Quantifying social capital creation in post-disaster recovery aid in Indonesia: methodological innovation by an AI-based language model.

Smooth interaction with a disaster-affected community can create and strengthen its social capital, leading to greater effectiveness in the provision of successful post-disaster recovery aid. To understand the relationship between the types of interaction, the strength of social capital generated, and the provision of successful post-disaster recovery aid, intricate ethnographic qualitative research is required, but it is likely to remain illustrative because it is based, at least to some degree, on the researcher's intuition. This paper thus offers an innovative research method employing a quantitative artificial intelligence (AI)-based language model, which allows researchers to re-examine data, thereby validating the findings of the qualitative research, and to glean additional insights that might otherwise have been missed. This paper argues that well-connected personnel and religiously-based communal activities help to enhance social capital by bonding within a community and linking to outside agencies and that mixed methods, based on the AI-based language model, effectively strengthen text-based qualitative research.

Surgical Technique for Sphinkeeper® Implantation.

Fecal incontinence is a distressing condition characterized by the involuntary loss of solid and liquid stool and gas, It affects a significant proportion of the general population, with a reported prevalence ranging from 1% to 20%. Despite its considerable impact on quality of life, therapeutic options for fecal incontinence remain limited. Current treatment modalities for fecal incontinence include conservative approaches such as dietary modifications, pelvic floor exercises, and pharmacotherapy. Surgical interventions, including sphincteroplasty or sacral nerve stimulation, may be considered in more severe cases. Recently, THD Labs (THD S.p.A. Correggio (RE), Italy) introduced the Gatekeeper® as a novel device that supports the implantation of up to four solid prostheses into the intersphincteric groove. Early data were promising, with success rates above 50% and only a few perioperative complications. Subsequently, Gatekeeper® was modified by increasing the length and number (up to 10) of prostheses, and renamed Sphinkeeper® (THD). With this device, nine to 10 small incisions measuring 2 mm are made at a distance of 2-3 cm from the anus. The intersphincteric space is accessed using the delivery system, and positioning is verified through endoanal ultrasound. This procedure is repeated for all 10 prostheses placed around the entire circumference. The Sphinkeeper® offers the potential to improve the management of fecal incontinence, and offers patients a less-invasive alternative to traditional surgical approaches.

Glaucoma Treatment in German Hospitals in 2019. / Glaukombehandlung in deutschen Krankenhäusern 2019.

BACKGROUND: Surgical procedures in ophthalmology are subject to fluctuations in their application and are dependent on new developments, availability, and success rates. In the field of glaucoma surgery in particular, numerous new procedures have been introduced over the last few years. So far, hardly any analyses have been done on the current application of these newer procedures. In this paper, we present the extent to which different glaucoma surgery procedures were used in German hospitals in 2019. METHODS: The quality reports of German hospitals from 2019 were evaluated regarding all glaucoma-specific procedure codes. In particular, laser procedures, "classic" glaucoma procedures, and "modern" procedures such as MIGS (minimally invasive glaucoma surgery) are compared below. RESULTS: In 2019, 49,031 glaucoma procedures were performed in German hospitals. Numerically, cyclodestructive procedures were used most frequently. MIGS accounted for approximately 10% of procedures according to the available data. Among filtering procedures, about 40% were implant-assisted. DISCUSSION AND CONCLUSION: On the one hand, the data analyzed show a mixed expansion of the spectrum with newer procedures such as the MIGS and implants; on the other hand, classic procedures such as cyclodestruction are still used. It can be assumed that further shifts in surgical methods will be seen in the coming years.

Long-Term Outcomes of Excimer Laser-Assisted Penetrating Keratoplasty Using a Commercially Available Laser System - A Retrospective Case Series.

BACKGROUND: Favorable functional outcomes have been reported after excimer laser-assisted penetrating keratoplasty (EXL PKP). But this technique has not been widely adopted, and there are reports on EXL PKP from only a very limited number of institutions. Some of these results refer to operations carried out with laser systems that are not commercially available. In this retrospective case series, we report the long-term outcome of EXL PKP using the Schwind Amaris 500E laser system. MATERIAL AND METHODS: This retrospective consecutive case series included 30 eyes of 29 patients who had undergone EXL PKP between 2010 and 2013. Primary outcome measures were topographic astigmatism and visual acuity. Secondary outcome measures were the rates of graft rejection and graft failure, and the rate of grafts with an endothelial cell density below 500 cells/mm2. Survival analyses were carried out for the following endpoints: visual acuity, rate of graft rejection, and rate of grafts with endothelial cell densities higher than 500 cells/mm2. RESULTS: The median interquartile range (IQR) duration of follow-up was 45 (36) months. The indications for PKP were keratoconus (n = 21), corneal scarring (n = 6), Fuchs endothelial dystrophy (n = 1), and corneal dystrophy other than Fuchs endothelial dystrophy (n = 2). The median (IQR) topographic astigmatism at the end of the follow-up period was 5.3 (2.9) D. Forty-five months after surgery, 73% of all eyes had a visual acuity better than 0.3 LogMAR. The rate of graft rejection after 45 months of follow-up was 32%. All eyes maintained endothelial cell densities higher than 500 cells/mm2. There was no graft failure. CONCLUSIONS: EXL PKP is a safe and effective surgical procedure. No general conclusions can be drawn on the refractive outcome of EXL PKP. Potential advantages, such as a higher degree of graft-host congruity, that could possibly improve the refractive outcome should be weighed against the higher costs of EXL PKP.

Neuroendocrine neoplasms of the gallbladder: early detection and surgery is key to improved outcome.

PURPOSE: Neuroendocrine neoplasms (NENs) of the gallbladder are very rare. As a result, the classification of pathologic specimens from gallbladder NENs, currently classified as gallbladder neuroendocrine tumors (GB-NETs) and carcinomas (GB-NECs), is inconsistent and makes nomenclature, classification, and management difficult. Our study aims to evaluate the epidemiological trend, tumor biology, and outcomes of GB-NET and GB-NEC over the last 5 decades. METHODS: This is a retrospective analysis of the SEER database from 1973 to 2016. The epidemiological trend was analyzed using the age-adjusted Joinpoint regression analysis. Survival was assessed with Kaplan-Meier analysis and Cox regression was used to assess predictors of poor survival. RESULTS: A total of 482 patients with GB-NEN were identified. Mean age at diagnosis was 65.2 ± 14.3 years. Females outnumbered males (65.6% vs. 34.4%). The Joinpoint nationwide trend analysis showed a 7% increase per year from 1973 to 2016. The mean survival time after diagnosis of GB-NEN was 37.11 ± 55.3 months. The most common pattern of nodal distribution was N0 (50.2%) followed by N1 (30.9%) and N2 (19.2%). Advanced tumor spread (into the liver, regional, and distant metastasis) was seen in 60.3% of patients. Patients who underwent surgery had a significant survival advantage (111.0 ± 8.3 vs. 8.3 ± 1.2 months, p < 0.01). Cox regression analysis showed advanced age (p < 0.01), tumor stage (P < 0.01), tumor extension (p < 0.01), and histopathologic grade (p < 0.01) were associated with higher mortality. CONCLUSION: Gallbladder NENs are a rare histopathological variant of gallbladder cancer that is showing a rising incidence in the USA. In addition to tumor staging, surgical resection significantly impacts patient survival, when patients are able to undergo surgery irrespective of tumor staging. Advanced age, tumor extension, and histopathological grade of the tumor were associated with higher mortality.

Robotic TAMIS: A Technical Note Comparing Si® versus Xi®.

Transanal minimally invasive surgery (TAMIS) can be performed robotically assisted (R-TAMIS) for easier rectal defect suture closure particularly on the anterior rectal wall. The surgical technique described in this technical note emphasizes three safety points: 1) decreased likelihood for rectal injury when the ports are inserted into the GelPOINT® Path Transanal Access Platform (Applied Medical, Rancho Santa Margarita, California) on the back table rather than being inserted into the rectum; 2) decreased external collision between ports when using ports of different length; and 3) increased stabilization of pneumorectum when insufflating with an AirSeal™ port (Intelligent Flow System, ConMed, Utica, New York). Although R-TAMIS can be safely performed with the da Vinci® Si® or Xi® (Intuitive Surgical Inc., Sunnyvale, California) patient cart, the following differences are noteworthy: a) the Si® vertically-mounted arms design forces the patient in an uncomfortable position with asymmetrical hip flexion as opposed to the Xi® boom-mounted horizontal arm design; b) the 28cm circumference of each Si® patient cart arms operating between the patient's legs offer decreased maneuvering freedom as opposed to the 19cm circumference of the Xi® counterparts; and c) the abduction pattern of movement of the Si® arms potentially increases the risk of external collision with the patient's legs as opposed to the Xi® "jack-knife" pattern of movement.

[Keratoplasty in Germany: Systematic Analysis of the Quality Reports of German Hospitals between 2006 and 2017]. / Die Keratoplastik in Deutschland: systematische Auswertung der Krankenhausqualitätsberichte der Jahre 2006 bis 2017.

BACKGROUND: Keratoplasty is considered the most frequently performed type of transplantation in humans. Traditionally, penetrating keratoplasty has been the most common procedure. However, over the last 15 years, the importance of posterior lamellar keratoplasty has increased for the treatment of Fuchs endothelial dystrophy and bullous keratopathy. In Germany, based on national surveys, it was suggested that there was a trend towards lamellar keratoplasty. OBJECTIVE: The main objective of this study was to determine whether the proportion of lamellar keratoplasties carried out in Germany between 2006 and 2017 had increased. Furthermore, the number of keratoplasties carried out as HLA-matched (HLA: human leukocyte antigen) keratoplasties should be calculated. MATERIALS AND METHODS: The numbers of all keratoplasties carried out as lamellar/penetrating and HLA-matched keratoplasties was extracted from the hospital quality reports published between 2006 and 2017. Descriptive statistical analysis was carried out in R (www.r-project.org). RESULTS: Between 2006 and 2017, 43,021 keratoplasties were carried out in Germany. The number of keratoplasties increased from 2,849 (2006) to 8,231 (2017). The number of penetrating keratoplasties remained stable. The proportion of lamellar keratoplasties increased from 6.5% (2006) to 61.4% (2017). The proportion of HLA-matched keratoplasties was below 20% and declined between 2010 and 2017 (2010: 19.7%; 2017: 9.8%). DISCUSSION: In Germany, posterior lamellar keratoplasty has become increasingly important. Since 2014, the number of lamellar keratoplasties has exceeded the number of penetrating keratoplasties. However, the number of penetrating keratoplasties remained stable between 2006 and 2017 and still plays an important role in the management of patients with predominantly stromal or corneal defects affecting all layers. The decreasing number of HLA-matched keratoplasties is most likely due to the lack of clear evidence of a significant reduction in the rejection rates in cases of normal risk keratoplasty.

The Eye Van - An Evaluation of the Quality of Care of Visually Impaired People in the Rural Areas of South Baden. / Die Versorgung Sehbehinderter im ländlichen Raum Südbadens ­ das Projekt "Augen-Bus".

BACKGROUND: Especially in rural areas, access of visually impaired people to ophthalmic care and counselling can be limited. The Eye Van is a project supported by the Ministry for Rural Affairs and Consumer Protection Baden-Württemberg which offers visually impaired people an on-the-spot ophthalmological examination and counselling on low-vision aids and social support services. The aim of this project was to evaluate the quality of care provided to visually impaired people in the rural areas of South Baden. MATERIALS AND METHODS: Between 2016 and 2019, 45 villages in South Baden participated in this project. The visits were advertised in the local press. Appointments were assigned and participant eligibility was assessed over the telephone by the local Federation of the Blind and Partially Sighted in South Baden. During the on-site visits, a medical history was obtained from participants, who then received a comprehensive ophthalmological examination and counselling on low-vision aids and social support services. Interviews were conducted in order to determine the expectations of the participants and to assess their quality of life. A second interview, focused on the measures that had been implemented and changes in the participants' quality of life, was carried out three months later. RESULTS: In total, 264 participants were examined. Of these, 101 participants fulfilled the criteria of moderate/severe visual impairment or blindness defined by the WHO (World Health Organization). The mean age of the visually impaired participants was 85 years. The median decimal visual acuity was 0.08. The median length of time since the participants' last ophthalmological examination was one year. Among the visually impaired participants, 13% did not have any low-vision aids. Their use was recommended to 62% of the visually impaired participants. The main expectation of participants was counselling on low-vision aids and support services. Among all the participants, 42 did one interview and 28 did two interviews. In the second interview, 72% of the participants claimed to have implemented the recommendations. There was no statistically significant change in their quality of life. CONCLUSION: The access of visually impaired people to ophthalmic care does not seem to be limited in the rural areas of South Baden. Nevertheless, there was a high demand for counselling on low-vision aids and social support services.

Meta-analysis of Postoperative Mortality and Morbidity After Total Abdominal Colectomy Versus Loop Ileostomy With Colonic Lavage for Fulminant Clostridium Difficile Colitis.

BACKGROUND: Emergency surgery is often required for fulminant Clostridium difficile colitis. Total abdominal colectomy has been the treatment of choice despite high morbidity and mortality. OBJECTIVE: The aim of this meta-analysis was to evaluate postoperative mortality and morbidity after total abdominal colectomy and loop ileostomy with colonic lavage in patients with fulminant C difficile colitis. DATA SOURCES: Studies comparing total abdominal colectomy to loop ileostomy for fulminant C difficile colitis were identified by a systematic search of PubMed, Cochrane Library, MEDLINE, and CINAHL. STUDY SELECTION: Relevant records were detected and screened using a cascade system (title, abstract, and/or full text article). INTERVENTION(S): Total abdominal colectomy (rectal-sparing resection of the entire colon with end ileostomy) was compared to loop ileostomy (exteriorization of an ileal loop not far from the ileocecal junction for colonic lavage). MAIN OUTCOMES MEASURES: This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. Primary outcome was postoperative mortality, defined as death occurring within 30 days after the intervention. Secondary end points were the rates of ostomy reversal, deep venous thrombosis/embolism, surgical site infection, urinary tract infection, respiratory complications, reoperations, and adverse events. Mantel-Haenszel method with random-effects model was used for meta-analysis. RESULTS: Five observational studies (3 cohort and 2 database analysis studies) totaling 3683 patients were included. Postoperative mortality rate was 31.3% after total abdominal colectomy and 26.2% after loop ileostomy (OR = 1.36 (95% CI, 0.83-2.24); p = 0.22; number needed to treat/harm = 20; I = 55%). Ostomy reversal rate was both statistically and clinically significantly higher after loop ileostomy as compared with total abdominal colectomy (80% vs 25%; OR = 0.08 (95% CI, 0.02-0.30); p = 0.002; number needed to treat/harm = 2) with low heterogeneity (I = 0%). LIMITATIONS: A limitation is the observational nature of the included studies introducing an overall high risk of selection bias. CONCLUSIONS: This meta-analysis suggests that loop ileostomy with colonic lavage for fulminant C difficile colitis may be associated with similar survival and decreased surgical site infection rates as compared with total abdominal colectomy. Although loop ileostomy with colonic lavage was associated with higher ostomy reversal rates, this finding was based on the data from only 2 studies.

Sleeve Gastrectomy: Surgical Technique, Outcomes, and Complications.

The number of bariatric surgical procedures performed worldwide increases every year and has recently exceeded 685,000. Over 50% of these are laparoscopic sleeve gastrectomy (SG), and Roux-en-Y gastric bypass accounts for an additional 30%. Bariatric/metabolic surgery seeks to achieve not only weight loss and the remission of comorbidities, such as diabetes mellitus type II, arterial hypertension, sleep apnea, risk of cancer, non-alcoholic liver steatosis, etc., but also improvements in the patient's quality of life. SG is mainly a restrictive procedure consisting of the resection and removal of a major part of the stomach, which has an additional impact on hormones such as Ghrelin and Glucagon-like Peptide 1. The first part of this article focuses on patient preparation before a bariatric procedure with mandatory and additional examinations to decrease the patient's risk. Next, the surgical technique itself, including positioning of the patient, positioning of the trocars and related tips and tricks, and the postoperative course are described. The second part discusses the outcomes of SG, including weight loss, remission of comorbidities and quality of life. Further possible acute complications of SG such as leaks, bleeding or stenoses as well as long-term complications (reflux, weight regain and malnutrition) and respective treatments are also described. In conclusion, SG is an effective procedure for weight loss with a low risk for the patient to develop malnutrition. In terms of post-operative care, regular check-ups are vital to ensure a positive outcome as well as for the early detection of possible issues. Reflux and weight regain are common issues with SG in a long-term follow-up; thus, patients should be selected carefully for this procedure.

[Scleral Buckling Surgery in Germany for Rhegmatogenous Retinal Detachment: A Spirit of the Past or Current Practice?] / Eindellende Operationen zur Behandlung der rhegmatogenen Amotio in Deutschland: ein Geist der Vergangenheit oder gelebte Praxis?

BACKGROUND AND OBJECTIVES: Scleral buckling and pars-plana vitrectomy are therapeutic options for the treatment of rhegmatogenous retinal detachment. Comparative studies still support the value of scleral buckling in phakic eyes. Nevertheless, the number of sceral buckling procedures may be continuously decreasing over time. The study aims to analyse the incidence of scleral buckling procedures for the treatment of patients with retinal detachment in Germany over time. MATERIAL AND METHODS: The numbers of scleral buckling procedures (OPS 5-152) and rhegmatogenous retinal detachment (ICD H33.0) in Germany are analysed on the basis of data from the quality reports published by the Federal Joint Committee and secondary analyses of the DRG-based billing system (DRG-Statistik) of the Federal Statistical Office between 2006 and 2017. RESULTS: Based on the quality reports, numbers of scleral buckling procedures performed between 2006 and 2017 dropped by 49% from 8841 to 4510. During this period of time, the number of rhegmatogenous retinal detachments, identified by the ICD code H33.0, rose by 102% from 11 507 to 23 314. A decrease in scleral buckling procedures of 42% between 2006 and 2017 was also observed in the DRG Statistics. Regional and age-dependent subgroup analyses suggests that there are both regional and age-dependent differences in the practice of scleral buckling. CONCLUSIONS: Our analysis clearly illustrates that scleral buckling procedures are now less commonly performed in Germany than in 2006. However, the total of ~ 4500 billed procedures in 2017 in Germany shows that scleral buckling is still an important and current therapeutic option in the treatment of retinal detachment.

Swept-source optical coherence tomography angiography alleviates shadowing artifacts caused by subretinal fluid.

PURPOSE: To characterize the choriocapillaris (CC) structure in relation to subretinal fluid (SRF) as a possible systematic error source using spectral domain (SD-OCTA) compared to swept-source optical coherence tomography angiography (SS-OCTA). METHODS: This is a prospective case-control study of 23 eyes. Ten patients with acute central serous chorioretinopathy (CSC), three patients with partial macular-off retinal detachment (RD) and ten healthy, age-matched controls were included. Abnormal CC decorrelation signals were quantitatively compared in CSC and controls by means of custom image processing. To investigate the influence of SRF on CC OCTA signal, the extent of SRF was quantified with a macular heatmap and compared with the corresponding OCTA signal of the CC. RESULTS: SS-OCTA yielded a more homogeneous OCTA signal from the CC than SD-OCTA, offering less signal dispersion and variability in healthy and diseased eyes. Both devices demonstrated CC signal voids in CSC and RD, respectively. In CCS, the voids were predominantly located in the area with SRF. Compared to SD-OCTA, SS-OCTA delivered a more homogenous OCTA signal and reduced signal voids in the CC underneath SRF in both RD and CSC (CSC, 7.6% ± 6.3% vs, 19.7% ± 9.6%, p < 0.01). Despite this significant attenuation of signal voids, SS-OCTA continued to reveal signal voids below SRF and more pixels with reduced OCTA signals in CSC patients compared to controls (7.6% ± 6.3%, 0.1% ± 0.1%, p < 0.0001). CONCLUSION: Understanding OCTA artifacts is critical to ensure accurate clinical evaluations. In this study, we describe the presence of SRF as an important shadow-causing artifact source for CC OCTA analysis which can be mitigated but not completely eliminated by employing SS-OCTA.

Childhood Lensectomy Is Associated with Static and Dynamic Reduction in Schlemm Canal Size: A Biomechanical Hypothesis of Glaucoma after Lensectomy.

PURPOSE: To compare Schlemm canal (SC) and trabecular meshwork (TM) in children with healthy eyes and those with and without glaucoma after lensectomy. DESIGN: Cross-sectional observational study. PARTICIPANTS: Fifty children 4 to 16 years of age with healthy eyes and 48 children who underwent lensectomy (124 healthy and 72 postlensectomy eyes). METHODS: Anterior segment (AS) OCT (Tomey SS-1000 CASIA; Tomey, Nagoya, Japan) of the nasal iridocorneal angle at 2 levels of accommodative effort (2.5 diopters [D] and 15 D). For each parameter and state of accommodation, a random effects model was fitted to estimate differences between healthy eyes and eyes with history of lensectomy. MAIN OUTCOME MEASURES: Dimensions of SC and TM and conventional AS OCT iridocorneal angle measurements. RESULTS: The horizontal diameter of SC and its cross-sectional area (CSA) are significantly smaller in eyes that have undergone lensectomy versus healthy eyes. Accommodative effort increases SC size in healthy eyes, but not in eyes that have undergone lensectomy. CONCLUSIONS: Lensectomy is associated with a reduction in SC size and a loss of physiologic SC dilatation during accommodative effort, which may reflect a reduction in outflow facility and may contribute to the development of glaucoma after lensectomy.

[The Role of Hospitals in the Treatment of Patients with Cataract in Germany: Systematic Analysis of the Quality Reports of German Hospitals for the Years 2006 to 2016]. / Die Bedeutung der Krankenhäuser für die Versorgung von Patienten mit Katarakt in Deutschland: Systematische Auswertung der Krankenhausqualitätsberichte der Jahre 2006 bis 2016.

BACKGROUND: Cataract is one of the most prevalent eye diseases in Germany. According to the German Ophthalmological Society, its prevalence will increase significantly in the coming years. It has been suggested that most cataract operations are carried out in an outpatient setting. However, there still seems to be a need for inpatient cataract surgery. OBJECTIVE: The main objective of this study was to determine the total number of cataract operations carried out in German hospitals over the last 12 years and to investigate whether the proportion of cataract operations carried out as outpatient procedures has increased in recent years. MATERIAL AND METHODS: The numbers of cataract operations carried out as outpatient and inpatient procedures were extracted from the quality reports published by the Federal Joint Committee between 2006 and 2016. The total number, the number of cataract operations per 1000 residents (inpatient and outpatient procedures) and the proportion of complex cataract operations carried out as inpatient procedures were calculated. The descriptive statistical analysis was carried out in R (www.r-project.org). RESULTS: Between 2006 and 2016, 1,884,506 cataract operations were carried out in German hospitals. There was an increase in the total number of cataract operations (2006: 223,070; 2016: 279,331). The proportion of outpatient procedures increased between 2006 (44%) and 2010 (48.9%) and remained stable between 2010 and 2016 (2016: 48.5%). Between 2006 and 2016, the proportion of complex cataract operations carried out as inpatient procedures ranged from 56 to 86%. DISCUSSION: A stable and significant proportion of cataract operations in Germany is still carried out in hospitals. The total number of cataract operations has increased. After increasing between 2006 and 2010, the proportion of cataract operations carried out as outpatient procedures remained stable. This sustained demand may be triggered by a group of patients who, due to medical and/or social reasons, require treatment under inpatient conditions.

[Automated Cell Counting Using "Deep Learning" in Donor Corneas from Organ Culture Achieves High Precision and Accuracy]. / Automatisierte Zellzählung in Spenderhornhäuten aus Organkultur mittels "Deep Learning" erreicht hohe Präzision und Genauigkeit.

BACKGROUND: Human corneal grafts from organ culture need to have more than 2000 endothelial cells/mm2 to be suitable for transplantation. Measurement of the endothelial cell density is complicated by invisible cell borders in phase contrast microscopy, as well as by limited areas for counting due to folds in the Descemet membrane of the swollen corneal grafts. To date, no automated counting method for measuring the endothelial cell density exists. The neuronal network U-Net has already proven itself in automated segmentation of specular microscopy images of human corneal endothelium. The aim of this study was the application of the U-Net in the quality control of human corneal grafts. MATERIAL AND METHODS: Training of the U-Net was performed using 100 manually tagged endothelial cell images of corneal grafts from the Lions eye bank in Baden-Württemberg. Another 100 images were obtained for testing the precision of measurements of the U-Net. These were adjudged manually by a) an experienced investigator and b) a less experienced ophthalmologist. The endothelial cells in identical images were then counted automatically by the trained U-Net. Comparison with the manually counted results was drawn by Pearson correlation. RESULTS: The correlation coefficient between the U-Net and the experienced investigator as gold standard was 0.9. The correlation coefficient between the less experienced ophthalmologist and the gold standard was only 0.81. Both correlations were statistically highly significant (p < 0.0001). DISCUSSION: The strong correlation between the U-Net and the gold standard points out that, given medical approval, effective assistance for eye banks is possible in quality control by automated counting. This could improve objectivity and efficiency of work flow.

[Unsupervised Linkage between ICD- and Alpha-ID Codes and Real-World Diagnoses from Medical Reports by Means of the "word2vec" Method]. / Automatisierte Zuordnung von ICD- und Alpha-ID-Codes zu "Real-World"-Arztbriefdiagnosen durch die "word2vec"-Methode.

BACKGROUND: Transformation into a standardised code system such as ICD-10 or Alpha-ID is required before medical reports can be scientifically analysed. This is due to the use of different terminologies and the frequent use of synonyms. The so-called "word vector embedding" seems to be suitable for the generation of the required thesaurus, because synonymous diagnoses can be identified independently of the spelling - after suitable training of the underlying neural network. METHODS: All letters from a total of 50,000 patients were extracted anonymously. Diagnoses consisting of several words were merged into single words by means of phrase recognition and the "word2vec" model was trained on the text corpus of 352 megabytes. A total of 3742 diagnoses and ophthalmological interventions were extracted semi-automatically. The ophthalmological ICD and Alpha-ID codes were downloaded together with the official descriptions from the DIMDI website and the ophthalmological diagnoses/interventions were automatically linked with the nearest ICD- and Alpha-ID codes in the "word2vec" model. RESULTS: The "word2vec" model assigned 90% of the doctor's letter diagnoses correctly to appropriate ICD-10 codes. At the finer level of Alpha-ID, the rate of correct assignments was only 76%. The interventions were assigned to the correct indication in 92% of cases. Rare diseases, unusual designations and code degeneration in the official DIMDI file were identified as sources of error for incorrect or missing allocations. DISCUSSION: A diagnostic thesaurus can be generated with the "word2vec" method from a corpus of anonymised medical reports and the official Alpha-ID file from the DIMDI website. This thesaurus could be used for automatic extraction of diagnoses from doctor's letters in the future, given appropriate manual revision.

Visual field defects following different resective procedures for mesiotemporal lobe epilepsy.

INTRODUCTION: One of the most common side effects of mesiotemporal lobe resection in patients with medically intractable epilepsy are visual field defects (VFD). While peripheral defects usually remain unnoticed by patients, extended VFD influence daily life activities and can, in particular, affect driving regulations. This study had been designed to evaluate frequency and extent of VFD following different surgical approaches to the mesiotemporal area with respect to the ability to drive. MATERIALS AND METHODS: This study comprises a consecutive series of 366 patients operated at the Epilepsy Center in Freiburg for intractable mesiotemporal lobe epilepsy from 1998 to 2016. The following procedures were performed: standard anterior temporal lobectomy (ATL: n=134; 37%), anterior temporal or keyhole resection (KH: n=53; 15%), and selective amygdalohippocampectomy via the transsylvian (tsAHE: n=145; 40%) and the subtemporal (ssAHE: n=34; 9%) approach. Frequency and extent of postoperative VFD were evaluated in relation to different surgical procedures. According to the German driving guidelines, postoperative VFD were classified as driving-relevant VFD with the involvement of absolute, homonymous central scotoma within 20° and driving-irrelevant VFD with either none or exclusively minor VFD sparing the center. RESULTS: Postoperative visual field examinations were available in 276 of 366 cases. Postoperative VFD were observed in 202 of 276 patients (73%) and were found to be driving-relevant in 133 of 276 patients (48%), whereas 69 patients (25%) showed VFD irrelevant for driving. Visual field defects were significantly less likely following ssAHE compared with other temporal resections, and if present, they were less frequently driving-relevant (p<0.05), irrespective of the side of surgery. CONCLUSION: Subtemporal sAHE (ssAHE) caused significantly less frequently and less severely driving-relevant VFD compared with all other approaches to the temporal lobe, irrespective of the side of surgery.

En-bloc excision of sacral squamous cell carcinoma with immediate reconstruction.

Sacral squamous cell carcinoma is an uncommon condition that may arise in scars following burns or in chronic wounds, such as an untreated pilonidal cyst. The aim of the present technical note is to describe a surgical technique aimed at minimizing local recurrence rates by en-bloc resection as well as providing immediate plastic reconstruction: 1. right-sided extended vertical rectus abdominis myo-cutaneous (VRAM) flap; 2. abdomino-perineal excision of the rectum with end colostomy; 3. en-bloc excision of the mass inclusive of gluteus maximus muscles and distal sacrectomy; 4. sacrectomy defect covered with VRAM flap; 5. bilateral gluteal defects covered with single-layer dermal substitute of bovine collagen and elastin hydrolysate followed by immediate split-thickness skin grafting from bilateral thigh donor sites, and negative pressure wound therapy dressings. This approach resulted in a favorable outcome at 2-year follow-up in a male patient presenting with a large locally advanced sacral squamous cell carcinoma involving the external anal sphincter muscle.

The deep abdominal ultrasound transducer (DAX) increases the success rate and diagnostic accuracy of shear wave elastography for liver fibrosis assessment in patients with obesity-A prospective biopsy-controlled study.

BACKGROUND: Obesity impacts the diagnostic accuracy of shear wave elastography (SWE). A deep abdominal ultrasound transducer (DAX) capable of point (pSWE) and two-dimensional (2D)-SWE has recently been introduced to address this issue. METHODS: We performed a prospective study in a cohort of mostly patients with obesity undergoing liver biopsy with a high prevalence of metabolic dysfunction-associate steatotic liver disease (MASLD). Liver stiffness measurement (LSM) was measured using vibration-controlled transient elastography (VCTE), as well as pSWE and 2D SWE on the standard (5C1) and the DAX transducers. RESULTS: We included 129 patients with paired LSM and liver biopsy: median age 44.0 years, 82 (63.6%) women, median BMI: 43.2 kg/m2. Histologic fibrosis stages: F0: N = 55 (42.6%), F1: N = 14 (10.9%), F2: N = 50 (38.8%), F3: N = 2 (1.6%), F4: N = 8 (6.2%). VCTE-LSM failed (N = 13) or were unreliable (IQR/median ≤30% in ≥7.1 kPa, N = 14) in 20.9% of patients. The Pearson correlation of reliable VCTE-LSM with both pSWE and 2D SWE was strong (all >0.78). The diagnostic accuracy for all LSM techniques was poor for significant fibrosis (≥F2, AUC: 0.54-0.63); however, it was good to excellent for advanced fibrosis (≥F3, AUC: 0.87-0.99) and cirrhosis (F4, AUC: 0.86-1.00). In intention-to-diagnose analysis, pSWE on DAX was significantly superior to VCTE-LSM. CONCLUSIONS: pSWE- and 2D-SWE enable the non-invasive identification of advanced fibrosis and cirrhosis in patients with obese MASLD. The use of the DAX transducer for acoustic radiation force imaging (ARFI)-LSM avoids technical failures in an obese population and subsequently offers advantages over VCTE-LSM for the evaluation of fibrosis in an obese MASLD population at risk for fibrosis.