bluuebunny/crossref_metadata_2025_split huggingface dataset:
Co-axial electrospinning of PLLA shell, collagen core nanofibers for skin tissue engineering
Authors: Baran Erkan T , Tahmasebifar Aydin , Yilmaz Bengi 
Published: March 2023

The main functions of wound dressing biomaterials are to promote a moist environment in the wound while protecting the area from mechanical injury and microbial contamination. Furthermore, the scaffold used for skin tissue engineering must mimic epidermal and dermal layers as well as support the growth of keratinocytes and fibroblasts. In this study, PLLA (shell) and EGF-encapsulated collagen (core) nanofibers were produced by coaxial electrospinning at 25 kV potential, 12 cm collector distance, and 0.125 mL/h flow rate of PLLA (15%) and collagen (4%). The bilayer structure was produced by gelling GeIMA in between two nanofiber membranes to imitate the epidermal and dermal layers of skin. Cytocompatibility properties of nanofiber membrane and bilayer structure were characterized by mono- and coculture of keratinocytes (HaCaT) and fibroblasts (3T3), respectively. TEM revealed that the PLLA shell and collagen core thicknesses were about 60 and 115 nm, respectively. Oxygen and water vapor could pass through the GeIMA- integrated bilayer nanofiber membranes. The presence of EGF in nanofibers could increase cell proliferation. Fluorescence and SEM imaging showed that HaCaT and 3T3 could cover the membrane after 14 days of monoculture. Cocultures showed a reduction in the proliferation of cells in the first week and a recovery during the second and third weeks. In a mechanical bioreactor, cocultured bilayer membranes formed interlocked polygonal keratinocyte cells. These results showed that the bilayer nanofiber membrane and GeIMA combination provided cell compatibility. Furthermore, the use of a mechanical reactor was found to be effective in the formation of a functional keratinocyte layer by stimulating cells.
Hypogammaglobulinemia after front-line immunochemotherapy in patients with follicular lymphoma
Authors: Díaz Acedo Rocío , Artacho Criado Silvia , Ríos Herranz Eduardo , Gutiérrez Pizarraya Antonio , Sánchez Romero Irene , Márquez Saavedra Esther 
Published: March 2023

Introduction Hypogammaglobulinemia after front-line immunochemotherapy for follicular lymphoma is a poorly studied adverse event that could be related to the appearance of severe and/or recurrent non-neutropenic infections which could affect the quality of life of the patients, even motivating a need of long-term replacement therapy with human immunoglobulins. Methods Observational, retrospective study aiming to estimate the incidence of hypogammaglobulinemia, as well as its severity and clinical consequences, and to explore possible predictive factors for its development. Specific immunoglobulin deficiencies were also studied. Results 76.5% of patients had hypogammaglobulinemia during or after front-line treatment, mostly grade 1-2; with 38.8% patients who developed clinically relevant infections and 20% patients requiring human immunoglobulins replacement therapy. A high-risk FLIPI score was identified as a risk factor for hypogammaglobulinemia (ods ratio: 4.51; 95% confidence interval: 1.29–15.68; p < 0.001) and basal gamma globulin level as a protective factor (odds ratio: 0.92; 95% confidence interval: 0.988–0.996; p  =  0.018). Any type of immunochemotherapy regimen was associated with different risks of hypogammaglobulinemia in our study. Conclusions Hypogammaglobulinemia appears in a high percentage of patients with follicular lymphoma in a real-world population, identifying a high-risk FLIPI score as a risk factor for its development and basal gamma globulins as a protective factor.
Malnutrition: A risk factor for vascular access problems
Authors: Badak Tolga Onur , Ada Sibel 
Published: March 2023

Background: Vascular access problems are leading causes of morbidity, hospitalization, and impaired quality of life in chronic hemodialysis patients. Native arteriovenous fistula is the gold standard of vascular access. Geriatric nutritional risk index (GNRI), has recently been shown to be an easy and objective instrument for assessing nutritional status in these patient groups. Considering the association between arteria-venous fistula patency and inflammation, as well as the fact that inflammation is a component of malnutrition, the objective of this study was to determine the relation of malnutrition identified by GNRI with fistula patency. Methods: This is a single-center, retrospective, observational study. Hemodialysis patients with AVF were included in the research. Preoperative and postoperative GNRI values were computed and laboratory data were recorded. The patients were analyzed in two groups as the ones without thrombosis history (Group 1) and with thrombosis history (Group 2). According to GNRI, patients were investigated in four groups: G0 (non-risk group, >98), G1 (low risk, 92–98), G2 (moderate risk, 82–91), and G3 (high risk, 82). Results: Of the 331 patients, 60.1% (199) were male and the average age was 55 ± 15 years. Preoperative GNRI levels were significantly higher in group 1. In correlation analysis, patency time was positively correlated with preoperative GNRI values. Among the preoperative GNRI groups, the G3 group had a patency duration of 6 months (4.9–7.04), whereas the G0 group had a patency length of 37.59 (35.5–39.65) months. By linear regression analysis, preoperative GNRI and postoperative albumin level were determined to be the significant indicators of patency time. Conclusion: GNRI a new tool for detecting malnutrition was strongly associated with fistula patency in hemodialysis patients. Detection of malnutrition before fistula operation may be helpful for the future follow up of the patients in terms of fistula patency.
Early prediction of 30- and 14-day all-cause unplanned readmissions
Authors: Lin Chaohsin , Pan Li-Fei , He Zuo-Quan , Hsu Shuofen 
Published: March 2023

Background An unplanned readmission is a dual metric for both the cost and quality of medical care. Methods We employed the random forest (RF) method to build a prediction model using a large dataset from patients’ electronic health records (EHRs) from a medical center in Taiwan. The discrimination abilities between the RF and regression-based models were compared using the areas under the ROC curves (AUROC). Results When compared with standardized risk prediction tools, the RF constructed using data readily available at admission had a marginally yet significantly better ability to identify high-risk readmissions within 30 and 14 days without compromising sensitivity and specificity. The most important predictor for 30-day readmissions was directly related to the representing factors of index hospitalization, whereas for 14-day readmissions the most important predictor was associated with a higher chronic illness burden. Conclusions Identifying dominant risk factors based on index admission and different readmission time intervals is crucial for healthcare planning.
Middle meningeal artery embolization as a perioperative adjunct to surgical evacuation of nonacute subdural hematomas: An multicenter analysis of safety and efficacy
Authors: Salah Walid K. , Baker Cordell , Scoville Jonathan P. , Hunsaker Joshua C. , Ogilvy Christopher S. , Moore Justin M. , Riina Howard A. , Levy Elad I. , Spiotta Alejandro M. , Jankowitz Brian T. , Michael Cawley C. , Khalessi Alexander A. , Tanweer Omar , Hanel Ricardo , Gross Bradley A. , Kuybu Okkes , Hoang Alex Nguyen , Baig Ammad A. , Khorasanizadeh Mir Hojjat , Mendez Aldo A. , Cortez Gustavo , Davies Jason M. , Narayanan Sandra , Howard Brian M. , Lang Michael J. , Siddiqui Adnan H. , Thomas Ajith , Kan Peter , Burkhardt Jan-Karl , Salem Mohamed M. , Grandhi Ramesh 
Published: March 2023

Background By 2030, nonacute subdural hematomas (NASHs) will likely be the most common cranial neurosurgery pathology. Treatment with surgical evacuation may be necessary, but the recurrence rate after surgery is as high as 30%. Minimally invasive middle meningeal artery embolization (MMAE) during the perioperative period has been posited as an adjunctive treatment to decrease the potential for recurrence after surgical evacuation. We evaluated the safety and efficacy of concurrent MMAE in a multi-institutional cohort. Methods Data from 145 patients (median age 73 years) with NASH who underwent surgical evacuation and MMAE in the perioperative period were retrospectively collected from 15 institutions. The primary outcome was the rate of recurrence requiring repeat surgical intervention. We collected clinical, treatment, and radiographic data at initial presentation, after evacuation, and at 90-day follow-up. Outcomes data were also collected. Results Preoperatively, the median hematoma width was 18 mm, and subdural membranes were present on imaging in 87.3% of patients. At 90-day follow-up, median NASH width was 6 mm, and 51.4% of patients had at least a 50% decrease of NASH size on imaging. Eight percent of treated NASHs had recurrence that required additional surgical intervention. Of patients with a modified Rankin Scale score at last follow-up, 87.2% had the same or improved mRS score. The total all-cause mortality was 6.0%. Conclusion This study provides evidence from a multi-institutional cohort that performing MMAE in the perioperative period as an adjunct to surgical evacuation is a safe and effective means to reduce recurrence in patients with NASHs.
Risk of hemorrhagic transformation with early use of direct oral anticoagulants after acute ischemic stroke: A pooled analysis of prospective studies and randomized trials
Authors: Alrohimi Anas , Rose David Z , Burgin W Scott , Renati Swetha , Hilker Nicholas Corbin , Deng Wei , Oliveira Guilherme H , Beckie Theresa M , Labovitz Arthur J , Fradley Michael G , Tran Nhi , Gioia Laura C , Kate Mahesh , Ng Kelvin , Dowlatshahi Dar , Field Thalia S , Coutts Shelagh B , Siddiqui Muzzafar , Hill Michael D , Miller Jodi , Jickling Glen , Shuaib Ashfaq , Buck Brian , Sharma Mike , Butcher Ken S 
Published: March 2023

Introduction: Precise risk of hemorrhagic transformation (HT) in acute ischemic stroke (AIS) remains unknown, leading to delays in anticoagulation initiation for secondary stroke prevention. We sought to assess the rate of HT associated with direct oral anticoagulant (DOAC) initiation within and beyond 48 h post-AIS. Methods: A pooled analysis of DOAC initiation within 14 days of AIS or transient ischemic attack (TIA) was conducted with six studies (four prospective open label treatment, blinded outcome studies and two randomized trials; NCT02295826 and NCT02283294). The primary endpoint was incident radiographic HT on follow-up imaging (days 7–30). Secondary endpoints included symptomatic HT, new parenchymal hemorrhage, recurrent ischemic events, extracranial hemorrhage, study period mortality, and follow-up modified Rankin Scale score. The results were reported as odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI). Results: We evaluated 509 patients; median infarct volume was 1.5 (0.1–7.8) ml, and median National Institutes of Health Stroke Scale was 2 (0–3). Incident radiographic HT was seen on follow-up scan in 34 (6.8%) patients. DOAC initiation within 48 h from index event was not associated with incident HT (adjusted OR 0.67, [0.30–1.50] P = 0.32). No patients developed symptomatic HT. Conversely, 31 (6.1%) patients developed recurrent ischemic events, 64% of which occurred within 14 days. Initiating a DOAC within 48 h of onset was associated with similar recurrent ischemic event rates compared with those in which treatment was delayed (HR: 0.42, [0.17–1.008] P = 0.052). In contrast to HT, recurrent ischemic events were associated with poor functional outcomes (OR = 6.8, [2.84–16.24], p < 0.001). Conclusions: In this pooled analysis, initiation of DOAC within 48 h post-stroke was not associated with increased incident risk of HT, and none developed symptomatic HT. The analysis was underpowered to determine the effect of early DOAC use upon recurrent ischemic events.
Time-frequency Feature Extraction Method of the Multi-Source Shock Signal Based on Improved VMD and Bilateral Adaptive Laplace Wavelet
Authors: Zhao Nanyang , Zhang Jinjie , Mao Zhiwei , Jiang Zhinong , Li He 
Published: March 2023

AbstractVibration signals have the characteristics of multi-source strong shock coupling and strong noise interference owing to the complex structure of reciprocating machinery. Therefore, it is difficult to extract, analyze, and diagnose mechanical fault features. To accurately extract sensitive features from the strong noise interference and unsteady monitoring signals of reciprocating machinery, a study on the time-frequency feature extraction method of multi-source shock signals is conducted. Combining the characteristics of reciprocating mechanical vibration signals, a targeted optimization method considering the variational modal decomposition (VMD) mode number and second penalty factor is proposed, which completed the adaptive decomposition of coupled signals. Aiming at the bilateral asymmetric attenuation characteristics of reciprocating mechanical shock signals, a new bilateral adaptive Laplace wavelet (BALW) is established. A search strategy for wavelet local parameters of multi-shock signals is proposed using the harmony search (HS) method. A multi-source shock simulation signal is established, and actual data on the valve fault are obtained through diesel engine fault experiments. The fault recognition rate of the intake and exhaust valve clearance is above 90% and the extraction accuracy of the shock start position is improved by 10°.
Improving family health climate, effect of role modeling and maternal support in female students
Authors: Ostovarfar Jeyran , Kaveh Mohammad Hossein , Vardanjani Hossein Molavi , Ghahramani Leila , Karimi Masoud , Asadollahi Abdolrahim , Zare Razie 
Published: March 2023

Abstract
Introduction
Girls can use their mother’s emotional, informational and behavioral support to perform healthy behaviors due to their constant access to their mothers. This study aimed to evaluate the effect of role modeling and maternal support in the family to improve healthy behaviors and perceived Family Health Climate (FHC) in female students.

Methods
In this educational quasi-experimental study, 261 female students (133 in the intervention group and 128 in the control group) and 223 mothers (109 intervention and 114 control) were selected using the cluster multi-stages sampling method and entered the study. Participants (intervention and control groups) completed the FHC scale at three stages (before intervention, immediately after the intervention, and 2 months after intervention). A training program that comprised 12 sessions for students and six sessions for their mothers using collaborative learning techniques and printed materials was conducted with the experimental group. Also after completing the questionnaire in the follow-up phase, pamphlets and educational videos were given to the control group. Data were analyzed using SPSS20 via a chi-square test, independent t-test, and Repeated Measures ANOVA at a significance level of 0.05.

Results
Before the intervention, there was no significant difference between demographic variables and the score of the FHC scale in both groups (p < 0.05). Immediately and 2 months after the intervention, the experimental group (female students and their mothers) showed a significant increase in dimensions of FHC, including FHC-NU (Family Health Climate-Nutrition) and FHC-PA (Family Health Climate-Physical Activity), compared to the control group (p < 0.05).

Conclusions
Educating and informing mothers about the impact of their role modeling on their children, especially girls, can make them more aware of health-oriented behaviors towards their children. Such findings reinforced the importance of focusing on actions to encourage a healthy lifestyle (healthy diet and physical activity) in students with a focus on role modeling and parental support, especially mothers.
The voice of healthcare: introducing digital decision support systems into clinical practice - a qualitative study
Authors: Frisinger Ann , Papachristou Panagiotis 
Published: March 2023

Abstract
Background
There is a need to accelerate digital transformation in healthcare to meet increasing needs and demands. The accuracy of medical digital diagnosis tools is improving. The introduction of new technology in healthcare can however be challenging and it is unclear how it should be done to reach desired results. The aim of this study was to explore perceptions and experiences of introducing new Information Technology (IT) in a primary healthcare organisation, exemplified with a Clinical Decision Support System (CDSS) for malignant melanoma.

Methods
A qualitative interview-based study was performed in Region Stockholm, Sweden, with fifteen medical doctors representing three different organisational levels – primary care physician, primary healthcare centre manager, and regional manager/chief medical officer. In addition, one software provider was included. Interview data were analysed according to content analysis.

Results
One central theme “Introduction of digital CDSS in primary healthcare requires a multidimensional perspective and handling” along with seven main categories and thirty-three subcategories emerged from the analysis. Digital transformation showed to be key for current healthcare providers to stay relevant and competitive. However, healthcare represents a closed community, very capable but with lack of time, fostered to be sceptical to new why change needs to bring true value and be inspired by people with medical background to motivate the powerful frontline.

Conclusions
This qualitative study revealed structured information of what goes wrong and right and what needs to be considered when driving digital change in primary care organisations. The task shows to be complex and the importance of listening to the voice of healthcare is valuable for understanding the conditions that need to be fulfilled when adopting new technology into a healthcare organization. By considering the findings of this study upcoming digital transformations can improve their success-rate. The information may also be used in developing a holistic approach or framework model, adapted to primary health care, that can support and accelerate the needed digitalization in healthcare as such.
Preoperative CA19-9 and GGT ratio as a prognostic indicator in ampullary carcinoma
Authors: Chen Rui-Qiu , Zhang Zhi-Lei , Jia Yu-Ming , Chen Rui-Xiang , Peng Li 
Published: March 2023

Abstract
Background and aims
In recent years, more and more inflammatory indicators have been studied to predict the long-term survival of patients with ampullary carcinoma (AC) after radical resection, but these prognostic indicators are still controversial. Therefore, based on previous inflammation scores, this study established a novel, easily accessible, more feasible and more predictive prognostic marker [Carbohydrate antigen199 to gamma-glutamyltransferase ratio (CA19-9/GGT)] to better assess the prognostic significance in AC patients undergoing radical resection.

Methods
Overall survival (OS) and recurrence-free survival (RFS) were analyzed by Cox regression model. Correlation between CA19-9/GGT and clinicopathological variables were analyzed by Chi-squared test, Fisher ' s exact test, independent sample t test and Mann–Whitney U test. The performance of prognostic indexes is compared by the consistency index (C-index). The prediction accuracy of nomogram is further confirmed by calibration curve and decision curve analysis (DCA).

Results
CA19-9/GGT was an independent risk factor affecting OS [P = 0.001, hazard ratio (HR) 2.459, 95% confidence intervals (CI) 1.450–4.167] and RFS (P = 0.002, HR 2.333, 95% CI 1.371–3.971) in multivariate analysis. The optimal cut-off value of CA19-9/GGT was 0.14. In CA19-9/GGT correlation analysis, high risk group (> 0.14) was significantly associated with poor prognosis. The predictive performance of CA19-9/GGT (OS: C-index = 0.753, RFS: C-index = 0.745) was confirmed to be superior to other prognostic indicators according to the C-index. Compared with the simple AJCC staging system, the Nomogram prediction model (OS: C-index = 0.787, RFS: C-index = 0.795) established by the combination of CA19-9/GGT and AJCC 8th TNM staging system has higher prediction accuracy.

Conclusions
CA19-9/GGT was an independent prognostic indicator after radical resection of AC. Incorporating CA19-9/GGT into the AJCC TNM staging system optimized the prediction accuracy of the TNM staging system, and further verified the predictive value of CA19-9/GGT.
Live birth in woman with premature ovarian insufficiency and 46, XY karyotype after chemotherapy and bone marrow transplant: a case report
Authors: Zhang Yaojia , Wang Haiyan , Pan Xiaoqin 
Published: March 2023

Abstract
Background
Premature ovarian insufficiency (POI) is a clinical syndrome defined by loss of ovarian function before the age of 40 years, characterized by elevated serum gonadotropin levels and decreased estrogen levels with menstrual disturbance. POI can be natural or iatrogenic such as after chemotherapy, radiotherapy and surgery.

Case presentation
In this study, we describe a successful live birth in a 31-year-old woman with POI and 46, XY Karyotype after being treated with chemotherapy and bone marrow transplant (BMT) for acute non-lymphocytic leukemia when she was 17 years old. With amenorrhea or oligomenorrhea for 11 years, her serum level of FSH was up to 35.0 IU/L and 53.0 IU/L taken 4 weeks apart, which can be diagnosed as POI. After controlled ovarian stimulation treatment for three cycles with different protocols and frozen-thawed embryo transfer (FET), she finally got a successful pregnancy and had a live birth later.

Conclusions
This case report serves as a reminder that karyotype of peripheral blood may mislead the diagnosis as disorders of sex development (DSD). It also demonstrates that it is possible for a woman with chemotherapy and bone marrow transplant induced POI can have successful pregnancy and live birth with appropriate therapy. Furthermore, as age may plays a predominant role in fertility rather than residual ovarian reserve, active treatment may be concerned for women with POI at younger age.