bluuebunny/crossref_metadata_2025_split huggingface dataset:
75 Lung ultrasound severity scores and its utility in predicting success of weaning off respiratory support in neonates born preterm
Authors: Elkordy Ahmed , Abuelnour Ahmed , De La Hoz Andrea , Miller Michael R , Brar Jagraj , Lalitha Renjini , Roychaudhuri Sriya 
Published: October 2024

Abstract

Background
Preterm infants often require respiratory support in the newborn intensive care unit. Complete trial off around 30-34 weeks post-menstrual age (PMA) is by trial and error based on clinical and physiological variables. Lung ultrasound (LUS) is a reliable adjunct in the diagnosis and management of most neonatal lung conditions. However, its utility in accessing readiness for successful weaning off respiratory pressure support in preterm neonates has not been explored.

Objectives
To determine the utility of LUS severity score (LUS-sc) in predicting successful weaning off of respiratory pressure support after 32weeks CGA in neonates born ≤32 weeks gestational age (GA).

Design/Methods
Prospective cohort study involving preterm neonates born ≤32 weeks needing any respiratory pressure support modes, admitted to a single tertiary care center in Canada between Sept 2022-Sept 2023. Eligible neonates were assessed by LUS at two time points- LUS1 at 30-30 + 6 weeks for those born &lt;30weeks GA and between 48-72hours of life for those born at 30-32 + 6 weeks GA; LUS2 within 12hours prior to trial off respiratory pressure support to room air or low flow after 32weeks PMA. LUS were scored for disease severity by two independent reviewers using the LUS-sc by Brat et al. Receiver operator characteristics (ROC) curves analyzed the reliability of LUS-sc to predict the successful cessation of respiratory pressure support to room air or low flow post LUS2.

Results
Of 50 preterm neonates included in the study, 32 (64%) were successfully weaned from pressure support after LUS2 at a mean (SD) GA of 33.03 (0.29). The mean (SD) GA at birth was 28.78 (0.46) in the successful group and 27.78 (0.62) in the unsuccessful group (p=0.197). The mean (SD) LUS-sc for LUS2 at which cessation of support was possible was significantly lower from those who failed [6.95(0.33) vs 8.69(0.55), p=0.006] (Table 1). The ROC curve (Figure 1) showed AUC of 0.717 (95%CI=0.56-0.86), for a cut-off of LUS-sc of 7.75, with sensitivity of 0.75 (95%CI=0.60-0.90) and specificity of 0.61 (95%CI=0.38-0.84). Independent of GA at birth and at respiratory pressure support trial off, LUS-sc ≤8 was associated with an increased odd of cessation of support by 9.0 (95%CI=1.9-42.6), p=0.005, and each additional week of GA at first trial off increased the odds of cessation by 2.2 (95%CI=1.1-4.4), p=0.031.

Conclusion
LUS is a reliable tool to assess readiness for successful non-invasive respiratory pressure support trial off. A LUS-sc ≤8 was associated with higher successful weaning off of non-invasive pressure support after 32weeks GA.
86 Sociodemographic and family characteristics of children with and without neurodevelopmental impairment in a Canadian cohort of extreme preterm children
Authors: Afifi Jehier , Lee Seungwoo , Colby Lindsay , Butt Arsalan , Hicks Matt , Beltempo Marc , Bourque Claude Julie , Olukotun Mary , Salami Bukola , Synnes Anne 
Published: October 2024

Abstract

Background
Despite improved survival of extreme preterm infants (&lt;29 weeks’ gestation), neurodevelopmental impairment (NDI) remains high. Certain sociodemographic characteristics (SDC) and limited family resources are known to adversely affect children health and development, particularly those born preterm. There is a dearth of recent data from large cohorts examining the impact of social determinants of health on the neurodevelopment of preterm children.

Objectives
(1) to describe SDC and family composition in a population-based cohort of extreme preterm children using the Canadian Neonatal Follow Up Network (CNFUN) database; (2) to develop a logistic regression model examining the association of significant NDI (sNDI any of: CP ≥ GMFCS stage 3, Bayley III &lt; 70 in any domain, deafness requiring aids, or bilateral blindness) with SDC using a unique family descriptor.

Design/Methods
A retrospective review of a national cohort of extreme preterm infants (230 -286 weeks) born between April 2009 and December 2018. We included children who had neurodevelopmental assessment at 18-24 month corrected age at a CNFUN participating Centre. We compared SDC of infants and caregivers and family descriptors (moderating variables) between children with no NDI and those with any NDI and sNDI. Multivariate logistic regression models were developed in two steps to evaluate the effect of SDC (Model 1) and family composition (Model 2) on the primary outcome of sNDI. GEE was used to account for clustering by multiples and within site.

Results
Out of 10833 eligible infants, 6219 (57%) were included. Of those, 3412 (55%) had no NDI and 2807 (45%) had any NDI. sNDI accounted for 17% of the cohort and 37% of those with NDI. Comparison of the SDC and family descriptors between the three groups are shown in Table 1. On multivariate analysis using SDC, infant’s gestational age and male sex, and primary caregiver’s ethnicity and level of education were independently associated with sNDI. Immigration and employment status were associated with sNDI when family descriptors were added to the first model (Table 2).

Conclusion
In this national cohort, half of extreme preterm children developed NDI and 1 in 7 had sNDI. There were differences in sociodemographic and family characteristics between those with and without sNDI. The degree of prematurity and caregiver’s education, employment and immigration status were independently associated with sNDI in those children. Future research is needed to determine what interventions and support to benefit those children at risk.
88 Evaluating the impact of ChatGPT-4 on medical abstracts
Authors: Gravel Jocelyn , Dion Chloé , Kermani Mandana Fadaei , Mousseau Sarah , Osmanlliu Esli 
Published: October 2024

Abstract

Background
Since its launch in November 2022, ChatGPT has received recognition for its use in medical writing. Some even suggested it could write scientific abstracts. However, its real-life effectiveness to help researchers improve conference abstracts remains unexplored.

Objectives
To evaluate whether ChatGPT 4.0 could improve the quality of abstracts submitted to a medical conference by clinical researchers with various experiences.

Design/Methods
In October 2023, we conducted an experimental study involving 24 international researchers who provided one “original” abstract intended for submission at the 2024 Pediatric Academic Society (PAS) conference. Our research team created a prompt asking ChatGPT-4 to improve the quality of the abstract while adhering PAS submission guidelines. Researchers received the revised version and were tasked with creating a “final” abstract. The quality of each version (original, ChatGPT and final) was evaluated by the researchers themselves using a numeric scale (0-100). Additionally, three co-investigators assessed abstracts blinded to the version. The primary analysis focused on the mean difference in scores between the final and original abstracts. We also compared scores of the three versions and determined the proportion of researchers reporting ChatGPT's impact on their abstract and its acceptance probability. For an effect size of 0.7, it was estimated that we needed at least 20 pairs of abstracts.

Results
Abstract quality varied between the three versions with mean scores of 82, 65 and 90 for the original, ChatGPT and final versions, respectively. Overall, the final version displayed significantly improved quality compared to the original (mean difference 8.0 points; 95% CI: 5.6-10.3). Of note, 3 (14%) abstracts remained unchanged between final and original versions. Independent ratings by the co-investigator confirmed statistical improvements (mean difference 0.94 points; 95% CI: 0.44-1.44). Researchers identified minor (n=10) and major (n=3) factual errors in ChatGPT’s abstracts. However, 18 (75%) participants reported that ChatGPT contributed to the enhancement of their final abstract. Ten (42%) participants believed it improved their abstract's chances of acceptance. Eighteen (75%) researchers reported being uncomfortable using ChatGPT version for submission.

Conclusion
While ChatGPT 4.0 does not produce abstracts of better quality then the one crafted by researchers, it serves as a valuable tool for researchers to enhance the quality of their own abstracts. The utilization of such tools is a potential strategy for researchers seeking to improve their abstracts.
Outcomes for Female Physicians Compared With Nonphysicians After Assisted Reproductive Technology
Authors: Vanderhoff Anna C. , Lanes Andrea , Herz-Roiphe Rachel , Mecklai Keizra , Camacho Oscar Leyva , Srouji Serene S. , Easter Sarah Rae , Fox Janis , Rangel Erika L. 
Published: October 2024

OBJECTIVE:
To evaluate outcomes of female physicians after assisted reproductive technology (ART).

METHODS:
We conducted a retrospective cohort study using data from 248 physician patients and 3,470 nonphysician patients who underwent a total of 10,095 fresh or frozen ART cycles at a single academic center in an insurance-mandated state between January 2015 and March 2022. The primary outcome was live-birth rate. The secondary outcomes were implantation rate, early pregnancy loss rate, and time to pregnancy. Models were adjusted for confounders where appropriate.

RESULTS:
Both groups were similar in age (mean physician age 36.29 years; mean nonphysician age 35.96 years, P=.35). Physicians had lower body mass index (BMI) (mean physician BMI 23.51, mean nonphysician BMI 26.37, P<.01), and a higher proportion were diagnosed with unexplained infertility (physician 33.9%, nonphysician 25.9%, P<.01) and used preimplantation genetic testing for aneuploidy (physician 21.5%, nonphysician 12.7%). Physicians and nonphysicians had similar live-birth rates (physician 39.3%, nonphysician 38.2%; adjusted relative risk [aRR] 1.01 95% CI, 0.91–1.13), implantation rates (physician 34.7%, nonphysician 33.7%; relative risk 1.03 95% CI, 0.94–1.14), and early pregnancy loss rates (physician 21.9%, nonphysician 19.8%; aRR 1.18 95% CI, 0.99–1.41) per transfer. Physicians had a shorter time from initial ART cycle to pregnancy (physician 21.82 weeks, nonphysician 25.16 weeks; aRR 0.86, 95% CI, 0.83–0.89).

CONCLUSION:
There was no difference between female physicians and nonphysicians in assisted reproduction cycle outcomes. Physicians become pregnant slightly faster than nonphysicians.
Nasal Light Reflex: A Useful Intraoperative Tool in Correction of Cleft Lip Nasal Deformity
Authors: Madaree Anil 
Published: October 2024

Background:
The correction of a unilateral cleft lip nasal deformity remains a challenge to cleft surgeons. It is difficult to obtain a routinely predictable outcome. This is in part due to there being no objective intraoperative method to assess the correction.

Methods:
We have come up with a simple objective intraoperative method to plan and assess the correction of the nasal deformity. This is done by assessing the nasal light reflex using a mobile phone camera to define the deformity. The points of the desired correction of the lower lateral cartilage are transposed onto the patient. Once the lip and nose repair is completed, another photograph is taken to assess the nasal light reflex and assess the extent of correction. If this is inadequate, further nasal correction is performed. We have used this procedure in 122 cleft lip patients with 93 complete and 29 incomplete.

Results:
We have found this to be a useful objective intraoperative method to assist in obtaining improved nasal correction in cleft lip patients. As is well known, relapse of the nose is common in cleft lip repairs, but this method allows one to better gauge the correction at the primary surgery.

Conclusion:
Nasal light reflex should be added to the armamentarium of cleft surgeons to assist in superior correction of the nose, which is an item that continues to vex these surgeons.
Periodontitis accelerates the onset of hypertension in spontaneously hypertensive rats, while the electrical activation of the carotid sinus nerve delays the beginning of the increase in blood pressure
Authors: Buzinari Tereza C. , Castania Jaci A. , Salvador Sergio L.S. , Ribeiro Aline B. , Junior Rubens Fazan , Salgado Helio C. 
Published: October 2024

Background:
We have previously demonstrated that electrical stimulation of the carotid sinus nerve (CSN) protects the development of periodontitis. In the current study, we evaluated whether periodontitis accelerates the onset of hypertension in spontaneously hypertensive rats (SHR); and whether electrical stimulation of the CSN would delay the onset of hypertension.

Methods:
Three-week old SHR were implanted with electrodes around the CSN for electrical stimulation for 13 days. Bilateral ligation of the first molar and oral administration of Porphyromonas gingivalis induced periodontitis. The femoral artery of the SHR was cannulated, and 24 h later, in a conscious state, the blood pressure was recorded.

Results:
Five-week old sham SHR (subjects without electrical stimulation of the CSN) did not demonstrate hypertension. However, when the SHR were submitted to periodontitis they exhibited hypertension at 5 weeks of age. Nevertheless, the stimulation of the CSN prevented the onset of hypertension. Periodontitis promoted alveolar bone loss in SHR; but, electrical stimulation of the CSN prevented this undesirable outcome following the exposure to periodontitis.

Conclusion:
Periodontitis accelerated the onset of hypertension in SHR; while the electrical stimulation of the CSN delayed the onset of hypertension.
Topical Losartan Dosage Response and Corneal Toxicity at Higher Concentrations
Authors: Dutra Barbara Araujo Lima , Martinez Valeria Villabona , Santhiago Marcony R. , Wilson Steven E. 
Published: October 2024

Purpose:
The purpose of this study was to evaluate the efficacy and safety of higher dosages of topical losartan in an alkali-burn fibrosis model in rabbits.

Methods:
In total, 18 rabbits had standardized alkali burns that trigger stromal fibrosis. Six eyes per group were treated with topical losartan (0.8 mg/mL, 8 mg/mL, or 40 mg/mL) 6 times per day. Slit-lamp photographs were obtained, and multiplex immunohistochemistry was performed for myofibroblast marker alpha-smooth muscle actin (α-SMA), mesenchymal cell marker vimentin, and basement membrane marker laminin alpha-5.

Results:
Topical losartan at 40 mg/mL 6 times per day produced severe discomfort and ocular surface toxicity in all rabbits, and treatment was discontinued at nine days in this group. Topical losartan at 8 mg/mL 6 times per day caused less rabbit discomfort on application, but there were persistent epithelial defects and marked stromal opacity in 5 of 6 eyes after 1 month of treatment. Topical losartan 0.8 mg/mL was well tolerated by rabbits, and corneal opacity was markedly reduced at 1 month in 5 of 6 corneas compared with corneas in the 8 mg/mL and 40 mg/mL losartan groups. A persistent epithelial defect with opacity was noted in 1 cornea in the 0.8 mg/mL losartan group. Both total SMA-positive stromal cells per section (14.5 ± 2.8 vs. 3.5 ± 0.7, P = 0.04) and total stromal vimentin intensity units (310 ± 64 vs. 132 ± 35, P = 0.02) were significantly greater after 1 month of treatment in corneas treated with 8 mg/mL than corneas treated with 0.8 mg/mL of topical losartan.

Conclusions:
Topical losartan dosages over 0.8 mg/mL should be used cautiously in patient eyes. In eyes with a current epithelial defect, it is recommended that 0.2 mg/mL losartan 6 times per day be used until the epithelium closes.
A look at the emerging trends of large language models in ophthalmology
Authors: Tan Ting Fang , Quek Chrystie , Wong Joy , Ting Daniel S.W. 
Published: October 2024

Purpose of review
As the surge in large language models (LLMs) and generative artificial intelligence (AI) applications in ophthalmology continue to expand, this review seeks to update physicians of the current progress, to catalyze further work to harness its capabilities to enhance healthcare delivery in ophthalmology.

Recent findings
Generative AI applications have shown promising performance in Ophthalmology. Beyond native LLMs and question-answering based tasks, there has been increasing work in employing novel LLM techniques and exploring wider use case applications.

Summary
In this review, we first look at existing LLM use case applications specific to Ophthalmology, followed by an overview of commonly used LLM techniques. We finally focus on the emerging trends of the generative AI space with an angle from ophthalmology.
Monitoring and modulating respiratory drive in mechanically ventilated patients
Authors: Consalvo Sebastián , Accoce Matías , Telias Irene 
Published: October 2024

Purpose of review
Respiratory drive is frequently deranged in the ICU, being associated with adverse clinical outcomes. Monitoring and modulating respiratory drive to prevent potentially injurious consequences merits attention. This review gives a general overview of the available monitoring tools and interventions to modulate drive.

Recent findings
Airway occlusion pressure (P0.1) is an excellent measure of drive and is displayed on ventilators. Respiratory drive can also be estimated based on the electrical activity of respiratory muscles and measures of respiratory effort; however, high respiratory drive might be present in the context of low effort with neuromuscular weakness. Modulating a deranged drive requires a multifaceted intervention, prioritizing treatment of the underlying cause and adjusting ventilator settings for comfort. Additional tools include changes in PEEP, peak inspiratory flow, fraction of inspired oxygen, and sweep gas flow (in patients receiving extracorporeal life-support). Sedatives and opioids have differential effects on drive according to drug category. Monitoring response to any intervention is warranted and modulating drive should not preclude readiness to wean assessment or delay ventilation liberation.

Summary
Monitoring and modulating respiratory drive are feasible based on physiological principles presented in this review. However, evidence arising from clinical trials will help determine precise thresholds and optimal interventions.
Spontaneous breathing trials: how and for how long?
Authors: Thille Arnaud W. , Arrivé François , Le Pape Sylvain 
Published: October 2024

Purpose of review
Guidelines recommend systematic performance of a spontaneous breathing trial (SBT) before extubation in ICUs, the objective being to reduce the risk of reintubation. In theory, a more challenging SBT performed with a T-piece may further reduce the risk of reintubation, whereas a less challenging SBT performed with pressure-support ventilation (PSV) may hasten extubation.

Recent findings
Recent findings show that a more challenging SBT with a T-piece or for a prolonged duration do not help to reduce the risk of reintubation. In contrast, a less challenging SBT with PSV is easier to pass than a T-piece, and may hasten extubation without increased risk of reintubation. Although SBT with PSV and additional positive end-expiratory pressure is indeed a less challenging SBT, further studies are needed to generalize such an easy trial in daily practice. Earlier screening for a first SBT may also decrease time to extubation without increased risk of reintubation. Lastly, reconnection to the ventilator for a short period after successful SBT facilitates recovery from the SBT-induced alveolar derecruitment.

Summary
Several recent clinical trials have improved assessment of the most adequate way to perform SBT before extubation.
Neutrophil count predicts the complete response after transarterial chemoembolization related to favorable outcome in hepatocellular carcinoma
Authors: Hong Young Mi 
Published: October 2024

Background
Systemic inflammatory markers have emerged as novel prognostic biomarkers associated with prognosis for tumors. This study aims to investigate the predictive value of systemic inflammatory markers for complete response (CR) in patients with hepatocellular carcinoma (HCC) who underwent transarterial chemoembolization (TACE).

Methods
This retrospective study enrolled 575 HCC patients undergoing TACE. Survival outcomes were evaluated based on tumor response, and the analysis was conducted using a Kaplan–Meier curve. Predictive factors for achieving a CR after the initial TACE were analyzed by univariate and multivariate analyses in a Cox regression model.

Results
After the initial TACE, 246 of 575 (42.8%) patients achieved a CR. During a median of 60 months follow-up, the CR group had better overall survival than non-CR group (median: 82.3 vs. 51.6 months, P < 0.001). Pre-TACE neutrophil count was associated with tumor response (P = 0.06). Multivariate analysis showed that hepatitis B virus infection [hazard ratio (HR) = 0.585, 95% confidence interval (CI) = 0.360–0.952, P = 0.031] and pre-TACE neutrophil count (HR = 2.854, 95% CI = 1.115–7.307, P = 0.029) were independent predictive factors for CR after the initial TACE. Additionally, a high pre-TACE neutrophil count was associated with male gender (P < 0.001), large tumor size (P < 0.001), advanced Barcelona Clinic Liver Cancer stage (P = 0.003), and high protein induced by vitamin K absence or antagonist-II level (P < 0.001).

Conclusion
Patients who achieved CR after the initial TACE showed a favorable prognosis. Pre-TACE neutrophil count was found to be an independent predictor of CR. These findings offer valuable insights for identifying patients who would derive the greatest benefit from TACE and for distinguishing those who may require alternative treatment approaches for HCC.
Perioperative systemic therapy, current paradigm and ongoing clinical trials in upper tract urothelial cancer
Authors: Bhanvadia Raj R. , Khene Zine-Eddine , Margulis Vitaly 
Published: October 2024

Purpose of review
To provide a comprehensive overview of existing and future paradigms for perioperative systemic therapy in the treatment of upper tract urothelial carcinoma.

Recent findings
Contemporary treatment paradigms for the management of upper tract urothelial carcinoma focus on use of neoadjuvant cisplatin based chemotherapy for high grade disease primarily based on two small single arm phase II clinical trials. More robust evidence from a phase III randomized clinical trial exists for the use of adjuvant platinum based chemotherapy for invasive disease after radical nephroureterectomy, but there are significant concerns about renal function and platinum eligibility after nephroureterectomy. There are currently ongoing clinical trials for nonplatinum based perioperative systemic therapies including checkpoint inhibitors/immunotherapy as well as antibody–drug conjugates, but currently no recommendation can be made for these approaches.

Summary
Current evidence supports neoadjuvant cisplatin chemotherapy in the setting of high grade disease or concern for significant renal dysfunction after radical nephroureterectomy or platinum based adjuvant chemotherapy in eligible patients with advanced disease after surgery. While there is no established role for nonplatinum based therapies yet, multiple ongoing trials exploring use of immunotherapies and antibody–drug conjugates as monotherapy or combination may provide new therapeutic options in this population.