bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Admission Glucose and Outcomes After Endovascular Treatment for Acute Stroke: Data From the ANGEL-ACT Registry
Authors: Wang Xinyan , Liang Fa , Wu Youxuan , Jia Baixue , Zhang Yijun , Jian Minyu , Liu Haiyang , Wang Anxin , Han Ruquan , Miao Zhongrong 
Published: August 2023

Background:
The association between admission glucose levels and clinical outcomes after stroke has not been effectively elucidated. This study assessed the association among admission glucose levels, admission hyperglycemia, diabetes mellitus, and 90-day neurological outcomes in patients with acute ischemic stroke undergoing endovascular therapy.

Methods:
The ANGEL-ACT registry enrolled adults with acute ischemic stroke undergoing endovascular therapy between 2017 and 2019 in China and patients with available admission glucose data were included. Restricted cubic spline regression was used to determine the knots of blood glucose levels. Binary or ordinal logistic regression models were used to examine the impact of different admission glucose levels on neurological outcomes and 90-day mortality.

Results:
In total, 1684 participants with available admission glucose concentrations were evaluated. The admission glucose level was divided into 4 levels according to the restricted cubic spline curves: level 1 (<5.3 mmol/L), level 2 (5.3 to 7.0 mmol/L), level 3 (7.0 to 11.6 mmol/L), and level 4 (≥11.6 mmol/L). Level 4 admission glucose was associated with a decreased incidence of a modified Rankin scale score of 0 to 2 (hazard ratio, 0.59; 95% CI, 0.40-0.87) and an increased risk of mortality (hazard ratio, 1.74; 95% CI, 1.06-2.85). Levels 3 and 4, hyperglycemia, and diabetes mellitus independently predicted symptomatic intracranial hemorrhage (sICH). Admission glucose levels showed J-shaped relationships with sICH.

Conclusions:
Higher admission glucose levels (≥11.6 mmol/L) were associated with a decreased likelihood of a modified Rankin scale score of 0 to 2 and an increased risk of mortality and sICH.
Are Patients With an International Classification of Diseases, 10th Edition Discharge Diagnosis Code for Sepsis Different in Regard to Demographics and Outcome Variables When Comparing Those With Sepsis Only to Those Also Diagnosed With COVID-19 or Those With a COVID-19 Diagnosis Alone?
Authors: Gaieski David F. , Tsukuda Jumpei , Maddox Parker , Li Michael 
Published: August 2023

OBJECTIVES:
We analyzed whether patients with the International Classification of Diseases, 10th Edition (ICD-10) discharge diagnosis code for sepsis are different in regard to demographics and outcome variables when comparing those with sepsis only to those also diagnosed with COVID-19 or those with a COVID-19 diagnosis alone.

DESIGN:
Retrospective cohort study.

SETTING:
Nine hospitals in an academic health system.

PATIENTS:
Patients with a final ICD-10 discharge diagnostic code for sepsis only, a diagnosis of COVID-19-only, or a final sepsis ICD-10 discharge code + a diagnosis of COVID-19 admitted to the hospital were analyzed for demographic and outcome differences between the cohorts.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A total of 11,395 patients met inclusion criteria: 6,945 patients (60.9%) were ICD-10 sepsis code only, 3,294 patients (28.9%) were COVID-19 diagnosis-only, and 1,153 patients (10.1%) were sepsis ICD-10 code + COVID-19 diagnosis. Comparing sepsis ICD-10 code + COVID-19 diagnosis patients to sepsis ICD-10 code only and COVID-19 diagnosis-only patients, the sepsis ICD-10 code + COVID-19 diagnosis patients were: older (69 [58–78] vs 67 [56–77] vs 64 [51–76] yr), less likely to be female (40.3% vs 46.7% vs 49.5%), more frequently admitted to the ICU (59.3% [684/1,153] vs 54.9% [1,810/3,297] vs 15% [1,042/6,945]), more frequently required ventilatory support (39.3% [453/1,153] vs 31.8% [1,049/3,297] vs 6.0% [417/6,945]), had longer median hospital length of stay (9 [5,16] vs 5 [3,8] vs 7. [4,13] d), and were more likely to die in the hospital (39.2% [452/1,153] vs 22.3% [735/3,297] vs 6.4% [444/6,945]).

CONCLUSIONS:
During the COVID-19 pandemic the sickest cohort of patients was those receiving an explicit ICD-10 code of sepsis + a COVID-19 diagnosis. A significant percentage of COVID-19 diagnosis-only patients appear to have been under-coded as they received a level of critical care (ICU admission; intubation) suggestive of the presence of acute organ dysfunction during their admission.
Facilitators and Barriers to Interacting With Clinical Decision Support in the ICU: A Mixed-Methods Approach
Authors: Wong Adrian , Berenbrok Lucas A. , Snader Lauren , Soh Yu Hyeon , Kumar Vishakha K. , Javed Muhammad Ali , Bates David W. , Sorce Lauren R. , Kane-Gill Sandra L. 
Published: August 2023

OBJECTIVES:
Clinical decision support systems (CDSSs) are used in various aspects of healthcare to improve clinical decision-making, including in the ICU. However, there is growing evidence that CDSS are not used to their full potential, often resulting in alert fatigue which has been associated with patient harm. Clinicians in the ICU may be more vulnerable to desensitization of alerts than clinicians in less urgent parts of the hospital. We evaluated facilitators and barriers to appropriate CDSS interaction and provide methods to improve currently available CDSS in the ICU.

DESIGN:
Sequential explanatory mixed-methods study design, using the BEhavior and Acceptance fRamework.

SETTING:
International survey study.

PATIENT/SUBJECTS:
Clinicians (pharmacists, physicians) identified via survey, with recent experience with clinical decision support.

INTERVENTIONS:
An initial survey was developed to evaluate clinician perspectives on their interactions with CDSS. A subsequent in-depth interview was developed to further evaluate clinician (pharmacist, physician) beliefs and behaviors about CDSS. These interviews were then qualitatively analyzed to determine themes of facilitators and barriers with CDSS interactions.

MEASUREMENTS AND MAIN RESULTS:
A total of 48 respondents completed the initial survey (estimated response rate 15.5%). The majority believed that responding to CDSS alerts was part of their job (75%) but felt they experienced alert fatigue (56.5%). In the qualitative analysis, a total of five facilitators (patient safety, ease of response, specificity, prioritization, and feedback) and four barriers (excess quantity, work environment, difficulty in response, and irrelevance) were identified from the in-depth interviews.

CONCLUSIONS:
In this mixed-methods survey, we identified areas that institutions should focus on to improve appropriate clinician interactions with CDSS, specific to the ICU. Tailoring of CDSS to the ICU may lead to improvement in CDSS and subsequent improved patient safety outcomes.
Characteristics of Long-Stay Patients in a PICU and Healthcare Resource Utilization After Discharge
Authors: Boerman Gerharda H. , Haspels Heleen N. , de Hoog Matthijs , Joosten Koen F. 
Published: August 2023

OBJECTIVES:
To examine the characteristics of long-stay patients (LSPs) admitted to a PICU and to investigate discharge characteristics of medical complexity among discharged LSP.

DESIGN:
We performed a retrospective cohort study where clinical data were collected on all children admitted to our PICU between July 1, 2017, and January 1, 2020.

SETTING:
A single-center study based at Erasmus MC Sophia Children’s Hospital, a level III interdisciplinary PICU in The Netherlands, providing all pediatric and surgical subspecialties.

PATIENTS:
LSP was defined as those admitted for at least 28 consecutive days.

INTERVENTIONS:
None.

MEASUREMENTS:
Length of PICU stay, diagnosis at admission, length of mechanical ventilation, need for extracorporeal membrane oxygenation, mortality, discharge location after PICU and hospital admission, medical technical support, medication use, and involvement of allied healthcare professionals after hospital discharge.

MAIN RESULTS:
LSP represented a small proportion of total PICU patients (108 patients; 3.2%) but consumed 33% of the total admission days, 47% of all days on extracorporeal membrane oxygenation, and 38% of all days on mechanical ventilation. After discharge, most LSP could be classified as children with medical complexity (CMC) (76%); all patients received discharge medications (median 5.5; range 2–19), most patients suffered from a chronic disease (89%), leaving the hospital with one or more technological devices (82%) and required allied healthcare professional involvement after discharge (93%).

CONCLUSIONS:
LSP consumes a considerable amount of resources in the PICU and its impact extends beyond the point of PICU discharge since the majority are CMC. This indicates complex care needs at home, high family needs, and a high burden on the healthcare system across hospital borders.
Precision medicine in extended adjuvant endocrine therapy for breast cancer
Authors: Tesch Megan E. 
Published: August 2023

Purpose of review
In this review, the evolving role of currently available genomic assays for hormone receptor-positive, early-stage breast cancer in the selection of patients for extended adjuvant endocrine therapy will be discussed.

Recent findings
Several studies have investigated the prognostic performance of the Oncotype DX, Breast Cancer Index (BCI), Prosigna, and EndoPredict genomic assays in the late recurrence setting (>5 years after diagnosis), beyond standardly used clinicopathologic parameters, with mixed results. Recently, BCI has also been validated to predict the likelihood of benefit from extended endocrine therapy, though certain data limitations may need to be addressed to justify routine use in clinical practice.

Summary
Even after 5 years of adjuvant endocrine therapy, patients with hormone receptor-positive breast cancer have a significant risk for late recurrence, including distant metastases, that might be prevented with longer durations of endocrine therapy. However, the added toxicity and variable benefit derived from extended endocrine therapy make optimal patient selection crucial. Genomic assays are in development to risk-stratify patients for late recurrence and determine efficacy of extended endocrine therapy, with the aim to help guide extended endocrine therapy decisions for clinicians and individualize treatment strategies for patients.
Reconstitution of double-negative T cells after cord blood transplantation and its predictive value for acute graft-versus-host disease
Authors: Pan Tianzhong , Ding Peng , Huang Aijie , Tang Baolin , Song Kaidi , Sun Guangyu , Wu Yue , Yang Shiying , Chen Xingchi , Wang Dongyao , Zhu Xiaoyu 
Published: August 2023

Abstract

Background:
With an increasing number of patients with hematological malignancies being treated with umbilical cord blood transplantation (UCBT), the correlation between immune reconstitution (IR) after UCBT and graft-versus-host disease (GVHD) has been reported successively, but reports on double-negative T (DNT) cell reconstitution and its association with acute GVHD (aGVHD) after UCBT are lacking.

Methods:
A population-based observational study was conducted among 131 patients with hematological malignancies who underwent single-unit UCBT as their first transplant at the Department of Hematology, the First Affiliated Hospital of USTC, between August 2018 and June 2021. IR differences were compared between the patients with and without aGVHD.

Results:
The absolute number of DNT cells in the healthy Chinese population was 109 (70–157)/μL, accounting for 5.82 (3.98–8.19)% of lymphocytes. DNT cells showed delayed recovery and could not reach their normal levels even one year after transplantation. Importantly, the absolute number and percentage of DNT cells were significantly higher in UCBT patients without aGVHD than in those with aGVHD within one year (F = 4.684, P = 0.039 and F = 5.583, P = 0.026, respectively). In addition, the number of DNT cells in the first month after transplantation decreased significantly with the degree of aGVHD increased, and faster DNT cell reconstitution in the first month after UCBT was an independent protective factor for aGVHD (HR = 0.46, 95% confidence interval [CI]: 0.23–0.93; P = 0.031).

Conclusions:
Compared to the number of DNT cells in Chinese healthy people, the reconstitution of DNT cells in adults with hematological malignancies after UCBT was slow. In addition, the faster reconstitution of DNT cells in the early stage after transplantation was associated with a lower incidence of aGVHD.
Medications for alcohol use disorder promote abstinence in alcohol-associated cirrhosis: Results from a systematic review and meta-analysis
Authors: Gratacós-Ginès Jordi , Bruguera Pol , Pérez-Guasch Martina , López-Lazcano Ana , Borràs Roger , Hernández-Évole Helena , Pons-Cabrera Maria T. , Lligoña Anna , Bataller Ramón , Ginès Pere , López-Pelayo Hugo , Pose Elisa 
Published: August 2023

Background and Aims:
The role of medications for alcohol use disorder (MAUD) in patients with cirrhosis is not well established. Evidence on the efficacy and safety of these drugs in these patients is scarce.

Approach and Results:
We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol guidelines on the efficacy of MAUD in patients with cirrhosis. A search was conducted in PubMed, Embase, and Scopus, including all studies until May 2022. The population was defined as patients with AUD and cirrhosis. The primary outcome was alcohol abstinence. Safety was a secondary outcome. We performed a random-effect analysis and expressed the results as relative risk of alcohol consumption. Heterogeneity was measured by I
2. Out of 4095 unique references, 8 studies on 4 different AUD treatments [baclofen (n = 6), metadoxine (n = 1), acamprosate (n = 1), and fecal microbiota transplant (n = 1)] in a total of 794 patients were included. Four were cohort studies, and 4 were RCTs. Only RCTs were included in the meta-analysis. MAUD was associated with a reduced rate of alcohol consumption [relative risk = 0.68 (CI: 0.48–0.97), P = 0.03], increasing alcohol abstinence by 32% compared to placebo or standard treatment, despite high heterogeneity (I
2 = 67%). Regarding safety, out of 165 serious adverse events in patients treated with MAUD, only 5 (3%) were possibly or probably related to study medications.

Conclusion:
MAUD in patients with cirrhosis is effective in promoting alcohol abstinence and has a good safety profile. Larger studies on the effects of MAUD are needed, especially in patients with advanced liver disease.
Impact of PNPLA3 I148M on alpha-1 antitrypsin deficiency-dependent liver disease progression
Authors: Volkert Ines , Fromme Malin , Schneider Carolin , Candels Lena , Lindhauer Cecilia , Su Huan , Thorhauge Katrine , Pons Monica , Mohamed Mohamed Ramadan , Schneider Kai Markus , Strnad Pavel , Trautwein Christian 
Published: August 2023

Background and Aims:
Genetic risk factors are major determinants of chronic liver disease (CLD) progression. Patatin-like phospholipase domain-containing protein 3 (PNPLA3) I148M polymorphism and alpha-1 antitrypsin (AAT) E342K variant, termed PiZ, are major modifiers of metabolic CLD. Both variants are known to affect metabolic CLD through increased endoplasmic reticulum stress, but their combined effect on CLD progression remains largely unknown. Here, we aimed to test our working hypothesis that their combined incidence triggers CLD disease progression.

Approach and Results:
We showed that patients with PiZZ/PNPLA3I148M from the European alpha-1-antitrypsin deficiency (AATD) liver consortium and the UK Biobank had a trend towards higher liver enzymes, but no increased liver fat accumulation was evident between subgroups. After generating transgenic mice that overexpress the PiZ variant and simultaneously harbor the PNPLA3I148M knockin (designated as PiZ/PNPLA3I148M), we observed that animals with PiZ and PiZ/PNPLA3I148M showed increased liver enzymes compared to controls during aging. However, no significant difference between PiZ and PiZ/PNPLA3I148M groups was observed, with no increased liver fat accumulation over time. To further study the impact on CLD progression, a Western-styled diet was administered, which resulted in increased fat accumulation and fibrosis in PiZ and PiZ/PNPLA3I148M livers compared to controls, but the additional presence of PNPLA3I148M had no impact on liver phenotype. Notably, the PiZ variant protected PNPLA3I148M mice from liver damage and obesity after Western-styled diet feeding.

Conclusion:
Our results demonstrate that the PNPLA3 polymorphism in the absence of additional metabolic risk factors is insufficient to drive the development of advanced liver disease in severe AATD.
Hepatocellular carcinoma reduced, HBsAg loss increased, and survival improved after finite therapy in hepatitis B patients with cirrhosis
Authors: Jeng Wen-Juei , Chien Rong-Nan , Chen Yi-Cheng , Lin Chih-Lang , Wu Chia-Ying , Liu Yen-Chun , Peng Chien-Wei , Su Chung-Wei , Hsu Cheng-Er , Liaw Yun-Fan 
Published: August 2023

Background and Aims:
Long-term nucleos(t)ide analog (Nuc) treatment can reduce HCC in patients with HBV-related liver cirrhosis (HBV-LC). Earlier small cohort studies showed a comparable 5-year incidence of HCC in HBeAg-negative patients with HBV-LC who stopped and those continued Nuc therapy. This study aimed to validate these findings using a large cohort with 10-year follow-up.

Approach and Results:
From 2 centers, 494 HBeAg-negative patients with HBV-LC who stopped (finite group) and 593 who continued (continuous group) Nuc therapy were recruited. HCC, HBsAg loss, liver-related mortality/transplantation, and overall survival rates were compared between 2 groups with 1:1 propensity score matching of sex, treatment history, types of Nuc, age, transaminases, platelet count, and HBsAg levels at end of therapy in finite group or 3-year on-therapy in continuous groups. During a median follow-up of 6.2 (3.4–8.9) years, the annual and 10-year HCC incidence were lower in finite group (1.6 vs. 3.3%/y and 10-y 15.7% vs. 26.8%, respectively; log-rank test, p<0.0001). The finite group showed greater HBsAg decline/year (−0.116 vs. −0.095 log10 IU/mL, p=0.0026) and 7.6 times higher 10-year incidence of HBsAg loss (22.7% vs. 3%, p<0.0001). Multivariate Cox regression showed finite therapy an independent factor for HBsAg loss (adjusted HR: 11.79) but protective against HCC (adjusted HR: 0.593), liver-related mortality/transplantation (adjusted HR: 0.312), and overall mortality (adjusted HR: 0.382).

Conclusions:
Finite Nuc therapy in HBeAg-negative HBV-LC may reduce HCC incidence, increase HBsAg loss, and improve survival. Greater HBsAg decline/loss may reflect enhanced immunity and contribute to the reduction of hepatic carcinogenesis.
Review of Toxocariasis at a Children’s Hospital Prompting Need for Public Health Interventions
Authors: Fortini Mary B. , Erickson Timothy A. , Leining Lauren M. , Robinson Karina M. , Carey Megan N. , Smith Sarah J. , Sullivan Brendan , Nelson Alisa R. , Gunter Sarah M. , Weatherhead Jill E. 
Published: August 2023

Background:
Toxocariasis, caused the by dog and cat roundworm, is one of the most common zoonotic helminth infections in the United States and can lead to severe lifelong morbidity in children. Although historical seroprevalence studies have identified a high frequency of toxocariasis regionally in the United States, there are few studies linking epidemiology and clinical disease in children. The study objective was to examine the contemporary epidemiology of pediatric toxocariasis within an endemic US region.

Methods:
We conducted an epidemiologic study analyzing children diagnosed with toxocariasis presenting to a tertiary pediatric hospital in Texas from 2010 to 2021. We examined risk factors and performed a geospatial analysis, including a comparative analysis of human cases and locations of surrendered infected stray animals in the same region.

Results:
Children diagnosed with toxocariasis were most commonly of Hispanic/Latino ethnicity (30/46; 65%), white race (41/45; 91%) and receiving Medicaid (34/44, 77%). Many infected children had contact with dogs or cats. Ocular toxocariasis was associated with a lack of peripheral eosinophilia (P < 0.001). No other Toxocara syndromes were associated with defined absolute eosinophil count levels. Post-treatment resolution of eosinophilia was variable, ranging from 1 to 172 weeks. A Toxocara hotspot was identified in northeast Houston, comprising one of the lowest median household incomes in the region.

Conclusions:
Toxocariasis is a devastating zoonotic infection in children living in the US. As it is not a reportable disease, the true burden remains unknown. It is critical to increase awareness of toxocariasis to direct public health interventions and ultimately reduce Toxocara-induced morbidity in US children.
DNA N6-methyladenine methylase N6AMT1 controls neuropathic pain through epigenetically modifying Kcnj16 in dorsal horn neurons
Authors: Zhou Hui-Min , Xu Heng-Jun , Sun Run-Hang , Zhang Ming , Li Xiao-Tong , Zhao Ya-Xuan , Yang Kehui , Wei Runa , Liu Qiaoqiao , Li Siyuan , Xue Zhouya , Hao Ling-Yun , Yang Li , Wang Qi-Hui , Wang Hong-Jun , Gao Fang , Cao Jun-Li , Pan Zhiqiang 
Published: August 2023

Abstract
Nerve injury–induced aberrant changes in gene expression in spinal dorsal horn neurons are critical for the genesis of neuropathic pain. N6-methyladenine (m6A) modification of DNA represents an additional layer of gene regulation. Here, we report that peripheral nerve injury significantly decreased the level of m6A-specific DNA methyltransferase 1 (N6amt1) in dorsal horn neurons. This decrease was attributed, at least partly, to a reduction in transcription factor Nr2f6. Rescuing the decrease in N6amt1 reversed the loss of m6A at the promoter for inwardly rectifying potassium channel subfamily J member 16 (Kcnj16), mitigating the nerve injury–induced upregulation of Kcnj16 expression in the dorsal horn and alleviating neuropathic pain hypersensitivities. Conversely, mimicking the downregulation of N6amt1 in naive mice erased DNA m6A at the Kcnj16 promoter, elevated Kcnj16 expression, and led to neuropathic pain–like behaviors. Therefore, decreased N6amt1 caused by NR2F6 is required for neuropathic pain, likely through its regulation of m6A-controlled KCNJ16 in dorsal horn neurons, suggesting that DNA m6A modification may be a potential new target for analgesic and treatment strategies.
Association of Work-Related Sedentary Behavior With Mental Health and Work Engagement Among Japanese White- and Blue-Collar Workers
Authors: Sakakibara Keiko , Miyanaka Daisuke , Tokita Masahito , Kawada Michiko , Mori Naana , Hamsyah Fuad , Lin Yuheng , Shimazu Akihito 
Published: August 2023

Objective
This study investigated the association of work-related sedentary behavior with mental health and work engagement among white- and blue-collar workers.

Methods
An Internet survey was conducted among 1600 workers aged 20 to 59 years. A total of 1213 valid responses were analyzed to examine the association of work-related sedentary behavior with mental health and work engagement.

Results
Higher level of occupational sedentary behavior significantly associated with poorer mental health and lower work engagement among white-collar workers. Considering the effect of occupation, association of sedentary behavior with mental health disappeared, whereas association with work engagement remained for white-collar workers.

Conclusions
Our result suggested the importance of decreasing work-related sedentary behavior for enhancing work engagement regardless of the occupation for white-collar workers. Further study is needed to confirm the association between these variables for blue-collar workers.