bluuebunny/crossref_metadata_2025_split huggingface dataset:
Simulation im Wahlfach Rechtsmedizin im Dritten Abschnitt der Ärztlichen Prüfung
Authors: Stoevesandt Dietrich , Woydt Lina , Steglich Jonas , Lessig Rüdiger , Rudzki Mathias , Schlitt Axel , Weber Marko 
Published: July 2022

ZusammenfassungIn der COVID-19-Pandemie konnte der Dritte Abschnitt der Ärztlichen Prüfung an Simulationspersonen und Simulatoren durchgeführt werden. Auch im Fach Rechtsmedizin ist deren Einsatz sinnvoll, da eine höhere Standardisierung und Vergleichbarkeit von Prüfungsleistungen erreicht wird und die Verwendung von echten Leichnamen aus medikolegalen Gründen oft nicht vertretbar ist. Der vorliegende Fall berichtet über die Vor- und Nachteile einer Simulation im Staatsexamen, in der anhand einer Leichenschau am Simulator und einer Fremdanamnese eine Todesbescheinigung vollständig ausgefüllt werden sollte.
Quantitative evaluation of a deep learning-based framework to generate whole-body attenuation maps using LSO background radiation in long axial FOV PET scanners
Authors: Sari Hasan , Teimoorisichani Mohammadreza , Mingels Clemens , Alberts Ian , Panin Vladimir , Bharkhada Deepak , Xue Song , Prenosil George , Shi Kuangyu , Conti Maurizio , Rominger Axel 
Published: July 2022

Abstract

Purpose
Attenuation correction is a critically important step in data correction in positron emission tomography (PET) image formation. The current standard method involves conversion of Hounsfield units from a computed tomography (CT) image to construct attenuation maps (µ-maps) at 511 keV. In this work, the increased sensitivity of long axial field-of-view (LAFOV) PET scanners was exploited to develop and evaluate a deep learning (DL) and joint reconstruction-based method to generate µ-maps utilizing background radiation from lutetium-based (LSO) scintillators.

Methods
Data from 18 subjects were used to train convolutional neural networks to enhance initial µ-maps generated using joint activity and attenuation reconstruction algorithm (MLACF) with transmission data from LSO background radiation acquired before and after the administration of 18F-fluorodeoxyglucose (18F-FDG) (µ-mapMLACF-PRE and µ-mapMLACF-POST respectively). The deep learning-enhanced µ-maps (µ-mapDL-MLACF-PRE and µ-mapDL-MLACF-POST) were compared against MLACF-derived and CT-based maps (µ-mapCT). The performance of the method was also evaluated by assessing PET images reconstructed using each µ-map and computing volume-of-interest based standard uptake value measurements and percentage relative mean error (rME) and relative mean absolute error (rMAE) relative to CT-based method.

Results
No statistically significant difference was observed in rME values for µ-mapDL-MLACF-PRE and µ-mapDL-MLACF-POST both in fat-based and water-based soft tissue as well as bones, suggesting that presence of the radiopharmaceutical activity in the body had negligible effects on the resulting µ-maps. The rMAE values µ-mapDL-MLACF-POST were reduced by a factor of 3.3 in average compared to the rMAE of µ-mapMLACF-POST. Similarly, the average rMAE values of PET images reconstructed using µ-mapDL-MLACF-POST (PETDL-MLACF-POST) were 2.6 times smaller than the average rMAE values of PET images reconstructed using µ-mapMLACF-POST. The mean absolute errors in SUV values of PETDL-MLACF-POST compared to PETCT were less than 5% in healthy organs, less than 7% in brain grey matter and 4.3% for all tumours combined.

Conclusion
We describe a deep learning-based method to accurately generate µ-maps from PET emission data and LSO background radiation, enabling CT-free attenuation and scatter correction in LAFOV PET scanners.
mCRPC patients with PSA fluctuations under radioligand therapy have comparable survival benefits relative to patients with sustained PSA decrease
Authors: Hartrampf Philipp E. , Bundschuh Ralph A. , Weinzierl Franz-Xaver , Serfling Sebastian E. , Kosmala Aleksander , Seitz Anna Katharina , Kübler Hubert , Buck Andreas K. , Essler Markus , Werner Rudolf A. 
Published: July 2022

Abstract
Introduction
In men with metastatic castration-resistant prostate cancer (mCRPC) scheduled for prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT), biochemical response is assessed based on repeated measurements of prostate-specific antigen (PSA) levels. We aimed to determine overall survival (OS) in patients experiencing sustained PSA increase, decrease, or fluctuations during therapy.

Materials and methods
In this bicentric study, we included 176 mCRPC patients treated with PSMA-directed RLT. PSA levels were determined using blood samples prior to the first RLT and on the admission days for the following cycles. We calculated relative changes in PSA levels compared to baseline. Kaplan–Meier curves as well as log-rank test were used to compare OS of different subgroups, including patients with sustained PSA increase, decrease, or fluctuations (defined as change after initial decrease or increase after the first cycle).

Results
Sixty-one out of one hundred seventy-six (34.7%) patients showed a sustained increase and 86/176 (48.8%) a sustained decrease in PSA levels. PSA fluctuations were observed in the remaining 29/176 (16.5%). In this subgroup, 22/29 experienced initial PSA decrease followed by an increase (7/29, initial increase followed by a decrease). Median OS of patients with sustained decrease in PSA levels was significantly longer when compared to patients with sustained increase of PSA levels (19 vs. 8 months; HR 0.35, 95% CI 0.22–0.56; P < 0.001). Patients with PSA fluctuations showed a significantly longer median OS compared to patients with sustained increase of PSA levels (18 vs. 8 months; HR 0.49, 95% CI 0.30–0.80; P < 0.01), but no significant difference relative to men with sustained PSA decrease (18 vs. 19 months; HR 1.4, 95% CI 0.78–2.49; P = 0.20). In addition, in men experiencing PSA fluctuations, median OS did not differ significantly between patients with initial decrease or initial increase of tumor marker levels (16 vs. 18 months; HR 1.2, 95% CI 0.38–4.05; P = 0.68).

Conclusion
Initial increase or decrease of PSA levels is sustained in the majority of patients undergoing RLT. Sustained PSA decrease was linked to prolonged survival and men with PSA fluctuations under treatment experienced comparable survival benefits. As such, transient tumor marker oscillations under RLT should rather not lead to treatment discontinuation, especially in the absence of radiological progression.
Association of Abdominal Arterial Calcification Score with Patients’ Survival and Kidney Allograft Function after Kidney Transplant
Authors: Jarmi Tambi , Spaulding Aaron C. , Jebrini Abdullah , Sella David M. , Alexander Lauren F. , Nussbaum Samuel , Shoukry Mira , White Launia , Wadei Hani M. , Farres Houssam 
Published: July 2022

AbstractBackgroundAbdominal arterial calcification (AAC) is common among candidates for kidney transplant. The aim of this study is to correlate AAC score value with post‐kidney transplant outcomes.MethodsWe modified the coronary calcium score by changing the intake data points and used it to quantitate the AAC. We conducted a retrospective clinical study of all adult patients who were transplanted at our center, between 2010 and 2013, and had abdominal computed tomography scan done before transplantation. Outcomes included mortality, pulse pressure (PP) measured by 24 h ambulatory blood pressure monitoring system, and kidney allograft function measured by iothalamate clearance.ResultsFor each 1000 increase of AAC score value, there is an associated 1.05 increase in the risk of death (95% CI 1.02, 1.08) (p < 0.001). Overall median AAC value for all patients was 1784; Kaplan–Meier curve showed reduced survival of all‐cause mortality for patients with AAC score value above median and reduced survival among patients with cardiac related mortality. The iothalamate clearance was lower among patients with total AAC score value above the median. Patients with abnormal PP (< 40 or > 60 mmHg) had an elevated median AAC score value at 4319.3 (IQR 1210.4, 11097.1) compared to patients with normal PP with AAC score value at 595.9 (IQR 9.9, 2959.9) (p < 0.001).ConclusionWe showed an association of AAC with patients’ survival and kidney allograft function after kidney transplant. The AAC score value could be used as a risk stratification when patients are considered for kidney transplant.
Applications of machine learning for imaging-driven diagnosis of musculoskeletal malignancies—a scoping review
Authors: Hinterwimmer Florian , Consalvo Sarah , Neumann Jan , Rueckert Daniel , von Eisenhart-Rothe Rüdiger , Burgkart Rainer 
Published: July 2022

Abstract
Musculoskeletal malignancies are a rare type of cancer. Consequently, sufficient imaging data for machine learning (ML) applications is difficult to obtain. The main purpose of this review was to investigate whether ML is already having an impact on imaging-driven diagnosis of musculoskeletal malignancies and what the respective reasons for this might be. A scoping review was conducted by a radiologist, an orthopaedic surgeon and a data scientist to identify suitable articles based on the PRISMA statement. Studies meeting the following criteria were included: primary malignant musculoskeletal tumours, machine/deep learning application, imaging data or data retrieved from images, human/preclinical, English language and original research. Initially, 480 articles were found and 38 met the eligibility criteria. Several continuous and discrete parameters related to publication, patient distribution, tumour specificities, ML methods, data and metrics were extracted from the final articles. For the synthesis, diagnosis-oriented studies were further examined by retrieving the number of patients and labels and metric scores. No significant correlations between metrics and mean number of samples were found. Several studies presented that ML could support imaging-driven diagnosis of musculoskeletal malignancies in distinct cases. However, data quality and quantity must be increased to achieve clinically relevant results. Compared to the experience of an expert radiologist, the studies used small datasets and mostly included only one type of data. Key to critical advancement of ML models for rare diseases such as musculoskeletal malignancies is a systematic, structured data collection and the establishment of (inter)national networks to obtain substantial datasets in the future.

Key Points
• Machine learning does not yet significantly impact imaging-driven diagnosis for musculoskeletal malignancies compared to other disciplines such as lung, breast or CNS cancer.
• Research in the area of musculoskeletal tumour imaging and machine learning is still very limited.
• Machine learning in musculoskeletal tumour imaging is impeded by insufficient availability of data and rarity of the disease.
Breast MRI: does a clinical decision algorithm outweigh reader experience?
Authors: Pötsch Nina , Korajac Aida , Stelzer Philipp , Kapetas Panagiotis , Milos Ruxandra-Iulia , Dietzel Matthias , Helbich Thomas H. , Clauser Paola , Baltzer Pascal A. T. 
Published: July 2022

Abstract
Objectives
Due to its high sensitivity, DCE MRI of the breast (MRIb) is increasingly used for both screening and assessment purposes. The Kaiser score (KS) is a clinical decision algorithm, which formalizes and guides diagnosis in breast MRI and is expected to compensate for lesser reader experience. The aim was to evaluate the diagnostic performance of untrained residents using the KS compared to off-site radiologists experienced in breast imaging using only MR BI-RADS.

Methods
Three off-site, board-certified radiologists, experienced in breast imaging, interpreted MRIb according to the MR BI-RADS scale. The same studies were read by three residents in radiology without prior training in breast imaging using the KS. All readers were blinded to clinical information. Histology was used as the gold standard. Statistical analysis was conducted by comparing the AUC of the ROC curves.

Results
A total of 80 women (median age 52 years) with 93 lesions (32 benign, 61 malignant) were included. The individual within-group performance of the three expert readers (AUC 0.723–0.742) as well as the three residents was equal (AUC 0.842–0.928), p > 0.05, respectively. But, the rating of each resident using the KS significantly outperformed the experts’ ratings using the MR BI-RADS scale (p ≤ 0.05).

Conclusion
The KS helped residents to achieve better results in reaching correct diagnoses than experienced radiologists empirically assigning MR BI-RADS categories in a clinical “problem solving MRI” setting. These results support that reporting breast MRI benefits more from using a diagnostic algorithm rather than expert experience.

Key Points
• Reporting breast MRI benefits more from using a diagnostic algorithm rather than expert experience in a clinical “problem solving MRI” setting.
• The Kaiser score, which provides a clinical decision algorithm for structured reporting, helps residents to reach an expert level in breast MRI reporting and to even outperform experienced radiologists using MR BI-RADS without further formal guidance.
3D finite-element brain modeling of lateral ventricular wall loading to rationalize periventricular white matter hyperintensity locations
Authors: Caçoilo Andreia , Rusinek Henry , Weickenmeier Johannes 
Published: July 2022

AbstractAging-related periventricular white matter hyperintensities (pvWMHs) are a common observation in medical images of the aging brain. The underlying tissue damage is part of the complex pathophysiology associated with age-related microstructural changes and cognitive decline. PvWMH formation is linked to blood–brain barrier dysfunction from cerebral small vessel disease as well as the accumulation of cerebrospinal fluid in periventricular tissue due to progressive denudation of the ventricular wall. In need of a unifying theory for pvWMH etiology, image-based finite-element modeling is used to demonstrate that ventricular expansion from age-related cerebral atrophy and hemodynamic loading leads to maximum mechanical loading of the ventricular wall in the same locations that show pvWMHs. Ventricular inflation, induced via pressurization of the ventricular wall, creates significant ventricular wall stretch and stress on the ependymal cells lining the wall, that are linked to cerebrospinal fluid leaking from the lateral ventricles into periventricular white matter tissue. Eight anatomically accurate 3D brain models of cognitively healthy subjects with a wide range of ventricular shapes are created. For all models, our simulations show that mechanomarkers of mechanical wall loading are consistently highest in pvWMHs locations (p < 0.05). Maximum principal strain, the ependymal cell thinning ratio, and wall curvature are on average 14%, 8%, and 24% higher in pvWMH regions compared to the remaining ventricular wall, respectively. Computational modeling provides a powerful framework to systematically study pvWMH formation and growth with the goal to develop pharmacological interventions in the future.
Real-time monitoring of intravenous thrombolysis in acute ischemic stroke using rotational thromboelastometry: a feasibility pilot study
Authors: Tinchon Alexander , Freydl Elisabeth , Fitzgerald Robert D. , Duarte Christina , Weber Michael , Calabek-Wohinz Bernadette , Waiß Christoph , Oberndorfer Stefan 
Published: July 2022

Abstract
Introduction
Rotational thromboelastometry (ROTEM) records whole blood coagulation in vitro. Data on dynamic changes of clot patterns during intravenous thrombolysis (IVT) in acute ischemic stroke is scarce. We investigated the feasibility of ROTEM as a potential point-of-care assessment tool for IVT.

Methods
In this prospective pilot study, patients with acute stroke symptoms received IVT. Whole blood coagulation was tracked on the ROTEM analyzer. Blood samples were analyzed before, and then 2, 15, 30 and 60 min after beginning IVT. In vitro clots (iCLs) were described by their maximum clot firmness (MCF), the time needed to reach MCF (MCF-t), as well as the area under the curve (AR10). National Institutes of Health Stroke Scale (NIHSS) was used as early clinical outcome parameter.

Results
We analyzed 288 iCLs from 12 patients undergoing IVT. In all iCLs, an early fibrinolysis (91% within the first 10 min) was detected during IVT. Three different curve progression patterns were observed: a low-responder pattern with a continuous clot increase, a high-responder pattern with a sustained clot decrease or total clotting suppression and an intermediate-responder pattern with alternating clot characteristics. There was a difference among these groups in early clinical outcome (AR10 and MCF each p = 0.01, MCF-t p = 0.02, Kruskal–Wallis Test).

Conclusion
The fibrinolysis patterns determined using ROTEM allow for the monitoring of IVT in patients with acute ischemic stroke. This pilot study found a correlation between the in vitro fibrinolysis patterns and early clinical outcomes. These findings support a potential for individualization of IVT in the future.
The role of bariatric surgery in liver transplantation: timing and type
Authors: Safavi Danial , Creavin Ben , Gallagher Tom K. , Kelly Michael E. 
Published: July 2022

Abstract

Introduction
The rise in obesity worldwide has shifted the indications for liver transplantation (LT), with non-alcoholic steatohepatitis (NASH) being the second most common indication for transplantation. There remains an underestimation of cirrhosis being attributed to NASH. Bariatric surgery (BS) is a reliable solution to overcome obesity and its associated comorbidities. The role of BS in LT has been investigated by different studies; however, the type of BS and timing of LT need further investigation.

Methods
A systemic review examining the role of BS in LT patients was performed. After selection of the studies based on inclusion and exclusion criteria, data extraction was performed by two independent reviewers. Primary outcomes included patient and graft survival.

Results
From a total of 2374 articles, five met the prefined criteria. One hundred sixty-two patients had both BS + LT and 1426 underwent LT alone. The percentage of female patients in the BS + LT and LT cohorts was 75% and 35% respectively. The average age in BS + LT and LT cohorts was 43.05 vs. 56.22 years respectively. Patients undergoing BS had comparable outcomes in terms of overall patient survival, graft survival and post-operative morbidity compared to LT alone. When comparing BMI change in patients with prior versus simultaneous BS + LT, no significant difference was found.

Conclusion
BS and LT patients achieve comparable outcomes to general LT populations. Further studies examining simultaneous BS + LT are needed to answer questions concerning patient selection and timing of surgery.
Harnessing the benefits of yoga for myositis, muscle dystrophies, and other musculoskeletal disorders
Authors: Saud Ahmad , Abbasi Maryam , Merris Holly , Parth Pranav , Jones Xaviar Michael , Aggarwal Rohit , Gupta Latika 
Published: July 2022

AbstractThe recent global increase in popularity of home-based yoga, an ancient Indian technique practiced for thousands of years, has translated into its use as a complementary therapy for a multitude of ailments. This review aims to examine the published literature regarding the effects of yoga therapy on systemic chronic diseases; in particular on the inflammatory myopathies (IMs) and other muscle disorders.Despite the fact that the evidence base for yoga in inflammatory myositis is in its infancy, collateral results in other disorders such as muscular dystrophies are promising. A beneficial effect of yoga in chronic pain has been shown alongside an improvement in motor function and muscle strength. Patients with Duchenne muscular dystrophy with respiratory involvement may find improvement in lung function. Elderly patients may experience reduction in falls secondary to an improvement in balance while practicing long-term yoga therapy.Further benefits are improving disorders of mental health such as depression and anxiety. A reported improvement in overall quality of life further suggests its efficacy in reducing morbidity in patients with chronic diseases, who often suffer co-existent psychological comorbidities.
Left ventricular assist device and pump thrombosis: the importance of the inflow cannula position
Authors: Kortekaas Kirsten A. , de Graaf Michiel A. , Palmen Meindert , Braun Jerry , Mertens Bart J. A. , Tops Laurens F. , Beeres Saskia L. M. A. 
Published: July 2022

AbstractPump thrombosis is a devastating complication after left ventricular assist device implantation. This study aims to elucidate the relation between left ventricular assist device implantation angle and risk of pump thrombosis. Between November 2010 and March 2020, 53 left ventricular assist device-patients underwent a computed tomography scan. Using a 3-dimensional multiplanar reformation the left ventricular axis was reconstructed to measure the implantation angle of the inflow cannula. All patients were retrospectively analyzed for the occurrence of pump thrombosis. In 10 (91%) patients with a pump thrombosis, the implantation angle was towards the lateral wall of the left ventricle. In only 20 patients (49%) of the patients without a pump thrombosis the inflow cannula pointed towards the lateral wall of the left ventricle. The mean angle in patients with a pump thrombosis was 10.1 ± 11.9 degrees towards the lateral wall of the left ventricle compared to 4.1 ± 19.9 degrees towards the septum in non-pump thrombosis patients (P = 0.005). There was a trend towards a significant difference in time to first pump thrombosis between patients with a lateral or septal deviated left ventricular assist device (hazard ratio of 0.15, P = 0.07). This study demonstrates that left ventricular assist device implantation angle is associated with pump thrombosis. Almost all patients in whom a pump thrombosis occurred during follow-up had a left ventricular assist device implanted with the inflow-cannula pointing towards the lateral wall of the left ventricle.
Dynamic slate recommendation with gated recurrent units and Thompson sampling
Authors: Eide Simen , Leslie David S. , Frigessi Arnoldo 
Published: July 2022

AbstractWe consider the problem of recommending relevant content to users of an internet platform in the form of lists of items, called slates. We introduce a variational Bayesian Recurrent Neural Net recommender system that acts on time series of interactions between the internet platform and the user, and which scales to real world industrial situations. The recommender system is tested both online on real users, and on an offline dataset collected from a Norwegian web-based marketplace, FINN.no, that is made public for research. This is one of the first publicly available datasets which includes all the slates that are presented to users as well as which items (if any) in the slates were clicked on. Such a data set allows us to move beyond the common assumption that implicitly assumes that users are considering all possible items at each interaction. Instead we build our likelihood using the items that are actually in the slate, and evaluate the strengths and weaknesses of both approaches theoretically and in experiments. We also introduce a hierarchical prior for the item parameters based on group memberships. Both item parameters and user preferences are learned probabilistically. Furthermore, we combine our model with bandit strategies to ensure learning, and introduce ‘in-slate Thompson sampling’ which makes use of the slates to maximise explorative opportunities. We show experimentally that explorative recommender strategies perform on par or above their greedy counterparts. Even without making use of exploration to learn more effectively, click rates increase simply because of improved diversity in the recommended slates.