bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of information accuracy and clarity: ChatGPT responses to the most frequently asked questions about premature ejaculation
Authors: Şahin Mehmet Fatih , Keleş Anil , Özcan Rıdvan , Doğan Çağrı , Topkaç Erdem Can , Akgül Murat , Yazıci Cenk Murat 
Published: May 2024

Abstract

Background
Premature ejaculation (PE) is the most prevalent sexual dysfunction in men, and like many diseases and conditions, patients use Internet sources like ChatGPT, which is a popular artificial intelligence–based language model, for queries about this andrological disorder.

Aim
The objective of this research was to evaluate the quality, readability, and understanding of texts produced by ChatGPT in response to frequently requested inquiries on PE.

Methods
In this study we used Google Trends to identify the most frequently searched phrases related to PE. Subsequently, the discovered keywords were methodically entered into ChatGPT, and the resulting replies were assessed for quality using the Ensuring Quality Information for Patients (EQIP) program. The produced texts were assessed for readability using the Flesch–Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), and DISCERN metrics.

Outcomes
This investigation has identified substantial concerns about the quality of texts produced by ChatGPT, highlighting severe problems with reading and understanding.

Results
The mean EQIP score for the texts was determined to be 45.93 ± 4.34, while the FRES was 15.8 ± 8.73. Additionally, the FKGL score was computed to be 15.68 ± 1.67 and the DISCERN score was 38.1 ± 3.78. The comparatively low average EQIP and DISCERN scores suggest that improvements are required to increase the quality and dependability of the presented information. In addition, the FKGL scores indicate a significant degree of linguistic intricacy, requiring a level of knowledge comparable to about 14 to 15 years of formal schooling in order to understand. The texts about treatment, which are the most frequently searched items, are more difficult to understand compared to other texts about other categories.

Clinical Implications
The results of this research suggest that compared to texts on other topics the PE texts produced by ChatGPT exhibit a higher degree of complexity, which exceeds the recommended reading threshold for effective health communication. Currently, ChatGPT is cannot be considered a substitute for comprehensive medical consultations.

Strengths and Limitations
This study is to our knowledge the first reported research investigating the quality and comprehensibility of information generated by ChatGPT in relation to frequently requested queries about PE. The main limitation is that the investigation included only the first 25 popular keywords in English.

Conclusion
ChatGPT is incapable of replacing the need for thorough medical consultations.
The Role of Roman Law in the Formation of the State and Modern Law
Authors: Pejo Erida , Kolaneci Esmeralda 
Published: May 2024

Abstract
The research aims to determine the role that Roman law played in the development of modern jurisprudence. Several methods of theoretical cognition were used in the course of the study, such as analysis, synthesis, comparison, specification, and generalization. As a result, some conclusions have been reached, in particular, that the mechanisms and principles of the Roman legal order, which have existed for many centuries, remain relevant in the modern legal context, and have influenced the formation of political and institutional structures, especially in the field of market relations and economic development. In addition, the study identifies how different branches of Roman law have influenced the further development of jurisprudence. Roman public law (ius publicum) influenced the development of constitutional law in modern countries by regulating relations between the state and citizens. Roman private law (ius privatum) defined the foundations of modern civil law systems, regulating the rights and obligations of citizens among themselves. Also, with the development of trade in Rome, the concept of ius gentium or “law of nations” emerged, which became the basis of modern international law through the formalization of rules and regulations governing the international exchange and circulation of goods.
Decreasing Stigma Toward People Who Inject Drugs: Harm Reduction Training for First-Year Medical Students
Authors: Avra Tucker , Cowan Amanda , Friedman Joseph , Fukushima Jack , Nelson Andrew , Truman Kyla , Stevens Autumn , Bourgois Philippe , Hansen Helena , Shover Chelsea , Goodman-Meza David 
Published: May 2024

AbstractProblemStigma in health care toward people who inject drugs (PWID) is a well-described, significant barrier to quality care, resulting in poor health outcomes. Harm reduction offers a person-centered counter-framework for minimizing harm for people who use drugs. Despite the evidence in support of harm reduction, medical students typically receive minimal training on harm reduction and the care of PWID.ApproachTo fill this gap, medical students at the University of California, Los Angeles organized around the principles of harm reduction to improve the medical school curriculum related to PWID. Students screened lectures for stigmatizing language and collaborated with faculty to improve lecture materials. They partnered with a community organizer and hosted a mandatory 1-hour lecture and 30-minute discussion introducing the principles of harm reduction within an overdose prevention, recognition, and response training for first-year medical students during medical school orientation in August 2022. An anonymous online pretest and posttest survey, assessing student attitudes toward PWID, was used to evaluate the effects of the training.OutcomesA total of 156 students completed the pretest survey, and 107 students completed the pretest and posttest survey (68.5% response rate). The overall posttest mean stigma score was 1.8 (standard deviation [SD] = 0.5) and was significantly lower than the pretest mean of 2.1 (SD = 0.7;P< .0001), indicating a reduction in stigma among medical student attitudes after the course. There was statistically significant improvement in attitudes for 7 of 13 component measures.Next StepsThis analysis demonstrated that the mandatory class has the capacity to improve medical student attitudes toward PWID. The authors plan to further evaluate the program’s effectiveness through measuring and reporting outcomes for future student cohorts. The authors are working with curriculum directors to further incorporate harm reduction principles into other lectures and problem-based learning exercises.
Preoperative Physical Therapy is Associated With Decreased Length of Stay and Improved Postoperative Mobility in Patients With Sarcopenia Undergoing Adult Spinal Deformity Surgery
Authors: Hirase Takashi , Lovecchio Francis C. , Allen Myles R.J. , Achebe Chukwuebuka C. , Mazzucco Michael , Uzzo Robert N. , Kazarian Gregory S. , Asada Tomoyuki , Nakarai Hiroyuki , Subramanian Tejas , Simon Chad Z. , Durbas Atahan , Kaidi Austin C. , Araghi Kasra , Samuel Justin T. , Kwas Cole , Albert Todd J. , Kim Han Jo 
Published: May 2024

Study Design.
Retrospective cohort study.

Objective.
To determine the relationship between preoperative physical therapy (PT) and postoperative mobility, adverse events (AEs), and length of stay (LOS) among patients with low normalized total psoas area (NTPA) undergoing adult spinal deformity (ASD) surgery.

Background.
Sarcopenia, as defined by low NTPA, has been shown to predict poor perioperative outcomes of ASD surgery. However, there is limited evidence correlating the benefits of PT within the patient population with sarcopenic.

Materials and Methods.
NTPA was analyzed at the L3 and L4 mid-vertebral bodies on preoperative magnetic resonance imaging. Receiver operating characteristic curve analysis was used to determine sex-specific NTPA cutoff values for predicting perioperative AEs. Patients were categorized as having low NTPA if both L3 and L4 NTPA were below these cutoff values. Perioperative outcomes were compared between patients with low NTPA who underwent documented formal PT within 6 months before ASD surgery with those who did not.

Results.
A total of 103 patients (42 males, 61 females) met the criteria for low NTPA for inclusion in the study, of which 42 underwent preoperative PT and 61 did not. The preoperative PT group had a shorter LOS (111.2 ± 37.5 vs. 162.1 ± 97.0 h, P < 0.001), higher ambulation distances (feet) on postoperative day (POD) 1 (61.7 ± 50.3 vs. 26.1 ± 69.0, P < 0.001), POD 2 (113.2 ± 81.8 vs. 62.1 ± 73.1, P = 0.003), and POD 3 (126.0 ± 61.2 vs. 91.2 ± 72.6, P = 0.029), and lower rates of total AEs (31.0% vs. 54.1%, P = 0.003) when excluding anemia requiring transfusion. Multivariable analysis found preoperative PT to be the most significant predictor of decreased LOS (odds ratio: 0.32, P = 0.013).

Conclusion.
Patients with sarcopenia may benefit from formal preoperative PT before undergoing ASD surgery to improve early postoperative mobility, decrease adverse eveents, and reduce length of stay.

Level of Evidence.
Level III.
Evaluating the Accuracy of Off-Label Placement of Pulse Oximetry Sensors in Comparison to On-Label Placement in the Adult Cardiac Intensive Care Unit Patient Population
Authors: Hlavin Danielle , Bosma Grace N. , Bolt Matthew A. , Sammel Mary D. , Seyller Nicole , Varty Maureen 
Published: May 2024

Background
Continuous pulse oximetry (Spo
2) is a commonly utilized tool to obtain an indirect, noninvasive measurement of hemoglobin oxygen saturation. Difficulty obtaining measurement with Spo
2 sensors can lead nurses to try off-label sites until they find placement that provides a signal. Currently, there is limited evidence to support this application.

Purpose
The purpose of this study was to evaluate the accuracy of off-label placement of pulse oximetry sensors in comparison to on-label placement in adult cardiac intensive care patients.

Methods
Data were collected on 24 participants. At the time of a medically necessary arterial blood gas laboratory draws, 4 Spo
2 measurements were gathered from an on-label finger sensor, an off-label finger sensor, an on-label ear sensor, and an off-label ear sensor. Results were analyzed using 4 Pearson correlation coefficients, Bland-Altman plots, and 2 linear mixed-effect models.

Results
Our study found that while both our on-label finger and off-label finger pulse oximetry sensor overestimated when compared to the arterial hemoglobin saturation (gold standard), there was greater overestimation found with the off-label placement. Though there was not a significant difference observed between the ear probe on the nose and the gold standard, figures examining off-label ear probe and gold standard measures show that, in lower ranges of oxygen saturation, the off-site probe substantially overestimates true oxygen saturation, while in higher ranges of oxygen saturation, the off-site ear probe underestimates true oxygen saturation.

Conclusions
No changes should be made to the current practice of using pulse oximetry sensor placement.
Care of the Patient With an Artificial Airway
Authors: Evers Julianne M. , Minton Lori A. , Webb Chris , Taylor Rachel M. , York Nancy L. 
Published: May 2024

Background
Artificial airways are essential in various clinical settings to maintain a patient's airway and provide necessary support for ventilation and oxygenation. These devices are commonly temporary and come in several types, each serving specific purposes. Understanding the indications, types, and proper care of artificial airways is crucial for health care professionals to ensure patients receive optimal care and prevent complications.

Objective
This article aims to review the indications for using artificial airways and discuss the most commonly used types, including supraglottic airway devices, endotracheal tubes, tracheostomy tubes, and laryngectomy tubes. It also provides insights into the procedures involved in intubation and percutaneous tracheostomy and offers guidance on patient management, emphasizing assessment, oral care, suctioning, and humidification for patients with these airway devices.

Conclusion
This article underscores the significance of understanding artificial airways, not just as a set of skills but as a commitment to patient welfare. Health care professionals who master the knowledge and care of these devices can significantly contribute to their patients' well-being and quality of life.
Optimizing thiopurine therapy in autoimmune hepatitis: A multicenter study on monitoring metabolite profiles and co-therapy with allopurinol
Authors: Weltzsch Jan Philipp , Bartel Claudius F. , Waldmann Moritz , Renné Thomas , Schulze Stephanie , Terziroli Beretta-Piccoli Benedetta , Papp Maria , Oo Ye H. , Ronca Vincenzo , Sebode Marcial , Lohse Ansgar W. , Schramm Christoph , Hartl Johannes 
Published: May 2024

Background and Aims:
In autoimmune hepatitis, achieving complete biochemical remission (CBR) with current weight-based thiopurine dosing is challenging. We investigated whether patients could be stratified regarding CBR according to a target range of thiopurine metabolites. Moreover, we explored the effects of azathioprine dosage increases and co-therapy of allopurinol with low-dose thiopurines on metabolite profiles and treatment response.

Approach and Results:
The relation between metabolites and treatment response was assessed in 337 individuals from 4 European centers. In a global, cross-sectional analysis, active metabolites 6-thioguanine nucleotides (6TGN) were similar in those with and without CBR. However, analyzing patients with sequential measurements over 4 years (N = 146) revealed higher average 6TGN levels in those with stable CBR (260 pmol/0.2 mL) compared to those failing to maintain CBR (181 pmol/0.2 mL; p = 0.0014) or never achieving CBR (153 pmol/0.2 mL; p < 0.0001), with an optimal 6TGN cutoff of ≥223 pmol/0.2 mL (sensitivity: 76% and specificity: 78%). Only 42% exhibited 6TGN ≥223 pmol/0.2 mL following weight-based dosing, as doses weakly correlated with 6TGN but with 6-methylmercaptopurine (6MMP), a metabolite associated with toxicity. Azathioprine dose increases led to preferential 6MMP formation (+127% vs. 6TGN +34%; p < 0.0001). Conversely, adding allopurinol to thiopurines in difficult-to-treat patients (N = 36) raised 6TGN (168→321 pmol/0.2 mL; p < 0.0001) and lowered 6MMP (2125→184 pmol/0.2 mL; p < 0.0001), resulting in improved transaminases in all patients and long-term CBR in 75%.

Conclusions:
Maintaining CBR in autoimmune hepatitis was associated with 6TGN ≥223 pmol/0.2 mL. For patients who fail to achieve CBR and therapeutic 6TGN levels despite thiopurine dose increase due to preferential 6MMP formation, comedication of allopurinol alongside low-dose thiopurines represents an efficient alternative.
Elucidating the mechanism of hepatotoxicity in Euodia rutaecarpa: insights from QSAR toxicity prediction and metabolomics
Authors: Yang Chunqi , Lai Chengcai , Ru Yi , Shen Baoying , Wu Xiangjun , Cui Jialu , Li Fangyang , Zhang Cheng , Shi Zhuo , Qian Qingyuan , Xiao Chengrong , Wang Yuguang , Zhang Boli , Gao Yue 
Published: May 2024

Objective:
Euodia rutaecarpa, (Wu Zhu Yu) a Chinese medicine clinically used to treat gastrointestinal disorders, has been widely employed. However, Euodia rutaecarpa is regarded as a small toxic traditional Chinese medicine in the Chinese Pharmacopoeia and other herbal works. Using toxicity predictions combined with in vitro and in vivo studies, this study aimed to identify the toxic components and toxic target organs of Euodia rutaecarpa, and explore its toxic mechanism from a metabolic perspective.

Methods:
The toxic target organs of Euodia rutaecarpa were identified through in vitro and in vivo studies. In vitro toxicity screening was performed by alkaloid enrichment and isolation. The potential toxicity of compounds was predicted by Absorption, Distribution, Metabolism, Excretion, and Toxicity Predictor (ADMET Predictor) based on Quantitative Structure–Activity Relationship (QSAR) construction. In addition, the study integrated the serum metabolomic analysis after the administration of potentially toxic components to clarify the effect of potentially toxic substances on metabolism in mice.

Results:
Comparing the acute toxicity in mice of different extraction methods and before and after processing, it was evident that Euodia rutaecarpa alcoholic extract had the highest toxicity, and the target organ of Euodia rutaecarpa toxicity was the liver. The alkaloid fraction of alcoholic extract of Euodia showed strong cytotoxicity. The potential toxicity of Euodia rutaecarpa was calculated and predicted by ADMET Predictor, and alkaloids are suspected to be responsible for the toxicity of Euodia rutaecarpa. Evodiamine significantly reduced the number of cells and increased the mitochondrial membrane potential in vitro. Different metabolites were significantly identified by serum metabolomics, of which bile acid metabolism and steroid hormone biosynthesis are the key pathways of hepatotoxicity.

Conclusions:
Clarify the scientific significance of clinical use of processed products by comparing the acute toxicity of different extraction methods before and after processing. Combining the toxicity prediction based on QSAR with the toxicity screening in vitro and in vivo, the potential toxic target organs and toxic components of Euodia rutaecarpa can be identified. Through metabolomics, we preliminarily revealed that the hepatotoxicity of Euodia rutaecarpa may be related to bile acid metabolism and steroid hormone biosynthesis. This study lays the foundation for elucidating the mechanism of Euodia rutaecarpa and evaluating its safety and quality.
FACTORS ASSOCIATED WITH DELAYED DIAGNOSIS IN PATIENTS WITH PRIMARY VITREORETINAL LYMPHOMA
Authors: Wang Kenny Y. , Xu Timothy T. , Mogil Rachel S. , Song Allisa J. , White Launia J. , Hodge David O. , Dalvin Lauren A. 
Published: May 2024

Purpose:
To identify demographic and clinical factors associated with delayed diagnosis in patients with primary vitreoretinal lymphoma (VRL).

Methods:
Retrospective, tertiary referral center-based cohort study of all patients at Mayo Clinic in Rochester, Minnesota, with a biopsy-proven diagnosis of VRL from January 1, 2000, to October 31, 2022.

Results:
There were 87 patients included during the 22-year study period with 73 patients (83.9%) diagnosed with VRL upon initial evaluation at the tertiary center, with the other 14 patients (16.1%) diagnosed later. The median referral time was 4.8 months (range: 0–113 months). Patients who received an initial diagnosis of inflammatory uveitis or another incorrect diagnosis elsewhere were referred slower than those initially diagnosed with VRL (P = 0.04). The most common incorrect initial diagnosis from an outside institution was inflammatory uveitis (n = 35, 40.2%). When patients were split into four groups based on referral time, prior use of corticosteroids was associated with a significant delay in referral (P = 0.03).

Conclusion:
Diagnosing VRL continues to be challenging, as months-long delays from initial evaluation to expert referral center evaluation are common. Prior use of corticosteroids was associated with delay in diagnosis and referral time, underscoring the need to increase awareness regarding differences between VRL and uveitis.
Widefield Swept-Source OCTA Findings in HELLP Syndrome: Choroidal Infarcts
Authors: Martinez-Velazquez Luis , Begaj Tedi , Garg Itika , Zhou Paul , Hoyek Sandra , Wai Karen M. , Miller John B. , Patel Nimesh A. 
Published: May 2024

Purpose:
Pre-eclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome have been previously implicated with ophthalmic complications including serous retinal detachments and disorders of the choroidal vasculature. Herein, we report a case of macular serous detachment associated with HELLP syndrome in which wide field swept-source optical coherence tomography angiography (WF SS-OCTA) was used.

Methods:
Retrospective case report of a patient who developed HELLP syndrome. The patient underwent multimodal retinal imaging and wide field swept-source OCT angiography (WF SS-OCTA) (PLEX® Elite 9000, Carl Zeiss Meditec Inc.).

Results:
A 36-year-old female patient diagnosed with HELLP syndrome presented with bilateral blurry vision. At presentation, dilated fundus exam revealed localized subretinal fluid in the macula. WF SS-OCTA showed areas of peripapillary and subfoveal flow signal attenuation in the choroid OD, consistent with choroidal infarction.

Conclusions:
These findings support the hypothesis that HELLP syndrome is associated with vascular changes that lead to choroidal dysfunction and subsequent serous retinal detachments. Furthermore, this case highlights a role for the non-invasive WF SS-OCTA technology in diagnosing and further characterizing the pathophysiology without the use of dye-based angiography.
Glaucoma and the Human Microbiome
Authors: Chang Chih-Chiun J. , Liu Benjamin , Liebmann Jeffrey M. , Cioffi George A. , Winn Bryan J. 
Published: May 2024

Purpose of Review:
To explore a view of the human microbiome as an interconnected, functional, dynamic system that may be linked to the pathogenesis and progression of glaucoma.

Methods:
A literature review was undertaken that included publications from 1966 to 2023.

Results:
Bacterial lipopolysaccharides (LPS) activate toll-like receptors (TLR) and mediate the human immune response. The LPS-TLR4 pathway is a potential avenue for the ocular, gut, and oral microbiomes to interface and/or influence ocular disease. Studies of gut dysbiosis have shown that alterations in the healthy microbiota can predispose the host to immune-mediated inflammatory and neurodegenerative conditions, while oral and ocular surface dysbiosis has been correlated with glaucoma. While developmental exposure to commensal microflora has shown to be necessary for the autoimmune and neurodegenerative responses to elevated intraocular pressure to take place, commensal bacterial products like short-chain fatty acids have regulatory effects protective against glaucoma.

Summary:
Alterations to human microbiotas have been associated with changes in intestinal permeability, gene regulation, immune cell differentiation, and neural functioning, which may predispose the host to glaucoma. Select microbes have been highlighted for their potential contributions to glaucoma disease progression or protection, raising the potential for microbiota-based treatment modalities. Current topical glaucoma treatments may disrupt the ocular surface microbiota, potentially having ramifications on host health. Further study of the relationships between human microbiome and glaucoma is needed.