bluuebunny/crossref_metadata_2025_split huggingface dataset:
FRI563 Subacute Thyroiditis Is An Uncommon Cause Of Pyrexia Of Unknown Origin
Authors: Luke Nathasha , Tay Donovan 
Published: October 2023

Abstract
Disclosure: N. Luke: None. D. Tay: None.
Introduction: Subacute thyroiditis is a rare self-limiting inflammatory thyroid disorder often follows a viral infection. It is a diagnosis that is made clinically when patients present with typical features of anterior neck pain and thyrotoxic symptoms. We share our experience in unraveling a diagnostic challenge of a patient with an atypical presentation of subacute thyroiditis presenting with pyrexia of unknown origin during the Covid 19 pandemic. Clinical case: A 29 years old previously healthy Burmese domestic helper was admitted to a hospital in Singapore for persistent fever of 2 weeks duration associated with persistent sore throat. She had a brief 3 days duration of cough at the onset of fever with no other localizing infective symptoms. She had a booster dose of COVID 19 Moderna vaccination 6 months prior to her presentation with 2 preceding doses of Pfizer-BioNtech vaccine 12 months prior. She was empirically treated for acute pharyngitis with a course of intravenous antibiotics without improvement of her fever. Extensive workup for the fever was performed. A complete blood count showed monocytosis. Blood and urine cultures, urinalysis, COVID polymerase chain reaction (PCR), CMV, EBV, and HIV testing were negative. Respiratory multiplex PCR was negative for adenovirus, coronavirus, influenza, parainfluenza, respiratory syncytial virus, metapneumovirus, rhinovirus, chlamydia, mycoplasma, and Bordetella. CT of the thorax, abdomen, and pelvis was normal. She denied heat intolerance, weight loss, diarrhea, palpitations, or hand tremors. Clinical examination revealed mild anterior neck tenderness but no thyrotoxic features. There were no signs of Graves ophthalmopathy or pre-tibial myxoedema. Thyroid function tests were performed in view of persistent tachycardia which showed elevated free T4 at 51.6 pmol/L (12.7-20.3) with suppressed TSH &lt;0.005 mIU/L (0.3-4.2). TSH receptor stimulating antibody levels (TRab) was elevated at 5.23IU/L (&lt;1.76) and ESR was markedly elevated (115 mm/hr). Thyroid ultrasound showed homogeneous thyroid echotexture with no discrete suspicious nodules or abnormal vascularity. She was started on non-steroidal anti-inflammatory drug (Etoricoxib) with resolution of her fever and neck pain Clinical lesson: Clinicians should be aware that subacute thyroiditis can be a rare cause of pyrexia of unknown origin even in the absence of typical features.
Presentation: Friday, June 16, 2023
THU419 Comprehensive Evaluation Of Osteoporosis And Impaired Bone Micro Architecture In Patients With Transfusion Dependent Beta Thalassemia
Authors: Dutta Pinaki 
Published: October 2023

Abstract
Disclosure: P. Dutta: None.
comprehensive evaluation of osteoporosis and impaired bone micro architecture in patients with transfusion dependent beta thalassemia
Authors: Pinaki Dutta, Liza Das, Alka Khadwal, Pankaj Malhotra, Sanjay Kumar Bhadada, Vandana Dhiman, Vivek Sharma, Raman
Introduction: Thalassemia-related bone disease is an entity that includes low bone mass, fractures and impaired bone microarchitecture. The current study was designed to evaluate the prevalence and determinants of low bone mass, osteoporosis and microarchitectural parameters using high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with transfusion-dependent thalassemia (TDT). Patients and Methods TDT patients (n=42) and age- and BMI-matched controls (n=40) were recruited. Demographic, biochemical and hormonal parameters were assessed. Bone mineral density (BMD), T- and Z- scores were measured by DEXA using the HOLOGIC Discovery A Viewer 6 machine. Bone microarchitecture was estimated by HR-pQCT (XtremeCT II, Scanco Medical AG, Switzerland). Results: The mean age of thalassemia patients at recruitment was 26.9 ± 6.5 years and that of controls was 28.9 ± 7.9 years. The mean age of transfusion initiation was 7 months (IQR 3-18) and the median number of transfusions required was 24 (15-25) annually. Serum calcium in cases (8.87 ± 0.67mg/dl) was significantly lower than the controls (9.40 ± 0.45mg/dl), with 9 patients having hypocalcemia and 7 of these having hypoparathyroidism. Hypogonadism was present in 40.4% patients. Bone turnover markers (P1NP, β-CTX) were not significantly different between cases and controls, except alkaline phosphatase (ALP) which was higher in the cases (102.6 ± 60.7 U/l) as opposed to controls (78.2 ± 32.1 U/l). There was a significant correlation between ALP and liver dysfunction (alanine transaminase exceeding the upper normal limit) (r = 0.36, p=0.01) and 63.6% of those with elevated ALP had liver dysfunction. Low bone mass (Z ≤−2) was present in significantly greater proportion of patients versus controls at femoral neck (29.3% vs 2.4%) and at lumbar spine (52.4% vs 14.7%). Total, cortical and trabecular volumetric bone mineral density were significantly lower in cases as compared to controls(p&lt;0.05). The trabecular number was significantly lower (p&lt;0.0001) and trabecular separation significantly higher at radius and tibia (p&lt;0.001). Cortical thickness at radius and tibia were also significantly lower in cases than controls (p&lt;0.0001). Conclusion: Patients with transfusion-dependent thalassemia have significantly lower areal and volumetric BMD (both cortical and trabecular). The bone microarchitecture is also significantly impaired in terms of lower number and wider spacing of trabeculae as well as lower cortical thickness at both radius and tibia.
Presentation: Thursday, June 15, 2023
FRI651 Usage Of Modern Sulphonylureas And Metformin Fixed Dose Combination (fdc) In Type 2 Diabetes Mellitus (t2dm) Patients With Established Complications
Authors: M Aushili , Prasad Dr Ashish , Nagendra Lakshmi , Sinha Binayak , Bansal Beena , Shaikh Shehla 
Published: October 2023

Abstract
Disclosure: A. M: None. D. Prasad: None. D. Birla: None. L. Nagendra: None. B. Bansal: None. S. Shaikh: None.
Aim: To evaluate the usage of sulphonylureas (SUs) and metformin fixed dose combinations (FDC) in type 2 diabetes mellitus (T2DM) patients with established complications Background: Patients with T2DM are at an increased risk of developing macrovascular and microvascular complications due to inadequate glycemic control. Therefore, it is crucial to understand various management strategies used for achieving intensive glycemic control in patients with T2DM having established complications Methodology: This was a retrospective multi-centric, cross-sectional study conducted at 670study sites. Patients of either sex, age above 18 years who have developed microvascular (neuropathy, nephropathy, retinopathy, foot ulcers, or any other complications) and/or macrovascular complications (CAD, stroke/transient ischemic attack, peripheral artery disease or heart failure) receiving any strength of glimepiride and metformin FDC for the treatment of T2DM were included. Data were analyzed using StatisticalPackage for The Social Sciences (SPSS) software, version 23.0. A paired samplet-test was used for comparing the pre-and post-treatment HbA1c, FPG and PPG levels. A P&lt;0.05 was considered statistically significant. Results: A total of 470 patients with a mean age of 53.6 years were included. The majority of patients were obese (68.1%). Macrovascular complications were observed in 101 (21.5%) patients withT2DM, with CAD being the most common, affecting 69 (14.7%) patients. Microvascular complications were present in 408 (86.8%) patients with T2DM.Neuropathy and retinopathy were the leading microvascular complications, each affecting40.6% of patients with T2DM. A total of 73.8% of patients received glimepiride and metformin FDC as a first-line therapy. The strength of glimepiride 2 mg and metformin 500 mg (30.2%) was the most commonly prescribed combination.
Presentation: Friday, June 16, 2023
SAT038 Dietary Trans-10,cis-12 Conjugated Linoleic Acid Regulates Glucose Levels In Mice With Severe Insulin Resistance: Potential Effects On The Liver Via HNF4α And FOX01
Authors: Man Lee Samuel , Trinidad Muratalla Jose , Wee Liew Chong , Cordoba-Chacon Jose 
Published: October 2023

Abstract
Disclosure: S.M. Lee: None. J.T. Muratalla: None. C.W. Liew: None. J. Cordoba-Chacon: None.
Plasma trans-10 cis-12-conjugated linoleic acid CLA (t10c12-CLA) is inversely associated with increased risk of diabetes in humans. In mice, it is well-known that t10c12-CLA induces whole-body insulin resistance due to severe lipodystrophy (loss of whole-body adipose tissue). However, t10c12-CLA-fed mice show normal glucose levels and, t10c12-CLA improved glucose clearance in models with preexisting insulin resistance: Zucker fatty/diabetic rats, obese and insulin resistant Ldlr-/- mice, and diet-induced obese and insulin resistant male mice. In this study, we assessed whether supplementation of t10c12-CLA in a low-fat diet reduces glucose levels in adipocyte-specific insulin receptor knockout (IRFKO) mice, which is a mouse model of congenital lipodystrophy. In addition to lipodystrophy, IRFKO mice show liver steatosis and increased blood glucose levels that are consequences of whole-body insulin resistance and increased hepatic gluconeogenesis. Briefly, 5-6-week-old male and female control and IRFKO mice were fed with a low-fat diet supplemented with 0.8% t10c12-CLA for 5 weeks. In IRFKO mice, dietary t10c12-CLA did not reduce adipose tissue mass. However, dietary t10c12-CLA increased liver steatosis and plasma insulin levels. Surprisingly, dietary t10c12-CLA reduced glucose levels in both male and female IRFKO mice. Also, dietary t10c12-CLA reduced food intake and polydipsia, which were increased in IRFKO mice due to lipodystrophy and hyperglycemia, respectively. A transcriptomic analysis (RNA-seq) of livers of control and IRFKO male mice fed with a t10c12-CLA diet showed that t10c12-CLA reduced the expression of the key gluconeogenic and mitochondrial fatty oxidation genes. Previous studies have suggested that t10c12-CLA reduces the expression of Forkhead box 01 (Fox01) and Hepatocyte nuclear factor 4 alpha (HNF4α). Of note, the livers of t10c12-CLA-fed control and IRFKO male mice showed a downregulation of positive targets of FoxO1 and HNF4α. In addition, livers of t10c12-CLA-fed mice showed reduced total FOXO1 protein levels, and increased phosphorylation of FOXO1 in t10c12-CLA-fed IRFKO mice. These findings suggest that t10c12-CLA could be directly acting on the liver to alter HNF4α and FOXO1-dependent regulation of hepatic fatty acid oxidation and glucose production. These actions may explain why t10c12-CLA-fed mice do not show increased glucose levels and is potentially linked to the inverse association between t10c12-CLA levels and diabetes risk.
Presentation: Saturday, June 17, 2023
Intrathecal Opioid Use in Kidney Transplantation: An Observational Cohort Study
Authors: Hofer Ryan E. , Sims Charles R. , Dean Patrick G. , Portner Erica R. , Hanson Andrew C. , Warner Matthew A. 
Published: October 2023

BACKGROUND:
Kidney transplant is the most common transplant operation performed in the United States. Although various approaches to pain management have been described, the optimal analgesic strategy remains undefined. Specifically, the role of intrathecal opioids in this patient population has not been comprehensively evaluated.

METHODS:
Using a retrospective cohort design, data from kidney transplant operations at a single tertiary care medical center between August 1, 2017, and July 31, 2022, were extracted. Inverse probability of treatment weighting (IPTW) was used to assess differences in clinical outcomes based on the presence or absence of intrathecal opioid administration before surgical incision. The primary outcome was total opioid exposure expressed in milligram morphine equivalents (MME) in the first 72 hours postoperatively, with secondary outcomes including total MME (intraoperative plus postoperative MME, postoperative pain scores, and the presence of postoperative nausea/vomiting [PONV], pruritus, or adverse events).

RESULTS:
A total of 1014 kidney transplants in 1012 unique patients were included, with 411 (41%) receiving intrathecal opioids preoperatively. Hydromorphone was the intrathecal opioid used in all cases with median dose of 100 µg (interquartile range [IQR], 100, 100; range 50–200). Subjects receiving intrathecal opioids had significantly lower postoperative opioid requirements at 72 hours (30 [0–68] vs 64 [22, 120] MME), with ratio of geometric means in the IPTW analysis (ratio of geometric means 0.34, 95% confidence interval [CI], 0.26–0.43; P < .001). Similar findings were observed for total opioids (45 [30–75] vs 75 [60–90] MME; ratio of geometric means 0.58, 95% CI, 0.54–0.63; P < .001). Maximum reported pain scores in the intrathecal group were lower at 24 hours (4 [2–7] vs 7 [5, 8]; OR, 0.28; 95% CI, 0.21–0.37 for experiencing a higher pain score with intrathecal opioids, P < .001) and 72 hours (6 [4–7] vs 7 [5–8]; OR, 0.41; 95% CI, 0.31–0.54; P < .001). Patients receiving intrathecal opioids were more likely to experience PONV (225 of 411 [55%] vs 232 of 603 [38%]; OR, 2.16; 95% CI, 1.63–2.86; P < .001).

CONCLUSIONS:
Intrathecal opioid administration was associated with improved pain outcomes in patients undergoing kidney transplantation, including lower opioid requirements and pain scores through 72 hours. However, this was accompanied by an increased risk of PONV.
Incentivos a la producción y la productividad, 1969–1973: Debates y dilemas en la izquierda chilena
Authors: Rojas Flores Jorge , Villar Vásquez Gorka 
Published: October 2023

Abstract
A lo largo del siglo xx, en el Tercer Mundo, la izquierda que se definía revolucionaria y permanecía en la oposición reivindicó una mejor distribución de la riqueza sin considerar el crecimiento económico ni los incentivos a la productividad. Cuando logró acceder al gobierno, debió enfrentar un dilema: desechar o promover incentivos al uso eficiente de los recursos y, junto con ello, definir si debía priorizar los estímulos morales por sobre los materiales. Así ocurrió con Salvador Allende en 1970. El debate y las acciones que desplegó durante tres años, hasta su caída en 1973, se nutrieron de la experiencia de otros países, tensionando distintas perspectivas sobre el carácter de las transformaciones y las posibles dosis de pragmatismo en la acción. Este artículo indaga los pormenores de esa discusión para el caso chileno, en un contexto de creciente complejidad, tomando como base las declaraciones de variadas vertientes de la izquierda.
Necrosectomy Versus Stand-Alone Suboccipital Decompressive Craniectomy for the Management of Space-Occupying Cerebellar Infarctions—A Retrospective Multicenter Study
Authors: Hernandez-Duran Silvia , Walter Johannes , Behmanesh Bedjan , Bernstock Joshua D. , Czabanka Marcus , Dinc Nazife , Dubinski Daniel , Freiman Thomas M. , Günther Albrecht , Hellmuth Kara , Herrmann Eva , Konczalla Juergen , Maier Ilko , Melkonian Ruzanna , Mielke Dorothee , Müller Sebastian Johannes , Naser Paul , Rohde Veit , Schaefer Jan Hendrik , Senft Christian , Storch Alexander , Unterberg Andreas , Walter Uwe , Wittstock Matthias , Gessler Florian , Won Sae-Yeon 
Published: October 2023

BACKGROUND AND OBJECTIVES:
Space-occupying cerebellar stroke (SOCS) when coupled with neurological deterioration represents a neurosurgical emergency. Although current evidence supports surgical intervention in such patients with SOCS and rapid neurological deterioration, the optimal surgical methods/techniques to be applied remain a matter of debate.

METHODS:
We conducted a retrospective, multicenter study of patients undergoing surgery for SOCS. Patients were stratified according to the type of surgery as (1) suboccipital decompressive craniectomy (SDC) or (2) suboccipital craniotomy with concurrent necrosectomy. The primary end point examined was functional outcome using the modified Rankin Scale (mRS) at discharge and at 3 months (mRS 0-3 defined as favorable and mRS 4-6 as unfavorable outcome). Secondary end points included the analysis of in-house postoperative complications, mortality, and length of hospitalization.

RESULTS:
Ninety-two patients were included in the final analysis: 49 underwent necrosectomy and 43 underwent SDC. Those with necrosectomy displayed significantly higher rate of favorable outcome at discharge as compared with those who underwent SDC alone: 65.3% vs 27.9%, respectively (P < .001, odds ratios 4.9, 95% CI 2.0-11.8). This difference was also observed at 3 months: 65.3% vs 41.7% (P = .030, odds ratios 2.7, 95% CI 1.1-6.7). No significant differences were observed in mortality and/or postoperative complications, such as hemorrhagic transformation, infection, and/or the development of cerebrospinal fluid leaks/fistulas.

CONCLUSION:
In the setting of SOCS, patients treated with necrosectomy displayed better functional outcomes than those patients who underwent SDC alone. Ultimately, prospective, randomized studies will be needed to confirm this finding.
Risk of Subdural Hematoma Expansion in Patients With End-Stage Renal Disease: Continuous Venovenous Hemodialysis Versus Intermittent Hemodialysis
Authors: Ran Kathleen R. , Ejimogu Nna-Emeka , Yang Wuyang , Kilgore Collin B. , Nair Sumil K. , Monroy Trujillo Jose M. , Jackson Christopher M. , Mukherjee Debraj , Anderson William S. , Gallia Gary L. , Weingart Jon D. , Robinson Shenandoah , Cohen Alan R. , Bettegowda Chetan , Huang Judy , Tamargo Rafael J. , Xu Risheng 
Published: October 2023

BACKGROUND AND OBJECTIVES:
Subdural hematoma (SDH) patients with end-stage renal disease (ESRD) require renal replacement therapy in addition to neurological management. We sought to determine whether continuous venovenous hemodialysis (CVVHD) or intermittent hemodialysis (iHD) is associated with higher rates of SDH re-expansion as well as morbidity and mortality.

METHODS:
Hemodialysis-dependent patients with ESRD who were discovered to have an SDH were retrospectively identified from 2016 to 2022. Rates of SDH expansion during CVVHD vs iHD were compared. Hemodialysis mode was included in a multivariate logistic regression model to test for independent association with SDH expansion and mortality.

RESULTS:
A total of 123 hemodialysis-dependent patients with ESRD were discovered to have a concomitant SDH during the period of study. Patients who received CVVHD were on average 10.2 years younger (P < .001), more likely to have traumatic SDH (47.7% vs 19.0%, P < .001), and more likely to have cirrhosis (25.0% vs 10.1%, P = .029). SDH expansion affecting neurological function occurred more frequently during iHD compared with CVVHD (29.7% vs 12.0%, P = .013). Multivariate logistic regression analysis found that CVVHD was independently associated with decreased risk of SDH affecting neurological function (odds ratio 0.25, 95% CI 0.08-0.65). Among patients who experienced in-hospital mortality or were discharged to hospice, 5% suffered a neurologically devastating SDH expansion while on CVVHD compared with 35% on iHD.

CONCLUSION:
CVVHD was independently associated with decreased risk of neurologically significant SDH expansion. Therefore, receiving renal replacement therapy through a course of CVVHD may increase SDH stability in patients with ESRD.
Theoretical Study on TiOOH Production over Au/TiO2 Catalyst —Support Dependency of Propylene Oxide Production—
Authors: Hamada Yasutaka , Mishima Yuki , Yonemori Tomohisa , Kawakami Takashi , Yamanaka Shusuke , Okumura Mitsutaka 
Published: October 2023

Abstract
Au supported anatase TiO2 enables the selective synthesis of propylene oxide from propylene using O2 and H2. However, this reaction does not proceed on Au supported rutile TiO2. The origin of this difference in the catalytic activity was examined using DFT calculations. DFT calculations revealed that the stability of the TiOOH active species was directly related to the product selectivity.
Ischiofemoral Impingement Due to an Undiagnosed Pelvic Avulsion Fracture
Authors: Warren Alec T. , Ahmed Abubakar , Raja Altamash E. 
Published: October 2023

Abstract
Ischial tuberosity (IT) avulsion fractures are an uncommon cause of injuries in athletes. In this case, a 26-year-old female suffering from posterior right hip pain for over a decade presented with debility and a decrease in athletic function. Notable history included a hamstring strain while sprinting in elementary school. Clinical examination suggested hamstring tendinopathy and ischiofemoral impingement (IFI). Magnetic resonance imaging (MRI) revealed a chronic, fragmented, IT apophyseal avulsion fracture with ischial bursitis and edema within the fragmented bone, suggesting the development of heterotopic ossification (HO). Diagnostic ultrasound revealed signs of IFI, not evident on MRI. Ultrasound-guided corticosteroid injection in her ischial bursa and ischiofemoral space provided complete relief. The patient was able to resume her activities of daily living and sports-related activities without pain. Although interventional treatments may provide temporary pain relief, a multimodal approach is required for the treatment of HO.
Ensemble Experiments to Optimize Interventions Along the Customer Journey: A Reinforcement Learning Approach
Authors: Song Yicheng , Sun Tianshu 
Published: October 2023

Firms adopt randomized experiments to evaluate various interventions (e.g., website design, creative content, and pricing). However, most randomized experiments are designed to identify the impact of one specific intervention. The literature on randomized experiments lacks a holistic approach to optimize a sequence of interventions along the customer journey. Specifically, locally optimal interventions unveiled by randomized experiments might be globally suboptimal when considering their interdependence as well as the long-term rewards. Fortunately, the accumulation of a large number of historical experiments creates exogenous interventions at different stages along the customer journey and provides a new opportunity. This study integrates multiple experiments within the reinforcement learning (RL) framework to tackle the questions that cannot be answered by stand-alone randomized experiments. How can we learn optimal policy with a sequence of interventions along the customer journey based on an ensemble of historical experiments? Additionally, how can we learn from multiple historical experiments to guide future intervention trials? We propose a Bayesian recurrent Q-network model that leverages the exogenous interventions from multiple experiments to learn their effectiveness at different stages of the customer journey and optimize them for long-term rewards. Beyond optimization within the existing interventions, the Bayesian model also estimates the distribution of rewards, which can guide subject allocation in the design of future experiments to optimally balance exploration and exploitation. In summary, the proposed model creates a two-way complementarity between RL and randomized experiments, and thus, it provides a holistic approach to learning and optimizing interventions along the customer journey. This paper was accepted by Anindya Ghose, information systems. Funding: This work was supported by Adobe Faculty Research Award and the Marketing Science Institute Research Grant. Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4914 .