bluuebunny/crossref_metadata_2025_split huggingface dataset:
Onset timing and duration of augmented renal clearance in a mixed intensive care unit
Authors: Mikami Ryusei , Hayakawa Mineji , Imai Shungo , Sugawara Mitsuru , Takekuma Yoh 
Published: March 2023

Abstract
Background
Augmented renal clearance (ARC) is associated with lower blood plasma concentrations of renally excreted drugs; however, its time course is unknown. The current study aimed to determine the onset timing/duration of ARC, its risk factors, and its association with clinical outcomes by continuous monitoring of urinary creatinine clearance (CrCl) in critically ill patients.

Methods
Data were retrospectively obtained from the medical records of 2592 critically ill patients admitted to the intensive care unit (ICU) from January 2019 to June 2022 at a tertiary emergency hospital. Among these, patients with continuously measured urinary CrCl were selected and observed over time. We evaluated the onset timing and duration of ARC by plotting Kaplan–Meier curves. Furthermore, by multivariate analyses, factors associated with the onset and persistence of ARC were analyzed, and the association between the ARC time course and clinical outcomes was evaluated.

Results
The prevalence of ARC was 33.4% (245/734). ARC onset was within 3 days of admission in approximately half of the cases, and within 1 week in most of the other cases. In contrast, the persistence duration of ARC varied widely (median, 5 days), and lasted for more than a month in some cases. Multivariate analysis identified younger age, male sex, lower serum creatinine at admission, admission with central nervous system disease, no medical history, use of mechanically assisted ventilation, and vasopressor use as onset factors for ARC. Furthermore, factors associated with ARC persistence such as younger age and higher urinary CrCl on ARC day 1 were detected. The onset of ARC was significantly associated with reduced mortality, but persistent of ARC was significantly associated with fewer ICU-free days.

Conclusions
Despite the early onset of ARC, its duration varied widely and ARC persisted longer in younger patients with higher urinary CrCl. Since the duration of ARC was associated with fewer ICU-free days, it may be necessary to consider a long-term increased-dose regimen of renally excreted drugs beginning early in patients who are predicted to have a persistent ARC.
Shallow resistivity structure around the 2018 craters of Mt. Motoshirane of Kusatsu-Shirane Volcano, Japan, revealed by audio-frequency magnetotellurics
Authors: Honda Asami , Kanda Wataru , Koyama Takao , Takakura Shinichi , Matsunaga Yasuo , Nishizawa Tatsuji , Ikezawa Satoshi 
Published: March 2023

AbstractIn 2018, a phreatic eruption occurred at Mt. Motoshirane, a pyroclastic cone group of the Kusatsu-Shirane Volcano in central Japan. The eruption was abrupt, and no signs of volcanic activity have been observed in recent years, in contrast to the other major pyroclastic cone group, Mt. Shirane, which hosts the active crater lake and has endured repeated phreatic eruptions. To understand the mechanism of the eruption at Mt. Motoshirane, information on the shallow hydrothermal system, which is thought to be the source region of phreatic eruptions, is required; however, few studies have been conducted on this particular cone group. In this study, we conducted an audio-frequency magnetotelluric survey in 2020 to reveal the shallow resistivity structure around the 2018 craters. A three-dimensional resistivity structure model showed generally two layers, with high resistivities at shallow depths overlain by low resistivities underneath. The boundary between the layers corresponded to the top boundary of the Neogene basement rocks. These low resistivities were not found beneath the 2018 craters; therefore, part of the Neogene basement rocks could have been lost by the eruption beneath the 2018 craters. This is consistent with the geochemical study on the mineral assemblage of the erupted deposits, which suggested that the explosions reached the depth of the basement.
Graphical Abstract
GloveCare: a pilot study in preparation for a cluster crossover randomized controlled trial of non-sterile glove-based care in preventing late-onset infection in the NICU
Authors: Khan Sarah , Tsang Kara K. , Hu Zheng Jing , Mostowiak Beata , El Helou Salhab , Science Michelle , Kaufman David , Pernica Jeffrey , Thabane Lehana , Mertz Dominik , Loeb Mark 
Published: March 2023

Abstract
Background
Late-onset infections (LOI) are a major cause of morbidity and mortality among patients in the neonatal intensive care unit (NICU). Gloving after hand hygiene may be a pragmatic approach to prevent infections that arise when healthcare workers’ hands transmit pathogens to neonates.

Objective
To determine the feasibility of conducting a multicenter, open-labeled randomized controlled trial (RCT) to determine whether a protocol that requires healthcare workers (HCWs) in a level 3 NICU to wear non-sterile gloves plus hand hygiene reduces the occurrence of a late-onset infection, compared to hand hygiene alone.

Methods
In this single-center pilot study, we recruited neonates admitted to the McMaster Children’s Hospital NICU from June 2017 to May 2018. The NICU was randomized to begin with the standard (control) arm for 6 months (June 2017 to Dec 2017), followed by the gloving (GloveCare) arm for 6 months (Jan 2018 to July 2018), with a 2-week washout period in-between to educate healthcare workers about gloving. We measured numerous feasibility outcomes including enrollment, event rate, and compliance with hand hygiene (Moment 1: before patient contact, Moment 2: before clean procedure, Moment 3: after body fluid contact, Moment 4: after patient contact) and gloving compliance.

Results
We enrolled 750 neonates (390 Standard care, 360 GloveCare) and achieved 100% enrollment. We found higher hand hygiene compliance during the standard care arm compared to the GloveCare for all four moments of hand hygiene (Moment 1: 87% vs 79%, OR=1.86 (1.34, 2.59); Moment 2: OR=1.73 (1.00, 3.01); Moment 3: OR=1.11 (0.62, 1.98); Moment 4: OR=1.65 (1.27, 2.14)). We developed and validated a method to calculate glove compliance, which ranged from 48 to 85%, and was highest for moment 3 (doffing after a procedure or body fluid exposure risk). No adverse events were documented for patients or staff.

Discussion
Reduction in hand hygiene compliance in the GloveCare arm presents a pragmatic challenge in ascertaining the effectiveness of gloving to prevent LOI. Most LOIs were non-sterile-site infections, which is considered a less patient-important or clinically relevant outcome compared to sterile-site LOI. Ensuring efficient collection and validation of hand hygiene and gloving data is imperative.

Conclusion
The pilot study demonstrated the feasibility of this intervention though modifications to improve hand hygiene compliance during GloveCare will be important prior to a multicenter cluster RCT to assess the efficacy of non-sterile glove-based care in preventing LOI in the NICU.

Trial registration
Clinicaltrials.gov, NCT03078335
Economic assessment of transporting refrigerated cargo between West-Africa and Europe: a chain cost analysis approach
Authors: Mohseni Seyed Abolfazl , Sys Christa , Vanelslander Thierry , van Hassel Edwin 
Published: March 2023

AbstractDetermining which ports to call at in a maritime loop is considered as an important determinant factor for shipping companies which impacts not only on efficiency, and productivity but also on transportation costs. The port selection process becomes more challenging and sensitive if the market is for perishable goods such as fruits and vegetables. Specifically, this paper aims to develop an efficient maritime supply chain for reefer cargo. A case study of refrigerated cargo trade between West-Africa and West-Europe is investigated for which the main objective is to minimize the trade route's supply chain costs. To do so, the paper analyzes various scenarios based upon the different types of cargo (transshipment and non-transshipment), commodity types (dry and reefer), and a combination of different (un)loading ports in and the Rotterdam–Gibraltar range. Four African ports, namely Tema (Ghana), Douala (Cameroon), Abidjan (Ivory Coast), and Dakar (Senegal), are considered for the outbound leg (Africa–Europe), while several ports in the E.U. and the U.K. are selected as inbound leg. The analysis is initiated by applying a data-gathering strategy to get the relevant container flow from European ports to West-African ports. Then, a chain cost modelling approach is used to determine what the sailing schedule of the vessel should be. By performing the import/export cargo volume and maritime and supply chain costs are calculated, which can be used by the involved stakeholders to decide which ports are the best to call on a specific route.
Highlight selection of radiochemistry and radiopharmacy developments by editorial board
Authors: Kiss Oliver C. , Scott Peter J. H. , Behe Martin , Penuelas Ivan , Passchier Jan , Rey Ana , Patt Marianne , Aime Silvio , Jalilian Amir , Laverman Peter , Cheng Zhen , Chauvet Alain Faivre , Engle Jonathan , Cleeren Frederik , Zhu Hua , Vercouillie Johnny , van Dam Michael , Zhang Ming Rong , Perk Lars , Guillet Benjamin , Alves Francisco 
Published: March 2023

Abstract
Background
The Editorial Board of EJNMMI Radiopharmacy and Chemistry releases a biannual highlight commentary to update the readership on trends in the field of radiopharmaceutical development.

Main Body
This selection of highlights provides commentary on 21
different topics selected by each coauthoring Editorial Board member addressing
a variety of aspects ranging from novel radiochemistry to first-in-human
application of novel radiopharmaceuticals.

Conclusion
Trends in radiochemistry and radiopharmacy are
highlighted. Hot topics cover the entire scope of EJNMMI Radiopharmacy and
Chemistry, demonstrating the progress in the research field, and include new
PET-labelling methods for 11C and 18F, the importance of
choosing the proper chelator for a given radioactive metal ion, implications of
total body PET on use of radiopharmaceuticals, legislation issues and
radionuclide therapy including the emerging role of 161Tb.
Methotrexate intolerance in Rheumatoid Arthritis
Authors: Nalwa Harjit Singh , Prasad Peeyush , Ganguly Nirmal Kumar , Chaturvedi Ved , Mittal Shivani Arora 
Published: March 2023

AbstractRheumatoid Arthritis is one of the most common autoimmune diseases, causing irreversible joint damage and disability. Methotrexate (MTX) is the gold standard drug for this. The low cost, easy availability and high efficacy makes it the most important and commonly used DMARD in developing and low income countries. However, long term use of MTX is also associated with intolerance including gastrointestinal effects such as nausea, vomiting, abdominal pain and diarrhoea. In addition, anticipatory, associative and behavioural symptoms such as anxiety and irritability are also observed. These adverse effects arise as a conditioned response and are often inadequately managed, leading to discontinuation of treatment. Understanding and assessing the incidence of MTX intolerance across ethnicities and geographical regions would lead to a better treatment compliance. In this review we present a compilation of the available literature on Methotrexate intolerance in Rheumatoid Arthritis and strategies to mitigate this effect.
An unusual case of delayed recovery from spinal anesthesia in a patient with Lambert-Eaton myasthenic syndrome—a case report
Authors: Mukherjee Souvik , Waindeskar Vaishali , Molli Kiran , Koovakattil Akhil Kuttan 
Published: March 2023

Abstract
Background
The Lambert-Eaton myasthenic syndrome (LEMS) is a rare disorder characterized by proximal muscle weakness and autonomic dysfunction due to involvement of the neuromuscular junction A case of delayed unilateral recovery from spinal anesthesia in a patient with LEMS undergoing open cholecystectomy is described.

Case presentation
A 42-year-old lady, on treatment for LEMS with pyridostigmine, prednisolone, and azathioprine presented with cholelithiasis and was scheduled for open cholecystectomy. Neuraxial anesthesia combined with a light plane of general anesthesia provided adequate muscle relaxation without the use of neuromuscular blocking drugs. In spite of perioperative continuation of anticholinesterases, the patient required 12 h post-surgery for complete bilateral motor recovery from spinal anesthesia.

Conclusions
A combination of spinal anesthesia with a light plane of general anesthesia appears to be a safe anesthetic technique for managing patients with Lambert-Eaton myasthenic syndrome undergoing open cholecystectomy. However, neurologically asymptomatic patients with good treatment compliance may also show an unusual delay in recovery from neuraxial anesthesia.
Effect of topical anticholinergic medication on clinical manifestations control among patients with vasomotor rhinitis versus allergic rhinitis: as comparative clinical trials
Authors: Askoura Anas Mohamed , Sabry Sabry Magdy , Fawaz Samia Ahmed , Salman Manal Ibrahim , El sordy Moustafa Ahmed Mahmoud Anter , Mady Ossama Mustafa 
Published: March 2023

Abstract
Background
The use of a topical anticholinergic medication, ipratropium bromide, and its ability to inhibit methacholine and rhinitis-induced hypersecretion is emphasized. Ipratropium bromide appears to be both safe and effective in reducing this troublesome symptom. This study is designed to show the therapeutic effect of anticholinergic local treatment on nasal mucosa in patients with vasomotor rhinitis.

Objective
To assess the therapeutic effect of local anticholinergic treatment on nasal mucosa in patients with vasomotor rhinitis compared to non-vasomotor (allergic) patients and normal individuals, and if there any down regulation of the muscarinic receptors or not.

Patients and methods
This prospective intervention study was conducted in Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University. This study was conducted on 60 cases. All patients were divided into 3 groups: study group (1) includes 20 patients diagnosed clinically non-allergic rhinitis suggestive to be vasomotor rhinitis. Study group (2) includes 20 patients diagnosed as allergic rhinitis. Study group (3) includes 20 patients performing surgery for non-vasomotor rhinitis non-allergic causes (as septoplasty or rhinoplasty).

Results
Comparison between the pre- and post-SNOT questionnaire of symptoms among vasomotor group showed that there was a significant difference between the pre- and post-treatment SNOT questionnaire symptoms; nasal obstruction, runny nose, post-nasal drip, thick nasal discharge and Lack of good night sleep. Among allergic cases group, there was a significant difference between the pre- and post-treatment IHC (immunohistochemistry) findings considering Epithelium, Glands, arteries and veins. 20% of cases had grade 3 epithelium before treatment while after treatment, this was dropped to 0%. Comparison between the pre- and post-SNOT questionnaire of symptoms among allergic group showed that there was a significant difference between the pre- and post-treatment SNOT questionnaire symptoms; runny nose, post-nasal drip, and thick nasal discharge. Among non-vasomotor rhinitis non-allergic causes (as septoplasty or rhinoplasty) group, there was a significant difference between the pre- and post-treatment IHC findings considering epithelium, glands, and arteries; however, no significant difference between the pre- and post-IHC veins grade. Also, there was no significant difference between the pre- and post-treatment SNOT questionnaire symptoms.

Conclusion
Topical anticholinergics such as ipratropium bromide nasal spray are effective in treating rhinorrhea symptoms in allergic and non-allergic rhinitis. Further controlled studies with larger sample size and longer follow-up are needed to confirm our results and to identify risk factors of adverse events.
Bringing sex toys out of the dark: exploring unmitigated risks
Authors: Sipe Joana Marie , Amos Jaleesia D. , Swarthout Robert F. , Turner Amalia , Wiesner Mark R. , Hendren Christine Ogilvie 
Published: March 2023

AbstractA majority of American adults report having used sex toys, which, by design, interact with intimate and permeable body parts yet have not been subject to sufficient risk assessment or management. Physical and chemical data are presented examining potential risks associated with four types of currently available sex toys: anal toy, beads, dual vibrator, and external vibrator. A standardized abrasion machine made real-time breakdown of products into microplastics and nanoplastics. The microplastics from the sex toys were then solvent extracted and analyzed using GC–MS. Rates of microplastics and nanoplastics released during abrasion testing from most microplastic release to least was the anal toy, beads, dual vibrator, external vibrator. Both micro- and nanoplastics particles were generated following the abrasion test, with the 50 percentile diameters (D50) ranging from the anal beads at 658.5 μm, dual vibrator at 887.83 μm, anal toy at 950 μm, and external vibrator at 1673.33 μm. The material matrix of each product was analyzed using ATR-FTIR, with results identifying the anal toy as polyethylene terephthalate (PET), the anal beads as polyvinyl chloride (PVC), the external vibrator as a silicone blend (polydimethylsiloxane [PDMS]), and the dual vibrator as a rubber mixture (polyisoprene). After extraction, phthalates known to be endocrine disruptors were present in all tested sex toys at levels exceeding hazard warnings. Analogous findings have been reported for similar materials that, when incorporated into other product categories, are subject to regulatory scrutiny in both the US and EU. This data set is not intended to be representative of sex toys as an entire class of products, nor are the abrasion experiments claiming to simulate exact use conditions. However, these exploratory data frame potential concerns, highlighting research questions and the need for prompt prioritization of protective action. Therefore, future studies and multi-stakeholder action are needed to understand and reduce risk for this class of products.
Family involvement, patient safety and suicide prevention in mental healthcare: ethnographic study
Authors: Gorman Louise S. , Littlewood Donna L. , Quinlivan Leah , Monaghan Elizabeth , Smith Jonathan , Barlow Stephen , Webb Roger T. , Kapur Navneet 
Published: March 2023

Background
Family involvement has been identified as a key aspect of clinical practice that may help to prevent suicide.

Aims
To investigate how families can be effectively involved in supporting a patient accessing crisis mental health services.

Method
A multi-site ethnographic investigation was undertaken with two crisis resolution home treatment teams in England. Data included 27 observations of clinical practice and interviews with 6 patients, 4 family members, and 13 healthcare professionals. Data were analysed using framework analysis.

Results
Three overarching themes described how families and carers are involved in mental healthcare. Families played a key role in keeping patients safe by reducing access to means of self-harm. They also provided useful contextual information to healthcare professionals delivering the service. However, delivering a home-based service can be challenging in the absence of a supportive family environment or because of practical problems such as the lack of suitable private spaces within the home. At an organisational level, service design and delivery can be adjusted to promote family involvement.

Conclusions
Findings from this study indicate that better communication and dissemination of safety and care plans, shared learning, signposting to carer groups and support for carers may facilitate better family involvement. Organisationally, offering flexible appointment times and alternative spaces for appointments may help improve services for patients.
Interpretation of Steroid Biomarkers in 21-Hydroxylase Deficiency and Their Use in Disease Management
Authors: Sarafoglou Kyriakie , Merke Deborah P , Reisch Nicole , Claahsen-van der Grinten Hedi , Falhammar Henrik , Auchus Richard J 
Published: March 2023

AbstractThe most common form of congenital adrenal hyperplasia is 21-hydroxylase deficiency (21OHD), which in the classic (severe) form occurs in roughly 1:16 000 newborns worldwide. Lifelong treatment consists of replacing cortisol and aldosterone deficiencies, and supraphysiological dosing schedules are typically employed to simultaneously attenuate production of adrenal-derived androgens. Glucocorticoid titration in 21OHD is challenging as it must balance the consequences of androgen excess vs those from chronic high glucocorticoid exposure, which are further complicated by interindividual variability in cortisol kinetics and glucocorticoid sensitivity. Clinical assessment and biochemical parameters are both used to guide therapy, but the specific purpose and goals of each biomarker vary with age and clinical context. Here we review the approach to medication titration for children and adults with classic 21OHD, with an emphasis on how to interpret adrenal biomarker values in guiding this process. In parallel, we illustrate how an understanding of the pathophysiologic and pharmacologic principles can be used to avoid and to correct complications of this disease and consequences of its management using existing treatment options.
Insulin Immunoassay Interference Due to Human Antimouse Antibodies in a Patient With Ketotic Hypoglycemia
Authors: Craven Meghan , Lord Katherine , Leavens Karla F , De Leon Diva D 
Published: March 2023

Abstract
Misinterpretation of common endocrine hormonal immunoassays can distort the clinical picture and lead to unnecessary medical workups. Potential assay inference is important to recognize when the clinical presentation and laboratory evaluation are inconsistent. This is demonstrated by the case of an 18-month-old girl who initially presented with ketotic hypoglycemia and was found on diagnostic fasting evaluation to have the triad of hypoglycemia, inappropriately high insulin levels, and low C-peptide levels—point-of-care glucose 43 mg/dL (2.39 mmol/L) (confirmatory 52 mg/dL [2.89 mmol/L]), insulin 48.1 μIU/mL (334 pmol/L), and C-peptide 0.2 ng/mL (0.07 nmol/L) concerning for factitious insulin (insulin:C-peptide ratio 4.77). On repeat diagnostic fast, insulin assays measured by liquid chromatography–mass spectrometry were incongruent with prior testing by immunoassay, demonstrating a falsely elevated insulin level when measured by immunoassay, likely due to human antimouse antibody interference (HAMA 181 ng/mL). This case represents a diagnostic challenge in which is it imperative to recognize possible immunoassay interference. It is critical to establish the difference between insulin assay interference and factitious insulin through use of alternative laboratory methods as misdiagnosis could lead to the serious implication of Munchausen by proxy resulting in the removal of a child from their home and potentially parents being charged with a crime.