bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Validation of a Diagnostic Model to Predict the Risk of Ischemic Liver Injury After Stanford A Aortic Dissection Surgery
Authors: Liu Maomao , Tan Wen , Yuan Wen , Wang Tengke , Lu Xuran , Liu Nan 
Published: September 2021

Objective: To define the risk factors of ischemic liver injury (ILI) following Stanford A aortic dissection surgery and to propose a diagnostic model for individual risk prediction.Methods: We reviewed the clinical parameters of ILI patients who underwent cardiac surgery from Beijing Anzhen Hospital, Capital Medical University between January 1, 2015 and October 30, 2020. The data was analyzed by the use of univariable and multivariable logistic regression analysis. A risk prediction model was established and validated, which showed a favorable discriminating ability and might contribute to clinical decision-making for ILI after Stanford A aortic dissection (AAD) surgery. The discriminative ability and calibration of the diagnostic model to predict ILI were tested using C statistics, calibration plots, and clinical usefulness.Results: In total, 1,343 patients who underwent AAD surgery were included in the study. After univariable and multivariable logistic regression analysis, the following variables were incorporated in the prediction of ILI: pre-operative serum creatinine, pre-operative RBC count &lt;3.31 T/L, aortic cross-clamp time &gt;140 min, intraoperative lactic acid level, the transfusion of WRBC, atrial fibrillation within post-operative 24 h. The risk model was validated by internal sets. The model showed a robust discrimination, with an area under the receiver operating characteristic (ROC) curve of 0.718. The calibration plots for the probability of perioperative ischemic liver injury showed coherence between the predictive probability and the actual probability (Hosmer-Lemeshow test, P = 0.637). In the validation cohort, the nomogram still revealed good discrimination (C statistic = 0.727) and good calibration (Hosmer-Lemeshow test, P = 0.872). The 10-fold cross-validation of the nomogram showed that the average misdiagnosis rate was 9.95% and the lowest misdiagnosis rate was 9.81%.Conclusion: Our risk model can be used to predict the probability of ILI after AAD surgery and have the potential to assist clinicians in making treatment recommendations.
Relationship Between First 24-h Mean Body Temperature and Clinical Outcomes of Post-cardiac Surgery Patients
Authors: Xu Fei , Zhang Cheng , Liu Chao , Bi Siwei , Gu Jun 
Published: September 2021

Background:This study was aimed to investigate the relationship between first 24-h mean body temperature and clinical outcomes of post cardiac surgery patients admitted to intensive care unit (ICU) in a large public clinical database.Methods:This is a retrospectively observational research of MIMIC III dataset, a total of 6,122 patients included. Patients were divided into 3 groups according to the distribution of body temperature. Multivariate cox analysis and logistic regression analysis were used to investigate the association between abnormal temperature, and clinical outcomes.Results:Hypothermia (&lt;36°C) significantly associated with increasing in-hospital mortality (HR 1.665, 95%CI 1.218–2.276;p= 0.001), 1-year mortality (HR 1.537, 95% CI 1.205–1.961;p= 0.001), 28-day mortality (HR 1.518, 95% CI 1.14–2.021;p= 0.004), and 90-day mortality (HR 1.491, 95% CI 1.144–1.943;p= 0.003). No statistical differences were observed between short-term or long-term mortality and hyperthermia (&gt;38°C). Hyperthermia was related to the extended length of ICU stay (p&lt; 0.001), and hospital stay (p&lt; 0.001).Conclusion:Hypothermia within 24h after ICU admission was associated with the increased mortality of post cardiac surgery patients. Enhanced monitoring of body temperature within 24h after cardiac surgery should be taken into account for improving clinical outcomes.
Acacia auriculiformis–Derived Bimodal Porous Nanocarbons via Self-Activation for High-Performance Supercapacitors
Authors: Bhat Vinay S. , Jayeoye Titilope John , Rujiralai Thitima , Sirimahachai Uraiwan , Chong Kwok Feng , Hegde Gurumurthy 
Published: September 2021

Carbon nanomaterials derived from Acacia auriculiformis pods as electrodes for the electrochemical double-layer capacitors were explored. Four pyrolysis temperatures were set (400, 600, 800, and 1,000°C) to understand the role of temperature in biomass pyrolysis via a possible “self-activation” mechanism for the synthesis of carbon materials. The carbon materials synthesized at 800°C (AAC800) were found to exhibit a well-organized hierarchical porous structure, quantified further from N2 adsorption/desorption isotherms with a maximum specific surface area of 736.6 m2/g. Micropores were found to be contributing toward enhancing the specific surface area. AAC800 exhibited a maximum specific capacitance of 176.7 F/g at 0.5 A/g in 6.0 M KOH electrolyte in a three-electrode setup. A symmetric supercapacitor was fabricated using AAC800 as an active material in an organic electrolyte composed of 1.0 M tetraethylammonium tetrafluoroborate (TEABF4) as a conducting salt in the acetonitrile (ACN) solvent. The self-discharge of the cell/device was analyzed from fitting two different mathematical models; the cell also exhibited a remarkable coulombic efficiency of 100% over 10,000 charge/discharge cycles, retaining ∼93% capacitance at 2.3 V.
Association of Gut Microbiota and Metabolites With Disease Progression in Children With Biliary Atresia
Authors: Song Wei , Sun Li-Ying , Zhu Zhi-Jun , Wei Lin , Qu Wei , Zeng Zhi-Gui , Liu Ying , Zhang Hai-Ming , Guo Wei 
Published: September 2021

Background and AimsBiliary atresia is the most common cause of liver disease and liver transplantation in children. The accumulation of bile acids in hepatocytes and the stimulation of the intestinal microbiome can aggravate the disease progression. This study investigated changes in the composition of the gut microbiota and its metabolites in biliary atresia and the possible effects of these changes on disease progression.MethodsStool samples of biliary atresia at different disease stages and matched control individuals were collected (early stage: 16 patients, 16 controls; later stage: 16 patients, 10 controls). Metagenomic sequencing was performed to evaluate the gut microbiota structure. Untargeted metabolomics was performed to detect and analyze the metabolites and bile acid composition.ResultsA disturbed gut microbiota structure occurred in the early and later stages of biliary atresia. Klebsiella, Streptococcus, Veillonella, and Enterococcus have always been dominant. The abundance of V. atypica displayed significant changes between the early and later stages of biliary atresia. Combined with clinical indicators, Spearman’s analysis showed that Klebsiella and Veillonella atypica strongly correlated with liver enzymes. Enterococcus faecium had an enormously positive relationship with lithocholic acid derivatives. Metabolites involved in tryptophan metabolism were changed in the patients with biliary atresia, which had a significant association with stool V. atypica and blood total bilirubin (p &lt; 0.05).ConclusionsThe liver damage of biliary atresia was directly or indirectly exacerbated by the interaction of enriched Klebsiella (K. pneumoniae), Veillonella (V. atypica), and Enterococcus (E. faecium) with dysmetabolism of tryptophan and bile acid.
Brain Versus Blood: A Systematic Review on the Concordance Between Peripheral and Central Kynurenine Pathway Measures in Psychiatric Disorders
Authors: Skorobogatov Katrien , De Picker Livia , Verkerk Robert , Coppens Violette , Leboyer Marion , Müller Norbert , Morrens Manuel 
Published: September 2021

ObjectiveDisturbances in the kynurenine pathway have been implicated in the pathophysiology of psychotic and mood disorders, as well as several other psychiatric illnesses. It remains uncertain however to what extent metabolite levels detectable in plasma or serum reflect brain kynurenine metabolism and other disease-specific pathophysiological changes. The primary objective of this systematic review was to investigate the concordance between peripheral and central (CSF or brain tissue) kynurenine metabolites. As secondary aims we describe their correlation with illness course, treatment response, and neuroanatomical abnormalities in psychiatric diseases.MethodsWe performed a systematic literature search until February 2021 in PubMed. We included 27 original research articles describing a correlation between peripheral and central kynurenine metabolite measures in preclinical studies and human samples from patients suffering from neuropsychiatric disorders and other conditions. We also included 32 articles reporting associations between peripheral KP markers and symptom severity, CNS pathology or treatment response in schizophrenia, bipolar disorder or major depressive disorder.ResultsFor kynurenine and 3-hydroxykynurenine, moderate to strong concordance was found between peripheral and central concentrations not only in psychiatric disorders, but also in other (patho)physiological conditions. Despite discordant findings for other metabolites (mainly tryptophan and kynurenic acid), blood metabolite levels were associated with clinical symptoms and treatment response in psychiatric patients, as well as with observed neuroanatomical abnormalities and glial activity.ConclusionOnly kynurenine and 3-hydroxykynurenine demonstrated a consistent and reliable concordance between peripheral and central measures. Evidence from psychiatric studies on kynurenine pathway concordance is scarce, and more research is needed to determine the validity of peripheral kynurenine metabolite assessment as proxy markers for CNS processes. Peripheral kynurenine and 3-hydroxykynurenine may nonetheless represent valuable predictive and prognostic biomarker candidates for psychiatric disorders.
Description and Analysis of a Novel Subtype of the Anti-Synthetase Syndrome Characterized by Frequent Attacks of Fever and Systemic Inflammation in a Single-Center Cohort Study
Authors: Sun Shuhui , Chen Zhiwei , Zhang Danting , Xu Wenwen , Wu Wanlong , Sun Fangfang , Gu Liyang , Chen Jie , Li Jiajie , Li Ting , Wang Xiaodong , Ye Shuang 
Published: September 2021

ObjectivesThe aim of this study was to investigate anti-synthetase syndrome (ASyS) patients who presented with recurrent episodes of fever and systemic inflammation.MethodsA retrospective cohort of Chinese ASyS patients (n=126) in our center (between January 2013 and January 2020) was included. Patients presenting with concomitant autoimmune rheumatic diseases or malignancies were subsequently excluded. The number of non-infectious fever attacks and attack frequency were recorded and calculated. Patients with two or more attacks and within the upper three quartiles of attack frequency were defined as high-inflammation group. Univariate and multivariate analyses were carried out to characterize the high-inflammation subtype.ResultsOut of 113 eligible patients with an average of 5 years follow up, 25 patients were defined as the high-inflammation group (16 for anti-Jo1, 9 for anti-PL7), with an average of 1.12 attack/patient-year. Compared to low-inflammation group (0–1 attack only and a frequency lower than 0.5 attack/patient-year), the high-inflammation group had higher occurrence of fever and rapid progressive interstitial lung disease (RPILD) as the first presentation (84% vs. 21% and 40% vs. 9%, respectively, both p&lt;0.01). Anti-PL-7 was related to the more inflammatory phenotype (p=0.014). Cumulative disease-modifying agent exposures (&gt;=3) were much higher in the high-inflammation group (60% vs. 26%), while biological agents, i.e., rituximab and tocilizumab, showed better “drug survival” for Jo-1+ and PL-7+ ASyS patients with high inflammation, respectively, in our cohort.ConclusionsASyS with recurrent systemic inflammatory episodes reflects a subtype of more aggressive and refractory disease in the spectrum of ASyS. Increased awareness of this subtype might lead to more appropriate management.
Effect of Dynamic Circuit Pressures Monitoring on the Lifespan of Extracorporeal Circuit and the Efficiency of Solute Removal During Continuous Renal Replacement Therapy
Authors: Li Peiyun , Zhang Ling , Lin Li , Tang Xin , Guan Mingjing , Wei Tiantian , Chen Lixin 
Published: September 2021

Objective: To observe the effects of dynamic pressure monitoring on the lifespan of the extracorporeal circuit and the efficiency of solute removal during continuous renal replacement therapy (CRRT).Materials and Methods: A prospective observational study was performed at the West China Hospital of Sichuan University in the ICU. Analyses of the downloaded pressure data recorded by CRRT machines and the solute removal efficiencies, calculated by 2*Ce/(Cpre+Cpost), where Ce, Cpre, and Cpost are the concentrations of the effluent, pre-filter blood, and post-filter blood, respectively, were performed. Samples were collected at 0, 2, 6, 12, and 24 h when continuous veno-venous hemodiafiltration (CVVHDF) was used after the initiation of CRRT. Measurements in concentrations of creatinine, blood urea nitrogen, and β2-microglobulin in the plasma and effluent were recorded.Results: Extracorporeal circuits characterized by moderate-to-severe (M–S) access outflow dysfunction (AOD) events, defined as access outflow pressure less than or equal to −200 mmHg for more than 5 min, had shorter median lifespans with no anticoagulation (32.3 vs. 10.90 h, P = 0.001) compared with the no M–S AOD events group. The significant outcome also existed in regional citrate anticoagulation (RCA) (72 vs. 42.47 h, P = 0.02). Moreover, Cox regression analysis revealed that the lack of M–S AOD events, RCA, or CVVHDF independently prolonged the circuit lifespan. All tested solutes removal efficiencies started to decline at 12 h. Furthermore, efficiencies of all solutes removal dropped obviously at 24 h when TMP ≥ 150 mmHg.Conclusion: RCA and CVVHDF predicted a longer circuit lifespan. M–S AOD events were associated with a shorter circuit lifespan when RCA or no anticoagulant was used. Replacement of extracorporeal circuit could be considered when running time of filter lasted up to 24 h with TMP ≥ 150 mmHg.
Case Report: Eculizumab and ECMO Rescue Therapy of Severe ARDS in Goodpasture Syndrome
Authors: Sobotta Michael , Moerer Onnen , Gross Oliver 
Published: September 2021

Introduction:Goodpasture's syndrome is a life-threatening autoimmune type IV collagen disease characterized by the presence anti–glomerular basement membrane antibodies, rapid progressive glomerulonephritis and/or pulmonary hemorrhage.Methods:Here, we describe new therapeutic options, which take recent advances in unraveling Goodpasture's pathogenesis into account.Results:In a 17-year old male, severe Goodpasture's syndrome resulted in acute respiratory distress syndrome (ARDS). Within 1 day after hospital admission, the patient required extracorporeal membrane oxygenation (ECMO). Despite steroid-pulse and plasmapheresis, ARDS further deteriorated. Eleven days after admission, the patient was in a pre-final stage. At last, we decided to block the complement-driven lung damage by Eculizumab. Three days after, lung-failure has stabilized in a way allowing us to initiate Cyclophosphamide-therapy. As mechanical ventilation further triggers Goodpasture-epitope exposure, the patient was taken from pressure support - breathing spontaneously by the help of maintaining ECMO therapy. After a total of 24 days, ECMO could be stopped and pulmonary function further recovered.Conclusions:In conclusion, our findings suggest that life-threatening organ-damage in Goodpasture's syndrome can be halted by Eculizumab as well as by lung-protective early withdrawal from pressure support by the help of ECMO. Both therapeutic options serve as new tools in otherwise hopeless situations to prevent further organ-damage and to gain time until the established immunosuppressive therapy works in otherwise lethal autoimmune-diseases.
Pharmacist-Led Education for Final Year Medical Students: A Pilot Study
Authors: Mokrzecki Sophie , Pain Tilley , Mallett Andrew , Perks Stephen 
Published: September 2021

Background: Prescribing is a core skillset for medical officers. Prescribing errors or deficiencies can lead to patient harm and increased healthcare costs. There is an undefined role for pharmacist-led education to final year medical students to improve prescribing skills.Aim: Assess if pharmacist-led education on prescription writing improves the quality and safety of final year medical students' prescribing skills.Method: Participants and Intervention: Final year medical students were randomised into tutorial (TG) or non-tutorial groups (NTG) and assessed pre- and post- intervention. TG received education by a clinical pharmacist and pharmacy educator using case-based learning. NTG received no additional training as per usual practice. Following the pre-test, all students completed a 3-week tertiary hospital medical ward placement. Students completed the post-test following placement and after the TG participated in the intervention.Student Assessment: Assessment included writing Schedule 4 (S4, prescription only), Schedule 8 (S8, controlled drug), S4 streamline (S4SL), and Mixed case (S4 and S8) prescriptions.Results: At baseline, there were no significant differences between TG and NTG for overall scores or proportion of passes. Post intervention scores significantly improved in TG (p = 0.012) whereas scores significantly decreased in the NTG (p = 0.004). The overall proportion of passes was significantly higher in the TG than NTG (p &lt; 0.001).Conclusion: Education by a clinical pharmacist improved short-term prescribing skills of final year medical students in this study. Students learning primarily experientially from peers and rotational supervisors showed decreased prescribing skills. We propose pharmacist-led education on prescription writing should be further evaluated in larger studies across more student cohorts and for longer periods of follow up time to clarify whether such an educational model could be included in future medical school curricula.
The Progress in the Treatment of Hepatocellular Carcinoma With Portal Vein Tumor Thrombus
Authors: Luo Fangzhou , Li Mengxia , Ding Jun , Zheng Shusen 
Published: September 2021

Hepatocellular carcinoma (HCC) is one of most prevalent cancer and is a serious healthcare issue worldwide. Portal vein tumor thrombus (PVTT) is a frequent complication and remains as the blockage in the treatment of HCC with high recurrence rate and poor prognosis. There is still no global consensus or standard guideline on the management of HCC with PVTT. In western countries, Sorafenib and Lenvatinib are recommended as the first-line treatment options for HCC patients with PVTT where this condition is now regarded as BCLC Stage C regardless of PVTT types. However, there is growing evidence that supports the close relationship of the extent of PVTT to the prognosis of HCC. Besides the targeted therapy, more aggressive treatment modalities have been proposed and practiced in the clinic which may improve the prognosis of HCC patients with PVTT and prolong the patients’ survival time, such as transarterial chemoembolization, radiotherapy, hepatic resection, liver transplantation, and various combination therapies. Herein, we aim to review and summarize the advances in the treatment of HCC with PVTT.
Reasonable Timing of Radiotherapy for Stage IV Non-Small-Cell Lung Cancer During Targeted Therapy Based on Tumour Volume Change
Authors: Li Qingsong , Liang Na , Zhang Xia , Zhang Yi , Ouyang Weiwei , Su Shengfa , Ma Zhu , Hu Yinxiang , Geng Yichao , Chen Xiaxia , Lu Bing 
Published: September 2021

PurposeThe aim of this study was to investigate the reasonable timing of radiotherapy for stage IV non-small-cell lung cancer (NSCLC) with EGFR-positive mutations during targeted therapy based on tumour volume change (TVC).Patients and MethodsSimulation Computed Tomography Scan (SCTS) measurements were taken to test TVC in patients with stage IV NSCLC during targeted therapy at intervals of 10 days. The SCTS measurement was terminated when the tumour volume shrinkage rate in the latter simulation compared with the previous simulation was ≤5% or when the time after treatment was 90 days. Then, primary tumour radiotherapy was performed. Related parameters of the radiotherapy plan were compared between the implementation and simulation plans.ResultsTwenty-seven patients were enrolled in the analysis. After treatment, shrinkage of the primary tumour was observed in all patients, but the rate and speed were inconsistent. The average tumour volume decreased obviously within 40 days and was significantly different every 10 days (P ≤ 0.001). The average volume decreased slowly and tended to be stable (P&gt;0.05) after 40 days. After the termination of SCTSs, 21 patients accepted primary tumour radiotherapy. No patients experienced grade 3+ acute radiation toxicity. The implementation radiotherapy plan was significantly better than that before treatment (all P&lt;0.05) but not better than that on the 40th day after treatment (all P&gt;0.05).ConclusionsTo obtain a high radiation dose and control radiation toxicity, the 40th day after targeted therapy may be a reasonable time to start radiotherapy for stage IV NSCLC with EGFR-positive mutations.Clinical Trial Registrationhttps://www.clinicaltrials.gov/ct2/show/NCT03258671, identifier, NCT03258671.
Case Report: Ocular Manifestations and Treatments of Ciliary Body Involvement by Lymphoma
Authors: Di Yu , Ye Junjie , Han Ruoan , Li Mengda , Zhang Bilei 
Published: September 2021

PurposeTo describe the ocular clinical features, histopathological findings, and treatment outcomes of lymphomas involving the ciliary body.MethodsWe demonstrate three cases of ciliary body involvement by lymphoma from 2013 to 2019 in Peking Union Medical College Hospital (PUMCH). All patients underwent examinations including best corrected visual acuity (BCVA), slit-lamp microscopy, indirect ophthalmoscope, ultrasound biomicroscopy (UBM), and diagnostic vitrectomy. In addition, cytopathology, immunohistochemistry, gene rearrangement, cytometric immunophenotypic, or in-situ hybridization were used for determining the pathological type of lymphoma.ResultsThe patients were a 25-year-old man, a 52-year-old woman, and a 54-year-old man. Two patients had unilateral involvement, and one patient had bilateral involvement. All patients presented with anterior uveitis and elevated intraocular pressure. Ciliary body masses or infiltration were found in 3 patients. Two patients had diffuse large B-cell lymphoma and one patient had natural killer/T-cell lymphoma. All patients received 0.4 mg methotrexate intravitreal injections, and the ciliary body lesions regressed completely.ConclusionLymphomatous involvement of the ciliary body usually presents as an atypical anterior chamber reaction. Vitreous biopsy should be considered in these patients for diagnosis. Methotrexate intravitreal injection combine with chemotherapy or radiotherapy, might extend the survival time and preserve visual acuity for patients with ciliary body involvement by lymphoma.