bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Generic Antiretroviral Drugs Introduction on Pharmaceutical Expenditure Patterns in the Netherlands: A Six-Year Retrospective Database Analysis from 2016 to 2022
Authors: Oosterhof Piter , Luin M Van , JW Vanhommerig , Brinkman K , DM Burger 
Published: February 2024

Abstract
Background
In the Netherlands, the annual expenditure on HIV care was 202 million euros in 2019, with about 70% allocated to antiretroviral therapy (ART). The introduction of generic antiretroviral medications (ARVs) in 2017 has offered potential cost-saving opportunities in healthcare. Understanding the financial implications of incorporating generic ART into the Dutch healthcare system is crucial to determine its impact.
Methods
We used data from the Foundation for Pharmaceutical Statistics (SFK), covering 98% of all community and outpatient clinic pharmacies across the Netherlands. This dataset contained medication information from 2016 to 2022. Medication data were classified using the Anatomical Therapeutic Chemical Classification with Defined Daily Dose (ATC/DDD) system. Cost analysis was based on Dutch drug prices (www.medicijnkosten.nl) for a specified period, and the data were processed using IBM SPSS.
Results
In the Netherland, people with HIV receiving ART increased from 20,072 to 24,573 between 2016-2022. HIV medication expenditure was 191 million euros in 2016, with generic medication at 6% DDDs. After an increase in 2017, a subsequent decrease in total HIV medication expenditure led to an overall cost of 180 million euros in 2022 (-9.4% compared to 2016). Simultaneously, the proportion of DDDs with a generic increased to 16-32% over the years. This could be linked to 97% compliance with generic substitutions for ARVs where a generic equivalent was available. Notably, the cost per patient per year has declined from €9,488 in 2016 to €7,352 in 2022 (-22.5% compared to 2016). Some of the potential cost-savings through generic substitution were not utilized because of the 20% increase in the use of novel branded single-tablet regimens (STRs).
Conclusions
Our analysis showed high compliance with generic substitution of ARVs in the Netherlands. The increased use of generic ARVs was accompanied by an almost 10% reduction in overall expenditure on ART costs despite a significant increase in the number of patients in care in the Netherlands during this period. A significant contributing factor to ART costs appears to be the high percentage of prescribed patented Single-Tablet Regimens (STRs). These findings underscore the complex dynamics of pharmaceutical expenditures in the Dutch healthcare system.
Astrocyte-derived apolipoprotein D is required for neuronal survival in Parkinson’s disease
Authors: Jiang Hong , Dai Yingying , Bi Mingxia , Jiao Qian , Du Xixun , Yan Chunling 
Published: February 2024

Abstract

Apolipoprotein D (Apo D), a lipocalin transporter of small hydrophobic molecules, plays an important role in several neurodegenerative diseases. It was reported that increased immunostaining for Apo D of glial cells surrounding dopmainergic (DAergic) neurons was observed in the brains of Parkinson’s disease (PD) patients. Although preliminary findings supported the role of Apo D in neuroprotection, its derivation and effects on the degeneration of nigral DAergic neurons are largely unknown. In the present study, we observed that Apo D levels released from astrocytes were increased in PD both in vivo and in vitro. When co-cultured with astrocytes, due to the increased release of astrocytic Apo D, the survival rate of primary cultured ventral midbrain (VM) neurons was significantly increased with 1-methyl-4-phenylpyridillium ion (MPP+) treatment. Increased levels of TAp73 and its phosphorylation at Tyr99 in astrocytes were required for the increased Apo D levels and its release. Conditional knockdown of TAp73 in the nigral astrocytes in vivo could aggravate the neurodegeneration in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) -treated PD mice. Our findings reported, for the first time, astrocyte-derived Apo D was essential for DAergic neuronal survival in PD, which might provide new therapeutic targets for PD.
One-stage method for removing dyes under the action of underwater plasma and ferrites of cobalt, nickel, and titanium
Authors: Khlyustova Anna , Sirotkin Nikolay 
Published: February 2024

Abstract

Pulsed underwater direct current discharge is considered as a tool for a one-step process for ferrite synthesis and organic dye removal. The formation of cobalt, nickel and titanium ferrites during the discharge firing process was confirmed by methods of light scattering dynamics and X-ray phase analysis. The transformation of dye molecules (fluorescein, methylene green) during the combined action of plasma and ferrites was detected by UV absorption spectroscopy. The contributions of the separate action of plasma and ferrites to the process of dye removal from the solution were investigated. It was found that the synthesized structures have a high sorption capacity. It was found that fluorescein can be used as an indicator for the presence of nickel ferrites.
Emergency department staff opinion on newly introduced phlebotomy services in the department. A cross-sectional study incorporating reflexive thematic analysis.
Authors: Osman Abdi D. , Yeak Daryl , Ben-Meir Michael , Braitberg George 
Published: February 2024

Abstract
Introduction
The demand for Emergency Department (ED) services, both in terms of patient numbers and complexity has risen over the past decades. According to reports, there has been an increase in the ED patient presentation rate from 321 per 1000 to 339 per 1000 between 2017-18 and 2021-22. Consequently, new care models have been introduced to address this surge in demand, mitigate associated risks, and improve overall safety. Among these models is the concept of "front loading" clinical care, involving the initiation of interventions at the point of arrival. This study evaluates the impact of introducing phlebotomists at triage.
Method
We conducted a cross-sectional survey using purposive sampling and employed quantitative analysis, complemented by reflexive thematic analysis.
Results
The response rate for the questionnaire was 61% (n = 207) with good representation from all ED craft groups. Nearly all the staff (99.5%) reported being aware of the presence of phlebotomists in the ED, while only 57% of the staff reported working in triage (p = 0.048, 0.0001599 to 0.043073). ‘Valuable/vital resource’ featured as a common response. Early decision making, patient safety, staff and patient satisfaction emerged as consistent themes.
Conclusion
Emergency Departments continue to introduce new models of care to address increasing demand for services. We present a model that utilises an existing workforce, relocating them from the ambulatory and outpatient setting to the ED and increasing their scope to complement triage needs, including COVID-19 PCR testing, ECG and venous blood gas analysis. Our staff have identified these tasks, and the concierge role provided by the phlebotomists as contributions to enhanced patient care and safety.
“Watch-and-wait” or “Lost to follow-up”? Real-World Adherence with Surveillance for Nonoperative Management of Rectal Cancer
Authors: Rubens Merrill , Oduyale Oluseye , Eltahir Ahmed , Kim Hyun , Ohman Kerri , Wise Paul , Hunt Steven , Silviera Matthew , Mutch Matthew , Glasgow Sean Christopher , Smith Radhika , Chapman William 
Published: February 2024

Abstract
Purpose
Due to potential for local regrowth in patients undergoing nonoperative management (NOM) of rectal adenocarcinoma, current guidelines recommend close surveillance as part of any “watch-and-wait” paradigm. These regimens require many visits, which may impose significant burden on patients. There is a paucity of data regarding optimal frequency of examinations. We sought to determine adherence with recommended surveillance, identify predictors of poor adherence, and describe the impact of adherence on oncologic outcomes during the first two years after clinical complete response (cCR).
Methods
This is an analysis of a prospectively-maintained registry of rectal cancer patients, initially seen between June 2016 and October 2021, who opted for NOM following cCR after treatment with radiation and chemotherapy. Surveillance was per-protocol and entailed periodic luminal exams and cross-sectional imaging. Adherence was quantified as the percentage of recommended examinations completed annually or until local regrowth was identified.
Results
Of 255 patients that received radiation and chemotherapy, 107 patients were found to have cCR and met criteria for inclusion. Of these, 65 patients had a sustained cCR and were eligible for a second year of surveillance. Fifty-four patients (50.5%) were fully adherent with the minimum number of recommended surveillance exams during the first year of NOM, and 22 patients (34%) during the second year. Local regrowth was identified in 31 patients (29%), all but two of whom subsequently underwent an R0 resection.
Conclusions
Less than half of patients were fully adherent with the minimum number of recommended surveillance exams during the first two years of nonoperative management. Improving real-world adherence to facilitate optimal oncologic outcomes requires the least burdensome, yet safe regimen, as well as collaborative systems-based practices.
Paraneoplastic Systemic Sclerosis: A Distinct Entity or A Mere Association - A Case Report
Authors: Sahoo Debananda , Devi Sujata , Anupam Anurag , Dey Anupam , Dash Arpita , Mishra Bodhisattwa 
Published: February 2024

Abstract
Background
Systemic Sclerosis is a multi-systemic rheumatological disorder which, in due course, progressed to present as ILD (Interstitial Lung Disease), PAH (Pulmonary Arterial hypertension), Scleroderma Renal Crisis etc. The association between Systemic Sclerosis and malignancy is unclear. Still, many malignancies cause skin thickening as a part of the paraneoplastic syndrome, including breast, gastric and skin neoplasms. These paraneoplastic Systemic Sclerosis patients are usually Scl 70 autoantibody negative. Whether it is a coexisting pathology or a paraneoplastic entity is still debatable [5]. Here we present a case of diffuse Systemic Sclerosis with ADPKD (Autosomal Dominant Polycystic Kidney Disease) and hypothyroidism with metastatic epithelial neoplasm of unknown primary with a positive auto-antibody profile for scleroderma.
Case Presentation:
A 52-year male presented to our ED with a complaint of significant progressive skin tightening over one month associated with increased skin pigmentation. All these symptoms are associated with substantial weight loss, decreased appetite and blurred vision. On examination, BP was 220/120 mm Hg, with deranged renal parameters (Urea 130 mg/dl and Creatinine 9mg/dl). Considering all these findings, D/D were made as Scleroderma Renal crisis or Paraneoplastic Systemic Sclerosis. We found a Supraclavicular LN on examination, which revealed metastatic epithelial malignancy of unknown origin with CK 7 (Cytokeratin 7) and TTF 1 (Transcription Termination Factor) positive on IHC (Immunohistochemistry). LN biopsy revealed a positive insertion mutation in exon 20 of the EGFR (epidermal growth factor receptor) gene, hinting towards an occult Adenocarcinoma of the Lung. The patient started treatment with Erlotinib for occult Adeno Ca of the Lung. He had started with Ramipril, Nifedipine, Clonidine, Prazosin, and MMF for Scleroderma Renal Crisis and skin involvement. HTN was reasonably controlled, and the skin tightening/thickening improved gradually.
Conclusions
Scl 70 antibodies are usually absent in paraneoplastic scleroderma, but there have been few reports of diffuse Systemic Sclerosis with Scl 70 positivity in the background of malignancy as in the present case. So, for any patient with rapid progression of the disease process irrespective of Scl 70 positivity, it is better to probe an underlying malignancy with imaging or endoscopic modalities thoroughly. Our case report will enlighten clinicians regarding the possibility of malignancy whenever such atypical presentation is encountered.
Chemo-Immunotherapy, a Combination Approach for the Treatment of HER2-Positive Breast Cancer in a Mouse Model
Authors: Serhan Cenk , Doğan KILIÇ Kubilay , Yiğit UYANIKGİL , İsmail KARABOZ , Ayşe NALBANTSOY 
Published: February 2024

Abstract
The discovery of tumor-associated antigens has been a major milestone for cancer therapy as the current conventional therapies (radiotherapy, chemotherapy) were found to be insufficient in terms of cancer treatment. Human epidermal growth factor receptor (HER2) is a tumor-associated antigen, aberrantly found in various cancers, including breast cancer. Today, most of the treatment strategies are skewed towards combination therapies rather than monotherapies, they were found to be ineffective mostly because of patients' resistance mechanisms. A combination of more than one therapeutic approach (passive/active immunotherapy, conventional therapies) was found to be more effective in the clinic.
Here, in this study, various vaccine combinations were investigated against the 4T1-HER2 xenograft model of Balb/c mice. Eight different groups of vaccine formulations were tested to find the best synergistic combination including combinations of BM-DC-based vaccine, Peptide-based vaccine, anti-PD-L1, Doxorubicin, and QS-21 adjuvant. Triple combination groups of immunotherapies exerted better activities in terms of tumor dimensions as Doxorubicin+BM-DC-HER2/Neu+QS-21+anti-PD-L1 and Doxorubicin+ HER2/Neu+QS-21+anti-PD-L1 groups significantly decreased tumor dimensions. Similar groups also demonstrated a better stimulation of lymphocytes and IFNγ cytokine in the flow cytometry study, inducing a HER2/Neu specific antibody response in ELISA studies. Doxorubicin+BM-DC-HER2/Neu+QS-21+anti-PD-L1 combination demonstrated significantly higher specific cytotoxicity in lactate dehydrogenase data, as well as the CD4+ and CD8+ responses in the immunohistochemical study.
In conclusion, these data indicated that the Doxotubicin+BM-DC+HER2/Neu+QS-21+anti-PD-L1 vaccine combination synergistically generated a promising activity in terms of tumor dimension and immune response stimulation against HER2 overexpressing breast cancer model in mice.
The effects of exercise on anxiety symptoms in women with gestational diabetes mellitus
Authors: TAOUSANI ELEFTHERIA , Savvaki Dimitra , Grammatikopoulou Maria G , Mintziori Gesthimani , Theodoridou Anatoli , Koukou Zoi , Goulis Dimitrios G 
Published: February 2024

Abstract

Purpose
Anxiety is a common mental health issue during pregnancy. Moreover, women with Gestational Diabetes Mellitus (GDM), seem to cope with higher levels of anxiety, being at a higher risk for several health and mental complications. Regular physical exercise in women with GDM is suggested to improve metabolic and reproductive outcomes. However, there are no specific guidelines for exercise in women with GDM. The aim of this study was to investigate the effect of exercise on anxiety symptoms in pregnant women with GDM.
Methods
The present non-randomized, open-label clinical trial aimed to investigate the effect of physical exercise on anxiety symptoms in women with GDM. Forty-three women were assigned to three study groups: (a) Advice (n = 17), Walking (n = 14) and Mixed Exercise (n = 12), from GDM diagnosis to delivery.
Results
According to Beck Anxiety Inventory (BAI) scores, all groups showed normal anxiety changes or mild anxiety levels pre- and post-intervention (pre-intervention range: 2.98–17.95, post-intervention range: 4.2–17.6), but none experienced severe anxiety.
Conclusion
In the present study, a trend of self-selected pace walking to reduce the BAI scores was detected as the Walking groups had lower scores after the intervention, however this trend did not reach statistical significance. Brisk walking (30–45 min) three times per week may create positive changes in both the treatment plan and the anxiety state of women with GDM. Moreover, the study confirms that routine medical care, counseling and support by an interdisciplinary team are protective against anxiety in women with GDM.
Basal Cell Adenoma and Basal Cell Adenocarcinoma of the Parotid Gland: Clinical Findings and Surgical Outcomes in a Single-Institution Study
Authors: Park Chongsoo , Min Sally , Park Joseph Kyuhyung , Kim Jong-Ho 
Published: February 2024

Abstract

Background
Basal cell adenoma (BCA) is a rare benign tumor within the salivary glands. Basal cell adenocarcinoma (BCAC), the malignant counterpart of BCA, is also an exceedingly rare tumor with very limited clinical studies conducted. This study aims to investigate the clinical characteristics, demographics, and surgical outcomes of patients diagnosed with BCA and BCAC within the parotid gland.
Methods
A retrospective analysis from May 2003 to August 2023 was performed for all patients undergoing parotidectomy for masses. Retrospective data on gender, age, tumor characteristics, and outcomes were collected. Surgical approaches, including negative margin attainment, capsule removal, and histological diagnosis, were also detailed.
Results
The study included 1268 patients who underwent parotidectomy, resulting in 81 cases of BCA and 7 cases of BCAC. BCA patients, with a mean age of 55.1 years, showed diverse age distribution and predominantly presented in the 50s. In BCAC cases, seven female patients exhibited a predominant location in the deep lobes. FNA revealed BCAC in three out of seven cases, and subsequent parotidectomy was performed, resulting in no observed recurrences or metastases.
Conclusion
This study reports the largest number of BCA cases from a single institution and provides comprehensive insights into the demographics, tumor characteristics, and clinical outcomes of both BCA and BCAC. Although further research should be conducted, based on clinical follow-up results, appropriately including the capsule in the tumor excision indicates favorable outcomes, especially when the tumor size is not large.
Prevalence and Associated risk factors of malaria among under-five years Children in, Ilugalan District, Oromia Region, West Ethiopia, 2023
Authors: Kedida Lelisa Fikadu , Zenebe Mengistu Hailemariam , Lemma Solomon Asnake 
Published: February 2024

Abstract

Background
Globally 61% of under-five children were died due to malaria. Information on malaria prevalence and associated risk factors among under-five children in the Ilu Galan district is lacking.
Methods
A community-based cross-sectional study was conducted from April to June 2023. A multi-stage sampling technique was conducted to select households. A systematic random sampling technique was applied to enroll study participants. Malaria prevalence determined by thick and thin blood film microscopy and a rapid diagnostic test. A pre-tested structured questionnaire was used to collect socio-demographic and associated factors. Data entered into Epi data version 3.1 and exported to SPSS version 26 for analysis. Bivariate and multivariable logistic regression analyses were done to identify factors associated with malaria. Adjusted odds ratios (AOR) with a 95% confidence interval were used to determine the strength of association. P-value < 0.05 was considered statistically significant.
Results
The prevalence of malaria among under-five children was 5.2% (95% CI = 3.5–7.4). P. falciparum, P. vivax, and mixed infection accounted for 71.4%, 25%, and 3.6% respectively. Staying out door at night (AOR = 3.09;95% CI = 1.01–9.48),utilization of ITN (AOR = 0.26;95% CI = 0.07–0.94), presence of eave on the house (AOR = 4.08; 95% CI = 1.20-13.44),less than 1km distance of house hold from river(AOR = 4.32;95% CI = 1.19–15.62) and presence of stagnant water nearby house (AOR = 11.40; 95% CI = 3.71–35.02) were found to increase the odds of getting malaria.
Conclusion
knowing that malaria is still a prevalent health problem among children under five in the study area, the local government and other concerned bodies should focus on malaria prevention and control to minimize the burden.
Establishment of seven lung ultrasound phenotypes: a retrospective observational study
Authors: Wang Qian , Zou Tongjuan , Zeng Xueying , Bao Ting , Yin Wanhong 
Published: February 2024

Abstract
Background
Lung phenotypes have been extensively utilized to assess lung injury and guide precise treatment. However, current phenotypic evaluation methods rely on CT scans and other techniques. Although lung ultrasound (LUS) is widely employed in critically ill patients, there is a lack of comprehensive and systematic identification of LUS phenotypes based on clinical data and assessment of their clinical value.
Methods
Our study was based on a retrospective database. A total of 821 patients were included from September 2019 to October 2020. 1902 LUS examinations were performed in this period. Using a dataset of 55 LUS examinations focused on lung injuries, a group of experts developed an algorithm for classifying LUS phenotypes based on clinical practice, expert experience, and lecture review. This algorithm was subsequently validated and refined using images from an additional 140 LUS examinations. Finally, machine learning was used to apply the validated algorithm to 1902 LUS phenotypes. After sampling 30% of LUS phenotypes, experts substantiated the efficacy of the machine learning algorithm through meticulous manual verification. By utilizing K-means cluster analysis and expert selection of images from a total of 1902 LUS examinations, we established seven distinct LUS phenotypes. To further explore the diagnostic value of these phenotypes for clinical diagnosis, we investigated their auxiliary diagnostic capabilities.
Results
A total of 1902 LUS phenotypes were tested by randomly selecting 30% to verify the phenotypic accuracy. With the 1902 LUS phenotypes, seven lung ultrasound phenotypes were established through statistical K-means cluster analysis and expert screening. The acute respiratory distress syndrome (ARDS) exhibited gravity-dependent phenotypes, while the cardiogenic pulmonary edema exhibited nongravity phenotypes. The baseline characteristics of the 821 patients included age (66.14 ± 11.76), sex (560/321), heart rate (96.99 ± 23.75), mean arterial pressure (86.5 ± 13.57), Acute Physiology and Chronic Health Evaluation II( APACHE II )score (20.49 ± 8.60), and duration of ICU stay (24.50 ± 26.22); among the 821 patients, 78.8% were cured. In severe pneumonia patients, the gravity-dependent phenotype accounted for 42% of the cases, whereas the nongravity-dependent phenotype constituted 58%. These findings highlight the value of applying different LUS phenotypes in various diagnoses.
Conclusions
Seven sets of LUS phenotypes were established through machine learning analysis of retrospective data; these phenotypes could represent the typical characteristics of patients with different types of critical illness.