bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midterm Outcomes of Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability in Ehlers-Danlos Syndrome
Authors: Parikh Shital N. , Nemunaitis James , Wall Eric J. , Cabatu Clarence , Gupta Rajul , Veerkamp Matthew W. 
Published: June 2024

Background: Patellar instability is frequently encountered in patients with Ehlers-Danlos syndrome (EDS). The clinical outcomes of isolated medial patellofemoral ligament reconstruction (MPFLR) for patellar instability in patients with EDS are unknown. Purpose: To evaluate midterm clinical outcomes of isolated MPFLR for patellar instability in patients with EDS and factors affecting these outcomes. Study Design: Case series; Level of evidence, 4. Methods: In a retrospective study, 31 patients (n = 47 knees) with EDS and patellar instability who underwent isolated MPFLR for recurrent patellar instability between 2008 and 2017 and had a minimum 2-year follow-up were identified. Preoperative radiographic images were measured for anatomic risk factors. Clinical outcomes—including postoperative complications—were evaluated. Factors associated with MPFLR failure were identified. Postoperative patient-reported outcomes (PROs)—including the pediatric version of the International Knee Documentation Committee, the Kujala score, the Hospital for Special Surgery Pediatric Functional Activity Brief Scale, the Banff Patellofemoral Instability Instrument 2.0, and the Knee injury and Osteoarthritis Outcome Score—were collected, and factors affecting PRO scores were analyzed. Results: The mean age of the cohort was 14.9 ± 2 years. At a mean follow-up of 7.2 years, 18 of 47 (38.3%) knees required reoperations, of which 9 of 47 (19.1%) knees required revision stabilization for recurrent patellar instability. Also, 7 of 31 knees (22.6%) with autografts failed compared with 2 of 16 (12.5%) with allografts ( P = .69). For autografts, 6 of 17 (35.3%) failures occurred with gracilis, but 0 of 13 (0%) occurred with semitendinosus ( P = .02). Compared with patients without failures, patients with failed primary MPFLR were significantly younger ( P = .0005) and were able to touch the palm to the floor with their knees extended ( P = .03). For radiographic parameters, the patellar height and tilt were significantly higher in the failure group. The postoperative PROs were suboptimal at a mean follow-up of 5.2 years. All but 1 patient were satisfied with the final outcome. Conclusion: At the midterm follow-up, 38.3% of patients with EDS required further surgery after isolated MPFLR for patellar instability; half of these revisions (19.1%) were to address recurrent instability. Recurrent instability after isolated MPFLR was more likely in younger patients and those who could touch the palm to the floor with their knees extended. Postoperative PROs were inferior; nonetheless, patient satisfaction was high.
Integrative Group Visits for Sleep Disturbance: A Brief Report
Authors: Kiefer David , Eby Katherine , Zaborek Jennifer , Goldstein Ellen 
Published: June 2024

Background There is limited research on the efficacy of group visits using integrative treatment modalities and for people whose chief concern is sleep disturbance. This quality improvement project delivered integrative health content in group visits for people with self-reported sleep disturbance. Objective To describe an integrative group visit for sleep disturbance, explore the evaluation process for several outcomes, and report on lessons learned. Methods A group visit series involved 4 sessions over the course of 1 month, covering integrative health topics such as acupuncture, mind-body therapies, and herbal medicine. Participants were administered 2 validated surveys (PSQI and PROMIS-29) at baseline and 1- and 3-months post-intervention. Results In 4 4 week GV series,18 people participated in-person pre-pandemic, and 5 people participated virtually during the pandemic. The mean age for the entire cohort was 63.2 years. Of the 23 participants, 18 (78%) attended all 4 GV sessions within their series. Conclusion Preliminary findings from this study suggest that an integrative group visit approach to sleep disturbance is feasible yet would benefit from a more rigorous investigation.
More early bleeds associated with high baseline direct oral anticoagulant levels in atrial fibrillation: the MAS study
Authors: Palareti Gualtiero , Testa Sophie , Legnani Cristina , Dellanoce Claudia , Cini Michela , Paoletti Oriana , Ciampa Antonio , Antonucci Emilia , Poli Daniela , Morandini Rossella , Tala Maurizio , Chiarugi Paolo , Santoro Rita Carlotta , Iannone Angela Maria , De Candia Erica , Pignatelli Pasquale , Faioni Elena Maria , Chistolini Antonio , Esteban Maria del Pilar , Marietta Marco , Tripodi Armando , Tosetto Alberto 
Published: June 2024

Abstract
Treatment with direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) is effective and safe. However, bleeding complications still occur. Whether DOAC level measurement may further improve treatment efficacy and safety is still an open issue. In the "Measure and See" study, venous blood was collected 15-30 days after DOAC initiation in patients with AF who were then followed up for 1 year to record the occurrence of major and clinically relevant nonmajor bleeding. DOAC plasma levels were measured in 1 laboratory, and results were kept blind to patients and treating doctors. Trough DOAC levels were assessed in 1657 patients (957 [57.7%] and 700 patients treated with standard and low-dose, respectively). Fifty bleeding events were recorded during 1606 years of follow-up (3.11% pt/yrs). Fifteen bleeding events (4.97% pt/yrs) occurred in patients with C-trough standardized values in the highest activity class (&gt;0.50), whereas 35 events (2.69% pt/yrs) occurred in those with values in the 2 lower classes (≤0.50, P = .0401). Increasing DOAC levels and low-dose DOAC use were associated with increased bleeding risk in the first 3 months of treatment. Overall, 19% of patients receiving low doses had standardized values in the highest class. More bleeding occurred in patients on low (4.3% pt/yrs) vs standard (2.2% pt/yrs; P = .0160) dose DOAC. Early measurement of DOAC levels in patients with AF identified many individuals with high levels despite the low doses use and had more bleeding risk during the first 3 months of treatment. This trial was registered at www.ClinicalTrials.gov as #NCT03803579.
Wogonin upregulates SOCS3 to alleviate the injury in Diabetic Nephropathy by inhibiting TLR4-mediated JAK/STAT/AIM2 signaling pathway
Authors: Liu Yufeng , Zhang Mengbi , Zeng Lu , Lai Yanhong , Wu Songzhao , Su Xiaoyan 
Published: June 2024

Abstract
Background
Diabetic nephropathy (DN) is a life-threatening renal disease and needs urgent therapies. Wogonin is renoprotective in DN. This study aimed to explore the mechanism of how wogonin regulated high glucose (HG)-induced renal cell injury.

Methods
Diabetic mice (db/db), control db/m mice, and normal glucose (NG)- or HG-treated human tubule epithelial cells (HK-2) were used to evaluate the levels of suppressor of cytokine signaling 3 (SOCS3), Toll-like receptor 4 (TLR4), inflammation and fibrosis. Lentivirus was used to regulate SOCS3 and TLR4 expressions. After oral gavage of wogonin (10 mg/kg) or vehicle in db/db mice, histological morphologies, blood glucose, urinary protein, serum creatinine values (Scr), blood urea nitrogen (BUN), superoxide dismutase (SOD), glutathione (GSH), and reactive oxygen species (ROS) were assessed. RT-qPCR and Western blot evaluated inflammation and fibrosis-related molecules.

Results
HG exposure induced high blood glucose, severe renal injuries, high serumal Src and BUN, low SOD and GSH, and increased ROS. HG downregulated SOCS3 but upregulated TLR4 and JAK/STAT, fibrosis, and inflammasome-related proteins. Wogonin alleviated HG-induced renal injuries by decreasing cytokines, ROS, Src, and MDA and increasing SOD and GSH. Meanwhile, wogonin upregulated SOCS3 and downregulated TLR4 under HG conditions. Wogonin-induced SOCS3 overexpression directly decreased TLR4 levels and attenuated JAK/STAT signaling pathway-related inflammation and fibrosis, but SOCS3 knockdown significantly antagonized the protective effects of wogonin. However, TLR4 knockdown diminished SOCS3 knockdown-induced renal injuries.

Conclusion
Wogonin attenuates renal inflammation and fibrosis by upregulating SOCS3 to inhibit TLR4 and JAK/STAT pathway.
Using expression data to fine map QTL associated with fertility in dairy cattle
Authors: van den Berg Irene , Chamberlain Amanda J. , MacLeod Iona M. , Nguyen Tuan V. , Goddard Mike E. , Xiang Ruidong , Mason Brett , Meier Susanne , Phyn Claire V. C. , Burke Chris R. , Pryce Jennie E. 
Published: June 2024

Abstract
Background
Female fertility is an important trait in dairy cattle. Identifying putative causal variants associated with fertility may help to improve the accuracy of genomic prediction of fertility. Combining expression data (eQTL) of genes, exons, gene splicing and allele specific expression is a promising approach to fine map QTL to get closer to the causal mutations. Another approach is to identify genomic differences between cows selected for high and low fertility and a selection experiment in New Zealand has created exactly this resource. Our objective was to combine multiple types of expression data, fertility traits and allele frequency in high- (POS) and low-fertility (NEG) cows with a genome-wide association study (GWAS) on calving interval in Australian cows to fine-map QTL associated with fertility in both Australia and New Zealand dairy cattle populations.

Results
Variants that were significantly associated with calving interval (CI) were strongly enriched for variants associated with gene, exon, gene splicing and allele-specific expression, indicating that there is substantial overlap between QTL associated with CI and eQTL. We identified 671 genes with significant differential expression between POS and NEG cows, with the largest fold change detected for the CCDC196 gene on chromosome 10. Our results provide numerous candidate genes associated with female fertility in dairy cattle, including GYS2 and TIGAR on chromosome 5 and SYT3 and HSD17B14 on chromosome 18. Multiple QTL regions were located in regions with large numbers of copy number variants (CNV). To identify the causal mutations for these variants, long read sequencing may be useful.

Conclusions
Variants that were significantly associated with CI were highly enriched for eQTL. We detected 671 genes that were differentially expressed between POS and NEG cows. Several QTL detected for CI overlapped with eQTL, providing candidate genes for fertility in dairy cattle.
Definition of metafounders based on population structure analysis
Authors: Anglhuber Christine , Edel Christian , Pimentel Eduardo C. G. , Emmerling Reiner , Götz Kay-Uwe , Thaller Georg 
Published: June 2024

Abstract
Background
Limitations of the concept of identity by descent in the presence of stratification within a breeding population may lead to an incomplete formulation of the conventional numerator relationship matrix ($$\mathbf{A}$$
A
). Combining $$\mathbf{A}$$
A
with the genomic relationship matrix ($$\mathbf{G}$$
G
) in a single-step approach for genetic evaluation may cause inconsistencies that can be a source of bias in the resulting predictions. The objective of this study was to identify stratification using genomic data and to transfer this information to matrix $$\mathbf{A}$$
A
, to improve the compatibility of $$\mathbf{A}$$
A
and $$\mathbf{G}$$
G
.

Methods
Using software to detect population stratification (ADMIXTURE), we developed an iterative approach. First, we identified 2 to 40 strata ($$k$$
k
) with ADMIXTURE, which we then introduced in a stepwise manner into matrix $$\mathbf{A}$$
A
, to generate matrix $${\mathbf{A}}^{{\varvec{\Gamma}}}$$

A

Γ

using the metafounder methodology. Improvements in consistency between matrix $$\mathbf{G}$$
G
and $${\mathbf{A}}^{{\varvec{\Gamma}}}$$

A

Γ

were evaluated by regression analysis and through the comparison of the overall mean and mean diagonal values of both matrices. The approach was tested on genotype and pedigree information of European and North American Brown Swiss animals (85,249). Analyses with ADMIXTURE were initially performed on the full set of genotypes (S1). In addition, we used an alternative dataset where we avoided sampling of closely related animals (S2).

Results
Results of the regression analyses of standard $$\mathbf{A}$$
A
on $$\mathbf{G}$$
G
were – 0.489, 0.780 and 0.647 for intercept, slope and fit of the regression. When analysing S1 data results of the regression for $${\mathbf{A}}^{{\varvec{\Gamma}}}$$

A

Γ

on $$\mathbf{G}$$
G
corresponding values were – 0.028, 1.087 and 0.807 for $$k$$
k
=7, while there was no clear optimum $$k$$
k
. Analyses of S2 gave a clear optimal $$k$$
k
=24, with − 0.020, 0.998 and 0.817 as results of the regression. For this $$k$$
k
differences in mean and mean diagonal values between both matrices were negligible.

Conclusions
The derivation of hidden stratification information based on genotyped animals and its integration into $$\mathbf{A}$$
A
improved compatibility of the resulting $${\mathbf{A}}^{{\varvec{\Gamma}}}$$

A

Γ

and $$\mathbf{G}$$
G
considerably compared to the initial situation. In dairy breeding populations with large half-sib families as sub-structures it is necessary to balance the data when applying population structure analysis to obtain meaningful results.
Serum beta2-microglobulin acts as a biomarker for severity and prognosis in glioma patients: a preliminary clinical study
Authors: Liu Zhen-Yuan , Tang Feng , Wang Jing , Yang Jin-Zhou , Chen Xi , Wang Ze-Fen , Li Zhi-Qiang 
Published: June 2024

Abstract
Background
Gliomas are the deadliest malignant tumors of the adult central nervous system. We previously discovered that beta2-microglobulin (B2M) is abnormally upregulated in glioma tissues and that it exerts a range of oncogenic effects. Besides its tissue presence, serum B2M levels serve as biomarkers for various diseases. This study aimed to explore whether serum B2M levels can be used in the diagnosis and prognosis of gliomas.

Methods
Medical records from 246 glioma patients were retrospectively analyzed. The relationship between preoperative serum B2M levels and clinicopathological features was examined. Kaplan-Meier analysis, alongside uni- and multivariate Cox regression, assessed the association between B2M levels, systemic inflammatory markers, and glioma patient prognosis. Receiver operating characteristic (ROC) curve analysis evaluated the diagnostic significance of these biomarkers specifically for glioblastoma (GBM).

Results
Patients with malignant gliomas exhibited elevated preoperative serum B2M levels. Glioma patients with high serum B2M levels experienced shorter survival times. Multivariate Cox analysis determined the relationship between B2M levels (hazard ratio = 1.92, 95% confidence interval: 1.05–3.50, P = 0.034) and the overall survival of glioma patients. B2M demonstrated superior discriminatory power in distinguishing between GBM and non-GBM compared to inflammation indicators. Moreover, postoperative serum B2M levels were lower than preoperative levels in the majority of glioma patients.

Conclusions
High preoperative serum B2M levels correlated with malignant glioma and a poor prognosis. Serum B2M shows promise as a novel biomarker for predicting patient prognosis and reflecting the therapeutic response.
Preparation of the pre-service teacher to deliver comprehensive sexuality education: teaching content and evaluation of provision
Authors: Hendriks Jacqueline , Mayberry Lorel , Burns Sharyn 
Published: June 2024

Abstract
Background
Despite the extensive benefits associated with the provision of comprehensive sexuality education (CSE) within a school context, many initial teacher training programs inadequately prepare pre-service teachers to deliver this content. Programs that do provide such instruction do not routinely share details of their curriculum, syllabi, or evaluation data.

Methods
This paper outlines the structure of an Australian undergraduate course for pre-service teachers that focuses on instruction in CSE. This course spans twelve teaching weeks, aligns with evidence-based principles for sexuality education, prioritises experiential learning and requires students to complete authentic, practical assessment tasks. Formative, process, and short-term impact evaluation data, based upon five years of delivery, are described.

Results
Students completing this course reported statistically significant improvements in attitudes associated with CSE and comfort in facilitating all domains of learning (knowledge, attitudes, skills).

Conclusions
Positive process and short-term impact data provide strong evidence for the provision of CSE to pre-service teachers, regardless of future teaching speciality. Proposed amendments include the creation of a fully online tuition pattern and an expansion of content to incorporate other audiences, such as community-based educators.
In vivo non-contact regions of proximal scaphoid in six extreme wrist positions
Authors: Xie Ren-Guo 
Published: June 2024

Abstract
Introduction
Fractures of the scaphoid are the most common carpal injuries, account for 80-90% of all carpal fractures. 5-15% nonunion of scaphoid fractures were reported even with adequate primary treatment, which probably progresses to osteoarthritic changes several decades later. Researches regarding to scaphoid physiological characteristic in vitro and in vivo and kinds of trials in clinical practice are being kept on going, which contribute much to our clinical practice. With the advancing wrist arthroscopy, 3D-print patient-specific drill guide, and intraoperative fluoroscopic guidance, dorsal approach (mini-invasive and percutaneous technique) is being popular, through which we can implant the screw in good coincidence with biomechanics and with less disturbing tenuous blood supply of the scaphoid. Investigating the noncontact area of the dorsal proximal scaphoid in different wrist positions can facilitate preoperatively estimating insert point of the screw.

Materials and methods
Eight volunteers were recruited to accept CT scans in six extreme wrist positions. The images of DICOM mode were imput into the Mimics analytical system, the segmented scaphoid, lunate and radius were exported in mode of ASCII STL and were opened in the software of Geomagic studio. We created four planes based on anatomic markers on the surface of the radius and scaphoid to confine the proximal scaphoid to form the so-called non-contact regions. We measured and compared the areas in six targeted positions.

Results
Amidst six extreme wrist positions, area of the non-contact region in extreme dorsal extension (59.81 ± 26.46 mm2) was significantly the smallest, and it in extreme palmar flexion significantly was largest (170.51 ± 30.44 mm2). The non-contact regions increased in order of dorsal extension, supination, ulnar deviation, radial deviation, pronation and palmar flexion. As for two-group comparison, the non-contact region showed significantly larger (p < 0.05) in palmar flexion than the others except for in pronation individually, and in radial deviation (p < 0.05) than in dorsal extension.

Conclusions
Sufficient space was available for the screw started from the dorsal approach despite the wrist positions.
Stress and exhaustion among medical students: a prospective longitudinal study on the impact of the assessment period on medical education
Authors: Santiago Isabela Silva , de Castro e Castro Safira , de Brito Ana Paula Amaral , Sanches Daniel , Quintanilha Luiz Fernando , Avena Katia de Miranda , Andrade Bruno Bezerril 
Published: June 2024

Abstract
Background
Stress significantly affects both the physical and emotional health of individuals, particularly students in health-related fields. Medical students in Brazil face unique challenges due to the demanding nature of their studies, especially during assessment periods, which heighten academic pressure. These pressures often lead to poor coping strategies and mental health concerns. It is crucial to understand the complex dynamics of stress within medical education to develop strategies that improve student well-being and promote a healthier academic environment. This study aims to investigate the intricate relationship between assessment periods and stress levels among medical students. It seeks to understand how academic demands and sociodemographic factors contribute to stress dynamics during these periods.

Methods
An online observational, longitudinal, and prospective study was conducted from February to October 2022. Medical students were recruited through snowball sampling and participated in surveys administered via Google Forms at two timepoints: before (T1) and during (T2) assessment periods. The surveys collected sociodemographic data and stress symptoms using Lipp’s Inventory of Stress Symptoms for Adults (LSSI).

Results
The transition from T1 to T2 was defined by a rise in the prevalence of stress from 59.6 to 84.2% (p = 0.001) and a decline in symptom-free students from 40.4 to 15.8% (p = 0.001). There was a significant increase in exhaustion, from 12.3 to 31.6% (p = 0.0001). Higher stress levels were notably more prevalent among younger students (≤ 24 years), females, those from wealthier families, students without scholarships, those without prior degrees, and those in the clinical phase of their studies. However, non significant correlations were found between these sociodemographic and academic factors and the increase in stress.

Conclusion
The findings highlight significant concerns regarding the mental health of medical students during assessment periods, marked by increased stress and exhaustion levels. These results emphasize the need for proactive interventions to manage stress effectively in medical education, considering its profound impact on students’ well-being.
The relationship between nurses’ moral competency and missed nursing care: a descriptive-correlational study
Authors: Nazari Amir Mohamad , Borhani Fariba , Zare-Kaseb Akbar , Zafarnia Niloofar 
Published: June 2024

Abstract
Background
When any aspect of patient care is overlooked or delayed, it is known as Missed Nursing Care (MNC), leading to adverse events such as medication errors, infections, increased mortality rates, and poor prognosis. Moral competence is crucial for clinical nurses as it guarantees high-quality patient care in nursing practice. Thus, this study aimed to investigate the correlation between moral competencies and MNC among nurses.

Methods
This study was conducted with a descriptive-correlational design. The participants in the study were nurses who were currently enrolled at Shahid Beheshti University of Medical Sciences. In order to recruit nurses for the study, a convenience sampling method was implemented. The study tools were completed by a total of two hundred nurses. Research tools included a demographic questionnaire, the Moral Competence of Clinical Nurses Questionnaire, and the Kalisch and Williams Missed Nursing Care (MISSCARE) survey.

Ethical consideration
This study was approved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences.

Results
The mean scores of moral competencies and MNC were 151.83 ± 12.60 and 42.71 ± 9.38, respectively. In other words, descriptive statistics showed that the moral competence score was more than 75%, and the MNC score was less than 50%. Also, there was a significant negative correlation between the total scores of moral competencies and MNC (r = -0.38, p < 0.001), indicating that more moral competence was correlated with lower levels of MNC.

Conclusion
The study revealed a negative correlation between nurses’ moral competence and MNC, suggesting that enhancing moral competence could reduce MNC. To reduce MNC occurrences, hospitals, and organizations should prioritize moral competency, according to our research.