bluuebunny/crossref_metadata_2025_split huggingface dataset:
A retrospective, observational study of real-world clinical data from the Cognitive Function Development Therapy program
Authors: Kirby Eric D. , Beyst Brian , Beyst Jen , Brodie Sonia M. , D’Arcy Ryan C. N. 
Published: December 2024

IntroductionCognitive deficits are common in psychiatric and mental health disorders, making the assessment of cognitive function in mental health treatment an important area of research. Cognitive Function Development Therapy (CFDT) is a novel therapeutic modality designed to enhance cognitive function and regulate the autonomic nervous system through targeted exercises and activities focused on attention networks and memory systems. The therapy is tracked and based on Primary Cognitive Function (PCF) scores.MethodsThis retrospective, observational study analyzed real world data from 183 children and adults undergoing CFDT to evaluate changes in cognition over time, incorporating both cognitive performance measures and an exploratory analysis of neurophysiological function. Objective neurophysiological measures in the form of the brain vital signs framework, based in event-related potentials (ERPs), were measured in a small subset of clients to explore the frameworks use in CFDT.ResultsOur findings indicate that CFDT holds promise for improving cognitive performance, as evidenced by increased PCF scores at the group level compared to pre-treatment levels [F (5, 173) = 7.087, p &lt; 0.001, ηp2 = 0.170]. Additionally, a weak effect of age [Spearman’s Rho range: −0.301 to −0.340, p &lt; 0.001] was found to influence the degree of cognitive improvement, suggesting the importance of early intervention for maximizing cognitive gains. The exploratory analysis suggested that CFDT may affect neurophysiological measures of information processing, particularly in basic attention, as reflected in increased amplitude in P300 measures.DiscussionWhile these initial findings are encouraging, caution is warranted due to the retrospective nature of the study, though overall, the results suggest a positive impact of CFDT on cognitive function.
Nutritional nursing competence of clinical nurses and its influencing factors: a cross-sectional study
Authors: Tang Yuan , Wen Xiumei , Tang Xiaoli , Li Xiaoxue , Zhang Li , Duan Shujuan , Long Ping , Zhou Zixuan 
Published: December 2024

ObjectiveAssessing the nutritional nursing competence of clinical nurses will enable nursing managers to develop measures to effectively address the nutritional nursing needs of patients. Therefore, the purpose of this study was to investigate the status quo and influencing factors of nutritional nursing competence of nurses in China.MethodA cross-sectional survey was conducted among more than 1300 clinical nurses from 10 provinces in eastern, central and western China by using self-designed socio-demographic questionnaire and nutrition nursing ability scale compiled by Zhu Xinyi.ResultThe median score of nurses’ nutritional nursing ability was 238 (210, 258). Univariate analysis confirmed that a total of 12 factors were shown to be statistically significant for nurses’ competency in nutritional care. The results of multiple linear regression analysis showed that department, hospital level, monthly income, learned nutrition courses, regular participation in nutrition continuing education and training, be a nutrition specialist nurse, participation in nutrition nursing knowledge and skills training, and the hospital’s regular conduct of special quality supervision of nutrition nursing and carried out special quality improvement projects of nutrition nursing.ConclusionIn China, the nutritional nursing competence of nurses is at an upper medium level and needs to be further improved. In order to improve the level of nutrition nursing, encourage and support nurses to take targeted nutrition care education and training, nursing managers should also adopt multi-mode intensive inspection and examination.
Effects of salt substitute on urinary electrolytes and blood pressure in a real-world setting—cohort study in Hunan, China
Authors: Wu Hao , Ouyang Wenbin , Deng Jing , He Yongmei , Yin Lu , Cao Xia , Chen Zhiheng , Yang Pingting , Wang Yaqin , Li Ying , Huang Xin 
Published: December 2024

Background and aimsSalt substitute is considered an effective strategy to reduce sodium and increase potassium intake and thereby lower blood pressure in China, but its benefits and risks are uncertain in real-world data. This study is designed to compare the difference in the 1-year efficacy of salt substitute and salt restriction on urinary electrolytes and blood pressure.Methods and resultsA total of 2,929 and 2,071 participants with the 24-h estimated urinary sodium excretion (eUNaE) above 2.36 g/d using salt substitute (SS) and salt restriction (SR) strategies, respectively, were followed for 1 year. Salt substitute users were further divided by potassium chloride (KCl) content (13% vs 25%) and duration (9–11 vs 12 months). The 24-h eUNaE and estimated urinary potassium excretion (eUKE) levels were calculated using the Kawasaki formula from spot urine sample. The SS group (n = 1,897) had lower eUNaE (3.82 ± 1.03 vs 4.05 ± 1.01 g/day, p &lt; 0.01) than the SR group (n = 1,897) after 1 year. Both 13 and 25% KCl substitutes reduced eUNaE versus restriction (p &lt; 0.05). The SS group had a higher eUKE than the SR group (2.09 ± 0.43 vs 1.71 ± 0.62 g/day, p &lt; 0.01). The eUKE was higher with 25% versus 13% KCl substitutes, while the Na/K was lower with 25% versus 13% KCl substitutes (p &lt; 0.05). No significant blood pressure differences occurred between the SS and SR groups (p &gt; 0.05), whereas 25% KCl exposure was related to a lower level of SBP, regardless of whether it was compared with SR or 13% KCl.ConclusionCompared with salt restriction, salt substitute results in more sodium reduction and greater potassium increase. In spite of this, it does not result in better control of blood pressure, especially for the group receiving 13% KCl.
Effectiveness of systemic treatments for advanced non-clear cell renal cell carcinoma: a systematic review and meta-analysis
Authors: Zhang Yaping , Chen Jian , Wang Xiaoyan , Wang Hui , Chen Xiaoli , Hong Jianfeng , Fang Hongming 
Published: December 2024

BackgroundNon-clear cell renal cell carcinoma (nccRCC) represents a heterogeneous group of malignancies with substantial differences in morphology, genetic profiles, clinical behavior, and prognosis. Optimal treatment for nccRCC remains unclear, largely extrapolated from evidence available for clear cell renal cell carcinoma (ccRCC). This study aimed to compare the efficacy of current mainstream drug treatments for nccRCC to provide clinical treatment guidance for advanced cases.MethodsWe systematically searched PubMed, Embase, and Cochrane databases for trials published up to January 2, 2024, including controlled and single-arm trials. Primary outcomes included overall response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS).ResultsWe selected six randomized controlled trials (RCTs) comparing mammalian target of rapamycin inhibitors (mTORi) with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs). These trials included four first-line and two second-line studies, with a total of 398 advanced nccRCC patients. Pooled results showed that VEGFR-TKIs significantly improved PFS compared to mTORi in first-line treatment (relative risk [RR] = 1.387; 95% confidence interval [CI]: 1.04-1.85; p = 0.026). In a single-arm meta-analysis, we included 22 VEGFR-TKI trials, three mTORi trials, 12 immune checkpoint inhibitor (ICI) therapies, five chemotherapy trials, and 10 combination therapy trials. The pooled ORR ranged from 6% (95% CI: 0–16%) to 36% (95% CI: 27–44%), and the pooled DCR ranged from 54% (95% CI: 50–58%) to 81% (95% CI: 70–91%). Subgroup analysis of ICI showed a higher ORR in the PD-L1 positive group compared to the PD-L1 negative group (RR = 3.044; 95% CI: 1.623-5.709; p = 0.001).ConclusionThis systematic review and meta-analysis demonstrate that VEGFR-TKIs improve PFS in first-line treatment compared to mTORi. The single-arm meta-analysis suggest that combination therapies with different mechanisms result in better ORR and DCR. Furthermore, PD-L1 positive patients showed significantly better therapeutic responses with ICI treatment than PD-L1 negative patients.
High-risk breast lesions: a combined intratumoral and peritumoral radiomics nomogram model to predict pathologic upgrade and reduce unnecessary surgical excision
Authors: Liao Tingting , Yang Yuting , Lin Xiaohui , Ouyang Rushan , Deng Yaohong , Ma Jie 
Published: December 2024

ObjectiveThis study aimed to develop a nomogram that combines intratumoral and peritumoral radiomics based on multi-parametric MRI for predicting the postoperative pathological upgrade of high-risk breast lesions and sparing unnecessary surgeries.MethodsIn this retrospective study, 138 patients with high-risk breast lesions (January 1, 2019, to January 1, 2023) were randomly divided into a training set (n=96) and a validation set (n=42) at a 7:3 ratio. The best-performing MRI sequence for intratumoral radiomics was selected to develop individual and combined radiomics scores (Rad-Scores). The best Rad-Score was integrated with independent clinical and radiological risk factors by a nomogram. The diagnostic performance of the nomogram was evaluated using the area under the curve (AUC) of the receiver operating characteristic curve, along with accuracy, specificity, and sensitivity analysis.ResultsThe nomogram based on the combined intratumoral and peritumoral Rad-Score of the dynamic contrast-enhanced MRI and clinical-radiological features achieved superior diagnostic efficacy in the training (AUC=0.914) and validation set (AUC=0.867) compared to other models. It also achieved a specificity and accuracy of 85.1% and 82.3% during training and 66.7% and 76.2% during validation.ConclusionThe nomogram encapsulating the combined intratumoral and peritumoral radiomics demonstrated superior diagnostic efficacy in postoperative pathological upgrades of high-risk breast lesions, enabling clinicians to make more informed decisions about interventions and follow-up strategies.
Immunosuppressant nonadherence profile in kidney transplant recipients and the impact of medication adherence on transplant outcomes
Authors: Zhi-yu Zou , Lin-rui Dai , Chen-zhen Yu , Ren-jie Chen , Fei-hong Yu , Song Chen , Sheng Chang , Wei-jie Zhang 
Published: December 2024

BackgroundDespite the fact that 1-year graft and recipient survival rates are above 90% in most transplant centers, improving long-term graft survival remains an important challenge. Immunosuppressant nonadherence has been recognized as one of the important risk factors for long-term graft failure. Understanding the modifiable correlates and risk factors for medication non-adherence is essential to develop interventions to improve adherence and thus long-term transplantation outcomes.MethodsThis study conducted a questionnaire survey on 431 renal transplant recipients who were followed up in the outpatient clinic between January 2022 and January 2023, and 409 valid questionnaires were returned. The BAASIS questionnaire was used to assess the prevalence of nonadherence to immunosuppressive therapy (implementation phase) in Chinese renal transplant recipients and to explore the multilevel correlates of immunosuppressive nonadherence. The BAASIS questionnaire was used to categorize renal transplant recipients into adherent (n = 239) and non-adherent (n = 170) groups, and a prospective cohort study with a 1-year follow-up was conducted to explore the impact of immunosuppressant non-adherence on clinical outcomes.ResultsThe prevalence of nonadherence to immunosuppressant therapy in renal transplant recipients in this study was as high as 41.6%. The number of years post-transplant (OR: 1.240, 95% CI: 1.136–1.353, p &lt; 0.001) and the frequency of twice-daily dosing (OR: 5.145, 95% CI: 2.690–9.840, p &lt; 0.001) were positively correlated with immunosuppressive nonadherence. There was a significant difference in TAC IPV (Intra-individual Variability) between the adherent and nonadherent groups (22.7 ± 8.7 vs. 25.4 ± 11.6, p = 0.010). Renal function remained stable during the follow-up period in the recipients in the adherence group and tended to decrease in the recipients in the non-adherence group (F = 4.932, p = 0.001). The rates of graft loss (7.1% vs. 1.7%, p = 0.006) and rejection (12.4% vs. 4.2%, p = 0.002) were higher in the nonadherent group than in the adherent group.ConclusionLonger time post-transplant and higher frequency of immunosuppressive dosing were positively associated with nonadherence to immunosuppressives medication. Immunosuppressant nonadherence was associated with adverse graft outcomes.
Role of memantine in adult migraine: a systematic review and network meta-analysis to compare memantine with existing migraine preventive medications
Authors: Li Guanglu , Qu Baoquan , Zheng Tao , Duan Shaojie , Liu Lei , Liu Zunjing 
Published: December 2024

BackgroundWhile memantine has been considered a promising drug for migraine prevention, no conclusive evidence exists comparing its efficacy with other migraine-preventive medications. This network meta-analysis (NMA) aimed to access the effectiveness and acceptability of memantine and other guideline-recommended prophylactic agents for migraine.MethodsWe searched the Cochrane Register of Controlled Trials, Embase, PubMed, and ClinicalTrials databases from their inception to 1 June 2024. Randomized placebo-controlled trials (RCTs) examining the pharmacological prevention of adult migraine patients were included. The primary efficacy outcome was the change in migraine days, and the primary safety outcome was withdrawal due to adverse events. Secondary outcomes included 50% response rates and frequency of any adverse events. The analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsThirty-eight RCTs, including a total of 13,223 participants, were analyzed. Our analysis showed that memantine demonstrated the second-largest reduction in migraine days [standardized mean difference (SMD): −0.83; 95% confidence interval (CI): −1.26, −0.41 compared with placebo] and the highest 50% response rates [odds ratio (OR): 5.58, 95% CI: 1.31 to 23.69] in all studied interventions. Moreover, among all interventions, memantine appeared to show the lowest dropout rate and moderate frequency of adverse events. However, its confidence intervals contained null values.ConclusionThis study provides prioritisation evidence for memantine in migraine prevention, as memantine can significantly decrease the frequency of migraine attacks, improves response rates, and fair acceptability. These beneficial effects were not inferior to currently recommended pharmacological regimens. However, due to the lack of long-term efficacy and safety data, as well as few direct comparisons with active control agents, the estimates of memantine may be overly optimistic. Clinicians should interpret the findings of current NMA cautiously and apply them in a relatively conservative manner.
Maintenance of flower color dimorphism in Ophiorrhiza japonica (Rubiaceae): responses to fluctuating temperatures in a dolomite Karst region
Authors: Wang Xiao-Yue , Tang Han-Qing , Liu Yun-Jing , Xiang Meng-Da , Yao Ren-Xiu , Li Bai-Zhu , Li Yu , Yi Yin , Wen Zhi-Rui , Tang Ming , Tang Xiao-Xin 
Published: December 2024

IntroductionFlower color polymorphism is often attributed to selection pressures from Q9 pollinators or other non-pollinator stress factors. Generally, flower color polymorphism demonstrates effective acclimatization linked to either pollinator-mediated selection or pleiotropic effects.MethodsTo test these hypotheses in Ophiorrhiza japonica, we compared pollinator visitation frequencies and plant traits between pink and white morphs in Shibing, a dolomite Karst region recognized as a World Natural Heritage Site. We also assessed the ratio of flower morphs and the reproductive success of the two morphs during spring and winter. Additionally, we examined the effects of temperature shifts on the two morphs under various temperature treatments.Results and discussionOur results revealed no significant difference in visitation frequencies between the morphs. However, the ratio of pink to white morph differed significantly between spring and winter. The temperature of pink morph was higher than that of white morph at temperatures ranging from 0-24°C, while white morph had higher temperatures than pink morph at -4°C. Based on the aforementioned results, pollinators are not the primary factor influencing the distribution of flower colors in spring and winter. Furthermore, the response of different flower colors to temperature suggests that temperature is more likely the factor driving changes in flower coloration. Our study provides further evidence supporting the pleiotropic effect hypothesis, which posits that flower color polymorphism can be maintained by fluctuating temperatures in the dolomite Karst region. This study offers a potential model for explaining flower color polymorphism in Karst regions.
A network approach to understanding occupational psychological distress: linking depression, anxiety, and burnout among Chinese healthcare professionals
Authors: Yang Cui , Chen Yao , Wang Xuelian , Xu Ping , Song Juan , Yang Lu , Fu Yue 
Published: December 2024

ObjectivesAs a population at high risk for psychological distress, healthcare workers typically experience varying degrees of anxiety, depression, and burnout. Studies have found that depression and anxiety have a negative impact on the mental health domain of burnout in healthcare workers. However, little is known about the symptom-to-symptom interactions between these psychological outcomes. This study aims to elucidate the characteristics of depression, anxiety, and burnout networks among healthcare workers.MethodsWe recruited 846 healthcare workers from March to April 2023 from three hospitals. A total of 826 healthcare workers completed the General Information Scale, the 16-item Quick Inventory of Depressive Symptomatology–Self-Report (QIDS-SR16), the Self-rating Anxiety Scale (SAS), and the Burnout Clinical Subtype Questionnaire (BCSQ)-36. The network models were constructed using network analysis. The expected influence and the bridge expected influence of nodes were calculated. The stability and accuracy of the network was assessed.ResultsThe results showed that the core symptoms in the symptom network mainly included QIDS8 (Energy/Fatigability), SAS3 (Easily upset or frightened), SAS11 (Dizzy), SAS8 (Tiredness), SAS10 (Tachycardia) and BCSQ3 (Worn-out), and the key nodes connecting these symptoms were QIDS2 (Sad mood), SAS20 (Have nightmares), BCSQ3 (Worn-out), SAS8 (Tiredness), QIDS8 (Energy/Fatigability), QIDS4 (Concentration/decision-making) and SAS4 (Madness).ConclusionUnique pathways of association between burnout, depression, and anxiety were found to exist. Interventions targeting core symptoms can maximize the improvement of depression, anxiety, and burnout, provide a deeper understanding of the relationship between the three conditions, and provide a target and basis for psychological interventions to improve the emotional wellbeing of healthcare workers and enhance their mental health.
Assessing serial recall as a measure of artificial grammar learning
Authors: Jenkins Holly E. , de Graaf Ysanne , Smith Faye , Riches Nick , Wilson Benjamin 
Published: December 2024

IntroductionImplicit statistical learning is, by definition, learning that occurs without conscious awareness. However, measures that putatively assess implicit statistical learning often require explicit reflection, for example, deciding if a sequence is ‘grammatical’ or ‘ungrammatical’. By contrast, ‘processing-based’ tasks can measure learning without requiring conscious reflection, by measuring processes that are facilitated by implicit statistical learning. For example, when multiple stimuli consistently co-occur, it is efficient to ‘chunk’ them into a single cognitive unit, thus reducing working memory demands. Previous research has shown that when sequences of phonemes can be chunked into ‘words’, participants are better able to recall these sequences than random ones. Here, in two experiments, we investigated whether serial visual recall could be used to effectively measure the learning of a more complex artificial grammar that is designed to emulate the between-word relationships found in language.MethodsWe adapted the design of a previous Artificial Grammar Learning (AGL) study to use a visual serial recall task, as well as more traditional reflection-based grammaticality judgement and sequence completion tasks. After exposure to “grammatical” sequences of visual symbols generated by the artificial grammar, the participants were presented with novel testing sequences. After a brief pause, participants were asked to recall the sequence by clicking on the visual symbols on the screen in order.ResultsIn both experiments, we found no evidence of artificial grammar learning in the Visual Serial Recall task. However, we did replicate previously reported learning effects in the reflection-based measures.DiscussionIn light of the success of serial recall tasks in previous experiments, we discuss several methodological factors that influence the extent to which implicit statistical learning can be measured using these tasks.
Validation of the World Health Organization’s Disability Assessment Schedule 2.0 for children with mental disorders in specialized health-care services
Authors: Díaz-Castro Lina , Arroyo-Belmonte Miriam , Suárez-Brito Paloma , Márquez-Caraveo María Elena , Garcia-Andrade Consuelo 
Published: December 2024

IntroductionMental disorders are highly prevalent among children, yet access to timely and effective treatment remains limited. Untreated or poorly managed mental disorders in children are associated with significant functional deterioration and long-term consequences. The validation of reliable assessment tools is crucial for identifying functional impairments and guiding interventions in this population. This study aimed to assess the utility and psychometric properties of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in evaluating functional impairment among children and adolescents receiving specialized mental health care in Mexican psychiatric hospitals.MethodA cross-sectional analytical study was conducted from January 2018 to February 2020 in two psychiatric public hospitals in Mexico. The Spanish version of the WHODAS 2.0 was adapted for the pediatric population, and its psychometric properties were evaluated among 390 children and adolescents receiving psychiatric care. Data were analyzed using descriptive statistics, exploratory and confirmatory factor analyses, and tests of internal consistency and validity.ResultsThe WHODAS 2.0 demonstrated high internal consistency (α = .92) and convergent validity, with significant correlations observed between WHODAS scores and clinical variables. Exploratory factor analysis revealed a six-dimensional structure, with gender-specific differences identified in functional impairment patterns.DiscussionThe study provides robust evidence supporting the utility and psychometric properties of the WHODAS 2.0 for assessing functional impairment in children and adolescents with mental disorders in Mexican psychiatric hospitals. These findings have implications for clinical practice, policy-making, and future research aimed at improving outcomes for this vulnerable population.