bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of sex on the persistence of different classes of targeted therapies for psoriatic arthritis: a cohort study of 14 778 patients from the French health insurance database (SNDS)
Authors: Pina Vegas Laura , Penso Laetitia , Sbidian Emilie , Claudepierre Pascal 
Published: December 2023

BackgroundSex differences in phenotype presentation, disease trajectory and treatment response in psoriatic arthritis (PsA) have been reported. Nevertheless, whether classes of targeted therapies differentially affect men and women with PsA remains unclear.ObjectivesTo assess the effect of sex on the long-term persistence of each class of targeted therapies in PsA.MethodsThis nationwide cohort study involved the administrative healthcare database of the French health insurance scheme linked to the hospital discharge database. We included all adults with PsA who were new users of targeted therapies (not in the year before the index date) during 2015–2021 and studied all treatment lines during the study period. Persistence was defined as the time from treatment initiation to discontinuation and was estimated by the Kaplan-Meier method. Comparison of persistence by sex involved multivariate frailty models with conventional synthetic disease-modifying antirheumatic drugs and prednisone as time-dependant variables.ResultsWe included 14 778 patients with PsA who were new users of targeted therapies: 8475 (57%) women (mean age 50±13 years; 15 831 lines), 6303 (43%) men (mean age 51±13 years; 10 488 lines). Overall, 1-year persistence was 52% for women and 62% for men and at 3 years it was 27% and 39%, respectively. After adjustments, persistence was lower for women than men for inhibitors of tumour necrosis factor (TNFi) (adjusted HR (HRa) 1.4, 99% CI 1.3 to 1.5) and interleukin 17 inhibitor (IL17i) (HRa1.2, 99% CI 1.1 to 1.3) but not IL12/23i (HRa1.1, 99% CI 0.9 to 1.3), IL23i (HRa1.1, 99% CI 0.7 to 1.5) or Janus kinase inhibitor (JAKi) (HRa1.2, 99% CI 0.9 to 1.6).ConclusionThe treatment persistence was lower for women than men for TNFi and IL17i but not for IL12/23i, IL23i or JAKi.
The “green” use of fluorocarbons in Cherenkov detectors and silicon tracker cooling systems: challenges and opportunities in an unfolding era of alternatives
Authors: Hallewell G. D. 
Published: December 2023

AbstractSaturated fluorocarbons (SFCs) of form CnF(2n+2) are chosen for their optical properties as Cherenkov radiators, with C4F10 and CF4 currently used at CERN in the COMPASS and LHCb ring imaging Cherenkov detectors. Their non-conductivity, non-flammability and radiation-resistance also make SFCs ideal coolants: C6F14 liquid cooling is used in all LHC experiments, while C3F8 is used for the evaporative cooling of TOTEM and the ATLAS silicon tracker. These fluids, however, have high global warming potentials (5000–10000*GWPCO2), and represented around 36% of CERN’s CO2-equivalent emissions in 2018. There is thus an impetus to reduce their use, losses in purification and wastage through leaks, through improved monitoring and closed circulation system design. Newer spur-oxygenated fluoro-ketones, for example from the 3 M NOVEC® range, with CnF2nO structures, can offer similar performance to SFCs with but with very low, or zero GWP. Although these fluids do not yet exist in large quantities over the full CnF2 “matrix” the radiation tolerance and thermal performance of NOVEC 649 (C6F12O) was sufficiently promising for it to be chosen as a C6F14 replacement for cooling silicon photomultipliers. Additionally, subject to optical testing, NOVEC 5110 (C5F10O) could (if blended with nitrogen) replace both C4F10 and CF4 in Cherenkov detectors. Lighter molecules (for example C2F4O, with similar thermodynamics to C2F6)—if and when available in industrial quantities—might allow lower temperature operation than evaporative CO2 in future silicon trackers operated at very high luminosity. Ultrasonic gas mixture analysis is very sensitive to concentration changes of a heavy vapour in a light carrier, and is used—in the only such fluorocarbon coolant leak monitoring system operating at LHC—for real-time monitoring of C3F8 coolant leaks from the ATLAS pixel and SCT silicon trackers into their nitrogen-flushed environmental volumes. A typical C3F8 sensitivity of better than 10−5 is achieved. Advanced new ultrasonic algorithms allow measurement of the concentrations of a pair of gases of particular interest on top of a varying known baseline of other gases. The technique is thus of considerable value in leak monitoring and could be used to blend fluoro-ketones with nitrogen or argon to reduce the GWP “load” of large volume atmospheric pressure gas Cherenkov radiators without the recourse to higher-pressure noble gas approaches. This paper outlines an approach to GWP reduction with fluoro-ketone fluids and the blending of heritage SFCs or fluoro-ketones with lighter gases using ultrasonic monitoring and control. Possible avenues for the use of fluoro-ketones in liquid phase and evaporative cooling of silicon trackers are discussed.
Perioperative Nerve Blockade Reduces Acute Postoperative Pain after Orthognathic Surgery
Authors: Oono Yuka , Takagi Saori , Arendt-Nielsen Lars , Kohase Hikaru 
Published: December 2023

Background. The role of perioperative pain management is not only to reduce acute postoperative pain (POP) but also to prevent chronic POP. It would be important to know the usefulness of nerve blockade for perioperative management. However, it has not been extensively studied in orofacial surgery. The objective of the study was to investigate whether perioperative nerve blockade reduces acute POP after orthognathic surgery. Methods. Patients scheduled for orthognathic surgery were retrospectively reviewed (“preblock group”: the nerve blockade was performed before emergence from general anesthesia, and “no preblock group”: the nerve blockade was not performed before emergence from general anesthesia). The visual analog scale (VAS; 0–100 mm)-POP intensity, the VAS-POP areas under the curves (VASAUCs (mm × day)) in addition to VASAUCs for postoperative hours 6 (VASAUC_6), 12 (VASAUC_12), 18 (VASAUC_18), and 24 (VASAUC_24), the analgesic requirement period (day), and the number of days with pain (day) were analyzed. Data are presented as median (interquartile range) values. Results. Fifty-six patients (preblock group, 22; no preblock group, 34) were included (21 males, 35 females; age: 22.0 [21.0–28.0] years). VASAUC_6, VASAUC_12, VASAUC_18, and VASAUC_24 in the preblock group were significantly smaller than those in the no preblock group (3.5 [2.0–7.2] vs. 7.4 [5.1–10.0],

p

= 0.0007; 9.5 [6.4–13.7] vs. 15.0 [7.2–22.9],

p

= 0.042; 15.7 [10.3–23.1] vs. 29.3 [18.9–37.2],

p

= 0.0002; and 17.6 [12.7–27.2] vs. 39.5 [22.9–46.9],

p

= 0.001, respectively). There were no significant differences between the 2 groups in VASAUC, the analgesic requirement period, and the number of days with pain (

p

> 0.05). Conclusions. Perioperative nerve blockade reduces POP after orthognathic surgery, especially for the acute postoperative period.
LILRB3 Supports Immunosuppressive Activity of Myeloid Cells and Tumor Development
Authors: Huang Ryan , Liu Xiaoye , Kim Jaehyup , Deng Hui , Deng Mi , Gui Xun , Chen Heyu , Wu Guojin , Xiong Wei , Xie Jingjing , Lewis Cheryl , Homsi Jade , Yang Xing , Zhang Chengcheng , He Yubo , Lou Qi , Smith Caroline , John Samuel , Zhang Ningyan , An Zhiqiang , Zhang Cheng Cheng 
Published: December 2023

Abstract
The existing T cell–centered immune checkpoint blockade therapies have been successful in treating some but not all patients with cancer. Immunosuppressive myeloid cells, including myeloid-derived suppressor cells (MDSC), that inhibit antitumor immunity and support multiple steps of tumor development are recognized as one of the major obstacles in cancer treatment. Leukocyte Ig-like receptor subfamily B3 (LILRB3), an immune inhibitory receptor containing tyrosine-based inhibitory motifs (ITIM), is expressed solely on myeloid cells. However, it is unknown whether LILRB3 is a critical checkpoint receptor in regulating the activity of immunosuppressive myeloid cells, and whether LILRB3 signaling can be blocked to activate the immune system to treat solid tumors. Here, we report that galectin-4 and galectin-7 induce activation of LILRB3 and that LILRB3 is functionally expressed on immunosuppressive myeloid cells. In some samples from patients with solid cancers, blockade of LILRB3 signaling by an antagonistic antibody inhibited the activity of immunosuppressive myeloid cells. Anti-LILRB3 also impeded tumor development in myeloid-specific LILRB3 transgenic mice through a T cell–dependent manner. LILRB3 blockade may prove to be a novel approach for immunotherapy of solid cancers.
УПРАВЛІНСЬКІ ФУНКЦІЇ ЯК ОДИН З ІНСТРУМЕНТІВ РЕАЛІЗАЦІЇ ЦІЛЕЙ УПРАВЛІННЯ МОДЕЛЛЮ РЕГІОНАЛЬНОЇ СИСТЕМИ ДОНОРСТВА ТА ТРАНСПЛАНТАЦІЇ ОРГАНІВ
Authors: Ковтун Г. І. 
Published: December 2023

Мета: обґрунтувати зміст основних управлінських функцій як інструменту реалізації цілей управління сучасною моделлю регіональної системи донорства та трансплантації органів.
Матеріали і методи. Для досягнення поставленої мети в роботі застосовувалися загальнонаукові методи аналізу, синтезу, узагальнення, інтерпретації наукових даних, а також системний та структурно-функціональний підходи при визначенні функцій управління регіональною системою донорства і трансплантації органів.
Результати. Розвиток технологій трансплантації органів у всьому світі впевнено доводить, що вони є життєрятуючими та безальтернативними. Українській охороні здоровʼя потрібні професійні управлінці, здатні ініціювати та реалізувати нові ідеї, розробляти стратегію розвитку медичного бізнесу, мислити практично та прагматично при забезпеченні реформування медичної сфери в Україні.
Для сучасної концептуальної регіональної системи донорства і трансплантації органів у статті обґрунтовано зміст функцій управління цією моделлю, як інструмент реалізації цілей управління моделлю і досягнення результату. Показано, що функція управління – це сукупність дій, призначених до створення реальних умов, для досягнення запланованих цілей. За допомогою функцій управління забезпечується виконання встановлених планових завдань із метою реалізації прийнятої стратегії розвитку організації.
Висновок. Обґрунтований у статті зміст основних управлінських функцій управління сучасною моделлю регіональної системи може бути програмою підготовки професіоналів нового покоління у сфері управління охорони здоровʼя.
ІСТОРИЧНІ АСПЕКТИ АКУШЕРСЬКОЇ СПРАВИ ЯК ПІДҐРУНТЯ ДЛЯ СТАНОВЛЕННЯ ТА РОЗВИТКУ АКУШЕРСЬКИХ НАУКОВИХ ШКІЛ
Authors: Литвинова О. Н. , Тріщ Н. М. , Теренда Н. О. 
Published: December 2023

Мета: обґрунтувати необхідність узагальнення та інтерпретації наукової інформації щодо вибору стратегій реформування акушерської допомоги в Україні.
Матеріали і методи. Для проведення дослідження історичних аспектів розвитку акушерських наукових шкіл були систематизовані та проаналізовані використані наукові публікації з аналізом історичних статей, монографій, дисертацій, архівні матеріали медичних університетів, наукових установ, медичних закладів та інших наукових публікацій з акушерської справи та медичної історії, що стали основою для отримання обґрунтованих даних.
Результати. Дослідження історичних аспектів акушерської справи виявило, що ця галузь медицини в Україні та світі має багатовікову історію, яка має вплинути на її розвиток та становлення акушерських наукових шкіл. Вже в давніх цивілізаціях існували знання про акушерську допомогу під час пологів. Систематизація та поширення знань про акушерську справу, розвиток акушерських посібників відбувалися в основному в період Середньовіччя та Ренесансу. Уже в ХХ ст. інтенсифікувалася дослідницька та навчальна діяльність у галузі акушерства та гінекології, що привело до формування різних наукових шкіл. Аналіз історичних аспектів акушерської справи вказує на те, що розвиток наукових шкіл у галузі акушерства був сильно повʼязаний із здобутками попередніх поколінь медиків. Традиції, методи та досвід минулих століть вплинули на визначення спрямувань та особливостей досліджень у відповідних школах.
Висновки. Результати дослідження показали, що протягом історії розвивалися методи та засоби, що відображали наукові, соціокультурні та медичні зрушення в акушерській справі.
Зіставлення їх із сучасними підходами дозволяє зрозуміти прогрес та виклики, з якими стикалися попередні покоління медиків.
Узагальнюючи висновки, можна стверджувати, що історичні аспекти акушерської справи є важливим підґрунтям для формування та розвитку наукових шкіл. Розвиток акушерської галузі є важливим чинником підвищення якості медичної допомоги жінкам та новонародженим, а відповідно, і покращення громадського здоров’я.
Abstract 12289: A Postpartum Diastolic Murmur
Authors: Han Joyce , Sheth Sameer , Isselbacher Eric M , Scott Nandita 
Published: December 2023

A 44-year-old G3P1011 underwent uncomplicated Caesarian section for obstetric indications with delivery of a healthy girl. Several hours postpartum, she developed hypoxemia requiring transient supplemental oxygen. Cardiology was consulted for further evaluation.
Upon initial assessment, she appeared comfortable with an oxygen saturation of 93% on room air. She reports an otherwise uneventful pregnancy. Her past medical history is significant for chronic hypertension on propranolol. She was afebrile with a HR of 91, BP 147/66 (left arm) and 155/68 (right arm). Her JVP was 10-11 cm H20. There was a III/IV low-pitched decrescendo early-mid diastolic murmur, loudest at the left lower sternal border, radiating to the apex, and a systolic ejection murmur. EKG (panel A) showed normal sinus rhythm, with no ischemic abnormalities.
Due to the discovery of a new murmur, there was concern for valvular pathology as a cause for her suspected heart failure, particularly aortic regurgitation (AR). An urgent TTE (panel C-E) was requested and showed a dissection flap in the ascending aorta, effacement of the sinotubular junction, and severe AR. CT angiogram confirmed the diagnosis of type A aortic dissection (AD; panel B).
Twelve hours after the delivery of her baby, she underwent emergent aortic valve repair and aortic arch replacement. She recovered well and was discharged home post-op day 6. Though no human data exists, animal data suggests increased AD risk in breastfeeding animals with Marfan Syndrome. Due to her near catastrophic presentation, she elected to not breastfeed. Her genetic testing results are pending.
AD in pregnancy is rare. There is an increased risk of AD in pregnant compared to non-pregnant women. AD often occurs in the third trimester or postpartum, and most women are unaware of a preexisting arteriopathy. In this case, the detection of a diastolic murmur resulted in rapid diagnosis and treatment, essential in the management of this life-threatening condition.
Abstract 15843: Biatrial and Recurrent Cardiac Myxoma in a Rare Case of Carney Complex
Authors: Saha Bibek , Danielson Alex P , Kalinoski-Dubose Victoria R , Klarich Kyle W , Chareonthaitawee Panithaya 
Published: December 2023

Primary cardiac tumors (CTs) are exceptionally rare, and are predominantly benign masses. Myxomas make up more than 60% of these lesions and most frequently develop in the left atrium (LA), followed by the right atrium (RA). Carney complex (CNC) is a rare, typically autosomal dominant, multiple endocrine neoplasia characterized by cutaneous findings, myxomas, endocrine and/or nonendocrine neoplasms. We report a rare case of CNC involving biatrial and recurrent myxomas.
A 36-year-old female presented to Cardiology Clinic at our center for management of CNC. Three years prior, she was evaluated at a local hospital for acute stroke where TTE showed a myxoma (2 x 2 x 2.5cm) attached to the left atrial septum, prompting resection. On followup TTE 2 years later, she had a mass in the LA, prolapsing through the mitral valve into the left ventricle. She underwent resection of the myxoma (2.9 x 3.9 cm) and left atrial appendage, which was complicated by recurrent stroke. She was found to have a PRKAR1A gene mutation (c.97 deletion) suggestive of CNC and was referred to our center. At Cardiology Clinic, she denied chest pain, dyspnea, presyncope, and syncope. Her father and children did not have the gene mutation. Exam revealed lentigines on her lower lip and pigmentation of an inner canthus. She was diagnosed with primary pigmented nodular adrenal disease by Endocrinology. On TEE, she was found to have a recurrent LA mass (1 x 1 x 0.8 cm) attached to the interatrial septum, but no right-to-left atrial shunt. This prompted surgery consultation. Numerous intracardiac myxomas were removed during surgery; one in the LA attached to the septum, 3-4 smaller ones, and one 2 cm myxoma located in the RA. The interatrial septum was also resected given recurrent myxoma in this region. She underwent cryoablation to prevent recurrence and did well post-surgery.
CTs, which includes primary CTs and secondary metastatic disease, are uncommon where the former has an incidence of 0.001-0.3%. We presented a case of recurrent and biatrial cardiac myxomas in the setting of CNC, which is seldomly reported in the literature. Taken together, given the rarity of primary CTs, genetic predispositions or syndromes should be considered especially in the setting of recurrence and/or multiple masses.
Abstract 16163: Low Dose Alteplase for Treatment of Pacemaker Lead Associated Thrombosis
Authors: hasan Aamir , mocanu marian 
Published: December 2023

Multiple previously published case reports highlighted the thromboembolic risks associated with permanent transvenous pacemaker leads. Even though mostly clinically silent, pacemaker lead associated thrombosis has been linked to fatal outcomes via pulmonary or paradoxical embolism in the case of large mobile RA or RV thrombi formation. There is a lack of consensus on the optimal strategy for managing this condition. Oral and IV anticoagulation, thrombolysis, surgical and percutaneous thrombectomy have been attempted previously with mixed results.
A 72 year old gentleman with a history of CAD requiring PCI, paroxysmal atrial fibrillation, and AV node ablation with subsequent biventricular pacemaker implant was admitted to our hospital with a few weeks of worsening dyspnea, now present at rest. Surface echocardiogram showed multiple mobile echo densities in the right ventricle and right atrium, attached to the pacemaker leads, confirmed by TEE, most likely thrombi. The venous duplex was positive for right lower extremity DVT. Bilateral pulmonary emboli with mild right-sided heart strain were noted on CTA chest. The patient was initially treated with IV unfractionated heparin. We subsequently decided to start low-dose tPA infusion for 24 hrs, similar to current off-label protocols for mechanical prosthetic valves or bioprosthetic valve thrombosis. After an initial IV bolus of 5 mg, 1 mg/hour of alteplase was continued for 24 hours. Our team has decided to use percutaneous thrombectomy as a last resort.Follow-up ECHO immediately post tPA infusion showed complete thrombi resolution. The patient was asymptomatic at this point. He was discharged the following day on Lovenox and Coumadin.
To our knowledge, this is the first case demonstrating complete resolution of pacemaker lead-associated thrombi by using a 24 hr low dose tPA infusion in addition to IV anticoagulation. This can be entertained as a simple conservative initial strategy in stable patients with pacemaker lead/catheter-associated intracardiac thrombi.
Abstract 16856: The Upside Down: A Case of Reverse McConnell’s Sign in Mixed Shock and ARDS
Authors: Curtis Brett , Ha Albert , Xie Jeffrey , Helms Adam S , Howe John , Hyzy Robert 
Published: December 2023

Introduction:
We present a case of reverse McConnell’s sign in shock and respiratory failure.

Hospital Course:
A 48-year-old woman with cirrhosis presented to the emergency department with hypoxia, hypotension, and tachycardia. She endorsed lower extremity edema and orthopnea.

Labs noted elevated BNP, procalcitonin, troponin, and lactate. Urinalysis showed signs of infection. EKG did not reveal ischemic changes. CT pulmonary embolism (PE) protocol was negative for PE but showed pulmonary edema. Parasternal short axis views on bedside ultrasound revealed interventricular septal flattening during systole consistent with right ventricular pressure overload ("D sign").
She received broad-spectrum antibiotics for E. coli bacteremia. Trans-thoracic echocardiogram showed a hyperdynamic LV and decreased RV function with a "reverse McConnell sign (rMS)" (figure 1).
Providers initiated diuresis once her vasopressor requirement stabilized. She was soon extubated and her oxygen requirement continued to improve with diuresis. Vasopressors weaned in several days.
Prior to discharge, trans-thoracic echocardiogram echo showed recovery of RV function.

Discussion:
This case of respiratory failure and shock highlights the value of prompt echocardiography. Her rMS was likely caused by increased pulmonary arterial pressure from hypoxic vasoconstriction and V/Q mismatch from ARDS. Other heart failure processes seem unlikely.

rMS refers to right apical hypokinesis and basal hyperkinesis, inverted compared to its counterpart. Cases are associated with PE and Takotsubo cardiomyopathy, but rMS likely more generally indicates right heart strain.
Evidence suggests that rMS may be associated with higher rates of comorbidities and adverse events. Finally, it may represent the RV’s protective mechanism for abruptly increased afterload.

Conclusion:
Providers should consider rMS as a sign of RV strain to assist diagnosis and management of undifferentiated shock.