bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transvaginal small bowel evisceration after cervical loop electrosurgical excision procedure: a case report
Authors: Yao Kui , Xie Chuan 
Published: September 2023

AbstractTransvaginal small bowel evisceration is a life-threatening condition, which is usually seen in postmenopausal women with a history of gynecological surgery. Cervical loop electrosurgical excision procedure (LEEP) is widely used in the treatment of cervical intraepithelial neoplasia (CIN), and its surgical risk and postoperative complications are relatively low because of the simplicity of the operation. However, improper operation may result in perforation of the uterus, which can cause prolapse of the small bowel into the vagina. We here reported an extremely rare case of a young woman with transvaginal small bowel evisceration after cervical LEEP, achieving a good prognosis after the prolapsed bowel was reduced. The patient underwent cervical LEEP as a treatment for CIN III, but the LEEP resulted in a laceration of about 4.0 cm × 3.5 cm on the peritoneum of the uterovesical peritoneal reflection and a laceration of about 2.0 cm × 1.5 cm on the anterior wall of the cervical canal. Through the two lacerations, the pelvic cavity is connected to the vagina and the small intestine prolapsed into the vagina. Due to aggressive surgical intervention, the patient achieved a favorable prognosis after successfully reducing the prolapsed bowel.
Expanding the non-technical skills vocabulary of operating room nurses: a qualitative study
Authors: Sirevåg Irene , Tjoflåt Ingrid , Hansen Britt Sætre 
Published: September 2023

Abstract
Background
Operating room nurses have specialised technical and non-technical skills and are essential members of the surgical team. The profession’s dependency of tacit knowledge has made their non-technical skills difficult to access for researchers, thus, creating limitations in the identification of the non-technical skills of operating room nurses. Non-technical skills are categorised in the crew resource management framework, and previously, non-technical skills of operating room nurses have been identified within the scope of the framework. The purpose of this study is to explore operating room nurses’ descriptions of their practices in search for non-technical skills not included in the crew resource management framework.

Methods
This study has a qualitative design. An expert panel of experienced operating room nurses (N = 96) in Norway provided qualitative descriptions of their practice in a Delphi survey. The data were analysed in an inductive thematic analysis. This study was conducted and reported in line with Standards for Reporting Qualitative Research (SRQR).

Results
The inductive thematic analysis developed two themes, ‘Ethical competence’ and ‘Professional accountability’, that encompass operating room nurses’ novel descriptions of their non-technical skills. The participants take pride in having the patients’ best interest as their main objective even if this may threaten their position in the team.

Conclusions
This study has identified novel non-technical skills that are not described in the crew resource management framework. These findings will contribute to the development of a new behavioural marker system for the non-technical skills of operating room nurses. This system will facilitate verbalisation of tacit knowledge and contribute to an increased knowledge about the operating room nursing profession.
macJNet: weakly-supervised multimodal image deformable registration using joint learning framework and multi-sampling cascaded MIND
Authors: Zhou Zhiyong , Hong Ben , Qian Xusheng , Hu Jisu , Shen Minglei , Ji Jiansong , Dai Yakang 
Published: September 2023

AbstractDeformable multimodal image registration plays a key role in medical image analysis. It remains a challenge to find accurate dense correspondences between multimodal images due to the significant intensity distortion and the large deformation. macJNet is proposed to align the multimodal medical images, which is a weakly-supervised multimodal image deformable registration method using a joint learning framework and multi-sampling cascaded modality independent neighborhood descriptor (macMIND). The joint learning framework consists of a multimodal image registration network and two segmentation networks. The proposed macMIND is a modality-independent image structure descriptor to provide dense correspondence for registration, which incorporates multi-orientation and multi-scale sampling patterns to build self-similarity context. It greatly enhances the representation ability of cross-modal features in the registration network. The semi-supervised segmentation networks generate anatomical labels to provide semantics correspondence for registration, and the registration network helps to improve the performance of multimodal image segmentation by providing the consistency of anatomical labels. 3D CT-MR liver image dataset with 118 samples is built for evaluation, and comprehensive experiments have been conducted to demonstrate that macJNet achieves superior performance over state-of-the-art multi-modality medical image registration methods.
Improving milk donation behavior through an educational intervention based on the theory of planned behavior: study protocol of a cluster randomized controlled trial
Authors: Shahbazi Sighaldeh Shirin , Moridi Maryam , Ghorban Sabagh Vafa , Kazemnejad Anoshirvan , Shateranni Fatemeh 
Published: September 2023

Abstract
Background
Breastfeeding mothers’ decisions to donate their milk is influenced by their knowledge, attitudes, and subjective norms such as their family’s opinions on milk donation. In Iran, women have favorable knowledge and positive attitudes toward breastfeeding, but they lack sufficient information and education about milk banks. With respect to current childbearing policies, an increase in the number of infants who will be admitted to neonatal intensive care units is expected. Accordingly, improving milk donation behavior, which requires mothers’ intention and ability to donate breast milk, is important for infants’ survival and well-being. Therefore, this study aims to evaluate whether an educational program based on the theory of planned behavior affects breastfeeding mothers’ decisions to donate their breast milk.

Methods
This cluster randomized controlled trial will be conducted in health centers affiliated to Tehran University of Medical Sciences and will enroll 66 breastfeeding mothers (intervention, n = 33; control, n = 33). After collecting baseline data, the intervention group will begin receiving a 60-minute weekly educational program based on Theory of Planned Behavior components for four weeks. The first follow-up assessment will be conducted immediately after the intervention, and the final one will be conducted 12 weeks later. The primary outcomes are the number of mothers who have donated their breast milk and changes in breastfeeding mothers’ knowledge, attitude, subjective norms, and perceived behavioral control about donor human milk and intention to donate milk.

Discussion
This trial will evaluate if a well-designed educational program can improve breastfeeding mothers’ knowledge and promote their behavioral factors regarding milk donation and lead to a significant increase in the number of potential milk donors.

Trial registration
irct.ir (IRCT20230124057203N1) registered February 14, 2023.
ScRNA analysis and ferroptosis-related ceRNA regulatory network investigation in microglia cells at different time points after spinal cord injury
Authors: Bao Junping , Yang Shu 
Published: September 2023

AbstractSpinal cord injuries (SCI) are usually caused by mechanical trauma that leads to serious physical and psychological damage to the patient as well as a huge economic burden to the whole society. The prevention, treatment, and rehabilitation of spinal cord injuries have become a major issue for the medical community today due to the enormous social and economic expenditure induced via spinal cord injuries. Therefore, in-depth research into SCI is necessary. Microglia have been shown to be the key player in the immune inflammatory response after spinal cord injury, but the mechanisms of immune regulation at different time points after spinal cord injury remain unclear. To investigate the inflammatory biomarkers associated with microglia at different time points after SCI, we downloaded single-cell RNA sequencing data from mouse spinal cords 3- and 14-days after the injury and identified subpopulations associated with microglia. Further functional enrichment analysis also confirmed that microglia are associated with immune system regulation at different time points and that both can modulate cytokine production. As ferroptosis is a newly identified non-apoptotic programmed cell death, microglia establish a bridge between ferroptosis and CNS inflammation and may play an important role in spinal cord injury. We then screened for genes differentially expressed in microglia during 3- and 14-days after spinal cord injury and associated with iron death, named Stmn1 and Fgfbr1, respectively, and verified that these pivotal genes are closely related to the immune cells. Finally, we also screened for drug fractions associated with these pivotal genes. Our results predict key genes in the immune inflammatory process associated with microglia at different time points after spinal cord injury at the single-cell level and provide a molecular basis for better treatment of SCI.
CircRNF10 triggers a positive feedback loop to facilitate progression of glioblastoma via redeploying the ferroptosis defense in GSCs
Authors: Wang Chengbin , Zhang Minjie , Liu Yingliang , Cui Daming , Gao Liang , Jiang Yang 
Published: September 2023

Abstract
Background
Glioma exhibit heterogeneous susceptibility for targeted ferroptosis. How circRNAs alterations in glioma promote iron metabolism and ferroptosis defense remains unclarified.

Methods
The highly enriched circRNAs in glioblastoma (GBM) were obtained through analysis of sequencing datasets. Quantitative real-time PCR (qRT–PCR) was used to determine the expression of circRNF10 in glioma and normal brain tissue. Both gain-of-function and loss-of-function studies were used to assess the effects of circRNF10 on ferroptosis using in vitro and in vivo assays. The hypothesis that ZBTB48 promotes ferroptosis defense was established using bioinformatics analysis and functional assays. RNA pull-down and RNA immunoprecipitation (RIP) assays were performed to examine the interaction between circRNF10 and target proteins including ZBTB48, MKRN3 and IGF2BP3. The posttranslational modification mechanism of ZBTB48 was verified using coimmunoprecipitation (co-IP) and ubiquitination assays. The transcription activation of HSPB1 and IGF2BP3 by ZBTB48 was confirmed through luciferase reporter gene and chromatin immunoprecipitation (ChIP) assays. The stabilizing effect of IGF2BP3 on circRNF10 was explored by actinomycin D assay. Finally, a series of in vivo experiments were performed to explore the influences of circRNF10 on the glioma progression.

Results
A novel circular RNA, hsa_circ_0028912 (named circRNF10), which is significantly upregulated in glioblastoma tissues and correlated with patients’ poor prognosis. Through integrated analysis of the circRNA-proteins interaction datasets and sequencing results, we reveal ZBTB48 as a transcriptional factor binding with circRNF10, notably promoting upregulation of HSPB1 and IGF2BP3 expression to remodel iron metabolism and facilitates the launch of a circRNF10/ZBTB48/IGF2BP3 positive feedback loop in GSCs. Additionally, circRNF10 can competitively bind to MKRN3 and block E3 ubiquitin ligase activity to enhance ZBTB48 expression. Consequently, circRNF10-overexpressed glioma stem cells (GSCs) display lower Fe2+ accumulation, selectively priming tumors for ferroptosis evading.

Conclusion
Our research presents abnormal circRNAs expression causing a molecular and metabolic change of glioma, which we leverage to discover a therapeutically exploitable vulnerability to target ferroptosis.
Report and follow-up on two new patients with congenital mesoblastic nephroma
Authors: Serra Gregorio , Cimador Marcello , Giuffrè Mario , Insinga Vincenzo , Montante Claudio , Pensabene Marco , Piro Ettore , Salerno Sergio , Schierz Ingrid Anne Mandy , Corsello Giovanni 
Published: September 2023

Abstract
Background
Tumors are rare in neonatal age. Congenital mesoblastic nephroma (CMN) is a usually benign renal tumor observed at birth, or in the first months of life. It may also be identified prenatally and associated with polyhydramnios leading to preterm delivery. Effective treatment is surgical in most cases, consisting in total nephrectomy. In literature, very few studies report on the neonatal management of such a rare disease, and even less are those describing its uncommon complications.

Cases presentation
We report on two single-center newborns affected with CMN. The first patient is a preterm female baby, born at 30+ 1 weeks of gestation (WG) due to premature labor, with prenatal (25 WG) identification of an intra-abdominal fetal mass associated with polyhydramnios. Once obtained the clinical stability, weight gain, instrumental (computed tomography, CT, showing a 4.8 × 3.3 cm left renal neoformation) and histological/molecular characterization of the lesion (renal needle biopsy picture of classic CMN with ETV6-NTRK3 translocation), a left nephrectomy was performed at 5 weeks of chronological age. The following clinical course was complicated by intestinal obstruction due to bowel adherences formation, then by an enterocutaneous fistula, requiring multiple surgical approaches including transitory ileo- and colostomy, before the conclusive anastomoses intervention. The second patient is a 17-day-old male term baby, coming to our observation due to postnatal evidence of palpable left abdominal mass (soon defined through CT, showing a 7.5 × 6.5 cm neoformation in the left renal lodge), feeding difficulties and poor weight gain. An intravenous diuretic treatment was needed due to the developed hypertension and hypercalcemia, which regressed after the nephrectomy (histological diagnosis of cellular CMN with ETV6-NTRK3 fusion) performed at day 26. In neither case was chemotherapy added. Both patients have been included in multidisciplinary follow-up, they presently show regular growth and neuromotor development, normal renal function and no local/systemic recurrences or other gastrointestinal/urinary disorders.

Conclusions
The finding of a fetal abdominal mass should prompt suspicion of CMN, especially if it is associated with polyhydramnios; it should also alert obstetricians and neonatologists to the risk of preterm delivery. Although being a usually benign condition, CMN may be associated with neonatal systemic-metabolic or postoperative complications. High-level surgical expertise, careful neonatological intensive care and histopathological/cytogenetic-molecular definition are the cornerstones for the optimal management of patients. This should also include an individualized follow-up, oriented to the early detection of any possible recurrences or associated anomalies and to a better quality of life of children and their families.
Inferring chromatin accessibility during murine hematopoiesis through phylogenetic analysis
Authors: Koyanagi Kanako O. 
Published: September 2023

Abstract
Objective
Diversification of cell types and changes in epigenetic states during cell differentiation processes are important for understanding development. Recently, phylogenetic analysis using DNA methylation and histone modification information has been shown useful for inferring these processes. The purpose of this study was to examine whether chromatin accessibility data can help infer these processes in murine hematopoiesis.

Results
Chromatin accessibility data could partially infer the hematopoietic differentiation hierarchy. Furthermore, based on the ancestral state estimation of internal nodes, the open/closed chromatin states of differentiating progenitor cells could be predicted with a specificity of 0.86–0.99 and sensitivity of 0.29–0.72. These results suggest that the phylogenetic analysis of chromatin accessibility could offer important information on cell differentiation, particularly for organisms from which progenitor cells are difficult to obtain.
Dual-layer spectral-detector CT for predicting microsatellite instability status and prognosis in locally advanced gastric cancer
Authors: Zhu Yongjian , Wang Peng , Wang Bingzhi , Jiang Zhichao , Li Ying , Jiang Jun , Zhong Yuxin , Xue Liyan , Jiang Liming 
Published: September 2023

Abstract
Objective
To construct and validate a prediction model based on dual-layer detector spectral CT (DLCT) and clinico-radiologic features to predict the microsatellite instability (MSI) status of gastric cancer (GC) and to explore the relationship between the prediction results and patient prognosis.

Methods
A total of 264 GC patients who underwent preoperative DLCT examination were randomly allocated into the training set (n = 187) and validation set (n = 80). Clinico-radiologic features and DLCT parameters were used to build the clinical and DLCT model through multivariate logistic regression analysis. A combined DLCT parameter (CDLCT) was constructed to predict MSI. A combined prediction model was constructed using multivariate logistic regression analysis by integrating the significant clinico-radiologic features and CDLCT. The Kaplan–Meier survival analysis was used to explore the prognostic significant of the prediction results of the combined model.

Results
In this study, there were 70 (26.52%) MSI-high (MSI-H) GC patients. Tumor location and CT_N staging were independent risk factors for MSI-H. In the validation set, the area under the curve (AUC) of the clinical model and DLCT model for predicting MSI status was 0.721 and 0.837, respectively. The combined model achieved a high prediction efficacy in the validation set, with AUC, sensitivity, and specificity of 0.879, 78.95%, and 75.4%, respectively. Survival analysis demonstrated that the combined model could stratify GC patients according to recurrence-free survival (p = 0.010).

Conclusion
The combined model provides an efficient tool for predicting the MSI status of GC noninvasively and tumor recurrence risk stratification after surgery.

Critical relevance statement
MSI is an important molecular subtype in gastric cancer (GC). But MSI can only be evaluated using biopsy or postoperative tumor tissues. Our study developed a combined model based on DLCT which could effectively predict MSI preoperatively. Our result also showed that the combined model could stratify patients according to recurrence-free survival. It may be valuable for clinicians in choosing appropriate treatment strategies to avoid tumor recurrence and predicting clinical prognosis in GC.

Key points
• Tumor location and CT_N staging were independent predictors for MSI-H in GC.
• Quantitative DLCT parameters showed potential in predicting MSI status in GC.
• The combined model integrating clinico-radiologic features and CDLCT could improve the predictive performance.
• The prediction results could stratify the risk of tumor recurrence after surgery.

Graphical Abstract
Cell-free therapy based on extracellular vesicles: a promising therapeutic strategy for peripheral nerve injury
Authors: Namini Mojdeh Salehi , Daneshimehr Fatemeh , Beheshtizadeh Nima , Mansouri Vahid , Ai Jafar , Jahromi Hossein Kargar , Ebrahimi-Barough Somayeh 
Published: September 2023

AbstractPeripheral nerve injury (PNI) is one of the public health concerns that can result in a loss of sensory or motor function in the areas in which injured and non-injured nerves come together. Up until now, there has been no optimized therapy for complete nerve regeneration after PNI. Exosome-based therapies are an emerging and effective therapeutic strategy for promoting nerve regeneration and functional recovery. Exosomes, as natural extracellular vesicles, contain bioactive molecules for intracellular communications and nervous tissue function, which could overcome the challenges of cell-based therapies. Furthermore, the bioactivity and ability of exosomes to deliver various types of agents, such as proteins and microRNA, have made exosomes a potential approach for neurotherapeutics. However, the type of cell origin, dosage, and targeted delivery of exosomes still pose challenges for the clinical translation of exosome therapeutics. In this review, we have focused on Schwann cell and mesenchymal stem cell (MSC)-derived exosomes in nerve tissue regeneration. Also, we expressed the current understanding of MSC-derived exosomes related to nerve regeneration and provided insights for developing a cell-free MSC therapeutic strategy for nerve injury.
Expansion of human bone marrow-derived mesenchymal stromal cells with enhanced immunomodulatory properties
Authors: Neo Shu Hui , Her Zhisheng , Othman Rashidah , Tee Ching Ann , Ong Li Ching , Wang Yuehua , Tan Irwin , Tan Jaylen , Yang Yanmeng , Yang Zheng , Chen Qingfeng , Boyer Laurie A. 
Published: September 2023

Abstract
Background
Mesenchymal stromal cells (MSCs) have broad potential as a cell therapy including for the treatment of drug-resistant inflammatory conditions with abnormal T cell proliferation such as graft-versus-host disease (GVHD). Clinical success, however, has been complicated by the heterogeneity of culture-expanded MSCs as well as donor variability. Here, we devise culture conditions that promote expansion of MSCs with enhanced immunomodulatory functions both in vitro and in animal models of GVHD.

Methods
Human bone marrow-derived MSCs were expanded at high-confluency (MSCHC) and low-confluency state (MSCLC). Their immunomodulatory properties were evaluated with in vitro co-culture assays based on suppression of activated T cell proliferation and secretion of pro-inflammatory cytokines from activated T cells. Metabolic state of these cells was determined, while RNA sequencing was performed to explore transcriptome of these MSCs. Ex vivo expanded MSCHC or MSCLC was injected into human peripheral blood mononuclear cells (PBMC)-induced GVHD mouse model to determine their in vivo therapeutic efficacy based on clinical grade scoring, human CD45+ blood count and histopathological examination.

Results
As compared to MSCLC, MSCHC significantly reduced both the proliferation of anti-CD3/CD28-activated T cells and secretion of pro-inflammatory cytokines upon MSCHC co-culture across several donors even in the absence of cytokine priming. Mechanistically, metabolic analysis of MSCHC prior to co-culture with activated T cells showed increased glycolytic metabolism and lactate secretion compared to MSCLC, consistent with their ability to inhibit T cell proliferation. Transcriptome analysis further revealed differential expression of immunomodulatory genes including TRIM29, BPIFB4, MMP3 and SPP1 in MSCHC as well as enriched pathways including cytokine–cytokine receptor interactions, cell adhesion and PI3K-AKT signalling. Lastly, we demonstrate in a human PBMC-induced GVHD mouse model that delivery of MSCHC showed greater suppression of inflammation and improved outcomes compared to MSCLC and saline controls.

Conclusion
Our study provides evidence that ex vivo expansion of MSCs at high confluency alters the metabolic and transcriptomic states of these cells. Importantly, this approach maximizes the production of MSCs with enhanced immunomodulatory functions without priming, thus providing a non-invasive and generalizable strategy for improving the use of MSCs for the treatment of inflammatory diseases.