bluuebunny/crossref_metadata_2025_split huggingface dataset:
Signaling pathways in the treatment of Alzheimer’s disease with acupuncture: a narrative review
Authors: Ke Chao , Shan Shengtao , Tan Yan , Cao Yang , Xie Zhengrong , Shi Senjie , Pan Jiang , Zhang Wei 
Published: June 2024

Background: To date, there is no effective treatment for Alzheimer’s disease (AD), a progressive neurodegenerative disorder that is increasing in prevalence worldwide. The objective of this review was to summarize the core targets and signaling pathways involved in acupuncture treatment for AD. Methods: We reviewed numerous signaling pathways, including mammalian target of rapamycin (mTOR), phosphatidylinositol 3-kinase–protein kinase B (PI3 K/Akt), adenosine monophosphate–activated protein kinase (AMPK), mitogen-activated protein kinase (MAPK), nuclear factor (NF)-kB, p53, Wnt, nitric oxide (NO), Janus kinase / signal transducer and activator of transcription (JAK/ STAT), RhoA/ROCK (Rho-associated protein kinase) and Ca2+/ calmodulin-dependent protein kinase II (CaMKII) / cyclic adenosine monophosphate-response element-binding protein (CREB). The relevant data were obtained from PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang databases. Results: In summary, the effects of acupuncture are mediated by multiple targets and pathways. Furthermore, acupuncture can improve pathological changes associated with AD (such as abnormal deposition of amyloid (A)β, tau hyperphosphorylation, synaptic dysfunction and neuronal apoptosis) through multiple signaling pathways. Conclusion: Overall, our findings provide a basis for future research into the effects of acupuncture on AD.
Understanding the Association Between Type 2 Diabetes Mellitus and Cognitive Impairment: A Single-centre Experience
Authors: Suvvari Tarun Kumar , Kali Chandra Shekar 
Published: June 2024

Background The global prevalence of diabetes mellitus has been increasing, leading to a rise in morbidity associated with the disease. While diabetic nephropathy, retinopathy and neuropathy are routinely screened in diabetic patients, the cognitive decline associated with diabetes is often overlooked. Purpose The purpose of this study is to investigate the prevalence of cognitive impairment and its associated risk factors among patients with type 2 diabetes mellitus (T2DM). Methods An observational cross-sectional study was conducted for two months. The Montreal Cognitive Assessment (MoCA) test, which consists of 30 questions, was used to assess cognitive function. In-depth clinical history along with glycaemic parameters were collected. The chi-square test was used to find out the association between categorical variables and cognitive impairment. Pearson’s correlation test was performed to determine the correlation between glycaemic parameters and cognitive impairment. Results A total of 96 patients participated in the study. The mean HbA1c (%) was 9.08 ± 1.73, and the mean MoCA score was 25.14 ± 1.63. Mild cognitive impairment (MCI) was noted in 56% patients. Attention was the most common cognitive domain defect found in all MCI patients—100%. Delayed recall and memory were the second most common cognitive domain defect found—92.5%. Higher HbA1c, high FBS and higher PPBS were found to be statistically associated with MCI. A negative correlation was found between glycaemic parameters (HbA1c, FBS and PPBS levels) and MoCA scores. Conclusion More than half of our study participants reported mild cognitive impairment. It highlights the need for the implementation of routine cognitive testing for diabetes patients. There is a strong negative correlation between MoCA scores and parameters of glycaemic control; higher levels of HbA1c, FBS, and PPBS are seen in people with a lower MoCA score, indicating mild cognitive impairment. Further studies are needed to evaluate whether improving glucose levels helps in improving cognition or not.
Cost burden of chemotherapy for Indonesian healthcare insurance and social security/Jaminan Kesehatan Nasional (JKN) patients with non-Hodgkin lymphoma
Authors: Yulistiani Yulistiani , Abdissalam Erfan , Rahem Abdul , Hamidi Nur Fauzi , Utomo Febriansyah Nur 
Published: June 2024

Background Cancer is among the leading causes of death globally, posing a significant economic burden on the healthcare sector. Among other types of cancer in Indonesia, non-Hodgkin lymphoma (NHL) ranks fifth in terms of prevalence. Chemotherapy for NHL patients is funded by a national health insurance scheme through the National Healthcare Insurance and Social Security/Jaminan Kesehatan Nasional (JKN). Objective This study aimed to analyze cost burden of chemotherapy for JKN patients with NHL. Data Source A retrospective cross-sectional observational study was conducted among NHL patients receiving chemotherapy at a hospital in East Java, Indonesia in 2021. Data were collected from medical record documents and a total of 44 patient visits were recorded in this study. Data Summary The result showed that patient visits were dominated by females (55%), a significant proportion were aged 31 to 40 years (32%), and the majority were JKN participants in the Contribution Assistance Recipients/Penerima Bantuan Iuran (PBI) category (64%). The most chemotherapy regimen given was R-CHOP (68%) and the mean total cost for NHL patients was Indonesian Rupiah (IDR) 5,178,146. The highest mean cost burden was on chemotherapy drugs with a value of IDR 6,333,315. Based on the regimen, the highest cost burden was R-CHOP-Bleo with a mean cost of IDR 8,764,091. Conclusion Based on the results, the highest cost burden for chemotherapy among JKN patients with NHL in Indonesia was attributed to R-CHOP-Bleo regimen with a mean of IDR 8,764,091.
Evaluating Post-concussion Clinical Management of University-Aged Performing Artists: A Systematic Review
Authors: Memmini Allyssa K. , Bos Lauren N. , Maluski Kelleen , Ellsworth-Kopkowski Alexis , Savvidou Paola , Schuyten Kristen H. 
Published: June 2024

Introduction: Contemporary concussion literature has yet to establish appropriate clinical management guidelines to address the unique needs of performing arts populations, especially at the collegiate level. Therefore, the purpose of this investigation was to collate current evidence regarding post-concussion return to performance management among university-aged performing artists to generate broad clinical implications. Methods: The research team was comprised of two faculty members in the performing arts, one concussion researcher, and athletic trainer, two university librarians, and one physical therapy graduate student with expertise in post-concussion management among performing arts patients. Two librarians searched the literature using PubMed, Cochrane, SPORTdiscus, and Education Research Complete. Studies were eligible for preliminary inclusion if they were written in English, conducted in the United States, as well as published in a peer-reviewed journal. There were no restrictions on publication date due to the limited literature on this topic. The most recent search was conducted in July 2023. Results: Of the 18 studies identified during the search process, only 2 met the inclusion criteria. Broadly, this investigation identified common mechanisms of injury among stage crew/technicians and dancers who are of university-age. Furthermore, both studies identified several patients who opted to return to performing arts on their own volition. However, there were no studies that solely focused on the collegiate performing arts population and their return to performance procedures. Conclusions: Overall, these findings highlight a momentous gap in concussion literature regarding how to guide clinicians and academic teams when returning collegiate performing artists back to their performance environment(s). Thus, additional research is strongly warranted to understand the lived experiences of performing artists with concussion, as well as how to address specific coursework-related demands to support their recovery.
Benefits of early highly effective versus escalation treatment strategies in relapsing multiple sclerosis estimated using a treatment-sequence model
Authors: Smets Ide , Versteegh Matthijs , Huygens Simone , Wokke Beatrijs , Smolders Joost 
Published: June 2024

Background: Uncertainty about disproportionate impact on health care budgets limits implementation of early highly effective treatment (EHT) in multiple sclerosis (MS). Objective: To estimate cost-effectiveness of escalation versus EHT disease-modifying treatment (DMT) sequences. Methods: Using a health-economic approach, we analysed health benefits (relapse rate reduction, disability prevention), direct/indirect DMT and societal costs of escalation versus EHT DMT sequences. In scenario analyses, we allowed (1) earlier use of alemtuzumab (ALE) and (2) a single retreatment with cladribine (CLA). Results: In our model, we showed that the ratio between costs and quality-adjusted life years (QALYs) for the most cost-effective EHT and escalation sequence results into a similar net health benefit with higher costs and also higher QALYs associated with an EHT versus escalation strategy. Earlier use of ALE is more cost-effective than in later lines, even when aggravating the impact of its side-effects tenfold. Retreatment with CLA was more cost-effective in both escalation and EHT sequences. Conclusions: Certain EHT sequences are equally cost-effective to escalation sequences and are likely to result in more health at uncertain additional costs. The favourable cost–benefit ratio of CLA and ALE suggests that a wider application of affordable highly effective therapies could promote the cost-effectiveness both EHT and escalation approaches.
Exploring the variation in associations between socioeconomic indicators and non-communicable diseases in the Tromsø Study: an algorithmic approach
Authors: Svalestuen Sigbjørn , Sari Emre , Langholz Petja Lyn , Vo Chi Quynh 
Published: June 2024

Aims: We contribute to the methodological literature on the assessment of health inequalities by applying an algorithmic approach to evaluate the capabilities of socioeconomic variables in predicting the prevalence of non-communicable diseases in a Norwegian health survey. Methods: We use data from the seventh survey of the population based Tromsø Study (2015–2016), including 11,074 women and 10,009 men aged 40 years and above. We apply the random forest algorithm to predict four non-communicable disease outcomes (heart attack, cancer, diabetes and stroke) based on information on a number of social root causes and health behaviours. We evaluate our results using the classification error, the mean decrease in accuracy, partial dependence statistics. Results: Results suggest that education, household income and occupation to a variable extent contribute to predicting non-communicable disease outcomes. Prediction misclassification ranges between 25.1% and 35.4% depending on the non-communicable diseases under study. Partial dependences reveal mostly expected health gradients, with some examples of complex functional relationships. Out-of-sample model validation shows that predictions translate to new data input. Conclusions: Algorithmic modelling can provide additional empirical detail and metrics for evaluating heterogeneous inequalities in morbidity. The extent to which education, income and occupation contribute to predicting binary non-communicable disease outcomes depends on both non-communicable diseases and socioeconomic indicator. Partial dependences reveal that social gradients in non-communicable disease outcomes vary in shape between combinations of non-communicable disease outcome and socioeconomic status indicator. Misclassification rates highlight the extent of variation within socioeconomic groups, suggesting that future studies may improve predictive accuracy by exploring further subpopulation heterogeneity.
No difference in midterm outcomes and complication rate between retroperitoneal and transperitoneal open aortic aneurysm repair in females
Authors: Sorour Ahmed A , Sharew Betemariam , Kuka Casey , Dong Siwei , Fulton Emma , Reinert Nathan J , Khalifeh Ali , Quatromoni Jon G , Rowse Jarrad W , Kirksey Lee , Lyden Sean P , Caputo Francis J 
Published: June 2024

Objectives Abdominal Aortic Aneurysms (AAA) in females are less prevalent, have higher expansion rates and experience rupture at smaller diameters than in males. Studies have compared outcomes of the retroperitoneal (RP) and transperitoneal (TP) approach in open aortic aneurysm repair (OAR) with conflicting results. No study to date has compared the two approaches solely in females. In this study we compare midterm outcomes of the RP and TP approach in females undergoing OAR. Methods Single-center, retrospective review of all females undergoing OAR from 2010 to 2021. Patients undergoing elective, symptomatic and ruptured OAR were included. The cohort was stratified by surgical approach RP versus TP and midterm outcomes were compared amongst the groups. Outcomes included mortality, graft related, and non-graft related complications. Results A total of 244 patients (RP n = 133; TP n = 111) were identified. Follow-up period was 28 ± 30.7 months. Baseline perioperative characteristics were similar except that more people in the RP group had ejection fraction ((EF) > 50% (82% vs 68%), p = .037). Patients who underwent RP repair had longer visceral/renal ischemia time ( p = .01), larger graft diameter (18 vs 16 mm; p = <0.001), were more likely to have a suprarenal clamp placed(70.5 vs 48.2; p < .001), and had decreased autotransfusion volume (611 vs 861 mL; p < .01) compared to those who underwent TP repair. Number of deaths was higher in the TP group during study follow-up period (36.4 vs 23.8; p = .035), but the difference of the time to event analysis was not significant. There was no difference in all-cause survival at 36 months between RP and TP (77.8 vs 76.8; p = .045). Overall midterm complications were 9.5% in both groups. Any graft related complication was 1.8% in TP versus 3% RP ( p = .69). In a multivariable model, after adjusting for age, urgency, smoking, prior aneurysm repair, and ASA level, the hazard ratio decreases with the RP approach, however this did not reach significance ( p = .052). Conclusion In a 12-year period of OAR in females, TP and RP results were comparable at midterm analysis. The RP approach appeared to be used more often for OAR requiring suprarenal clamping. Although the TP group had increased mortality, the difference of the time to event analysis was not significant. Midterm postoperative complications in both groups were low. This suggests that both approaches are safe in the female population and decision should be driven by anatomy and surgeon’s preference.
The medically complex pregnant patient
Authors: Sri Kumaran Shalini , Phang Chee Chin 
Published: June 2024

In our contemporary society, where medical advancements occur daily, many women with complex medical conditions are becoming pregnant and successfully carrying pregnancies to term. We report a case of a complicated, unplanned pregnancy in a newly initiated haemodialysis patient. The patient presented with breathlessness and was discovered to be 13 weeks pregnant while also being diagnosed with bilateral pulmonary embolisms. Unfortunately, she later developed pregnancy-induced complications that required her to remain hospitalised throughout her entire pregnancy. This case illustrates the complex care needed to manage a pregnant woman with multiple co-morbidities. It emphasises the importance of pre-pregnancy counselling and optimizing care among women of childbearing age who have complex medical backgrounds. Such awareness is crucial for both physicians and obstetricians.
Gamification preferences in nutrition apps: Toward healthier diets and food choices
Authors: Berger Michelle , Jung Carolin 
Published: June 2024

BackgroundUnhealthy eating habits are costly and can lead to serious diseases such as obesity. Nutrition apps offer a promising approach to improving dietary behavior. Gamification elements (GEs) can motivate users to continue using nutrition apps by making them more enjoyable, which can lead to more positive behavioral changes regarding dietary choices. However, the effects of users’ preferences and individual characteristics on gamified systems are not yet understood. Current calls for research suggest that personalized gamified systems might lead to user satisfaction, continuous app use, and—ultimately—long-term improvements in diet.ObjectiveThe aim was to determine the most preferred GEs in nutrition apps and to define clusters of GEs preferences in terms of personality and socio-demographic characteristics.MethodsWe surveyed 308 people to measure their preferences regarding GEs in nutrition apps and applied best-worst scaling to determine the most preferred GEs. Furthermore, we used cluster analysis to identify different user clusters and described them in terms of personality and socio-demographic characteristics.ResultsWe determine that GEs most favored are goals, progress bars, and coupons. We revealed three distinct user clusters in terms of personality and socio-demographic characteristics. Based on the individual factors of openness and self-perception, we find that significant differences exist between the preferences for leaderboards and coupons.ConclusionWe contribute by shedding light on differences and similarities in GE preferences relating to specific contexts and individual factors, revealing the potential for individualized nutrition apps. Our findings will benefit individuals, app designers, and public health institutions.
Summary of the best evidence on self-management support schemes for patients with inflammatory bowel disease based on mobile health systems
Authors: Ren Chenfei , Zhou Yunxian , Cai Qian , Zhou Mi 
Published: June 2024

Objective Self-management support services can improve patients’ self-management ability. This study summarized the best evidence on a self-management support scheme for patients with inflammatory bowel disease based on a mobile health system to accurately describe the current status of the field and provide recommendations for healthcare workers. Methods Two researchers retrieved studies from computer decision support systems, guideline websites, official association websites, and databases from the establishment of the database until October 2023. The quality of the included studies was independently evaluated by two authors using the Appraisal of Guidelines for Research and Evaluation Instrument II and the 2016 version of the corresponding evaluation standards of the Australian Joanna Briggs Institute Evidence-based Health Care Center. The classification of evidence and recommendation level adopted the 2014 version of the Australian Joanna Briggs Institute evidence pregrading and recommending level system. Results Fifteen studies were included, comprising one guideline, two expert consensuses, four systematic reviews, four quasi-experimental studies, and four qualitative studies. The overall quality of the included studies was moderate to high. Thirty-six pieces of best evidence were compiled for seven elements, namely, mobile health system type and functional support; mobile health system application preparation; health information recording, uploading, and presentation; zoning management of diseases and early warning of the active period; support related to health education; healthcare support team formation and services; and virtual communities. Conclusions Our study evaluated the quality of the included studies and summarized a self-management support scheme for patients with inflammatory bowel disease based on a mobile health system. The main scheme was divided into 7 parts and 36 items, which can be used as a reference for healthcare workers so that they can provide more comprehensive and scientific self-management support services for patients with inflammatory bowel disease through mobile health systems.
Knee Extensor Torque Steadiness and Quadriceps Activation Variability in Collegiate Athletes 4, 6, and 12 Months After ACL Reconstruction
Authors: Cobian Daniel G. , Oppenheim Zachary R. , Roehl Tyler J. , Joachim Mikel R. , Heiderscheit Bryan C. 
Published: June 2024

Background: Quadriceps performance after anterior cruciate ligament reconstruction (ACLR) is typically characterized by peak force/torque, but the ability to generate consistent knee extensor torque may be clinically meaningful. Purpose/Hypothesis: The purpose of this study was to evaluate knee extensor torque steadiness and quadriceps activation variability in collegiate athletes 4 to 12 months after ACLR. It was hypothesized that between-limb asymmetries in torque steadiness and activation variability would be observed and that steadiness would be associated with activation variability and peak knee extensor torque symmetry. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 30 National Collegiate Athletic Association Division I athletes completed maximal voluntary isometric contractions 4, 6, and 12 months after ACLR. Torque and surface electromyography of the superficial quadriceps were recorded. Torque steadiness was calculated as the mean difference between initial and low-pass filtered torque signals and was expressed as a percentage of peak torque. Quadriceps activation variability was calculated similarly and was expressed as a percentage of peak electromyography. Linear mixed models were used to assess change in torque steadiness and activation variability over time. Associations between torque steadiness of the operated limb, activation variability, and quadriceps strength symmetry were evaluated using the Spearman correlation coefficient. Results: Limb-by-time interactions were detected for torque steadiness and activation variability ( P < .001), with reductions (improvements) in limb steadiness and activation variability observed with increasing time since surgery. Between-limb differences in torque steadiness and activation variability were observed at 4 and 6 months postoperatively ( P < .05). Significant associations between operated limb torque steadiness and quadriceps activation variability were observed at 4 months ( P < .001) and 6 months ( P < .01). Torque steadiness of the operated limb was associated with peak knee extensor torque symmetry at 4 months ( rS = −0.49; P < .01) and 6 months ( rS = −0.49; P < .01). Conclusion: In collegiate athletes, impaired knee extensor torque steadiness of the operated limb and associated abnormal quadriceps activation patterns were observed 4 to 12 months after ACLR, and the consistency of knee extensor torque production was associated with greater quadriceps strength asymmetries, particularly 4 to 6 months after surgery. Operated limb torque steadiness and activation variability improved from 4 to 12 months after ACLR. Clinical assessment of knee extensor torque steadiness after ACLR may improve prognosis and specificity of rehabilitation efforts.