bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self-care behaviors and associated factors among individuals with type 2 diabetes in Ghana: a systematic review
Authors: Opoku Richmond , Ackon Solomon Kwesi , Kumah Emmanuel , Botchwey Charles Owusu-Aduomi , Appiah Nana Esi , Korsah Shadrach , Peprah Michael 
Published: November 2023

Abstract
Background
Self-care remains an effective model for diabetes management and care in low-and-middle-income countries due to the limited resources available for the clinical management of the disease and its complications This study examined adherence to self-care behaviors and associated factors among people with type 2 diabetes in Ghana.

Methods
PubMed, PsycINFO, Scopus, Web of Science, Embase and Google scholar were used to identify quantitative observational studies published between 1990 and September 30, 2023. Studies exclusive to persons with type 2 diabetes ≥ 18 years of age in a Ghanaian setting were included in this review. Findings of primary studies were analyzed using narrative synthesis.

Results
Twelve studies, presenting data on a total of 2,671 persons with type 2 diabetes, were included. All the studies were published in the last decade (2015–2022) and a majority of them were from the Greater Accra Region. The mean number of days (per week) participants adhered to a self-care behavior were in the ranges of 3.9–4.4 for diet, 4.2–4.8 for physical activity, 0.5–2.2 for self-monitoring of blood glucose (SMBG), and 2.9–5.0 for foot care. Adherence rates for medication were in the range of 33.5–84.5%. Patient-related factors, sociodemographic/economic-related factors, condition-related factors, and healthcare system-related factors were associated with various self-care behaviors.

Conclusion
Adherence to self-care behaviors among persons with type 2 diabetes in Ghana remains an ongoing challenge with significant variations in adherence among patients with different characteristics.
Gallic acid rescues uranyl acetate induced-hepatic dysfunction in rats by its antioxidant and cytoprotective potentials
Authors: Elmileegy Ibtisam M. H. , Waly Hanan S. A. , Alghriany Alshaimaa A. I. , Abou Khalil Nasser S. , Mahmoud Sara M. M. , Negm Eman A. 
Published: November 2023

Abstract
Background
The liver was identified as a primary target organ for the chemo-radiological effects of uranyl acetate (UA). Although the anti-oxidant and anti-apoptotic properties of gallic acid (GA) make it a promising phytochemical to resist its hazards, there is no available data in this area of research.

Methods
To address this issue, eighteen rats were randomly and equally divided into three groups. One group was received carboxymethyl cellulose (vehicle of GA) and kept as a control. The UA group was injected intraperitoneally with UA at a single dose of 5 mg/kg body weight. The third group (GA + UA group) was treated with GA orally at a dose of 100 mg/kg body weight for 14 days before UA exposure. UA was injected on the 15th day of the experiment in either the UA group or the GA + UA group. The biochemical, histological, and immunohistochemical findings in the GA + UA group were compared to both control and UA groups.

Results
The results showed that UA exposure led to a range of adverse effects. These included elevated plasma levels of aspartate aminotransferase, lactate dehydrogenase, total protein, globulin, glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and very-low-density lipoprotein and decreased plasma levels of high-density lipoprotein cholesterol. The exposure also disrupted the redox balance, evident through decreased plasma total antioxidant capacity and hepatic nitric oxide, superoxide dismutase, reduced glutathione, glutathione-S-transferase, glutathione reductase, and glutathione peroxidase and increased hepatic oxidized glutathione and malondialdehyde. Plasma levels of albumin and alanine aminotransferase did not significantly change in all groups. Histopathological analysis revealed damage to liver tissue, characterized by deteriorations in tissue structure, excessive collagen accumulation, and depletion of glycogen. Furthermore, UA exposure up-regulated the immuno-expression of cleaved caspase-3 and down-regulated the immuno-expression of nuclear factor-erythroid-2-related factor 2 in hepatic tissues, indicating an induction of apoptosis and oxidative stress response. However, the pre-treatment with GA proved to be effective in mitigating these negative effects induced by UA exposure, except for the disturbances in the lipid profile.

Conclusions
The study suggests that GA has the potential to act as a protective agent against the adverse effects of UA exposure on the liver. Its ability to restore redox balance and inhibit apoptosis makes it a promising candidate for countering the harmful effects of chemo-radiological agents such as UA.
“Tell me what is ‘better’!” How medical students experience feedback, through the lens of self-regulatory learning
Authors: Spooner Muirne , Larkin James , Liew Siaw Cheok , Jaafar Mohamed Hasif , McConkey Samuel , Pawlikowska Teresa 
Published: November 2023

Abstract
Introduction
While feedback aims to support learning, students frequently struggle to use it. In studying feedback responses there is a gap in explaining them in relation to learning theory. This study explores how feedback experiences influence medical students’ self-regulation of learning.

Methods
Final-year medical students across three campuses (Ireland, Bahrain and Malaysia) were invited to share experiences of feedback in individual semi-structured interviews. The data were thematically analysed and explored through the lens of self-regulatory learning theory (SRL).

Results
Feedback interacts with learners’ knowledge and beliefs about themselves and about learning. They use feedback to change both their cognitive and behavioural learning strategies, but how they choose which feedback to implement is complex. They struggle to generate learning strategies and expect teachers to make sense of the “how” in addition to the “what”” in planning future learning. Even when not actioned, learners spend time with feedback and it influences future learning.

Conclusion
By exploring our findings through the lens of self-regulation learning, we advance conceptual understanding of feedback responses. Learners’ ability to generate “next steps” may be overestimated. When feedback causes negative emotions, energy is diverted from learning to processing distress. Perceived non-implementation of feedback should not be confused with ignoring it; feedback that is not actioned often impacts learning.
Developing a virtual patient: design, usability, and learning effect in communication skills training
Authors: Sezer Baris , Sezer Tufan Asli , Teker Gulsen Tasdelen , Elcin Melih 
Published: November 2023

Abstract
Background
Literature shows that Virtual Patients (VPs) find extensive usage in the field of health sciences, especially in the post-pandemic period. VPs are successfully utilized in developing various effective skills like medical interview. However, this technology is quite new in Turkey and has not yet been used in communication skills training in a structured form. This research aimed to develop a virtual patient to improve the communication skills of medical students.

Methods
Developmental research method was used in the study. The implementation phase involved the one group posttest quasi-experimental design. The study group comprised of experts in various fields and 213 medical students. Needs Analysis Form, Scenario Building Form, System Validation Form, Communication Skills Assessment Form, and Interview Form were used as data collection tools. The research primarily concentrated on ensuring minimal errors within the system and enhancing students’ communication skill scores.

Results
The study found that VP was effective in teaching communication skills. Communication skills improved from a mean score of 36.74 in the first interview with 15 students to 74.2 in the final application with 198 students. It was determined that the students who practiced repeatedly (n = 26) made 17% more effective interviews than their first practices (score: 89.2). The script matching of the VP was 83%. Other data obtained from the students generally showed that the VP application was developed in accordance with the purpose, that it was user-friendly, and that the scenarios were adequate.

Conclusion
VPs like this have the potential to develop skills such as history taking, clinical reasoning, etc., which are very important in the field of health sciences.
Self-care nursing assessment: cross-cultural adaptation and validation of the Spanish version of the Self-care of chronic illness inventory
Authors: Durán-Gómez Noelia , López-Jurado Casimiro Fermín , Martín-Parrilla Miguel Ángel , Montanero-Fernández Jesús , Pérez-Civantos Demetrio , Cáceres Macarena C. 
Published: November 2023

Abstract
Background
Self‐care is the primary means of caring for a chronic condition. Therefore, it is necessary to assess it by using a good validity and reliability instrument. The Self-Care of Chronic Illness Inventory (SC-CII) is a generic instrument developed to measure self-care processes behaviors using three separate scales in patients with chronic illness. The original cross-cultural assessment concluded the need for future studies sampling patients from different sites to increase the generalizability of the psychometric evaluation results. It was unclear whether this tool had sound psychometrics properties in the context of Spanish culture. The purpose of this study was to cross-culturally adapt the SC-CII, test its psychometric properties and validate its use among Spanish people with chronic diseases.

Methods
A cross-cultural translation of the SC-CII was performed from English to Spanish. The psychometric evaluation was conducted in a sample of 350 patients with chronic conditions through a multicenter cross-sectional study based on the STROBE guideline. Data were collected from face-to-face interviews during 2022. Internal validity was assessed with Confirmatory Factor Analysis, internal consistency reliability with Cronbach alpha for unidimensional scales and McDonald's Omega reliability coefficient for multidimensional scales.

Results
Most (63.4%) participants were older adults aged 65 years or older with a mean age of 65.45 ± 14.97. The average number of chronic conditions reported was 2.81%; the most common conditions were hypertension (52.3%), musculoskeletal disorders (46.3%) and diabetes (38.9%). Patients reported adequate self-care behaviors in all three scales of the SC-CII. The Self-Care Maintenance and Management scales were multidimensional, and the Self-Care Monitoring scale was unidimensional. In Confirmatory Factor Analysis, the Self-Care Maintenance and Monitoring scales had satisfactory fit indices. The Self-care Management scale had acceptable fit indices. The Omega reliability coefficient for multidimensional scales was 0.75 (Self-Care Maintenance) and 0.72 (Self-Care Management). The Cronbach alpha coefficient of the Self-Care Monitoring scale was 0.85. Item-total correlations were all significant except one. Test–retest reliability showed an intraclass correlation coefficient of 0.92.

Conclusions
The SC-CII has appropriate psychometrics characteristics and is a culturally suitable and reliable instrument for assessing to the self-care behaviors of patients with chronic disease in Spain. The scale provides a simple and rapid solution to assess the self-care process.
Orphan response regulator CovR plays positive regulative functions in the survivability and pathogenicity of Streptococcus suis serotype 2 isolated from a pig
Authors: Zhang Yanyan , Li Rui , Li Qian , Zhu Yongwei , Yang Xiaopei , Zhao Di , Zong Bingbing 
Published: November 2023

Abstract
Background
Streptococcus suis serotype 2 (S. suis 2) is an important zoonotic pathogen. Orphan response regulator CovR plays crucial regulative functions in the survivability and pathogenicity of S. suis 2. However, research on the CovR in S. suis 2 is limited.

Results
In this study, the regulative functions of CovR in the survivability and pathogenicity were investigated in S. suis 2 isolated from a diseased pig. The deletion of CovR significantly weakened the survivability and pathogenicity of S. suis 2. Compared with the wild-type strain, ΔcovR showed slower growth rates and thinner capsular polysaccharides. Moreover, ΔcovR showed reduced adhesion and invasion to Hep-2 cells as well as anti-phagocytosis and anti-killing ability to 3D4 cells and anti-serum killing ability. In addition, the deletion of CovR significantly reduced the colonisation ability of S. suis 2 in mice. The survival rate of mice infected with ΔcovR was increased by 16.7% compared with that of mice infected with S. suis 2. Further, the deletion of CovR led to dramatic changes in metabolism-related pathways in S. suis 2, five of those, including fructose and mannose metabolism, glycerolipid metabolism, ABC transporters, amino sugar and nucleotide sugar metabolism and phosphotransferase system, were significantly down-regulated.

Conclusions
Based on the results, CovR plays positive regulative functions in the survivability and pathogenicity of S. suis 2 SC19 strain isolated from a pig.
TH-302-loaded nanodrug reshapes the hypoxic tumour microenvironment and enhances PD-1 blockade efficacy in gastric cancer
Authors: Wang Zhixiong , Zhu Menglin , Dong Runyu , Cao Danping , Li Yanna , Chen Zhiqiang , Cai Juan , Zuo Xueliang 
Published: November 2023

Abstract
Background
Hypoxia, a common characteristic of the tumour microenvironment, is involved in tumour progression and immune evasion. Targeting the hypoxic microenvironment has been implicated as a promising antitumour therapeutic strategy. TH-302 can be selectively activated under hypoxic conditions. However, the effectiveness of TH-302 in gastric cancer combined immunotherapy remains unclear.

Methods
We designed mPEG-PLGA-encapsulated TH-302 (TH-302 NPs) to target the hypoxic area of tumour tissues. A particle size analyzer was used to measure the average size and zeta potential of TH-302 NPs. The morphology was observed by transmission electron microscopy and scanning electron microscopy. The hypoxic area of tumour tissues was examined by immunofluorescence assays using pimonidazole. Flow cytometry analysis was performed to measure the levels of TNF-α, IFN-γ, and granzyme B. The synergistic antitumour activity of the combination of TH-302 NPs with anti-PD-1 (α-PD-1) therapy was assessed in vitro and in vivo. Haematoxylin and eosin staining of major organs and biochemical indicator detection were performed to investigate the biological safety of TH-302 NPs in vivo.

Results
TH-302 NPs inhibited the proliferation and promoted the apoptosis of gastric cancer cells under hypoxic conditions. In vitro and in vivo experiments confirmed that TH-302 NPs could effectively alleviate tumour hypoxia. TH-302 NPs exhibited high bioavailability, effective tumour-targeting ability and satisfactory biosafety. Moreover, the combination of TH-302 NPs with α-PD-1 significantly improved immunotherapeutic efficacy in vivo. Mechanistically, TH-302 NPs reduced the expression of HIF-1α and PD-L1, facilitated the infiltration of CD8+ T cells and increased the levels of TNF-α, IFN-γ, and granzyme B in tumours, thereby enhancing the efficacy of α-PD-1 therapy.

Conclusion
TH-302 NPs alleviated the hypoxic tumour microenvironment and enhanced the efficacy of PD-1 blockade. Our results provide evidence that TH-302 NPs can be used as a safe and effective nanodrug for combined immunotherapy in gastric cancer treatment.
Short- and long-term outcomes of Roux-en-Y and Billroth II with Braun reconstruction in total laparoscopic distal gastrectomy: a retrospective analysis
Authors: Chen Yan-xin , Huang Qiao-zhen , Wang Peng-cheng , Zhu Yue-Jia , Chen Li-quan , Wu Chu-ying , Wang Jin-tian , Chen Jun-xing , Ye Kai 
Published: November 2023

Abstract
Background
The controversy surrounding Roux-en-Y (R-Y) and Billroth II with Braun (BII + B) reconstruction as an anti-bile reflux procedure after distal gastrectomy has persisted. Recent studies have demonstrated their efficacy, but the long-term outcomes and postoperative quality of life (QoL) among patients have yet to be evaluated. Therefore, we compared the short-term and long-term outcomes of the two procedures as well as QoL.

Methods
The clinical data of 151 patients who underwent total laparoscopic distal gastrectomy (TLDG) at the Gastrointestinal Surgery Department of the Second Hospital of Fujian Medical University from January 2016 to December 2019 were retrospectively analyzed. Of these, 57 cases with Roux-en-Y procedure (R-Y group) and 94 cases with Billroth II with Braun procedure were included (BII + B group). Operative and postoperative conditions, early and late complications, endoscopic outcomes at year 1 and year 3 after surgery, nutritional indicators, and quality of life scores at year 3 postoperatively were compared between the two groups.

Results
The R-Y group recorded a significantly longer operative time (194.65 ± 21.52 vs. 183.88 ± 18.02 min) and anastomotic time (36.96 ± 2.43 vs. 27.97 ± 3.74 min) compared to the BII + B group (p < 0.05). However, no other significant differences were observed in terms of perioperative variables, including blood loss (p > 0.05). Both groups showed comparable rates of early and late complications. Endoscopic findings indicated similar food residuals at years 1 and 3 post-surgery for both groups. The R-Y group had a lower occurrence of residual gastritis and bile reflux at year 1 and year 3 after surgery, with a statistically significant difference (p < 0.001). Reflux esophagitis was not significantly different between the R-Y and BII + B groups in year 1 after surgery (p = 0.820), but the R-Y group had a lower incidence than the BII + B group in year 3 after surgery (p = 0.023). Nutritional outcomes at 3 years after surgery did not differ significantly between the two groups (p > 0.05). Quality of life scores measured by the QLQ-C30 scale were not significantly different between the two groups. However, on the QLQ-STO22 scale, the reflux score was significantly lower in the R-Y group than in the BII + B group (0 [0, 0] vs. 5.56 [0, 11.11]) (p = 0.003). The rest of the scores were not significantly different (p > 0.05).

Conclusion
Both R-Y and B II + B reconstructions are equally safe and efficient for TLDG. Nevertheless, the R-Y reconstruction reduces the incidence of residual gastritis, bile reflux, and reflux esophagitis, as well as postoperative reflux symptoms, and provides a better quality of life for patients. R-Y reconstruction is superior to BII + B reconstruction for TLDG.
Physical activity and cognitive function: moment-to-moment and day-to-day associations
Authors: Kekäläinen Tiia , Luchetti Martina , Terracciano Antonio , Gamaldo Alyssa A. , Mogle Jacqueline , Lovett Hephzibah H. , Brown Justin , Rantalainen Timo , Sliwinski Martin J. , Sutin Angelina R. 
Published: November 2023

Abstract
Background
The beneficial effect of acute physical exercise on cognitive performance has been studied in laboratory settings and in long-term longitudinal studies. Less is known about these associations in everyday environment and on a momentary timeframe. This study investigated momentary and daily associations between physical activity and cognitive functioning in the context of everyday life.

Methods
Middle-aged adults (n = 291, aged 40–70) were asked to wear accelerometers and complete ecological momentary assessments for eight consecutive days. Processing speed and visual memory were assessed three times per day and self-rated evaluations of daily cognition (memory, thinking, and sharpness of mind) were collected each night. The number of minutes spent above the active threshold (active time) and the maximum vector magnitude counts (the highest intensity obtained) before each cognitive test and at a daily level were used as predictors of momentary cognitive performance and nightly subjective cognition. Analyses were done with multilevel linear models. The models were adjusted for temporal and contextual factors, age, sex, education, and race/ethnicity.

Results
When participants had a more active time or higher intensity than their average level within the 20 or 60 minutes prior to the cognitive test, they performed better on the processing speed task. On days when participants had more active time than their average day, they rated their memory in the evening better. Physical activity was not associated with visual memory or self-rated thinking and sharpness of mind.

Conclusions
This study provides novel evidence that outside of laboratory settings, even small increases in physical activity boost daily processing speed abilities and self-rated memory. The finding of temporary beneficial effects is consistent with long-term longitudinal research on the cognitive benefits of physical activity.
Biological underpinnings of radiomic magnetic resonance imaging phenotypes for risk stratification in IDH wild-type glioblastoma
Authors: Guan Fangzhan , Wang Zilong , Qiu Yuning , Guo Yu , Pei Dongling , Wang Minkai , Xing Aoqi , Liu Zhongyi , Yu Bin , Cheng Jingliang , Liu Xianzhi , Ji Yuchen , Yan Dongming , Yan Jing , Zhang Zhenyu 
Published: November 2023

Abstract
Background
To develop and validate a conventional MRI-based radiomic model for predicting prognosis in patients with IDH wild-type glioblastoma (GBM) and reveal the biological underpinning of the radiomic phenotypes.

Methods
A total of 801 adult patients (training set, N = 471; internal validation set, N = 239; external validation set, N = 91) diagnosed with IDH wild-type GBM were included. A 20-feature radiomic risk score (Radscore) was built for overall survival (OS) prediction by univariate prognostic analysis and least absolute shrinkage and selection operator (LASSO) Cox regression in the training set. GSEA and WGCNA were applied to identify the intersectional pathways underlying the prognostic radiomic features in a radiogenomic analysis set with paired MRI and RNA-seq data (N = 132). The biological meaning of the conventional MRI sequences was revealed using a Mantel test.

Results
Radscore was demonstrated to be an independent prognostic factor (P < 0.001). Incorporating the Radscore into a clinical model resulted in a radiomic-clinical nomogram predicting survival better than either the Radscore model or the clinical model alone, with better calibration and classification accuracy (a total net reclassification improvement of 0.403, P < 0.001). Three pathway categories (proliferation, DNA damage response, and immune response) were significantly correlated with the prognostic radiomic phenotypes.

Conclusion
Our findings indicated that the prognostic radiomic phenotypes derived from conventional MRI are driven by distinct pathways involved in proliferation, DNA damage response, and immunity of IDH wild-type GBM.