bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation and Effectiveness of Self-Assessment Scale on Active Learning and Critical Thinking (SSACT) using Flipped Classroom and Journal Club Techniques
Authors: Ahmad Maryam , Mumtaz Sadaf , Mumtaz Rafia , Rizwan Fatima , Nawaz Zerlis , Malik Nasir Javed 
Published: September 2023

Abstract
Background:
Rapid changes in medical education have led to the inclusion of different teaching strategies in the curriculum. Journal clubs and flipped classrooms are innovative techniques that are used worldwide. We have combined these techniques to assess their impact on critical thinking and active learning among dental students using SSACT questionnaire. This is a rigorous step for inculcating evidence-based medicine skills in early years of medical education.
Methods:
A quasi-experimental study was conducted at Dental College HITEC-IMS using convenience sampling. The SSACT questionnaire was validated through a pilot study. Students prepared and delivered PowerPoint presentations on the assigned topic. Instructors evaluated the presentations using judgment criteria from Texas Undergraduate Studies.
Results:
This study included 46 students (86% female, 14% male) with a mean age of 19 years. The reliability and internal consistency of the tool, as measured by Cronbach's alpha, was found to be 0.8. Paired sample t-test showed a mean value of 0.68 ± 0.4. The p value was highly significant (0.00). A significant majority (n = 41, 89%) showed a positive attitude towards setting their own learning objectives. An increase in the utilization of multiple learning strategies for independent learning, and reflecting on the learning process was seen at 93% (n = 43) and 98% (n = 45) respectively. Students reported enhancement in team-based performance (n = 44, 78%), demonstrated improvements in communication of ideas, application of previous knowledge from independent study, and linking of previous and new knowledge 93% (n = 43). The implementation of scenario-based questions has been found to significantly increase critical thinking skills among a majority of students (n = 40, 87%).
Conclusion:
Our results show that implementation of journal clubs and flip classrooms in a combined fashion has led to overall enhancement of critical thinking and active learning and SSACT questionnaire is a valid tool for self-assessment of students in our population.
Orthodontic Management of a developing Dentigerous Cyst related to lower second molar: A Case Report
Authors: El-Beialy Amr , BinRahima AbdulMonem Moftah , Shhab Mohammed Al , Mostafa Yehya 
Published: September 2023

Abstract
The dentigerous cyst is a developmental odontogenic asymptomatic cyst, that is associated with the crown of an unerupted or impacted tooth. Early diagnosis is important to avoid any related complications and elect the best treatment option. The purpose of this case report is to describe the management of a dentigerous cyst related to lower second molar in a young female patient using orthodontic traction as a conservative treatment plan. This procedure helps to spare the patient an unnecessary surgical excision procedure with the accompanied bone removal with safety margin, stimulates bone healing and promotes the eruption of the cyst-associated tooth.
Exposure to phthalates and their alternatives in relation to biomarkers of inflammation and oxidative stress in adults: Evidence from NHANES 2017-2018
Authors: Jin Shihao , Cui Shanshan , Mu Xiaoyu , Liu Zhao , Han Yu , Cui Tingkai , Xiong Wenjuan , Xi Wei , Zhang Xin 
Published: September 2023

Abstract
Phthalates and their alternatives are considered significant environmental risk factors that potentially influence inflammation and oxidative stress. However, their impact on biomarkers of inflammation and oxidative stress was inconsistent. This study aimed to explore the associations between phthalates and high-sensitivity C-reactive protein (hsCRP), gamma-glutamyl transferase (GGT), and white blood cell (WBC) counts, employing both univariate exposure and multivariate co-exposure models. For this analysis, a total of 1619 individuals aged 18 years and above, sourced from the National Health and Nutrition Examination Survey (NHANES) conducted between 2017 and 2018, were selected as subjects. We explored the associations between hsCRP, GGT, and WBC counts and eighteen different phthalate metabolites. Multiple linear regression analysis revealed significant associations between hsCRP and two specific metabolites: MCNP (β = 0.060, P = 0.034) and MEHP (β = -0.054, P = 0.049). We observed negative correlations of MCOP, MCPP, MHBP, and MONP with GGT (β = -0.036, P = 0.027; β = -0.045, P = 0.019; β = -0.046, P = 0.023; β = -0.053, P = 0.001, respectively). Conversely, MEHHP and MEHTP exhibited positive correlations with GGT (β = 0.048, P = 0.011; β = 0.029, P = 0.009). Furthermore, MECPTP and MEHTP showed positive correlations with WBC (β = 0.011, P = 0.026; β = 0.017, P = 0.001). Notably, we identified a non-linear relationship between phthalates and inflammation and oxidative stress markers. The Bayesian kernel machine regression (BKMR) analysis demonstrated a negative joint effect of the phthalates mixture on GGT, particularly at lower concentrations. The BKMR model also found that MEOHP and MHiBP were negatively associated with GGT. In contrast, MEHHP showed a significant positive association with GGT. Moderating effect analysis suggested that increased dietary inflammatory index (DII), income-to-poverty ratio (PIR), age, BMI, and less physical activity strengthened the association between phthalates and inflammation and oxidative stress. These findings contribute to a deeper understanding of the relationships between phthalates and inflammation and oxidative stress.
Clinical characteristics and perinatal outcomes of twin pregnancies with severe preeclampsia conceived by assisted reproductive technology: A retrospective study
Authors: Xing Yuan , Ling Zhonghui , Ji Xiaohong , Li Li , Wu Lili , Chen Min , Wang Yixiao 
Published: September 2023

Abstract
Objective: To investigate the clinical characteristics and perinatal outcomes of twin pregnancies complicated by severe preeclampsia (sPE) conceived by assisted reproductive technology (ART).
Methods: We retrospectively analyzed 306 pregnant women with twin pregnancies complicated by sPE from January 2016 to December 2022, including 212 cases conceived by ART (ART group) and 94 cases conceived naturally (natural conception group). Student's t test, chi-square, continuity correction and Fisher's exact test were used to analyze clinical characteristics, clinical medications and perinatal outcomes.
Results: (1) The proportion of primiparas and advanced-age primiparas in the ART group was higher than that in the natural conception group, and the proportion of scarred uteri was lower than that in the natural conception group (P < 0.05). (2) The results showed that the percentage of women in the ART group who received dexamethasone injection was higher than that in the natural conceptiongroup (P < 0.05). (3) The incidence of preterm labor (especially late preterm labor), placental adhesions, and PPH was significantly higher in the ART group than in the natural conception group (P < 0.001). (4) We obtained 601 live births (including 420 in the ART group and 181 in the natural conception group). The birth weight of newborns in the ART group was lower than that of the natural conception group, whereas the rate of NICU hospitalization and the number of days of hospitalization were higher than those of the natural conception group (P < 0.05).
Conclusion: Twin pregnancies complicated by sPE conceived via ART lead to severe adverse maternal and infant outcomes. Risk prediction management should be the main focus, with early identification of high-risk populations, such as primiparas (especially advanced-age primiparas), and proactive medical interventions, especially preventive strategies, could be taken to reduce the incidence of sPE in twin pregnancies conceived via ARTand to maximize the improvement of pregnancy outcomes in such populations.
Predictors and outcomes of recurrent retroperitoneal liposarcoma: new insights into its recurrence patterns
Authors: Deng Huan , Gao Jingwang , Xu Xingming , Liu Guibin , Song Liqiang , Pan Yisheng , Wei Bo 
Published: September 2023

Abstract
Background
The clinical profiles of recurrent retroperitoneal liposarcoma (RLS) need to be explored. The recurrence patterns of RLS are controversial and ambiguous.
Methods
A total of 138 patients with recurrent RLS were finally recruited in the study. The analysis of overall survival (OS) and recurrence-free survival (RFS) was performed by Kaplan‒Meier analysis. The nomogram model was built to predict the survival status of patients. Univariate and multivariate analysis were performed for the selection of independent prognostic factors that were correlated with OS or RFS.
Results
Among patients, the 1-, 3-, and 5-year OS rates were 70.7%, 35.9% and 30.9%, respectively. The 1-, 3- and 5-year RFS rates of the 55 patients who underwent R0 resection were 76.1%, 50.8% and 34.4%, respectively. The multivariate analysis revealed that resection method, tumor size, status of pathological differentiation, pathological subtypes and recurrence pattern were independent risk factors for OS or RFS. Patients with distant recurrence (DR) pattern usually had multifocal tumors (90.5% vs. 74.7%, P < 0.05); they were prone to experience changes of pathological differentiation (69.9% vs. 33.3%, P < 0.05) and had a better prognosis than those with local recurrence (LR) pattern. R0 resection and combined organ resection favored the survival of patients with DR pattern in some cases.
Conclusions
Patients with DR pattern had a better prognosis, and they may benefit more from aggressive combined resection than those with LR. Classifying the recurrence patterns of RLS provides guidance for individualized clinical management of recurrent RLS.
The first prospective registry-based cohort study focused on type 2 diabetes mellitus patients from high-altitude regions: The HLA-DR study protocol
Authors: Zhang Chenghui , Chen Rui , Wang Suyuan , Du Rong , Li Qiuyue , Guo Yanhong , Sun Shuyao , He Hua , Yin Weijing , Zhang Dan , Wang Xi , Li Mingxia , Zou Kun , Zhao Li , Wu Yunhong 
Published: September 2023

Abstract
Background: Diabetes is the leading cause of disease burden in many countries, owing to its microvascular and macrovascular complications. Tibetans who have lived on Qinghai-Tibet Plateau for thousands of years have genetically adapted to their hypoxic high-altitude environment through positive natural selection for a hyporesponsive hypoxia-inducible factor (HIF) pathway. Highlanders have lower prevalence of type 2 diabetes mellitus (T2DM). However, whether high altitude affects diabetic complications is unclear. The Highlander diabetes registry study (HLA-DR) will investigate whether high altitude and the unique positive selection for the HIF pathway among Tibetans influence diabetes-related complications in patients with T2DM.
Methods: The HLA-DR is a longitudinal, hospital-based cohort study. A total of 3,840 patients (including indigenous Tibetans and Han Chinese) will be enrolled and followed up over 5 years, to assess diabetes-related vascular complications. Baseline medical data, laboratory test results, imageological examination, and blood samples will be collected. The primary endpoints of HLA-DR will be major adverse cardiovascular events, defined as a composite of nonfatal myocardial infarction, nonfatal stroke, and death from cardiovascular causes, and a composite of microvascular complications. Patients will be followed up every 3 months by telephone and at the hospital every 1–2 years.
Discussion: This study will fill an important gap in our understanding of the contribution of long-term high-altitude exposure to diabetes and its complications and will promote the optimization of medical care and disease management in residents of higher altitudes.
Trial Registration: Clinicaltrials.gov: ChiCTR2000040956
The interaction between type 2 diabetes and chronic kidney disease worsens the outcomes of patients with COVID-19: a retrospective study
Authors: Wu Dong , Huang Bangxiao , Long Bingyu , Chen Yujuan , Liao Jinyu , Liu Gege , Huang Qiu , Chen Min , Li Dongming , Gan Yajiao , Hu Juan , Wu Bin , Huang Dan , Zhao Xuanna 
Published: September 2023

Abstract
Background
Type 2 diabetes and chronic kidney disease (CKD) have been reported to be associated with COVID-19, but the effect of an interaction between the two on the outcomes of COVID-19 has not been defined. Therefore, we aimed to investigate the effect of their interaction on COVID-19 outcomes.
Methods
The data of this retrospective study was from the multicenter study with COVID-19, type 2 diabetes, CKD and confounding factors information. Multivariate logistic regression model and subgroup analyses of different worse outcomes were conducted to assess the relationship between type 2 diabetes and CKD on worse outcomes in patients with COVID-19. Relative excess risk due to interaction (RERI), attributable proportion of interaction (AP) and synergy index (S) were utilized to assess the additive interaction.
Results
We found that patients with COVID-19 alongside type 2 diabetes or CKD were more likely to experience poor outcomes. Moreover, there was a significant interaction between type 2 diabetes and CKD regarding the risk of a poor outcome [RERI 20.134 (95% confidence interval (CI) 12.256–60.093), AP 0.742 (95% CI 0.538–0.945), SI 4.353 (95% CI 1.843–10.277)]. A subgroup analysis of the various adverse outcomes showed that the combination had a synergistic effect on in-hospital mortality.
Conclusions
Thus, type 2 diabetes and CKD increase the risk of a poor outcome in patients with COVID-19, and they interact synergistically to induce worse outcomes, especially in-hospital mortality.
Fractal Chiral Organic Molecular Cages
Authors: Wang Zhen , Zhang Qing-Pu , Guo Fei , Ma Hui , Liang Zi-Hui , Yi Changhai , Zhang Chun , Chen Chuan-Feng 
Published: September 2023

Abstract
Mimicking the intricate hierarchical superstructures of biological macromolecules in organisms, evolving organic molecular cages (OMCs) into higher-level chiral OMC with fractal superstructures presents an extremely challenging task. Herein, we utilized 2D tri-bladed propeller shaped triphenylbenzene (TPB) as building blocks to synthesize a racemic 3D tri-bladed propeller shaped helical molecular cage (TMC) that can be furthermore used as building blocks to construct a pair of higher-level 3D tri-bladed chiral helical molecular cages 4P-HTMC and 4M-HTMC with multilayer sandwich structures, and display elegant fractal characteristics with self-similarity in a discrete superstructure at different levels. During the evolutionary procession of the higher-level cages HTMC, the intramolecular self-shielding effect and exclusive chiral narcissistic self-sorting behaviors were observed. Moreover, the enantiomers 4P-HTMC and 4M-HTMC can be interconverted by introducing an excess of corresponding chiral cyclohexanediamine (CHDA). In solid state, 4P-HTMC and 4M-HTMC can also self-assemble into supermolecule architectures of L-helical or D-helical nanofibers. Therefore, the scale transformation of chiral characteristics from chiral atoms (chiral carbon atoms in CHDA) to microscopic (trihelical in advanced cages) and then to mesoscopic (spiral of nanofibers) has been realized.
Cadherin-based adhesion regulates mechanical polarization in the actin cortex through Rac1
Authors: Lin Hao , Moazzeni Seyedsajad , Kyker-Snowman Kelly , Cohen Rick , Wang Huan , Li Ran , Shreiber David , Zahn Jeffrey , Shi Zheng 
Published: September 2023

Abstract
Tension-adhesion interplay is a crucial mechanism in multicellular organisms that determines the tension differential among internal and external interfaces, which in turn, mediates tissue surface tension and cell sorting, morphogenesis and remodeling, and cancer progression. Cadherins are widely believed to be involved, yet key aspects of the process are neither well characterized nor quantified. This study demonstrates the critical role of N-cadherin in driving mechanical polarization throughout the actin cortical network. N-cadherin regulates both tension increase at the cell-medium (external) interface and decrease at the cell-cell (internal) interface, and their quantitative magnitudes, both absolute and relative, strongly depend on the surface density of N-cadherin. Furthermore, the strength of polarization also increases with respect to the number of cell-cell interfaces for cells within a multicellular cluster. The cadherin-actin contractility linkage is mediated by Rac1, which serves as a molecular switch to trigger cortex remodeling and contraction via myosin II. Inhibition of Rac1 activity decreases polarization and leads to reduced coherence in both small clusters and spheroids. These results provide a pathway to reconcile opposing theories for tissue surface tension generation and perspectives in cancer treatment.
3D amplified single-cell RNA and protein imaging identifies oncogenic transcript subtypes in B cell acute lymphoblastic leukemia
Authors: Choi Sungyoung , Shin Suyeon , Kim Yoon-Jin , Chung Haerim , Cho Hyunsoo , Yun Hyo Geun 
Published: September 2023

Abstract
Simultaneous in situ detection of transcript and protein markers at single-cell level is essential for gaining a better understanding of tumor heterogeneity and for predicting and monitoring treatment responses. However, the limited accessibility to advanced 3D imaging techniques has hindered its rapid implementation. Here, we present a 3D single-cell imaging technique, termed 3D digital rolling circle amplification (4DRCA), capable of the multiplexed and amplified simultaneous digital quantification of single-cell RNAs and proteins using standard fluorescence microscopy and off-the-shelf reagents. We generated spatially and spectrally distinguishable DNA amplicons from molecular markers through an integrative protocol combining single-cell RNA and protein assays, and directly enumerated the amplicons by leveraging an open-source algorithm for 3D deconvolution with a custom-built automatic gating algorithm. With 4DRCA, we were able to simultaneously quantify surface protein markers and cytokine transcripts in T lymphocytes. We also show that 4DRCA can distinguish BCR-ABL1 fusion transcript positive B-cell acute lymphoblastic leukemia cells with or without CD19 protein expression. The accessibility and extensibility of 4DRCA render it broadly applicable to other cell-based diagnostic workflows, enabling sensitive and accurate single-cell RNA and protein profiling.
On the use of NASGRO software to estimate fatigue life under constant and variable amplitude loadings in aluminum alloy SAE-AMS 7475-T7351
Authors: Neto Raimundo Amorim , Chemin Aline Emanuele Albuquerque , Filho Waldek Wladimir Bose , Ruchert Cassius Terra 
Published: September 2023

Abstract
This paper uses several fatigue life prediction models implemented in the NASGRO program in order to predict the behavior of cracks on constant amplitude and variable amplitude loads. The experimental data consist of an aeronautical aluminum alloy SAE-AMS 7475-T7351. In the cases of constant loading amplitude (CAL) C(T) compact test specimens were used and M(T) type specimens were used in variable load amplitude casings (VAL). With respect to the constant amplitude data the fatigue growth rates and consequently the parameters of the Paris equation and the KIC values were obtained with the simulations. In this way the obtained values were satisfactory having good correlations. Regarding VAL the calibration parameters for each of the interaction models were obtained for each of the charge spectrum which for this work were TWIST and FALLSTAFF spectrums and their mini versions. The NASGRO 4.0 program presented overall good forecasting results.
Short-term outcomes of intraocular inflammation after brolucizumab injection in Japanese patients with neovascular age-related macular degeneration
Authors: Hirono Kazushi , Ikeda Shoko , Maruyama-Inoue Maiko , Inoue Tatsuya , Yanagi Yasuo , Kadonosono Kazuaki 
Published: September 2023

Abstract

PurposeThis study investigates the short-term outcomes of neovascular age-related macular degeneration (nAMD) patients who developed intraocular inflammation (IOI) after intravitreal brolucizumab injection (IVBr).MethodsWe studied 285 eyes of 279 cases diagnosed with nAMD and focused on 18 eyes of 17 cases (6.3%) which developed IOI after IVBr. IVBr was performed either on the initial treatment or for switching of other anti-vascular endothelial growth factor agents during January 2020 to December 2021. We evaluated clinical features and the course of treatment of a 6-month follow-up after IOI occurred.ResultsThe average age was 76 years old. Of 17 cases, 9 cases were male, 8 cases were female. Baseline log MAR visual acuity (VA) was 0.36, VA before IOI occurred was 0.30, and VA when IOI occurred was 0.43. 16 eyes had symptoms such as visual loss or floaters when IOI occurred. On the other hand, the remaining 2 eyes had no symptoms. 11 eyes had only IOI, while the remaining 7 eyes had IOI and perivascular sheathing. Steroid sub-tenon injection was performed on 1 eye, steroid eye drops were used in 11 eyes, and 6 eyes were followed-up without treatment. nAMD recurred in 16 eyes after IOI occurred and were treated with aflibercept. VA at 3 and 6 months after IOI occurred were significantly improved to 0.34 and 0.30, respectively (P = 0.09 at 3 months and P = 0.02 at 6 months). The symptoms of patients were improved in all cases. We were able to stop steroid treatment in all cases.ConclusionsIOI occurred in 6.3% of nAMD patients after IVBr treatment. All of which showed improvement with steroid treatment or without any treatment. We should consider the possibility of IOI after IVBr as a complication, however, they have a relatively good prognosis if treated at an early stage.
Prognosis of TACE combined with sorafenib in hepatocellular carcinoma patients with microvascular invasion: A retrospective cohort study
Authors: Zhang Qi , Zhou ongyuan , Zhou Yanzhao , Cui Yunlong , Song Tianqiang , liu Shuaijing , Li Qiang 
Published: September 2023

Abstract
Purpose
Transcatheter arterial chemoembolization (TACE) and sorafenib each has shown therapeutic effects in patients with hepatocellular carcinoma (HCC) and microvascular invasion (MVI). The present study evaluated the feasibility of postoperative TACE combined with sorafenib in HCC patients with MVI and assessed the optimal indications for postoperative TACE treatment.
Patients and methods:
The present study included 217 HCC patients who underwent radical resection from April 2017 to April 2020 and whose postoperative pathological report showed MVI. Patients were treated with TACE, TACE plus sorafenib, of neither (control group). The primary endpoints were overall survival (OS) and disease-free survival (DFS).
Results
Patients treated with TACE plus sorafenib had higher 1-year (96.4% vs. 84.9%) and 2-year (91.6% vs. 68.9%) OS rates than patients treated with TACE alone. Median OS was significantly longer in patients treated with TACE plus sorafenib (44.6 months; 95% confidence interval [CI ] 40.81–48.4 months) than with TACE alone (39 months; 95% CI 30.2–48.3 months; (p = 0.025). Cox proportional hazard model showed that factors associated with a higher risk of death after treatment included maximum tumor diameter of tumor (hazard ratio [HR] = 6.783, p = 0.012), number of TACE sessions (HR = 0.284, p = 0.01) and liver cirrhosis (HR = 6.446, p = 0.002).
Conclusion
Compared with TACE alone, TACE plus sorafenib significantly prolonged OS in patients with HCC and MVI. Factors associated with improved prognosis included maximum tumor diameter < 7 cm and more than three TACE sessions.