bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between primary dysmenorrhoea on quality of life, mental health and academic performance among medical students in Indonesia: a cross-sectional study
Authors: Situmorang Herbert , Sutanto Reynardi Larope , Tjoa Kevin , Rivaldo Rivaldo 
Published: January 2025

ObjectivesTo investigate the association between primary dysmenorrhoea and quality of life, mental health and academic performance among medical students in Indonesia.DesignA cross-sectional study using an online survey was conducted among Indonesian medical students. Primary dysmenorrhoea occurrence and severity, as well as their associations with quality of life, mental health and academic performance, were assessed using validated questionnaires. The associations of dysmenorrhoea occurrence and severity were analysed alongside other potential independent variables, including age, region, stage of study and parental income. Statistical analyses included χ2tests, t-tests and multiple regression models to adjust for confounders (p<0.05).Setting and participantsIndonesia (June–July 2021: n=630 medical students).OutcomesThe primary outcomes were quality of life, mental health and academic performance, assessed as dependent variables. Quality of life was measured using the Quality of Life Scale, mental health was assessed through depression and stress scores from the Depression Anxiety Stress Scales-42; and academic performance was evaluated through concentration and activity disruption, absenteeism andcum laudegrade point average (GPA). The independent variables were primary dysmenorrhoea occurrence and severity, categorised as mild or moderate-to-severe using the Verbal Multidimensional Scoring System.ResultsPrimary dysmenorrhoea was significantly associated with reduced quality of life, mental health challenges and academic disruptions. Students with dysmenorrhoea had significantly lower Quality of Life scores (–1.82, 95% CI: –2.63 to –1.02; p<0.001), with moderate-to-severe pain linked to an even more significant reduction (–2.09, 95% CI: –2.54 to –1.63; p<0.001). Dysmenorrhoea occurrence was significantly associated with depression (OR 2.16, 95% CI: 1.23 to 3.81; p=0.007), while severity was associated with both depression (OR 2.07, 95% CI: 1.47 to 2.92; p<0.001) and stress (OR 1.82, 95% CI: 1.26 to 2.62; p<0.001). Dysmenorrhoea occurrence and severity significantly disrupted concentration (OR 12.92, 95% CI: 6.14 to 27.22; p<0.001 and OR 7.24, 95% CI: 4.68 to 11.19; p<0.001, respectively), activities (OR 34.95, 95% CI: 4.77 to 256.16; p<0.001 and OR 6.92, 95% CI: 4.63 to 10.36; p<0.001) and absenteeism (OR 12.10, 95% CI: 1.65 to 88.83; p=0.014 and OR 5.65, 95% CI: 3.32 to 9.63; p<0.001).Cum laudeGPA was not significantly associated.ConclusionsPrimary dysmenorrhoea is significantly associated with the quality of life, mental health and academic performance of medical students in Indonesia. Addressing its implications can enhance student well-being and academic outcomes.
NCHD handover in the acute mental health setting: a quality improvement initiative implementing an electronic handover tool
Authors: Naxakis Stelios , Wafer Megan , Gardezi Syeda , Sadia Aamina , Mujahid Rimsha , O’Connor Karen 
Published: January 2025

BackgroundCork University Hospital, Ireland’s largest teaching hospital, faced challenges in maintaining consistent handover processes in its Acute Mental Health Unit (AMHU). Prior to 2019, handovers relied on informal methods, risking information loss and compromising patient care. This quality improvement (QI) initiative aimed to standardise handover practices using an electronic tool integrated with the ISBAR communication protocol.ObjectivesThe project aimed to ensure accurate clinical information recording, improve patient care and safety, centralise handover material, enhance clinical transparency and accountability, and measure handover quality using the electronic tool.MethodsUsing a Plan-Do-Study-Act (PDSA) model, the initiative began with a critical incident in July 2020, prompting the creation and piloting of an electronic ‘handover tool’ aligned with ISBAR. Subsequent PDSA cycles included mandatory policy implementation and educational interventions to reinforce tool usage and adherence to communication standards.ResultsThe electronic handover tool improved handover practices, with increased compliance to recommended criteria and enhanced tool utilisation. Notable improvements followed targeted educational interventions, leading to more comprehensive and standardised handover entries. These improvements enhanced communication and information transfer among NCHDs, contributing to better continuity of care and patient safety.ConclusionsThe QI initiative successfully standardised handover processes and improved communication among NCHDs in the AMHU. While improvements were observed, ongoing efforts are needed to address challenges and sustain effectiveness. Continuous training, feedback mechanisms and further refinement of the handover tool are essential for long-term success. Future directions include exploring additional technological solutions and reinforcing a culture of effective communication.
Reusable menstrual hygiene products may lead to underdiagnosis of heavy menstrual bleeding: a randomised trial
Authors: Samuelson Bannow Bethany , Ramsey Katrina , Courchaine Katherine , Edelman Alison , Colwill Alyssa C 
Published: January 2025

BackgroundClinical diagnosis of heavy menstrual bleeding (HMB) is dependent on patient report of menstrual product usage of pads and tampons, but it is unknown if newer reusable menstrual products (cup and underwear) are similarly diagnostic.MethodsWe enrolled 20 regularly menstruating individuals with HMB for two menstrual cycles. Participants completed a retrospective baseline Pictorial Blood loss Assessment Chart (PBAC) at the time of enrolment (eligibility PBAC score ≥100) as well as several different measures with each study cycle. In cycle 1, participants used study-provided disposable pads and tampons. For cycle 2, participants were randomised to menstrual cup or underwear and collected their menstrual fluid on their heaviest 2 days. We compared the two cycles with respect to the weight of menstrual fluid collected and the frequency of product changes and leaks during the heaviest days in cycles 1 and 2, as well as questionnaire responses.ResultsOverall, the mean rate of product changes per heaviest day were 5.5 disposable product changes (range 1.5–11), 3.6 cup changes (range 1.3–6.2), and 3.5 underwear changes (range 2.7–6.9). Both groups (cup users and underwear users) reported a median 3.5 leaks (range 1–5) per heaviest day in cycle 2, while using the menstrual cup or underwear.DiscussionParticipants reported fewer daily changes of reusable products compared with disposable ones, but more leaks, suggesting that ‘rate of product change’ with reusable products may result in missed diagnoses of HMB.
Growing problem: frailty in midlife adult trauma patients in the USA
Authors: Bloeser Colleen , Engelbart Jacklyn Maye , Ten Eyck Patrick , Torner James C , Galet Colette , Skeete Dionne A 
Published: January 2025

BackgroundUnintentional falls are the greatest cause of injury-related hospitalisation in adult patients. Frailty is an important contributor to fall risk and poor outcomes in both midlife and older adult trauma patients. Despite this, the incidence of frailty remains understudied among midlife adults, and the CDC fall screening guidelines are limited to older adults. Here, we assessed the incidence of frailty among midlife and older trauma patients in the USA.MethodsThis was a retrospective study using the Trauma Quality Improvement Program database in midlife (aged 50–64 years) and older adult (aged 65 years and older) trauma patients from 2012 to 2021. Frailty was assessed using the five-item Modified Frailty Index. The adjusted change of frailty incidence over the study period was evaluated via Poisson regression.ResultsFrailty incidence in midlife trauma patients rose from 2.4% in 2012 to 5.1% in 2021. The adjusted annual incidence rate ratio (IRR) for midlife frailty was 1.08 (95% CI 1.08, 1.09). Among older adult patients, frailty incidence rose from 6.4% to 14.7%, with an adjusted annual frailty IRR of 1.10 (95% CI 1.10, 1.10).ConclusionFrailty is rising in both the midlife and older adult populations, indicating that these groups present increasing risk for unintentional falls and further morbidity and mortality. This underscores the necessity of fall screening in both midlife and older adult patients alongside further explorations into methods to delay the onset of frailty.
GP73 reinforces cytotoxic T-cell function by regulating HIF-1α and increasing antitumor efficacy
Authors: Liu Jialong , Feng Chao , Zhao Ruzhou , Song Hongbin , Huang Linfei , Jiang Nan , Yang Xiaopan , Liu Lanlan , Duan Cuijuan , Wan Luming , Gao Qi , Sun Lijuan , Hou Xufeng , Liu Muyi , Zhang Yanhong , Zhang Xuemiao , Zhang Dandan , Wang Yufei , Li Yong , Ma Xueping , Zhong Hui , Min Min , Wei Congwen , Cao Yuan , Yang Xiaoli 
Published: January 2025

BackgroundImmunotherapy that targets immune checkpoints has achieved revolutionary success, but its application in solid tumors remains limited, highlighting the need for reliable enhancement of the efficacy of immunotherapy. Golgi protein 73 (GP73), a Golgi membrane protein, has been implicated in various cellular processes, including immune regulation. Recent studies suggested that GP73 may play a role in modulating the immune response in patients with cancer. In this study, we investigated the mechanism by which GP73 regulates T-cell-mediated antitumor immunity within the tumor microenvironment.MethodsWe used T-cell specific GP73 knockout mice to establish MC38 and B16 tumor models to investigate the impact of GP73-deficient T cells on tumor growth. Single-cell sequencing was subsequently employed to classify tumor-infiltrating immune cells and assess changes in cytokines and metabolic genes. Through RNA sequencing, real-time quantitative PCR, western blotting, flow cytometry, seahorse analysis, glucose uptake, and L-lactic acid secretion assays, we explored how GP73 regulates hypoxia-inducible factor 1α (HIF-1α) to influence T-cell antitumor functionality. Furthermore, we established adoptive transfer experiments to study the ability of GP73-overexpressing T cells to combat tumors. Blood samples of patient with clinical tumor were collected to assess the relationship between immunotherapy efficacy and T-cell GP73 levels.ResultsIn this study, the absence of GP73 in mouse T cells promoted tumor growth and metastasis, accompanied by a decrease in the proportion of cytotoxic CD8+T cell subsets infiltrating the tumor and an increase in exhausted CD8+ T-cell subsets. Further analysis revealed that the effector function of CD8+T cells in tumors relies on glycolysis regulated by HIF-1α rather than immune checkpoints. GP73-deficient T cells exhibit severely impaired glycolysis in hypoxic environments, whereas ectopic GP73 expression restores HIF-1α levels. In adoptive immunotherapy, overexpression of GP73 in T cells inhibits tumor growth. In cytotoxicity assays, knockdown of GP73 affected the ability of CD8+T cells to kill target cells. Clinically, tumor immunotherapy partial response patients present significantly elevated levels of GP73 expression in T cells.ConclusionsThese findings reveal the role of GP73 in regulating T-cell glycolysis and may lead to new therapeutic strategies for the prognosis and treatment of clinical tumor immunotherapy.
Disruption of tumor-intrinsic PGAM5 increases anti-PD-1 efficacy through the CCL2 signaling pathway
Authors: Wei Xiaoying , Wang Hong , Liu Huiquan , Wang Jianguo , Zhou Peijie , Li Xiaoyang , He Yuan , Li Yan , Han Dong , Mei Ting , Wang Yuwen , Li Ziye , Ning Junhao , Xu Zilong , Wang Anlin , Li Yixuan , Cheng Jingjing , Qian Dong 
Published: January 2025

BackgroundImmunosuppressive phenotype compromised immunotherapy efficacy of hepatocellular carcinoma. Tumor cells intrinsic mitochondria dynamics could pass effects on the extracellular microenvironment through mtDNA stress. PGAM5 anchors at mitochondria and regulates mitochondria functions. We aim to explore whether the regulation of tumor-intrinsic PGAM5 on mitochondria affects tumor-infiltrating immune cells in the microenvironment and whether tumor-intrinsic PGAM5 can be a therapeutic target to enhance the immunotherapy efficacy of hepatocellular carcinoma (HCC).MethodsWe analyzed the correlation of PGAM5 expression and immune cells infiltration using Gene Expression Omnibus (GEO) and The Cancer Genome Atlas Liver Hepatocellular Carcinoma (TCGA-LIHC) data sets based on cibersort algorithm and tumor-tissue arrays from two independent cohorts. To further validate our findings, we established subcutaneous and orthotopic mouse HCC models with tumor-intrinsic Pgam5 deficiency and analyzed tumor-infiltrating immune cells by flow cytometry and single-cell RNA sequencing. Mechanistically, we established an in vitro co-culture system and analyzed proteomics data to find out the bridge between tumor cell PGAM5 and tumor-associated macrophages (TAMs) in the microenvironment. Immunofluorescence, chromatin-immunoprecipitation, ELISA, mass spectrometry were conducted to explore the molecular pathway. Macrophages were depleted to investigate whether the effects of tumor-intrinsic PGAM5 on TAMs could affect immunotherapy efficacy in HCC orthotopic and subcutaneous mouse models.ResultsPGAM5 expression in tumor was positively correlated with M2-phenotype TAM infiltration in patients with both HCC and mouse HCC tumor models. High tumor-intrinsic PGAM5 expression promoting M2 TAMs infiltration correlated with poor clinical-pathological characteristics and prognosis in patients with HCC. Disruption of tumor-intrinsic Pgam5 reduced TAM M2 polarization and inhibited HCC tumor growth in tumor-bearing mice. Mechanistically, in HCC cells PGAM5 deficiency inhibited mitochondria fission by promoting TRIM28 binding with DRP1, which increased ubiquitination and degradation of DRP1. Tumor-intrinsic PGAM5 deficiency mediated mitochondria fusion and reduced cytosolic mtDNA stress which attenuated TLR9 activation and downstream NF-κB-regulated CCL2 secretion. Furthermore, disruption of tumor-intrinsic Pgam5 significantly facilitated CD8+T cells activation and improved anti-programmed cell death protein-1 therapeutic efficacy with macrophages depletion compromising synergistic antitumor immune response.ConclusionOur results shed light on the effect of tumor mitochondria dynamics on TAMs in tumor microenvironment. Tumor-intrinsic PGAM5 can be a therapeutic target to improve immunotherapy efficacy in patients with HCC.
Lipid metabolic remodeling delays senescence of T cells to potentiate their immunity against solid tumors
Authors: Xu Yemin , Ding Li , Wu Mengyue , Wang Xiya , Wang Lu , Xu Zhou , Xia Yinhe , Cao Zhennan , Zhang Yanqing , Song Ruilong , Deng Bin , Chen Gang 
Published: January 2025

BackgroundTumor cells can drive the senescence of effector T cells by unbalancing their lipid metabolism, thereby limiting adoptive T cell therapy and contributing to tumor immune evasion. Our objective is to provide a feasible strategy for enhancing T cell treatment efficacy against solid tumors.MethodsIn this study, liposomal arachidonyl trifluoromethyl ketone (ATK) was anchored onto the adoptive T cell surface via bioorthogonal reactions, aiming to specifically inhibit the group IVA cytosolic phospholipase A2α (cPLA2α), a key enzyme facilitating phospholipid metabolism and senescent state of T cells.ResultsThe surface engineering exerted rare side effects on the activation and migration of T cells, but local and sustained extravasation of ATK downregulated cPLA2α expression, reprogrammed lipid metabolism, and inhibited lipid droplet accumulation. This endows T cells with delayed senescence and declined apoptosis to maintain their tumor-killing potency. Systemic administration of surface-engineered T cells resulted in superior infiltration in solid tumors and improved antitumor efficacy by enhancing the secretion of cytotoxic molecules, thereby prolonging the survival of mice bearing colorectal carcinoma and melanoma xenografts.ConclusionsLipid-metabolically remodeled T cells with delayed senescence increase efficacy in tumor microenvironment, highlighting a novel strategy for solid tumor immunotherapy.
Belimumab versus telitacicept in sequential treatment after rituximab for refractory lupus nephritis: a real-world multicentre study
Authors: Chen Yiting , Lei Xin , Xu Jianhang , Chen Xiaochan , Pan Hong , Zhang Qiankun , Wang Junni , Ren Pingping , Lan Lan , Shi Nan , Chen Liangliang , Wang Yaomin , Chen Jianghua , Jin Lie , Yang Yi , Xue Jing , Han Fei 
Published: January 2025

ObjectiveBoth belimumab and telitacicept are recognised blockers for B lymphocyte activation, both of which have been approved as add-on therapies for SLE in China. The aim of this study is to compare the efficacy of rituximab (RTX) followed by belimumab or telitacicept in a real-world cohort.MethodsA total of 49 refractory lupus nephritis patients were enrolled from four independent centres, subsequently categorised into two treatment groups: belimumab group (n=35) and telitacicept group (n=14) based on their treatment following RTX. The outcomes of renal response rates were evaluated.ResultsIn this study cohort, 63.3% presented with anti-dsDNA antibody positivity and 79.6% exhibited hypocomplementemia, with a mean Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) Score of 13±6, estimated glomerular filtration rate (eGFR) of 76.2 (30.2, 113.7) mL/min and urinary protein creatinine ratio (uPCR) of 2.45 (0.77, 5.19) g/g. There was no significant differences between groups. After a follow-up duration of 26±12 months, renal objective remission rate was 80.0% (28 patients) in belimumab group and 85.7% (12 patients) in telitacicept group (difference, 5.7 percentage points, 95% CI, −25.8 to 26.8, p=1.000). Renal complete response was 54.3% (19 patients) in belimumab group and 78.6% (11 patients) in telitacicept group (difference, 24.3 percentage points, 95% CI, 9.7 to 47.8, p=0.194). The anti-dsDNA antibody, complement, eGFR, uPCR and SLEDAI-2K Score were improved in both groups with a significant reduction in prednisone dose. Major adverse effects included immunoglobulin deficiency, respiratory tract infection and urinary tract infection. No death occurred.ConclusionsThe sequential treatment of belimumab or telitacicept following RTX may represent a promising therapeutic approach in the management of refractory lupus nephritis. Further investigation is necessary to establish optimal protocols and long-term benefits.
Electroreduction of Magnetite for Steel Production from Ceramic Suspensions Containing Metallic Iron
Authors: Fumo Adélio , Lopes Daniela V. , Starykevich Maksim , Kovalevsky Andrei V. 
Published: January 2025

The presence of impurities in the iron oxides feedstock introduces significant challenges during the electrowinning process for green steelmaking, leading to unpredictable effects. In the present study, the impact of metallic iron content on the Faradaic efficiency and microstructure of iron deposits obtained through the electroreduction of iron-magnetite powders in alkaline suspensions (10 M NaOH) at low temperature (80 °C) was evaluated. The findings reveal that the presence of metallic iron may negatively impact the reduction process. A comparative analysis of suspensions with and without iron content showed that the Faradaic efficiency for iron-free samples (63%–76%) significantly exceeds that of iron-containing suspensions (37%–57%). This demonstrates that the presence of metallic iron in the suspension can hinder the electroreduction of magnetite to Fe, with the effect becoming more pronounced at higher Fe concentration. Changes were observed in the microstructure of iron deposits, with the dendrites becoming less sharp and more disordered in iron-containing suspensions. Particle size distribution analysis further revealed that larger metallic iron particles may contribute to the sedimentation and entrapment of magnetite particles, which negatively affect the current density and Faradaic efficiency.
Navigating the Complexities of Molar Incisor Hypomineralization: Challenges and Strategies in Pediatric Dentistry
Authors: Al-Nerabieah Zuhair , AlKhouli Muaaz , Dashash Mayssoon 
Published: January 2025

Background: Molar incisor hypomineralization (MIH) presents a multifaceted challenge in pediatric dentistry, impacting diagnostics, clinical management, resource accessibility, and psychosocial care. The condition’s complexity is exacerbated by diagnostic variability, overlapping clinical symptoms, and the need for tailored treatment approaches.Objectives: This study aims to explore the key challenges associated with the management of MIH in pediatric dentistry, including diagnostic precision, clinical management, resource limitations, interdisciplinary care, long‐term follow‐up, and psychosocial impact, and to propose strategies for overcoming these obstacles.Methods: A comprehensive literature review was conducted to identify and synthesize existing evidence on MIH’s etiology, diagnosis, treatment, and prognosis. The review highlighted the barriers encountered in providing optimal care, particularly in resource‐constrained settings, and explored potential solutions through clinical and interdisciplinary approaches.Results: The key findings included the need for standardized diagnostic criteria, the role of individualized treatment plans, and the importance of resource allocation. Limited access to specialized equipment and education hampers care, especially in under‐resourced areas. Long‐term management complexities were further compounded by the necessity for interdisciplinary collaboration and attention to psychosocial factors affecting pediatric patients.Conclusion: Effective MIH management requires standardized diagnostic protocols, resource advocacy, interdisciplinary collaboration, and holistic patient care. Advancements in research, education, and policy are essential to improve outcomes in pediatric patients. By addressing both clinical and psychosocial challenges, the overall well‐being of MIH‐affected children can be enhanced.