bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing frailty amongst older people admitted to hospital in a low-income setting: a multicentre study in northern Tanzania
Authors: Davidson Sean L , Emmence Luke , Motraghi-Nobes Sara May , Bickerstaff Emily , Rayers George , Lyimo Godrule , Kilasara Joseph , Chuwa Mary , Kisheo Fortunatus , Kisaruni Elibariki , Urasa Sarah , Mitchell Emma , Dotchin Catherine L , Walker Richard W 
Published: February 2024

Abstract
Background
Populations are ageing globally and Low- and Middle-Income Countries (LMICs) are experiencing the fastest rates of demographic change. Few studies have explored the burden of frailty amongst older people in hospital in LMICs, where healthcare services are having to rapidly adapt to align with the needs of older people. This study aimed to measure the prevalence of frailty amongst older people admitted to hospital in Tanzania and to explore their demographic and clinical characteristics.

Methods
This study had a prospective observational design. Over a six-month period, all adults ≥ 60 years old admitted to medical wards in four hospitals in northern Tanzania were invited to participate. They were screened for frailty using the Clinical Frailty Scale (CFS) and the Frailty Phenotype (FP). Demographic and clinical characteristics of interest were recorded in a structured questionnaire. These included the Barthel Index, the Identification of Elderly Africans Instrumental Activities of Daily Living (IADEA-IADL) and Cognitive (IDEA-Cog) screens, the EURO-D depression scale and Confusion Assessment Method.

Results
540 adults aged ≥ 60 were admitted, and 308 completed assessment. Frailty was present in 66.6% using the CFS and participants with frailty were significantly older, with lower levels of education and literacy, greater disability, greater comorbidity, poorer cognition and higher levels of delirium. Using the FP, 57.0% of participants were classed as frail though a majority of participants (n = 159, 51.6%) could not be classified due to a high proportion of missing data.

Conclusions
This study indicates that the prevalence of frailty on medical wards in northern Tanzania is high according to the CFS. However, the challenges in operationalising the FP in this setting highlight the need for future work to adapt frailty screening tools for an African context. Future investigations should also seek to correlate frailty status with long-term clinical outcomes after admission in this setting.
Vagococcus fluvialis isolation from the urine of a bladder cancer patient: a case report
Authors: Chen Qian , Tan Siwen , Long Sheng , Wang Kaixuan , Liu Qi 
Published: February 2024

AbstractVagococcus fluvialis infection is rare in humans, and there is limited research on the clinical manifestations and antimicrobial susceptibility testing of Vagococcus fluvialis infection. Here, We isolated Vagococcus fluvialis from the urine samples of bladder cancer patients at Hunan Provincial People’s Hospital, and it is the first reported case of Vagococcus fluvialis isolated from the urine. The fully automated microbial identification system and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) identified the bacterium as Vagococcus fluvialis with a confidence level of 99.9%. The VITEK-2Compact fully automated microbial susceptibility analysis system indicated that it was most sensitive to tigecycline, vancomycin, quinupristin/dalfopristin, linezolid, and showed moderate sensitivity to erythromycin, levofloxacin, ciprofloxacin, ampicillin/sulbactam, and tetracycline. Additionally, it exhibited synergy when combined with high-level gentamicin and vancomycin, showing sensitivity. However, it displayed poor activity against penicillin and furanth. According to our knowledge, this is the first study to isolate and identify Vagococcus fluvialis from the urine of bladder cancer patients and the systematically reviewed other reported Vagococcus infections on human, which provide an experimental basis for guiding the rational use of drugs in the clinical treatment and diagnose of Vagococcus fluvialis infection and related pathogenic mechanism research. Meanwhile, we have systematically reviewed other reported.
Selective feticide in dichorionic diamniotic (DCDA) twins complicated with previable premature rupture of membrane before 24 weeks may be a safe therapeutic alternative to ongoing pregnancy
Authors: Zhu Caixia , Liu Haiyan , Zhu Hui , Huang Linhuan 
Published: February 2024

Abstract
Background
To date, there are no clinical guidelines for dichorionic diamniotic (DCDA) twins complicated with previable premature rupture of membrane (PV-ROM) before 24 weeks of gestation. The typical management options including expectant management and/or pregnant termination, induce the risks of fetal mortality and morbidity.

Objective
To explore the feasibility selective feticide in DCDA twins complicated with PV-ROM.

Study design
A Retrospective cohort study, enrolling 28 DCDA twins suffering from PV-ROM in a tertiary medical center from Jan 01 2012 to Jan 01 2022. The obstetric outcome was compared between selective feticide group and expectant management group.

Results
There were 12 cases managed expectantly and 16 underwent selective feticide. More cases suffered from oligohydramnios in expectant management group compared to selective feticide group (P = 0.008). Among 13 cases with ROM of upper sac, the mean gestational age at delivery was (33.9 ± 4.9) weeks in the selective feticide group, which was significantly higher than that in the expectant management (P = 0.038). Five fetuses (83.3%) with selective feticide delivered after 32 weeks, whereas only one (14.3%) case in expectant management group (P = 0.029). However, in the subgroup with ROM of lower sac, no significant difference of the mean gestation age at delivery between groups and none of cases delivered after 32 weeks.

Conclusion
There was a trend towards an increase in latency interval in DCDA twins with PV-ROM following selective feticide, compared to that with expectant management. Furthermore, selective feticide in cases with PV-ROM of upper sac has a favorable outcome.
A dynamic nomogram predicting symptomatic pneumonia in patients with lung cancer receiving thoracic radiation
Authors: Zha Yawen , Zhang Jingjing , Yan Xinyu , Yang Chen , Wen Lei , Li Minying 
Published: February 2024

Abstract
Purpose
The most common and potentially fatal side effect of thoracic radiation therapy is radiation pneumonitis (RP). Due to the lack of effective treatments, predicting radiation pneumonitis is crucial. This study aimed to develop a dynamic nomogram to accurately predict symptomatic pneumonitis (RP ≥ 2) following thoracic radiotherapy for lung cancer patients.

Methods
Data from patients with pathologically diagnosed lung cancer at the Zhongshan People’s Hospital Department of Radiotherapy for Thoracic Cancer between January 2017 and June 2022 were retrospectively analyzed. Risk factors for radiation pneumonitis were identified through multivariate logistic regression analysis and utilized to construct a dynamic nomogram. The predictive performance of the nomogram was validated using a bootstrapped concordance index and calibration plots.

Results
Age, smoking index, chemotherapy, and whole lung V5/MLD were identified as significant factors contributing to the accurate prediction of symptomatic pneumonitis. A dynamic nomogram for symptomatic pneumonitis was developed using these risk factors. The area under the curve was 0.89(95% confidence interval 0.83–0.95). The nomogram demonstrated a concordance index of 0.89(95% confidence interval 0.82–0.95) and was well calibrated. Furthermore, the threshold values for high- risk and low- risk were determined to be 154 using the receiver operating curve.

Conclusions
The developed dynamic nomogram offers an accurate and convenient tool for clinical application in predicting the risk of symptomatic pneumonitis in patients with lung cancer undergoing thoracic radiation.
Comparison of Twin Block appliance and Herbst appliance in the treatment of Class II malocclusion among children: a meta-analysis
Authors: Xu Feifei , Fang Ying , Sui Xiaoling , Yao Yapeng 
Published: February 2024

Abstract
Background
Our meta-analysis aimed to evaluate the efficacy of applying Herbst and Twin Block appliances in the treatment of Class II malocclusion among children.

Methods
Databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China VIP Database (VIP), and Wanfang were thoroughly searched from inception to August 9, 2023. The outcomes included skeletal, dental, and soft tissue changes. The weighted mean difference (WMD) was used as the effect indicator, and the effect size was expressed with a 95% confidence interval (CI). The heterogeneity of each outcome effect size was tested, and the heterogeneity statistic I2 ≥ 50% was analyzed by the random-effect model, otherwise, the fixed-effect model was conducted. Sensitivity analysis was performed.

Results
A total of 12 studies involving 574 patients were included in this meta-analysis. Herbst appliance had a statistically significant increase in mandibular body length (WMD: 1.44, 95% CI: 0.93 to 1.96, P < 0.001) compared with the Twin Block appliance. More increases in angle and distance of L1 to mandibular plane (MP) were found in the Herbst appliance compared with the Twin Block appliance. Significant and greater improvements in molar relationship (WMD: 0.79, 95% CI: 0.28 to 1.29, P = 0.002), posterior facial height (WMD: -1.23, 95% CI: -2.08 to -0.38, P = 0.005), convexity angle (WMD: -1.89, 95% CI: -3.12 to -0.66, P = 0.003), and Sella-Nasion plane angle (U1 to SN) (WMD: 3.34, 95% CI: 2.25 to 4.43, P < 0.001) were achieved in the Twin Block appliance. Herbst and Twin Block appliances produced similar effects in the skeletal and dentoalveolar changes including Sella-Nasion-point A (SNA), Sella-Nasion-point B, point A-Nasion-point B (ANB), overjet, and overbite.

Conclusion
As the findings revealed both Herbst and Twin Block appliances contributed successfully to the correction of Class II malocclusion. Compared with the Twin Block appliance, the Herbst appliance may have more advantages in mandibular bone movement. Twin Block therapy resulted in more improvement in the aesthetics of the face.
A qualitative co-design-based approach to identify sources of workplace-related distress and develop well-being strategies for cardiovascular nurses, allied health professionals, and physicians
Authors: Jelen Ahlexxi , Goldfarb Rebecca , Rosart Jennifer , Graham Leanna , Rubin Barry B. 
Published: February 2024

Abstract
Objective
Clinician distress is a multidimensional condition that includes burnout, decreased meaning in work, severe fatigue, poor work–life integration, reduced quality of life, and suicidal ideation. It has negative impacts on patients, providers, and healthcare systems. In this three-phase qualitative investigation, we identified workplace-related factors that drive clinician distress and co-designed actionable interventions with inter-professional cardiovascular clinicians to decrease their distress and improve well-being within a Canadian quaternary hospital network.

Methods
Between October 2021 and May 2022, we invited nurses, allied health professionals, and physicians to participate in a three-phase qualitative investigation. Phases 1 and 2 included individual interviews and focus groups to identify workplace-related factors contributing to distress. Phase 3 involved co-design workshops that engaged inter-professional clinicians to develop interventions addressing drivers of distress identified. Qualitative information was analyzed using descriptive thematic analysis.

Results
Fifty-one clinicians (24 nurses, 10 allied health professionals, and 17 physicians) participated. Insights from Phases 1 and 2 identified five key thematic drivers of distress: inadequate support within inter-professional teams, decreased joy in work, unsustainable workloads, limited opportunities for learning and professional growth, and a lack of transparent leadership communication. Phase 3 co-design workshops yielded four actionable interventions to mitigate clinician distress in the workplace: re-designing daily safety huddles, formalizing a nursing coaching and mentorship program, creating a value-added program e-newsletter, and implementing an employee experience platform.

Conclusion
This study increases our understanding on workplace-related factors that contribute to clinician distress, as shared by inter-professional clinicians specializing in cardiovascular care. Healthcare organizations can develop effective interventions to mitigate clinician distress by actively engaging healthcare workers in identifying workplace drivers of distress and collaboratively designing tailored, practical interventions that directly address these challenges.
Psoriasis may increase the risk of idiopathic pulmonary fibrosis: a two-sample Mendelian randomization study
Authors: Chen Lingli , Wei Yujie , Hu Mengjin , Liu Yile , Zheng Xiangrong 
Published: February 2024

Abstract
Background
Although some studies have indicated that Psoriasis could contribute to the risk of idiopathic pulmonary fibrosis (IPF), no study has reported a clear causal association between them. Our aim was to explore the potential relationship between Psoriasis and IPF using Mendelian randomization (MR) design.

Methods
To explore a causal association between Psoriasis and IPF, we used genetic instruments from the largest available genome-wide association study (GWAS) of European ancestry, including psoriasis (5314 cases, 457,619 controls) and IPF (1028 cases, 196,986 controls). Our main analyses were conducted by inverse-variance weighted (IVW) method with random-effects model, with the other complementary four analyses: weighted median method, weighted mode, multivariable MR and MR-Egger approach.

Results
The results of IVW methods demonstrated that genetically predicted psoriasis was significantly associated with higher odds of IPF, with an odds ratio (OR) of 1.09 (95%CI, 1.01–1.18; P = 0.02). Weighted median method, weighted mode and multivariable MR also demonstrated directionally similar results (P < 0.05), while the MR-Egger regression did not reveal the impact of psoriasis on IPF (OR = 1.09, 95%CI, 0.98–1.21; P = 0.11). In addition, both funnel plots and MR-Egger intercepts indicated no directional pleiotropic effects between psoriasis and IPF.

Conclusions
Our study provided potential evidence between genetically predicted psoriasis and IPF, which suggests that understanding the mutual risk factors between psoriasis and IPF can facilitate the clinical management of both diseases.
Efficacy and safety of direct oral anticoagulants versus low-molecular-weight heparin for thromboprophylaxis after cancer surgery: a systematic review and meta-analysis
Authors: Zhou Hong , Chen Ting-Ting , Ye Ling-ling , Ma Jun-Jie , Zhang Jin-Hua 
Published: February 2024

Abstract
Background
Direct oral anticoagulants (DOACs) used as an alternative to low-molecular-weight heparin (LMWH) for thromboprophylaxis after cancer surgery for venous thromboembolic events (VTE) remains unclear. This study aimed to investigate the efficacy and safety of DOACs versus LMWH in these patients.

Materials and methods
A search of EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science was carried out and included all randomized controlled trials (RCTs) and observational studies that directly compared DOACs with LMWH for thromboprophylaxis in patients after cancer surgery through July 25, 2023. The primary efficacy and safety outcomes were VTE, major bleeding, and clinically relevant non-major bleeding (CRNMB) within 30 days of surgery. The risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB2) tool for RCTs and ROBINS-I tool for non-randomized studies. This study was registered in PROSPERO (CRD42023445386).

Results
We retrieved 5149articles, selected 27 for eligibility, and included 10 studies (three RCTs and seven observational studies) encompassing 3054 patients who underwent postoperative thromboprophylaxis with DOACs (41%) or LMWH (59%). Compared to LMWH thromboprophylaxis, DOACs had a comparable risk of VTE (RR:0.69[95% CI:0.46–1.02], I2 = 0%), major bleeding (RR:1.55 [95% CI:0.82–2.93], I2 = 2%), and CRNMB (RR, 0.89 [95% CI, 0.4–1.98], I2 = 31%) during the 30-day postoperative period. Subgroup analysis of VTE and major bleeding suggested no differences according to study type, extended thromboprophylaxis, tumor types, or different types of DOAC.

Conclusion
DOACs are potentially effective alternatives to LMWH for thromboprophylaxis in patients undergoing cancer surgery, without increasing the risk of major bleeding events.
Essential role of PLD2 in hypoxia-induced stemness and therapy resistance in ovarian tumors
Authors: Muñoz-Galván Sandra , Verdugo-Sivianes Eva M. , Santos-Pereira José M. , Estevez-García Purificación , Carnero Amancio 
Published: February 2024

Abstract
Background
Hypoxia in solid tumors is an important source of chemoresistance that can determine poor patient prognosis. Such chemoresistance relies on the presence of cancer stem cells (CSCs), and hypoxia promotes their generation through transcriptional activation by HIF transcription factors.

Methods
We used ovarian cancer (OC) cell lines, xenograft models, OC patient samples, transcriptional databases, induced pluripotent stem cells (iPSCs) and Assay for Transposase-Accessible Chromatin using sequencing (ATAC-seq).

Results
Here, we show that hypoxia induces CSC formation and chemoresistance in ovarian cancer through transcriptional activation of the PLD2 gene. Mechanistically, HIF-1α activates PLD2 transcription through hypoxia response elements, and both hypoxia and PLD2 overexpression lead to increased accessibility around stemness genes, detected by ATAC-seq, at sites bound by AP-1 transcription factors. This in turn provokes a rewiring of stemness genes, including the overexpression of SOX2, SOX9 or NOTCH1. PLD2 overexpression also leads to decreased patient survival, enhanced tumor growth and CSC formation, and increased iPSCs reprograming, confirming its role in dedifferentiation to a stem-like phenotype. Importantly, hypoxia-induced stemness is dependent on PLD2 expression, demonstrating that PLD2 is a major determinant of de-differentiation of ovarian cancer cells to stem-like cells in hypoxic conditions. Finally, we demonstrate that high PLD2 expression increases chemoresistance to cisplatin and carboplatin treatments, both in vitro and in vivo, while its pharmacological inhibition restores sensitivity.

Conclusions
Altogether, our work highlights the importance of the HIF-1α-PLD2 axis for CSC generation and chemoresistance in OC and proposes an alternative treatment for patients with high PLD2 expression.
Deciphering cancer cell state plasticity with single-cell genomics and artificial intelligence
Authors: Holton Emily , Muskovic Walter , Powell Joseph E 
Published: February 2024

AbstractCancer stem cell plasticity refers to the ability of tumour cells to dynamically switch between states—for example, from cancer stem cells to non-cancer stem cell states. Governed by regulatory processes, cells transition through a continuum, with this transition space often referred to as a cell state landscape. Plasticity in cancer cell states leads to divergent biological behaviours, with certain cell states, or state transitions, responsible for tumour progression and therapeutic response. The advent of single-cell assays means these features can now be measured for individual cancer cells and at scale. However, the high dimensionality of this data, complex relationships between genomic features, and a lack of precise knowledge of the genomic profiles defining cancer cell states have opened the door for artificial intelligence methods for depicting cancer cell state landscapes. The contribution of cell state plasticity to cancer phenotypes such as treatment resistance, metastasis, and dormancy has been masked by analysis of ‘bulk’ genomic data—constituted of the average signal from millions of cells. Single-cell technologies solve this problem by producing a high-dimensional cellular landscape of the tumour ecosystem, quantifying the genomic profiles of individual cells, and creating a more detailed model to investigate cancer plasticity (Genome Res 31:1719, 2021; Semin Cancer Biol 53: 48-58, 2018; Signal Transduct Target Ther 5:1-36, 2020). In conjunction, rapid development in artificial intelligence methods has led to numerous tools that can be employed to study cancer cell plasticity.
Comprehensive linear and nonlinear analysis of the effects of spinning on dynamic balancing ability in Hungarian folk dancers
Authors: Pálya Zsófia , Kiss Rita M. 
Published: February 2024

AbstractPurposeIn the case of Hungarian folk dancers, it is crucial to maintain correct posture and promptly respond to imbalances. However, traditional dances often lack specific training to develop these skills.MethodsIn this present study, twelve dancers (8 male, 4 female, age: 21.7 ± 3.6 years) and ten non-dancers subjects forming a control group (6 male, 4 female, age: 21.6 ± 2.87 years) participated. During the measurements a 60-second long bipedal balancing test on the balance board was completed two times, and a spinning intervention was inserted in between the two sessions. The balance capabilities of the two groups were assessed through the characterization of motion on an unstable board, and the analysis of subject’s center of mass and head movements.ResultsDancers applied a more sophisticated and resource-intensive strategy to address the balancing task, yielding a better balancing performance in terms of balance board parameters. By preferring a solid stability in the medio-lateral direction, a greater fluctuation in the anterior-posterior direction can be observed (e.g., significantly lowerSampEnvalues). The overall more successful performance is further evidenced by within-subject comparison since significant differences were observed mostly within the control group. Based on the results, the advanced balancing ability of the folk dancer group is more likely to be acquired through years of experience.ConclusionThe results indicate that additional specialized training could further enhance this ability, encouraging the reliance on poorly memorized corrective movements and reducing the risk of injury.