bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum total bilirubin is a risk factor of metabolic syndrome and its components in obese Egyptians
Authors: El-Eshmawy Mervat M. , Mahsoub Nancy , Elsehely Ibrahim 
Published: November 2024

Abstract

Background/Aim:
The link between serum total bilirubin and metabolic syndrome and its components has been previously proposed. However, it is unknown whether total bilirubin is a risk factor of metabolic syndrome and its components in obese Egyptians. Therefore, this study was conducted to clarify the association of total bilirubin levels with metabolic syndrome and its components in obese Egyptians.

Methods:
A total of 200 adults with obesity were enrolled in this study. Obese participants were evaluated for metabolic syndrome; there were 92 obese participants with metabolic syndrome and 108 obese participants without metabolic syndrome. Anthropometric measurements, fasting blood glucose (FBG), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), HOMA-β (%), lipid profile, uric acid, alanine aminotransferase, aspartate aminotransferase, and serum total bilirubin were assessed.

Results:
Total bilirubin was significantly lower in obese participants with metabolic syndrome than in those without metabolic syndrome. Compared with middle bilirubin tertile, high and low bilirubin tertiles were independently associated with metabolic syndrome. Regarding metabolic syndrome components, a significant positive association between low bilirubin tertile and hypertension was found independent of the all studied confounding factors, whereas the association of total bilirubin level with waist circumference (WC), FBG, high-density lipoprotein cholesterol, and triglycerides was dependent on body mass index (BMI), HOMA-IR, and high sensitive C-reactive protein (hs-CRP).

Conclusion:
Total bilirubin is an independent risk factor of metabolic syndrome in obese Egyptians. We have found an independent association between high bilirubin level and reduced risk of metabolic syndrome, whereas low bilirubin level was associated with increased risk of metabolic syndrome. Bilirubin is also independently associated with hypertension, but its association with other components of metabolic syndrome is mainly dependent on BMI, HOMA-IR, and hs-CRP.
Effect of a Hydration Game-Based Learning Program in Improving Fluid Intake and Hydration Status in Institutional Residents
Authors: LIN Li-Chan , CHEN Ting-Wei , CHEN Yi-Heng , WU Shiao-Chi 
Published: November 2024

ABSTRACT

Background
Approximately 50% of residents living in institutions have insufficient fluid intake, and 20%–30% experience dehydration. Implementing strategies that effectively increase fluid intake is crucial to preventing dehydration-related complications and reducing complications and comorbidities in this population.

Purpose
This study was designed to explore the effects on fluid intake and hydration status of a hydration game-based learning program in institutional residents.

Methods
A single-blind, cluster, randomized controlled trial was conducted. Sixty-four subjects from five long-term care facilities in northern Taiwan were randomly assigned to either an experimental or control group. The experimental group received a 40-minute game-based hydration care program intervention twice weekly for 8 weeks. The control group received routine care. The data obtained were analyzed using generalized estimating equation analysis to verify changes in observed variables in the two groups at 4 and 8 weeks (during and immediately after the intervention).

Results
The results showed a significant improvement in fluid intake in the experimental group at 4 and 8 weeks (p = .002 and p < .001, respectively). In terms of dehydration-related indicators, although total body water was significantly improved at 8 weeks in the experimental group (p = .009), no significant improvement was found in urine-specific gravity. In terms of signs of possible urinary tract infection, the experimental group showed significant improvement in urine leukocytes (p = .029) and nitrites (p = .004) at 8 weeks.

Conclusions/Implications for Practice
The findings of this study support the positive effects of applying the concept of uncertain rewards and game-based learning in institutional group activities. Specifically, the interventions increased social interaction and enhanced enjoyment of drinking. The findings call for nursing professionals at institutions to offer similar hydration game-based learning programs as part of residents' daily activities to improve fluid intake.
Physician Assistant Student Perceptions of the Benefits of and Barriers to a Doctor of Medical Science Degree
Authors: Sasek Cody , Quincy Brenda 
Published: November 2024

Introduction
This study explored physician assistant (PA) student perceptions of benefits of and barriers to the Doctor of Medical Science (DMS) degree.

Methods
Program leaders from 30 purposively selected PA programs were asked to forward an email invitation to their students to complete a cross-sectional survey of student perceptions of the benefits and barriers of a DMS degree, their thoughts on timing of enrollment, and personal characteristics. Sponsoring institution characteristics were obtained from program websites. Student perception of benefits and barriers and their interest in enrollment in a DMS programs were compared across subgroups of personal and institutional characteristics.

Results
Respondents to the study's electronic survey included 312 PA students from 15 PA programs. Mean PA student interest in pursuing a DMS degree centers around neutral, with 51.3% of respondents indicating an interest in pursuing a DMS degree, with varied desired timing for entering a doctoral program. Benefits of a DMS degree identified most strongly included skills regarding scholarly activity such as presentations and research and remaining competitive in an evolving professional landscape. Barriers identified included cost, competing priorities, and burnout from PA school. Several significant relationships were found between the number of a respondent's PA faculty with a doctoral degree and student interest in a DMS degree. Gender differences were also identified.

Discussion
The current study offers perspective on PA student views of the DMS degree. Noted barriers and benefits should continue to be explored to better understand PA student understanding and perceptions of the DMS degree.
Risk factors for left ventricular remodeling after myocardial infarction: A meta-analysis
Authors: Xu Baozhu , Li Wenhui , You Zhuozhi , Yang Nan , Lin Lanxiang , Li Yuefeng 
Published: November 2024

Background:
This study aimed to assess potential risk factors for left ventricular remodeling (LVR) after acute myocardial infarction (MI).

Methods:
We systematically searched PubMed, the Cochrane Library, MEDLINE, Embase, Web of Science databases CNKI Scholar, VIP, and WanFang databases for all relevant epidemiological studies published up to August 1, 2023. Fixed-effects model or random-effects model was employed to pool the study-specific effect sizes and 95% confidence intervals (CIs).

Results:
Fifteen studies with a total of 3,093,792 participants were included according to inclusion criteria. Major modifiable risk factors associated with LVR after MI were diabetes (odds ratio [OR] = 2.053, 95% CI: 1.504–2.803), MI site (OR = 2.423, 95% CI: 1.584–3.708), cystatin C (OR = 6.204, 95% CI: 1.830–21.036), B-type natriuretic peptide (OR = 2.280, 95% CI: 1.466–3.546), as well as creatine kinase-myocardial band (OR = 1.013, 95% CI: 0.985–1.042).

Conclusion:
The current study provides evidence indicating that diabetes, the site of MI, cystatin C, B-type natriuretic peptide, and creatine kinase-myocardial band are the primary risk factors for LVR after MI. Recognizing and addressing these modifiable risk factors is crucial for the development of effective preventive and treatment strategies.
Complex intestinal fistula treatment and care: A case report and literature review
Authors: Hu Yuee , Qin Yanyan , Dong Wei , Zhong Yuxu , Chu Haibo 
Published: November 2024

Rationale:
Abdominal cocoon is an uncommon abdominal disease. Intestinal rupture complicated with intestinal fistula rarely occurs in patients with abdominal cocoon.

Patient concerns:
A 51-year-old man was referred to hospital, with a 4-hour history of abdominal injuries caused by traffic accident. Intraoperatively, the small intestine in the abdominal cavity was surrounded by dense, tough, grayish-white fibrous tissue. There were the rupture of 2 sites in the ileum. The ileum was anastomosed side-to-side using a cutting and closing device. The patient was postoperatively transferred to the intensive care unit and received ventilator-assisted breathing, along with anti-infection and supportive treatments. On the 10th day after surgery, grass green turbid fluid of approximately 150 mL was extracted from the abdominal drainage tube. The secondary laparotomy was performed on the 12th day post-surgery, revealing a 1.5 cm diameter fistula at the end of the ileum.

Intervention and outcomes:
Nursing strategies included ensuring optimal mechanical ventilation for oxygenation, utilizing Li’s double cannula for continuous abdominal irrigation and negative pressure drainage to prevent abdominal abscess formation, emphasizing the importance of enteral nutrition, implementing direct suture treatment to manage retrograde infection and expedite stoma healing, and employing Li’s double cannula and vacuum-assisted closure technique to promote incision healing. After 48 days secondary post-surgery, the incision was fully healed, and the patient was discharged home with the stoma bag. Five months later, he was readmitted to the hospital, and the stoma was reversed.

Lessons:
Intestinal fistula poses a remarkable challenge after abdominal cocoon surgery, typically manifesting 4 to 5 days postoperatively. However, in this case, it occurred on the 10th day, highlighting the critical role of vigilant monitoring of drainage fluid color and volume in postoperative care. Navigating the complex management of intestinal rupture in abdominal cocoon necessitates a more efficacious approach, highlighting the importance of accumulating comprehensive nursing expertise through such cases.
Sequential treatment from bisphosphonate to denosumab improves lumbar spine bone mineral density in postmenopausal osteoporosis patients: A meta-analysis of randomized controlled trials
Authors: Jiang Xu , Hou Siyi , Deng Xiaolei , Hu Liyou , Wang Jian , Hou Decai 
Published: November 2024

Background:
Bisphosphonates are effective in the treatment of postmenopausal osteoporosis. However, their prolonged use induces adverse events and may lead to a rapid decline in bone mineral density (BMD) after discontinuation. Denosumab, a human monoclonal antibody, is a widely used antiresorptive agent that is more effective than bisphosphonates in improving bone density. Whether sequential treatment with denosumab after bisphosphonate therapy can maintain or further increase BMD at all sites has not been conclusively demonstrated. Thus, we performed a meta-analysis of randomized controlled trials (RCTs) to assess the effects of this sequential therapy on BMD.

Methods:
We searched the PubMed, Embase, and Cochrane Library databases from December 1, 1986, to May 2, 2024, for all RCTs that assessed the efficacy of sequential therapy of bisphosphonate transition to denosumab in postmenopausal women with osteoporosis. BMD changes at the lumbar spine, femoral neck, and total hip were used as outcomes. We assessed methodological quality, extracted relevant data according to the Cochrane Handbook for Systematic Reviews of Interventions, applied random-effects models for meta-analyses, performed heterogeneity analyses, and assessed publication bias.

Results:
A total of 3290 patients from 4 RCTs were included in the meta-analysis. Forest plot analysis showed that sequential treatment with bisphosphonate–denosumab was associated with higher lumbar spine BMD gain than continuous bisphosphonate treatment [mean difference (MD) = 5.50, 95% confidence interval (CI) = 5.26–5.75, I
2 = 32.88%). No risk of bias was observed for the 4 trials, but there was an increase in femoral neck and total hip BMD. Moreover, analyses could not be performed because of high heterogeneity (femoral neck BMD: MD = 3.85, 95% CI = 2.84–4.85, I
2 = 97.88%; total hip BMD: MD = 5.65, 95% CI = 4.28–7.02, I
2 = 97.91%).

Conclusion:
Sequential therapy that involves a transition from bisphosphonates to denosumab had a positive effect on lumbar spine bone density, and this type of therapy may be a potential treatment option for increasing lumbar spine bone density in postmenopausal women.
Understanding the Concept of Patient Safety Culture
Authors: Fontenele Lima de Carvalho Rhanna Emanuela , Bates David W. 
Published: November 2024

Background:
Patient safety culture is crucial for improving health care quality, however, there is no consensus on its definition.

Purpose:
This study aimed to clarify and update the concept of patient safety culture.

Methods:
We employed Norris’ 6-step concept clarification method. The content was organized through a scoping review of 4 databases. Twelve health professionals participated in focus groups and 10 experts participated in content validation. The content validity coefficient (CVC) was calculated for agreement between experts.

Results:
Three patient safety culture domains were identified: organizational, professional, and patient and family participation. The experts rated the definitions favorably, with high CVC scores (>0.87), indicating good agreement. The operational definitions were reduced from 76 to 54 items after expert evaluation.

Conclusion:
An updated definition of patient safety culture is provided, which can inform development of assessment instruments by managers and health care professionals.
Quantity of Caloric Support After Pediatric Severe Traumatic Brain Injury: Description of Associated Outcomes in a Single Retrospective Center Cohort, 2010–2022
Authors: Elliott Elizabeth C. , Trujillo-Rivera Eduardo A. , Dughly Omar , Dean Terry , Harrar Dana , Bell Michael J. , Wai Kitman 
Published: November 2024

OBJECTIVES:
To examine the relationship between adequacy of caloric nutritional support during the first week after severe traumatic brain injury (TBI) and outcome.

DESIGN:
Single-center retrospective cohort, 2010–2022.

SETTING:
Tertiary care children’s hospital with a level 1 trauma center.

PATIENTS:
Children younger than 18 years with PICU stay greater than 7 days for management of TBI, who had severe TBI, defined as Glasgow Coma Scale (GCS) score less than or equal to 8 at initial presentation and/or placement of an intracranial pressure monitor or external ventricular drain, and/or decompressive hemicraniectomy.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A total of 93 patients were identified (median age 46 mo; 53% male; median GCS 5; hospital mortality 4%). Caloric goal was assigned by a dietician and the proportion of prescribed calories delivered to each patient over the first 7 days of PICU admission were analyzed. At the end of the first 7 days post-injury, overall median (interquartile range [IQR]) caloric and protein adequacies were 42% (IQR, 28–62%) and 48% (IQR, 29–61%), respectively. We failed to identify an association between adequacy of caloric support and greater odds of higher Functional Status Scale (FSS) score or higher Glasgow Outcome Scale Extended for Pediatrics score at discharge. However, at outpatient follow-up, prior adequacy of PICU caloric support was associated with greater odds of worse FSS (multiplicative increase per 10% increase in calories [MI], 1.10; 95% CI, 1.03–1.18; p = 0.002) and worse GOS E-Peds (MI, 1.16; 95% CI, 1.08–1.27; p < 0.001) at outpatient follow-up.

CONCLUSIONS:
In pediatric patients with severe TBI, there is an association between delivery of a greater proportion of their goal calories during the first 7 days after injury and greater odds of worse outcome at outpatient follow-up.
Using Machine Learning Techniques to Predict Viral Suppression Among People With HIV
Authors: Yang Xueying , Cai Ruilie , Ma Yunqing , Zhang Hao H. , Sun XiaoWen , Olatosi Bankole , Weissman Sharon , Li Xiaoming , Zhang Jiajia 
Published: November 2024

Background:
This study aims to develop and examine the performance of machine learning (ML) algorithms in predicting viral suppression among statewide people living with HIV (PWH) in South Carolina.

Methods:
Extracted through the electronic reporting system in South Carolina, the study population was adult PWH who were diagnosed between 2005 and 2021. Viral suppression was defined as viral load <200 copies/mL. The predictors, including sociodemographics, a historical information of viral load indicators (eg, viral rebound), comorbidities, health care utilization, and annual county-level factors (eg, social vulnerability), were measured in each 4-month windows. Using historic information in different lag time windows (1-, 3- or 5-lagged time windows with each 4-month window as a unit), both traditional and ML approaches (eg, Long Short-Term Memory Network) were applied to predict viral suppression. Comparisons of prediction performance between different models were assessed by area under curve (AUC), recall, precision, F1 score, and Youden index.

Results:
ML approaches outperformed the generalized linear mixed model. In all the 3 lagged analysis of a total of 15,580 PWH, the Long Short-Term Memory Network (Lag 1: AUC = 0.858; Lag 3: AUC = 0.877; Lag 5: AUC = 0.881) algorithm outperformed all the other methods in terms of AUC performance for predicting viral suppression. The top-ranking predictors that were common in different models included historical information of viral suppression, viral rebound, and viral blips in the Lag-1 time window. Inclusion of county-level variables did not improve the model prediction accuracy.

Conclusions:
Supervised ML algorithms may offer better performance for risk prediction of viral suppression than traditional statistical methods.
Leveraging Phase Information of 3D Isotropic Ultrashort Echo Time Pulmonary MRI for the Detection of Thoracic Lymphadenopathy
Authors: Ziegelmayer Sebastian , Van Anh Tu , Weiss Kilian , Marka Alexander W. , Lemke Tristan , Scheuerer Florian , Huber Thomas , Sauter Andreas , Robison Ryan , Gawlitza Joshua , Makowski Marcus R. , Karampinos Dimitrios C. , Graf Markus 
Published: November 2024

Background
Ultrashort echo time (UTE) allows imaging of tissues with short relaxation times, but it comes with the expense of long scan times. Magnitude images of UTE magnetic resonance imaging (MRI) are widely used in pulmonary imaging due to excellent parenchymal signal, but have insufficient contrast for other anatomical regions of the thorax. Our work investigates the value of UTE phase images (UTE-Ps)—generated simultaneously from the acquired UTE signal used for the magnitude images—for the detection of thoracic lymph nodes based on water-fat contrast. It employs an advanced imaging sequence and reconstruction allowing isotropic 3D UTE MRI in clinically acceptable scan times.

Methods
In our prospective study, 42 patients with 136 lymph nodes had undergone venous computed tomography and pulmonary MRI scans with UTE within a 14-day interval. 3D isotropic UTE images were acquired using FLORET (fermat looped, orthogonally encoded trajectories). Background-corrected phase images (UTE-P) and magnitude images were reconstructed simultaneously from the UTE-Signal. Three radiologists performed a blinded reading in which all lymph nodes with a short-axis diameter (SAD) of at least 0.5 cm were detected. Detection rates and performance metrics of UTE-P for all lymph node regions and for pathologic (SAD ≥10 mm) and nonpathologic lymph nodes (SAD <10 mm) were calculated using computed tomography as a reference. The interreader agreement defined as the presence or absence of lymph nodes based on patient and region was calculated using Fleiss kappa (κ).

Findings
In the phase images, pathologic lymph nodes in the mediastinal and hilar region were detected with a high diagnostic confidence due to the achieved water-fat contrast (average sensitivity, specificity, positive predictive value, and negative predictive value of 95.83% [confidence interval (CI), 92.76%–98.91%], 100%, 100%, and 99.32% [CI, 98.08%–100%]). Stepwise inclusion of all lymph node regions and nonpathologic lymph nodes was associated with a moderate decrease resulting in an average sensitivity, specificity, positive predictive value, and negative predictive value of 77.9% (CI, 70.9%–84.7%), 99.4% (CI, 98.7%–99.9%), 97.0% (CI, 93.4%–99.7%), and 94.7% (CI, 92.8%–96.4%) for the inclusion of all lymph nodes sizes and regions. Interreader agreement was almost perfect (κ = 0.92).

Conclusions
Pathological lymph nodes in the mediastinal and hilar region can be detected in phase-images with high diagnostic confidence, thanks to the ability of the phase images to depict water-fat contrast in combination with high spatial 3D resolution, extending the clinical applicability of UTE into the simultaneous assessment of lung parenchyma and lymph nodes.
Restoration ofPKM1improves functional maturation of human stem-cell derived-β cell by regulating PEP metabolism
Authors: Lin Haopeng , Chen Deqi , Zhang Feng , Liu Xin , Xie Xiaoxiao , Dong Qifei , Yan Jiawei , Yin Jiaxiang , Bi Zirong , Jiang Kuo , Zhang Tongran , Xue Peng , Peng Wei , Chen Lihua , Xu Tao , Guo Yanying , Li Zonghong , Liu Huisheng 
Published: November 2024

AbstractHuman stem cell-derived β (SC-β) cells still exhibit limited glucose response required for insulin secretion due to glycolytic bottlenecks, yet how these metabolic abnormalities impact glucose response and functional maturation of SC-β cells remains unclear. In this study, we identified a metabolic checkpoint located at PEP accumulation that impeded the functional maturation, which was rescued by restoration of pyruvate kinase 1 (PKM1). Glucose-tracing metabolomics in human stem cell-derived islets revealed abnormal glycolytic PEP accumulation at resting condition, resulting in impaired calcium response and insulin secretion upon high glucose or glycolytic metabolite stimulation. Mechanistically, elevated PEP significantly raised intracellular basal calcium levels, leading to downregulated expression of genes involved in TCA cycle elucidated by single cell transcriptomics. Furthermore, the activity of pyruvate kinase, which metabolizes PEP, was notably reduced due to low PKM1 expression. By overexpressing PKM1, the impairment of TCA-related genes caused by PEP accumulation was reversed via modulating PEP metabolism, resulting in enhanced calcium responses and insulin secretion upon high glucose stimulation. Together, we discovered a novel role of PKM1-regulated PEP metabolism in mediating the functional maturation of human SC-β cells. This study highlights the importance of metabolic reprogramming in human SC-β cell maturation, advancing cell therapy approaches for diabetes treatment.