bluuebunny/crossref_metadata_2025_split huggingface dataset:
Simultaneous Cardiopulmonary Bypass and Dialysis
Authors: Wiggins Debbie L. , Dearing James P. 
Published: September 2023

An increasing number of patients are presenting for cardiac surgery with renal impairment. A simplified technique for dialysis during cardiopulmonary bypass (CPB) was designed and evaluated in the laboratory. The system has successfully been applied to patient care.
A dialysis circuit consisting of a hollow fiber dializer, a roller pump for propelling dializing fluid, and blood lines was incorporated into a simulated CPB circuit primed with blood having values comparable to those found in the uremic patient: hematocrit, 14 percent; potassium, 8.8 mEq/L; colloid osmotic pressure, 8. 7 mm Hg; creatinine, 19.6 mg/dl; BUN, 109 mg/dl. Blood flow through the dializer was controlled to produce inlet pressure of 200 mm Hg, similar to the pressure found in the arterial line filter. Lactated Ringers contained in one liter bags was used as dialysate. Dialysate was aspirated through the dializer using a roller pump. Four dialyses were carried out varying the ultrafiltration pressure and the frequency with which fresh dialysate was used.
Creatinine, BUN, and potassium levels returned to normal while the colloid osmotic pressure and hematocrit were elevated. More frequent changes in dializing bath resulted in more rapid dialysance and increasing ultrafiltration pressure resulted in more rapid hematocrit and colloid osmotic pressure elevation.
This technique has been applied to patients in renal failure undergoing heart surgery and has been effective in reducing fluid load and normalizing blood chemistries.
Some Considerations Regarding the Use of the Delta Lev-L-Sentry Low Level Alarm System
Authors: Walton Howard G. , Sugden Ernest H. , White Judith A. 
Published: September 2023

The possibility of infusing an air embolus during extracorporeal circulation is of concern to every perfusionist. The perfusionist uses a variety of devices to prevent such an accident. The Delta Lev-L-Sentry alarm system is one such device. It consists of a disposable sensor tape, an electronic sensor head, and a power/control box. The sensor head and tape are attached to the oxygenator. The unit will warn of a low level situation in the oxygenator when the fluid falls below the preset sensor tape position. This paper describes two possible situations where the Delta-L-Sentry alarm system may not activate properly, and one situation in which it will activate improperly.
A protein coating from the blood can result in a low sensitivity of the sensor tape. This, combined with a rapid draining of the oxygenator, can produce a false negative alarm. To avoid this false negative alarm mode it is recommended that the sensor tapes be cut and attached at the prescribed 50 degree angle (from the horizontal) regardless of the angle supplied by the manufacture. Another situation which can cause a false negative alarm mode is spilling electrolyte solution on the sensor tape. This can be avoided by protecting the sensor head. The one instance of a false positive alarm mode was caused by electrocautery interference during surgery. The use of a grounding cable will reduce the interference thus avoiding the false positive alarm signals.
Extracorporeal Circulation in Liver Transplantation
Authors: Garavet Scott P. , Crowley Jeffrey C. 
Published: September 2023

Extracorporeal circulation has recently expanded outside the realm of the traditional cardiac procedures. Extracorporeal circulation and cardiopulmonary bypass has expanded to include: left and right heart long and short term support, systemic and regional hyperthermic perfusion for cancer therapy, systemic rewarming for hypothermia victims due to exposure, repair of aortic tears and aneurysms, support for respiratory failure, and more recently involvement in support of the surgical process for liver transplantation.
The first orthotopic liver graft was performed by Starzl and colleagues in 1963 at The University of Colorado at Denver. Then in 1982 Starzl began utilizing veno-veno extracorporeal circulation. Vena-arterial bypass has also been utilized in other centers.
Presently, the use of extracorporeal circulation in liver transplantation is being implemented in an increasing number of centers. There have been a wide range of benefits with the use of extracorporeal circulation in liver transplantation. These benefits are the control of the systemic and perihepatic circulation, greater control of volume status through efficient rapid infusion systems and decreased morbidity and mortality. The increased confidence gained by the use of extracorporeal circulation, enables patients to be referred for transplant surgery at an earlier stage, with a more reasonable prospect for a successful surgery.
Intermittent Ischemia: An Alternative to Cardioplegic Arrest during Myocardial Revascularization Surgery
Authors: Galbraith George D. , Gassmann Craig J. 
Published: September 2023

Cardioplegic myocardial protection has become the standard for myocardial revascularization surgery (MRS). In contrast, our group performed 500 consecutive MRS' with intermittent aortic cross-clamping for distal anastomoses, left ventricular venting, and systemic hypothermia. Average patient age was 62 years (range: 30-89 years). 194 patients (38.8%) had urgent or emergent MRS. 251 patients (50.2%) had unstable angina and 123 others (24.6%) had preinfarction angina (rest pain in the hospital); 27 (5.4%) had evolving myocardial infarctions (MI). 174 patients (34.8%) had ejection fractions (EF) <0.50 including 75 patients (15.0%) with EFs <0.40; 16 patients (3.2%) had left ventricular aneurysms. Average number of grafts was 3.3 per patient and average ischemic time was 7.6 minutes per graft.
There were five hospital deaths (1.0%), none due to poor myocardial protection and low cardiac output. Only three survivors (0.6%) required an intra-aortic balloon pump (IABP) to wean from cardiopulmonary bypass (CPB): two had acute MIs preoperatively; the other had EF <0.30 and intractable atrial arrhythmias. Only two other patients (0.4%) received any inotropic infusions postoperatively. 18 patients (3.6%) had perioperative MIs.
These results, particularly the virtual absence of postoperative inotropic support, in unselected patients of whom 80% had acute coronary syndromes, indicate that intermittent ischemia (II) can provide excellent myocardial protection for MRS. Brief periods of II alleviate concerns about cardioplegic protection via occluded coronary arteries or internal mammary artery grafts. II provides a simple and safe alternative to cardioplegic arrest for myocardial protection during MRS.
Oxygenation of a Crystalloid Cardioplegic Solution
Authors: Hodges William E. , Beshere George A. , Dearing James P. , Sutton Robin G. 
Published: September 2023

The purpose of this study is to compare the effectiveness of an alternative method of oxygenating a crystalloid cardioplegic solution to the use of a bubble oxygenator. Five hundred milliliters of 100% oxygen was introduced, using sterile technique, into 100 ml bags of Ringer's solution at varying temperatures (20°, 10°, and 4°C). The contents of the bags were shaken for one minute by hand and then cooled to 4°C or maintained at that temperature using a Shiley CSD 103 Cardioplegia Delivery Set. This method of oxygenation was compared to constant bubbling of 100% oxygen into Ringer's solution in a Shiley S70 bubble oxygenator at 4°C.
Samples of oxygenated solution from the bubble oxygenator were collected over a 60 minute time period. After 30 minutes the values stabilized and the last 12 samples were used as the reference for the bubble oxygenator. Samples of the solutions cooled using the Shiley CSD 103 were taken when the temperature stabilized at 4°C. All 4°C samples were then analyzed for pO2 using an IL 326 blood gas analyzer and the values compared for the various techniques. The results of this study showed the following pO2 values:

S70
20°→4°C
10°→4°C
4°→4°C

n
12
12
12
12

x̅mmHg ± SD
1183 ± 28
795 ± 59
983 ± 26
1116 ± 18

The conclusion drawn from this study is that the use of Ringer's solution oxygenated and maintained at 4°C is a cost effective alternative to the use of a bubble oxygenator to increase the pO2 in crystalloid cardioplegic solutions.
Accuracy of polyp characterization by artificial intelligence and endoscopists: a prospective, non-randomized study in a tertiary endoscopy center
Authors: Baumer Sebastian , Streicher Kilian , Alqahtani Saleh A. , Brookman-Amissah Dominic , Brunner Monika , Federle Christoph , Muehlenberg Klaus , Pfeifer Lukas , Salzberger Andrea , Schorr Wolfgang , Zustin Jozef , Pech Oliver 
Published: September 2023

Abstract
Background and study aims Artificial intelligence (AI) in
gastrointestinal endoscopy is developing very fast. Computer-aided detection of polyps and
computer-aided diagnosis (CADx) for polyp characterization are available now. This study was
performed to evaluate the diagnostic performance of a new commercially available CADx system
in clinical practice.
Patients and methods This prospective, non-randomized study was
performed at a tertiary academic endoscopy center from March to August 2022. We included
patients receiving a colonoscopy. Polypectomy had to be performed in all polyps. Every patient
was examined concurrently by an endoscopist and AI using two opposing screens. The AI system,
overseen by a second observer, was not visible to the endoscopist. The primary outcome was
accuracy of the AI classifying the polyps into “neoplastic” and “non-neoplastic.” The
secondary outcome was accuracy of the classification by the endoscopists. Sessile serrated
lesions were classified as neoplastic.
Results We included 156 patients (mean age 65; 57 women) with 262
polyps ≤10 mm. Eighty-four were hyperplastic polyps (32.1%), 158 adenomas (60.3%), seven
sessile serrated lesions (2.7%) and 13 other entities (normal/inflammatory colonmucosa,
lymphoidic polyp) (4.9%) on histological diagnosis. Sensitivity, specificity and accuracy of
AI were 89.70% (95% confidence interval [CI]: 84.02%-93.88%), 75.26% (95% CI: 65.46%-83.46%)
and 84.35% (95% CI:79.38%-88.53%), respectively. Sensitivity, specificity and accuracy for
less experienced endoscopists (2–5 years of endoscopy) were 95.56% (95% CI: 84.85%-99.46%),
61.54% (95% CI: 40.57%-79.77%) and 83.10% (95% CI: 72.34%-90.95%) and for experienced
endoscopists 90.83% (95% CI: 84.19%-95.33%), 71.83% (95% CI: 59.90%-81.87%) and 83.77% (95%
CI: 77.76%-88.70%), respectively.
Conclusion Accuracy for polyp characterization by a new
commercially available AI system is high, but does not fulfill the criteria for a
“resect-and-discard” strategy.
Pilotstudie pferdegestützte Therapie bei Morbus
Parkinson
Authors: Alexandridis A. K. , Bittner H. , Straeten G. , Wittschier R. 
Published: September 2023

Zusammenfassung
Hintergrund Die S3-Leitlinie Idiopathisches Parkinson-Syndrom (IPS)
empfiehlt Bewegungstherapie als integralen Bestandteil der Behandlung. Basierend
auf vorliegenden Arbeiten zur Wirksamkeit pferdegestützter
(Bewegungs-)Therapie bei anderen neurologischen Erkrankungen sowie
Einzelfallberichten wurde die Hypothese aufgestellt, dass auch bei IPS eine
entsprechende Behandlung erfolgversprechend sein müsste. Kontrollierte
Studien zu dieser Fragestellung liegen nicht vor. Es ist unklar, ob durch eine
pferdegestützte Bewegungstherapie die Symptomatik von Patienten und
Patientinnen mit IPS verbessert werden kann und welche der gängigen
Tests zur Evaluierung der Effekte geeignet sind.
Methodik Im Rahmen einer kontrollierten, prospektiven und randomisierten
Multicenter-Studie wurden 20 Patienten und Patientinnen in 2 Gruppen à
10 Patienten und Patientinnen in die Studie inkludiert. Die Interventionsgruppe
erhielt add-on insgesamt 12 pferdegestützte Therapieeinheiten mit einer
Frequenz von 2 Mal/Woche; in beiden Gruppen wurde die weitere Behandlung
wie vor Studienbeginn beibehalten. Der neurologische Status wurde vor der ersten
und nach der letzten Therapieeinheit bei allen Probanden und Probandinnen
erhoben.
Ergebnisse In der Interventionsgruppe fand sich trotz der geringen
Patienten- und Patientinnenzahl eine hochsignifikante Verbesserung im MDS-UPDRS
(Unified Parkinson’s Disease Rating Scale der Movement Disorder Society)
Teil 3, bei der Gangbildtestung und der Beurteilung der posturalen
Stabilität. Weitere untersuchte Parameter zeigten durchweg positive
Trends, eine Verschlechterung konnte in keinem Fall beobachtet werden.
Diskussion In der Pilotstudie konnten deutliche Hinweise auf eine sehr
hohe Effektivität einer pferdegestützten Bewegungstherapie bei
Patienten und Patientinnen mit IPS dokumentiert werden. Durch die vorliegende
Studie konnten grundlegende Erkenntnisse zum Setting einer mit 100 Patienten und
Patientinnen geplanten Hauptstudie gewonnen werden.
Association of Four Medication Classes and Non-suicidal Self-injury
in Adolescents with Affective Disorders – A Retrospective Chart
Review
Authors: Eggart Vincent , Mortazavi Matin , Kirchner Sophie-Kathrin , Keeser Daniel , Brandstetter Lisa , Hasan Alkomiet , Wagner Elias 
Published: September 2023

Abstract
Background Non-suicidal self-injury (NSSI) behaviour is frequently
observed in children and adolescents with psychiatric conditions. Affected
individuals are regularly treated with psychotropic drugs, although the impact
of these agents on NSSI behaviour remains elusive.
Methods We performed a retrospective chart review from clinical routine
data in a large cohort (N=1140) of adolescent inpatients with primary
affective and non-affective psychiatric disorders according to ICD-10 (mean
age=15.3±1.3 years; 72.6% female). Four separate mixed
regression models compared the frequency of NSSI between treatment periods
without any medication and four medication categories (benzodiazepines,
selective serotonin reuptake inhibitors (SSRIs), high- and low-potency
antipsychotics).
Results In those individuals with affective disorders as the primary
diagnosis, periods without medication were associated with significantly lower
NSSI/day compared to all four other medication conditions
(benzodiazepines p<10−8,
antidepressants/SSRIs p=0.0004, high-potency antipsychotics
p=0.0009, low-potency antipsychotics p<10
−4). In individuals with a primary diagnosis other than an
affective disorder, NSSI was significantly lower during the period without
medication compared to the treatment periods with benzodiazepines
(p=0.005) and antidepressants/SSRIs (p=0.01). However,
NSSI rates in the no-medication condition were comparable to NSSI rates under
high-potency (p=0.89) and low-potency antipsychotics
(p=0.53).
Conclusions The occurrence of NSSI correlates with the treatment with a
psychotropic drug in children and adolescents with psychiatric disorders. Due to
the retrospective design, it remains elusive to what extent psychotropic drugs
might alter the frequency of NSSI in adolescents or if NSSI might indicate a
transdiagnostic feature of more pronounced disease severity.
Vanderbilt Electronic Health Record Voice Assistant Supports Clinicians
Authors: Kumah-Crystal Yaa A. , Lehmann Christoph U. , Albert Dan , Coffman Tim , Alaw Hala , Roth Sydney , Manoni Alexandra , Shave Peter , Johnson Kevin B. 
Published: September 2023

Abstract
Background Electronic health records (EHRs) present navigation challenges due to time-consuming searches across segmented data. Voice assistants can improve clinical workflows by allowing natural language queries and contextually aware navigation of the EHR.
Objectives To develop a voice-mediated EHR assistant and interview providers to inform its future refinement.
Methods The Vanderbilt EHR Voice Assistant (VEVA) was developed as a responsive web application and designed to accept voice inputs and execute the appropriate EHR commands. Fourteen providers from Vanderbilt Medical Center were recruited to participate in interactions with VEVA and to share their experience with the technology. The purpose was to evaluate VEVA's overall usability, gather qualitative feedback, and detail suggestions for enhancing its performance.
Results VEVA's mean system usability scale score was 81 based on the 14 providers' evaluations, which was above the standard 50th percentile score of 68. For all five summaries evaluated (overview summary, A1C results, blood pressure, weight, and health maintenance), most providers offered a positive review of VEVA. Several providers suggested modifications to make the technology more useful in their practice, ranging from summarizing current medications to changing VEVA's speech rate. Eight of the providers (64%) reported they would be willing to use VEVA in its current form.
Conclusion Our EHR voice assistant technology was deemed usable by most providers. With further improvements, voice assistant tools such as VEVA have the potential to improve workflows and serve as a useful adjunct tool in health care.
Complete Remission of Cutaneous Metastasis from Invasive Breast Cancer with Abemaciclib plus Letrozole
Authors: Valame Shaunak N. , Manek Dhruti D. 
Published: September 2023

AbstractSkin metastases from internal malignancies can be the first clinical finding of cancer recurrence. If presentation is delayed, they may ulcerate and develop secondary infection. Through this case, we will highlight a case of breast cancer recurrence with extensive cutaneous metastases that clinically completely responded to oral systemic therapy, thereby obviating the need for chemotherapy and leading to stark improvement in performance status and quality of life.
The impact of the digital economy on inter-city carbon transfer in China using the life cycle assessment model
Authors: Luan Bingjiang , Yang Hanshuo , Zou Hong , Yu Xi 
Published: September 2023

AbstractThe haven paradise hypothesis has been widely supported in the international carbon transfer, but there is still a lack of inter-city evidence. The emergence of the digital economy in recent years has introduced unprecedented opportunities and challenges for carbon emissions reduction and carbon transfer. As the world’s largest carbon emitter and a major player in the digital economy, exploring whether the pollution haven hypothesis exists among cities in China and how the digital economy affects inter-city carbon transfer is crucial for countries to optimize their domestic carbon reduction structures. To this end, this paper employs the 2012 and 2015 Chinese Urban Household Survey data alongside input-output tables based on the life cycle assessment method to quantify the inter-city carbon transfer. In addition, the impact and mechanisms of the digital economy on inter-city carbon transfer are explored using the two-way fixed effects model. The results show that 54% of Chinese cities’ carbon emissions come from outside, with third-tier cities bearing high carbon transfer pressures, indicating the presence of the pollution haven hypothesis. The digital economy exacerbates inter-city carbon transfer by promoting market integration and facilitating industrial transfer, and it mainly promotes the transfer of high-intensity carbon emissions to third-tier cities. Considering carbon emission reduction targets, mandatory environmental regulations have strengthened the effect of the digital economy on carbon transfer. Therefore, the Chinese government needs to properly address carbon transfer by improving the collaborative carbon reduction system, enhancing carbon emission reduction efficiency, and accelerating the equitable progress of the digital economy.
Effects of manufacturing input servitization on labor income share and income distribution
Authors: Wang Hongsen , Guo Qing , Kuang Xianming 
Published: September 2023

AbstractIn recent times, a transformative phenomenon has emerged within the realm of manufacturing known as “manufacturing input servitization.” This concept involves the integration of services into traditional manufacturing processes, and while it has received some attention, its implications for labor income distribution have not been extensively explored. This study embarks on an exploration of the intricate relationship between manufacturing input servitization and labor income share, with a specific focus on its impact on income distribution. Employing rigorous regression analysis techniques, this paper rigorously assesses the relationship between manufacturing input servitization and labor income share. Our analysis also delves into mediation effects, uncovering the pivotal roles played by labor productivity and human capital in driving labor income share improvements. The results consistently reveal a positive correlation between manufacturing input servitization and labor income share, an association that persists even after controlling for various factors. Heterogeneity analysis further showcases that the medium-technology manufacturing sector benefits the most from servitization, closely followed by the high-technology and low-technology sectors. In addition, this research highlights a pronounced impact of manufacturing servitization on labor income in developing economies compared to their developed counterparts. Beyond the empirical discoveries, extended analysis reveals a implication: the enhancement of labor income share in the manufacturing sector contributes significantly to reducing income inequality across the broader economy. These findings hold substantial implications for both policymakers and manufacturing firms. Encouraging the adoption of servitization strategies within manufacturing not only fosters labor income growth but also aligns with the broader societal goal of reducing income inequality. As such, this research provides invaluable insights for stakeholders committed to nurturing inclusive economic growth.