bluuebunny/crossref_metadata_2025_split huggingface dataset:
A modified Child-Turcotte-Pugh score based on plasma ammonia predicts survival for patients with decompensated cirrhosis
Authors: Wang X , Zhang M , Xiao J , Zhang W , Wang Y , Zhang S , Zou X , Wang L , Zhuge Y , Zhang F 
Published: April 2023

Summary

Background
Plasma ammonia has been shown to be an independent prognostic factor for patients with liver cirrhosis.

Aim
We aimed to investigate the discrimination and calibration of a new prognostic model (aCTP) based on plasma ammonia (Amm) replacing hepatic encephalopathy (HE) in the Child-Turcotte-Pugh (CTP) score.

Design
Diagnostic test, paired design.

Methods
Baseline Amm levels were corrected to the upper limit of normal (Amm-ULN). We designed the new model based on the cut-off value of Amm-ULN in the observational cohort of 554 clinically stable cirrhotic patients from January 2012 to July 2019. External validation was carried out using prospective data from 185 patients with liver cirrhosis.

Results
Our analysis showed that each 1-point increase in Amm-ULN was associated with a 2-fold increase in the likelihood of mortality [hazard ratio (HR), 2.06; 95% CI: 1.81–2.36, P &lt; 0.001]. In the aCTP score, Amm-ULN &lt; 1.0 was defined as a score of 1, 1.0 ≤ Amm-ULN &lt; 1.4 as 2 and ≥1.4 as 3. The survival curves among three aCTP grades were significantly different (P &lt; 0.0001). The aCTP score showed the better agreements between predicted and observed events in the validating cohorts than the CTP score (C-statistics: 0.75 and 0.69, P &lt; 0.001). The aCTP score showed inspiring power to predict acute decompensation (C-statistics: 0.76; 95% CI: 0.71–0.81) and acute-on-chronic liver failure (C-statistics: 0.81; 95% CI: 0.77–0.86).

Conclusion
This study demonstrates the feasibility and the potential for plasma Amm replacing HE (aCTP) to enhance the prognostication of transplant-free survival provided by the CTP score for patients with decompensated cirrhosis.
Diagnosing and managing dysphagia in inclusion body myositis: a systematic review
Authors: Ambrocio Kevin Renz , Garand Kendrea L (Focht) , Roy Bhaskar , Bhutada Ankita M , Malandraki Georgia A 
Published: April 2023

Abstract

Objectives
Dysphagia is a common debilitating clinical feature of IBM. However, the impact of dysphagia in IBM has been historically overlooked. This study aimed to identify, evaluate and summarize the evidence regarding the assessment and management of dysphagia in persons with IBM undergoing treatment.

Methods
A systematic review was conducted using a multiengine search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Eligible studies had to employ an intervention for persons with IBM, report a swallowing outcome and be published in English. Quality assessments of the eligible studies were performed.

Results
Of 239 studies found, 19 met the inclusion criteria. One study was rated as ‘fair’ and the rest as ‘poor’ quality, particularly due to the lack of published and validated swallowing assessment procedures and outcome measures. Cricopharyngeal (CP) dysfunction (12/19) was the most commonly reported swallowing abnormality. Interventions for disease management included pharmacological agents (10/19), followed by surgical (3/19), behavioral (1/19) and combined approaches (5/19). Interventions with immunosuppressants, botulinum toxin injection, balloon dilation and/or CP myotomy led to mixed and transient benefits. Few studies examining statins or behavioral therapies (primarily focused on respiratory function) showed no effects for dysphagia.

Conclusion
Various interventions have been reported to temporarily improve dysphagia in persons with IBM. However, these findings are based on limited and overall low-quality evidence. This study cautions against the generalization of these findings and emphasizes the need for further systematic research to improve the diagnosis and management of dysphagia in IBM.
Engaging non-mathematics students in mathematics learning through collaborative teaching
Authors: Mathias Jinhua , Saville Christopher , Leech Steve 
Published: April 2023

Abstract
Mathematics is a common component of many science and social science degrees, but frequently not considered a prerequisite for their study. This can lead to some students studying mathematics components at undergraduate level with little or no previous mathematical learning and varying levels of motivation, or desire, to study mathematics. This situation has consequences for student experience and teaching practice, including the potential for lower levels of student engagement, higher levels of student anxiety and lack of student motivation for studying a subject that is not what they chose as their degree subject. This paper details an intervention designed to address issues experienced in the teaching of mathematics to undergraduate students, with varying motivation for the study of mathematics and high levels of mathematics anxiety, in their first year of study in a department of Earth Sciences at a UK university. The intervention provided a bespoke mathematics module, designed and taught collaboratively by a teaching specialist in mathematics and a subject specialist in Earth Sciences. The mathematics specialist was able to provide extensive experience in teaching students from widening participation backgrounds and those with mathematics anxiety, making the content more accessible to the students, particularly those with mathematics anxiety. The Earth Sciences specialist was able to contextualize the mathematics content, showing students how the content was applicable to the rest of the degree and helping locate the mathematical content within the broader scope of the discipline. Previous approaches to this module were taught either solely by an Earth Sciences specialist or solely by a mathematics specialist. Compared with those approaches the collaborative teaching intervention improved student attainment by 10% in the average module mark and moved the module from having the lowest student satisfaction scores in the department to the highest. This innovation also benefited both teachers with respect to professional development, which is discussed in the paper.
Molecular mechanisms of postoperative atrial fibrillation in patients with obstructive sleep apnea
Authors: López‐Gálvez Raquel , Rivera‐Caravaca José Miguel , Mandaglio‐Collados Darío , Orenes‐Piñero Esteban , Lahoz Álvaro , Hernández‐Romero Diana , Martínez Carlos M. , Carpes Marina , Arribas José María , Cánovas Sergio , Lip Gregory Y. H. , Marín Francisco 
Published: April 2023

AbstractObstructive sleep apnea (OSA) promotes atrial remodeling and fibrosis, providing a substrate for atrial fibrillation (AF). Herein, we investigate the pathophysiological mechanisms of AF in association with OSA in a cohort of cardiac surgery patients. A prospective study including patients undergoing cardiac surgery. Biomarkers reflective of AF pathophysiology (interleukin [IL‐6], C‐reactive protein [CRP], von Willebrand factor [vWF], N‐terminal pro‐brain natriuretic peptide [NT‐proBNP], high‐sensitivity Troponin T [hs‐TnT], and Galectin‐3 [Gal‐3]) was assessed by functional or immunological assays. miRNAs involved in AF were analyzed by reverse transcription‐polymerase chain reaction (RT‐PCR). Using atrial tissue samples, fibrosis was assessed by Masson's trichrome. Connexin 40 and 43 (Cx40; Cx43) were evaluated by immunolabeling. Fifty‐six patients (15 with OSA and 41 non‐OSA) were included in this hypothesis‐generating pilot study. OSA group had a higher incidence of postoperative AF (POAF) (46.7% vs. 19.5%; p = .042), presented an increased risk of POAF (OR 3.61, 95% CI 1.01–12.92), and had significantly higher baseline levels of NT‐proBNP (p = .044), vWF (p = .049), Gal‐3 (p = .009), IL‐6 (p = .002), and CRP (p = .003). This group presented lower levels of miR‐21 and miR‐208 (both p < .05). Also, lower Cx40 levels in POAF and/or OSA patients (50.0% vs. 81.8%, p = .033) were found. The presence of interstitial fibrosis (according to myocardial collagen by Masson's trichrome) was raised in OSA patients (86.7% vs. 53.7%, p = .024). Several biomarkers and miRNAs involved in inflammation and fibrosis were dysregulated in OSA patients, which together with a higher degree of interstitial fibrosis, altered miRNA, and Cxs expression predisposes to the development of a substrate that increases the AF risk.
Surgical Stress: The Muscle and Cognitive Demands of Robotic and Laparoscopic Surgery
Authors: Shugaba Abdul , Subar Daren A. , Slade Kate , Willett Mark , Abdel-Aty Mohammed , Campbell Iain , Heywood Nick , Vitone Louis , Sheikh Adnan , Gill Mike , Zelhof Bachar , Nuttall Helen E. , Bampouras Theodoros M. , Gaffney Christopher J. 
Published: April 2023

Introduction:
Surgeons are among the most at-risk professionals for work-related musculoskeletal decline and experience high mental demands. This study examined the electromyographic (EMG) and electroencephalographic (EEG) activities of surgeons during surgery.

Methods:
Surgeons who performed live laparoscopic (LS) and robotic (RS) surgeries underwent EMG and EEG measurements. Wireless EMG was used to measure muscle activation in 4 muscle groups bilaterally (biceps brachii, deltoid, upper trapezius, and latissimus dorsi), and an 8-channel wireless EEG device was used to measure cognitive demand. EMG and EEG recordings were completed simultaneously during (1) noncritical bowel dissection, (2) critical vessel dissection, and (3) dissection after vessel control. Robust ANOVA was used to compare the %MVCRMS and alpha power between LS and RS.

Results:
Thirteen male surgeons performed 26 LS and 28 RS. Muscle activation was significantly higher in the right deltoid (P = 0.006), upper trapezius (left, P = 0.041; right, P = 0.032), and latissimus dorsi (left, P = 0.003; right, P = 0.014) muscles in the LS group. There was greater muscle activation in the right biceps than in the left biceps in both surgical modalities (both P = 0.0001). There was a significant effect of the time of surgery on the EEG activity (P < 0.0001). A significantly greater cognitive demand was observed in the RS than in the LS with alpha, beta, theta, delta, and gamma (P = 0.002 – P <0.0001).

Conclusions:
These data suggest greater muscle demands in laparoscopic surgery, but greater cognitive demands in RS. This trial was registered at Clinicaltrials.gov (NCT04477746).
ICU Bereaved Surrogates’ Transition Through States of Co-Occurring Prolonged Grief Disorder, Posttraumatic Stress Disorder, and Depression Symptoms*
Authors: Wen Fur-Hsing , Prigerson Holly G. , Chou Wen-Chi , Huang Chung-Chi , Hu Tsung-Hui , Chiang Ming Chu , Chuang Li-Pang , Tang Siew Tzuh 
Published: April 2023

OBJECTIVES:
Grief-related psychological distress often co-occurs to conjointly impair function during bereavement. Knowledge of comorbid grief-related psychological distress is limited: no longitudinal study has examined dynamic patterns of co-occurring prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression, and previous assessment time frames have been variable and potentially inadequate given the duration criterion for PGD. Therefore, the purpose of this study was to investigate the transition of distinct symptom states based on the co-occurrence of PGD, PTSD, and depression symptoms for ICU bereaved surrogates over their first two bereavement years.

DESIGN:
Prospective, longitudinal, observational study.

SETTING:
Medical ICUs at two academically affiliated medical centers in Taiwan.

PATIENTS/PARTICIPANTS:
Three hundred three family surrogates responsible for decision-making for critically ill patients at high risk of death (Acute Physiology and Chronic Evaluation II scores > 20) from a disease.

INTERVENTION:
None.

MEASUREMENTS AND MAIN RESULTS:
Participants were assessed by 11 items of the Prolonged Grief Disorder (PG-13) scale, the Impact of Event Scale—Revised, and the depression subscale of the Hospital Anxiety and Depression Scale at 6, 13, 18, and 24 months postloss. PGD-PTSD-depression-symptom states and their evolution were examined by latent transition analysis. The following four distinct PGD-PTSD-depression-symptom states (prevalence) were initially identified: resilient (62.3%), subthreshold depression-dominant (19.9%), PGD-dominant (12.9%), and PGD-PTSD-depression comorbid (4.9%) states. These PGD-PTSD-depression-symptom states remained highly stable during the first two bereavement years, with transitions predominantly toward resilience. Prevalence for each state at 24 months postloss was 82.1%, 11.4%, 4.0%, and 2.5%, respectively.

CONCLUSIONS:
Four highly stable PGD-PTSD-depression-symptom states were identified, highlighting the importance of screening for subgroups of ICU bereaved surrogates with increased PGD or comorbid PGD, PTSD, and depression symptoms during early bereavement.
Immune checkpoint inhibitors for the treatment of non-small cell lung cancer brain metastases
Authors: Wei Yuxi , Xu Yan , Wang Mengzhao 
Published: April 2023

Abstract
Lung cancer has the highest risk of brain metastasis (BM) among all solid carcinomas. The emergence of BM has a significant impact on the selection of oncologic treatment for patients. Immune checkpoint inhibitors (ICIs) are the most promising treatment option for patients without druggable mutations and have been shown to improve survival in patients with non-small cell lung cancer (NSCLC) BM in clinical trials with good safety. Moreover, ICI has shown certain effects in NSCLC BM, and the overall intracranial efficacy is comparable to extracranial efficacy. However, a proportion of patients showed discordant responses in primary and metastatic lesions, suggesting that multiple mechanisms may exist underlying ICI activity in BM. According to studies pertaining to tumor immune microenvironments, ICIs may be capable of provoking immunity in situ. Meanwhile, systematic immune cells activated by ICIs can migrate into the central nervous system and exert antitumor effects. This review summarizes the present evidence for ICI treatment efficacy in NSCLC BM and proposes the possible mechanisms of ICI treatment for NSCLC BMs based on existing evidence.
Facial Anthropometric Norms of the Young Black South African Woman
Authors: Wilson Stephen P. , Medapati Vengal , Segwapa Kenneth 
Published: April 2023

Background:
Ethnic pride and the push toward preservation of ethnicity in all areas of aesthetic and reconstructive medicine has created the need for normative facial anthropometric data specific to localized geographical populations. This study aimed to gather a set of soft tissue anthropometric norms for the young Black South African woman and to compare this with international data and neoclassical anthropometric maxims.

Methods:
In total, 156 Black female students from Sefako Makgatho University between 18 and 25 years of age, with a normal dental occlusion and a normal body mass index were included in the study. Computer-based photographic analysis of participants’ faces in anterior, lateral, and basal views was undertaken under strict studio conditions and compared with international studies.

Results:
Facial height proportions tended toward a smaller upper facial third in comparison with mid and lower facial thirds. Nasal width was greater than other populations, and exceeded the neoclassical canon of one-fifth of facial width. Nasal tip projection was greater than Congolese and African American counterparts. Vermilion height ratios approximated a ratio of 1:1 with lip protrusion beyond the classical Rickets E-line.

Conclusions:
The “classical” anthropometric measurements most often quoted in academic literature, although important in their own right, do not consider the distinct differences in facial anthropometric norms between population and racial groups. These differences must be taken into consideration to preserve ethnic traits and optimize aesthetic outcomes.
Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions
Authors: Ferdinand Keith C. , Charbonnet Rachel M. , Laurent Jodie , Villavaso Chloe D. 
Published: April 2023

Purpose of review
Hypertension in non-Hispanic black (NHB) adults in the United States has an earlier onset, higher prevalence, and increased severity compared with other racial/ethnic populations. Uncontrolled hypertension is responsible for the increased burden of cardiovascular disease (CVD) morbidity and mortality and decreased longevity in NHB adults. Unfortunately, eliminating the persistent hypertension-associated disparities and the white/black mortality gap, worsened by the COVID-19 pandemic, has been challenging. Overcoming the social determinants of health (SDOH), implementing therapeutic lifestyle changes (TLC), and using intensive guideline-directed medical therapy are required. Moreover, novel approaches, including community-based interventions and self-measured blood pressure (SMBP) monitoring, may mitigate U.S. disparities in hypertension.

Recent findings
In this review, we discuss recent data regarding the U.S. NHB adult disparate hypertension control and CVD morbidity and mortality. We note current approaches to address disparities, such as TLC, evidence-based pharmacotherapy, community-based interventions and SMBP. Finally, we explore future research and initiatives to seek hypertension-related health equity.

Summary
In the final analysis, longstanding, unacceptable hypertension and CVD morbidity and mortality in U.S. NHB adults must be addressed. Appropriate TLC and evidence-based pharmacotherapy benefit all populations, especially NHB adults. Ultimately, novel community-based interventions and SMBP may help overcome the SDOH that cause hypertension disparities.
Secondary hypertension: evaluation and management
Authors: Tandan Nitin , Lavie Carl J. , Stewart Merrill H. , Milani Richard V. , Ventura Hector O. 
Published: April 2023

Purpose of review
Hypertension (HTN) that can be attributed to a particular source is known as secondary HTN (SH). Often, SH is difficult to control and thus referred to as resistant HTN, although the two terms are not mutually exclusive.

Recent findings
A common theme across several contributors to SH are coactivation of the sympathetic drive and hormonal changes, independent of hormonal axis activation. The key to effective management of SH is early recognition and treatment to avoid catastrophic cardiovascular disease effects and mortality.

Summary
This review article provides a contemporary summary of the conditions associated with SH and briefly reviews diagnostics and management.
Impact of perinatal factors on biomarkers of cardiovascular disease risk in preadolescent children
Authors: Mansfield Roshni , Cecula Paulina , Pedraz Carmen Traseira , Zimianiti Ioanna , Elsaddig Malaz , Zhao Rebecca , Sathiyamurthy Sundar , McEniery Carmel M. , Lees Christoph , Banerjee Jayanta 
Published: April 2023

Background:
This review aims to summarize associations of the perinatal environment with arterial biophysical properties in childhood, to elucidate possible perinatal origins of adult cardiovascular disease (CVD).

Methods:
A systematic search of PubMed database was performed (December 2020). Studies exploring associations of perinatal factors with arterial biophysical properties in children 12 years old or less were included. Properties studied included: pulse wave velocity; arterial stiffness or distensibility; augmentation index; intima–media thickness of aorta (aIMT) or carotids; endothelial function (laser flow Doppler, flow-mediated dilatation). Two reviewers independently performed study selection and data extraction.

Results:
Fifty-two of 1084 identified records were included. Eleven studies explored associations with prematurity, 14 explored maternal factors during pregnancy, and 27 explored effects of low birth weight, small-for-gestational age and foetal growth restriction (LBW/SGA/FGR). aIMT was consistently higher in offspring affected by LBW/SGA/FGR in all six studies examining this variable. The cause of inconclusive or conflicting associations found with other arterial biophysical properties and perinatal factors may be multifactorial: in particular, measurements and analyses of related properties differed in technique, equipment, anatomical location, and covariates used.

Conclusion:
aIMT was consistently higher in LBW/SGA/FGR offspring, which may relate to increased long-term CVD risk. Larger and longer term cohort studies may help to elucidate clinical significance, particularly in relation to established CVD risk factors. Experimental studies may help to understand whether lifestyle or medical interventions can reverse perinatal changes aIMT. The field could be advanced by validation and standardization of techniques assessing arterial structure and function in children.
Relationship Between Degree of Neonatal Physiologic Desquamation and Skin Barrier Function
Authors: Yonezawa Kaori , Haruna Megumi 
Published: April 2023

Background/Objectives:
This study examined the relationship between degree of neonatal physiologic desquamation and skin barrier functionality. In addition, we identified factors associated with neonatal desquamation.

Methods:
This cross-sectional study assessed 4-day-old newborns. The desquamation level was evaluated and placed in one of the following categories based on the severity of the desquamation: no desquamation, a small amount, and severe (including cracked or bleeding). Skin barrier function was assessed by evaluating transepidermal water loss, stratum corneum hydration, skin pH, and sebum secretion.

Results:
Among study participants, 67 (39.9%) showed no desquamation, 82 (48.8%) displayed a small amount, and 19 (11.3%) had severe desquamation. The group with severe desquamation had significantly elevated facial transepidermal water loss levels and reduced levels of stratum corneum hydration throughout the body, indicating skin barrier dysfunction, than other groups. In addition, the group with severe desquamation had a significantly longer gestational age, lower temperature and humidity level, smaller vernix caseosa, and tended to be born during winter.

Conclusions:
To our knowledge, this is the first report indicating that infants with severe desquamation had worsened skin barrier function versus those with moderate and no desquamation. Future research should consider what kind of care should be provided to newborns with severe desquamation.