bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antenatal depression among pregnant mothers in Afghanistan: A cross-sectional study
Authors: Sarem Shararah , Neyazi Ahmad , Mohammadi Abdul Qadim , Neyazi Mehrab , Ahamdi Mozhgan , Razaqi Nosaibah , Wali Sadaf , Timilsina Shashank , Faizi Hamida , Griffiths Mark D. 
Published: May 2024

Abstract
Background
Approximately one in five pregnant women experience antenatal depression globally. The purpose of the present study was to estimate the prevalence of antenatal depression and explore its relationship between various demographic variables, recent sexual engagement, and recent adverse life events among pregnant Afghan women.

Methods
A cross-sectional survey study was carried out between January, 2023 and April 2023 among 460 women aged 15–45 years who were recruited using convenience sampling from Herat province (Afghanistan). Logistic regression models were utilized to explore the relationship between antenatal depression and socio-demographic characteristics among the participants.

Results
The prevalence of antenatal depression symptoms was 78.5%. Multiple regression analysis indicated that antenatal depression was significantly associated with (i) being aged 30–45 years (AOR: 4.216, 95% CI: 1.868–9.515, p = .001), (ii) being of low economic status (AOR:2.102, 95% CI: 1.051–4.202, p = .036), (iii) not being employed (AOR: 2.445, 95% CI:1.189–5.025, p = .015), (iv) not having had sex during the past seven days (AOR: 2.335, 95% CI: 1.427–3.822, p = .001), and (v) not experiencing a traumatic event during the past month (AOR:0.263, 95% CI: 0.139–0.495, p < .001).

Conclusion
The present study provides insight into the factors associated with the high prevalence of antenatal depression among pregnant Afghan women (e.g., demographic variables, recent adverse life events, and recent sexual engagement). It highlights the urgency of addressing antenatal depression in Afghanistan and provides a foundation for future research and interventions aimed at improving the mental health and well-being of pregnant women in the Afghan context.
Effect of young age (below 40 years) on oncologic outcomes in Lebanese patients with breast cancer: a matched cohort study
Authors: Sbaity Eman , Tamim Hani , El-Hajj Fuleihan Ghada , Abbas Jaber , Zahwe Mariam , El Sayed Razan , Shamseddine Ali 
Published: May 2024

Abstract
Background
Developing countries have a significantly higher incidence of breast cancer in patients younger than 40 years as compared to developed countries. This study aimed to examine if young age at diagnosis is an independent prognostic factor for worse survival outcomes in breast cancer as well as the effect of age on Disease-free survival (DFS) and local recurrence free survival (LRFS) after adjusting for various tumor characteristics, local and systemic treatments.

Methods
This is a secondary analysis of prospective cohort of patients from two existing databases. We identified patients with breast cancer aged 40 years or less and we matched them to those older than 40 years. We also matched based on stage and molecular subtypes. In cohort 1, we matched at a ratio of 1:1, while in cohort 2 we matched at a ratio of 1:3.

Results
In cohort 1, Disease-free survival (DFS) at 5 years was significantly shorter for those younger than 40 years (75.6% and 92.7% respectively; p < 0.03). On multivariate analysis, only chemotherapy was found to be significant, while age was not found to be an independent predictor of prognosis. Local recurrence free survival at 5 years was similar between both age categories. Only hormonal therapy is a significant predictor for LRFS at 5 years. In the second cohort, DFS and LRFS at 3 years were similar between those younger and those older than 40 years. On multivariate analysis, no factor including age was found to be an independent predictor of prognosis.

Conclusion
Data in the literature is controversial on the effect of young age on breast cancer prognosis. Our findings could not demonstrate that age is an independent prognostic factor in our population. There is a need for outcomes from larger, prospective series that have longer follow-ups and more data from our region.
Changes in the epidemiology and clinical characteristics of viral gastroenteritis among hospitalized children in the Mainland of China: a retrospective study from 2016 to 2020
Authors: Li Fei , Guo Lingyun , Li Qi , Xu Hui , Fu Yiliang , Huang Luci , Feng Guoshuang , Liu Gang , Chen Xiangpeng , Xie Zhengde 
Published: May 2024

Abstract
Background
Acute gastroenteritis (AGE) causes significant morbidity in children worldwide; however, the disease burden of children hospitalized with viral gastroenteritis in China has been rarely described. Through this study, we analyzed the data of hospitalized children with viral gastroenteritis to explore the changes in the epidemiology and clinical characteristics of viral gastroenteritis in the mainland of China.

Methods
Data were extracted from Futang Children's Medical Development Research Center (FRCPD), between 2016 and 2020, across 27 hospitals in 7 regions. The demographics, geographic distribution, pathogenic examination results, complications, hospital admission date, length of hospital stays, hospitalization charges and outcomes were collected and analyzed.

Results
Viral etiological agents included rotavirus (RV), adenovirus (ADV), norovirus (NV) and coxsackievirus (CV) that were detected in 25,274 (89.6%), 1,047 (3.7%), 441 (1.5%) and 83 (0.3%) cases. There was a higher prevalence of RV and NV infection among children younger than 3 years of age. RV and NV had the highest detection rates in winter, while ADV in summer. Children with viral gastroenteritis were often accompanied by other diseases, such as myocardial diseases (10.98–31.04%), upper respiratory tract diseases (1.20–20.15%), and seizures (2.41–14.51%). Among those cases, the co-infection rate with other pathogens was 6.28%, with Mycoplasma pneumoniae (M. pneumoniae), Epstein-Barr virus (EBV), and influenza virus (FLU) being the most common pathogens. The median length of stay was 5 days, and the median cost of hospitalization corresponded to587 US dollars.

Conclusions
This finding suggests that viral gastroenteritis, especially those caused by RV, is a prevalent illness among younger children. Co-infections and the presence of other diseases are common. The seasonality and regional variation of viral etiological agents highlight the need for targeted prevention and control measures. Although viral gastroenteritis rarely leads to death, it also results in a significant economic burden on healthcare systems.
Congenital chloride diarrhoea in a Chinese infant with a compound heterozygous SLC26A3 mutation
Authors: Li Qian , Wang Jing , Zang Ruixian , Yu Lichun , Yang Zhenle , Sun Shuzhen 
Published: May 2024

Abstract
Introduction
Congenital chloride diarrhoea (CCD) is an autosomal recessive condition that causes secretory diarrhoea and potentially deadly electrolyte imbalances in infants because of solute carrier family 26 member 3 (SLC26A3) gene mutations.

Case presentation
A 7-month-old Chinese infant with a history of maternal polyhydramnios presented with frequent watery diarrhoea, severe dehydration, hypokalaemia, hyponatraemia, failure to thrive, metabolic alkalosis, hyperreninaemia, and hyperaldosteronaemia. Genetic testing revealed a compound heterozygous SLC26A3 gene mutation in this patient (c.269_270dup and c.2006 C > A). Therapy was administered in the form of oral sodium and potassium chloride supplements, which decreased stool frequency.

Conclusions
CCD should be considered when an infant presents with prolonged diarrhoea during infancy, particularly in the context of maternal polyhydramnios and dilated foetal bowel loops.
Intracranial residual lesions following early intensification in a patient with T-cell acute lymphoblastic leukemia: a case report
Authors: Nagamatsu Yuichi , Isoda Takeshi , Inaji Motoki , Oyama Jun , Niizato Daiki , Tomomasa Dan , Mitsuiki Noriko , Yamashita Motoi , Kamiya Takahiro , Imai Kohsuke , Kanegane Hirokazu , Morio Tomohiro , Takagi Masatoshi 
Published: May 2024

Abstract
Background
T-cell acute lymphoblastic leukemia (T-ALL) tends to involve central nervous system (CNS) infiltration at diagnosis. However, cases of residual CNS lesions detected at the end of induction and post early intensification have not been recorded in patients with T-ALL. Also, the ratio and prognosis of patients with residual intracranial lesions have not been defined.

Case presentation
A 9-year-old boy with T-ALL had multiple intracranial tumors, which were still detected post early intensification. To investigate residual CNS lesions, we used 11C-methionine (MET)-positron emission tomography. Negative MET uptake in CNS lesions and excellent MRD status in bone marrow allowed continuing therapies without hematopoietic cell transplantation.

Conclusions
In cases with residual lesions on imaging studies, treatment strategies should be considered by the systemic response, direct assessment of spinal fluid, along with further development of noninvasive imaging methods in CNS. Further retrospective or prospective studies are required to determine the prognosis and frequency of cases with residual intracranial lesions after induction therapy.
Does “National Civilized City” policy mitigate air pollution in China? A spatial Durbin difference-in-differences analysis
Authors: Jiang Lei , Zhang Zinan , Zhang Bo , He Shixiong 
Published: May 2024

Abstract“National Civilized City” (NCC) is regarded as China’s highest honorary title and most valuable city brand. To win and maintain the “golden city” title, municipal governments must pay close attention to various key appraisal indicators, mainly environmental ones. In this study we verify whether cities with the title are more likely to mitigate SO2 pollution. We adopt the spatial Durbin difference-in-differences (DID) model and use panel data of 283 Chinese cities from 2003 to 2018 to analyze the local (direct) and spillover effects (indirect) of the NCC policy on SO2 pollution. We find that SO2 pollution in Chinese cities is not randomly distributed in geography, suggesting the existence of spatial spillovers and possible biased estimates. Our study treats the NCC policy as a quasi-experiment and incorporates spatial spillovers of NCC policy into a classical DID model to verify this assumption. Our findings show: (1) The spatial distribution of SO2 pollution represents strong spatial spillovers, with the most highly polluted regions mainly situated in the North China Plain. (2) The Moran’s I test results confirms significant spatial autocorrelation. (3) Results of the spatial Durbin DID models reveal that the civilized cities have indeed significantly mitigated SO2 pollution, indicating that cities with the honorary title are acutely aware of the environment in their bid to maintain the golden city brand. As importantly, we notice that the spatial DID term is also significant and negative, implying that neighboring civilized cities have also mitigated their own SO2 pollution. Due to demonstration and competition effects, neighboring cities that won the title ostensibly motivates local officials to adopt stringent policies and measures for lowering SO2 pollution and protecting the environment in competition for the golden title. The spatial autoregressive coefficient was significant and positive, indicating that SO2 pollution of local cities has been deeply affected by neighbors. A series of robustness check tests also confirms our conclusions. Policy recommendations based on the findings for protecting the environment and promoting sustainable development are proposed.
Extensor tendon rupture and preoperative mri confirmations of suture anchor prolapse: a case report and literature review
Authors: Alhaskawi Ahmad , Zhou Haiying , Dong Yanzhao , Ezzi Sohaib Hasan Abdullah , Zou Xiaodi , Weijie Zhou , Yi Fangyu , Abdalbary Sahar Ahmed , Lu Hui 
Published: May 2024

Abstract
Background
While suture anchors are widely used in medical procedures for their advantages, they can sometimes lead to complications, including anchor prolapse. This article presents a unique case of suture anchor prolapse at the base of the distal phalanx of the little finger after extensor tendon rupture reconstruction surgery.

Case presentation
A 35-year-old male, underwent extensor tendon rupture reconstruction using a non-absorbable suture anchor. After seven years the patient visited our outpatients complaining of stiffness, pain, and protrusion at the surgical site. Initial X-ray imaging suggested suggesting either a fracture of the distal phalanx or tendon adhesion but lacked a definitive diagnosis. Subsequent magnetic resonance imaging (MRI) revealed bone connectivity between the middle and distal phalanges with irregular signal shadow and unclear boundaries while maintaining a regular finger shape. MRI proved superior in diagnosing prolapsed suture anchors, marking the first reported case of its kind. Surgical intervention confirmed MRI findings.

Conclusions
Suture anchor complications, such as prolapse, are a concern in medical practice. This case underscores the significance of MRI for accurate diagnosis and the importance of tailored surgical management in addressing this uncommon complication.
Mechanism of action of Coptidis Rhizome in treating periodontitis based on network pharmacology and in vitro validation
Authors: Li Wei , Jiao Ruofeng , Luo Shiyi , Liu Zefei , Song Jukun , Chen Zhu 
Published: May 2024

Abstract
Objective
Explore the therapeutic mechanism of Coptidis Rhizome (CR) in periodontitis using network pharmacology, and validate it through molecular docking and in vitro experiments.

Methods
Screened potential active components and target genes of CR from TCMSP and Swiss databases. Identified periodontitis-related target genes using GeneCards. Found common target genes using Venny. Conducted GO and KEGG pathway analysis. Performed molecular docking and in vitro experiments using Berberine, the main active component of CR, on lymphocytes from healthy and periodontitis patients. Assessed effects on inflammatory factors using CCK-8, flow cytometry, and ELISA.

Results
Fourteen active components and 291 targets of CR were identified. 30 intersecting target genes with periodontitis were found. GO and KEGG analysis revealed oxidative stress response and IL-17 signaling pathway as key mechanisms. Molecular docking showed strong binding of Berberine with ALOX5, AKT1, NOS2, and TNF. In vitro experiments have demonstrated the ability of berberine to inhibit the expression of Th17 + and other immune related cells in LPS stimulated lymphocytes, and reduce the secretion of IL-6, IL-8, and IL-17.

Conclusion
CR treats periodontitis through a multi-component, multi-target, and multi-pathway approach. Berberine, its key component, acts through the IL-17 signaling pathway to exert anti-inflammatory effects.
Delivering clinical tutorials to medical students using the Microsoft HoloLens 2: A mixed-methods evaluation
Authors: Connolly Murray , Iohom Gabriella , O’Brien Niall , Volz James , O’Muircheartaigh Aogán , Serchan Paschalitsa , Biculescu Agatha , Gadre Kedar Govind , Soare Corina , Griseto Laura , Shorten George 
Published: May 2024

Abstract
Background
Mixed reality offers potential educational advantages in the delivery of clinical teaching. Holographic artefacts can be rendered within a shared learning environment using devices such as the Microsoft HoloLens 2. In addition to facilitating remote access to clinical events, mixed reality may provide a means of sharing mental models, including the vertical and horizontal integration of curricular elements at the bedside. This study aimed to evaluate the feasibility of delivering clinical tutorials using the Microsoft HoloLens 2 and the learning efficacy achieved.

Methods
Following receipt of institutional ethical approval, tutorials on preoperative anaesthetic history taking and upper airway examination were facilitated by a tutor who wore the HoloLens device. The tutor interacted face to face with a patient and two-way audio-visual interaction was facilitated using the HoloLens 2 and Microsoft Teams with groups of students who were located in a separate tutorial room. Holographic functions were employed by the tutor. The tutor completed the System Usability Scale, the tutor, technical facilitator, patients, and students provided quantitative and qualitative feedback, and three students participated in semi-structured feedback interviews. Students completed pre- and post-tutorial, and end-of-year examinations on the tutorial topics.

Results
Twelve patients and 78 students participated across 12 separate tutorials. Five students did not complete the examinations and were excluded from efficacy calculations. Student feedback contained 90 positive comments, including the technology’s ability to broadcast the tutor’s point-of-vision, and 62 negative comments, where students noted issues with the audio-visual quality, and concerns that the tutorial was not as beneficial as traditional in-person clinical tutorials. The technology and tutorial structure were viewed favourably by the tutor, facilitator and patients. Significant improvement was observed between students’ pre- and post-tutorial MCQ scores (mean 59.2% Vs 84.7%, p < 0.001).

Conclusions
This study demonstrates the feasibility of using the HoloLens 2 to facilitate remote bedside tutorials which incorporate holographic learning artefacts. Students’ examination performance supports substantial learning of the tutorial topics. The tutorial structure was agreeable to students, patients and tutor. Our results support the feasibility of offering effective clinical teaching and learning opportunities using the HoloLens 2. However, the technical limitations and costs of the device are significant, and further research is required to assess the effectiveness of this tutorial format against in-person tutorials before wider roll out of this technology can be recommended as a result of this study
Lipocalin-2 as a prognostic marker in patients with acute exacerbation of idiopathic pulmonary fibrosis
Authors: Tanahashi Hiroki , Iwamoto Hiroshi , Yamaguchi Kakuhiro , Sakamoto Shinjiro , Horimasu Yasushi , Masuda Takeshi , Nakashima Taku , Ohshimo Shinichiro , Fujitaka Kazunori , Hamada Hironobu , Hattori Noboru 
Published: May 2024

Abstract
Background
Lipocalin-2 (LCN2) is a secretory glycoprotein upregulated by oxidative stress; moreover, patients with idiopathic pulmonary fibrosis (IPF) have shown increased LCN2 levels in bronchoalveolar lavage fluid (BALF). This study aimed to determine whether circulatory LCN2 could be a systemic biomarker in patients with IPF and to investigate the role of LCN2 in a bleomycin-induced lung injury mouse model.

Methods
We measured serum LCN2 levels in 99 patients with stable IPF, 27 patients with acute exacerbation (AE) of IPF, 51 patients with chronic hypersensitivity pneumonitis, and 67 healthy controls. Further, LCN2 expression in lung tissue was evaluated in a bleomycin-induced lung injury mouse model, and the role of LCN2 was investigated using LCN2-knockout (LCN2 -/-) mice.

Results
Serum levels of LCN2 were significantly higher in patients with AE-IPF than in the other groups. The multivariate Cox proportional hazards model showed that elevated serum LCN2 level was an independent predictor of poor survival in patients with AE-IPF. In the bleomycin-induced lung injury mouse model, a higher dose of bleomycin resulted in higher LCN2 levels and shorter survival. Bleomycin-treated LCN2 -/- mice exhibited increased BALF cell and protein levels as well as hydroxyproline content. Moreover, compared with wild-type mice, LCN2-/- mice showed higher levels of circulatory 8-isoprostane as well as lower Nrf-2, GCLC, and NQO1 expression levels in lung tissue following bleomycin administration.

Conclusions
Our findings demonstrate that serum LCN2 might be a potential prognostic marker of AE-IPF. Moreover, LCN2 expression levels may reflect the severity of lung injury, and LCN2 may be a protective factor against bleomycin-induced acute lung injury and oxidative stress.
Combinatorial metabolic engineering of Streptomyces sp. CB03234-S for the enhanced production of anthraquinone-fused enediyne tiancimycins
Authors: Zhuang Zhoukang , Kong Wenping , Wen Zhongqing , Tong Nian , Lin Jing , Zhang Fan , Fan Zhiying , Yi Liwei , Huang Yong , Duan Yanwen , Yan Xiaohui , Zhu Xiangcheng 
Published: May 2024

Abstract
Background
Anthraquinone-fused enediynes (AFEs) are excellent payloads for antibody-drug conjugates (ADCs). The yields of AFEs in the original bacterial hosts are extremely low. Multiple traditional methods had been adopted to enhance the production of the AFEs. Despite these efforts, the production titers of these compounds are still low, presenting a practical challenge for their development. Tiancimycins (TNMs) are a class of AFEs produced by Streptomyces sp. CB03234. One of their salient features is that they exhibit rapid and complete cell killing ability against various cancer cell lines.

Results
In this study, a combinatorial metabolic engineering strategy guided by the CB03234-S genome and transcriptome was employed to improve the titers of TNMs. First, re-sequencing of CB03234-S (Ribosome engineered mutant strains) genome revealed the deletion of a 583-kb DNA fragment, accounting for about 7.5% of its genome. Second, by individual or combined inactivation of seven potential precursor competitive biosynthetic gene clusters (BGCs) in CB03234-S, a double-BGC inactivation mutant, S1009, was identified with an improved TNMs titer of 28.2 ± 0.8 mg/L. Third, overexpression of five essential biosynthetic genes, including two post-modification genes, and three self-resistance auxiliary genes, was also conducted, through which we discovered that mutants carrying the core genes, tnmE or tnmE10, exhibited enhanced TNMs production. The average TNMs yield reached 43.5 ± 2.4 mg/L in a 30-L fermenter, representing an approximately 360% increase over CB03234-S and the highest titer among all AFEs to date. Moreover, the resulting mutant produced TNM-W, a unique TNM derivative with a double bond instead of a common ethylene oxide moiety. Preliminary studies suggested that TNM-W was probably converted from TNM-A by both TnmE and TnmE10.

Conclusions
Based on the genome and transcriptome analyses, we adopted a combined metabolic engineering strategy for precursor enrichment and biosynthetic pathway reorganization to construct a high-yield strain of TNMs based on CB03234-S. Our study establishes a solid basis for the clinical development of AFE-based ADCs.