bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vasopressors and inotropes in cardiogenic shock patients: an analysis of the MIMIC-IV database
Authors: Sasmita Bryan Richard , Wang ChuanYing , Xie Siyuan 
Published: November 2023

IntroductionPharmacological support has become the mainstay therapy in patients with cardiogenic shock (CS). Unfortunately, the clinical benefits of such potent drugs remain unclear, therefore, the present study aims to elucidate the safety and efficacy of vasoactive agents in CS patients.MethodsMedical Information Mart for Intensive Care (MIMIC) IV databases were used for this retrospective study. The primary outcome of this study was 30-day all-cause mortality. The subgroup analysis of was the relationship between the combined use of vasopressors and inotropes and 30-day all-cause mortality.ResultsA total of 2,216 patients diagnosed with CS were enrolled in this study. The non-survivors group was more likely to be older, presented with chronic kidney disease, have a lower systolic blood pressure, lower heart rate, and higher respiratory rate (all p &lt; 0.05). In the multivariate Cox regression analysis, only dopamine [HR (95%CI): 1.219 (1.003–1.482)], norepinephrine [HR (95%CI): 2.528 (1.829–3.493)], and milrinone [HR (95%CI): 0.664 (0.512–0.861)] remained an independent predictor for 30-day all-cause mortality. Furthermore, a subgroup analysis was performed and found that no statistically significant difference between no vasopressor/inotrope use and 1 vasopressor/inotrope use (p = 0.107). Meanwhile, a substantial deterioration of cumulative survival was observed when a combination of 2 or more vasopressors/inotropes was used in CS patients in comparison with no vasopressor/inotrope or only 1 vasopressor/inotrope use (all p &lt; 0.05).ConclusionsUsing vasopressors/inotropes agents was associated with a higher risk of 30-day all-cause mortality in CS patients. In addition, only milrinone was associated with a better prognosis among the available vasoactive agents.
Challenges for numeracy awareness in the 21st century: making visible the invisible
Authors: Díez-Palomar Javier , Ramis-Salas Mimar , Močnik Ivan , Simonič Marijana , Hoogland Kees 
Published: November 2023

IntroductionThe contemporary scientific literature indicates that numeracy is a multifaceted concept. The ongoing societal and technological transformations underscore the imperative to re-evaluate the attributes characterizing a numerate individual and the strategic initiatives that policymakers should devise and implement to ensure that individuals are not marginalized from participation in public and private domains due to their lack of numeracy proficiency. Numerous empirical investigations on numeracy consistently affirm its pivotal role in enabling individuals to engage autonomously across diverse contexts within their daily lives. However, numeracy’s fundamental role has often been neglected in our societies. The present study scrutinizes the overarching challenges associated with numeracy, particularly emphasizing the challenges regarding healthcare, finance, and the critical utilization and interpretation of data awareness.MethodsA two-phase research framework was adopted to address this inquiry. A comprehensive literature review was conducted to discern the prevalent challenges regarding numeracy awareness. Subsequently, two illustrative case studies were undertaken in Slovenia and Spain to contrast and deliberate upon the insights derived from the literature review. Qualitative research methods were employed to engage in a nuanced exploration of the gathered data.ResultsThis empirical analysis deduced guidelines aimed at enhancing awareness and ameliorating some of these challenges.Discussion and ConclusionWe conclude that making visible the awareness that adults already have about numeracy in aspects of their lives, such as finance, health, or the use and critical interpretation of data, can give policymakers and curriculum developers clues to design effective numeracy programs to address the multifaceted challenges confronting contemporary society, both in the immediate and foreseeable future.
Clinical characteristics of male prolactinoma patients mainly presenting with severe obesity and the metabolic response to dopamine agonist therapy
Authors: Wang Linjie , Wang Xiaojing , Gong Fengying , Pan Hui , Zhu Huijuan 
Published: November 2023

ObjectiveTo summarize the clinical characteristics of 4 male prolactinoma patients with severe obesity.MethodsThe clinical data of all the patients were retrospectively analyzed.ResultsAll the patients visited our hospital for severe obesity at the age of 16-30 years old with their body mass index (BMI) of 37.9-55.9 kg/m2. All the patients were obese since childhood, even at birth. Hyperprolactinemia (72.3-273.0 ng/ml) was found during the etiological screening of obesity and MRI revealed pituitary adenomas. Additionally, all of them had multiple obesity related complications, such as hyperinsulinemia and dyslipidemia. Treatment of dopamine agonists (DAs) effectively normalized their prolactin level and the pituitary MRI reexamination after 6 months of DAs treatment showed the shrinkage of the pituitary adenomas in 3 patients. Their weight also decreased in different degrees (2.70~19.03% lower than the baseline) with improved metabolic profiles.ConclusionSerum prolactin level should be screened in obese patients, especially those with severe obesity.
The association between fibrinogen levels and severity of coronary artery disease and long-term prognosis following percutaneous coronary intervention in patients with type 2 diabetes mellitus
Authors: Su Hong , Cao Yi , Chen Qiang , Ye Tao , Cui Caiyan , Chen Xu , Yang Siqi , Qi Lingyao , Long Yu , Xiong Shiqiang , Cai Lin 
Published: November 2023

BackgroundFibrinogen is a potential risk factor for the prognosis of CAD and is associated with the complexity of CAD. There is limited research specifically investigating the predictive role of fibrinogen in determining the severity of CAD among patients with T2DM, as well as its impact on the prognosis following PCI.MethodsThe study included 675 T2DM patients who underwent PCI at the Third People’s Hospital of Chengdu between April 27, 2018, and February 5, 2021, with 540 of them remaining after exclusions. The complexity of CAD was assessed using the SYNTAX score. The primary endpoint of the study was the incidence of MACCEs.ResultsAfter adjusting for multiple confounding factors, fibrinogen remained a significant independent risk factor for mid/high SYNTAX scores (SYNTAX score &gt; 22, OR 1.184, 95% CI 1.022-1.373, P = 0.025). Additionally, a dose-response relationship between fibrinogen and the risk of complicated CAD was observed (SYNTAX score &gt; 22; nonlinear P = 0.0043). The area under the receiver operating characteristic curve(AUROC) of fibrinogen for predicting mid/high SYNTAX score was 0.610 (95% CI 0.567–0.651, P = 0.0002). The high fibrinogen group (fibrinogen &gt; 3.79 g/L) had a higher incidence of calcified lesions and an elevated trend of more multivessel disease and chronic total occlusion. A total of 116 patients (21.5%) experienced MACCEs during the median follow-up time of 18.5 months. After adjustment, multivariate Cox regression analysis confirmed that fibrinogen (HR, 1.138; 95% CI 1.010-1.284, P = 0.034) remained a significant independent risk factor for MACCEs. The AUROC of fibrinogen for predicting MACCEs was 0.609 (95% CI 0.566-0.650, P = 0.0002). Individuals with high fibrinogen levels (fibrinogen &gt; 4.28 g/L) had a higher incidence of acute myocardial infarction (P &lt; 0.001), MACCEs (P &lt; 0.001), all-cause death (P &lt; 0.001), stroke (P = 0.030), and cardiac death (P = 0.002). Kaplan-Meier analysis revealed a higher incidence of MACCEs in the high fibrinogen group (Log-Rank test: P &lt; 0.001).ConclusionsElevated fibrinogen levels were associated with increased coronary anatomical complexity (as quantified by the SYNTAX score) and a higher incidence of MACCEs after PCI in patients with T2DM.
Imaging for assessment of cancer treatment response to immune checkpoint inhibitors can be complementary in identifying hypophysitis
Authors: Galligan Anna , Iravani Amir , Lasocki Arian , Wallace Roslyn , Weppler Alison M. , Sachithanandan Nirupa , Chiang Cherie , Colman Peter G. , Wentworth John , Spain Lavinia , Au-Yeung George , Lee Belinda , Kay Thomas W. H. , Hicks Rodney J. , Sandhu Shahneen , Krishnamurthy Balasubramanian 
Published: November 2023

IntroductionHypophysitis is reported in 8.5%–14% of patients receiving combination immune checkpoint inhibition (cICI) but can be a diagnostic challenge. This study aimed to assess the role of routine diagnostic imaging performed during therapeutic monitoring of combination anti-CTLA-4/anti-PD-1 treatment in the identification of hypophysitis and the relationship of imaging findings to clinical diagnostic criteria.MethodsThis retrospective cohort study identified patients treated with cICI between January 2016 and January 2019 at a quaternary melanoma service. Medical records were reviewed to identify patients with a documented diagnosis of hypophysitis based on clinical criteria. Available structural brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT) of the brain and 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography with computed tomography (FDG-PET/CT) were assessed retrospectively. The main radiological outcome measures were a relative change in pituitary size or FDG uptake temporally attributed to cICI.ResultsThere were 162 patients (median age 60 years, 30% female) included. A total of 100 and 134 had serial CT/MRI of the brain and FDG-PET/CT, respectively. There were 31 patients who had a documented diagnosis of hypophysitis and an additional 20 who had isolated pituitary imaging findings. The pituitary gland enlargement was mild, and the largest absolute gland size was 13 mm, with a relative increase of 7 mm from baseline. There were no cases of optic chiasm compression. Pituitary enlargement and increased FDG uptake were universally transient. High-dose glucocorticoid treatment for concurrent irAEs prevented assessment of the pituitary–adrenal axis in 90% of patients with isolated imaging findings.ConclusionCareful review of changes in pituitary characteristics on imaging performed for assessment of therapeutic response to iICI may lead to increased identification and more prompt management of cICI-induced hypophysitis.
Using feature optimization and LightGBM algorithm to predict the clinical pregnancy outcomes after in vitro fertilization
Authors: Li Lu , Cui Xiangrong , Yang Jian , Wu Xueqing , Zhao Gang 
Published: November 2023

BackgroundAccording to a recent report by the WHO, approximately 17.5\% (about one-sixth) of the global adult population is affected by infertility. Consequently, researchers worldwide have proposed various machine learning models to improve the prediction of clinical pregnancy outcomes during IVF cycles. The objective of this study is to develop a machine learning(ML) model that predicts the outcomes of pregnancies following in vitro fertilization (IVF) and assists in clinical treatment.MethodsThis study conducted a retrospective analysis on provincial reproductive centers in China from March 2020 to March 2021, utilizing 13 selected features. The algorithms used included XGBoost, LightGBM, KNN, Naïve Bayes, Random Forest, and Decision Tree. The results were evaluated using performance metrics such as precision, recall, F1-score, accuracy and AUC, employing five-fold cross-validation repeated five times.ResultsAmong the models, LightGBM achieved the best performance, with an accuracy of 92.31%, recall of 87.80%, F1-score of 90.00\%, and an AUC of 90.41%. The model identified the estrogen concentration at the HCG injection(etwo), endometrium thickness (mm) on HCG day(EM TNK), years of infertility(Years), and body mass index(BMI) as the most important features.ConclusionThis study successfully demonstrates the LightGBM model has the best predictive effect on pregnancy outcomes during IVF cycles. Additionally, etwo was found to be the most significant predictor for successful IVF compared to other variables. This machine learning approach has the potential to assist fertility specialists in providing counseling and adjusting treatment strategies for patients.
Optimal site and size of FACTS devices with the integration of uncertain wind generation on a solution of stochastic multi-objective optimal power flow problem
Authors: Hafeez Abdul , Ali Aamir , Keerio M. U. , Mugheri Noor Hussain , Abbas Ghulam , Khan Aamir , Mirsaeidi Sohrab , Yousef Amr , Touti Ezzeddine , Bouzguenda Mounir 
Published: November 2023

To reduce the Carbon footprint and reduce emissions from the globe, the world has kicked-off to leave reliance of fossil fuels and generate electrical energy from renewable energy sources. The MOOPF problem is becoming more complex, and the number of decision variables is increasing, with the introduction of power electronics-based Flexible AC Transmission Systems (FACTS) devices. These power system components can all be used to increase controllability, effectiveness, stability, and sustainability. The added uncertainty and variability that FACTS devices and wind generation provide to the power system makes it challenging to find the right solution to MOOPF issues. In order to determine the best combination of control and state variables for the MOOPF problem, this paper develops three cases of competing objective functions. These cases include minimizing the total cost of power produced as well as over- and underestimating the cost of wind generation, emission rate, and the cost of power loss caused by transmission lines. In the case studies, power system optimization is done while dealing with both fixed and variable load scenarios. The proposed algorithm was tested on three different cases with different objective functions. The algorithm achieved an expected cost of $833.014/h and an emission rate of conventional thermal generators of 0.665 t/h in the case 1. In Case 2, the algorithm obtained a minimum cost of $731.419/h for active power generation and a cost of power loss is 124.498 $/h for energy loss. In Case 3, three objective functions were minimized simultaneously, leading to costs of $806.6/h for emissions, 0.647 t/h, and $214.9/h for power loss.
Short-term risk and long-term incidence rate of infection and malignancy with IL-17 and IL-23 inhibitors in adult patients with psoriasis and psoriatic arthritis: a systematic review and meta-analysis
Authors: Wu Shuwei , Xu Yuanyuan , Yang Lihua , Guo Linghong , Jiang Xian 
Published: November 2023

The risk of infection and malignancy may be a concern for patients with psoriasis receiving interleukin (IL)-17 and IL-23 inhibitors, particularly with long-term treatments. We aimed to estimate the short-term risks and long-term incidence rates of infection and malignancy with IL-17 or IL-23 antagonists in adult patients with psoriasis and psoriatic arthritis through this comprehensive meta-analysis (PROSPERO registration number: CRD42022363127). We searched PubMed, MEDLINE, Web of Science and ClinicalTrials.gov until May 17, 2023 for randomized placebo-controlled trials and long-term (≥ 52 weeks) open-label extension studies. The estimates of short-term risk ratios (RRs) and long-term exposure-adjusted incidence rates (EAIRs) were pooled using R software 4.1.1 and STATA 16.0. This review included 45 randomized placebo-controlled studies and 27 open-label extension studies. Short-term RRs of serious infection, overall infection and malignancy were 1.45 (95% confidence intervals, 95% CI: 0.81-2.59), 1.20 (95% CI: 1.06-1.35), 0.83 (95% CI: 0.41-1.71) with IL-17 inhibitors; and 0.68 (95% CI: 0.38-1.22), 1.13 (95% CI: 1.00-1.28), 0.87 (95% CI: 0.37-2.04) with IL-23 inhibitors. Increased short-term risks of nasopharyngitis and Candida infection with IL-17 inhibitors were found. Long-term EAIRs of serious infection, overall infection, nonmelanoma skin cancer (NMSC), malignancies excluding NMSC, nasopharyngitis and upper respiratory tract infection were 1.11/100 patient-years (PYs), 57.78/100PYs, 0.47/100PYs, 0.24/100PYs, 15.07/100PYs, 8.52/100PYs, 3.41/100PYs with IL-17 inhibitors; and 1.09/100PYs, 48.50/100PYs, 0.40/100PYs, 0.43/100PYs, 10.75/100PYs, 5.84/100PYs with IL-23 inhibitors. Long-term EAIR of Candida infection was 3.41/100PYs with IL-17 inhibitors. No active or reactivated tuberculosis was ever reported in all the trials, and only a few cases of latent tuberculosis, hepatitis, and herpes zoster were reported during the long-term extension periods. No evidence of increased EAIRs of infection and malignancy with longer durations was found. Our study suggested that short-term risk and long-term incidence of infections and malignancies in psoriasis patients receiving IL-17 inhibitors and IL-23 inhibitors are generally low. However, close monitoring is required for nasopharyngitis and Candida infection with IL-17 inhibitors.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022363127.
Interleukin-10 disrupts liver repair in acetaminophen-induced acute liver failure
Authors: Roth Katherine , Strickland Jenna , Pant Asmita , Freeborn Robert , Kennedy Rebekah , Rockwell Cheryl E. , Luyendyk James P. , Copple Bryan L. 
Published: November 2023

IntroductionSystemic levels of the anti-inflammatory cytokine interleukin 10 (IL-10) are highest in acetaminophen (APAP)-induced acute liver failure (ALF) patients with the poorest prognosis. The mechanistic basis for this counterintuitive finding is not known, as induction of IL-10 is hypothesized to temper the pathological effects of immune cell activation. Aberrant production of IL-10 after severe liver injury could conceivably interfere with the beneficial, pro-reparative actions of immune cells, such as monocytes.MethodsTo test this possibility, we determined whether IL-10 levels are dysregulated in mice with APAP-induced ALF and further evaluated whether aberrant production of IL-10 prevents monocyte recruitment and/or the resolution of necrotic lesions by these cells.ResultsOur studies demonstrate that in mice challenged with 300 mg/kg acetaminophen (APAP), a hepatotoxic dose of APAP that fails to produce ALF (i.e., APAP-induced acute liver injury; AALI), Ly6Chi monocytes were recruited to the liver and infiltrated the necrotic lesions by 48 hours coincident with the clearance of dead cell debris. At 72 hours, IL-10 was upregulated, culminating in the resolution of hepatic inflammation. By contrast, in mice treated with 600 mg/kg APAP, a dose that produces clinical features of ALF (i.e., APAP-induced ALF; AALF), IL-10 levels were markedly elevated by 24 hours. Early induction of IL-10 was associated with a reduction in the hepatic numbers of Ly6Chi monocytes resulting in the persistence of dead cell debris. Inhibition of IL-10 in AALF mice, beginning at 24 hours after APAP treatment, increased the hepatic numbers of monocytes which coincided with a reduction in the necrotic area. Moreover, pharmacologic elevation of systemic IL-10 levels in AALI mice reduced hepatic myeloid cell numbers and increased the area of necrosis.DiscussionCollectively, these results indicate that during ALF, aberrant production of IL-10 disrupts the hepatic recruitment of monocytes, which prevents the clearance of dead cell debris. These are the first studies to document a mechanistic basis for the link between high IL-10 levels and poor outcome in patients with ALF.
The peritonsillar abscess and its management – is incision and drainage only a makeshift to the tonsillectomy or a permanent solution?
Authors: Ketterer Manuel Christoph , Maier Maren , Burkhardt Valentin , Mansour Naglaa , Knopf Andreas , Becker Christoph 
Published: November 2023

IntroductionThis study aims to examine the long-term management of peritonsillar abscess and compare needle aspiration, incision with drainage, and tonsillectomy in terms of comorbidities, complication rates, and recurrences in the largest study cohort published to date.MethodsWe conducted a retrospective analysis of patients, both adults and children, who were treated for peritonsillar abscess between 2007 and 2019. Patient charts were analyzed to assess surgical treatment, infection and inflammation rates, risk of bleeding, recurrence rates, duration of illness, and sick certificates. Additionally, patient imaging and blood levels were compared. Postal questionnaires were sent to all patients to evaluate subjective success rates, complications, and long-term benefits of the different treatment regimens. General practitioners and ENT doctors in private practices were contacted to gather missing data on the long-term course of the disease.ResultsA total of 821 patients with peritonsillar abscess were included in this study. Two patients had to be excluded due to incidental pathological findings. Of the remaining 819 patients, 180 were successfully treated with needle aspiration or incision. Among these patients, 37.7% required tonsillectomy during the same inpatient stay. Laboratory parameters such as leukocyte count or C-reactive protein levels were not indicative of the need for tonsillectomy. Furthermore, computed tomography was only necessary in cases of suspected parapharyngeal abscess, not in clear cases of peritonsillar abscess. Among the 641 patients who underwent tonsillectomy, 11.4% experienced postoperative bleeding requiring treatment. Only patients who underwent bilateral tonsillectomy reported recurrent episodes of sore throat and pharyngitis resulting in absence from work. The ipsilateral recurrence rate for peritonsillar abscess after needle aspiration or incision was 2.8%. There were no contralateral recurrences during the observation period.ConclusionDue to the lower risk of postoperative bleeding, shorter absence from work, and shorter inpatient stay, incision and drainage are the preferable treatment for peritonsillar abscess. Additionally, patients who underwent bilateral tonsillectomy reported higher rates of work incapacity due to sore throat caused by pharyngitis. No patient met the clear indication for bilateral tonsillectomy due to recurrent acute tonsillitis. The recurrence rate after drainage without tonsillectomy was very low (2.8% ipsilaterally, no recurrence contralaterally).