Abstract only Introduction Transradial access (TRA) has become increasingly utilized among neurointerventionalists. There is evidence of reduced complications and higher patient satisfaction compared ...to transfemoral access (TFA), but more data directly comparing the safety and efficacy of the two approaches is needed. To assess the proportion of technical success and complications with TRA versus TFA in patients who underwent neuroendovascular diagnostic and therapeutic procedures. Methods PRISMA guidelines were used to conduct a systematic review of the literature with PubMed/Medline, Scopus, Embase, and Cochrane databases up to February 2023. Randomized clinical trials (RCT) and observational studies that compared TRA and TFA were included. Studies reporting results of patients who underwent diagnostic angiograms, endovascular management of acute stroke, aneurysm repair, and carotid or vertebral stenting were included. Our primary outcome was technical success, defined as successful arterial access and completion of the intended procedure without crossover. Secondary safety outcomes were rate of complications including access site and non‐access site related, and other efficacy measures such as procedure duration, fluoroscopy time, and radiation exposure. Random effects model was used to perform a meta‐analysis. The Mantel‐Haenszel method was used to calculate risk ratio (RR) and 95% confidence intervals (CI) for each outcome. Heterogeneity was evaluated using I2 and considered high if over 70%. Results Twenty‐nine studies comprising 14,523 patients met inclusion criteria. TRA was attempted in 5,865 (40.38%) patients and TFA in 8,658 (59.62%). Baseline characteristics were similar between groups. The rate of technical success was 95.46% (95% CI: 93.59 – 96.81; p < 0.01) in the TRA group compared with 98.43% (95% CI: 97.60 – 98.97; p = 0.02) in the TFA group. Patients who underwent a diagnostic or therapeutic angiogram via TRA had a slightly lower chance of achieving technical success (RR = 0.98; 95% CI: 0.96 – 0.99; p < 0.01) compared to TFA, with substantial heterogeneity (I2 = 68%). Major access site complications were non‐significantly lower in the TRA group (RR = 0.64; 95% CI: 0.29 – 1.41; p = 0.81) with null heterogenicity (I2 = 0%) between groups. Minor access site complications were significantly lower in the TRA group (RR = 0.43; 95% CI 0.28 – 0.67; p < 0.01), with moderate heterogeneity (I2 = 57%). Non‐access site related complications (including mortality) were lower in the TRA group (RR = 0.69; 95% CI 0.51 – 0.94; p = 0.14) with low heterogeneity (I2 = 26%) between groups; for this outcome, the TRA approach shows a protective but not statistically significant result. Conclusion Our study suggests TRA is feasible and safe for diagnostic and therapeutic neuroendovascular procedures with low certainty of evidence. Minor complications were lower in the TRA group. RCTs directly comparing TRA vs TFA for these procedures are needed to confirm these results.
In this paper we study the optimization process of an object classification task for an image-based steel quality measurement system. The goal is to distinguish hollow from solid defects inside of ...steel samples by using texture and shape features of reconstructed 3D objects. In order to optimize the classification results we propose a holistic machine learning framework that should automatically answer the question "How well do state-of-the-art machine learning methods work for my classification problem?" The framework consists of three layers, namely feature subset selection, feature transform and classifier which subsequently reduce the data dimensionality. A system configuration is defined by feature subset, feature transform function, classifier concept and corresponding parameters. In order to find the configuration with the highest classifier accuracies, the user only needs to provide a set of feature vectors and ground truth labels. The framework performs a totally data-driven optimization using partly heuristic grid search. We incorporate several popular machine learning concepts, such as Principal Component Analysis (PCA), Support Vector Machines (SVM) with different kernels, random trees and neural networks. We show that with our framework even non-experts can automatically generate a ready for use classifier system with a significantly higher accuracy compared to a manually arranged system.
Enteral nutrition support was provided to 12 critically ill, traumatized patients by continuous NG infusion with a nutritionally complete formula for at least 7 consecutive days. Serum for ...fibronectin (Fn) and somatomedin-C (Sm-C) was collected and nitrogen balance (NB) was measured on days 1, 4, 7, 14, 21, and 28 of the study period. Estimated energy and protein requirements were based, respectively, on the patient's calculated basal energy expenditure multiplied by a stress factor and urea nitrogen excretion (plus 4) during 24-h urine collections. Enteral feedings were started 5.3 +/- 3.8 days after injury; patients received an average of 33.2 +/- 3.9 kcal/kg.day and 1.5 +/- 0.4 g protein/kg.day. Fn concentrations increased significantly (p less than .05) from baseline on study days 7, 14, 21, and 28, whereas NB increased significantly (p less than .05) on study days 4, 7, 14, 21, and 28. Significant correlations were found between Fn and NB (r = .52, p less than .005), Fn and cumulative caloric intake (r = .54, p less than .005), and Fn and cumulative nitrogen intake (r = .62, p less than .005). There were no significant changes observed with Sm-C concentrations during the study period. Measurement of Fn concentrations appears to have potential as a nutrition support marker in traumatized patients, particularly in monitoring short courses of nutrition support. The role of Sm-C as a nutrition marker requires further investigation.
The purpose of this study was to evaluate the use of serum fibronectin and serum somatomedin-C as nutritional markers during enteral nutrition support (ENS) of critically ill, traumatized patients ...using an enteral product containing high concentrations of branched-chain amino acids. Twelve critically injured patients received a standard enteral formula with 30 g of a 44% branched-chain amino acid supplement added to each liter of formula. Fibronectin concentration, somatomedin-C concentration, and nitrogen balance were measured on study days 1, 4, 7, 14, 21, 28 or until adequate oral intake began. Both fibronectin and somatomedin-C concentrations increased significantly from baseline by day 7 of ENS. Nitrogen balance increased significantly from baseline by day 4. On days 14 and 21, only somatomedin-C and nitrogen balance increased significantly from baseline. Nitrogen balance was significantly correlated with somatomedin-C concentration (r = 0.53, p less than 0.01), cumulative caloric intake (r = 0.68, p less than 0.01), and cumulative nitrogen intake (r = 0.72, p less than 0.01). The results of this study suggest that serum somatomedin-C is useful and serum fibronectin has potential in monitoring nutrition support response in critically ill, traumatized patients.
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