bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of immediate initiation of invasive ventilation on mortality in acute hypoxemic respiratory failure: a target trial emulation
Authors: Mellado-Artigas Ricard , Borrat Xavier , Ferreyro Bruno L. , Yarnell Christopher , Hao Sicheng , Wanis Kerollos N. , Barbeta Enric , Torres Antoni , Ferrando Carlos , Brochard Laurent 
Published: May 2024

Abstract
Purpose
Invasive ventilation is a fundamental treatment in intensive care but its precise timing is difficult to determine. This study aims at assessing the effect of initiating invasive ventilation versus waiting, in patients with hypoxemic respiratory failure without immediate reason for intubation on one-year mortality.

Methods
Emulation of a target trial to estimate the benefit of immediately initiating invasive ventilation in hypoxemic respiratory failure, versus waiting, among patients within the first 48-h of hypoxemia. The eligible population included non-intubated patients with SpO2/FiO2 ≤ 200 and SpO2 ≤ 97%. The target trial was emulated using a single-center database (MIMIC-IV) which contains granular information about clinical status. The hourly probability to receive mechanical ventilation was continuously estimated. The hazard ratios for the primary outcome, one-year mortality, and the secondary outcome, 30-day mortality, were estimated using weighted Cox models with stabilized inverse probability weights used to adjust for measured confounding.

Results
2996 Patients fulfilled the inclusion criteria of whom 792 were intubated within 48 h. Among the non-invasive support devices, the use of oxygen through facemask was the most common (75%). Compared to patients with the same probability of intubation but who were not intubated, intubation decreased the hazard of dying for the first year after ICU admission HR 0.81 (95% CI 0.68–0.96, p = 0.018). Intubation was associated with a 30-day mortality HR of 0.80 (95% CI 0.64–0.99, p = 0.046).

Conclusion
The initiation of mechanical ventilation in patients with acute hypoxemic respiratory failure reduced the hazard of dying in this emulation of a target trial.
Incidence, risk factors and outcomes of nosocomial infection in adult patients supported by extracorporeal membrane oxygenation: a systematic review and meta-analysis
Authors: Ait Hssain Ali , Vahedian-Azimi Amir , Ibrahim Abdulsalam Saif , Hassan Ibrahim Fawzy , Azoulay Elie , Darmon Michael 
Published: May 2024

Abstract
Background
An increasing number of patients requires extracorporeal membrane oxygenation (ECMO) for life support. This supportive modality is associated with nosocomial infections (NIs). This systematic review and meta-analysis aim to assess the incidence and risk factors of NIs in adult.

Methods
We searched PubMed, Scopus, Web of Science, and ProQuest databases up to 2022. The primary endpoint was incidence of NI. Secondary endpoints included time to infection, source of infection, ECMO duration, Intensive care and hospital length of stay (LOS), ECMO survival and overall survival. Incidence of NI was reported as pooled proportions and 95% confidence intervals (CIs), while dichotomous outcomes were presented as risk ratios (RR) as the effective index and 95% CIs using a random-effects model.

Results
Among the 4,733 adult patients who received ECMO support in the 30 included studies, 1,249 ECMO-related NIs per 1000 ECMO-days was observed. The pooled incidence of NIs across 18 studies involving 3424 patients was 26% (95% CI 14–38%).Ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) were the most common NI sources. Infected patients had lower ECMO survival and overall survival rates compared to non-infected patients, with risk ratio values of 0.84 (95% CI 0.74–0.96, P = 0.01) and 0.80 (95% CI 0.71–0.90, P < 0.001), respectively.

Conclusion
Results showed that 16% and 20% lower of ECMO survival and overall survival in patients with NI than patients without NI, respectively. However, NI increased the risk of in-hospital mortality by 37% in infected patients compared with non-infected patients. In addition, this study identified the significant positive correlation between ECMO duration and ECMO-related NI.
Early identification of macrophage activation syndrome secondary to systemic lupus erythematosus with machine learning
Authors: Lin Wenxun , Xie Xi , Luo Zhijun , Chen Xiaoqi , Cao Heng , Fang Xun , Song You , Yuan Xujing , Liu Xiaojing , Du Rong 
Published: May 2024

Abstract
Objective
The macrophage activation syndrome (MAS) secondary to systemic lupus erythematosus (SLE) is a severe and life-threatening complication. Early diagnosis of MAS is particularly challenging. In this study, machine learning models and diagnostic scoring card were developed to aid in clinical decision-making using clinical characteristics.

Methods
We retrospectively collected clinical data from 188 patients with either SLE or the MAS secondary to SLE. 13 significant clinical predictor variables were filtered out using the Least Absolute Shrinkage and Selection Operator (LASSO). These variables were subsequently utilized as inputs in five machine learning models. The performance of the models was evaluated using the area under the receiver operating characteristic curve (ROC-AUC), F1 score, and F2 score. To enhance clinical usability, we developed a diagnostic scoring card based on logistic regression (LR) analysis and Chi-Square binning, establishing probability thresholds and stratification for the card. Additionally, this study collected data from four other domestic hospitals for external validation.

Results
Among all the machine learning models, the LR model demonstrates the highest level of performance in internal validation, achieving a ROC-AUC of 0.998, an F1 score of 0.96, and an F2 score of 0.952. The score card we constructed identifies the probability threshold at a score of 49, achieving a ROC-AUC of 0.994 and an F2 score of 0.936. The score results were categorized into five groups based on diagnostic probability: extremely low (below 5%), low (5–25%), normal (25–75%), high (75–95%), and extremely high (above 95%). During external validation, the performance evaluation revealed that the Support Vector Machine (SVM) model outperformed other models with an AUC value of 0.947, and the scorecard model has an AUC of 0.915. Additionally, we have established an online assessment system for early identification of MAS secondary to SLE.

Conclusion
Machine learning models can significantly improve the diagnostic accuracy of MAS secondary to SLE, and the diagnostic scorecard model can facilitate personalized probabilistic predictions of disease occurrence in clinical environments.
Clinical research on point-of-care lung ultrasound: misconceptions and limitations
Authors: Volpicelli Giovanni , Rovida Serena 
Published: May 2024

AbstractOver the last 20 years, advances in point-of-care lung ultrasound (PoCLUS) have been consistent. The clinical application of PoCLUS has drastically changed the diagnosis of some respiratory conditions mainly in the acute setting. Despite these improvements, misconceptions regarding the current scientific evidence and errors in the direction given to the latest research are delaying the implementation of PoCLUS in the clinical field. The diagnostic power of PoCLUS is still under-evaluated in many settings and there is a generalized yet unjustified feeling that further evidence is needed before introducing PoCLUS as a standard of care. In the effort to build up further evidence by new studies, the role of randomized clinical trials is over-emphasized and gold standards used to investigate diagnostic accuracy of PoCLUS are sometimes not appropriate. Moreover, the sonographic patterns and techniques used to confirm the diagnoses not always are adapted to the patients’ clinical condition, which limit the scientific value of those clinical studies. Finally, there is a recurrent confusion in the role of PoCLUS scoring techniques, which should be only applied to quantify and monitor injury severity and not to diagnose lung diseases. Awareness of these misconceptions and errors could help the researchers when approaching new study projects on PoCLUS.
Enzyme variants in biosynthesis and biological assessment of different molecular weight hyaluronan
Authors: Ebrahimi Tahereh , Keramati Malihe , Khodabakhsh Farnaz , Cohan Reza Ahangari 
Published: May 2024

AbstractIn the present study, low- and high-molecular-weight hyaluronic acids (LMW-HA and HMW-HA) were synthesized in vitro by truncated Streptococcus equisimilis hyaluronan synthases (SeHAS). The enzyme kinetic parameters were determined for each enzyme variant. The MW, structure, dispersity, and biological activity of polymers were determined by electrophoresis, FTIR spectroscopy, carbazole, cell proliferation, and cell migration assay, respectively. The specific activities were calculated as 7.5, 6.8, 4.9, and 2.8 µgHA µgenzyme−1 min−1 for SeHAS, HAS123, HAS23, and HASIntra, respectively. The results revealed SeHAS produced a polydisperse HMW-HA (268 kDa), while HAS123 and HAS23 produced a polydisperse LMW-HA (< 30 kDa). Interestingly, HASIntra produced a low-disperse LMW-HA. Kinetics studies revealed the truncated variants displayed increased Km values for two substrates when compared to the wild-type enzyme. Biological assessments indicated all LMW-HAs showed a dose-dependent proliferation activity on endothelial cells (ECs), whereas HMW-HAs exhibited an inhibitory effect. Also, LMW-HAs had the highest cell migration effect at 10 µg/mL, while at 200 µg/mL, both LMW- and HMW-HAs postponed the healing recovery rate. The study elucidated that the transmembrane domains (TMDs) of SeHAS affect the enzyme kinetics, HA-titer, HA-size, and HA-dispersity. These findings open new insight into the rational engineering of SeHAS to produce size-defined HA.
Graphical abstract
Constrained optimal grouping of cloud application components
Authors: Różańska Marta , Horn Geir 
Published: May 2024

AbstractCloud applications are built from a set of components often deployed as containers, which can be deployed individually on separate Virtual Machines (VMs) or grouped on a smaller set of VMs. Additionally, the application owner may have inhibition constraints regarding the co-location of components. Finding the best way to deploy an application means finding the best groups of components and the best VMs, and it is not trivial because of the complexity coming from the number of possible options. The problem can be mapped onto may known combinatorial problems as binpacking and knapsack formulations. However, these approaches often assume homogeneus resources and fail to incorporate the inhibition constraints. The main contribution of this paper are firstly a novel formulation of the grouping problem as constrained Coalition Structure Generation (CSG) problem, including the specification of the value function which fulfills the criteria of a Characteristic Function Game (CFG). The CSG problem aims to determine stable and disjoint groups of players collaborating to optimize the joint outcome of the game, and a CFG is a common representation of a CSG, where each group is assigned a value and where the value of the game is the sum of the groups’ contributions. Secondly, the Integer-Partition (IP) CSG algorithm has been modified and extended to handle constraints. The proposed approach is evaluated with the extended IP algorithm, and a novel exhaustive search algorithm establishing the optimum grouping for comparison. The evaluation shows that our approach with the modified algorithm evaluates on average significantly less combinations than the CSG state-of-the-art algorithm. The proposed approach is promising for optimized constrained Cloud application management as the modified IP algorithm can optimally solve constrained grouping problems of attainable sizes.
Electronic prescription systems in Greece: a large-scale survey of healthcare professionals’ perceptions
Authors: Grammatikopoulou Margarita , Lazarou Ioulietta , Giannios George , Kakalou Christina Asimina , Zachariadou Martha , Zande Maria , Karanikas Haralampos , Thireos Eleftherios , Stavropoulos Thanos G. , Natsiavas Pantelis , Nikolopoulos Spiros , Kompatsiaris Ioannis 
Published: May 2024

Abstract
Background
The national e-prescription system in Greece is one of the most important achievements in the e-health sector. Healthcare professionals’ feedback is essential to ensure the introduced system tends to their needs and reduces their everyday workload. The number of surveys collecting the users’ views is limited, while the existing studies include only a small number of participants.

Methods
In this study, healthcare professionals’ perceptions on e-prescription are explored. For this, a questionnaire was distributed online, containing closed- and open-ended questions aiming to address strengths and identify drawbacks in e-prescription. Answers were collected from primary health care physicians, specialized medical doctors and pharmacists.

Results
In total, 430 answers were collected (129 from primary health care physicians, 164 responses from specialized medical doctors and 137 pharmacists). Analysis of the collected answers reveals that the views of the three groups of healthcare professionals mostly converge. The positive impact e-prescribing systems have on the overall prescribing procedure in preventing errors and providing automation is commented. Among gaps identified and proposed improvements, health care professionals note the need for access to information on adverse drug reactions, side effects, drug-to-drug interactions and allergies. Flexible interaction with Therapeutic Prescription Protocols is desired to ameliorate monitoring and decision-making, while drug dosing features, and simplified procedures for copying, repeating, canceling a prescription, are perceived as useful to incorporate.

Conclusions
Collecting healthcare professionals’ feedback is important, as their views can be transcribed to system requirements, to further promote e-prescribing and improve the provided health care services by facilitating decision making through safer and more efficient e-prescription. Introduction of the identified improvements can simplify the everyday workflow of healthcare professionals. To the best of our knowledge, a survey with more than 400 answered questionnaires on the use of e-prescription systems by healthcare professionals has never been conducted in Greece before.
Ratio of photosynthetically active radiation to global solar radiation above forest canopy in complex terrain: measurements and analyses based on Qingyuan Ker Towers
Authors: Li Shuangtian , Yan Qiaoling , Gao Tian , Wang Xingchang , Wang Qingwei , Yu Fengyuan , Lu Deliang , Liu Huaqi , Zhang Jinxin , Zhu Jiaojun 
Published: May 2024

Abstract
Background
Understanding of the ratio of photosynthetic photon flux density (Qp) to global solar radiation (Rs) (Qp/Rs) is crucial for applying Rs to ecology-related studies. Previous studies reported Qp/Rs and its variations based on measurements from a single observatory tower, instead of multi-site-based measurements over complex terrains. This may neglect spatial heterogeneity in the terrain, creating a gap in an understanding of how terrain affects Qp/Rs and how this effect interacts with meteorological factors.

Methods
Here the Qingyuan Ker Towers (three towers in a valley with different terrains: T1, T2, and T3) were utilized to measure Qp and Rs over mountainous forests of Northeast China. An airborne LiDAR system was used to generate a digital elevation model, and sky view factor of sectors (SVFs) divided from the field of view of tower’s pyranometer was calculated as a topographic factor to explain the variations of Qp/Rs.

Results
The results identified significant differences in Qp/Rs of the three towers at both daily and half-hour scales, with larger differences on clear days than on overcast days. Qp/Rs was positively correlated with SVFs of T1 and T3, while this correlation was negative with that of T2. The effect of SVFs on Qp/Rs interacted with clearness index, water vapor pressure and solar zenith angle. Random forest-based importance assessment demonstrated that explanation (R2) on Qp/Rs was improved when SVFs was included in the predictor variable set, indicating that incorporating terrain effects enhances the prediction accuracy of Qp/Rs. The improvement in the R2 values was more pronounced on clear days than on overcast days, suggesting that the effect of terrain on Qp/Rs depended on sky conditions.

Conclusions
All findings suggested that Qp/Rs is affected by terrain, and integrating terrain information into existing Qp/Rs models is a feasible solution to improve Qp/Rs estimates in mountainous areas.
Twenty four-month follow-up after bullectomy, unilateral and bilateral lung volume reduction surgery: a single-center retrospective analysis of consecutive cases
Authors: Bascarevic Slavisa , Ercegovac Maja , Hoda Mir Alireza , Savic Milan , Vesovic Radomir , Milenkovic Vladimir , Moromila Marina , Popovic Marko , Gompelmann Daniela , Madzarevic Petar 
Published: May 2024

Abstract
Purpose
While pharmacologic therapy remains the cornerstone of lung emphysema treatment, surgery is an additional therapeutic option in selected patient groups with advanced emphysema. The aim of lung volume reduction surgery (LVRS) is to improve lung function, exercise capacity, quality of life and survival. We sought to determine the therapeutic value of surgical resection in specific patients with lung emphysema.

Patients and methods
A retrospective study was performed consisting of 58 patients with lung emphysema who underwent surgical intervention over a 10-year period and were followed for 2 years postoperatively. The clinical characteristics recorded were FEV1 (forced expiratory volume in 1 s), the 6-min walk test (6-MWT), the Modified Medical Research Council (mMRC), body mass index (BMI) and quality of life prior to and 6, 12 and 24 months after surgical intervention. Moreover, all peri- and post-operative complications were noted.

Results
Out of 58 emphysema patients (72% male, FEV1 (L) 2.21 ± 0.17, RV (L) 3.39 ± 0.55), 19 underwent surgical bullectomy, 31 unilateral LVRS and 8 sequential bilateral LVRS. Six months after surgery, there was a statistically significant improvement in FEV1, RV, TLC, 6-MWT and mMRC. Over a period of 12 to 24 months postoperatively, clinical benefit gradually declines most likely due to COPD progression but patients still experienced a significant improvement in FEV1. The most common postoperative complications were persistent air leakage (> 7 days), arrhythmia and subcutaneous emphysema in 60%, 51.6% and 22.4%, respectively. No deaths were observed after surgical intervention.

Conclusion
In a selected patient population, surgery led to significant improvement of lung function parameters, exercise capacity and quality of life. Over a period of 12 to 24 months postoperatively, clinical benefit gradually decreased most likely due to COPD progression.
Associations of body composition with physical activity, nutritional intake status, and chronotype among female university students in Japan
Authors: Oshita Kazushige , Ishihara Yujiro , Seike Kohei , Myotsuzono Ryota 
Published: May 2024

Abstract
Background
Having higher muscle mass in early adulthood is an important factor in preventing sarcopenia. However, university students undergo lifestyle changes compared to their high school years, which may lead to changes in body composition, such as an increase in body fat and a decrease in muscle mass. The study aimed to investigate the association between body composition and lifestyle behaviors, including chronotype, among Japanese female university students, due to the prevalence of underweight among young females in the country.

Methods
The physical activity level (PAL), daily dietary intake status, morningness-eveningness questionnaire (MEQ) score, and body composition of 230 students were assessed in this cross-sectional study. Body composition was measured using a multifrequency bioelectrical impedance analyzer, and body mass index (BMI), body fat percentage (%BF), and skeletal muscle mass index (SMI) were determined.

Results
Individuals who were evening type (ET) had a higher %BF and lower SMI than those who were non-ET, but no differences in body weight or BMI were found. Although ET individuals had lower total energy intake, protein intake, and PALs than non-ETs, the differences were small. However, multiple regression analyses showed that SMI was significantly positively associated with MEQ and PAL, and %BF was significantly negatively associated with MEQ and PAL.

Conclusion
These results suggest that female university students with lateness of chronotype and low physical activity have a body composition imbalance resulting in higher body fat and lower muscle mass. Therefore, young females may need to take chronotype-specific measures (especially ET individuals) to help them maintain an appropriate body composition.
Dietary glycine supplementation enhances syntheses of creatine and glutathione by tissues of hybrid striped bass (Morone saxatilis ♀ × Morone chrysops ♂) fed soybean meal-based diets
Authors: He Wenliang , Li Xinyu , Wu Guoyao 
Published: May 2024

Abstract
Background
We recently reported that supplementing glycine to soybean meal-based diets is necessary for the optimum growth of 5- to 40-g (Phase-I) and 110- to 240-g (Phase-II) hybrid striped bass (HSB), as well as their intestinal health. Although glycine serves as an essential substrate for syntheses of creatine and glutathione (GSH) in mammals (e.g., pigs), little is known about these metabolic pathways or their nutritional regulation in fish. This study tested the hypothesis that glycine supplementation enhances the activities of creatine- and GSH-forming enzymes as well as creatine and GSH availabilities in tissues of hybrid striped bass (HSB; Morone saxatilis♀ × Morone chrysops♂).

Methods
Phase-I and Phase-II HSB were fed a soybean meal-based diet supplemented with 0%, 1%, or 2% glycine for 8 weeks. At the end of the 56-d feeding, tissues (liver, intestine, skeletal muscle, kidneys, and pancreas) were collected for biochemical analyses.

Results
In contrast to terrestrial mammals and birds, creatine synthesis occurred primarily in skeletal muscle from all HSB. The liver was most active in GSH synthesis among the HSB tissues studied. In Phase-I HSB, supplementation with 1% or 2% glycine increased (P < 0.05) concentrations of intramuscular creatine (15%–19%) and hepatic GSH (8%–11%), while reducing (P < 0.05) hepatic GSH sulfide (GSSG)/GSH ratios by 14%–15%, compared with the 0-glycine group; there were no differences (P > 0.05) in these variables between the 1% and 2% glycine groups. In Phase-II HSB, supplementation with 1% and 2% glycine increased (P < 0.05) concentrations of creatine and GSH in the muscle (15%–27%) and liver (11%–20%) in a dose-dependent manner, with reduced ratios of hepatic GSSG/GSH in the 1% or 2% glycine group. In all HSB, supplementation with 1% and 2% glycine dose-dependently increased (P < 0.05) activities of intramuscular arginine:glycine amidinotransferase (22%–41%) and hepatic γ-glutamylcysteine synthetase (17%–37%), with elevated activities of intramuscular guanidinoacetate methyltransferase and hepatic GSH synthetase and GSH reductase in the 1% or 2% glycine group. Glycine supplementation also increased (P < 0.05) concentrations of creatine and activities of its synthetic enzymes in tail kidneys and pancreas, and concentrations of GSH and activities of its synthetic enzymes in the proximal intestine.

Conclusions
Skeletal muscle and liver are the major organs for creatine and GSH syntheses in HSB, respectively. Dietary glycine intake regulates creatine and GSH syntheses by both Phase-I and Phase-II HSB in a tissue-specific manner. Based on the metabolic data, glycine is a conditionally essential amino acid for the growing fish.