bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying households with children who have complex needs: a segmentation model for integrated care systems
Authors: Piroddi Roberta , Astbury Andrea , Baker Wesam , Daras Kostantinos , Rafferty Joe , Buchan Iain , Barr Benjamin 
Published: January 2025

Abstract

Background
Adversity in childhood is increasing in the United Kingdom. Complex health and social problems affecting children cluster in families where adults also have high need, but services are rarely aligned to support the whole family. Household level segmentation can help identify households most needing integrated support. Thus, the aim was to develop a segmentation model to identify those households with children who have high levels of complex cross-sectoral needs, to use as a case-finding tool for health and social care services, and to describe characteristics of identified households, to inform service integration.

Method
Working with stakeholders—in an English region of 2.7m population- we agreed a definition of families having complex needs which would benefit from service integration – including households with high intensity use, who had both physical and mental health problems amongst both adults and children and wider social risks. We then used individual and household linked data across multiple health and social care services to identify these households, providing an algorithm to be used in a case finding interface. Finally, to understand the needs of this segment, and to identify unmet need, to tailor support, we used descriptive statistics and Poisson regression to profile the segment and compare them with the rest of the population.

Results
Twenty one thousand and five hundreds twenty seven households (8% of the population of the region) were identified with complex needs, including 89,631 people (41,382 children), accounting for 34% of health and social care costs for families with children, £362 million in total, of which 42% was on children in care of local authorities. The households had contact with 3–4 different services, had high prevalence of mental health problems, most frequently co-morbid with respiratory problems, with high mental health emergency service use particularly amongst teenage girls many of whom had no prior elective treatment for conditions.

Conclusion
Our model provides a potentially useful tool for identifying households that could benefit from better integration of services and targeted family support that can help break intergenerational transfer of adversity.
Nationwide guideline implementation: a qualitative study of barriers and facilitators from the perspective of guideline organizations
Authors: Thoonsen Andrea C. , Gans Anika , Broeders Toby T. , van Beusekom Ilse , Delnoij Diana M. J. , de Bruijne Martine C. , Merten Hanneke 
Published: January 2025

Abstract

Background
Although the number of Dutch guidelines is growing, their uptake and impact in clinical practice lag behind. Dutch guideline organizations, including guideline developers, governmental agencies, health insurers and other national organizations, play a crucial role in developing, authorizing and/or supporting the use of guidelines. They influence end users' awareness, accessibility, understanding, acceptability and applicability of guidelines. In this study, we explored the barriers and facilitators that representatives of guideline organizations perceive in nationwide guideline implementation.

Methods
In this qualitative study, we conducted semi-structured interviews with 35 representatives of 24 different guideline organizations. We employed framework analysis, using the updated Consolidated Framework for Implementation Research (CFIR), and thematic analysis to guide our data analysis and synthesis.

Results
We found 45 different implementation barriers and 35 implementation facilitators. We identified seven overarching themes of interrelated barriers and facilitators that extended across the stakeholders involved and domains within the updated CFIR. These included 1) healthcare demand and resource availability, 2) implementation knowledge and expertise, 3) guideline characteristics: representation, evidence base and design, 4) partnerships and collaboration, 5) characteristics of guideline implementation planning, execution and evaluation strategies, 6) characteristics of healthcare professionals: need, capability, opportunity and motivation, and 7) legal and regulatory compliance.

Conclusions
We obtained valuable insights into the complex dynamics of barriers and facilitators perceived by guideline organizations in nationwide guideline implementation. Our findings help explain why healthcare professionals and healthcare facilities may (not), slowly or inconsistently adhere to guideline recommendations in practice. The identified barriers and facilitators provide guidance for policymakers to re-evaluate and improve nationwide quality and guideline implementation policies, to eventually improve clinical practice and health outcomes for patients.
Does diabetes modify the triglyceride–glucose index associated with cardiovascular events and mortality? A meta-analysis of 50 cohorts involving 7,239,790 participants
Authors: Zhang Jun , Zhan Qiye , Deng Zhihao , Lin Ling , Feng Zhaolan , He Huabin , Zhang Deju , Zhao Huilei , Gu Xiang , Yin Xiaoping , Yu Peng , Liu Xiao 
Published: January 2025

Abstract

Introduction
Previous studies highlighted the association between the triglyceride–glucose (TyG) index and cardiovascular events in patients with diabetes. However, whether diabetes affects TyG-cardiovascular diseases (CVD) is still unclear. This study aimed to evaluate the association between the TyG index and CVD risk, stratified by diabetes status, as well as the potential modifying effect of diabetic status.

Methods/design
The PubMed, Cochrane Library, and Embase databases were searched for studies on the associations between the TyG index and cardiovascular events and mortality in patients with and without diabetes from inception to December 2, 2024. The random effects model was employed to pool the effect sizes.

Results
A total of 50 cohort studies (7,239,790 participants) were included. The mean age of participants was 31.46 years (diabetes mellitus [DM]: 65.18; non-DM: 31.23), and 40.66% of participants were female (DM: 36.07%; non-DM: 40.70%). The associations between the TyG index and cardiovascular events (HR: 1.72 vs. 1.55, P = 0.55), major adverse cardiovascular and cerebrovascular events (HR: 2.02 vs. 1.91, P = 0.84), stroke (HR: 1.46 vs. 1.39, P = 0.77) and cardiovascular death (HR: 1.85 vs. 1.60, P = 0.56) were similar among DM and non-DM individuals. However, the associations between the TyG index and ischemic heart disease (IHD) (HR: 2.20 vs. 1.57, P = 0.03) as well as all-cause mortality (HR: 1.94 vs. 1.24, P = 0.01) were stronger in DM patients than in non-DM patients.

Conclusion
TyG index showed association with cardiovascular events, mortality, and all-cause mortality independent of diabetic status, with low to moderate certainty. The associations for IHD and all-cause death were stronger in diabetic patients than in individuals without diabetes. Future studies should explore the role of diabetes in the TyG index-associated CVD outcomes and mortality.

Graphical abstract
Impact of cariprazine on body weight and blood pressure among adults with bipolar I disorder, schizophrenia, or major depressive disorder in a real-world setting
Authors: Correll Christoph U. , Cutler Andrew J. , Laliberté François , Germain Guillaume , MacKnight Sean D. , Boudreau Julien , Wade Sally W. , Nabulsi Nadia , Nguyen Huy-Binh , Parikh Mousam 
Published: January 2025

Abstract

Background
Atypical antipsychotics are a common treatment for serious mental illness, but many are associated with adverse effects, including weight gain and cardiovascular issues, and real-world experience may differ from clinical trial data. Cariprazine has previously demonstrated a favorable safety and tolerability profile in clinical trials. Here, we evaluated the effects of cariprazine on body weight and blood pressure for bipolar I disorder (BP-I), schizophrenia, or as adjunctive treatment for major depressive disorder (MDD) using real-world data.

Methods
Symphony Health’s Integrated Dataverse® with electronic medical record access (3/1/2015–10/31/2018) was used to identify adults (≥ 18 years) diagnosed with BP-I depression, BP-I mania/mixed, schizophrenia, or MDD, with ≥ 2 cariprazine dispensings (first dispensing = index) and continuous clinical activity for ≥ 12 months pre-index (baseline) and ≥ 3 months post-index. The on-treatment period spanned from index to cariprazine discontinuation, exposure to another atypical or long-acting injectable antipsychotic, or end of clinical activity/data availability. Outcomes included estimated annual linear trajectories for weight, body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) during baseline and on treatment. Changes were estimated using linear mixed-effects models fitted over measurements pre-index and on treatment; 95% CIs were derived from nonparametric bootstrap procedures.

Results
The body weight analysis included 612 patients (BP-I, n = 331 [BP-I depression, n = 172; BP-I mania/mixed, n = 159]; schizophrenia, n = 75; MDD, n = 206). The mean patient age was 43.4 years, 75.2% were female, and the mean (SD) on-treatment period was 219 (185) days. Among patients with measurements before and during cariprazine treatment, estimated annual weight trajectories were + 3.55 (95% CI 2.38, 4.59) kg/year before cariprazine initiation and + 0.91 (− 1.17, 2.82) kg/year during cariprazine treatment. Additionally, annual linear trajectories evaluated across the on-treatment period were + 0.31 (− 0.42, 1.01) kg/m2/year for BMI, − 2.38 (− 4.27, − 0.76) mmHg/year for SBP, and − 0.57 (− 1.75, 0.61) mmHg/year for DBP.

Conclusion
In this real-world analysis, cariprazine was associated with an estimated weight gain of + 0.91 kg/year and had minimal impact on BMI and blood pressure when evaluated up to 12 months.
Feasibility and accuracy of continuous intraabdominal pressure monitoring with a capsular device in human pilot trial
Authors: Liao Chien-Hung , Spain David A. , Chen Chih-Chi , Cheng Chi-Tung , Lin Wei-Cheng , Ho Dong-Ru , Lin Heng-Fu , Catena Fausto 
Published: January 2025

Abstract

Background
Intrabdominal pressure (IAP) is an important parameter. Elevated IAP can reduce visceral perfusion, lead to intraabdominal hypertension, and result in life-threatening abdominal compartment syndrome. While ingestible capsular devices have been used for various abdominal diagnoses, their application in continuous IAP monitoring remains unproven.

Method
We conducted a prospective clinical trial to evaluate the feasibility of IAP measurement using a digital capsule PressureDOT, an ingestible capsule equipped with wireless transmission capability and a pressure sensor, then compared its reliability with conventional intravesical method. Patients undergoing laparoscopic or robotic surgeries were recruited. During surgery, we created pneumoperitoneum by inflating CO2 into the peritoneal cavity and IAP was simultaneously monitored using both the ingestible capsules and intravesical measurements from Foley catheter. We assessed the feasibility of signal transmission and the accuracy of pressure measurements.

Results
Six patients were enrolled in this pilot study. No adverse events were reported, and the average first-intake time was within 24 h. All capsules were successfully expelled, with an average excretion time of 81 h. In the summarized data, the mean IAPdot is 0.6 mmHg lower than the IAPivp, with a standard deviation of 1.68 mmHg. However, capsule measurements showed excellent correlation with intravesical IAP measurements, with an intraclass correlation coefficient of 0.916 (95% CI: 0.8821–0.9320).

Conclusion
Our study demonstrates the feasibility and safety of using digital capsules for continuous IAP monitoring, providing the agreement between IAP measurements from digital capsules and conventional intravesical measurement within a near-normal pressure.
A strategy for selective screening of dual-target bioactive compounds against hypertrophic scar through inhibiting angiotensin II type 1 receptor while stimulating type 2 receptor from Chinese herbs
Authors: Qu Lejing , Jiao Meizhi , Zhang Zilong , Ou Yuanyuan , Zhao Xue , Zhang Yajun , Zhao Xinfeng 
Published: January 2025

Abstract

Background
Cutaneous hypertrophic scar is a fibro-proliferative hard-curing disease. Recent studies have proved that antagonists of angiotensin II type 1 receptor (AT1R) and agonists of type 2 receptor (AT2R) were able to relieve hypertrophic scar. Therefore, establishing new methods to pursue dual-target lead compounds from Chinese herbs is in much demand for treating scar.

Methods
To this end, we immobilized AT1R or AT2R onto the surface of silica gel from cell lysates through a specific covalent bond by bioorthogonal chemistry. The columns containing immobilized AT1R or AT2R were jointly utilized to pursue potential bioactive compounds simultaneously binding to AT1R and AT2R from the extract of Rhei Radix et Rhizoma. Their functions on AT1R and AT2R expressions were investigated by in vitro and in vivo experiments.

Results
Aloe-emodin and emodin were identified as the potential bioactive compounds binding to both of the two receptors, thereby improving the appearance and pathomorphology of hypertrophic scar. They blocked the AT1R pathway to down-regulate the expression of transforming growth factor-β1 (TGF-β1) and stimulate matrix metalloproteinase-1 (MMP-1) expression. As such, the expression of collagen I/III reduced. Conversely, the bindings of the two compounds to AT2R reduced the production of nuclear factor-кB1 (NF-кB1), whereby the generation of interleukin-6 (IL-6) was blocked.

Conclusion
We reasoned that aloe-emodin and emodin had the potential to become dual-target candidates against hypertrophic scar through the regulation of AT1R and AT2R signaling pathways. It showed considerable potential to become a universal strategy for pursuing multi-target bioactive compounds from Chinese herbs by the utilization of diverse immobilized receptors in a desired order.
The association of chronotype, sleep duration and trajectories of health-risk behaviors among college students: a cohort study
Authors: Che Wanyu , Wang Chenfang , Tao Shuman , Li Tingting , Xie Yang , Tao Fangbiao , Wu Xiaoyan 
Published: January 2025

Abstract

Purpose
To describe the trajectories of health-risk behaviors (HRBs) among college students through four consecutive surveys and explore the relationship between chronotype, sleep duration and different trajectories of HRBs.

Methods
We used a data sample of 1,042 college students from the College Student Behavior and Health Cohort Study. Students reported sleep parameters, including chronotype (Morningness-Eveningness Questionnaire-5, MEQ-5) and sleep duration. The behavior scale was used to evaluate four HRBs (smoking, alcohol use, low physical activity, smartphone addiction). The latent class growth analysis (LCGA) was used to estimate the trajectory of self-reported HRBs. Multivariate logistic regression models were used to study whether sleep parameters (chronotype and sleep duration) correlated with HRBs’ trajectories.

Results
Four unique trajectories of behaviors were identified: unhealthy group (7.4%), increasing group (21.3%), decreasing group (10.3%) and healthy group (61.0%). Compared with the normal sleep, results from logistic regression analyses indicated that long sleep (> 9 h) was associated with the decreasing group and the unhealthy group (P < 0.05), while short sleep (< 7 h) was associated with the increasing group and the unhealthy group (P < 0.05). Compared with the M-type, the E-type were positively correlated with the unhealthy group, the increasing group, and the decreasing group (P < 0.05).

Conclusion
E-type, short sleep duration and long sleep duration were significantly associated with the trajectory of HRBs. Findings underscore the need for targeted screening and prevention of modifiable sleep behaviors with the aim of improving HRBs in college students.
Single-cell transcriptomics identify a novel macrophage population associated with bone invasion in pituitary neuroendocrine tumors
Authors: Wu Xinzhi , Han Xueshuai , Zhu Haibo , Li Mingxuan , Gong Lei , Jing Sicheng , Xie Weiyan , Liu Zhaoqi , Li Chuzhong , Zhang Yazhuo 
Published: January 2025

Abstract

Background
Bone-invasive Pituitary Neuroendocrine Tumors (BI PitNETs) epitomize an aggressive subtype of pituitary tumors characterized by bone invasion, culminating in extensive skull base bone destruction and fragmentation. This infiltration poses a significant surgical risk due to potential damage to vital nerves and arteries. However, the mechanisms underlying bone invasion caused by PitNETs remain elusive, and effective interventions for PitNET-induced bone invasion are lacking in clinical practice.

Methods
In this study, we performed single-cell (n = 87,287) RNA sequencing on 10 cases of bone-invasive PitNETs and 5 cases of non-bone-invasion PitNETs (Non-BI PitNETs). We identified various cell types and determined their interactions through cell-cell communication analysis, which was further validated experimentally.

Results
We identified a novel TNF-α+ TAM macrophage subset. BI PitNETs showed increased IL-34 secretion, impacting TNF-α+ TAMs via the IL34/CSF1R axis, leading to TNF-α production. TNF-α+ TAMs, in turn, communicate with CD14
+ monocytes to promote their differentiation into osteoclasts and leading to bone invasion. In addition, we defined a gene signature for TNF-α+ TAM to guide the clinical prognosis prediction of BI PitNETs.

Conclusions
Our study elucidates the tumor microenvironment changes in bone invasion and identifies the critical role of TNF-α+ TAMs in promoting bone invasion of PitNETs, laying a foundation for developing new molecular markers or therapeutic agents targeting BI PitNETs.
A new method for detecting mixed Mycobacterium tuberculosis infection and reconstructing constituent strains provides insights into transmission
Authors: Sobkowiak Benjamin , Cudahy Patrick , Chitwood Melanie H. , Clark Taane G. , Colijn Caroline , Grandjean Louis , Walter Katharine S. , Crudu Valeriu , Cohen Ted 
Published: January 2025

Abstract

Background
Mixed infection with multiple strains of the same pathogen in a single host can present clinical and analytical challenges. Whole genome sequence (WGS) data can identify signals of multiple strains in samples, though the precision of previous methods can be improved. Here, we present MixInfect2, a new tool to accurately detect mixed samples from Mycobacterium tuberculosis short-read WGS data. We then evaluate three approaches for reconstructing the underlying mixed constituent strain sequences. This allows these samples to be included in downstream analysis to gain insights into the epidemiology and transmission of mixed infections.

Methods
We employed a Gaussian mixture model to cluster allele frequencies at mixed sites (hSNPs) in each sample to identify signals of multiple strains. Building upon our previous tool, MixInfect, we increased the accuracy of classifying in vitro mixed samples through multiple improvements to the bioinformatic pipeline. Major and minor proportion constituent strains were reconstructed using three approaches and assessed by comparing the estimated sequence to the known constituent strain sequence. Lastly, mixed infections in a real-world Mycobacterium tuberculosis population from Moldova were detected with MixInfect2 and clusters of recent transmission that included major and minor constituent strains were built.

Results
All 36/36 in vitro mixed and 12/12 non-mixed samples were correctly classified with MixInfect2, and major strain proportions were estimated with high accuracy (within 3% of the true strain proportion), outperforming previous tools. Reconstructed major strain sequences closely matched the true constituent sequence by taking the allele at the highest frequency at hSNPs, while the best-performing approach to reconstruct the minor proportion strain sequence was identifying the closest non-mixed isolate in the same population, though no approach was effective when the minor strain proportion was at 5%. Finally, fewer mixed infections were identified in Moldova than previous estimates (6.6% vs 17.4%) and we found multiple instances where the constituent strains of mixed samples were present in transmission clusters.

Conclusions
MixInfect2 accurately detects samples with evidence of mixed infection from short-read WGS data and provides an excellent estimate of the mixture proportions. While there are limitations in reconstructing the constituent strain sequences of mixed samples, we present recommendations for the best approach to include these isolates in further analyses.
Relationship between humeral head translation, spur formations, and the locations of tendon tears in massive rotator cuff tears
Authors: Yoshida Yuki , Yoshida Atsushi 
Published: January 2025

Abstract

Objective
This study aimed to clarify the relationship between the directions of humeral head translation, the presence of acromial or coracoid spurs, and the locations of tendon tears in massive rotator cuff tears. Thirty shoulders from thirty patients with massive rotator cuff tears who underwent reverse shoulder arthroplasty were included. Preoperative 3DCT classified humeral head translation into three groups: minimal type, posterosuperior type, and anterosuperior type. The presence of acromial or coracoid spurs was also assessed. Preoperative MRI and intraoperative findings determined the torn tendons in each rotator cuff, along with ruptures of the anterior fascia covering the subscapularis or the long head of the biceps tendon (LHB). Relationships between humeral head translations, spur formations, and tendon tear locations were analyzed using chi-square tests and adjusted standardized residuals.

Results
Acromial spurs were more frequent in the posterosuperior type, while coracoid spurs, subscapularis tears, anterior fascia ruptures, and LHB ruptures were significantly associated with the anterosuperior type. Anterior fascia ruptures were significantly less frequent in the minimal type. Anterosuperior humeral head translation and coracoid spurs indicate subscapularis tears, anterior fascia ruptures, and LHB ruptures.
Secondary Immunodeficiency
Authors: Pourshahnazari Persia , Betschel Stephen D. , Kim Vy. H. D. , Waserman Susan , Zhu Rongbo , Kim Harold 
Published: January 2025

Abstract
The field of medicine is constantly changing and, as healthcare providers, we are fortunate to be practicing in a time when patients are living longer and novel therapeutic options continue to evolve. However, these new advances may be associated with adverse effects that practitioners need to be aware of. Some of these impair the immune system leading to secondary immunodeficiencies (SID) that increase host susceptibility to infections and other complications. The causes and consequences of these SID are extremely broad, and a detailed review is beyond the scope of this article. The goal of this primer is to provide a general overview and understanding of common conditions and therapies leading to SID, as well as a guide to the assessment and management of patients with SID.