bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors influencing access to primary health care in Luanda, Angola
Authors: de Carvalho Maquengo Antónia Sónia , Bastos Alfredo Manuel , Santana Marli Stela 
Published: February 2025

Abstract

Introduction
The primary health care system is the first of the three hierarchical levels of care, and it is the first point of contact of the population with the health system. In Luanda, Angola, the primary care network presents challenges in its management, as well as in the perception of its purposes, which constitutes a serious problem for the demand for health services, being the reason for this study. The present research aimed to evaluate the level of adherence and satisfaction related to the health care system and their influence on usage of the public primary health care facilities in Luanda, from the perspective of health professionals and users.

Methods
A cross-sectional and descriptive study was carried out on 120 health professionals and 423 users.

Results
We found a statistically significant association between the level of education and the professionals' disbelief in health services (P = 0.001), as well as the users' family income (P = 0.0002).

Discussion
The users' perception is that there is a switch in test results (P = 0.01). Furthermore, they also believe that when attending health units, the user leaves sicker than he entered (P = 0.01).

Conclusion
Thus, it was found that the level of user adherence to the services of the primary health care units in Luanda ranged between "good" and "acceptable". We identified elements capable of compromising the quality of services and, consequently, interfering with adherence to them, which suggests the need for the development of management strategies for health facilities, in order to overcome the challenges presented in the study.
An exploratory study of electronic medical record implementation and recordkeeping culture: the case of hospitals in Indonesia
Authors: Hossain Md. Khalid , Sutanto Juliana , Handayani Putu Wuri , Haryanto Anasthasia Agnes , Bhowmik Joy , Frings-Hessami Viviane 
Published: February 2025

Abstract

Background
The digitization of healthcare, through electronic medical records (EMRs), is recognized globally as a transformative initiative. Indonesia mandated all healthcare facilities to adopt EMRs by December 31, 2023. However, this transition is complicated by diverse technological, cultural, and infrastructural challenges, with little research addressing the recordkeeping culture's impact on EMR adoption. This study investigates the electronic recordkeeping culture in Indonesian hospitals following a government mandate to adopt Electronic Medical Records (EMRs). It aims to understand the readiness and challenges in implementing EMRs across hospitals on Java and Sulawesi islands, focusing on infrastructure, staff digital skills, and varied adoption approaches.

Methods
A qualitative case study approach was utilized, involving focus groups and semi-structured interviews with 150 staff from 12 hospitals. Conducted between November 2023 and June 2024, the study applied thematic analysis based on Oliver and Foscarini’s (2020) recordkeeping culture framework to explore organizational readiness, technological infrastructure, and healthcare professionals' skills in managing electronic records.

Results
The findings reveal significant differences in EMR adoption between the islands. Hospitals on Java exhibited proactive engagement, supported by better technological infrastructure and staff training programs, while Sulawesi hospitals adopted EMRs primarily to meet regulatory requirements. Challenges included inconsistent internet connectivity, low digital literacy among staff, and ongoing reliance on paper records during the transition. Some Java hospitals have begun fostering a culture conducive to electronic recordkeeping by focusing on developing staff skills in EMR management.

Conclusions
The effectiveness of EMR adoption in Indonesia relies on addressing technological infrastructure issues and enhancing staff digital literacy. While progress has been made, particularly in more developed regions, a cohesive national strategy emphasizing technological support and targeted training is essential to fully realize the benefits of EMRs in improving healthcare and recordkeeping standards across Indonesia.
Placental expression of estrogen and progesterone receptors and vascular endothelial growth factor in buffaloes suffering from uterine torsion
Authors: Amin Yahia A. , Elnegiry Ahmed Abdou , Awadalla Eatemad A. , Hussein Hassan A. , Mohamed Ragab H. 
Published: February 2025

Abstract

Background
Although several risk factors have been suggested for uterine torsion, the pathogenesis is still unclear. Therefore, the current study aims to investigate the pathogenesis of uterine torsion by assessing the histological, histochemical, and immunohistochemical changes that occur in the placenta obtained from uterine torsion cases. Immunohistochemical changes include investigation of the expression of estrogen receptors (ERs), progesterone receptors (PRs), and the vascular endothelial growth factor (VEGF) in the placental tissue.

Methods
Forty intrapartum dairy cows were included in this investigation. The cows were divided into two equal groups. The first group was the uterine torsion (UT) group, while the second group was the normal control group (Ctrl). After caesarian section treatment, placentas were collected from all animals in the study. Histopathological, histochemical, and immunohistochemical examinations were performed. Estrogen receptors, progesterone receptors, and vascular endothelial growth factor expression in the placenta were evaluated.

Results
The results revealed numerous trophoblast giant or binucleate cells in the trophoblastic epithelium. Through Masson’s trichrome technique, the distribution of collagen fibers as shiny, blue-colored stripes on the fetal mesenchyme was observed. Additionally, the results showed a strong, intense PAS-positive reaction in the cytoplasmic vesicles of most trophoblastic cells due to mucopolysaccharides. The immunohistochemical findings of the UT placenta revealed moderate to weak staining for ERs in contrast to those of the Ctrl placenta, which revealed moderate staining for ERs. In addition, non-statistical differences in the expression of PRs were found between the two tested groups. For VEGF, strong positive immunoreactivity was found in the Ctrl group compared to the UT group, which exhibits a general absence in many trophoblast cells.

Conclusion
It can be concluded that significant variation was observed in the placentas obtained from buffaloes suffering from UT compared to those obtained from normal pregnant ones. These significant variations were involved in the decreased expression of ERs and VEGF in the UT group compared to the normal Ctrl one. Investigating the expression of these placental molecules may monitor the changes in the placental tissue and provide insight into the pathogenesis of UT.
Development of computer adaptive tests to assess the psychological status of individuals with an eating disorder or type 2 diabetes
Authors: Horie Takeshi , Kurisu Ken , Inada Shuji , Kawahara Kenshi , Matsuyama Yutaka , Kikuchi Hiroe , Yamamoto Yoshiharu , Yamauchi Toshimasa , Yoshiuchi Kazuhiro 
Published: February 2025

Abstract

Background
Individuals with type 2 diabetes and eating disorders must change their eating behaviors, which are often influenced by psychological factors like depression and anxiety. To efficiently assess daily psychological status, the present study aimed to develop computerized adaptive tests (CAT) based on item response theory (IRT).

Methods
Individuals with depression, anxiety disorders, eating disorders, type 2 diabetes, and healthy persons participated in the study. Participants completed six questionnaires, including momentary and most recent one-week depression, anxiety, and positive affect. We selected items meeting the IRT assumptions, applied a graded response model, and conducted CAT simulations.

Results
Across all six questionnaires, the CAT simulations used a smaller number of items and exhibited substantial Pearson’s correlation coefficients exceeding 0.95 between simulated and full item-set mood status estimates. These estimated mood scores demonstrated satisfactory concurrent validity with the Hospital Anxiety and Depression Scale and sufficient discriminant validity between the clinical group and healthy controls.

Conclusion
These findings suggest that these scales offer efficient measurement of the mood status of individuals with an eating disorder or type 2 diabetes.
Gender differences in symptom interactions between problematic smartphone use and social anxiety in adolescents: a network analysis
Authors: Guo Sipu , Zou Xinyuan , Tao Yanqiang , Lv Yichao , Liu Xiangping , Huang Silin 
Published: February 2025

Abstract

Background
Increased prevalence of problematic smartphone use (PSU) in adolescents, results in a cycle of interaction between PSU and social anxiety. However, it is still unknown whether PSU and social anxiety symptoms have interacted among adolescents and whether there are gender differences in these symptoms. Therefore, this study investigated the gender differences in the symptom interactions between PSU and social anxiety via symptom network analysis.

Methods
This study included 2918 adolescents (52.71% boys; M
age = 14.73, SD
age = 1.39) from junior and senior high schools in China. The Mobile Phone Addiction Index and Social Anxiety Scale were used to evaluate symptomatology and networks. Network analysis and network comparison tests were used to determine the network structure, centrality, bridge symptoms and gender differences in the PSU-social anxiety network among adolescents.

Results
The most influential symptoms were “productivity loss” and “afraid of negative evaluation”. “Afraid of negative evaluation” was the bridge through which PSU was related to social anxiety. Gender differences were not found in network strength but occurred in network structure. Although girls reported more social anxiety, boys had a tighter network structure. The correlation between PSU and social anxiety was greater in boys than in girls. The “inability to control craving” was particularly critical for girls, while “feeling anxious and lost” was prominent for boys.

Conclusions
The current study highlights the symptom interactions between PSU and social anxiety among adolescents and the gender differences in network structures. Further intervention that targets “afraid of negative evaluation” may disassociate the interaction between PSU and social anxiety symptoms. In particular, changing girls’ cognitive ability (e.g., inhibition) and boys’ negative emotions are potentially effective means of intervention. The limitations of the cross-sectional design and data-driven methodology necessitate interpreting the results with caution.
Multi-pathway targeted therapy of MASH-HCC using miR-22
Authors: Hu Ying , Setayesh Tahereh , Wei Dongguang , Testerman Trenton , Ji Yutong , Wan Yu-Jui Yvonne 
Published: February 2025

Abstract

Background
The treatment options for hepatocellular carcinoma (HCC) are limited, and there is no effective drug that can improve long-term survival rates. Complicated cocktails consisting of multiple medications with toxicities are frequently used to treat cancer. The current study addresses these challenges.

Methods
The study uses metabolic dysfunction-associated steatohepatitis (MASH)-HCC and HCC mouse models established by transfecting the livers using myr-AKT1, NRasV12, and Sleeping Beauty transposase. AAV8-miR-22 was delivered to MASH-HCC and HCC to study its preventive and therapeutic effects. Spatial transcriptomic profiling revealed the signaling pathways affected by miR-22 according to histological locations.

Results
miR-22 treatment effectively treated MASH-HCC and HCC. Treating mice with miR-22 before tumor initiation prevented oncogenesis. The promising anti-cancer effects were revealed by reduced tumor load, fibrosis, and splenomegaly, extending the survival time. miR-22 treatment generated anti-tumor immunity. The favorable treatment outcomes were accompanied by a reduction in dendritic cells, T and B cells, and plasma cells, which were expanded inside the tumors of MASH-HCC. In all animal trials, miR-22 improved metabolism and reduced glycolysis inside the tumors. Moreover, miR-22 profoundly inhibited extracellular matrix (ECM) and targeted MET, PDGF, tyrosine kinase signaling, and IGF pathways inside the tumors. Furthermore, the roles of miR-22 in blocking collagen formation and cross-assembly of collagen fibrils could be due to miR-22's effects in inhibiting Rho GTPase pathways, revealed at the tumor margin.

Conclusion
miR-22 generates anti-HCC effects by targeting many critical pathways in liver carcinogenesis in cancer and tumorigenic niches, potentially revolutionizing HCC treatment.
Treatment rationale in nutcracker syndrome with concurrent pelvic congestion syndrome
Authors: Steffen Dominik A. , Najafi Arash , Festas Georgios , Binkert Christoph A. 
Published: February 2025

Abstract
The optimal management strategy of nutcracker syndrome is debated, especially in the setting of concurrent pelvic congestion syndrome. In this article, we describe our treatment algorithm as illustrated by four different case scenarios. In our experience, renocaval pressure gradients are often inconclusive, but evaluation of the left renal vein waveform as well as a “test PTA” with evidence of a waist in the balloon can be helpful in unmasking a relevant stenosis. We consider nutcracker syndrome not to be a contraindication for ovarian vein embolization. Decision for simultaneous or sequential stenting should be based on angiographic findings and clinical course.
Patients with anti-PM/Scl-positive and idiopathic inflammatory myopathy resemble anti-synthetase syndrome
Authors: Barbosa Rafaella do Amaral , Shinjo Samuel Katsuyuki 
Published: February 2025

Abstract

Background
Anti-PM/Scl autoantibody has been associated with an overlap between polymyositis (PM) and systemic sclerosis (SSc). However, due to limited studies, the relevance of this autoantibody in patients with idiopathic inflammatory myopathies (IIMs) without SSc was analyzed.

Methods
This single-center retrospective cohort study was conducted between 2004 and 2024. A total of 93 adult patients with IIMs (66 with dermatomyositis and 27 with PM - EULAR/ACR 2017) without SSc were included: 16 anti-PM/Scl(+) and 77 anti-PM/Scl(-). Patients with other types of IIMs, cancer-associated myositis, or overlap myositis, including SSc, as well as those with other myositis-specific and/or myositis-associated autoantibodies were excluded.

Results
The median age, sex distribution, and median follow-up duration were comparable between the anti-PM/Scl(+) and anti-PM/Scl(-) groups. There were no differences in clinical and laboratory characteristics, except for a higher frequency of lung involvement, joint involvement, “mechanics’ hand,” “hiker’s feet,” and Raynaud’s phenomenon, in contrast to a lower frequency of facial rash and “V”-neck sign in patients with anti-PM/Scl(+) than in those with anti-PM/Scl(-) (all P < 0.05). Furthermore, patients with anti-PM/Scl(+) exhibited a higher frequency of disease relapse (68.8% vs. 33.8%), disease activity (50.0% vs. 24.7%), and immunosuppressant use (methotrexate or azathioprine) at the last medical evaluation (all P < 0.05). Severe infection and death rates were comparable between the groups.

Conclusions
Anti-PM/Scl positivity was observed in 17.2% of the sample analyzed in the present study. Patients with this autoantibody present clinical manifestations resembling anti-synthetase syndrome, with increased disease relapse and activity rates.
Selective Therapeutic Potential of a H2O2 Inducible DNA Interstrand Cross-Linker in Anaplastic Thyroid Carcinoma
Authors: Lu Chenghui , Yu Dehao , Wang Xufu , Li Jiao , Zhang Yingying , Wang Congcong , Jia Qiang , Tan Jian , Zheng Wei , Sun Huabing , Meng Zhaowei 
Published: February 2025

Abstract

Objective
We aimed to investigate Hydrogen Peroxide Inducible DNA Interstrand Cross-Linker (HP-ICL) as a targeted therapy for anaplastic thyroid cancer (ATC) due to its higher H2O2 content compared to normal cells.

Methods
In vitro analysis included fluorescence microscopy for H2O2 levels, and exposure of ATC cells to various HP-ICL concentrations followed by assessment of cell viability, apoptosis, cell cycle, and DNA damage using MTT, flow cytometry, and a γH2AX assay. Protein levels related to apoptosis and the PI3K/AKT/mTOR pathway were measured by western blotting. An ATC xenograft mouse model was used to evaluate HP-ICL's in vivo effects.

Results
ATC cells had higher H2O2 levels than normal thyroid cells. HP-ICL treatment caused a dose-dependent decrease in cell viability and an increase in apoptosis, with a slight G2/M phase arrest. A 30 µM HP-ICL treatment doubled γH2AX foci. Bcl-2 levels decreased, while Bax, cleaved-Caspase 3 and PARP increased in a dose-dependent manner. It also inhibited p-PI3K, p-AKT, and p-mTOR. In vivo, HP-ICL significantly inhibited tumor growth while maintaining body weight and without causing organ damage or altering thyroid hormone levels. Additionally, tumor sections exhibited increased TUNEL staining, decreased Ki67 expression, and reduced levels of p-PI3K, p-AKT, and p-mTOR.

Conclusion
HP-ICL significantly inhibited ATC both in vitro and in vivo, suggesting its potential as an effective therapy for ATC.
Small-Scale Institutions in Karen Tei Yamashita's I Hotel
Authors: Strombeck Andrew 
Published: February 2025

Abstract
This article examines tensions between I Hotel's sprawling, experimental form—which appears tailored to the disruptions of the 1960s and 1970s—and its continual return to the stabilizing function of the hotel itself. I Hotel meditates on the problems and possibilities of literary building, within a historical setting that represents the very epitome of anti-institutionalism. Published at a moment—the aftermath of the 2008 crash—when housing insecurity had again emerged as a significant site of activism, I Hotel examines the utopian possibilities latent within small-scale institutions, even as it also acknowledges the real limitations of such institutions. Rife with productive contradictions, I Hotel depicts the hotel as both real and imaginary, singular and multiple, actual and potential. In doing so, Yamashita's novel suggests ways that literary works help readers conceptualize the difficult territory between revolutionary transformation and institutional reform.
Transforaminal Full-Endoscopic Surgery for Lumbar Foraminal Pathologies: A Comparative Clinical Effectiveness Study
Authors: Sugiura Kosuke , Payne Cathryn , Tran Nguyen T. , Leyendecker Jannik , Ogunlade John , LaVanne Mary , Derman Peter B. , Quon Robert , Telfeian Albert E. , Hofstetter Christoph P. ,   on behalf of the Endoscopic Spine Research Group (ESRG)
Published: February 2025

BACKGROUND AND OBJECTIVES:
Full-endoscopic surgery is increasingly used for treating lumbar foraminal pathologies, though the specific indications remain unclear. This study aims to evaluate patient-reported outcomes after transforaminal full-endoscopic spine surgery for various lumbar foraminal conditions.

METHODS:
Multicenter cohort study of patients with intervertebral lumbar foraminal pathology who underwent full-endoscopic decompression at four medical centers. Postoperative patient-reported outcomes, including low back and leg pain as well as Oswestry Disability Index (ODI) scores, were prospectively tracked using a mobile app for 6 months. Six-month outcome measures (patient-reported outcome measures) were used as the primary outcome variable to determine treatment effectiveness regarding various foraminal pathologies.

RESULTS:
A total of 83 patients with a mean age of 57.04 ± 1.63 years were included. The most common operative levels were L4/5 for transforaminal endoscopic discectomies (59.6%) and L5/S1 for endoscopic foraminotomies (58.1%). Endoscopic discectomies resulted in significant improvements in Visual Analog Scale scores for low back pain (from 5.85 ± 0.43 to 3.02 ± 0.41; P < .001), leg pain (from 6.66 ± 0.34 to 3.12 ± 0.57; P < .001), and ODI scores (from 24.39 ± 1.35 to 12.32 ± 176; P < .001). Endoscopic foraminotomies also resulted in significant improvements in Visual Analog Scale scores for low back pain (from 5.58 ± 0.53 to 3.68 ± 0.58; P < .001) and leg pain (from 6.42 ± 0.47 to 4.21 ± 0.58; P < .001), as well as ODI scores (from 19.28 ± 1.41 to 14.67 ± 2.03; P < .01). The amount of improvement was independent of the severity of foraminal stenosis, as determined on preoperative MRI. However, vertical foraminal stenosis was associated with the lowest treatment response rate.

CONCLUSION:
Endoscopic foraminotomies result in clinically meaningful symptomatic improvement for most lumbar foraminal pathologies. However, the effectiveness of decompression surgery for vertical foraminal stenosis is limited and requires further investigation.
How Do Robotics and Navigation Facilitate Minimally Invasive Spine Surgery? A Case Series and Narrative Review
Authors: Quiceno Esteban , Soliman Mohamed A. R. , Khan Asham , Mullin Jeffrey P. , Pollina John 
Published: February 2025

BACKGROUND AND OBJECTIVES:
Image guidance has transformed minimally invasive spine surgery (MISS), allowing for safer procedures without excessive bony exposure and reducing radiation exposure for the surgical team. Robotic platforms have enhanced the benefits of navigation by providing high precision and accuracy. Here we describe a case series to demonstrate the accuracy and low complication rates of real-time image-guided robotic-assisted (RA) MISS at a tertiary referral center. In addition, we performed a narrative review on how robotics and navigation facilitate MISS.

METHODS:
A retrospective chart review was conducted to obtain data for patients who underwent RA lumbar fusions with real-time navigation for degenerative lumbar pathology between September 1, 2021, and January 1, 2024. The Mazor X Stealth Edition (Medtronic) robotic platform was used. The accuracy of screw placement was determined according to Gertzbein-Robbins classification. Intraoperative and postoperative complication rates up to 90 days were recorded. Intraoperative variables and length of stay were compared between open and percutaneous groups.

RESULTS:
A total of 247 patients underwent insertion of 1156 pedicle screws. The mean patient age was 61.1 ± 11.5 years. The mean total operative time was 195.1 ± 80.8 minutes. The mean operative time per screw was 4.2 ± 1.4 minutes, with a mean of 4.6 ± 1.4 screws per case. The mean fluoroscopy time per screw was 6.4 ± 6.2 seconds. Eighty-five patients (34.4%) underwent open RA pedicle screw placement, and 162 (65.6%) underwent percutaneous RA pedicle screw placement. No differences in operative time, length of stay, fluoroscopy time, and surgical complications were found between groups. Intraoperatively, 2 patients (0.8%) experienced complications and 4 patients (1.6%) developed complications within 90 days. Screw placement accuracy was perfect in 1126 screws (97.4%) and clinically acceptable in 30 screws (2.6%). These results were consistent with those reported in the literature.

CONCLUSION:
Robotic platforms have further enhanced navigation benefits by providing high precision and accuracy, with low complication rates.