bluuebunny/crossref_metadata_2025_split huggingface dataset:
IntestinalMicrobiota Transplant Prior toAllogeneicStem CellTransplant (MAST) trial: study protocol for a multicentre, double-blinded, placebo-controlled, phase IIa trial
Authors: Mullish Benjamin H , Innes Andrew J , Roberts Lauren A , Anim-Burton Shian , Webber Lee , Johnson Nicholas A , Ghani Rohma , Farshi Pakhshan , Khan Anjum B , Kinsella Francesca , Kottaridis Panagiotis , Krishnamurthy Pramila , Nicholson Emma , Palanicawandar Renuka , Wheeler Graham , Davies Frances , Marchesi Julian R , Pavlů Jiří 
Published: December 2024

IntroductionLower diversity of the gut microbiome prior to allogeneic haematopoietic cell transplantation (HCT) correlates with reduced survival after the intervention. Most patients undergoing HCT for a haematological malignancy have previously received intensive chemotherapy, resulting in prolonged neutropenic episodes requiring broad-spectrum antibiotics; use of these has been linked to reduced microbiome diversity. Intestinal microbiota transplant (IMT) is a novel treatment approach that restores this diversity. We hypothesised that IMT performed prior to initiation of HCT conditioning restores microbiome diversity during the early stages of HCT, leading to decreased frequency of complications and improved outcomes of HCT.Methods and analysis50 adult patients receiving allogeneic HCT will be recruited into this phase IIa trial and randomised 1:1 to receive capsulised IMT or matched placebo shortly prior to initiation of HCT conditioning and followed for up to 12 months. The primary outcome will be to assess the increase in alpha diversity between pre-IMT and that measured at ~42 days after IMT administration (day +28 of HCT), comparing the difference between patients receiving IMT compared with placebo. Secondary outcomes will include tolerability, the dynamics of gut microbiome diversity metrics and taxonomy over all time points assessed, as well as clinical outcomes (including burden of invasive infections, days of fever, admission to intensive care, development of graft-vs-host disease and mortality).Ethics and disseminationThis study was approved by a UK Research Ethics Committee (REC reference: 23/NE/0105). Dissemination of results will be in concert with patient and public involvement group input and is expected to be primarily via abstract presentation at conferences and manuscripts in peer-reviewed journals.Trial registration numbersNCT6355583; EudraCT: 2022-003617-10.
Physical activity for children and adolescents with attention deficit hyperactivity disorder: a protocol of a systematic review and meta-analysis
Authors: Jensen Marie-Louise , Storebø Ole Jakob , Bjerrum Merete Bender , Vamosi Marianne 
Published: December 2024

IntroductionAttention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder among children and adolescents. The disorder negatively influences their academic performance and social relations, and their quality of life (QoL) is lower than that of peers without ADHD. The majority of children and adolescents with ADHD are treated with medication that potentially has an insufficient effect or frequently occurring adverse events. Physical activity is thought to alter the physiology of ADHD by affecting the same catecholaminergic system in the brain which is targeted by medication.Methods and analysisThis protocol is written in accordance with the ‘Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols’ guideline. Randomised clinical trials with participating children and adolescents between the ages of 3 and 18 years with a primary diagnosis of ADHD or hyperkinetic disorder will be included in the systematic review. The main objective of the review is to examine the effect of physical activity on QoL, executive functions, symptoms and functional impairment in this population. Previous systematic reviews on the effect of physical activity in children and adolescents with ADHD have several methodological and conceptual limitations. These reviews, for example, included both randomised and non-randomised clinical trials or had restrictions regarding the frequency and intensity of the physical activity interventions they included. The present review will include the newest studies in the field and follow the main principles outlined in the ‘Cochrane Handbook for Systematic Reviews of Interventions’. Furthermore, it will be the first review in the field to include QoL as an outcome and to apply trial sequential analysis as part of the meta-analysis.Ethics and disseminationAs the systematic review is a secondary analysis of data from primary trials, approval from an ethics committee is not required. The results of the review will be published in a peer-reviewed scientific journal and presented at relevant conferences.Trial registration numberThis protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 16 August 2024 (CRD42024576670).
Effects of minocycline on patients with acute anterior circulation ischaemic stroke undergoing intravenous thrombectomy (MIST-A): the study protocol for a multicentre, prospective, randomised, open-label, blinded-endpoint trial
Authors: Zhang Xiao , Zhao Jingjing , Sun Zhongqing , Wei Dong , Yao Li , Li Weiwang , Zhu Hao , Liu Wen , Zhang Huiping , Yuan Xiangjun , Ma Xingshun , Meng Junpeng , Wang Bin , Jia Yi , Qin Na , Jiang Wen 
Published: December 2024

IntroductionDespite the implementation of mechanical thrombectomy, acute ischaemic stroke with large vessel occlusion (AIS-LVO) remains a significant health concern, characterised by substantial morbidity and mortality. Our trial aims to evaluate the efficacy and safety of minocycline in reducing infarct volume and improving functional outcomes in patients undergoing mechanical thrombectomy for anterior circulation AIS-LVO.Methods and analysisThe MIST-A trial is a prospective, randomised, open-label, blinded-endpoint trial to be conducted across 12 medical centres. The study will enrol 180 adult patients who have experienced an anterior circulation AIS-LVO and have undergone mechanical thrombectomy. These patients will be randomly divided into two groups: one receiving minocycline in addition to standard care and the other receiving only standard care. The primary efficacy outcome is the change in infarct volume as measured by MRI, from baseline to day 5. The secondary efficacy outcomes include the incidence of intracerebral haemorrhage occurring within 24 hours and the clinical scores between the baseline and follow-up assessments. The primary outcome will be assessed using a mixed-effects model to determine the association between treatment and outcomes.Ethics and disseminationThe study is approved by the Ethics Committee of Xijing Hospital (XJLL-KY20222186) and is registered at ClinicalTrials.gov (NCT05487417). This trial is estimated to end in the first quarter of 2025 and study findings are expected to be published in scientific journals that undergo peer review and also to be showcased at scientific conferences.Trial registration numberNCT05487417.
Prevalence and factors associated with burnout among healthcare providers at Kasulu district in Kigoma region, 2024: an analytical cross-sectional study in a primary healthcare setting
Authors: Mfuru Godbless Henry , Ubuguyu Omary , Yahya-Malima Khadija I 
Published: December 2024

BackgroundBurnout among healthcare providers affects their well-being and quality of care. Despite its importance, limited data exist on burnout among primary healthcare providers in Tanzania.ObjectivesTo determine the prevalence of burnout and associated factors among healthcare providers in Kasulu district, Kigoma region, 2024.Study designAnalytical cross-sectional study conducted from January to June 2024.Study settingPrimary health facilities at Kasulu district in Kigoma region.ParticipantsHealthcare providers working in Kasulu district for more than 6 months before study.Primary outcomeBurnout.ResultsAmong 266 healthcare providers with a response rate of 99%, 59.4% were male. The median age was 32 years (IQR 27–37). Burnout prevalence was 54.5% (95% CI 48.5% to 60.4%), higher among nurses (61.3%), those living off-site (69.6%) and those considering leaving their careers (86.2%). Significant factors included age 21–30 years (adjusted prevalence ratio (aPR) 1.55, 95% CI 1.06 to 2.27), nursing profession (aPR 2.19, 95% CI 1.07 to 4.48), off-site residence (aPR 1.23, 95% CI 1.02 to 1.49), 6 months to 2 years of experience (aPR 1.44, 95% CI 1.12 to 1.86), dissatisfaction with salary (aPR 1.77, 95% CI 1.02 to 3.07), poor colleague relationships (aPR 1.25, 95% CI 1.03 to 1.51), ≥4 night shifts/week (aPR 2.54, 95% CI 1.33 to 4.86), attending ≥41 patients per day (aPR 1.52, 95% CI 1.06 to 2.19) and lack of academic growth opportunities (aPR 1.62, 95% CI 1.15 to 2.29).ConclusionRural settings like Kasulu face unique challenges, including limited resources and heavy workloads, exacerbating burnout among healthcare providers. Over half of healthcare providers experienced burnout, with younger providers, nurses, those living off-site, less experienced staff, poor colleague relationships and high patient loads at higher risk. To mitigate burnout, authorities should provide career counselling, onsite housing, mental health support and increased staffing.
Enlarged airspaces in the distal lung in adolescents born very preterm as measured by aerosol
Authors: Öhrneman Hugo , Lindström Frida , Hagman Cecilia , Petersson Sjögren Madeleine , Rissler Jenny , Wollmer Per , Tufvesson Ellen , Löndahl Jakob 
Published: December 2024

RationalePreterm infants diagnosed with bronchopulmonary dysplasia (BPD) are thought to have fewer and larger alveoli than their term peers, but it is unclear to what degree this persists later in life.ObjectivesTo investigate to what degree the distal airspaces are enlarged in adolescents born preterm and to evaluate the new Airspace Dimension Assessment (AiDA) method in investigating this group.MethodsWe investigated 41 adolescents between 15 and 17 years of age, of whom 25 were born very preterm (a gestational age <31 weeks, with a mean of 26 weeks) and 16 were term-born controls. Of the preterms, 17 were diagnosed with BPD. The AiDA method was used to measure the average distal airspace radius (rAiDA) in the lungs. In addition, lung function was evaluated by spirometry, impulse oscillometry and diffusing capacity of carbon monoxide (DLCO).Measurements and main resultsWe observed a mean rAiDAof 295±53 µm for the preterm group compared with 231±12 µm for the control group (p<0.0001). The adolescents diagnosed with BPD had a mean rAiDAof 313±54 µm. There was a strong negative correlation between gestational age and distal airspace radius (p<0.0001). The BPD group had a decreased FEV1(forced expiratory volume in 1 s, z-score: −1.28±1.37, p=0.012) and DLCO(z-score: −0.92±1.01, p=0.013) compared with the controls, but all other lung function variables showed normal values.ConclusionsOur results suggest that the enlarged airspaces seen in preterm infants likely remain in adolescence. Distal airspace radius as measured by AiDA was the lung function variable that showed the most significant difference between preterm and term-born adolescents.
Professional obligations and the demandingness of acting against one’s conscience
Authors: Giubilini Alberto 
Published: December 2024

Conscience is typically invoked in healthcare to defend a right to conscientious objection, that is, the refusal by healthcare professionals to perform certain activities in the name of personal moral or religious views. On this approach, freedom of conscience should be respected when the individual is operating in a professional capacity. Others would argue, however, that a conscientious professional is one who can set aside one’s own moral or religious views when they conflict with professional obligations. The debate on conscientious objection has by and large crystallised around these two positions, with compromise positions aiming at striking a balance between the two, for instance, by arguing for referral requirements by objecting healthcare professionals.In this article, I suggest that the debate on conscientious objection in healthcare could benefit from being reframed as a problem around demandingness rather than one about freedom of conscience and moral integrity. Being a professional, and a healthcare professional specifically, typically requires taking on additional burdens compared with non-professionals. For instance, healthcare professionals are expected to take on themselves higher risks than the rest of the population. However, it is also widely agreed that there are limits to the additional risks and burdens that healthcare professionals should be expected to take on themselves. Thus, a question worth exploring is whether, among the extra burdens that healthcare professionals should be expected to take on themselves as a matter of professional obligation, there is the burden of acting against one’s own conscience.
Smartphone application-based pulmonary rehabilitation in COPD: a multicentre randomised controlled trial
Authors: Gloeckl Rainer , Spielmanns Marc , Stankeviciene Asta , Plidschun Anne , Kroll Daniela , Jarosch Inga , Schneeberger Tessa , Ulm Bernhard , Vogelmeier Claus F , Koczulla Andreas Rembert 
Published: December 2024

BackgroundPulmonary rehabilitation (PR) is an essential element of chronic obstructive pulmonary disease (COPD) management. However, access to conventional face-to-face PR programmes is limited.MethodsThis multicentre, randomised controlled trial recruited patients with COPD from 18 sites in Germany and Switzerland, aiming to evaluate the impact of 12 weeks of a mobile app (intervention group; IVG) on quality of life, measured by COPD Assessment Test (CAT), and exercise capacity, assessed by 1-minute-sit-to-stand-test (1MSTST), compared with a control group (CTG) receiving ’enhanced standard-of-care’.Results278 patients were included in the study with a median age of 65 years (IQR 60–70) and forced expiratory volume in 1 s 48% predicted (IQR 37–60). In the intention-to-treat analysis at week 12, CAT improved from baseline by median −4 points versus −3 points in the IVG versus CTG groups, respectively (difference: 0 points (95% CI: −1, 2); p=0.7); 1MSTST improved by 1 vs 2 repetitions, respectively (difference: 1 repetition (95% CI: 0, 2); p=0.12)). In a subset of the IVG, with patients grouped by application adherence (≥3 days/week for≥75% of the weeks), adherent users (40.4%) improved 1MSTST versus non-adherent users by median 2 repetitions (95% CI: 1, 3]; p=0.006. Application use did not raise any safety concerns.ConclusionsApplication-based PR improved outcomes in COPD compared with baseline, and adherent users improved exercise capacity more compared with non-adherent users. Although not statistically significant compared with enhanced standard-of-care, this study may support the use of this application for COPD management and addresses the healthcare challenge of access to PR interventions.Trial registration numberDRKS 00024390.
Internal Fixation for Unstable Distal Ulnar Fractures by 2.7 mm Semitubular Hook Plate
Authors: I. Abulsoud Mohamed , Elmarghany Mohammed , Zakaria Ahmed R. , Alshal Ehab A. , Moawad Mohamed , Elzahed Ehab A. , Elhalawany Mohamed F. , Kornah Bahaa A. 
Published: December 2024

Objective: The purpose of this study is to investigate the outcomes of the use of a 2.7 mm semitubular hook plate for internal fixation of unstable metaphyseal ulnar fractures.Methods: Between January 2015 and July 2019, 30 consecutive patients with a recent unstable distal ulnar fracture were included in this prospective case series. All patients were subjected to follow‐up with the time of union, range of motion, pain using a Visual Analog Scale (VAS), and radiological and functional outcome using the quick Disabilities of the Arm, Shoulder, and Hand (DASH) score and Mayo wrist score after 12 months.Results: The mean age of the patients was 45.3 ± 10 years. There were 18 males (60%) and 12 females (40%), and there were 16 patients associated with distal radius fractures (53.33%). According to the AO classification of distal ulnar fractures, 3 fractures were type A2.1 (10%), 9 were type A2.2 (30%), 8 fractures were type A2.3 (26.67%), and 10 fractures were type A3 (33.33%). All fractures have been united with a mean duration of 9 ± 1.4 weeks, the mean supination was 81.4° ± 3.5°, the mean pronation was 81.3° ± 4.5°, the mean flexion was = 71.7° ± 3.6°, and the mean extension was = 81.7° ± 3.4°. The mean VAS was 1.1 ± 1 points, the mean DASH score was 9.3 ± 5.6 points, and the mean Mayo wrist score was 88.5 ± 7.2 points; 17 patients were excellent (56.67%) and 10 patients were good (33.33%) while 3 patients had satisfactory outcome (10%).Conclusion: Using the 2.7 mm semitubular hook plate is a successful choice for internal fixation of unstable distal ulnar fractures isolated or associated with distal radius fractures with a favorable union time, functional outcome, and range of motion with minimal complications.
The Effect of Nanocurcumin Supplementation on Inflammatory and Biochemical Indicators in Hospitalized Patients With COVID‐19: A Randomized Controlled Clinical Trial
Authors: Ahmadi Sedigheh , Mohit Mohsen , Mehrabi Zeinab , Heydari Mohammad Reza , Faraji Seyed Nooreddin , Yaghoubi Shoeleh , Zare Morteza , Masoumi Seyed Jalil 
Published: December 2024

Background: The prior studies showed that nanocurcumin (NC) has potential anti‐viral properties against a wide range of viral infections, making it a promising candidate for treating COVID‐19. This study aimed to investigate the effect of NC supplementation on the acute phase proteins, including interleukin‐6 (IL‐6), C‐reactive protein (CRP), albumin (ALB) and Erythrocyte Sedimentation Rate (ESR), and biochemical markers including lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine transaminase (ALT) and complete blood cells (CBC) in the hospitalized patients with Coronavirus disease 2019 (COVID‐19).Methods and Materials: In a double‐blind placebo‐controlled clinical trial conducted at Ali‐Asghar Hospital of Shiraz University of Medical Sciences, 76 COVID‐19 patients with mild to moderate disease severity were randomly assigned to two groups. All patients received the national treatment guideline for COVID‐19. The intervention group was administered 160 mg/day of NC for a period of 2 weeks. Blood samples were obtained at the start and the end of the research, and nutritional consumption was determined using a 24 h dietary recall.Results: The mean age of participants in the NC and placebo groups was 54.69 ± 13.44 and 53.94 ± 11.62 years, respectively. In the NC group, compared with placebo group, the levels of IL‐6 (p = 0.017) and LDH (p = 0.004) was significantly reduced. There was no significant difference in the mean changes of AST (p = 0.197), ALT (p = 0.086), ALB (p = 0.560), CRP (p = 0.197), ESR (p = 0.298), hemoglobin (Hb) (p = 0.372), white blood cells (WBC) (p = 0.995), neutrophils (p = 0.264), and lymphocyte (p = 0.418) between two groups.Conclusion: According to the research results, it seems that adding NC supplementation to the treatment plan for COVID‐19 patients who are hospitalized and have mild to moderate illness severity might possibly reduce inflammation.Trial Registration: ClinicalTrials.gov identifier: IRCT20211126053183N1.
Causes, Complications and Short‐Term Outcome of Acute Kidney Injury in a Resource‐Limited Setting
Authors: Herath Nalaka , De Silva Shamila , Liyanage Prasitha , Kumara Sameera , Devi Suganthika , Abeysekara Vajira , Mallawarachi Ruvini , Perera Suharshi , Karunathilaka Iresha , Samarasinghe Sameera , Weerakoon Kosala 
Published: December 2024

Aims: The outcome of acute kidney injury (AKI) depends on causes, patient factors and care received. We studied the causes, complications and 90‐day outcomes of patients with AKI at a tertiary referral centre in Sri Lanka.Methods: Patients aged 18 years or older with AKI referred to nephrology services were analysed retrospectively. AKI severity was assessed using the KDIGO classification. Information was gathered from hospital and clinic records.Results: Of the 464 patients studied, 262 (56.5%) were males. The mean age of the study sample was 57.04 (SD 16.85) years. The majority (212–45.69%) were discharged with normal renal functions, 173 (37.28%) were discharged with impaired functions, and 79 (17.03%) died during hospital stay. There were 377 patients at 3 months follow‐up; 331 (87.8%) had normalised renal function, 40 (10.6%) had not recovered fully and 6 (1.6%) had succumbed. Progression of AKI to chronic kidney disease or death was significantly high in patients aged > 60 years (p = 0.017). More severe AKI was associated with type 2 diabetes (p = 0.0042), hypertension (p < 0.0001) and multiple comorbidities (p = 0.0014). Persons with no comorbidities had less severe AKI (p = 0.0004). Even in the early stages of AKI, there was significantly high mortality (11% in AKI stages 1 and 2) which doubled in stage 3 (22%). Mortality was low in patients with prerenal causes of AKI (OR: 0.59, 95% CI: 0.35–0.99 and p = 0.047).Conclusions: AKI in elderly and comorbid patients has high morbidity and mortality. Identification of individuals who are at high risk of developing AKI is important for its prevention, early diagnosis and proper treatment. Limitations in infrastructure, manpower, local research, reporting and recording of AKI are key challenges in providing optimal care for AKI in Sri Lanka.
Ursolic Acid as a Protective Agent against UVB-Induced Metabolic and Epigenetic Alterations in Human Skin Keratinocytes: An Omics-Based Study
Authors: Li Shanyi , Li Zixin , Kuo Hsiao-Chen Dina , Kong Ah-Ng 
Published: December 2024

Abstract
This study aimed to assess how ursolic acid (UA) can protect human skin keratinocytes from damage caused by UVB radiation. Utilizing an omics-based approach, we characterized the features of photodamage and investigated the potential of UA to reverse HaCaT cell subpopulation injury caused by UVB radiation. The most significant changes in metabolite levels after UA treatment were in pathways associated with phosphatidylcholine biosynthesis and arginine and proline metabolism. Treatment with UA can reverse the levels of certain metabolites, including creatinine, creatine phosphate, and succinic acid. Pathways activated by UA treatment in UVB-irradiated HaCaT cells were associated with several biological processes, including the positive regulation of protein modification process, cell division, and enzyme-linked receptor protein signaling pathway. Treatment with UA demonstrates the capability to mitigate the effects of UVB radiation on specific genes, including S100 calcium-binding protein A9 and IL6 receptor. DNA/CpG methylation indicates that UA can partially reverse some of the alterations in the UVB-induced CpG methylome. Utilizing integrated RNA sequencing and methylation sequencing data, starburst plots illustrate the correlation between mRNA expression and CpG methylation status. UA potentially influences the metabolic pathway of glycerophospholipid metabolism by modulating the expression of several key enzymes, including phospholipase A2 group IIA and lipin 2. Altogether, these results indicate that UVB radiation induces metabolic reprogramming, epigenetic changes, and transcriptomic shifts. Meanwhile, UA demonstrates the capacity to inhibit or reduce the severity of these alterations, which may underlie its potential protective role against skin damage caused by UVB exposure.
Prevention Relevance: Our research indicates that UA has the potential to mitigate or lessen the impact of UVB radiation, which is known to cause metabolic reprogramming, epigenetic alterations, and transcriptomic changes. These effects could be responsible for UA’s possible protective function against skin damage induced by UVB exposure.