bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Sleep Disturbance With Neurocognition, Symptom Severity, and Recovery in Pediatric Concussion: A 10-Year Retrospective Analysis of a Tertiary Referral Concussion Clinic
Authors: Cassimatis Maree , Orr Rhonda , Fyffe Andrew , Browne Gary 
Published: July 2022

Objectives:
To investigate the relationship between sleep disturbance, neurocognition, symptom severity, and recovery in children and adolescents with concussion. Sex-related comparisons were also examined.

Setting:
Pediatric tertiary referral concussion clinic.

Participants:
Children and adolescents (aged 6-18 years; n = 554) diagnosed with concussion.

Design:
Cross-sectional retrospective study.

Main Measures:
Assessment data were obtained from Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) Applications. Sleep disturbance was quantified using the sleep-related domains of the Post-Concussion Symptom Scale (PCSS) and self-report sleep duration. Sleep duration was categorized as short (<7 hours), intermediate (7-9 hours), and long (≥9 hours). Outcome measures included neurocognition, measured via composite scores of ImPACT cognitive domains (verbal memory, visual memory, visual motor speed, reaction time); symptom severity, using the PCSS; and concussion recovery time (days).

Results:
Short sleep resulted in significantly poorer verbal memory (P = .03), visual memory (P = .02), and reaction time (P = .01). Sleep disturbance was strongly associated with total symptom burden (ρ = 0.90, P < .001). Recovery time, median (interquartile range), was significantly prolonged with short sleep, 61 (30-136) days, compared with intermediate, 38 (21-72) days, and long, 34 (19-71) days, sleep (P < .001). Overall, female participants demonstrated significantly longer recovery times than male participants (mean 91 ± 95 vs 58 ± 85 days, P < .001). Females exhibited similar concussion recovery times irrespective of reported sleep duration (P = .95), whereas mean recovery time in males was significantly longer with short sleep (84 ± 82 days) than with intermediate (61 ± 106 days) and long (49 ± 62 days) sleep (P < .001).

Conclusion:
Sleep disturbance following concussion poses as a promising modifiable risk factor to alleviate postinjury impairments, including cognitive deficits and symptom burden. Female children were found to experience more severe concussion symptoms and protracted recovery times than their male counterparts. Investigations into the factors that may contribute to sex-related differences following concussion are warranted.
Highly Prevalent SARS-CoV-2 Antigenemia in COVID-19 Patients
Authors: Zhang Wenyan , Liu Wei , Lin Jiawang , Jin Jing , Zhao Kefu , Zhu Liwei , Wang Xiuzhen , Wang Lijie , Tang Renshu , Zhu Yindi , Zhou Wei , You Enqing , Zhang Lei , Liu Xuxiang , Wu Jinju , Chen Lili , Wang Wenjing , Zhang Qiang , Gao Rongbao 
Published: July 2022

Abstract

Background:
Many issues, such as severity assessment and antibody responses, remain to be answered eagerly for evaluation and understanding of COVID-19. Immune lesion is one of key pathogenesis of the disease. It would be helpful to understand the disease if an investigation on antigenemia and association was conducted in the patients with SARS-CoV-2 infection.

Methods:
A total of 156 patients admitted to the First People's Hospital of Hefei or Anhui Provincial Hospital on January to February 2020 were involved in this study. SARS-CoV-2 nucleocapsid (NP) antigen, specific IgM/IgG antibodies, and RNA were detected in sequential sera from three COVID-19 patients, and additional 153 COVID-19 patients by means of NP-antigen capture enzyme-linked immunosorbent assay, colloidal gold quick diagnosis, and real-time RT-PCR, respectively. The clinical types of COVID-19 patients were classified into asymptomatic, mild, moderate, severe, and critical, following on the Chinese guideline of COVID-19 diagnosis and treatment. The demographic and clinical data of patients were obtained for comparable analysis.

Results:
NP antigen was detected in 5 of 20 sequential sera collected from three COVID-19 patients with typically clinical symptoms, and 60.13% (92/153) expanded samples collected within 17 days after illness onset. No SARS-CoV-2 RNA segment was detected in these sera. The NP positive proportion reached a peak (84.85%, 28/33) on 6 to 8 days after illness onset. Both NP concentration and positive proportion were increased with the increase of clinical severity of COVID-19. Compared to NP negative patients, NP positive patients had older age [years, medians (interquartile ranges (IQR)), 49 (6) vs. 31 (11)], lower positive proportion of NP specific IgM [27.17% (25/92) vs. 59.02% (36/61)], and IgG [21.74% (20/92) vs. 59.02% (36/61)] antibodies, and longer duration [days, medians (IQR), 24 (10) vs. 21 (13)] from illness to recovery.

Conclusions:
SARS-CoV-2 NP antigenemia occurred in COVID-19, and presented highly prevalent at early stage of the disease. The antigenemia was related to clinical severity of the disease, and may be responsible for the delay of detectable SARS-Cov-2 IgM.
MHC Class I Assembly Function and Intracellular Transport Routes for Hepatitis B Virus Antigen Cross-presentation by Heat Shock Protein gp96
Authors: Qin Lijuan , Liu Yongai , Xu Yuxiu , Li Yang , Hu Jun , Ju Ying , Zhang Yu , Wang Shuo , Li Zihai , Li Changfei , Li Xin , Meng Songdong 
Published: July 2022

Abstract

Background:
During hepatitis B virus (HBV) infection, virus-infected hepatocytes directly cross-present viral antigens and regulate T cell response within the liver microenvironment. However, little is known regarding the regulatory pathways involved in viral antigen presentation in HBV-infected hepatocytes. This study investigated the underlying mechanism of antigen assembly and the HBV antigen-presenting function of major histocompatibility complex (MHC) class I molecules using heat shock protein gp96.

Methods:
First, western blotting, flow cytometry, co-immunoprecipitation, GST pull-down, and confocal microscopic assays were performed to determine whether endogenous gp96 affects MHC-I levels via an antigen presentation pathway. Second, the B3Z assay and an AAV/HBV-infected hepatocyte-specific gp96-deficient mouse model were used to determine whether gp96 knockout functionally impaired peptide cross-presentation and produced a weakened antiviral cytotoxic T cell (CTL) response both in vivo and in vitro. Finally, confocal microscopic analysis and the B3Z assay were employed to show that exogenous gp96-associated peptide was present in MHC-I molecules via the endoplasmic reticulum (ER)-Golgi secretory pathway.

Results:
Compared with the control, gp96 knockdown significantly reduced the cell surface levels of MHC-I by approximately 75% (P < 0.01). Endogenous gp96 interacts with MHC-I and is involved in antigen presentation. Moreover, a weakened antiviral CTL response (34% compared to control mice) has been observed in hepatocyte-specific gp96-deficient mice following HBV infection. gp96 directed exogenous antigen to the ER, and the exogenous gp96-chaperoned peptide was endosome- and proteasome-dependent but not transporter associated with antigen processing dependent.

Conclusions:
Cellular gp96 promotes the assembly and antigen presentation of MHC class I molecules. In addition, extracellular gp96 served as a natural adjuvant to induce a CTL response in a concerted and regulated manner within different cellular compartments. Our results elucidate the mechanism of assembly of MHC class I molecules by gp96, which may be beneficial for the design of immunotherapy and vaccines.
Descriptive Analysis of Cornea and Anterior Segment Fellowship Program Directors in 2020
Authors: Lam Sophia S. , Garg Kartik , Shalaby Wesam S. , Rapuano Christopher J. , Syed Zeba A. 
Published: July 2022

Abstract

Purpose:
To investigate demographic characteristics, educational backgrounds, and academic achievements among program directors (PDs) of Cornea and External Disease and Anterior Segment fellowships in the United States in 2020.

Setting:
N/A.

Design:
Cross-sectional study.

Methods:
PDs of Cornea and External Disease and Anterior Segment fellowships were identified using the San Francisco Match website. Fellowship program features reviewed included academic or private practice type, number of cornea faculty, and sex of chairperson. PD demographic characteristics, educational and training background, and academic productivity were analyzed using publicly available profiles and databases.

Results:
76 Cornea and External Disease and 10 Anterior Segment fellowships were reviewed. Of 86 reviewed programs, 55 (64.0%) were considered academic, 30 (34.9%) were private practice, and 1 (1.2%) was hybrid. 76 Cornea and External Disease PDs and 12 Anterior Segment PDs were identified. Overall, 21 (23.9%) of PDs were women and the mean age for all PDs was 52.6±11.5 years. Of the 88 PDs, the average number of publications was 45.1±55.9. Mean h-index was 16.7±15.4 and was higher among Cornea and External Disease than Anterior Segment PDs (18.2±15.5 vs. 7.1±11.4, p=0.008) and also higher among academic than private practice PDs (19.9±15.1 vs. 11.2±14.7, p=0.011). More female PDs were in departments with a female chairperson compared to male PDs [6 (28.6%) vs. 4 (6.0%), p=0.011].

Conclusions:
Cornea and External Disease and Anterior Segment fellowship PDs represent a wide array of backgrounds and scholarly achievements. Female PDs remain in the minority and are more common in departments with female chairpersons.
Factors predisposing to Intraoperative Floppy Iris Syndrome (IFIS): an updated systematic review and meta-analysis
Authors: Christou Chrysanthos D. , Esagian Stepan M. , Ziakas Nikolaos , Prousali Efthymia , Tzamalis Argyrios 
Published: July 2022

Abstract:
Intraoperative Floppy Iris Syndrome (IFIS) is an increasingly recognized condition that is proven to lead to higher rates of intraoperative complications. This study provides an updated systematic review and meta-analysis regarding all the identified factors predisposing to IFIS. The study was performed in accordance with the PRISMA guidelines. 38 studies were finally included in the meta-analysis. The factors that were found to predispose to IFIS significantly were male gender(OR=4.25/CI=2.58-7.01), hypertension(OR=1.55/CI=1.01-2.37), tamsulosin(OR=31.06/CI=13.74-70.22), finasteride(OR=4.60/CI=1.97-10.73), benzodiazepines(OR=2.88/CI=1.17-7.12) and antipsychotics intake(OR=6.91/CI=2.22-21.50). A decreased dilated pupil preoperatively was found predisposing to IFIS (weighted mean difference=-0.93/CI=-1.19--0.67]). Intracameral epinephrine which was investigated as a potential prophylactic measure for preventing IFIS, did not reach statistical significance (OR=0.29/CI=0.08-1.06). A comprehensive preoperative assessment of all risk factors is vital to stratify the surgical risk, which is crucial in addressing IFIS since unanticipated IFIS could turn a routine surgery into one of significant visual morbidity.
Transcatheter edge-to-edge repair in patients with mitral regurgitation and cardiogenic shock: a new therapeutic target
Authors: Jung Richard G. , Simard Trevor , Di Santo Pietro , Hibbert Benjamin 
Published: July 2022

Purpose of review
Cardiogenic shock with significant mitral regurgitation portends a poor prognosis with limited therapeutic options. Herein, we review the available evidence regarding the patient characteristics, management, impact of transcatheter edge-to-edge repair (TEER) on hemodynamics, and clinical outcomes of patients with cardiogenic shock and mitral regurgitation.

Recent findings
Several observational studies and systematic reviews have demonstrated the feasibility and safety of TEER in cardiogenic shock complicated by degenerative or functional mitral regurgitation. Surgical interventions for mitral regurgitation remain limited owing to the risk profile of patients in cardiogenic shock. TEER has been studied in both degenerative and functional mitral regurgitation and remains feasible in the critically ill population. Moreover, TEER is associated with reduction in mitral regurgitation and improvement in-hospital and long-term mortality.

Summary
TEER remains a promising therapeutic option in cardiogenic shock complicated by significant mitral regurgitation, but additional research is required to identify patient and procedural characteristics, hemodynamic parameters, and the optimal time for intervention. Moreover, future randomized controlled trials are in progress to evaluate the potential benefit of TEER against medical management in cardiogenic shock and mitral regurgitation.
Evaluation of the effect of intravenous nitroglycerine on short-term survival of patients with acute heart failure according to congestion and perfusion status at emergency department arrival
Authors: Miró Òscar , Espinosa Begoña , Gil Víctor , Jacob Javier , Alquézar-Arbé Aitor , Masip Josep , Llauger Lluís , Tost Josep , Andueza Juan Antonio , Garrido José Manuel , Mojarro Enrique Martín , Urbano Carmen Agüera , Núñez Julio , Chioncel Ovidiu , Mullens Wilfred , Cotter Gad , Llorens Pere ,   on behalf of the ICA-SEMES Research Group
Published: July 2022

Objectives:
We investigated if the phenotypic classification of acute heart failure (AHF) based on the number of signs/symptoms of congestion and hypoperfusion at emergency department (ED) arrival identifies subgroups in which intravenous (IV) nitroglycerine (NTG) use improves short-term survival.

Methods:
We included consecutive AHF patients diagnosed in 45 Spanish EDs, who were grouped according to phenotype severity. The main outcome was 30-day all-cause death. Propensity scores (PS) for NTG use were generated using variables associated with death. Analysis of interaction was performed in subgroups of patients based on congestion, hypoperfusion, age, sex, coronary artery disease (CAD), left ventricular ejection fraction (LVEF) and SBP.

Results:
We analyzed 16 437 AHF patients (median = 83 years; women = 56%); 1882 received NTG (11.4%). In the whole cohort, the cumulative 30-day mortality in patients receiving NTG was higher (11.5% vs. 9.6%; unadjusted HR, 1.19; 95% CI, 1.04–1.36), but not in the PS-matched cohorts (1698 pairs of patients; 11.5% vs. 10.5%; HR, 1.10; 95% CI, 0.90–1.35). Mortality was increased in NTG-treated patients with mild congestion (HR, 2.09; 95% CI, 1.19–3.67), especially in those without hypoperfusion (HR, 2.51; 95% CI, 1.24–5.10). Interaction analysis of the PS-matched cohorts confirmed detrimental effects of NTG use in less congested patients, whereas beneficial effects were only observed in patients with decreased LVEF (<50% subgroup: HR, 0.59; 95% CI, 0.37–0.92; ≥50% subgroup: HR, 1.30; 95% CI, 0.66–2.56; P = 0.002).

Conclusion:
Phenotypical classification of AHF based on congestion/hypoperfusion at ED arrival does not identify subgroups of patients in whom IV-NTG would decrease mortality, although it could potentially be beneficial in those with LVEF of less than 50%. This hypothesis will have to be confirmed in the future. Conversely, our results suggest that IV-NTG may be harmful in patients with only mild clinical congestion.
Polygenic risk score in prostate cancer
Authors: Oh Jong Jin , Hong Sung Kyu 
Published: July 2022

Purpose of review
This study was conducted in order to review the outcomes regarding polygenic risk score (PRS) in prediction of prostate cancer (PCa). With the increasing proficiency of genetic analysis, assessment of PRS for prediction of PCa has been performed in numerous studies. Genetic risk prediction models for PCa that include hundreds to thousands of independent risk-associated variants are under development. For estimation of additive effect of multiple variants, the number of risk alleles carried by an individual is summed, and each variant is weighted according to its estimated effect size for generation of a PRS.

Recent findings
Currently, regarding the accuracy of PRS alone, PCa detection rate ranged from 0.56 to 0.67. A higher rate of accuracy of 0.866–0.880 was observed for other models combining PRS with established clinical markers. The results of PRS from Asian populations showed a level of accuracy that is somewhat low compared with values from Western populations (0.63–0.67); however, recent results from Asian cohorts were similar to that of Western counterparts. Here, we review current PRS literature and examine the clinical utility of PRS for prediction of PCa.

Summary
Emerging data from several studies regarding PRS in PCa could be the solution to adding predictive value to PCa risk estimation. Although commercial markers are available, development of a large-scale, well validated PRS model should be undertaken in the near future, in order to translate hypothetical scenarios to actual clinical practice.
FGFR3 Nuclear Translocation Contributes to Proliferative Potential and Poor Prognosis in Pancreatic Ductal Adenocarcinoma
Authors: Zhou Li , Lu Jun , Liang Zhi-Yong , Zhou Wei-Xun , Jiang Bo-Lun , Wang Yi-Zhi , Liu Cheng-Xi , Huang Bo-Wen , You Lei , Guo Jun-Chao 
Published: July 2022

Objectives
Fibroblast growth factor receptor 3 (FGFR3) was revealed to have divergent, even opposite roles in different neoplasms. In pancreatic ductal adenocarcinoma (PDAC), its impact on biological behavior and prognosis was not well elucidated.

Methods
Fibroblast growth factor receptor 3 was downregulated by RNA interference to explore its impact on cell proliferative proclivity in PDAC cells. Furthermore, tissue microarray-based immunohistochemistry for FGFR3 was performed in 326 patients with PDAC who underwent radical resection, and its clinicopathologic and prognostic implications were then evaluated.

Results
First, successful FGFR3 knockdown remarkably decreased its expression, cell proliferation, and S-phase ratio in the cell cycle in 2 PDAC cell lines, BxPC-3 and AsPC-1. Meanwhile, alterations in p-Akt, cyclin D1, cyclin B1, and p21 were also observed. Subsequently, high nuclear FGFR3 expression, but not cytoplasmic, was significantly common in tumor tissues and positively associated with N stage and dismal overall survival in the entire cohort. In addition, nuclear FGFR3 expression was also prognostic in 10 of 14 subsets. Univariate and multivariate Cox regression analyses identified nuclear expression of FGFR3 as an independent prognosticator in the entire cohort.

Conclusions
Our data showed that FGFR3 nuclear translocation contributes to cell proliferative potential and predicts poor long-term prognosis in PDAC after surgical resection.
Chemical Exchange Saturation Transfer for Pancreatic Ductal Adenocarcinoma Evaluation
Authors: Wang Lixia , Zhou Zhengwei , Gaddam Srinivas , Wang Nan , Xie Yibin , Deng Zixin , Fan Zhaoyang , Christodoulou Anthony G. , Han Fei , Lo Simon K. , Wachsman Ashley M. , Hendifar Andrew E. , Jiang Tao , Pandol Stephen J. , Li Debiao 
Published: July 2022

Objectives
The aims of the study are to evaluate the feasibility of using pH-sensitive magnetic resonance imaging, chemical exchange saturation transfer (CEST) in pancreatic imaging and to differentiate pancreatic ductal adenocarcinoma (PDAC) with the nontumor pancreas (upstream and downstream) and normal control pancreas.

Methods
Sixteen CEST images with PDAC and 12 CEST images with normal volunteers were acquired and magnetization transfer ratio with asymmetric analysis were measured in areas of PDAC, upstream, downstream, and normal control pancreas. One-way analysis of variance and receiver operating characteristic curve were used to differentiate tumor from nontumor pancreas.

Results
Areas with PDAC showed higher signal intensity than upstream and downstream on CEST images. The mean (standard deviation) values of magnetization transfer ratio with asymmetric analysis were 0.015 (0.034), −0.044 (0.030), −0.019 (0.027), and −0.037 (0.031), respectively, in PDAC area, upstream, downstream, and nontumor area in patient group and −0.008 (0.024) in normal pancreas. Significant differences were found between PDAC and upstream (P < 0.001), between upstream and normal pancreas (P = 0.04). Area under curve is 0.857 in differentiating PDAC with nontumor pancreas.

Conclusions
pH-sensitive CEST MRI is feasible in pancreatic imaging and can be used to differentiate PDAC from nontumor pancreas. This provides a novel metabolic imaging method in PDAC.
Birth Center Breastfeeding Rates
Authors: George Erin K. 
Published: July 2022

Abstract

Introduction:
Breastfeeding rates in the United States fall short of national targets and are marked by racial and ethnic disparities. Birth centers are associated with high rates of breastfeeding initiation and duration, yet no systematic review has compiled reported birth center breastfeeding data.

Methods:
A PRISMA-guided literature review was conducted in CINAHL, PubMed, and Web of Science to retrieve quantitative studies that reported breastfeeding data in birth centers. Inclusion criteria focused on English language studies published since 2011 with breastfeeding outcomes from birth centers in the United States.

Results:
Ten studies were included for analysis. Breastfeeding rates that exceeded actual and target national breastfeeding rates were reported among all 10 studies. Characteristics about breastfeeding outcomes were reported heterogeneously across the studies, which included a range of breastfeeding timepoints (immediately postpartum up to 6 weeks postpartum) and definitions of breastfeeding.

Discussion:
Although breastfeeding rates reported in birth centers are higher than national breastfeeding rates and targets, authors of the included studies did not explore or analyze these rates in-depth. Developing standard definitions and data collection may enhance research about breastfeeding outcomes in birth centers.

Clinical Implications:
Giving birth in a birth center is associated with higher than national breastfeeding rates.
Nursing Work Environment Staffing Councils
Authors: Skarbek Anita , Mastro Kari A. , Kowalski Mildred Ortu , Caruso Judith , Cole Donna A. , de Cordova Pamela B. , Johansen Mary L. , Vitale Tracy R. , Weaver Susan Heidenwolf 
Published: July 2022

OBJECTIVE
The aim of this study was to examine the self-reported perceptions of the healthy work environment (HWE) of nurses who are members of Nursing Workplace Environment and Staffing Councils (NWESCs).

BACKGROUND
In a statewide initiative, NWESCs were established at hospitals throughout the state of New Jersey as an alternative to nurse staffing ratio laws and to provide clinical nurses a voice in determining resources needed for patient care and support an HWE.

METHODS
This quantitative descriptive study presents the results of the Healthy Workplace Environment Assessment Tool (HWEAT) and open-ended questions about NWESCs among a sample of 352 nurses.

RESULTS
Three years after NWESC implementation, all HWEAT standard mean scores increased and were rated higher than the American Association of Critical-Care Nurses benchmark. There were statistically significant differences in clinical nurses' perceptions of an HWE compared with nurse leaders. Respondents also shared their NWESC's best practices and challenges. Responses to questions identified NWESC best practices and challenges.

CONCLUSION
This study offers insight into the improvement in nurses' perceptions of the HWE after the introduction of a statewide NWESCs. Structures such as the NWESCs may provide an alternative to mandated staffing ratios.