bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring potential opportunities and strategies of using the new WHO Labour Care Guide to improve labour monitoring and health outcomes among health care providers in Uganda: A Qualitative Study
Authors: Mugyenyi Godfrey R , Atukunda Esther C , Tumuhimbise Wilson , Farjardo Yarine F , Byamugisha Josaphat 
Published: October 2023

Abstract
Background: Prolonged labour remains a major pathway to common labour complications. WHO Labor Care Guide (LCG) has been developed for health care providers (HCPs) to timely identify deviations from normal through regular assessment. We explored potential opportunities and strategies of using this LCG to improve labour monitoring among HCPs and MOH officials in Uganda.
Methods: Between June and September 2023, we purposively selected and conducted in-depth qualitative face-to-face interviews with 30 HCPs, and 6 MOH/WHO officials exposed to the LCG in Uganda. Interviews were digitally recorded in a private setting following informed consent. Translated transcripts were generated and coded. Coded data was iteratively reviewed and sorted to inductively construct categories describing multilevel factors that might influence HCP’s sustained engagement in labour monitoring, LCG uptake and implementation.
Results: The median age of the interviewed HCPs was 36 years(IQR,27-54). All participants demonstrated great enthusiasm, describing the new LCG as a simple, better, detailed, easy-to-use and comprehensive tool that could quickly and accurately detect prolonged labor for timely management, if modified appropriately. HCPs identified LCG’s potential to facilitate sustained use through perceived ability to; correctly define active labour at a more acceptable 5cm of cervical dilatation, have major labour parameters recorded on one-A4-paper for easy comparison and reference, stimulate HCP-patient-labour companion interaction for social support, undergo customization to address user needs, enhance accountability and reduce over-documentation, and workloadsince the same A4 paper could capture all the necessary details needed to make a “one-stop quick and effective clinical decision”. HCPs underscored the role and sustained benefitsof off-site training, team building, guidelines accessibility, real-time feedback, peer mentorships and championships. Noted LCG pitfalls included; small fonts, observation ordering that needed modifications to facilitate an easy-to-use interface, missing record of social-demographic and key outcome data, plus fields/parameters deemed redundant/inappropriate.
Conclusion: Our data demonstrates a responsive, enthusiastic and supportive environment that has potential to facilitate LCG customization, uptake and scale up. The high LCG expectations are important considerations in developing sustainable and acceptable implementation strategies that meet user needs. More work is needed to refine and evaluate the tool’s effectiveness in improving labour monitoring in Uganda.
Effects of a symptom cluster management intervention on the symptom cluster of pain-cough-fatigue-shortness of breath-anorexia and quality of life among post-thoracoscopic-surgery patients with lung cancer: A randomized controlled trial
Authors: Wang Xiaoxu , Liu Jiaxun , Duan Haiyang , Wei Holly , Dong Qiaona , Meng Qinghui 
Published: October 2023

Abstract

Purpose
To construct a symptom cluster management intervention based on symptom cluster theory for patients with non-small cell lung cancer (NSCLC) undergoing 3D thoracoscopic lobectomy and evaluate the efficacy and feasibility of the intervention on a five-symptom cluster, including pain, cough, fatigue, shortness of breath, anorexia, and quality of life (QoL) and hospital stay time of patients with lung cancer in the early period after lung cancer surgery.
Methods
A total of 100 patients with NSCLC after surgery from a hospital in a city in northern China from October 2019 to December 2019 were randomly assigned to either the intervention group (N = 50) or the control group (N = 50). The participants in the intervention group received symptom cluster management intervention based on the symptom management theory, while the control group received only usual care. The study outcomes, including pain, cough, shortness of breath, anorexia, fatigue, and QoL, were evaluated at baseline and on the first and fourth postoperative days.
Results
The baseline characteristic was comparable between the two groups. Pain, daytime cough, nighttime cough, fatigue, and shortness of breath were similar in both groups on the first postoperative day (all P > 0.05). Compared with the control group, the intervention group reported less pain, cough, fatigue, shortness of breath, and anorexia and more QoL on the fourth postoperative day, and shorter postoperative hospital stay time (all P < 0.05).
Conclusion
The symptom management intervention appears to be a feasible and acceptable method to manage the five-symptom cluster, promote QoL, and reduce postoperative hospital stay time in patients with NSCLC. Future studies are needed to examine the long-term effects of this intervention.
Trial registration
This study is retrospectively registered at Chinese Clinical Trial Registry (ChiCTR2300076312).
Preliminary utilization of high-resolution direct MRI fistulography with hydrogen peroxide in diagnosing anorectal fistula
Authors: Chang Cancan , Qiao Longhu , Zhang Zhenqi , Tian Xiao , Zhang Yu , Cheng Wenwen , Wang Xia , Yang Qing 
Published: October 2023

Abstract
Background: Fistula-in-ano is an abnormal tunnel formation linking the anal canal with the perineum and perianal skin. Multiple imagining methods are available to evaluate it, among which magnetic resonance imaging (MRI) is the most advanced noninvasive preoperative method. However, it is limited in its visualization function. Therefore, this study aims to investigate the feasibility of using a specific mixture of 3% hydrogen peroxide (HP) and gadolinium as a direct contrast agent for high-resolution MRI (HPMRI) of perianal fistula. Additionally, it investigated the value of this new method for preoperative examination of complex or recurrent fistula via a preliminary study.
Methods: Preoperative physical examination, conventional ultrasonography, MRI plain scan, and high-resolution direct HPMRI fistulography data from nine patients with surgically confirmed complex or recurrent fistula-in-ano were retrospectively analyzed. We also assessed the detection rates of fistula tracks and their associated internal openings, including the connection between them and the internal and external anal sphincters. Furthermore, the detection of perianal abscess was analyzed relative to the intraoperative observations.
Results: Surgical confirmation revealed nine cases of anal fistula, including 17 internal openings, 18 fistula tracks, 21 external openings, and six perianal abscesses. ROC curve analysis revealed that the effectiveness of the physical examination, conventional ultrasound, and MRI plain scans for detecting internal openings was lower than that of high-resolution direct HPMRI fistulography (Z = 3.739, 2.642, 2.642, all p < 0.05). The efficacy of physical examination and conventional ultrasound in detecting fistula tracks was lower than that of high-resolution direct HPMRI fistulography (Z = 2.394, 2.503, all p < 0.05). The effectiveness of physical examination in detecting perianal abscess was inferior to that of high-resolution direct HPMRI fistulography (Z = 3.417, p < 0.05). No statistically significant difference was observed in the ability of MRI plain scan to detect fistula tracks or in the capacity of conventional ultrasound to detect perianal abscesses than that of high-resolution direct HPMRI fistulography.
Conclusions: This novel high-resolution direct HPMRI fistulography technique enhances the visualization of recurrent and complex fistula-in-ano, enabling visualization of branched fistulas, thereby improving surgical outcomes.
Fiscal space and government-spending cyclicality: Disparity between the procyclical and the countercyclical
Authors: Lin Yi-Chen , Deng Wen-Shuenn 
Published: October 2023

Abstract
This study employs quantile regression analysis on a dataset encompassing 160 countries spanning the period from 1990 to 2020. Its primary objective is to investigate the relationship between fiscal space and various conditional quantiles of government-spending cyclicality. Unlike prior literature, which predominantly centers on government debt sustainability, our study introduces a comprehensive perspective on fiscal space, encompassing dimensions that have received comparatively limited attention. These dimensions include sovereign balance sheet vulnerability, contingent liabilities arising from risks associated with external and private sector debt, and market perceptions of sovereign risk. Our analysis suggests that fiscal space is statistically significant only at the upper part of the conditional government-spending cyclicality distribution, i.e., fiscally procyclical countries. We also find that, in fiscally procyclical countries, the share of foreign currency debt in total government debt, the share of government debt held by nonresidents in total government debt, the share of short-term external debt in total external debt, the ratio of government debt to tax revenue, natural resource dependence, and inflation rate are associated with higher government-spending procyclicality. In contrast, factors such as sovereign debt rating, financial depth, and the share of short-term debt in total external debt are associated with lower government-spending cyclicality.
JEC codes: H30, H60, H63
A single-centre analysis of pregnancies with placenta accreta spectrum (PAS): from one-step surgery towards two-step surgical approach
Authors: Weydandt Laura , Lia Massimiliano , Schöne Amanda , Hoffmann Janine , Dornhöfer Nadja , Aktas Bahriye , Stepan Holger 
Published: October 2023

Abstract
Background
Placenta accreta spectrum (PAS) can be the cause of major morbidity and its optimal management is still controversial. The aim of this study was to compare the traditional one-step surgery with a two-step surgical approach in which the placenta is left in situ and the second final operation is delayed to minimize blood loss.
Methods
We conducted a monocentric retrospective cohort study including all patients operated for PAS between 2006 and 2023. During this period, one-step surgery was abandoned and a two-step surgical approach was adopted. The number of units of red blood cells (RBC) needed during surgery were the primary outcomes used to compare these two approaches.
Results
A total of 43 cases were included in this analysis. Median blood loss during surgery was 2000 ml and 2800 ml for two-step and one-step surgery, respectively (p = 0.095). In the two-step surgical approach median number of RBC units transfused during surgery was significantly lower (p = 0.049) and the odds ratio for needing more than four units of RBC was 0.28 (95%-CI: 0.063 ‒ 1.15, p = 0.067). Longer interval between the caesarean section and the second operation showed a trend to lower blood loss (p = 0.065) and were associated with a significantly lower number of RBC units needed during surgery (p = 0.019).
Conclusion
Two-step surgery for the treatment of PAS was safe in our cohort and could lead to a reduction of blood transfusion. Leaving the placenta in situ and delay final operation represents a possible alternative to traditional cesarean hysterectomy (one-step surgery).
Correlation of Academic Emotion and Hardiness Personality of Undergraduate Nursing Students
Authors: Guo Lili , Yan Danfeng , Yan Junping , Jiao Rui 
Published: October 2023

Abstract
Background: Academic emotion is a fundamental emotional concept closely linked to academic achievement. Understanding the connection between academic emotion and the personality trait of hardiness is pivotal in maintaining a stable career orientation throughout one's educational journey. Therefore, in pursuit of fostering the robust growth of nursing careers, it is imperative to delve into the academic emotions experienced by undergraduate nursing students. This study endeavors to mitigate the impact of gender differences among nursing students while investigating the intricate relationship between academic emotions and the trait of hardiness in their personalities.
Methods: This study employed a cross-sectional research design. We gathered data from a convenient sample of 292 nursing students enrolled at XX University of Traditional Chinese Medicine. Each student provided demographic information and responded to a general academic mood questionnaire, as well as a hardiness Personality Rating Scale. Subsequently, we used canonical correlation analysis to evaluate the correlation between academic emotion and tenacity personality in 292 undergraduate nursing students.
Results: We discovered that academic emotions among nursing students are predominantly characterized by feelings of disappointment and boredom. Furthermore, personality hardiness is primarily influenced by the dimensions of engagement and control. It is important to note that a heightened level of negative, low-arousal academic emotions can diminish the level of engagement. The first typical correlation coefficients corresponding to academic emotion and hardiness were 0.660. The linear combination of standardized variables of the first typical variable corresponding to academic emotion (X1) = -0.444*negative hyperarousal -0.443 * positive hyperarousal + 0.694 * negative hypoarousal -0.260 * positive hypoarousal. The standardized variable equation of the first typical variable corresponding to hardiness personality (η1) = 0.235* hardiness -0.433* control -0.530* investment -0.303* challenge.
Conclusions: The collective academic emotions experienced by nursing students tend to lean towards negativity with lower arousal levels. Additionally, there is a prevailing perception among them that the amount of effort they invest is often disproportionate to the rewards they receive. These feelings of inequity can significantly undermine their academic emotions. These findings offer valuable insights for nursing educators, highlighting the importance of focusing on enhancing nursing students' academic interests and aiding them in selecting suitable career paths within the nursing profession.
Pattern of lymph node metastases and its implication in radiotherapeutic clinical target volume in patients with small cell carcinoma of the esophagus: A multicenter retrospective trial from China (CHiSCEC)
Authors: Zhang Qi , Sun Hongfu , Wang Qifeng , Zhang Yaowen , Zhao Lina , Shen Wenbin , Zhang Wencheng , Ge Xiaolin , Su Xiujun , Yang Ning , Li Lei , Liu Shenxiang , Wang Feng , Ma Jie , Yang Ya , Wang Yi , Tan Bingxu , Dong Wei , Zhang Jian , Sun Daqing , Huang Wei 
Published: October 2023

Abstract
Purpose:
In order to study the pattern of LNM after esophagectomy of small cell carcinoma of the esophagus (SCCE) and clarify the clinical target volume (CTV) delineation of definite radiotherapy for SCCE.
Methods:
From January 2007 to December 2020, 286 patients with SCCE who had undergone esophagectomy and lymphadenectomy were retrospectively examined from 14 cancer centers in China. The distribution of lymph node metastases (LNM) were evaluated and the clinicopathologic factors related to lymph node metastasis were analyzed using logistic regression analysis.
Results:
177 patients (61.9%) occurred LNM in the 286 patients, and the incidence of LNM was 12.3%(597/4850).Those sites with an LNR rate higher than 10% in upper thoracic SCCE were as follows: No.105, No. 106recR and No.106recL. Those with middle thoracic SCCE were as follows: No.107, No.108 and abdominal No. 7. Lastly, individuals with lower thoracic SCCE were as follows: No.107, No. 110, abdominal No. 2, and abdominal No. 7. T stage, age and the length of tumor were the statistically significant risk factors of LNM of SCCE (P < 0.05).A nodal clinical target volume ༈CTVn) countoring recommendation were offered.
Conclusions:
LNM pattern of SCCE varies depending upon the primary tumor location. The irradiation field must be designed according to the primary tumor location. The rate of lymph node metastasis of the SCCE increased with the T stage and the length of tumor. These factors and the correlated lymphatic drainage regions should be considered when designing the CTV for Selective regional irradiation of SCCE.
Single-cell RNA sequencing and m6A RNA methylation sequencing and reveal cellular and molecular mechanisms of radiation combined with PD-1 blockade in NSCLC
Authors: Yang Hao , Hou Hui , Dou Ting , Geng Hongwei , Li Hong , Zhang Wei , Yu Hongfang , Sun Liping , He Jiefu , Zhao Haiping , Liu Kuan , Wang Zhenfei 
Published: October 2023

Abstract
Background: Lung cancer is the leading cause of cancer-related mortality, and more than 85% of lung cancer cases are non-small cell lung cancer (NSCLC). The heterogeneity and molecular basis of this disease remain incompletely understood.
Methods: To address this question, we have performed a single-cell RNA sequencing as well as m6A RNA methylation sequencing of matched untreated and radiation combined with PD-1 blockade NSCLC samples.
Results: A total of 21019 cells are categorized into eleven distinct cell types, including fibroblast, macrophages\monocyte, B cell, dendritic cell, endothelial cells, neutrophils, T\Natural killer (NK) cells, NK cells, and cancer stem cells (CSCs). Further analysis of the CSCs showed that radiotherapy combined with immunotherapy effectively reduced the number of CSCs and exhausted CD8+T cells, and increased the naive CD8+ T cells. Dysregulation of multiple signaling pathways, including the Wnt, is associated with lung cancer metastasis through the TCGA tumor dataset analysis. Wnt10b is a member of the Wnt family, which plays an important role in the Wnt signalling pathway. Moreover, N6-methyladenosine (m6A) sequencing has identified obesity-associated protein (FTO) as a direct target of m6A modification whose levels were regulated by Wnt10b, suggesting the FTO as a potential therapeutic target for treatment of lung cancer. Finally, our study reveals the potential pathogenesis of FTO/Wnt10b/b-catenin signaling pathway in NSCLC development.
Conclusions: Collectively, this study proves that radiation combined with PD-1 blockade inhibits the stemness of CSCs through the FTO/Wnt10b/β-catenin pathway in NSCLC, which might provide insights for cancer immunotherapies.
Effects of Optimal Medical Therapy in Patients Undergoing PCI: Subgroup Analysis of the POST-PCI Trial
Authors: Kwun Ju-Seung , Choi Jina , Kim Sun-Hwa , Kang Do-Yoon , Park Duk-Woo , Park Seung-Jung , Hur Seung-Ho , Kim Won-Jang , Park Chul Soo , Lee Bong-Ki , Yoon Jung Han , Choi Jae Woong , Kim Kee-Sik , Choi Si Wan , Lee Su Nam , Chae In-Ho , Suh Jung-Won 
Published: October 2023

Abstract
Coronary artery disease (CAD) is a major global health concern, and percutaneous coronary intervention (PCI) is commonly used for revascularization. Optimal medical therapy (OMT) is recommended to complement PCI. However, whether OMT significantly benefits high-risk CAD patients remains unclear. This study aimed to investigate potential benefits of OMT in high-risk CAD patients who underwent PCI, through a post-hoc subgroup analysis of the POST-PCI trial comparing patients who did and did not receive OMT. The primary endpoint was major cardiovascular events (death from any cause, myocardial infarction, or hospitalization for unstable angina) at 2 years; secondary endpoints included individual components of the primary outcome. The OMT group comprised patients with a higher prevalence of cardiovascular risk factors. However, clinical outcomes did not differ significantly between OMT and non-OMT groups. Additionally, the OMT group had a significantly reduced invasive coronary angiography rate than the non-OMT group (74.0% vs. 89.1%, odds ratio: 0.35, 95% confidence interval: 0.15–0.81, p = 0.014). The non-OMT group tended to have a higher proportion of symptomatic patients undergoing repeat revascularization than the OMT group (81.7% vs. 65.5%, p = 0.070). In conclusion, OMT did not result in significantly different clinical outcomes in high-risk CAD patients post-PCI compared with non-administration of OMT. However, OMT has potential benefits in reducing unnecessary procedures and optimizing patient care. Further studies are needed to better understand OMT benefits in this patient population.
GIMAP8 is a promising prognostic biomarker correlated with immune infiltration in lung adenocarcinoma
Authors: Liu Shiyue , Li Hong , Hu Pengchao , Zhuo Yuejian , Hu Jiegang , Sun Weizi , Dong Youhong , He Zhongshi 
Published: October 2023

Abstract
Background
GIMAP8 reportedly regulates the progression of several cancers. However, data regarding its prognostic value in lung adenocarcinoma (LUAD) are limited. We aimed to investigate the correlation between GIMAP8 expression, prognosis, and tumor infiltration in LUAD.
Material and methods
The expression and prognostic value of GIMAP8 in LUAD were explored using public The Cancer Genome Atlas-LUAD databases and validated using multiple resources, including the Human Protein Atlas, Gene Expression Omnibus, Gene Expression Profiling Interactive Analysis, OncoLnc, receiver operating characteristic (ROC) curves, and univariate and multivariate analyses. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and gene set enrichment analysis (GSEA) were used to investigate the biological roles of GIMAP8. The ESTIMATE and CIBERSORT algorithms, The Cancer Immunome Database, and ssGSEA analyses were used to investigate the correlation between GIMAP8 expression and cancer immune characteristics.
Results
Low GIMAP8 expression was observed in LUAD compared to that in normal lung tissues, whereas high GIMAP8 expression correlated with clinicopathological characteristics and increased overall survival (OS). ROC analysis confirmed GIMAP8 to have a high diagnostic value for LUAD. Univariate and multivariate Cox analyses further confirmed that GIMAP8 expression was an independent risk factor for OS in patients with LUAD. GO, KEGG and GSEA showed that immune responses were the most enriched terms. We identified six positively correlated CMKLR1, GIMAP7, GIMAP4, FLI1, GIMAP1, and GIMAP6) and five negatively correlated (PSMG3, MRPS15, UQCC2, COX5B, and ZNF593) coexpression genes, most of which are involved in immune effector processes. Specifically, GIMAP8 had a significant negative correlation with infiltrating cells, such as T, mast, plasma, and dendritic cells, and a positive association with CD4, M1, mast, and M2 cells in LUAD. GIMAP8 was significantly associated with important immune checkpoints.
Conclusion
GIMAP8 is a promising prognostic biomarker in LUAD and its expression was related to immune cell infiltration.