Publications by authors named "Victor Chang"

198 Publications

Prophylactic Low-Molecular-Weight Heparin Versus Unfractionated Heparin in Spine Surgery (PLUSS): A Pilot Matched Cohort Study.

Neurosurgery 2021 Oct 11. Epub 2021 Oct 11.

Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.

Background: Despite a proven superior efficacy of prophylactic low-molecular-weight heparin (LMWH) over unfractionated heparin (UFH) in the majority of surgical specialties, chemoprophylactic techniques after spine surgery have not been established because of the fear of epidural hematomas with LMWH.

Objective: To determine the efficacy of LMWH vs UFH in the prevention of venous thromboembolism (VTE) events, balanced against the risk of epidural hematoma.

Methods: This is the first matched cohort design that directly compares prophylactic LMWH to UFH after spine surgery for degenerative/deformity pathologies at a tertiary academic center. Prospectively collected patients receiving prophylactic LMWH and a historical cohort of patients receiving prophylactic UFH (prior to 2017) were matched in 1:1 ratio based on age ±5 yr, American Society of Anesthesiologists classification, location in the spinal column, and type of surgery.

Results: Of 562 patients, VTE events equaled 1.4% (n = 8): 1.4% (n = 4) with LMWH was exactly equal to 1.4% (n = 4) with UFH. Epidural hematomas reached 0.8% (n = 5): 1.4% (n = 4) with UFH vs 0.3% (n = 1) with the LMWH (P = .178). Utilizing adjusted odds ratio (ORadj), the type of chemoprophylaxis after spine surgery failed to predict VTE events. Similarly, the chemoprophylactic technique failed to predict epidural hematoma in the multivariable regression analysis, although UFH trended toward a higher complication rate (ORadj = 3.15 [0.48-20.35], P = .227).

Conclusion: Chemoprophylactic patterns failed to predict VTE. Although no differences in epidural hematoma rates were detected, our analysis does highlight a trend toward a safer profile with LMWH vs UFH. LMWH may be a safe alternative to UFH in spine surgery.
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http://dx.doi.org/10.1093/neuros/nyab363DOI Listing
October 2021

Big Data Applications in Guangzhou Restaurants Analysis.

Big Data 2021 Oct 28;9(5):358-372. Epub 2021 Sep 28.

Artificial Intelligence and Information Systems Research Group, School of Computing and Digital Technologies, Teesside University, Middlesbrough, United Kingdom.

With the development of modern information and communication technologies, such as the internet of things and big data analytics, businesses and users have become more adaptable to rapid changes. Both consumers and merchants have obtained great convenience. Meanwhile, a huge amount of data is generated. However, many businesses lack the ability to process these data, which contain critical business values. Therefore, this article uses data from the Dianping website to show how to use big data analytics techniques to exploit the valuable information from these raw data. First, descriptive analysis is conducted by using kernel density estimation. Then, multilinear regression analysis, Naive Bayes, and J48 are used to predict the level of restaurants. We found that flavor, environment, and service score are essential factors to the restaurant level. Moreover, J48 performs best among the three models with an accuracy of 88.89%.
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http://dx.doi.org/10.1089/big.2020.0222DOI Listing
October 2021

Symptom Clusters and Quality of Life in Gastric Cancer Patients Receiving Chemotherapy.

J Pain Symptom Manage 2021 Sep 16. Epub 2021 Sep 16.

Department of Nursing (L. F., R. L., X. Y.),. Electronic address:

Context: Although gastric cancer is one of the most common tumors worldwide, there is little knowledge about symptom clusters and quality of life (QoL) in this population.

Objectives: The objectives were to identify the symptom clusters in gastric cancer patients receiving chemotherapy, and explore their effects on QoL.

Methods: Gastric cancer patients receiving chemotherapy were recruited. Data were collected using the Memorial Symptom Assessment Scale Short Form, the Functional Assessment of Cancer Therapy-Gastric and the self-designed General Information Evaluation Form. The symptom clusters were extracted through the exploratory factor analysis. The influencing factors of symptom clusters and their effects on QoL were identified using multiple linear regression analysis.

Results: A total of 322 participants were enrolled from three medical centers. Five factors were identified in this exploratory factor analysis based on symptom prevalence, namely fatigue related symptom cluster, epithelial symptom cluster, neurologic symptom cluster, malnutrition related symptom cluster and psychological symptom cluster (χ=31.470, P<0.05). The affecting factors across symptom clusters and QoL subscales were relatively stable, but also different. Generally, fatigue related symptom cluster, malnutrition related symptom cluster and psychological symptom cluster demonstrated significantly negative effects on all aspects of QoL except social well being.

Conclusion: Five symptom clusters were identified in gastric cancer patients receiving chemotherapy in mainland China. The symptom clusters negatively contributed to the variance in all aspects of QoL except social well being. Further studies should examine interventions for symptom clusters, their influencing factors, and their effects on improving QoL.
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http://dx.doi.org/10.1016/j.jpainsymman.2021.09.003DOI Listing
September 2021

The role of postoperative antibiotic duration on surgical site infection after lumbar surgery.

J Neurosurg Spine 2021 Sep 17:1-7. Epub 2021 Sep 17.

Departments of1Neurosurgery.

Objective: Despite a general consensus regarding the administration of preoperative antibiotics, poorly defined comparison groups and underpowered studies prevent clear guidelines for postoperative antibiotics. Utilizing a data set tailored specifically to spine surgery outcomes, in this clinical study the authors aimed to determine whether there is a role for postoperative antibiotics in the prevention of surgical site infection (SSI).

Methods: The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar operations performed for degenerative spinal pathologies over a 5-year period from 2014 to 2019. Preoperative prophylactic antibiotics were administered for all surgical procedures. The study population was divided into three cohorts: no postoperative antibiotics, postoperative antibiotics ≤ 24 hours, and postoperative antibiotics > 24 hours. This categorization was intended to determine 1) whether postoperative antibiotics are helpful and 2) the appropriate duration of postoperative antibiotics. First, multivariable analysis with generalized estimating equations (GEEs) was used to determine the association between antibiotic duration and all-type SSI with adjusted odds ratios; second, a three-tiered outcome-no SSI, superficial SSI, and deep SSI-was calculated with multivariable multinomial logistical GEE analysis.

Results: Among 37,161 patients, the postoperative antibiotics > 24 hours cohort had more men with older average age, greater body mass index, and greater comorbidity burden. The postoperative antibiotics > 24 hours cohort had a 3% rate of SSI, which was significantly higher than the 2% rate of SSI of the other two cohorts (p = 0.004). On multivariable GEE analysis, neither postoperative antibiotics > 24 hours nor postoperative antibiotics ≤ 24 hours, as compared with no postoperative antibiotics, was associated with a lower rate of all-type postoperative SSIs. On multivariable multinomial logistical GEE analysis, neither postoperative antibiotics ≤ 24 hours nor postoperative antibiotics > 24 hours was associated with rate of superficial SSI, as compared with no antibiotic use at all. The odds of deep SSI decreased by 45% with postoperative antibiotics ≤ 24 hours (p = 0.002) and by 40% with postoperative antibiotics > 24 hours (p = 0.008).

Conclusions: Although the incidence of all-type SSI was highest in the antibiotics > 24 hours cohort, which also had the highest proportions of risk factors, duration of antibiotics failed to predict all-type SSI. On multinomial subanalysis, administration of postoperative antibiotics for both ≤ 24 hours and > 24 hours was associated with decreased risk of only deep SSI but not superficial SSI. Spine surgeons can safely consider antibiotics for 24 hours, which is equally as effective as long-term administration for prophylaxis against deep SSI.
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http://dx.doi.org/10.3171/2021.4.SPINE201839DOI Listing
September 2021

A Matched Cohort Analysis of Drain Usage in Elective Anterior Cervical Discectomy and Fusion: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study.

Spine (Phila Pa 1976) 2021 Jul 8. Epub 2021 Jul 8.

Departments of Neurological Surgery.

Study Design: This is a retrospective, cohort analysis of multi-institutional database.

Objective: This study was designed to analyze the impact of drain use following elective anterior cervical discectomy and fusion (ACDF) surgeries.

Summary Of Background Data: After ACDF, a drain is often placed to prevent postoperative hematoma. However, there has been no high quality evidence to support its use with ACDF despite the theoretical benefits and risks of drain placement.

Methods: The Michigan Spine Surgery Improvement Collaborative database was queried to identify all patients undergoing elective ACDF between February 2014 and October 2019. Cases were divided into two cohorts based on drain use. Propensity-score matching was utilized to adjust for inherent differences between the two cohorts. Measured outcomes included surgical site hematoma, length of stay, surgical site infection, dysphagia, home discharge, readmission within 30 days, and unplanned reoperation.

Results: We identified 7,943 patients during the study period. Propensity-score matching yielded 3,206 pairs. On univariate analysis of matched cohorts, there were no differences in rate of post-operative hematoma requiring either return to OR or readmission. We noted patients with drains had a higher rate of dysphagia (4.6% vs 6.3%; p = 0.003) and had longer hospital stay (p < 0.001). On multivariate analysis, drain use was associated with significantly increased length of stay (RR 1.23, 95% CI 1.13-1.34; p < 0.001). There were no significant differences in other outcomes measured.

Conclusion: Our analysis demonstrated that drain use is associated with significant longer hospital stay.
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http://dx.doi.org/10.1097/BRS.0000000000004169DOI Listing
July 2021

Minimally Invasive Posterior Cervical Discectomy: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Sep 8. Epub 2021 Sep 8.

Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.

Minimally invasive posterior cervical microdiscectomy is an appropriate surgical approach for patients with foraminal stenosis from herniated disc with radicular symptoms that is not responsive to conservative management. While anterior cervical discectomy and fusion (ACDF) or arthroplasty is increasingly utilized to treat herniated disc, a posterior approach eliminates the risk of potential approach related injuries to the esophagus, carotid artery, or recurrent laryngeal nerve. Additional benefits of posterior decompression include avoidance of instrumentation, which represents an increased healthcare cost, as well as potential long-term risks of adjacent-level pathologies or device failures.  A traditional open posterior cervical approach has the potential to cause significant postoperative pain due to dissection of the paraspinal musculature and the potential for disrupting the posterior tension band with inadvertent injury to the interspinous ligaments. Such disadvantages are reduced by utilizing the minimally invasive technique where a small tubular working channel is placed through a muscle splitting technique via a paramedian approach. This technique minimizes the need for muscle stripping, and thus decreases postoperative functional and structural disturbance. Discectomy in this case can also be safely performed with minimal retraction at the axilla of the nerve root. Additionally, this approach can be utilized in an ambulatory setting, which coupled with the lack of any additional instrumentation helps contribute to the overall healthcare cost savings of such a procedure.  This video describes how the minimally invasive posterior cervical discectomy can be effectively and safely performed in this illustrative case. The patient consented to the procedure and publication.
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http://dx.doi.org/10.1093/ons/opab311DOI Listing
September 2021

NFĸB Targeting in Bone Marrow Mesenchymal Stem Cell-Mediated Support of Age-Linked Hematological Malignancies.

Stem Cell Rev Rep 2021 Aug 19. Epub 2021 Aug 19.

Department of Medicine, Hematology/Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA.

Mesenchymal stem cells (MSCs) can become dysfunctional in patients with hematological disorders. An unanswered question is whether age-linked disruption of the bone marrow (BM) microenvironment is secondary to hematological dysfunction or vice versa. We therefore studied MSC function in patients with different hematological disorders and found decreased MHC-II except from one sample with acute myeloid leukemia (AML). The patients' MSCs were able to exert veto properties except for AML MSCs. While the expression of MHC-II appeared to be irrelevant to the immune licensing of MSCs, AML MSCs lost their ability to differentiate upon contact and rather, continued to proliferate, forming foci-like structures. We performed a retrospective study that indicated a significant increase in MSCs, based on phenotype, for patients with BM fibrosis. This suggests a role for MSCs in patients transitioning to leukemia. NFĸB was important to MSC function and was shown to be a potential target to sensitize leukemic CD34+/CD38- cells to azacitidine. This correlated with their lack of allogeneic stimulation. This study identified NFĸB as a potential target for combination therapy to treat leukemia stem cells and showed that understanding MSC biology and immune response could be key in determining how the aging BM might support leukemia. More importantly, we show how MSCs might be involved in transitioning the high risk patient with hematological disorder to AML.
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http://dx.doi.org/10.1007/s12015-021-10235-6DOI Listing
August 2021

Age as a Risk Factor for Complications Following Anterior Cervical Discectomy and Fusion: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC).

Spine (Phila Pa 1976) 2021 Aug 13. Epub 2021 Aug 13.

Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI Division of Neurosurgery, Ascension Macomb-Oakland Hospital, Warren, MI Department of Neurosurgery, Henry Ford Hospital, Detroit, MI Department of Neurosurgery, University of Michigan, Ann Arbor, MI.

Study Design: Retrospective analysis of prospectively collected registry data using multivariable analyses of imputed data.

Objective: We sought to demonstrate that age would not be associated with complications in patients undergoing anterior cervical discectomy and fusion (ACDF).

Summary Of Background Data: Elderly patients (≥70 yrs) undergoing ACDF are considered a higher risk for complications. However, conclusive evidence is lacking. The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a quality improvement collaborative with 30 hospitals across Michigan.

Methods: The study included all patients who had 1 to 4 level ACDF (September 2015-August 2019) for 90-day complications. Major and minor complications were defined using a validated classification. Multiple imputations were used to generate complete covariate datasets. Generalized estimating equation model was used to identify associations with complications using the whole cohort and elderly subgroup analyses. Bonferroni correction was used.

Results: Nine thousand one hundred thirty five patients (11.1% ≥ 70 yrs and 88.9% <70 yrs) with 2266 complications were analyzed. Comparing elderly versus non-elderly, the elderly had a significantly higher rate of any complications (31.5% vs. 24.0%, P < 0.001) and major complications (14.1% vs. 7.0%, P < 0.001). On multivariable analysis, age was not independently associated with any complication. POD#0 ambulation and preop independent ambulation were independently associated with significantly decreased odds of any complication. In the elderly, independent preoperative ambulation was protective for any complication (odds ratio [OR] 0.53, 0.39-0.73 95% confidence interval [CI]), especially major complications (OR 0.41, 0.27-0.61 95% CI).

Conclusion: Age was not an independent risk factor for complications in patients that underwent ACDF. In the elderly, independent preoperative ambulation was especially protective for major complications.Level of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000004200DOI Listing
August 2021

Hypomethylating Chemotherapeutic Agents as Therapy for Myelodysplastic Syndromes and Prevention of Acute Myeloid Leukemia.

Pharmaceuticals (Basel) 2021 Jul 4;14(7). Epub 2021 Jul 4.

Department of Biological Sciences, Rutgers University-Newark, Newark, NJ 07102, USA.

Myelodysplastic Syndromes (MDSs) affect the elderly and can progress to Acute Myeloid Leukemia (AML). Epigenetic alterations including DNA methylation and chromatin modification may contribute to the initiation and progression of these malignancies. DNA hypomethylating agents such as decitabine and azacitidine are used as therapeutic treatments and have shown to promote expression of genes involved in tumor suppression, apoptosis, and immune response. Another anti-cancer drug, the proteasome inhibitor bortezomib, is used as a chemotherapeutic treatment for multiple myeloma (MM). Phase III clinical trials of decitabine and azacitidine used alone and in combination with other chemotherapeutics demonstrated their capacity to treat hematological malignancies and prolong the survival of MDS and AML patients. Although phase III clinical trials examining bortezomib's role in MDS and AML patients are limited, its underlying mechanisms in MM highlight its potential as a chemotherapeutic for such malignancies. Further research is needed to better understand how the epigenetic mechanisms mediated by these chemotherapeutic agents and their targeted gene networks are associated with the development and progression of MDS into AML. This review discusses the mechanisms by which decitabine, azacitidine, and bortezomib alter epigenetic programs and their results from phase III clinical trials.
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http://dx.doi.org/10.3390/ph14070641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308509PMC
July 2021

Preoperative HbA1c > 8% Is Associated With Poor Outcomes in Lumbar Spine Surgery: A Michigan Spine Surgery Improvement Collaborative Study.

Neurosurgery 2021 Oct;89(5):819-826

Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA.

Background: Preoperative hemoglobin A1c (HbA1c) is a useful screening tool since a significant portion of diabetic patients in the United States are undiagnosed and the prevalence of diabetes continues to increase. However, there is a paucity of literature analyzing comprehensive association between HbA1c and postoperative outcome in lumbar spine surgery.

Objective: To assess the prognostic value of preoperative HbA1c > 8% in patients undergoing elective lumbar spine surgery.

Methods: The Michigan Spine Surgery Improvement Collaborative (MSSIC) database was queried to track all elective lumbar spine surgeries between January 2018 and December 2019. Cases were divided into 2 cohorts based on preoperative HbA1c level (≤8% and >8%). Measured outcomes include any complication, surgical site infection (SSI), readmission (RA) within 30 d (30RA) and 90 d (90RA) of index operation, patient satisfaction, and the percentage of patients who achieved minimum clinically important difference (MCID) using Patient-Reported Outcomes Measurement Information System.

Results: We captured 4778 patients in this study. Our multivariate analysis demonstrated that patients with HbA1c > 8% were more likely to experience postoperative complication (odds ratio [OR] 1.81, 95% CI 1.20-2.73; P = .005) and be readmitted within 90 d of index surgery (OR 1.66, 95% CI 1.08-2.54; P = .021). They also had longer hospital stay (OR 1.12, 95% CI 1.03-1.23; P = .009) and were less likely to achieve functional improvement after surgery (OR 0.64, 95% CI 0.44-0.92; P = .016).

Conclusion: HbA1c > 8% is a reliable predictor of poor outcome in elective lumbar spine surgery. Clinicians should consider specialty consultation to optimize patients' glycemic control prior to surgery.
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http://dx.doi.org/10.1093/neuros/nyab294DOI Listing
October 2021

Analysis of Factors associated with Return to Work After Lumbar Surgery up to 2-years follow-up: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study.

Spine (Phila Pa 1976) 2021 Jul 7. Epub 2021 Jul 7.

Departments of Neurosurgery School of Medicine, Wayne State University, Detroit, MI Public Health Sciences, and Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI Departments of Neurosurgery and Orthopaedic Surgery, University of Michigan Hospital, Ann Arbor, MI Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI USA. Center for Henry Ford Hospital, Detroit, MI USA.

Study Design: Michigan Spine Surgery Improvement Collaborative (MSSIC) prospectively collects data on all patients undergoing operations for degenerative and/or deformity indications.

Objective: We aimed to identify which factors are significantly associated with return-to-work after lumbar surgery at long-term follow-up.

Summary Of Background Data: Prior publications have created a clinically relevant predictive model for return-to-work, wherein education, gender, race, comorbidities, and preoperative symptoms increased likelihood of return-to-work at 3 months after lumbar surgery. We sought to determine if these trends 1) persisted at 1 year and 2 years postoperatively; or 2) differed among preoperatively employed versus unemployed patients.

Methods: MSSIC was queried for all patients undergoing lumbar operations (2014-2019). All patients intended to return-to-work postoperatively. Patients were followed for up to 2 years postoperatively. Measures of association were calculated with multivariable generalized estimating equations (GEE).

Results: Return-to-work increased from 63% (3542/5591) at 90 days postoperatively to 75% (3143/4147) at 1 year and 74% (2133/2866) at 2 years postoperatively. Following GEE, neither clinical nor surgical variables predicted return-to-work at all three time intervals: 90 days, 1 year, and 2 years postoperatively. Only socioeconomic factors reached statistical significance at all follow-up points. Preoperative employment followed by insurance status had the greatest associations with return-to-work. In a sub-analysis of patients who were preoperatively employed, insurance was the only factor with significant associations with return-to-work at all three follow-up intervals. The return-to-work rates among unemployed patients at baseline increased from 29% (455/1100) at 90 days, 44% (495/608) at 1 year, and 46% (366/426) at 2 years postoperatively. The only two significant factors associated with return-to-work at all three follow-up intervals were Medicaid, as compared to private insurance, and male gender.

Conclusion: In patients inquiring about long-term return-to-work after lumbar surgery, insurance status represents the important determinant of employment status.Level of Evidence: 2.
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http://dx.doi.org/10.1097/BRS.0000000000004163DOI Listing
July 2021

A scalable framework for smart COVID surveillance in the workplace using Deep Neural Networks and cloud computing.

Expert Syst 2021 May 6:e12704. Epub 2021 May 6.

Artificial Intelligence and Information Systems Research Group, School Computing, Engineering and Digital Technologies Teesside University Middlesbrough UK.

A smart and scalable system is required to schedule various machine learning applications to control pandemics like COVID-19 using computing infrastructure provided by cloud and fog computing. This paper proposes a framework that considers the use case of smart office surveillance to monitor workplaces for detecting possible violations of COVID effectively. The proposed framework uses deep neural networks, fog computing and cloud computing to develop a scalable and time-sensitive infrastructure that can detect two major violations: wearing a mask and maintaining a minimum distance of 6 feet between employees in the office environment. The proposed framework is developed with the vision to integrate multiple machine learning applications and handle the computing infrastructures for pandemic applications. The proposed framework can be used by application developers for the rapid development of new applications based on the requirements and do not worry about scheduling. The proposed framework is tested for two independent applications and performed better than the traditional cloud environment in terms of latency and response time. The work done in this paper tries to bridge the gap between machine learning applications and their computing infrastructure for COVID-19.
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http://dx.doi.org/10.1111/exsy.12704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209860PMC
May 2021

Patient-induced progressive facial subcutaneous emphysema masquerading as odontogenic abscess.

BMJ Case Rep 2021 Jun 23;14(6). Epub 2021 Jun 23.

Oral and Maxillofacial Surgery, Townsville Hospital and Health Service, Townsville, Queensland, Australia.

Facial subcutaneous emphysema (SE) is an uncommon sequelae of dental procedures and often attributed to the use of high-speed air-driven handpieces during surgical extractions, forcing air through fascial spaces. Rarely have there been documented cases of patient-induced SE. In this case report, we present an 18-year-old woman who was referred to the emergency department with a 5-day history of progressive swelling and pain to her right cheek, following a prolonged, but simple extraction of tooth 18. While the dentist and emergency physicians were concerned about an infectious aetiology, history taking, clinical review and imaging corroborated the diagnosis of patient-induced SE secondary to habitual straw use. This report highlights the need for routine postextraction counselling of sinus precautions irrespective of extraction complexity. Additionally, emergency physicians should be aware of SE masquerading as other pathology, including odontogenic abscesses, allergic reactions, angioedema and gas-forming bacterial infections, such as necrotising fasciitis, to ensure appropriate treatment is provided to patients.
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http://dx.doi.org/10.1136/bcr-2021-243489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8230972PMC
June 2021

Commentary: Comparison of the Safety of Prophylactic Anticoagulants After Intracranial Surgery.

Neurosurgery 2021 08;89(3):E158-E159

Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.

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http://dx.doi.org/10.1093/neuros/nyab230DOI Listing
August 2021

Commentary: Lumbar Laminoplasty for Resection of Myxopapillary Ependymoma of the Conus Medullaris: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 07;21(2):E157-E159

Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.

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http://dx.doi.org/10.1093/ons/opab160DOI Listing
July 2021

Expandable Cage Technology-Transforaminal, Anterior, and Lateral Lumbar Interbody Fusion.

Oper Neurosurg (Hagerstown) 2021 06;21(Suppl 1):S69-S80

Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.

This review of the literature will focus on the indications, surgical techniques, and outcomes for expandable transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and lateral lumbar interbody fusion (LLIF) operations. The expandable TLIF cage has become a workhorse for common degenerative pathology, whereas expandable ALIF cages carry the promise of greater lordotic correction while evading the diseased posterior elements. Expandable LLIF cages call upon minimally invasive techniques for a retroperitoneal, transpsoas approach to the disc space, obviating the need for an access surgeon and decreasing risk of injury to the critical neurovascular structures. Nuances between expandable and static cages for all 3 TLIF, ALIF, and LLIF operations are discussed in this review.
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http://dx.doi.org/10.1093/ons/opaa342DOI Listing
June 2021

Real-World Experience with Targeted Therapy in BRAF Mutant Advanced Melanoma Patients: Results from a Multicenter Retrospective Observational Study Advanced Melanoma in Russia (Experience) (ADMIRE).

Cancers (Basel) 2021 May 21;13(11). Epub 2021 May 21.

FSBI "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Moscow, Russia.

Clinical trials of targeted therapy (TT) and immunotherapy (IT) for highly aggressive advanced melanoma have shown marked improvements in response and survival rates. However, real-world data on treatment patterns and clinical outcomes for patients with advanced BRAF V600 mutant melanoma are ultimately scarce. The study was designed as an observational retrospective chart review study, which included 382 patients with advanced BRAF V600 mutant melanoma, who received TT in a real-world setting and were not involved in clinical trials. The data were collected from twelve medical centers in Russia. The objective response rates (ORRs) to combined BRAFi plus MEKi and to BRAFi mono-therapy were 57.4% and 39.8%, respectively. The median progression-free survival (PFS) and median overall survival (OS) were 9.2 months and 22.6 months, respectively, for the combined first-line therapy; 9.4 months and 16.1 months, respectively, for the combined second-line therapy; and 7.4 months and 17.1 months, respectively, for the combined third- or higher-line therapy. Analysis of treatment patterns demonstrated the effectiveness of the combined TT with BRAF plus MEK inhibitors in patients with brain metastases, rare types of BRAF mutations, and across lines of therapy, as well as a well-tolerated and manageable safety profile.
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http://dx.doi.org/10.3390/cancers13112529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196785PMC
May 2021

Decompression of Lumbar Central Spinal Canal Stenosis Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Clin Spine Surg 2021 Oct;34(8):E439-E449

Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO.

Study Design: This was a retrospective clinical series.

Objective: The objective of this study was to evaluate radiologic changes in central spinal canal dimensions following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with placement of a static or an expandable interbody device.

Summary Of Background Data: MIS-TLIF is used to treat lumbar degenerative diseases and low-grade spondylolisthesis. MIS-TLIF enables direct and indirect decompression of lumbar spinal stenosis, with patients experiencing relief from radiculopathy and neurogenic claudication. However, the effects of MIS-TLIF on the central spinal canal are not well-characterized.

Materials And Methods: We identified patients who underwent MIS-TLIF for degenerative lumbar spondylolisthesis and concurrent moderate to severe spinal stenosis. We selected patients who had both preoperative and postoperative magnetic resonance imaging (MRI) and upright lateral radiographs of the lumbar spine. Measurements on axial T2-weighted MRI scans include anteroposterior and transverse dimensions of the dural sac and osseous spinal canal. Measurements on radiographs include disk height, neural foraminal height, segmental lordosis, and spondylolisthesis. We made pairwise comparisons between each of the central canal dimensions and lumbar sagittal segmental radiologic outcome measures relative to their corresponding preoperative values. Correlation coefficients were used to quantify the association between changes in lumbar sagittal segmental parameters relative to changes in radiologic outcomes of central canal dimensions. Statistical analysis was performed for "all patients" and further stratified by interbody device subgroups (static and expandable).

Results: Fifty-one patients (age 60.4 y, 68.6% female) who underwent MIS-TLIF at 55 levels (65.5% at L4-L5) were included in the analysis. Expandable interbody devices were used in 45/55 (81.8%) levels. Mean duration from surgery to postoperative MRI scan was 16.5 months (SD 11.9). MIS-TLIF was associated with significant improvements in dural sac dimensions (anteroposterior +0.31 cm, transverse +0.38 cm) and osseous spinal canal dimensions (anteroposterior +0.16 cm, transverse +0.32 cm). Sagittal lumbar segmental parameters of disk height (+0.56 cm), neural foraminal height (+0.35 cm), segmental lordosis (+4.26 degrees), and spondylolisthesis (-7.5%) were also improved following MIS-TLIF. We did not find meaningful associations between the changes in central canal dimensions relative to the corresponding changes in any of the sagittal lumbar segmental parameters. Stratified analysis by interbody device type (static and expandable) revealed similar within-group changes as in the overall cohort and minimal between-group differences.

Conclusions: MIS-TLIF is associated with radiologic decompression of neural foraminal and central spinal canal stenosis. The mechanism for neural foraminal and central canal decompression is likely driven by a combination of direct and indirect corrective techniques.
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http://dx.doi.org/10.1097/BSD.0000000000001192DOI Listing
October 2021

Disparities in outcomes after spine surgery: a Michigan Spine Surgery Improvement Collaborative study.

J Neurosurg Spine 2021 May 7:1-9. Epub 2021 May 7.

1Department of Neurosurgery, Henry Ford Hospital, Detroit.

Objective: Most studies on racial disparities in spine surgery lack data granularity to control for both comorbidities and self-assessment metrics. Analyses from large, multicenter surgical registries can provide an enhanced platform for understanding different factors that influence outcome. In this study, the authors aimed to determine the effects of race on outcomes after lumbar surgery, using patient-reported outcomes (PROs) in 3 areas: the North American Spine Society patient satisfaction index, the minimal clinically important difference (MCID) on the Oswestry Disability Index (ODI) for low-back pain, and return to work.

Methods: The Michigan Spine Surgery Improvement Collaborative was queried for all elective lumbar operations. Patient race/ethnicity was categorized as Caucasian, African American, and "other." Measures of association between race and PROs were calculated with generalized estimating equations (GEEs) to report adjusted risk ratios.

Results: The African American cohort consisted of a greater proportion of women with the highest comorbidity burden. Among the 7980 and 4222 patients followed up at 1 and 2 years postoperatively, respectively, African American patients experienced the lowest rates of satisfaction, MCID on ODI, and return to work. Following a GEE, African American race decreased the probability of satisfaction at both 1 and 2 years postoperatively. Race did not affect return to work or achieving MCID on the ODI. The variable of greatest association with all 3 PROs at both follow-up times was postoperative depression.

Conclusions: While a complex myriad of socioeconomic factors interplay between race and surgical success, the authors identified modifiable risk factors, specifically depression, that may improve PROs among African American patients after elective lumbar spine surgery.
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http://dx.doi.org/10.3171/2020.10.SPINE20914DOI Listing
May 2021

A Proposed Sentiment Analysis Deep Learning Algorithm for Analyzing COVID-19 Tweets.

Inf Syst Front 2021 Apr 20:1-13. Epub 2021 Apr 20.

Artificial Intelligence and Information Systems Research Group, School of Computing, Engineering and Digital Technologies, Teesside University, Middlesbrough, UK.

With the rise in cases of COVID-19, a bizarre situation of pressure was mounted on each country to make arrangements to control the population and utilize the available resources appropriately. The swiftly rising of positive cases globally created panic, anxiety and depression among people. The effect of this deadly disease was found to be directly proportional to the physical and mental health of the population. As of 28 October 2020, more than 40 million people are tested positive and more than 1 million deaths have been recorded. The most dominant tool that disturbed human life during this time is social media. The tweets regarding COVID-19, whether it was a number of positive cases or deaths, induced a wave of fear and anxiety among people living in different parts of the world. Nobody can deny the truth that social media is everywhere and everybody is connected with it directly or indirectly. This offers an opportunity for researchers and data scientists to access the data for academic and research use. The social media data contains many data that relate to real-life events like COVID-19. In this paper, an analysis of Twitter data has been done through the R programming language. We have collected the Twitter data based on hashtag keywords, including COVID-19, coronavirus, deaths, new case, recovered. In this study, we have designed an algorithm called Hybrid Heterogeneous Support Vector Machine (H-SVM) and performed the sentiment classification and classified them positive, negative and neutral sentiment scores. We have also compared the performance of the proposed algorithm on certain parameters like precision, recall, F1 score and accuracy with Recurrent Neural Network (RNN) and Support Vector Machine (SVM).
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http://dx.doi.org/10.1007/s10796-021-10135-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057010PMC
April 2021

The influence of sagittal spinopelvic alignment on patient discharge disposition following minimally invasive lumbar interbody fusion.

J Spine Surg 2021 Mar;7(1):8-18

Department of Neurosurgery, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, USA.

Background: The aim of this study was to investigate the changes to spinopelvic sagittal alignment following minimally invasive (MIS) lumbar interbody fusion, and the influence of such changes on postoperative discharge disposition.

Methods: The Michigan Spine Surgery Improvement Collaborative was queried for all patients who underwent transforaminal lumbar interbody fusion (TLIF)or lateral lumbar interbody fusion (LLIF) procedures for degenerative spine disease. Several spinopelvic sagittal alignment parameters were measured, including sagittal vertical axis (SVA), lumbar lordosis, pelvic tilt, pelvic incidence, and pelvic incidence-lumbar lordosis mismatch. Primary outcome measure-discharge to a rehabilitation facility-was expressed as adjusted odds ratio (ORadj) following a multivariable logistical regression.

Results: Of the 83 patients in the study population, 11 (13.2%) were discharged to a rehabilitation facility. Preoperative SVA was equivalent. Postoperative SVA increased to 8.0 cm in the discharge-to-rehabilitation division versus a decrease to 3.6 cm in the discharge-to-home division (P<0.001). The odds of discharge to a rehabilitation facility increased by 25% for every 1-cm increase in postoperative sagittal balance (OR =1.27, P=0.014). The strongest predictor of discharge to rehabilitation was increasing decade of life (OR =3.13, P=0.201).

Conclusions: Correction of sagittal balance is associated with greater odds of discharge to home. These findings, coupled with the recognized implications of admission to a rehabilitation facility, will emphasize the importance of spine surgeons accounting for SVA into their surgical planning of MIS lumbar interbody fusions.
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http://dx.doi.org/10.21037/jss-20-596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024762PMC
March 2021

TMJ pain as a presentation of metastatic breast cancer to the right mandibular condyle.

BMJ Case Rep 2021 Mar 2;14(3). Epub 2021 Mar 2.

Oral and Maxillofacial Surgery, Gold Coast University Hospital, Southport, Queensland, Australia.

Cancer metastasis to the oral and maxillofacial region is uncommon, and metastasis to the mandibular condyle is considered rare. We present a case of a 56-year-old woman with a history of invasive ductal cell carcinoma of the right breast, 10 years in remission, presenting with a 6-month history of symptoms typical of temporomandibular joint (TMJ) dysfunction. Imaging revealed an osteolytic lesion of her right TMJ and subsequent open biopsy confirmed the diagnosis of metastatic breast cancer. Despite the rarity of metastatic cancer to the head and neck region, it is still important for clinicians from both medical and dental backgrounds to consider this differential diagnosis, particularly in patients with a history of hormonal positive subtype of breast cancer. Given that bony metastasis can manifest even 10 years after initial diagnosis, surveillance which includes examination of the head and neck region is important, and may include routine plain-film imaging surveillance with an orthopantomogram (OPG).
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http://dx.doi.org/10.1136/bcr-2021-241601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929852PMC
March 2021

Development and Pilot Test of a Culturally Relevant Toolkit to Enhance Advance Care Planning With Chinese American Patients.

J Pain Symptom Manage 2021 09 27;62(3):e186-e191. Epub 2021 Feb 27.

MJHS Institute for Innovation in Palliative Care, New York, New York, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA.

Background: First-generation Chinese American patients have low engagement in advance care planning (ACP). Among the causes may be clinician uncertainty about traditional cultural values.

Aim: Based on a survey identifying barriers to ACP among older ethnic Chinese American patients, we created a toolkit to support clinicians in culturally relevant ACP practices and conducted a pilot test to evaluate usability, acceptability, and preliminary outcomes.

Design/setting/participants: The toolkit includes culturally relevant information and an ACP guideline with a prompt list of questions. Six clinicians (three physicians, two nurse practitioners, and one physician assistant) in two New York City-based practices piloted the toolkit through discussions with 66 patients.

Results: Patients' age averaged 70.2 years (SD=12.4); 56.1% were women. Almost two-thirds had not finished high school and 53.0% spoke only Cantonese. More than three-quarters (78.8%) did not understand the purpose of ACP before the discussion. During the discussion, 58 patients (87.9%) completed a new proxy naming a health care agent, 21 (31.8%) requested a nonhospital DNR order, and two (3%) completed a living will. Topics discussed included treatment preferences (discussed with 80.3% of patients); health care values (77.3%); treatment decisions (72.7%); goals of care (68.2%), and hospice (1.5%). Five of the six clinicians expressed satisfaction ("very" or "somewhat") with the toolkit, four were "very" comfortable using it, and three stated that it helped them "a lot" with effective discussions.

Conclusions: An ACP toolkit may facilitate culturally relevant ACP discussions by increasing clinician competency and patient engagement. Further studies of this approach are needed.
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http://dx.doi.org/10.1016/j.jpainsymman.2021.02.031DOI Listing
September 2021

Commentary: Single-Position Surgery: Prone Lateral Lumbar Interbody Fusion: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 04;20(5):E373-E375

Department of Neurological Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI 48202, USA.

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http://dx.doi.org/10.1093/ons/opab055DOI Listing
April 2021

Age as a Predictor for Complications and Patient-reported Outcomes in Multilevel Transforaminal Lumbar Interbody Fusions: Analyses From the Michigan Spine Surgery Improvement Collaborative (MSSIC).

Spine (Phila Pa 1976) 2021 Mar;46(6):356-365

Division of Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, MI.

Study Design: Retrospective review of a multi-institutional data registry.

Objective: The authors sought to determine the association between age and complications & patient-reported outcomes (PRO) in patients undergoing multilevel transforaminal interbody lumbar fusion (MTLIF).

Summary Of Background Data: Elderly patients undergoing MTLIF are considered high risk. However, data on complications and PRO are lacking. Additionally, safety of multilevel lumbar fusion in the elderly remains uncertain.

Methods: Patients ≥50-year-old who underwent MTLIF for degenerative lumbar spine conditions were analyzed. Ninety-day complications and PROs (baseline, 90-d, 1-y, 2-y) were queried using the MSSIC database. PROs were measured by back & leg visual analog scale (VAS), Patient-reported Outcomes Measurement Information System (PROMIS), EuroQol-5D (EQ-5D), and North American Spine Society (NASS) Patient Satisfaction Index. Univariate analyses were used to compare among elderly and complication cohorts. Generalized estimating equation (GEE) was used to identify predictors of complications and PROs.

Results: A total of 3120 patients analyzed with 961 (31%) ≥ 70-y-o and 2159 (69%) between 50-69. A higher proportion of elderly experienced postoperative complications (P = .003) including urinary retention (P = <.001) and urinary tract infection (P = .002). Multivariate analysis demonstrated that age was not independently associated with complications. Number of operative levels was associated with any (P = .001) and minor (P = .002) complication. Incurring a complication was independently associated with worse leg VAS and PROMIS scores (P = <.001). Preoperative independent ambulation was independently associated with improved PROMIS, and EQ5D (P = <.001). Within the elderly, preoperative independent ambulation and lower BMI were associated with improved PROMIS (P = <.001). Complications had no significant effect on PROs in the elderly.

Conclusions: Age was not associated with complications nor predictive of functional outcomes in patients who underwent MTLIF. Age alone, therefore, may not be an appropriate surrogate for risk. Furthermore, baseline preoperative independent ambulation was associated with better clinical outcomes and should be considered during preoperative surgical counseling.Level of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000003792DOI Listing
March 2021

Minimally Invasive Techniques for Iliac Bolt Placement: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 03;20(4):E292

Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.

As the popularity of minimally invasive surgery (MIS) continues to grow, novel techniques are needed to meet the demands of multisegment fixation for advanced spinal diseases. In one such example, iliac bolts are often required to anchor large fusion constructs, but MIS technical notes are missing from the literature.  A 67-yr-old female presented with a symptomatic coronal deformity: preoperative pelvic incidence = 47°, pelvic tilt = 19°, and lumbar lordosis = 29°, sagittal vertical axis = +5.4 cm with 30° of scoliosis. The operative plan included T10-ilium fusion with transforaminal interbody grafts at L2-3, L3-4, L4-5, and L5-S1. The intraoperative video is of minimally invasive placement of iliac bolts using the O-Arm Surgical Imaging System (Medtronic®). The patient consented to the procedure.  A mini-open exposure that remains above the fascial planes allows for multilevel instrumentation with appropriate decompression at the interbody segments. After the placement of the pedicle screws under image-guidance, the direction is turned to the minimally invasive iliac bolts. Following the trajectory described in the standard open approach,1 the posterior superior iliac spine (PSIS) is identified with the navigation probe, which will guide the Bovie cautery through the fascia. This opening assists in the trajectory of the navigated-awl tap toward the anterior superior iliac spine (ASIS). Next, 8.5 mm x 90 mm iliac screws were placed in the cannulated bone under navigation. After intraoperative image confirmation of screw placement, the contoured rods are threaded under the fascia. The setscrews lock the rod in position. MIS approaches obviate cross-linking the rods, rendering pelvic fixation more facile.  This technique allows for minimal dissection of the posterior pelvic soft tissue while maintaining adequate fixation.
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http://dx.doi.org/10.1093/ons/opab001DOI Listing
March 2021

FSS-2019-nCov: A deep learning architecture for semi-supervised few-shot segmentation of COVID-19 infection.

Knowl Based Syst 2021 Jan 4;212:106647. Epub 2020 Dec 4.

Capability Systems Centre, School of Engineering and IT, UNSW Canberra, Australia.

The newly discovered coronavirus (COVID-19) pneumonia is providing major challenges to research in terms of diagnosis and disease quantification. Deep-learning (DL) techniques allow extremely precise image segmentation; yet, they necessitate huge volumes of manually labeled data to be trained in a supervised manner. Few-Shot Learning (FSL) paradigms tackle this issue by learning a novel category from a small number of annotated instances. We present an innovative semi-supervised few-shot segmentation (FSS) approach for efficient segmentation of 2019-nCov infection (FSS-2019-nCov) from only a few amounts of annotated lung CT scans. The key challenge of this study is to provide accurate segmentation of COVID-19 infection from a limited number of annotated instances. For that purpose, we propose a novel dual-path deep-learning architecture for FSS. Every path contains encoder-decoder (E-D) architecture to extract high-level information while maintaining the channel information of COVID-19 CT slices. The E-D architecture primarily consists of three main modules: a feature encoder module, a context enrichment (CE) module, and a feature decoder module. We utilize the pre-trained ResNet34 as an encoder backbone for feature extraction. The CE module is designated by a newly introduced proposed Smoothed Atrous Convolution (SAC) block and Multi-scale Pyramid Pooling (MPP) block. The conditioner path takes the pairs of CT images and their labels as input and produces a relevant knowledge representation that is transferred to the segmentation path to be used to segment the new images. To enable effective collaboration between both paths, we propose an adaptive recombination and recalibration (RR) module that permits intensive knowledge exchange between paths with a trivial increase in computational complexity. The model is extended to multi-class labeling for various types of lung infections. This contribution overcomes the limitation of the lack of large numbers of COVID-19 CT scans. It also provides a general framework for lung disease diagnosis in limited data situations.
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http://dx.doi.org/10.1016/j.knosys.2020.106647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836902PMC
January 2021

Co-pyrolysis of sewage sludge and organic fractions of municipal solid waste: Synergistic effects on biochar properties and the environmental risk of heavy metals.

J Hazard Mater 2021 06 22;412:125200. Epub 2021 Jan 22.

CAS Key Laboratory of Urban Pollutant Conversion, Institute of Urban Environment, Chinese Academy of Sciences, Xiamen 361021, China. Electronic address:

The introduction of heavy metal-free biomass into the sewage sludge (SS) pyrolysis can effectively improve the biochar properties and reduce the bioavailability and toxicity of heavy metals (HMs) in blended biochar. Herein, this study aimed to understand the biochar properties and associated environmental risks of HMs, by comparing the residual contents from the co-pyrolysis of SS with various organic fractions of municipal solid waste (OFMSW) at 550 °C and pyrolysis alone at different temperatures between 350 and 750 °C. The results indicated that, compared with SS pyrolysis alone, co-pyrolysis of SS with various OFMSW (except PVC) lead to lower biochar yields but with higher pH values (increased between 21.80% and 31.70%) and carbon contents (raised between 33.45% and 48.22%) in blended biochars, and the chemical speciation analysis suggested that co-pyrolysis further promoted the HMs transformation into more stable forms which significantly reduce the associated environmental risk of HMs in the blended biochars (the values of RI lower than 55.80). The addition of PVC, however, impeded biochar properties and compromised HMs immobilization during SS pyrolysis.
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http://dx.doi.org/10.1016/j.jhazmat.2021.125200DOI Listing
June 2021

ADOPT: automatic deep learning and optimization-based approach for detection of novel coronavirus COVID-19 disease using X-ray images.

J Biomol Struct Dyn 2021 Jan 21:1-13. Epub 2021 Jan 21.

Department of Computer Science & Engineering, ASET, Amity University, Noida, India.

In the hospital, because of the rise in cases daily, there are a small number of COVID-19 test kits available. For this purpose, a rapid alternative diagnostic choice to prevent COVID-19 spread among individuals must be implemented as an automatic detection method. In this article, the multi-objective optimization and deep learning-based technique for identifying infected patients with coronavirus using X-rays is proposed. J48 decision tree approach classifies the deep feature of corona affected X-ray images for the efficient detection of infected patients. In this study, 11 different convolutional neural network-based (CNN) models (AlexNet, VGG16, VGG19, GoogleNet, ResNet18, ResNet50, ResNet101, InceptionV3, InceptionResNetV2, DenseNet201 and XceptionNet) are developed for detection of infected patients with coronavirus pneumonia using X-ray images. The efficiency of the proposed model is tested using k-fold cross-validation method. Moreover, the parameters of CNN deep learning model are tuned using multi-objective spotted hyena optimizer (MOSHO). Extensive analysis shows that the proposed model can classify the X-ray images at a good accuracy, precision, recall, specificity and F1-score rates. Extensive experimental results reveal that the proposed model outperforms competitive models in terms of well-known performance metrics. Hence, the proposed model is useful for real-time COVID-19 disease classification from X-ray chest images.Communicated by Ramaswamy H. Sarma.
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http://dx.doi.org/10.1080/07391102.2021.1875049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832390PMC
January 2021
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