bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pop‐up screening nested within routine community activities unmasks an addressed cardiovascular risk: A pilot study (Gippsland Healthy Heart Study)
Authors: Fujino Masashi , Butters Julie , Boyes Mark , Duncan Noel , Streets Fleur , Sabatini Amy , Herschtal Alan , Nelson Adam J. , Nicholls Stephen J. 
Published: September 2023

AbstractObjectiveTo evaluate the benefits of a pop‐up health screening for cardiovascular risk factors (CVRF) in the Gippsland region, and to assess the acceptability of the screening and to determine whether such a process results in attendance at a general practitioner (GP).ParticipantsOverall, 454 participants over the age of 18 who were residents of the Gippsland region were enrolled.MethodsThis is a community‐based, observational, prospective cohort study using pop‐up screening sites at six retail locations or workplaces, where participants' blood pressure, body weight and lipid profile were measured. The primary outcome was to assess the proportion of participants with at least one unaddressed CVRF (hypertension [blood pressure >140/90 mmHg], overweight and obesity [body mass index >25 kg/m2] or hypercholesterolaemia [low‐density lipoprotein cholesterol >2.5 mmol/L]). Email surveys were performed after 4 weeks of follow‐up.ResultsOverall, 85.8% (95% confidence interval [CI], 82.1%–88.8%) of participants had at least one unaddressed CVRF. Among the 54 participants who responded to the email survey, 50 participants (92.6% [95% CI, 81.3%–97.6%]) found the screening approach acceptable, and 31 (57.4% [95% CI, 43.3%–70.5%]) considered a discussion with the GP.ConclusionsThis study supported the feasibility and effectiveness of pop‐up screening to detect CVRF in rural communities.
Universal cervical length screening for preterm birth is not useful after 24 weeks of gestation
Authors: Seravalli Viola , Abati Isabella , Strambi Noemi , Tofani Lorenzo , Tucci Claudia , Tartarotti Enrico , Di Tommaso Mariarosaria 
Published: September 2023

AbstractIntroductionCervical length measurement using transvaginal sonography at 18+0–24+0 weeks of gestation is used to identify women at risk of preterm delivery, who may benefit from treatment with progesterone to prevent premature birth. Few and conflicting data exist regarding the predictive value of cervical length measurement performed at later gestational ages. The primary objective of this study was to evaluate the predictive accuracy for spontaneous preterm birth of a single cervical length measurement performed between 24 and 32 weeks of gestation in asymptomatic singleton pregnancies at low risk for spontaneous preterm birth. The secondary objective was to test the predictive accuracy of different cervical length thresholds in the same population.Material and methodsThis was a historical cohort study conducted in a tertiary referral hospital. A total of 2728 asymptomatic women with singleton pregnancy at low risk for spontaneous preterm birth were recruited. Of these women, 1548 had cervical length measured at 24+0–27+6 weeks of gestation and 2191 women at 28+0–32+0 weeks. In all, 1010 women were present in both gestational age windows. Maternal demographics, medical and obstetrical history, and pregnancy outcome were reviewed. The predictive value of cervical length for spontaneous preterm birth was evaluated through logistic regression analysis. Results were adjusted for confounding factors.ResultsOverall, spontaneous preterm birth occurred in 53/2728 women (1.9%). In both the 24+0–27+6 and 28+0–32+0 weeks groups, a shorter cervical length was significantly associated with spontaneous preterm birth (p < 0.01), but it had a low predictive value, as shown by the receiver operating characteristics curve analysis (areas under the curve 0.62, 95% CI 0.50–0.74 for the 24+0–27+6 weeks group, and 0.61, 95% CI 0.52–0.70 in the 28+0–32+0 weeks group). When the predictive accuracy for preterm delivery of different cervical length cut‐offs was evaluated, the sensitivity and positive predictive value were low in both gestational age windows, irrespective of the threshold used.ConclusionsIn asymptomatic women with singleton pregnancy at low risk for spontaneous preterm birth, the predictive value of cervical length after 24+0 weeks of gestation is low. Therefore, cervical length screening in these women should be discouraged.
Complement in immune thrombocytopenia (ITP): The role of complement in refractory ITP
Authors: Weitz Ilene Ceil , Liebman Howard Allen 
Published: September 2023

SummaryImmune thrombocytopenia (ITP) is a disorder characterized by low platelets due to increased clearance and decreased platelet production. While ITP has been characterized as an acquired disorder of the adaptive immune system, the resulting platelet autoantibodies provide ancillary links to the innate immune system via antibody interaction with the complement system. Most autoantibodies in patients with ITP are of the IgG1 subclass, which can be potent activators of the classical complement pathway. Antibody‐coated platelets can initiate complement activation via the classical pathway leading to both direct platelet destruction and enhanced clearance of C3b‐coated platelets by complement receptors. Similar autoantibody interactions with bone marrow megakaryocytes can also result in complement injury and ineffective thrombopoiesis. The development of novel therapeutic complement inhibitors has revived interest in the role of complement in autoantibody‐mediated disorders, such as ITP. A recent early‐phase clinical trial of a classical complement pathway inhibitor has demonstrated efficacy in a subset of ITP patients refractory to conventional immune modulation. In this review, we will analyse the role of complement in refractory ITP.
Immunomodulation with romiplostim as a second‐line strategy in primary immune thrombocytopenia: The iROM study
Authors: Schifferli Alexandra , Rüfer Axel , Rovo Alicia , Nimmerjahn Falk , Cantoni Nathan , Holbro Andreas , Favre Geneviève , Dirks Jan , Wieland Anna , Faeth Heike , Pereira Renata , Kühne Thomas 
Published: September 2023

SummaryThrombopoietin receptor agonists (TPO‐RAs) stimulate platelet production, which might restore immunological tolerance in primary immune thrombocytopenia (ITP). The iROM study investigated romiplostim's immunomodulatory effects. Thirteen patients (median age, 31 years) who previously received first‐line treatment received romiplostim for 22 weeks, followed by monitoring until week 52. In addition to immunological data, secondary end‐points included the sustained remission off‐treatment (SROT) rate at 1 year, romiplostim dose, platelet count and bleedings. Scheduled discontinuation of romiplostim and SROT were achieved in six patients with newly diagnosed ITP, whereas the remaining seven patients relapsed. Romiplostim dose titration was lower and platelet count response was stronger in patients with SROT than in relapsed patients. In all patients, regulatory T lymphocyte (Treg) counts increased until study completion and the counts were higher in patients with SROT. Interleukin (IL)‐4, IL‐9 and IL‐17F levels decreased significantly in all patients. FOXP3 (Treg), GATA3 (Th2) mRNA expression and transforming growth factor‐β levels increased in patients with SROT. Treatment with romiplostim modulates the immune system and possibly influences ITP prognosis. A rapid increase in platelet counts is likely important for inducing immune tolerance. Better outcomes might be achieved at an early stage of autoimmunity, but clinical studies are needed for confirmation.
Novel therapeutics and future directions for refractory immune thrombocytopenia
Authors: Al‐Samkari Hanny , Neufeld Ellis J. 
Published: September 2023

SummaryImmune thrombocytopenia (ITP) is an autoimmune bleeding disorder affecting approximately 1 in 20 000 people. While most patients with ITP are successfully managed with the current set of standard and approved therapeutics, patients who cannot be adequately managed with these therapies, considered to have refractory ITP, are not uncommon. Therefore, there remains an ongoing need for novel therapeutics and drug development in ITP. Several agents exploiting novel targets and mechanisms in ITP are presently under clinical development, with trials primarily recruiting heavily pretreated patients and those with otherwise refractory disease. Such agents include the neonatal Fc receptor antagonist efgartigimod, the Bruton tyrosine kinase inhibitor rilzabrutinib, the complement inhibitors sutimlimab and iptacopan and anti‐CD38 monoclonal antibodies such as daratumumab and mezagitamab, among others. Each of these agents exploits therapeutic targets or other aspects of ITP pathophysiology currently not targeted by the existing approved agents (thrombopoietin receptor agonists and fostamatinib). This manuscript offers an in‐depth review of the current available data for novel therapeutics in ITP presently undergoing phase 2 or 3 studies in patients with heavily pretreated or refractory ITP. It additionally highlights the future directions for drug development in refractory ITP, including discussion of innovative clinical trial designs, health‐related quality of life as an indispensable clinical trial end‐point and balancing potential toxicities of drugs with their potential benefits in a bleeding disorder in which few patients suffer life‐threatening bleeding.
Chronic refractory immune thrombocytopenia in adolescents and young adults
Authors: Schifferli Alexandra , Le Gavrian Gautier , Aladjidi Nathalie , Moulis Guillaume , Godeau Bertrand , Kühne Thomas 
Published: September 2023

SummaryDefining immune thrombocytopenia (ITP) in two age groups—children and adults—overlooks the specific clinical features and needs of adolescents and young adults (AYAS). We previously reported a high risk of chronic disease at 12 months (50%); however, data on the course of chronic ITP, the risk of refractoriness and treatment strategies in AYAS are limited. Data from patients aged 12–25 years with chronic primary ITP at 12 months were extracted from three large registries between 2004 and 2021. Clinical and laboratory data were evaluated until 48 months of follow‐up (FU). Refractory ITP was defined as the administration of ≥3 different lines of therapy. A total of 427 AYAS (64% female) with chronic ITP were included. Overall, 7% and 14% were classified as ‘refractory’ at 12 and 48 months of FU respectively. The proportion of males was greater in the refractory group than in the non‐refractory group (43% vs. 35%). AYAS with refractory disease displayed lower median platelet counts, more bleeding and a higher need for treatment at initial diagnosis and FU than non‐refractory patients. This study reveals that refractory ITP is uncommon in AYAS; however, AYAS with refractory ITP display a high disease burden at all time points, including at initial diagnosis.
Early child development and its determinants: Findings from a large cohort of healthy children growing up in a low‐risk environment
Authors: Kappelt Jonas , Meigen Christof , Schild Clara Elise , Kiess Wieland , Poulain Tanja 
Published: September 2023

AbstractBackgroundDespite numerous studies on early child development, there is still much to be discovered about the significance of possible risk factors. This study examines cognitive, motor, and language development of healthy children growing up in a low‐risk environment and how various individual and environmental factors are associated with it. The study also considers whether the importance of particular parameters changes depending on child age.MethodsWithin the framework of the LIFE Child study in Leipzig, Germany, 481 children participated in a total of 832 visits between 1 and 36 months of age. Developmental status was assessed using the Third Edition of the Bayley Scales of Infant and Toddler Development. Linear regression analyses were applied to examine the associations between child development and sex, gestational age, birth weight, birth mode, overweight, height, and parental education.ResultsMean Bayley composite scores for cognitive, language, and motor development were close to the standard value of 100. Poorer developmental outcomes were significantly associated with lower gestational age, vacuum cup/forceps birth, being overweight, small height, and lower parental education, although some of the associations became insignificant after applying multivariate models. While the association between gestational age and language development became weaker with advancing age, our interaction models found disparities related to parental education to become more apparent in older children across all three domains of early child development.ConclusionsSeveral factors were identified to be associated with early child development. As children grow older, obstetric parameters, for example, gestational age, might become less relevant compared with sociodemographic factors, for example, parental education.
Associations between socio‐demographic characteristics of pregnant women and birth outcome: The Nutritional status of Expectant Mothers and their newborn Infants study
Authors: Jordaan Elizabeth Margaretha , Joubert Gina , Robb Liska , Ngounda Jennifer , Walsh Corinna May 
Published: September 2023

AbstractBackgroundLow socio‐economic status is associated with poor birth outcomes, however, few studies on this topic have been conducted in South Africa. We determined associations between socio‐demographic variables of pregnant women and birth outcome in their offspring.MethodsThis study was nested in a prospective cohort study conducted at an antenatal clinic at a regional hospital in Bloemfontein, South Africa. Questionnaires on socio‐demographic information were completed on 682 pregnant women in a structured interview. Post‐delivery, 331 participants provided the Road to Health Booklets for 347 infants, in which birth data were recorded. Associations between socio‐demographic variables and birth outcome (defined as premature delivery or low length‐for‐age or low weight‐for‐length at birth) were investigated. Logistic regression with backward selection (p < 0.05) was used to select independent factors that were significantly associated with birth outcome. Variables with a p‐value of <0.15 on bivariate analysis were considered for inclusion in the model.ResultsPoor birth outcome was observed in 36.3% (116/320) of women. The odds of experiencing poor birth outcome were lower for women who owned a stove versus those who did not (OR 0.11, 95% CI: 0.02–0.67), and higher for women with grade 8–10 (OR 5.84, 95% CI: 1.90–17.91) or grade 10–12 (OR 4.33, 95% CI: 1.50–12.49) as their highest level of education versus tertiary education. The odds of experiencing poor birth outcomes were also higher for those employed part‐time (OR 2.55, 95% CI: 1.10–5.93) versus full‐time and/or self‐employed.ConclusionOur findings confirm that the presence of basic amenities such as a stove, better education and employment improve the chances of better birth outcomes. Early screening of pregnant women for the identification of socio‐demographic risk factors that may impact on birth outcome is recommended.
Veridiction and juridiction in Confessions of the Flesh
Authors: Clements Niki Kasumi 
Published: September 2023

AbstractIn an archived draft at the Bibliothèque nationale de France, Foucault describes two questions haunting him since 1963: “Why are we obliged to tell the truth about ourselves? Which truth?” Foucault poses these two questions in 1980 in drafts for his lectures at the University of California, Berkeley, and I see in these two questions two argumentative threads that weave through Foucault's changing History of Sexuality series over his last decade. These two threads correspond to the dimorphism Foucault frames in Part III of Confessions of the Flesh between confessing monks and married men, that correlates with the distinction between “veridiction” and “juridiction” as two forms relating subjectivity and sexuality. To help tease out these threads, I make two recommendations for how to read Confessions of the Flesh in this following review essay: (1) situate Confessions of the Flesh in relation to Foucault's History of Sexuality series which spans his last decade from 1974 to 1984 and (2) untangle two major threads of Confessions of the Flesh in Foucault's treatment of Cassian and Augustine, as progenitors of veridiction and juridiction respectively, which together produce the conditions for modern disciplinary subjects.
Do monosymptomatic stroke patients with dizziness present a vestibular syndrome without nystagmus? An underestimated entity
Authors: Nikles Florence , Kerkeni Hassen , Zamaro Ewa , Korda Athanasia , Wagner Franca , Sauter Thomas C. , Kalla Roger , Morrison Miranda , Mantokoudis Georgios 
Published: September 2023

AbstractBackground and purposeVestibular symptoms are common in emergency department (ED) patients and have various causes, including stroke. Accurate identification of stroke in patients with vestibular symptoms is crucial for timely management. We conducted a prospective cross‐sectional study from 2015 to 2019 to determine stroke prevalence and associated symptoms in ED patients with vestibular symptoms, aiming to improve diagnosis and outcomes.MethodsAs part of the DETECT project, we screened 1647 ED patients with acute vestibular symptoms. Following a retrospective analysis of 961 head and neck magnetic resonance imaging (MRI) scans, we included 122 confirmed stroke cases and assessed them for vestibular signs and symptoms.ResultsStroke prevalence in dizzy patients was 13% (122/961 MRI scans). Most patients (95%) presented with acute vestibular symptoms with or without nystagmus, whereas 5% had episodic vestibular syndrome (EVS). Nystagmus was present in 50% of stroke patients. Eighty percent had a purely posterior circulation stroke, and nystagmus was absent in 46% of these patients. Seven patients (6%) had lesions in both the anterior and posterior circulation. Vertigo was experienced by 52% regardless of territory.ConclusionsA stroke was identified in 13% of ED patients presenting with acute vestibular symptoms. In 5%, it was EVS. Most strokes were in the posterior circulation territory; vertigo occurred with similar frequency in anterior and posterior circulation stroke, and absence of nystagmus was common in both.
Frailty is associated with the clinical expression of neuropsychological deficits in older adults
Authors: Canevelli Marco , Wallace Lindsay M. K. , Bruno Giuseppe , Cesari Matteo , Rockwood Kenneth , Ward David D. 
Published: September 2023

AbstractBackground and purposeThe aim was to determine whether frailty is associated with the relationship between neuropsychological markers and global cognition in older adults.MethodsCross‐sectional analyzes were conducted of baseline data from three large cohort studies: National Alzheimer's Coordinating Center (NACC), Rush Memory and Aging Project (MAP) and Alzheimer's Disease Neuroimaging Initiative (ADNI). Studies recruited North American participants along the spectrum of cognitive functioning (44% no cognitive impairment at baseline). A frailty index was computed in each dataset. Frailty indices, neuropsychological tests (including measures of processing speed, episodic, semantic and working memory) and Mini‐Mental State Examination (MMSE) scores were the variables of interest, with age, sex, education and apolipoprotein E ε4 evaluated as confounders.ResultsAcross all studies, 23,819 participants aged 55–104 (57% female) were included in analyzes. Frailty index scores were significantly and inversely associated with MMSE scores and significantly moderated relationships between neuropsychological test scores and MMSE scores. In participants with higher frailty index scores, lower neuropsychological test scores were more strongly associated with lower MMSE scores (standardized interaction coefficients ranged from −0.19 to −1.17 in NACC, −0.03 to −2.27 in MAP and −0.04 to −0.38 in ADNI, depending on the neuropsychological test). These associations were consistent across the different databases and were mostly independent of the composition of frailty indices (i.e., after excluding possible symptoms of dementia).ConclusionsAmongst older Americans, frailty is associated with the cognitive expression of neuropsychological deficits. Implementation of frailty assessment in routine neurological and neuropsychological practice should be considered to optimize care outcomes for older adults.
Predicting mild cognitive impairment in older adults: A machine learning analysis of the Alzheimer's Disease Neuroimaging Initiative
Authors: Wu Yafei , Wang Xing , Fang Ya 
Published: September 2023

AimMild cognitive impairment (MCI) in older adults is potentially devastating, but an accurate prediction model is still lacking. We hypothesized that neuropsychological tests and MRI‐related markers could predict the onset of MCI early.MethodsWe analyzed data from 306 older adults who were cognitive normal (CN) attending the Alzheimer's Disease Neuroimaging Initiative sequentially (474 pairs of visits) within 3 years. There were 231 pairs of MCI conversion (CN to MCI), and 242 pairs of CN maintenance (CN to CN). Variables on demographic, neuropsychological tests, genetic, and MRI‐related markers were collected. Machine learning was used to construct MCI prediction models, comparing the area under the receiver operating characteristic curve (AUC) as the primary metric of performance. Important predictors were ranked for the optimal model.ResultsThe baseline age of the study sample was 74.8 years old. The best‐performing model (gradient boosting decision tree) with 13 variables predicted MCI with an AUC of 0.819, and the rank of variable importance showed that intracranial volume, hippocampal volume, and score from task 4 (word recognition) of the Alzheimer's Disease Assessment Scale were important predictors of MCI.ConclusionsWith the help of machine learning, fewer neuropsychological tests and MRI‐related markers are required to accurately predict MCI within 3 years, thereby facilitating targeted intervention. Geriatr Gerontol Int 2024; 24: 96–101.
Invasive stratified mucin‐producing carcinoma (ISMC) of the cervix: a clinicopathological and molecular analysis of 59 cases with special emphasis on histogenesis and potential therapeutic targets
Authors: Yao Yeli , Wang Yan , Ye Lei , Lu Bingjian , Lu Weiguo 
Published: September 2023

AimsThis study aimed to better characterize the clinical and molecular features in invasive stratified mucin‐producing carcinoma (ISMC), an uncommon aggressive subtype of endocervical adenocarcinoma (EAC).Methods and ResultsWe recruited 59 ISMC for clinicopathological analysis, immunohistochemistry (n = 56), and targeted next‐generation sequencing (n = 17). Our cases contained 29 pure and 30 mixed‐type ISMC. Five patients developed local recurrence at 6–32 months (median: 13 months), and died of disease at 16–55 months (median: 16 months). Pure and mixed‐type ISMC showed no significant difference in overall survival and tumour relapse (P > 0.05) except larger tumour size in the pure‐type (P = 0.009). Compared to the usual‐type EAC (n = 217), ISMsC were more frequently associated with large tumour size (P = 0.003), advanced FIGO stage (P = 0.017), lymph node metastasis (P = 0.022), Silva pattern C (P < 0.001), and poor overall survival and short tumour recurrence. SOX2 expression was observed in 82.1% (46/56) ISMC, substantially higher than p63 expression (P < 0.001), while positive SOX17 was present in 3.6% (2/56) cases. PD‐L1 was positive in 41/56 ISMC (73.21%) (combined positive score: range: 1–92, median: 22). Three ISMC patients (17.65%) had PIK3CA mutations, while one each (5.88%) patient harboured an ERBB2, TP53, STK11, and PTEN mutation, respectively.ConclusionWe conclude that ISMC is clinically more aggressive than the usual‐type EAC. ISMC may originate from cervical reserve cells with bidirectional differentiation. PD‐L1 overexpression and the molecular profiles raise the possibility that a subset of ISMC patients may benefit from anti‐PD‐L1 immunotherapy and other targeted therapy, such as mTOR inhibitor and T‐DM1.