bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinico-demographic characteristics and outcomes of radiation-induced sarcomas (RIS): a CanSaRCC study
Authors: Ribeiro Mauricio Fernando , Peretz Soroka Hagit , Bhura Zainab , Hirsch Ian , Wunder Jay , Ferguson Peter , Tsoi Kim , Brar Savtaj , Gladdy Rebecca , Swallow Carol , Chung Peter , Catton Charles , Wong Philip , Watson Geoffrey , Razak Albiruni Ryan Abdul , Gupta Abha A. , Shultz David 
Published: September 2023

Background: Radiation-induced sarcomas (RIS) tend to have aggressive behaviour and because of their rarity, the most appropriate management for these malignancies is uncertain. Objectives: Using the Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC) database, a national sarcoma registry, we aimed to investigate prognostic factors and outcomes for RIS. Design: Retrospective study of RIS patients treated from 1996 to 2021 at three Canadian centres. Methods: RIS was defined as a sarcoma arising in a previously irradiated field following a 3+ year latency period, whose histology was distinct from the initially irradiated tumour. Clinicopathologic and treatment-related information was extracted from the CanSaRCC database. Overall survival (OS) was defined as the time from RIS diagnosis to death from any cause. Response rate (RR) to neoadjuvant chemotherapy (NACT) was based on physician assessment. Time-to-event analyses were estimated using the Kaplan–Meier method, with Cox regression for multivariate analysis. We considered a two-tailed p-value of <0.05 as statistically significant. Results: One hundred seven tumours met the criteria for RIS and were divided into three subgroups: breast angiosarcoma (BAS, n = 54), osteosarcoma (OST, n = 16), and other soft-tissue sarcomas (STS, n = 37). Patients were mostly female ( n = 85, 79%), treated initially for breast carcinomas ( n = 54, 50.5%), and diagnosed with high-grade tumours ( n = 61/71, 86%). None had evidence of synchronous metastasis. Patients with OST were younger (median age: 48 years, p < 0.001), and BAS had the shortest latency interval (8 versus 18 years for OST/STS, p < 0.001). Most patients underwent surgery, 76% ( n = 76/100) R0; 24% ( n = 26) received radiation therapy, mostly ( n = 15, 57.7%) neoadjuvant. Among those receiving chemotherapy, 30 (75%) underwent NACT; among patients with documented response assessment, the RR was 68% ( n = 17/25), being even higher in the BAS population (89.5%, n = 13/17). Median OS was 53 months (95% CI 34–101), with a 5-year OS of 47.6%; larger tumour size, high histologic grade and older age were independent prognostic factors for worse OS. Conclusion: Surgery is standard, and NACT might be useful to downsize large lesions, especially in BAS patients. Raising RIS awareness is fundamental to promoting appropriate management and fostering research through multi-institutional collaborations.
Has Sustained Time Away From Sports Due to the COVID-19 Pandemic Led to Increased Sport-Related Soft Tissue Injuries?
Authors: Yang Daniel , Orellana Kevin , Lee Julianna , Stevens Alex , Talwar Divya , Ganley Theodore 
Published: September 2023

Background: A decrease in sport-related injuries was observed in 2020, which has been attributed to COVID-19 and recommendations to suspend organized sports. In adult populations, increased injury rates have been noted in athletes returning to play after an extended period of reduced play, attributable to deconditioning. There is growing literature surrounding concern over increased injury risk after return to sport after the COVID-19 shutdowns. Hypothesis: Like adults, pediatric patients experience an increase in sport-related injuries after periods of “deconditioning,” such as during the COVID-19 shutdown. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: The Consumer Product Safety Commission’s National Electronic Injury Surveillance System database was queried to identify 13- to 18-year-old patients who sustained a sprain/strain type injury in 2019 or 2021 to an extremity, and involved sporting equipment for basketball, baseball/softball, soccer, and football. The control group was established as patients who sustained injury in 2019, and the post-COVID-19 group was established as those in 2021. Quantity of injuries sustained in these 2 groups were compared and analyzed by subgroup. Results: There was a significant difference in the total number of sport-related sprains/strains in 2019 versus 2021 ( P = 0.01), with more injuries in 2019 (n = 151,067) than in 2021 (n = 104,041). There were more injuries in boys than in girls. Proportion of injuries by sports were similar in both time periods. There was a significant decrease in basketball-related injuries by 21% ( P ≤ 0.01, relative risk ratio [rrr] = 0.7979) and a significant increase in football-related injuries by 14% ( P = 0.01, rrr = 1.1404) and in soccer injuries by 14.2% ( P = 0.03, rrr = 1.1422). Conclusion: There is significant heterogeneity in injury rates by sports, with no conclusive increase in injuries, contrary to expectations. Clinical Relevance: This study suggests that the relationship between deconditioning and injury may be less clear in the child-athlete, and gives recommendations for return to sport after extended breaks. Strength-of-Recommendation Taxonomy (SORT): Level 2c.
Examining the Threat of ChatGPT to the Validity of Short Answer Assessments in an Undergraduate Medical Program
Authors: Morjaria Leo , Burns Levi , Bracken Keyna , Ngo Quang N. , Lee Mark , Levinson Anthony J. , Smith John , Thompson Penelope , Sibbald Matthew 
Published: September 2023

OBJECTIVES ChatGPT is an artificial intelligence model that can interpret free-text prompts and return detailed, human-like responses across a wide domain of subjects. This study evaluated the extent of the threat posed by ChatGPT to the validity of short-answer assessment problems used to examine pre-clerkship medical students in our undergraduate medical education program. METHODS Forty problems used in prior student assessments were retrieved and stratified by levels of Bloom's Taxonomy. Thirty of these problems were submitted to ChatGPT-3.5. For the remaining 10 problems, we retrieved past minimally passing student responses. Six tutors graded each of the 40 responses. Comparison of performance between student-generated and ChatGPT-generated answers aggregated as a whole and grouped by Bloom's levels of cognitive reasoning, was done using t-tests, ANOVA, Cronbach's alpha, and Cohen's d. Scores for ChatGPT-generated responses were also compared to historical class average performance. RESULTS ChatGPT-generated responses received a mean score of 3.29 out of 5 (n = 30, 95% CI 2.93-3.65) compared to 2.38 for a group of students meeting minimum passing marks (n = 10, 95% CI 1.94-2.82), representing higher performance ( P = .008, η2 = 0.169), but was outperformed by historical class average scores on the same 30 problems (mean 3.67, P = .018) when including all past responses regardless of student performance level. There was no statistically significant trend in performance across domains of Bloom's Taxonomy. CONCLUSION While ChatGPT was able to pass short answer assessment problems spanning the pre-clerkship curriculum, it outperformed only underperforming students. We remark that tutors in several cases were convinced that ChatGPT-produced responses were produced by students. Risks to assessment validity include uncertainty in identifying struggling students and inability to intervene in a timely manner. The performance of ChatGPT on problems requiring increasing demands of cognitive reasoning warrants further research.
Liraglutide attenuates type 2 diabetes mellitus-associated non-alcoholic fatty liver disease by activating AMPK/ACC signaling and inhibiting ferroptosis
Authors: Guo Tingli , Yan Wenhui , Cui Xin , Liu Na , Wei Xiaotong , Sun Yuzhuo , Fan KeXin , Liu Jieyun , Zhu Yuanyuan , Wang Zhuanzhuan , Zhang Yilei , Chen Lina 
Published: September 2023

Abstract
Background
Non-alcoholic fatty liver disease (NAFLD) is one of the most common complications of type 2 diabetes mellitus (T2DM). The pathogenesis of NAFLD involves multiple biological changes, including insulin resistance, oxidative stress, inflammation, as well as genetic and environmental factors. Liraglutide has been used to control blood sugar. But the impact of liraglutide on T2DM-associated NAFLD remains unclear. In this study, we investigated the impact and potential molecular mechanisms of inhibiting ferroptosis for liraglutide improves T2DM-associated NAFLD.

Methods
Mice were fed on high-fat-diet and injected with streptozotocin to mimic T2DM-associated NAFLD and gene expression in liver was analysed by RNA-seq. The fast blood glucose was measured during the period of liraglutide and ferrostatin-1 administration. Hematoxylin and eosin staining was used to evaluate the pathological changes in the liver. The occurrence of hepatic ferroptosis was measured by lipid peroxidation in vivo. The mechanism of liraglutide inhibition ferroptosis was investigated by in vitro cell culture.

Results
Liraglutide not only improved glucose metabolism, but also ameliorated tissue damage in the livers. Transcriptomic analysis indicated that liraglutide regulates lipid metabolism related signaling including AMPK and ACC. Furthermore, ferroptosis inhibitor rather than other cell death inhibitors rescued liver cell viability in the presence of high glucose. Mechanistically, liraglutide-induced activation of AMPK phosphorylated ACC, while AMPK inhibitor compound C blocked the liraglutide-mediated suppression of ferroptosis. Moreover, ferroptosis inhibitor restored liver function in T2DM mice in vivo.

Conclusions
These findings indicate that liraglutide ameliorates the T2DM-associated NAFLD, which possibly through the activation of AMPK/ACC pathway and inhibition of ferroptosis.
Digital image processing realized by memristor-based technologies
Authors: Wang Lei , Meng Qingyue , Wang Huihui , Jiang Jiyuan , Wan Xiang , Liu Xiaoyan , Lian Xiaojuan , Cai Zhikuang 
Published: September 2023

AbstractToday performance and operational efficiency of computer systems on digital image processing are exacerbated owing to the increased complexity of image processing. It is also difficult for image processors based on complementary metal–oxide–semiconductor (CMOS) transistors to continuously increase the integration density, causing by their underlying physical restriction and economic costs. However, such obstacles can be eliminated by non-volatile resistive memory technologies (known as memristors), arising from their compacted area, speed, power consumption high efficiency, and in-memory computing capability. This review begins with presenting the image processing methods based on pure algorithm and conventional CMOS-based digital image processing strategies. Subsequently, current issues faced by digital image processing and the strategies adopted for overcoming these issues, are discussed. The state-of-the-art memristor technologies and their challenges in digital image processing applications are also introduced, such as memristor-based image compression, memristor-based edge and line detections, and voice and image recognition using memristors. This review finally envisages the prospects for successful implementation of memristor devices in digital image processing.
Novel image analyser-assisted morphometric methodology offer unique opportunity for selection of embryos with potential for implantation
Authors: Alhelou Y , Hamdan M , Razali N , Adenan NAM , Ali J 
Published: September 2023

Abstract
Background
Previous studies looked into the connections between pregnancy and the Zona Pellucida (ZP) thickness and Zona Pellucida Thickness Variation (ZPTV), as well as the embryo’s radius, circumference, perimeter and global symmetry. However, no research has linked embryo implantation and pregnancy to the percentage of ZP thinning, the reduction in ooplasm volume, and the increase in perivitelline space (PVS) volume. Our objective is to correlate the percentage of ZP thinning, the percentage of ooplasm volume shrinkage and the percentage of PVS increase to the implantation. These data will be used for embryo selection as well as it can be put into a software that will assist embryo selection.

Materials and methods
Retrospective study included 281 patients, all of them had 2 embryos transferred, 149 patients got pregnant with two gestation sacs and 132 patients did not get pregnant. All of the transferred embryos had the ZP thickness measured several times from time of ICSI till Embryo Transfer (ET), the ooplasm volume was calculated from time of ICSI till two Pronuclei (2PN) fading and the PVS was calculated from the ICSI time till the 2PN fading.

Results
The first characteristic is the change in the average ZP thickness that decreased by 32.7% + 5.3% at 70 h for the implanted embryos (Group 1) versus 23.6% + 4.8% for non-implanted embryos (Group 2) p = 0.000. The second characteristic is the average reduction in the volume of the ooplasm which is 20.5% + 4.3% in Group 1 versus 15.1% + 5.2% in Group 2, p = 0.000. The third characteristic is the increase in the volume of the PVS which was 38.1% + 7.6% in Group 1 versus 31.6% + 9.7% in Group 2 p = 0.000.

Conclusion
The implanted embryos showed higher percent of ZP thinning, higher percent of ooplasm reduction and higher percent of PVS increase.
Association of high-risk comorbidity with overall survival among patients with gastric cancer and its sex-specific differences in China: a retrospective observational cohort study
Authors: Wu Ju , Tian Simiao , Xu Jian , Cheng Nan , Chen Xi , Yin Jiajun , Nie Zhequn 
Published: September 2023

Abstract
Background
Concomitant diseases often occur in cancer patients and are important in decision-making regarding treatments. However, information regarding the prognostic relevance of comorbidities for mortality risk is still limited among Chinese gastric cancer (GC) patients. This study aimed to investigate the association between comorbidities and 3-year mortality risk.

Methods
This retrospective study enrolled 376 GC patients undergoing radical gastrectomy at the Affiliated Zhongshan Hospital of Dalian University from January 2011 to December 2019. Demographic and clinicopathological information and treatment outcomes were collected. Patients were divided into low-, moderate- and high-risk comorbidity groups based on their Charlson Comorbidity Index (CCI) and age-adjusted CCI (ACCI) scores. Kaplan-Meier survival and Cox regression analyses were used to examine 3-year overall survival (OS) and mortality risk for each group.

Results
The median follow-up time was 43.5 months, and 40.2% (151/376) of GC patients had died at the last follow-up. There were significant differences in OS rates between ACCI-based comorbidity groups (76.56; 64.51; 54.55%, log-rank P = 0.011) but not between CCI-based comorbidity groups (log-rank P = 0.16). The high-risk comorbidity group based on the ACCI remained a significant prognostic factor for 3-year OS in multivariate analysis, with an increased mortality risk (hazard ratio [HR], 1.99; 95% CI, 1.15–3.44). Subgroup analysis revealed that this pattern only held for male GC patients but not for female patients.

Conclusion
The present study suggested that high-risk comorbidities were significantly associated with a higher mortality risk, particularly in Chinese male GC patients. Moreover, the ACCI score was an independent prognostic factor of long-term mortality.
National survey on the availability of oncology palliative care services at tertiary general and cancer hospitals in China
Authors: Li Xiaomei , Wang Xin Shelley , Huang Haili , Liu Miao , Wu Yinan , Qiu Jiaojiao , Zhang Boran , Cui Linhong , Hui David 
Published: September 2023

Abstract
Background
This nationwide survey studied the level of palliative care (PC) access for Chinese patients with cancer among cancer care providers either in tertiary general hospitals or cancer hospitals in China.

Methods
Using a probability-proportionate-to-size method, we identified local tertiary general hospitals with oncology departments to match cancer hospitals at the same geographic area. A PC program leader or a designee at each hospital reported available PC services, including staffing, inpatient and outpatient services, education, and research, with most questions adapted from a previous national survey on PC. The primary outcome was availability of a PC service.

Results
Most responders reported that some type of PC service (possibly called “comprehensive cancer care,” “pain and symptom management,” or “supportive care”) was available at their institution (84.3% of tertiary general hospitals, 82.8% of cancer hospitals). However, cancer hospitals were significantly more likely than tertiary general hospitals to have a PC department or specialist (34.1% vs. 15.5%, p < 0.001). The most popular services were pain consultation (> 92%), symptom management (> 77%), comprehensive care plans (~ 60%), obtaining advanced directives and do-not-resuscitate orders (~ 45%), referrals to hospice (> 32%), and psychiatric assessment (> 25%). Cancer hospitals were also more likely than tertiary general hospitals to report having inpatient beds for PC (46.3% vs. 30.5%; p = 0.010), outpatient PC clinics (28.0% vs. 16.8%; p = 0.029), educational programs (18.2% vs. 9.0%, p = 0.014), and research programs (17.2% vs. 9.3%, p < 0.001).

Conclusions
Cancer hospitals are more likely to offer PC than are tertiary general hospitals in China. Our findings highlight opportunities to further increase the PC capacity in Chinese hospitals.
Early infant diagnosis of HIV infection: a mixed-method study of uptake and challenges at primary health centers in Lagos State, Nigeria
Authors: Okusanya BO , Nweke CI , Akeju DO , Ehiri J 
Published: September 2023

Abstract
Introduction
Nigeria has a low uptake of early infant diagnosis (EID) of HIV despite its high pediatric HIV infection rate. Efforts to increase the EID of HIV have been limited by many factors. This research assessed EID uptake and challenges service providers experienced in providing routine care for HIV-exposed infants.

Methods
This is a mixed-method study at primary health centers (PHCs) in Lagos state, Nigeria. The quantitative component of the research was a review of the PMTCT Infant Follow-up Register at a purposive sample of 22 PHCs of Lagos State. The number of HIV-exposed infants (HEIs) returned for a dried blood sample (DBS) collection, date of collection, and the infant’s EID results for one year preceding the study were captured on Research Electronic Data Capture (RedCap). In-depth interviews were conducted with service providers purposively selected per participating PHC. Electronic transcripts were analyzed using MAXQDA 2020 (VERBI Software, 2019).

Results
Twenty-two Lagos State primary health centers participated in the research. Fifteen PHCs (68.2%) had PMTCT HIV counseling and Infant follow-up registers. Documentation of DBS sample collection was observed in 12 (54.6%) PHCs. Both DBS sample collection and EID results documentation were observed in only nine (40.9%) PHCs. In-depth interviews revealed both maternal and health systems’ challenges to EID. The denial of HIV status was the only maternal factor reported as a barrier against the use of EID services. Health systems challenges include unavailability of EID services, uncertainty regarding whether EID is performed in a facility, referral to secondary health facilities for EID services (leading to losses to follow-up), and delay in getting results of EID. Task-shifting of DBS collection by nurses was suggested as means to increase access to EID services.

Conclusions
There is a need to expand EID services and address women’s denial of HIV infection. Counseling women and linkage to available services are emphasized. Re-training of health workers on DBS collection and proper documentation of EID services were noted as key to improving the implementation of early infant diagnosis of HIV in the state.
The impact of the national volume-based procurement policy on the use of policy-related drugs in Nanjing: an interrupted time-series analysis
Authors: Wang Xiao , He Xuan , Zhang Pei , Zhang Mengdie , Ma Rui , Dai Rouli , Li Xin 
Published: September 2023

Abstract
Background
In September 2019, the “4 + 7” centralized procurement pilot program was expanded nationwide aiming at reducing drug prices by means of volume-based procurement and using accredited generic drugs for branded drug substitutes. Given the current uncertain effect of the policy outside pilot areas, this study was conducted to evaluate the impact of the National Volume-based Procurement policy on the use of policy-related drugs after expansion.

Method
A single-group interrupted time series was applied using drug purchase data, covering 25 months from December 2018 to December 2020. Drugs related to the centralized procurement policy were selected as samples, including 25 first-batch policy-related drugs and 56 alternative drugs. Centralized procured drugs can be divided into bid-winning and non-winning products, where non-winning products were sorted into generic and branded drugs, and alternative products were classified according to different degrees of substitution. Purchase volume, expenditures, and daily costs were measured.

Results
After the implementation of the policy, a significant increase was associated with the volume of bid-winning drugs (p < 0.001) and the volume of generic and branded drugs decreased immediately. The DDDc of drugs under the same generic name significantly reduced (an instantaneous drop of bid-winning drugs by approximately 25%, 7.62 CNY for generics and 3.07 CNY for branded drugs), saving 48.2 million CNY of drug expenditures. The policy has a significant effect on the drug for the treatment of cardiovascular diseases and exerted little influence on the drug for the treatment of nervous diseases, and the substitution of generics for antitumor-branded drugs was not obvious. In addition, the procurement volume of alternative drugs appeared to be a “carry-over”.

Conclusions
These findings indicated that the policy demonstrated positive effects in terms of price reductions and cost savings and accelerated the substitution of generics against branded drugs. The “patent cliff” for branded drugs has gradually emerged. Besides, a short-term “spillover effect” of the volume of alternative drugs was observed, requiring special attention and vigilance.