bluuebunny/crossref_metadata_2025_split huggingface dataset:
Procedure-Related Complication Rates With the Use of Vascular Closure Devices; Does Size Only Matter? A Large Single Centre Retrospective Study
Authors: Sethi Sifut , Michalski Jakub , Moh’d Elayyan Al-shboul Rand , Carey Frank , Tan Kelvin , Ali Tariq 
Published: August 2024

Introduction Our retrospective study aimed at assessing safety of vascular closure devices (VCDs) used in a large single-centre Interventional Radiology (IR) department. Complication and deployment failure rates using collagen-based (Angio-seal) and suture-based (ProGlide) devices for common femoral artery haemostasis were compared. Materials and Methods Data from VCDs deployed over a 6-year period were retrospectively analysed for patient age, procedure indication, puncture mode (antegrade/retrograde), sheath size, deployment failure and complications (haematoma, pseudoaneurysm formation, limb occlusion). Numerical and statistical analysis was undertaken. Results Overall, 1321 common femoral artery punctures in 1217 patients were closed using VCDs. Failure rate using ProGlide was significantly higher when compared with Angio-seal ( P=<0.001) in sheath sizes ≤8 Fr. Heparin was not administered in embolisation procedures compared with angioplasty with or without stenting. Therefore, haematoma tended to occur more frequently following angioplasty without stenting ( P = 0.003) and angioplasty with stenting ( P = 0.001), when compared with embolisation. Deployment failure occurred more frequently when heparin was used during the procedure ( P = 0.005). Conclusion Although complications relating to sheath size are well established in the literature, there remains a paucity of data assessing the impact of procedure specific factors when comparing VCDs. Our study challenges that size is the sole determinant of VCD success and invites a more holistic view of VCD deployment strategies. This study advocates continued research into the nuances of other potential confounding variables to optimise patient outcomes.
Optimizing Surgical Choices of Renal Artery Aneurysm With Sequential Use of “Two-Click AVA” Technique and FlightPlan for Embolization: A Report of Two Cases
Authors: Li Siting , Li Fangda , Zeng Rong , Liu Xiaolong , Liu Zhili , Zheng Yuehong 
Published: August 2024

Background Selecting intervention strategies for renal artery aneurysms (RAAs) is challenging especially for those located at the vessel bifurcation. The relationship between the aneurysm and renal branches could not always be accurately viewed from traditional computed tomography angiography (CTA) images. Case presentation This study proposed a new method to investigate the anatomy and affected vessel branches of RAAs using automated software. Two patients with RAAs located at the renal artery bifurcation underwent Cone beam CTA (CBCTA) analysis. We sequentially coupled the “two-click AVA” function of Vessel IQ Xpress (GE Healthcare) with the “vascular tree extraction” function from FlightPlan for Embolization (GE Healthcare) to evaluate the relationship among the main renal artery, vessel branches, and aneurysms. The results showed that one patient had 1 out of 3 branches affected by the aneurysm, whereas the other’s branches were all affected. Endovascular repair and open surgery were performed respectively based on the image analysis. Both patients recovered well at follow-up examination. Conclusions Based on CBCTA analysis, the combination use of the “two-click AVA” function of VesselIQ Xpress and FlightPlan for Embolization software could assist in aneurysm assessment and intervention choices for RAAs.
A Comparison of Outcome in Patient With and Without Undergoing Cardiopulmonary Exercise Testing (CPET)
Authors: Veeralakshmanan Pushpa , Juszczak Maciej , Tiwari Alok 
Published: August 2024

Background Cardiopulmonary exercise testing (CPET) is a preoperative risk stratification tool providing an objective measure of fitness and functional capacity. There is however little evidence on the use of this compared to non-physiological test in vascular surgery despite its current use. This study investigates whether CPET perioperatively has value alongside non-physiological testing for patients undergoing elective open abdominal aortic aneurysm (AAA) repair. Method Retrospective data was collected at 2 vascular centres between 2015-2019 in a CPET centre vs non-CPET centre in patients undergoing elective AAA repair. Outcomes measured included: length of stay in an intensive care unit (ICU); total length of stay; post-operative complications and acute kidney injury (AKI). Statistical analysis was performed using IBM SPSS software. Results There were 38 patients at each centre. The mean duration of stay in ICU for patients in CPET centre was 2.5 ± 2.13 days whilst in non-CPET centre it was 3.68 ± 4.08 days ( P = 0.05). The mean duration of stay in ICU and total length of stay was significantly shorter in CPET centre ( P = 0.05 and P = 0.015 respectively). Mortality in CPET centre was 2.63% and 5.26% in non-CPET centre (not significant). The number of patients developing AKI post-operatively was 13.61% in CPET vs 28.95% in non-CPET centre. Conclusion CPET tested patients have statistically significant lower length of total and ICU stay compared to non-CPET patients. CPET is therefore a useful adjunct in selecting patients for open surgery compared to non-physiological testing. This study provides some evidence on the use of this routinely but not validated assessment tool in aortic aneurysm repair.
The impact of delivery technique on Woven EndoBridge deployment and detachment in an in vitro aneurysm model
Authors: Essibayi Muhammed Amir , Altschul David J. 
Published: August 2024

Background The Woven EndoBridge (WEB) device is increasingly used for treatment of wide-neck bifurcation aneurysms. With the newer 17 system, WEB deployment has been associated with a phenomenon known as incomplete or “sticky” detachment from the delivery wire, which may lead to imprecise placement. Optimal techniques for WEB manipulation and delivery to avoid this problem are poorly defined. This study aimed to evaluate standard WEB deployment techniques and determine the impact of delivery techniques and WEB stickiness on procedural success. Methods An in vitro study using identical silicone middle cerebral artery aneurysm models ( n = 32) assessed WEB (6 × 2 mm) deployment through a VIA 17 microcatheter via three techniques that involved: “loading,” “neutral,” and “tension” on the pusher wire. Microcatheter position was placed in varied positions from the WEB device. Woven EndoBridge stickiness was graded during detachment attempts. Primary outcomes were detachment stickiness and attempt number, compared between techniques using Fisher's exact test. Results The tension technique resulted in significantly fewer sticky detachments and detachment attempts compared to forward load or neutral techniques (p < 0.001). Sticky detachment was lower with tension (0% sticky) versus forward load (42% sticky, 8% very sticky) (p < 0.001). Forward load had a 50% rate of stickiness versus 0% with tension and neutral (p < 0.001). Forward load required multiple attempts in 100%, compared to 57% with neutral and 8% with tension (p < 0.001). Higher stickiness grades increased the need for multiple attempts (p < 0.001). Conclusion The tension technique reduces incomplete WEB detachment and enables precise single-attempt detachment, optimizing delivery precision. In vivo confirmation is needed.
Comparing visualization performance of liquid embolic agents using a novel injectable phantom
Authors: Mason J Ryan , Dodge Cristina , Beardsley Adam , Hilsenbeck Susan , Benndorf Goetz 
Published: August 2024

Background Radiographic visualization of liquid embolic agents (LEAs) during embolization procedures in neurovascular territory represents a crucial feature to ensure efficacy and safety for the patients during endovascular treatment of arteriovenous shunting lesions. Radiopacity of available LEAs varies significantly and limited methods are currently available for comparison. The purpose of this study was to compare the contrast resolution (CR) during injection under blank roadmap of various LEAs, as well as standard contrast material. Methods An injectable angiographic phantom was designed consisting of parallel tubings between 313 and 1000 micron. Under roadmap, eight radiopaque liquid agents were injected and analyzed: Onyx18®, 34® Squid®12, 18, PHIL®25% (PHIL®25), PHIL®30% (PHIL®30). TrufillTM (NBCA), 30% dilution and Omnipaque®300. CR was evaluated as a contrast to noise ratio (CNR) and calculated as mean peak signal (Sa) minus mean background signal (Sb) divided by the standard deviation of the background signal (Std) [Formula: see text]. Results Omnipaque 300 and NBCA were found to have the highest CR. PHIL®25 demonstrated the lowest CNR (45% of Omnipaque CNR). Onyx 18 and 34 (Both around 82% of Omnipaque CNR) demonstrated higher CNR compared to Squid®12 and 18 (52–55% of Omnipaque CNR). On average, at 500 micron there is a >70% reduction in CNR, and at 313 micron there is a 90% reduction in CNR compared to 1000 micron. Conclusions Significantly different CNR between most LEAs and iodinated contrast media was evident under roadmap conditions and should be considered prior to injection.
Single- versus double-artery repair without vein anastomosis in Tamai I fingertip replantations: a retrospective cohort study
Authors: Ozcelik Ismail Bulent , Kabakas Fatih , Mersa Berkan , Purisa Husrev , Sezer Ilker , Jusoh Mohd Hanifah 
Published: August 2024

The aim of the study was to report outcomes of fingertip replantations in Tamai zone I without vein anastomosis. The success rate and need for external bleeding between patients who underwent single and double-artery repair were compared. In this retrospective multicentre study, 144 replantations were carried out with a single-artery repair and 35 with a double-artery repair. The difference between the success of replantation in these two groups was not statistically significant: 108 (75%) in the single-artery group and 29 (83%) in the double-artery group. External bleeding was more frequently needed in the single-artery repair group ( n = 135, 94%) than in the double-artery repair group ( n = 6, 17%). Although there was no statistical difference in replantation success, performing double-artery repair may be more beneficial as there was less need for external bleeding and as a result complications associated with external bleeding can be avoided. Level of evidence: III
The use of ultrasound to predict flexor tendinopathy after anterior locking plating of the distal radius
Authors: Estermann Lea , Donaldson Matthew , Spasojevic Milos , Lurie Brett , Sivakumar Brahman , Ledgard James , Hile Mark 
Published: August 2024

This study compares ultrasound to clinical and radiographic measurements for assessing tendon pathology associated with distal radial anterior locking plates. A total of 46 patients undergoing removal of a distal radial plate had a preoperative clinical examination, radiographs and ultrasound evaluation to detect evidence of tendon irritation. Gross changes to the tendon were assessed during plate removal. In total, 32 patients demonstrated clinical abnormality. Soong 2 position was noted in 13 patients. Ultrasound revealed tenosynovitis in nine patients, tendon fibrillation or thickening in four patients and a single case of partial discontinuity. Intraoperative assessment revealed tenosynovitis in 28 patients and tendon fibre discontinuity in eight patients. Ultrasound findings were not predictive of intraoperative tenosynovitis and discontinuity. A relationship was noted between higher Soong grade, especially grade 2, and intraoperative presence of tenosynovitis, as well as Soong grade and amount of soft-tissue coverage. This study negates our hypothesis that ultrasound is useful for identifying tendinopathy after distal radial anterior plate fixation. Level of evidence: II
The impact on time between injury and semi-acute surgery for hand fractures after virtual fracture clinic implementation
Authors: Salentijn Dorien A. , Willinge Gijs J.A. , Dijkgraaf Marcel G.W. , van Veen Ruben N. 
Published: August 2024

The aim of this before-and-after study was to evaluate the implementation of a virtual fracture clinic (VFC) on the time between injury and surgery in patients presenting with a phalangeal or metacarpal fracture and in need of semi-acute surgical treatment. Between 1 January and 30 September 2018 (pre-VFC) and in the same period in 2022 (VFC), 101 and 113 patients were included, respectively. Before VCF implementation, the time between injury and surgery was 8.9 days (95% confidence interval [CI]: 8.1 to 9.6), while after VCF implementation it was 7.6 days (95% CI: 7.0 to 8.3). In 2018, 7% of operations were unacceptably delayed beyond 14 days from injury, which was reduced to 5% in 2022, despite patient-presentation delays of up to 10 days. VFC implementation was associated with a reduction in time until semi-acute surgery for phalangeal or metacarpal fractures and improved the quality of semi-acute surgery planning. Level of evidence: Level III
Is the feeling of ‘weakness’ associated with unhelpful thoughts or distress regarding symptoms?
Authors: Davids Floor A. , Brinkman Niels , Broekman Melle M. , Ring David , Reichel Lee M. , Vagner Gregg A. 
Published: August 2024

This cross-sectional study looked for factors associated with feelings of weakness, level of capability and pain intensity in people seeking musculoskeletal speciality care for non-traumatic upper extremity conditions. A survey was conducted in 139 English-speaking adults, with 135 participants completing it. We found that greater intensity of feelings of weakness correlated with higher distress regarding symptoms and with older age. Lower level of capability was associated with greater intensity of feelings of weakness, greater distress regarding symptoms and older age. Higher pain intensity was associated with greater distress regarding symptoms and greater intensity of feelings of weakness. These findings suggest that the symptom of weakness may be a cue to explore potential distress about symptoms in addition to examining for actual weakness. This understanding could be a guide to a more compassionate approach to alleviate distress rather than focusing on neuromuscular pathophysiology alone, with the potential to reduce unnecessary tests and treatments. Level of evidence: IV
Kaempferol Protects Pulmonary Vascular Endothelial Function in Rats with High Altitude Pulmonary Hypertension by Regulating RAS System and AMPK/Arg2/eNOS Signaling Pathway
Authors: Xie Xin , Li Huiru , Wang Liangqi , Zhang Xiaonan , Lu Dianxiang , Li Zhanqiang 
Published: August 2024

Background Previous studies have found that kaempferol can relieve pulmonary hypertension (PH). Objective Explore the protective impact of kaempferol on pulmonary vascular endothelium in rats with high altitude pulmonary hypertension (HAPH). Materials and methods In a simulated altitude of 5000 m environment, rats were induced to develop HAPH after continuous intragastric administration of kaempferol (25, 50 and 100 mg·kg−1) and Sildenafil (30 mg·kg−1) for 28 days. Assessment of isolated pulmonary arterial rings in rats and relevant indicators in lung tissue was performed, with the mechanism of action investigated using Western blotting. Results Kaempferol effectively dilates rat pulmonary arterial rings, with an EC50 of 55.75 μmol/L. L-NAME can effectively counteract the vasodilatory effect of kaempferol. Acetylcholine demonstrated better relaxation of pulmonary arterial rings in HAPH rats after kaempferol intervention. Elastic Van Gieson staining (EVG) and immunohistochemistry (CD31) results indicate that kaempferol can partially protect pulmonary vascular endothelial function in HAPH rats. Western blotting reveals that kaempferol has the ability to regulate the Renin-Angiotensin System (RAS). This leads to a compensatory increase in eNOS expression, upregulation of AMPK activity, and downregulation of eNOS monomer/dimer levels. Conclusions Kaempferol can improve pulmonary vascular endothelial dysfunction caused by chronic hypoxia by upregulating the phosphorylation level of AMPK, regulating the RAS system, and inhibiting eNOS uncoupling, thereby achieving vasodilation and endothelial protection.
Assessing the Readability, Reliability, and Quality of AI-Modified and Generated Patient Education Materials for Endoscopic Skull Base Surgery
Authors: Warn Michael , Meller Leo L.T. , Chan Daniella , Torabi Sina J. , Bitner Benjamin F. , Tajudeen Bobby A. , Kuan Edward C. 
Published: August 2024

Background Despite National Institutes of Health and American Medical Association recommendations to publish online patient education materials at or below sixth-grade literacy, those pertaining to endoscopic skull base surgery (ESBS) have lacked readability and quality. ChatGPT is an artificial intelligence (AI) system capable of synthesizing vast internet data to generate responses to user queries but its utility in improving patient education materials has not been explored. Objective To examine the current state of readability and quality of online patient education materials and determined the utility of ChatGPT for improving articles and generating patient education materials. Methods An article search was performed utilizing 10 different search terms related to ESBS. The ten least readable existing patient-facing articles were modified with ChatGPT and iterative queries were used to generate an article de novo. The Flesch Reading Ease (FRE) and related metrics measured overall readability and content literacy level, while DISCERN assessed article reliability and quality. Results Sixty-six articles were located. ChatGPT improved FRE readability of the 10 least readable online articles (19.7 ± 4.4 vs. 56.9 ± 5.9, p < 0.001), from university to 10th grade level. The generated article was more readable than 48.5% of articles (38.9 vs. 39.4 ± 12.4) and higher quality than 94% (51.0 vs. 37.6 ± 6.1). 56.7% of the online articles had “poor” quality. Conclusions ChatGPT improves the readability of articles, though most still remain above the recommended literacy level for patient education materials. With iterative queries, ChatGPT can generate more reliable and higher quality patient education materials compared to most existing online articles and can be tailored to match readability of average online articles.
Projectile spinning effects undergoing normal impact
Authors: Vaggu Pranay , Panigrahi SK 
Published: August 2024

The present research deals with the study of the effects of spinning on a projectile undergoing normal impact using the principle of energy. When the projectile is fired from firearms, some of the energy liberated by the propellant is utilized for engaging the driving band with the rifling of a gun barrel which causes the projectile to spin. The spinning helps the projectile to stabilize in the air. The total energy of the projectile comprises both translational and rotational energies just before the impact of the target. Most of the research studies consider translational energy of the projectile only in impact studies by ignoring other forms of energy such as energy due to spinning velocity of the projectile. In the present study, the effect of spinning is studied considering a 7.62 Armour piercing (AP) projectile, at different impact velocities for a varying target thickness having two different target materials viz. Al 7075-T651 and Mild steel. The residual velocity of the projectile and energy required to penetrate the target has been evaluated by Finite Element Analysis (FEA) using a commercially available FE code known as LS-DYNA. Initially, the model is validated with experimental results available in the literature. Subsequently, the validated model is used for studying the projectile spinning effects. It is observed that at some impact velocities, there is very little variation in residual velocity with spin while considering the variation in energy required to penetrate the target is significant. So, the energy required to penetrate the target with spin and without spin is compared for analysis. Another observation is, that near the ballistic limit velocity, the spin of the projectile made the projectile stuck inside the target with partial perforation. For a particular target with a specific target thickness, there is a velocity range in which the energy required to penetrate the target with spin is less than without spin. Within the considered impact velocities, the velocity ranges for the target of Al 7075-T651 with 12 mm thickness are 818–900 m/s, for 20 mm target thickness these velocities are 818–1000 m/s, and for mild steel target of thickness values of 12 mm and 20 mm it is 640.5 to 900 m/s. For a particular target material with finite thickness, the effect of spin is very less or approximately negligible for a given velocity. For the considered impact velocity condition, in case of mild steel, this velocity is approximately equa to 900 m/s, and for Al 7075-T651, it is between 715.7 and 818 m/s.
Toward reliable diabetes prediction: Innovations in data engineering and machine learning applications
Authors: Talukder Md. Alamin , Islam Md. Manowarul , Uddin Md Ashraf , Kazi Mohsin , Khalid Majdi , Akhter Arnisha , Ali Moni Mohammad 
Published: August 2024

Objective Diabetes is a metabolic disorder that causes the risk of stroke, heart disease, kidney failure, and other long-term complications because diabetes generates excess sugar in the blood. Machine learning (ML) models can aid in diagnosing diabetes at the primary stage. So, we need an efficient ML model to diagnose diabetes accurately. Methods In this paper, an effective data preprocessing pipeline has been implemented to process the data and random oversampling to balance the data, handling the imbalance distributions of the observational data more sophisticatedly. We used four different diabetes datasets to conduct our experiments. Several ML algorithms were used to determine the best models to predict diabetes faultlessly. Results The performance analysis demonstrates that among all ML algorithms, random forest surpasses the current works with an accuracy rate of 86% and 98.48% for Dataset 1 and Dataset 2; extreme gradient boosting and decision tree surpass with an accuracy rate of 99.27% and 100% for Dataset 3 and Dataset 4, respectively. Our proposal can increase accuracy by 12.15% compared to the model without preprocessing. Conclusions This excellent research finding indicates that the proposed models might be employed to produce more accurate diabetes predictions to supplement current preventative interventions to reduce the incidence of diabetes and its associated costs.