bluuebunny/crossref_metadata_2025_split huggingface dataset:
Centrally inserted central catheter placement using a novel, handheld, image-guided, robotic device: Results of initial feasibility trial in patients
Authors: Herlihy James P , Cohn William E , Ebner Adrian 
Published: February 2025

Background: Central venous access devices (CVADs) are an essential and widely used tool for the treatment of the critically ill, patients undergoing major surgery, and for many patients requiring hemodialysis. Automation of centrally inserted central catheters (CICCs) could potentially make CVAD placement safer, more effective, and more accessible. A new device that uses ultrasound image-guided, robotic needle placement, in addition to traditional Seldinger technique, to place a CICC is described. Objective: The device was used in a small, first-in-human, trial for placing non-tunneled hemodialysis catheters (NTHDCs), in order to determine feasibility of clinical use. Methods: Consecutive patients requiring a NTHDC, at one institution, over a 48 h period, were recruited to consent to placing the catheter by the device. Observations of safety, efficacy, and efficiency of the procedure were recorded. Results: There were 19 catheter placement attempts in 17 patients. All placements were successful (100%). The first placement attempt was successful in 16/19 catheterizations (84%). Two catheterizations required two attempts and one required three attempts. There were no complications for any catheterization. The device provided rapid access to the target central vein and required relatively little training time for operators. Conclusions: The study demonstrates the feasibility for clinical application of a novel central venous access robotic device.
Cervical spinal cord stimulation for treatment of upper limb paralysis: a narrative review
Authors: Lo Yu Tung , Lam Jordan LW , Jiang Lei , Lam Wee Leon , Edgerton Victor R , Liu Charles Y 
Published: February 2025

Recent advances in cervical spinal cord stimulation (SCS) have demonstrated improved efficacy as a therapeutic intervention for restoring hand functions in individuals with spinal cord injuries or stroke. Accumulating evidence consistently shows that cervical SCS yields significant improvements in grip force, proximal arm strength and muscle activation, with both immediate and sustained effects. This review synthesizes the evidence that electrical stimulations modulate the spinal and supraspinal organization of uninjured descending motor tracts, primarily the residual corticospinal tract, reticulospinal tract and propriospinal network of neurons, as well as increasing the sensitivity of spinal interneurons at the stimulated segments to these inputs. Additionally, we examine contemporary strategies aimed at achieving more precise patterned stimulations, including intraspinal microstimulation, ventral cord stimulation and closed-loop neuromodulation, and discuss the potential benefits of incorporating cervical SCS into a multimodal treatment paradigm. Level of evidence: V
Education Paradigm Shifts in the Age of AI: A Spatiotemporal Analysis of Learning
Authors: Zhong (仲若君) Ruojun , Zhao (赵勇) Yong 
Published: February 2025

Purpose The purpose of this article is to analyze how to make changes to prescribed curriculum, pedagogy, activities, learning environments, and assessments to loosen control over time and space of learning to increase time for student autonomy. Design/Approach/Methods A theoretical analysis of functions of the five elements (curriculum, pedagogy, activities, learning environments, and assessments) of schooling in controlling time and space in learning. Findings Students’ time available for autonomy is limited due to prescribed curriculum, which occupies all students’ school time. Pedagogical practices that aim to efficiently implement the prescribed curriculum force and tempt students to spend all available time on the prescribed curriculum and extend work on the prescribed curriculum beyond classrooms through time concentration. Furthermore, the design and implementation of learning activities alter students’ perception of time, making activities long and tedious. Moreover, students’ time occupation by the prescribed curriculum compresses their space in learning environments. Finally, assessments and evaluations are typically limited to a distorted picture of students due to misplaced observers on different time scales and from an observation perspective. All these can be changed and we proposed possible directions of change. Originality/Value This article furthers our positions in the previous article published in ECNU Review of Education—“Paradigm Shifting in Education: An Ecological Analysis.” In this article, we provided a more detailed analysis of schooling from spatiotemporal perspectives and gave a uniquely fresh perspective on changes we need in the age of AI to increase the time available for autonomy.
Medical Practitioners’ Views on Barriers in Collaboration with Dentists in Long-Term Care Settings
Authors: Tada S. , Koh S.M.Y. , Lee G.K.Y. , Wong M.L. 
Published: February 2025

Introduction: In long-term care settings (LTCs), oral health care often remains fragmented from other geriatric care services. Medical practitioners (MPs) typically take the lead in addressing medical aspects of geriatric care plans, making it essential for them to understand the importance of oral health and to collaborate with dental professionals. However, little is known about MPs’ perceptions toward oral health management in LTCs. This qualitative study aimed to gain an in-depth understanding of MPs’ views on oral health management in LTCs and explore challenges in collaborating with dental professionals in Singapore. Methods: Participants were recruited using a purposive sampling strategy, initially through targeted outreach to those with experience in LTCs, followed by snowball sampling to identify additional participants until data saturation was achieved. One-to-one interviews with participants were conducted via teleconferencing using a semi-structured interview guide. The transcripts were analyzed using a hybrid (inductive and deductive) thematic analysis supported by NVivo data management software. Results: Participants (n = 13) felt that oral health care was currently not well-integrated into the existing LTC system. They frequently encountered oral health issues but arranged for dental appointments only when their patients complained of acute symptoms. Key barriers identified were (1) a cultural misconception within the eldercare community that poor oral health was an inevitable part of aging, (2) systemic barriers related to the inadequate geriatric oral health care services and infrastructure, and (3) knowledge gaps in geriatric oral health management among MPs. These factors collectively hindered effective collaboration with dental professionals in LTCs. Conclusion: Participants emphasized the lack of oral health care integration in LTCs, identifying cultural, systemic, and internal barriers. Strengthening collaboration with dental professionals in LTCs, implementing oral health education for the eldercare community, and introducing domiciliary services could address these challenges and support more effective geriatric care, with insights for similar systems globally. Knowledge Transfer Statement: This qualitative study highlighted a critical gap in oral health care integration within eldercare described by the MPs in this study in Singapore’s long-term care settings. Although findings are context specific, they may offer insights for aging nations facing similar challenges. Overcoming misconceptions about aging and oral health, improving systems, and educating MPs are key to fostering interdisciplinary collaboration and enhancing eldercare. Addressing these barriers could improve the overall well-being of care-dependent older adults.
Miglustat ameliorates isoproterenol-induced cardiac fibrosis via targeting UGCG
Authors: Liu Jing , Li Wenqi , Jiao Ran , Liu Zhigang , Zhang Tiantian , Chai Dan , Meng Lingxin , Yang Zhongyi , Liu Yuming , Wu Hongliang , Gu Xiaoting , Li Xiaohe , Yang Cheng 
Published: February 2025

Abstract

Background
Cardiac fibrosis is significant global health problem, which is associated with numerous cardiovascular diseases, and ultimately leads to the progression to heart failure. β-adrenergic receptor (β-AR) overactivation play a role in the development of cardiac fibrosis. Miglustat (Mig) has shown anti-fibrosis effects in multiple fibrotic diseases. However, it is unclear whether and how Mig can ameliorate cardiac fibrosis induced by β-AR overactivation.

Methods
In vivo, mice were injected with isoproterenol (ISO) to induce cardiac fibrosis and treated with Mig. In vitro, primary cardiac fibroblasts were stimulated by ISO and treated with Mig. Levels of cardiac fibrosis, cardiac dysfunction, activation of cardiac fibroblasts were evaluated by real-time polymerase chain reaction, western blots, sirius red staining, immunohistochemistry staining and echocardiography. Through GEO data and knockdown UDP-glucose ceramide glycosyltransferase (UGCG) in primary cardiac fibroblasts, whether Mig alleviates cardiac fibrosis by targeting UGCG was explored.

Results
The results indicated that Mig alleviated ISO-induced cardiac dysfunction. Consistently, Mig also suppressed ISO-induced cardiac fibrosis. Moreover, Mig attenuated ISO-induced cardiac fibroblasts (CFs) activation. To identify the protective mechanism of Mig on cardiac fibrosis, several classical β-AR downstream signaling pathways, including ERK, STAT3, Akt and GSK3β, were further analyzed. As expected, ISO activated the ERK, STAT3, Akt and GSK3β in both CFs and mouse hearts, but this effect was reversed pretreated with Mig. Besides, Mig ameliorates ISO-induced cardiac fibrosis by targeting UDP-glucose ceramide glycosyltransferase (UGCG) in CFs.

Conclusions
Mig ameliorates β-AR overactivation-induced cardiac fibrosis by inhibiting ERK, STAT3, Akt and GSK3β signaling and UGCG may be a potential target for the treatment of cardiac fibrosis.
Human cytomegalovirus tegument protein UL23 promotes gastric cancer immune evasion by facilitating PD-L1 transcription
Authors: Feng Shiyu , Shen Yitian , Zhang Haoke , Liu Wanfeng , Feng Weixu , Chen Xiuting , Zhang Liang , Chen Jiangli , Lu Mingdong , Xue Xiangyang , Shen Xian 
Published: February 2025

Abstract
Immune checkpoint therapy targeting PD-1/PD-L1 has shown promise in treating tumors, however, its clinical benefits are limited to a subset of gastric cancer (GC) patients. Recent research has highlighted a the correlation between PD-L1 expression and the clinical efficacy of anti-PD-1/PD-L1 therapies. Human cytomegalovirus (HCMV) has been implicated in GC, but its specific role in modulating this disease remains elusive. In this study, we analyzed clinical tissue samples using bioinformatics and real-time quantitative polymerase chain reaction (RT-qPCR). We found that GC tissues infected with HCMV presented higher PD-L1 expression compared to those without virus. Furthermore, we demonstrated that HCMV infection enhances PD-L1 expression in GC cells. Cytotoxicity assays revealed that HCMV modulates cancer immune responses via the PD-1/PD-L1 pathway. Mechanistically, we showed that HCMV activates the PI3K-Akt signaling cascade and modulates PD-L1 expression through its tegument protein UL23. Functionally, increased UL23 expression leads to elevated PD-L1 levels, which diminishes tumor cell sensitivity to T-cell-mediated cytotoxicity and triggers T-cell apoptosis. Additionally, in vivo experiments revealed that UL23-induced PD-L1 upregulation inhibits CD8+ T-cell infiltration and reduces the expression of inflammatory factors in tumor microenvironment, ultimately weakening antitumor immunity. Our findings reveal a novel mechanism whereby HCMV and its tegument protein UL23 contribute to cancer immunosuppression through the regulation of PD-L1 expression. This discovery may serve as a potential therapeutic target for enhancing the efficacy of cancer immunotherapy.
Association between sensory impairment and sarcopenia in older Chinese adults: a 4-Year longitudinal study
Authors: Huang Chunjie , He Xiaoqing 
Published: February 2025

Abstract

Objectives
Sarcopenia is a common geriatric syndrome that significantly increases the risk of falls, fractures, disability, and death in older adults. Sensory impairments are also prevalent among the elderly and may exacerbate the decline in physical function, even affecting muscle health. Understanding whether sensory impairments are risk factors affecting sarcopenia in older adults is crucial for developing effective public health policies and intervention strategies. Therefore, this study aims to explore the association between sensory impairments and sarcopenia and its components.

Methods
This study, based on the Chinese Health and Retirement Longitudinal Study (CHARLS), included 4,195 participants aged 60 and above. The assessment of sensory impairment was based on self-reported visual and hearing capabilities. The diagnosis of sarcopenia followed the consensus of the Asian Working Group on Sarcopenia (AWGS) from 2019. Data analysis was conducted using an ordered logistic regression model, and the results report the odds ratios (ORs) and their 95% confidence intervals (CI).

Results
Single sensory impairments at baseline showed no significant correlation with sarcopenia four years later, while dual sensory impairments (DSI) at baseline were significantly associated with sarcopenia (ORs: 1.308, 95% CI: 1.126–1.519). In the analysis of trends over time, transitions from no sensory impairments (NSI) to DSI (ORs: 1.372, 95% CI: 1.028–1.830), from hearing impairments (HI) to DSI (ORs: 1.334, 95% CI: 1.002–1.778), and persistent DSI (ORs: 1.470, 95% CI: 1.159–1.864) were all significantly associated with sarcopenia. Additionally, we found DSI is associated with poor physical performance and muscle mass but not muscle strength.

Conclusions
Our study indicates that DSI have a more severe impact on sarcopenia compared to single sensory impairments. Our findings offer a new perspective for prevention and intervention strategies, suggesting the inclusion of sensory impairment assessments in the clinical evaluation of sarcopenia risk. For elderly individuals with DSI, comprehensive intervention measures should be provided, such as sensory rehabilitation, nutritional support, and guidance on physical activities. For those with only a single sensory impairment, proactive preventive measures should be taken to prevent the progression to DSI.
Association between isolated abnormal 1-hour glucose challenge test and adverse pregnancy outcomes: a retrospective review from an urban tertiary care center in the United States
Authors: Hosier Hillary , Lundsberg Lisbet S. , Culhane Jennifer , Partridge Caitlin , Son Moeun 
Published: February 2025

Abstract

Background
The objective of this study was to investigate whether an isolated abnormal 1-hour glucose challenge test (GCT) among patients without gestational diabetes (GDM) is associated with adverse outcomes.

Methods
This is a retrospective cohort study of patients who underwent GDM screening at ≥ 24 weeks’ gestation with a 1-hour GCT and delivered a singleton fetus at > 35 weeks’ gestation at an urban tertiary hospital from 1/2013 to 10/2021. Data were extracted from an electronic medical record data warehouse using standardized billing/diagnosis codes. Individuals were categorized into 3 groups: normal screening (1-hour GCT value < 140 mg/dL), intermediate screening (1-hour GCT value ≥ 140 and < 200 but normal 3-hour glucose tolerance test (GTT)), and GDM (1-hour GCT ≥ 200 mg/dL or abnormal 3-hour GTT). The primary composite perinatal morbidity outcome included any of the following: large for gestational age (LGA) birthweight, birth injury, hypoglycemia with neonatal intensive care unit (NICU) admission, respiratory distress syndrome, transient tachypnea of the newborn, apnea, NICU admission, or perinatal death. Multiple secondary outcomes were also evaluated. Bivariable analyses and multivariable logistic regression modeling were performed.

Results
Of 37,277 eligible patients, 29,698 (79.7%) had normal screening results, 5092 (13.7%) had intermediate screening results, and 2487 (6.6%) were diagnosed with GDM. There were significant differences in baseline characteristics between the three groups, including age, parity, race and ethnicity, payer-type, obesity, and pre-pregnancy metformin use. Compared to normal screening, intermediate screening was associated with an increased risk for the composite perinatal morbidity outcome (OR 1.23, 95% CI 1.15–1.32), cesarean (OR 1.37, 95% CI 1.28–1.46), and hypertensive disorders of pregnancy (OR 1.30, 95% CI 1.20–1.40). Associations for these outcomes were further pronounced in those with GDM compared to normal screening (OR 1.86, 95% CI 1.70–2.03; OR 1.69, 95% CI 1.56–1.84; and OR 1.57, 95% CI 1.42–1.74, respectively). After adjusting for potential confounders, increased risks for the composite perinatal morbidity outcome persisted for those with intermediate screening (aOR 1.18, 95% CI 1.10–1.26).

Conclusions
In addition to patients with GDM, individuals an isolated abnormal 1-hour GCT without GDM were also at increased risks for adverse pregnancy outcomes. Further investigation is needed to understand if patients with mild dysregulation may still benefit from other interventions.
Health literacy disparities in Thai university students: exploring differences between health science and non-health science disciplines
Authors: Manochaiwuthikul Thanyaporn , Chaichutchouwakul Amornrat , Yunan Nantakarn , Winothai Niwarin , Kanta Peewara , Sapbamrer Ratana 
Published: February 2025

Abstract

Background
Health literacy (HL) in Thailand remains a significant issue, with a large portion of the population demonstrating limited HL, and limited research exists on specific determinants among Thai university students. Some culture shapes health decision-making and HL disparities within this group, highlighting the need to evaluate HL comprehensively. This study aims to assess and compare HL levels among health science and non-health science students, and identify key predictors associated with HL.

Methods
A cross-sectional study was conducted among 1,647 Thai university students, comprising 676 health science and 971 non-health science students, recruited through multi-stage stratified random sampling. Data were collected using validated questionnaires that measured sociodemographic characteristics, academic background, lifestyle behaviors, and HL levels across three sub-domains, including healthcare, disease prevention, and health promotion. Statistical analyses included univariable and multivariable regression models, with significance set at p-value < 0.05.

Results
Health sciences students demonstrated significantly higher HL scores across all sub-domains compared to non-health sciences students. Limited HL was found in 12.6% for health science students, and 28.4% for non-health science students. Key predictors of overall HL included gender, income, faculty of study, and lifestyle-related health behaviors. Female students showed higher total HL (β = 1.41; 95% CI: 0.62, 2.21), as did those with higher income (β = 1.28; 95% CI: 0.76, 1.80). Students enrolled in health sciences programs had higher HL scores (β = 2.86; 95% CI: 2.07, 3.64). Lifestyle behaviors also correlated with HL, with non-smoking (β = -0.58; 95% CI: -1.03, -0.13), no alcohol consumption (β = -0.45, 95%CI: -0.89, -0.01), and regular physical activity (β = 0.35; 95% CI: 0.04, 0.66). Consumption of sweet foods/drinks was inversely related to HL scores (β = -0.87; 95% CI: -1.49, -0.26).

Conclusions
HL among Thai university students varies significantly by sociodemographic factors, academic background, and lifestyle behaviors. Health sciences students exhibited stronger HL skills, underscoring the importance of integrating health education into non-health sciences curricula. Targeted HL interventions are recommended for non-health sciences students, males, and individuals from lower-income backgrounds to enhance health decision-making and reduce HL disparities. These findings have implications for policy and practice, emphasizing the integration of HL modules into university curricula, health promotion campaigns, and the provision of accessible health services to foster an inclusive and health-literate student population.
“ I can’t do it anymore”: a qualitative study on the emergence of crisis in outpatient palliative care—the perspective of family caregivers
Authors: Azhar Sofia , Herrmann-Johns Anne , Wolff Daniel , Rechenmacher Michael , Kaiser Ulrich , Wasner Maria 
Published: February 2025

Abstract

Background
The outpatient palliative care system is a central component of the palliative care structure in Germany, with family caregivers playing a vital role in ensuring and maintaining its success. However, crisis situations can destabilise and harm outpatient care. Previous studies have analysed hospitalisations and emergency admissions during palliative care. However, little is known about the factors that contribute to the emergence of crises in palliative outpatient care. The aim of this study was to identify factors contributing to the emergence of crisis in palliative outpatient care including the identification of protective strategies.

Methods
A qualitative study using semi-structured interviews with family caregivers recently involved in outpatient palliative care was performed. The analysis was conducted using thematic coding.

Results
A total of 15 family caregivers (13 female and 2 male) were recruited for the study. Crisis situations emerged through a cumulation of factors. Four categories of factors were identified: (1) structural factors, including limited access to health care professionals and a lack of necessary information, (2) illness related factors such as sudden progression in the illness trajectory and symptoms, (3) the intensity of care involvement and (4) emotional and psychological burden of family caregivers. A diverse range of protective strategies were employed by family caregivers, encompassing the involvement of the social network, the pursuit of information and the identification of a sense of purpose.

Conclusion
The findings of this study confirm the importance of providing continuous, competent, and empathetic care to both family caregivers and patients in palliative outpatient care. The study highlights the importance of expanding the palliative care infrastructure, as well as ensuring unrestricted access to palliative care professionals, developing tailored information tools for family caregivers, and reducing bureaucracy. Further studies are needed to identify additional influencing factors and evaluate effective measures.