bluuebunny/crossref_metadata_2025_split huggingface dataset:
Toxicity of para-phenylenediamine (PPD;1, 4 diaminobenzene) on isolated human lymphocytes: The key role of intracellular calcium enhancement in PPD-induced apoptosis
Authors: Salami Maryam , Pourahmad Jalal , Zarei Mohammad Hadi 
Published: May 2023

Para-phenylenediamine (PPD) is a derivative of benzene used as an ingredient in dyes, a photographic developing agent, and a component of engineered polymers. The carcinogenicity of PPD, which has been documented in several studies, may be related to its toxic effects on different compartments of the immune system. The main goal of this research was to evaluate the mechanism of the toxicity of PPD on human lymphocytes by exploiting the accelerated cytotoxicity mechanism screening (ACMS) technique. Lymphocytes were isolated from the blood of healthy persons using a Ficoll-Paque PLUS standard method. Assessment of cell viability was carried out 12 h following treatment of human lymphocytes with 0.25–1 mM PPD. For determination of cellular parameters, isolated human lymphocytes were incubated with 1/2 the IC50 (0.4 mM), the IC50 (0.8 mM), and twice the IC50 (1.6 mM) for 2, 4, and 6 h. Half maximal inhibitory concentration (IC50) is the concentration that reduces cell viability approximately 50% following treatment. The results of this study demonstrated that PPD-associated apoptosis in human lymphocytes was mainly through the enhancement of intracellular calcium, oxidative stress, and following adverse effect on lymphocyte organelles (like mitochondria and lysosomes). Lipid peroxidation, activation of caspase-3, and stimulation of cytokines (IL2, interferon-gamma (IFN-γ), and TNF-alpha) production were also observed in PPD-treated lymphocytes. Considering the results of this study, we can suggest an association between PPD carcinogenicity and its toxic effects on different compartments of the immune system.
The Significance of Radiotherapy in Ovarian Clear Cell Carcinoma: A Systematic Review and Meta-Analysis
Authors: Zhuang Yuan , Yang Hua 
Published: May 2023

Objective To assess the response rate and survival effect of adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) during ovarian clear cell carcinoma (OCCC). Methods We searched Web of Science, PubMed, Cochrane library electronic databases, Clinical Trials, WanFang Data and Chinese National Knowledge Infrastructure (CNKI) up to October 2022. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. Results We identified a total of 4259 patients from 14 studies met the inclusion criteria. The pooled response rate of residual tumors for RT/CRT was 80.0%, the pooled 5-year progression-free survival (PFS) ratio during RT/CRT group was 61.0%, and the pooled 5-year overall survival (OS) ratio during RT/CRT group was 68.0%; heterogeneity tests demonstrated significant difference between studies (I2 >50%). Cumulative results suggested adjuvant RT/CRT improved 5-year PFS ratio of OCCC patients (OR: 0.51 (95% CI: 0.42–.88), I2 = 22%, P = .009), had no impact on 5-year OS ratio (OR: 0.52 (95% CI: 0.19–1.44), I2 = 87%, P = .21); meta-regression of studies before and after 2000 found consistent results. Sub-analysis observed that adjuvant RT/CRT had no impact on 5-year OS ratio of early-stage (stage I + II) OCCC patients (OR: 0.67 (95% CI: 0.25–1.83), I2 = 85%, P = .44), but might improve 5-year OS ratio of advanced and recurrent OCCC patients (OR: 0.13(95% CI: 0.04–.44), P = .001). Conclusion This analysis suggested that adjuvant RT/CRT might improve oncologic outcomes of OCCC, especially for advanced and recurrent cases. Due to the inherent selective biases of retrospective studies enrolled in the meta-analysis, more convincing evidences based on prospective randomized controlled trials (RCTs) are urgently needed.
The impact of COVID-19 on receipt of health services among children with and without autism
Authors: Brunt Sophie , Sadikova Eleonora , Pappagianopoulos Jessica , Mazurek Micah O 
Published: May 2023

The COVID-19 pandemic disrupted a range of health services for children across the United States. Autistic children have well-documented deficits in health-related services compared to nonautistic children. Parents of autistic children reported an increase in mental health and behavior problems with the onset of the pandemic, increasing the need for supportive services. The current study used data from the National Survey of Children’s Health from 2019 and 2020 to conduct logistic regressions predicting the likelihood of having unmet service needs before and after the onset of the pandemic. Results suggested that autistic children were more likely to have unmet medical, dental, and mental health service needs across years compared to nonautistic children, but there were no interactions by year. All children experienced an increased likelihood of having unmet needs from pre- to post-pandemic. Results suggest that although the pandemic disrupted services across the board, autistic children lacked health services regardless of the pandemic, pointing to persisting disparities in service receipt. A discussion of ongoing barriers to services and issues related to virtual services is included. Future research should further investigate the feasibility of virtual services as well as ways of reducing barriers to all services for autistic children. Lay abstract The COVID-19 pandemic disrupted doctor’s and dental visits, mental health treatments, and other special therapies for children across the United States. Prior research has found that autistic children were more likely to lack these services even before the pandemic, but they experienced more mental health and behavior problems with the onset of the pandemic, increasing the need for these services. This study analyzed data from before (2019) and after (2020) the onset of the pandemic to determine whether autistic children had even more severe disruptions in services after the pandemic started compared to nonautistic children. We found that autistic children were more likely to have unmet medical, dental, and mental health needs in both 2019 and 2020. Overall, children experienced increased disruptions from 2019 to 2020, but this did not differ by diagnosis. Our results suggest that there are persisting gaps in autistic children’s healthcare regardless of the pandemic. We discuss issues surrounding barriers to services for autistic children and issues surrounding virtual services, such as teletherapy. Future research should further explore how to reduce barriers to services for autistic children, including virtual and in-person services.
Clinical Outcomes of Lunocapitate Arthrodesis: A Retrograde Single-Screw Approach
Authors: Mirza Ather , Mirza Justin B. , Zappia Luke C. , Thomas Terence L. , Corabi Jagger , Dusckas Zachary , Lubahn John D. 
Published: May 2023

Background: A single-site retrospective study was designed to evaluate the clinical outcomes of single-screw lunocapitate arthrodesis (LCA) using a retrograde approach for the treatment of scapholunate advanced collapse (SLAC) wrist. Methods: We retrospectively identified 31 patients (33 cases) between September 2010 and December 2019 with SLAC wrist changes who were treated with single-screw LCA. Objective outcomes included time to fusion, union rate, range of motion, and grip and pinch strength recovery. Subjective outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Results: We report on 33 cases (7 female), mean age 58.4 years (range: 41-85), with SLAC wrist who underwent LCA. Our cohort reported a 94% union rate and a 90-day mean time to fusion. Final active wrist range of motion was 38° dorsiflexion, 35° volarflexion, 17° radial deviation, 17° ulnar deviation, 82° pronation, and 83° supination (mean: 450.8 days). Final grip and pinch strengths recovered was 75% gross grip, 84% lateral pinch, and 75% precision pinch (mean: 379.0 days) compared with the contralateral side. The mean postoperative DASH score was 27 (mean: 1203.9 days). Two nonunions were observed. Two hardware complications occurred: one symptomatic screw and one screw fatigue fracture. Conclusions: We found retrograde single-screw LCA to be an effective salvage procedure for SLAC wrist. LCA is a less-taxing procedure, requires shorter operating time, and produces range of motion and grip and pinch strength recovery comparable to those of 4-corner arthrodesis. Furthermore, the viability of single-screw fixation may reduce hardware-related operative costs without compromising union rates.
Prevalence of Sleep Disorders and the Effect of Sleep Health Education on Sleep Quality in Pregnant Women With Sleep Disorders
Authors: Sarvaran Kosar , Abbasalizadeh Fatemeh , Alaei Maede , Fathnezhad-Kazemi Azita 
Published: May 2023

Objective Sleep quality affects pregnant women’s health and quality of life. The aims of the study were to investigate the prevalence of sleep disorders and the effect of sleep health education on sleep quality in pregnant women with sleep disorders. Methods To examine the frequency of sleep disorders among pregnant women, a cross-sectional study was conducted with an initial enrollment of 370 participants. Subsequently, 162 pregnant women were recruited for a pretest-posttest quasi-experimental design study. The intervention group (n = 82) performed sleep health education for four weeks and the control group (n = 80) received standard care. Sleep quality was assessed with Pittsburgh Sleep Quality. Results The prevalence of sleep disorder was 61.9 percent (CI 95% 56.85-66.69). It was determined that health education improved some sleep quality subscales including subjective sleep quality, sleep latency, sleep duration and habitual sleep efficiency, and sleep disturbances, daytime dysfunction, and global sleep quality. The difference was still significant after adjusting for the PSQI baseline (η2 = .311, P < .001). Conclusion These findings provide evidence of a relatively high prevalence of sleep disorders in pregnancy. Therefore, screening for sleep disorders and providing supportive programs and models to improve sleep quality during pregnancy should be considered as part of prenatal care.
An example of implementing a safety protocol in remote intervention and survey research with college students
Authors: Mehus Christopher J , Stevenson Brittany , Weiler Lindsey , Gunlicks-Stoessel Meredith , Morrell Nicole , Patrick Megan E 
Published: May 2023

Introduction This article draws attention to the need for open evaluation and reporting on safety protocols in survey and intervention research. We describe a protocol for responding to those who indicate increased risk of self-harm (i.e. suicidality or potentially lethal alcohol use) as an example and report on the outcome of our procedures. Methods Participants were first-year college students ( n = 891) participating in an intervention trial for binge drinking. We describe the protocol, provide descriptive outcomes, and examine whether participant sex, attrition, or study intervention condition were related to endorsing items that indicated risk for suicidality or potentially lethal alcohol use. Results Of the 891 participants, 167 (18.7%) were identified as being at risk in one or more study wave. Of those, we were able to successfully contact 100 (59.9%), 76 (45.5%) by phone, and 24 (14.4%) by email. Of those 100, 78 accepted mental health resources as a result of outreach. Participant sex, attrition, and intervention condition were not related to risk. Discussion This article may aid other research teams in developing similar protocols. Strategies to reach an even greater proportion of high-risk participants are needed. A body of literature documenting published safety protocols in research and the associated outcomes would help to identify opportunities for improvement.
Performance of Cox regression models for composite time-to-event endpoints with component-wise censoring in randomized trials
Authors: Speiser Jaime Lynn , Ambrosius Walter T , Pajewski Nicholas M 
Published: May 2023

Background Composite time-to-event endpoints are beneficial for assessing related outcomes jointly in clinical trials, but components of the endpoint may have different censoring mechanisms. For example, in the PRagmatic EValuation of evENTs And Benefits of Lipid-lowering in oldEr adults (PREVENTABLE) trial, the composite outcome contains one endpoint that is right censored (all-cause mortality) and two endpoints that are interval censored (dementia and persistent disability). Although Cox regression is an established method for time-to-event outcomes, it is unclear how models perform under differing component-wise censoring schemes for large clinical trial data. The goal of this article is to conduct a simulation study to investigate the performance of Cox models under different scenarios for composite endpoints with component-wise censoring. Methods We simulated data by varying the strength and direction of the association between treatment and outcome for the two component types, the proportion of events arising from the components of the outcome (right censored and interval censored), and the method for including the interval-censored component in the Cox model (upper value and midpoint of the interval). Under these scenarios, we compared the treatment effect estimate bias, confidence interval coverage, and power. Results Based on the simulation study, Cox models generally have adequate power to achieve statistical significance for comparing treatments for composite outcomes with component-wise censoring. In our simulation study, we did not observe substantive bias for scenarios under the null hypothesis or when the treatment has a similar relative effect on each component outcome. Performance was similar regardless of if the upper value or midpoint of the interval-censored part of the composite outcome was used. Conclusion Cox regression is a suitable method for analysis of clinical trial data with composite time-to-event endpoints subject to different component-wise censoring mechanisms.
Acceptance, drivers, and barriers to use eHealth interventions in patients with post-COVID-19 syndrome for management of post-COVID-19 symptoms: a cross-sectional study
Authors: Schröder Julia , Bäuerle Alexander , Jahre Lisa Maria , Skoda Eva-Maria , Stettner Mark , Kleinschnitz Christoph , Teufel Martin , Dinse Hannah 
Published: May 2023

Background: Post-COVID-19 syndrome is a new and debilitating disease without adequate treatment options. eHealth could be a reasonable approach for symptom management. Objectives: This study aims to evaluate the acceptance for eHealth interventions for symptom management in individuals with post-COVID-19 syndrome, as well as drivers and barriers influencing acceptance. Design: Cross-sectional study. Methods: This study was conducted from January 19 until 24 May 2022. Recruitment took place with a web-based survey. Acceptance and predictors of eHealth interventions were measured by the extended UTAUT model. Included in the model were the core predictor performance expectancy, social influence, and effort expectancy. Previously diagnosed mental illness was estimated and mental health by using the well-established Generalized Anxiety Disorder Scale-7 and the Patient Health Questionnaire Depression Scale. The effect of sociodemographic and medical data was assessed. Multiple hierarchical regression analyses as well as group comparisons were performed. Results: 342 individuals with post-COVID-19 syndrome were examined. The acceptance of eHealth interventions for symptom management was moderate to high (M = 3.60, SD = 0.89). Acceptance was significantly higher in individuals with lower/other education, patients with moderate to severe symptoms during initial COVID-19 infection, still significantly impaired patients, and individuals with a mental illness. Identified predictors of acceptance were age (β = .24, p < .001), current condition including moderate (β = .49, p = .002) and still significantly impaired (β = .67, p < .001), digital confidence (β = .19, p < .001), effort expectancy (β = .26, p < .001), performance expectancy (β = .33, p < .001), and social influence (β = .26, p < .001). Conclusion: Patients with post-COVID-19 syndrome reported a satisfying level of acceptance and drivers and barriers could be identified. These factors need to be considered for the implementation and future use of eHealth interventions.
Prognostic value of postoperative ctDNA detection in patients with early non-small cell lung cancer: a systematic review and meta-analysis
Authors: Guo Kaibo , Lu Jiamin , Lou Yidan , Zheng Song 
Published: May 2023

Background: Circulating tumor DNA (ctDNA) has emerged as a potential biomarker for monitoring early non-small cell lung cancer (ENSCLC), particularly after radical surgery. However, the prognostic value of postoperative ctDNA is still being investigated due to the small sample size and heterogeneity of patients with ENSCLC in current trials. Moreover, the potential clinical utility of ctDNA assessment for administering adjuvant therapy (AT) in patients with ENSCLC is also an important area of active research. Objectives: We aimed to identify the prognostic value of postoperative ctDNA detection in ENSCLC patients with stages I–III. Design: This study type is a systematic review and meta-analysis. Data sources and methods: We conducted a search in the Cochrane Library, Embase, PubMed, and ScienceDirect for prospective or retrospective investigations involving patients with ENSCLC, gathering outcomes based on predefined end points. The literature review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the Newcastle–Ottawa scale was employed to carry out a quality evaluation of the included studies. The primary end point of the study was to evaluate the association of ctDNA status in two time points (within 1 month after surgery and long-term postoperative monitoring with more than 3 months) with relapse-free survival (RFS) and overall survival (OS). In addition, the study investigated the role of ctDNA in predicting the response to AT. The secondary end points of the study were to determine the impact of ctDNA on RFS and OS in different subgroups of ENSCLC patients based on pathological subtypes and TNM staging. Results: In total, 2149 studies were screened, and 11 studies met the inclusion criteria for the analysis. The presence of ctDNA within 1 month after surgery as well as long-term postoperative ctDNA were both associated with poorer RFS [hazard ratio (HR) = 4.43; 95% CI: 3.23–6.07 and HR = 7.99; 95% CI: 3.28–19.44, respectively] and worse OS (HR = 5.07; 95% CI: 2.80–9.19 and HR = 7.49; 95% CI: 3.42–16.43, respectively). Most subgroup analyses yielded similar results. Moreover, ctDNA-positive patients could acquire survival benefits from AT (HR = 0.30; 95% CI: 0.16–0.54), while ctDNA-negative patients that received AT did not show significant improvement in RFS (HR = 1.18; 95% CI: 0.67–2.09). Conclusion: The postoperative ctDNA assessment is a promising approach to stratify the risk of relapse and death in ENSCLC patients. Our data suggest that patients with negative ctDNA in the postoperative setting may not benefit from AT, which warrants further investigation. This finding, if validated in prospective trials with a larger sample size, could aid in better-individualized treatment for patients and avoid potential side effects of AT. Registration: This study was designed in accordance with PRISMA and registered with PROSPERO (CRD42022311615).
Decline of thrombolysis rates before endovascular therapy in patients with acute anterior circulation large vessel occlusion ischemic stroke: A multicenter analysis from the German Stroke Registry
Authors: Schlemm Ludwig , Siebert Eberhard , Kleine Justus F , Riegler Christoph , Bode Felix J , Petersens Martina , Schlemm Eckhard , Keil Fee , Tiedt Steffen , Bohner Georg , Nolte Christian H 
Published: May 2023

Introduction: In recent years, the role of intravenous thrombolysis (IVT) before endovascular stroke treatment (EVT) has been discussed intensively. Whether the discussion was accompanied by changing rates of bridging IVT is unknown. Methods: Data were extracted from the prospectively maintained German Stroke Registry, including patients treated with EVT at one of 28 stroke centers in Germany between 2016 and 2021. Primary outcome parameters were the rate of bridging IVT (a) in the entire registry cohort and (b) in patients without formal contraindications to IVT (i.e. recent oral anticoagulants, time window ⩾4.5 h, extensive early ischemic changes) adjusted for demographic and clinical confounders. Results: 10,162 patients (52.8% women, median age 77 years, median National Institutes of Health Stroke Scale score 14) were analyzed. In the entire cohort, the rate of bridging IVT decreased from 63.8% in 2016 to 43.6% in 2021 (average absolute annual decrease 3.1%, 95% CI 2.4%–3.8%), while the proportion of patients with at least one formal contraindication increased by only 1.2% annually (95% CI 0.6%–1.9%). Among 5460 patients without record of formal contraindications, the rate of bridging IVT decreased from 75.5% in 2016 to 63.2% in 2021 and was significantly associated with admission date in a multivariable model (average absolute annual decrease 1.4%, 95% CI 0.6%–2.2%). Clinical factors associated with lower odds of bridging IVT included diabetes mellitus, carotid-T-occlusion, dual antiplatelet therapy, and direct admission to a thrombectomy center. Conclusion: We observed a substantial decline in bridging IVT rates independent of demographic confounders and not explained by an increase in contraindications. This observation deserves further exploration in independent populations.
Symptom Profile, Proton Pump Inhibitor Therapy, and Diagnostic Testing in Patients With Persistent Reflux-Like Symptoms: Results From a Population-Based Survey
Authors: Armstrong David , Srinivasan Sachin , Rooker Ceciel , Sinclair Paul , Taylor Emily , Sharma Prateek 
Published: May 2023

Background: Proton pump inhibitors (PPIs) are highly effective in treating gastroesophageal reflux disease (GERD). However, persistent, troublesome reflux symptoms despite PPI use are common, and a proportion of individuals with these persistent symptoms is considered to have refractory GERD (rGERD). There are limited data on patients’ experience with persistent reflux-like symptoms to guide healthcare professionals in managing this troublesome condition. Methods: An international, population-based, online survey was conducted among adults who reported persistent reflux-like symptoms; 24 questions were posed regarding the participants’ symptoms, diagnosis, treatment, and comorbid conditions. Descriptive analyses were performed to characterize participants’ experience with diagnosis and their satisfaction with treatment. All data were self-reported. Results: Of 565 initial respondents, 283 (51%) answered the question regarding being formally diagnosed by a healthcare professional with GERD and/or rGERD. The 197 (70%) participants who answered “yes” made up the survey population. Heartburn (65%) and acid regurgitation (62%) were the most common troublesome symptoms. PPI use was reported by 145 (74%) respondents, but only 30% were satisfied with PPI therapy. The most common alternative therapies included antacid/alginates (63%), histamine H2-receptor antagonists (33%), mucosal protectants (25%), and lifestyle modifications (84%). Conclusions: In this population-based survey, nearly one-third of participants with persistent reflux-like symptoms had not received a formal diagnosis of GERD or rGERD. Although most participants diagnosed with GERD/rGERD had received PPI therapy, persistent symptoms, dissatisfaction with PPI therapy, and concerns about long-term PPI use were common. These data emphasize the need for patient input when developing management strategies for GERD and persistent reflux-like symptoms or rGERD.