bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors for refractory respiratory distress syndrome among very-low-birth-weight infants
Authors: Shin Jeongmin , Choi Chang Won , Lee Byung Kook 
Published: October 2024

Abstract
Background
The objective was to evaluate refractory respiratory distress syndrome (RDS) risk factors among very-low-birth-weight infants (VLBWIs).

Method
The data of VLBWIs born between January 2013 and December 2020 registered in the Korean Neonatal Network (KNN) were analyzed. Infants who died within 5 postnatal days or who were not given surfactant were excluded. Infants were divided into a well-responding RDS group, which received surfactant replacement therapy (SRT) only once, and a refractory RDS group, which received SRT twice or more. The associations between perinatal characteristics and refractory RDS were investigated via multivariate logistic regression analysis.

Results
Multivariate logistic regression analysis revealed that low gestational age (adjusted odds ratio [aOR] = 1.26, 95% confidence interval (CI) [1.23, 1.26], male sex (aOR = 1.17, 95% CI [1.06, 1.29]), cesarean section (aOR = 1.59, 95% CI [1.38, 1.80]), maternal hypertensive disorder (aOR = 1.54, 95% CI[1.35, 1.75]), and low 5-minute Apgar scores (aOR = 1.24, 95% CI [1.12, 1.37]) were significantly associated with refractory RDS. Antenatal corticosteroid use (aOR = 0.81, 95% CI [0.73, 0.89]) and maternal chorioamnionitis (aOR = 0.79, 95% CI [0.71, 0.88]) were significantly inversely associated with refractory RDS. Compared with well-responding RDS, refractory RDS was significantly associated with increased major neonatal morbidity and mortality risk at 5 postnatal days.

Conclusion
Maternal hypertensive disorder is a significant risk factor for refractory RDS. Refractory RDS was associated with unfavorable neonatal outcomes.
Analyzing early childhood allergy prevention motivation of mothers of infants and its predictors using latent class analysis and structural equation modelling
Authors: Wirtz Markus Antonius , Schulz Anja Alexandra , Heiberger Andrea , Dresch Carolin 
Published: October 2024

Abstract
Background
Allergic diseases are among the most common chronic diseases in childhood. Early childhood allergy prevention (ECAP) behaviors of those caring for the infant during pregnancy and the first months of life may influence the risk of allergy development over the life course. Motivation and intention to use appropriate primary ECAP measures are thus of critical importance.

Aims
To characterize parental ECAP motivation, (a) valid indicators will be developed and (b) typical parental characteristics will be identified. (c) According to socio-cognitive models, the predictive value of parental risk perception, control belief and self-efficacy for parental ECAP motivation shall be determined.

Method
A sample of N = 343 (expectant) mothers of infants completed a questionnaire on self-reported ECAP motivation, risk perception, control belief, and self-efficacy. The cross-sectional data were analyzed using latent class analysis and structural equation modelling including nominal regression models.

Results
Four typical maternal response profiles (motivated to a customary degree, 70%; motivated to use primary preventive measures, 17.8%; reluctant towards new prevention measures, 6.4%; highly motivated to apply preventive measures in case of an existing allergy, 5.8%) could be identified for the items on ECAP motivation. After splitting the model variables “risk perception” (allergy vs. allergy-associated general health problems) and “self-efficacy” (trust vs. insecurity) a satisfactory model-fit was achieved (CFI = .939; RMSEA = .064). Particularly, increased “risk perception-allergy” (OR = 1.655) and “self-efficacy-insecurity” (OR = 2.013) as well as lower “risk perception-general health” (OR = 0.555) and “control belief” (OR = 0.217), respectively, are associated with higher ECAP motivation.

Conclusion
The use of ECAP-measures by parents to protect their newborns from allergies is important, but there are deficiencies in their implementation. Based on a social cognitive model approach, predictive characteristics could be identified, which are associated with increased motivation to implement ECAP-measures. For public health our findings provide a promising basis for conception of behavioral and environmental ECAP prevention measures and their motivated implementation by parents.
Association between healthy lifestyle on life course and multimorbidity in adults: results from two national prospective cohort studies
Authors: Ye Xiaoying , Liang Mengdan , Chen Zhehui , Jiang Xiannuan , Xie Mengying , Xie Xiaowei , Lan Guohui , Lu Xiaoli , Huang Zelin , Xu Tingting , Xie Xiaoxu 
Published: October 2024

Abstract
Objectives
To examine the correlation between healthy lifestyle patterns, their change trajectories, and the risk of multimorbidity in adults.

Methods
Based on two representative national cohorts, the English Longitudinal Study of Aging (ELSA) and the Health and Retirement Study (HRS) including adults aged 50 years and over. We employed Cox regression, lifestyle change trajectories, and restricted mean survival times to explore the relationship between lifestyle (assessed by SCORE2, LE’8, and HLS scores) and multimorbidity. We also conducted mediation analysis to investigate the underlying mechanisms.

Results
A healthy lifestyle (higher LE’8, higher HLS, or lower SCORE2) can reduce the risk of multimorbidity. 2-10% lower multimorbidity risk per one-point increase in LE’8 and HLS. The hazard ratio of multimorbidity for improvements in unhealthy lifestyles or deterioration in healthy lifestyles compared to always healthy lifestyles ranged from 1.598 to 5.602. Besides, for LE’8 and HLS, participants with higher scores had a slower decrease in survival probability in ELSA. Triglyceride, C-reaction protein, fibrinogen, and cystatin C partly mediate the association between lifestyle and multimorbidity.

Conclusions
Keeping a healthy lifestyle over time can help reduce the risk of multimorbidity.
Preparation and characterization of bovine dental pulp-derived extracellular matrix hydrogel for regenerative endodontic applications: an in vitro study
Authors: Elnawam Hisham , Thabet Abdelrahman , Mobarak Ahmed , Abdallah Amr , Elbackly Rania 
Published: October 2024

Abstract
Background
The use of biological scaffolds in regenerative endodontics has gained much attention in recent years. The search for a new biomimetic scaffold that contains tissue-specific cell homing factors could lead to more predictable tissue regeneration. The aim of this study was to prepare and characterize decellularized bovine dental pulp-derived extracellular matrix (P-ECM) hydrogels for regenerative endodontic applications.

Methods
Freshly extracted bovine molar teeth were collected. Bovine dental pulp tissues were harvested, and stored at -40º C. For decellularization, a 5-day protocol was implemented incorporating trypsin/EDTA, deionized water and DNase treatment. Decellularization was evaluated by DNA quantification and histological examination to assess collagen and glycosaminoglycans (GAGs) content. This was followed by the preparation of P-ECM hydrogel alone or combined with hyaluronic acid gel (P-ECM + HA). The fabricated scaffolds were then characterized using protein quantification, hydrogel topology and porosity, biodegradability, and growth factor content using Enzyme-linked immunosorbent assay (ELISA): transforming growth factor beta-1(TGF-β1), basic fibroblast growth factor (bFGF), bone morphogenetic protein 2 (BMP-2) and vascular endothelial growth factor (VEGF).

Results
Decellularization was histologically confirmed, and DNA content was below (50 ng/mg tissue). P-ECM hydrogel was prepared with a final ECM concentration of 3.00 mg/ml while P-ECM + HA hydrogel was prepared with a final ECM concentration of 1.5 mg/ml. Total protein content in P-ECM hydrogel was found to be (439.0 ± 123.4 µg/µl). P-ECM + HA showed sustained protein release while the P-ECM group showed gradual decreasing release. Degradation was higher in P-ECM + HA which had a significantly larger fiber diameter, while P-ECM had a larger pore area percentage. ELISA confirmed the retention and release of growth factors where P-ECM hydrogel had higher BMP-2 release, while P-ECM + HA had higher release of TGF-β1, bFGF, and VEGF.

Conclusions
Both P-ECM and P-ECM + HA retained their bioactive properties demonstrating a potential role as functionalized scaffolds for regenerative endodontic procedures.
A modified protocol merging two published techniques for computer guided zygomatic implants surgery: a technical note
Authors: Abouzeid Omar Effat Mokhtar , Gaber Ramy M. , Maergy Haitham A. , Hany Hossam El-Dien , Abdelmohsen Karim M. , Elkassaby Marwa A. , Taha Moustafa M. 
Published: October 2024

Abstract
Objectives
Zygomatic implant surgery can be difficult due to the limited intraoperative visibility of the surgical field and the complex anatomy of the zygomatic bone, which could lead to serious complications. This study aims to assess the accuracy of zygomatic implants placement using computer-guided surgical templates.

Materials and methods
A total of 13 zygomatic implants were placed in four participants. Double-sleeve drill guides were used with the help of computer-guided surgical templates designed with a lateral window. The accuracy was evaluated by measuring the linear deviations regarding the implants’ platforms and apices’ positions in addition to the angular deviations. Moreover, deviations of both implants from three fixed planes of space were measured.

Results
The mean linear deviation at platforms was 2.44 mm ± 1.57 and at the apices 2.32 mm ± 1 while the mean angular deviation was 3.6˚ ± 1.92. Differences at the entry points were 0.43 ± 1.79 mm, 0.39 ± 1.12 mm, and − 0.54 ± 2.00 mm from the mid-sagittal, horizontal, and coronal planes respectively. Differences at the exit points were − 0.75 ± 1.25 mm, -0.06 ± 1.09 mm, and 0.63 ± 1.24 mm from the same planes respectively. Within all planes, there was no statistically significant difference.

Conclusion
Given the limitations of this study, the use of the computer-guided surgical templates augmented by the double sleeve drill guides allowed favorable control over the tip of the long surgical drill away from vital structures during the zygomatic implant osteotomy. It also allowed control over alveolar crest osteotomy and its placement in a favorable prosthetic position. Overall, this protocol should be considered for further research and improvement to allow more predictable surgical outcomes while preventing the occurrence of complications. Before conducting this study, the protocol was reviewed and approved by the Research Ethical Committee of Faculty of Dentistry, Ain Shams University in meeting no. (105), on 15th of July 2020 with the application no.: (FDASU-RecD072029).
The predictive capacity of biomarkers for clinical pulmonary oedema in patients with severe falciparum malaria is low: a prospective observational study
Authors: Ishioka Haruhiko , Ghose Aniruddha , Kingston Hugh W. , Plewes Katherine , Leopold Stije J. , Srinamon Ketsanee , Charunwatthana Prakaykaew , Ahmed Maswood , Alam A. K. M. Shamsul , Tuip-de Boer Anita , Hossain Md Amir , Dondorp Arjen M. , Schultz Marcus J. 
Published: October 2024

Abstract
Background
Pulmonary oedema is a feared and difficult to predict complication of severe malaria that can emerge after start of antimalarial treatment. Proinflammatory mediators are thought to play a central role in its pathogenesis.

Methods
An exploratory study was conducted to evaluate the predictive capacity of biomarkers for development of clinical pulmonary oedema in patients with severe falciparum malaria at two hospitals in Bangladesh. Plasma concentrations of interleukin-6 (IL-6), IL-8, tumour necrosis factor (TNF), soluble Receptor of Advanced Glycation End-products (sRAGE), surfactant protein-D (SP-D), club cell secretory protein (CC16), and Krebs von den Lungen-6 (KL-6) on admission were compared with healthy controls. Correlations between these biomarker and plasma lactate and Plasmodium falciparum histidine-rich protein 2 (PfHRP2) levels were evaluated. Receiver Operating Characteristic (ROC) curves were constructed to assess the predictive capacity for clinical pulmonary oedema of the biomarkers of interest.

Results
Of 106 screened patients with falciparum malaria, 56 were classified as having severe malaria with a mortality rate of 29%. Nine (16%) patients developed clinical pulmonary oedema after admission. Plasma levels of the biomarkers of interest were higher in patients compared to healthy controls. IL-6, IL-8, TNF, sRAGE, and CC16 levels correlated well with plasma PfHRP2 levels (rs = 0.39; P = 0.004, rs = 0.43; P = 0.001, rs = 0.54; P < 0.001, rs = 0.44; P < 0.001, rs = 0.43; P = 0.001, respectively). Furthermore, IL-6 and IL-8 levels correlated well with plasma lactate levels (rs = 0.37; P = 0.005, rs = 0.47; P < 0.001, respectively). None of the biomarkers of interest had predictive capacity for development of clinical pulmonary oedema.

Conclusions
IL-6, IL-8, TNF, sRAGE, SP-D, CC16 and KL-6 cannot be used in predicting clinical pulmonary oedema in severe malaria patients.
Enhancing the estimation of PaCO2 from etCO2 during ventilation through non-invasive parameters in the ovine model
Authors: Grüne Mike , Olivier Lena , Pfannschmidt Valerie , Hütten Matthias , Orlikowsky Thorsten , Stollenwerk Andre , Schoberer Mark 
Published: October 2024

Abstract
Background
In mechanically ventilated neonates, the arterial partial pressure of $$\text {CO}_{2}$$

CO
2

($$\text {PaCO}_{2}$$

PaCO
2

) is an important indicator for the adequacy of ventilation settings. Determining the $$\text {PaCO}_{2}$$

PaCO
2

is commonly done using invasive blood gas analyses, which constitute risks for neonates and are typically only available infrequently. An accurate, reliable, and continuous estimation of $$\text {PaCO}_{2}$$

PaCO
2

is of high interest for medical staff, giving the possibility of a closer monitoring and faster reactions to changes. We aim to present a non-invasive estimation method for $$\text {PaCO}_{2}$$

PaCO
2

in neonates on the basis of end-tidal $$\text {CO}_{2}$$

CO
2

($$\text {etCO}_{2}$$

etCO
2

) with inclusion of different physiological and ventilation parameters. The estimation method should be more accurate than an estimation by unaltered $$\text {etCO}_{2}$$

etCO
2

measurements with regard to the mean absolute error and the standard deviation.

Methods
Secondary data from 51 preterm lambs are used, due to its high comparability to preterm human data. We utilize robust linear regression on 863 $$\text {PaCO}_{2}$$

PaCO
2

measurements below or equal to 75 mmHg from the first day of life. $$\text {etCO}_{2}$$

etCO
2

along with a set of ventilation settings and measurements as well as vital parameters are included in the regression. Included independent variables are chosen iteratively by highest Pearson correlation to the remaining estimation deviation.

Results
The evaluation is carried out on 12 additional neonatal lambs with 246 $$\text {PaCO}_{2}$$

PaCO
2

measurements below or equal to 75 mmHg from the first two days of life. The estimation method shows a mean absolute error of 3.80 mmHg with a 4.92 mmHg standard deviation of differences and a standard error of 0.31 mmHg in comparison to measured $$\text {PaCO}_{2}$$

PaCO
2

by blood gas analysis.

Conclusions
The estimation of $$\text {PaCO}_{2}$$

PaCO
2

by the proposed equation is less biased than unaltered $$\text {etCO}_{2}$$

etCO
2

. The usage of this method in clinical practice or in applications like the automation of ventilation needs further investigation.
Two-sample Mendelian Randomization to evaluate the causal relationship between inflammatory arthritis and female-specific cancers
Authors: Meisinger Christa , Fischer Simone , O’Mara Tracy , Freuer Dennis 
Published: October 2024

Abstract
Background
There is evidence that inflammatory arthritis in the form of ankylosing spondylitis (AS), psoriatic arthritis (PsA), and rheumatoid arthritis are both positively and negatively associated with certain female-specific cancers. However, the study results are very heterogeneous.

Methods
Based on up to 375,814 European women, we performed an iterative two-sample Mendelian randomization to assess causal effects of the occurrence of the inflammatory arthritis on the risk of female-specific cancer in form of breast, endometrial, and ovarian cancer sites as well as their subtypes. Evidence was strengthened by using similar exposures for plausibility or by replication with a subsequent meta-analysis. P-values were Bonferroni adjusted.

Results
Genetic liability to AS was associated with ovarian cancer (OR = 1.03; 95% CI: [1.01; 1.04]; $$\:{P}_{adj}$$=0.029) and liability to PsA with breast cancer (OR = 1.02; CI: [1.01; 1.04]; $$\:{P}_{adj}$$=0.002). Subgroup analyses revealed that the high-grade serous ovarian cancer (OR = 1.04; CI: [1.02; 1.06]; $$\:{P}_{adj}$$=0.015) and the ER- breast cancer (OR = 1.04; CI: [1.01; 1.07]; $$\:{P}_{adj}$$=0.118) appeared to drive the observed associations, respectively. No further associations were found between the remaining inflammatory arthritis phenotypes and female-specific cancers.

Conclusions
This study suggests that AS is a risk factor for ovarian cancer, while PsA is linked to an increased breast cancer risk. These results are important for physicians caring women with inflammatory arthritis to advise their patients on cancer screening and preventive measures.
Holy grail or convenient excuse? Stakeholder perspectives on the role of health system strengthening evaluation in global health resource allocation
Authors: Sriram Veena , Palmer Natasha , Pereira Shreya , Bennett Sara 
Published: October 2024

Abstract
Background
The role of evaluation evidence in guiding health systems strengthening (HSS) investments at the global-level remains contested. A lack of rigorous impact evaluations is viewed by some as an obstacle to scaling resources. However, others suggest that power dynamics and knowledge hierarchies continue to shape perceptions of rigor and acceptability in HSS evaluations. This debate has had major implications on HSS resource allocation in global-level funding decisions. Yet, few studies have examined the relationship between HSS evaluation evidence and prioritization of HSS. In this paper, we explore the perspectives of key global health stakeholders, specifically around the nature of evidence sought regarding HSS and its potential impact on prioritization, the challenges in securing such evidence, and the drivers of intra- and inter-organizational divergences. We conducted a stakeholder analysis, drawing on 25 interviews with senior representatives of major global health organizations, and utilized inductive approaches to data analysis to develop themes.

Results
Our analysis suggests an intractable challenge at the heart of the relationship between HSS evaluations and prioritization. A lack of evidence was used as a reason for limited investments by some respondents, citing their belief that HSS was an unproven and potentially risky investment which is driven by the philosophy of HSS advocates rather than evidence. The same respondents also noted that the ‘holy grail’ of evaluation evidence that they sought would be rigorous studies that assess the impact of investments on health outcomes and financial accountability, and believed that methodological innovations to deliver this have not occurred. Conversely, others held HSS as a cross-cutting principle across global health investment decisions, and felt that the type of evidence sought by some funders is unachievable and not necessary – an ‘elusive quest’ – given methodological challenges in establishing causality and attribution. In their view, evidence would not change perspectives in favor of HSS investments, and evidence gaps were used as a ‘convenient excuse’. Respondents raised additional concerns regarding the design, dissemination and translation of HSS evaluation evidence.

Conclusions
Ongoing debates about the need for stronger evidence on HSS are often conducted at cross-purposes. Acknowledging and navigating these differing perspectives on HSS evaluation may help break the gridlock and find a more productive way forward.
Trends in Israeli clinical trials registration “MyTrial”
Authors: Engel Anat , Cohen Ornit 
Published: October 2024

Abstract
Background
Clinical trial registration is critical for research transparency and integrity. Since 2005, the Declaration of Helsinki has required prospective registration of trials before subject recruitment. In Israel, the MyTrial registry was established in 2015 to register interventional trials and became mandatory in 2016 for ethical approval. The study aimed to analyze the registration practices, challenges, and trends in clinical trial registration in Israel using the local registry “MyTrial”.

Methods
A total of 3,895 clinical trial records from 2011 to December 2022 were retrieved from the MyTrial platform and subjected to descriptive analysis.

Results
A significant increase occurred from 2016 to 2021 due to mandated registration, with a peak in 2020 (733 trials) and a decrease in 2022 (462 trials), likely due to COVID-19. Most of the trials included drugs (56%) or medical devices (33%). Geographically, 53% were from central Israel. Only 39% of the patients were registered at both MyTrial and ClinicalTrials.gov. 65% had no blinding. 47% featured unregistered products. 56% had not started recruitment. Since 2016, the number of advanced therapy trials has steadily increased, reaching 19 in 2022. There are gaps between registered trials and official government reports.

Conclusion
These findings provide valuable insights into the current landscape of clinical trial registration in Israel and highlight the need for improvements in compliance with prospective registration and adherence to the WHO-ICTRP standards.
Comparison of conventional internal limiting membrane versus pars plana vitrectomy without peeling for small idiopathic macular hole
Authors: Ruggeri Maria Ludovica , Quarta Alberto , Marolo Paola , Zeppa Lucio , Motta Lorenzo , Gironi Matteo , Toto Lisa , Reibaldi Michele , Mastropasqua Rodolfo 
Published: October 2024

Abstract
Background
The aim of this study was to compare functional and anatomical changes in patients with small full thickness macular holes (FTMHs) who underwent pars plana vitrectomy (PPV) with or without Internal limiting membrane (ILM) peeling.

Methods
42 eyes of 42 patients diagnosed for FTMHs (< 250 micron) were included in our prospective interventional study. Main outcome measures were: Best Corrected Visual Acuity (BCVA), Macular hole closure rate, Ellipsoid Zone (EZ) and External Limiting Membrane (ELM) recover, Vessel Density in both Superficial (VDSCP) and deep (VDDCP) capillary plexus, Macular pigment Optical density (MPOD) and mean Central Macular Sensitivity (CMS).Patients were randomly divided into “peeling group” (21 patients), in which the ILM peeling maneuver was performed and “no-peeling group” (21 patients) in which the ILM was not peeled off. Examinations were repeated one month (T1), three months (T2) and six months (T3) after surgery.

Results
Although significant improvements in terms of MPOD, CMS, VDSCP and VDDCP over time (p < 0.001) no significant differences were found between the peeling and no peeling group. Conversely, FTMHs closure was achieved in all cases (100%) in the peeling group, whereas 10% of cases in the no peeling group experienced the hole re-opening at T3, with reported different rates of ELM/EZ recover between the two groups. Nevertheless, BCVA improved significantly (p < 0.001) but without significant differences between the two groups.

Conclusions
No significant differences were found in terms of anatomical and functional outcomes between the peeling or not the ILM in small FTMHs at 6 months follow-up.