bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular Outcomes of Sodium–Glucose Cotransporter 2 Inhibitors Across Body Mass Index Spectrum in Patients With Heart Failure: An Updated Systematic Review and Meta-Analysis
Authors: Zhou Lingyan , Huang Zijia , Zeng Ya , Zhang Ying 
Published: July 2024

Abstract:
Sodium–glucose cotransporter 2 (SGLT-2) inhibitors have shown efficacy in improving cardiovascular outcomes in patients with chronic heart failure (HF). However, their impact on HF patients with varying body mass index (BMI) levels remains uncertain. To explore potential interactions between baseline BMI and the cardiovascular benefits of SGLT-2 inhibitors, we conducted a systematic review of studies from PubMed, Scopus, and the Cochrane Library database spanning from inception to March 2024. Eligible studies reported cardiovascular outcomes according to baseline BMI in HF patients treated with SGLT-2 inhibitors. Ultimately, our analysis included 4 studies encompassing 20,723 patients. We conducted separate random-effects meta-analyses for the composite outcome of first hospitalization for HF (HHF) or cardiovascular death (CVD), total HHF, CVD, and all-cause mortality. Compared with placebo, SGLT-2 inhibitors significantly reduced the risk of the composite outcome of first HHF or CVD (hazard ratio = 0.78, 95% confidence interval: 0.72–0.83) and total HHF (hazard ratio = 0.73, 95% confidence interval: 0.61–0.83), with consistent effects observed across different BMI categories (test for subgroup differences: P = 0.63 and P = 0.56, respectively). Furthermore, no statistical heterogeneity was found in the effects of SGLT-2 inhibitors on CVD (P = 0.84, I2 = 0%) and all-cause mortality (P = 0.52, I2 = 0%) across each baseline BMI subgroup in patients with HF. No significant difference in safety was found between the placebo and SGLT-2 inhibitor arms. In conclusion, our findings suggest that the cardiovascular benefits of SGLT-2 inhibitors seem to be independent of baseline BMI in patients with HF.
Involvement of D1 dopamine receptor in the nucleus of the solitary tract of rats in stress-induced hypertension and exercise
Authors: Yamanaka Ko , Suzuki Makoto , Pham Linh Thuy , Tomita Keisuke , Van Nguyen Thu , Takagishi Miwa , Tsukioka Kei , Gouraud Sabine , Waki Hidefumi 
Published: July 2024

Objective:
Chronic stress can cause hypertension, whereas daily exercise promotes healthy well being through destressing. Although the nucleus of the solitary tract (NTS) is involved in the development of hypertension, the molecular and physiological mechanisms of stress and exercise remain unclear. In this study, we tested whether gene expression in the NTS is altered by stress and daily exercise and whether this is involved in cardiovascular regulation.

Methods:
We have performed RT2 Profiler PCR arrays targeting a panel of neurotransmitter receptor genes in the NTS of Wistar rats subjected to chronic restraint stress (1 h a day over 3 weeks) with or without voluntary wheel exercise. We also performed immunohistochemistry to determine whether the identified molecules were expressed at the protein level. Additionally, microinjection studies in anesthetized rats were performed to examine whether validated molecules exhibit physiological roles in cardiovascular regulation of the NTS.

Results:
We observed that blood pressure was significantly increased by stress and the increase was suppressed by exercise. Using PCR analysis, we determined that the expression levels of four genes in the NTS, including the dopamine receptor D1 gene (Drd1), were significantly affected by stress and suppressed by exercise. We also examined dopamine D1 receptor (D1R) expression in NTS neurons and found significantly greater expression in the stressed than nonstressed animals. Furthermore, the microinjection of a D1R agonist into the NTS in anesthetized rats induced hypotensive effects.

Conclusion:
These results suggest that NTS D1R plays a role in the counteracting processes of stress-induced hypertension.
Development of a Nuclear Safety and Security Integration Assessment Tool for Research Reactors and Associated Facilities
Authors: Thomas Theodore , Harris Jason 
Published: July 2024

Abstract
Nuclear safety and security are essential elements of radiation protection. Integration of nuclear safety and security provides a means to identify conflict and synergy points. Research has not been performed to enable integrated practices at the facility level. A tool was developed through research to help staff and regulators assess the level of integration practiced within a research reactor. This tool aims to improve the identification of synergistic and conflict points. Eight criteria of nuclear safety and security integration were used to create the integration assessment tool: access control, transportation, emergency response, proper disposal of materials, testing and maintenance, defense in depth, training and education, and culture. The tool’s final score can range from 0.0375 to 1, with a score of 1 indicating complete integration. The tool was used by research reactor staff to assess practiced integrative techniques. The testing and maintenance criterion scored the highest level of integration (0.84). Training and education and culture scored the lowest levels of integration (0.50). The areas with the highest scores identified points of actively practiced integration. In contrast, those areas with lower scores indicated a lack of integrative practices. The total integration score was 0.69. This tool determined that the facility practiced an adequate level of integration. By analyzing integration levels with this tool, a measurable standard of integrative practices can be employed to achieve improved radiation protection.
Landolt Ring-Shaped Epithelial Keratopathy: A Novel Corneal Disease in a Non-Japanese White Patient
Authors: Elsharawi Radwa , Pegany Roma B. , Redd Travis K. , Huang David , Stutzman Richard D. , Chamberlain Winston D. , Nanji Afshan A. 
Published: July 2024

Purpose:
Landolt ring-shaped epithelial keratopathy is a corneal disease that has only been reported in 11 Japanese patients in 2014.
1
We describe the first case of Landolt ring-shaped epithelial keratopathy in the United States in a patient of European background.

Methods:
This is a single case report with longitudinal care.

Results:
A 35-year-old White patient presented with a history of ocular burning, photophobia, and decreased vision. Corneal examination showed bilateral and asymmetric microcystic lesions in a unique Landolt ring (or the letter “C”) shape, distributed randomly in the epithelium. Confocal microscopy revealed cellular ballooning and hyperreflective opacities in the basal layer of the corneal epithelium. The patient has had multiple recurrences of her symptoms year-round, each lasting 4 to 8 days. Topical treatment with cyclosporine, steroids, and lubrication resolved her symptoms but without complete resolution of signs on examination.

Conclusions:
Our patient's clinical signs and symptoms are similar to those described previously in 11 Japanese patients. However, unlike those patients, our patient demonstrates symptomatic response to topical treatment, no seasonal association to her condition, and to date, incomplete resolution of her disease after more than 2 years. This case highlights that Landolt ring-shaped epithelial keratopathy, a novel corneal disease of unclear origin, has relevance outside of the Japanese population.
AI-Powered Patient-Centered Care: A Call to Action for Innovation
Authors: Rothlisberger Paige N. 
Published: July 2024

SUMMARY
The influential report Crossing the Quality Chasm: A New Health System for the 21st Century established six core objectives to enhance healthcare quality. It highlighted the necessity for healthcare to encompass safety, effectiveness, a patient-centered approach, timeliness, efficiency, and equity. This essay focuses on one of these six core objectives: a patient-centered approach. Healthcare leaders actively seek solutions to improve and ensure the delivery of high-quality care. The imperative to provide quality healthcare underscores the need for artificial intelligence (AI) to become an essential component in a patient-centered approach rather than merely an optional advantage. Despite the expansion of AI, there is a lack of understanding of how AI can improve patient-centered care. This essay examines the fundamental aspects of patient-centered care, as outlined by the Picker Institute, while also exploring the prospective role of AI in advancing the core principles of patient-centered care and proposing frameworks for applying AI in healthcare.
Fall Risk Screening in Older Adult Patients on Chronic Opioid Therapy: A Quality Improvement Project
Authors: Greenberg Johanna , Curtin Andrew , Taylor Eliza , Fortenberry Katherine 
Published: July 2024

ABSTRACT
Many older adults prescribed opioid pain medications may be at increased risk of falls. As a quality improvement (QI) initiative, the University of Utah Sugar House clinic initiated a 9-month fall risk screening pilot for older adult patients on chronic opioids. This QI project sought to determine the feasibility of adding screening to a busy clinical practice, examine risk of falls in this patient cohort, and examine whether there were significant clinical and demographic differences between the patients who did or did not receive screening. We observed whether conventionally understood fall risk factors, including higher opioid doses, concurrent benzodiazepine prescription, and age, correlate with high fall risk. After the screening initiative, we determined that it was possible to significantly increase fall risk screening rates with prompts in Electronic Health Record (EHR). This cohort's fall risk screening increased from 18% to 33%. In the patients who were screened, 43% were found to be at high risk of falls. We did not see a correlation with high fall risk and patients taking higher doses of opioids or concurrent benzodiazepine prescriptions. These findings emphasize the need for consistent screening in primary care because review of the medication list alone is not a reliable predictor of fall risk.
Cranial Remolding Orthosis Study on the Use of a Temperature Sensor to Measure Wear Time
Authors: Thach Scott , Corso Jessica , Cimorelli Anthony , Owens Jaccalyn , Davis Catherine Leigh 
Published: July 2024

ABSTRACT

Introduction
The effectiveness of cranial remolding orthoses (CROs) in treating nonsynostotic deformational plagiocephaly (DP) is anecdotally related to adherence. Efficacy of CROs has been evaluated but lacks evidence regarding necessary wear time to achieve a positive outcome. A 23 hr/d wear schedule is generally prescribed regardless of presentation. The study compares daily wear time to treatment outcomes.

Materials and Methods

Subjects
Infants aged 3–18 months diagnosed with DP were included with initial cranial vault asymmetry (CVA) > 6 mm or cephalic ratio (CR) > 0.90. Subjects were treated with an Orthomerica STARband CRO. A total of 106 subjects enrolled, with 69 completed.

Apparatus
A questionnaire assessed caregiver’s reported adherence with the CRO. Maximum Integrated’s iButton temperature loggers (iButtons) recorded objective wear time.

Procedures
3D head shape measurements via Orthomerica STARScanner, caregivers’ questionnaires, and iButton data were collected every 5–8 weeks.

Data Analysis
Descriptive statistics were obtained, and data reported as mean ± SD or median [25th, 75th percentiles]. Nonparametric sign tests were used to assess differences from CRO fabrication scan to subsequent follow-ups. Spearman rank correlations and corresponding 95% confidence intervals and P values between average wear time and change of measurements were obtained.

Results
Self-reported wear time was 22 (22, 23) hrs/d. Measured wear time was 17–18 (12, 20) hrs/d. Longer average wear time was significantly associated with larger reductions in CVA (P = 0.0054), CR (P = 0.0080), and CVAI (P = 0.0059).

Conclusions
Results showed longer average daily wear increased effectiveness in CRO treatment of plagiocephaly. Increased sample sizing is required to determine if generalizable to brachycephalic and asymmetrical brachycephalic head shapes.

Clinical Relevance
A CRO wear schedule of 23 hrs a day is currently recommended, but difficult for families to adhere. The impact of the study may indicate a more realistic wear schedule that would improve adherence while achieving optimal outcomes.
Prognostic model for resected borderline and locally advanced pancreatic cancer after neoadjuvant chemotherapy
Authors: Son Jimin , Lee Woohyung , Lee Jung Bok , Hong Kwangpyo , Sung Min Kyu , Park Yejong , Jun Eunsung , Song Ki Byung , Hwang Dae Wook , Lee Jae Hoon , Kim Song Cheol 
Published: July 2024

Background:
The current AJCC 8th has been reported to have a poor ability to predict the prognosis in patients with resected borderline resectable pancreatic cancer and locally advanced pancreatic cancer following neoadjuvant chemotherapy. This study aimed to develop an improved prognostic model by incorporating pathology and parameters of biologic response (BR).

Materials and methods:
A retrospective cohort study was conducted including patients who underwent curative-intent surgery following chemotherapy. The authors developed a modified ypT staging system and incorporated the BR, involving normalization of carbohydrate antigen 19-9 and reduction in the maximum standardized uptake value simultaneously after chemotherapy. The prognostic performance of the current pathologic system, modified pathologic system, and newly developed system incorporating pathology and BR were compared.

Results:
In this study, 171 patients underwent surgery following chemotherapy. The modified T stage, which unified ypT2 and ypT3, demonstrated improved prognostic performance than the current staging system [area under the curve (AUC): 0.706 vs. 0.661]. Biologic unresponsiveness was an independent prognostic factor for worse survival (hazard ratio 2.31, 95% CI: 1.50–3.55, P<0.001). The modified pathology with BR system demonstrated the highest discriminative ability in predicting 5-year overall survival than the current pathologic system (AUC: 0.785 vs. 0.661, P=0.010) and modified pathologic staging system (AUC: 0.785 vs. 0.706, P=0.002).

Conclusions:
The prognostic model, incorporating modified ypT staging and elevated carbohydrate antigen 19-9 levels and maximum standardized uptake value simultaneously, demonstrated improved results in predicting oncologic outcomes for patients who underwent surgery following neoadjuvant chemotherapy.
Restratification of intermediate risk factors on the recurrence of papillary thyroid carcinoma: a retrospective cohort study
Authors: Chen Qiang , Zou Xiuhe , Liu Feng , Su Anping , Jiang Yong , Wei Tao , Gong Rixiang , Zhu Jingqiang , Li Zhihui 
Published: July 2024

Background:
Data regarding the long-term recurrence in patients with intermediate-risk papillary thyroid carcinoma (PTC) are limited. The aim of this study was to assess the impact of primary tumor-related risk factors and lymph node (LN)-only risk factors on recurrence-free survival (RFS) in patients with intermediate-risk PTC.

Materials and methods:
Patients with PTC who received initial treatment at our institution between 2010 and 2016 were retrospectively reviewed. A total of 799 intermediate-risk PTC patients were included and further categorized into subgroups according to the different categories of intermediate-risk factors. The RFS rates of these subgroups were investigated and compared.

Results:
Structural recurrence developed in 11 patients (1.4%) of the whole cohort during a median follow-up duration of 96 months. There were no significant differences in RFS between the primary tumor-only risk group and the LN-only risk group, while the combined group of primary tumor risk factors and LN risk factor (metastatic LNs >5) was associated with a worse RFS rate. In the matched-pair analysis, no significant difference in RFS was found between patients who underwent thyroid lobectomy and those who underwent total thyroidectomy (6-year RFS: 99.6 vs. 98.8%, P=0.316) during a median follow-up duration of 100 months.

Conclusions:
Intermediate-risk PTC patients who underwent thyroid lobectomy had a comparable RFS to those who underwent total thyroidectomy. The combination of primary tumor risk factors and LN risk factor (metastatic LNs >5) may be a useful tool for predicting the risk of long-term structural recurrence in patients with intermediate-risk PTC.
What are the Protocols and Resources for Sport-Related Concussion Among Top National Collegiate Athletic Association Football Programs? A Cross-Sectional Survey of A5 Schools
Authors: Clugston James R. , Diemer Kelsey , Chrabaszcz Sarah L. , Long Connor C. , Jo Jacob , Terry Douglas P. , Zuckerman Scott L. , Fitch Robert Warne 
Published: July 2024

Objective:
This study summarizes findings from a cross-sectional survey conducted among National Collegiate Athletic Association (NCAA) Division 1 football programs, focusing on sport-related concussion (SRC) protocols for the 2018 season.

Design:
Cross-sectional survey study.

Setting:
65 football programs within the Autonomy Five (A5) NCAA conferences.

Participants:
Athletic trainers and team physicians who attended a football safety meeting at the NCAA offices June 17 to 18, 2019, representing their respective institutions.

Intervention:
Electronic surveys were distributed on June 14, 2019, before the football safety meeting.

Main Outcome Measures:
Results for 16 unique questions involving SRC protocols and resources were summarized and evaluated.

Results:
The survey garnered responses from 46 of 65 programs (response rate = 71%). For baseline testing, 98% measured baseline postural stability and balance, 87% used baseline neurocognitive testing, while only 61% assessed baseline vestibular and/or ocular function. Regarding concussion prevention, 51% did not recommend additional measures, while 4% and 24% recommended cervical compression collars and omega-3 supplementation, respectively. In postconcussion treatment, 26% initiated aerobic exercise 1 day postconcussion if symptoms were stable, 24% waited at least 48 hours, 4% waited for the athlete to return to baseline, 11% waited until the athlete became asymptomatic, and 35% determined procedures on a case-by-case basis.

Conclusions:
Most institutions assessed postural stability/balance and neurocognitive functioning at baseline and introduced light aerobic exercise within 48 h postconcussion. There was variation in baseline assessment methods and concussion prevention recommendations. These survey findings deepen our understanding of diverse SRC protocols in NCAA football programs.
Characteristics analysis of hepatitis B core–related antigen in children with hepatitis B e antigen–positive chronic viral hepatitis B infection
Authors: Wang Fu-Chuan , Dong Yi , Xu Zhi-Qiang , Gao Yin-Jie , Yan Jian-Guo , Cao Li-Li , Feng Dan-Ni , Liu Chao , Zhong Yan-Wei , Zhang Min , Xin Shao-Jie 
Published: July 2024

Background
The objective of antiviral therapy for chronic viral hepatitis B infection (CHB) is to achieve a functional cure. An important viral marker in the serum of patients with CHB is the serum hepatitis B core–related antigen (HBcrAg). However, there is limited research on HBcrAg in juvenile patients with CHB. In this study, we aimed to investigate the correlation between serum HBcrAg and other hepatitis B virus (HBV) markers in children with CHB and its predictive significance for prognosis during antiviral therapy.

Methods
A single-center retrospective study was conducted involving 79 children with CHB, aged between 0 and 16 years. All the children were treated with interferon [or combined nucleos(t)ide analogs] for 48 weeks. HBcrAg, hepatitis B surface antigen (HBsAg), and HBV DNA were measured before treatment, and at 12 and 48 weeks after treatment. The enrolled children were classified into the seroclearance group and the nonseroclearance group based on the therapeutic outcome.

Results
HBsAg seroclearance was observed in 28 out of 79 patients and hepatitis B e antigen seroconversion without HBsAg seroclearance was observed in 14 out of 79 patients following the conclusion of the treatment, with baseline HBcrAg titer levels showing no statistical significance in both the seroclearance and nonseroclearance groups (P = 0.277). HBsAg and HBV DNA were positively correlated with HBcrAg in children with CHB (R
2 = 0.3289, 0.4388). The area under the receiver operating characteristic curve of the decrease in HBcrAg at 12 weeks of treatment as a predictor of seroclearance at 48 weeks of treatment, exhibited a value of 0.77.

Conclusion
A decrease in serum HBcrAg levels in children with hepatitis B serves as a prognostic indicator.
Association of dietary intake and serum concentration of omega-3 fatty acids on celiac disease: evidence from observational study and Mendelian randomization
Authors: Bai Tongtong , Peng Juanjuan , Wu Chengyu 
Published: July 2024

Objective
The association between omega-3 fatty acids (O3FA) and celiac disease lacks sufficient investigation.

Methods
Utilizing data gleaned from the 2009 to 2014 National Health and Nutrition Examination Survey (NHANES), this research comprises a sample of 13 403 adults, each aged 20 years and above. We conducted a multivariable logistic regression analysis to assess the association between dietary intake of O3FA and celiac disease. Subsequently, a two-sample Mendelian randomization was performed to estimate the unconfounded causal relationship between serum O3FA and celiac disease. The principal analytical strategy utilized the inverse-variance weighted methodology.

Results
In this cross-sectional study, 48 occurrences (0.36%) of celiac disease were encompassed. In the multivariable model, there was no association between dietary intake of O3FA and cases of celiac disease (odds ratio: 1.12, 95% confidence interval: 0.47–2.66, P = 0.792). However, serum levels of O3FA determined by genetic assay were correlated with celiac disease (inverse-variance weighted, β = 0.2439, P = 0.0287), with no evidence of horizontal pleiotropy (P = 0.3689).

Conclusion
The dietary consumption of O3FA did not exhibit an association with the risk of celiac disease in this cross-sectional investigation. However, a correlation between celiac disease and serum levels of O3FA was observed in the Mendelian randomization. Further investigations, including human clinical trials, are warranted.