorination (GAC/Cl2), and occasionally pre-chlorination upstream of GAC (Cl2/GAC/Cl2), compared to water treated by chlorination followed by chloramination (Cl2/NH2Cl). The research was conducted at various bromide and iodide levels and across three GAC bed volumes. To assess DNA stress and oxidative stress in water extracts, we employed the yeast toxicogenomic assay and human cell RT-qPCR assay, along with the DBP analysis from our previous study. Our results indicated that under environmental halogen conditions, GAC/Cl2typically reduces both genotoxicity and oxidative stress in treated water more effectively than Cl2/NH2Cl and Cl2treatment. However, Cl2/GAC/Cl2does not consistently lower toxicity compared to GAC/Cl2. Notably, under high halogen conditions, Cl2/GAC/Cl2fails to reduce genotoxicity and oxidative stress compared to samples without GAC treatment. Correlation analysis suggested that iodinated DBPs (I-DBPs) and nitrogenous DBPs (N-DBPs) were particularly associated with increased DNA stress and oxidative stress, indicating these classes of DBPs as significant contributors to the observed toxicity. While neither of these two categories of DBPs are regulated by the EPA, it appears that unregulated and unidentified DBPs significantly contribute to the genotoxicity and oxidative stress in drinking water. This research highlights the complex dynamics of water treatment processes and underscores the critical impact of unregulated DBPs on water toxicity.
Nonlinear thinking in ecology and evolution: The case for ecological scaling of the Threshold Elemental Ratio
Authors: Tumolo Benjamin B. , Olson Carly R. , Larson Erin I. , Halvorson Halvor M. , Wagner Catherine E. , Krist Amy C. , Osburn Felicia S. , Moody Eric K. , Rock Linnea A. , Ogbenna Uchechukwu V. C. , Wess Eli N. , Najev Briante , Pignatelli Anthony J. , Corman Jessica R. 
Published: August 2024

AbstractNonlinear dynamics govern ecological processes, thus understanding thresholds is important for measuring and forecasting effects of climate change and management of natural resources. However, identifying whether and how such thresholds scale across biological levels of organization remains challenging. Ecological stoichiometry, the study of the balance of multiple elements and energy in ecological systems, provides a framework for scaling thresholds. We broaden a key organismal concept from ecological stoichiometry theory, the Threshold Elemental Ratio (TER), to study how nonlinear dynamics operate in evolutionary and ecological processes across the organizational hierarchy. Traditionally, TERs are used to describe the elemental ratio at which the limitation of organismal growth shifts from one element to another. Following this definition, we make a case for broadening the ecological scale of the TER beyond organisms to include populations, clades, communities, and ecosystems. We show how TERs can be detected and translated across different scales of biological and evolutionary organization through simulation modeling, literature review, and synthesis of empirical examples from diverse systems and ecological scales including: cyanotoxin production in lakes, alder-salmon dynamics, and the Cambrian explosion. Collectively, we demonstrate that TERs are widespread and consequential across levels of biological organization and that such thresholds manifest from a diversity of mechanisms. Thus, scaling of the TER concept holds promise for advancing our understanding of nonlinear dynamics from the micro-evolutionary to macro-ecological.
Neural dynamics of visual streams interactions during memory-guided actions investigated by intracranial EEG
Authors: Moraresku Sofiia , Hammer Jiri , Dimakopoulos Vasileios , Kajsova Michaela , Janca Radek , Jezdik Petr , Kalina Adam , Marusic Petr , Vlcek Kamil 
Published: August 2024

AbstractThe dorsal and ventral visual streams play distinct roles in visual processing for action: the dorsal stream is assumed to support real-time actions, while the ventral stream facilitates memory-guided actions. As the recent evidence suggests a more integrated function of these streams, we investigated the neural dynamics and functional connectivity between them during memory-guided actions using intracranial EEG. We tracked neural activity in the inferior parietal lobule in the dorsal stream, and ventral temporal cortex in the ventral stream as well as hippocampus during a delayed action task. We found increased alpha power in both streams during the delay, indicating their role in maintaining visual information. We also observed an increase in theta band synchronization between the inferior parietal lobule and ventral temporal cortex, and between the inferior parietal lobule and hippocampus during the delay. Our study provides unique electrophysiological evidence for close interactions between dorsal and ventral streams, supporting an integrated processing model.
Reliability of tactile perception and suppression measurements
Authors: Voudouris Dimitris , Georgiadis Petros , Fiehler Katja , Arikan Belkis Ezgi 
Published: August 2024

AbstractTactile signals arising on one’s own body allow estimation of one’s own sensory state and foster interactions with the environment. However, tactile perception can be influenced by various factors. For instance, tactile perception is suppressed on a moving limb compared to when it is resting, a phenomenon termed tactile suppression. Here we examine whether tactile perception during resting and during movement is robust over shorter and longer time intervals. Participants had to detect tactile stimuli of various intensities on their index finger while this finger was resting or moving (finger extension). This detection task was performed on four sessions at separate days across a period of one month. We found that tactile perception during resting is robust within single sessions and across days. However, tactile perception during movement changed across days, but these changes lacked a clear systematic pattern. We further show that temporal changes in perception alone cannot fully account for the previously reported tactile suppression effects. Finally, split-half correlations reveal high consistency in the estimated perceptual measures, demonstrating that estimates of tactile perception are robust across measurement points.