bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physicochemical, antioxidant and microbial properties of sweetened yoghurt produced from partial substitution of sugar with soursop puree
Authors: Sanusi Mayowa Saheed , Sunmonu Musliu Olushola , Alaka Abdulquadri , Raji Akeem Olayemi , Abdulazeez Ahmed , Joshua Victoria Auhoiza , Adeyemi Ikimot Adejoke 
Published: March 2023

Abstract
This study was targeted towards evaluating the outcome of partially substituting sugar with soursop puree at different proportions, varying pasteurization temperatures, storage durations and with the application of sodium benzoate and potassium sorbate as chemical preservatives on physiochemical, antioxidant and microbial qualities of yoghurt. There was a strong correlation (R2 = 0.7, Adjusted R2 = 0.65) between the syneresis and the water-holding capacity of the yoghurt as the substitution increased. At 50% soursop puree substitution in the yoghurt production, DPPH radical scavenging activity, total phenolic content, vitamin C, carbohydrate, protein, and ash contents increased to 34.40%, 1.25 mg GAE/L, 58.50 mg/100 g, 29.26, 4.02 and 0.69%, respectively. Storage duration does not have a significant influence on the proximate composition of the yoghurt samples. However, the vitamin C content of the yoghurt decreased when the pasteurization temperature was more than 80 °C. The growth of lactic acid bacteria ranged between 2.9 × 105 and 2.16 × 106 CFU/ml. The use of sodium benzoate inhibited yeast growth more than potassium sorbate while soursop substitution inhibited the growth of mould from 1.0 × 106 CFU/ml to 3.05 × 105 CFU/ml than the preservatives. Coliform was absent in all the yoghurt samples with or without preservatives. This information would be valuable in yoghurt development and quality control.

Graphical Abstract
349 ZYX is a Novel Candidate Gene in Moyamoya Pathogenesis
Authors: Barak Tanyeri , Yalcin Kanat , Miyagishima Danielle F. , Gunel Murat 
Published: March 2023

INTRODUCTION:
Moyamoya disease (MMD) is characterized by progressive bilateral stenosis in the proximal branches of the internal carotid arteries with compensatory angiogenesis. It is common in Japanese population; accounting for one fifth of pediatric stroke cases associated with arteriopathies. Although the etiology remains largely unknown, genetic factors have been implicated in the pathophysiology of MMD.

METHODS:
We performed gene-based mutational burden analysis using WES results of 23 MMD patients and a control cohort of 8380 Japanese individuals obtained from jMorp (8.3 kjpn). We performed a case-control analysis by comparing the enrichment of rare (Japanese minor allele frequency <2.5e-4) and deleterious variants including loss of function (LoF) variants (stop gain, start loss, frameshift, splice acceptor and splice donor) and missense variants annotated as “deleterious” in MetaSVM (D-Mis).

RESULTS:
We identified ZYX gene, encoding a focal adhesion molecule Zyxin, top significantly enriched gene in MMD cohort (two tailed Fisher's P = 1.52E-5; OR 77.55 [95% CI 13.91–291.69]), with three individuals were found to carry a heterozygous LoF and two missense mutations in ZYX gene. ZYX expression was found above 96th percentile for an ‘arterial-enrichment ratio’ calculated using GtEX portal, suggesting its critical role in vascular cell types.

CONCLUSIONS:
In this study, we identified ZYX as a novel candidate gene in Moyamoya pathogenesis. Zyxin is a known focal adhesion molecule involved in mechanosensation in the vasculature, while its implication in MMD has not been previously reported.
867 Postoperative Metformin is Associated With Improved Survival of Glioblastoma Patients
Authors: Mohammad Amro , Jatana Sukhdeep , Al-Saadi Tariq , Shenouda George , Diaz Roberto 
Published: March 2023

INTRODUCTION:
Metformin may improve clinical outcomes for glioblastoma (GBM) patients as metformin showed in vitro tumor suppressor functions, such as reducing the proliferation of GBM tumor-initiating cells by reversing Akt kinase activation.

METHODS:
A single-centre retrospective study of 288 patients who underwent biopsy or surgery for GBM between 2014-2018 was conducted. Postoperative metformin treatment includes patients who received metformin as part of an adjuvant therapy with temozolomide and/or hyper-fractionated radiotherapy. Kaplan-Meier curves and log-rank p test were used for univariate analysis. Cox-proportional hazards model was used to generate adjusted hazard ratios with 95% CI for multivariate analysis.

RESULTS:
Metformin use impacted OS of patients with MGMT-methylated (MGMTm+) tumors (n = 71 no metformin (Met-), n = 35 metformin use (Met +); median OS = 442 vs. 662 days; p = 0.13) but not in patients with unmethylated MGMT tumors (n = 104 Met-, n = 44 Met+; median OS = 279 vs 295 days; p = 0.674). Postoperative metformin treatment of MGMTm+ tumor patients improved OS when compared to no or only preoperative metformin treatment (n = 66 no or preoperative metformin use, n = 40 postoperative metformin use; median OS = 443 vs 595; p = 0.012). Further, postoperative metformin treatment of nondiabetic patients with MGMTm+ tumors improved OS (n = 70 Met-, n = 18 postoperative Met+; median OS = 422 vs 582; p = 0.017). A multivariable model considering age, Karnofsky Performance Status (KPS), and extent of resection (EOR), demonstrated that postoperative metformin improves OS of MGMTm+ patients (aHR 0.500, 0.287-0.872, p = 0.015). Comparing postoperative with no or preoperative use of metformin produced a similar effect on OS (aHR 0.411, 0.177-0.954, p = 0.038). Postoperative treatment of nondiabetic patients with MGMTm+ tumors demonstrated improved OS (aHR 0.367, 0.156-0.864, p = 0.022).

CONCLUSIONS:
Postoperative metformin treatment of patients with MGMTm+ tumors is associated with improved OS, irrespective of age, diabetic status, KPS, or EOR.
Data-Driven Surgical Tray Optimization to Improve Operating Room Efficiency
Authors: Deshpande Vinayak , Mundru Nishanth , Rath Sandeep , Knowles Martyn , Rowe David , Wood Benjamin C. 
Published: March 2023

Improving Operating Room Efficiency After each surgery in a hospital, every reusable instrument that has entered the operating room must be sterilized before it can be used again. Hospitals spend several million dollars a year on this sterilization process, instrument tray assembly, and instrument repurchase costs. However, 70%–80% of instruments that enter the operating room are not used at a large majority of hospitals resulting in wastage of millions of dollars. For a medium-sized hospital, approximately $4–$7 million are spent on the sterilization process. Across more than 5,000 hospitals in the United States, several billion dollars per year are wasted on unnecessary sterilization. Researchers at UNC Kenan-Flagler Business School, with partners from healthcare technology firm Operative Flow Technologies, have developed an algorithm that uses detailed data of instruments used to create optimized instrument tray configuration. The algorithm creates trays informed by historical usage of instruments to reduce unused instruments in trays significantly. This algorithm scales for hundreds of trays, thousands of instruments, and thousands of surgeries and can be applied to major healthcare systems. At one implementation, the number of unused instruments was reduced by 54%. Their solution has subsequently been implemented at multiple healthcare systems leading to several million dollars of cost savings for the hospitals.
Recognizing giant cell arteritis in dental practice
Authors: Shenoy Riddhi , French Kathryn , Eke Tom , Mukhtyar Chetan 
Published: March 2023

Giant cell arteritis (GCA) is a rare condition that causes inflammation of blood vessels. Early diagnosis and treatment is essential to prevent ischaemic complications, including blindness, tongue necrosis and stroke. GCA can present with orofacial symptoms, such as toothache and pain/difficulty in chewing, which may cause individuals with GCA to first present to the dentist. This has important patient safety and medicolegal implications. Dental practitioners should be alert to the possibility of GCA and should direct suspected cases to their general medical practitioner or a hospital specialist. Increased awareness of GCA should minimize the risk of blindness and stroke.CPD/Clinical Relevance: Early recognition and treatment of GCA is key to prevent complications, such as blindness, tongue necrosis and stroke.
Pica: recognizing the presentation in primary dental care
Authors: Atkinson James , Kavanagh Grace , McCracken Giles 
Published: March 2023

Pica is an eating disorder characterized by compulsive eating of non-food items. It can present to dentists through patient medical histories, and also through causing atypical patterns of non-carious tooth surface loss. In highlighting two cases of pica presenting in general practice, we aim to raise awareness of this condition and its dental implications. CPD/Clinical Relevance: This article advises on how pica may present to a general dentist and gives advice on management.
Trajectory play
Authors: Grimmer Tamsin 
Published: March 2023

Trajectory play is one of the earliest forms of schematic play that we can observe in babies. In this month's article, Tamsin Grimmer explores the benefits of trajectory play and shares practical advice on supporting it in your setting. Trajectory – children are fascinated with movement including moving themselves or moving objects (e.g. throwing, kicking, running). Repeated behaviours include dropping items or food from cots, high-chairs etc. Playing with running water from the tap, building and knocking down towers, climbing and jumping off furniture, throwing, bouncing or kicking balls.
Reliability of the retrospective Clinical Interview Schedule Revised (rCIS-R) to assess relapse in depression in primary care patients
Authors: Duffy Larisa , Marston Louise , Lewis Gemma , Lewis Glyn 
Published: March 2023

Objectives
We are not aware of a simple and short structured measure that retrospectively assesses time to relapse for depression. We developed the retrospective Clinical Interview Schedule Revised (rCIS-R) to assess depression relapse in the previous 12 weeks, for use in a clinical trial of maintenance antidepressant treatment. We assessed test-retest reliability and construct validity in relation to a Global Rating Question (GRQ) about worsening mood, participants stopping their study medication and Patient Health Questionnaire (PHQ‐9) scores.

Methods
In our study 444 participants provided data for rCIS-R, GRQ and PHQ-9 and 396 participants completed rCIS-R on two occasions about 30 minutes apart. The reliability study was nested within a randomised controlled trial (ANTLER).

Results
We found substantial test-retest agreement for the rCIS-R definition of relapse (kappa 0.84 (95%CI 0.71 to 0.97)), for individual sections and timing of relapse (Intraclass Correlation Coefficient 0.94 (95%CI 0.92 to 0.95)). Comparison of relapse with GRQ, stopping study medication and PHQ-9 supported the construct validity of the rCIS-R.

Conclusions
The rCIS-R provides a reliable way of assessing relapse of depression over the previous 12 weeks. Its brevity, self-report format, simplicity of scoring and absence of training requirement makes it attractive to use in randomised controlled trials.
Diuretic treatment before and after transcatheter aortic valve implantation: A Danish nationwide study
Authors: Begun Xenia , Butt Jawad Haider , Kristensen Søren Lund , Weeke Peter Ejvin , De Backer Ole , Schou Morten , Køber Lars , Loldrup Fosbøl Emil 
Published: March 2023

Objectives
We examined loop diuretic treatment before and 1-year after transcatheter aortic valve implantation (TAVI), as a proxy for changes in symptom severity and secondly assessed how changes in loop diuretics related to mortality risk.

Background
Randomized clinical trials suggest that approximately one third of patients undergoing TAVI do not achieve symptom relief, but “all-comer” data are lacking.

Methods
Using Danish nationwide registries, we identified all citizens, who underwent TAVI from 2008 to 2019 and were alive at 1-year post-discharge. Loop diuretic treatment pre-TAVI and at 1-year post-TAVI were assessed and grouped as receiving 1) no-loop diuretics; 2) low: 1–40 mg of furosemide (or equivalent bumetanide) daily; 3) intermediate: 41–120 mg of furosemide daily; or 4) high: >120 mg furosemide daily.

Results
Among the 4431 patients undergoing TAVI, 2173 (49%) patients were not treated with loop diuretics at the time of TAVI, 918 (21%) had low-loop diuretics, 881 (20%) had intermediate-loop diuretics, and 459 (10%) had high-loop diuretics. At 1-year post-TAVI, 893 (20%) patients had increased, 1010 (23%) had reduced, and 2528 (57%) had unchanged loop diuretic treatment. The cumulative 5-year risk of death in patients surviving one year, was 61% (95% CI: 56.4% to 65.3%) in patients with increased and 47% (95% CI: 44.9% to 49.9%) in patients with reduced/unchanged loop diuretic treatment, respectively. In multivariable Cox proportional hazard analysis, increased loop diuretic treatment was associated with a higher risk of death compared with reduced/unchanged loop diuretic treatment (Hazard ratio: 1.4; 95% CI: 1.22 to 1.52).

Conclusions
Among patients undergoing TAVI, surviving one year, one fifth of patients had increased loop diuretic treatment, and a little over one fifth had reduced loop diuretic treatment 1-year post-procedure. In patients with increased diuretic treatment, the risk of death was higher compared to those with reduced/unchanged loop diuretic treatment.
A new method for customized fetal growth reference percentiles
Authors: Grantz Katherine L. , Hinkle Stefanie N. , He Dian , Owen John , Skupski Daniel , Zhang Cuilin , Roy Anindya 
Published: March 2023

Background
Customized fetal growth charts assume birthweight at term to be normally distributed across the population with a constant coefficient of variation at earlier gestational ages. Thus, standard deviation used for computing percentiles (e.g., 10th, 90th) is assumed to be proportional to the customized mean, although this assumption has never been formally tested.

Methods
In a secondary analysis of NICHD Fetal Growth Studies-Singletons (12 U.S. sites, 2009–2013) using longitudinal sonographic biometric data (n = 2288 pregnancies), we investigated the assumptions of normality and constant coefficient of variation by examining behavior of the mean and standard deviation, computed following the Gardosi method. We then created a more flexible model that customizes both mean and standard deviation using heteroscedastic regression and calculated customized percentiles directly using quantile regression, with an application in a separate study of 102, 012 deliveries, 37–41 weeks.

Results
Analysis of term optimal birthweight challenged assumptions of proportionality and that values were normally distributed: at different mean birthweight values, standard deviation did not change linearly with mean birthweight and the percentile computed with the normality assumption deviated from empirical percentiles. Composite neonatal morbidity and mortality rates in relation to birthweight < 10th were higher for heteroscedastic and quantile models (10.3% and 10.0%, respectively) than the Gardosi model (7.2%), although prediction performance was similar among all three (c-statistic 0.52–0.53).

Conclusions
Our findings question normality and constant coefficient of variation assumptions of the Gardosi customization method. A heteroscedastic model captures unstable variance in customization characteristics which may improve detection of abnormal growth percentiles.

Trial registration
ClinicalTrials.gov identifier: NCT00912132.
Correlates of self-reported and biomarker based adherence to daily oral HIV pre-exposure prophylaxis among a cohort of predominantly men who have sex with men in Nigeria
Authors: Adeyemi Olusegun A. , Nowak Rebecca G. , Marzinke Mark , Morgan Daniel , Sam-Agudu Nadia , Craddock Jaih , Zhan Min , Crowell Trevor A. , Baral Stefan , Ndembi Nicaise , Adebajo Sylvia , Charurat Manhattan E. ,   for the TRUST/RV368 Study Group
Published: March 2023

Introduction
HIV pre-exposure prophylaxis (PrEP) significantly reduces the risk of HIV acquisition. However, studies have demonstrated discordance between self-reported measures and biomedical benchmarks of PrEP adherence. We estimated the correlation between self-reported PrEP adherence and PrEP biomarkers and explored factors associated with adherence among men who have sex with men (MSM) in Nigeria.

Methods
TRUST-PrEP, an open-label, prospective study; conducted in Abuja between April 2018 and May 2019. MSM ≥ 18 years with substantial HIV risk were enrolled. Participants reported PrEP adherence in the last month using a 4-point scale from “poor” to “perfect” and serum samples for PrEP biomarkers were collected at months 3 and 9. Serum tenofovir concentration was measured by liquid chromatography-tandem mass spectrometry and considered protective for adherence if ≥ 4.2 ng/ml. Spearman’s rank correlation was used to estimate correlation between self-reported adherence and measured tenofovir levels. Generalized estimating equations with a logit link was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between self-reported adherence and laboratory-measured adherence.

Results
A total of 219 MSM with median age 23 (interquartile range 20–27) years had at least one PrEP biomarker assay. Only 66/219 (30%) had at least one record of protective tenofovir concentration. Correlation between tenofovir and self-reported adherence at 3 and 9 months were 0.1 and 0.02 respectively. Furthermore, 17/219 (8%,) and 49/219 (22%) had serum tenofovir of 4.2–35.4 ng/mL and ≥ 35.5 ng/mL, corresponding to at least 4 and 7 days’ PrEP use in a week, respectively. PrEP adherence was higher among participants introduced to PrEP in the clinics compared with communities (aOR: 8.35, 95%CI: [3.24, 21.5]) and those with same-sex practices family disclosure (aOR: 3.60 95% CI: [1.73, 7.51]).

Conclusion
Self-reported PrEP adherence poorly correlated with biomarkers. Facilitating clinic-based PrEP introduction and disclosure of same-sex practices to family among MSM may improve PrEP adherence.
Diffusion-weighted magnetic resonance sequence and CA125/CEA ratio can be used as add-on tools to ultrasound for the differentiation of ovarian from non-ovarian pelvic masses
Authors: Nunes Pereira Patrick , Françoise Derchain Sophie , Yoshida Adriana , Hoelz de Oliveira Barros Ricardo , Menezes Jales Rodrigo , Sarian Luís Otávio 
Published: March 2023

Objective
To provide a straightforward approach to the sequential use of ultrasound (US), magnetic resonance (MR) and serum biomarkers in order to differentiate the origin of pelvic masses, making the most efficient use of these diagnostic resources.

Study design
This is a cross-sectional study with 159 patients (133 with ovarian and 26 with non-ovarian tumors) who underwent surgery/biopsy for an adnexal mass. Preoperative CA125 and CEA serum measurements were obtained and a pelvic/abdominal ultrasound was performed. Preoperative pelvic MR studies were performed for all patients. Morphological and advanced MR sequences were obtained. Using a recursive partitioning algorithm to predict tumor origin, we devised a roadmap to determine the probability of non-ovarian origin using only statistically significant US, laboratory and MR parameters.

Results
Upfront US classification as ovarian versus non-ovarian and CA125/CEA ratio were significantly associated with non-ovarian tumors. Signal diffusion (absent/low versus high) was the only MR parameter significantly associated with non-ovarian tumors. When upfront US designated a tumor as being of ovarian origin, further MR signal diffusion and CA125/CEA ratio were corrected nearly all US errors: patients with MR signal diffusion low/absent and those with signal high but CA125/CEA ratio ≥25 had an extremely low chance (<1%) of being of non-ovarian origin. However, for women whose ovarian tumors were incorrectly rendered as non-ovarian by upfront US, neither MR nor CA125/CEA ratio were able to determine tumor origin precisely.

Conclusion
MR signal diffusion is an extremely useful MR parameter to help determine adnexal mass origin when US and laboratory findings are inconclusive.
Burnout among healthcare providers: Its prevalence and association with anxiety and depression during the COVID-19 pandemic in Macao, China
Authors: Zheng Yu , Tang Pou Kuan , Lin Guohua , Liu Jiayu , Hu Hao , Wu Anise Man Sze , Ung Carolina Oi Lam 
Published: March 2023

IntroductionBurnout in healthcare providers (HPs) might lead to negative consequences at personal, patient-care and healthcare system levels especially during the COVID-19 pandemic. This study aimed to investigate the prevalence of burnout and the contributing variables, and to explore how, from health workforce management perspective, HPs’ experiences related to carrying out COVID-19 duties would be associated with their burnout.MethodsA cross-sectional, open online survey, informed by physical and psychological attributes reportedly related to burnout, the Copenhagen Burnout Inventory (CBI) and the Hospital Anxiety and Depression Scale (HADS), was completed by HPs in Macau, China during October and December 2021. Factors associated with burnout were analysed using multiple logistic regressions.ResultsAmong the 498 valid responses, the participants included doctors (37.5%), nurses (27.1%), medical laboratory technologist (11.4%) and pharmacy professionals (10.8%), with the majority being female (66.1%), aged between 25-44years (66.0%), and participated in the COVID-19 duties (82.9%). High levels of burnout (personal (60.4%), work-related (50.6%) and client-related (31.5%)), anxiety (60.6%), and depression (63.4%) were identified. Anxiety and depression remained significantly and positively associated with all types of burnout after controlling for the strong effects of demographic and work factors (e.g. working in the public sector or hospital, or having COVID-19 duties). HPs participated in COVID-19 duties were more vulnerable to burnout than their counterparts and were mostly dissatisfied with the accessibility of psychological support at workplace (62.6%), workforce distribution for COVID-19 duties (50.0%), ability to rest and recover (46.2%), and remuneration (44.7%), all of which were associated with the occurrence of burnout.ConclusionsPersonal, professional and health management factors were found attributable to the burnout experienced by HPs during the COVID-19 pandemic, requiring actions from individual and organizational level. Longitudinal studies are needed to monitor the trend of burnout and to inform effective strategies of this occupational phenomenon.
Desarrollo de un método analítico por cromatografía iónica para la cuantificación de aniones en aguas residuales de origen minero
Authors: Cardona-Castaño Julio-Andrés , Rivera-Giraldo Juan-David , Chávez-Vallejo Fernando-Antonio 
Published: March 2023

El objetivo de este trabajo fue desarrollar un método por cromatografía iónica con detector de conductividad para la determinación simultánea de tiocianato en aguas residuales mineras y aniones como bromuro, cloruro, fluoruro, fosfato, nitrito, nitrato y sulfato. Como eluente se utilizó hidróxido de potasio (KOH) en un rango de concentraciones entre , flujos entre y corriente del supresor entre . Se determinó que la mejor separación de las especies estudiadas se logró con una concentración de KOH de en modo isocrático y un flujo de en una columna analítica AS20. Además, se determinó una serie de parámetros analíticos como sensibilidad, linealidad, precisión, exactitud y límites de detección y cuantificación que permiten la validación del método analítico. Se obtuvieron valores de desviación estándar relativa (RSD) menores al 20 % en cuanto a la precisión del método analítico, con recuperaciones mayores al 96 %. El método desarrollado es por lo tanto adecuado para la determinación de tiocianato y aniones en aguas residuales de origen minero.