Predicting blood transfusion demand in intensive care patients after surgery by comparative analysis of temporally extended data selection.

Background: Blood transfusion (BT) is a critical aspect of medical care for surgical patients in the Intensive Care Unit (ICU). Timely and accurate identification of BT needs can enhance patient outcomes and healthcare resource management.

Methods: This study aims to determine whether a machine learning (ML) model can be trained to predict the need for blood transfusion (BT) in patients on the ICU after a wide range of surgeries, utilizing only data from the ICU.

Simplifying Multiparty Computation: A Client-Driven Metaprotocol for Federated Secure Computing.

Introduction: Secure Multi-Party Computation (SMPC) offers a powerful tool for collaborative healthcare research while preserving patient data privacy.

State Of The Art: However, existing SMPC frameworks often require separate executions for each desired computation and measurement period, limiting user flexibility.

Concept: This research explores the potential of a client-driven metaprotocol for the Federated Secure Computing (FSC) framework and its SImple Multiparty ComputatiON (SIMON) protocol as a step towards more flexible SMPC solutions.

A Comparative Analysis of Federated and Centralized Learning for SpO2 Prediction in Five Critical Care Databases.

This study explores the potential of federated learning (FL) to develop a predictive model of hypoxemia in intensive care unit (ICU) patients. Centralized learning (CL) and local learning (LL) approaches have been limited by the localized nature of data, which restricts CL approaches to the available data due to data privacy regulations. A CL approach that combines data from different institutions, could offer superior performance compared to a single-institution approach.

Predicting Successful Weaning from Mechanical Ventilation by Reduction in Positive End-expiratory Pressure Level Using Machine Learning.

Weaning patients from mechanical ventilation (MV) is a critical and resource intensive process in the Intensive Care Unit (ICU) that impacts patient outcomes and healthcare expenses. Weaning methods vary widely among providers. Prolonged MV is associated with adverse events and higher healthcare expenses.

Predicting Hypoxia Using Machine Learning: Systematic Review.

Background: Hypoxia is an important risk factor and indicator for the declining health of inpatients. Predicting future hypoxic events using machine learning is a prospective area of study to facilitate time-critical interventions to counter patient health deterioration.

Objective: This systematic review aims to summarize and compare previous efforts to predict hypoxic events in the hospital setting using machine learning with respect to their methodology, predictive performance, and assessed population.

Efficacy, Feasibility, and Safety of the X-Tack Endoscopic HeliX Tacking System: A Multicenter Experience.

Background And Aims: The application of endoscopic suturing has revolutionized defect closures. Conventional over-the-scope suturing necessitates removal of the scope, placement of the device, and reinsertion. A single channel, single sequence, through-the-scope suturing device has been developed to improve this process.

Querying a Clinical Data Warehouse for Combinations of Clinical and Imaging Data.

This study aims to show the feasibility and benefit of single queries in a research data warehouse combining data from a hospital's clinical and imaging systems. We used a comprehensive integration of a production picture archiving and communication system (PACS) with a clinical data warehouse (CDW) for research to create a system that allows data from both domains to be queried jointly with a single query. To achieve this, we mapped the DICOM information model to the extended entity-attribute-value (EAV) data model of a CDW, which allows data linkage and query constraints on multiple levels: the patient, the encounter, a document, and a group level.

When Two Become One: Conformational Changes in FXR/RXR Heterodimers Bound to Steroidal Antagonists.

Farnesoid X receptor (FXR) is a nuclear receptor with an essential role in regulating bile acid synthesis and cholesterol homeostasis. FXR activation by agonists is explained by an αAF-2-trapping mechanism; however, antagonism mechanisms are diverse. We discuss microsecond molecular dynamics (MD) simulations investigating our recently reported FXR antagonists 2a and 2 h.

Preoperative Factors Associated with Target Lesion Revascularization following Endovascular Therapy of the Superficial Femoral Artery.

Objectives: In patients with symptomatic peripheral arterial occlusive disease (PAOD), endovascular revascularization of the superficial femoral artery (SFA) is the most frequent intervention. A major drawback of endovascular procedures is clinically driven target lesion revascularization (CD-TLR), which may cause recurrence of symptoms, re-hospitalizations, and re-interventions. Outcome studies comparing endovascular modalities are heterogeneous and focus more on intraoperative rather than preoperative aspects.

Implications of pre-transplant sarcopenia and frailty in patients with non-alcoholic steatohepatitis and alcoholic liver disease.

Frailty manifesting as sarcopenia is an independent risk factor for mortality in cirrhosis, and often presents in low model for end-stage liver disease (MELD) patients. Its etiology is multifactorial, but key physiologic changes culminate in altered energy utilization in the fasting state, preferentially utilizing muscle amino acids for gluconeogenesis thereby promoting sarcopenia. Hyperammonemia alters the circulating amino acid profile, diminishing pro-muscle branched-chain amino acids like leucine.

Selectivity of Oxidizing Agents toward Axial and Equatorial Hydroxyl Groups.

A total of 16 oxidizing reagents were screened to compare their oxidation selectivities for axial and equatorial hydroxyl moieties using steroidal methyl chenodeoxycholate, methyl deoxycholate, and 4--butylcyclohexanol (/ 1:1 mixture). These compounds were selected for their stable chair conformations. The results of our study demonstrated that, for the oxidation of a scaffold bearing both axial and equatorial hydroxyl groups, nitroxide-radical-based reagents should be the first choice if oxidation of the equatorial hydroxyl group is needed and Stevens or Dess-Martin reagents should be the first choice for the preferential oxidation of the axial hydroxyl group.

Gastroenterologist's Guide to Gastrostomies.

Gastroenterologists are frequently consulted for evaluation feeding tube placement, or for management of complications in an existing feeding tube. Though a frequent topic of consultation for GI Fellows, there are few comprehensive resources for feeding tube placement and troubleshooting available. In this review, we discuss different types of feeding tubes, when each should be considered, and various methods and techniques for placement.

Sarcopenia in Chronic Pancreatitis - Prevalence, Diagnosis, Mechanisms and Potential Therapies.

Purpose Of Review: To investigate the prevalence, pathogenesis, diagnosis, clinical sequelae, and management of sarcopenia to improve mortality and quality of life in those with Chronic Pancreatitis.

Recent Findings: Sarcopenia is prevalent in chronic pancreatitis and can significantly affect clinical outcomes. Sarcopenia is prevalent in chronic pancreatitis.

When Can we Feed after a Gastrointestinal Bleed?

Purpose Of Review: Gastrointestinal (GI) bleeding can carry minimal or significant risk for recurrent hemorrhage. Timing of feeding after GI bleeding remains an area of debate, and here we review the evidence supporting recommendations.

Recent Findings: Improved understanding of the pathophysiology of GI bleeding and the evolution of treatment strategies has significantly altered the management of GI bleeding and the associated propensity for rebleeding.

Optimizing the nutrition support care model: Analysis of survey data.

Background: Malnutrition is underrecognized and underdiagnosed, despite high prevalence rates and associated poor clinical outcomes. The involvement of clinical nutrition experts, especially physicians, in the care of high-risk patients with malnutrition remains low despite evidence demonstrating lower complication rates with nutrition support team (NST) management. To facilitate solutions, a survey was designed to elucidate the nature of NSTs and physician involvement and identify needs for novel nutrition support care models.

Automated provision of clinical routine data for a complex clinical follow-up study: A data warehouse solution.

A deep integration of routine care and research remains challenging in many respects. We aimed to show the feasibility of an automated transformation and transfer process feeding deeply structured data with a high level of granularity collected for a clinical prospective cohort study from our hospital information system to the study's electronic data capture system, while accounting for study-specific data and visits. We developed a system integrating all necessary software and organizational processes then used in the study.

(E)-7-Ethylidene-lithocholic Acid (7-ELCA) Is a Potent Dual Farnesoid X Receptor (FXR) Antagonist and GPBAR1 Agonist Inhibiting FXR-Induced Gene Expression in Hepatocytes and Stimulating Glucagon-like Peptide-1 Secretion From Enteroendocrine Cells.

Bile acids (BAs) are key signaling steroidal molecules that regulate glucose, lipid, and energy homeostasis via interactions with the farnesoid X receptor (FXR) and G-protein bile acid receptor 1 (GPBAR1). Extensive medicinal chemistry modifications of the BA scaffold led to the discovery of potent selective or dual FXR and GPBAR1 agonists. Herein, we discovered 7-ethylidene-lithocholic acid (7-ELCA) as a novel combined FXR antagonist/GPBAR1 agonist (IC = 15 μM/EC = 26 nM) with no off-target activation in a library of 7-alkyl substituted derivatives of BAs.

On the way to routine cardiac MRI at 7 Tesla - a pilot study on consecutive 84 examinations.

Introduction: Cardiac magnetic resonance (CMR) at ultrahigh field (UHF) offers the potential of high resolution and fast image acquisition. Both technical and physiological challenges associated with CMR at 7T require specific hardware and pulse sequences. This study aimed to assess the current status and existing, publicly available technology regarding the potential of a clinical application of 7T CMR.

A Specialized System for Arrhythmia Detection for Basic Research in Cardiology.

The detection of cardiac arrhythmias has a long history in medicine, with current developments focusing on early detection using mobile devices. In basic research, however, the use cases and data differ greatly from the experimental setup. We developed a Python-based system to ease detection and analysis of arrhythmic sections in signals measured on extracted and stimulated cardiac myocytes.

Improved Lipid Target Level Attainment in Patients with Peripheral Artery Disease.

Background: Patients with peripheral artery disease (PAD) fall under the category of a very high cardiovascular risk. Although consequent lipid-lowering therapy (LLT) is advised, only sparse data on attained target level in PAD exists.

Objectives: We aimed to analyse contemporary guideline recommendations for LLT in symptomatic PAD patients.

H2A Histone Family Member X (H2AX) Is Upregulated in Ovarian Cancer and Demonstrates Utility as a Prognostic Biomarker in Terms of Overall Survival.

: H2AX can be of prognostic value in breast cancer, since in advanced stage patients with high levels, there was an association with worse overall survival (OS). However, the clinical relevance of H2AX in ovarian cancer (OC) remains to be elucidated. : OC expression studied using the TCGA/GTEX datasets.

3β-Isoobeticholic acid efficiently activates the farnesoid X receptor (FXR) due to its epimerization to 3α-epimer by hepatic metabolism.

Bile acids (BAs) are important signaling molecules acting via the farnesoid X nuclear receptor (FXR) and the membrane G protein-coupled bile acid receptor 1 (GPBAR1). Besides deconjugation of BAs, the oxidoreductive enzymes of colonic bacteria and hepatocytes enable the conversion of BAs into their epimers or dehydrogenated forms. Obeticholic acid (OCA) is the first-in-class BA-derived FXR agonist approved for the treatment of primary biliary cholangitis.

Development of a 3-Dimensional Prognostic Score for Patients With Symptomatic Peripheral Artery Disease: PAD Score.

Peripheral artery disease (PAD) is a high-risk condition for cardiovascular (CV) events, but no specific prognosis assessment tool exists. We developed an individual risk score (PAD) based on the combined predictive value for mortality, including (1) age, (2) severity of PAD, and (3) extent of atherosclerosis. Patients (n = 1310) with symptomatic PAD were followed up for a mean of 50 ± 26 months.

Unlocking the PACS DICOM Domain for its Use in Clinical Research Data Warehouses.

Clinical Data Warehouses (DWHs) are used to provide researchers with simplified access to pseudonymized and homogenized clinical routine data from multiple primary systems. Experience with the integration of imaging and metadata from picture archiving and communication systems (PACS), however, is rare. Our goal was therefore to analyze the viability of integrating a production PACS with a research DWH to enable DWH queries combining clinical and medical imaging metadata and to enable the DWH to display and download images ad hoc.