bluuebunny/crossref_metadata_2025_split huggingface dataset:
One stage transanal versus one stage laparoscopic-assisted transanal endorectal pull-through in managing Hirschsprung’s disease in pediatric age group; a retrospective study
Authors: Elrouby Ahmed , Shehata Sameh , Waheeb Saber , Khairi Ahmed , AbdAl-Aziz Doaa , Looka Baher 
Published: February 2025

Abstract

Background
The management of Hirschsprung’s disease has evolved from the conventional route to the minimally invasive route in one stage either from the pure transanal route or with the assistance of laparoscopy. Our study compared the surgical and functional outcomes of both approaches.

Methods
Our retrospective study included 72 pediatric patients presented with Hirschsprung’s Disease to Elshatby University Hospital, 40 patients were treated by TAERPT (Group A) and 32 patients were treated by LAERPT (Group B). The two groups were compared as regards the personal data, the operative data, and the post-operative outcomes including the time of passage of stools, time of tolerating oral feeding, the duration of hospital stay, and the development of any early postoperative complications. Moreover, the frequency of defecation, constipation, enterocolitis, anastomotic stricture, and continence were assessed.

Results
The age at operation was significantly lower (p < 0.001*) in patients of Group A (13.95 ± 18.18) than in patients of Group B (32.03 ± 16.20). The total operative duration was not different between the two groups, however, a significantly shorter duration of the anal part (p < 0.001*) in Group B (47.81 ± 18) than in Group A (96.50 ± 38.60) was recorded. A significantly longer colonic segment (p < 0.001*) was resected in Group A (28 ± 4.05) than in Group B (22.70 ± 8.12). The hospital stay was significantly shorter in Group B (5.78 ± 2.41) than in Group A (7.20 ± 2.78). (p = 0.001*) The excised segment revealed a proximal aganglionic zone in four patients denoting a missed segment; three in Group B and only one patient in Group A. There were no differences as regards the early and late follow-up parameters.

Conclusions
Endorectal pull-through for the treatment of Hirschsprung’s disease could be approached either completely transanal or with the assistance of laparoscopy with nearly similar surgical and functional outcomes, however a longer operative duration with a shorter anal stage is recorded with the laparoscopic assistance. Furthermore, a shorter hospital stay could be achieved with the aid of laparoscopy.

Trial registration
Protocol ID: 0306356, Registration number: NCT06419998, 20/05/2024 - Retrospectively registered
Clinical anxiety among a sample of dental students in South Sinai
Authors: Mikhail Christine Raouf George , Ragab Mai Hamdy , Ahmed Yousra , El Desouky Eman D. , Hassanein Fatma E. A. , Bekhit Mohamed , Mostafa Marwa Hassan 
Published: February 2025

Abstract

Background
Anxiety may be induced in the dental clinics, which is an essential learning environment for undergraduate dental students. This could have a negative impact on clinical performance. This study aimed to estimate the incidence of clinical anxiety among a sample of Dental students and to determine possible precipitating factors for clinical anxiety among them.

Methods
A cross-sectional study was carried out among 3rd and 4th year dental students at King Salman International University using the modified 34 items of Moss and McManus clinical anxiety questionnaire.

Results
263 students participated. Dental students reported higher incidence of clinical anxiety (60.8%), particularly with different dental treatment plan procedures related clinical situations fulfilling 31.2 out of mean score of anxiety all (74.0 ). Females had higher anxiety score in all domains than males, the same trend noticed in students who reported dental phobia and previous bad dental experiences (P < 0.001, P 0.016, P 0.003 respectively). Participants rated the clinical anxiety precipitating situations in a descending order as follows: extracting wrong tooth (39.5%), giving wrong treatment (37.6%), tearing of the cheek/lips due to catching on a dental burr (35.7%), fracturing a tooth (34.4%), wrong diagnosis (28.1%), inadvertently hurting the patient (22.1%), inability to meet requirements before exams (19.1%), dealing with a fainting patient during dental treatment (18.7%). Two clinical anxiety precipitating situations had almost the same score including restoration failure/recurrent caries and endodontic retreatment procedures 14.8% and 14.4% respectively. Also, extracting tooth and arresting postoperative bleeding had the same score of 13.7%, while the rest of other clinical situations ranged from 11.8 to 1.1%.

Conclusions
dental students had a comparatively high level of anxiety during clinical classes especially females and those with dental phobia and previous bad dental experiences. Dental students may benefit from stress management classes, mentorship programs, and improved clinical supervision in order to reduce clinical anxiety and build resilience.
Clinical study on horizontal bone augmentation using an alveolar mucosa-periosteal bone flap
Authors: Xu Xinghuanyu , Xu Pu , Liu Shuangxi , Yang Yanlan , Cheng Yanan , Zhang WenBai , Yu Dou , Lu Liying 
Published: February 2025

Abstract
The current study aimed to assess the effectiveness of the alveolar bone mucosa- periosteal bone flap technique in horizontally augmenting the alveolar ridge during dental implant placement. This retrospective analysis included 20 patients with a total of 45 implants, and was designed to evaluate the alveolar ridge widths both before and after surgery. Preoperative measurements indicated an average alveolar ridge width of 3.62 ± 0.90 mm, which increased to 6.58 ± 1.16 mm postoperatively. Statistical analysis revealed a significant increase in alveolar ridge width following the procedure (P < 0.05), with an average gain of 2.96 ± 1.21 mm. In summary, these findings suggest that the alveolar bone mucosa-periosteal bone flap technique is an effective approach for widening the alveolar ridge while placing dental implants, meriting its consideration for clinical application.
AI versus human-generated multiple-choice questions for medical education: a cohort study in a high-stakes examination
Authors: Law Alex KK , So Jerome , Lui Chun Tat , Choi Yu Fai , Cheung Koon Ho , Kei-ching Hung Kevin , Graham Colin Alexander 
Published: February 2025

Abstract

Background
The creation of high-quality multiple-choice questions (MCQs) is essential for medical education assessments but is resource-intensive and time-consuming when done by human experts. Large language models (LLMs) like ChatGPT-4o offer a promising alternative, but their efficacy remains unclear, particularly in high-stakes exams.

Objective
This study aimed to evaluate the quality and psychometric properties of ChatGPT-4o-generated MCQs compared to human-created MCQs in a high-stakes medical licensing exam.

Methods
A prospective cohort study was conducted among medical doctors preparing for the Primary Examination on Emergency Medicine (PEEM) organised by the Hong Kong College of Emergency Medicine in August 2024. Participants attempted two sets of 100 MCQs—one AI-generated and one human-generated. Expert reviewers assessed MCQs for factual correctness, relevance, difficulty, alignment with Bloom’s taxonomy (remember, understand, apply and analyse), and item writing flaws. Psychometric analyses were performed, including difficulty and discrimination indices and KR-20 reliability. Candidate performance and time efficiency were also evaluated.

Results
Among 24 participants, AI-generated MCQs were easier (mean difficulty index = 0.78 ± 0.22 vs. 0.69 ± 0.23, p < 0.01) but showed similar discrimination indices to human MCQs (mean = 0.22 ± 0.23 vs. 0.26 ± 0.26). Agreement was moderate (ICC = 0.62, p = 0.01, 95% CI: 0.12–0.84). Expert reviews identified more factual inaccuracies (6% vs. 4%), irrelevance (6% vs. 0%), and inappropriate difficulty levels (14% vs. 1%) in AI MCQs. AI questions primarily tested lower-order cognitive skills, while human MCQs better assessed higher-order skills (χ² = 14.27, p = 0.003). AI significantly reduced time spent on question generation (24.5 vs. 96 person-hours).

Conclusion
ChatGPT-4o demonstrates the potential for efficiently generating MCQs but lacks the depth needed for complex assessments. Human review remains essential to ensure quality. Combining AI efficiency with expert oversight could optimise question creation for high-stakes exams, offering a scalable model for medical education that balances time efficiency and content quality.
Nurses retention: the impact of transformational leadership, career growth, work well-being, and work-life Balance
Authors: AbdELhay Eman Sameh , Taha Samah Mohamed , El-Sayed Mona Metwally , Helaly Sahar Hassan , AbdELhay Islam Sameh 
Published: February 2025

Abstract

Background
Nurse retention is critical for healthcare systems worldwide, as high turnover rates adversely affect patient care and organizational stability.

Aim
Examines the impact of transformational leadership, career growth opportunities, work well-being, and work-life balance on nurse retention.

Methods
A cross-sectional study was conducted with 297 nurses employed in inpatient wards at Mansoura University Hospital. The study measured variables using the Nursing Retention Index, Global Transformational Leadership Scale, Career Growth Scale, Work Well-Being Scale, and Work-Life Balance Scale.

Results
A linear regression analysis identified significant predictors of nurse retention. Work-life balance was found to be a strong predictor, with an unstandardized coefficient (B) of 0.255 (p < 0.001) and a standardized coefficient (β) of 0.426, indicating a positive relationship with retention, transformational leadership also significantly influenced retention, with a B of 0.082 (p = 0.002) and a β of 0.171. In contrast, Career Growth and Work-Life Balance did not significantly predict retention, showing coefficients of -0.082 (p = 0.154) and -0.042 (p = 0.482). The model explained 23.4% of the variance in nurse retention (R-squared = 0.234) and demonstrated statistical significance (F = 22.294, p < 0.001).

Conclusion
This study highlights the critical role of transformational leadership and work-life balance in enhancing nurse retention. However, career growth and work well-being did not significantly predict retention in this study. Healthcare institutions should focus on transformational leadership and work-life balance to enhance nurse retention. Future studies should explore factors related to career growth and work well-being to determine their potential impact on retention.
Effect of the application of humanized nursing care on the clinical outcomes of neonates with hyperbilirubinemia
Authors: Abdelgawad Sahar Mahmoud Elkhedr , Galalah Eman Salah Elmetwaly Abdelrahman , El-mahdy Heba Saied , Elmahdy Nagafa Hafez Farag 
Published: February 2025

Abstract

Background
Neonatal hyperbilirubinemia is a potentially fatal condition that has toxic effects on the brain and may have negative effects. Humanized care is a comprehensive approach that focuses on the nutritional, therapeutic and hygienic needs of neonates, which helps in the resolution of hyperbilirubinemia.

Method
A quasi-experimental design was utilized in this study to evaluate the effect of humanized nursing care application on the clinical outcomes of neonates with hyperbilirubinemia. It was carried out at the Neonatal Intensive Care Unit at Tanta Main University Hospital. A total of 120 neonates with hyperbilirubinemia who fit the inclusion criteria were randomly assigned to both the study and control groups. The data were collected using the biosocial-demographic characteristics of the studied neonates and neonatal clinical outcome measures for humanized care.

Results
On the seventh day after receiving humanized care, total bilirubin levels in the study group decreased to 4.03 ± 1.48 compared to 10.21 ± 2.08 in the control group; there was also a decline in the time of jaundice regression with a mean of 3.966 ± 1.09 in the study group compared to 4.66 ± 1.29. in the control group. The mean days of phototherapy were 1.83 ± 0.73 in the study group and 2.41 ± 1.01 in the control group. Additionally, oxygen saturation increased significantly on the 7th day in the study group compared to the control group; the mean amount of daily milk intake was 752.8 ± 262.9 ml in the study group compared with 600.76 ± 290.31 ml in the control group.

Conclusion
Applying humanized care improved neonatal clinical outcomes, including O2 saturation, jaundice regression, enhanced newborn feeding and decreased duration of phototherapy.
ANO7 expression in the prostate modulates mitochondrial function and lipid metabolism
Authors: Löf Christoffer , Sultana Nasrin , Goel Neha , Heron Samuel , Wahlström Gudrun , House Andrew , Holopainen Minna , Käkelä Reijo , Schleutker Johanna 
Published: February 2025

Abstract

Background
Prostate cancer (PrCa) is a significant health concern, ranking as the second most common cancer in males globally. Genetic factors contribute substantially to PrCa risk, with up to 57% of the risk being attributed to genetic determinants. A major challenge in managing PrCa is the early identification of aggressive cases for targeted treatment, while avoiding unnecessary interventions in slow-progressing cases. Therefore, there is a critical need for genetic biomarkers that can distinguish between aggressive and non-aggressive PrCa cases. Previous research, including our own, has shown that germline variants in ANO7 are associated with aggressive PrCa. However, the function of ANO7 in the prostate remains unknown.

Methods
We performed RNA-sequencing (RNA-seq) on RWPE1 cells engineered to express ANO7 protein, alongside the analysis of a single-cell RNA-sequencing (scRNA-seq) dataset and RNA-seq from prostate tissues. Differential gene expression analysis and gene set enrichment analysis (GSEA) were conducted to identify key pathways. Additionally, we assessed oxidative phosphorylation (OXPHOS), glycolysis, and targeted metabolomics. Image analysis of mitochondrial morphology and lipidomics were also performed to provide further insight into the functional role of ANO7 in prostate cells.

Results
ANO7 expression resulted in the downregulation of metabolic pathways, particularly genes associated with the MYC pathway and oxidative phosphorylation (OXPHOS) in both prostate tissue and ANO7-expressing cells. Measurements of OXPHOS and glycolysis in the ANO7-expressing cells revealed a metabolic shift towards glycolysis. Targeted metabolomics showed reduced levels of the amino acid aspartate, indicating disrupted mitochondrial function in the ANO7-expressing cells. Image analysis demonstrated altered mitochondrial morphology in these cells. Additionally, ANO7 downregulated genes involved in fatty acid metabolism and induced changes in lipid composition of the cells, characterized by longer acyl chain lengths and increased unsaturation, suggesting a role for ANO7 in regulating lipid metabolism in the prostate.

Conclusions
This study provides new insights into the function of ANO7 in prostate cells, highlighting its involvement in metabolic pathways, particularly OXPHOS and lipid metabolism. The findings suggest that ANO7 may act as a key regulator of cellular lipid metabolism and mitochondrial function in the prostate, shedding light on a previously unknown aspect of ANO7’s biology.
Immune profiling of human vestibular schwannoma secretions identifies TNF-α and TWEAK as cytokines with synergistic potential to impair hearing
Authors: Vasilijic Sasa , Seist Richard , Yin Zhenzhen , Xu Lei , Stankovic Konstantina M. 
Published: February 2025

Abstract

Background
Vestibular schwannoma (VS) is an intracranial tumor arising from the Schwann cells of the vestibular nerve and is an important cause of sensorineural hearing loss (SNHL) in humans. The mechanisms underlying this SNHL are incompletely understood and currently, there are no drugs FDA approved specifically for VS. This knowledge gap significantly limits the development of effective treatments aimed at preventing, stabilizing, or reversing VS-induced SNHL.

Methods
To identify effector molecules involved in VS-induced SNHL, we analyzed 47 immune-related factors secreted by tumor tissue in over 50 patients with sporadic VS and studied their correlation with preoperative hearing ability and tumor size. The most promising effector molecules were validated in vivo in an anatomically accurate mouse model of VS, and in vitro with mouse fibroblasts (L929) and auditory cell lines representing pro-sensory precursors of hair cells (UB-OC1) and auditory neuroblasts (US-VOT-N33).

Results
We demonstrated that VS-induced SNHL was linked to increased secretion of TNF-α, IL-2R, CD163, eotaxin, and HGF, while larger tumor size was associated with higher levels of TNF-α, TNF-R2, IL-1α, IFN-α, MIP-1β, and IL-21 secretion. We identified heterogeneity among VS tumors in their capacity to secrete TNF-α. Tumors with high levels of TNF-α secretion released cytokines and chemokines that significantly correlated with poor hearing (TWEAK and eotaxin) or better hearing (LIF, GRO-α, MIP-1α, MIP-3α, and IL-1α). Among these, TWEAK was notably abundant, with levels exceeding those in normal nerve tissue, elevated in patients with non-serviceable hearing and strongly linked to poor hearing in patients with TNF-α high-secreting tumors. In vivo, we demonstrated that VS-secreted factors reach the inner ear, with elevated TNF-α and TWEAK in the perilymph and blood of tumor-bearing mice with impaired hearing. In vitro, TWEAK amplified TNF-α -mediated cytotoxicity in TNF-α sensitive cells (L929) and auditory cell lines (UB-OC1 and US-VOT-N33) at tumor-secreted concentrations.

Conclusion
This study provides compelling evidence that VS-secreted TNF-α and TWEAK act synergistically to drive tumor-induced SNHL. Targeting the TNF-α/TWEAK axis presents a promising new avenue for preventing VS-induced SNHL.
Diagnostic value of the appendicitis inflammatory response (AIR) score. A systematic review and meta-analysis
Authors: Andersson Roland E. , Stark Joachim 
Published: February 2025

Abstract

Background
Clinical scoring algorithms are cost efficient in patients with suspicion of acute appendicitis. This is a systematic review and meta-analysis of the diagnostic properties of the Appendicitis Inflammatory Response (AIR) score compared with the Alvarado score.

Methods
The PubMed, EMBASE, Web of Science and Google Scholar databases were searched for reports on the diagnostic properties of the AIR score from 2008 to July 18, 2024. A meta-analysis of the receiver operating characteristic (ROC) area and the sensitivity and specificity for all and advanced appendicitis patients was performed. Advanced appendicitis was defined as perforated or gangrenous appendicitis or appendicitis abscess or phlegmon or if described as complicated appendicitis. The risk of bias was estimated via the QUADAS-2 tool. The ROC areas of the AIR score and the Alvarado score were compared.

Results
A total of 26 reports with a total of 15.699 patients were included. The area under the ROC curve for the AIR score was 0.86 (95% CI 0.83–0.88) for all patients with appendicitis and 0.93 (CI 0.91–0.96) for those with advanced appendicitis, which was greater than the corresponding areas for the Alvarado score (0.79, CI 0.76; 0.81) and 0.88, CI 0.82; 0.95), respectively.
At > 4 points, the sensitivity was 0.91 (CI 0.88; 0.94) for all patients with appendicitis and 0.95 (CI 0.94; 0.97) for those with advanced appendicitis. At > 3 points, the sensitivity was 0.95 (0.90; 0.97) for all patients with appendicitis and 0.99 (0.97; 0.99) for those with advanced appendicitis.
At > 8 points, the specificity was 0.98 (0.97; 0.99) for all patients with appendicitis and 0.99 (0.97; 0.99) for those with advanced appendicitis. The included studies had a low risk for bias and low heterogeneity.

Conclusion
The AIR score has a better diagnostic capacity than the Alvarado score does. The AIR score is a safe and efficient basis for risk-stratified management of patients suspected of having appendicitis.
Clinical spectrum, treatment and outcomes of the m.10197G>A mutation in MT-ND3: a case report, systematic review and meta-analysis
Authors: Shi YuZhi , Chen Bin , Niu SongTao , Wang XinGao , Zhang ZaiQiang 
Published: February 2025

Abstract

Background
A correlation between various sites or types of mutations in mitochondrial DNA ND3 and the development of a specific mitochondrial disease or phenotype has yet to be fully established.

Methods
This study reports a rare case of adult-onset Leigh syndrome (LS) and Leber hereditary optic neuropathy and dystonia (LDYT) overlap syndrome caused by the m.10197G>A mutation in ND3. A review of the literature was conducted to investigate the clinical spectrum, treatment and outcome resulting from the m.10197G>A mutation. Phenotypes associated with the m.10197G>A mutation were classified into three categories: LS/LS+ (LS-involved overlap syndrome), Leber hereditary optic neuropathy (LHON)/LHON+ (LHON-involved overlap syndrome) and other mitochondrial encephalopathies or presentations.

Results
A total of 84 participants (78 patients and 6 asymptomatic carriers) with the m.10197G>A mutation retrieved from 33 articles and the patient whose case we reported were included in the review and meta-analysis. Among all the participants, 55.3% (47/85) and 28.2% (24/85) presented with LS/LS+ and LHON/LHON+, respectively. The median age at onset for LS/LS+ was significantly younger than that for LHON/LHON+ [median, (Q1–Q3), 3.0 (0.58–9.5) vs. 13.5 (5.75–41.75), P = 0.001]. A negative linear correlation was observed between mutation load and age of onset in patients who presented with LS/LS+ (R2 = 0.592, P < 0.001), with the age of onset ranging from infancy to adulthood. Patients with an older age at onset [OR (95% CI), 1.46 (1.12–1.91), P = 0.005] or higher mutation loads [OR (95% CI), 1.14 (1.03–1.26), P = 0.011] were more likely to present with LHON/LHON+ than with LS/LS+. A total of 17 patients were documented as having received a combination of mitochondrial cofactor treatments. Compared with patients with LHON/LHON+, patients with LS/LS+ exhibited an exceedingly high probability of a stable or worsen outcome (93.8% vs. 33.3%, P = 0.006).

Conclusions
LS/LS+ and LHON/LHON+ are the predominant presentations of the m.10197G>A mutation. An older age at onset and greater mutation load increases the probability of an LHON/LHON+ presentation. Patients presenting with LS/LS+ have an exceedingly high possibility of an unfavorable outcome. The identification of factors and outcomes associated with phenotypes in patients with the m.10197G>A mutation facilitates the provision of improved prognostic counseling for patients and their family members who are carriers of this mutation.