bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non–Interferon-Dependent Role of STING Signaling in Pulmonary Hypertension
Authors: Pham Ann T. , Oliveira Aline C. , Albanna Muhammad , Alvarez-Castanon Jimena , Dupee Zadia , Patel Diya , Fu Chunhua , Mukhsinova Laylo , Nguyen Amy , Jin Lei , Bryant Andrew J. 
Published: November 2023

BACKGROUND:
Patients with constitutive activation of DNA-sensing pathway through stimulator of IFN (interferon) genes (STING), such as those with STING-associated vasculopathy with onset in infancy, develop pulmonary hypertension (PH). However, the role of STING signaling in general PH patients is heretofore undescribed. Here, we seek to investigate the role of STING in PH development.

METHODS:
STING expression in patient lung samples was examined. PH was induced in global STING-deficient mice and global type I IFN receptor 1–deficient mice using bleomycin or chronic hypoxia exposure. PH development was evaluated by right ventricular systolic pressure and Fulton index, with additional histological and flow cytometric analysis. VEGF (vascular endothelial growth factor) expression on murine immune cells was quantified and evaluated with multiplex and flow cytometry. Human myeloid-derived cells were differentiated from peripheral blood mononuclear cells and treated with either STING agonist or STING antagonist for evaluation of VEGF secretion.

RESULTS:
Global STING deficiency protects mice from PH development, and STING-associated PH seems independent of type I IFN signaling. Furthermore, a role for STING-VEGF signaling pathway in PH development was demonstrated, with altered VEGF secretion in murine pulmonary infiltrated myeloid cells in a STING-dependent manner. In addition, pharmacological manipulation of STING in human myeloid-derived cells supports in vivo findings. Finally, a potential role of STING-VEGF-mediated apoptosis in disease development and progression was illustrated, providing a roadmap toward potential therapeutic applications.

CONCLUSIONS:
Overall, these data provide concrete evidence of STING involvement in PH, establishing biological plausibility for STING-related therapies in PH treatment.
On- and off-label utilisation of antipsychotics in Australia (2000–2021): Retrospective analysis of two medication datasets
Authors: Radha Krishnan Ramya Padmavathy , Harrison Christopher , Buckley Nicholas , Raubenheimer Jacques Eugene 
Published: November 2023

Objective: To determine antipsychotic utilisation patterns in Australian adults from 2005 to 2021, with a focus on on-label and off-label prescriptions. Methods: We examined antipsychotic dispensing trends in adults from 2005 to 2021 using a 10% sample of the Pharmaceutical Benefits Scheme (PBS) dataset, which contains patient-level information on medicines dispensed throughout Australia. The lack of diagnostic information in PBS was substituted by analysing BEACH (Bettering the Evaluation And Care of Health) dataset, a cross-sectional national survey from 2000 to 2016, consisting of data from general practitioner–patient encounters. Results: There were 5.6 million dispensings for 164,993 patients in PBS throughout this period; 69% patients had >1 dispensing, with a median of 6 per patient. Calculating the estimated period of exposure gave a total of 693,562 treatment episodes, with a median duration of 80 days. There were steady increases in both the incidence and prevalence of antipsychotic dispensings, mainly due to oral second-generation antipsychotics. The most commonly prescribed antipsychotics were quetiapine, olanzapine and risperidone, with a significant portion of patients receiving low-dose quetiapine without dose titration. Analysis of diagnostic indications from BEACH indicated that 27% of antipsychotic prescriptions were off-label for indications such as depression, dementia, anxiety and insomnia, at much lower prescribed daily dosages. Conclusion: The increasing prescribing and off-label use highlights concerns about chronic adverse effects caused by antipsychotics. The combined analysis of medication dispensings and the diagnostic indications for which they are prescribed is a novel approach and throws a spotlight on the need for additional monitoring of antipsychotics.
Causes, clinical characteristics, and outcomes of high lithium levels and intoxications: Retrospective analysis of patient records
Authors: Kaczmarczyk Michael , Batke Madeleine , Wingenfeld Katja , Deuter Christian Eric , Otte Christian 
Published: November 2023

Background: The mood stabilizer lithium has a narrow therapeutic index with a relevant risk of intoxication. We used real-world hospital data to identify causes, treatment courses, and outcomes of high lithium levels and intoxications. Methods: Retrospective chart review of patients with a lithium concentration of ⩾1.1 mmol/L, who were treated at Charité University Medical Center Berlin. Results: We identified 136 patients (58% women; mean age: 54.7 years) with high lithium levels or intoxication. 66.9% were chronic (stable lithium dose but changes in other variables such as co-medication). 40.4% took at least one risk medication with a relative contraindication for concurrent lithium treatment. 11.1% of the cases with a high therapeutic level showed moderate to severe intoxications. Feverish infections were significantly associated with severe intoxications. Overall, 97.1% (132/136) of patients fully recovered, two had residual but mild symptoms and two died during hospitalization (unlikely related to the intoxication). In 37.5% of patients, no psychiatrist was involved in the management of high lithium levels or intoxication. In these patients, lithium treatment was adjusted or discontinued in 37.3% of the cases compared to 64.7% when a psychiatrist was involved (χ²(1) = 9.683, p = 0.002). Conclusions: Patients and medical doctors should be aware of the increased risk of lithium intoxication already within the high therapeutic range and should consider alternative medications without relative contraindications for concurrent lithium use. Involving psychiatrists during or after an intoxication event is associated with more frequent adjustment of the maintenance lithium dose and should be considered in most cases.
COVID-19 induced type 1 diabetes: A systematic review of case reports and series
Authors: Stathi Dimitra , Triantafyllidis Konstantinos Katsikas , Zafeiri Marina , Karalliedde Janaka , Kechagias Konstantinos S. 
Published: November 2023

Aims To provide an overview of reported cases of new-onset type 1 diabetes mellitus (T1D) following COVID-19 infection. Methods PubMed and Scopus library databases were screened for relevant case reports published between January 2020 and June 2022. Study design, geographic region or language were not restricted. Results Twenty studies were identified and involved 37 patients (20 [54%] male, 17 [46%] female). Median age was 11.5 years (range 8 months–33 years) and 31 (84%) patients were aged ≤17 years. Most patients (33, 89%) presented with diabetic ketoacidosis (DKA). In total, 23 (62%) patients presented at the time of positive COVID-19 testing and 14 (38%) had symptoms consistent with COVID-19 infection or a previous positive test (1–56 days). Diabetes symptomatology was provided in 22 cases and (19, 86%) reported polyuria, polydipsia, polyphagia, fatigue, or weight loss or a combination of the aforementioned in the preceding weeks (3 days–12 weeks). Of the 28 patients that had data on acute and long-term treatment, all recovered well and most were managed with basal bolus insulin regimens. Quality assessment showed that most reports were either ‘good’ or ‘moderate quality’. Conclusions Although uncommon, new-onset T1D is a condition healthcare professionals may expect to see following a COVID-19 infection.
The Impact of the Implementation of a Pharmacist-Driven Protocol of Second Dose Cefepime for Adult Patients With Sepsis in the Emergency Department at a Tertiary Care Academic Medical Center
Authors: Miele Scott , Gohel Ankit , Cham Samantha , Brady Jason 
Published: November 2023

Purpose: Prior literature evaluating the importance of timely second-dose antibiotics in patients with sepsis has led to better outcomes and a possible reduction in mortality, length of mechanical ventilation, and length of time requiring vasopressors. Objective: To evaluate the impact of a newly developed pharmacist-led two-dose cefepime protocol implemented within an emergency department (ED) service. Methods: This was a retrospective, single-center, pre-post observational cohort study. Institutional review board approval was obtained. The primary endpoint was a reduction in time between the first and the second doses of antibiotics for patients with sepsis who present to the emergency department. Secondary endpoints included length of vasopressor therapy, intensive care unit (ICU) length of stay, hospital length of stay, duration of mechanical ventilation, and mortality. Results: A total of 84 patients were included in the pharmacist-led two-dose hospital protocol and 79 patients were included in the historical control. In the control cohort, the median time between the first and second dose of antibiotics was 12 hours vs 8.5 hours in the tested cohort. The average time requiring vasopressors was 1.20 days for the control cohort vs .46 days for the post-implementation group. Lastly, the median hospital length of stay in days was 8 for the control group vs 7 for the tested cohort. Conclusion: Implementation of a pharmacist-led two-dose cefepime protocol was associated with a numerically lower duration between second-dose antibiotics, days requiring vasopressors, and a slight reduction in hospital length of stay.
Convolutional neural network–based structural health monitoring framework for wind turbine blade
Authors: Saharan Nisha , Kumar Pardeep , Pal Joy 
Published: November 2023

Wind energy is a renewable energy source with a significant impact on the date for harnessing it. Different types of wind turbines (WTs) are being built to generate affordable, dependable, and eco-friendly renewable wind energy. Over time, cracks are found to be developed in the blades of the WTs, which is considered the most common type of damage that ultimately causes the catastrophic failure of the structures. This study aims to develop a structural health monitoring (SHM) framework for localizing cracks of a WT blade using a convolutional neural network (CNN)–based deep learning algorithm. With that objective, the NACA (National Advisory Committee for Aeronautics) 63-412 profile (WT blade) of length 29 m was modelled in finite element analysis (FEA) ANSYS 2022 R2. A crack is introduced to the model by making a groove at different blade locations. The mode shape and natural frequencies are obtained and validated with those reported in the literature. Further, the blade is excited by an impact load applied at the tip of the blade, and acceleration time histories are collected. The acceleration time history data are converted to scalogram images and fed into the CNN algorithm for damage classification and localization. In this study, the concept of class activation maps is also utilized for visual representations of the input images’ areas that significantly influence a class’s classification score. The classified results show that using CNN can successfully localize the region of the cracks and motivate us to examine it on a laboratory-based model.
Longitudinal increase of humoral responses after four SARS-CoV-2 vaccinations and infection in MS patients on fingolimod
Authors: van Kempen Zoé LE , van Dam Koos PJ , Keijser Jim BD , Stalman Eileen W , Kummer Laura YL , Strijbis Eva MM , Steenhuis Maurice , ten Brinke Anja , van Ham S. Marieke , Kuijpers Taco , Rispens Theo , Eftimov Filip , Wieske Luuk , Killestein Joep 
Published: November 2023

Background: Humoral responses after SARS-CoV-2 vaccination are greatly impaired in multiple sclerosis (MS) patients on fingolimod. Effects of repeated vaccination and infections on long-term responses are unclear. Methods: Prospective study in 60 MS patients on fingolimod measuring humoral responses after up to four vaccinations and 8 months after fourth vaccination. Results: Anti-WH1 antibody titers increased with each additional vaccination. At long-term follow-up titers increased further and most patients developed new humoral responses against the BA.1 omicron variant. Conclusion: Repeated SARS-CoV-2 vaccinations boost humoral immunity and, probably together with SARS-CoV-2 infections, induce humoral responses on the long-term in almost all patients.
Ballistic performance of multi-layer fabric panels considering fabric structure and inter-yarn friction
Authors: Chu Yanyan , Liu Yingying , Fahaduzzaman Mohammad , Rahman Md.Riazur , Huang Weihan , Li Shichen , Chen Chao , Yang Dan , Chen Xiaogang 
Published: November 2023

The importance of inter-yarn friction to ballistic fabric has been widely investigated. However, the couple effects of inter-yarn friction, fabric structure and number of layers have not been explored. Therefore, this paper put forward to investigate the ballistic performance of multi-layer fabric panels with different weave structure and inter-yarn friction. Three different structures (plain, sateen and UD-like), various number of layer (1-layer, 4-layer, 8-layer and 12-layer) and three levels of coefficients of friction were considered and their effects on the ballistic performance will be discussed through finite element (FE) method. The impact velocity is set as 475 m/s and the projectile is a 1 g steel flat cylinder with both the diameter and height of 5.5 mm. It has been found that the sateen fabric structure with 12-layer and higher coefficients of friction firstly reduces the projectile velocity to zero, while the corresponding plain structure and the UD-like structure reduce the projectile velocity to 125 m/s and 200 m/s individually, which indicates that when the number of layer and coefficients of friction are both much larger, the sateen fabric shows the best ballistic performance among the three structures. The reasons behind are as following. As far as the structure concerned, sateen structure has more interlacements than UD-like fabric and more straight sections than plain fabric. In addition, at higher coefficients of friction, this structure enables higher stress distribute in more layers and in larger areas than plain fabric and UD-like fabric and give rise to a layer-by-layer fracture but not fracture simultaneously.
Rare Case of Abdominal Aortic and Multiple Visceral Aneurysms in a Pediatric Patient With PIK3CA Mutation and Vasculitis
Authors: Gomes Vivian Carla , Parodi Federico Ezequiel , Wood Jacob C. , Motta Fernando , Farber Mark A. 
Published: November 2023

Abdominal aortic aneurysms (AAA) are most commonly observed in elderly male patients and are particularly rare in children. Among the pediatric population, they are usually diagnosed in the context of connective tissue disorders, genetic mutations, or vasculitis. The same is true of visceral arteries aneurysms. This case report describes the staged management of an 11-year-old patient presenting PIK3CA mutation and a 5.8 cm infrarenal AAA associated with bilateral common iliac arteries and multiple visceral aneurysms, the largest observed in the superior mesenteric artery (SMA = 3.2 cm). After careful evaluation, decision was made to first approach the most life-threatening lesion (the infrarenal AAA due to the large diameter) and the remaining aneurysms in secondary procedures, with special attention to the SMA aneurysm. The patient underwent a staged repair, with the first phase consisting of an aortobi-iliac graft with the distal anastomosis made at the left common iliac artery and right external iliac artery. The right hypogastric artery was ligated. The second procedure consisted of SMA aneurysm repair with a plication technique, as 7 branches were visualized coming off the aneurysm sac. Postoperative pathology analysis of the aortic and SMA aneurysms sac revealed vasculitis with a mixed inflammatory pattern and a COL3A1 gene heterozygote variant. He is currently in his 18th month after the last surgical intervention, receiving immunomodulatory therapy, with a planned follow-up by the interdisciplinary team to monitor the medications’ side effects and the diameter of the remaining visceral aneurysms.
Preoperative Depression Is Associated With Increased Complications Following Distal Radius Fracture Surgery
Authors: Broggi Matthew S. , Runge William O. , Hurt John T. , Dawes Alexander A. , Toston Roy J. , Ojemakinde Akinade A. , Cooke Hayden L. , Gottschalk Michael B. , Wagner Eric R. 
Published: November 2023

Background: Depression is a known risk factor for inferior outcomes after orthopedic procedures, but its specific relationship with distal radius fractures remains unknown. This study investigates the relationship between preoperative diagnosed depression and common postoperative complications occurring within the first year after open reduction internal fixation (ORIF) for distal radius fractures. Methods: This retrospective study used Truven MarketScan database and the Current Procedural Terminology (CPT) codes to identify distal radius fracture patients who underwent ORIF in the United States between January 1, 2009, and December 31, 2019. International Classification of Diseases (ICD) codes were used to identify patients with and without a diagnosis of preoperative depression. Univariate, multivariate, t test, and χ2 analyses were performed to determine the association between preoperative depression and postoperative complications following a distal radius fracture surgery. Results: Of the 75 098 eligible patients, 9.9% had at least one ICD code associated with preoperative depression. Preoperative depression was associated with increased odds for surgical site infection (odds ratio [OR] 1.25, confidence interval [CI] 1.14-1.37), emergency department visits for postoperative pain (OR 1.28, CI 1.15-1.36), hardware complication (OR 1.18, CI 1.07-1.30), removal of hardware within 1 year (OR 1.16, CI 1.09-1.27), wound complication (OR 1.17, CI 1.08-1.27), and 30-day readmission (OR 1.21, CI 1.07-1.31). Conclusions: Preoperative diagnosed depression is associated with increased complications following distal radius fracture surgery. These results can help guide preoperative and postoperative protocols in these higher risk patients. More research is needed to investigate if depression is a modifiable risk factor, as depression treatment could potentially improve postsurgical outcomes.
Positioning Stakeholder Perspectives in COPD End-of-Life Care Using Critical Theory and Actor-Network Theory: A Methodological Approach
Authors: Landers Amanda , Pitama Suzanne G. , Palmer Suetonia C. , Beckert Lutz 
Published: November 2023

Background Meaningful engagement with stakeholders in the provision of healthcare and services is recommended by the World Health Organisation. Culturally specific evaluation may enable deeper exploration of the critical views of people living with advanced long-term conditions, their support people, and healthcare providers. Aim and design This article describes how critical theory and Actor-Network theory involved all stakeholders including patients with severe chronic obstructive pulmonary disease as expert voices during the evaluation of end-of-life care services. Results We describe how critical theory and Actor-Network theory informed the methodologies for focus groups and how stakeholders spoke as critical experts about and in the system. An analytical sample of the focus group study is presented to demonstrate how the frameworks were applied to identify cohesive themes that were inclusive of all stakeholders. Conclusions This paper highlights how the evaluation of health systems can include a critical methodological approach to include the values and perspectives of all stakeholders. The outcomes may be used by those who design health systems to develop high-quality services.
The association between inpatient rehabilitation intensity and outcomes after stroke in Ontario, Canada
Authors: MacDonald Shannon L , Linkewich Elizabeth , Bayley Mark , Jeong Irene JH , Fang Jiming , Fleet Jamie L 
Published: November 2023

Background: Several studies have demonstrated improved outcomes poststroke when higher intensity rehabilitation is provided. Canadian Stroke Best Practice Recommendations advise patients receive 180 min of therapy time per day; however, the exact amount required to reach benefit is unknown. Aims: The primary aim of this study was to determine the association between rehabilitation intensity (RI) and total Functional Independence Measure (FIM) Instrument change. Secondary aims included determining the association between RI and discharge location, 90-day home time, rehabilitation effectiveness, and motor and cognitive FIM change. Methods: A retrospective cohort study was conducted using available administrative databases of acute stroke patients discharged to inpatient rehabilitation facilities in Ontario, Canada, from January 2017 to December 2021. RI was defined as number of minutes per day of direct therapy by all providers divided by rehabilitation length of stay. The association between RI and the outcomes of interest were analyzed using regression models with restricted cubic splines. Results: A total of 12,770 individuals were included. Mean age of the sample was 72.6 years, 46.0% of individuals were female, and 87.6% had an ischemic stroke. Mean RI was 74.7 min (range: 5–162 min) per day. Increased RI was associated with an increase in mean FIM change. However, there was diminishing incremental increase after reaching 95 min/day. Increased RI was positively associated with motor and cognitive FIM change, rehabilitation effectiveness, 90-day home time, and discharge to preadmission setting. Higher RI was associated with a lower likelihood of discharge to long-term care. Conclusions: None of the patients met the recommended RI of 180 min/day based on the Canadian Stroke Best Practice Recommendations. Despite this, higher intensity was associated with better outcomes. Given that most positive associations were observed with a RI ⩾95 min/day, this may be a more feasible target.