bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in disease characteristics and premature mortality among hospitalised middle-aged patients in Anhui Southern Area, China, between 2011 and 2020: a cross-sectional study
Authors: Yuanying Yao , Lei Chen , Ma Lijuan 
Published: December 2024

ObjectivesWe aimed to explore the characteristics of age, disease and premature mortality among middle-aged inpatients.DesignCross-sectional.SettingData were gathered from the electronic medical records system of the hospitals between 2011 and 2020: a regional study.ParticipantsA total of 151 320 patients, aged 45–59 years, underwent hospitalisation.Primary outcome measuresWe analysed the characteristics of age and disease using the database from the electronic medical record system. Moreover, a binary logistic regression model was adopted to investigate the risk factors for premature mortality.ResultsWe identified 151 320 eligible inpatients, 53.0% of whom were female. The proportion of middle-aged inpatients increased alarmingly over a decade from 6.4% in 2011 to 28.3% in 2020. The incidence rate of inpatients aged 45 to 50 years increased perpendicularly, with its peak observed at the age of 50. The prevalence tended to decrease after the age of 50; however, it increased at the age of 59. Overall, cancer had the highest incidence rate (22.7%), followed by accidental injury, digestive system disease, cardiovascular disease and cerebrovascular disease (9.0%, 7.9%, 6.3% and 4.5%, respectively). The overall mortality among the middle-aged inpatients was 0.5%. Logistic regression analysis showed that sex, marital status and comorbidity were the factors contributing to mortality in hospitalised patients, with male, divorced and more than two comorbidities being risk factors for death.ConclusionsA rising trend in the number of middle-aged inpatients was observed during the study period. The number of hospitalisations reaches its peak at the age of 50. Being male, divorced and having more than two comorbidities are risk factors for premature mortality. So prevention, early detection and appropriate treatment of comorbidities are beneficial in improving health and reducing mortality.
Mother–newborn couplet care and the expectations, concerns and educational needs of healthcare professionals: a qualitative study
Authors: Larsen Joan Neergaard , Navne Laura Emdal , Hansson Helena , Maastrup Ragnhild , Poorisrisak Porntiva , Sørensen Jette Led , Broberg Lotte 
Published: December 2024

ObjectivesOur aim was to explore healthcare professionals’ (HCPs) expectations, concerns and educational needs regarding preparing for implementing the concept of couplet care, keeping newborns in need of intensive care together with their mothers in need of obstetrical care.DesignA qualitative focus group study based on semistructured interviews. We analysed the data using reflexive thematic analysis. This study is part of a comprehensive research project and pre-implementation based on curriculum development principles and implementation theory.SettingWe conducted four focus group interviews from May to June 2023 at a tertiary referral university hospital in Denmark.ParticipantsNeonatologists, obstetricians, midwives and nurses (n=21) were recruited from neonatal and obstetric departments. Inclusion criteria: Neonatologists, obstetricians, midwives and nurses with various levels of postgraduate experience.ResultsWe identified the overarching theme of building bridges in relation to HCPs’ expectations, concerns and educational needs and five subthemes: Enhancing meaningfulness through increased teamwork; compromising or improving patient safety; challenging professional comfort zones; encountering other cultural and ethical values; and recognising educational requirements.ConclusionsHCPs widely support mother–newborn couplet care and emphasise the need for closer collaboration between neonatal and obstetric departments. Implementing couplet care is seen as meaningful, potentially enhancing the well-being of mothers and newborns and positively impacting HCPs’ job satisfaction. Key concerns include patient safety, quality of treatment and care and the well-being of HCPs navigating their skills, psychological safety and professional boundaries. While the importance of couplet care for early closeness and connection is acknowledged, challenges arise in meeting diverse maternal and neonatal needs. Additional research, especially in highly specialised settings, is necessary to understand the complexities associated with changing the care paradigm for newborns and mothers to be cared for together and in implementing couplet care. We found focus groups useful as a tool for needs assessment and uncovering and adapting practices to address challenges in implementing couplet care.
Transition experiences of UK junior doctors who leave clinical practice to pursue careers in medical education: a qualitative study
Authors: Coldicutt Olivia , Owen Katherine 
Published: December 2024

ObjectivesThe increasing complexity and scale of medical education in the UK demands increasing numbers of medical educators. A small proportion of educators are qualified doctors, but did not reach completion of clinical training (CCT) to become consultants or general practitioners before pursuing a career exclusively in education. This study aimed to (1) explore the experiences of medical educators who left clinical practice as junior doctors and (2) identify the barriers to professional identity formation in this group.DesignIn this constructivist qualitative study, semi-structured interviews were conducted with medical educators. Audio data was recorded, transcribed and iteratively interpreted through the lens of reflexive thematic analysis.Setting and participantsNine UK-based educators were recruited using purposive and snowball sampling. Participants self-identified as medical educators who have experience of the transition from working as junior clinicians to holding positions exclusively in medical education. Participants had not completed clinical training before transitioning into medical education.ResultsThree broad themes were identified: (1) push factors away from clinical medicine; (2) pull factors towards medical education; (3) navigating professional identity formation as an educator. Educators reported that medical education offered positives such as improved work-life balance, professional development opportunities and a sense of being more ‘upstream’ in the world of education. Significant barriers to successful transition were reported, including: a lack of guidance; low respect for medical education by the wider medical profession; and disparity between the educational opportunities afforded to consultant colleagues compared with educators who left medicine before CCT.ConclusionsEducators who leave clinical medicine before CCT perceive themselves as being disadvantaged in their education careers. This study highlights that more could be done to tackle stigmatising perceptions of a medical education career and present medical education as a viable option to junior doctors.
Decisions to decline breast screening and/or breast cancer treatment based on the potential harms of overdiagnosis and overtreatment: a qualitative study
Authors: Jeffers Shavez , Pilnick Alison , Armstrong Natalie 
Published: December 2024

ObjectivesTo explore the experiences of women who have made the decision to decline breast screening and/or breast cancer treatment for overdiagnosis/overtreatment reasons after being invited to the National Health Service Breast Screening Programme (NHS BSP).DesignQualitative interview study using reflexive thematic analysis.SettingParticipants were recruited via social media, online forums and word of mouth. Semi-structured interviews were conducted between May 2021 and April 2022.Participants20 women aged between 49 and 76 years old who had declined one or more of the following after receiving an invitation to participate in the NHS BSP: (1) screening investigation, that is, mammogram; (2) further investigations, for example, biopsy, ultrasound; (3) treatment, for example, mastectomy, chemotherapy, radiotherapy and (4) any other medical intervention, for example, ongoing medication.ResultsThe three main themes were as follows: (1) the perception that the NHS BSP information was biased towards uptake and so constrained choice; (2) taking an active role in decision-making by considering the benefits and harms of the NHS BSP and (3) navigating potential regret for having declined.ConclusionsIn-depth understanding of the potential harms of overdiagnosis and overtreatment influenced the decision to decline for these participants and contributed to their dissatisfactions with the way that information was presented in the invitation to the NHS BSP and the women felt confident in their assessments of the benefits and harms. These findings differ from previous studies, which have suggested that the vast majority lack knowledge and understanding of what overdiagnosis and overtreatment are whereas the participants in this study demonstrated high levels of health literacy. Findings have implications for the way informed choice is considered and constructed in relation to the NHS BSP.
Global epidemiological profile in nasopharyngeal carcinoma: a prediction study
Authors: Zhang Yuna , Gu Shanshan , Deng Hongxia , Shen Zhisen 
Published: December 2024

ObjectivesThis study delineates the global nasopharyngeal carcinoma’s (NPC) incidence and mortality across 185 countries in 2020 and projects the disease’s burden by 2040.DesignA prediction study.SettingCountries within the 20 world regions.ParticipantsGlobal NPC population.Primary and secondary outcome measuresThe estimated counts of NPC cases and deaths were retrieved from the GLOBOCAN 2020 database. Age-standardised incidence rates (ASIR) and age-standardised death rates (ASDR) were computed. Projections for NPC by 2040 were derived from global population forecasts.ResultsIn the year 2020, East Asia emerged as the epicentre of both NPC incidences and mortalities, encompassing 49.39% (65 866 of the total 133 354 cases) and 45.56% (36 453 of the total 80 008 deaths), respectively, with China’s contribution being the most substantial (46.82% of cases and 43.50% of deaths). The disparity between genders was notable, as the ASIR and ASDR for males were approximately triple those observed in females. The incidence exhibited regional diversity, with South-Eastern Asia and East Asia recording the highest ASIR for males and females (7.7 and 2.5, and 3.9 and 1.5 per 100 000 person-years, respectively). Similarly, South-Eastern Asia also reported the highest ASDR for both genders (5.4 and 1.5 per 100 000 person-years, respectively). Projections for 2040 anticipate a rise in annual cases and deaths to 179 476 (indicating a 34.58% increase from 2020) and 113 851 (reflecting a 42.29% increase), respectively. Further analysis revealed a correlation between the Human Development Index and disease burden.ConclusionsNPC, primarily impacting East Asia and predominantly affecting men, is poised for a significant increase in incidence and mortality by 2040, especially in Asia.
A Case Report of Angiotensin II Use in the Treatment of Refractory Shock due to Amlodipine and Lisinopril Toxicity
Authors: Keller John H. , Kendric Kayla J. , LeSaint Kathy T. 
Published: December 2024

Introduction: Coingestion of cardiovascular drugs with angiotensin‐converting enzyme inhibitors (ACEIs) can be associated with refractory shock derangements complicated by vasopressor resistance, prompting the use of novel, unconventional, or uncommonly used agents.Case Report: A young adult male presented to the emergency department (ED) 10 h after ingesting lisinopril and amlodipine. On arrival, he was hypotensive with a blood pressure of 72/39 mmHg. In addition to crystalloid fluids, he was incrementally started on four vasopressors including norepinephrine, phenylephrine, epinephrine, and vasopressin without improvement in mean arterial pressure (MAP). He was then administered methylene blue, calcium gluconate, and hyperinsulinemic euglycemia therapy after discussion with medical toxicology. Shortly afterwards, he was started on an angiotensin II infusion with an improvement in MAP to a goal of > 65 mmHg.Conclusion: Despite evidence of efficacy in refractory vasodilatory shock secondary to sepsis, there is a paucity of data on the use of angiotensin II as an adjunctive vasopressor in drug‐induced shock. We report a case of successful use of angiotensin II in combined lisinopril and amlodipine overdose refractory to conventional vasopressor support. Combined overdose of ACEIs with calcium channel blockers (CCBs) has been shown to cause more significant hypotension and higher vasopressor requirements than overdose of CCBs alone. This may be due to the synergism between CCBs and ACEIs, where the normal homeostatic mechanism of the renin–angiotensin–aldosterone system (RAAS) activation in response to shock is now inhibited, leading to decreased compensatory vasoconstriction via angiotensin II and decreased endogenous catecholamine release. We hypothesize that angiotensin II may have been of particular benefit in this patient given the likelihood that reduced angiotensin II levels were contributing to his refractory shock.
Hypoxia-Induced Senescent Fibroblasts Secrete IGF1 to Promote Cancer Stemness in Esophageal Squamous Cell Carcinoma
Authors: Ou Zhengjie , Zhu Liang , Chen Xinjie , Liu Tianyuan , Cheng Guoyu , Liu Rucheng , Zhang Shaosen , Tan Wen , Lin Dongxin , Wu Chen 
Published: December 2024

Abstract
Cancer-associated fibroblasts (CAFs) contribute to cancer initiation and progression and play a pivotal role in therapeutic response and patient prognosis. CAFs exhibit functional and phenotypic heterogeneity, highlighting the need to clarify the specific subtypes of CAFs to facilitate the development of targeted therapies against pro-tumorigenic CAFs. Here, using single-cell RNA sequencing on patient samples of esophageal squamous cell carcinoma (ESCC), we identified a CAF subcluster associated with tumor stemness that was enriched in genes associated with hypoxia and senescence. The CAF subpopulation, termed as hypoxia-induced senescent fibroblasts (hsCAFs), displayed high secretion of insulin-like growth factor 1 (IGF1). The hsCAFs inhibited AMP-activated protein kinase (AMPK) activity in cancer cells via IGF1 to promote tumor stemness. The formation of hsCAFs was induced by the synergetic effect of hypoxia and cancer cells. Activation of nuclear factor erythroid 2-related factor 2 (NRF2) in cancer cells under hypoxia drove interleukin-1 alpha (IL-1α) production to trigger CAF senescence and IGF1 secretion via nuclear factor I A (NFIA). Knockout of IGF1 in CAFs or NRF2 in ESCC cells suppressed the tumor growth and chemotherapy resistance induced by CAFs in vivo. Importantly, patients with high proportions of hsCAFs showed poor survival and a worse response to chemotherapy. In summary, these findings identify a hsCAF subpopulation generated by interplay between cancer cells and CAFs under hypoxic conditions that promotes ESCC stemness and reveal targeting hsCAFs as an effective therapeutic strategy against chemotherapy-resistant ESCC.
A Phase I Study of FHD-609, a Heterobifunctional Degrader of Bromodomain-Containing Protein 9, in Patients with Advanced Synovial Sarcoma or SMARCB1-Deficient Tumors
Authors: Livingston J. Andrew , Blay Jean-Yves , Trent Jonathan , Valverde Claudia , Agulnik Mark , Gounder Mrinal , Le Cesne Axel , McKean Meredith , Wagner Michael J. , Stacchiotti Silvia , Agresta Samuel , Quintás-Cardama Alfonso , Reilly Sarah A. , Healy Kathleen , Hickman Denice , Zhao Tina , Ballesteros-Perez Alex , Khalil Alexis , Collins Michael P. , Piel Jessica , Horrigan Kim , Lefkovith Ariel , Innis Scott , Lazar Alexander J. , Cote Gregory M. , Wagner Andrew J. 
Published: December 2024

Abstract

Purpose:
FHD-609, a potent, selective, heterobifunctional degrader of bromodomain-containing protein 9 (BRD9), was evaluated for treating patients with advanced synovial sarcoma or SMARCB1-deficient tumors.

Patients and Methods:
In this multinational, open-label, phase I study (NCT04965753), patients received FHD-609 intravenously at escalating doses either twice weekly (5–80 mg; n = 40) or once weekly (40–120 mg; n = 15).

Results:
Fifty-five patients received FHD-609 for a median of 43 days. The maximum tolerated doses were 40 mg twice weekly and the equivalent weekly dose, 80 mg once weekly. Dose-limiting toxicities of QTc (heart rate–corrected QT interval) prolongation and syncope were observed at 40 and 60 mg twice weekly. Treatment-related adverse events were predominantly grades 1 to 2 in severity, most commonly dysgeusia (40%), dry mouth (29.1%), fatigue (27.3%), and anemia (25.5%). Eleven (20%) patients had treatment-emergent QTc (Fridericia formula) prolongation preceded by T-wave inversions; 21 (38.2%) patients had T-wave inversions without further cardiac events or ECG abnormalities. FHD-609 showed dose-dependent increases in pharmacokinetic exposure, with no substantial accumulation. Extensive BRD9 degradation in tumor tissue corresponded to the downregulation of cancer cell proliferation gene sets. One (2%) patient achieved a partial response; eight (15%) patients achieved stable disease, which lasted longer than 6 months in two patients.

Conclusions:
FHD-609 showed dose-dependent increases in systemic FHD-609 exposure and pharmacodynamic response profiles. The maximum tolerated doses were identified (40 mg twice weekly/80 mg once weekly) and preliminary clinical activity was observed. Future studies of BRD9 degraders will require strict cardiac monitoring given the QTc prolongation observed in this study.
Bridging Cultures, Building Relationships: the Fulbright Program’s Legacy in Taiwan
Authors: Bettie Molly 
Published: December 2024

Abstract
Following Professor Hsin-huang Michael Hsiao’s induction into the Fulbright Taiwan Hall of Fame in 2023, this report explores the history and purpose of the Fulbright Program and examines the role of educational exchange in US–Taiwan relations. It analyses the programme’s goal of fostering mutual understanding and the mechanism of intergroup contact. Drawing on archival research carried out at the University of Arkansas Fayetteville and the National Archives in College Park, Maryland, this report traces the development of the US–Taiwan Fulbright Program, highlighting its contribution to building meaningful interpersonal connections that promote mutual understanding and international goodwill. As we celebrate Professor Hsiao’s achievements, this reflection situates the programme within the broader historical context of educational exchange and public diplomacy.
Community out-of-hours palliative care – ‘It’s a patchwork of services’: A qualitative study exploring care provision
Authors: Firth Alice M , Goodrich Joanna , Gaczkowska Inez , Harding Richard , Murtagh Fliss EM , Evans Catherine J 
Published: December 2024

Background: People in receipt of community palliative care usually receive care from a range of services and require access to care 24/7. However, care outside of normal working hours varies, with little understanding of which models of care are optimal. Aim: To identify and characterise current models of out-of-hours community palliative care in the UK and explore healthcare professionals’ views on the barriers and facilitators to providing high quality community out-of-hours care. Design: Exploratory qualitative study using semi-structured interviews, analysed using reflexive thematic analysis. Setting and participants: We recruited 39 healthcare professionals from 20 geographic areas. Participants were service leads from community palliative care, district/community nursing and primary care providers. Results: Four overarching models of out-of-hours palliative care identified, characterised by levels of integration between services, balance between generalist and specialist providers, availability of care and type of care provided (hands-on clinical care/ advisory care). Analysis of barriers and facilitators generated three themes: (1) ‘It’s never one service’: challenges of coordination of care across multiple services, (2) Need for timely skilled management of distressing symptoms, (3) ‘We’re just plugging gaps’: prioritising patient care within limited resources. Patterns within the themes varied across the four models. Conclusion: This study identifies key characteristics of four common models of out-of-hours palliative care, from the perspectives of professionals. Facilitators of high quality out-of-hours care include: a palliative care specific single point of access for patients; formal structures to integrate generalist/specialist services; and timely/skilled management of symptoms. We provide recommendations for a potential model incorporating these factors.
The effect of silk short fiber biomimetic materials on the recovery of sports function in patients with meniscal injury during sports
Authors: Wang Yong , Bin Dongsong 
Published: December 2024

Background In sports, especially high-intensity and high-risk activities, the meniscus is easily damaged. For patients with meniscus injuries, it is necessary to repair or replace the patient's meniscus. However, as age increases, the human meniscus tissue gradually forms and cannot be repaired through its own meniscus. Therefore, it is necessary to maintain the patient's movement function through meniscus support materials. Objective Traditional meniscus support materials have poor mechanical properties and poor biocompatibility. In response to this issue, this study designed a meniscus scaffold made of silk short fibers, silk fibroin, and wool protein. Methods Through electrospinning and freeze-drying techniques, the material was processed to obtain a silk short fiber meniscus with a biomimetic structure. Results Through experiments, the surface morphology, hydrophobicity, porosity, secondary structure, thermal stability, water absorption swelling, and MP of MCS made of SSF biomimetic materials were characterized. Conclusion The experimental results show that the manufactured silk short fiber meniscus has good compressive performance, thermal stability, and water absorption and swelling properties, and it also exhibits good biocompatibility.