bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of mycophenolate and azathioprine use with cognitive function in systemic lupus
Authors: Dobrowolski Chrisanna , McGinley John , Fazzari Melissa , Su Jiandong , Bingham Kathleen S , Anderson Nicole , Ruttan Lesley , Beaton Dorcas E , Wither Joan E , Tartaglia Maria Carmela , Kakvan Mahta , Bonilla Dennisse , Choi May Y , Fritzler Marvin J , Diaz Martinez Juan Pablo , Katz Patricia , Green Robin , Putterman Chaim , Touma Zahi 
Published: September 2022

Abstract

Objectives
Cognitive dysfunction (CD) is a common manifestation of SLE that can have detrimental consequences for those affected. To date, no treatments have been approved for SLE-CD. This study aims to assess the association of azathioprine (AZA) and mycophenolate (MMF) use with SLE-CD, given that these medications have demonstrated neuroprotective qualities in prior studies.

Methods
Consecutive adult SLE patients presenting to a single healthcare center were considered for participation. The ACR neuropsychological battery for SLE was administered to consenting patients at 0, 6 and 12 months. Scores were compared with age- and sex-matched controls. Primary outcome was CD, defined as a z-score ≤−1.5 in two or more cognitive domains. Mixed-effects logistic regression models were constructed to estimate the odds of CD with respect to AZA and MMF use.

Results
A total of 300 participants representing 676 patient visits completed the study; 114 (38%) met criteria for CD at baseline. The cumulative AZA dose (g/kg) was associated with reduced odds of CD [odds ratio (OR) 0.76 (95% CI 0.58, 0.98), P = 0.04]. Years of AZA treatment was also associated with reduced odds of CD [OR 0.72 (95% CI 0.54, 0.97), P = 0.03]. MMF use was not associated with CD.

Conclusion
AZA use was associated with significantly lower odds of SLE-CD, while MMF use was not. Additional studies are warranted to further investigate the relationship of AZA and SLE-CD.
The large firm dilemma: anchor embeddedness and high-technology competition
Authors: Ornston Darius , Camargo Lorena 
Published: September 2022

Abstract
Do large firms support or suppress regional entrepreneurship? Comparing Ottawa and Waterloo, two entrepreneurial ecosystems dominated by large, flagship firms, Nortel and Research in Motion (RIM), we demonstrate how an anchor firm’s relationship to the entrepreneurial community shapes entrepreneurial activity. In Ottawa, an engaged anchor delivered the public goods to overcome the negative externalities associated with large firm growth. In the long run, however, this vibrant, startup scene proved surprisingly vulnerable to Nortel’s decline. In Waterloo, in contrast, new firm formation plummeted under a detached anchor. RIM’s isolation, however, enabled Waterloo to construct the independent, entrepreneurial infrastructure it needed to capitalize on its collapse. Illuminating the mechanisms behind ‘entrepreneurial recycling’, or the reallocation of labor from declining anchor firms, we argue that regions confront a strategic dilemma in how they engage large firms.
Gaps and Silences: Gender and Climate Policies in the Global North
Authors: Eggebø Helga , Lundberg Aase Kristine , Teigen Mari 
Published: September 2022

AbstractFor decades, feminist activists and scholars have stressed the importance of integrating gender perspectives into the most defining challenge of our time: the climate disaster. In this article, we analyze official Norwegian policy documents in the context of regional and supra-national levels. We identify a lack of connection between gender equality policy and climate policy in the Norwegian policy documents that is symptomatic of a general silence on gender in climate policy in the Global North. We argue that there is untapped potential for gender mainstreaming in Norwegian climate policy and suggest that gendered, disaggregated data on climate issues could be combined with scholarly insights about the Nordic gender equality model so as to further our understanding of the climate crisis. Finally, we ask whether the absence of gender perspectives in Norwegian climate policy may reflect an unrecognized contradiction between Nordic gender equality policy and sustainability.
Assessment of coagulation markers, serum zinc and copper in children with beta-thalassemia major in Egypt
Authors: El Sehmawy Asmaa A , Hassan Donia Ahmed , Elamir Reham Yousri , Eldesoky Noha Abdel-Rahman , Al Anany Mona Gamal El Din , El-Fattah Doaa Aly Abd , El Attar Shahinaz , Abdelbadea Alzahra 
Published: September 2022

Abstract

Background
Thalassemia is one of the commonest single gene disorders usually associated with many complications. Coagulation changes as well as trace elements levels alterations have been described in children with β thalassemia. Activation of coagulation can be assessed by measuring thrombin–antithrombin (TAT) complex, plasmin–antiplasmin (PAP) complex and β-thromboglobulin (β-TG).

Methods
A total of 200 children and adolescents were enrolled in the study; 100 were from the Al-Azhar University hospital’s pediatric hematology clinic diagnosed as thalassemia major, while the other 100 were apparently healthy volunteers who acted as the control group. Complete blood count, liver function test, kidney function tests, TAT complex, PAP complex, β-TG as indicators of coagulation changes, serum zinc and copper were performed on all participants.

Results
Significantly higher levels of TAT complex, PAP complex and β-TG in thalassemia children than the controls. Decreased serum zinc and increased serum copper levels in thalassemia children compared to the controls. A negative correlation was observed between the serum level of TAT and hemoglobin level, besides the negative correlation of TAT complex and β-TG with the serum zinc.

Conclusion
Thalassemia major was associated with increased serum level of coagulation activation markers, increased serum copper while decreased serum zinc.
Clinical features and risk factors for death in acute undifferentiated fever: A prospective observational study in rural community hospitals in six states of India
Authors: Mørch Kristine , Manoharan Anand , Chandy Sara , Singh Ashita , Kuriakose Cijoy , Patil Suvarna , Henry Anil , Chacko Novin , Alvarez-Uria Gerardo , Nesaraj Joel , Blomberg Bjørn , Kurian Siby , Haanshuus Christel Gill , Antony George Vasanthan , Langeland Nina , Mathai Dilip 
Published: September 2022

Abstract

Background
Acute undifferentiated fever (AUF) ranges from self-limiting illness to life-threatening infections, such as sepsis, malaria, dengue, leptospirosis and rickettsioses. Similar clinical presentation challenges the clinical management. This study describes risk factors for death in patients hospitalized with AUF in India.

Methods
Patients aged ≥5 y admitted with fever for 2–14 d without localizing signs were included in a prospective observational study at seven hospitals in India during 2011–2012. Predictors identified by univariate analysis were analyzed by multivariate logistic regression for survival analysis.

Results
Mortality was 2.4% (37/1521) and 46.9% (15/32) died within 2 d. History of heart disease (p=0.013), steroid use (p=0.011), altered consciousness (p&lt;0.0001), bleeding (p&lt;0.0001), oliguria (p=0.020) and breathlessness (p=0.015) were predictors of death, as were reduced Glasgow coma score (p=0.005), low urinary output (p=0.004), abnormal breathing (p=0.006), abdominal tenderness (p=0.023), leucocytosis (p&lt;0.0001) and thrombocytopenia (p=0.001) at admission. Etiology was identified in 48.6% (18/37) of fatal cases.

Conclusions
Bleeding, cerebral dysfunction, respiratory failure and oliguria at admission, suggestive of severe organ failure secondary to systemic infection, were predictors of death. Almost half of the patients who died, died shortly after admission, which, together with organ failure, suggests that delay in hospitalization and, consequently, delayed treatment, contribute to death from AUF.
Dying to retire or living to work
Authors: Hidinger Julie , Lu-Hsu Stephanie , Otis-Smith Holly , De la Cruz Edward , Palecek Nancy 
Published: September 2022

Abstract:
Nurses who work in high-stress positions may be at risk for health problems that may result in early retirement. This article identifies health risks to aging nurses who continue to work in clinical settings and suggests methods for reducing negative health impacts to prevent them from retiring prematurely.
The Effect of Paraspinal Fatty Muscle Infiltration and Cumulative Lumbar Spine Degeneration on the Outcome of Patients with Lumbar Spinal Canal Stenosis: Analysis of the Lumbar Stenosis Outcome Study (LSOS) Data
Authors: Getzmann Jonas M. , Ashouri Hamidreza , Burgstaller Jakob M. , Valeri Fabio , Winklhofer Sebastian , Ulrich Nils H. , Guggenberger Roman 
Published: September 2022

Study Design.
Prospective.

Objective.
To investigate the influence of paraspinal fatty muscle infiltration (FMI) and cumulative lumbar spine degeneration as assessed by magnetic resonance imaging (MRI) on long-term clinical outcome measures in patients with lumbar spinal canal stenosis (LSCS) of the Lumbar Stenosis Outcome Study (LSOS) cohort.

Summary of Background Data.
Past studies have tried to establish correlations of morphologic imaging findings in LSCS with clinical endpoints. However, the impact of FMI and overall lumbar spinal degeneration load has not been examined yet.

Methods.
Patients from the LSOS cohort with moderate to severe LSCS were included. Two radiologists assessed the degree of LSCS as well as cumulative degeneration of the lumbar spine. FMI was graded using the Goutallier scoring system. Spinal Stenosis Measure (SSM) was used to measure the severity level of symptoms and disability. European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) was used to measure health-related quality of life.

Results.
The non-surgically treated group consisted of 116 patients (age 74.8±8.5 y), whereas the surgically treated group included 300 patients (age 72.3±8.2 y). Paraspinal FMI was significantly different between the groups (54.3% vs. 32.0% for Goutallier grade ≥2; P<0.001). Total degeneration score was comparable in both groups (9.5±2.0 vs. 9.3±2.0; P=0.418). FMI was associated with lower SSM function and lower EQ-5D-3L (all P<0.05), but not with SSM symptoms. Total degeneration of the lumbar spine was associated neither with SSM symptoms, nor with SSM function, nor with EQ-5D-3L (all P>0.05).

Conclusion.
FMI is associated with higher disability and worse health-related quality of life of LSCS patients in the LSOS cohort. There was no significant association between total cumulative lumbar spine degeneration and the outcome of either surgically or non-surgically treated patients.

Level of Evidence.
Level 3
Patient Comfort, Safety, and Effectiveness of Resilient Hyaluronic Acid Fillers Formulated With Different Local Anesthetics
Authors: Kaufman-Janette Joely , Joseph John H. , Dayan Stephen H. , Smith Stacy , Eaton Laura , Maffert Pauline 
Published: September 2022

BACKGROUND
Maximizing patient comfort during hyaluronic acid gel injection is a common concern that is usually addressed by selecting fillers with lidocaine.

OBJECTIVE
Two randomized, double-blinded, split-face trials aimed to demonstrate noninferiority of specific hyaluronic acid fillers incorporating mepivacaine (RHA-M) versus their lidocaine controls, at providing pain relief.

METHODS
Thirty subjects per trial received injections of RHAR-M versus RHAR, and RHA4-M versus RHA4, respectively, in the perioral rhytids (PR) and nasolabial folds (NLF). Pain was assessed on a visual analog scale; aesthetic effectiveness was evaluated with validated scales, and safety was monitored based on common treatment responses (CTRs) and adverse events (AEs).

RESULTS
RHA-M fillers proved as effective as their lidocaine counterparts at reducing pain (noninferior, p < .0002 and p < .0001). Bilateral wrinkle improvement was measured both in the PR (−1.5 ± 0.6 points on each side) and in the NLF (−1.8 ± 0.6 and −1.9 ± 0.5 points) trials at one month, with virtually identical responder rates (≥96.7%). Common treatment responses and AEs were similar between treated sides, and none was clinically significant.

CONCLUSION
Resilient hyaluronic acid fillers with either mepivacaine or lidocaine are equally effective at reducing pain during treatment and equally performant and safe for correction of dynamic facial wrinkles and folds.
Donor-Derived Cell-free DNA for Personalized Immunosuppression in Renal Transplantation
Authors: Oellerich Michael , Budde Klemens , Osmanodja Bilgin , Bornemann-Kolatzki Kirsten , Beck Julia , Schütz Ekkehard , Walson Philip D. 
Published: September 2022

Background:
The long-term outcomes of solid organ transplantation remain suboptimal. Therefore, appropriate biomarkers are needed in addition to immunosuppressive drugs and other traditional approaches for graft monitoring to achieve personalized immunosuppression and reduce premature graft loss.

Methods:
Donor-derived cell-free DNA (dd-cfDNA) is a minimally invasive biomarker of cell death due to graft injury. It can be quantified using droplet digital polymerase chain reaction and next-generation sequencing. Fractional dd-cfDNA determination can be affected by changes in recipient cfDNA, such as those caused by leukopenia or infection, leading to false-positive or false-negative results, respectively. Absolute quantification of dd-cfDNA helps in overcoming this limitation.

Results:
Overall, there is sufficient evidence of the clinical validity of dd-cfDNA. It detects rejection episodes early at an actionable stage and reflects the severity of graft injury without being rejection-specific. Owing to its high negative predictive value, dd-cfDNA is very useful for ruling out graft injury. Dd-cfDNA complements histological findings and can help in avoiding unnecessary biopsies. It indicates a response to rejection treatment and detects underimmunosuppression.

Conclusions:
Monitoring changes in dd-cfDNA over time may be helpful in adapting immunosuppression to prevent graft rejection. Moreover, serial dd-cfDNA determination may increase the effectiveness of transplant recipient surveillance and facilitate personalized immunosuppression when combined with other relevant clinical and diagnostic findings.
Antihypertensive therapy of late arterial hypertension in children following successful coarctation correction
Authors: Sendzikaite Skaiste , Sudikiene Rita , Lubaua Inguna , Silis Pauls , Rybak Agata , Brzezinska-Rajszys Grazyna , Obrycki Łukasz , Litwin Mieczysław , Jankauskiene Augustina 
Published: September 2022

Backgroung:
Late arterial hypertension (AH) is the most significant complication of coarctation of the aorta (CoA). Only a few clinical studies described antihypertensive treatment of late AH following successful CoA repair. The primary objective of this multicentre cross-sectional study was to describe real-life antihypertensive therapy for late AH in children after hemodynamically successful CoA repair. The secondary objective was to describe antihypertensive therapy used within different haemodynamic phenotypes of AH.

Method:
Blood pressure status, echocardiographic parameters and central blood pressure measurements were evaluated in 110 children aged 6–18 years following successful CoA repair with right arm blood pressure not exceeding leg blood pressure by at least 20 mmHg.

Results:
AH was found in 62 (56%) patients including 47 who were already treated and 15 with new diagnosed AH of whom seven presented with masked hypertension. Among treated patients, 10 presented with masked hypertension. The dominant phenotype of AH among patients with uncontrolled AH was isolated systolic hypertension (32 patients out of 37; 87.5%). AH was controlled in 53% of treated patients. Fifty-three percent of hypertensive patients had elevated central SBP and 39% had left ventricular hypertrophy with various left ventricle geometry patterns, 23% of them had both. β-adrenergic receptor blockers were the most used antihypertensive drugs followed by angiotensin-converting enzyme inhibitors with doses within the lower recommended range.

Conclusion:
High prevalence of uncontrolled AH despite successful CoA repair and use of relatively low doses of antihypertensive drugs indicates the need of close blood pressure monitoring and more intensive and combined antihypertensive therapy.
Sleep and risk of hypertension in general American adults: the National Health and Nutrition Examination Surveys (2015–2018)
Authors: Li Chunnan , Shang Shaomei , Liang Wannian 
Published: September 2022

Objective:
The purpose of research is to investigate the associations of sleep factors separately and jointly with risk of hypertension.

Methods:
The National Health and Nutrition Examination Surveys (NHANES) is a nationally representative survey. Participants aged over 20 years with complete and credible data from the NHANES 2015–2016 and 2017–2018 waves were included. Hypertension was assessed based on self-report medical diagnoses, or antihypertensive medication use, or systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Sleep information (sleep duration, trouble sleeping, daytime sleepiness, self-reported snoring and sleep-related breathing issue) was obtained from household interview.

Results:
Of 7426 participants, the mean (standard deviation) age was 48.0 (17.3) years, 3845 (51.8%) were females. The prevalence of hypertension was 32.8%, and lower in those with 7–9 h sleep, no trouble sleeping, no excessive daytime sleepiness, no snoring or sleep apnea symptoms, decreased as the quantity of healthy sleep factors increased. The self-reported short sleep (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.02−1.54, P = 0.032), trouble sleeping (OR: 1.53, 95% CI: 1.20 to 1.95, P = 0.001), excessive daytime sleepiness (OR: 1.17, 95% CI: 1.01−1.35, P = 0.041) and sleep apnea symptoms (OR: 1.33, 95% CI: 1.10−1.61, P = 0.004) were associated with 25%, 53%, 17% and 33% increased risk of hypertension, respectively. Participants with a poor sleep pattern was associated with higher hypertension risk (OR: 2.47, 95% CI: 1.90−3.22, P < 0.001).

Conclusion:
Sleep behaviors were cross-sectionally associated with a considerably higher hypertension risk.
Comparison of 2 open-sourced 3-dimensional modeling techniques for orthopaedic application
Authors: Chai Yuan , Simic Robert , Smith Paul N. , Valter Krisztina , Limaye Ajay , Li Rachel W. 
Published: September 2022

Abstract

Objectives: Although 3-dimensional (3D) printing is becoming more widely adopted for clinical applications, it is yet to be accepted as part of standard practice. One of the key applications of this technology is orthopaedic surgical planning for urgent trauma cases. Anatomically accurate replicas of patients' fracture models can be produced to guide intervention. These high-quality models facilitate the design and printing of patient-specific implants and surgical devices. Therefore, a fast and accurate workflow will help orthopaedic surgeons to generate high-quality 3D printable models of complex fractures. Currently, there is a lack of access to an uncomplicated and inexpensive workflow.

Methods: Using patient DICOM data sets (n = 13), we devised a novel, simple, open-source, and rapid modeling process using Drishti software and compared its efficacy and data storage with the 3D Slicer image computing platform. We imported the computed tomography image directory acquired from patients into the software to isolate the model of bone surface from surrounding soft tissue using the minimum functions. One pelvic fracture case was further integrated into the customized implant design practice to demonstrate the compatibility of the 3D models generated from Drishti.

Results: The data sizes of the generated 3D models and the processing files that represent the original DICOM of Drishti are on average 27% and 12% smaller than that of 3D Slicer, respectively (both P < 0.05). The time frame needed to reach the stage of viewing the 3D bone model and the exporting of the data of Drishti is 39% and 38% faster than that of 3D Slicer, respectively (both P < 0.05). We also constructed a virtual model using third-party software to trial the implant design.

Conclusions: Drishti is more suitable for urgent trauma cases that require fast and efficient 3D bone reconstruction with less hardware requirement. 3D Slicer performs better at quantitative preoperative planning and multilayer segmentation. Both software platforms are compatible with third-party programs used to produce customized implants that could be useful for surgical training.

Level of Evidence: Level V.
Male partner age, viral load, and HIV infection in adolescent girls and young women: evidence from eight sub-Saharan African countries
Authors: Ayton Sarah , Schwitters Amee , Mantell Joanne E. , Nuwagaba-Biribonwoha Harriet , Hakim Avi , Hoffman Susie , Biraro Sam , Philip Neena , Wiesner Lubbe , Gummerson Elizabeth , Brown Kristin , Nyogea Daniel , Barradas Danielle , Nzima Masauso , Fischer-Walker Christa , Payne Danielle , Mulenga Lloyd , Mgomella George , Kirungi Wilford L. , Maile Limpho , Aibo Dorothy , Musuka Godfrey , Mugurungi Owen , Low Andrea 
Published: September 2022

Objective:
We aimed to elucidate the role of partnerships with older men in the HIV epidemic among adolescent girls and young women (AGYW) aged 15–24 years in sub-Saharan Africa.

Design:
Analysis of Population-based HIV Impact Assessments in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe.

Methods:
We examined associations between reported partner age and recent HIV infection among AGYW, incorporating male population-level HIV characteristics by age-band. Recent HIV infection was defined using the LAg avidity assay algorithm. Viremia was defined as a viral load of more than 1000 copies/ml, regardless of serostatus. Logistic regression compared recent infection in AGYW with older male partners to those reporting younger partners. Dyadic analysis examined cohabitating male partner age, HIV status, and viremia to assess associations with AGYW infection.

Results:
Among 17 813 AGYW, increasing partner age was associated with higher odds of recent infection, peaking for partners aged 35–44 (adjusted odds ratio = 8.94, 95% confidence interval: 2.63–30.37) compared with partners aged 15–24. Population-level viremia was highest in this male age-band. Dyadic analyses of 5432 partnerships confirmed the association between partner age-band and prevalent HIV infection (male spousal age 35–44-adjusted odds ratio = 3.82, 95% confidence interval: 2.17–6.75). Most new infections were in AGYW with partners aged 25–34, as most AGYW had partners in this age-band.

Conclusion:
These results provide evidence that men aged 25–34 drive most AGYW infections, but partners over 9 years older than AGYW in the 35–44 age-band confer greater risk. Population-level infectiousness and male age group should be incorporated into identifying high-risk typologies in AGYW.
False-Positive for Pulmonary Emboli on Ventilation/Perfusion Scan Due to Improper Patient Positioning During Tracer Administration
Authors: Ulaner Gary A. , Grigore Catalan 
Published: September 2022

Abstract
A 67-year-old woman presented with shortness of breath and a ventilation/perfusion scan was performed. Initial images demonstrated mismatched bilateral apical defects that would be classified as high probability for pulmonary emboli. However, it was unusual that the defects were only in the bilateral apices. Investigation discovered that 99mTc-MAA was administered while the patient was in a seated position. Repeat scan the following day with the patient in the correct, supine, position during 99mTc-MAA administration demonstrated no defects. In this case, incorrect patient positioning could have resulted in an incorrect diagnosis of pulmonary emboli and inappropriate treatment of the patient.