Artículos de revistas: "Slice admission control"

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Han, Bin, Di Feng y Hans D. Schotten. "A Markov Model of Slice Admission Control". IEEE Networking Letters 1, n.º 1 (marzo de 2019): 2–5. http://dx.doi.org/10.1109/lnet.2018.2873978.

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Ibrahim, Mai, Mohamed TALAAT FAHIM y Nada Elshennawy. "Slice Admission control based on Reinforcement Learning for 5G Networks". Journal of Engineering Research 7, n.º 3 (1 de septiembre de 2023): 144–52. http://dx.doi.org/10.21608/erjeng.2023.228909.1209.

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Challa, Rajesh, Vyacheslav V. Zalyubovskiy, Syed M. Raza, Hyunseung Choo y Aloknath De. "Network Slice Admission Model: Tradeoff Between Monetization and Rejections". IEEE Systems Journal 14, n.º 1 (marzo de 2020): 657–60. http://dx.doi.org/10.1109/jsyst.2019.2904667.

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Ampririt, Phudit, Yi Liu, Makoto Ikeda, Keita Matsuo, Leonard Barolli y Makoto Takizawa. "Effect of Slice Priority for admission control in 5G Wireless Networks: A comparison study for two Fuzzy-based systems considering Software-Defined-Networks". Journal of High Speed Networks 26, n.º 3 (27 de noviembre de 2020): 169–83. http://dx.doi.org/10.3233/jhs-200637.

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The Fifth Generation (5G) networks are expected to be flexible to satisfy demands of high-quality services such as high speed, low latencies and enhanced reliability from customers. Also, the rapidly increasing amount of user devices and high user’s requests becomes a problem. Thus, the Software-Defined Network (SDN) will be the key function for efficient management and control. To deal with these problems, we propose a Fuzzy-based SDN approach. This paper presents and compares two Fuzzy-based Systems for Admission Control (FBSAC) in 5G wireless networks: FBSAC1 and FBSAC2. The FBSAC1 considers for admission control decision three parameters: Grade of Service (GS), User Request Delay Time (URDT) and Network Slice Size (NSS). In FBSAC2, we consider as an additional parameter the Slice Priority (SP). So, FBSAC2 has four input parameters. The simulation results show that the FBSAC2 is more complex than FBSAC1, but it has a better performance for admission control.

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Koutlia, K., R. Ferrús, E. Coronado, R. Riggio, F. Casadevall, A. Umbert y J. Pérez-Romero. "Design and Experimental Validation of a Software-Defined Radio Access Network Testbed with Slicing Support". Wireless Communications and Mobile Computing 2019 (12 de junio de 2019): 1–17. http://dx.doi.org/10.1155/2019/2361352.

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Network slicing is a fundamental feature of 5G systems to partition a single network into a number of segregated logical networks, each optimized for a particular type of service or dedicated to a particular customer or application. The realization of network slicing is particularly challenging in the Radio Access Network (RAN) part, where multiple slices can be multiplexed over the same radio channel and Radio Resource Management (RRM) functions shall be used to split the cell radio resources and achieve the expected behaviour per slice. In this context, this paper describes the key design and implementation aspects of a Software-Defined RAN (SD-RAN) experimental testbed with slicing support. The testbed has been designed consistently with the slicing capabilities and related management framework established by 3GPP in Release 15. The testbed is used to demonstrate the provisioning of RAN slices (e.g., preparation, commissioning, and activation phases) and the operation of the implemented RRM functionality for slice-aware admission control and scheduling.

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Ojijo, Mourice O. y Olabisi E. Falowo. "A Survey on Slice Admission Control Strategies and Optimization Schemes in 5G Network". IEEE Access 8 (2020): 14977–90. http://dx.doi.org/10.1109/access.2020.2967626.

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Hurtado Sánchez, Johanna Andrea, Katherine Casilimas y Oscar Mauricio Caicedo Rendon. "Deep Reinforcement Learning for Resource Management on Network Slicing: A Survey". Sensors 22, n.º 8 (15 de abril de 2022): 3031. http://dx.doi.org/10.3390/s22083031.

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Network Slicing and Deep Reinforcement Learning (DRL) are vital enablers for achieving 5G and 6G networks. A 5G/6G network can comprise various network slices from unique or multiple tenants. Network providers need to perform intelligent and efficient resource management to offer slices that meet the quality of service and quality of experience requirements of 5G/6G use cases. Resource management is far from being a straightforward task. This task demands complex and dynamic mechanisms to control admission and allocate, schedule, and orchestrate resources. Intelligent and effective resource management needs to predict the services’ demand coming from tenants (each tenant with multiple network slice requests) and achieve autonomous behavior of slices. This paper identifies the relevant phases for resource management in network slicing and analyzes approaches using reinforcement learning (RL) and DRL algorithms for realizing each phase autonomously. We analyze the approaches according to the optimization objective, the network focus (core, radio access, edge, and end-to-end network), the space of states, the space of actions, the algorithms, the structure of deep neural networks, the exploration–exploitation method, and the use cases (or vertical applications). We also provide research directions related to RL/DRL-based network slice resource management.

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Hikmah Puspita, Ratih, Jehad Ali y Byeong-hee Roh. "An Intelligent Admission Control Scheme for Dynamic Slice Handover Policy in 5G Network Slicing". Computers, Materials & Continua 75, n.º 2 (2023): 4611–31. http://dx.doi.org/10.32604/cmc.2023.033598.

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Jiang, Weiwei, Yafeng Zhan y Xiaolong Xiao. "Multi-Domain Network Slicing in Satellite–Terrestrial Integrated Networks: A Multi-Sided Ascending-Price Auction Approach". Aerospace 10, n.º 10 (23 de septiembre de 2023): 830. http://dx.doi.org/10.3390/aerospace10100830.

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With the growing demand for massive access and data transmission requests, terrestrial communication systems are inefficient in providing satisfactory services. Compared with terrestrial communication networks, satellite communication networks have the advantages of wide coverage and support for massive access services. Satellite–terrestrial integrated networks are indispensable parts of future B5G/6G networks. Challenges arise for implementing and operating a successful satellite–terrestrial integrated network, including differentiated user requirements, infrastructure compatibility, limited resource constraints, and service provider incentives. In order to support diversified services, a multi-domain network slicing approach is proposed in this study, in which network resources from both terrestrial and satellite networks are combined to build alternative routes when serving the same slice request as virtual private networks. To improve the utilization efficiency of limited resources, slice admission control is formulated as a mechanism design problem. To encourage participation and cooperation among different service providers, a multi-sided ascending-price auction mechanism is further proposed as a game theory-based solution for slice admission control and resource allocation, in which multiple strategic service providers maximize their own utilities by trading bandwidth resources. The proposed auction mechanism is proven to be strongly budget-balanced, individually rational, and obviously truthful. To validate the effectiveness of the proposed approach, real-world historical traffic data are used in the simulation experiments and the results show that the proposed approach is asymptotically optimal with the increase in users and competitive with the polynomial-time optimal trade mechanism, in terms of admission ratio and service provider profit.

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Othman, Anuar y Nazrul Anuar Nayan. "Efficient admission control and resource allocation mechanisms for public safety communications over 5G network slice". Telecommunication Systems 72, n.º 4 (27 de julio de 2019): 595–607. http://dx.doi.org/10.1007/s11235-019-00600-9.

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Ampririt, Phudit, Ermioni Qafzezi, Kevin Bylykbashi, Makoto Ikeda, Keita Matsuo y Leonard Barolli. "Application of Fuzzy Logic for Slice QoS in 5G Networks". International Journal of Mobile Computing and Multimedia Communications 12, n.º 2 (abril de 2021): 18–35. http://dx.doi.org/10.4018/ijmcmc.2021040102.

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The fifth generation (5G) network is expected to be flexible to satisfy quality of service (QoS) requirements, and the software-defined network (SDN) with network slicing will be a good approach for admission control. In this paper, the authors present and compare two fuzzy-based schemes to evaluate the QoS (FSQoS). They call these schemes FSQoS1 and FSQoS2. The FSQoS1 considers three parameters: slice throughput (ST), slice delay (SD), and slice loss (SL). In FSQoS2, they consider as an additional parameter the slice reliability (SR). So, FSQoS2 has four input parameters. They carried out simulations for evaluating the performance of the proposed schemes. From simulation results, they conclude that the considered parameters have different effects on the QoS performance. The FSQoS2 is more complex than FSQoS1, but it has a better performance for evaluating QoS. When ST and SR are increasing, the QoS parameter is increased. But, when SD and SL are increasing, the QoS is decreased. When ST is 0.1, SD is 0.1, SL is 0.1, and the QoS is increased by 32.02% when SR is increased from 0.3 to 0.8.

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Ampririt, Phudit, Ermioni Qafzezi, Kevin Bylykbashi, Makoto Ikeda, Keita Matsuo y Leonard Barolli. "International Journal of Distributed Systems and Technologies (IJDST)". International Journal of Distributed Systems and Technologies 13, n.º 1 (1 de enero de 2022): 1–25. http://dx.doi.org/10.4018/ijdst.300339.

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In our previous work, we proposed an Integrated Fuzzy-based Admission Control System (IFACS) for admission control in 5G wireless networks. In this paper, we present a new system by considering Service Level Agreement (SLA) as a new parameter. We call this system IFACS-Q3S. We also implemented a new scheme for Slice Overloading Cost (SOC), called Fuzzy-based Scheme for SOC (FSSOC). The SOC is used as a new input for the IFACS-Q3S system. The other input parameters for IFACS-Q3S are Quality of Service (QoS), Slice Priority (SP) and SLA. From simulation results, we conclude that the considered parameters have different effects on the acceptance decision. The increase of QoS, SP, and SLA caused an increase in the AD value, whereas the increase in SOC resulted in a decrease in the AD value. For SOC 0.3, when the QoS value is 0.1 and the SP value is 0.1, in the case when SLA is increased from 0.1 to 0.5 and 0.5 to 0.9, the AD is increased by 5% and 11%, respectively. On the other side, when the SLA value is 0.9, we see that AD is decreased 14% by increasing the SOC values from 0.3 to 0.8.

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AlQahtani, Salman Ali. "Towards an Optimal Cloud-Based Resource Management Framework for Next-Generation Internet with Multi-Slice Capabilities". Future Internet 15, n.º 10 (19 de octubre de 2023): 343. http://dx.doi.org/10.3390/fi15100343.

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With the advent of 5G networks, the demand for improved mobile broadband, massive machine-type communication, and ultra-reliable, low-latency communication has surged, enabling a wide array of new applications. A key enabling technology in 5G networks is network slicing, which allows the creation of multiple virtual networks to support various use cases on a unified physical network. However, the limited availability of radio resources in the 5G cloud-Radio Access Network (C-RAN) and the ever-increasing data traffic volume necessitate efficient resource allocation algorithms to ensure quality of service (QoS) for each network slice. This paper proposes an Adaptive Slice Allocation (ASA) mechanism for the 5G C-RAN, designed to dynamically allocate resources and adapt to changing network conditions and traffic delay tolerances. The ASA system incorporates slice admission control and dynamic resource allocation to maximize network resource efficiency while meeting the QoS requirements of each slice. Through extensive simulations, we evaluate the ASA system’s performance in terms of resource consumption, average waiting time, and total blocking probability. Comparative analysis with a popular static slice allocation (SSA) approach demonstrates the superiority of the ASA system in achieving a balanced utilization of system resources, maintaining slice isolation, and provisioning QoS. The results highlight the effectiveness of the proposed ASA mechanism in optimizing future internet connectivity within the context of 5G C-RAN, paving the way for enhanced network performance and improved user experiences.

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Ampririt, Phudit, Ermioni Qafzezi, Kevin Bylykbashi, Makoto Ikeda, Keita Matsuo y Leonard Barolli. "FSSLA: A Fuzzy-based scheme for slice service level agreement in 5G wireless networks and its performance evaluation". Journal of High Speed Networks 28, n.º 1 (11 de febrero de 2022): 47–64. http://dx.doi.org/10.3233/jhs-220678.

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The Software-Defined Network (SDN) with Network Slicing will be a good approach for admission control in the Fifth Generation (5G) wireless network, which is planned to be adaptable to meet user requirements. The system’s resources are limited, and the number of devices is growing much faster than it can handle. So, the overloading problem will be a very critical problem. To deal with these problems, this paper presents a Fuzzy-based Scheme for Service Level Agreement (SLA) evaluation (FSSLA). We compare two models: FSSLA1 and FSSLA2. The FSSLA1 considers three input parameters: Reliability (Re), Availability (Av), Latency (La) and the output parameter is SLA. In FSSLA2, we consider Traffic Load (Tl) as a new parameter. From simulation results, we conclude that the considered parameters have different effects on the SLA. When Re and Av are increasing, the SLA parameter is increased but when La and Tl are increasing, the SLA parameter is decreased. When the Tl value is changed from 20% to 80%, the SLA is decreased by 16.62% when Re 10%, Av 90% and the La value is 1 ms. When the Re is increased from 10% to 90% and 50% to 90% and the Tl value is 50%, the Av is 50% and the La is 1 ms, the SLA is increased by 22.76% and 11.38%, respectively.

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Ussov, W. Yu, S. P. Yaroshevsky, A. M. Tlyuniaeva, A. S. Maksimova, L. N. Alekseeva y A. E. Suhareva. "QUANTITATIVE PROCESSING OF T2-WEIGHTED CEREBRAL MRI CONCOMITANT WITH THIN-SLICE CORTEX MEASUREMENTS IN PATIENTS WITH SEVERE CAROTID ATHEROSCLEROSIS FOR PROGNOSIS OF CEREBRAL COMPLICATIONS AFTER INVASIVE CARDIOVASCULAR INTERVENTIONS". Diagnostic radiology and radiotherapy, n.º 4 (31 de enero de 2019): 48–56. http://dx.doi.org/10.22328/2079-5343-2018-4-48-56.

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Fim of the study. We attempted to select a complex of signs for prognosis of early post-intervention stroke in patients referred for extensive invasive cardiovascular surgery or intravascular procedures, from the data of routine MRI of the brain.Material and methods. Basing on the histories of 540 patients underwent non-carotid cadiosurgical or invasive intravascular procedures we selected ten in whom the post-operation early stroke was diagnosed and who also underwent pre-surgically the MRI study of the brain. The control comparative group comprised twelve persons in whom no post-intervention stroke was observed and also pre-intervention MRI was present. At the admission before surgery or intervention in everybody the T2-weighted MRI has been carried out in T2-weighted and T1-weighted thin slice (1,5– 3 mm) modes with subsequent quantification of cerebral ischemic preconditioning from quantitatification of T2-w. Imaged and with measurement of cortex’thickness.Results. In patients of both post-surgical stroke and control groups the coexistance of critical carotid stenosis or carotid occlusion with contralateral subcritical or mild/minimal contralateral carotid stenosis was detected. The post-operation ishemic stroke was detected in those persons obly, in whom pre-surgically the region of ishaemic leucodystrophy (unilateral leucoarayosis) was detected as signal-enhanced region on T2-weighted MRI scans on the side of carotid occlusion/critical stenosis, simultaneously with cortical thinning on the side. The index of physical volume of the T2-w.hyperintence region was in patients in whom post-surgically the ischemic stroke occurred as high as 18–51 сm3, whereas the volume of irreversibly damaged tissue diffusely distributed over the T2-w.hyperintensive leucoarayosis area 3,9–14,7 сm3. The ratio of volumes of irreversibly damaged tissue to the physical volume of damage was 0,17–0,29. Simultaneously in these persons in the middle cerebral artery perfusion region ipsilaterally the relative thinning of the cortex was seen with no cerebral stroke in the personal history. The cortex was in these patients on the side of ICA critical stenosis/ ICA occlusion 1,7–3,1 mm, and contralaterally 2,5–3,2 mm, with asimmetry index 0,65–0,82. This syndrome of «ischemic preconditioning of the brain» seen as combination {T2-hyperintensity & cortical dystrophy} was also detected in hree patients in whom the ishaemic stroke after cardiovascular surgery did not occur, and all these persons were treated befor the operation with high — up to 750 mg daily — doses ethylmethyl hydroxypiridine succinate (mexidol). The sensitivity of MRI syndrome {T2-hyperintensity & cortical dystrophy} in prognosis of post-operation ischemic stroke was as high as 100%, whereas specificity 75%, and diagnostic accuracy 86%.Conclusion. Thus, the detection of extensive unilateral area of T2-hyperintensity in the internal carotid artery region (unilateral leucoarayosis) concomitant with thinning of cortex in the region, on the side of occlusion or critical stenosis of internal carotid artery can be accepted as factor of high risk of ishemic stroke early after extensive vascular surgery or intervention. It is necessary to carry out the MRI study of the brain in every patient before and after extensive cardiovascular intervention, for scoring of stroke risk early after procedure.

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Osikov, Mikhail V., Vladimir N. Antonov, Semen O. Zotov y Galina L. Ignatova. "The role of redox status in platelet dysfunction in severe COVID-19-associated pneumonia". HERALD of North-Western State Medical University named after I.I. Mechnikov 14, n.º 3 (16 de noviembre de 2022): 69–78. http://dx.doi.org/10.17816/mechnikov109076.

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BACKGROUND: Platelet dysfunction in patients with COVID-19 is a well-known fact; however, its formation mechanisms remain unclear. AIM: To evaluate the role of oxidative stress in dysfunction of platelets in the patients with severe COVID-19-associated pneumonia. MATERIALS AND METHODS: The study has involved patients with COVID-19 (n = 27) aged 47 to 75 with more than 50% lung damage according to the chest multi-slice computed tomography. The control group has included healthy people comparable in sex and age (n = 24). All the patients have undergone evaluation of the number of platelets in blood, measurement of platelet aggregation induced by adenosine diphosphate, collagen, adrenaline and ristocetin and the level of lipid peroxidation and protein oxidative modifications products in platelet-rich plasma. The calculation and analysis of the obtained data has been carried out using the IBM SPSS Statistics v. 23. RESULTS: For the patients with severe COVID-19, a decrease in the number of platelets in the blood is characteristic. Acceleration of platelet aggregation induced by collagen and ristocetin has been observed on the 1st day, with the induction of adenosine diphosphate, collagen, adrenaline and ristocetin on the 8th day of the admission. Oxidative stress in COVID-19 leads to a significant increase in the level of primary markers of protein oxidative modifications in the platelets and an increase in the level of products of primary and secondary lipid peroxidation markers in the platelets. A direct correlation between the products of lipid peroxidation and protein oxidative modifications in the platelets and their aggregation has been found. CONCLUSIONS: The following study deepens the knowledge of the status of oxidative stress in SARS-CoV-2 infection, confirming its important role in the pathogenesis of COVID-19. The growth of protein oxidative modifications and lipid peroxidation products in patients with severe COVID-19-associated pneumonia in the course of the disease may be one of the causes of platelet dysfunction and, as a result, lead to lethal thrombotic complications.

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Ai, Yuan, Gang Qiu, Chenxi Liu y Yaohua Sun. "Joint resource allocation and admission control in sliced fog radio access networks". China Communications 17, n.º 8 (agosto de 2020): 14–30. http://dx.doi.org/10.23919/jcc.2020.08.002.

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Kobyakova, E., E. Nechipay, D. Sashin, N. Kobiakov y G. L. Kobyakov. "P14.105 High incidence of brain metastases in lung cancer patients at the time of primary diagnosis". Neuro-Oncology 21, Supplement_3 (agosto de 2019): iii92—iii93. http://dx.doi.org/10.1093/neuonc/noz126.340.

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Abstract BACKGROUND Brain metastases (BM) affect 8%-10% of all cancer patients and 40% of patients with metastatic cancer. The majority of BM originate from lung cancer (40%-50%), breast cancer (15%-25%), and melanoma (5%-20%). Total incidence proportions percentage (IP %) of brain metastases was reported as 9.6% for all primary sites combined, and was highest for lung cancer (19.9%). The incidence of BM is believed to be increasing, likely resulting from longer patient survival due to more effective systemic therapies for the primary cancer and the increased use of neuroimaging in neurologically asymptomatic patients. MATERIAL AND METHODS Our aim was to determine incidence of brain metastases in lung cancer patients at the time of primary diagnosis on cohort of our regular clinical practice. Since September 2014 till December 2017 189 primarily diagnosed patients with suspected lung cancer were evaluated with brain MRI as obligatory part of diagnostic protocol at N.N. Blokhin Russian Cancer Research Center. MR imaging protocol included T1, T2-weighted images, FLAIR, DWI, VIBE (with contrast enhancement, slice thickness <1.2 mm). According to diagnostic guidelines for lung cancer in Russia, all patients underwent chest CT scan with contrast enhancement, bronchoscopy, abdominal ultrasonography, ultrasonography of cervical lymph nodes (+ CT to evaluate detected abnormalities), bone scintigraphy with X-ray control of detected abnormalities, surgical removal (in case of T1-T2 tumor) or tumor biopsy to determine morphology. Additionally, all patients underwent Whole Body MR DWI, some patients received FDG-PET/CT scan. RESULTS Brain metastases were detected in 89 (48%) of 189 patients, while only 9 patients (10.1% of patients with brain metastases) had neurological deficits. Lesion sizes were as follows: 0.1–0.5 cm in 46 (51.7%) patients, 0.5–1.0 cm in 21 (23.6%) patients, 1.0–2.0 cm in 7 (7.9%) patients, 2.0–3.0 cm in 8 (9.0%) patients and >3.0 in 7 (7.9% patients). The majority of patients (45 - 50.56%) had solitary metastases, 10 patients (11.24%) had two lesions and 34 (38.20 %) patients had three and more lesions. Metastatic disease most commonly affected frontal lobes - 45 (50.56%) patients, temporal lobes - 36 (40.45%) patients, parietal lobes - 22 (24.72%) patients, occipital lobes - 22 (24.72%), basal ganglia and brainstem - 18 (20.22%), - 3 (3.37%), cerebellum - 30 (33.71%) patients. Concerning morphology, in 80 of 89 brain metastases NSCLC was identified and in 9 patients SCLC was observed. CONCLUSION Very high incidence of brain metastases in lung cancer patients at the time of primary diagnosis in our study cohort may be explained by the use of precision brain MRI as an obligatory part of diagnostic protocol at the time of primary admission. We suggest including precision brain MRI in guidelines for primary diagnosis of lung cancer patients as an obligatory examination

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Sun, Yanzan, Yanyu Huang, Tao Yu, Xiaojing Chen y Shunqing Zhang. "A Novel QoS Guaranteed Joint Resource Allocation Framework for 5G NR with Supplementary Uplink Transmission". Electronics 12, n.º 7 (26 de marzo de 2023): 1563. http://dx.doi.org/10.3390/electronics12071563.

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In 5G scenarios, the dynamic resource allocation of network slicing is crucial for quality-of-service (QoS) guaranteed under fluctuating traffic demands in rapidly changing communication environments. In this paper, we propose a novel QoS guaranteed joint resource allocation framework for NR with supplementary uplink (SUL) called QGJRA-SUL, where three parameters of SUL admission, TDD pattern, and band slicing scheme are jointly optimized. The framework is driven by a well-designed deep reinforcement learning agent. By combining the activation functions tanh and softmax, the agent can jointly optimize three parameters at the same time. Under the original problem of QoS satisfaction rate maximization, we introduce the load unbalance degree of slices into the reward function as a penalty term. The simulation results show that the framework can guarantee the QoS satisfaction rate well and balance the load of slices. QGJRA-SUL can accommodate 15% more user equipments (UEs) with the same QoS satisfaction rate than that of a traditional single-band solution without SUL, and achieve a 73% increase in the performance of load balancing than that without a load balancing mechanism near the full load.

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Hsiao, Chiu-Han, Frank Yeong-Sung Lin, Evana Szu-Han Fang, Yu-Fang Chen, Yean-Fu Wen, Yennun Huang, Yang-Che Su, Ya-Syuan Wu y Hsin-Yi Kuo. "Optimization-Based Resource Management Algorithms with Considerations of Client Satisfaction and High Availability in Elastic 5G Network Slices". Sensors 21, n.º 5 (8 de marzo de 2021): 1882. http://dx.doi.org/10.3390/s21051882.

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A combined edge and core cloud computing environment is a novel solution in 5G network slices. The clients’ high availability requirement is a challenge because it limits the possible admission control in front of the edge cloud. This work proposes an orchestrator with a mathematical programming model in a global viewpoint to solve resource management problems and satisfying the clients’ high availability requirements. The proposed Lagrangian relaxation-based approach is adopted to solve the problems at a near-optimal level for increasing the system revenue. A promising and straightforward resource management approach and several experimental cases are used to evaluate the efficiency and effectiveness. Preliminary results are presented as performance evaluations to verify the proposed approach’s suitability for edge and core cloud computing environments. The proposed orchestrator significantly enables the network slicing services and efficiently enhances the clients’ satisfaction of high availability.

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Assunção, H., M. Rodrigues, A. R. Prata, J. A. P. Da Silva y L. Inês. "POS0713 PREDICTORS OF HOSPITALIZATION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A 10-YEAR COHORT STUDY OF 398 PATIENTS FROM A TERTIARY CENTRE". Annals of the Rheumatic Diseases 80, Suppl 1 (19 de mayo de 2021): 606.1–606. http://dx.doi.org/10.1136/annrheumdis-2021-eular.832.

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Background:Patients with systemic lupus erythematosus (SLE) often require hospitalization. The cause of admission may vary, but active disease and infection are consistently reported as the main reasons for hospitalization and are associated with worse survival and damage accrual. Recent improvements in the standard of care, including minimization of glucocorticoid dose and more effective and safe immunosuppressive regimens, may have changed the incidence and risk factors for hospitalization due to these causes. Hence, it is useful to identify predictors of hospitalization to further reduce the risk of admission for disease activity and severe infection in patients with SLE.Objectives:To identify predictors of hospitalization in patients with SLE, according to the underlying cause.Methods:Patients with SLE fulfilling classification criteria (ACR’97 and/or SLICC), regularly followed at an academic lupus clinic from January 2009 to December 2020 and with at least two outpatient visits were included in this cohort study. Time to first hospitalization up to 120 months was identified separately for the following admission causes: (a) any cause; (b) active SLE; (c) infection. Predictors of hospitalization were sought through survival analysis, with distinct models for each of the major admission causes. Univariate analysis was performed using Kaplan-Meier curves and Log-Rank tests. Tested variables assessed at baseline included: gender; age at SLE onset; age; disease duration; SLE Disease Activity Index (SLEDAI-2K) score; ongoing antimalarial use; ongoing immunosuppressants; ongoing prednisolone daily dose; lupus nephritis up to baseline; SLICC Damage Index (SDI) score. Variables with p<0.1 were further tested in multivariate Cox regression models. Hazard ratios (HR) were determined with 95% confidence intervals (95%CI).Results:We included 398 patients (female: 86.2%, mean age: 41.2±15.1 years, mean disease duration: 10.1±9.2 years; previous lupus nephritis: 28.9%; mean SLEDAI-2K score: 3.4±2.7; ongoing antimalarials: 78.9%; ongoing immunosuppressant: 29.9%; ongoing prednisolone >7.5 mg/day: 17.1%; SDI score ≥1: 28.4%). During the follow-up period, 50.5%, 23.6% and 17.3% were hospitalized at least once for any cause, active SLE or infection, respectively.In the multivariate model, significant baseline predictors for hospitalization due to active disease were (table 1): SLEDAI-2K score >5; disease duration ≤2 years; ongoing immunosuppressants; SDI score ≥1. Baseline independent predictors of hospitalization for infection included (table 1): male gender; SDI score ≥1; ongoing antimalarials were protective.Table 1.Predictors of hospitalization in multivariate Cox regression according to the admission causePredictorsHospitalization for active SLEHospitalization for infectionSLEDAI-2K score >52.43 (1.53-3.88)n.s.SLE duration ≤2 years1.70 (1.04-2.77)n.s.Ongoing immunosuppressant1.91 (1.24-2.95)n.s.SDI score ≥11.82 (1.16-2.86)2.14 (1.33-3.45)Male gendern.s.2.19 (1.23-3.89)No antimalarial treatmentn.s.2.20 (1.34-3.60)Risk for each predictor reported as Hazard Ratio (95% Confidence Interval); n.s.: non-significantConclusion:Tight control of disease activity, prevention of damage accrual, and treatment with antimalarials may contribute to minimize the risk of hospitalization for these two major causes of admission in patients with SLE.Disclosure of Interests:None declared

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Leonardi, Luca, Lucia Lo Bello y Simone Aglianò. "Priority-Based Bandwidth Management in Virtualized Software-Defined Networks". Electronics 9, n.º 6 (17 de junio de 2020): 1009. http://dx.doi.org/10.3390/electronics9061009.

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In Industrial Internet of Things (IoT) applications, when the network size increases and different types of flows share the bandwidth, the demand for flexible and efficient management of the communication network is compelling. In these scenarios, under varying workload and flow priorities, the combined use of Software-Defined Networking (SDN) and Network Virtualization (NV) is a promising solution, as such techniques allow to reduce the network management complexity. This work presents the PrioSDN Resource Manager (PrioSDN_RM), a resource management mechanism based on admission control for virtualized SDN-based networks. The proposed combination imposes bounds on the resource utilization for the virtual slices, which therefore share the network links, while maintaining isolation from each other. The presented approach exploits a priority-based runtime bandwidth distribution mechanism to dynamically react to load changes (e.g., due to alarms). The paper describes the design of the approach and provides experimental results obtained on a real testbed.

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Schable, Barbara, Margarita E. Villarino, Martin S. Favero y J. Michael Miller. "Application of Multilocus Enzyme Electrophoresis to Epidemiologic Investigations ofXanthomonas Maltophilia". Infection Control & Hospital Epidemiology 12, n.º 3 (marzo de 1991): 163–67. http://dx.doi.org/10.1086/646310.

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AbstractObjective:To test the utility of a newly developed multilocus enzyme electrophoresis typing method for Xanthomonas maltophilia.Design:Isolates were first screened by slide agglutination, which served as the standard to characterize the outbreak strains. All isolates were then subjected to multilocus enzyme elec-trophoresis and the results analyzed based on epidemiological data.Setting:This outbreak occurred in a shock-trauma intensive care unit of a large general community hospital.Patients:Patients admitted to the shock-trauma intensive care unit who had X maltophilia isolated from any site > 24 hours after admission met the case definition. Specimens from patients who fit the case definition were characterized, as were specimens from other patients that were used as controls for nonoutbreak isolates. Environmental samples were also evaluated for X maltophilia.Results:Most of the 64 isolates received during this outbreak were serotype 10, and when they were subjected to multilocus enzyme electro-phoresis, one electrophoretic type predominated and correlated to most outbreak isolates. Unrelated isolates of serotype 10 from other institutions all exhibited unique electrophoretic types.Conclusion:Application of multilocus enzyme electrophoresis to X maltophilia outbreaks is a valuable addition to the characterization of suspected outbreak strains.

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Quintana, R., L. Garcia, P. Alba, S. Roverano, A. Alvarez, C. Graf, C. Pisoni et al. "POS0707 POTENTIAL USE OF BELIMUMAB IN LUPUS PATIENTS FROM ARGENTINE COHORT ACCORDING DISEASE ACTIVITY STATE". Annals of the Rheumatic Diseases 81, Suppl 1 (23 de mayo de 2022): 634.1–634. http://dx.doi.org/10.1136/annrheumdis-2022-eular.789.

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BackgroundThe goal of targeted treatment in patients with Systemic Lupus Erythematosus (SLE) is to achieve clinical remission or low disease activity, with the best quality of life, low damage rates and better survival 1-4. RELESSAR is a multicenter, cross-sectional study registry of ≥18 years SLE (ACR 97) patients 5.ObjectivesTo describe demographic, clinical characteristics and treatments in SLE patients according to disease activity state. To evaluate the proportion of SLE and refractory SLE patients that are potentially candidates for Belimumab treatment (Active SLE despite standard treatment including increased acDNA autoantibodies and low complement).MethodsWe evaluated demographic and clinical data, treatments, score of damage (SLICC), activity (SLEDAI) and comorbidity (Charlson), hospital admissions and severe infections. The patients were compared according to disease activity: remission (SLEDAI = 0 and without corticosteroids), low disease activity (LDA, SLEDAI> 0 and ≤4 and without corticosteroids) and non-optimal control (SLEDAI> 4 and any dose of corticosteroids). Refractory SLE was defined according to Rituximab (RTX) use, non-response to cyclophosphamide or two or more immunosuppressant or splenectomized patients. Potential use of Belimumab according approved prescription in Argentina was analyzed.ResultsOverall, 1277 patients were analyzed: 299 (23.4%) were in remission, 162 (12.7%) in LDA and 816 (63.9%) with non-optimal control of the disease.Patients in non-optimal control group were younger, less frequently female and they showed less time of disease and lower socioeconomic status (p < 0.001). They were also more prevalent mestizos (p= 0.004), had higher SLEDAI and SLICC indexes (p <0.001) and higher use of immunosuppressant therapy (p <0.001). There was no difference regarding biologic treatment (RTX p= 0.547 and Belimumab p= 0.08). This group had higher proportion of hospital admissions and severe infections (p<0.001, respectively).Two hundred and one SLE patients fulfilled the use of Belimumab prescription criteria but only 45/201 patients (22,3%) received it in the last visit. Malar rash was the only clinical variable associated with the use of Belimumab (72.7% vs 29.8% p= 0.005).Seventy-six patients classified as refractory SLE (15.7%) and 56/76 (75.7%) never received Belimumab. Patients on Belimumab therapy were associated to treatment with lower doses of corticoids (p= 0.018) and lower rate of hospital admission caused by SLE flare (p= 0.027).ConclusionA high percentage of patients had uncontrolled disease upon entry into the registry and were potential candidates for treatment with Belimumab. The patients who received biologic treatment showed the benefit of requiring fewer doses of corticosteroids and having a lower rate of hospitalizations.References[1]Mok CC. Treat-to-target in systemic lupus erythematosus: Are we there yet? Expert Rev Clin Pharmacol. 2016;9(5).[2]Morand EF, Mosca M. Treat to target, remission and low disease activity in SLE. Vol. 31, Best Practice and Research: Clinical Rheumatology. 2017.[3]Golder V, Tsang-A-Sjoe MWP. Treatment targets in SLE: Remission and low disease activity state. Rheumatol (United Kingdom). 2020;59.[4]Ruiz-Irastorza G, Bertsias G. Treating systemic lupus erythematosus in the 21st century: new drugs and new perspectives on old drugs. Vol. 59, Rheumatology (United Kingdom). 2021.[5]Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum [Internet]. 1997;40(9):1725. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9324032Disclosure of InterestsRosana Quintana: None declared, Lucila Garcia: None declared, Paula Alba: None declared, Susana Roverano: None declared, Analia Alvarez: None declared, Cesar Graf: None declared, Cecilia Pisoni: None declared, Alberto Spindler: None declared, Catalina Gomez: None declared, Heber Matias Figueredo: None declared, Silvia Papasidero: None declared, Raul Horacio Paniego: None declared, Maria DeLaVega: None declared, Emma Estela Civit De Garignani: None declared, Luciana Gonzalez Lucero: None declared, Victoria Martire: None declared, Rodrigo Águila Maldonado: None declared, Sergio Gordon: None declared, Carla Gobbi: None declared, Romina Nieto: None declared, Gretel Rausch: None declared, Vanina Góngora: None declared, Maria Agustina D´Amico: None declared, Diana Dubinsky: None declared, Alberto Omar Orden: None declared, Johana Zacariaz: None declared, Julia Romero: None declared, Mariana Alejandra Pera: None declared, Oscar Rillo: None declared, Roberto Baez: None declared, Valeria Arturi: None declared, Andrea Gonzalez: None declared, Florencia Vivero: None declared, Marcela Schmid: None declared, Victor Caputo: None declared, Maria Silvia Larroude: None declared, Graciela Gomez: None declared, Graciela Rodriguez: None declared, Josefina Marin: None declared, Maria Victoria Collado: None declared, Marisa Jorfen: None declared, Zaida Bedran: None declared, Judith Sarano: None declared, David Zelaya: None declared, MONICA SACNUN: None declared, Pablo Finucci: None declared, Romina Rojas Tessel: None declared, Maria Emilia Sattler: None declared, MAXIMILIANO MACHADO ESCOBAR: None declared, Pablo Astesana: None declared, Ursula Vanesa Paris: None declared, Alberto Allievi: None declared, Juan Manuel Vandale: None declared, Bernardo Pons-Estel: None declared, Guillermo Pons-Estel: None declared, Mercedes García Grant/research support from: GSK grant

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Cetin, C., M. G. Can, S. Oztaskin, Y. Yalçinkaya, A. Gül, M. Inanc y B. Artim-Esen. "POS0710 ANALYSIS OF 5-YEAR HOSPITALIZATION DATA OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: DAMAGE IS A RISK FACTOR FOR FREQUENT AND LONGER STAYS". Annals of the Rheumatic Diseases 80, Suppl 1 (19 de mayo de 2021): 604.2–605. http://dx.doi.org/10.1136/annrheumdis-2021-eular.529.

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Background:The rates of hospitalization in patients with SLE is around 10% per year.1Objectives:In this study, we aimed to examine the hospitalization data of patients with SLE in the last 5 years at our center and determine the factors that affect hospitalization.Methods:Hospitalization data of patients with SLE (2012 SLICC classification) admitted to our rheumatology ward between January 2015 and 2020 were analyzed. Cumulative clinical and laboratory findings were retrieved from the existing SLE database and revised. SLICC SLE damage index (SDI), and the disease activity at admission were determined (SLEDAI-2K).Results:Eighty-six % (n=138) of 161 hospitalized patients were female. The mean age of the patients was 38 ± 13 years whilst mean duration of disease was 97.3 ±96.9 months. Thirty-eight% of the patients were hospitalized more than once and the mean number of hospitalizations was 1.8±1.5 The mean hospitalization duration covering all stays for each patient was 25±27 days. Active disease followed by infection and damage-related complications ranked the first three among all causes of hospitalization.Compared to patients hospitalized for active disease or other reasons, patients hospitalized for infection had a significantly higher number of readmissions (p<0.05) and their total duration of hospitalization was longer (p<0.01). Duration of disease was significantly shorter in patients hospitalized for active disease compared to patients hospitalized for infection and damage related causes (p<0.05).The frequency of patients with damage and the mean SDI score was significantly lower in the group with active disease (68% and 1.9 ± 2) compared to patients hospitalized for infection (90% and 2.7±1.6) and other causes (96% and 3±1.7) (p<0.05 for both). Distribution of damage according to organ/systems is presented in Graph 1. Highest frequency of damage was detected in the cardiovascular (30%), followed by neuropsychiatric (26.7%), renal (23%), pulmonary (23%) and musculoskeletal (20.5%) domains. A positive correlation was found between the mean SDI score and duration of hospitalization (r=0.551, p<0.001) as well as the number of hospitalizations (r=0.393, p<0.001). Regarding disease activity at the time of admission, the mean score of patients hospitalized for active disease was 11.0 ± 6.1 whilst was 3.2 ± 2.8 in patients hospitalized for infection and 2.9 ± 3.3 in patients hospitalized for other reasons (p<0.001). Renal active disease was the most common (44%), followed by hematological (34.8%), articular (21.7%) and mucocutaneous (21%) activity. Ten% of the patients all of whom had damage were admitted to intensive care unit (ICU). Total hospitalization duration (p=0.012), mean SDI (p=0.008), antiphospholipid syndrome (p=0.033), lupus anticoagulant (p=0.010), thrombocytopenia (p=0.015), serositis (p=0.034), pulmonary hypertension (p=0.021), history of alveolar haemorrhage (p<0.001) and cardiac valve involvement (p=0.002) were associated with ICU hospitalization.Conclusion:Disease activity, infections and damage are the leading causes of hospitalization in patients with SLE. Damage increases the frequency of hospitalizations, prolongs the duration of stay, and increases the need for follow-up in the ICU. Tight control of disease activity with rational use of immunosuppressive treatment is important to reduce damage and hospitalizations.Graphic 1.Distribution of damage according to organs/systems in hospitalized patientsReferences:[1]Gu K, Gladman DD, Su J, Urowitz MB. Hospitalizations in patients with systemic lupus erythematosus in an academic health science center. The Journal of rheumatology 2017;44:1173-8.Disclosure of Interests:None declared

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Cheung, C. L., C. H. To, L. Y. Ho, K. L. Chan, S. M. Tse y C. C. Mok. "AB0614 EFFECT OF COVID-19 INFECTION ON DISEASE FLARES AND HERPES ZOSTER REACTIVATION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE-CONTROL STUDY". Annals of the Rheumatic Diseases 82, Suppl 1 (30 de mayo de 2023): 1508.1–1508. http://dx.doi.org/10.1136/annrheumdis-2023-eular.3372.

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BackgroundWhether COVID-19 infection worsens SLE activity is uncertain.ObjectivesTo study the effect of COVID-19 infection on disease flares and herpes zoster (HZ) reactivation in patients with systemic lupus erythematosus (SLE).MethodsPatients who fulfilled the ACR or SLICC criteria for SLE and were followed in our rheumatology clinics were retrospectively studied. We identified patients who had documented COVID-19 infection (Omicron and its variants) between February and November 2022 and a group of SLE controls who did not have COVID-19 infection randomly matched for age, sex and the time period of COVID-19 infection in a 1:2 ratio. The primary outcomes of interest were SLE flares (clinical or serological) and the occurrence of HZ infection within 90 days of COVID-19 infection. SLE flares were assessed by the SELENA flare instruments, with modifications (mild/moderate or severe). HZ infection was a clinical diagnosis based on history and physical signs by attending physicians. The rates of SLE flares and HZ reactivation were compared between COVID-infected SLE patients and controls.Results91 SLE patients with COVID-19 infection (age 48.6±14.0 years; 95.6% women; SLE duration 14.2±8.3 years; 53% history of lupus nephritis) and 182 SLE controls not infected by COVID-19 (age 48.7±13.8 years; 95.6% women; SLE duration 15.2±9.0 years) were studied. Eleven of 90 (12.2%) COVID-infected patients had serious manifestations (oxygen requirement, use of mechanical ventilator, lung infiltrates on imaging studies or admission to the intensive care unit). Patients with mild COVID-19 infection were treated symptomatically or oral anti-viral agents whereas those with serious COVID-19 infection was treated with intravenous remdesivir, dexamethasone and/or biologic/targeted agents. One (1.1%) of our patients died and 7(7.7%) patients developed severe complications. Within 90 days of COVID-19 infection, 14 (15.4%) patients developed mild/moderate SLE flares and 2 (2.2%) patients had severe SLE flares. The incidence of SLE flares in COVID-19-infected patients was significantly higher than those without (17.6% vs 5.5%; p=0.001). The changes in anti-dsDNA and complement C3 levels, however, were not significantly different between the two groups. Among COVID-19 infected SLE patients, those with clinical SLE flares had significantly lower C3 values (p=0.004) but non-significantly higher anti-dsDNA titer (p=0.32) before COVID-19 infection than those without SLE flares. HZ reactivation occurred in 2 patients (2.2%) with COVID-19 infection, which was numerically higher than those not infected by COVID-19 (2 patients, 1.1%; p=0.48). No particular risk factors were identified for HZ reactivation after COVID-19 infection.ConclusionIn this retrospective case-control study, clinical flares within 90 days were significantly more common in patients infected with COVID-19 than age and gender matched non-infected SLE controls. SLE patients with lower C3 levels were more likely to flare after COVID-19 infection. HZ reactivation occurred at a numerically higher rate after COVID-19 infection in SLE patients than controls. The results from our study support the hypothesis for a viral trigger for disease exacerbation in SLE.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

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Patwardhan, Akshay A., Solomon Oshabaheebwa, Christopher A. Delianides, Zoe Sekyonda, Ashwin P. Patel, Erica N. Evans, Justin J. Yoo et al. "Comparison of Devices That Measure Sickle Red Cell Deformability". Blood 142, Supplement 1 (28 de noviembre de 2023): 3669. http://dx.doi.org/10.1182/blood-2023-187557.

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Background With the emergence of novel pharmacologic and gene-based therapies, identifying the rheological and biophysical RBC abnormalities of sickle cell disease (SCD) not captured by clinical laboratory techniques is crucial. Ektacytometry (LORRCA), the current standard to assess RBC function, does not reflect mechanical stress that RBCs experience in capillary microvasculature in the body. The device is costly, requires a nitrogen gas tank, and its use is difficult to translate outside of large-scale laboratory settings. In comparison, the Microfluidic Impedance Red Cell Assay (MIRCA) is a low-cost, portable device that mimics capillary microvasculature with micropillar arrays spaced 3-12 µm apart. Thus, MIRCA measures mechanical deformability, which is more physiologic, mimicking RBCs squeezing through microvasculature. An impedance analyzer calculates the MIRCA Occlusion Index (OI), representing the % occlusion of the chip. Here we compare the MIRCA to the LORRCA, assessing the correlations of OI and Elongation Index maximum (EI) to conventional laboratory tests and SCD related complications. Methods Peripheral blood from 53 adult (n = 28) and pediatric (n = 25) individuals (HbSS = 35, HbSB0 = 6, HbSC = 5, HbSB0 = 1, and HbAA controls = 6) were obtained under an Emory University IRB approved protocol. Patients transfused < 90 days prior were excluded. Hospitalizations / emergency department (ED) visits for pain within 12 months of sample collection were determined by chart review. Samples were collected in EDTA, stored at 4°C up to 48 hours, centrifuged at 500g, washed, and resuspended to a 20% hematocrit to run on MIRCA, an oxygen gradient ektacytometer (LORRCA), and an ADVIA hematology analyzer. Polydimethylsiloxane (PDMS) fabricated MIRCA chips were bonded to a standard glass slide with pairs of gold-sputtered electrodes adjacent to each array. Chips were prepared by perfusing ethanol, 1X phosphate-buffered saline (PBS), and 3% bovine-serum albumin (BSA) in 1X PBS via syringe pump and were incubated overnight at 4°C prior to use. Baseline impedance was taken for a 2-minute perfusion of 1X PBS, then OIs were calculated from impedance values 10 minutes after sample introduction normalized to baseline. The data was analyzed using the Mann-Whitney U test, Spearman correlation, and linear regression. OriginPro (Northampton, MA, USA) and Stata 18 (College Station, TX, USA) were used for the analyses and a p < 0.05 was considered significant. Results The correlation coefficients for OI and EI with laboratory tests (Table 1) and to each other (Figure 1) were comparable (p < 0.05). HbSS/SB0 had higher OIs than HbSC/SB+ (median = 13.7% vs 6.8%, p < 0.01) and HbAA (median = 4.6%, p < 0.01). Patients with ≥ 1 vaso-occlusive events (VOE) in the past year had higher OIs and lower EIs compared to those without a VOE (median = 15.3% vs 9.6%, p <0.01; median = 0.4 vs 0.5, p = 0.02, respectively). Patients that received acute medical care (admission or ED visit) had higher OIs and lower EIs compared to those that did not (median = 15.7% vs 9.8%, p < 0.01; median = 0.4 vs 0.5, p = 0.02, respectively). In multiple linear regression, HbSS/SB0 (p < 0.01), adults (p = 0.01), and DRBC (p < 0.01) were associated with OI while HbSS/SB0 (p = 0.01), DRBC (p < 0.01), hemoglobin % (p = 0.04), absolute neutrophil count (p = 0.02), and VOE+ (p = 0.02) were associated with EI. The models explained 55.2% and 66.8% variability of OI and EI, respectively. Lower Akaike's information criterion (AIC, 186 vs -80) and Bayesian information criterion (BIC, 192 vs -71) of the EI model suggest a higher correlation to conventional laboratory values and clinical features compared to OI; OI may possibly be a unique biomarker that both laboratory tests and LORRCA fail to fully characterize. Conclusion MIRCA OI and LORRCA EI normoxic deformability are correlated to each other, and both show statistically comparable correlations to many parameters associated with SCD severity. Both OI and EI are significantly associated with SCD outcomes like VOE and acute care. Due to lower device size, cost, and relative ease-of-use, MIRCA may be more convenient for routine clinical use and for use in low resource settings where LORRCA costs and requirements hamper implementation. As the addition of chemical hypoxia to MIRCA is now underway, future work will examine OI under hypoxia and its associations with SCD-relevant outcomes like pain events, stroke and acute chest syndrome.

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Johnson, G., K. Hickey, A. Azin, K. Guidolin, K. Guidolin, F. Shariff, J. Gentles et al. "2021 Canadian Surgery Forum01. Design and validation of a unique endoscopy simulator using a commercial video game03. Is ethnicity an appropriate measure of health care marginalization?: A systematic review and meta-analysis of the outcomes of diabetic foot ulceration in the Aboriginal population04. Racial disparities in surgery — a cross-specialty matched comparison between black and white patients05. Starting late does not increase the risk of postoperative complications in patients undergoing common general surgical procedures06. Ethical decision-making during a health care crisis: a resource allocation framework and tool07. Ensuring stability in surgical training program leadership: a survey of program directors08. Introducing oncoplastic breast surgery in a community hospital09. Leadership development programs for surgical residents: a review of the literature10. Superiority of non-opioid postoperative pain management after thyroid and parathyroid operations: a systematic review and meta-analysis11. Timing of ERCP relative to cholecystectomy in patients with ductal gallstone disease12. A systematic review and meta-analysis of randomized controlled trials comparing intraoperative red blood cell transfusion strategies13. Postoperative outcomes after frail elderly preoperative assessment clinic: a single-institution Canadian perspective14. Selective opioid antagonists following bowel resection for prevention of postoperative ileus: a systematic review and meta-analysis15. Peer-to-peer coaching after bile duct injury16. Laparoscopic median arcuate ligament release: a video abstract17. Retroperitoneoscopic approach to adrenalectomy19. Endoscopic Zenker diverticulotomy: a video abstract20. Variability in surgeons’ perioperative management of pheochromocytomas in Canada21. The contribution of surgeon and hospital variation in transfusion practice to outcomes for patients undergoing elective gastrointestinal cancer surgery: a population-based analysis22. Perioperative transfusions for gastroesophageal cancers: risk factors and short- and long-term outcomes23. The association between frailty and time alive and at home after cancer surgery among older adults: a population-based analysis24. Psychological and workplace-related effects of providing surgical care during the COVID-19 pandemic in British Columbia, Canada25. Safety of venous thromboembolism prophylaxis in endoscopic retrograde cholangiopancreatography: a systematic review26. Complications and reintervention following laparoscopic subtotal cholecystectomy: a systematic review and meta-analysis27. Synchronization of pupil dilations correlates with team performance in a simulated laparoscopic team coordination task28. Receptivity to and desired design features of a surgical peer coaching program: an international survey9. Impact of the COVID-19 pandemic on rates of emergency department utilization due to general surgery conditions30. The impact of the current COVID-19 pandemic on the exposure of general surgery trainees to operative procedures31. Association between academic degrees and research productivity: an assessment of academic general surgeons in Canada32. Laparoscopic endoscopic cooperative surgery (LECS) for subepithelial gastric lesion: a video presentation33. Effect of the COVID-19 pandemic on acute care general surgery at an academic Canadian centre34. Opioid-free analgesia after outpatient general surgery: a pilot randomized controlled trial35. Impact of neoadjuvant immunotherapy or targeted therapies on surgical resection in patients with solid tumours: a systematic review and meta-analysis37. Surgical data recording in the operating room: a systematic review of modalities and metrics38. Association between nonaccidental trauma and neighbourhood socioeconomic status during the COVID-19 pandemic: a retrospective analysis39. Laparoscopic repair of a transdiaphragmatic gastropleural fistula40. Video-based interviewing in medicine: a scoping review41. Indocyanine green fluorescence angiography for prevention of anastomotic leakage in colorectal surgery: a cost analysis from the hospital payer’s perspective43. Perception or reality: surgical resident and faculty assessments of resident workload compared with objective data45. When illness and loss hit close to home: Do health care providers learn how to cope?46. Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial47. The evolving use of robotic surgery: a population-based analysis48. Prophylactic retromuscular mesh placement for parastomal hernia prevention: a retrospective cohort study of permanent colostomies and ileostomies49. Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: a retrospective cohort study on anastomotic complications50. A lay of the land — a description of Canadian academic acute care surgery models51. Emergency general surgery in Ontario: interhospital variability in structures, processes and models of care52. Trauma 101: a virtual case-based trauma conference as an adjunct to medical education53. Assessment of the National Surgical Quality Improvement Program Surgical Risk Calculator for predicting patient-centred outcomes of emergency general surgery patients in a Canadian health care system54. Sustainability of a narcotic reduction initiative: 1 year following the Standardization of Outpatient Procedure (STOP) Narcotics Study55. Barriers to transanal endoscopic microsurgery referral56. Geospatial analysis of severely injured rural patients in a geographically complex landscape57. Implementation of an incentive spirometry protocol in a trauma ward: a single-centre pilot study58. Impostor phenomenon is a significant risk factor for burnout and anxiety in Canadian resident physicians: a cross-sectional survey59. Understanding the influence of perioperative education on performance among surgical trainees: a single-centre experience60. The effect of COVID-19 pandemic on current and future endoscopic personal protective equipment practices: a national survey of 77 endoscopists61. Case report: delayed presentation of perforated sigmoid diverticulitis as necrotizing infection of the lower limb62. Investigating disparities in surgical outcomes in Canadian Indigenous populations63. Fundoplication is superior to medical therapy for Barrett esophagus disease regression and progression: a systematic review and meta-analysis64. Development of a novel online general surgery learning platform and a qualitative preimplementation analysis65. Hagfish slime exudate as a potential novel hemostatic agent: developing a standardized assessment protocol66. The effect of the first wave of the COVID-19 pandemic on surgical oncology case volumes and wait times67. Safety of same-day discharge in high-risk patients undergoing ambulatory general surgery68. External validation of the Codman score in colorectal surgery: a pragmatic tool to drive quality improvement69. Improved morbidity and gastrointestinal restoration rates without compromising survival rates for diverting loop ileostomy with colonic lavage versus total abdominal colectomy for fulminant Clostridioides difficile colitis: a multicentre retrospective cohort study70. Potential access to emergency general surgical care in Ontario71. Immersive virtual reality (iVR) improves procedural duration, task completion and accuracy in surgical trainees: a systematic review01. Clinical validation of the Canada Lymph Node Score for endobronchial ultrasound02. Venous thromboembolism in surgically treated esophageal cancer patients: a provincial population-based study03. Venous thromboembolism in surgically treated lung cancer patients: a population-based study04. Is frailty associated with failure to rescue after esophagectomy? A multi-institutional comparative analysis of outcomes05. Routine systematic sampling versus targeted sampling of lymph nodes during endobronchial ultrasound: a feasibility randomized controlled trial06. Gastric ischemic conditioning reduces anastomotic complications in patients undergoing esophagectomy: a systematic review and meta-analysis07. Move For Surgery, a novel preconditioning program to optimize health before thoracic surgery: a randomized controlled trial08. In case of emergency, go to your nearest emergency department — Or maybe not?09. Does preoperative SABR increase the risk of complications from lung cancer resection? A secondary analysis of the MISSILE trial10. Segmental resection for lung cancer: the added value of near-infrared fluorescence mapping diminishes with surgeon experience11. Toward competency-based continuing professional development for practising surgeons12. Stereotactic body radiotherapy versus surgery in older adults with NSCLC — a population-based, matched analysis of long-term dependency outcomes13. Role of adjuvant therapy in esophageal cancer patients after neoadjuvant therapy and curative esophagectomy: a systematic review and meta-analysis14. Evaluation of population characteristics on the incidence of thoracic empyema: an ecological study15. Determining the optimal stiffness colour threshold and stiffness area ratio cut-off for mediastinal lymph node staging using EBUS elastography and AI: a pilot study16. Quality assurance on the use of sequential compression stockings in thoracic surgery (QUESTs)17. The relationship between fissureless technique and prolonged air leak for patients undergoing video-assisted thoracoscopic lobectomy18. CXCR2 inhibition as a candidate for immunomodulation in the treatment of K-RAS-driven lung adenocarcinoma19. Assessment tools for evaluating competency in video-assisted thoracoscopic lobectomy: a systematic review20. Understanding the current practice on chest tube management following lung resection among thoracic surgeons across Canada21. Effect of routine jejunostomy tube insertion in esophagectomy: a systematic review and meta-analysis22. Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: a retrospective analysis23. Surgical outcomes following chest wall resection and reconstruction24. Outcomes following surgical management of primary mediastinal nonseminomatous germ cell tumours25. Does robotic approach offer better nodal staging than thoracoscopic approach in anatomical resection for non–small cell lung cancer? A single-centre propensity matching analysis26. Competency assessment for mediastinal mass resection and thymectomy: design and Delphi process27. The contemporary significance of venous thromboembolism (deep venous thrombosis [DVT] and pulmonary embolus [PE]) in patients undergoing esophagectomy: a prospective, multicentre cohort study to evaluate the incidence and clinical outcomes of VTE after major esophageal resections28. Esophageal cancer: symptom severity at the end of life29. The impact of pulmonary artery reconstruction on postoperative and oncologic outcomes: a systematic review30. Association with surgical technique and recurrence after laparoscopic repair of paraesophageal hernia: a single-centre experience31. Enhanced recovery after surgery (ERAS) in esophagectomy32. Surgical treatment of esophageal cancer: trends in surgical approach and early mortality at a single institution over the past 18 years34. Adverse events and length of stay following minimally invasive surgery in paraesophageal hernia repair35. Long-term symptom control comparison of Dor and Nissen fundoplication following laparoscopic para-esophageal hernia repair: a retrospective analysis36. Willingness to pay: a survey of Canadian patients’ willingness to contribute to the cost of robotic thoracic surgery37. Radiomics in early-stage lung adenocarcinoma: a prediction tool for tumour immune microenvironments38. Effectiveness of intraoperative pyloric botox injection during esophagectomy: how often is endoscopic intervention required?39. An artificial intelligence algorithm for predicting lymph node malignancy during endobronchial ultrasound40. The effect of major and minor complications after lung surgery on length of stay and readmission41. Measuring cost of adverse events following thoracic surgery: a scoping review42. Laparoscopic paraesophageal hernia repair: characterization by hospital and surgeon volume and impact on outcomes43. NSQIP 5-Factor Modified Frailty Index predicts morbidity but not mortality after esophagectomy44. Trajectory of perioperative HRQOL and association with postoperative complications in thoracic surgery patients45. Variation in treatment patterns and outcomes for resected esophageal cancer at designated thoracic surgery centres46. Patient-reported pretreatment health-related quality of life (HRQOL) predicts short-term survival in esophageal cancer patients47. Analgesic efficacy of surgeon-placed paravertebral catheters compared with thoracic epidural analgesia after Ivor Lewis esophagectomy: a retrospective noninferiority study48. Rapid return to normal oxygenation after lung surgery49. Examination of local and systemic inflammatory changes during lung surgery01. Implications of near-infrared imaging and indocyanine green on anastomotic leaks following colorectal surgery: a systematic review and meta-analysis02. Repeat preoperative endoscopy after regional implementation of electronic synoptic endoscopy reporting: a retrospective comparative study03. Consensus-derived quality indicators for operative reporting in transanal endoscopic surgery (TES)04. Colorectal lesion localization practices at endoscopy to facilitate surgical and endoscopic planning: recommendations from a national consensus Delphi process05. Black race is associated with increased mortality in colon cancer — a population-based and propensity-score matched analysis06. Improved survival in a cohort of patients 75 years and over with FIT-detected colorectal neoplasms07. Laparoscopic versus open loop ileostomy reversal: a systematic review and meta-analysis08. Posterior mesorectal thickness as a predictor of increased operative time in rectal cancer surgery: a retrospective cohort study09. Improvement of colonic anastomotic healing in mice with oral supplementation of oligosaccharides10. How can we better identify patients with rectal bleeding who are at high risk of colorectal cancer?11. Assessment of long-term bowel dysfunction in rectal cancer survivors: a population-based cohort study12. Observational versus antibiotic therapy for acute uncomplicated diverticulitis: a noninferiority meta-analysis based on a Delphi consensus13. Radiotherapy alone versus chemoradiotherapy for stage I anal squamous cell carcinoma: a systematic review and meta-analysis14. Is the Hartmann procedure for diverticulitis obsolete? National trends in colectomy for diverticulitis in the emergency setting from 1993 to 201515. Sugammadex in colorectal surgery: a systematic review and meta-analysis16. Sexuality and rectal cancer treatment: a qualitative study exploring patients’ information needs and expectations on sexual dysfunction after rectal cancer treatment17. Video-based interviews in selection process18. Impact of delaying colonoscopies during the COVID-19 pandemic on colorectal cancer detection and prevention19. Opioid use disorder associated with increased anastomotic leak and major complications after colorectal surgery20. Effectiveness of a rectal cancer education video on patient expectations21. Robotic-assisted rectosigmoid and rectal cancer resection: implementation and early experience at a Canadian tertiary centre22. An online educational app for rectal cancer survivors with low anterior resection syndrome: a pilot study23. The effects of surgeon specialization on the outcome of emergency colorectal surgery24. Outcomes after colorectal cancer resections in octogenarians and older in a regional New Zealand setting — What are the predictors of mortality?25. Long-term outcomes after seton placement for perianal fistulae with and without Crohn disease26. A survey of patient and surgeon preference for early ileostomy closure following restorative proctectomy for rectal cancer — Why aren’t we doing it?27. Crohn disease independently associated with longer hospital admission after surgery28. Short-stay (≤ 1 d) diverting loop ileostomy closure can be selectively implemented without an increase in readmission and complication rates: an ACS-NSQIP analysis29. A comparison of perineal stapled rectal prolapse resection and the Altemeier procedure at 2 Canadian academic hospitals30. Mental health and substance use disorders predict 90-day readmission and postoperative complications following rectal cancer surgery31. Early discharge after colorectal cancer resection: trends and impact on patient outcomes32. Oral antibiotics without mechanical bowel preparation prior to emergency colectomy reduces the risk of organ space surgical site infections: a NSQIP propensity score matched study33. The impact of robotic surgery on a tertiary care colorectal surgery program, an assessment of costs and short-term outcomes — a Canadian perspective34. Should we scope beyond the age limit of guidelines? Adenoma detection rates and outcomes of screening and surveillance colonoscopies in patients aged 75–79 years35. Emergency department admissions for uncomplicated diverticulitis: a nationwide study36. Obesity is associated with a complicated episode of acute diverticulitis: a nationwide study37. Green indocyanine angiography for low anterior resection in patients with rectal cancer: a prospective before-and-after study38. The impact of age on surgical recurrence of fibrostenotic ileocolic Crohn disease39. A qualitative study to explore the optimal timing and approach for the LARS discussion01. Racial, ethnic and socioeconomic disparities in diagnosis, treatment and survival of patients with breast cancer: a SEER-based population analysis02. First-line palliative chemotherapy for esophageal and gastric cancer: practice patterns and outcomes in the general population03. Frailty as a predictor for postoperative outcomes following pancreaticoduodenectomy04. Synoptic electronic operative reports identify practice variation in cancer surgery allowing for directed interventions to decrease variation05. The role of Hedgehog signalling in basal-like breast cancer07. Clinical and patient-reported outcomes in oncoplastic breast conservation surgery from a single surgeon’s practice in a busy community hospital in Canada08. Upgrade rate of atypical ductal hyperplasia: 10 years of experience and predictive factors09. Time to first adjuvant treatment after oncoplastic breast reduction10. Preparing to survive: improving outcomes for young women with breast cancer11. Opioid prescription and consumption in patients undergoing outpatient breast surgery — baseline data for a quality improvement initiative12. Rectal anastomosis and hyperthermic intraperitoneal chemotherapy: Should we avoid diverting loop ileostomy?13. Delays in operative management of early-stage, estrogen-receptor positive breast cancer during the COVID-19 pandemic — a multi-institutional matched historical cohort study14. Opioid prescribing practices in breast oncologic surgery15. Oncoplastic breast reduction (OBR) complications and patient-reported outcomes16. De-escalating breast cancer surgery: Should we apply quality indicators from other jurisdictions in Canada?17. The breast cancer patient experience of telemedicine during COVID-1918. A novel ex vivo human peritoneal model to investigate mechanisms of peritoneal metastasis in gastric adenocarcinoma (GCa)19. Preliminary uptake and outcomes utilizing the BREAST-Q patient-reported outcomes questionnaire in patients following breast cancer surgery20. Routine elastin staining improves detection of venous invasion and enhances prognostication in resected colorectal cancer21. Analysis of exhaled volatile organic compounds: a new frontier in colon cancer screening and surveillance22. A clinical pathway for radical cystectomy leads to a shorter hospital stay and decreases 30-day postoperative complications: a NSQIP analysis23. Fertility preservation in young breast cancer patients: a population-based study24. Investigating factors associated with postmastectomy unplanned emergency department visits: a population-based analysis25. Impact of patient, tumour and treatment factors on psychosocial outcomes after treatment in women with invasive breast cancer26. The relationship between breast and axillary pathologic complete response in women receiving neoadjuvant chemotherapy for breast cancer01. The association between bacterobilia and the risk of postoperative complications following pancreaticoduodenectomy02. Surgical outcome and quality of life following exercise-based prehabilitation for hepatobiliary surgery: a systematic review and meta-analysis03. Does intraoperative frozen section and revision of margins lead to improved survival in patients undergoing resection of perihilar cholangiocarcinoma? A systematic review and meta-analysis04. Prolonged kidney procurement time is associated with worse graft survival after transplantation05. Venous thromboembolism following hepatectomy for colorectal metastases: a population-based retrospective cohort study06. Association between resection approach and transfusion exposure in liver resection for gastrointestinal cancer07. The association between surgeon volume and use of laparoscopic liver resection for gastrointestinal cancer08. Immune suppression through TIGIT in colorectal cancer liver metastases09. “The whole is greater than the sum of its parts” — a combined strategy to reduce postoperative pancreatic fistula after pancreaticoduodenectomy10. Laparoscopic versus open synchronous colorectal and hepatic resection for metastatic colorectal cancer11. Identifying prognostic factors for overall survival in patients with recurrent disease following liver resection for colorectal cancer metastasis12. Modified Blumgart pancreatojejunostomy with external stenting in laparoscopic Whipple reconstruction13. Laparoscopic versus open pancreaticoduodenectomy: a single centre’s initial experience with introduction of a novel surgical approach14. Neoadjuvant chemotherapy versus upfront surgery for borderline resectable pancreatic cancer: a single-centre cohort analysis15. Thermal ablation and telemedicine to reduce resource utilization during the COVID-19 pandemic16. Cost-utility analysis of normothermic machine perfusion compared with static cold storage in liver transplantation in the Canadian setting17. Impact of adjuvant therapy on overall survival in early-stage ampullary cancers: a single-centre retrospective review18. Presence of biliary anaerobes enhances response to neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma19. How does tumour viability influence the predictive capability of the Metroticket model? Comparing predicted-to-observed 5-year survival after liver transplant for hepatocellular carcinoma20. Does caudate resection improve outcomes in patients undergoing curative resection for perihilar cholangiocarcinoma? A systematic review and meta-analysis21. Appraisal of multivariable prognostic models for postoperative liver decompensation following partial hepatectomy: a systematic review22. Predictors of postoperative liver decompensation events following resection in patients with cirrhosis and hepatocellular carcinoma: a population-based study23. Characteristics of bacteriobilia and impact on outcomes after Whipple procedure01. Inverting the y-axis: the future of MIS abdominal wall reconstruction is upside down02. Progressive preoperative pneumoperitoneum: a single-centre retrospective study03. The role of radiologic classification of parastomal hernia as a predictor of the need for surgical hernia repair: a retrospective cohort study04. Comparison of 2 fascial defect closure methods for laparoscopic incisional hernia repair01. Hypoalbuminemia predicts serious complications following elective bariatric surgery02. Laparoscopic adjustable gastric band migration inducing jejunal obstruction associated with acute pancreatitis: aurgical approach of band removal03. Can visceral adipose tissue gene expression determine metabolic outcomes after bariatric surgery?04. Improvement of kidney function in patients with chronic kidney disease and severe obesity after bariatric surgery: a systematic review and meta-analysis05. A prediction model for delayed discharge following gastric bypass surgery06. Experiences and outcomes of Indigenous patients undergoing bariatric surgery: a mixed-methods scoping review07. What is the optimal common channel length in revisional bariatric surgery?08. Laparoscopic management of internal hernia in a 34-week pregnant woman09. Characterizing timing of postoperative complications following elective Roux-en-Y gastric bypass and sleeve gastrectomy10. Canadian trends in bariatric surgery11. Common surgical stapler problems and how to correct them12. Management of choledocholithiasis following Roux-en-Y gastric bypass: a systematic review and meta-analysis". Canadian Journal of Surgery 64, n.º 6 Suppl 2 (14 de diciembre de 2021): S80—S159. http://dx.doi.org/10.1503/cjs.021321.

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khani, mohsen, shahram jamali y mohammad karim sohrabi. "Intelligent Slice Admission Control in Cloud-Ran by Approximate Reinforcement Learning". SSRN Electronic Journal, 2022. http://dx.doi.org/10.2139/ssrn.4111779.

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Dai, Miao, Gang Sun, Hongfang Yu y Dusit Niyato. "Maximize the Long-Term Average Revenue of Network Slice Provider via Admission Control Among Heterogeneous Slices". IEEE/ACM Transactions on Networking, 2023, 1–16. http://dx.doi.org/10.1109/tnet.2023.3297883.

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Dai, Miao, Long Luo, Jing Ren, Hongfang Yu y Gang Sun. "PSACCF: Prioritized Online Slice Admission Control Considering Fairness in 5G/B5G Networks". IEEE Transactions on Network Science and Engineering, 2022, 1–15. http://dx.doi.org/10.1109/tnse.2022.3195862.

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jamali, shahram, mohsen khani y mohammad karim sohrabi. "Isac: Intelligent Slice Admission Control in Cloud-Ran by Approximate Reinforcement Learning". SSRN Electronic Journal, 2022. http://dx.doi.org/10.2139/ssrn.4295388.

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Bakri, Sihem, Bouziane Brik y Adlen Ksentini. "On using reinforcement learning for network slice admission control in 5G: Offline vs. online". International Journal of Communication Systems 34, n.º 7 (21 de febrero de 2021). http://dx.doi.org/10.1002/dac.4757.

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Luu, Quang-Trung, Sylvaine Kerboeuf y Michel Kieffer. "Admission Control and Resource Reservation for Prioritized Slice Requests with Guaranteed SLA under Uncertainties". IEEE Transactions on Network and Service Management, 2022, 1. http://dx.doi.org/10.1109/tnsm.2022.3160352.

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Wang, Jiadai, Jingyi Li y Jiajia Liu. "Digital twin-assisted flexible slice admission control for 5G core network: A deep reinforcement learning approach". Future Generation Computer Systems, diciembre de 2023. http://dx.doi.org/10.1016/j.future.2023.12.018.

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Khani, Mohsen, Shahram Jamali y Mohammad Karim Sohrabi. "Three-layer data center-based intelligent slice admission control algorithm for C-RAN using approximate reinforcement learning". Cluster Computing, 16 de febrero de 2024. http://dx.doi.org/10.1007/s10586-023-04252-y.

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Kim, S., L. Goelz, F. Münn, D. Kim, M. Millrose, A. Eisenschenk, S. Thelen y M. Lautenbach. "Detection of missed fractures of hand and forearm in whole-body CT in a blinded reassessment". BMC Musculoskeletal Disorders 22, n.º 1 (26 de junio de 2021). http://dx.doi.org/10.1186/s12891-021-04425-z.

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Abstract Background We examined the visibility of fractures of hand and forearm in whole-body CT and its influence on delayed diagnosis. This study is based on a prior study on delayed diagnosis of fractures of hand and forearm in patients with suspected polytrauma. Methods Two blinded radiologists examined CT-scans of patients with fractures of hand or forearm that were diagnosed later than 24 h after admission and control cases with unremarkable imaging of those areas. They were provided with clinical information that was documented in the admission report and were asked to examine forearm and hands. After unblinding, the visibility of fractures was determined. We examined if time of admission or slice thickness was a factor for late or missed diagnoses. Results We included 72 known fractures in 36 cases. Of those 65 were visible. Sixteen visible fractures were diagnosed late during hospital stay. Eight more fractures were detected on revision by the radiologists. Both radiologists missed known fractures and found new fractures that were not reported by the other. Missed and late diagnoses of fractures occurred more often around 5 pm and 1 am. Slice thickness was not significantly different between fractures and cases with fractures found within 24 h and those found later. Conclusions The number of late diagnosis or completely missed fractures of the hand and forearm may be reduced by a repeated survey of WBCT with focus on the extremities in patients with suspected polytrauma who are not conscious. Level of evidence III

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Autio, Anniina H., Juho Paavola, Joona Tervonen, Maarit Lång, Terhi J. Huuskonen, Jukka Huttunen, Virve Kärkkäinen et al. "Should individual timeline and serial CT/MRI panels of all patients be presented in acute brain insult cohorts? A pilot study of 45 patients with decompressive craniectomy after aneurysmal subarachnoid hemorrhage". Acta Neurochirurgica, 30 de enero de 2023. http://dx.doi.org/10.1007/s00701-022-05473-7.

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Abstract Purpose Our review of acute brain insult articles indicated that the patients’ individual (i) timeline panels with the defined time points since the emergency call and (ii) serial brain CT/MRI slice panels through the neurointensive care until death or final brain tissue outcome at 12 months or later are not presented. Methods We retrospectively constructed such panels for the 45 aneurysmal subarachnoid hemorrhage (aSAH) patients with a secondary decompressive craniectomy (DC) after the acute admission to neurointensive care at Kuopio University Hospital (KUH) from a defined population from 2005 to 2018. The patients were indicated by numbers (1.–45.) in the pseudonymized panels, tables, results, and discussion. The timelines contained up to ten defined time points on a logarithmic time axis until death ($$n=25$$ n = 25 ; 56%) or 3 years ($$n=20$$ n = 20 ; 44%). The brain CT/MRI panels contained a representative slice from the following time points: SAH diagnosis, after aneurysm closure, after DC, at about 12 months (20 survivors). Results The timelines indicated re-bleeds and allowed to compare the times elapsed between any two time points, in terms of workflow swiftness. The serial CT/MRI slices illustrated the presence and course of intracerebral hemorrhage (ICH), perihematomal edema, intraventricular hemorrhage (IVH), hydrocephalus, delayed brain injury, and, in the 20 (44%) survivors, the brain tissue outcome. Conclusions The pseudonymized timeline panels and serial brain imaging panels, indicating the patients by numbers, allowed the presentation and comparison of individual clinical courses. An obvious application would be the quality control in acute or elective medicine for timely and equal access to clinical care.

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Kappelhof, Manon, Manon L. Tolhuisen, Kilian M. Treurniet, Bruna G. Dutra, Heitor Alves, Guang Zhang, Scott Brown et al. "Endovascular Treatment Effect Diminishes With Increasing Thrombus Perviousness". Stroke, 20 de julio de 2021. http://dx.doi.org/10.1161/strokeaha.120.033124.

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Background and Purpose: Thrombus perviousness estimates residual flow along a thrombus in acute ischemic stroke, based on radiological images, and may influence the benefit of endovascular treatment for acute ischemic stroke. We aimed to investigate potential endovascular treatment (EVT) effect modification by thrombus perviousness. Methods: We included 443 patients with thin-slice imaging available, out of 1766 patients from the pooled HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke trials) data set of 7 randomized trials on EVT in the early window (most within 8 hours). Control arm patients (n=233) received intravenous alteplase if eligible (212/233; 91%). Intervention arm patients (n=210) received additional EVT (prior alteplase in 178/210; 85%). Perviousness was quantified by thrombus attenuation increase on admission computed tomography angiography compared with noncontrast computed tomography. Multivariable regression analyses were performed including multiplicative interaction terms between thrombus attenuation increase and treatment allocation. In case of significant interaction, subgroup analyses by treatment arm were performed. Our primary outcome was 90-day functional outcome (modified Rankin Scale score), resulting in an adjusted common odds ratio for a one-step shift towards improved outcome. Secondary outcomes were mortality, successful reperfusion (extended Thrombolysis in Cerebral Infarction score, 2B–3), and follow-up infarct volume (in mL). Results: Increased perviousness was associated with improved functional outcome. After adding a multiplicative term of thrombus attenuation increase and treatment allocation, model fit improved significantly ( P =0.03), indicating interaction between perviousness and EVT benefit. Control arm patients showed significantly better outcomes with increased perviousness (adjusted common odds ratio, 1.2 [95% CI, 1.1–1.3]). In the EVT arm, no significant association was found (adjusted common odds ratio, 1.0 [95% CI, 0.9–1.1]), and perviousness was not significantly associated with successful reperfusion. Follow-up infarct volume (12% [95% CI, 7.0–17] per 5 Hounsfield units) and chance of mortality (adjusted odds ratio, 0.83 [95% CI, 0.70–0.97]) decreased with higher thrombus attenuation increase in the overall population, without significant treatment interaction. Conclusions: Our study suggests that the benefit of best medical care including alteplase, compared with additional EVT, increases in patients with more pervious thrombi.

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Basavaraju, Umamaheshwari K., Narasipur Lingaiah Rajendra Kumar, Manupratap Narayana, Kn Rashmi, Ps Prathibha, Mahesh Seetharam, B. Sriviruthi y Rinu Pious. "Use of Shear Wave Elastography to Diagnose Acute Pancreatitis: A Cross-sectional Study". INTERNATIONAL JOURNAL OF ANATOMY RADIOLOGY AND SURGERY, 2021. http://dx.doi.org/10.7860/ijars/2021/46213:2619.

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Introduction: Acute inflammation process of the pancreas with or without involvement of surrounding tissues and remote organ systems is termed as Acute Pancreatitis (AP). Contrast Enhanced Computed Tomography (CECT) if performed immediately may underestimate the severity. Therefore, ultrasound examination remains the first imaging diagnostic method in suspected cases of AP. The sensitivity of B-mode sonography for the early diagnosis of AP can be increased by the detection of an increase in pancreatic tissue stiffness with Shear Wave Elastography (SWE). Aim: To evaluate the efficacy of SWE in the analysis of AP. Materials and Methods: A cross-sectional study was conducted in Tertiary Care Hospital attached to Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from August 2019 to September 2019. The pancreatic parenchyma of 30 patients with symptoms of AP that included acute onset of severe central epigastric pain, poorly localised tenderness and pain increased by supine positioning radiating to the back. The study also included 40 healthy, asymptomatic volunteer who were examined using B-mode sonography and SWE. Computed Tomography (CT) was performed in all patients with AP with a SEIMENS SOMATOM DEFINITION EDGE 128 slice CT scanner. Elastographic measurements were performed and quantitative SWE values represented in kilopascal (kPa) of the patients and asymptomatic volunteers group were compared. Patients’ amylase and lipase levels were done by biochemical tests. Descriptive and Inferential statistical analysis was carried out in the present study. Student’s t-test (two tailed, independent), Leven’s test for homogeneity of variance and Chi-square test was used to find the significance of study parameters. Results: The mean SWE values for the asymptomatic volunteers with normal pancreatic parenchyma were 9.53±2.62 kPa. The mean SWE values for the pancreatic parenchyma of the patients with AP were 17.23±6.24 kPa. The mean SWE value for the patients with AP was significantly higher than the value for the control group (p<0.001). A SWE cut-off value of 13.5 kPa was associated with 70% sensitivity and 92.5% specificity for diagnosis of AP. Conclusion: For the diagnosis of AP at initial hospital admission, SWE can be used as it is a rapid, radiation-free, and non- invasive tool. It is a useful imaging method with high sensitivity and specificity for the diagnosis of AP.

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Roelfsema, Ferdinand, Peter Y. Liu, Paul Takahashi, Rebecca Yang y Johannes D. Veldhuis. "OR32-04 Dynamic Interactions Between Luteinizing Hormone and Testosterone in Healthy Community-Dwelling Men: Impact by Age and Body Composition". Journal of the Endocrine Society 4, Supplement_1 (abril de 2020). http://dx.doi.org/10.1210/jendso/bvaa046.034.

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Abstract Context. Aging is associated with diminished testosterone (Te) secretion, which could be attributed to Leydig cell dysfunction, decreased pituitary stimulation and altered Te feedback. Objective. The goal was to quantify all three regulatory nodes of the GnRH-LH-Leydig cell- axis in the same cohort of healthy men, by measuring (1) indirectly the strength of the endogenous GnRH signal on the gonadotrope, (2) the strength of Te feedback on LH by ketoconazole (KTCZ), and (3) the effect of LH infusions on Te secretion, in relation to age and body composition. Design. This was a placebo-controlled, blinded, prospectively randomized cross-over study in 40 men, age 19–73 yr, BMI 20–34.3 kg/m2. A submaximal dose of ganirelix (GnRH antagonist) was used to assess outflow of GnRH, by calculating the difference between LH output during the control and ganirelix arm. Ketoconazole (steroidogenic inhibitor) was used to estimate feedback, by the difference in LH output during ketoconazole and control arm. High-dose ganirelix and repeated 6-min LH (18.75 IU) infusions were used to measure testicular responsivity. Blood sampling was at 10-min intervals. The 4 sessions were concluded with, a single submaximally GnRH stimulus to assess the responsiveness of the gonadotrope during ganirelix inhibition. Setting. The study was performed in a Clinical Translational Research Unit. Interventions. In 3 of the 4 experiments subjects underwent 5 h of blood sampling at 10-min intervals, starting at 0800 h. At 1100 h GnRH was injected and sampling was continued for another 2 h. Admission was at 1700 h the day before. At 2000 h they received KTCZ, dexamethasone or ganirelix and/or placebo. KTCZ and dexamethasone (or placebo) were administered again at 0700 when the IV catheter was placed. High-dose ganirelix was used to test the testicular responsiveness, and 7 LH pulses (90 min intervals) were given., with blood sampling from 1500 till 1300 h next day. Outcome measures. Mean concentrations of LH and (bio)Te, deconvolution analysis, endogenous dose-response LH-bioTe relation, and approximate entropy. Abdominal visceral fat (AVF) was calculated from single slice CT. Results. There were age-, but not body composition-related decreases in estimated endogenous GnRH secretion, Te’s feedback strength on LH, and Leydig cell responsivity to LH, accompanied by changes in approximate entropy. Bioavailable Te levels were negatively related to both age and AVF, without interaction between these variables. The LH response to a submaximal dose of GnRH was independent of age and AVF. Conclusion. Advancing age is associated with 1) attenuated bioavailable Te secretion caused by diminished GnRH outflow and not by decreased GnRH responsivity of the gonadotrope, 2) diminished testicular responsivity to infused LH pulses, and 3) partial compensation by diminished Te feedback on central gonadotropic regulation.

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Migdal, Alexandra L., Charlie Fortin-Leung, Francisco Pasquel, Heqiong Wang, Limin Peng y Guillermo E. Umpierrez. "Inpatient Glycemic Control With Sliding Scale Insulin in Noncritical Patients With Type 2 Diabetes: Who Can Slide?" Journal of Hospital Medicine 16, n.º 8 (21 de julio de 2021). http://dx.doi.org/10.12788/jhm.3654.

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OBJECTIVE: Despite clinical guideline recommendations, sliding scale insulin (SSI) is widely used for the hospital management of patients with type 2 diabetes (T2D). We aimed to determine which patients with T2D can be appropriately managed with SSI in non–critical care settings. METHODS: We used electronic health records to assess inpatient glycemic control in medicine and surgical patients treated with SSI according to admission blood glucose (BG) concentration between June 2010 and June 2018. Primary outcome was the percentage of patients with T2D achieving target glycemic control, defined as mean hospital BG 70 to 180 mg/dL without hypoglycemia <70 mg/dL during SSI therapy. RESULTS: Among 25,813 adult patients with T2D, 8,095 patients (31.4%) were treated with SSI. Among patients with admission BG <140 mg/dL and BG 140 to 180 mg/dL, 86% and 83%, respectively, achieved target control without hypoglycemia, as compared with only 18% of those with admission BG ≥250 mg/dL (P < .001). After adjusting for age, gender, body mass index (BMI), race, Charlson Comorbidity Index score, and setting, the odds of poor glycemic control increased with higher admission BG (BG 140-180 mg/dL: odds ratio [OR], 1.8; 95% CI, 1.5-2.2; BG 181-250 mg/dL: OR, 3.7; 95% CI, 3.1-4.4; BG >250 mg/dL: OR, 7.2; 95% CI, 5.8-9.0), as compared with patients with BG <140 mg/dL. A total of 1,192 patients (15%) treated with SSI required additional basal insulin during hospitalization. CONCLUSION: Most non–intensive care unit patients with admission BG <180 mg/dL treated with SSI alone achieve target glycemic control during hospitalization, suggesting that cautious use of SSI may be a viable option for certain patients with mild hyperglycemia.

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Bumm, R., A. Lasso, N. Kawel-Böhm, A. Wäckerlin, P. Ludwig y M. Furrer. "First results of spatial reconstruction and quantification of COVID-19 chest CT infiltrates using lung CT analyzer and 3D slicer". British Journal of Surgery 108, Supplement_4 (1 de mayo de 2021). http://dx.doi.org/10.1093/bjs/znab202.077.

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Abstract Objective Lung CT scans are early diagnostic tests in evaluation of COVID-19 patients. Data are usually analyzed visually and the extent of infiltrations can only roughly be estimated. The aim of the present study was to create a software to spatially visualize and quantify infiltrated and collapsed areas in lung CT scans and set these volumes into relation with non-affected lung areas. Methods A new software "Lung CT Analyzer" (LCTA, 1) was created from scratch in an international team-effort within the 3D medical imaging software 3D Slicer (2). LCTA consists of two components: "Lung CT Segmenter" implements an intuitive and semiautomatic workflow for the generation of lung masks. LCTA then uses masked thresholds of Hounsfield units to detect non-affected versus affected (emphysematous, infiltrated, and collapsed) areas of the lung. Intrapulmonary vessels are subtracted from the other volumes. Segment volumes are expressed in milliliters and displayed in 3D. COVID-Q was defined as affected divided by non-affected volume and can be calculated separately for both lungs. 3D Slicer and LCTA are open source, freely available and maintained on Github. Results CT data of twelve patients with moderate to severe COVID-19 (9 m, 3 f) were selected for the present retrospective study. All scans were performed shortly after admission. Thresholds of Hounsfield units (HU) for areas of interest were defined prior to the study and processing was identical for all patients. The median time effort for 3D reconstruction was 8 minutes per patient. For more detailed results please see the enclosed table. A 3D Slicer demo data set (Control) has been included for comparison. Conclusion The COVID-19 pandemic promoted fast-paced innovations such as LCTA in our hospital. LCTA was feasible, reproducible and easy to perform. COVID-Q correlated with COVID-19 lung involvement in all cases. All fatal cases showed COVID-Q values of > 2.0. LCTA enabled the serial 3D reconstruction of infiltrated and collapsed lung areas in lung CT scans. The procedure may be of great help in the future analysis of pulmonary infiltrates of any cause. In COVID-19 disease, volumetric lung CT reconstruction could result in the definition of new prognostic factors, identify patients “at-risk” in the ICU, and be useful for follow-up. (1) Lung CT Analyzer: https://github.com/rbumm/SlicerLungCTAnalyzer (2) 3D Slicer: http://slicer.org

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Çetin, Çiğdem, Melodi Gizem Can, Sinem Öztaşkın, Yasemin Yalçınkaya, Ahmet Gül, Murat İnanç y Bahar Artım Esen. "Analysis of 5-year hospitalization data of patients with systemic lupus erythematosus: Damage is a risk factor for frequent and longer stays". Lupus, 9 de enero de 2024. http://dx.doi.org/10.1177/09612033241227023.

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Objective The annual hospitalization rate of patients with systemic lupus erythematosus (SLE) is approximately 10%, and hospitalizations are responsible for most of the healthcare expenses. Herein, we analyzed 5-year hospitalization data of SLE patients and determined factors leading to hospitalization. Methods Clinical, laboratory, and hospitalization data of SLE patients admitted to our rheumatology clinic in 2015–2020 were retrieved from our SLE database and analyzed. SLICC SLE damage index (SDI) and disease activity at admission (SLEDAI-2K) were determined. Results Among 161 hospitalized patients, 86% were females. Total rheumatologic hospitalization number was 298, and 38% of the patients were hospitalized more than once (1.85 ± 1.56). The mean hospitalization duration covering all stays for each patient was 25 ± 26.5 days. Active disease, infection, and damage-related complications were first three causes of hospitalization. Compared to patients hospitalized for active disease or damage, patients hospitalized for infection had a significantly higher number of readmissions ( p < .05) and their total hospital stay was longer ( p < .01). The frequency of patients with damage and the mean SDI score was significantly lower in the active disease group (68%, 1.93 ± 2.05) than hospitalizations for infection (90%, 2.68 ± 1.63) and damage-related causes (96%, 3.04 ± 1.65) ( p < .05). The mean SDI score and duration (r = 0.551, p < .001) and the number of hospitalizations (r = 0.393, p < .001) were positively correlated. The mean disease activity scores of patients hospitalized for active disease, infection, and damage-related reasons were 11.03 ± 6.08, 3.21 ± 2.80, and 2.96 ± 3.32, respectively ( p < .001). Renal active disease was the most common (44%), followed by hematological (34.8%), articular (21.7%), and mucocutaneous (21%) activity. Ten percent of the patients all of whom had damage were admitted to intensive care unit (ICU). Total hospitalization duration, mean SDI, antiphospholipid syndrome, lupus anticoagulant, thrombocytopenia, serositis, pulmonary hypertension, history of alveolar hemorrhage, and cardiac valve involvement were associated with ICU admission ( p < .05 for all). Conclusion Disease activity, infections, and damage are the leading causes of hospitalization in SLE patients. Damage prolongs hospital stay and increases hospitalization rate and ICU need. Tight control of disease activity with rational use of immunosuppressive treatment is important to reduce damage and hospitalizations.

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Rawal, Kala Bahadur, Dhruba Rana Chhetri, Ashish Giri, H. N. Girish, Min Bahadur Luhar, S. Anusha, A. Ashvil y R. Lalrinsiama. "Metoprolol-induced hyperkalemia – A case report". Indian Journal of Medical Sciences, 10 de octubre de 2020, 1–4. http://dx.doi.org/10.25259/ijms_134_2020.

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Hyperkalemia is a condition that increased serum potassium levels, which can lead to life-threatening cardiac conditions. A 59-year-old female patient admitted to an emergency medicine ward with complaints of gradually progressive retrosternal chest pain. She was a known case of diabetes mellitus (DM), hypertension, and ischemic heart disease with a positive family history of DM and hypertension. She has treated with tablet metoprolol 12.5 mg twice daily from 20 days. On examination, the patient was restless due to unstable angina BP in the range of 110/70–180/90 mm of Hg, PR range 84–86 bpm, and SPO2 – 98%. Laboratory investigation revealed that the HbA1c was 7.19, and mean blood glucose of the past 90 days was in average control. Ultrasonography shows the Grade I renal parenchymal disease. The serum blood sugar level was elevated. Serum troponin I was 0.91 ng/ml. Ultrasonography abdomen was normal. Electro cardiogram: Sinus tachycardia suspected left inferior hemiblock, poor R-wave progression, inverted T- wave, and slide ST segments elevation and 2D-echocardiogram: IHD and RWMA at rest (basal inferior moderate left ventricle dysfunction). On hospital admission, the patient was treated with antiplatelet agents, anticoagulant, insulin, anti-ischemic agents, hypolipidemic agents, and potassium binder resins and diuretics. Patients with diabetes and kidney dysfunction have a higher risk of hyperkalemia in concomitants therapy with beta-blockers, so the health care workers should be aware of life-threatening events due to hyperkalemia secondary to beta-blockers. This case-report adds the evidence on the electrolyte related adverse drug reactions due to the beta-blockers.

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Powell, Kimerly A., Katie M. Gallagher y Yousef Hannawi. "Abstract TMP96: Automated Segmentation of White Matter Hyperintensities and Enlarged Perivascular Spaces in a Cohort of Patients With Acute Ischemic Stroke or Transient Ischemic Attack". Stroke 51, Suppl_1 (febrero de 2020). http://dx.doi.org/10.1161/str.51.suppl_1.tmp96.

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Introduction: Cerebral Small Vessel Disease (CSVD) is a major cause of acute ischemic stroke (AIS), intracerebral hemorrhage and cognitive impairment. Methods to quantify the disease burden have been largely limited to white matter hyperintensities (WMH) as the disease surrogate and focused mainly on MRI sequences acquired for research purposes. We develop here novel methods to quantify WMH and enlarged perivascular spaces (EPVs) based on clinically acquired MRI sequences in patients with transient ischemic attack (TIA) or AIS. Methods: Subjects presenting with TIA or AIS and had brain MRI within 24 hour of hospital admission were selected for this study. Preprocessing pipeline was developed locally that included bias correction, image rescaling, rigid body registration to the Montreal Neurological Institute (MNI) space, skull stripping and intensity normalization. WMH segmentation was performed using a combination of global thresholding of FLAIR sequences that was spatially restricted to the white matter regions which were defined using a population-based atlas of age matched controls. EPVs in the basal ganglia were segmented on T2 sequences using adaptive thresholding of basal ganglia mask that was created from the ICBM template image and age-matched population average atlas. Segmented objects less than 3 mm in diameter were labelled as EPVs. Validation of the accuracy of EPVs segmentation was performed by expert counting of EPVs and WMH was validated using volume similarity against expert manual segmentation of WMH. Results: 41 patients (age 61.2±16.1, 65% males, 19.5% had TIAs, and 79.5% had AIS) were included. WMH volume was (manual: 21.34±20.48 mls vs automated: 15.74±14.56 mls) achieving a volume similarity of 0.92±0.01. EPVs in the basal ganglia counts were 16.32±5.4 using the automated method. Validation through comparison with manual segmentation of the axial slice with the highest EPVs (Doubal Method) showed significant correlation (Spearman’s rho=0.53, P = 0.0004). Conclusions: We describe successful segmentation of WMH and EPVs on clinically acquired MRI sequences in patients with TIA or AIS. This method will have applications to quantify CSVD burden in large clinical trials and clinical practice.

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Mangat, Halinder S., Jana Ivanidze, Xiangling Mao, Dikoma Shungu, Malik Fakhar, Ajay Gupta y Philip E. Stieg. "Abstract 191: Selective Frontal Lobe Metabolic Dysfunction After Sub-arachnoid Hemorrhage". Stroke 48, suppl_1 (febrero de 2017). http://dx.doi.org/10.1161/str.48.suppl_1.191.

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Aneurysmal SAH results in high morbidity. Patients who make a good neurological recovery report significant neuropsychological impairment such as loss of motivation, interests, and concentration, all of which are commonly associated with frontal lobe dysfunction. We hypothesize that subclinical frontal lobe injury occurs in neurologically intact SAH patients and may be identified by measuring brain energy metabolism using regional N-acetyl aspartate (NAA) as an imaging marker of neuronal integrity and mitochondrial function, and CSF lactate, as a marker of anaerobic metabolism. We utilized MR Spectroscopy (MRS) to measure regional NAA in SAH patients who had suffered neither cerebral infarction nor neurological deficits. Only patients who underwent endovascular aneurysm coiling were included. Measurements were made in frontal, temporal, occipital lobes, lateral ventricles, and averaged in each hemisphere from 3 slices. Matching ROIs were placed on the most proximate CT perfusion maps to measure corresponding rCBF. MR spectra were compared to controls from our data library (7 subjects) and to rCBF. Average age was 58 years, Hunt Hess score was 2.43±1.09, modified Fisher score was 2.79±1.05. 3 patients had DCI and none had cerebral infarction. Median GCS at discharge was 15. MRS was done at 9.93±7.73 days from admission. 1 patient had no MRS data, 3 patients had no CT perfusion. SAH patients demonstrated significantly reduced NAA/RMS in frontal lobes (16.18±4.96 vs. 20.93±5.56, p=0.042) but not in temporal (16.49±4.37 vs. 19.37±4.38, p=0.09) or occipital lobes (20.62±4.50 vs. 21.05±4.23, p=0.41). CSF lactate was significantly higher in SAH patients (7.74±2.27 vs. 4.02±0.76, p=0.001). NAA/RMS did not correlate with CBF in pooled data (R 2 =0.02, p=0.40) or in frontal lobe rCBF (R 2 =0.001, p=0.92); nor with CSF lactate (R 2 =0.02, p=0.53). Total frontal lobe NAA is selectively reduced and CSF lactate is elevated in neurologically intact survivors after SAH. This preliminary data is suggestive of energy depletion and subclinical brain injury, which appears to be independent of cerebral blood flow. In addition to validating this pilot data, we will study the association with cognitive impairment in these patients.

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