bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain Assessment Following Opioid Administration in Aneurysmal Subarachnoid Hemorrhage Associated Headache
Authors: Bui Van T. , Pfeifer Carolyn , Snelgrove Dan K. , Neyens Ron R. 
Published: April 2024

Background: Headache is a debilitating complication following an aneurysmal subarachnoid hemorrhage (aSAH). Despite its impact on morbidity and quality of life, limited evidence characterizes the effectiveness of opioids. Objective: The aim of this study was to evaluate opioid associated reduction in pain scores in patients with aSAH-associated headache. Methods: This is a retrospective study of adult patients with an aSAH, Hunt and Hess grades I – III, admitted to a neurosciences intensive care unit. Descriptive and inferential statistics were used to characterize headache treatment strategies and opioid associated reduction in pain scores. Results: Opioids were used in up to 97.6% of patients for the management of aSAH-associated headache. Median reduction in pain after opioid administration was −1 (IQR: -3-0). Correlation between opioid dose and change in pain scores was negligible (rs = .01). Overall, 68.8% of patients were discharged on an opioid analgesic with predictive factors being severe headache (OR 2.52; 1.04 – 6.14) and oral morphine milligram equivalents ≥60 mg per day during the hospital stay (OR 3.02; 1.22 – 7.47). Conclusions: Opioids were associated with a small reduction in pain when assessed via the NRS. An increased opioid dose did not correlate with a greater reduction in assessed pain scores. A high percentage of patients remained on opioids throughout hospitalization and were eventually discharged on an opioid. The impact of discharge opioid prescriptions and risk of opioid persistence creates a cause for concern. It is imperative that we seek improved pain management strategies for aSAH-associated headache.
Cleft Summit 2022: The Impact of a Unified Voice
Authors: Vyas Raj M. , Najjar Wassim , Losee Joseph E. , Kummer Ann W. , Hamdan Usama S. ,   The Cleft Summit 2022 Consortium
Published: April 2024

Objective The inaugural Cleft Summit aimed to unite experts and foster interdisciplinary collaboration, seeking a collective understanding of velopharyngeal insufficiency (VPI) management. Design An interactive debate and conversation between a multidisciplinary cleft care team on VPI management Setting A two-hour discussion within a four-day comprehensive cleft care workshop (CCCW). Participants Thirty-two global leaders from various cleft disciplines Interventions Cleft Summit that allows for meaningful interdisciplinary collaboration and knowledge exchange. Main Outcome Measures Ability to reach consensus on a unified statement for VPI management. Results Participants agreed that a patient with significant VPI and a dynamic velum should first receive a surgery that lengthens the velum to optimize patient outcome. A global, multicenter prospective study should be done to test this hypothesis. Conclusion The 1st Cleft Summit successfully distilled global expertise into actionable best-practice guidelines through iterative discussions, fostering interdisciplinary collaboration and paving the way for a transformative multi-center prospective study on VPI care.
The Water Drinking Provocation Test- an aid to decision making in the management of OHT and POAG
Authors: Lele Alpana , Pal Shabari , Goel Upsham 
Published: April 2024

Purpose To study response to water drinking provocation in primary open angle glaucoma (POAG), ocular hypertensives and glaucoma suspects and establish the role of water drinking provocation test (WDPT) as a relevant supplementary tool in glaucoma management. Materials and methods 319 eyes of 161 patients were included in the study after retrospectively analyzing hospital records of patients who underwent WDPT. The patients were categorized into Group A (POAG on treatment), Group B (treatment-naïve POAG), Group C (Ocular hypertensives), Group D (glaucoma suspects). All patients were asked to drink 1 liter of water within 5 min and intraocular pressures (IOP) were recorded after 20 and 30 min of water intake. The baseline, peak and IOP fluctuation were analysed. A fluctuation of ≥ 5 mm Hg was considered positive response. Results 19 eyes were categorized as Group A, 58 as Group B, 96 and 146 eyes as groups C and D respectively. Baseline IOP in different groups differed significantly. Mean peak IOP was higher in Groups B and C, followed by Groups A and D. Mean IOP fluctuation differed significantly across groups being maximum in Group A (7.0 ± 2.5) and minimum in Group D (4.8 ± 2.9). Positive WDPT response was seen in 89.5% eyes in Group A, 77.6% of those in Group B, 55.2% and 48.6% in Groups C and D respectively. The baseline IOP had a significant positive correlation with the peak IOP across all groups. Conclusion The WDPT is an inexpensive practical tool which serves as an invaluable aid in glaucoma management.
Predictors of acute post-thrombectomy intracranial hemorrhage expansion in anterior circulation infarcts
Authors: Bhamidipati Akshay , Mummareddy Nishit , Ahn Seoiyoung , Bendfeldt Gabriel , Lyons Alexander T , Gangavarapu Surya , Chen Jeffrey , Jo Jacob , Kamal Naveed , Roth Steven G , Froehler Michael T , Chitale Rohan V , Fusco Matthew R 
Published: April 2024

Background Post-mechanical thrombectomy (MT) intracranial hemorrhage (ICH) is a major source of morbidity in treated acute ischemic stroke patients with large vessel occlusion. ICH expansion may further contribute to morbidity. We sought to identify factors associated with ICH expansion on imaging evaluation post-MT. Methods We performed a retrospective cohort study of patients undergoing MT at a single comprehensive stroke center. Per protocol, patients underwent dual-energy head CT (DEHCT) post-MT followed by a 24-h interval non-contrast enhanced MRI. ICH expansion was defined as any increase in blood volume between the two studies if identified on the DEHCT. Univariate and multivariable analyses were performed to identify risk factors for ICH expansion. Results ICH was identified on DEHCT in 13% of patients ( n = 35/262), with 20% (7/35) demonstrating expansion on interval MRI. The average increase in blood volume was 11.4 ml (SD 6.9). Univariate analysis identified anticoagulant usage (57% vs 14%, p = 0.03), petechial hemorrhage inside the infarct margins or intraparenchymal hematoma on DEHCT (ECASS-II HI2/PH1/PH2) (71% vs 14%, p < 0.01), basal ganglia hemorrhage (71% vs 21%, p = 0.02), and basal ganglia infarction (86% vs 32%, p = 0.03) as factors associated with ICH expansion. Multivariate regression demonstrated that anticoagulant usage (OR 20.3, 95% C.I. 2.43–446, p < 0.05) and ECASS II scores of HI2/PH1/PH2 (OR 11.7, 95% C.I. 1.24–264, p < 0.05) were significantly predictive of ICH expansion. Conclusion Expansion of post-MT ICH on 24-h interval MRI relative to immediate post-thrombectomy DEHCT is significantly associated with baseline anticoagulant usage and petechial hemorrhage inside the infarct margins or presence of intraparenchymal hematoma (ECASS-II HI2/PH1/PH2).
Six-year progression of medically treated infective aortitis
Authors: Zhang Daniel , Lee Arvind Dhas 
Published: April 2024

Objective To report a medically treated case of infective aortitis with mycotic aneurysms that went on to have many years of surveillance imaging. This has not yet been documented as current recommendations for infective aortitis strongly suggest operative intervention combined with aggressive antibiotics, with very high reported mortality for non-operative management. Thus, the natural progression of sac growth during the acute infective period and in the long-term has had an opportunity to be explored. Methods A 77-year-old patient presented with infective aortitis confirmed on computed tomography angiography and refused operative intervention despite being explained the associated risks and benefits. She was treated aggressively with antibiotics and monitored in the community, successfully clearing the infection. Results She received a total of 6 weeks of ceftriaxone intravenously and 1 year of oral ciprofloxacin. She rapidly developed mycotic aneurysmal disease both infrarenal and suprarenal which stabilised within 1 year after diagnosis and did not progress further. Conclusions Infective aortitis with mycotic aneurysms is usually treated surgically due to the significant risk of rupture in the acute period. This case suggests that if the acute infective period is passed, the aneurysmal disease stabilises and does not progress.
Assessing the effectiveness and safety of lenvatinib and everolimus in advanced renal cell carcinoma: insights from the RELIEVE study’s analysis of heavily pretreated patients
Authors: Buti Sebastiano , Olivari Alessandro , Masini Cristina , Bimbatti Davide , Sartori Donata , Ermacora Paola , Cattrini Carlo , Vitale Maria Giuseppa , Rossi Ernesto , Mucciarini Claudia , Rizzo Mimma , Sisani Michele , Santoni Matteo , Roviello Giandomenico , Mollica Veronica , Conteduca Vincenza , Grillone Francesco , Cinausero Marika , Prati Giuseppe , Atzori Francesco , Stellato Marco , Massari Francesco , Bersanelli Melissa 
Published: April 2024

Background: The treatment of heavily pretreated patients with metastatic renal cell carcinoma (mRCC) represents an unmet medical need and is still challenging. Objectives: The primary objective was to assess the effectiveness of the lenvatinib plus everolimus combination and the secondary objective was the toxicity profile of this combination. Design: We conducted a longitudinal retrospective study examining mRCC patients pre-treated with one or more lines of therapy among different cancer centers in Italy. Methods: The study included patients who received the combination of lenvatinib plus everolimus as either a second-line treatment or beyond. We assessed progression-free survival (PFS), time to treatment failure (TTF), overall survival (OS), response rate (RR), and toxicity profile. In addition, we explored the potential relationship between treatment effectiveness and clinical and laboratory parameters. Results: In all, 33 patients were assessed, the median age was 60 years, 57% had an Eastern Cooperative Oncology Group performance status of 1–2 and. 63% received ⩾ 3 prior lines of therapy. 62% were ‘intermediate risk’ according to the International Metastatic Renal Cell Carcinoma Database Consortium and 30% were ‘poor risk’. The RR was 42% (no complete response), 18% stable disease. Median OS was 11.2 months (95% CI 6.8–19.9), median PFS was 6.7 months (95% CI 0.6–30.8), and median TTF was 6.7 months (95% CI 4.8–16.6). A shorter OS was significantly associated with lymph node metastases ( p = 0.043, 95% CI), neutrophils/ lymphocytes ratio (NLR) ⩾ 3 ( p = 0.007), hemoglobin/red cell distribution width ratio cutoff value <0.7 was significant ( p = 0.03) while a shorter PFS was associated with lung ( p = 0.048) and brain metastases ( p = 0.023). The most frequent G1 toxicity was diarrhea (24%), G2 was fatigue (30%), and hypertension and skin toxicity (6%) for G3. Conclusion: Our findings suggest a clinically relevant effectiveness of lenvatinib plus everolimus combination with an acceptable toxicity profile for heavily pretreated patients with mRCC.
Assessment of Glycemia Risk Index and Standard Continuous Glucose Monitoring Metrics in a Real-World Setting of Exercise in Adults With Type 1 Diabetes: A Post-Hoc Analysis of the Type 1 Diabetes and Exercise Initiative
Authors: Morrison Dale , Vogrin Sara , Zaharieva Dessi P. 
Published: April 2024

Background: Standardized reporting of continuous glucose monitoring (CGM) metrics does not provide extra weighting for very high or very low glucose, despite their distinct clinical significance, and thus may underestimate glycemic risk in people with type 1 diabetes (T1D) during exercise. Glycemia Risk Index (GRI) is a novel composite metric incorporating clinician-validated extra weighting for glycemic extremes, which may provide a novel summary index of glycemia risk around exercise. Methods: Adults (≥18 years) in the T1D EXercise Initiative study wore CGM and activity trackers for four weeks. For this analysis, exercise days were defined as 24 hours following ≥20 minutes of exercise, with no other exercise in the 24-hour period. Sedentary days were defined as any 24 hours with no recorded exercise within that period or the preceding 24 hours. Linear mixed-effects regression was used to evaluate exercise effects on GRI and CGM metrics within 24 hours postexercise. Results: In 408 adults with T1D with >70% CGM and activity data, GRI on exercise (N = 3790) versus sedentary days (N = 1865) was significantly lower (mean [SD]: 29.9 [24.0] vs 34.0 [26.1], respectively, absolute mean difference −1.70 [−2.73, −0.67], P < .001), a ~5% reduction in glycemic risk. Percent time in range (TIR; 70-180 mg/dL) increased on exercise days (absolute mean difference 2.67 [1.83, 3.50], P < .001), as did time below range (TBR; relative mean difference 1.17 [1.12, 1.22], P < .001), while time above range (TAR) decreased (relative mean difference 0.84 [0.79, 0.88], P < .001). Conclusions: Glycemia Risk Index improved on exercise versus sedentary days, despite increased TBR, which is weighted most heavily in the GRI calculation, due to a robust reduction in TAR.
Bioinformatic Analysis and in Vitro Experimental Verification of the Intervention Effect of Shipi-Xiaoji Recipe on the Progression of non-Alcoholic Fatty Liver Disease to Liver Cancer
Authors: Zhang Jingting , Chen Hongyao , Li Kexiong , Peng Wei , Yang Renyi , Zeng Puhua 
Published: April 2024

Objective This study aimed to screen and identify central genes associated with the progression of non-alcoholic fatty liver disease (NAFLD) to hepatocellular carcinoma (HCC), to establish prognostic and clinical prediction models based on the expression of these genes, and to evaluate the intervention of a traditional Chinese medicine (TCM) formula—SPXJF—on the development of NAFLD into HCC through network pharmacology analysis and in vitro and in vivo validation. Methods Datasets for analysis were retrieved from multiple public databases using bioinformatics techniques. Through network pharmacology analysis, SPXJF's active components and their related targets were assessed, while in vitro experiments validated the inhibitory effects of SPXJF on the growth and migration of HepG2 cells. Results The results revealed that the expression levels of the two central genes, regulator of cell cycle gene (RGCC) and atypical chemokine receptor 3 (ACKR3), were closely tied to the survival prognosis of HCC patients. Furthermore, SPXJF significantly inhibited the proliferation and migration of HepG2 cells. Conclusion RGCC and ACKR3, as hub genes, significantly influence HCC patient survival during “NAFLD-HCC” progression. The risk scoring system and prediction model perform well. In vitro experiments showed that SPXJF could inhibit the proliferation and invasion of hepG2 cells. These findings support the discovery of molecular targets for early diagnosis and drug intervention in HCC. They also underscore TCM's potential in anti-HCC strategies and clinical application.
Improved survival outcomes with anakinra over etoposide-based therapies for the management of adults with hemophagocytic lymphohistiocytosis: a retrospective multicenter research network study
Authors: Lee Benjamin J. 
Published: April 2024

Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening, hyperinflammatory syndrome for which etoposide-based regimens have historically been the standard of care. Recent reports have described positive outcomes with the utilization of ruxolitinib or anakinra although these studies are often limited to small samples. Objectives: We aimed to compare the efficacy of ruxolitinib, anakinra, and etoposide-based therapies for the management of HLH in adult patients. Design: We performed a population-based, multicenter, retrospective cohort study utilizing the TriNetX Networks database. Methods: Adult patients (⩾18 years) diagnosed with HLH who received first-line treatment with ruxolitinib, anakinra, or etoposide between 2008 and 2023 were analyzed. The primary endpoint was overall survival (OS) at 1 year. A 1:1 propensity-score matching analysis was utilized. Results: Anakinra ( p = 0.020) but not ruxolitinib ( p = 0.19) resulted in a significantly higher 1-year OS when compared with etoposide-based therapies. Conclusions: Anakinra is effective for the management of adult patients with HLH.
Evaluating ChatGPT's efficacy in assessing the safety of non-prescription medications and supplements in patients with kidney disease
Authors: Sheikh Mohammad S. , Barreto Erin F. , Miao Jing , Thongprayoon Charat , Gregoire James R , Dreesman Benjamin , Erickson Stephen B. , Craici Iasmina M. , Cheungpasitporn Wisit 
Published: April 2024

Background This study investigated the efficacy of ChatGPT-3.5 and ChatGPT-4 in assessing drug safety for patients with kidney diseases, comparing their performance to Micromedex, a well-established drug information source. Despite the perception of non-prescription medications and supplements as safe, risks exist, especially for those with kidney issues. The study's goal was to evaluate ChatGPT's versions for their potential in clinical decision-making regarding kidney disease patients. Method The research involved analyzing 124 common non-prescription medications and supplements using ChatGPT-3.5 and ChatGPT-4 with queries about their safety for people with kidney disease. The AI responses were categorized as “generally safe,” “potentially harmful,” or “unknown toxicity.” Simultaneously, these medications and supplements were assessed in Micromedex using similar categories, allowing for a comparison of the concordance between the two resources. Results Micromedex identified 85 (68.5%) medications as generally safe, 35 (28.2%) as potentially harmful, and 4 (3.2%) of unknown toxicity. ChatGPT-3.5 identified 89 (71.8%) as generally safe, 11 (8.9%) as potentially harmful, and 24 (19.3%) of unknown toxicity. GPT-4 identified 82 (66.1%) as generally safe, 29 (23.4%) as potentially harmful, and 13 (10.5%) of unknown toxicity. The overall agreement between Micromedex and ChatGPT-3.5 was 64.5% and ChatGPT-4 demonstrated a higher agreement at 81.4%. Notably, ChatGPT-3.5's suboptimal performance was primarily influenced by a lower concordance rate among supplements, standing at 60.3%. This discrepancy could be attributed to the limited data on supplements within ChatGPT-3.5, with supplements constituting 80% of medications identified as unknown. Conclusion ChatGPT's capabilities in evaluating the safety of non-prescription drugs and supplements for kidney disease patients are modest compared to established drug information resources. Neither ChatGPT-3.5 nor ChatGPT-4 can be currently recommended as reliable drug information sources for this demographic. The results highlight the need for further improvements in the model's accuracy and reliability in the medical domain.
Does chronic urticaria affect quality of sleep and quality of life?
Authors: Abdel-Meguid Azza M , Awad Sara M , Noaman Mostafa , Abdel Gawad Asmaa M , Abou-Taleb Doaa A E 
Published: April 2024

Background: Urticaria affects a wide range of daily activities and social relationships. It has a severe impact on quality of life (QOL) and causes psychological problems. Objective: was to assess the impact of chronic urticaria (CU) on quality of sleep, the levels of depression, anxiety, QOL and their interaction with each other and their relation to disease related factors. Patients and methods: The study included 25 patients with CU and 25 healthy controls. Urticaria Activity Score (UAS) was used for objective evaluation of the intensity of urticaria. Patients completed a 10-cm visual analogue score (VAS) indicating the overall severity of their itching over the previous 2 weeks. The Dermatology Life Quality Index (DLQI) was used to evaluate patients’ QOL. Patients were also assessed for anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). Pittsburgh Sleep Quality Index (PSQI) was used for evaluation of sleep quality and sleep disturbances. Results: In our CU patients the mean of UAS7 score was 39.72 ± 2.76 and the mean of VAS score was 28 ± 1.34. The mean of DLQI score was 24.8 ± 4.37 indicating severe impact of QOL. CU patients had higher total HADS score when compared to controls; 72% of the patients had depression and 92% had anxiety. By using PSQI, CU patients had significantly longer sleep latency onset, shorter total sleep duration, lower sleep efficiency and higher PSQI scores compared to controls. Conclusion: CU highly affects the QOL of patients and is associated with higher levels of anxiety, depression and poor sleep quality.
Early seizures and risk of epilepsy and death after intracerebral haemorrhage: The MUCH Italy
Authors: Pezzini Alessandro , Tarantino Barbara , Zedde Marialuisa , Marcheselli Simona , Silvestrelli Giorgio , Ciccone Alfonso , DeLodovici Maria Luisa , Princiotta Cariddi Lucia , Vidale Simone , Paciaroni Maurizio , Azzini Cristiano , Padroni Marina , Gamba Massimo , Magoni Mauro , Del Sette Massimo , Tassi Rossana , De Franco Ivo Giuseppe , Cavallini Anna , Calabrò Rocco Salvatore , Cappellari Manuel , Giorli Elisa , Giacalone Giacomo , Lodigiani Corrado , Zenorini Mara , Valletta Francesco , Cutillo Gianni , Bonelli Guido , Abrignani Giorgia , Castellini Paola , Genovese Antonio , Latte Lilia , Trapasso Maria Claudia , Ferraro Chiara , Piancatelli Francesco , Pascarella Rosario , Grisendi Ilaria , Assenza Federica , Napoli Manuela , Moratti Claudio , Acampa Maurizio , Grassi Mario 
Published: April 2024

Introduction: It is unclear which patients with non-traumatic (spontaneous) intracerebral haemorrhage (ICH) are at risk of developing acute symptomatic seizures (provoked seizures occurring within the first week after stroke onset; early seizures, ES) and whether ES predispose to the occurrence of remote symptomatic seizures (unprovoked seizures occurring more than 1 week after stroke; post-stroke epilepsy, PSE) and long-term mortality. Patients and Methods: In the setting of the Multicenter Study on Cerebral Haemorrhage in Italy (MUCH-Italy) we examined the risk of ES and whether they predict the occurrence of PSE and all-cause mortality in a cohort of patients with first-ever spontaneous ICH and no previous history of epilepsy, consecutively hospitalized in 12 Italian neurological centers from 2002 to 2014. Results: Among 2570 patients (mean age, 73.4 ± 12.5 years; males, 55.4%) 228 (8.9%) had acute ES (183 (7.1%) short seizures and 45 (1.8%) status epilepticus (SE)). Lobar location of the hematoma (OR, 1.49; 95% CI, 1.06–2.08) was independently associated with the occurrence of ES. Of the 2,037 patients who were followed-up (median follow-up time, 68.0 months (25th–75th percentile, 77.0)), 155 (7.6%) developed PSE. ES (aHR, 2.34; 95% CI, 1.42–3.85), especially when presenting as short seizures (aHR, 2.35; 95% CI, 1.38–4.00) were associated to PSE occurrence. Unlike short seizures, SE was an independent predictor of all-cause mortality (aHR, 1.50; 95% CI, 1.005–2.26). Discussion and Conclusion: The long-term risk of PSE and death after an ICH vary according to ES subtype. This might have implications for the design of future clinical trials targeting post-ICH epileptic seizures.