bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does liver biopsy accurately measure fibrosis in Fontan‐associated liver disease? A comparison of liver biopsy pre–combined heart and liver transplant and liver explant post‐transplant
Authors: Vaikunth Sumeet S. , Higgins John P. , Concepcion Waldo , Haeffele Christiane , Wright Gail E. , Chen Sharon , Lui George K. , Daugherty Tami 
Published: October 2020

AbstractThe accuracy of liver biopsy to stage fibrosis due to Fontan‐associated liver disease (FALD) remains unclear. We compared the results of biopsy pre–combined heart and liver transplantation (CHLT) to the results of whole liver explant. Liver biopsy and explants from 15 Fontan patients (ages 16‐49, median 28 years) were retrospectively reviewed. Staging was as follows: stage 0: no fibrosis, stage 1: pericellular fibrosis, stage 2: bridging fibrosis, and stage 3: regenerative nodules. There is no stage 4. Clinical characteristics including Model of End‐stage Liver Disease eXcluding INR and Varices, Ascites, Splenomegaly, and Thrombocytopenia (VAST) scores were collected, and descriptive statistics and Mann‐Whitney U tests were used to analyze the data. All patients had biopsies with at least bridging fibrosis, and all had nodularity on explant; transjugular biopsy never overestimated fibrosis. Explant showed higher‐grade fibrosis (stage 3) than pre‐CHLT biopsy (stage 2) in 6 of 15 patients and equal grade of fibrosis (stage 3) in 9 of 15 patients. Though clinical characteristics varied significantly, VAST score was ≥2 in all but two patients. Transjugular liver biopsy does not overestimate and can underestimate fibrosis in Fontan patients undergoing CHLT, likely due to the patchy nature of fibrosis in FALD.
Relationship between obesity and severe COVID‐19 outcomes in patients with type 2 diabetes: Results from the CORONADO study
Authors: Smati Sarra , Tramunt Blandine , Wargny Matthieu , Caussy Cyrielle , Gaborit Bénédicte , Vatier Camille , Vergès Bruno , Ancelle Deborah , Amadou Coralie , Bachir Leila A. , Bourron Olivier , Coffin‐Boutreux Christine , Barraud Sara , Dorange Anne , Fremy Bénédicte , Gautier Jean‐François , Germain Natacha , Larger Etienne , Laugier‐Robiolle Stéphanie , Meyer Laurent , Monier Arnaud , Moura Isabelle , Potier Louis , Sabbah Nadia , Seret‐Bégué Dominique , Winiszewski Patrice , Pichelin Matthieu , Saulnier Pierre‐Jean , Hadjadj Samy , Cariou Bertrand , Gourdy Pierre ,   for the CORONADO investigators
Published: October 2020

AbstractAimTo assess the relationship between body mass index (BMI) classes and early COVID‐19 prognosis in inpatients with type 2 diabetes (T2D).MethodsFrom the CORONAvirus‐SARS‐CoV‐2 and Diabetes Outcomes (CORONADO) study, we conducted an analysis in patients with T2D categorized by four BMI subgroups according to the World Health Organization classification. Clinical characteristics and COVID‐19–related outcomes (i.e. intubation for mechanical ventilation [IMV], death and discharge by day 7 [D7]) were analysed according to BMI status.ResultsAmong 1965 patients with T2D, 434 (22.1%) normal weight (18.5‐24.9 kg/m2, reference group), 726 (36.9%) overweight (25‐29.9 kg/m2) and 805 (41.0%) obese subjects were analysed, including 491 (25.0%) with class I obesity (30‐34.9 kg/m2) and 314 (16.0%) with class II/III obesity (≥35 kg/m2). In a multivariable‐adjusted model, the primary outcome (i.e. IMV and/or death by D7) was significantly associated with overweight (OR 1.65 [1.05‐2.59]), class I (OR 1.93 [1.19‐3.14]) and class II/III obesity (OR 1.98 [1.11‐3.52]). After multivariable adjustment, primary outcome by D7 was significantly associated with obesity in patients aged younger than 75 years, while such an association was no longer found in those aged older than 75 years.ConclusionsOverweight and obesity are associated with poor early prognosis in patients with T2D hospitalized for COVID‐19. Importantly, the deleterious impact of obesity on COVID‐19 prognosis was no longer observed in the elderly, highlighting the need for specific management in this population.
High rates of pulmonary artery occlusions in COVID‐19. A meta‐analysis
Authors: Birocchi Simone , Manzoni Marco , Podda Gian Marco , Casazza Giovanni , Cattaneo Marco 
Published: October 2020

AbstractBackgroundCOVID‐19 patients are considered at high risk of venous thromboembolism (VTE). The real nature of pulmonary artery occlusions (PAO) in COVID‐19 has been questioned, suggesting that it is caused also by in situ thrombi, rather than only by emboli (PE) from peripheral thrombi.MethodsWe searched MEDLINE for studies published until 6 June 2020 that included COVID‐19 patients or non‐COVID‐19 medical patients at VTE risk, treated with heparins, in whom VTE (PE and deep vein thrombosis, DVT) had been reported. Systematic review and results reporting were conducted in accordance with PRISMA guidelines. Data were independently extracted by two observers, and estimates were pooled using random‐effects meta‐analysis.ResultsWe identified 17 studies including 3224 COVID‐19 patients and 7 including 11 985 non‐COVID‐19 patients. Two analyses were performed: in all COVID‐19 patients and only in those (n = 515) who, like non‐COVID‐19 patients, were screened systematically for DVT. The latter analysis revealed that the prevalence of DVT was 15.43% (95%CI, 4.08‐31.77) in COVID‐19 and 4.21% (2.27‐6.68) in non‐COVID‐19 patients (P = .0482). The prevalence of PE was 4.85% (40.33‐13.01) in COVID‐19 patients and 0.22% (0.03‐0.55) in non‐COVID‐19 patients (P = .0128). The percentage of PE among VTE events was 22.15% (5.31‐44.60) in COVID‐19 and 6.39% (3.17‐10.41) in non‐COVID‐19 patients (P = .0482). Differences were even more marked when all COVID‐19 patients were analysed.ConclusionsThe results of our meta‐analysis highlight a disproportion in the prevalence of PE among all VTE events in COVID 19 patients, likely reflecting PAO by pulmonary thrombi, rather than emboli from peripheral vein thrombi.
The clinical characteristics and prognosis of COVID‐19 patients with cerebral stroke: A retrospective study of 113 cases from one single‐centre
Authors: Yao Xiaolong , Liu Shengwen , Wang Junwen , Zhao Kai , Long Xiaobing , He Xuejun , Kang Huicong , Yang Yiping , Ma Xiaopeng , Yue Pengjie , Shu Kai , Tang Zhouping , Lei Ting , Liu Jihong , Wang Wei , Zhang Huaqiu 
Published: October 2020

AbstractTo explore the clinical characteristics and prognosis of COVID‐19 patients with cerebral stroke. A total of 2,474 COVID‐19 patients from February 10th to March 24th, 2020 were admitted and treated in two branches (Optic Valley and Sino‐French New City branch) of the Tongji Hospital. Data on the clinical characteristics, laboratory parameters and prognosis of COVID‐19 patients with or without cerebral stroke were collected and comparatively analysed. Of the 2,474 COVID‐19 patients, 113 (4.7%) patients had cerebral stroke and 25 (1.0%) patients had new‐onset stroke. Eighty‐eight (77.9%) patients in the previous‐stroke group had cerebral ischaemia, while 25 (22.1%) patients in the new‐onset stroke group had cerebral ischaemia. Most COVID‐19 patients with stroke were elderly with more comorbidities such as hypertension, diabetes and heart diseases than patients without stroke. Laboratory examinations showed hypercoagulation and elevated serum parameters such as IL‐6, cTnI, NT pro‐BNP and BUN. Consciousness disorders, a long disease course and poor prognosis were also more commonly observed in stroke patients. The mortality rate of stroke patients was almost double (12.4% vs. 6.9%) that of patients without stroke. In addition, age, male sex and hypertension were independent predictors for new cerebral stroke in COVID‐19 patients. In conclusion, the high risk of new‐onset stroke must be taken into consideration when treating COVID‐19 patients with an elderly age combined with a history of hypertension. These patients are more vulnerable to multiorgan dysfunction and an overactivated inflammatory response, in turn leading to an unfavourable outcome and higher mortality rate.
Children with refractory epilepsy demonstrate alterations in myocardial strain
Authors: Schreiber John M. , Frank Lowell H. , Kroner Barbara L. , Bumbut Adrian , Ismail Moussa O. , Gaillard William D. 
Published: October 2020

AbstractObjectiveTo test whether children with epilepsy have impairments in myocardial mechanics compared to controls without epilepsy.MethodsChildren with refractory epilepsy with epilepsy duration of at least 3 years underwent echocardiography including conventional measurements and speckle tracking to assess longitudinal and circumferential strain. Parent‐completed surveys, capturing critical aspects of the children's seizure history and cardiac risk factors, complemented retrospective chart reviews, which also included antiepileptic drug history. Normal echocardiograms from controls, matched for age and gender, were obtained from our institutional database and evaluated for strain.ResultsForty‐one patients (median age = 10 years, interquartile range [IQR] = 5‐15; 58.5% male) were enrolled. Epilepsy etiology included genetic (n = 26), structural (n = 6), genetic and structural (n = 5), infection (n = 3), and unknown (n = 1). No cardiac structural abnormalities were identified. Both longitudinal and circumferential strain were impaired (P < .03) in patients compared to controls (median [IQR] = 22.7% [21.2‐24.2] vs 23.6% [22.2‐26.1] and 22.0% [20.3‐25.4] vs 24.5% [22.3‐27.0], respectively), indicating decreased myocardial deformation/contraction. Shortening fraction was higher in patients (37.6% [35.7‐39.7] vs 34.9% [32.5‐38.7], P = .009); mitral valve E wave inflow velocity (84.8 cm/s [78.4‐92.8] vs 97.2 cm/s [85.9‐105.8], P = .005) and tissue Doppler lateral E’ wave (13.9 cm/s [12.3‐16.1] vs 17.3 cm/s [15.4‐18.5], P < .001) were decreased compared to controls. Findings were similar in the pairs with epilepsy patients distinguished by the ability to independently ambulate. There was no difference between patients and controls in ejection fraction. Among the epilepsy patients, there were no associations between cardiac measurements and epilepsy characteristics, including seizure type and frequency and cardiotoxic antiseizure medication exposure after correction for multiple comparisons.SignificanceChildren with refractory epilepsy had impaired systolic ventricular strain compared to controls, not correlated with epilepsy history. Further studies are needed to determine the significance of these changes.
Enduring language deficits in children of women with epilepsy and the potential role of intrauterine exposure to antiepileptic drugs
Authors: Unnikrishnan Gopikrishnan , Jacob Nikita Susan , Salim Salma , Jose Manna , Salini Reshma A. , Pavithran Veena , Jeemon Panniyammakal , Thomas Sanjeev V. 
Published: October 2020

AbstractObjectiveExposure to certain intrauterine antiepileptic drugs (AEDs) can negatively influence the language skills and intelligence of young children. It remains unanswered whether these deficits are transient or persist as children grow up. This study aims to evaluate the language function of children of women with epilepsy (CWE) aged 9‐13 years in comparison with their peers, and its relationship with intrauterine AED exposure.MethodsWe included 191 CWE in our study from the Kerala Registry of Epilepsy and Pregnancy. Children in the same age group (n = 144) and without maternal epilepsy or antenatal AED exposure served as controls. We used Clinical Examination for Language Function version IV to assess language in both groups. Relevant data related to maternal epilepsy and AED use were obtained from the registry records.ResultsThe average Core Language Scaled Score (CLSS) was significantly lower in CWE as compared to controls (83.19 vs 90.18, P = .001). Similarly, the mean scaled scores in other language parameters were also significantly lower in CWE. In the multivariate analysis, compared to control children, the average CLSS in CWE was 4.5 units lower (95% confidence interval [CI] = −8.8 to −0.2, P = .04) with AED monotherapy exposure and 7.3 units lower with exposure to AED polytherapy (95% CI = −13.8 to −0.8, P = .03). Intrauterine exposure to phenobarbitone (n = 61) and valproate (n = 55) as either monotherapy or polytherapy showed a negative effect on CLSS in CWE as compared to control children. However, carbamazepine (n = 75) and phenytoin (n = 37) use was not associated with significant variation of CLSS. In head‐to‐head comparisons between AED monotherapies in CWE, phenobarbitone showed a negative effect on CLSS (−14.7, 95% CI = −23.1 to −6.4, P = .001) as compared to carbamazepine.SignificanceIntrauterine exposure to phenobarbitone and valproate impairs language development in CWE, with effects persisting into the second decade.
Dual impacts of lncRNA XIST and lncRNA SNHG5 on inflammatory reaction and apoptosis of endothelial cells via regulating miR‐155/CARHSP1 axis
Authors: Song Xianjing , Yang Chuang , Chang Jing , Xue Xin 
Published: October 2020

AbstractConsidering the significance of lncRNA/miRNA axis in explaining atherosclerosis (AS) progression, this investigation was intended to clarify whether lncRNAs XIST/SNHG5 would regulate AS aetiology by sponging miR‐155, an AS‐promoting molecule. We altogether recruited 367 patients who were examined by coronary angiography, and meanwhile, human coronary artery endothelial cells (HCAECs) were purchased to establish cells models via ox‐LDL treatment. The study results indicated that lowly expressed XIST/SNHG5 and highly expressed miR‐155 were frequently detectable among AS patients who showed severe stenosis and possessed high triglyceride (TG), low‐density lipoprotein cholesterol (LDL‐C) and high‐sensitivity C‐reactive protein (hs‐CRP) levels. Besides, HCAECs treated by ox‐LDL released large amounts of inflammatory cytokines, and their apoptosis rate was also raised. Moreover, expressions of XIST and SNHG5 declined markedly within ox‐LDL‐treated HCAECs, whereas miR‐155 expression significantly ascended. Transfection of pcDNA‐XIST and pcDNA‐SNHG5 both reduced the expression of TNF‐α, IL‐6, IL‐8 and IL‐1β within HCAECs and also dampened the apoptotic tendency of HCAECs. Co‐treatment of pcDNA‐XIST and pcDNA‐SNHG5 produced a larger effect on HCAEC activity than pcDNA‐XIST or pcDNA‐SNHG5 alone. Furthermore, miR‐155, modified by XIST and SNHG5, was capable of reversing the impacts of XIST and SNHG5 on HCAEC activity. Eventually, CARHSP1 was activated by XIST and SNHG5, and its overexpression dwindled impacts of miR‐155 mimic on proliferation and inflammation response of HCAECs. In conclusion, targeting XIST and SNHG5 might be an ideal alternative in delaying AS progression, allowing for their repression of downstream miR‐155.
An instrument for evaluating the clinical applicability of guidelines
Authors: Linan Zeng , Qiusha Yi , Chuan Zhang , Chao Huang , Hailong Li , Chunsong Yang , Mao Lin , Liang Huang , Dan Liu , Deying Kang , Guanjian Liu , Qiaolan Liu , Rongsheng Zhao , Junhua Zhang , Youping Li , Hanmin Liu , Qiang Wang , Lingli Zhang 
Published: October 2020

AbstractObjectiveTo establish an instrument for evaluating the clinical applicability of guidelines from the guideline‐users’ perspective.MethodsWe established this instrument through forming a working group, forming an initial list of items based on a qualitative systematic review, establishing initial instrument via two rounds of modified Delphi surveys, and external review the initial instrument.ResultsThe results of modified Delphi surveys establishing appraisal aspects, appraisal items, general information of the evaluator met the preset requirements. The instrument includes three parts: general information of the evaluator (12 items), evaluation of clinical applicability (12 items, including items on the availability, readability, acceptability, feasibility, and overall applicability of guideline), and scoring scheme.ConclusionsThe instrument for evaluating the clinical applicability of guidelines from the guideline‐users’ perspective provides criteria and methods for improving the clinical applicability of guidelines during development and updating.
Pre‐ and post‐intervention study examining immunisation rates, documentation, catch‐up delivery and the impact of a dedicated immunisation service at a tertiary paediatric hospital
Authors: Tarca Adrian J , Lau Gloria TY , Mascaro Filomena , Clifford Patricia , Campbell Anita J , Taylor Ellen 
Published: October 2020

AimTo explore immunisation rates and catch‐up delivery to children admitted to hospital before and after an immunisation service was commenced.MethodsThis pre‐ and post‐intervention study examined 300 admissions prior to (cohort 1) and 300 following (cohort 2) the introduction of an immunisation service. Immunisation rates, documentation, catch‐up delivery and accuracy of the Australian Immunisation Register (AIR) were examined.ResultsOn admission, 75% (cohort 1) and 89% (cohort 2) were up‐to‐date with immunisations. Immunisation history was documented in the medical record in 78% and requirement for catch‐up documented in 10%. AIR was incorrect in one‐third of cases. By 3 months following discharge, 28% (cohort 1) and 64% (cohort 2) of patients were immunised.ConclusionsChildren admitted to hospital have lower immunisation rates than the national average. Documentation was poor, opportunities for catch‐up were missed and AIR is error‐prone. Catch‐up rates increased following the introduction of an immunisation service.
Social Security and the increasing longevity gap
Authors: Sheshinski Eytan , Caliendo Frank N. 
Published: October 2020

AbstractGrowth in overall life expectancy is straining the Social Security budget, and the gap in life expectancy between the rich and poor is widening. Motivated by these facts, this paper does four things. First, we develop a simple way to summarize the degree of progressivity in a Social Security system. Second, we show that growth in the life expectancy gap over the last few decades unwinds three‐quarters of the progressivity of the Social Security system. Third, we develop simple reforms to Social Security that maintain the progressivity of the system and restore fiscal solvency. Fourth, we estimate the welfare effects of these potential reforms.
High level of medication adherence is required to lower mortality in patients with chronic hepatitis B taking entecavir: A nationwide cohort study
Authors: Lee Jayoun , Cho Songhee , Kim Hyo Jeong , Lee Hangil , Ko Min Jung , Lim Young‐Suk 
Published: October 2020

AbstractIt is unclear whether suboptimal adherence contributes to adverse clinical outcomes in patients with chronic hepatitis B (CHB). Moreover, there is no consensus regarding the optimal level of drug adherence. This was a population‐based historical cohort study including 51 975 adult CHB patients treated with entecavir (0.5 mg/d orally). Data were obtained from the Korean national health insurance service claims database, which covers >99% of the entire population, between 2007 and 2015. Medication adherence was categorized as high (proportion of days covered [PDC], ≥90%; n = 32 089), intermediate (PDC, 80%‐89%; n = 10 197) and low (PDC, <80%; n = 9689). During a median 4.5 years (maximal 9 years) of follow‐up in 51 975 CHB patients treated with entecavir, multivariable analyses revealed that the risk of mortality/transplantation was significantly greater in the low‐adherers (adjusted hazard ratio [HR], 1.38; P < .001) and intermediate‐adherers (adjusted HR, 1.44; P < .001) than the high‐adherers (P for trend < 0.001). The risk of renal failure in the low‐ and intermediate‐adherence groups was also significantly higher than the high‐adherence group (P for trend < 0.001). By contrast, the risk of hepatocellular carcinoma (HCC) was not significantly different between groups (P for trend = 0.70). The higher risk of mortality/transplantation and renal failure but similar risk of HCC for low‐ and intermediate‐adherers compared with high‐adherers was consistent in inverse probability treatment weighting analysis of the entire cohort and subcohorts with or without cirrhosis. In conclusion, high medication adherence (≥90%) is required to significantly lower risk of mortality and renal failure in patients with CHB during long‐term treatment with entecavir.
Byssal re‐attachment behavior in the winged pearl oyster Pteria penguin in response to low salinity levels
Authors: Vasquez Hebert Ely , Xing Zheng , Zhan Xin , Gu Zhifeng , Wang Aimin 
Published: October 2020

AbstractThe effect of low salinity levels on byssal re‐attachment behavior in Pteria penguin juveniles was observed in the laboratory. Juvenile pearl oysters were submerged in seawater blended to 8.0, 12.0, 16.0, 20.0, 24.0, 28.0, and 32.0 salinity levels for a period of 48 hr. The sub‐lethal salinity level was greater than 20.0 psu. Although salinity levels of 20.0 and 24.0 psu did not affect the oyster survival, the observed byssogenesis activity was significantly reduced and locomotion activity was delayed. Description of the effects of low salinity levels on the byssal re‐attachment behavior of P. penguin juveniles provides a foundation for the design of more complex experiments and approaches to further the exploration and development of improved pearl production techniques.
Impaired purine homeostasis plays a primary role in trimethoprim‐mediated induction of virulence genes in Burkholderia thailandensis
Authors: Thapa Sudarshan S. , Grove Anne 
Published: October 2020

AbstractOne of the most commonly prescribed antibiotics against Burkholderia infections is co‐trimoxazole, a cocktail of trimethoprim and sulfamethoxazole. Trimethoprim elicits an upregulation of the mal gene cluster, which encodes proteins involved in synthesis of the cytotoxic polyketide malleilactone; trimethoprim does so by increasing expression of the malR gene, which encodes the activator MalR. We report that B. thailandensis grown on trimethoprim exhibited increased virulence against Caenorhabditis elegans. This enhanced virulence correlated with an increase in expression of the mal gene cluster. Notably, inhibition of xanthine dehydrogenase by addition of allopurinol led to similar upregulation of malA and malR, with addition of trimethoprim or allopurinol also resulting in an equivalent intracellular accumulation of xanthine. Xanthine is a ligand for the transcription factor MftR that leads to attenuated DNA binding, and we show using chromatin immunoprecipitation that MftR binds directly to malR. Our gene expression data suggest that malR expression is repressed by both MftR and by a separate transcription factor, which also responds to a metabolite that accumulates on exposure to trimethoprim. Since allopurinol elicits a similar increase in malR/malA expression as trimethoprim, we suggest that impaired purine homeostasis plays a primary role in trimethoprim‐mediated induction of malR and in turn malA.