bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for obstructive sleep apnea in patients with cancer — a machine learning approach
Authors: Wong Karen A , Paul Ankita , Fuentes Paige , Lim Diane C , Das Anup , Tan Miranda 
Published: November 2023

AbstractBackgroundObstructive sleep apnea (OSA) is a highly prevalent sleep disorder associated with daytime sleepiness, fatigue, and increased all-cause mortality risk in patients with cancer. Existing screening tools for OSA do not account for the interaction of cancer-related features that may increase OSA risk.Study Design and MethodsThis is a retrospective study of patients with cancer at a single tertiary cancer institution who underwent a home sleep apnea test (HSAT) to evaluate for OSA. Unsupervised machine learning (ML) was used to reduce the dimensions and extract significant features associated with OSA. ML classifiers were applied to principal components and model hyperparameters were optimized using k-fold cross-validation. Training models for OSA were subsequently tested and compared with the STOP-Bang questionnaire on a prospective unseen test set of patients who underwent an HSAT.ResultsFrom a training dataset of 249 patients, kernel principal component analysis (PCA) extracted eight components through dimension reduction to explain the maximum variance with OSA at 98%. Predictors of OSA were smoking, asthma, chronic kidney disease, STOP-Bang score, race, diabetes, radiation to head/neck/thorax (RT-HNT), type of cancer, and cancer metastases. Of the ML models, PCA + RF had the highest sensitivity (96.8%), specificity (92.3%), negative predictive value (92%), F1 score (0.93), and ROC-AUC score (0.88). The PCA + RF screening algorithm also performed better than the STOP-Bang questionnaire alone when tested on a prospective unseen test set.ConclusionsThe PCA + RF ML model had the highest accuracy in screening for OSA in patients with cancer. History of RT-HNT, cancer metastases, and type of cancer were identified as cancer-related risk factors for OSA.
Fluid Intake in Critically Ill Patients: The “Save Useless Fluids For Intensive Resuscitation” Multicenter Prospective Cohort Study*
Authors: Schortgen Frédérique , Tabra Osorio Cécilia , Carpentier Dorothée , Henry Matthieu , Beuret Pascal , Lacave Guillaume , Simon Georges , Blanchard Pierre-Yves , Gobe Tiphanie , Guillon Antoine , Bitker Laurent , Duhommet Guillaume , Quenot Jean-Pierre , Le Meur Matthieu , Jochmans Sébastien , Dubouloz Fabrice , Mainguy Nolwenn , Saletes Josselin , Creutin Thibault , Nicolas Pierre , Senay Julien , Berthelot Anne-Lise , Rizk Delphine , Tran Van David , Riviere Audrey , Heili-Frades Sarah Beatrice , Nunes Justine , Robquin Nadine , Lhotellier Sylvie , Ledochowski Stanislas , Guénégou-Arnoux Armelle , Constan Adrien ,   Save Useless Fluids For Intensive Resuscitation (SUFFIR) Study Group, Reseau European de Recherche en Ventilation Artificielle (REVA) Network
Published: November 2023

OBJECTIVES:
Patients at risk of adverse effects related to positive fluid balance could benefit from fluid intake optimization. Less attention is paid to nonresuscitation fluids. We aim to evaluate the heterogeneity of fluid intake at the initial phase of resuscitation.

DESIGN:
Prospective multicenter cohort study.

SETTING:
Thirty ICUs across France and one in Spain.

PATIENTS:
Patients requiring vasopressors and/or invasive mechanical ventilation.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
All fluids administered by vascular or enteral lines were recorded over 24 hours following admission and were classified in four main groups according to their predefined indication: fluids having a well-documented homeostasis goal (resuscitation fluids, rehydration, blood products, and nutrition), drug carriers, maintenance fluids, and fluids for technical needs. Models of regression were constructed to determine fluid intake predicted by patient characteristics. Centers were classified according to tertiles of fluid intake. The cohort included 296 patients. The median total volume of fluids was 3546 mL (interquartile range, 2441–4955 mL), with fluids indisputably required for body fluid homeostasis representing 36% of this total. Saline, glucose-containing high chloride crystalloids, and balanced crystalloids represented 43%, 27%, and 16% of total volume, respectively. Whatever the class of fluids, center of inclusion was the strongest factor associated with volumes. Compared with the first tertile, the difference between the volume predicted by patient characteristics and the volume given was +1.2 ± 2.0 L in tertile 2 and +3.0 ± 2.8 L in tertile 3.

CONCLUSIONS:
Fluids indisputably required for body fluid homeostasis represent the minority of fluid intake during the 24 hours after ICU admission. Center effect is the strongest factor associated with the volume of fluids. Heterogeneity in practices suggests that optimal strategies for volume and goals of common fluids administration need to be developed.
Effect of a Performance Feedback Dashboard on Hospitalist Laboratory Test Utilization
Authors: McCormick Caroline , Ahluwalia Sarvpreet , Segon Ankur 
Published: November 2023

Background:
Healthcare spending continues to be an area of improvement across all forms of medicine. Overtreatment or low-value care, including overutilization of laboratory testing, has an estimated annual cost of waste of $75.7–$101.2 billion annually. Providing performance feedback to hospitalists has been shown to be an effective way to encourage the practice of quality-improvement-focused medicine. There remains limited data regarding the implementation of performance feedback and direct results on hospital laboratory testing spending in the short term.

Objective:
The objective of this project was to identify whether performance-based feedback on laboratory utilization between both hospitalists and resident teams results in more conservative utilization of laboratory testing.

Design, Setting, Participants:
This quality improvement project was conducted at a tertiary academic medical center, including both direct-care and house-staff teams.

Intervention or Exposure:
A weekly performance feedback report was generated and distributed to providers detailing laboratory test utilization by all hospitalists in a ranked system, normalized by the census of patients, for 3 months.

Main Outcomes and Measures:
The outcome measure was cumulative laboratory utilization during the intervention period compared to baseline utilization during the corresponding 3 months in the year prior and the weekly trend in laboratory utilization over 52 weeks. The aggregate laboratory utilization rate during intervention and control time periods was defined as the total number of laboratory tests ordered divided by the total number of patient encounters. Additionally, the cost difference was averaged per quarter and reported. The week-by-week trend in laboratory utilization was evaluated using a statistical process control (SPC) chart.

Results:
We found that following intervention during January–March 2020, the cumulative complete blood count utilization rate decreased from 5.54 to 4.83 per patient encounter and the basic metabolic panels/CMP utilization rate decreased from 6.65 to 6.11 per patient encounter compared with January–March 2019. This equated to cost savings of ~$42,700 in total for the quarter. Nonrandom variation was seen on SPC charts in weekly laboratory utilization rates for common laboratory tests during the intervention period.

Conclusions:
We found that our intervention did result in a decrease in laboratory test utilization rates across direct-care and house-staff teams. This study lays promising groundwork for one tool that can be used to eliminate a source of hospital waste and improve the quality and efficiency of patient care.
Self-reported Cardiovascular Disease in Career Firefighters With and Without World Trade Center Exposure
Authors: Mueller Alexandra K. , Cohen Hillel , Singh Ankura , Webber Mayris P. , Hall Charles B. , Prezant David J. , Zeig-Owens Rachel 
Published: November 2023

ObjectiveTo assess the effect of World Trade Center (WTC) exposure on cardiovascular disease (CVD) in career firefighters.Methods:Firefighters from four US cities completed health questionnaires that provide information about demographics, CVD diagnoses, and CVD risk factors. Firefighters were also compared with respondents of the 2019 National Health Interview Survey.Results:Greater WTC exposure was positively associated with combined coronary artery disease, myocardial infarction, and angina (termed “CAD”) when comparing WTC-exposed with non-WTC–exposed firefighters. Compared with the National Health Interview Survey population, firefighters had lower odds of CAD and stroke.Conclusions:An occupationally appropriate comparison is important to mitigate potential bias from the healthy worker effect. While the risk of CVD in WTC-exposed and non-WTC–exposed firefighters was significantly lower than a general US population, we observed an exposure gradient where greater WTC exposure was associated with greater odds of CVD.
Postresuscitation management
Authors: Behringer Wilhelm , Skrifvars Markus B. , Taccone Fabio Silvio 
Published: November 2023

Purpose of review
To describe the most recent scientific evidence on ventilation/oxygenation, circulation, temperature control, general intensive care, and prognostication after successful resuscitation from adult cardiac arrest.

Recent findings
Targeting a lower oxygen target (90–94%) is associated with adverse outcome. Targeting mild hypercapnia is not associated with improved functional outcomes or survival. There is no compelling evidence supporting improved outcomes associated with a higher mean arterial pressure target compared to a target of >65 mmHg. Noradrenalin seems to be the preferred vasopressor. A low cardiac index is common over the first 24 h but aggressive fluid loading and the use of inotropes are not associated with improved outcome. Several meta-analyses of randomized clinical trials show conflicting results whether hypothermia in the 32–34°C range as compared to normothermia or no temperature control improves functional outcome. The role of sedation is currently under evaluation. Observational studies suggest that the use of neuromuscular blockade may be associated with improved survival and functional outcome. Prophylactic antibiotic does not impact on outcome. No single predictor is entirely accurate to determine neurological prognosis. The presence of at least two predictors of severe neurological injury indicates that an unfavorable neurological outcome is very likely.

Summary
Postresuscitation care aims for normoxemia, normocapnia, and normotension. The optimal target core temperature remains a matter of debate, whether to implement temperature management within the 32–34°C range or focus on fever prevention, as recommended in the latest European Resuscitation Council/European Society of Intensive Care Medicine guidelines Prognostication of neurological outcome demands a multimodal approach.
Successful management of a giant retroperitoneal ancient schwannoma mimicking malignant tumors: A case report and literature review
Authors: Zaresharifi Nooshin , Karimzadhagh Sahand , Ebrahimian Ramin , Reihanian Zoheir , Abbaspour Elahe , Karimian Paridokht , Taheri Talesh Jouan 
Published: November 2023

Introduction and Importance:
Schwannomas, originating from Schwann cells surrounding nerve sheaths, tend to be slow-growing. Among these, giant ancient schwannomas are remarkable for their rare occurrence and their capacity for substantial growth and regressive changes. Furthermore, the expansiveness and flexibility of the retroperitoneal space often conceal the symptoms of retroperitoneal schwannomas, leading to delayed diagnosis and allowing these tumors to grow significantly and become large and long-standing before detection.

Case Presentation:
A 24-year-old man presented with left flank pain and a growing abdominal bulge in the left upper quadrant. Computed tomography scan revealed a 15×15×10 cm lytic expansile lesion. Consequently, the encapsulated mass was surgically excised and diagnosed as an ancient retroperitoneal schwannoma through histological and immunohistochemical studies.

Clinical Discussion:
Comprehensive preoperative planning and a multidisciplinary strategy are imperative for the complete excision of schwannomas. These tumors can present diagnostic complexities, particularly due to nuclear atypia and pleomorphism, which might lead to misinterpretation regarding malignancy. Despite the risks associated with percutaneous biopsies, the low mitotic count is a critical diagnostic factor. Our study underscores the consensus that the definitive diagnosis should rely on postoperative histopathological findings, highlighting the importance of accurate assessment.

Conclusion:
Rare giant retroperitoneal ancient schwannomas pose diagnostic challenges due to their rarity, lack of distinct symptoms, and atypical locations. This study presents a successful case and management.
Assessment of open rhinoplasty in correction of secondary nasal deformities associated with congenital anomalies in maxillofacial region
Authors: Hassoun Murad , Sleman Nadim 
Published: November 2023

Purpose:
Nasal deformities associated with cleft lip are one of the most difficult nose correction procedures. This study aims at correction of the nasal deformity that occurred after the initial repair of the lip, which was done at an early age, and achieving the best possible results aesthetically and functionally.

Methods:
The sample included patients presenting at the department of oral and maxillofacial surgery in Hospital between 2017-2018. We applied open rhinoplasty technique to correct nasal deformity according to a specific protocol. One year post operation, we analyzed clinical images before and after surgery and compared the results with the ideal normative values within society. Functional results were evaluated and the level of satisfaction of patients aesthetically was determined.

Results:
10 patients aged between 16-35 years old were included in our study. The results showed improvement in the aesthetic aspect of the nose through the correction of the emergence and rotation of the tip of the nose. This technique did not significantly affect the functional results. Therefore the functional results were satisfactory. This technique has achieved good and satisfying results aesthetically and functionally.

Conclusion:
The data collected from this study demonstrates that open rhinoplasty technique in nasal deformities is effective in aesthetic improvement and it presents satisfactory results at the functional level.
Chronic Social and Psychological Stress Impact Select Neuropathologies in the PS19 Mouse Model of Tauopathy
Authors: Lyons Carey E. , Graves Sara I. , Razzoli Maria , Jeganathan Karthik , Mansk Rachel P. , McGonigle Seth , Sabarinathan Nivedita , van Deursen Jan M. , Baker Darren J. , Bartolomucci Alessandro 
Published: November 2023

ABSTRACT

Objective
Despite advances toward understanding the etiology of Alzheimer’s disease (AD), it remains unclear which aspects of this disease are affected by environmental factors. Chronic life stress increases the risk of aging-related diseases including AD. The impact of stress on tauopathies remains understudied. We examined the effects of stress elicited by social (chronic subordination stress [CSS]) or psychological/physical (chronic restraint stress [CRS]) factors on the PS19 mouse model of tauopathy.

Methods
Male PS19 mice (average age, 6.3 months) were randomized to receive CSS or CRS, or to remain as singly housed controls. Behavioral tests were used to assess anxiety-like behaviors and cognitive functions. Immunofluorescence staining and Western blotting analysis were used to measure levels of astrogliosis, microgliosis, and tau burden. Immunohistochemistry was used to assess glucocorticoid receptor expression.

Results
PS19 mice exhibit neuroinflammation (glial fibrillary acidic protein, t tests: p = .0297; allograft inflammatory factor 1, t tests: p = .006) and tau hyperphosphorylation (t test, p = .0446) in the hippocampus, reduced anxiety (post hoc, p = .046), and cognitive deficits, when compared with wild-type mice. Surprisingly, CRS reduced hippocampal levels of both total tau and phospho-tauS404 (t test, p = .0116), and attenuated some aspects of both astrogliosis and microgliosis in PS19 mice (t tests, p = .068–.0003); however, this was not associated with significant changes in neurodegeneration or cognitive function. Anxiety-like behaviors were increased by CRS (post hoc, p = .046). Conversely, CSS impaired spatial learning in Barnes maze without impacting tau phosphorylation or neurodegeneration and having a minimal impact on gliosis.

Conclusions
Our results demonstrate that social or psychological stress can differentially impact anxiety-like behavior, select cognitive functions, and some aspects of tau-dependent pathology in PS19 male mice, providing entry points for the development of experimental approaches designed to slow AD progression.
Knee disarticulation vs. transfemoral amputation after failed transtibial amputation: Surgical outcome and prosthetic fitting in patients with peripheral vascular disease
Authors: Sjödin Lina S. , Ottosson Carin C. , Lapidus Lasse J. 
Published: November 2023

Objective:
Our aim was to compare transfemoral amputation (TFA) to knee disarticulation (KD) as a reamputation level after failed transtibial amputation (TTA) in patients with peripheral vascular disease and/or diabetes.

Methods:
We studied 152 patients undergoing reamputation, 86 TFA and 66 KD, after a failed TTA. The primary outcome was reamputation and reoperation, and secondary outcomes were prosthetic fitting and mortality. Logistic regression analyses were performed to identify factors associated with the outcome.

Results:
The reamputation rate was 36% after KD and 15% after TFA (p = 0.004). The multivariable analysis showed that TFA was associated with a significantly reduced risk of reamputation, odds ratio (OR) = 0.31 (95% confidence interval [95% CI], 0.1–0.7). The overall reoperation rate was 38% after KD and 22% after TFA (p = 0.03). This reduction of risk for TFA was not significant in the multivariable analysis, OR = 0.49 (95% CI, 0.2–1.0). Prosthetic limb fitting was possible in 30% after KD and 19% after TFA (p = 0.1). Previous amputation in the contralateral leg was the only factor associated with reduced ability for prosthetic fitting in the multivariable analysis, OR = 0.15 (95% CI, 0.03–0.7). Mortality at 30 d was 17% and 53% at 1 year. No independent factors affected 30-d mortality in the multivariable analysis.

Conclusions:
In this study, we found a significantly lower risk of reamputation after TFA compared with KD after a failed TTA. We consider TFA to be the reamputation level of choice, especially when there is a need of reducing risk of further reamputations.
Relationship between Protein Conformational Stability and Its Immunogenicity When Administering Antigens to Mice Using Adjuvants
Authors: Oyama Kosuke , Ueda Tadashi 
Published: November 2023

AbstractAntigen-presenting cells (APCs) are crucial in the immune system by breaking down antigens into peptide fragments that bind to major histocompatibility complex molecules. Previous research suggests that stable proteins may hinder CD4+T cell stimulation by impeding antigen processing and presentation. Conversely, some proteins require stabilization to activate the immune response. This discrepancy may be influenced by various factors, including protein characteristics and the use of different adjuvants in animal experiments. Here, we investigated the effects of adjuvants on antigen administration, specifically focusing on the stability of the CH2domain. Together with the previous study, we show that protein stability is also crucial in triggering an immune response in mice by binding protein antigens to B cell receptors on APCs. Together with the study so far, we propose that intrinsic protein stability is crucial for binding to B cell receptors on APCs in mice when administering antigens with adjuvants.
ParabrachialCalcaneurons drive nociplasticity
Authors: Condon Logan F. , Yu Ying , Park Sekun , Cao Feng , Pauli Jordan L. , Nelson Tyler S. , Palmiter Richard D. 
Published: November 2023

ABSTRACTPain that persists beyond the time required for tissue healing and pain that arises in the absence of tissue injury are poorly understood phenomena mediated by plasticity within the central nervous system. The parabrachial nucleus (PBN) is a hub that relays aversive sensory information and appears to play a role in nociplasticity. Here, by preventing PBNCalcaneurons from releasing neurotransmitter or directly stimulating them we demonstrate that activation ofCalcaneurons is both necessary for the manifestation of chronic pain after nerve ligation and is sufficient to drive nociplasticity in wild-type mice. Aversive stimuli such as exposure to nitroglycerin, cisplatin, or LiCl can drive nociplasticity in aCalca-neuron-dependent manner. Calcium fluorescence imaging reveals that nitroglycerin activates PBNCalcaneurons and potentiates their responses to mechanical stimulation. The activity and excitability ofCalcaneurons increased for several days after aversive events, but prolonged nociplasticity likely occurs in downstream circuitry.
Drug-Target-Interaction Prediction with Contrastive and Siamese Transformers
Authors: Ikechukwu Daniel , Kumar Arav 
Published: November 2023

AbstractAs machine learning (ML) becomes increasingly integrated into the drug development process, accurately predicting Drug-Target Interactions (DTI) becomes a necessity for pharmaceutical research. This prediction plays a crucial role in various aspects of drug development, including virtual screening, repurposing of drugs, and proactively identifying potential side effects. While Deep Learning has made significant progress in enhancing DTI prediction, challenges related to interpretability and consistent performance persist in the field. This study introduces two innovative methodologies that combine Generative Pretraining and Contrastive Learning to specialize Transformers for bio-chemical modeling. These systems are designed to best incorporate cross-attention, which enables a nuanced alignment of multi-representation embeddings. Our empirical evaluation will showcase the effectiveness and interpretability of this proposed framework. Through a series of experiments, we provide compelling evidence of its superior predictive accuracy and enhanced interpretability. The primary objective of this research is not only to contribute to the advancement of novel DTI prediction methods but also to promote greater transparency and reliability within the drug discovery pipeline.