bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracheostomy for the pediatric patient with fibrodysplasia ossificans progressiva: a case report
Authors: Kobayashi Megumi , Hirai Misako , Suzuki Makoto , Sasaki Akira 
Published: March 2024

Abstract
Background
Fibrodysplasia ossificans progressiva (FOP) is an extremely rare connective tissue disease characterized by subsequent ossification of skeletal muscles, tendons, ligaments, and other fibrous tissues. The ossification of these tissues progresses during childhood and leads to limb and trunk deformities. Since any surgery may trigger subsequent ossification, it is relatively contraindicated for patients with FOP. In this report, we describe our experience in performing tracheostomy in a pediatric patient with FOP who developed a restrictive respiratory disorder due to progressive deformity of the trunk.

Case presentation
A 12-year-old boy, diagnosed with FOP at the age of one, was referred for a tracheotomy after requiring 2 months of oral intubation and mechanical ventilation due to severe deformity-induced dyspnea. After changing from oral intubation to nasal intubation, we carefully considered the indications and benefits of tracheostomy in patients with FOP. Eventually, tracheostomy was successfully performed using our surgical design: creating a skin incision at the level of the cricoid cartilage that can always be identified, creating inverted U-shaped incision on the anterior tracheal wall to make a flap, and suturing the entire circumference of the tracheotomy and skin. One month after the surgery, he regained normal breathing and pronunciation and returned to school. The patient showed no unfavorable postoperative outcomes over a 4-year follow-up period.

Conclusions
Tracheostomy in our pediatric case of FOP required careful perioperative management. However, it could effectively improve the patient’s quality of life.
Ectopic bile duct concomitant with gastric ulcer hemorrhage: report of a case
Authors: Nagasawa Yuiko , Ohta Masayuki , Shitomi Yuki , Satoh Hiroshi , Aramaki Masanori 
Published: March 2024

Abstract
Background
An ectopic bile duct opening into the stomach is a rare congenital anomaly of the biliary system, and thus, there are few case reports with gastric ulcer hemorrhage. Herein, we presented a case of ectopic bile duct concomitant with gastric ulcer hemorrhage.

Case presentation
A 75-year-old woman was referred to our hospital because she repeatedly vomited blood and had melena. Endoscopic hemostasis was attempted for hemorrhage from a gastric ulcer located on the anterior wall of the antrum. However, the bleeding was difficult to stop, and a laparoscopic distal gastrectomy was performed. Her postoperative course was uneventful. Pathological examination revealed that the bleeding point was an ectopic bile duct. In retrospect, an annual endoscopy performed at her family clinic had revealed a bulge in the same portion of the stomach. Exposure to bile acids from an ectopic bile duct opening can cause gastric mucosal damage and ulceration.

Conclusions
Ectopic bile ducts opening into the stomach can cause gastric ulcer and hemorrhage. Hemorrhage from a submucosal ridge with ulcer in the stomach may be rarely related to the presence of ectopic bile ducts.
Working from home is here to stay, but how does it affect workplace learning?
Authors: Morlet Guillaume M. A. , Bolli Thomas 
Published: March 2024

AbstractThis paper analyses how working from home affects workplace learning in terms of theoretical and practical knowledge during COVID19. We employ panel data gathered in monthly surveys of respondents in training companies between October 2020 and March 2022 to investigate this question. Apprentices in Switzerland are our case study. We address potential endogeneity concerns in two ways. First, we exploit variation across survey respondents and time in two-way fixed effects models. Second, we pursue an instrumental variable “shift-share”-type approach that leverages how occupations react to exogenous changes in working from home regulations. The results suggest that working from home has a significantly negative impact on practical knowledge but not theoretical knowledge, relative to frequenting the workplace. We do not find significant heterogeneity across company size. Similarly, our results do not vary significantly between occupations in which working from home is relatively more or less prevalent. Our findings remain robust to a wide range of robustness checks. Our evidence-based recommendations aim to preserve the acquisition of knowledge through workplace training.
Mass transfer analyses of reactive boundary schemes for lattice Boltzmann method with staircase approximation
Authors: Tong Zi-Xiang , Li Ming-Jia , Du Yanxia , Yuan Xianxu 
Published: March 2024

AbstractLattice Boltzmann (LB) methods with reactive boundary conditions are widely used in pore-scale simulations of dissolution and ablation processes. The staircase approximation of curved boundary is often employed because of its simplicity in handling solid structure changes. In this work, the mass transfer of two typical LB reactive boundary schemes are analyzed for the staircase boundary. The Type I boundary scheme is based on relations of local distribution functions and a wet-node boundary mesh. The Type II boundary scheme adopts the half-way bounce-back scheme. Boundary concentrations are determined by finite difference, and a link-wise boundary mesh is used. The analyses demonstrate that for straight boundaries, both the boundary schemes have accurate mass transfer rates, which means the mass transfer calculated by exchanges of distribution functions is the same as that calculated by reaction rates. For curved boundaries with staircase approximation, including interfacial normal directions in the Type I boundary scheme can provide accurate mass transfer for inclined straight boundaries. However, if the staircase boundary geometry is used directly without normal directions, the reaction rate will be overestimated. One-dimensional and two-dimensional reaction-diffusion processes with dissolution are simulated to validate the analyses. Both the boundary schemes work well for one-dimensional simulations. For two-dimensional simulations, the Type II boundary scheme significantly overestimates the reaction rate, and stronger artificial anisotropic effects are observed. The Type I boundary scheme with normal directions has better performance, but error still exists.
Improving healthcare quality by unifying the American electronic medical report system: time for change
Authors: Kumari Roopa , Chander Subhash 
Published: March 2024

Abstract
Background
In recent years, innovation in healthcare technology has significantly improved the efficiency of the healthcare system. Advancements have led to better patient care and more cost-effective services. The electronic medical record (EMR) system, in particular, has enhanced interoperability and collaboration across healthcare departments by facilitating the exchange and utilization of patient data. The COVID-19 pandemic further accelerated this trend, leading to a surge in telemedicine services, which rely on electronic communication to deliver healthcare remotely.

Main body
Integrating artificial intelligence (AI) and machine learning (ML) in healthcare have been instrumental in analyzing vast data sets, allowing for identifying patterns and trends that can improve care delivery and pinpoint potential issues. The proposal of a unified EMR system in the USA aims to capitalize on these technological advancements. Such a system would streamline the sharing of patient information among healthcare providers, improve the quality and efficiency of care, and minimize the likelihood of errors in patient treatment.

Conclusion
A unified electronic medical record system represents a promising avenue for enhancing interoperability within the US healthcare sector. By creating a more connected and accessible network of patient information, it sets the stage for a transformation in healthcare delivery. This change is imperative for maintaining the momentum of progress in healthcare technology and realizing the full potential of recent advancements in patient care and system efficiency.
Investigation of mechanical properties of high-performance concrete via optimized neural network approaches
Authors: Wang Xuyang , Cong Rijie 
Published: March 2024

AbstractIn this paper, an artificial intelligence approach has been employed to analyze the slump and compressive strength (CS) of high-performance concrete (HPC), focusing on its mechanical properties. The importance of assessing these critical concrete characteristics has been widely acknowledged by experts in the field, leading to the development of innovative methods for estimating parameters that typically require laboratory testing. These intelligent techniques improve the accuracy of mechanical property predictions and reduce the resource-intensive and costly nature of experimental work. The radial basis function neural network (RBFNN) is the foundational model for predicting the mechanical attributes of various HPC mixtures. To fine-tune the RBFNN’s performance in replicating the mechanical properties of HPC samples, two optimization algorithms, namely the Golden Eagle Optimizer (GEO) and Dynamic Arithmetic Optimization Algorithm (DAOA), have been employed. In this manner, both RBGE and RBDA models were trained using a dataset comprising 181 HPC samples that included superplasticizers and fly ash. The results show that DAOA has significantly improved the base model’s predictive capability, achieving a higher correlation with a value R2 of 0.936 when estimating slump. Furthermore, RBDA exhibited a more favorable root mean square error (RMSE) in predicting compressive strength compared to RBGE, with a notable 16% difference. Ultimately, both integrated models demonstrated their effectiveness in accurately modeling the mechanical properties of HPC.
The 13C Glucose Breath Test Accurately Identifies Insulin Resistance in People With Type 1 Diabetes
Authors: Mertens Jonathan , Roosens Laurence , Braspenning Rie , Vandebeeck Joeri , Francque Sven , De Block Christophe 
Published: March 2024

Abstract

Objective
This study investigated whether the delta-over-baseline of exhaled 13CO2 (Δ13CO2), generated from a 13C glucose breath test (13C-GBT), measured insulin resistance (IR) in people with type 1 diabetes, using the hyperinsulinemic-euglycemic clamp (HEC) as a reference method. The secondary objective was to compare the 13C-GBT with the estimated glucose disposal rate (eGDR).

Methods
A 40 mU/m2/min HEC and 2 separate 13C-GBTs (euglycemic with insulin bolus and hyperglycemic without bolus) were consecutively performed in 44 adults with type 1 diabetes with varying body compositions. eGDR was calculated based on hemoglobin A1c (HbA1c), presence of hypertension, and waist circumference.

Results
The mean glucose disposal rate (M-value) was 5.9 ± 3.1 mg/kg/min and mean euglycemic Δ13CO2 was 6.4 ± 2.1 δ‰, while median eGDR was 5.9 [4.3-9.8] mg/kg/min. The hyperglycemic Δ13CO2 did not correlate with the M-value, while the euglycemic Δ13CO2 and the M-value correlated strongly (r = 0.74, P &lt; .001). The correlation between M-value and eGDR was more moderate (Spearman's rho = 0.63, P &lt; .001). Linear regression showed an association between Δ13CO2 and M-value, adjusted for age, sex, and HbA1c ]adjusted R² = 0.52, B = 1.16, 95% confidence interval (CI) .80-1.52, P &lt; .001]. The area under the receiver-operator characteristics curve for Δ13CO2 to identify subjects with IR (M-value &lt; 4.9 mg/kg/min) was 0.81 (95% CI .68-.94, P &lt; .001). The optimal cut-off for Δ13CO2 to identify subjects with IR was ≤ 5.8 δ‰.

Conclusion
Under euglycemic conditions, the 13C-GBT accurately identified individuals with type 1 diabetes and concurrent IR, suggesting its potential as a valuable noninvasive index.
Clinical Trial Identifier: NCT04623320
102 BB-031 Recanalizes MCAO and Reduces Inflammation in Canine Model of LVO Stroke
Authors: Carfora Arianna , Wheeler Debra , Huttinger Allyson , Kini Aarushi , Mandybur Ian , Holthaus Blake , Yacoub Simon , Piracha Zain , Zakeri Amanda Sahar , Anderson Cole , Stork Taggart , Joseph Matthew , Nimjee Shahid Mehdi 
Published: March 2024

INTRODUCTION:
Acute ischemic stroke (AIS) is the leading cause of long term disability. rtPA treatment of AIS results in intracranial hemorrhage (ICH) in 7% of patients with 40% mortality. Increased matrix metalloprotease-9 (MMP-9) correlates with ICH, while reduced levels maintain integrity of the blood brain barrier (BBB), preventing ICH. Von Willebrand Factor (VWF) induces both thrombosis and inflammation in large vessel occlusion (LVO) stroke. BB-031 targets VWF, and lyses thrombotic occlusion. BB-025 reverses BB-031.

METHODS:
After 6 hours of autologous canine MCAO, animals were treated with vehicle, BB-031, and BB-031+BB-025. VWF inhibition, TICI scores, and plasma inflammatory markers [VWF, interleukin-1 (IL-1b), interleukin-6 (IL-6), tumor necrosis factor-a (TNF- a), and matrix metalloproteinase-9 (MMP-9)] were analyzed over the course of the study.

RESULTS:
Within 15 minutes of vehicle treatment, VWF increased by 3.102 ± .382 ng/ml (n = 6) whereas BB-031 reduced VWF by 0.223 ± .154 ng/ml (p < 0.05) (n = 8). BB-031-treated animals had TICI > 2B in 62.5% of the animals. Although IL-1b and IL-6 were unchanged, and TNF-a was not detectable, MMP-9 levels were lower in BB-031-treated animals at sacrifice compared to both vehicle and BB-031+BB-025 (p < 0.0001).

CONCLUSIONS:
BB-031 treatment inhibited VWF, increased reperfusion, and reduced MMP-9 after canine MCAO, suggesting that in addition to recanalization, inhibiting VWF mitigates inflammation and iatrogenic ICH.
1067 Accuracy of an Augmented Reality Spine Surgery Guidance System With Stereoscopic Targeting Head Mounted Display Compared to Standard Computer Navigation, Robotic Systems, and Existing AR Systems
Authors: O'Connor Tim , Hussain Ibrahim , Srivastav Sudesh , Pan John , Voegeli Thomas 
Published: March 2024

INTRODUCTION:
Augmented Reality (AR) offers the benefit of improved hand-eye coordination by accurately superimposing 3D stereoscopic displays for surgical instruments onto anatomic landmarks.

METHODS:
120 pedicle screws were implanted using an AR system (OnPoint AR, OnPoint Surgical, Bedford, MA) (thoracic 50, lumbosacral 70; pre-op CT 40, O-arm 80). Heary grading was applied by an independent radiologist assessing the degree of pedicle breaches. 3D measurements of positional error (PE) and angular error (AE) were performed by comparing post-operative CT scans of implanted screws with planned trajectories. Statistical analyses compared PE and AE for OnPoint AR with the available values for other systems using an unequal variance t-test method.

RESULTS:
113 screws placed demonstrated Heary grade 1 accuracy. 6 screws had a larger diameter than the pedicle and were planned with in-out-in technique with Heary grade 2 accuracy. One screw demonstrated a lateral breach (grade 2) caused by a loose connection to the screwdriver. PE and AE (mean ± 1SD) for OnPoint AR were the following: for intra-operative spin 1.1mm±0.5mm and 1.3°±0.5°; for pre-operative CT 1.9mm±1.2mm and 2.2°±1.3°. Percent increment in PE and AE for Medtronic Stealth Station, Brainlab navigation, Stryker nav3i, Medtronic Mazor X robot, Globus Excelsius robot, Augmedics Xvision, and Novarad VisAR compared to OnPoint AR ranged between 40–80%, with differences being highly significant for all comparisons.

CONCLUSIONS:
PE and AE for placing pedicle screws are statistically significantly smaller for the novel AR system compared to existing navigation, robotic, and AR systems. A positional error of 1.1mm and angular error of 1.3° makes this technology particularly suited for small pedicles, challenging anatomy, and MIS techniques.
1069 Assessing the Safety and Efficacy of Spinal Anesthesia in Patients With Higher Risk Comorbidities
Authors: Karimi Helen , Ahsan Tameem , Yu-Der Wang Andy , Kanter Matthew , Olmos Michelle , Kosarchuk Jacob , Balonov Konstantin , Liu Penny , Riesenburger Ron I. , Kryzanski James 
Published: March 2024

INTRODUCTION:
Spinal anesthesia (SA) is a safe and effective alternative to general anesthesia (GA) for lumbar surgery. Widespread adoption of SA has not occurred presumably due to surgeons’ concerns for difficulties in management of patients with comorbidities. Obesity (BMI =30 kg/m2), anxiety, obstructive sleep apnea, re-operation at the same level, and multilevel operations have recently been identified as risk factors for perioperative complications.

METHODS:
A retrospective analysis of 422 patients who underwent thoracolumbar surgery under spinal anesthesia by a single surgeon at a single academic center (2017-2021) was carried out. Patient demographics, comorbidities, as well as intraoperative and postoperative complications were abstracted from the medical record. In the overlapping groups, 149 patients had a BMI =30, 95 had diagnosed anxiety, 79 underwent multilevel surgery, 98 had obstructive sleep apnea, and 65 had a prior operation at the same level. The control group included 132 patients without these risk factors. Differences in perioperative outcomes were assessed with the Kruskal-Wallis rank sum test, Pearson's Chi-squared test, or Fisher's exact test using R (The R Foundation, v 4.1.1, Vienna, Austria).

RESULTS:
Postoperative pneumonia was observed in two patients in the anxiety group and in one patient in the reoperative group (p-value < 0.05). There were no other statistically significant differences in intraoperative and postoperative complications within the entire cohort including when stratified by number of comorbidities. Rate of spinal fusion was comparable among groups, though mean length of stay and operative time were different (p-value < 0.001).

CONCLUSIONS:
Spinal anesthesia is a feasible and safe anesthetic modality for most patients, including those with significant comorbidities. An updated algorithm for SA candidate selection is thus recommended.
107 Conventional Catheter-based Angiography Versus Non-invasive Imaging in the Evaluation of Symptomatic Carotid Disease
Authors: Keister Alex , Khalife Jane , Weinberg Joshua H. , Padron Zachary , Vignolles-Jeong; Renato Oliveira Joshua , Shaikh Hamza , Tonetti Daniel , Patel Pratit , Thomas Ajith J. , Nimjee Shahid Mehdi , Jovin Tudor 
Published: March 2024

INTRODUCTION:
The indication for invasive treatment of symptomatic carotid disease with CEA or carotid stenting was established based on catheter digitally subtracted imaging (DSA) however operative referral for symptomatic carotid disease is still largely based on non-invasive imaging such as CTA or ultrasound.

METHODS:
Retrospective analysis all consecutive patients who were referred for evaluation and treatment of symptomatic carotid disease after non-invasive imaging with CTA or ultrasound showed ipsilateral carotid stenosis of >50% or occlusion. Patients were included if they had ipsilateral cerebral or ocular ischemia within two weeks of index event.

RESULTS:
A total of 280 patients with stenosis >50 and <100% were included. Of those, 53 (19%) were found to have stenosis <50% leading to treatment with best medical therapy instead of intervention. Out of 50 patients with total occlusion, 16 (32%) were found to have a string sign and were treated with stenting. Percent stenosis of 80 or more on non-invasive imaging was more likely to correlate with stenosis of 50% or more on DSA.

CONCLUSIONS:
In a cohort of two large North American institutions, 19% of patients referred for revascularization of symptomatic carotid disease based on non-invasive imaging were found to have non-significant carotid stenosis and were treated with best medical therapy and 32% of those with suspected occlusion were successfully revascularized. Our findings highlight the importance of catheter cased angiography in the evaluation of carotid disease.
1072 SIJ Fusion Device Testing
Authors: Buck Brian , Wright Nathan , Rajpal Sharad 
Published: March 2024

INTRODUCTION:
Screw use for SIJ fixation began in the 1980s with the FDA first classifying SIJ fusion devices in 2002. For 40 years, no standardized test method existed. Various methodologies (for bone screw, intramedullary nail, or spinal fusion implants) were modified to accommodate the design and function of sacroiliac devices including ASTM F543’s torsion, pullout, and insertion tests, ASTM F1264’s three- or four-point bending tests, and ASTM F2193’s cantilever bending tests. For many years, SIJ fusion screw indications were limited to fixation of pelvic bones for sacroiliac joint disruptions and degenerative sacroiliitis. While the FDA typically accepted performance testing according to combinations of the aforementioned tests, the specific test expectations have been relatively undefined with inconsistent testing batteries from submission to submission.

METHODS:
Collaboration among testing experts, manufacturers, and FDA regulators within ASTM’s Spinal Devices sub-committee resulted in the development and publication of ASTM F3574 (Standard Test Methods for Sacroiliac Joint Fusion Devices) based on physiologic loading conditions in the joint as documented in published studies. These tests included: For SI Screws: • Static/dynamic cantilever bending •Static torsion •Driving torque •Pullout For SI Posterior Spacers: •Static/dynamic shear •Static/dynamic torsion.

RESULTS:
The medical device industry now has access to standardized test methods for SI devices while the FDA or other regulators now have device specific test methods to recommend for pre-clinical testing.

CONCLUSIONS:
Many new standards drag through years of development and refinement within sub-committees, but ASTM F3574 developed quickly due to efforts of the Spinal sub-committee task group to meet the needs for SI fusion devices.
108 A Translational Approach to Suppress Local Inflammation in the Ischemic Penumbra and Deliver Local Anti-platelet Activity After Stroke
Authors: Alawieh Ali M. , Grossberg Jonathan Andrew , Tomlinson Stephen 
Published: March 2024

INTRODUCTION:
Mechanical thrombectomy is the standard of care for ischemic stroke, but there is a significant mismatch between successful recanalization and clinical outcomes. Inflammation in the ischemic penumbra remains a target for neuroprotective interventions even in recanalized and non-recanalized patients. P-selectin (Psel) is a marker of endothelial cell activation and could be used to deliver therapeutics locally to the site of ischemic injury.

METHODS:
The fusion protein Pselectin-Crry was constructed using single chain antibody sequence linked to the extracellular region of mouse Crry. In-vivo testing using surface plasmon resonance for binding affinity to Psel, and zymosan assay for complement inhibitory activity. In-vivo studies were performed in C57bl/6 mice subjected to transient middle cerebral artery occlusion for 1 hour followed by administration of Psel-Crry 2 hours after reperfusion. Psel-Crry was labelled using far-red fluorescence and live-animal imaging was used to study brain-specific targeting. The modified Neurological Severity (NS) score was used for functional outcome along with survival, infarct volume and histological outcomes.

RESULTS:
Psel-Crry demonstrated dose-dependent complement inhibitory activity, and localized specifically to the stroke brain on in-vivo live imaging. Ex-vivo imaging of explanted brain showed Psel-Crry binding specifically to the injured hemisphere without off-target binding (Stroke vs. Sham, p < 0.001). Psel-Crry resulted in 60% reduction in infarct volume at 3 days compare to vehicle (N = 8/group, p < 0.05), reduction in NS scores compared to vehicle (Median 3 vs. 1.5, p < 0.05), and improved 1-week survival (80% vs. 50%, p < 0.05). Histological analyses demonstrated preservation of dendritic arborization in the ischemic penumbra with Psel-Crry treatment with concurrent significant reduction in microglial activation.

CONCLUSIONS:
Psel-Crry is a translational agent that can achieve local complement inhibitory effect and antiplatelet activity after stroke and has promise for potential use as ajuvant therapy in stroke.