bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcranial direct current stimulation to facilitate neurofunctional rehabilitation in children with autism spectrum disorder: a protocol for a randomized, sham-controlled, double-blind clinical trial
Authors: Araujo Marcela O. , Tamplain Priscila , Duarte Natália A. C. , Comodo Andréa C. M. , Ferreira Giselle O. A. , Queiróga Amanda , Oliveira Claudia S. , Collange-Grecco Luanda A. 
Published: June 2023

BackgroundAnodal transcranial direct current stimulation (tDCS) over the primary motor cortex and cerebellum is gaining prominence in the literature due to its potential to favor learning and motor performance. If administered during motor training, tDCS is capable of increasing the effect of training. Considering the motor impairment presented by children with Autism Spectrum Disorders (ASD), atDCS applied during motor training may contribute to the rehabilitation of these children. However, it is necessary to examine and compare the effects of atDCS over the motor cortex and the cerebellum on the motor skills of children with ASD. This information may benefit future clinical indications of tDCS for rehabilitation of children with ASD. The aim of the proposed study is to determine whether anodal tDCS over the primary motor cortex and cerebellum can enhance the effects of gait training and postural control on motor skills, mobility, functional balance, cortical excitability, cognitive aspects and behavioral aspects in children with ASD. Our hypothesis is the active tDCS combined with motor training will enhance the performance of the participants in comparison to sham tDCS.Methods and designA randomized, sham-controlled, double-blind clinical trial will be conducted involving 30 children with ASD that will be recruited to receive ten sessions of sham or ten sessions of active anodal tDCS (1 mA, 20 min) over the primary motor cortex or cerebellun combined with motor training. The participants will be assessed before as well as one, four and eight weeks after the interventions. The primary outcome will be gross and fine motor skills. The secondary outcomes will be mobility, functional balance, motor cortical excitability, cognitive aspects and behavioral aspects.DiscussionAlthough abnormalities in gait and balance are not primary characteristics of ASD, such abnormalities compromise independence and global functioning during the execution of routine activities of childhood. If demonstrated that anodal tDCS administered over areas of the brain involved in motor control, such as the primary motor cortex and cerebellum, can enhance the effects of gait and balance training in only ten sessions in two consecutive weeks, the clinical applicability of this stimulation modality will be expanded as well as more scientifically founded.Clinical trial registration February 16, 2023 (https://ensaiosclinicos.gov.br/rg/RBR-3bskhwf).
The risk of dementia in multiple sclerosis and neuromyelitis optica spectrum disorder
Authors: Cho Eun Bin , Jung Se Young , Jung Jin-Hyung , Yeo Yohwan , Kim Hee Jin , Han Kyungdo , Shin Dong Wook , Min Ju-Hong 
Published: June 2023

IntroductionCognitive impairment is a common feature of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). However, there is a lack of population-based study of dementia risk in these disorders. In the present study, the risk of dementia in MS and NMOSD patients in Republic of Korea was estimated.MethodsData analyzed in this study were obtained from the Korean National Health Insurance Service (KNHIS) database between January 2010 and December 2017. The study included 1,347 MS patients and 1,460 NMOSD patients ≥40 years of age who had not been diagnosed with dementia within 1 year prior to the index date. Matched controls were selected based on age, sex, and the presence of hypertension, diabetes mellitus, or dyslipidemia.ResultsIn MS and NMOSD patients, the risk of developing any dementia [adjusted hazard ratio (aHR) = 2.34; 95% confidence interval (CI) = 1.84–2.96 and aHR = 2.19; 95% CI = 1.61–3.00, respectively], Alzheimer’s disease [AD; aHR = 2.23; 95% confidence interval (CI) = 1.70–2.91 and aHR = 1.99; 95% CI = 1.38–2.88, respectively], and vascular dementia (aHR = 3.75; 95% CI = 1.91–7.35 and aHR = 3.21; 95% CI = 1.47–7.02, respectively) was higher compared with the matched controls. NMOSD patients had a lower risk of any dementia and AD compared with MS patients after adjusting for age, sex, income, hypertension, diabetes, and dyslipidemia (aHR = 0.67 and 0.62).ConclusionThe risk of dementia increased in MS and NMOSD patients and dementia risk was higher in MS than in NMOSD.
Maternal hemoglobin change from early pregnancy to second trimester is associated with risk of gestational diabetes mellitus: a retrospective cohort study
Authors: Sulhariza Husni Zain , Zalilah Mohd Shariff , Geeta Appannah 
Published: June 2023

IntroductionThe accrual of iron that is reflected in high maternal hemoglobin (Hb) status is increasingly recognized as a risk factor for gestational diabetes mellitus (GDM). Changes in maternal Hb level could also implicate glycemic status in pregnancy. This study aimed to determine the associations between maternal Hb levels and their changes with GDM.MethodsIn this retrospective cohort study, a total of 1,315 antenatal records of mothers with singleton pregnancies from eight health clinics of a district in the northern region of Peninsular Malaysia who delivered between 1st January 2016–31st December 2017 were analyzed. Data extracted from the records were socio-demographic, anthropometric, obstetrical, and clinical data. Hb levels were extracted at booking (&lt;14 weeks) and second trimester (14–28 weeks). Change in Hb was determined by subtracting the Hb level in the second trimester from the booking Hb level and was categorized as decreased, unchanged, and increased Hb. The associations between maternal Hb levels and their changes with GDM risk were analyzed using multiple regression, adjusting for covariates in four different models. Model 1: maternal age and height. Model 2: covariates of Model 1 added with parity, history of GDM, and family history of diabetes. Model 3: covariates of Model 2 added with iron supplementation at booking. Model 4: covariates of Model 3 added with Hb level at booking.Results and DiscussionsUnchanged Hb level from booking to second trimester was significantly associated with GDM risk in Model 1 (AOR: 2.55; 95% CI: 1.20, 5.44; p &lt; 0.05), Model 2 (AOR: 2.45, 95% CI: 1.13, 5.34; p &lt; 0.05) Model 3 (AOR: 2.42; 95% CI: 1.11, 5.27; p &lt; 0.05), and Model 4 (AOR: 2.51; 95% CI: 1.15, 5.49; p &lt; 0.05). No significant associations were observed between maternal Hb levels and GDM in the study.ConclusionUnchanged Hb levels from the booking (&lt;14 weeks of gestation) to the second trimester (14–28 weeks) increased GDM risk. Further investigation is warranted to evaluate the associations between changes in maternal Hb and GDM risk and to identify potential factors influencing this relationship.
Dose outside of the prostate is associated with improved outcomes for high-risk prostate cancer patients treated with brachytherapy boost
Authors: Shortall Jane , Vasquez Osorio Eliana , Green Andrew , McWilliam Alan , Elumalai Thriaviyam , Reeves Kimberley , Johnson-Hart Corinne , Beasley William , Hoskin Peter , Choudhury Ananya , van Herk Marcel 
Published: June 2023

BackgroundOne in three high-risk prostate cancer patients treated with radiotherapy recur. Detection of lymph node metastasis and microscopic disease spread using conventional imaging is poor, and many patients are under-treated due to suboptimal seminal vesicle or lymph node irradiation. We use Image Based Data Mining (IBDM) to investigate association between dose distributions, and prognostic variables and biochemical recurrence (BCR) in prostate cancer patients treated with radiotherapy. We further test whether including dose information in risk-stratification models improves performance.MethodPlanning CTs, dose distributions and clinical information were collected for 612 high-risk prostate cancer patients treated with conformal hypo-fractionated radiotherapy, intensity modulated radiotherapy (IMRT), or IMRT plus a single fraction high dose rate (HDR) brachytherapy boost. Dose distributions (including HDR boost) of all studied patients were mapped to a reference anatomy using the prostate delineations. Regions where dose distributions significantly differed between patients that did and did-not experience BCR were assessed voxel-wise using 1) a binary endpoint of BCR at four-years (dose only) and 2) Cox-IBDM (dose and prognostic variables). Regions where dose was associated with outcome were identified. Cox proportional-hazard models with and without region dose information were produced and the Akaike Information Criterion (AIC) was used to assess model performance.ResultsNo significant regions were observed for patients treated with hypo-fractionated radiotherapy or IMRT. Regions outside the target where higher dose was associated with lower BCR were observed for patients treated with brachytherapy boost. Cox-IBDM revealed that dose response was influenced by age and T-stage. A region at the seminal vesicle tips was identified in binary- and Cox-IBDM. Including the mean dose in this region in a risk-stratification model (hazard ratio=0.84, p=0.005) significantly reduced AIC values (p=0.019), indicating superior performance, compared with prognostic variables only. The region dose was lower in the brachytherapy boost patients compared with the external beam cohorts supporting the occurrence of marginal misses.ConclusionAssociation was identified between BCR and dose outside of the target region in high-risk prostate cancer patients treated with IMRT plus brachytherapy boost. We show, for the first-time, that the importance of irradiating this region is linked to prognostic variables.
Opportunities for understanding the COVID-19 pandemic and child health in the United States: the Environmental influences on Child Health Outcomes (ECHO) program
Authors: Bekelman Traci A. , Trasande Leonardo , Law Andrew , Blackwell Courtney K. , Jacobson Lisa P. , Bastain Theresa M. , Breton Carrie V. , Elliott Amy J. , Ferrara Assiamira , Karagas Margaret R. , Aschner Judy L. , Bornkamp Nicole , Camargo Carlos A. , Comstock Sarah S. , Dunlop Anne L. , Ganiban Jody M. , Gern James E. , Karr Catherine J. , Kelly Rachel S. , Lyall Kristen , O’Shea T. Michael , Schweitzer Julie B. , LeWinn Kaja Z. 
Published: June 2023

ObjectiveOngoing pediatric cohort studies offer opportunities to investigate the impact of the COVID-19 pandemic on children's health. With well-characterized data from tens of thousands of US children, the Environmental influences on Child Health Outcomes (ECHO) Program offers such an opportunity.MethodsECHO enrolled children and their caregivers from community- and clinic-based pediatric cohort studies. Extant data from each of the cohorts were pooled and harmonized. In 2019, cohorts began collecting data under a common protocol, and data collection is ongoing with a focus on early life environmental exposures and five child health domains: birth outcomes, neurodevelopment, obesity, respiratory, and positive health. In April of 2020, ECHO began collecting a questionnaire designed to assess COVID-19 infection and the pandemic's impact on families. We describe and summarize the characteristics of children who participated in the ECHO Program during the COVID-19 pandemic and novel opportunities for scientific advancement.ResultsThis sample (n = 13,725) was diverse by child age (31% early childhood, 41% middle childhood, and 16% adolescence up to age 21), sex (49% female), race (64% White, 15% Black, 3% Asian, 2% American Indian or Alaska Native, &lt;1% Native Hawaiian or Pacific Islander, 10% Multiple race and 2% Other race), Hispanic ethnicity (22% Hispanic), and were similarly distributed across the four United States Census regions and Puerto Rico.ConclusionECHO data collected during the pandemic can be used to conduct solution-oriented research to inform the development of programs and policies to support child health during the pandemic and in the post-pandemic era.
Tetrandrine inhibits the proliferation of mesangial cells induced by enzymatically deglycosylated human IgA1 via IgA receptor/MAPK/NF-κB signaling pathway
Authors: Xu Wencheng , Song Wanci , Chen Shuhe , Jin Shanshan , Xue Xue , Min Jinwen , Wang Xiaoqin , You Pengtao 
Published: June 2023

Objective: Despite the use of renin-angiotensin system blockade and immunosuppressive drugs, including corticosteroids, the current treatment regimens for Immunoglobulins A nephropathy (IgAN) are severely limited. The proliferation of mesangial cell and deposition of deglycosylated human IgA1 immune complex are the most common pathologic features of IgAN. We examined the tetrandrine potential of suppressing the proliferation of mesangial cells and explored its underlying mechanisms with a focus on IgA receptor/MAPK/NF-κB signaling pathway.Methods: Standard human IgA (native IgA) were enzymatically desialylated (deS IgA) or further degalactosylated (deS/deGal IgA) using neuraminidase and β-galactosidase. Rat glomerular mesangial cells (HBZY-1) and human renal mesangial cells (HRMC) stimulated by IgA were used to observe the suppressive effect of tetrandrine. The MTT assay was used to detect the cell viability. The protein expression of IgA receptor/MAPK/NF-κB signaling pathway was examined by Western blot. Cell cycle analysis was measured by flow cytometer.Results: Native IgA and deS IgA showed limited stimulation effect on both HBZY-1 cells and HRMCs, whereas deS/deGal IgA significantly stimulated the proliferation of both HBZY-1 cells and HRMCs (p &lt; 0.05). Compared with non-stimulation of deS/deGal IgA, 1–3 μM of tetrandrine had stronger inhibitory effect on the proliferation of HBZY-1 cells and HRMCs with the stimulation of deS/deGal IgA (p &lt; 0.05), suggesting that tetrandrine possibly inhibited the proliferation of mesangial cells induced by deglycosylated human IgA1 specifically. Molecular mechanism study revealed that tetrandrine decreased the expression of IgA1 receptor, CD71 and β4GALT1, and inhibited the activation of MAPK/NF-κB significantly (p &lt; 0.05). Moreover, these inhibitory effect of tetrandrine caused cell cycle arrest and stopped the cell growth in the S phase companied with the upregulating of cyclin A2 and downregulating of cyclin D1.Conclusion: Taken together, tetrandrine inhibited the proliferation of mesangial cells induced by enzymatically deglycosylated human IgA1 via IgA receptor/MAPK/NF-κB signaling pathway. Based on these potential molecular mechanisms, tetrandrine would be an appealing therapeutic option for IgAN.
Experiences of neurodivergent students in graduate STEM programs
Authors: Syharat Connie Mosher , Hain Alexandra , Zaghi Arash E. , Gabriel Rachael , Berdanier Catherine G. P. 
Published: June 2023

IntroductionDespite efforts to increase the participation of marginalized students in Science, Technology, Engineering, and Mathematics (STEM), neurodivergent students have remained underrepresented and underserved in STEM graduate programs. This qualitative study aims to increase understanding of the experiences of neurodivergent graduate students pursuing advanced degrees in STEM. In this analysis, we consider how common graduate school experiences interface with the invisibility of neurological diversity, thus contributing to a set of unique challenges experienced by neurodivergent students.Materials and methodsIn this qualitative study, 10 focus group sessions were conducted to examine the experiences of 18 students who identify as neurodivergent in graduate STEM programs at a large, research-intensive (R1) university. We used thematic analysis of the transcripts from these focus groups to identify three overarching themes within the data.ResultsThe findings are presented through a novel model for understanding neurodivergent graduate STEM student experiences. The findings suggest that students who identify as neurodivergent feel pressure to conform to perceived neurotypical norms to avoid negative perceptions. They also may self-silence to maintain stability within the advisor-advisee relationship. The stigma associated with disability labels contributes a heavy cognitive and emotional load as students work to mask neurodiversity-related traits, navigate decisions about disclosure of their neurodivergence, and ultimately, experience significant mental health challenges and burnout. Despite these many challenges, the neurodivergent graduate students in this study perceived aspects of their neurodivergence as a strength.DiscussionThe findings may have implications for current and future graduate students, for graduate advisors who may or may not be aware of their students’ neurodivergence, and for program administrators who influence policies that impact the wellbeing and productivity of neurodivergent students.
Quality of life assessment in diabetic patients: validity of the creole version of the EQ-5D-5L in Reunion Island
Authors: Safieddine Maissa , Bruneau Lea , Soulaimana Ibtissame , Debussche Xavier , Lafarge Sophie , Falissard Bruno , Ferdynus Cyril , Huiart Laetitia 
Published: June 2023

IntroductionDue to the high prevalence of diabetes and its complications, evaluating the patient’s quality of life is critical. EQ-5D-5L is a valid tool for assessing health-related quality of life (HRQOL) in chronic diseases, including diabetes. However, no psychometric measures have been validated in a Creole-speaking population. Therefore, this study aimed for the first time to validate and cross-culturally adapt Creole and French versions of EQ-5D-5L on Type II diabetes patients in Reunion Island.Materials and methodsThe Creole translation and cross-cultural adaptation process were based on the EUROQOL methods. Internal consistency and construct validity were determined using confirmatory factor analysis (CFA) of EQ-5D-5L for both versions. CFA model for HRQOL and global fit measures were calculated based on the EQ-5D-5L items using the maximum likelihood (ML) method.ResultsFrom November 2016 to October 2017, 148 patients were included in the Creole group and 152 in the French group. EQ-5D-5L measures were unidimensional for both versions. Cronbach’s coefficient alpha was 0.76 for the Creole version and 0.81 for the French version in CFA models. The root mean square error of approximation (RMSEA) was 0.06 for the Creole version and 0.02 for the French version. The Comparative Fit Index (CFI) was closer to 1 for both versions. CFA models for both the Creole and French versions fit the data adequately.DiscussionOverall, our findings provided evidence that both the Creole and French versions of EQ-5D-5L are suitable for assessing HRQOL in diabetes patients in Reunion Island. However, further research could be done to investigate French–Creole differences concerning the perception of health status, and a cultural adaptation of the French version will be considered.
Effects of BPD tendencies and subjective well-being on NSSI in adolescents with PTSD
Authors: Deng Weixi , Yan Shu , Xu Yongjun , Lu Zhaoyuan , Liu Lianzhong , Zhou Yang , Chen Mo 
Published: June 2023

BackgroundSevere posttraumatic stress disorder (PTSD) may lead to non-suicidal self-injury (NSSI), and borderline personality disorder (BPD) tendencies may play a role in this process. Secondary vocational students experience more social, familial and other pressures and are more vulnerable to psychological problems. Thus, we explored the effect of BPD tendencies and subjective well-being (SWB) on NSSI in secondary vocational students with PTSD.MethodsA total of 2,160 Chinese secondary vocational students in Wuhan participated in our cross-sectional investigation. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), criteria for PTSD, NSSI Questionnaire, Personality Diagnostic Questionnaire-4+, subjective well-being scale, and family adaptation, partnership, growth, affection, and resolve (APGAR) Index were used. We conducted a binary logistic regression model and linear regression analysis.ResultsSex (odds ratio [OR] = 0.354, 95% confidence interval [CI] = 0.171–0.733), BPD tendencies (OR = 1.192, 95% CI = 1.066–1.333) and SWB (OR = 0.652, 95% CI = 0.516–0.824) were independent factors that predicted NSSI in secondary vocational students with PTSD. Spearman’s correlation analysis showed that BPD tendencies were positively correlated with NSSI frequency (r = 0.282, P &lt; 0.01). SWB was negatively correlated with NSSI frequency (r = −0.301, P &lt; 0.01). The linear regression showed that BPD tendencies (β = 0.137, P &lt; 0.05 and β = −0.230, P &lt; 0.001) were significantly correlated with NSSI frequency. Spearman’s correlation analysis showed that family functioning was positively correlated with SWB (r = 0.486, P &lt; 0.01) and negatively correlated with BPD tendencies (r = −0.296, P &lt; 0.01).ConclusionIn adolescents, PTSD in response to stressful events could lead to NSSI, and BPD tendencies promote the intensity of NSSI, while SWB diminishes its intensity. Improvement in family functioning may actively guide the development of mental health and improve SWB; such steps may constitute interventions to prevent or treat NSSI.
Machine learning approach to predict body weight in adults
Authors: Fujihara Kazuya , Yamada Harada Mayuko , Horikawa Chika , Iwanaga Midori , Tanaka Hirofumi , Nomura Hitoshi , Sui Yasuharu , Tanabe Kyouhei , Yamada Takaho , Kodama Satoru , Kato Kiminori , Sone Hirohito 
Published: June 2023

BackgroundObesity is an established risk factor for non-communicable diseases such as type 2 diabetes mellitus, hypertension and cardiovascular disease. Thus, weight control is a key factor in the prevention of non-communicable diseases. A simple and quick method to predict weight change over a few years could be helpful for weight management in clinical settings.MethodsWe examined the ability of a machine learning model that we constructed to predict changes in future body weight over 3 years using big data. Input in the machine learning model were three-year data on 50,000 Japanese persons (32,977 men) aged 19–91 years who underwent annual health examinations. The predictive formulas that used heterogeneous mixture learning technology (HMLT) to predict body weight in the subsequent 3 years were validated for 5,000 persons. The root mean square error (RMSE) was used to evaluate accuracy compared with multiple regression.ResultsThe machine learning model utilizing HMLT automatically generated five predictive formulas. The influence of lifestyle on body weight was found to be large in people with a high body mass index (BMI) at baseline (BMI ≥29.93 kg/m2) and in young people (&lt;24 years) with a low BMI (BMI &lt;23.44 kg/m2). The RMSE was 1.914 in the validation set which reflects ability comparable to that of the multiple regression model of 1.890 (p = 0.323).ConclusionThe HMLT-based machine learning model could successfully predict weight change over 3 years. Our model could automatically identify groups whose lifestyle profoundly impacted weight loss and factors the influenced body weight change in individuals. Although this model must be validated in other populations, including other ethnic groups, before being widely implemented in global clinical settings, results suggested that this machine learning model could contribute to individualized weight management.