bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Surreptitious Glucocorticoids in Over-the-Counter Arthritis Supplements
Authors: Wei Kevin S , De La Torre Miguel O , Flores Antonio , Chiu Christine E , Hurtado Carolina R , Angell Trevor E 
Published: December 2024

Abstract
Adrenal dysfunction due to over-the-counter (OTC) health supplements containing unlabeled glucocorticoids has been previously reported. Here, we present a case series of 12 patients at an urban safety net medical center evaluated by endocrinology for iatrogenic adrenal dysfunction, Cushing syndrome (CS) and/or adrenal insufficiency (AI), associated with use of OTC arthritis supplements surreptitiously containing glucocorticoids. There were 12 patients using OTC arthritis supplements (Artri King [n = 8], Ardosons [n = 3], Ajo Rey [n = 1]) included. The mean age was 51.6 years and 33.3% were female. Findings of CS were identified in 10/12 (83.3%) patients, including moon facies (66%), central adiposity (66%), and abdominal striae (50%). Symptoms of AI were identified in 8/12 (66.7%) patients, including nausea/vomiting (42%), fatigue (42%), and abdominal pain (33%). Of 10/12 (83.3%) patients initially needing glucocorticoid replacement therapy, 4 continue to require treatment, 3 have successfully discontinued treatment, and 3 have been lost to follow-up. The literature reviewed identified 10 cases in 7 previously published reports, which did not include consistent follow-up data on adrenal function after discontinuation of the supplement. This case series demonstrates possible presentations of CS and/or AI from glucocorticoid exposure in patients taking these OTC arthritis supplements. Including more cases than all previously published reports combined, this series expands data for cortisol levels, cosyntropin test results, and glucocorticoid replacement needs for these patients and highlights the necessity for vigilant identification of supplement sources of exogenous steroids and the recognition of possible AI when such supplements are discontinued.
Symptomatic Progression, Recurrence, and Long-Term Follow-Up of Patients With Intracranial Epidermoid Cysts
Authors: Ramesh Rithvik , Quintana Daniel , Osorio Robert C. , Jimenez Christian J. , Aghi Manish K. , McDermott Michael W. , Theodosopoulos Philip V. , Goldschmidt Ezequiel 
Published: December 2024

BACKGROUND AND OBJECTIVES:
Intracranial epidermoid cysts are rare, slow-growing but highly recurrent tumors with incompletely understood symptoms, progression, complications, and outcomes. The aim of the study was to characterize the symptomatology, surgical management, and long-term outcomes of these tumors.

METHODS:
This single-center retrospective analysis identified patients with pathologically confirmed intracranial epidermoid cysts from 1989 to 2023. Demographic and clinical variables were collected at diagnosis, before and after each resection, and at the latest follow-up. Differences across time points were evaluated using analysis of variance with post hoc Tukey's honestly significant difference tests and Pearson χ2 test with posthoc Bonferroni-corrected z-tests for independent proportions (significance: P ≤ .05). Kaplan-Meier, Cox regression, and multivariate logistic regression analyses were used to investigate predictors for recurrence-free survival and 30-day readmission following first surgery, respectively.

RESULTS:
Of 146 patients in the final cohort, the average age at diagnosis was 40.3 years, and 52.1% of patients were female. The mean maximum tumor dimension at presentation was 4.3 cm. Most presenting symptoms were significantly reduced at the latest follow-up, including headaches (presentation: 40.4%/latest follow-up: 8.8%, P < .001), vertigo/nausea/vomiting (33.1%/3.7%, P < .001), ataxia/incoordination (22.8%/4.4%, P < .001), and seizures (11.8%/2.9%, P < .005). Similarly, significant improvements were observed in cranial nerve (CN) II deficits (11.0%/3.7%, P = .020) and CN V (11.8%/3.7%, P = .012) and CN VIII excitatory symptoms (11.8%/2.9%, P = .005). Following the first resection, 12.5% of patients were readmitted within 30 days; lumbar drain placement was associated with higher odds of readmission (adjusted odds ratio [95% CI] = 8.26 [1.29-88.19]). Evidence of tumor remnant on the immediate postoperative MRI was associated with a shorter time to recurrence following the first surgery (P = .023).

CONCLUSION:
The clinical progression of intracranial epidermoid cysts is marked by a spectrum of troublesome presenting symptoms and a notable tendency for recurrence, particularly following subtotal resection. Nevertheless, symptomatic improvement is the rule even if reoperations are needed, and mortality is exceedingly rare.
From molecular to physiological responses: improved stress tolerance and longevity in Drosophila melanogaster under fluctuating thermal regimes
Authors: Hunter-Manseau Florence , Cormier Jolène , Pichaud Nicolas 
Published: December 2024

ABSTRACT
Climate change introduces greater thermal variability, profoundly affecting ectothermic species whose body temperatures rely heavily on the environment. Understanding the physiological and metabolic responses to such variability is crucial for predicting how these species will cope with changing climates. This study investigates how chronic thermal stress impacts mitochondrial metabolism and physiological parameters in Drosophila melanogaster, hypothesizing that a fluctuating thermal regime (FTR) activates protective mechanisms enhancing stress tolerance and longevity. To test this, Drosophila were exposed to constant 24°C or to an FTR of 24°C:15°C (day:night) cycle following an initial 5 day period at 24°C. The FTR group exhibited rapid transcript level changes after the first day of FTR, particularly those related to heat shock proteins, mitophagy and regulatory factors, which returned to initial levels after 5 days. Mitochondrial respiration rates initially decreased after 1 and 2 days of FTR, then recovered by day 5, indicating rapid acclimation. Enhanced antioxidant enzyme activities were observed early in the FTR group, after 1 day for mtSOD and SODcyt+ext and 3 days for both SOD and catalase, followed by a decline by day 5, suggesting efficient oxidative stress management. The FTR group showed lower CTmax on day 3, reflecting possible physiological strain at that time point, and complete recovery by day 5. Longevity increased under FTR, highlighting the activation of protective mechanisms with beneficial long-term effects. These results suggest that FTR prompts a temporal succession of rapid physiological adjustments at different levels of organisation, enhancing long-term survival in D. melanogaster.
Insights into the Efficacy of GLP-1 Agonists and Dual Agonists: Semaglutide and Tirzepatide in Obesity and Type 2 Diabetes
Authors: Opalska Laura , Muciek Adrianna , Mocarska Martyna , Orłowska Anna , Strakowska Katarzyna , Maryńczak Anna , Mencel Jan , Nitschke Nicole 
Published: December 2024

The increasing global prevalence of obesity and type 2 diabetes (T2D) has prompted significant advancements in pharmacological treatments, with glucagon-like peptide-1 (GLP-1) receptor agonists and dual agonists representing key innovations. Semaglutide, a GLP-1 receptor agonist, and tirzepatide, a novel dual agonist targeting both GLP-1 and glucose-dependent insulinotropic peptide (GIP) receptors, have shown remarkable efficacy in improving glycemic control and promoting weight loss.
This review synthesizes the latest clinical evidence on the efficacy and safety of semaglutide and tirzepatide in the management of obesity and T2D, highlighting the findings from recent pivotal trials. In patients with T2D, semaglutide has consistently demonstrated superior glycemic control and weight loss compared to traditional therapies, as evidenced by the SUSTAIN trials [1]. Similarly, tirzepatide has emerged as a more efficacious option, with the SURPASS trials demonstrating greater reductions in HbA1c and more substantial weight loss compared to semaglutide. This positions tirzepatide as a potential first-line therapy for T2D.[2].
Both therapies have shown a favorable safety profile, with gastrointestinal side effects being the most common, and cardiovascular benefits observed in both drug classes. Given their dual mechanism of action, tirzepatide has shown unique potential in addressing both glycemic control and obesity, with emerging evidence supporting its use in non-diabetic patients with obesity [3].This review highlights the potential of these agents to revolutionise the management of obesity and T2D, with tirzepatide emerging as a promising next-generation treatment for metabolic diseases.
Advancements in Corneal Transplantation: Addressing Rejection Risks, Innovations and Challenges
Authors: Ziemińska Daria , Motolko Karina , Burczyk Rafał , Duszyński Konrad , Tokarczyk Elżbieta 
Published: December 2024

Introduction and Objective: Corneal transplantation is an increasingly common surgical procedure, with lamellar keratoplasty now favored over penetrating keratoplasty due to its advantages in outcomes and precision.
Review methods: A literature review utilizing databases like Scopus, Google Scholar, and PubMed, with keywords such as "corneal transplantation rejection" and "high risk of rejection," underscores the need for advancements in understanding and managing graft rejection.
Brief knowledge status: Key insights highlight the importance of deeper exploration into the immunological mechanisms of rejection to refine therapeutic strategies. The development of bioengineered materials like acellular porcine corneal stroma (APCS) offers a promising solution to the global donor shortage, though further validation of their clinical utility is needed. Complementary therapies such as amniotic membrane transplantation show promise in mitigating graft failure and treating corneal surface disorders due to their anti-inflammatory and regenerative properties. Moreover, comparative studies suggest that advanced keratoplasty techniques, such as Descemet Membrane Endothelial Keratoplasty (DMEK), may achieve lower rejection rates compared to alternatives like Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).
Discussion: Future priorities include advancing drug delivery systems, ensuring the feasibility and accessibility of bioengineered materials, and conducting large-scale multicenter trials to validate novel treatments and surgical methods across diverse populations.
Summary: Addressing these challenges is particularly crucial for high-risk and pediatric patients, with the ultimate goal of reducing graft failure rates and the necessity for repeat interventions.
Implementation of a goal-directed Care Bundle for intracerebral hemorrhage: Results of embedded process evaluation in the INTERACT3 trial
Authors: Ouyang Menglu , Anjum Anila , Mc Cawley Francisca Gonzalez , Wasay Mohammad , Ma Lu , Hu Xin , Chen Xiaoying , Malavera Alejandra , Li Xi , Venturelli Paula Muñoz , Silva H. Asita de , Thang Nguyen Huy , Wahab Kolawole W. , Pandian Jeyaraj D. , Pontes-Neto Octavio M. , Abanto Carlos , Cano-Nigenda Venessa , Arauz Antonio , You Chao , Jan Stephen , Song Lili , Anderson Craig S. , Liu Hueiming ,   for the INTERACT3 Investigators
Published: December 2024

The third, stepped-wedge, cluster-randomized, Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT3), has shown that a goal-directed multi-faceted Care Bundle incorporating protocols for the management of physiological variables was safe and effective for improving functional recovery in a broad range of patients with acute intracerebral hemorrhage (ICH). The INTERACT3 Care Bundle included time- and target-based protocols for the management of early intensive lowering of systolic blood pressure (SBP, target <140mmHg), glucose control (target 6.1–7.8 mmol/L in those without diabetes and 7.8–10.0 mmol/L in those with diabetes), anti-pyrexia treatment (target body temperature ≤37.5°C), and the rapid reversal of warfarin-related anticoagulation (target international normalized ratio <1.5). An embedded process evaluation was conducted to allow a better understanding of how the Care Bundle was implemented in different countries to enhance the transferability of this evidence in the international context. This study used a mixed-methods approach involving interviews, focus group discussions, and surveys to evaluate the implementation outcomes included fidelity, dose, reach, acceptability, appropriateness, adoption, and sustainability. Interviews (n = 27), focus group discussions (n = 3), and quantitative surveys (n = 48) were conducted in 7 low- and middle-income countries (LMICs) and 1 high-income country during 2019–2022. The Care Bundle was generally delivered as planned and well accepted by stakeholders, although some difficulties were reported in reaching the SBP and glycemic targets. Contextual factors including staff shortage, limited availability of antihypertensive drugs, and delayed systems of care processes, were common barriers to implementing the Care Bundle. Facilitating factors included good communication and collaboration with staff in emergency departments, the development of pathways within available resources, and regular training and monitoring. Our process evaluation provides useful insights into the contextual barriers which need to be addressed for effective scale up of the Care Bundle implementation in a global context.
Trial registration: INTERACT3 is registered at Clinicaltrials.gov (NCT03209258) and the Chinese Clinical Trial Registry (ChiCTR-IOC-17011787).
Understanding the role of potential biomarkers in attenuating multiple sclerosis progression via multiomics and network-based approach
Authors: Shriwash Nitesh , Aiman Ayesha , Singh Prithvi , Basir Seemi Farhat , Shamsi Anas , Shahid Mohammad , Dohare Ravins , Islam Asimul 
Published: December 2024

Background
Multiple sclerosis (MS) is a complex neurological disorder marked by neuroinflammation and demyelination. Understanding its molecular basis is vital for developing effective treatments. This study aims to elucidate the molecular progression of MS using multiomics and network-based approach.

Methods
We procured differentially expressed genes in MS patients and healthy controls by accessing mRNA dataset from a publicly accessible database. The DEGs were subjected to a non-trait weighted gene co-expression network (WGCN) for hub DEGs identification. These hub DEGs were utilized for enrichment, protein-protein interaction network (PPIN), and feed-forward loop (FFL) analyses.

Results
We identified 880 MS-associated DEGs. WGCN revealed a total of 122 hub DEGs of which most significant pathway, gene ontology (GO)-biological process (BP), GO-molecular function (MF) and GO-cellular compartment (CC) terms were assembly and cell surface presentation of N-methyl-D-aspartate (NMDA) receptors, regulation of catabolic process, NAD(P)H oxidase H2O2 forming activity, postsynaptic recycling endosome. The intersection of top 10 significant pathways, GO-BP, GO-MF, GO-CC terms, and PPIN top cluster genests identified STAT3 and CREB1 as key biomarkers. Based on essential centrality measures, CREB1 was retained as the final biomarker. Highest-order subnetwork FFL motif comprised one TF (KLF7), one miRNA (miR-328-3p), and one mRNA (CREB1) based on essential centrality measures.

Conclusions
This study provides insights into the roles of potential biomarkers in MS progression and offers a system-level view of its molecular landscape. Further experimental validation is needed to confirm these biomarkers’ significance, which will lead to early diagnostic and therapeutic advancements.
Problem nutrients in diet of under-five children and district food security status: Linear programming analyses of 37 stunting priority districts in Indonesia
Authors: Fahmida Umi , Pramesthi Indriya Laras , Kusuma Sari , Sudibya Arienta R. P. , Rahmawati Rahmawati , Suciyanti Dini , Gusnedi Gusnedi , Diana Aly 
Published: December 2024

Background
In Indonesia, food security and dietary patterns varied by regions. This might lead to differences in problem nutrients (PN) and should be considered in developing local-specific food-based recommendations (FBRs) for stunting prevention.

Objectives
This study aims to identify PNs in diet of under-five children in selected 37 stunting priority districts in Indonesia and assess whether the number of PNs was associated with district food security status.

Methods
Linear programming analysis (LP) using Optifood was done using single 24-hour dietary recall data Ministry of Health 2016 Food Consumption Survey. PN was defined as nutrient which did not meet 100% Recommended Nutrient Intake (RNI) based on Indonesian-RNI in the 2-best-diets scenario. District’s food security status was determined using Food Security Vulnerability Atlas 2018.

Results
The top three PNs amongst under-five childrenwere iron, folate, vitamin B12 (6-11mo); folate, calcium, zinc (12-23mo); folate, calcium, vitamin C (24-35mo); and calcium, folate, vitamin C (36-59mo). There were no significant differences in number of PNs based on food security status. After integrating the nutrient-dense foods into FBRs, the number of districts with dietary inadequacy decreased for the top-3 problem nutrients in each age group, with the exception of iron for infants.

Conclusions
Our findings showed that problem nutrients and dietary inadequacy were prevalent in diet of under-five children, even in food-secure areas. Promoting locally available nutrient-dense foods through FBRs (nutrition-specific intervention) and ensuring availability and access to these foods (nutrition-sensitive intervention) are recommended. Additional intervention(s), particularly for iron in infants, are required.
Learning hand hygiene from the champions: Investigating key compliance facilitators among healthcare workers through interviews
Authors: von Auer Charis , Probst Magdalena , Schneider-Bachart Wulf , Gaube Susanne 
Published: December 2024

Introduction
Good hand hygiene compliance among healthcare workers is crucial for preventing healthcare-associated infections. While an extensive amount of research has focused on barriers to compliance with hand hygiene guidelines, there remains a critical gap in understanding the factors contributing to consistently excellent compliance among some individuals. Thus, the main aim of this study is to learn from these "champions" of hand hygiene and identify facilitating factors that enable and sustain high compliance using the Theoretical Domains Framework (TDF).

Methods
In this qualitative study, we conducted problem-oriented semi-structured interviews with questions based on the 14 domains of the revised TDF. The N = 25 participants included physicians and nurses from three German hospitals. They were selected based on a reported history of excellent hand hygiene compliance.

Results
All topics discussed by the interviewees could be categorised into the 14 TDF domains. Five TDF domains were particularly prominent: environmental context and resources, behavioural regulation, knowledge, social influences, and skills. The single most important facilitator for good hand hygiene compliance among both physicians and nurses was the construct/code goals (i.e., patient protection and self-protection). Additionally, for physicians, developing hand hygiene as a habit was considered particularly advantageous. Conversely, nurses emphasised that learning correct hand hygiene during their vocational training was especially beneficial for good compliance.

Conclusions
The results highlight the importance of clear goals, habit development, comprehensive training, adequate resources, and a positive culture of communication in promoting good hand hygiene practices. The TDF has been proven to be a suitable model for identifying facilitating factors for hand hygiene compliance among healthcare workers.
Uporaba teorije sistemov Betty Neuman pri razumevanju stresorjev na delovnem mestu medicinskih sester
Authors: Levstik Jašarevič Debora , Bogićević Menkinoska Marija , Verdev Sandra , Pavšič Lea , Prosen Mirko , Ličen Sabina 
Published: December 2024

Uvod: Namen raziskave je bil na podlagi teorije Betty Neuman raziskati obseg različnih vrst stresorjev (intrapersonalnih, interpersonalnih, ekstrapersonalnih in tistih, povezanih z zdravstvenimi nastanitvami) ter njihov vpliv na dojemanje delovnega okolja in dobro počutje zaposlenih v zdravstvenih ustanovah.Metode: Uporabljena je bila opisna neeksperimentalna kvantitativna metoda raziskovanja s pomočjo spletne ankete. Anketa je vsebovala 20 trditev. Sodelovalo je 140 zaposlenih v zdravstveni negi različnih izobrazbenih stopenj in delovnih okolij.Rezultati: Rezultati kažejo, da zdravstveni delavci doživljajo zmerno nizko raven stresorjev na delovnem mestu: povprečna ocena 54,17 na lestvici, ki se točkuje od 20 do 100. Višja prisotnost stresorjev je bila zabeležena pri osebah z znanstvenim magisterijem ali doktoratom znanosti (x = 92,83, s = 0,668). Na terciarni ravni zdravstvene dejavnosti so poročali o višji prisotnosti stresorjev (x = 80,00, s = 1,039) v primerjavi s primarnim, sekundarnim nivojem in socialnovarstvenimi zavodi (x = 60,90, s = 1,039). Anketiranci se strinjajo, da je preprečevanje poškodb in bolezni na delovnem mestu skupna odgovornost (x = 4,43, s = 0,689). Prav tako so visoko ocenili občutenje stresa zaradi obsega dela (x = 3,74, s = 0,976). Večja prisotnost stresorjev je prisotna pri anketirancih z izmenskim delom ( x = 89,64, s =1,737) in na delovnih mestih, kot je služba nujne medicinske pomoči (x = 73,30, s = 3,449).Diskusija in zaključek: Rezultati kažejo na potrebo po prilagojenih intervencijah za obvladovanje stresorjev zlasti v terciarni zdravstveni dejavnosti, pri zaposlenih z izmenskim delom in v visoko stresnih delovnih okoljih.
Evaluation of cashew apple RTS beverages blend with mango and papaya for its physicochemical properties and storage life
Authors: Kannan S , Noorjehan AKAH , Baskaran A , Raja N 
Published: December 2024

For every tonne of cashew nuts, 10 to 15 tonnes of cashew apples are spoiled in orchards, representing a significant economic loss in India. Cashew apple juice is astringent because of the presence of anacardic acid and tannins when eaten as such. Ready-to-serve (RTS) beverages prepared from cashew apple juice blended with mango and papaya in varying proportions were evaluated for physicochemical properties, organoleptic scores and microbial counts at 0, 30, 60, and 90 days of storage during 2022-2023 using Completely Randomized Design with two replications and six treatments. RTS blend of 50% cashew apple and 50% mango juice (T2) exhibited a gradual reduction in pH and ascorbic acid content and an increase in density, total soluble solids (TSS), acidity, reducing sugar and TSS/acid ratio from 0 to 90 days of storage followed by T6, a blend of 25% cashew apple and 75% papaya juice RTS. The RTS blends T2 and T6 had low microbiological counts and excellent quality, colour, taste, and general acceptance based on organoleptic score. The highest net benefit for an RTS beverage was in T3 (Rs.32/-) followed by T2 (Rs.27.25/-) when compared to control (100% cashew apple juice @Rs.21/-). They also had affordable preparation costs, which added value to the cashew apple juice.