bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integrating telerehabilitation and serious gaming during home-based exercise intervention after stroke: A randomized controlled pilot trial of the DISKO-tool
Authors: Åkesson Elisabet , Bergqvist Maria , Eder Maja , Bäckström Nanna , Franzén Erika , Borg Jörgen , Palmcrantz Susanne 
Published: January 2025

Background To support recovery after stroke, rehabilitative actions and innovations are needed in resource-limited health care and geographically distant regions. Objective The first objective was to explore the feasibility of performing home-based training using the novel DISKO-tool including both telerehabilitation and serious gaming customized to target dynamic balance poststroke. The second objective was to assess the outcome using the Balance Evaluation Systems Test as the primary outcome. Methods This randomized controlled pilot trial, included ambulatory patients ≥18 years of age with physical impairments 3–6 months poststroke. During primary care rehabilitation, patients were randomized to conventional and 6 weeks of DISKO-tool training in the home ( n = 10) or conventional training only ( n = 11). Feasibility was assessed with process, resource, management, and scientific perspectives using questionnaires, logbooks, DISKO-tool data and clinical assessments. Results The study design was feasible including safety, resource capacity, a retention rate of 87%, high compliance to the protocol (mean 30 training days), and highly rated experience of the tool (median 10 of 10) despite some technical issues. The recruitment rate was low. The DISKO-group presented improved balance, especially in anticipatory postural adjustment compared to the conventional group ( p < 0.001; effect size 2.195; 95% CI 1.015–3.336). Conclusions Applying the DISKO-tool in home-based stroke rehabilitation was feasible and the piloted methodology suited for a larger RCT, as long as a wider inclusion time window poststroke is applied to enhance the recruitment rate. Rapid development and a limited lifespan of off-the-shelf hardware products warrant continuous technical development.
Digital assessment of muscle adaptation in obese patients with osteoarthritis: Insights from surface electromyography (sEMG)
Authors: Luo Xinran , Wang Qiaojie , Tan Hongyu , Zhao Wenbo , Yao Yifei , Lu Shengdi 
Published: January 2025

Background Obesity and severe knee osteoarthritis (KOA) lead to significant gait and muscle adaptations. However, the relationship between core muscle strength and the severity of KOA in obese patients remains unclear. This study aimed to determine the association between muscle strength adaptation and the severity of KOA in obese individuals. Methods We recruited 119 obese participants with unilateral KOA from January 2021 to December 2023, all classified with mild to moderate KOA grades. KOA severity was assessed using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), which categorized participants into two groups based on disease severity. Electromyographic data from the psoas, gluteus medius, vastus lateralis, vastus medialis, rectus femoris, medial gastrocnemius, lateral gastrocnemius, tibialis anterior, and biceps femoris muscles were collected during isometric and dynamic knee extension. Results Significant differences were observed in all selected muscles between the affected knee joint and the contralateral side during both dynamic and isometric knee extensions. The difference in electromyographic data—including mean absolute value (MAV), root mean square (RMS), and center frequency (CF)—was significantly different across groups categorized by KOA severity. Notably, the MAV values of the vastus medialis, lateral gastrocnemius, and biceps femoris, as well as the CF values of the medial and lateral gastrocnemius, showed no significant differences in some instances during both dynamic and isometric extensions. Conclusion This study indicates that obese individuals with KOA exhibit lower muscle intensity and higher fatigability in comparison to the contralateral side during both isometric and dynamic knee extensions. Furthermore, significant reductions in muscle intensity were observed in the psoas, gluteus medius, vastus lateralis, rectus femoris, medial gastrocnemius, and tibialis anterior muscles, correlating with the advanced severity of KOA.
TiO2–ZnO functionalized low-cost ceramic membranes from coal fly ash for the removal of tetracycline from water under visible light
Authors: Sawunyama Lawrence , Oyewo Opeyemi A. , Makgato Seshibe S. , Bopape Mokgadi F. , Onwudiwe Damian C. 
Published: January 2025

AbstractHybrid wastewater treatment systems offer viable solutions to enhance the removal of complicated contaminants from aqueous system. This innovation has opened new avenues for advanced wastewater treatment processes. Herein, a novel TiO2–ZnO functionalized coal fly ash-based ceramic membrane was fabricated by utilizing a combined pressing and sintering method. The intrinsic properties of the functionalized membranes were characterized and their chemical and physical properties such as chemical stability, mechanical stability, water absorption, and porosity were established. The shape, crystallinity, thermal characteristics, and functional groups present were also determined using SEM, XRD, TGA, and FTIR studies, respectively. The results showed that the ceramic membrane functionalized with 0.5 g of TiO2–ZnO and sintered at 850 °C exhibited the best thermal, and chemical stability, and possessed the required porosity for ultrafiltration applications. Photocatalytic degradation of tetracycline (TC) as a model pollutant was examined and the optimum efficiency of 77% was achieved within 100 min of visible irradiation using the functionalized membrane. Moreso, the functionalized membrane was found to be stable with 73% degradation efficiency after 5 consecutive cycles of reusability study, showing negligible loss of efficiency. The scale-up of photocatalytic ceramic membranes and their utilization in real industrial applications will confirm their robustness.
Graphical Abstract
Real-world clinical outcome of unresectable locally advanced & de-novo metastatic pancreatic ductal adenocarcinoma: a multicentre retrospective study
Authors: Aseafan Mohamed , Alfakeeh Ali H. , Tashkandi Emad , Mahrous Mervat , Alghamdi Mohammed , Alshamsan Bader , Al-Hajeili Marwan , Bakhsh Safwan , Alshammari Kanan , Almugbel Fahad A. , Alfagih Abdulhameed H. , Allehebi Ahmed , Montaser Mohamed , Elsafty Mohamed Hamdy , Elnaghi Khaled Abd Elaziz , Issa Ibrahim , Bakshi Eesa , AlSubaie Sadeem , AlMutairi Bandar , Mokhtar Hoda , Aboelatta Mohamed , Bukhari Nedal , Alzahrani Ali M. , Elhassan Tusneem , Alqahtani Ali , Bazarbashi Shouki 
Published: January 2025

Abstract
Background
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with limited treatment options yielding poor outcomes. This study aimed to evaluate the real-world clinical characteristics, treatment patterns, and outcomes of patients with locally advanced unresectable and de-novo metastatic PDAC in Saudi Arabia, providing regional data to compare with international benchmarks.

Methods
This is a retrospective, multicentre study involving 350 patients diagnosed with unresectable locally advanced or de-novo metastatic PDAC between January 2015 and November 2023. Data were collected from 10 oncology centers across Saudi Arabia.

Results
The median age at diagnosis was 60 years, with 63% of patients presenting with multiple metastatic sites, primarily in the liver (66.3%). FOLFIRINOX was the most common first-line treatment (55.1%), followed by gemcitabine plus nab-paclitaxel (15.1%). The median PFS for first-line treatment was 5.3 months, with FOLFIRINOX achieving the longest PFS (6.5 months). The median OS was 10.34 months for the entire cohort, with better survival outcomes observed in patients receiving FOLFIRINOX (12.3 months). Independent prognostic factors for PFS and OS included performance status, first-line regimen, and neutrophil-lymphocyte ratio (NLR). Among patients tested, 7.1% had deficient mismatch repair (d-MMR), and 5.8% harbored BRCA mutations.

Conclusions
This real-world study confirms that clinical outcomes for locally advanced unresectable and metastatic PDAC in Saudi Arabia are consistent with international data, with FOLFIRINOX showing superior outcomes over gemcitabine-based regimens. However, both treatments reflect the persistent poor prognosis of PDAC, underscoring the need for novel therapeutic strategies. Further research is warranted to optimize treatment selection and improve survival outcomes in this population.
Predictors of self-reported hypertension among women of reproductive age in North Dakota
Authors: Day Corey A. , Njau Grace , Schmidt Matthew , Odoi Agricola 
Published: January 2025

Abstract
Background
Understanding the risk factors of hypertension among women of reproductive age (18–44 years) is important for guiding health programs aimed at reducing the burden of hypertensive disorders in this population. Therefore, the objective of this study was to investigate predictors of self-reported hypertension among women of reproductive age in North Dakota.

Methods
Behavioral Risk Factor Surveillance System data for the years 2017, 2019, and 2021 were obtained from North Dakota Department of Health and Human Services. A conceptual model was used to identify potential predictors of hypertension including sociodemographic characteristics, behavioral factors, chronic health conditions, and healthcare access. A multivariable binary logistic regression model was then used to identify significant predictors of hypertension. The predictive ability of the final model was assessed using a Receiver Operating Characteristic (ROC) curve and area under the curve (AUC).

Results
The odds of hypertension were significantly higher among women of reproductive age who reported frequent mental distress (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.3–3.3), resided in a primary care health professional shortage area (OR = 1.8, 95% CI = 1.2–2.6), were obese (OR = 2.6, 95% CI = 1.7–4.1) and were 35–44 years old (OR = 2.3, 95% CI = 1.6–3.4), relative to their counterparts who did not have frequent mental distress, did not reside in a health professional shortage area, had a normal body mass index, and were 18–34 years old, respectively. Additionally, the odds of hypertension were lower among women who did not have a checkup within the last year compared to those who did have a checkup within the last year (OR = 0.6, 95% CI = 0.4–0.9). The AUC of the final model was 0.68.

Conclusions
There is evidence that frequent mental distress and disparities in healthcare access or utilization are predictors of hypertension among women of reproductive age in North Dakota. Further research is warranted to determine whether improved mental health can reduce the risk of hypertension in this population. Public health officials may consider promoting hypertension awareness and control programs in areas with limited access to healthcare professionals.
Paediatric dental trauma: insights from epidemiological studies and management recommendations
Authors: Laforgia Alessandra , Inchingolo Angelo Michele , Inchingolo Francesco , Sardano Roberta , Trilli Irma , Di Noia Angela , Ferrante Laura , Palermo Andrea , Inchingolo Alessio Danilo , Dipalma Gianna 
Published: January 2025

AbstractDental trauma is common in all age groups, although, epidemiologically, it is more common in children with studies that indicate that 15% of preschoolers and 20–25% of school-age children experience it. These injuries, which frequently call for immediate attention, can affect the hard tissues and supporting components of the teeth, and, because dental damage in deciduous teeth occurs frequently and affects speech, nutrition, and oral development, it is particularly worrying. After searching three databases, Scopus, Web of Science (WoS), and PubMed, and removing duplicates, 3,630 articles were screened, and 12 publications were included in the qualitative analysis. Due to their busy lifestyles, children are particularly susceptible to oral trauma and in certain areas and lower socioeconomic groups, the incidence is higher. From little fractures in the enamel to serious dislocations and avulsions, injuries vary and must be treated promptly in order to avoid consequences and to prevent long-term issues. Furthermore, a conservative treatment strategy is recommended to preserve tooth vitality and prevent extractions. Reducing the occurrence of dental injuries requires the implementation of preventive measures including mouthguard use and educational campaigns. In summary, this review emphasizes the importance of early diagnosis, immediate management, and long-term care, by synthesizing existing knowledge on the prevalence, types, management, complications, and prevention of dental trauma in deciduous teeth. Finally, it’s important to underscore the need for continued research to refine treatment approaches.
Evaluation of health-related quality of life changes in an Australian rapid access chest pain clinic
Authors: Black J Andrew , Sharman James E. , Chen Gang , Palmer Andrew J. , de Graaff Barbara , Nelson Mark , Chapman Niamh , Campbell Julie A. 
Published: January 2025

Abstract
Objective
To evaluate the impact of absolute cardiovascular risk counselling on quality-of-life indices within a chest pain clinic.

Data sources and study setting
Primary data was collected at the Royal Hobart Hospital, Australia, between 2014 and 2020.

Study design
Patients attending an Australian chest pain clinic were randomised into a prospective, open-label, blinded-endpoint study over a minimum 12-months follow-up.

Data collection / extraction methods
The SF-36 questionnaire was completed at baseline/follow-up and SF-6D multi-attribute utility instrument’s health state utilities (HSU) were generated using SF-36 responses and the SF-6D’s Australian tariff. SF-6D minimal important difference was 0.04 points. Absolute cardiovascular risk was also stratified into high/intermediate/low-risk categories for exploratory analysis of summary HSUs and dimensional scores. ANZCTR registration number 12617000615381 (registered 28/4/17).

Principal findings
Of n = 189 patients enrolled, HSUs were generated for 96% at baseline (intervention n = 93, usual care n = 88) and 61% at follow-up. There were no statistical differences in age, sex, absolute cardiovascular risk or mean HSU between groups at baseline. Summary HSUs improved more for the intervention group and the median between-group difference exceeded the minimal important difference threshold (intervention 0.16 utility points, control 0.10 utility points). For Intervention patients with high absolute risk (≥ 15%), HSU did not significantly change.

Conclusions
Absolute cardiovascular risk counselling in a chest pain clinic yielded clinically meaningful improvement in health-related quality of life.
Deep-learning prediction of cardiovascular outcomes from routine retinal images in individuals with type 2 diabetes
Authors: Syed Mohammad Ghouse , Trucco Emanuele , Mookiah Muthu R. K. , Lang Chim C. , McCrimmon Rory J. , Palmer Colin N. A. , Pearson Ewan R. , Doney Alex S. F. , Mordi Ify R. 
Published: January 2025

Abstract
Background
Prior studies have demonstrated an association between retinal vascular features and cardiovascular disease (CVD), however most studies have only evaluated a few simple parameters at a time. Our aim was to determine whether a deep-learning artificial intelligence (AI) model could be used to predict CVD outcomes from routinely obtained diabetic retinal screening photographs and to compare its performance to a traditional clinical CVD risk score.

Methods
We included 6127 individuals with type 2 diabetes without myocardial infarction or stroke prior to study entry. The cohort was divided into training (70%), validation (10%) and testing (20%) cohorts. Clinical 10-year CVD risk was calculated using the pooled cohort equation (PCE) risk score. A polygenic risk score (PRS) for coronary heart disease was also obtained. Retinal images were analysed using an EfficientNet-B2 network to predict 10-year CVD risk. The primary outcome was time to first major adverse CV event (MACE) including CV death, myocardial infarction or stroke.

Results
1241 individuals were included in the test cohort (mean PCE 10-year CVD risk 35%). There was a strong correlation between retinal predicted CVD risk and the PCE risk score (r = 0.66) but not the polygenic risk score (r = 0.05). There were 288 MACE events. Higher retina-predicted risk was significantly associated with increased 10-year risk of MACE (HR 1.05 per 1% increase; 95% CI 1.04–1.06, p < 0.001) and remained so after adjustment for the PCE and polygenic risk score (HR 1.03; 95% CI 1.02–1.04, p < 0.001). The retinal risk score had similar performance to the PCE (both AUC 0.697) and when combined with the PCE and polygenic risk score had significantly improved performance compared to the PCE alone (AUC 0.728). An increase in retinal-predicted risk within 3 years was associated with subsequent increased MACE likelihood.

Conclusions
A deep-learning AI model could accurately predict MACE from routine retinal screening photographs with a comparable performance to traditional clinical risk assessment in a diabetic cohort. Combining the AI-derived retinal risk prediction with a coronary heart disease polygenic risk score improved risk prediction. AI retinal assessment might allow a one-stop CVD risk assessment at routine retinal screening.

Graphical abstract
Extensible lateral approach versus sinus tarsi approach for sanders type II and III calcaneal fractures osteosynthesis: a randomized controlled trial of 186 fractures
Authors: Fadle Amr A. , Khalifa Ahmed A. , Shehata Peter Mamdouh , EL-Adly Wael , Osman Ahmed Ekram 
Published: January 2025

Abstract

Aims
Which is the best extensile lateral (ELA) or sinus tarsi (STA) approach for osteosynthesis displaced intraarticular calcaneal fracture (DIACF) is still debatable. The current RCT’s primary objective was to compare the complications incidence after open reduction and internal fixation of DIACFs through STA vs. ELA. The secondary objectives were the differences in intraoperative radiation exposure, time to fracture union, functional and radiological outcomes.

Methods
Between August 2020 and February 2023, 157 patients with Sanders type II and III fractures were randomly assigned to either ELA (81 patients with 95 fractures) or STA (76 patients with 91 fractures). The primary outcome was the incidence of complications. The secondary outcomes were Böhler’s and Gissane angles angle, fracture union, and American Orthopaedic Foot and Ankle Society (AOFAS) score.

Results
No statistical differences between both groups regarding basic demographic data, injury characteristics, and fracture classification; however, patients in the STA group were operated upon significantly earlier (4.43 ± 7.37 vs. 7 ± 6.42 days, p = 0.001). STA’s operative time was significantly shorter (55.83 ± 7.35 vs. 89.66 ± 7.12 min, p < 0.05), and no statistical difference regarding intraoperative radiation exposure. The time to fracture union was significantly shorter in STA (6.33 ± 0.8 vs. 7.13 ± 0.7 weeks, p = 0.000). Skin complications (superficial or deep infection) and Subtalar osteoarthritis were significantly higher in ELA (18.9% vs. 3.3%, p = 0.001) and (32.6% vs. 9.9%, p = 0.001), respectively. The radiological parameters were significantly better in STA postoperatively and at the last follow up. The AOFAS scores were significantly better in STA (83.49 ± 7.71 vs. 68.62 ± 7.05, respectively, p = 0.000).

Conclusion
During osteosynthesis of Sanders type II and III DIACFs, STA is superior to ELA in terms of operating earlier, shorter operative time, fewer complications, and better radiological and functional outcomes.
Magnolia kobus DC. suppresses neointimal hyperplasia by regulating ferroptosis and VSMC phenotypic switching in a carotid artery ligation mouse model
Authors: Kim Jong Min , Kim Yiseul , Na Hyun-Jin , Hur Haeng Jeon , Lee Sang Hee , Sung Mi Jeong 
Published: January 2025

Abstract

Background

Magnolia kobus DC (MO), as a plant medicine, has been reported to have various physiological activities, including neuroprotective, anti-inflammatory, and anti-diabetic effects. However, vascular protective effects of MO remain incompletely understood. In this study, we evaluated the vascular protective effect of MO against ferroptosis in a carotid artery ligation (CAL)-induced neointimal hyperplasia mouse model and in aortic thoracic smooth muscle A7r5 cells.

Methods
This study was conducted to estimate the vascular protective effects of MO by systematically measuring histopathological analysis and western blot analysis in CAL animal model. In vitro protective effects of MO were evaluated by estimating cell viability, reactive oxygen species (ROS) content, glutathione (GSH) levels, lipid peroxidation, mitochondrial morphological change, cell proliferation, migration, western blot analysis, and qRT-PCR against erastin (Era)-induced A7r5 cells.

Results
MO intake significantly improved neointimal formation, inhibited ferroptosis and vascular smooth muscle cell (VSMC) phenotypes, and ameliorated the antioxidant system of carotid artery tissues. In addition, MO treatment effectively ameliorated Era-induced ferroptotic cytotoxicity, including cellular death, ROS production, and cell migration status. MO treatment also suppressed proliferation and migration in Era-induced A7r5 cells. MO considerably regulated Era-induced abnormal mechanisms related to ferroptotic changes, VSMC phenotype switching, and the ROS scavenging system in A7r5 cells.

Conclusion
MO has the potential for use as a functional food supplement, nutraceutical, or medicinal food, with protective effects on vascular health by regulating ferroptosis and VSMC phenotypic switching.
Aidi injection inhibits the migration and invasion of gefitinib-resistant lung adenocarcinoma cells by regulating the PLAT/FAK/AKT pathway
Authors: Zhang Jingyuan , Yang Siyun , Chen Xiaodong , Zhang Fanqin , Guo Siyu , Wu Chao , Wang Tieshan , Wang Haojia , Lu Shan , Qiao Chuanqi , Sheng Xiaoguang , Liu Shuqi , Zhang Xiaomeng , Luo Hua , Li Qinglin , Wu Jiarui 
Published: January 2025

Abstract

Background
With extended gefitinib treatment, the therapeutic effect in some non-small cell lung cancer (NSCLC) patients declined with the development of drug resistance. Aidi injection (ADI) is utilized in various cancers as a traditional Chinese medicine prescription. This study explores the molecular mechanism by which ADI, when combined with gefitinib, attenuates gefitinib resistance in PC9GR NSCLC cells.

Methods
In vitro and in vivo pharmacological experiments were conducted in PC9GR cells and NSG mice with PC9GR cell-derived tumors, respectively. The molecular mechanism of ADI was further studied using whole-transcriptome sequencing technology. Bioinformatics and molecular biology methods were employed to validate the critical targets of ADI.

Results
Firstly, ADI treatment alone and combined with gefitinib significantly inhibited the proliferation, migration, and invasion of PC9GR cells. Then, whole-transcriptome sequencing and bioinformatics analysis revealed that PLAT is a key target for the increased efficacy of ADI combined with gefitinib. Additionally, ADI downregulates the expression of PLAT, TNC, ITGB3, p-AKT, p-PI3K, and p-FAK. ADI inhibits the migration and invasion of PC9GR cells by regulating the PLAT/FAK/AKT pathway.

Conclusions
Aidi injection inhibits the migration and invasion of gefitinib-resistant lung adenocarcinoma cells by regulating the PLAT/FAK/AKT pathway. This study provides essential evidence for elucidating the mechanism of ADI in synergistic therapy for lung cancer.