Technical Considerations Research Articles

Toward diffusion tensor imaging as a biomarker in neurodegenerative diseases: technical considerations to optimize recordings and data processing.

Neuroimaging biomarkers have shown high potential to map the disease processes in the application to neurodegenerative diseases (NDD), e.g., diffusion tensor imaging (DTI). For DTI, the implementation of a standardized scanning and analysis cascade in clinical trials has potential to be further optimized. Over the last few years, various approaches to improve DTI applications to NDD have been developed. The core issue of this review was to address considerations and limitations of DTI in NDD: we discuss suggestions for improvements of DTI applications to NDD. Based on this technical approach, a set of recommendations was proposed for a standardized DTI scan protocol and an analysis cascade of DTI data pre-and postprocessing and statistical analysis. In summary, considering advantages and limitations of the DTI in NDD we suggest improvements for a standardized framework for a DTI-based protocol to be applied to future imaging studies in NDD, towards the goal to proceed to establish DTI as a biomarker in clinical trials in neurodegeneration.

Is the robotic approach the future of distal pancreatectomy with splenectomy? A propensity score matched analysis.

Our study provides a comparative analysis of the Laparo-Endoscopic Single Site (LESS) and robotic surgical approaches for distal pancreatectomy and splenectomy, examining their cosmetic advantages, patient outcomes, and operative efficiencies through propensity score matching (PSM). We prospectively followed 174 patients undergoing either the LESS or robotic procedure, matched by cell type, tumor size, age, sex, and BMI from 2012 to 2023. Propensity score matching (PSM) was utilized for data adjustment, with results presented as median (mean ± SD). Post-PSM analysis showed no significant differences in age or BMI between the two groups. LESS approach exhibited a shorter operative duration (180(180 ± 52.0) vs. 248(262 ± 78.5) minutes, p = 0.0002), but increased estimated blood loss (200(317 ± 394.4) vs. 100 (128 ± 107.2) mL, p = 0.04). Rates of intraoperative and postoperative complications, length of hospital stay, readmissions within 30days, in-hospital mortalities, and costs were comparably similar between the two procedures. While the robotic approach led to lower blood loss, LESS was more time-efficient. Patient outcomes were similar in both methods, suggesting that the choice between these surgical techniques should balance cosmetic appeal with technical considerations.

Application of Perfusion Imaging in the Telehealth Setting for Acute Ischemic Stroke

In the remote telehealth setting, computed tomography perfusion (CTP) provides important information in assessing the suitability of reperfusion therapy for patients with stroke syndromes. This review will discuss key concepts surrounding the use of CTP, including basic science, clinical applications, pitfalls, recent trials, and technical considerations. CTP can enhance decision-making for patients who are in the extended window from stroke onset, and this review will address key concepts relevant to its use.

Evaluation of Failed ACL Reconstruction: An Updated Review.

Failure rates among primary Anterior Cruciate Ligament Reconstruction (ACLR) range from 3.2% to 11.1%. Recently, there has been increased focus on surgical and anatomic considerations which predispose patients to failure, including excessive posterior tibial slope (PTS), unaddressed high-grade pivot shift, and improper tunnel placement. The purpose of this review was to provide a current summary and analysis of the literature regarding patient-related and technical factors surrounding revision ACLR, rehabilitation considerations, overall outcomes and return to sport (RTS) for patients who undergo revision ACLR. There is a convincingly higher re-tear and revision rate in patients who undergo ACLR with allograft than autograft, especially amongst the young, athletic population. Unrecognized Posterior Cruciate Ligament (PLC) injury is a common cause of ACLR failure and current literature suggests concurrent operative management of high-grade PLC injuries. Given the high rates of revision surgery in young active patients who return to pivoting sports, the authors recommend strong consideration of a combined ACLR + Anterolateral Ligament (ALL) or Lateral extra-articular tenodesis (LET) procedure in this population. Excessive PTS has been identified as an independent risk factor for ACL graft failure. Careful consideration of patient-specific factors such as age and activity level may influence the success of ACL reconstruction. Additional technical considerations including graft choice and fixation method, tunnel position, evaluation of concomitant posterolateral corner and high-grade pivot shift injuries, and the role of excessive posterior tibial slope may play a significant role in preventing failure.

Transpalpebral mini-orbitozygomatic approach for nonvascular skull base lesions: a single neurosurgeon's experience.

The authors aim to describe the advantages, utility, and disadvantages of the transpalpebral mini-orbitozygomatic (MOZ) approach for tumors of the lateral and superior orbit, orbital apex, anterior clinoid, anterior cranial fossa, middle cranial fossa, and parasellar region. The surgical approach from skin incision to closure is described while highlighting key technical and anatomical considerations, and cadaveric dissection demonstrates the surgical steps and focuses on important anatomy. Intraoperative images were included to supplement the cadaveric dissection. A retrospective review of adults who had undergone the MOZ approach for nonvascular pathology performed by a single neurosurgeon from 2017 to 2023 was included in this institutional review board-approved study. Descriptive statistics was used to summarize the data. Four representative cases were included to demonstrate the utility of the MOZ approach. The study included 65 patients (46 female, 19 male), average age 54.84 years, who had undergone transpalpebral MOZ surgery. Presenting symptoms included visual changes (53.8% of cases), vision loss (23.1%), diplopia (21.8%), and proptosis (13.8%). The optic nerve and optic chiasm were involved in 32.3% and 10.8% of cases, respectively. The most common pathology was meningioma (81.5% of cases), and gross-total resection was achieved in 50% of all cases. Major complications included an infection and a carotid injury. Improvement of preoperative symptoms was reported in 92.2% of cases. Visual acuity improved in 12 patients. The mean follow-up was 8.57 ± 8.45 months. The MOZ approach is safe and durable. The transpalpebral incision provides better cosmesis and functional outcomes than those of standard anterolateral approaches to the skull base. Careful consideration of the limits of the approach is paramount to appropriate application on a case-by-case basis. Further quantitative anatomical studies can help to define and compare the utility of the approach to open cranio-orbital and endoscopic transorbital approaches.

Use of Web-GIS Database Model to Accommodate Public Participation in the Improvement of Sustainable Road and Bridge Management: A Conceptual Idea

Sustainability is usually associated with energy source, ecological, soil and environmental aspects. Periodical road and bridge preservation is required to ensure the increasing of accessibility and mobility level, to increase regional economics’ growth, to minimize unplanned or unpredicted environmental consequences and to improve institutional arrangement capability as well. Road and bridge preservation is commonly managed based on its level of damage and constrained in budgeting. Poor public policy makes it worst. Therefore, the issue of strengthening the capacity of regional road and bridge management institutions is deemed important and urgent not only to reduce roads and bridges preservation cost but also to increase regional economics’ growth. Therefore, a proper road preservation type and priority should be determined based on technical, socio-economics, environment and public policy consideration. However, annual road and bridge functional condition data collection took high cost because it has been carried out by engineering consultant. The aim of this study is resolve it by providing a public participation portion in a road and bridge data base model. They are simply asked to send a real time condition of road s or bridge nearby to the local authority. The results strongly indicate that cost saved obtained from it could be focused to road and bridge preservation cost.

Cross-Border Data Forensics: Challenges and Strategies in the Belt and Road Initiative Digital Era

Cross-border data forensics in the era of the Belt and Road Initiative (BRI) are facing increased complexity. Multinational enterprises are encountering legal and technical challenges due to the fragmentation of global data regulations. The different data protection standards in major jurisdictions such as the European Union, China and the United States have created varying approaches to data privacy, national security, and cross-border data flow management. A study was conducted to explore the intricate framework of traditional Mutual Legal Assistance (MLA) in criminal cases. It highlights the inefficiency of cross-border data forensics and proposes reform proposals to strengthen international data-sharing cooperation. The study suggests that data localization is an effective alternative, but developing digital forensics standards in line with the goals of the Belt and Road Initiative would be a better option. To achieve this, a comprehensive regulatory framework needs to be established that balances national security, personal privacy and international cooperation in data exchange. The framework should emphasize that cross-border data management needs to coordinate and integrate technical, legal and business considerations.

Transforming university records management: A comprehensive review of blockchain and self-sovereign identity applications

Traditional university records management systems often rely on centralized, fragmented, and vulnerable methods of data storage. This can compromise security, hinder efficient sharing of information, and limit students' ownership of their educational journeys. Blockchain technology, coupled with the principles of self-sovereign identity (SSI), offers the potential to revolutionize how student records are created, stored, and shared. This review paper synthesizes emerging research and explores the transformative implications of blockchain and SSI for university records management. It examines how these technologies streamline administrative processes, enhance data security and trustworthiness, empower students to control their narratives and foster collaboration between educational institutions. Key benefits, technical considerations, and real-world implementation challenges are critically analyzed. The paper concludes with a call to action for universities, technology providers, researchers, and policymakers to collaborate on innovative solutions. This collaboration will pave the way for a more secure, student-centric, and efficient future for educational records management.

Environmental Impact Evaluation of Floating Solar Power Plant in Cirata Reservoir, West Java

This qualitative study investigates community perceptions of the environmental impacts of floating solar power plants (FSPPs) in Cirata Reservoir, West Java. Through semi-structured interviews and participant observations, data were collected from fifteen diverse stakeholders, including local residents, community leaders, environmental activists, government officials, and energy project developers. Thematic analysis revealed key themes and subthemes related to environmental concerns, economic implications, social impacts, technical considerations, and trust and transparency issues surrounding FSPP development. Participants expressed a range of perspectives, including support for solar energy, concerns about habitat disruption and water quality degradation, and calls for inclusive decision-making processes and transparent communication. The findings underscore the importance of addressing community concerns and incorporating local perspectives into the planning and implementation of FSPP projects to ensure environmental sustainability and social acceptance.

Ethanol Sclerotherapy in the Management of Ovarian Endometrioma: Technical Considerations for Catheter- and Needle-Directed Sclerotherapy

PurposeTo provide technical guidance on applying catheter-directed and needle-directed ethanol sclerotherapy for endometriomas and present the results of these sclerotherapy methods.Materials and MethodsFrom January 2015 to March 2021, the results of the patients with symptomatic ovarian endometriomas who underwent needle-directed or catheter-directed sclerotherapy were evaluated, retrospectively. The decision to apply which sclerotherapy technique was made during the procedure for each patient considering the following factors: cyst size, cyst location, cyst viscosity, and tissue rigidity.ResultsBoth needle-directed (n = 34 cysts) and catheter-directed (n = 34 cysts) sclerotherapy techniques were effective, with a 100% technical success rate and a 97% clinical success rate. In two of 34 cysts (6%) treated with needle-directed sclerotherapy, recurrence was detected and successfully retreated with catheter-directed sclerotherapy. Significant reductions in cyst size, pain, and serum cancer antigen 125 levels (p < 0.05) were noted. Serum anti-Müllerian hormone levels remained unaffected, indicating preserved ovarian reserve (p > 0.05). Among those treated for infertility, the pregnancy rate was 54% (n = 6/11). The mean ± SD cyst size decline was greater in catheter-directed sclerotherapy than needle-directed sclerotherapy (5.5 ± 3.1 cm vs. 4.0 ± 2.1 cm, p < 0.05). However, the pretreatment cyst volumes were considerably higher in catheter-directed sclerotherapy group (202.0 ± 233.5 mL vs. 78.8 ± 59.7 mL, p < 0.05) and were associated with significant post-treatment volume decrease (p < 0.05).ConclusionThe choice between catheter-directed and needle-directed ethanol sclerotherapy should be determined during the procedure, with a preference for catheter-directed sclerotherapy when feasible. Crucial factors in making this decision include cyst size, cyst location, cyst viscosity, and tissue rigidity.Level of evidence Level 3, non-controlled retrospective cohort study.Graphical

Technical considerations and sizing of external annuloplasty in the Ross procedure.

Pure aortic regurgitation and dilation of aortic annulus are the most significant risk factors for the failure of pulmonary autograft after the Ross procedure. Aortic annuloplasty has a positive effect on the durability of the autograft. Previously, we described a technique for external annuloplasty with dedicated CORONEO ring. In the present manuscript, we suggest the sizing of annuloplasty based on the diameter of pulmonary autograft annulus.

The anterior saphenous vein. Part 4. Clinical and technical considerations in treatment. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum, and the International Union of Phlebology

BackgroundThe decision to treat a refluxing anterior saphenous vein (ASV) should be a clinical decision based on the assessment on the ASV’s contribution to patient’s signs and symptoms. Once the decision to treat has been made, there are anatomic, clinical, and technical considerations in treatment planning. MethodsClinical scenarios were discussed by a panel of experts and common anatomic, clinical, and technical considerations were identified. ResultsThere are unique clinical considerations such as whether both the great saphenous vein (GSV) and ASV should be concomitantly treated, if a normal ASV should be treated when treating a refluxing GSV and when and how to treat the associated tributary varicose tributaries. Being aware of the anatomic, clinical, and technical considerations allows development of a treatment plan that optimizes long-term outcomes in patients with ASV reflux. ConclusionsUltimately the treatment plan should be tailored to address these types of variables in a patient-centered discussion.

Special Considerations in Pediatric Endoscopic Skull Base Surgery.

Originally pioneered in adults, endoscopic endonasal approaches for skull base pathology are being increasingly applied as a minimally invasive alternative for young children. Intrinsic anatomic differences between these patient populations have sparked discussions on the feasibility, safety, and efficacy of these techniques in pediatric patients. This work aims to serve as a primer for clinicians engaged in the rapidly evolving field of pediatric endoscopic skull base surgery. A succinct overview of relevant embryology, sinonasal anatomy, and diagnostic workup is presented to emphasize key differences and unique technical considerations. Additional discussions regarding select skull base lesions, reconstructive paradigms, potential surgical complications, and postoperative care are also highlighted in the setting of multidisciplinary teams.

Strategies for CO2 Laser Use in Laryngeal Microsurgery: A Systematic Review.

We aim to systematically review the literature addressing perioperative practices for optimal use of the CO2 laser in laryngeal transoral laser microsurgery (TOLMS), with a focus on safety. A systematic review of publications indexed in Medline, Embase, and EBM reviews-Cochrane Central Register of Controlled Trials which evaluated perioperative strategies for the use of CO2 laser in laryngeal TOLMS was conducted. Records obtained from the search strategy were assessed for eligibility in a 2-step process by 2 independent researchers using the Covidence software. Among 2143 identified records, 103 were included in this study. The majority of studies (n = 25) focused on the use of the CO2 laser in oncologic resection, while 20 addressed the treatment of vocal cord paralysis, 16 discussed the treatment of pediatric or congenital pathologies, 11 detailed the management of benign lesions, and 31 studies tackled other surgical indications. Strategies for safe CO2 TOLMS were highly heterogeneous across studies and included preoperative measures (ie, related to the environment, staff preparation, patient protection, and ventilation), intraoperative precautions (ie, protection of nontarget structures, technical considerations, topical and systemic medications), and postoperative strategies (ie, related to airway protection, oral intake, vocal rest, hospitalization duration, drug regimen, and consultant follow-up). The results provided in this study can be used as a framework to guide the creation of laser safety protocols across institutions, guide quality improvement initiatives, the development of simulation training activities, and as a tool to facilitate resident teaching and skill assessment.

Spectral Flow Cytometry Methods and Pipelines for Comprehensive Immunoprofiling of Human Peripheral Blood and Bone Marrow.

This study introduces optimized methods and analysis algorithms that enhance capabilities in comprehensive immunophenotyping of human blood and bone marrow using spectral flow cytometry. This approach facilitates detection of rare cell types, enables measurement of cell variations across donors, and provides proof-of-concept in identifying known hematologic malignancies. By unlocking complexities of hematopoietic and immune landscapes at the single-cell level, this advancement holds potential for understanding disease states and therapeutic responses.

Building Cognitive Data Lakes on Cloud: Integrating NLP and AI to Make Data Lakes Smart

The enormous increase in the volume of digital data in all industries has made organizations look for more efficient storage and processing techniques for data which has provided further impetus for the change from conventional data lakes to cognitive data lakes. In addition to being a structured or unstructured data pool, cognitive data lakes have AI and NLP strategic built-in features to offer real-time intelligent data analytics to support the organization’s strategic decisions and plans (Smith et al., 2023). Consequently, they provide a more effective method for data utilization enabling enterprises to get context, sentiment and value from elaborate data. These data lakes can grow on demand by procuring additional cloud infrastructure which fulfils the requirements of large data storage and computing while containing costs (Johnson &amp; Lee, 2022). This article extends the discussion of CDLs and CI on cloud infrastructures to discuss the architectural and technical considerations for cognitive data lakes that include information and natural language models for contextualizing and classifying data. In this paper, we consider the detailed usage of NLP, which is applied to converting the best textual data into structured insights using such approaches as entity extraction or sentiment analysis as well as topic modeling, which is also useful in understanding how textual data can be used effectively in practice by organizations (Brown, 2024). In addition, we measure the effects of machine learning algorithms in sorting, sifting, and forecasting data patterns in such lakes, building an interactive and cognitive data environment (Garcia &amp; Patel, 2023). Nevertheless, cognitive data lakes are not problem-free solutions and certain challenges are worth discussing. Some of the problems that organisations have to solve include quality of the data, its security, and compliance particularly if the information shared is sensitive and takes place in distributed structures (Davis, 2024). In this paper, we cover detailed information about the strategies and approaches that should be used in order to overcome the given challenges, including data governance strategies, cloud-native security practices, and more. In specific case descriptions, we demonstrate how cognitive data lakes work in practice across industries like healthcare, finance, and retail with tangible examples related to productivity, customer satisfaction, and market differentiation (Xu, 2023). Thus, we conclude with a discussion on future prospects of cognitive data lakes by taking into account the innovative solutions of AI and NLP to advance the intuitiveness of cognitive data lake in the future. With newer trends arising in the future including generative AI, real-time analytics, advanced NLP methods, cognitive data lakes can therefore be expected to become more essential in helping adopters derive valuable predictions and responses to changes in the market (Chen &amp; Li, 2024). In essence, this article offers a futuristic view of cognitive data lakes with emphasis on their chief positionality in the operating data environment.

The Evolving Regulatory Paradigm of AI in MedTech: A Review of Perspectives and Where We Are Today.

Artificial intelligence (AI)-enabled technologies in the MedTech sector hold the promise to transform healthcare delivery by improving access, quality, and outcomes. As the regulatory contours of these technologies are being defined, there is a notable lack of literature on the key stakeholders such as the organizations and interest groups that have a significant input in shaping the regulatory framework. This article explores the perspectives and contributions of these stakeholders in shaping the regulatory paradigm of AI-enabled medical technologies. The formation of an AI regulatory framework requires the convergence of ethical, regulatory, technical, societal, and practical considerations. These multiple perspectives contribute to the various dimensions of an evolving regulatory paradigm. From the global governance guidelines set by the World Health Organization (WHO) to national regulations, the article sheds light not just on these multiple perspectives but also on their interconnectedness in shaping the regulatory landscape of AI.

Modeling the mosaic structure of bacterial genomes to infer their evolutionary history

The chronology and phylogeny of bacterial evolution are difficult to reconstruct due to a scarce fossil record. The analysis of bacterial genomes remains challenging because of large sequence divergence, the plasticity of bacterial genomes due to frequent gene loss, horizontal gene transfer, and differences in selective pressure from one locus to another. Therefore, taking advantage of the rich and rapidly accumulating genomic data requires accurate modeling of genome evolution. An important technical consideration is that loci with high effective mutation rates may diverge beyond the detection limit of the alignment algorithms used, biasing the genome-wide divergence estimates toward smaller divergences. In this article, we propose a novel method to gain insight into bacterial evolution based on statistical properties of genome comparisons. We find that the length distribution of sequence matches is shaped by the effective mutation rates of different loci, by the horizontal transfers, and by the aligner sensitivity. Based on these inputs, we build a model and show that it accounts for the empirically observed distributions, taking the Enterobacteriaceae family as an example. Our method allows to distinguish segments of vertical and horizontal origins and to estimate the time divergence and exchange rate between any pair of taxa from genome-wide alignments. Based on the estimated time divergences, we construct a time-calibrated phylogenetic tree to demonstrate the accuracy of the method.

Blockchain-based governance models in e-government: a comprehensive framework for legal, technical, ethical and security considerations

Purpose This study aims to evaluate blockchain as an e-government governance model. It assesses its alignment with legal frameworks, emphasizing robustness against disruptions and adherence to existing laws. Design/methodology/approach The paper explores blockchain’s potential in e-government, focusing on legal, ethical and governance aspects. It conducts an in-depth analysis of blockchain’s integration into data governance, emphasizing legal compliance and resilient security protocols. Findings The study comprehensively evaluates blockchain’s implementation, covering privacy, interoperability, consensus mechanisms, scalability and regulatory alignment. It highlights governance’s critical role in ensuring legal compliance within blockchain paradigms. Research limitations/implications Ethical and legal concerns arising from blockchain adoption remain unresolved. The study underscores how blockchain challenges its core principles of anonymity and decentralization in e-government settings. Practical implications The framework outlined offers potential for diverse technological environments, albeit raising ethical and legal queries. It emphasizes governance’s pivotal role in achieving legal compliance in blockchain adoption. Social implications Blockchain’s impact on legal and ethical facets necessitates further exploration to align with its core principles while addressing governance in e-government settings. Originality/value This study presents a robust framework for assessing blockchain’s viability in e-government, emphasizing legal compliance, despite ethical and legal intricacies that challenge its fundamental principles.

Abstract 6443: Enhanced detection of ctDNA molecular response for immunotherapy treated non-small cell lung cancer through analyses of cell-free and matched white blood cell DNA

Abstract Introduction: Immune checkpoint inhibitors (ICIs) have greatly improved clinical outcomes for patients with non-small cell lung cancer (NSCLC), however, programmed death-ligand 1 (PD-L1) and tumor mutation burden (TMB) have failed to consistently predict therapeutic response and outcomes in this population. There remains a critical unmet need to identify patients who are likely to experience clinical benefit from treatment, particularly as additional treatment regimens become available. Longitudinal cell-free tumor DNA (ctDNA) assessments have recently been applied as a strategy to identify molecular response (mR) and better predict long term clinical response. Through this real-world analysis of NSCLC, we explore the technical and biological considerations associated with determination of ctDNA mR through matched cell-free and white blood cell (WBC) DNA analyses and apply this optimized approach to assess therapeutic response to ICIs. Methods: Plasma from 50 patients with advanced or metastatic NSCLC who received ICIs from 2017-2019 at Hospital del Mar had detectable pre-treatment ctDNA and underwent analysis using the 521 gene PGDx elio plasma complete liquid biopsy assay. Patient blood was collected prior to the start of ICI therapy, early on-treatment (median 4 weeks; range 2.4-9 weeks) and longitudinally throughout clinical follow-up and disease progression. Matched WBCs were also analyzed for each patient to identify alterations arising from germline polymorphisms and clonal hematopoiesis (CH). mR was calculated as the percent change in mean variant allele frequency of the tumor-specific alterations assessed at the early on-treatment timepoint compared to the pre-treatment timepoint, and compared to radiographic response, progression-free, and overall survival (OS). Results: Best overall response for patients within the cohort was 4% complete response, 26% partial response, 34% stable disease, and 36% progressive disease. The removal of germline or CH variants allowed for improved characterization of tumor-specific somatic alterations and associations with radiographic and survival-based endpoints. With the integrated ctDNA and matched WBC approach, we observed a mR rate of 34% (17/50) with a median OS of 36.8 months compared to 9.2 months for patients experiencing molecular progression at the early on-treatment timepoint (HR 5.6, 95% CI 2.4-12.7, p&amp;lt;0.001, log-rank test). Specifically, of all patients that survived ≤12 months after initiation of treatment, 84% (21/25) were categorized as experiencing molecular progression through early on-treatment ctDNA analyses. Conclusions: This real-world study of ICI treated, advanced NSCLC highlights the opportunity afforded through integrated analyses of ctDNA and matched WBCs to accurately determine mR and the associations with radiographic response and OS. Citation Format: Jennifer B. Jackson, Pedro Rocha, James R. White, Andrew P. Georgiadis, Ellen L. Verner, Amy Greer, Rafael Bach Mora, Laura Masfarré Pintó, Nil Navarro, Álvaro Taus, Beatriz Bellosillo Paricio, Sergi Clavé, Mark T. Sausen, Edurne Arriola. Enhanced detection of ctDNA molecular response for immunotherapy treated non-small cell lung cancer through analyses of cell-free and matched white blood cell DNA [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6443.