bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative care integration into outpatient heart failure management: pilot study
Authors: Nadarajah Shamara , Sirianni Giovanna , Poon Stephanie , Bonares Michael 
Published: October 2024

ObjectivesPeople with heart failure have palliative care needs yet services remain underused. The heart failure clinic is a potential setting for initial palliative care delivery though evidence for such services is lacking. We explored the outcomes of an embedded model of palliative medicine within a heart failure clinic.MethodsWe conducted a retrospective cohort study of individuals who received a palliative medicine consultation in a heart failure clinic. Descriptive statistics were used to characterise the cohort and their outcomes, and the McNemar test to compare rates of advance care planning before/after consultation.ResultsMajority of individuals who received a palliative medicine consultation experienced New York Heart Association (NYHA) class II symptoms (65.5%) and had a Palliative Performance Scale score of≥60% (66.8%). While only 17% engaged in advance care planning in the year before consultation, 93% had advance care planning during the first consultation (p<0.001). Care was provided in multiple domains including advance care planning (95%), symptom management (97%) and caregiver support (30%), regardless of the reason for referral.ConclusionsOur embedded model of palliative medicine within the heart failure clinic was associated with increased advance care planning at a time when patients were functional and minimally symptomatic. Further research should substantiate these findings at other sites.
Modified U-Net and Convolutional Networks for Breast Cancer Segmentation and Classification with New Texture Descriptors
Authors: Porwal Priya , Singh Ajay Shanker , Kannapiran Thirunavukkarasu 
Published: October 2024

Effective techniques for detection and classification are necessary to enhance the results of patients with common fatal diseases like breast cancer. With benefits including increased effectiveness and precision, DL and ML methods are currently being used as effective tools in the breast cancer diagnosis process. However, the efficiency and stability constraints of current approaches highlight the necessity for additional study. Therefore, this work suggested a new model of modified U-Net and convolutional networks for Breast Cancer (BC) segmentation and classification with new texture descriptors and the proposed model is named “U-TexBCNet”. First, mammography images are preprocessed by enhancing the image using the CLAHE filter and after inputting the preprocessed image into the modified U-Net-based segmentation for the segmentation process, the modified U-Net segmentation is named as “HexpNet”. Once the segmentation process is completed, the feature extraction process takes place. Here, the features include shape feature, color feature, VGG-16 feature, Inception V3 feature, GoogLeNet and modified LGTP feature extracted from the segmented image. Then, the extracted features are inputted into the hybrid classification model including modified CNN and LSTM. Lastly, the outcome from the classifiers (Modified CNN and LSTM) is averaged together to get the outcome of the proposed model. Ultimately, the results of the simulation are evaluated using both positive and negative criteria by contrasting them with the conventional models.
Evaluation of the Anatomical Cross‐Sectional Area of Psoas Major Muscle Using an Ultrasound Imaging System Combined With an Inertial Measurement Unit
Authors: Ito Kazuhiro , Maeshima Etsuko , Arai Nobuyuki , Saito Koichi , Koshiba Hiroya , Maruyama Junko , Asada Keiji , Nakamata Takaaki , Yamaguchi Kazuki , Hatanaka Yasuhiko 
Published: October 2024

Introduction: Recently, ultrasound (US) imaging has been used to estimate the cross‐sectional area of skeletal muscle, but the reliability is uncertain. To improve the reliability of the US, we investigated skeletal muscle thickness measurement using an inertial measurement unit (IMU) to determine the direction of US beam incidence based on posture angle information. In addition, we examined whether the anatomical cross‐sectional area (ACSA) of muscle can be estimated from the muscle thickness measured using the US with the IMU.Methods: In Experiment 1, two examiners measured the right psoas major at the fourth lumbar vertebra level in 10 university students using the US with and without an IMU. The intraclass correlation coefficient (ICC) was used to examine intra‐ and inter‐rater variability. In Experiment 2, the two examiners measured the muscle thickness of the right psoas major in 31 male subjects using the US with an IMU. In addition, the ACSA of this muscle was measured using MRI. Pearson’s correlation coefficient was used to examine the relationship between muscle thickness and ACSA, and a single regression analysis was performed.Results: Both intrarater reliability ICC (1, 2) and inter‐rater reliability ICC (2, 2) were higher when US was used with IMU compared to without IMU (Experiment 1). A significant positive correlation (r = 0.84, p < 0.01) was observed between muscle thickness and ACSA (Experiment 2). The regression equation was significant at R2 = 0.71 (p < 0.01).Conclusion: Using an IMU during US measurement of the psoas major improves intra‐ and interexaminer reliability and can be used to estimate the ACSA of the muscle.
CTR-FAPI PET Enables Precision Management of Medullary Thyroid Carcinoma
Authors: Kong Ziren , Li Zhu , Cui Xi-Yang , Wang Jian , Xu Mengxin , Liu Yang , Chen Junyi , Ni Song , Zhang Zongmin , Fan Xiaowei , Huang Jiazhao , Lin Yansong , Sun Yuning , He Yuqin , Lin Xinfeng , Meng Tianyu , Li Han , Song Yixuan , Peng Boshizhang , An Changming , Gao Chenyan , Li Nan , Liu Chen , Zhu Yiming , Yang Zhi , Liu Zhibo , Liu Shaoyan 
Published: October 2024

Abstract
Medullary thyroid carcinoma (MTC) can only be cured through the excision of all metastatic lesions, but current clinical practice fails to localize the disease in 29% to 60% of patients. Previously, we developed a fibroblast activation protein inhibitor (FAPI)-based covalent targeted radioligand (CTR) for improved detection sensitivity and accuracy. In this first-in-class clinical trial, we head-to-head compared [68Ga]Ga-CTR-FAPI PET-CT and [18F]fluorodeoxyglucose ([18F]FDG) PET-CT in 50 patients with MTC. The primary endpoint was the patient-based detection rate, with [68Ga]Ga-CTR-FAPI exhibiting higher detection than [18F]FDG (98% vs. 66%, P = 0.0002). This improved detection was attributed to increased tumor uptake (maximum standardized uptake value = 11.71 ± 9.16 vs. 2.55 ± 1.73, P &lt; 0.0001). Diagnostic accuracy, validated on lesions with gold-standard pathology, was greater for [68Ga]Ga-CTR-FAPI compared with [18F]FDG (96.7% vs. 43.3%, P &lt; 0.0001). Notably, the management of 32% of patients was altered following [68Ga]Ga-CTR-FAPI PET-CT, and the surgical plan was changed for 66.7% of patients. Overall, [68Ga]Ga-CTR-FAPI PET-CT provided superior detection and diagnostic accuracy compared with [18F]FDG PET-CT, enabling precision management of patients with MTC.
Significance: In this first-in-class clinical trial of CTR, [68Ga]Ga-CTR-FAPI demonstrated an improved patient-based detection rate (98%), tumor uptake (maximum standardized uptake value = 11.71 ± 9.16), and pathology-validated diagnostic accuracy (96.7%) compared with the currently approved method in MTC treatment. It directly altered management in 32% of patients, enabling precision diagnosis and management of MTC.
See related commentary by Witney, p. 264
Transgender Legal Recognition in North Africa: Between the Hammer of Sharia and the Anvil of the Judiciary
Authors: Noralla Nora 
Published: October 2024

Abstract
The right to legal gender recognition is integral to transgender rights and is the final step for many transgender people to realise their true gender identity. However, In North Africa, this right is primarily restricted due to the lack of a legislative framework that governs the issue. This legislative vacuum means two things: firstly, principles of Sharīʿah are the de-facto law regulating the matter, and secondly, Courts will have the jurisdiction over reviewing legal gender recognition applications. Sunni Islamic scholars did engage on transgender issues starting in the 1980s when Egypt’s Al-Azhar and Saudi Arabia’s Islamic Fiqh Council issued prominent fatwas, providing a very unfavourable interpretation of transgender people. The fatwas viewed transgender people as mentally ill who should not be allowed access to gender-affirming healthcare and should be provided with mental treatment to ‘return to their true sex’ and fit within the binary. While the fatwas only discussed banning access to gender-affirming healthcare, North African Courts adapted this ban to mean a ban on legal gender recognition for transgender people. Thus, judicial opinions in the region developed to deny legal gender recognition on the grounds of Sharīʿah. However, a 2018 Tunisian Court became an anomaly when it reinterpreted Sharīʿah to allow a transman legal gender recognition in a landmark decision. The impact of this judgment remains limited, as so far, Courts still maintain their ban on legal gender recognition. The paper is conducting the primary scholarly effort to establish a legal theory on legal gender recognition for transgender people in North Africa by investigating the issue by analysing case law from Egypt, Tunisia, Algeria, and Sunni Fatwas from Al-Azhar and Islāmic Fiqh Council to theorise the region’s legal and religious discourse on legal gender recognition for transgender people.
Ottoman Tobacco and the Moral Economy of State-Led Development (c. 1908–12)
Authors: Adney Kaleb Herman 
Published: October 2024

Abstract
In the Second Constitutional Era (1908–18), proponents of various models for national development debated the Ottoman future under the Committee for Union and Progress (cup). Public discussions of cup policies related to the tobacco sector were central to these discussions in the southern Balkans. As such, they provide a window into the political and moral economy of the region and some of the public critiques of international finance after the 1908 Constitutional Revolution. By 1908, tobacco had been at the crossroads of regional economic development and European financial domination for nearly three decades. Since the domestic tobacco monopoly was set to expire in 1913, the region was primed for debates about the agricultural credit market and the customs regime. This article argues that cup proposals for state-led development aimed to satisfy the divergent moral demands of agriculturalists (zürrāʿ) and merchants (tüccar) in the tobacco-producing zones of the empire.
Dielectric drying of black soldier fly larvae (Hermetia illucens): impact on microbiological product quality, safety and stability
Authors: Vandeweyer D. , Lachi D. , Geheniau H. , Goovaerts V. , van der Zweep P. , Groffils C. , Thijs M. , Van Der Borght M. 
Published: October 2024

Abstract
Along with the increasing scale of industrial production of insects as food and feed, the need for processing methods applicable on large scale is rising within the insect sector. One important processing technology in this context is drying, which aims at stabilising the quality of the insects. This study investigated the impact of dielectric drying technologies, specifically microwave (μW) and radio frequency (RF) drying, on the microbiological quality, safety, and stability of black soldier fly (BSF) larvae in comparison to the traditional methods oven drying and freeze drying. Before, during and after subjecting a large batch of blanched BSF larvae to the four drying technologies, their water activity and moisture content as well as general microbial and pathogen counts were assessed. Dielectric drying effectively reduced water activity, thus enhancing product stability. Microbiological analyses revealed the efficacy of blanching in microbial reduction, with dielectric (especially RF) drying further contributing to these reductions. The results, however, do not conclusively support nonthermal microbial inactivation through dielectric treatment. Specific analyses targeting foodborne pathogens indicated the absence of most selected bacterial pathogens, except for (presumptive) Bacillus cereus. This pathogen was detected in a few samples but remained below safety thresholds and was effectively eliminated by dielectric drying. Finally, a shelf life stability evaluation showed minimal changes in dielectrically dried BSF larvae over six months, indicating a microbiologically stable product. In conclusion, dielectric drying technologies can retain or even improve the microbiological quality and stability of BSF larvae in the insect industry and can be considered as valuable and more efficient (time, energy consumption) alternatives to oven and freeze drying.
Wrist Stabilising Exercise Versus Hand Orthotic Intervention for Persons with Hypermobility – A Randomised Clinical Trial
Authors: Susanne Lindholm , Lisbeth Claesson 
Published: October 2024

Objective To investigate the effectiveness of wrist stabilisation exercises compared to conventional intervention, whether it reduces pain and/or paraesthesia in the hand, as well as how the interventions affected activity ability, health-related quality of life and effects on hand function and grip strength in people with Hypermobility Diagnosis. Design A randomised controlled trial. Setting: Units of Occupational therapy in Primary Care, Kalmar County Council, Sweden Participants: The study included 169 participants’ data randomised to the Exercise group (n = 83) or the Control group (n = 86). The samples consisted of adults in diagnosed Hypermobility Spectrum Disorders or hypermobility Ehlers Danlos Syndrome with symptoms of pain and/or paraesthesia in the hands in the last three years. Interventions: The Exercise group trained according to structured progressive exercises and weights programme. The Control group used the hand orthosis during selected activities. Both groups performed randomised intervention for 12 weeks. Main measures: The primary outcome was the Disabilities of Arm, Shoulder, and Hand questionnaire. Secondary outcomes were the Grip Ability Test, the Jamar dynamometer and the EuroQol EQ-5D. Results There were 116 subjects who completed the intervention. There were no statistically significant difference between the wrist stabilisation exercise and the conventional intervention in terms of activity ability, health-related quality of life, hand function, grip strength, pain or paraesthesia in people with Hypermobility Spectrum Disorders or hypermobility Ehlers Danlos Syndrome. Conclusion There is no statistically significant difference between the Exercise group and the Control group regarding activity ability after 12 weeks intervention period.
Exploring the Challenges Faced by Primary Care Physicians in Providing Optimal Care for Patients With Hypertension: A Qualitative Study
Authors: Oka Prawira , Moosa Aminath Shiwaza , Ng Chirk Jenn 
Published: October 2024

Background: Globally, most patients with hypertension have suboptimal blood pressure (BP) control. Multiple barriers prevent primary care physicians (PCPs) from effectively caring for these patients. This study aimed to explore the challenges faced by PCPs in providing optimal care for patients with hypertension, with a specific focus on identifying new barriers. Methods: This qualitative study involved 17 PCPs across 5 primary care clinics in Singapore. A trained researcher conducted individual in-depth interviews using a topic guide. Purposive sampling was employed to ensure adequate representation of seniority until data saturation was achieved. The audio-recorded interviews were transcribed verbatim and independently checked. The data were managed using NVivo and thematic analysis was conducted. Results: New barriers were divided into patient, physician, drug, and systemrelated factors. Patient factors included a preference for natural health remedies and the inconvenience of blood tests. Meanwhile, physicians faced challenges diagnosing and treating patients with various BP phenotypes and BP variability. The initiation of dual therapy was a drugrelated barrier. Finally, system factors included the suboptimal layout of the electronic medical records (EMR) that impeded effective hypertension management. Conclusion: A multi-pronged approach is required to address the significant barriers to providing optimal hypertension care. Patients should be empowered through education and minimizing the inconvenience of medication titrations. Additionally, physicians should be better equipped to diagnose and treat patients with more challenging BP phenotypes. Finally, improved access to combination pills and an optimized EMR would contribute to improved care for patients with hypertension.
Dihydroberberine alleviates Th17/Treg imbalance in premature ovarian insufficiency mice via inhibiting Rheb/mTOR signaling
Authors: Deng Disi , Wu Yeke , Wu Keming , Zeng Nan , Li Wanjing 
Published: October 2024

Abstract
Background
Premature ovarian insufficiency (POI) is an immune-related condition. Dihydroberberine (dhBBR) plays a regulatory role in maintaining the T-helper 17 (Th17)/regulatory T (Treg) cell balance. This study aimed to explore the action mechanisms of dhBBR on POI.

Methods
In vivo, female BALB/c mice were used as POI models, treated with dhBBR, or injected with recombinant interleukin (rIL)-17 and anti-CD25 monoclonal antibody. Hematoxylin and eosin staining was used to validate the model and assess the therapeutic effects of dhBBR. mRNA expression levels of cytochrome P450 (Cyp)-17a1, Cyp19a1, Cyp11a1, steroidogenic acute regulatory protein, and luteinizing hormone receptor in mouse ovaries were quantified via quantitative polymerase chain reaction (qPCR). Enzyme-linked immunosorbent assay was used to determine the cytokine and sex hormone levels. Immunohistochemical staining for cleaved-caspase 3 and Ki-67 were performed to assess ovarian cell apoptosis and proliferation. Flow cytometry was used to analyze the Th17/Treg cell balance in the ovary and spleen. In vitro cytotoxicity of dhBBR was measured using the cell counting kit-8 assay. GTP-Ras homolog enriched in brain (Rheb) activity was determined via immunofluorescence assay. Co-immunoprecipitation was performed to assess Rheb activity, Th17 or Treg induction, and binding between Rheb and mammalian target of rapamycin (mTOR) after dhBBR treatment. Flow cytometry and qPCR assays were used to verify the effect of dhBBR on CD4 + cell differentiation. Finally, Rheb/mTOR pathway activation was confirmed via western blotting of proteins, including mTOR, p-mTOR, p70S6K, p-p70S6K, 4E-BP1, and p-4E-BP1.

Results
dhBBR improved the ovarian function in a dose-dependent manner. It also decreased ovarian cell apoptosis and increased cell proliferation. It decreased Th1 and Th17 cell proportions but increased Treg cell proportions in the ovaries and spleens of POI model mice. Cell experiments revealed that dhBBR promoted CD4 + cell differentiation into Treg cells. Co-immunoprecipitation revealed Rheb as the dhBBR target that bound to mTOR. However, MHY1485 restored dhBBR-induced changes in forkhead box P3, IL-10, transforming growth factor-β1, IL-17, IL-22, retinoic acid-related orphan receptor-γt and p-mTOR levels in Th17- and Treg-induced CD4 + cells.

Conclusion
Overall, dhBBR targeted the Rheb/mTOR pathway to promote CD4 + cell differentiation into Treg cells and alleviate POI.
Antineoplastic with DNA fragmentation assay and anti-oxidant, anti-inflammatory with gene expression activity of Lactobacillus plantarum isolated from local Egyptian milk products
Authors: Elhalik Mohamed A. , Mekky Alsayed E. , Khedr Mohamed , Suleiman Waleed B. 
Published: October 2024

AbstractMany lactic acid bacteria (LAB), known for their human health benefits, are derived from milk and utilized in biotherapeutic applications or for producing valuable nutraceuticals. However, the specific role of milk-associated LAB in biotherapeutics remains underexplored. To address this, eight milk product samples were randomly selected from the Egyptian market, diluted, and then cultured anaerobically on MRS agar. Subsequently, 16 suspected LAB isolates were recovered and underwent rapid preliminary identification. Among these isolates, the Lactobacillus plantarum strain with accession number (OQ547261.1) was identified due to its strong antioxidant activity depending on the DPPH assay, L. plantarum displayed notable antioxidant activities of 71.8% and 93.8% at concentrations of 125–1000 µg/mL, respectively. While ascorbic acid showed lower concentrations of 7.81, 3.9, and 1.95 µg/mL which showed activities of 45.1%, 34.2%, and 27.2%, respectively. The anti-inflammatory efficacy of L. plantarum was evaluated based on its capability to prevent hemolysis induced by hypotonic conditions. At a concentration of 1000 µg/mL, L. plantarum could reduce hemolysis by 97.7%, nearly matching the 99.5% inhibition rate achieved by the standard drug, indomethacin, at an identical concentration. Moreover, L. plantarum exhibited high hemolytic activity at 100 µg/mL (14.3%), which decreased to 1.4% at 1000 µg/mL. The abundance of phenolic acids and flavonoids was determined by high-performance liquid chromatography (HPLC) in L. plantarum. Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) demonstrated that L. plantarum increased gene expression of the inflammatory marker TLR2 by 133%, and cellular oxidation markers SOD1 and SOD2 by 65% and 74.2%, respectively, while suppressing CRP expression by 33.3%. These results underscore L. plantarum’s exceptional anti-inflammatory and antioxidant activities. Furthermore, L. plantarum induces cancer cell death through necrotic nuclear DNA fragmentation. These findings suggest that L. plantarum is not only suitable for nutraceutical production but also holds potential as a probiotic strain. Future research should focus on enhancing the capacity of this strain across various industries and fostering innovation in multiple fields.
The tale of two Ions Na+ and Cl−: unraveling onion plant responses to varying salt treatments
Authors: Romo-Pérez M. L. , Weinert C. H. , Egert B. , Kulling S. E. , Zörb C. 
Published: October 2024

Abstract
Background
Exploring the adaptive responses of onions (Allium cepa L.) to salinity reveals a critical challenge for this salt-sensitive crop. While previous studies have concentrated on the effects of sodium (Na+), this research highlights the substantial yet less-explored impact of chloride (Cl−) accumulation. Two onion varieties were subjected to treatments with different sodium and chloride containing salts to observe early metabolic responses without causing toxicity.

Results
The initial effects of salinity on onions showed increased concentrations of both ions, with Cl− having a more pronounced impact on metabolic profiles than Na+. Onions initially adapt to salinity by first altering their organic acid concentrations, which are critical for essential functions such as energy production and stress response. The landrace Birnförmige exhibited more effective regulation of its Na+/K+ balance and a milder response to Cl− compared to the hybrid Hytech. Metabolic alterations were analyzed using advanced techniques, revealing specific responses in leaves and bulbs to Cl− accumulation, with significant changes observed in organic acids involved in the TCA cycle, such as fumaric acid, and succinic acid, in both varieties. Additionally, there was a variety-specific increase in ethanolamine in Birnförmige and lysine in Hytech in response to Cl− accumulation.

Conclusion
This comprehensive study offers new insights into onion ion regulation and stress adaptation during the initial stages of salinity exposure, emphasizing the importance of considering both Na+ and Cl− when assessing plant responses to salinity.