bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimization of cardiopulmonary bypass prime fluid to preserve microcirculatory perfusion during on-pump coronary artery bypass graft surgery: PRIME study protocol for a double-blind randomized trial
Authors: Beukers Anne M. , Bulte Carolien S. E. , Bosch Ruben J. , Eberl Susanne , van den Brom Charissa E. , Loer Stephan A. , Vonk Alexander B. A. 
Published: March 2024

Abstract
Background
Acute microcirculatory perfusion disturbances and organ edema are important factors leading to organ dysfunction during cardiac surgery with cardiopulmonary bypass (CPB). Priming of the CPB system with crystalloid or colloid fluids, which inevitably leads to hemodilution, could contribute to this effect. However, there is yet no optimal evidence-based strategy for this type of priming. Hence, we will investigate different priming strategies to reduce hemodilution and preserve microcirculatory perfusion.

Methods
The PRIME study is a single-center double-blind randomized trial. Patients undergoing elective coronary artery bypass graft surgery with CPB will be randomized into three groups of prime fluid strategy: (1) gelofusine with crystalloid, (2) albumin with crystalloid, or (3) crystalloid and retrograde autologous priming. We aim to include 30 patients, 10 patients in each arm. The primary outcome is the change in microcirculatory perfusion. Secondary outcomes include colloid oncotic pressure; albumin; hematocrit; electrolytes; fluid balance and requirements; transfusion rates; and endothelial-, glycocalyx-, inflammatory- and renal injury markers. Sublingual microcirculatory perfusion will be measured using non-invasive sidestream dark field video microscopy. Microcirculatory and blood measurements will be performed at five consecutive time points during surgery up to 24 h after admission to the intensive care unit.

Discussion
PRIME is the first study to assess the effect of different prime fluid strategies on microcirculatory perfusion in cardiac surgery with CPB. If the results suggest that a specific crystalloid or colloid prime fluid strategy better preserves microcirculatory perfusion during on-pump cardiac surgery, the current study may help to find the optimal pump priming in cardiac surgery.

Trial registration
ClinicalTrials.gov NCT05647057. Registered on 04/25/2023. ClinicalTrials.gov PRS: Record Summary NCT05647057, all items can be found in the protocol.
Novel synthesis of new triazine sulfonamides with antitumor, anti-microbial and anti-SARS-CoV-2 activities
Authors: Mohamed-Ezzat Reham A. , Elgemeie Galal H. 
Published: March 2024

AbstractNovel approach for synthesizing triazine sulfonamide derivatives is accomplished via reacting the sulfaguanidine derivatives with N-cyanodithioiminocarbonate. Further reaction of the novel triazine sulfonamide analogues with various secondary amines and anilines generated various substituted triazine sulfonamide analogues of promising broad-spectrum activities including anti-microbial, anti-tumor, and anti-viral properties. The in vitro anti-proliferative activities of most of the novel compounds were evaluated on the NCI-60 cell line panel. The antifungal and antibacterial activities of the compounds were also estimated. The anti-viral activity against SARS CoV-2 virus was performed using MTT cytotoxicity assay to evaluate the half-maximal cytotoxic concentration (CC50) and inhibitory concentration 50 (IC50) of a representative compound from the novel triazine sulfonamide category. Compound 3a demonstrated potent antiviral activity against SARS-CoV-2 with IC50 = 2.378 µM as compared to the activity of the antiviral drug remdesivir (IC50 = 10.11 µM). Our results indicate that, upon optimization, these new triazine sulfonamides could potentially serve as novel antiviral drugs.
Landscape level associations between birds, mosquitoes and microclimates: possible consequences for disease transmission?
Authors: Krol Louie , Remmerswaal Laure , Groen Marvin , van der Beek Jordy G. , Sikkema Reina S. , Dellar Martha , van Bodegom Peter M. , Geerling Gertjan W. , Schrama Maarten 
Published: March 2024

Abstract
Background
Mosquito-borne diseases are on the rise. While climatic factors have been linked to disease occurrences, they do not explain the non-random spatial distribution in disease outbreaks. Landscape-related factors, such as vegetation structure, likely play a crucial but hitherto unquantified role.

Methods
We explored how three critically important factors that are associated with mosquito-borne disease outbreaks: microclimate, mosquito abundance and bird communities, vary at the landscape scale. We compared the co-occurrence of these three factors in two contrasting habitat types (forest versus grassland) across five rural locations in the central part of the Netherlands between June and September 2021.

Results
Our results show that forest patches provide a more sheltered microclimate, and a higher overall abundance of birds. When accounting for differences in landscape characteristics, we also observed that the number of mosquitoes was higher in isolated forest patches.

Conclusions
Our findings indicate that, at the landscape scale, variation in tree cover coincides with suitable microclimate and high Culex pipiens and bird abundance. Overall, these factors can help understand the non-random spatial distribution of mosquito-borne disease outbreaks.

Graphical Abstract
Automatic segmentation of fat metaplasia on sacroiliac joint MRI using deep learning
Authors: Li Xin , Lin Yi , Xie Zhuoyao , Lu Zixiao , Song Liwen , Ye Qiang , Wang Menghong , Fang Xiao , He Yi , Chen Hao , Zhao Yinghua 
Published: March 2024

Abstract
Objective
To develop a deep learning (DL) model for segmenting fat metaplasia (FM) on sacroiliac joint (SIJ) MRI and further develop a DL model for classifying axial spondyloarthritis (axSpA) and non-axSpA.

Materials and methods
This study retrospectively collected 706 patients with FM who underwent SIJ MRI from center 1 (462 axSpA and 186 non-axSpA) and center 2 (37 axSpA and 21 non-axSpA). Patients from center 1 were divided into the training, validation, and internal test sets (n = 455, 64, and 129). Patients from center 2 were used as the external test set. We developed a UNet-based model to segment FM. Based on segmentation results, a classification model was built to distinguish axSpA and non-axSpA. Dice Similarity Coefficients (DSC) and area under the curve (AUC) were used for model evaluation. Radiologists’ performance without and with model assistance was compared to assess the clinical utility of the models.

Results
Our segmentation model achieved satisfactory DSC of 81.86% ± 1.55% and 85.44% ± 6.09% on the internal cross-validation and external test sets. The classification model yielded AUCs of 0.876 (95% CI: 0.811–0.942) and 0.799 (95% CI: 0.696–0.902) on the internal and external test sets, respectively. With model assistance, segmentation performance was improved for the radiological resident (DSC, 75.70% vs. 82.87%, p < 0.05) and expert radiologist (DSC, 85.03% vs. 85.74%, p > 0.05).

Conclusions
DL is a novel method for automatic and accurate segmentation of FM on SIJ MRI and can effectively increase radiologist’s performance, which might assist in improving diagnosis and progression of axSpA.

Critical relevance statement
DL models allowed automatic and accurate segmentation of FM on sacroiliac joint MRI, which might facilitate quantitative analysis of FM and have the potential to improve diagnosis and prognosis of axSpA.

Key points
• Deep learning was used for automatic segmentation of fat metaplasia on MRI.
• UNet-based models achieved automatic and accurate segmentation of fat metaplasia.
• Automatic segmentation facilitates quantitative analysis of fat metaplasia to improve diagnosis and prognosis of axial spondyloarthritis.

Graphical Abstract
Right ventricular injury in patients with COVID-19-related ARDS eligible for ECMO support: a multicenter retrospective study
Authors: Petit Matthieu , Bouaoud Misylias , Jullien Edouard , Joseph Adrien , Evrard Bruno , Charron Cyril , Daulasim Anousone , Legras Annick , Gourraud Maeva , Goudelin Marine , Vignon Philippe , Vieillard-Baron Antoine 
Published: March 2024

Abstract
Background
Coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membrane oxygenation (ECMO) has been proposed in this setting, but optimal criteria to select target patients remain unknown. Our hypothesis is that evaluation of right ventricular (RV) function could be helpful. The aims of our study were to report the incidence and outcomes of patients eligible for ECMO according to EOLIA criteria, and to identify a subgroup of patients with RV injury, which could be a target for ECMO.

Methods
Retrospective observational study involving 3 French intensive care units (ICUs) of teaching hospitals. Patients with confirmed SARS-CoV-2 infection between March 2020 and March 2021, presenting ARDS and with available echocardiography, were included. Patients were classified in three groups according to whether or not they met the EOLIA criteria and the presence of RV injury (RVI) (“EOLIA −”, “EOLIA + RVI −” and “EOLIA + RVI + ”). RVI was defined by the association of RV to left ventricular end-diastolic area ratio > 0.8 and paradoxical septal motion. Kaplan–Meier survival curves were used to analyze outcome as well as a Cox model for 90 day mortality.

Results
915 patients were hospitalized for COVID-19, 418 of them with ARDS. A total of 283 patients with available echocardiography were included. Eighteen (6.3%) patients received ECMO. After exclusion of these patients, 107 (40.5%) were classified as EOLIA −, 126 (47.5%) as EOLIA + RVI −, and 32 (12%) as EOLIA + RVI + . Ninety-day mortality was 21% in the EOLIA-group, 44% in the EOLIA + RVI-group, and 66% in the EOLIA + RVI + group (p < 0.001). After adjustment, RVI was statistically associated with 90-day mortality (HR = 1.92 [1.10–3.37]).

Conclusions
Among COVID-19-associated ARDS patients who met the EOLIA criteria, those with significant RV pressure overload had a particularly poor outcome. This subgroup may be a more specific target for ECMO. This represented 12% of our cohort compared to 60% of patients who met the EOLIA criteria only. How the identification of this high-risk subset of patients translates into patient-centered outcomes remains to be evaluated.
Rural and urban clinician views on COVID-19’s impact on substance use treatment for individuals on community supervision in Kentucky
Authors: Oser Carrie B. , Rockett Maria , Otero Sebastian , Batty Evan , Booty Marisa , Gressick Rachel , Staton Michele , Knudsen Hannah K. 
Published: March 2024

Abstract
Background
The COVID-19 pandemic produced system-level changes within the criminal legal system and community-based substance use disorder (SUD) treatment system with impacts on recovery efforts. This study examines rural and urban clinicians’ perspectives of COVID-19 on SUD treatment delivery for people on community supervision.

Methods
Virtual qualitative interviews were conducted between April and October 2020 with 25 community supervision clinicians employed by Kentucky’s Department of Corrections (DOC), who conduct assessments and facilitate community-based treatment linkages for individuals on probation or parole. Transcripts were analyzed in NVivo using directed content analysis methods.

Results
Clinicians were predominantly white (92%) and female (88%) with an average of over 9 years working in the SUD treatment field and 4.6 years in their current job. Four COVID-19 themes were identified by both rural and urban clinicians including: (1) telehealth increases the modes of communication, but (2) also creates paperwork and technological challenges, (3) telehealth requires more effort for inter/intra-agency collaboration, and (4) it limits client information (e.g., no urine drug screens). Two additional rural-specific themes emerged related to COVID-19: (5) increasing telehealth options removes SUD treatment transportation barriers and (6) requires flexibility with programmatic requirements for rural clients.

Conclusions
Findings indicate the need for community-based SUD treatment providers approved or contracted by DOC to support and train clients to access technology and improve information-sharing with community supervision officers. A positive lesson learned from COVID-19 transitions was a reduction in costly travel for rural clients, allowing for greater engagement and treatment adherence. Telehealth should continue to be included within the SUD continuum of care, especially to promote equitable services for individuals from rural areas.
Evaluation of Chinese traditional military settlements’ defensive capabilities via principal component analysis (PCA): a case study of coastal Wei forts in the Ming dynasty
Authors: Zhou Jiayin , Jiang Yilin , Liu Jiayi , Tan Lifeng , Meng Lingxin 
Published: March 2024

Abstract
Defensive capability is one of the essential attributes of traditional military settlements. In the Ming dynasty, coastal Wei fort was the one of the most functionally complex and wide-ranging fortifications in the military defense system of China. Because many factors affect their defensive capacities, including three dimensions: individual construction, synergistic links, and regional jurisdiction, it is not easy to compare different settlements’ defensive capacities or to judge the degrees of different factors’ influences. Through principal component analysis, this study determines the weights of each minor factor. It constructs a model for evaluating traditional Chinese military settlements’ defensive capabilities, to quantify the defensive capability. The results show that the synergistic relationship between the settlements, especially settlement accessibility, has the most significant impact on defensive capability, much higher than a single castle's defensive construction. The defensive capability index of the Wei forts in Guangdong is the highest, consistent with the highest rate of victory in the wars fought on the coast during the Ming dynasty. The defensive capacity is directly proportional to the rate of victory, which validates this evaluation model’s soundness. This study not only comprehensively evaluates the coastal Wei forts’ defensive capacity in the Ming Dynasty, but also provides new methods for the quantitative or comparative analysis of military settlements at other temporal and spatial scales.
Rapidly growing right atrial myxoma in an older patient with advanced chronic kidney disease: a case report
Authors: Taira Natsuki , Nishiwaki Hiroki , Aiba Moeko , Kadowaki Tasuku , Kajitani Hideto , Takami Reiji , Sasai Fumihiko , Tanaka Hiroyuki , Koiwa Fumihiko 
Published: March 2024

Abstract
Background
Right atrial myxoma is a rare cardiac tumor, with few reports on its growth rate.

Case presentation
We found a right atrial myxoma in a male patient in his 80s with chronic kidney disease on the second echocardiogram that was performed for the creation of an arteriovenous fistula at 9 months after the initial echocardiogram, which showed no evidence of myxoma. Echocardiography revealed a mass measuring 37 mm × 28 mm in the right atrium. The patient was asymptomatic, and the tumor was surgically removed.

Conclusions
To the best of our knowledge, our patient is the oldest compared with all the patients in previously reported cases of rapidly growing right atrial tumors.
Roxadustat and transfusional iron overload induced hypothyroidism in a hemodialysis patient: a case report with a literature review
Authors: Yamashita Chikako , Hirai Yuri , Nishigaito Toshiya , Mitsumoto Kensuke , Mizumoto Aya , Kawakami Manabu , Uzu Takashi 
Published: March 2024

Abstract
Background
Although roxadustat has been reported to cause central hypothyroidism, the details of the mechanisms and clinical characteristics of patients who are prone to developing hypothyroidism with roxadustat are uncertain.

Case presentation
A 53-year-old man with a 3-year history of hemodialysis due to diabetic kidney disease who had been treated with roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, for 2 years was admitted to the hospital because of worsening gait disturbance and impaired consciousness. He had also acquired pure red cell aplasia associated with T-cell large granular lymphocytic leukemia and received multiple blood transfusions. Because his serum concentration of thyroid hormones was low, we diagnosed him with hypothyroidism, and his consciousness level recovered to normal with thyroid hormone replacement therapy. Computed tomography revealed a high-intensity atrophic thyroid gland, and magnetic resonance imaging showed diffusely reduced T2 and T1 signals of the pituitary anterior gland. These findings confirmed the accumulation of iron in the pituitary and thyroid glands. Combined pituitary stimulation tests with thyrotropin-releasing hormone, luteinizing hormone-releasing hormone, and corticotropin-releasing hormone revealed that the patient had pan-hypopituitarism. After discontinuation of roxadustat, the patient was treated with another hypoxia-inducible factor prolyl hydroxylase inhibitor, vadadustat. One month after switching medication, a stimulation test with thyrotropin-releasing hormone showed normal responses to thyroid-stimulating hormone. The patient was treated with levothyroxine 50 μg daily without any significant symptoms and is currently under follow-up observation as an outpatient.

Conclusions
We encountered a dialysis patient with roxadustat-induced hypothyroidism associated with transfusion iron overload. To our knowledge, this is the first case to clearly show that roxadustat can impair thyroid-stimulating hormone secretion in repeated thyrotropin-releasing hormone stimulation tests. Because the present patient had received roxadustat for more than 2 years before hypothyroidism became apparent, regular monitoring of the thyroid function may be needed in patients with renal anemia who have been treated with roxadustat, especially those at high risk of thyroid dysfunction.
Anti-LGI1 autoimmune encephalitis: insights from three cases with serial PET imaging
Authors: Ravat Parthvi , Pawar Shwetal , Jain Neeraj , Ravat Sangeeta 
Published: March 2024

Abstract
Background
Autoimmune encephalitis (AE) can be a disabling condition, but it is manageable when identified in its early phases. Multiple diagnostic modalities can aid the diagnosis and delineation of areas of involvement in the brain, which is essential in correlating the symptoms to their pathology.

Case presentation
This case series focuses on three cases of anti-LGI1 encephalitis in their 3rd and 5th decades, each displaying facio-brachial dystonic seizures (FBDS) and varying symptoms, such as behavioural changes and hyperhidrosis. Their MRI brains were not conclusive, but when the patients underwent a PET scan, all three of them showed involvement of the Basal Ganglia, which reversed along with clinical improvement after standard treatment for AE.

Conclusions
AE can be a morbid condition for a long time, but some factors that might predispose to better patient outcomes might be early diagnosis and treatment. A PET scan is a modality that might help pick up functional changes before structural changes set in, and so should be considered in the diagnostic workup. Patterns of involvement of brain areas in Anti LGI1 AE need delineation, and basal ganglia seems to be a consistent region of involvement.
Hepatic arterial hemodynamics and model for end-stage liver disease (MELD) scores in chronic liver disease: insights from Doppler ultrasonography
Authors: Tuladhar Sasmita , Katwal Shailendra , Gurung Ghanshyam , Khanal Umesh 
Published: March 2024

Abstract
Background
Doppler ultrasonography is essential to provide insights into hemodynamic alterations and liver function changes in pre-cirrhotic and cirrhotic patients. Utilizing Doppler examinations, this study aims to explore the correlation between hepatic arterial hemodynamics and Model for end-stage liver disease (MELD) scores in chronic liver disease patients.

Methods
A study of 50 chronic liver disease patients included sonographic assessments, measuring liver, portal vein size, and flow. Hepatic artery velocity, resistive index (RI), pulsatility index (PI), and acceleration time (AT) were evaluated. Biochemical parameters (serum bilirubin, creatinine, INR) were used to calculate MELD scores, compared with different Doppler sonographic parameters.

Results
The study found a mean peak systolic velocity (PSV) of 107.42 ± 48.10, with end-diastolic velocity (EDV) of 26.40 ± 14.68, RI of 0.74 ± 0.06, and PI of 1.47 ± 0.24. The mean MELD score was 19.28 ± 6.09. Correlations between MELD scores and PSV, EDV, RI, PI, and AT did not yield statistically significant correlations. 80% of subjects displayed high RI (> 0.7) values in the hepatic artery, and a significant correlation was found between portal vein thrombosis and hepatic artery PSV and RI (p < 0.05).

Conclusions
Hepatic artery RI and PSV show a significant correlation with portal vein thrombosis. Doppler ultrasonography, while not directly tied to MELD scores, is valuable for non-invasive liver disease monitoring when invasive methods are impractical. Further research is needed to unravel the relationships between hemodynamic changes, MELD scores, and clinical outcomes in a broader patient population.
Predictors of mortality of hospitalized COVID-19 pneumonia patients in university hospital
Authors: Wafy Safa M. , Saman Marina O. , Ahmed Mostafa K. 
Published: March 2024

Abstract
Introduction
COVID-19 pneumonia is a leading cause for worse outcome of infected patients. Factors associated with mortality in COVID-19 pneumonia vary among studies; identification of most possible factors related to worse outcome might add for management.

Patients and methods
Consecutive COVID-19 pneumonia patients referred to the Assiut University Hospital, Egypt, from June 2020 to August 2022 were included in our study. All the included patients were followed up from admission until discharge to identify the factors that worsen the outcome. Our cohort study includes two groups: survivors and non-survivors. Clinical, laboratory, and management data of both groups were recorded.

Results
Two-hundred and fifty-one confirmed COVID-19 pneumonia patients were included in the study; 147 (58.6%) patients were improved (survivors’ group), and 104 (41.4%) patients were deteriorated and died (non-survivors’ group). Non-survivors’ group had significantly higher MMRC dyspnea scale, pneumonia severity index, CURB-65 score, and baseline respiratory rate. Non-survivors group had significantly lower mean lymphocytes (0.81 ± 0.61 vs. 1.25 ± 0.75; p < 0.001), higher ferritin (1272.45 ± 143.76 vs. 615.84 ± 75.47; p < 0.001), and higher d-dimer (6.65 ± 2.67 vs. 2.78 ± 0.38; p < 0.001), with interestingly significantly higher mean platelet volume (MPV) (10.34 ± 1.64 vs. 10.07 ± 1.93 (fl); p < 0.001). Non-survivors group was frequently admitted to ICU (88 (84.6%) vs. 38 (25.9%); p < 0.001) and had longer duration in ICU than survivors group (9.71 ± 3.36 vs. 5.90 ± 2.34 (days); p < 0.001). The predictors for mortality among patients with COVID-19 pneumonia were old age, high MPV, high CT score, and admission to ICU.

Conclusion
Old age, severe lung infiltrate with HRCT, high mean platelet volume, and ICU admission are the main clinical determinants of worse outcome of COVID-19 pneumonia.