bluuebunny/crossref_metadata_2025_split huggingface dataset:
The learning curve of the MS-TRAM/DIEP breast reconstruction by dual-trained breast surgeons
Authors: Li Shunrong , Zhang Songliang , Zhang Xiaolan , Yan Jingwen , Wang Shuai , Tan Luyuan , Rao Nanyan , Chen Kai , Zhu Liling 
Published: February 2024

Abstract
Background
Breast cancer surgeries involving MS-TRAM/DIEP breast reconstruction has traditionally been collaborative efforts between breast surgeons and plastic surgeons. However, in our institution, this procedure is performed by dual-trained breast surgeons who are proficient in both breast surgery and MS-TRAM/DIEP breast reconstruction. This study aims to provide insights into the learning curve associated with this surgical approach.

Materials and methods
We included eligible breast cancer patients who underwent MS-TRAM/DIEP breast reconstruction by dual-trained breast surgeons between 2015 and 2020 at our institution. We present the learning curve of this surgical approach, with a focus on determining factors affecting flap harvesting time, surgery time, and ischemic time. Additionally, we assessed the surgical complication rates.

Results
A total of 147 eligible patients were enrolled in this study. Notably, after 30 cases, a statistically significant reduction of 1.7 h in surgery time and 21 min in ischemic time was achieved, signifying the attainment of a plateau in the learning curve. And the major and minor complications were comparable between the early and after 30 cases.

Conclusion
This study explores the learning curve and feasibility experienced by dual-trained breast surgeons in performing MS-TRAM/DIEP breast reconstruction.

Trial registration
NCT05560633.
Impact of molar teeth distalization by clear aligners on maxillary alveolar bone thickness and root resorption: a three‑dimensional study
Authors: Al-Worafi Naseem Ali , Zheng Bowen , Al-Warafi Leena Ali , Alyafrusee Enas Senan , Alsomairi Majedh Abdo Ali , Liu Yi 
Published: February 2024

Abstract
Objective
This study aimed to evaluate the impact of molar teeth distalization movement by clear aligners on changes in the alveolar bone thickness and orthodontically induced inflammatory root resorption (OIIRR) in maxillary molars using conebeam computed tomography (CBCT).

Materials and methods
Three-dimensional CBCT scans of 35 adult patients (one hundred forty maxillary molars) with pre-designed selection criteria and a mean age of 24.4 ± 7.1 years were included. The measured parameters, including alveolar bone thickness for maxillary molars and root resorption (OIIRR), were analyzed using pre-and post-treatment CBCT (T0 and T1, respectively) with Invivo 6.0 software.

Result
Post-treatment, relevant statistically significant changes included deposition of bone in the average palatal surface of the 1st molars. The reduction of bone was seen in the average buccal surface of the first molars and both surfaces of the second molars. Regarding root length after treatment, the average maxillary 1st molar roots showed significant OIIRR (p < 0.001).

Conclusion
Clear aligner treatment could effectively reduce the incidence of alveolar bone thickness reduction and OIIRR in treating Class II malocclusions compared to conventional braces, as shown in previous studies. This research will aid in fully grasping the benefits of clear aligners.
Exploring the benefits of wild plants in dietary nutrition: investigating perspectives, choices, health impacts and sustainable practices
Authors: Anwar Tauseef , Qureshi Huma , Shahzadi Sumbal , Siddiqi Ejaz Hussain , Ali Hayssam M. , Abdelhamid Mohamed M. A. , Nazim Muhammad 
Published: February 2024

Abstract
Background
This ethnobotanical study in Dunyapur, District Lodhran, Pakistan, focuses on traditional medicinal knowledge, exploring 41 plants across 28 families. The research involves 496 informants from diverse backgrounds, including farmers, herbalists, housewives, teachers, and shopkeepers. The prevalence of herbs (68%) aligns with their accessibility and rapid regrowth, shaping the local medicinal landscape. The study investigates socio-demographic features, emphasizing the importance of considering the community's diverse perspectives.

Methods
The research employs quantitative ethnobotanical data analysis, introducing various indices like PPV, FUV, FIV, RFC, UV, and RI. The analysis of plant growth habits underscores the dominance of herbs, and the method of preparation evaluation identifies decoction as the most common (23%). Leaves (27%) are the most utilized plant part, and Resedaceae stands out with the highest FUV (0.38). FIV highlights the ecological and cultural significance of Poaceae, Boraginaceae, Fabaceae, and Solanaceae.

Results
The RFC values range from 0.016 to 0.032, with Cucumis melo having the highest value (0.032), indicating its frequent citation and cultural significance. The study reveals specific plants like Melia azedarach, Peganum harmala and Salvadora oleoides with high PR values for skin issues, reflecting their widespread acceptance and effectiveness. Oligomeris linifolia emerges with the highest UV (0.38), emphasizing its greater significance in local traditional practices. Leptadenia pyrotechnica records the highest RI (9.85), underlining its exceptional importance in the community's traditional pharmacopeia.

Conclusion
The findings offer a holistic understanding of ethnobotanical knowledge in Dunyapur, emphasizing the role of local contexts and ecological factors in shaping traditional plant uses. The study contributes valuable insights into the diverse practices within the community, laying the foundation for sustainable integration of traditional knowledge into broader healthcare frameworks.
Quality improvement project to reduce medicare 1-day write-offs due to inappropriate admission orders
Authors: Oke Olufolarin , Sullivan K. Michaela , Hom Jason , Svec David , Weng Yingjie , Shieh Lisa 
Published: February 2024

Abstract
Background
We identified that Stanford Health Care had a significant number of patients who after discharge are found by the utilization review committee not to meet Center for Mediare and Medicaid Services (CMS) 2-midnight benchmark for inpatient status. Some of the charges incurred during the care of these patients are written-off and known as Medicare 1-day write-offs. This study which aims to evaluate the use of a Best Practice Alert (BPA) feature on the electronic medical record, EPIC, to ensure appropriate designation of a patient’s hospitalization status as either inpatient or outpatient in accordance with Center for Medicare and Medicaid services (CMS) 2 midnight length of stay benchmark thereby reducing the number of associated write-offs.

Method
We incorporated a best practice alert (BPA) into the Epic Electronic Medical Record (EMR) that would prompt the discharging provider and the case manager to review the patients’ inpatient designation prior to discharge and change the patient’s designation to observation when deemed appropriate. Patients who met the inclusion criteria (Patients must have Medicare fee-for-service insurance, inpatient length of stay (LOS) less than 2 midnights, inpatient designation as hospitalization status at time of discharge, was hospitalized to an acute level of care and belonged to one of 37 listed hospital services at the time of signing of the discharge order) were randomized to have the BPA either silent or active over a three-month period from July 18, 2019, to October 18, 2019.

Result
A total of 88 patients were included in this study: 40 in the control arm and 48 in the intervention arm. In the intervention arm, 8 (8/48, 16.7%) had an inpatient status designation despite potentially meeting Medicare guidelines for an observation stay, comparing to 23 patients (23/40, 57.5%) patients in the control group (p = 0.001). The estimated number of write-offs in the control arm was 17 (73.9%, out of 23 inpatient patients) while in the intervention arm was 1 (12.5%, out of 8 inpatient patient) after accounting for patients who may have met inpatient criteria for other reasons based on case manager note review.

Conclusion
This is the first time to our knowledge that a BPA has been used in this manner to reduce the number of Medicare 1-day write-offs.
Effect of leadership styles on turnover intention among staff nurses in private hospitals: the moderating effect of perceived organizational support
Authors: Pattali Surabhila , Sankar Jayendira P. , Al Qahtani Haitham , Menon Nidhi , Faizal Shabana 
Published: February 2024

AbstractLeadership styles have often been proven to support employees in performing their duties better and with more efficiency while enabling them to have extended organizational tenures. Staff nurses are an essential resource of hospitals to ensure proper administration and quality patient health care. The study aims to determine how transformational and authentic leadership styles affect the staff nurses’ turnover intention in private hospitals. In addition, it also finds the moderating effect of perceived organizational support. An explanatory quantitative research design with a cross-sectional investigation and a stratified sampling strategy was used for the study. Data from 296 nurses from the eight chosen private hospitals in the Kingdom of Bahrain were gathered using a questionnaire with 24 items. Smart-PLS was employed to conduct PLS-SEM (partial least squares structural equation modeling) to measure direct and indirect effects. The result indicates that transformational, authentic leadership styles and perceived organizational support significantly negatively affect nurses’ turnover intention. The study confirms the negative moderating effect of perceived organizational support between transformational leadership and turnover intention and the positive moderating effect of perceived organizational support between authentic leadership and turnover intention. Managers should concentrate on the leadership style to avoid its impact on turnover intention. By considering human resource practices such as communication and training strategies to cope with the negative effect of turnover intention, organizations can enhance employee engagement, improve job satisfaction, and foster a more stable and productive work environment. The present research revealed the adverse impact of turnover intention within hospitals by examining its association with leadership styles. The research made a significant contribution to the existing literature by delving into the impact of leadership styles on turnover intention, focusing on the moderating effect of perceived organizational support. The study’s findings shed light on the intricate relationship between leadership practices and employee turnover, providing valuable insights for both scholars and practitioners in the field. The study used a cross-sectional design to collect data and ensured the absence of standard method variance. The research enhanced the social dominance theory (SDT) by examining how perceived organizational support moderates the relationship between leadership styles and turnover intention.
Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis
Authors: Teh Jhia J. , Pascoe Dominic J. , Hafeji Safiya , Parchure Rohini , Koczoski Adam , Rimmer Michael P. , Khan Khalid S. , Al Wattar Bassel H. 
Published: February 2024

Abstract
Background
Effective pain control is crucial to optimise the success of medical procedures. Immersive virtual reality (VR) technology could offer an effective non-invasive, non-pharmacological option to distract patients and reduce their experience of pain. We aimed to evaluate the efficacy of Immersive virtual reality (VR) technology in reducing patient’s pain perception during various medical procedures by conducting a systematic review and meta-analysis.

Methods
We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and SIGLE until December 2022 for all randomised clinical trials (RCT) evaluating any type of VR in patients undergoing any medical procedure. We conducted a random effect meta-analysis summarising standardised mean differences (SMD) with 95% confidence intervals (CI). We evaluated heterogeneity using I2 and explored it using subgroup and meta-regression analyses.

Results
In total, we included 92 RCTs (n = 7133 participants). There was a significant reduction in pain scores with VR across all medical procedures (n = 83, SMD − 0.78, 95% CI − 1.00 to − 0.57, I2 = 93%, p = < 0.01). Subgroup analysis showed varied reduction in pain scores across trial designs [crossover (n = 13, SMD − 0.86, 95% CI − 1.23 to − 0.49, I2 = 72%, p = < 0.01) vs parallel RCTs (n = 70, SMD − 0.77, 95% CI − 1.01 to − 0.52, I2 = 90%, p = < 0.01)]; participant age groups [paediatric (n = 43, SMD − 0.91, 95% CI − 1.26 to − 0.56, I2 = 87%, p = < 0.01) vs adults (n = 40, SMD − 0.66, 95% CI − 0.94 to − 0.39, I2 = 89%, p = < 0.01)] or procedures [venepuncture (n = 32, SMD − 0.99, 95% CI − 1.52 to − 0.46, I2 = 90%, p = < 0.01) vs childbirth (n = 7, SMD − 0.99, 95% CI − 1.59 to − 0.38, I2 = 88%, p = < 0.01) vs minimally invasive medical procedures (n = 25, SMD − 0.51, 95% CI − 0.79 to − 0.23, I2 = 85%, p = < 0.01) vs dressing changes in burn patients (n = 19, SMD − 0.8, 95% CI − 1.16 to − 0.45, I2 = 87%, p = < 0.01)]. We explored heterogeneity using meta-regression which showed no significant impact of different covariates including crossover trials (p = 0.53), minimally invasive procedures (p = 0.37), and among paediatric participants (p = 0.27). Cumulative meta-analysis showed no change in overall effect estimates with the additional RCTs since 2018.

Conclusions
Immersive VR technology offers effective pain control across various medical procedures, albeit statistical heterogeneity. Further research is needed to inform the safe adoption of this technology across different medical disciplines.
Icariin exerts anti-tumor activity by inducing autophagy via AMPK/mTOR/ULK1 pathway in triple-negative breast cancer
Authors: Zhao Mei , Xu Panling , Shi Wenjing , Wang Juan , Wang Ting , Li Ping 
Published: February 2024

Abstract
Background
Breast cancer is the most prevalent female tumor, of which triple-negative breast cancer (TNBC) accounts for about 15%. Characterized by its aggressive nature and limited treatment options, TNBC currently stands as a significant clinical challenge. This study aimed to investigate the effects of icariin (ICA) on TNBC and explore the underlying molecular mechanism.

Methods
Cell viability was assessed using CCK-8 assay, whereas the impact of ICA on cell proliferation was determined using colony formation assay and detection of proliferating cell nuclear antigen protein. Wound healing and transwell assays were used to evaluate the effects of ICA on cell migration and invasion, respectively. Flow cytometry was used to analyze cell cycle distribution and apoptosis. Transmission electron microscopy and monodansylcaverine staining were performed to detect the induction of autophagy, whereas molecular docking was conducted to predict the potential targets associated with autophagy. The in vivo anti-tumor effects of ICA were evaluated using a TNBC 4T1 xenograft mouse model. Protein expression levels were examined using immunoblotting and immunohistochemistry.

Results
In vitro, ICA effectively suppressed the viability, proliferation, migration, and invasion of TNBC cells and induced G0/G1 phase cell cycle arrest, apoptosis, and autophagy in TNBC cells by regulating the adenosine monophosphate-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR)/Unc-51-like kinase 1 (ULK1) signaling pathway. The knockdown of AMPK and inhibition of autophagy with 3-methyladenine reversed the effects of ICA, highlighting the importance of AMPK and autophagy in the anti-cancer mechanism of ICA. In vivo, ICA significantly inhibited TNBC growth, promoted autophagy, and regulated AMPK/mTOR/ULK1 pathway.

Conclusions
Our findings demonstrated that ICA exerts anti-cancer effects against TNBC and the associated molecular mechanisms. This study will help to facilitate further preclinical and clinical investigations for the treatment of TNBC.
ZNF460-mediated circRPPH1 promotes TNBC progression through ITGA5-induced FAK/PI3K/AKT activation in a ceRNA manner
Authors: Zhang Chuanpeng , Yu Ziyi , Yang Susu , Liu Yitao , Song Jiangni , Mao Juan , Li Minghui , Zhao Yi 
Published: February 2024

Abstract
Background
Circular RNAs are highly stable regulatory RNAs that have been increasingly associated with tumorigenesis and progression. However, the role of many circRNAs in triple-negative breast cancer (TNBC) and the related mechanisms have not been elucidated.

Methods
In this study, we screened circRNAs with significant expression differences in the RNA sequencing datasets of TNBC and normal breast tissues and then detected the expression level of circRPPH1 by qRT‒PCR. The biological role of circRPPH1 in TNBC was then verified by in vivo and in vitro experiments. Mechanistically, we verified the regulatory effects between circRPPH1 and ZNF460 and between circRPPH1 and miR-326 by chromatin immunoprecipitation (ChIP), fluorescence in situ hybridization assay, dual luciferase reporter gene assay and RNA pull-down assay. In addition, to determine the expression of associated proteins, we performed immunohistochemistry, immunofluorescence, and western blotting.

Results
The upregulation of circRPPH1 in TNBC was positively linked with a poor prognosis. Additionally, both in vivo and in vitro, circRPPH1 promoted the biologically malignant behavior of TNBC cells. Additionally, circRPPH1 may function as a molecular sponge for miR-326 to control integrin subunit alpha 5 (ITGA5) expression and activate the focal adhesion kinase (FAK)/PI3K/AKT pathway.

Conclusion
Our research showed that ZNF460 could promote circRPPH1 expression and that the circRPPH1/miR-326/ITGA5 axis could activate the FAK/PI3K/AKT pathway to promote the progression of TNBC. Therefore, circRPPH1 can be used as a therapeutic or diagnostic target for TNBC.
Early brain cognitive development in late preterm infants: an event-related potential and resting EEG study
Authors: Zhang Qinfen , Dong Xuan , Jin Wenjie , Fan Jiaojiao 
Published: February 2024

Abstract
Background
Late preterm infants (LPIs) are at risk of neurodevelopmental delay. Research on their cognitive development is helpful for early intervention and follow-up.

Methods
Event-related potential (ERP) and resting electroencephalography (RS-EEG) were used to study the brain cognitive function of LPIs in the early stage of life. The Gesell Developmental Scale (GDS) was used to track the neurodevelopmental status at the age of 1 year after correction, and to explore the neurophysiological indicators that could predict the outcome of cognitive development in the early stage.

Results
The results showed that mismatch response (MMR) amplitude, RS-EEG power spectrum and functional connectivity all suggested that LPIs were lagging behind. At the age of 1 year after correction, high-risk LPIs showed no significant delay in gross motor function, but lagged behind in fine motor function, language, personal social interaction and adaptability. The ROC curve was used to evaluate the predictive role of MMR amplitude in the brain cognitive development prognosis at 1 year, showing a sensitivity of 80.00% and a specificity of 90.57%. The area under the curve (AUC) was 0.788, with a P-value of 0.007.

Conclusions
Based on our findings we supposed that the cognitive function of LPI lags behind that of full-term infants in early life. Preterm birth and perinatal diseases or high risk factors affected brain cognitive function in LPIs. MMR amplitude can be used as an early predictor of brain cognitive development in LPIs.

Trial registration
This clinical trial is registered with the Chinese Clinical Trial Registry (ChiCTR). Trial registration number: ChiCTR2100041929. Date of registration: 2021-01-10. URL of the trial registry record: https://www.chictr.org.cn/.
Outpatient follow-up of tumour diseases through video-based value-oriented behavioural activation (ViVA): study protocol for a randomised controlled trial
Authors: Reder Maren , Hofheinz Christine , Melzner Lena , Prinz Gabriele , Kröger Christoph 
Published: February 2024

Abstract
Background
In Germany, approximately half a million people are diagnosed with cancer annually; this can be traumatic and lead to depression, anxiety, and adjustment disorders necessitating psycho-oncological intervention. Value-oriented behavioural activation, adopted from depression psychotherapy, aims to provide structured support to help patients adjust their personal values, goals, and activities within the context of their changed life situation. This trial aims to evaluate the effectiveness of video-based value-oriented behavioural activation against German S3-Guideline-compliant aftercare for cancer patients dealing with psychological distress.

Methods
This trial will use covariate-adaptive randomisation according to gender and type of tumour disease to assign participants to one of two study arms (value-oriented behavioural activation consisting of 12 manualised follow-up sessions delivered via video consultation vs. S3-Guideline-compliant aftercare comprising three supportive talks). Psychological strain, psychosocial distress, quality of life, work-related outcomes, fear of cancer recurrence, goal adjustment, satisfaction with the consultant-participant relationship, and rumination will be measured at baseline, twice during treatment, posttreatment, and at the 6-month follow-up. The target sample of 146 tumour patients experiencing high psychosocial distress will be recruited at the Rehazentrum Oberharz, Germany.

Discussion
This trial aims to test the effectiveness of value-oriented behavioural activation in aftercare for tumour patients, focusing on its capacity to reduce distress and the potential for long-term effects evaluated through a 6-month follow-up. The study’s possible challenges include enrolling a sufficient sample and ensuring adherence to treatment, mitigated through in-person recruitment and rigorous training of staff. If successful, the results will be of high public health relevance, especially for psychotherapeutic care in rural areas and among patients with limited mobility considering the video-based approach of the trial.

Trial registration
This study was registered at the German Clinical Trials Register: DRKS00031900 on Sep 19, 2023.