bluuebunny/crossref_metadata_2025_split huggingface dataset:
Restricted Polypharmacy Compared to Usual Care in Mechanically Ventilated Patients: A Retrospective Cohort Study
Authors: Bose Somnath , Lehman Li-Wei , Talmor Daniel , Shahn Zachary 
Published: April 2023

BACKGROUND:
Adverse effects of excessive sedation in critically ill mechanically ventilated patients are well described. Although guidelines strongly recommend minimizing sedative use, additional agents are added as infusions, often empirically. The tradeoffs associated with such decisions remain unclear.

METHODS:
To test the hypothesis that a pragmatic propofol-based sedation regimen with restricted polypharmacy (RP; ie, prohibits additional infusions unless a predefined propofol dosage threshold is exceeded) would increase coma-and ventilator-free days compared with usual care (UC), we performed a retrospective cohort study of adults admitted to intensive care units (ICUs) of a tertiary-level medical center who were mechanically ventilated, initiated on propofol infusion, and had >50% probability of need for continued ventilation for the next 24 hours. We compared RP to UC, adjusting for baseline and time-varying confounding (demographics, care unit, calendar time of admission, vitals, laboratories, other interventions such as vasopressors and fluids, and more) through inverse probability weighting in a target trial framework. Ventilator-free days and coma-free days within 30 days of intubation and in-hospital mortality were the outcomes of interest.

RESULTS:
A total of 7974 patients were included in the analysis, of which 3765 followed the RP strategy until extubation. In the full cohort under UC, mean coma-free days were 23.5 (95% confidence interval [CI], [23.3–23.7]), mean ventilator-free days were 20.6 (95% CI, [20.4–20.8]), and the in-hospital mortality rate was 22.0% (95% CI, [21.2–22.8]). We estimated that an RP strategy would increase mean coma-free days by 1.0 days (95% CI, [0.7–1.3]) and ventilator-free days by 1.0 days (95% CI, [0.7–1.3]) relative to UC in our cohort. Our estimate of the confounding-adjusted association between RP and in-hospital mortality was uninformative (−0.5%; 95% CI, [−3.0 to 1.9]).

CONCLUSIONS:
Compared with UC, RP was associated with more coma- and ventilator-free days. Restricting addition of adjunct infusions to propofol may represent a viable strategy to reduce duration of coma and mechanical ventilation. These hypothesis-generating findings should be confirmed in a randomized control trial.
Age-Related Differences between Old and Very Old Men in Performance and Fatigability Are Evident after Cycling but Not Isometric or Concentric Single-Limb Tasks
Authors: VARESCO GIORGIO , LUNEAU ERIC , MILLET GUILLAUME Y. , FÉASSON LÉONARD , LAPOLE THOMAS , ROZAND VIANNEY 
Published: April 2023

ABSTRACT

Purpose
This study aimed to compare performance and fatigability between young (n = 13; 18–30 yr), old (n = 13; 60–80 yr), and very old (n = 12; >80 yr) men during a single-joint isometric (ISO) and concentric (CON) task performed on an isokinetic dynamometer and a cycling (BIKE) task.

Methods
Participants randomly performed incremental tasks consisting of stages of 75 contractions (i.e., 120 s, 0.8 s on/0.8 s off) for ISO and CON and 120 s at 37.5 rpm (similar duty cycle) for BIKE. Increments were set as a percentage of body weight. Knee extensor maximal force, voluntary activation, and twitch amplitude were measured at baseline, after each stage, and at task failure (five out of eight contractions below the target force or 6 s in a row at a cadence <37.5 rpm).

Results
Compared with young men, performance (number of stages) was 24% and 40% lower in old and very old men in ISO, 54% and 59% lower in CON, and 36% and 60% lower in BIKE (all P < 0.05). Performance of old and very old differed only in BIKE (P < 0.01). For the last common stages performed, compared with young, force loss was greater for very old men in ISO and for old and very old men in BIKE (all P < 0.05). Overall, for the last common stage performed and task failure, old and very old men presented similar force loss, alterations in voluntary activation, and twitch amplitude.

Conclusions
Our findings reveal that, with workloads relative to body weight, differences in performance between old and very old men could only be observed during BIKE (i.e., the more ecologically valid task). Results from isometric or concentric conditions might not be transferable to dynamic exercise with large muscle masses.
Cinematic rendering to improve visualization of supplementary and ectopic teeth using CT datasets
Authors: Willershausen Ines , Necker Fabian , Kloeckner Roman , Seidel Corinna Lesley , Paulsen Friedrich , Gölz Lina , Scholz Michael 
Published: April 2023

Objectives: Ectopic, impacted, and supplementary teeth are the number one reason for cross-sectional imaging in pediatric dentistry. The accurate post-processing of acquired data sets is crucial to obtain precise, yet also intuitively understandable three-dimensional (3D) models, which facilitate clinical decision-making and improve treatment outcomes. Cinematic rendering (CR) is anovel visualization technique using physically based volume rendering to create photorealistic images from DICOM data. The aim of the present study was to tailor pre-existing CR reconstruction parameters for use in dental imaging with the example of the diagnostic 3D visualization of ectopic, impacted, and supplementary teeth. Methods: CR was employed for the volumetric image visualization of midface CT data sets. Predefined reconstruction parameters were specifically modified to visualize the presented dental pathologies, dentulous jaw, and isolated teeth. The 3D spatial relationship of the teeth, as well as their structural relationship with the antagonizing dentition, could immediately be investigated and highlighted by separate, interactive 3D visualization after segmentation through windowing. Results: To the best of our knowledge, CR has not been implemented for the visualization of supplementary and ectopic teeth segmented from the surrounding bone because the software has not yet provided appropriate customized reconstruction parameters for dental imaging. When employing our new, modified reconstruction parameters, its application presents a fast approach to obtain realistic visualizations of both dental and osseous structures. Conclusions: CR enables dentists and oral surgeons to gain an improved 3D understanding of anatomical structures, allowing for more intuitive treatment planning and patient communication.
Epigallocatechin-3-gallate chitosan nanoparticles in an extender improve the antioxidant capacity and post-thawed quality of Kacang goat semen
Authors: Mustofa Imam , Susilowati Suherni , Suprayogi Tri Wahyu , Akintunde Adeyinka Oye , Oktanella Yudit , Purwanto Djoko Agus 
Published: April 2023

Background and Aim: The Kacang goat (Capra hircus) is an indigenous livestock species in Indonesia that is at risk of extinction due to cross-breeding. Artificial insemination (AI) techniques are expected to increase the population of these goats. This study aimed to determine the addition of epigallocatechin-3-gallate chitosan nanoparticles (EGCG CNPs) to skim milk–egg yolk (SM–EY) extender to obtain the best possible quality of post-thawed Kacang buck semen for AI. Materials and Methods: Fresh Kacang buck semen was diluted in SM–EY without or with the addition of 0.5, 1.0, 1.5, or 2.0 µg of EGCG CNPs/mL extender. Extended semen was packaged in French mini straws, frooze, and stored in liquid nitrogen at −196℃ for 24 hours. Six replicates from each treatment group were thawed for catalase, 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging, malondialdehyde (MDA), sperm intact plasma membrane (IPM), viability and motility analyses. Results: Post-thawed semen that was previously frozen without EGCG CNPs in the extender (control group) exhibited the lowest levels of catalase, DPPH, sperm living cells, sperm motility, MPI, and the highest levels of MDA. The addition of EGCG CNPs in the T3 and T4 groups was increased (p < 0.05) post-thawed catalase, DPPH, living cells, and sperm motility and decreased (p < 0.05) MDA levels than those of the T0 group. Meanwhile, sperm MPI was higher (p < 0.05) in the T4 group than the sperm MPI of the T0 group. Conclusion: This study was the first in using of EGCG CNPs in the SM–EY extender, in which adding 1.5 or 2.0 μg/mL of EGCG CNPs in this extender increased the antioxidant capacity and post-thawed quality of Kacang buck semen.
The impact of varying the number and selection of conditions on estimated multimorbidity prevalence: A cross-sectional study using a large, primary care population dataset
Authors: MacRae Clare , McMinn Megan , Mercer Stewart W. , Henderson David , McAllister David A. , Ho Iris , Jefferson Emily , Morales Daniel R. , Lyons Jane , Lyons Ronan A. , Dibben Chris , Guthrie Bruce 
Published: April 2023

Background
Multimorbidity prevalence rates vary considerably depending on the conditions considered in the morbidity count, but there is no standardised approach to the number or selection of conditions to include.

Methods and findings
We conducted a cross-sectional study using English primary care data for 1,168,260 participants who were all people alive and permanently registered with 149 included general practices. Outcome measures of the study were prevalence estimates of multimorbidity (defined as ≥2 conditions) when varying the number and selection of conditions considered for 80 conditions. Included conditions featured in ≥1 of the 9 published lists of conditions examined in the study and/or phenotyping algorithms in the Health Data Research UK (HDR-UK) Phenotype Library. First, multimorbidity prevalence was calculated when considering the individually most common 2 conditions, 3 conditions, etc., up to 80 conditions. Second, prevalence was calculated using 9 condition-lists from published studies. Analyses were stratified by dependent variables age, socioeconomic position, and sex. Prevalence when only the 2 commonest conditions were considered was 4.6% (95% CI [4.6, 4.6] p < 0.001), rising to 29.5% (95% CI [29.5, 29.6] p < 0.001) considering the 10 commonest, 35.2% (95% CI [35.1, 35.3] p < 0.001) considering the 20 commonest, and 40.5% (95% CI [40.4, 40.6] p < 0.001) when considering all 80 conditions. The threshold number of conditions at which multimorbidity prevalence was >99% of that measured when considering all 80 conditions was 52 for the whole population but was lower in older people (29 in >80 years) and higher in younger people (71 in 0- to 9-year-olds). Nine published condition-lists were examined; these were either recommended for measuring multimorbidity, used in previous highly cited studies of multimorbidity prevalence, or widely applied measures of “comorbidity.” Multimorbidity prevalence using these lists varied from 11.1% to 36.4%. A limitation of the study is that conditions were not always replicated using the same ascertainment rules as previous studies to improve comparability across condition-lists, but this highlights further variability in prevalence estimates across studies.

Conclusions
In this study, we observed that varying the number and selection of conditions results in very large differences in multimorbidity prevalence, and different numbers of conditions are needed to reach ceiling rates of multimorbidity prevalence in certain groups of people. These findings imply that there is a need for a standardised approach to defining multimorbidity, and to facilitate this, researchers can use existing condition-lists associated with highest multimorbidity prevalence.
Integration of targeted sequencing and pseudo-tetraploid genotyping into clinically assisted decision support for β-thalassemia invasive prenatal diagnosis
Authors: Jia Wenguang , Shi Jiying , Zhu Hengying , Wu Xiaojing , Ling Yayun , Chen Ping 
Published: April 2023

Background
The high prevalence of β-thalassemia indicates the severe medical burden in Guangxi province in China. Millions of thousands of prenatal women with healthy or thalassemia-carrying fetuses received an unnecessary prenatal diagnosis. We designed a prospective single-center proof-of-concept study to evaluate the utility of a noninvasive prenatal screening method in the stratification of beta-thalassemia patients before invasive procedures.

Methods
Next-generation and optimized pseudo-tetraploid genotyping-based methods were utilized in preceding invasive diagnosis stratification to predict the mater-fetus genotype combinations in cell-free DNA, which is from maternal peripheral blood. Populational linkage disequilibrium information with additional neighboring loci to infer the possible fetal genotype. The concordance of the pseudo-tetraploid genotyping with the gold standard invasive molecular diagnosis was used to evaluate the effectiveness of this method.

Results
127 β-thalassemia carrier parents were consecutively recruited. The total genotype concordance rate is 95.71%. The Kappa value was 0.8248 for genotype combinations and 0.9118 for individual alleles.

Conclusion
This study offers a new approach to picking out the health or carrier fetus before invasive procedures. It provides valuable novel insight into patient stratification management on β-thalassemia prenatal diagnosis.
The stability of blood gases and CO-oximetry under slushed ice and room temperature conditions
Authors: Zavorsky Gerald S. , van Wijk Xander M.R. 
Published: April 2023

AbstractObjectivesHuman blood gas stability data is limited to small sample sizes and questionable statistical techniques. We sought to determine the stability of blood gases under room temperature and slushed iced conditions in patients using survival analyses.MethodsWhole blood samples from ∼200 patients were stored in plastic syringes and kept at room temperature (22–24 °C) or in slushed ice (0.1–0.2 °C) before analysis. Arterial and venouspO2(15–150 mmHg),pCO2(16–72 mmHg), pH (6.73–7.52), and the CO-oximetry panel [total hemoglobin (5.4–19.3 g/dL), percentages of oxyhemoglobin (O2Hb%, 20–99%), carboxyhemoglobin (COHb, 0.1–5.4%) and methemoglobin (MetHb, 0.2–4.6%)], were measured over 5-time points. The Royal College of Pathologists of Australasia’s (RCPA’s) criteria determined analyte instability. Survival analyses identified storage times at which 5% of the samples for various analytes became unstable.ResultsCOHb and MetHb were stable up to 3 h in slushed ice and at room temperature;pCO2, pH was stable at room temperature for about 60 min and 3 h in slushed ice. Slushed ice shortened the storage time beforepO2became unstable (from 40 to 20 min), and the instability increased when baselinepO2was ≥60 mmHg. The storage time forpO2,pCO2, pH, and CO-oximetry, when measured together, were limited by thepO2.ConclusionsWhen assessingpO2in plastic syringes, samples kept in slushed ice harm their stability. For simplicity’s sake, the data support storage times for blood gas and CO-oximetry panels of up to 40 min at room temperature if following RCPA guidelines.
Clinical implication by differential analytical performances of serum free light chain quantitation analysis using fully automated analyzers
Authors: Yun Shin Young , Rim John Hoon , Park Hak , Kang Hyein , Lee Sang-Guk , Lim Jong-Baeck 
Published: April 2023

Abstract

Objectives
Free light chain (FLC) is used for the diagnosis and prediction with regard to the progression risk of plasma cell disorders and Freelite reagent using the SPAplus analyzer (The Binding Site) has been one of the widely used option. However, N Latex FLC reagent with the Atellica CH 930 analyzer (Siemens Healthineers) has shown the advantages of automation and high throughput. We aimed to evaluated clinical implication by differential analytical performances of two assays.

Methods
A total of 322 serum samples were collected from 193 patients requested for FLC analysis including 131 multiple myeloma patients. The precision, linearity, dilution recovery of N Latex FLC assay was evaluated. We compared the two assays and analyzed the monomer-dimer pattern for discrepant results.

Results
The precision, linearity, and dilution recovery performance was appropriate for the routine use in clinical laboratories. Despite the good correlation within normal range, proportional bias up-to 170% was observed in samples with high concentrations especially for lambda. The higher value samples with N Latex FLC assay contained more monomer forms than controls. All opposite changes of FLC burden by the N Latex FLC assay proved to present concordant dynamic changes when assessed by serum protein electrophoresis.

Conclusions
Clinical laboratories should be aware of the inter-assay variability of FLC quantitative measurements using different platforms, especially for high concentrations of both kappa and lambda measurements, possibly due to monomer/dimer ratio diversity. Clinical interpretations for multiple myeloma disease status might not be dramatically affected only when the same assay is utilized during follow-up periods.
Elevated levels of renal function tests conferred increased risks of developing various pregnancy complications and adverse perinatal outcomes: insights from a population-based cohort study
Authors: Xu Zhengwen , Yang He S. , Liu Lin , Meng Lanlan , Lu Yifan , Han Lican , Tang Guodong , Wang Jing , Chen Lu , Zhang Yue , Zhai Yanhong , Su Shaofei , Cao Zheng 
Published: April 2023

Abstract

Objectives
Physiological changes during pregnancy can affect the results of renal function tests (RFTs). In this population-based cohort study, we aimed to establish trimester-specific reference intervals (RIs) of RFTs in singleton and twin pregnancies and systematically investigate the relationship between RFTs and adverse pregnancy outcomes.

Methods
The laboratory results of the first- and third-trimester RFTs, including blood urea nitrogen (BUN), serum uric acid (UA), creatinine (Crea) and cystatin C (Cys C), and the relevant medical records, were retrieved from 29,328 singleton and 840 twin pregnant women who underwent antenatal examinations from November 20, 2017 to January 31, 2021. The trimester-specific RIs of RFTs were estimated with both of the direct observational and the indirect Hoffmann methods. The associations between RTFs and pregnancy complications as well as perinatal outcomes were assessed by logistic regression analysis.

Results
Maternal RFTs showed no significant difference between the direct RIs established with healthy pregnant women and the calculated RIs derived from the Hoffmann method. In addition, elevated levels of RFTs were associated with increased risks of developing various pregnancy complications and adverse perinatal outcomes. Notably, elevated third-trimester RFTs posed strong risks of preterm birth (PTB) and fetal growth restriction (FGR).

Conclusions
We established the trimester-specific RIs of RFTs in both singleton and twin pregnancies. Our risk analysis findings underscored the importance of RFTs in identifying women at high risks of developing adverse complications or outcomes during pregnancy.
Effect of Moringa oleifera on serum YKL-40 level: In vivo rat periodontitis model
Authors: Kocabas Rahim , Yarkac Fatma Ucan , Karabulut Ercan , Keles Mert 
Published: April 2023

Abstract
Periodontitis is a chronic inflammatory disease that destroys the bones and soft tissues that support the tooth as a result of inflammatory reactions. YKL-40 is an inflammatory marker associated with inflammation and is also associated with periodontal diseases. Moringa oleifera (MO) is a plant rich in high nutritional values, minerals, vitamins, and other essential phytochemicals. The aim of this study was to investigate the effect of MO administration on serum YKL-40 levels in an experimental periodontitis model. In the study, a total number of 24 female Wistar albino rats, which were 4–5 months old with a body weight of 275 ± 25 g, were used. Animals were divided into three groups. 1st group: Control (n = 8), 2nd group: periodontitis group (PG) (n = 8), 3rd group: Periodontitis group (PG + MO) with an additional 200 mg/kg/4 weeks MO (n = 8). In the PG and PG + MO were formed experimental periodontitis model. Compared to the PG, the decrease in the interleukin-6 (IL-6) and YKL-40 values in the PG + MO (p < 0.05, p < 0.05) was found to be significant in terms of statistical evaluation. As a result, MO decreased YKL-40 levels in the experimental periodontitis model. Although further research is needed, drugs containing MO can be used in the treatment of periodontal diseases.
Evaluation of performances in DI Diesel engine with different split injection timings
Authors: Balamurugan G. , Gowthaman S. 
Published: April 2023

Abstract
An injection mechanism which is split injection was found to reduce emissions in Diesel engines. In this mechanism, split injection proportion and split injection timing was varied and analyzed to reduce engine emissions. Injection proportion was varied at 25% of the pilot and 75% of the fuel as main injection and timing as 54° ATDC (after top dead center) and 40° ATDC for split injection. Since a homogeneous mixture occurs in this pilot injection, combustion is becoming complete for Diesel Engine. Hence, BTE was increased by 1.5% for timing 40° ATDC and 12° BTDC (before top dead center) and reduced by 1.4% for timing 54° ATDC and 12° BTDC. The reduction in BTE for 54° ATDC is because the increase in timing increases cooling effect of air and combustion rating was reduced. Also, combustion takes place at low temperature itself due to homogeneous mixture. So, NOx emission was also reduced by 8.4% and 18.6% for 40° ATDC and 54° ATDC injection timing respectively. The other emissions like HC and CO were also observed to be reduced upto 35% and 11% respectively due to increase in homogeneous mixture in Diesel Engine.
Comparison of internet usage and internet addiction scores in healthy children and children with type 1 diabetes mellitus
Authors: Büyükyılmaz Gönül , Toksoy Adıgüzel Keziban , Koca Serkan Bilge 
Published: April 2023

Abstract

Objectives
The Internet, an integral part of modern life, can lead to internet addiction, which negatively affects academic performance, family relationships, and emotional development. This study aimed to evaluate the Internet addiction scores (IAS) during COVID-19 in children with type 1 diabetes mellitus (T1DM) compared with healthy controls.

Methods
Children with T1DM and healthy controls aged 8–18, were evaluated with the Parent–Child Internet Addiction Test (PCIAT20). Internet addiction scores of the participants were assessed. The relationship between diabetes duration, mean HbA1c level and IAS were also examined in children with T1DM.

Results
The study included 139 patients with T1DM and 273 controls. The IAS were significantly lower in patients compared with controls (25.28 ± 15.52 vs. 29.69 ± 19.08, p=0.019). There was a weak negative correlation between the duration of diabetes and IAS in children with diabetes (r=−0.21, p=0.021). There was no significant association between IAS and mean HbA1c (r=0.14, p=0.128) or age (r=0.08, p=0.115). Furthermore, there was no statistically significant difference in IAS between children with well-controlled diabetes (n=17) and those with poorly-controlled diabetes (n=122) (IAS: 27.1 ± 17.2; 24.8 ± 15.5, p=0.672, respectively).

Conclusions
Internet addiction scores were lower in patients with T1DM compared with their healthy peers. Unlike previous studies reporting an increase in problematic internet use, the results of the present study did not confirm internet use as a real challenge in front of the diabetes management for the majority of children with T1DM. This result may be attributed to the important role played by families in the management of T1DM.