bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Miscarriage in Relation to Seasonal Influenza Vaccination Before or During Pregnancy
Authors: Regan Annette K. , Wesselink Amelia K. , Wang Tanran R. , Savitz David A. , Yland Jennifer J. , Rothman Kenneth J. , Hatch Elizabeth E. , Wise Lauren A. 
Published: August 2023

OBJECTIVE:
To evaluate the association between seasonal influenza vaccination and miscarriage using data from an ongoing, prospective cohort study.

METHODS:
We analyzed 2013–2022 data from PRESTO (Pregnancy Study Online), a prospective prepregnancy cohort study of female pregnancy planners and their male partners in the United States and Canada. Female participants completed a baseline questionnaire and then follow-up questionnaires every 8 weeks until pregnancy, during early and late pregnancy, and during the postpartum period. Vaccine information was self-reported on all questionnaires. Miscarriage was identified from self-reported information during follow-up. Male partners were invited to complete a baseline questionnaire only. We used Cox proportional hazard models to estimate the hazard ratio (HR) and 95% CI for the association between vaccination less than 3 months before pregnancy detection through the 19th week of pregnancy and miscarriage, with gestational weeks as the time scale. We modeled vaccination as a time-varying exposure and used propensity-score fine stratification to control for confounding from seasonal and female partner factors.

RESULTS:
Of 6,946 pregnancies, 23.3% of female partners reported exposure to influenza vaccine before or during pregnancy: 3.2% during pregnancy (gestational age 4–19 weeks) and 20.1% during the 3 months before pregnancy detection. The miscarriage rate was 16.2% in unvaccinated and 17.0% among vaccinated participants. Compared with no vaccine exposure, influenza vaccination was not associated with increased rate of miscarriage when administered before (HR 0.99, 95% CI 0.81–1.20) or during (HR 0.83, 95% CI 0.47–1.47) pregnancy. Of the 1,135 couples with male partner vaccination data available, 10.8% reported vaccination less than 3 months before pregnancy. The HR for the association between male partner vaccination and miscarriage was 1.17 (95% CI 0.73–1.90).

CONCLUSION:
Influenza vaccination before or during pregnancy was not associated with miscarriage.
Practical Review of the Cost of Diagnosis and Management of Positional Plagiocephaly
Authors: Watt Ayden , Alabdulkarim Abdulaziz , Lee James , Gilardino Mirko 
Published: August 2023

Background:
Positional plagiocephaly has garnered increased research interest since the introduction of the Back to Sleep campaign in the 1990s, and the subsequent increase in infants with cranial deformity. Research has focused on treatment outcomes and developing new modalities to address asymmetric heads. Little attention has been given to the cost of treatment and diagnosis. This study aimed to summarize the literature and provide an overview of the costs associated with a diagnosis of positional plagiocephaly.

Methods:
A literature review was performed by searching PubMed and Ovid Embase to identify studies pertaining to the “cost” of plagiocephaly diagnosis or treatment through direct financial factors, disturbance to daily routines (ie, through treatment prolongation), or related stress.

Results:
Twenty-nine peer-reviewed studies were included. Treatment options for plagiocephaly are stratified by severity and age of diagnosis, with different pathways available to treat different stages of asymmetry. The common factor across all treatment modalities is that earlier diagnosis unequivocally leads to better aesthetic outcomes and shorter treatment times. This leads to lower costs for treatment, a lower stress burden for parents, and lower costs for the healthcare system in the future through reduction of long-term effects. Our theoretical cost model suggests that early diagnosis at 4 months can lead to a treatment cost of $1495, when compared with $5195 for detection of deformity at or after 6 months.

Conclusion:
The dramatic cost disparity between early and late diagnosis highlights the need for reliable methods to accurately detect cranial deformity early in an infant’s life.
Consecutive Liver and Bone Marrow Transplantation for Erythropoietic Protoporphyria: Case Report and Literature Review
Authors: Portich Júlia Plentz , Ribeiro Aline Sinhorelo , Rodrigues Taniguchi Adriano Nori , Backes Ariane , de Souza Carolina Fischinger Moura , Kieling Carlos Oscar , Scherer Fernanda Fetter , de Oliveira Poswar Fabiano , Leipnitz Ian , Doederlein Schwartz Ida Vanessa , Sekine Leo , Rigoni Lisandra Della Costa , Marquardt da Silveira Luciana , de Almeida Furlanetto Marina , Adami Marina Rossato , Breunig Raquel Cristine , Guedes Renata Rostirola , do Amaral Sheila Nogueira , Gonçalves Vieira Sandra Maria , de Brum Soares Tahiane , Silva Thiago Oliveira , da Rocha Silla Lúcia Mariano , Astigarraga Claudia Caceres , Paz Alessandra Aparecida , Daudt Liane Esteves 
Published: August 2023

Background:
Erythropoietic protoporphyria (EPP) is a rare inherited disease of heme biosynthesis resulting in the accumulation of protoporphyrin, characterized by liver failure in a minority of cases. Although liver transplant (LT) is the therapeutic strategy for advanced hepatic disease, it does not correct the primary defect, which leads to recurrence in liver graft. Thus, hematopoietic stem cell transplantation (HSCT) is an approach for treating EPP.

Methods:
We aim to describe the first sequential LT and HSCT for EPP performed in Latin America, besides reviewing the present-day literature.

Results
The patient, a 13-year-old female with a history of photosensitivity, presented with symptoms of cholestatic and hepatopulmonary syndrome and was diagnosed with EPP. Liver biopsy demonstrated cirrhosis. She was submitted to a successful LT and showed improvement of respiratory symptoms. However, she had disease recurrence on the liver graft. She underwent a myeloablative HSCT using a matched unrelated donor, conditioning with BuCy (busulfan and cyclophosphamide), and GvHD (graft vs. host disease) prophylaxis with ATG (thymoglobulin), tacrolimus and methotrexate. Neutrophil engraftment occurred on D+18. She has presented mixed chimerism, but normalization of PP levels, being 300 days after HSCT, in good state of health and normal liver function.

Conclusions:
Consecutive LT and HSCT for EPP is a procedure that has been described in 10 cases in the literature and, even though these patients are a highly diversified population, studies have shown favorable results. This concept of treatment should be considered in patients with established liver disease.
Baseline Quality of Life in Pediatric Patients With Low-flow Vascular Malformations
Authors: Arleo Timothy L. , Swerdlin Rachel F. , Gill Anne E. , Goudy Steven L. , Meisel Jonathan A. , Briones Michael A. , Shah Jay H. , Wright Allyson , Hawkins Clifford Matthew 
Published: August 2023

Objective:
The aim of this study was to quantify and describe baseline patient and parent-proxy health-related quality of life scores in patients with low-flow vascular malformations at a single, tertiary-care vascular anomalies clinic.

Study design:
This is a retrospective study of data collected on patients with low-flow vascular malformations between the ages of 2 to 25 who were seen at a single, tertiary-care center vascular anomalies clinic. A total of 266 patients are included in this study.

Results:
Patients with lymphatic malformations report decreased quality of life scores as compared with venous malformations in the emotional, psychological, school, and social domains. Patients with lower extremity malformation report decreased quality of life scores as compared with head/neck, trunk, upper extremity, and multifocal malformations; most notably in the physical domain.

Conclusions:
Treatment of low-flow vascular malformations should aim to improve patient quality of life. The use of standardized health-related quality of life measures in this study quantifies baseline quality of life scores among patients with low-flow vascular malformations.
Strategies for Teaching Diversity, Equity, and Inclusion in Principles of Nursing
Authors: Victor Joyce , Gangaware Ashley , Siek Jacob 
Published: August 2023

Background:
Nursing programs need to identify creative teaching strategies, guiding students to reflect on individual value systems and consider the values of others as they apply diversity, equity, and inclusion (DEI) in the provision of individualized nursing care.

Purpose:
The purpose of this project was to develop teaching strategies related to DEI content and examine how first clinical semester, prelicensure baccalaureate nursing students perceived these strategies.

Methods:
Participants engaged in self-reflection on topics related to DEI, using guided questions in discussion boards, a written paper, and a simulation-based experience. Thirteen students completed an anonymous survey with consideration of these activities and their perceived impact on DEI in their personal nursing practice.

Outcomes:
Three investigators analyzed survey responses by employing Word Clouds, word counts, and interdependent content analysis and found that using the existing syllabi for the Principles of Nursing course and modifying it to address DEI concepts resulted in perceived increases in awareness, sensitivity, knowledge, competence, and holism.
Clinical Characterization of Congenital Anophthalmic and Microphthalmic Cavities in Inidviduals With Craniofacial Anomalies
Authors: Parizotto Paula Isabella , Gonçalves Paula Raul , Kokitsu Nancy Mizue , Alonso Nivaldo , Tonello Cristiano 
Published: August 2023

Objective:
Measure the frequency of anophthalmic and microphthalmic patients with craniofacial anomalies (FCAs).

Design:
Descriptive, cross-sectional, retrospective study.

Setting:
Hospital for Rehabilitation of Craniofacial Anomalies of the University of São Paulo (HRAC-USP). The medical records of patients treated at HRAC from 2000 to 2012 with a diagnosis of congenital anophthalmia or microphthalmia were examined. Patients were excluded for secondary anophthalmia, incomplete medical records, or information that could not be accessed.

Outcome Measures:
Frequency of anophthalmia and microphthalmia; the proportions and diagnoses of associated FCAs; impairment of ocular appendages; extracranial or facial anomalies; genetic alterations; and surgical approach.

Results:
A total of 56 patients had anophthalmia (52.3%), 35 had microphthalmia (32.7%), and 16 patients had both (15%). Individuals with FCAs associated with microphthalmia, anophthalmia, or both totaled 74, corresponding to 69.2%. Anophthalmia was more likely than microphthalmia to be accompanied by FCAs, at 76.4% of patients (P < 0.05). Cleft lip and palate were the main malformations associated with anophthalmia (23.64%), with microphthalmia (45%), and with both (44.44%). Reconstructive surgery was done in 63.6% of cases. The ocular attachments were compromised in 71% of cases. Extracraniofacial malformations were found in 9.3% of patients. Only 7 records contained karyotypes, and no changes directly related to anophthalmia or microphthalmia were found.

Conclusion:
Anophthalmia is more frequent than microphthalmia and is more often accompanied by FCA. Cleft lip and cleft palate are the most frequent concomitant malformations.
Impact of Pregnancy on Papilledema and Vision Loss in Idiopathic Intracranial Hypertension Patients: A Chart Review and Case Series of 13 Patients
Authors: Lambert-Cheatham Nathan A. , Nagia Lina , Pasmanter Nathaniel R. , Pellizzari Richard , Lee Beom , Miller Neysa J. , Kaufman David I. 
Published: August 2023

Background:
Studies suggest that weight gain is a prominent risk factor for recurrence of papilledema in idiopathic intracranial hypertension (IIH). Given this information, the significant weight gain that occurs during pregnancy, and the fact that pharmacologic therapy is many times discontinued, raises concerns for worsening edema and vision loss. To examine the impact of pregnancy weight gain on IIH, a retrospective chart review of patients with IIH and pregnancy was performed. Compared with previous studies, we 1) quantified findings with optical coherence tomography (OCT) and Humphrey visual field (HVF) data, 2) Included baseline data before pregnancy, 3) determined excess pregnancy weight gain using body mass index-adjusted weight gain goals, and 4) correlated worsening in IIH symptoms with changes in papilledema.

Methods:
Charts were reviewed for patients with diagnoses of IIH who had at least 2 visits with neuro-ophthalmology during pregnancy. Thirteen patients met inclusion criteria. Data were compared from baseline visits before pregnancy, pregnancy visits, and postpregnancy visits.

Results:
Comparisons of HVF mean deviation (MD), OCT retinal nerve fiber layer (RNFL), and Max OCT RNFL during pregnancy were not significant compared with baseline (P = 0.51, 0.41, and 0.25). Three patients were found to have increased papilledema during pregnancy (Max Avg OCT RNFL of 152.5, 129, and 123.5 μm) of which 2 developed new reproducible mild visual field defects (HVF ∆MD −1.78 and −4.49). All patients showed more than the 6% weight gain, typically observed in recurrent IIH. Eleven patients gained more than their weight from initial diagnosis. Eight patients had excess pregnancy weight gain. Six patients discontinued pharmacologic therapy for IIH.

Conclusions:
Weight gain seems to carry a lower risk in IIH patients when associated with pregnancy. This is suggested by the high rate of stable or even decreased disc edema in patients despite medication discontinuation and excess pregnancy weight gain. We postulate these findings may be related to changes in weight distribution or endocrine changes during pregnancy.
Study on Good Clinical Practices among Researchers in a Tertiary Healthcare Institute in India
Authors: Harshita  , Panda Prasan Kumar 
Published: August 2023

AbstractBACKGROUNDGood Clinical Practice (GCP) is put in place to protect human participants in clinical trials as well as to ensure the quality of research. Non-adherence to these guidelines can produce research that may not meet the standards set by the scientific community. Therefore, it must be ensured that researchers are well-versed in the GCP. But not much is known about the knowledge and practices of the GCP in the medical colleges of North India.AIMTo assess the knowledge and practices of researchers about GCP and analyze these with respect to the demographics of participants.METHODSThis is a cross-sectional study. A self-structured questionnaire about GCP, after expert validations, was circulated among researchers, at a tertiary healthcare institute, All India Institute of Medical Sciences (AIIMS), Rishikesh. A total of 59 individuals, who were selected by universal sampling, participated in the study. All healthcare workers who have been investigators of Institutional Ethics Committee-approved research projects, except residents and faculty, and are still a part of the institute have been included in the study. The study was approved by the Institutional Ethics Committee of AIIMS, Rishikesh. We used descriptive analysis and the Chi-squared test to analyze data. P-value < 0.05 was considered significant.RESULTSOut of 59 participants, only 11 (18.6%) were certified for GCP. Most of the participants (64.4%) had “Average” knowledge, 33.9% had “Good” knowledge and 1.7% had “Poor” knowledge. Only 49% of participants had satisfactory practices related to GCP. There was a significant difference in the knowledge based on the current academic position for the items assessing knowledge of institutional review board (P=0.010), confidentiality & privacy (P=0.011), and participant safety & adverse events (P<0.001). There was also a significant difference in knowledge of research misconduct (P=0.024) and participant safety & adverse events (P=0.011) based on certification of GCP. There was a notable difference in the practices related to recruitment & retention on the basis of current academic position (P<0.001) and certification of GCP (P=0.023). We also observed a considerable difference between the knowledge and practices of GCP among the participants (P=0.013).CONCLUSIONParticipants have basic knowledge of GCP but show a lack thereof in certain domains of GCP. This can be addressed by holding training sessions focusing on these particular domains.Core tipThere is a lack of knowledge about the Good Clinical Practices in the researchers of medical colleges. In order to improve the quality of research, as well as, make research a better experience for the participants of research, we must work on improving awarenss of the GCP among researchers. This can be done by organising training sessions or workshops which throw light on the principles of GCP.
Evaluation of fractional flow reserve and atherosclerotic plaque characteristics on coronary non-contrast T1-weighted magnetic resonance imaging
Authors: Sugane Hiroki , Asaumi Yasuhide , Ogata Soshiro , Kimura Michito , Kanaya Tomoaki , Hoshi Tomoya , Sato Akira , Miura Hiroyuki , Tomishima Yoshiyuki , Morita Yoshiaki , Nakao Kazuhiro , Otsuka Fumiyuku , Kataoka Yu , Kawasaki Tomohiro , Nishimura Kunihiro , Narula Jagat , Yasuda Satoshi , Noguchi Teruo 
Published: August 2023

AbstractBackgroundThe relationship between high-risk coronary plaque characteristics regardless of the severity of lesion stenosis and myocardial ischemia remains unsettled. High-intensity plaques (HIPs) on non-contrast T1-weighted magnetic resonance imaging (T1WI) have been characterized as high-risk coronary plaques. We sought to elucidate whether the presence of coronary HIPs on T1WI influences fractional flow reserve (FFR) in the distal segment of the vessel.MethodsWe retrospectively analyzed 232 vessels in 190 patients with chronic stable coronary syndrome who underwent both invasive FFR measurement and coronary T1WI using a multicenter registry. The plaque-to-myocardial signal intensity ratio (PMR) of the most stenotic lesion was evaluated; a coronary plaque with PMR >1.4 was defined as a HIP.ResultsThe median PMR of coronary plaques on T1WI in vessels with FFR ≤0.80 was significantly higher than that of plaques with FFR >0.80 (1.18 [interquartile range (IQR): 0.96–1.45] vs. 0.97 [IQR: 0.85–1.12]; p<0.001)). Multivariable analysis showed that an increase in PMR of the most stenotic segment is associated with lower FFR (beta-coefficient, –0.051; p<0.001). The presence of coronary HIPs was an independent predictor of FFR ≤0.80 (odds ratio, 5.54; 95% confidence interval, 1.50–20.5; p=0.010).ConclusionsCoronary plaques with high PMR are associated with low FFR in the corresponding vessel, indicating that plaque morphology might influence the degree of myocardial ischemia.Trial registrationUMIN 000029246Clinical PerspectiveWhat is new?Incremental of coronary plaque to myocardial signal intensity ratio on T1-weithted magnetic resonance imaging (T1WI), which is represented as instability of coronary plaques was associated with low factional flow reserve (FFR) value in patients with chronic coronary syndrome (CCS).The presence of a coronary high-intensity plaque (HIP) detected with T1WI is a strong predictor of low fractional flow reserve (FFR) even after adjusting age, gender, proximal left anterior descending artery, the severity of stenosis in the most stenotic lesion and variables related to plaque volume evaluated on computed tomography angiography.What are the clinical implications?Non-contrast T1WI without contrast media is an anatomy-based, but not ischemia-based, screening method for predicting future coronary events.The presence of a coronary HIP on T1WI, which represents a complicated atheroma, is an additional determinant of coronary physiology.
Tetherin restricts SARS-CoV-2 replication despite antagonistic effects of Spike and ORF7a
Authors: Hagelauer Elena , Lotke Rishikesh , Kmiec Dorota , Hu Dan , Hohner Mirjam , Stopper Sophie , Layer Mirjam , Nchioua Rayhane , Kirchhoff Frank , Sauter Daniel , Schindler Michael 
Published: August 2023

ABSTRACTSARS-CoV-2 infection induces interferon-stimulated genes, one of which encodes Tetherin, a transmembrane protein inhibiting the release of various enveloped viruses from infected cells. Previous studies revealed that SARS-CoV encodes two Tetherin antagonists: the Spike protein (S) inducing lysosomal degradation of Tetherin, and ORF7a altering its glycosylation. SARS-CoV-2 ORF7a has also been shown to antagonize Tetherin. Therefore, we here investigated whether SARS-CoV-2 S is also a Tetherin antagonist and compared the abilities and mechanisms of S and ORF7a in counteracting Tetherin. SARS-CoV and SARS-CoV-2 S reduced Tetherin cell surface levels in a cell type-dependent manner, possibly related to the basal protein levels of Tetherin. In HEK293T cells, under conditions of high exogenous Tetherin expression, SARS-CoV-2 S and ORF7a reduced total Tetherin levels much more efficiently than the respective counterparts derived from SARS-CoV. Nevertheless, ORF7a from both strains was able to alter Tetherin glycosylation. The ability to decrease total protein levels of Tetherin was conserved among S proteins from different SARS-CoV-2 variants (D614G, Cluster 5, α, γ, δ, ο). While SARS-CoV-2 S and ORF7a both colocalized with Tetherin, only ORF7a directly interacted with the restriction factor. Despite the presence of two Tetherin antagonists, however, SARS-CoV-2 replication in Caco-2 cells was further enhanced upon Tetherin knockout. Altogether, our data show that endogenous Tetherin restricts SARS-CoV-2 replication, and that the antiviral activity of Tetherin is partially counteracted by two viral antagonists with differential and complementary modes of action, S and ORF7a.IMPORTANCEViruses have adopted multiple strategies to cope with innate antiviral immunity. They blunt signaling and encode proteins that counteract antiviral host factors. One such factor is Tetherin, that tethers nascent virions to the cell membrane and interferes with virus release. For SARS-CoV, the viral glycoprotein Spike (S) and the accessory protein ORF7a are Tetherin antagonists. For pandemic SARS-CoV-2, such activity has only been shown for ORF7a. We therefore analyzed whether SARS-CoV-2 S is a Tetherin-counteracting protein and whether there are differences in the abilities of the viral proteins to antagonize Tetherin. Of note, the efficiency of Tetherin antagonism was more pronounced for S and ORF7a from SARS-CoV-2 compared to their SARS-CoV orthologs. Still, Tetherin was able to restrict SARS-CoV-2 replication. Our results highlight the fundamental importance of the innate immune response in the context of SARS-CoV-2 control and the evolutionary pressure on pathogenic viruses to withhold efficient Tetherin antagonism.