bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing availability, prices, and market share of quality-assured malaria ACT and RDT in the private retail sector in Nigeria and Uganda
Authors: Woldeghebriel Meley , Aso Ezinne , Berlin Erica , Fashanu Chizoba , Kirumira Sylvia N. , Lam Felix , Mugerwa Robert , Nakiganda Juliet , Olaleye Tayo , Opigo Jimmy , Osinupebi Funlola , Priestley Natalie , Stringham Rodger , Uhomoibhi Perpetua , Visser Theodoor , Ward Abigail , Wiwa Owens , Woolsey Aaron 
Published: February 2024

Abstract
Background
An estimated 50% of suspected malaria cases in sub-Saharan Africa first seek care in the private sector, especially in private medicine retail outlets. Quality of care in these outlets is generally unknown but considered poor with many patients not receiving a confirmatory diagnosis or the recommended first-line artemisinin-based combination therapy (ACT). In 2010, a subsidy pilot scheme, the Affordable Medicines Facility malaria, was introduced to crowd out the use of monotherapies in favour of WHO-pre-qualified artemisinin-based combinations (WHO-PQ-ACTs) in the private health sector. The scheme improved the availability, market share, and cost of WHO-PQ-ACTs in countries like Nigeria and Uganda, but in 2018, the subsidies were halted in Nigeria and significantly reduced in Uganda. This paper presents findings from six retail audit surveys conducted from 2014 to 2021 in Nigeria and Uganda to assess whether the impact of subsidies on the price, availability, and market share of artemisinin-based combinations has been sustained after the subsidies were reduced or discontinued.

Methods
Six independent retail audits were conducted in private medicine retail outlets, including pharmacies, drug shops, and clinics in Nigeria (2016, 2018, 2021), and Uganda (2014, 2019, 2020) to assess the availability, price, and market share of anti-malarials, including WHO-PQ-ACTs and non-WHO-PQ-ACTs, and malaria rapid diagnostic tests (RDTs).

Results
Between 2016 and 2021, there was a 57% decrease in WHO-PQ-ACT availability in Nigeria and a 9% decrease in Uganda. During the same period, non-WHO-PQ-ACT availability increased in Nigeria by 41% and by 34% in Uganda. The price of WHO-PQ-ACTs increased by 42% in Nigeria to $0.68 and increased in Uganda by 24% to $0.95. The price of non-WHO-PQ-ACTs decreased in Nigeria by 26% to $1.08 and decreased in Uganda by 64% to $1.23. There was a 76% decrease in the market share of WHO-PQ-ACTs in Nigeria and a 17% decrease in Uganda. Malaria RDT availability remained low throughout.

Conclusion
With the reduction or termination of subsidies for WHO-PQ-ACTs in Uganda and Nigeria, retail prices have increased, and retail prices of non-WHO-PQ-ACTs decreased, likely contributing to a shift of higher availability and increased use of non-WHO-PQ-ACTs.
Textbook oncologic outcomes are associated with increased overall survival in patients with pancreatic head cancer after undergoing laparoscopic pancreaticoduodenectomy
Authors: Zhang Jing , Cai He , Zhang Man , Wang Xin , Cai Yunqiang , Peng Bing 
Published: February 2024

Abstract
Background
Textbook oncologic outcomes (TOO) have been used to evaluate long-term oncologic outcomes for patients after pancreaticoduodenectomy (PD) but not laparoscopic pancreaticoduodenectomy (LPD). The aim of the study was to assess the prognostic value of TOO for patients with pancreatic head cancer undergoing LPD and discuss the risk factors associated with achieving TOO.

Methods
Patients with pancreatic head cancer who underwent LPD in West China Hospital from January 2015 to May 2022 were consecutively enrolled. TOO was defined as achieving R0 resection, examination of ≥ 12 lymph nodes, no prolonged length of stay, no 30-day readmission/death, and receiving adjuvant chemotherapy. Survival analysis was used to determine the prognostic value of a TOO on overall survival (OS) and recurrence-free survival (RFS). Logistic regression was used to identify the risk factors of a TOO. The rates of a TOO and of each indicator were compared in patients who suffered or not from delayed gastric emptying (DGE).

Results
A total of 44 (25.73%) patients achieved TOO which was associated with improved median OS (TOO 32 months vs. non-TOO 20 months, P = 0.034) and a better RFS (TOO 19 months vs. non-TOO 13 months, P = 0.053). Patients suffering from DGE [odds ratio (OR) 4.045, 95% CI 1.151–14.214, P = 0.029] were independent risk factors for TOO. In addition, patients with DGE after surgery had a significantly lower rate of TOO (P = 0.015) than patients without DGE.

Conclusions
As there were significant differences between patients who achieved TOO or not, TOO is a good indicator for long-term oncologic outcomes in patients with pancreatic head cancer after undergoing LPD. DGE is the risk factor for achieving TOO, so it is important to prevent the DGE after LPD to improve the rate of TOO.
Harnessing the potential of HLA-G in cancer therapy: advances, challenges, and prospects
Authors: Wang Siyuan , Wang Jiaxin , Xia Yu , Zhang Le , Jiang Yueqiang , Liu Man , Gao Qinglei , Zhang Cuntai 
Published: February 2024

AbstractImmune checkpoint blockades have been prized in circumventing and ablating the impediments posed by immunosuppressive receptors, reaching an exciting juncture to be an innovator in anticancer therapy beyond traditional therapeutics. Thus far, approved immune checkpoint blockades have principally targeted PD-1/PD-L1 and CTLA-4 with exciting success in a plethora of tumors and yet are still trapped in dilemmas of limited response rates and adverse effects. Hence, unveiling new immunotherapeutic targets has aroused immense scientific interest in the hope of expanding the clinical application of immune checkpoint blockades to scale new heights. Human leukocyte antigen-G (HLA-G), a non-classical major histocompatibility complex (MHC) class I molecule, is enriched on various malignant cells and is involved in the hindrance of immune effector cells and the facilitation of immunosuppressive cells. HLA-G stands out as a crucial next-generation immune checkpoint showing great promise for the benefit of cancer patients. Here, we provide an overview of the current understanding of the expression pattern and immunological functions of HLA-G, as well as its interaction with well-characterized immune checkpoints. Since HLA-G can be shed from the cell surface or released by various cells as free soluble HLA-G (sHLA-G) or as part of extracellular vesicles (EVs), namely HLA-G-bearing EVs (HLA-GEV), we discuss the potential of sHLA-G and HLA-GEV as predictive biomarkers. This review also addresses the advancement of HLA-G-based therapies in preclinical and clinical settings, with a focus on their clinical application in cancer.
Bidirectional glenn surgery without palliative pulmonary artery banding in univentricular heart with unrestricted pulmonary flow. Retrospective multicenter experience
Authors: Abdelmohsen Gaser A. , Gabel Hala A. , Alamri Rawan M. , Baamer Ahmed , Al-Radi Osman O. , Binyamin Aliaa , Jamjoom Ahmed A. , Elmahrouk Ahmed F. , Bahaidarah Saud A. , Alkhushi Naif A. , Abdelsalam Mohamed H. , Ibrahim Hossam , Elakaby Ahmed R. , Khawaji Adeep , Alghobaishi Abdullah , Maghrabi Khadijah A. , Zaher Zaher F. , Al-Ata Jameel A. , Azhar Ahmad S. , Dohain Ahmed M. 
Published: February 2024

Abstract
Background
Although pulmonary artery banding (PAB) has been generally acknowledged as an initial palliative treatment for patients having single ventricle (SV) physiology and unrestrictive pulmonary blood flow (UPBF), it may result in unfavorable outcomes. Performing bidirectional Glenn (BDG) surgery without initial PAB in some selected cases may avoid the complications associated with PAB and reduce the number of operative procedures for these patients. This research aimed to assess the outcome of BDG surgery performed directly without doing initial PAB in patients with SV-UPBF.

Methods
This Multicenter retrospective cohort includes all patients with SV-UPBF who had BDG surgery. Patients were separated into two groups. Patients in Group 1 included patients who survived till they received BDG (20 Patients) after initial PAB (28 patients), whereas patients in Group 2 got direct BDG surgery without first performing PAB (16 patients). Cardiac catheterization was done for all patients before BDG surgery. Patients with indexed pulmonary vascular resistance (PVRi) ≥ 5 WU.m2 at baseline or > 3 WU.m2 after vasoreactivity testing were excluded.

Results
Compared with patients who had direct BDG surgery, PAB patients had a higher cumulative mortality rate (32% vs. 0%, P = 0.016), with eight deaths after PAB and one mortality after BDG. There were no statistically significant differences between the patient groups who underwent BDG surgery regarding pulmonary vascular resistance, pulmonary artery pressure, postoperative usage of sildenafil or nitric oxide, intensive care unit stay, or hospital stay after BDG surgery. However, the cumulative durations in the intensive care unit (ICU) and hospital were more prolonged in patients with BDG after PAB (P = 0.003, P = 0.001respectively).

Conclusion
Direct BDG surgery without the first PAB is related to improved survival and shorter hospital stays in some selected SV-UPBF patients.
Per-cell histone acetylation is associated with terminal differentiation in human T cells
Authors: Yang Cheng , Li You , Hu Yaqiu , Li Qian , Lan Yinghua , Li Yongguo 
Published: February 2024

Abstract
Background
Epigenetic remodeling at effector gene loci has been reported to be critical in regulating T cell differentiation and function. However, efforts to investigate underlying epigenetic mechanisms that control T cell behaviors have been largely hindered by very limited experimental tools, especially in humans.

Results
In this study, we employed a flow cytometric assay to analyze histone acetylation at single-cell level in human T cells. The data showed that histone acetylation was increased during T cell activation. Among T cell subsets, terminally differentiated effector memory T (TEMRA) cells robustly producing effector cytokines were hyper-acetylated. Conversely, these TEMRA cells had lower expression levels of TCF-1, a key transcription factor for maintaining stem cell features. Pharmaceutical inhibition of histone acetylation using a small molecule C646 restrained the production of effector molecules, but retained stem cell-like properties in T cells after expansion.

Conclusions
Per-cell histone acetylation is associated with terminal differentiation and poor stemness in human T cells. These observations suggest a new approach to enhance the stem cell-like properties of T cells and improve the efficacy of immunotherapy.
Unilateral upper and lower limb ischemia mimics stroke: a case report
Authors: Péčová Monika , Benko Jakub , Péč Martin Jozef , Bolek Tomáš , Hurtová Tatiana , Sokol Juraj , Staško Ján , Samoš Matej , Mokáň Marián 
Published: February 2024

Abstract
Background
Although stroke and acute limb ischemia seem easily distinguishable by anamnesis and physical examination, symptoms may overlap and sometimes mislead the examiner. Such a situation can arise in the occurrence of unilateral neurological symptoms affecting the upper and lower limbs at the same time. As timely diagnosis and a correct therapeutic intervention are crucial to prevent irreversible damage in both diseases, knowledge of the possibility of one disease mimicking the other is essential. We present a unique case of acute unilateral upper and lower limb ischemia mimicking an acute stroke.

Case presentation
A 69-year-old Caucasian patient with known atherosclerotic risk factors was admitted to the emergency department with a suspected stroke with unilateral paresthesia. After a comprehensive examination of the patient with the need for repeated reevaluation and a negative brain computed tomography scan, acute left-sided upper and lower limb ischemia was eventually diagnosed. The patient underwent surgical revascularization of the upper and lower limbs with a satisfactory result and was discharged from the hospital after a few days.

Conclusion
It is of utmost importance to always stay alert for stroke mimics, as overlooking can lead to severe complications and delay adequate therapy. Our case shows that persistent diagnostic effort leads to successful treatment of the patient even on rare occasions, as is the acute unilateral upper and lower limb ischemia.
Increasing the Length of Concrete Pavement Slabs Using Shrinkage Reducing Admixture and Polypropylene Fiber
Authors: Gholami Masood , Moghadas Nejad Fereidoon , Ramezanianpour Amir Mohammad 
Published: February 2024

AbstractPavement engineers frequently employ concrete pavements because of their benefits such as extended lifetime, superior performance and durability, and so on. However, there are some disadvantages of these pavements such as shrinkage which may lead to cracking, warping, and limiting the length of the concrete pavement slabs. Shrinkage reducing admixture (SRA) and polypropylene fibers can be employed to prevent or control shrinkage cracking. In this study, increasing the length of concrete pavement slabs using shrinkage reducing admixture and polypropylene fiber was investigated. For mix compositions, two water–cement ratios of 0.35 and 0.4 were employed, and the percentages of SRA and polypropylene fiber utilized in mixes were 2% and 1% by weight of cement, respectively. Slump, compressive strength, third point flexural strength, electrical resistance, free and restrained shrinkage tests were carried out as the experimental programming to investigate the effect of these materials on concrete behavior and evaluate the amount of concrete pavement design parameters. Statistical analysis and RSM were used to determine the significance of each parameter and their interactions on concrete properties. It was observed that the use of SRA had no influence on workability; however, polypropylene fibers reduced the slump flow of concrete. Also, the use of SRA resulted in a decrease in mechanical properties. In addition, the use of polypropylene fibers considerably enhanced the energy absorption of concrete. Furthermore, on concrete containing SRA and polypropylene fiber, the magnitude of free and restrained shrinkage and crack width were reduced. Finally, the length and thickness of concrete pavement slabs were evaluated using the experimental results on the Tehran-Shomal freeway as a case study. The slab length could be increased by about 20% without any significant change in the slab thickness using SRA and polypropylene fiber in concrete mix composition. This can lead to an increase in construction speed, improve the durability of pavement and generally increase the quality of the concrete pavement.
Strengthening graduate education and addressing environmental challenges through solutions-oriented partnerships and interdisciplinary training
Authors: Templer Pamela , Atherton Kathryn F. , Conrad-Rooney Emerson , Ho Heather , Hutyra Lucy R. , Ianniello Caroline F. , Kashian Donna R. , Levy Jonathan I. , Meshoulam David , Urban Mark C. 
Published: February 2024

AbstractGraduate students across disciplines are eager for experiential training that enables them to address real-world environmental challenges. Simultaneously, communities across the world face numerous environmental challenges, including increased frequency of extreme heat in summer and poor air quality, and could benefit from the expertise and engagement of graduate students with the requisite skills and interests to address these challenges. In this paper we bring together lessons learned from three interdisciplinary graduate training programs focused on preparing graduate students to contribute to urban environmental solutions by working in partnerships with non-academic organizations. We discuss the multiple elements required for partnerships to be mutually beneficial, including using a T-shaped approach to training that incorporates both depth and breadth while making strong efforts to broaden participation. We share lessons with the goal of enhancing graduate programs to improve training of students to address urban environmental challenges globally. This training aligns with the United Nations Sustainable Development Goal 17, “Partnership for the Goals,” which aims to achieve sustainable development goals through partnerships among entities.
Medical Students’ Perceptions at Dow University of Health Sciences using Dundee Ready Education Environment Measure Inventory
Authors: Zuberi Bader Faiyaz , Shaikh Majid Ahmed , Zuberi Faisal Faiyaz , Rasheed Tazeen , Ali Faiza Sadaqat , Nawaz Zunaira 
Published: February 2024

Objectives: To assess medical students’ perceptions regarding learning, teachers, academics, atmosphere at campus and social self-perceptions at Dow University of Health Sciences using Dundee Ready Education Environment Measure (DREEM) Inventory.
Method: This cross-sectional observational study was conducted from March 1st, 2022 to September 30th, 2022. All medical students at Dow University of Health Sciences were offered to participate. All students were given the choice to respond to DREEM questionnaire via online Form or printed copy anonymously. The DREEM Inventory measures five domains of students’ perceptions of a given institution. Comparison of responses between different years and institution was carried out by χ2 test. Means scores were compared by Student’s t-test and ANOVA, p-value of ≤.05 was taken as significant.
Results: Total of 1054 out of 1750 (60.23%) students submitted fully completed forms and were included, out of these 632 (60.0%) belonged to Dow Medical College & 422 (40.0%) belonged to Dow International Medical College. The mean ±SD of total score of DREEM by DMC students was 100.07 ±31.46 and that of DIMC was 100.52 ±32.73. According to DREEM Global scoring both colleges scores fell into category of “many problems”. Analysis according to domains showed that maximum score was given to 2nd domain of their “perception regarding teachers” and minimum score was allocated to 5th domain regarding “social self-perceptions”.
Conclusion: Overall Students perceived environment at DUHS as “many problems” category. This needs to be investigated for betterment of Educational Environment (EE) at campus.
doi: https://doi.org/10.12669/pjms.40.4.7712
How to cite this: Zuberi BF, Shaikh MA, Zuberi FF, Rasheed T, Ali FS, Nawaz Z. Medical Students’ Perceptions at Dow University of Health Sciences using Dundee Ready Education Environment Measure Inventory. Pak J Med Sci. 2024;40(4):711-717. doi: https://doi.org/10.12669/pjms.40.4.7712
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Unveiling the spectrum: A cross-sectional exploration of hirsutism causes in women
Authors: Ansari Rana Tabassum , Syed Uneeba , Riaz Musarrat , Askari Saima , Anjum Sarwat 
Published: February 2024

Background and Objective: Hirsutism is a common endocrine disorder and its etiology varies from benign and idiopathic disorders to serious malignant diseases. Hirsutism creates negative impact on quality of life and considerable effects on fertility. Our objective was to determine the various causes of hirsutism in women presenting at two endocrine clinics.
Method: This cross-sectional study was conducted at Baqai Institute of Diabetology and Endocrinology, Karachi and at Jinnah hospital, Lahore from August 2020 to December 2021 women between 12-45 years of age with complains of hirsutism were included in the study. Severity of Hirsutism was evaluated using modified Ferriman-Gallwey score (FG). Patients with modified FG score of 8 or more were considered having hirsutism.
Results: The study had 113 patients with a mean age of 15.50+7.29 years with 89% having moderate hirsutism (FG score 16-25). Polycystic ovaries was the most common cause of hirsutism. Common sites for hirsutism included back (83%), arms (74%), buttocks (70%), and upper abdomen (47%). High BMI (p-value <0.01) and high Dehydroepiandrosterone levels were positively associated with the severity of hirsutism (p-value of 0.006).
Conclusion: The various causes of hirsutism identified were polycystic ovaries, followed by idiopathic, thyroid dysfunction, congenital adrenal hyperplasia, and hyperprolactinemia; therefore, all women presenting with hirsutism should be evaluated for potential serious and curable etiologies, before embarking on a treatment plan.
doi: https://doi.org/10.12669/pjms.40.4.8271
How to cite this: Ansari RT, Syed U, Riaz M, Askari S, Anjum S. Unveiling the spectrum: A cross-sectional exploration of hirsutism causes in women. Pak J Med Sci. 2024;40(4):736-740. doi: https://doi.org/10.12669/pjms.40.4.8271
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Clinical value of the expression levels of tumor protein D52 and miR-133a on prognosis assessment of pancreatic cancer surgery
Authors: Wang Zhen-yong , Liu Ru-hai , Meng Yu , Li Jin-chao 
Published: February 2024

Objective: To investigate the clinical value of the expression levels of tumor protein D52 (TPD52) and miR-133a on the prognosis assessment of pancreatic cancer surgery.
Methods: This was a retrospective study. Ninety-seven patients who underwent radical surgery for pancreatic cancer in Cangzhou Central Hospital from January 2018 to January 2022 were selected and divided into four groups: TPD52 high expression group, TPD52 low expression group, miR-133a high expression group and miR-133a low expression group. The relationship between the expression levels of TPD52 and miR-133a and the clinicopathological features of patients with pancreatic cancer was analyzed. The COX regression model was used to analyze the risk factors affecting the prognosis of patients with pancreatic cancer.
Results: The high expression rate of TPD52 and the low expression rate of miR-133a in pancreatic cancer tissues were higher than those in normal paracancerous tissues(P<0.05). Based on the comparison of prognosis and survival, the median survival time of patients with high expression of TPD52 and low expression of miR-133a was lower than that of patients with low expression of TPD52 and high expression of miR-133a, with a statistically significant difference(P<0.05). Moreover, multivariate Cox regression analysis showed that low differentiation of pancreatic cancer, III-IV stage of TNM, high expression of TPD52, as well as low expression of miR-133a were independent risk factors for postoperative survival of patients with pancreatic cancer(P<0.05).
Conclusion: TPD52 is expressed at a high level whereas miR-133a at a low level in pancreatic cancer tissues, both of which together with low differentiation of pancreatic cancer and III-IV stage of TNM constitute independent risk factors affecting the surgical prognosis of patients with pancreatic cancer.
doi: https://doi.org/10.12669/pjms.40.4.8389
How to cite this: Wang Z, Liu R, Meng Y, Li J. Clinical value of the expression levels of tumor protein D52 and miR-133a on prognosis assessment of pancreatic cancer surgery. Pak J Med Sci. 2024;40(4):723-729. doi: https://doi.org/10.12669/pjms.40.4.8389
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.