bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Utility of Quantitative Parameters of Shear-Wave Elastography to Predict Prognostic Histologic Features of Breast Cancer
Authors: Avdan Aslan Aydan , Gültekin Serap , İnan Mehmet Arda 
Published: March 2023

Abstract
In this study, we aimed to investigate the correlation of stiffness values of shear-wave elastography (SWE) and histopathological prognostic factors in patients with breast cancer. Between January 2021 and June 2022, SWE images of 138 core-biopsy proven breast cancer lesions from 132 patients were retrospectively reviewed. Histopathogic prognostic factors, including tumor size, histologic grade, histologic type, hormone receptor positivity, human epidermal growth factor receptor (HER2) status, immunohistochemical subtype and Ki-67 index were documented. Elasticity values including mean and maximum elasticity (E
mean and E
max) and lesion-to-fat ratio (E
ratio) were recorded. The association between histopathological prognostic factors and elasticity values were assessed using Mann-Whitney U and Kruskal-Wallis test, and multiple linear regression analysis. Tumor size, histological grade, and Ki-67 index were significantly associated with the E
ratio (P < 0.05). Larger tumor size and higher Ki-67 index also showed significantly higher E
mean and E
max values (P < 0.05). However, hormone receptor positivity, HER2 status, and immunohistochemical subtype were not significantly associated with elasticity values (P > 0.05). Multivariate logistic regression analysis revealed that tumor size was significantly associated with E
mean, E
max, and E
ratio values (P < 0.05). A high Ki-67 index was also significantly associated with high E
ratio values. Larger tumor size and higher Ki-67 index are independently associated with high E
ratio values. Preoperative SWE may improve the performance of conventional ultrasound in predicting prognosis and treatment planning.
Differentiation Between Compressive Cervical and Thoracic Myelopathy Using the Central Motor Conduction Time Ratio
Authors: Kamei Naosuke , Nakamae Toshio , Nakanishi Kazuyoshi , Maruyama Toshiaki , Nakao Kazuto , Farid Fadlyansyah , Adachi Nobuo 
Published: March 2023

Purpose:
Thoracic myelopathy is a rare condition whose diagnosis is often missed or delayed. This study aimed to differentiate between cervical and thoracic myelopathy using motor-evoked potential testing.

Methods:
The authors included 835 patients with compressive cervical myelopathy and 94 patients with compressive thoracic myelopathy. Myelopathy using motor-evoked potentials were recorded from the bilateral abductor digiti minimi and abductor hallucis muscles through transcranial magnetic stimulation. The peripheral conduction time was measured through electrical stimulation of the ulnar and tibial nerves; moreover, the central motor conduction time (CMCT) was calculated by subtracting the peripheral conduction time from the myelopathy using motor-evoked potential latency.

Results:
The most accurate differentiation between compressive cervical myelopathy and compressive thoracic myelopathy was achieved by the CMCT ratios (CMCT-ADM:CMCT-AH; cutoff value of 0.490, sensitivity of 83.0%, and specificity of 80.5%). After excluding patients with compressive cervical myelopathy who had spinal cord compression at C6-7, the cutoff value was 0.490, with a sensitivity of 83.0% and specificity of 87.3%.

Conclusions:
Determining the CMCT ratio (cutoff value of 0.490) through motor-evoked potential testing could facilitate differentiation between compressive cervical myelopathy and compressive thoracic myelopathy.
Continuous Electroencephalogram Use and Hospital Outcomes in Critically Ill Children
Authors: Oh Ahyuda , Wusthoff Courtney J. , Kim Hyunmi 
Published: March 2023

Purpose:
To examine the association between CEEG use and discharge status, length of hospitalization, and health care cost in a critically ill pediatric population.

Methods:
Four thousand three hundred forty-eight critically ill children were identified from a US nationwide administrative health claims database; 212 (4.9%) of whom underwent CEEG during admissions (January 1, 2015–june 30, 2020). Discharge status, length of hospitalization, and health care cost were compared between patients with and without CEEG use. Multiple logistic regression analyzed the association between CEEG use and these outcomes, controlling for age and underlying neurologic diagnosis. Prespecified subgroups analysis was performed for children with seizures/status epilepticus, with altered mental status and with cardiac arrest.

Results:
Compared with critically ill children without CEEG, those who underwent CEEG were likely to have shorter hospital stays than the median (OR = 0.66; 95% CI = 0.49–0.88; P = 0.004), and also total hospitalization costs were less likely to exceed the median (OR = 0.59; 95% CI = 0.45–0.79; P < 0.001). There was no difference in odds of favorable discharge status between those with and without CEEG (OR = 0.69; 95% CI = 0.41–1.08; P = 0.125). In the subgroup of children with seizures/status epilepticus, those with CEEG were less likely to have unfavorable discharge status, compared with those without CEEG (OR = 0.51; 95% CI = 0.27–0.89; P = 0.026).

Conclusions:
Among critically ill children, CEEG was associated with shorter stay and lower costs of hospitalization but was not associated with change of favorable discharge status except the subgroup with seizures/status epilepticus.
Interhemispheric Asymmetries in Intracortical Facilitation Correlate With Fatigue Severity in Individuals With Poststroke Fatigue
Authors: Kindred John H. , Gregory Chris M. , Kautz Steven A. , Bowden Mark G. 
Published: March 2023

Purpose:
Poststroke fatigue (PSF) contributes to increased mortality and reduces participation in rehabilitative therapy. Although PSF's negative influences are well known, there are currently no effective evidence-based treatments for PSF. The lack of treatments is in part because of a dearth of PSF pathophysiological knowledge. Increasing our understanding of PSF's causes may facilitate and aid the development of effective therapies.

Methods:
Twenty individuals, >6 months post stroke, participated in this cross-sectional study. Fourteen participants had clinically relevant pathological PSF, based on fatigue severity scale (FSS) scores (total score ≥36). Single-pulse and paired-pulse transcranial magnetic stimulation were used to measure hemispheric asymmetries in resting motor threshold, motor evoked potential amplitude, and intracortical facilitation (ICF). Asymmetry scores were calculated as the ratios between lesioned and nonlesioned hemispheres. The asymmetries were then correlated (Spearman rho) to FSS scores.

Results:
In individuals with pathological PSF (N = 14, range of total FSS scores 39–63), a strong positive correlation (r
s = 0.77, P = 0.001) between FSS scores and ICF asymmetries was calculated.

Conclusions:
As the ratio of ICF between the lesioned and nonlesioned hemispheres increased so did self-reported fatigue severity in individuals with clinically relevant pathological PSF. This finding may implicate adaptive/maladaptive plasticity of the glutamatergic system/tone as a contributor to PSF. This finding also suggests that future PSF studies should incorporate measuring facilitatory activity and behavior in addition to the more commonly studied inhibitory mechanisms. Further investigations are required to replicate this finding and identify the causes of ICF asymmetries.
EEG Monitoring in Critically Ill Children: Establishing High-Yield Subgroups
Authors: Fung France W. , Parikh Darshana S. , Donnelly Maureen , Jacobwitz Marin , Topjian Alexis A. , Xiao Rui , Abend Nicholas S. 
Published: March 2023

Purpose:
Continuous EEG monitoring (CEEG) is increasingly used to identify electrographic seizures (ES) in critically ill children, but it is resource intense. We aimed to assess how patient stratification by known ES risk factors would impact CEEG utilization.

Methods:
This was a prospective observational study of critically ill children with encephalopathy who underwent CEEG. We calculated the average CEEG duration required to identify a patient with ES for the full cohort and subgroups stratified by known ES risk factors.

Results:
ES occurred in 345 of 1,399 patients (25%). For the full cohort, an average of 90 hours of CEEG would be required to identify 90% of patients with ES. If subgroups of patients were stratified by age, clinically evident seizures before CEEG initiation, and early EEG risk factors, then 20 to 1,046 hours of CEEG would be required to identify a patient with ES. Patients with clinically evident seizures before CEEG initiation and EEG risk factors present in the initial hour of CEEG required only 20 (<1 year) or 22 (≥1 year) hours of CEEG to identify a patient with ES. Conversely, patients with no clinically evident seizures before CEEG initiation and no EEG risk factors in the initial hour of CEEG required 405 (<1 year) or 1,046 (≥1 year) hours of CEEG to identify a patient with ES. Patients with clinically evident seizures before CEEG initiation or EEG risk factors in the initial hour of CEEG required 29 to 120 hours of CEEG to identify a patient with ES.

Conclusions:
Stratifying patients by clinical and EEG risk factors could identify high- and low-yield subgroups for CEEG by considering ES incidence, the duration of CEEG required to identify ES, and subgroup size. This approach may be critical for optimizing CEEG resource allocation.
Impact of family support on the cognitive functions of Egyptian elderly
Authors: Moustafa Sara A. , Gaballah Nada , Heikal Shimaa , Salama Mohamed 
Published: March 2023

AbstractBackgroundSocial support is essential in the daily activities of the elderly, which can impact their cognitive functions over time.Aim of the studyThis study investigates the hypothesis that there is a link between social support and cognitive function in the elderly living in the Egyptian community using the Arabic translation of the Survey of Health, Ageing, Retirement in Europe (SHARE) questionnaire.Subjects and methodsCross-sectional analytic study was conducted as a part of the pilot study for A Longitudinal Study of Egyptian Healthy Ageing (AL-SEHA) project. It included 299 participants (50+ years of age). Investigators collected data using the Arabic translation of the SHARE questionnaire in five Egyptian Universities. Data were then uploaded to the Social Research Centre (SRC) at the American University in Cairo (AUC).ResultsThe prevalence of declined cognitive functions was 39.467% (95% CI: 33.89-45.04). Cognitive impairment was significantly less among university and postgraduate degree holders (p<0.001), married (p=0.0378) or contacted by their kids on a daily or weekly basis (p=0.0364).ConclusionBeing married, with a university degree or higher, and increased contact frequency with children, all showed positive correlation with cognitive function in our sample. In conclusion, this research contributes to our understanding of the impact of family network and support and cognitive function in the older Egyptian population. Our findings can be a base to add on to the literature.
Typological distinction of remotely sensed metrics of neighborhood vegetation for environmental health intervention design
Authors: Fleischer Daniel , Turner Jay , Heitmann Ivan , Bucknum Brent , Bhatnagar Aruni , Yeager Ray 
Published: March 2023

AbstractThe extent to which urban vegetation improves environmental quality and affects the health of nearby residents is dependent on typological attributes of “greenness”, such as canopy area to alleviate urban heat, grass to facilitate exercise and social interaction, leaf area to disperse and capture air pollution, and biomass to absorb noise pollution. The spatial proximity of these typologies to individuals further modifies the extent to which they impart benefits and influence health. However, most evaluations of associations between greenness and health utilize a single metric of greenness and few measures of proximity, which may disproportionately represent the effect of a subset of mediators on health outcomes.To develop an approach to address this potentially substantial limitation of future studies evaluating associations between greenness and health, we measured and evaluated distinct attributes, correlations, and spatial dependency of 13 different metrics of greenness in a residential study area of Louisville, Kentucky, representative of many urban residential areas across the Eastern United States. We calculated NDVI, other satellite spectral indices, LIDAR derived leaf area index and canopy volume, streetview imagery derived semantic view indices, distance to parks, and graph-theory based ecosystem connectivity metrics. We utilized correlation analysis and principal component analysis across spatial scales to identify distinct groupings and typologies of greenness metrics.Our analysis of correlation matrices and principal component analysis identified distinct groupings of metrics representing both physical correlates of greenness (trees, grass, their combinations and derivatives) and also perspectives on those features (streetview, aerial, and connectivity / distance). Our assessment of typological greenness categories contributes perspective important to understanding strengths and limitations of metrics evaluated by past work correlating greenness to health. Given our finding of inconsistent correlations between many metrics and scales, it is likely that many past investigations are missing important context and may underrepresent the extent to which greenness may influence health. Future epidemiological investigations may benefit from these findings to inform selection of appropriate greenness metrics and spatial scales that best represent the cumulative influence of the hypothesized effects of mediators and moderators. However, future work is needed to evaluate the effect of each of these metrics on health outcomes and mediators therein to better inform the understanding of metrics and differential influences on environments and health.
Contrast-Enhanced Magnetic Resonance Imaging Based T1-Mapping and Extracellular Volume Fractions are Associated with Peripheral Artery Disease
Authors: Fitian Asem , Shieh Michael C. , Gimnich Olga A. , Belousova Tatiana , Taylor Addison A. , Ballantyne Christie M. , Bismuth Jean , Shah Dipan J. , Brunner Gerd 
Published: March 2023

AbstractBackgroundExtracellular volume fraction (ECV), measured with contrast-enhanced magnetic resonance imaging (CE-MRI), has been utilized to study myocardial fibrosis but its role in peripheral artery disease (PAD) remains unknown. We hypothesized that T1-mapping and ECV differ between PAD patients and matched-controls.Methods and ResultsA total of 37 individuals (18 PAD, 19 controls) underwent 3.0T CE-MRI at the mid-calf. T1-mapping was done before and after gadolinium contrast with a motion corrected Modified Look Locker Inversion Recovery (MOLLI) pulse sequence. T1 values were calculated with a 3-parameter Levenberg-Marquardt curve fitting algorithm. T1-maps were quantified in 5 calf muscle compartments (anterior [AM], lateral [LM], and deep posterior [DM] muscle groups; soleus [SM], and gastrocnemius [GM] muscles). Averaged peak blood pool T1 values were obtained from the posterior (PT) and anterior tibialis (AT); and peroneal artery (PE). PAD ECV was calculated for each muscle group. T1 values and ECV are heterogeneous across calf muscle compartments. Native peak T1 values of the AM, LM, and DM were significantly higher in PAD patients compared to controls (all p<0.028). ECV of the AM and SM were significantly higher in PAD patients compared to controls (AM: 26.4% (21.2, 31.6) vs. 17.3% (10.2, 25.1), p=0.046; SM: 22.7% (19.5, 27.8) vs. 13.8% (10.2, 19.1), p=0.020).ConclusionsNative peak T1 values and ECV fractions of several calf muscle compartments are higher in PAD patients compared with matched-controls. These data suggest a potential utility of ECV to noninvasively determine skeletal muscle fibrosis in PAD.
Convergent Evolution of A-Lineage (Clade 19B) SARS-CoV-2 Spike Sequences with B-Lineage Variants of Concern Affects Virus Replication in a Temperature-Dependent Manner on Human Nasal Epithelial Cell Cultures
Authors: Yoon Steve , Anaya Eddy , Sachithanandham Jaiprasath , Pinsky Benjamin , Sullivan David , Mostafa Heba H. , Pekosz Andrew 
Published: March 2023

AbstractThe first three months of the COVID-19 pandemic was dominated by two SARS-CoV-2 lineages: A-lineages (Clade 19B) and B-lineages (Clade 19A). However, with the emergence of the Spike D614G substitution in B.1 lineages (Clade 20A), both early lineages were outcompeted and remained near-extinction from mid-2020 onwards. In early-2021, there was a re-emergence and persistence of novel A-lineage variants with substitutions in the Spike gene resembling those found in Variants of Concern (VOCs). An early A.3 variant (MD-HP00076/2020) and three A.2.5 variants (MD-HP02153/2021, MD-HP05922/2021 and CA-VRLC091/2021) were isolated and characterized for their genomic sequences, antibody neutralization, andin vitroreplication. All A.2.5 isolates had five Spike mutations relative to the A.3 variant sequence: D614G, L452R, Δ141-143, D215A, and ins215AGY. Plaque reduction neutralization assays demonstrated that A.2.5 isolates had a 2.5 to 5-fold reduction in neutralization using contemporaneous COVID-19 convalescent plasma when compared to A.3.In vitroviral characterization in VeroE6 cell lines revealed that the A.3 isolate grew faster and spread more than A.2.5. On VeroE6-TMPRSS2 cells, significant syncytia formation was also observed with the A.2.5 isolates, however Spike cleavage efficiency did not explain these differences. In human nasal epithelial cell (hNEC) cultures, the A.2.5 isolates grew significantly faster and to higher total infectious virus titers than A.3. All A.2.5 lineage isolates grew significantly faster at 37°C than at 33°C irrespective of cell type, and to higher peak titers except compared to A.3. This suggests A.2.5’s adapted to improve replication using similar mutations found in the B-lineage SARS-CoV-2 variants.ImportanceWhile both A- and B-lineage SARS-CoV-2 variants emerged and circulated together during the early months of the pandemic, the B-lineages that acquired Spike D614G eventually outcompeted all other variants. We show that the A-lineage variants eventually evolved mutations including Spike D614G and Spike L452R that improved their in vitro replication in human nasal epithelial cells in a temperature dependent manner, suggesting there are some highly selectable mutation landscapes that SARS-CoV-2 can acquire to adapt to replication and transmission in humans.
Individual, organisational and system capacities, and the functioning of a multi-country implementation-focused network for maternal, newborn and child health: Bangladesh, Ethiopia, Malawi, and Uganda
Authors: Tesfa Anene , Nakidde Catherine , Akter Kohenour , Khatun Fatama , Mwandira Kondwani , Lemma Seblewengel , Seruwagi Gloria , Mwaba Kasonde , English Mike , Daniels-Howell Callie ,   QCN Evaluation Group, Djellouli Nehla , Colbourn Tim , Marchant Tanya 
Published: March 2023

AbstractBetter policies, investments, and programs are needed to improve the integration and quality of maternal, newborn, and child health services. Previously, partnerships and collaborations that involved multiple countries with a unified aim have been observed to yield positive results. Since 2017, the WHO and partners have hosted the Quality of Care Network [QCN], a multi-country implementation network focused on improving maternal, neonatal, and child health care. In this paper we examine the functionality of QCN in different contexts. We focus on implementation capacities and contexts in four network countries: Bangladesh, Ethiopia, Malawi, and Uganda. In each country, the study was conducted over several consecutive rounds between 2019-2022, employing 227 key informant interviews with major stakeholders and members of the network countries, and 42 facility observations. The collected data were coded using Nvivo-12 software and categorized thematically. The study showed that individual, organizational and system-level capacities, and circumstances all played an important role in shaping implementation success in network countries, but that these levels were inter-linked. Across all levels, systems that enabled leadership, motivated and trained staff, and created a positive culture of data use were critical – from the policy making arena including addressing financing issues - to the day-to-day practice improvement at the front line. Some characteristics of QCN actively supported these levels, for example shared learning forums for continuous learning, a focus on data and tracking progress, and emphasising the importance of coordinated efforts towards a common goal. However, inadequate system financing and capacity also hampered network functioning, especially in the face of external shocks.
Genome-wide screen identifies host loci that modulateM. tuberculosisfitness in immunodivergent mice
Authors: Meade Rachel K. , Long Jarukit E. , Jinich Adrian , Rhee Kyu Y. , Ashbrook David G. , Williams Robert W. , Sassetti Christopher M. , Smith Clare M. 
Published: March 2023

AbstractGenetic differences among mammalian hosts andMycobacterium tuberculosis(Mtb) strains determine diverse tuberculosis (TB) patient outcomes. The advent of recombinant inbred mouse panels and next-generation transposon mutagenesis and sequencing approaches has enabled dissection of complex host- pathogen interactions. To identify host and pathogen genetic determinants ofMtbpathogenesis, we infected members of the BXD family of mouse strains with a comprehensive library ofMtbtransposon mutants (TnSeq). Members of the BXD family segregate forMtb-resistant C57BL/6J (B6 orB) andMtb-susceptible DBA/2J (D2 orD) haplotypes. The survival of each bacterial mutant was quantified within each BXD host, and we identified those bacterial genes that were differentially required forMtbfitness across BXD genotypes. Mutants that varied in survival among the host family of strains were leveraged as reporters for “endophenotypes”, each bacterial fitness profile directly probing specific components of the infection microenvironment. We conducted QTL mapping of these bacterial fitness endophenotypes and identified 140host-pathogenquantitative trait loci (hpQTL). We identified a QTL hotspot on chromosome 6 (75.97–88.58 Mb) associated with the genetic requirement of multipleMtbgenes;Rv0127(mak),Rv0359(rip2),Rv0955(perM), andRv3849(espR). Together, this screen reinforces the utility of bacterial mutant libraries as precise reporters of the host immunological microenvironment during infection and highlights specific host-pathogen genetic interactions for further investigation. To enable downstream follow-up for both bacterial and mammalian genetic research communities, all bacterial fitness profiles have been deposited into GeneNetwork.org and added into the comprehensive collection of TnSeq libraries in MtbTnDB.