bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of antenatal corticosteroids among infants during gestational age at 24 to 31 weeks in 57 neonatal intensive care units of China: a cross-sectional study
Authors: Zhao Jing , Feng Zongtai , Dai Yun , Zhang Wanxian , Jiang Siyuan , Wang Yanchen , Gu Xinyue , Sun Jianhua , Cao Yun , Lee Shoo K. , Tian Xiuying , Yang Zuming 
Published: February 2023

Abstract

Background:
Antenatal corticosteroids (ACS) can significantly improve the outcomes of preterm infants. This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units (NICU) and to explore perinatal factors associated with ACS use, using the largest contemporary cohort of very preterm infants in China.

Methods:
This cross-sectional study enrolled all infants born at 24+0 to 31+6 weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st, 2019 to December 30th, 2019. The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery. Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage.

Results:
A total of 7828 infants were enrolled, among which 6103 (78.0%) infants received ACS. ACS use rates increased with increasing gestational age (GA), from 177/259 (68.3%) at 24 to 25 weeks’ gestation to 3120/3960 (78.8%) at 30 to 31 weeks’ gestation. Among infants exposed to ACS, 2999 of 6103 (49.1%) infants received a single complete course, and 33.4% (2039/6103) infants received a partial course. ACS use rates varied from 30.2% to 100.0% among different hospitals. Multivariate regression showed that increasing GA, born in hospital (inborn), increasing maternal age, maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS.

Conclusions:
The use rate of ACS remained low for infants at 24 to 31 weeks’ gestation admitted to Chinese NICUs, with fewer infants receiving a complete course. The use rates varied significantly among different hospitals. Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.
Integrins in human hepatocellular carcinoma tumorigenesis and therapy
Authors: Gao Qiong , Sun Zhaolin , Fang Deyu 
Published: February 2023

Abstract
Integrins are a family of transmembrane receptors that connect the extracellular matrix and actin skeleton, which mediate cell adhesion, migration, signal transduction, and gene transcription. As a bi-directional signaling molecule, integrins can modulate many aspects of tumorigenesis, including tumor growth, invasion, angiogenesis, metastasis, and therapeutic resistance. Therefore, integrins have a great potential as antitumor therapeutic targets. In this review, we summarize the recent reports of integrins in human hepatocellular carcinoma (HCC), focusing on their abnormal expression, activation, and signaling of integrins in cancer cells as well as their roles in other cells in the tumor microenvironment. We also discuss the regulation and functions of integrins in hepatitis B virus-related HCC. Finally, we update the clinical and preclinical studies of integrin-related drugs in the treatment of HCC.
Challenges and optimal strategies of CAR T therapy for hematological malignancies
Authors: Zhang Yajing , Xu Yang , Dang Xiuyong , Zhu Zeyu , Qian Wenbin , Liang Aibin , Han Weidong 
Published: February 2023

Abstract
Remarkable improvement relative to traditional approaches in the treatment of hematological malignancies by chimeric antigen receptor (CAR) T-cell therapy has promoted sequential approvals of eight commercial CAR T products within last 5 years. Although CAR T cells’ productization is now rapidly boosting their extensive clinical application in real-world patients, the limitation of their clinical efficacy and related toxicities inspire further optimization of CAR structure and substantial development of innovative trials in various scenarios. Herein, we first summarized the current status and major progress in CAR T therapy for hematological malignancies, then described crucial factors which possibly compromise the clinical efficacies of CAR T cells, such as CAR T cell exhaustion and loss of antigen, and finally, we discussed the potential optimization strategies to tackle the challenges in the field of CAR T therapy.
Continuation, reduction, or withdrawal of tofacitinib in patients with rheumatoid arthritis achieving sustained disease control: a multicenter, open-label, randomized controlled trial
Authors: Wang Mengyan , Xue Yu , Du Fang , Ma Lili , Lu Liang-jing , Jiang Lindi , Tao Yi-Li , Yang Chengde , Shi Hui , Liu Honglei , Cheng Xiaobing , Ye Junna , Su Yutong , Zhao Dongbao , Dai Sheng-Ming , Teng Jialin , Hu Qiongyi 
Published: February 2023

Abstract

Background:
Rheumatoid arthritis (RA), a chronic systemic autoimmune disease, is characterized by synovitis and progressive damage to the bone and cartilage of the joints, leading to disability and reduced quality of life. This study was a randomized clinical trial comparing the outcomes between withdrawal and dose reduction of tofacitinib in patients with RA who achieved sustained disease control.

Methods:
The study was designed as a multicenter, open-label, randomized controlled trial. Eligible patients who were taking tofacitinib (5 mg twice daily) and had achieved sustained RA remission or low disease activity (disease activity score in 28 joints [DAS28] ≤3.2) for at least 3 months were enrolled at six centers in Shanghai, China. Patients were randomly assigned (1:1:1) to one of three treatment groups: continuation of tofacitinib (5 mg twice daily); reduction in tofacitinib dose (5 mg daily); and withdrawal of tofacitinib. Efficacy and safety were assessed up to 6 months.

Results:
Overall, 122 eligible patients were enrolled, with 41 in the continuation group, 42 in the dose-reduction group, and 39 in the withdrawal group. After 6 months, the percentage of patients with a DAS28-erythrocyte sedimentation rate (ESR) of <3.2 was significantly lower in the withdrawal group than that in the reduction and continuation groups (20.5%, 64.3%, and 95.1%, respectively; P < 0.0001 for both comparisons). The average flare-free time was 5.8 months for the continuation group, 4.7 months for the dose reduction group, and 2.4 months for the withdrawal group.

Conclusion:
Withdrawal of tofacitinib in patients with RA with stable disease control resulted in a rapid and significant loss of efficacy, while standard or reduced doses of tofacitinib maintained a favorable state.

Trial Registration:
Chictr.org, ChiCTR2000039799.
Remote ischemic conditioning-induced hyperacute and acute responses of plasma proteome in healthy young male adults: a quantitative proteomic analysis
Authors: Song Siying , Wu Hao , Liu Yunhuan , Lan Duo , Jiao Baolian , Wan Shuling , Guo Yibing , Zhou Da , Ding Yuchuan , Ji Xunming , Meng Ran 
Published: February 2023

Abstract

Background:
Long-term remote ischemic conditioning (RIC) has been proven to be beneficial in multiple diseases, such as cerebral and cardiovascular diseases. However, the hyperacute and acute effects of a single RIC stimulus are still not clear. Quantitative proteomic analyses of plasma proteins following RIC application have been conducted in preclinical and clinical studies but exhibit high heterogeneity in results due to wide variations in experimental setups and sampling procedures. Hence, this study aimed to explore the immediate effects of RIC on plasma proteome in healthy young adults to exclude confounding factors of disease entity, such as medications and gender.

Methods:
Young healthy male participants were enrolled after a systematic physical examination and 6-month lifestyle observation. Individual RIC sessions included five cycles of alternative ischemia and reperfusion, each lasting for 5 min in bilateral forearms. Blood samples were collected at baseline, 5 min after RIC, and 2 h after RIC, and then samples were processed for proteomic analysis using liquid chromatography-tandem mass spectrometry method.

Results:
Proteins related to lipid metabolism (e.g., Apolipoprotein F), coagulation factors (hepatocyte growth factor activator preproprotein), members of complement cascades (mannan-binding lectin serine protease 1 isoform 2 precursor), and inflammatory responses (carboxypeptidase N catalytic chain precursor) were differentially altered at their serum levels following the RIC intervention. The most enriched pathways were protein glycosylation and complement/coagulation cascades.

Conclusions:
One-time RIC stimulus may induce instant cellular responses like anti-inflammation, coagulation, and fibrinolysis balancing, and lipid metabolism regulation which are protective in different perspectives. Protective effects of single RIC in hyperacute and acute phases may be exploited in clinical emergency settings due to apparently beneficial alterations in plasma proteome profile. Furthermore, the beneficial effects of long-term (repeated) RIC interventions in preventing chronic cardiovascular diseases among general populations can also be expected based on our study findings.

Registration:
ClinicalTrials.gov, NCT03105141.
Hepatocyte apoptosis fragment product cytokeratin-18 M30 level and non-alcoholic steatohepatitis risk diagnosis: an international registry study
Authors: Zhang Huai , Rios Rafael S. , Boursier Jerome , Anty Rodolphe , Chan Wah-Kheong , George Jacob , Yilmaz Yusuf , Wong Vincent Wai-Sun , Fan Jiangao , Dufour Jean-François , Papatheodoridis George , Chen Li , Schattenberg Jörn M. , Shi Jun-ping , Xu Liang , Wong Grace Lai-Hung , Lange Naomi F. , Papatheodoridi Margarita , Mi Yuqiang , Zhou Yujie , Byrne Christopher D. , Targher Giovanni , Feng Gong , Zheng Minghua 
Published: February 2023

Abstract

Background:
Liver biopsy for the diagnosis of non-alcoholic steatohepatitis (NASH) is limited by its inherent invasiveness and possible sampling errors. Some studies have shown that cytokeratin-18 (CK-18) concentrations may be useful in diagnosing NASH, but results across studies have been inconsistent. We aimed to identify the utility of CK-18 M30 concentrations as an alternative to liver biopsy for non-invasive identification of NASH.

Methods:
Individual data were collected from 14 registry centers on patients with biopsy-proven non-alcoholic fatty liver disease (NAFLD), and in all patients, circulating CK-18 M30 levels were measured. Individuals with a NAFLD activity score (NAS) ≥5 including a score of ≥1 for each of steatosis, ballooning, and lobular inflammation were diagnosed as having definite NASH; individuals with a NAS ≤2 and no fibrosis were diagnosed as having non-alcoholic fatty liver (NAFL).

Results:
A total of 2571 participants were screened, and 1008 (153 with NAFL and 855 with NASH) were finally enrolled. Median CK-18 M30 levels were higher in patients with NASH than in those with NAFL (mean difference 177 U/L; standardized mean difference [SMD]: 0.87 [0.69–1.04]). There was an interaction between CK-18 M30 levels and serum alanine aminotransferase, body mass index (BMI), and hypertension (P < 0.001, P = 0.026 and P = 0.049, respectively). CK-18 M30 levels were positively associated with histological NAS in most centers. The area under the receiver operating characteristics (AUROC) for NASH was 0.750 (95% confidence intervals: 0.714–0.787), and CK-18 M30 at Youden's index maximum was 275.7 U/L. Both sensitivity (55% [52%–59%]) and positive predictive value (59%) were not ideal.

Conclusions:
This large multicenter registry study shows that CK-18 M30 measurement in isolation is of limited value for non-invasively diagnosing NASH.
Mental Health of Caregivers of Children with Medical Complexity During COVID-19
Authors: Aryee Emmanuel , Perrin James M. , Clancy Sandra , Merrill Caitlin , Curran Marjorie , Oreskovic Nicolas M. 
Published: February 2023

ABSTRACT:

Objective:
The purpose of this study is to investigate the relationship between mental health and financial burden among caregivers of children with medical complexity (CMC) during the COVID-19 pandemic.

Methods:
We conducted a cross-sectional survey on the mental health and financial burden of caregivers of CMC from April 2020 to April 2021. The study sample included 70 caregivers. We analyzed the association between caregiver mental health and caregiver demographics and child characteristics through bivariate linear regressions. We then used multivariate linear regression to assess the association between caregiver mental health and caregiver financial burden adjusting for significant covariates from our bivariate analysis.

Results:
Caregivers reported lower mental health scores (56.2) and higher financial burden scores (15.5) than reference population means: (72.6; SD 20.2) and (10.4; SD 2.2), respectively. Financial burden [−3.4; p = 0.0003; CI: −5.1 to −1.6] and child age [−0.1; p = 0.02; CI: 0.2–1.8] were significantly associated with caregiver mental health in our bivariate analysis. In our multivariate analysis, caregivers with an increased financial burden had lower mental health scores [−3.0; p = 0.002; CI: −4.8 to −1.2].

Conclusion:
Caregivers of children with medically complex conditions experienced more mental health symptoms and greater financial burdens than normative samples during the COVID-19 pandemic. Parents with a greater financial burden also tend to have more mental health issues. Eligibility for financial assistance should include financial burden and income when providing help to families in this population. Local and national stakeholders should consider the provision of financial help in their quest to improve the mental health of caregivers.
Association Between Maternal Postnatal Depression and Offspring Anxiety and Depression in Adolescence and Young Adulthood: A Meta-Analysis
Authors: Chithiramohan Tamara , Eslick Guy D. 
Published: February 2023

Abstract:

Objective:
Postnatal depression (PND) is common, with an incidence of 10% to 20% in new mothers. Studies have identified an association between maternal PND and adverse childhood effects. Fewer studies have explored the risk of psychiatric disorders in adolescence and adulthood.

Methods:
MEDLINE, PubMed, PsycINFO, Embase, and EmCare were searched. Studies evaluating the association between maternal PND and offspring anxiety or depression in adolescence or adulthood were included. Five prospective cohort studies met the inclusion criteria. The odds ratios were pooled using a random effects model, and heterogeneity and publication bias were assessed.

Results:
Anxiety: The 4 relevant studies were composed of 273 mothers with PND and 916 controls, followed up for 12 to 23 years. The pooled odds ratio (OR) was 2.19 (1.33–3.61), p = 0.002, with no heterogeneity (I2 = 0.00, p = 0.49). Depression: The 5 studies were composed of 937 mothers with PND and 3099 controls, followed up from 12 to 23 years. The pooled OR was 1.92 (1.08–3.42), p = 0.026, with heterogeneity (I2 = 62.89, p = 0.03).

Conclusion:
Offspring of mothers with PND are twice as likely to suffer from anxiety and almost twice as likely to suffer from depression than those without exposure. This evidence heightens the importance of detection and treatment of postnatal depression. Furthermore, early assessment and support could be provided to the high-risk group of offspring.
Parent-Reported Caregiving Roles of Siblings of Children with Inborn Errors of Metabolism
Authors: Granovetter Madeleine A. , Sumrall Sydney , Lea Dawn , Gelles Shani , Koehly Laura M. 
Published: February 2023

ABSTRACT:

Objectives:
Research examining sibling caregiving contributions to medically complex pediatric patients, including those with inborn errors of metabolism (IEMs), is limited. We assess caregiving roles and attributes of siblings and hypothesize that there will be differences in parent-reported contributions among siblings of children with IEMs and siblings of typically developing (TD) children.

Study design:
A convergent parallel mixed-methods study design guided analysis of data from parental surveys and semistructured interviews. Interviews were conducted with parents (n = 49) of children with IEMs and parents (n = 28) of exclusively TD children. We used inductive thematic analysis to identify themes related to sibling caregiving. The caregiving and support roles for siblings (n = 55) of children with IEMs and siblings (n = 42) of TD children were coded to assess each sibling's caregiving contributions and personal attributes.

Results:
Logistic regressions, using generalized estimating equations, were fitted. Results showed that siblings of children with IEMs were significantly more likely to provide monitoring (odds ratio [OR]: 3.62, confidence interval [CI]: 1.30–10.07) and emotional/social support (OR: 4.02, CI: 1.67–9.67) than siblings of TD children. Themes arising from interviews with parents of children with IEMs focused on sibling attributes, parental expectations regarding sibling caregiving, and challenges to the sibling-sibling and parent-sibling relationships. Themes revealed nuances in the sibling caregiving experience.

Conclusion:
Siblings of children with IEMs make meaningful caregiving contributions and may provide care differently than siblings of TD children. Understanding childhood caregiving roles may inform how health care providers and parents encourage sibling caregiving contributions into adulthood.
Hepatic venous reconstruction of the left lateral segment with emphasis on anomalous hepatic vein in pediatric liver transplantation
Authors: da Fonseca Eduardo Antunes , Feier Flavia Heinz , Costa Carolina Magalhães , Benavides Marcel Albeiro Ruiz , Vincenzi Rodrigo , de Oliveira Roda Vincenzi Karina Moreira , Pugliese Renata Pereira Sustovich , Porta Gilda , Miura Irene Kazuo , de Oliveira Caio Marcio Vieira , Chapchap Paulo , Neto João Seda 
Published: February 2023

Left lateral segment grafts have become a suitable option in pediatric liver transplantation (PLT). The correlation between hepatic vein (HV) reconstruction and outcome is relevant when assessing the safe use of these grafts. We retrospectively reviewed the medical records prospectively collected from a pediatric living donor liver transplantation database and conducted a comparative analysis of the different left lateral segment graft types according to HV reconstruction. Donor, recipient, and intraoperative variables were analyzed. Post-transplant outcomes included vascular complications such as hepatic vein outflow obstruction, early (≤30 d) and late (>30 d) PVT, hepatic artery thrombosis, and graft survival. From February 2017 to August 2021, 303 PLTs were performed. According to venous anatomy, the distribution of the left lateral segment was as follows: single HV (type I) in 174 (57.4%), close HVs, simple venoplasty for reconstruction (type II) in 97 (32.01%), anomalous hepatic vein (AHV) with a distance between the HVs orifices that allowed simple venoplasty (type IIIA) in 25 (8.26%) and AHV with a distance between the HVs orifices requiring homologous venous graft interposition (type IIIB) in 07 (2.31%) grafts. Type IIIB grafts came from male donors (p=0.04) and had a higher mean donor height (p=0.008), a higher mean graft weight, and a higher graft-to-recipient weight ratio, both p=0.002. The median follow-up time was 41.4 months. The overall cumulative graft survival was 96.3%, and comparative graft survival showed no difference (log-rank p=0.61). No hepatic vein outflow obstructions were observed in this cohort study. There was no statistically significant difference in the post-transplant outcomes between the graft types. The venous reconstruction of the AHV with homologous venous graft interposition had similar outcomes in the short and long term.
Comparison of Internal and External Distraction in Frontofacial Monobloc Advancement: A Three-Dimensional Quantification
Authors: Rickart Alexander J , van de Lande Lara S , O’ Sullivan Eimear , Bloch Kevin , Arnaud Eric , Schievano Silvia , Jeelani Noor ul Owase , Paternoster Giovanna , Khonsari Roman , Dunaway David J 
Published: February 2023

Introduction
Crouzon syndrome is characterised by complex craniosynostosis and midfacial hypoplasia. Where frontofacial monobloc advancement (FFMBA) is indicated, the method of distraction used to achieve advancement holds an element of equipoise. This two-centre retrospective cohort study quantifies the movements produced by internal or external distraction methods used for FFMBA. Using shape analysis, this study evaluates if the different distraction forces cause plastic deformity of the frontofacial segment, producing distinct morphological outcomes.

Methods
Patients with Crouzon syndrome who underwent FFMBA with internal distraction (Necker, Hôpital Necker - Enfants Malades, Paris) or external distraction (GOSH, Great Ormond Street Hospital for Children, London) were compared. DICOM files of pre- and post-operative CT-scans were converted to three-dimensional bone meshes and skeletal movements were assessed using non-rigid iterative closest point registration. Displacements were visualised using colour maps and statistical analysis of the vectors undertaken.

Results
51 patients met the strict inclusion criteria. 25 underwent FFMBA with external distraction and 26 with internal distraction. External distraction provides a preferential midfacial advancement whereas internal distractors produce a more positive movement at the lateral orbital rim. This confers good orbital protection but does not advance the central midface to the same extent. Vector analysis confirmed this to be statistically significant (p<0.01).

Conclusion
Morphological changes resulting from monobloc surgery differ depending on the distraction technique used. Although the relative merits of internal and external distraction still stand, it may be that external distraction is more suited to addressing the midfacial biconcavity seen in syndromic craniosynostosis.
Factors Influencing the Lagophthalmos and Lid Lag After Simple Congenital Blepharoptosis Correction
Authors: Miao Xiaoteng , Wang Tailing , Wang Jiaqi 
Published: February 2023

Background:
Lagophthalmos and lid lag is the most common complication after ptosis correction. Great efforts had been made to control it, but little was known about the factors influencing it. So we ran this research to explore the possible mechanisms underlying it. This would be beneficial to solving this problem.

Materials and Methods:
In this cohort study, patients treated with the forked frontalis muscle aponeurosis suspension and levator aponeurosis-Muller’s muscle complex resection were identified. Lagophthalmos height and lid lag was measured at the postoperative week 1 visits. The Spearman correlation test was run to test whether lagophthalmos was related to patients’ age, levator function, and severity of ptosis. Then we measured the contents of collagen and elastin fibers of frontalis muscle fascia and levator aponeurosis from the patients and levator aponeurosis from cadaver heads histologically and compared the contents in these 3 groups.

Results:
No correlation was found between patients’ age, levator function, the severity of ptosis, and with lagophthalmos height. However, the contents of collagen and elastic fibers were both higher in the frontalis fascia than in the normal aponeurosis tissues. The difference in collagen fibers content between frontalis muscle fascia and patients’ aponeurosis was statistically insignificant.

Conclusions:
The severe lagophthalmos and lid lag may be caused by the poor mechanical features of the frontalis muscle. A better source of motive force to elevate the eyelids and a novel sling material with proper elasticity and stiffness would be the solution to improve the lagophthalmos and lid lag after ptosis correction.