bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serious games vs. traditional tutorials in the pandemic: a randomised controlled trial
Authors: Tan Su Min Joyce , Coffey Michael J. , Blazek Katrina , Sitaram Neela , Dobrescu Isabella , Motta Alberto , Chuang Sandra , Ooi Chee Y. 
Published: November 2024

Background and aimThe COVID-19 pandemic necessitated the transition to online medical education. This study evaluated the efficacy of online case-based tutorials using a serious game tutorial [PlayMed™ (PM)], as compared to a traditional slideshow tutorial (TT).MethodsWe performed a prospective, mixed-methods, randomised controlled trial on undergraduate medical students during the COVID-19 pandemic, from May 2020 to January 2021. Students were block randomised into the PM or TT groups. Tutors conducted online teaching on bronchiolitis and gastroenteritis cases using PM or TT to facilitate the presentation. Educational experience was assessed using a continuous interval scale (0–100; with pre-defined categories) and free text responses. Immediate and long-term knowledge acquisition was assessed using 6 multiple-choice questions (MCQ) for each case (total of 12 MCQ). A modified intention-to-treat mixed methods and a sensitivity per-protocol analysis were performed to compare outcomes between PM and TT groups.ResultsIn total, 80 PM and 73 TT participants attended at least one tutorial. Sixty-five (81%) PM and 52 (71%) TT participants completed at least one survey and were included for analysis. PlayMed™ students had an increased likelihood of completing the surveys, which included the MCQ [odds ratio (95% CI) of 2.4 (1.6–3.8), p &lt; 0.00006]. Regarding the immediate reactions post bronchiolitis and gastroenteritis cases, several responses were significantly more positive in the PM group compared to the TT group; e.g. ‘The learning activity was engaging’ [medium effect size: d (95% CI) = 0.58 (0.32–0.85), p &lt; 0.0001]. Higher proportions of participants in the PM group reported feeling safe in the gastroenteritis and bronchiolitis tutorials (96 and 89%), compared to the TT group (76 and 74%). PlayMed™ participants significantly outperformed TT participants on the bronchiolitis MCQs done immediately post tutorial, 4.1 (1.0) vs. 3.5 (1.0), respectively, p = 0.004 [medium effect size: d (95% CI) = 0.54 (0.16–0.91)].ConclusionThis study demonstrates the utility of a serious game (PlayMed™) as an online teaching tool for medical education. Students exposed to PM demonstrated superior engagement and feelings of safety. Utilisation of serious games may also facilitate knowledge acquisition, at least in the short term.
Cardiac risk and myocardial fibrosis assessment with cardiac magnetic resonance in patients with myotonic dystrophy
Authors: Abati Elena , Alberti Claudia , Tambè Valentina , Esseridou Anastasia , Comi Giacomo Pietro , Corti Stefania , Meola Giovanni , Secchi Francesco 
Published: November 2024

IntroductionNon-invasive evaluation of myocardial tissue is a major goal of cardiac imaging. This is the case of myocardial fibrosis which is crucial in many myocardial diseases. Cardiac extracellular volume (ECV) was shown to indicate myocardial fibrosis and early cardiac involvement. With this study, our objective is to evaluate ECV measured with cardiac magnetic resonance (CMR) in patients with myotonic dystrophy type 1 (DM1) and 2 (DM2) as potential imaging biomarkers of subclinical cardiac pathology, and its relationship with demographic and clinical parameters, ECG-derived measures of cardiac conduction, and neuromuscular performance status.Materials and methodsWe retrospectively analyzed 18 DM1 patients and 4 DM2 patients without apparent cardiac disease who had CMR at our center. Differences between independent distributions were evaluated using Mann–Whitney U test, while correlations were evaluated using Spearman’s ρ.ResultsGlobal ECV in DM1 patients (median 28.36; IQR 24.81–29.77) was significantly higher (p = 0.0141) than in DM2 patients (median 22.93; IQR 21.25–24.35), and than that reported in literature in healthy subjects (p = 0.0374; median 25.60; IQR 19.90–31.90). Septal ECV was significantly higher (p = 0.0074) in DM1 (median 27.37; IQR 25.97–29.74) than in DM2 patients (median 22.46; 21.57–23.19). Global ECV showed a strong, positive correlation with septal ECV (ρ = 0.9282, p &lt; 0.0001). We observed that DM1 women showed significantly higher global (p = 0.0012) and septal (p &lt; 0.0001) ECV values compared to men.DiscussionWe found a significant increase in global and septal cardiac ECV in patients with DM1. These values might thus suggest that DM1 patients present an increased cardiovascular risk, mainly due to cardiac fibrosis, even in absence of overt cardiac pathology at other common cardiovascular exams. DM1 patients may also be at increased risk of early septal fibrosis, with important implications on the risk for fatal arrhythmias. In addition, our results suggest the presence of gender-related differences, with DM1 women being more prone to myocardial fibrosis. Physicians dealing with DM1 may consider CMR as a screening tool for the early identification of patients with increased cardiovascular risk.
Acupuncture combined with Chinese herbs versus Chinese herbs alone to improve the clinical efficacy of uterine fibroids: a systematic review and meta-analysis
Authors: Chen Tianyu , Chen Xin , He Wei , Ma Xiaojing , Zuo Zheng 
Published: November 2024

ObjectiveThe objective of this study was to evaluate the clinical efficacy of acupuncture combined with Chinese herbs versus Chinese herbs alone in treating uterine fibroids.MethodsA literature search of eight databases identified nine randomized controlled trials (RCTs) evaluating the clinical efficacy of acupuncture combined with Chinese herbs compared to Chinese herbs alone for treating uterine fibroids. Subsequently, data extraction and analysis were conducted to assess the methodological quality and risk of bias in the studies, followed by an analysis of the data from the randomized controlled trials.ResultsNine randomized controlled trials involving 640 women were included. The results indicated that acupuncture combined with Chinese herbs significantly increased the overall clinical efficacy rate [Z=5.00, P=0.74, relative risk(RR)1.20, 95%CI 1.12 to 1.30, P&lt;0.00001, I²=0%] and reduced the size of uterine fibroids [Z=2.95, P=0.003, SMD=-0.82, 95%CI -1.36 to -0.27, P&lt;0.00001, I²=90%].ConclusionsStudies have shown that acupuncture combined with Chinese herbs reduces uterine size, lowers hormone levels, and improves quality of life. According to the findings of this study, acupuncture combined with Chinese herbs has a more positive effect on the treatment of uterine fibroids than Chinese herbs alone. However, due to the limited number and quality of the included studies, these conclusions need to be validated by further high-quality research.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier CRD42024507248.
Analysis of linear accelerator-based fractionated stereotactic radiotherapy in brain metastases: efficacy, safety, and dose tolerances
Authors: Li Yuhong , Ma Huiying , Hua Rui , Wang Tingting , Ding Naixin , Deng Liping , Lu Xiaomin , Chen Wei 
Published: November 2024

ObjectiveTo assess the efficacy and safety of linear accelerator-based fractionated stereotactic radiotherapy (LINAC-FSRT) in patients with brain metastases (BM).MethodsWe retrospectively analyzed 214 patients treated with LINAC-FSRT, categorized based on biologically effective dose (BED10, α/β = 10) into two groups (≤55 Gy, &gt;55 Gy). Stratified analyses were conducted based on targeted therapy to compare survival outcomes. To examine brain tissue dose-tolerance volume, patients were divided into two groups: the standard Hypofractionated Treatment Effects in the Clinic (HyTEC) protocol group and an adjusted HyTEC protocol group where dose-volume restrictions exclude the planning target volume (PTV).ResultsResults as of December 2023 showed median intracranial progression-free survival (iPFS) at 12.4 months, with median overall survival (OS) not reached and a one-year local control (LC) rate of 68.7%. Mild to moderate toxicity affected 17.3% of patients, while severe toxicity occurred in 2.8%. Multivariate Cox analysis indicated that uncontrolled extracranial disease significantly reduced iPFS (HR = 2.692, 95%CI:1.880–3.853, P &lt; 0.001) and OS (HR = 3.063, 95%CI:1.987–4.722, P &lt; 0.001). BED10 &gt;55 Gy (HR = 0.656, 95%CI:0.431–0.998, P = 0.049) improved OS, showing statistical significance (P = 0.037) without affecting iPFS or CNS toxicity (P = 0.127, P = 0.091). Stratified analysis highlighted nearly significant OS improvements with high-dose FSRT and targeted therapy (P = 0.054), while concurrent therapy markedly enhanced iPFS (P = 0.027). No significant differences were observed in intracranial local failure (ILF—which represents progression in previously treated areas during follow-up), one-year LC rates, iPFS, or OS between dose-volume groups. Adjusting HyTEC volume restrictions did not significantly increase CNS adverse reactions (P = 0.889).ConclusionsLINAC-FSRT is safe and effective in BM. BED10&gt;55 Gy notably enhances OS post-LINAC-FSRT and may benefit LC. High BED10 FSRT with targeted therapy likely boosts synergy, and concurrent targeted therapy significantly improves iPFS. Diminishing dose volume constraints at different fractions based on the HyTEC guidelines is feasible.
Analysis of BoDV-1 status, EEG resting-state alpha activity and pro-inflammatory cytokines in adults with and without major depressive disorder
Authors: Torner Anna J. , Baune Bernhard T. , Folta-Schoofs Kristian , Dietrich Detlef E. 
Published: November 2024

IntroductionIn severe cases, an infection with the Borna Disease Virus 1 (BoDV-1), the causative agent of Borna disease in horses, sheep, and other domestic mammals, was reported to be accompanied by cognitive dysfunctions, seizures, deep coma, or severe to fatal encephalitis in humans. In addition, asymptomatic or mild courses of BoDV-1 infection are discussed to act as a co-factor in the etiology of Major Depressive Disorder (MDD). Previously, studies using electroencephalography (EEG) reported BoDV-1-dependent changes in event-related potentials (ERPs), thus indicating the use and added value of non-invasive studies in Borna research.MethodsHere, we examined possible connections between BoDV-1 status, EEG restingstate alpha activity, and serum levels of pro-inflammatory Interleukin 6 (IL-6) and Interleukin 8 (IL-8) in MDD patients and in a comparison group of adults without MDD diagnosis.ResultsInterestingly, for both groups, we revealed a comparable high number of BoDV-1 positive and BoDV-1 negative participants. Compared to adults without MDD diagnosis, MDD patients showed a decrease in their relative EEG alpha power at posterio-central, but increased values at anterio-central electrode sites. Most important, no group-dependent effect of BoDV-1 status on EEG resting-state activity had been observed. Compared to BoDV-1 positive and negative adults without MDD diagnosis, as well as BoDV-1 positive MDD patients, BoDV-1 negative MDD patients revealed a comparatively weak significant negative correlation between relative fronto-central EEG alpha power and concentrations of pro-inflammatory IL-8.DiscussionTaken together, our data confirm MDD-dependent alterations in EEG resting-state alpha activity, which, however, were not accompanied by major BoDV-1 dependent neurophysiological or immunological effects. Future – probably more invasive – studies further have to clarify the significance of the observed negative correlation between relative fronto-central EEG alpha power and concentrations of pro-inflammatory IL-8.
Correlation between the APOE ε4 genotype, lifestyle habits, and cognitive deficits in Chinese adults over 60: a cross-sectional analysis in China
Authors: Li Wei , Wang XiaoLiang , Sun Lin , Yue Ling , Xiao Shifu 
Published: November 2024

IntroductionApolipoprotein E (APOE) epsilon 4 is regarded as the most significant genetic contributor linked to mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Daily life elements might also influence cognitive abilities to some extent. This research aimed to investigate whether carrying APOE ε4 alters the effects of lifestyle on cognitive ability.MethodsThe research included 1871 senior community members with APOE gene data, all participating in clinical, neuropsychological, and daily living factor assessments. Based on their APOE ε4 status, they were categorized into two groups: the APOE ε4 group (n = 362) and the non-APOE ε4 group (n = 1,509). Subsequently, a multivariate logistic regression analysis was employed to investigate the link between cognitive deficits and APOE ε4, along with lifestyle patterns.ResultsOur research revealed a reduced incidence of MCI (OR = 0.745, 95% CI: 0.587–0.945, p = 0.015) and dementia (OR = 0.422, 95% CI: 0.259–0.688, p = 0.001) in the non-APOE ε4 carriers. Furthermore, the general linear regression analysis revealed a notable interplay between APOE ε4 and sleep disturbances, potentially impacting cognitive deterioration together (F = 6.817, p = 0.001).ConclusionsThe research indicates that possessing APOE ε4 alters the impact of everyday life factors on cognitive decline. In addition, there is a significant interaction between APOE ε4 and sleep disorders, which may jointly lead to the appearance of cognitive impairment.
Effects of modern dance programs on improving health-related physical fitness in girls
Authors: Ilić Aleksandra , Marinkovic Dragan , Herodek Romina , Vlašić Jadranka , Jovanović Saša 
Published: November 2024

IntroductionAs creative physical activity influences many aspects of child development—including physical, social, and emotional wellbeing—the effects of two experimental modern dance programs on the development of health-related physical fitness in young school-aged girls were assessed in this longitudinal study.Materials and methodsThe study sample comprised 203 girls aged 7–11 years, 102 of whom (the control group) were recruited from the elementary school “Vuk Karadžić” from Bačka Palanka, while Experimental Group 1 (n = 51) and Experimental Group 2 (n = 50) respectively consisted of girls who have been involved in a modern dance program for no longer than 1 year and at least 2 years. The participants were also divided into AGE 1 (7–9 years, n = 103) and AGE 2 (9–11 years, n = 100) groups to assess the influence of age on the treatment effect. During the six-month experimental period, Experimental Group 1 met three times a week while Experimental Group 2 had five weekly training sessions. All participants were subjected to the extended ALPHA battery of tests both at baseline and at the end of the study.ResultsThe Experimental Group 1 and Experimental Group 2 results showed a statistically significant difference (p = 0.005) between the initial and final measurements, suggesting that participation in a modern dance program had a positive impact on the transformation of morphological characteristics by increasing muscle mass and reducing subcutaneous fat. In addition, both experimental groups had a greater muscle strength, muscle endurance, and aerobic fitness at the end of the treatment.ConclusionThe study findings support the view that health-related physical fitness in young school-aged children can be improved through modern dance.
Metagenomic characterization of the tracheobronchial microbiome in lung cancer
Authors: Bailey Alexis , Hogue Stephanie , Pierce Christine M. , Paul Shirlene , La Fuente Natalie , Thapa Ram , Kim Youngchul , Robinson Lary A. 
Published: November 2024

BackgroundThe tracheobronchial and oral microbiome may be associated with lung cancer, potentially acting as predictive biomarkers. Therefore, we studied the lung and oral bacteriome and virome in non-small cell lung cancer (NSCLC) patients compared to melanoma controls to discover distinguishable features that may suggest lung cancer microbial biomarkers.MethodsIn this pilot case-control study, we recruited ten patients with early-stage NSCLC (cases) and ten age-matched melanoma patients (controls) who both underwent tumor resection. Preoperative oral gargles were collected from both groups, who then underwent transbronchoscopic tracheal lavage after intubation. Lung tumor and adjacent non-neoplastic lung were sterilely collected after resection. Microbial DNA from all lung specimens underwent 16S rRNA gene sequencing. Lavage and gargle specimens underwent whole-genome shotgun sequencing. Microbiome metrics were calculated to compare both cohorts. T-tests and Wilcoxon rank sum tests were used to test for significant differences in alpha diversity between cohorts. PERMANOVA was used to compare beta diversity.ResultsNo clear differences were found in the microbial community structure of case and control gargles, but beta diversity of case and control lavages significantly differed. Two species, Granulicatella adiacens and Neisseria subflava, which are both common oral commensal organisms, appeared in much higher abundance in case versus control lavages. Case lavages also maintained higher relative abundances of other oral commensals compared to controls.ConclusionsLung lavages demonstrated oral microbiota enrichment in cases compared to controls, suggesting microaspiration and resultant inflammation. The oral commensals Granulicatella adiacens and Neisseria subflava were more abundant in the tracheobronchial lavages of lung cancer versus melanoma patients, implicating these microorganisms as potential lung cancer biomarkers, warranting further validation studies.
Decolonizing climate change response: African indigenous knowledge and sustainable development
Authors: David James Ojochenemi 
Published: November 2024

BackgroundAnthropogenic Global Warming (AGW) poses a critical challenge necessitating effective global climate change mitigation efforts. However, the pervasive influence of scientism in AGW discourse often marginalizes Indigenous perspectives crucial for addressing climate impacts, particularly in Africa where adaptive capacity is limited.ObjectiveThis study, rooted in Transformative Learning Theory and Ubuntu philosophy, employs critical qualitative research methods to examine how scientism shapes AGW discourse epistemologically and ethically. It explores the hindrances posed by climate change denialism and ecomodernism due to scientism while advocating the integration of African Indigenous Knowledge Systems (AIKs) into climate response strategies, particularly within the African education landscape.MethodsDrawing on the theoretical frameworks of Transformative Learning and Ubuntu philosophy, and informed by critical qualitative research methodology, this research analyzes the role of scientism in AGW discourse. It investigates its implications for Education for Sustainable Development (ESD) and discusses arguments for the inclusion of AIK in educational and policy frameworks.ResultsThe study reveals that scientism perpetuates epistemological biases that undervalue AIK, thereby impeding comprehensive climate response strategies. Pathways are proposed that promote AIK integration and mainstreaming, thereby decolonizing climate response efforts and enhancing ESD within Africa’s educational institutions.ConclusionIntegrating insights from AIK, construed in terms of ‘exemplary ethical communities’ (EEC), into climate change responses is pivotal for fostering inclusive and effective strategies. This approach not only addresses the ethical imperatives of decolonization but also enhances resilience and sustainability in climate-vulnerable regions.SignificanceThis study contributes to scholarship by highlighting the urgent need to diversify climate response strategies through the inclusion of AIK. By advocating for the integration of wisdom from EECs, it advances discussions on decoloniality within climate change discourse, emphasizing the importance of Indigenous knowledge in global sustainability efforts.
Epidemiological situation of bovine and bubaline tuberculosis in the state of Pará, Amazon region of Brazil
Authors: Oliveira Bruno Cesar Ribeiro da Silva , Oliveira Jefferson Pinto , Pinho Ana Paula Vilhena Beckman , Dias Ricardo Augusto , Grisi Filho José Henrique Hidebrand , Gonçalves Vitor Salvador Picão , Heinemann Marcos Bryan , Amaku Marcos , Telles Evelise Oliveira , Ferreira Bruno Fontana Soares , Ferreira Fernando , Ferreira Neto José Soares 
Published: November 2024

IntroductionBovine tuberculosis is one of the primary infectious diseases affecting cattle. Although several countries have managed to eradicate this zoonosis it remains endemic and uncontrolled across many countries in Africa, Asia, Latin America, and the Middle East. Brazil launched its national control and eradication program in 2001, and since then, epidemiological studies have been carried out to define optimal control strategies and to enable the management of the process in each region.MethodsThis study covered the state of Pará, which was divided into three regions, in each of which a pre-established number of properties were randomly selected, and within each property, a minimum number of animals were drawn to be tested by the tuberculin test to classify the farm as infected or free of the disease. A questionnaire was administered to the selected properties to identify the risk factors for the disease.ResultsA total of 976 properties comprising 17,151 animals were tested. The prevalence of infected properties in the regions ranged from 3.1% [1.3; 4.9] to 18.6% [14.3; 22.9], while tuberculin-positive animals ranged from 0.24% [0.09; 0.40] to 4.8% [2.4; 7.3]. The introduction of cattle untested for bTB and the renting of pastures have been identified as risk factors for the disease in this state.DiscussionPará has one of the highest prevalences of bovine tuberculosis in Brazil, and the implications of these results for public health were discussed. We therefore proposed that the state’s Official Veterinary Service, together with the private dairy and meat sectors, pursue the objective of controlling or eradicating the disease, along with mechanisms to verify its effectiveness. The differences between the two objectives were discussed, but in both cases, an education program is necessary to inform cattle and buffalo breeders that they need to test animals for tuberculosis before introducing them to their farms, and also to avoid renting pastures for cattle to graze and rest while moving on foot, as these practices have contributed the most to the spread of bTB in the state.