bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adherence to pharmacological therapy for hypertension in Portugal: a health professionals focus groups study
Authors: Rosendo-Silva Beatriz , Gonçalves João , Prazeres Filipe , Santiago Luiz Miguel , Rosendo Inês 
Published: February 2025

Abstract

Introduction
The perspectives of local healthcare professionals for developing effective strategies to enhance medication adherence in arterial Hypertension as well as its barriers have not yet been explored through qualitative research in Portugal.

Objectives
This study aimed to assess the views of healthcare professionals including general practitioners/family physicians, nurses, and community pharmacists, from Portugal on effective strategies to improve medication adherence in Hypertension, and to identify factors hindering pharmacological adherence.

Methods and analyses
This was a qualitative study with synchronous online focus groups, in which, the participants were general practitioners/family physicians, family nurses, or community pharmacists in Portugal with experience managing patients with Hypertension. They were selected based on age, sex, and geographical region with the number of focus groups determined by theoretical saturation. Recruitment was facilitated through specific mailing lists. Purposive and snowball sampling techniques were employed. Focus group discussions were recorded and transcribed. Two researchers conducted content analyses via MAXQDA®2023, applying comparative analysis and reaching consensus. The results are described narratively.

Results
Three focus group discussions revealed a multifaceted approach to improving medication adherence for Hypertension. Key strategies to enhance coordination and communication among healthcare professionals, patients, and caregivers were identified. These included shared informatics software among healthcare professionals; using mobile applications and wearables; health literacy initiatives and patient empowerment; preprepared medication in pillboxes; involving family and the concept of a “family pharmacist”. Participants highlighted barriers to medication adherence such as the lack of communication with patients concerning issues like medication adherence.

Conclusions
This qualitative study outlines strategies to improve medication adherence among patients with Hypertension in Portugal. These involve improving healthcare coordination and communication, patient empowerment, and involving family and “family pharmacists” in supporting adherence. These strategies are based on the insights of healthcare professionals and could be implemented following robust intervention studies.

Clinical trial number
Not applicable.
Knowledge, attitudes, and self-reported practices regarding cholera among six MENA countries following cholera outbreaks in the region
Authors: Bekhit Salma A. , Rafei Rayane , Elnaggar Fatma , AL-Sakkaf Omar Zain , Seif Hussein Kamal , Samardali Dana , Alabead Yara Turkmani , Sanosi Mohammed Osman Omer , Abdou Marwa Shawky , Elbanna Eman H. , Khalil Doaa Mahmoud 
Published: February 2025

Abstract

Background
Cholera persists as a global public health threat, endangering the lives of vulnerable societies including the MENA region where many countries are facing recent cholera outbreaks. The present study aimed to characterize the knowledge, attitude, and practices status related to cholera in six MENA countries in the MENA region.

Methods
A cross-sectional study was conducted using a structured, validated questionnaire and distributed across different social media platforms in Egypt, Sudan, Jordan, Syria, Lebanon, and Yemen between December 2022 and January 2023. Univariate and multivariate analyses were used to determine factors associated with knowledge, attitudes, and practices related to cholera.

Results
A total of 2971 participants were included in the study, of which 62.5% were females; with a mean age of 34.8 ± 12.3 years; 85.4% heard about cholera; and 1.9% experienced cholera infection during cholera outbreaks in their countries. Among those who heard about cholera, 50.7% had adequate knowledge, 67.3% had desirable attitudes, and 50.3% reported good practices. Multivariate analysis revealed that being older, highly educated, employed, working in the medical field, and living in an outbreak country were the significant predictors affecting good knowledge. Additionally, good attitudes were significantly increased by older ages, females, those working in the medical sector, and those living in an outbreak country. Whereas working in the medical sector and having a larger number of people living in the same house significantly decreased the practice scores.

Conclusions
Raising community awareness about fecal-oral diseases transmitted via contaminated food or water, such as cholera, is crucial. This can be achieved by organizing targeted awareness campaigns for the whole community. Furthermore, mandatory educational workshops and programs for medical professionals are essential, as they serve as role models for the community.
Association between visceral fat area and metabolic syndrome in individuals with normal body weight: insights from a Chinese health screening dataset
Authors: Sun Yongbing , Lin Xinbei , Zou Zhi , Zhou Yang , Liu Ao , Li Xin , Du Yawei , Ji Xiaoqi , Li Zhonglin , Wu Xiaoling , Wang Yong , Lv Xue , Li Tao , Zhang Jiancheng , Guo Zhiping , Li Hao , Li Yongli 
Published: February 2025

Abstract

Background
Metabolic syndrome (MetS) is increasingly diagnosed in individuals with normal body weight, and visceral fat emerges as a significant risk factor. However, the relationship between visceral fat area (VFA) and MetS within this population remains inadequately explored, and the diagnostic threshold for MetS in normal-weight individuals is yet to be established.

Methods
This study used a cross-sectional design combined with longitudinal cohort analysis. Data were collected from 5,944 normal-weight participants who underwent health screenings at Henan Provincial People’s Hospital of China between October 2018 and October 2024. VFA was measured via multislice computed tomography scanning, and VFA-based tertile categorization was applied among the participants. The relationship between VFA and MetS was examined using univariate and multivariate logistic regression analyses. Nonlinear relationship was investigated by restricted cubic spline (RCS) modeling, and diagnostic accuracy was determined by receiver operating characteristic (ROC) curve analysis. Furthermore, data from individuals who completed three or more screenings were used to construct Kaplan–Meier survival curves for MetS events, with significance tested using the log-rank method.

Results
Among the individuals with a normal BMI, elevated VFA was associated with a high incidence of MetS. After the adjustment for confounders, VFA was significantly associated with MetS risk [odds ratio (OR) = 1.13, 95% confidence interval (CI): 1.12–1.25]. The subjects in the highest VFA tertile showed significantly elevated MetS risk (OR = 30.33; 95% CI: 19.00–48.43, P < 0.001) versus those in the lowest tertile. The RCS model demonstrated a nonlinear, positive association between VFA and MetS risk (P for nonlinearity < 0.001), with risk escalation slowing down when the VFA exceeded 100 cm². ROC analysis showed that VFA had the highest diagnostic accuracy for MetS compared with other abdominal fat measures (AUC = 0.844, sensitivity = 0.839, specificity = 0.793, and accuracy = 0.785). In a longitudinal subset of 398 normal-weight participants followed for 6 years, 106 MetS cases occurred, with cumulative incidence rising as VFA increased (log-rank test, P < 0.001).

Conclusion
VFA shows an independent, nonlinear, positive association with MetS risk among normal-weight individuals, with a threshold effect at 100 cm². VFA = 162.85 cm² may serve as an accurate and effective predictor for MetS in this population.
Incidence trends of surgical complications after oesophagectomy for oesophageal cancer: a population-based, nationwide cohort study in Finland over 30 years
Authors: Sirviö Ville E.J. , Räsänen Jari V. , Helminen Olli , Helmiö Mika , Huhta Heikki , Kallio Raija , Koivukangas Vesa , Kokkola Arto , Laine Simo , Lietzen Elina , Meriläinen Sanna , Pohjanen Vesa-Matti , Rantanen Tuomo , Ristimäki Ari , Saarnio Juha , Sihvo Eero , Toikkanen Vesa , Tyrväinen Tuula , Uimonen Mikko , Valtola Antti , Kauppila Joonas H. 
Published: February 2025

Abstract

Background
Knowledge on the incidence of surgical complications after oesophagectomy for oesophageal cancer in nationwide practice is scarce. The aim of this study was to assess complication trends after oesophagectomy in a nationwide, population-based, unselected cohort.

Methods
All patients undergoing oesophagectomy for oesophageal cancer in Finland in 1987–2016 were included. All complications defined by the Esophagectomy Complications Consensus Group (ECCG) were reported in three 10-year periods. Chi-square test and Kruskal-Wallis test were used to compare outcomes in these periods.

Results
A total of 1493 patients were included. From 1987 to 1996 to 2007–2016, improvements were seen in the rate of major complications (49% vs. 43%, p = 0.039), length of hospital stay (19 vs. 14 days, median, p < 0.001), length of ICU-stay (3 vs. 2 days, median, p < 0.001) and 90-day mortality (17.9% vs. 5.4%, p < 0.001), while pneumonia (16% vs. 23%, p = 0.029) and anastomotic leak (8% vs. 12% in total leaks, p = 0.006 for type II leak) increased. The most common complications were pneumonia, pleural effusion requiring drainage (16% vs. 23%, p = 0.080), atrial dysrhythmia (16% vs. 15%, p = 0.464) and anastomotic leak. The most common complication categories defined by ECCG were pulmonary (36% vs. 42%, p = 0.151) and gastrointestinal (21% vs. 23%, p = 0.398) complications.

Conclusions
This study reports high postoperative morbidity after oesophagectomy in nationwide practice. Mortality has significantly improved during the years, and it appears that patients who would have died earlier, can now be rescued. While the relative occurrence of complications has remained constant, overall morbidity has decreased as the more severe outcomes have decreased.
Bilateral lung herniation with parenchymal infarction following clamshell thoracotomy for lobar lung transplantation: a case report
Authors: Tavandžis Janis , Novysedlák René , Pozniak Jiří , Švorcová Monika , Mošna František , Vajter Jaromír , Ozaniak Střížová Zuzana , Suchánek Vojtěch , Šimonek Jan , Vachtenheim Jiří , Lischke Robert 
Published: February 2025

Abstract

Background
Pulmonary hernia is a rare condition characterized by the protrusion of lung tissue through a chest wall defect. Trauma and thoracic surgery are the most common causes of acquired lung hernias. We present an unusual case of (sequential) bilateral lung herniation with parenchymal infarction after bilateral lobar lung transplantation.

Case presentation
A 50-year-old female, wait-listed as high-urgency candidate, with a body mass index (BMI) of 29 kg/m2 underwent a bilateral lobar lung transplantation for pulmonary fibrosis through a clamshell thoracotomy approach. Due to a size mismatch, stapler resection of the segment 3 and the middle lobe of the right lung, as well as an upper left lobectomy was required. The chest was closed with 3 braided non-absorbable pericostal sutures on each side. Sternal osteosynthesis was performed with a titanium sternal splint along with 7 self-tapping screws with a length of 18 mm. On the posttransplant day (PTD) 18, patient’s clinical condition deteriorated. Physical examination didn’t reveal any palpable subcutaneous chest resistance. However, a computed tomography (CT) scan showed a herniation of the segment 6 of the right lung. During acute surgical revision, perioperative finding revealed posterior pericostal suture failure. Therefore, a stapler resection was performed due to the infarction of the herniated segment. On the PTD 36, herniation of the left lung parenchyma was detected by acute CT scan. The protruding vital parenchyma was surgically repositioned without necessity of resection. Two posterior pericostal sutures were broken, and distal part of sternal splint detached. Thoracotomy was closed using 5 braided non-absorbable sutures. Sternum was re-osteosynthesized with the STRATOS™ system. After 3 months of intensive postoperative care, the patient was transferred to the rehabilitation department. She was discharged on the PTD 99. After 20 months of follow-up, lung function remains stable without the need for oxygen support.

Conclusion
Clamshell incision remains ultimate approach in thoracic surgery. However, pulmonary herniation after clamshell thoracotomy is a rare complication and may manifest as acute respiratory distress syndrome with an inflammatory response. In these cases, CT scan should be always considered, even if no palpable pathology of chest is present.
Effect of the flavonoid compound glabridin on tachyzoites and bradyzoites of Toxoplasma gondii
Authors: Qiu Yanhua , Wang Weiwei , Wang Qing , Lin Hongling , Bai Yubin , Zhang Jiyu 
Published: February 2025

Abstract

Background

Toxoplasma gondii (T. gondii) is one of the most prevalent parasites worldwide. At present, the majority of drugs used for the treatment of toxoplasmosis target the tachyzoite stage of T. gondii and are largely ineffective against bradyzoites. Furthermore, these treatments are typically accompanied by adverse events. Consequently, there is an urgent need for the development of novel drugs that are both safe and effective against T. gondii.

Methods
A total of 20 flavonoids were preliminarily screened for their anti-T. gondii activity using microscopy. Next, the cell counting kit (CCK)-8 method was employed to assess the toxicity of glabridin (GLA) to host cells, while the RH strain of T.0gondii, which expresses β-galactosidase, was utilized to evaluate the inhibitory, anti-invasive, and antiproliferative effects of GLA on T. gondii. In addition, the Prugniaud (PRU) strain was employed to investigate the impact of GLA on the bradyzoites of T. gondii. Subsequently, the effect of GLA on the ultrastructure of T. gondii was examined via transmission electron microscopy (TEM), followed by an assessment of the influence of GLA on the autophagy and mitochondria of T. gondii through monodansylcadaverine (MDC), MitoTracker™ red CMXRos, and CM-HDCFDA and MitoSOX Red staining.

Results
Among the 20 flavonoids assessed, GLA exhibited the most potent anti-T. gondii activity. Indeed, it significantly inhibited both the invasive and proliferative abilities of T. gondii, thereby disrupting its lytic cycle. Moreover, GLA markedly reduced the number of bradyzoites and concurrently inhibited cyst growth. Meanwhile, ultrastructural analysis revealed that GLA induced mitochondrial swelling, membrane rupture, and autophagy in T. gondii. Finally, fluorescent probe staining provided further evidence that GLA triggers mitochondrial dysfunction and autophagy in this parasite.

Conclusions
Our findings collectively indicate that the flavonoid compound GLA exhibits significant activity against both T. gondii tachyzoites and bradyzoites. The underlying mechanism of action potentially involves the induction of autophagy and mitochondrial dysfunction and the disruption of the membrane of T. gondii, thereby offering new avenues for treating toxoplasmosis and establishing a theoretical reference for future research.

Graphical Abstract
Gut microbiota dysbiosis and associated immune response in systemic lupus erythematosus: impact of disease and treatment
Authors: Ali Aya Y. , Zahran Sara A. , Eissa Mervat , Kashef Mona T. , Ali Amal Emad 
Published: February 2025

Abstract

Background
Gut microbial dysbiosis and leaky gut play a role in systemic lupus erythematosus (SLE). Geographical location and dietary habits affect the microbiome composition in diverse populations. This study explored the gut microbiome dysbiosis, leaky gut, and systemic immune response to gut bacterial consortium in patients with SLE exhibiting mild/moderate and severe disease activity.

Methods
Fecal and blood samples were collected from patients with SLE and healthy volunteers. Genomic DNA was extracted from the stool samples and subjected to 16S rRNA amplicon sequencing and microbiome profiling. Additionally, enzyme-linked immunosorbent assays were employed to determine the serum lipopolysaccharide level, as an assessment of gut permeability, and the systemic immune response against gut bacteria.

Results
Patients with SLE showed significantly lower gut bacterial richness and diversity, indicated by observed OTUs (56.6 vs. 74.44; p = 0.0289), Shannon (3.05 vs. 3.45; p = 0.017) and Simpson indices (0.91 vs. 0.94; p = 0.033). A lower Firmicutes-to-Bacteroidetes ratio (1.07 vs. 1.69; p = 0.01) was observed, with reduced genera such as Ruminococcus 2 (0.003 vs. 0.026; p = 0.0009) and Agathobacter (0.003 vs. 0.012; p < 0.0001) and elevated Escherichia-Shigella (0.04 vs. 0.006; p < 0.0001) and Bacteroides (0.206 vs. 0.094; p = 0.033). Disease severity was associated with a higher relative abundance of Prevotella (0.001 vs. 0.0001; p = 0.04). Medication effects included lower Romboutsia (0.0009 vs. 0.011; p = 0.005) with azathioprine and higher Prevotella (0.003 vs. 0.0002; p = 0.038) with cyclophosphamide. Furthermore, categorization by prednisolone dosage revealed significantly higher relative abundances of Slackia (0.0007 vs. 0.00002; p = 0.0088), Romboutsia (0.009 vs. 0.002; p = 0.0366), and Comamonas (0.002 vs. 0.00007; p = 0.0249) in patients receiving high-dose prednisolone (> 10 mg/day). No differences in serum lipopolysaccharide levels were found, but SLE patients exhibited elevated serum gut bacterial antibody levels, suggesting a systemic immune response.

Conclusion
This study confirms the gut microbiome dysbiosis in patients with SLE, influenced by disease severity and specific medication usage.
Are technical performance differences in wheelchair fencing linked to disability categories?
Authors: Borysiuk Zbigniew , Błaszczyszyn Monika , Piechota Katarzyna , Akbaş Anna 
Published: February 2025

Abstract

Background
This study aimed to examine differences in muscle activity and activation timing in wheelchair fencers across disability categories A and B to better understand the neuromuscular dynamics involved in their performance.

Methods
Sixteen right-handed wheelchair fencers from the Polish National Paralympic Team, grouped into categories A and B, participated in the study. Muscle activity and activation timing (reaction time) were recorded during a visual-cue task using a surface electromyography system and a 3D accelerometer. Eight upper body muscles, including the deltoid, triceps, biceps, forearm extensors/flexors, latissimus dorsi, and obliques, were assessed. Data were processed using MyoResearch and MATLAB, and statistical analyses utilized the Wald-Wolfowitz runs test.

Results
Intergroup differences in reaction time and muscle activity were found: category A fencers tended to achieve lower reaction times and higher muscle bioelectric tension values than category B fencers. Significant differences between the groups were found in the activity of the left latissimus dorsi and the deltoid muscles (p < 0.05).

Conclusions
The study indicates the important role of the back and abdominal muscles as stabilizing postural muscles in wheelchair fencing. The significant differences in muscle activity for the back and deltoid muscles suggest distinct neuromuscular profiles between disability categories A and B. These findings could enhance classification accuracy and inform training strategies for para-athletes, optimizing performance and targeting specific muscle groups for improvement.
Cultural tightrope walkers: a qualitative study of being a young refugee in quest for identity and belonging in Norway
Authors: Binder Per-Einar , Heggen Hanna , Vase Elisabeth Buer , Sandal Gro Mjeldheim 
Published: February 2025

Abstract

Background
Refugee experiences significantly challenge personal identity, especially for youth orienting themselves in new cultural contexts. The study explores the complex process of balancing expectations from two cultures: how do formative encounters in Norway mold the self-perception and sense of belonging of those who arrived as child and adolescent refugees?

Methods
A qualitative approach in which life story interviews were conducted with eight young refugees who arrived in Norway between the ages of 8 and 17 years was used. Through thematic analysis grounded in hermeneutical phenomenology, we analyzed their narratives to identify core experiences and perspectives. The interviews lasted 90–150 min, providing insights into personal identity development amid cultural adaptation.

Results
A recurring and overarching theme is that participants grapple with feelings of “outsiderness” both in Norwegian society and within their culture of origin, creating a dual sense of alienation. This experience is painful, but they also perceive that it has given them the opportunity to develop open-mindedness and a unique perspective on cultural existence. Three subthemes were identified that describe various aspects of these narratives in greater detail: (1) Experiences of being a stranger; (2) value conflicts, but value reconciliation is possible; and (3) a unique perspective: navigating between two cultures. The narratives highlight the complex negotiation between maintaining heritage and adapting to Norwegian norms.

Conclusions
The study of participants’ narrative identities reveals ways of coping with these transitions, revealing how participants continuously reconstruct their self-narratives to adapt to their new cultural environment. The findings suggest that while acculturation is a challenging process characterized by psychological tension and existential vulnerability, it can also foster personal resilience and new opportunities for meaning-making. The research contributes to understanding the refugee experience in Norway, emphasizing the need for social support systems that acknowledge both the struggles and potential for growth inherent in cultural integration.
Usage of permeability ratio to check the stability of a pile-soil model with retaining wall support – Huizhou slope failure as a case study
Authors: Khan Muhammad Israr , Fei Jianbo , Chen Xiangsheng , Chen Yue 
Published: February 2025

Abstract
This paper presents a comprehensive investigation into the role of soil permeability variation on the stability of slopes reinforced by retaining walls, with a focus on the Huizhou slope failure as a case study. The study demonstrates that rising groundwater levels diminish the Factor of Safety (FoS) for retaining walls, with stability most compromised under combined loading from adjacent soil and lightweight concrete. These findings emphasize the need for enhanced drainage or structural support in retaining wall designs subjected to elevated groundwater conditions. It integrates advanced numerical simulations, utilizing Abaqus and GeoStudio, with empirical field data to analyze the interactions between soil permeability, pore water pressure, moisture content, shear strength, and the overall stability of the slope. The dynamics of water infiltration are influenced by permeability, moisture content, and the groundwater table. These factors change the pore pressure and decrease shear strength, which causes shear failure in the slope mass. This research also looks at how surcharge loading affects slope stability. Higher permeability soils cause faster infiltration rates, leading to higher pore pressures, lower effective shear strengths, and a higher likelihood of slope failure. The opposite is true for reduced permeability, which makes drainage more difficult and ultimately leads to hydrostatic pressure building up behind retaining walls, which in turn makes the slope even more unstable. This study demonstrates the critical need for optimized drainage systems to reduce the hazards of infiltration-induced failure and the role of precise permeability evaluation in geotechnical design. Geotechnical engineers can use these results to better understand how to construct and maintain slope stabilization systems.