bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined use of CA125, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio for the diagnosis of borderline and malignant epithelial ovarian tumors
Authors: Huang Ke , Xu Shengjie , Wang Jiatong , Ge Lili , Xu Juan , Jia Xuemei 
Published: February 2023

Abstract
Background
The mortality rate of ovarian cancer ranks first among three common gynecological malignant tumors due to insidious onset and lack of effective early diagnosis methods. Borderline epithelial ovarian tumor (BEOT) is a type of low malignant potential tumor that is typically associated with better outcomes than ovarian cancer. However, BEOTs are easily confused with benign and malignant epithelial ovarian tumors (EOTs) due to similar clinical symptoms and lack of specific tumor biomarkers and imaging examinations. Notably, a small subset of BEOTs will transform into low-grade serous ovarian carcinoma with a poor prognosis. Therefore, searching for potential biomarkers that can be easily obtained and accurately identify malignant epithelial ovarian tumors (MEOTs) as well as BEOTs is essential for the clinician. Cancer antigen 125 (CA125) is a commonly used biomarker for the diagnosis of EOTs in the preoperative scenario but has low sensitivity and specificity. Nowadays, inflammatory biomarkers including inflammatory cell counts and derived ratios such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been proved to be associated with tumor progression and poor prognosis, and were considered to be the most economically potential surrogate biomarkers for various malignancies. The purpose of this study was to find appropriate combinations of inflammatory and tumor biomarkers to improve the diagnostic efficiency of EOTs, especially the BEOTs.

Results
CA125, NLR and PLR increased steadily among benign, borderline and malignant EOTs and tended to be higher in advanced (stage III-IV) and lymph node metastasis MEOT groups than in early stage (stage I-II) and non-lymph node metastasis MEOT groups. CA125, NLR and PLR could be used separately in the differentiation of EOTs but could not take into account both sensitivity and specificity. The combined use of CA125, NLR and PLR was evaluated to be more efficient, especially in the identification of BEOTs, with both high sensitivity and high specificity.

Conclusions
The levels of CA125, NLR and PLR were closely related to the nature of EOTs and malignant progression of MEOTs. The combination of CA125, NLR and PLR was more accurate in identifying the nature of EOTs than either alone or double combination, especially for BEOTs.
Down Syndrome: how to communicate the diagnosis
Authors: Gori Caterina , Cocchi Guido , Corvaglia Luigi Tommaso , Ramacieri Giuseppe , Pulina Francesca , Sperti Giacomo , Cagnazzo Valeria , Catapano Francesca , Strippoli Pierluigi , Cordelli Duccio Maria , Locatelli Chiara 
Published: February 2023

AbstractCommunicating the diagnosis of Down Syndrome to a couple of parents is never easy, whether before or after birth. As doctors, we must certainly rely on our own relational skills, but it is also necessary to be confident in some general indications, which are often overlooked in the strict hospital routine. This article is intended as a summary of the main articles published on this subject in the international literature, collecting and summarising the most important indications that have emerged in years of medical practice all over the world as well as in our personal experience. The diffusion of these guidelines is essential to help the doctor in this difficult task, on which there is often little training, and above all to guarantee to the parents the least traumatic communication possible.
Leveraging explainable AI for gut microbiome-based colorectal cancer classification
Authors: Rynazal Ryza , Fujisawa Kota , Shiroma Hirotsugu , Salim Felix , Mizutani Sayaka , Shiba Satoshi , Yachida Shinichi , Yamada Takuji 
Published: February 2023

AbstractStudies have shown a link between colorectal cancer (CRC) and gut microbiome compositions. In these studies, machine learning is used to infer CRC biomarkers using global explanation methods. While these methods allow the identification of bacteria generally correlated with CRC, they fail to recognize species that are only influential for some individuals. In this study, we investigate the potential of Shapley Additive Explanations (SHAP) for a more personalized CRC biomarker identification. Analyses of five independent datasets show that this method can even separate CRC subjects into subgroups with distinct CRC probabilities and bacterial biomarkers.
An innovative web-based decision-aid about birth after cesarean for shared decision making in Taiwan: study protocol for a randomized control trial
Authors: Chen Shu Wen , Shorten Allison , Yeh Chang Ching , Kao Chien Huei , Lu Yu Ying , Hu Hsiang Wei 
Published: February 2023

Abstract
Background
Taiwan has a high national caesarean rate coupled with a low vaginal birth after caesarean (VBAC) rate. This study aims to develop and evaluate a web-based decision-aid with communication support tools, to increase shared decision making (SDM) about birth after caesarean.

Methods
A quantitative approach will be adopted using a randomized pre-test and post-test experimental design in a medical centre in northern Taiwan. The web-based decision aid consists of five sections. Section 1 provides a two-part video to introduce SDM and how to participate in SDM. Section 2 presents an overview of functions and features of the birth decision-aid. Section 3 presents relevant VBAC information, including definitions, benefits and risks, and an artificial intelligence (AI) calculator for rate and likelihood of VBAC success. Section 4 presents the information regarding elective repeat caesarean delivery (ERCD), involving definitions, benefits, and risks. Section 5 comprises four steps of decision making to meet women’s values and preferences. Pregnant women who have had one previous caesarean and are eligible for VBAC, will be recruited at 14–16 weeks. Participants will complete a baseline survey prior to random allocation to either the control group (usual care) or intervention group (usual care plus an AI-decision aid). A follow up survey at 35–38 weeks will measure change in decisional conflict, knowledge, birth mode preference, and decision-aid acceptability. Actual birth outcomes and satisfaction will be assessed one month after birth.

Discussion
The innovative web-based decision-aid with support tools will help to promote pregnant women’s decision-making engagement and communication with their providers and improve opportunities for supportive communication about VBAC SDM in Taiwan. Linking web-based AI data analysis into the medical record will also be assessed for feasibility during implementation in clinical practice.

Trial registration
ClinicalTrials.gov identifier (NCT05091944), Registered on October 24, 2021.
Efficacy and tolerability of a specific blend of amino acids in patients with anorexia nervosa treated in a hospital setting: study protocol for a randomized controlled trial
Authors: Dalle Grave Riccardo , Calugi Simona , Ruocco Chiara , Chimini Mirko , Segala Agnese , Ragni Maurizio , Carruba Michele , Valerio Alessandra , Nisoli Enzo 
Published: February 2023

Abstract
Background
Specific blends of essential amino acids (EAA) containing a high percentage of branched-chain amino acids preserves mitochondrial metabolism and higher physical resistance in elderly mice, increasing their survival and improving physical performance and cognitive functions in malnourished elderly patients. However, no study has been yet done on patients with anorexia nervosa (AN) who regain weight with specialized intensive treatment. The present study aims to evaluate the efficacy of supplementation with EAA on the change in lean body mass (LBM) and other physical and psychological outcomes in patients with AN who are undergoing specialist treatment for eating disorders.

Methods
This is a 13-week randomized, double-blind, placebo-controlled study. Patients will be randomized to either a mixture of a complex blend of EAA and intermediates of the tricarboxylic acid (TCA) cycle (citrate, malate, succinate) supplementation (or placebo) upon admission at the intensive residential and day-hospital treatment for eating disorders. Ninety-two participants with AN aged 16–50 years will be recruited from a specialized intensive treatment of eating disorders. Double-blind assessment will be conducted at baseline (T0) and the end of the 13 weeks of treatment (T1). The study’s primary aim is to evaluate the efficacy of supplementation with EAA and TCA intermediates on the change in lean body mass (LBM) with weight restoration in patients with AN who are undergoing specialist treatment for eating disorders. The secondary aims of the study are to assess the effect of dietary supplementation on physical fitness, weight restoration, modification of AN and general psychopathology, and psychosocial impairment.

Discussion
The study’s results will inform researchers and clinicians on whether supplementing a mixture of EAA and TCA cycle intermediates will improve the increase of LBM and other important physical and psychological outcomes in patients with AN who regain weight with specialized intensive treatment.

Trial registration
NCT, NCT05290285. Registered on 22 March 2022.
Regulation of seed oil accumulation by lncRNAs in Brassica napus
Authors: Li Yuqing , Tan Zengdong , Zeng Chenghao , Xiao Mengying , Lin Shengli , Yao Wei , Li Qing , Guo Liang , Lu Shaoping 
Published: February 2023

Abstract
Background
Studies have indicated that long non-coding RNAs (lncRNAs) play important regulatory roles in many biological processes. However, the regulation of seed oil biosynthesis by lncRNAs remains largely unknown.

Results
We comprehensively identified and characterized the lncRNAs from seeds in three developing stages in two accessions of Brassica napus (B. napus), ZS11 (high oil content) and WH5557 (low oil content). Finally, 8094 expressed lncRNAs were identified. LncRNAs MSTRG.22563 and MSTRG.86004 were predicted to be related to seed oil accumulation. Experimental results show that the seed oil content is decreased by 3.1–3.9% in MSTRG.22563 overexpression plants, while increased about 2% in MSTRG.86004, compared to WT. Further study showed that most genes related to lipid metabolism had much lower expression, and the content of some metabolites in the processes of respiration and TCA (tricarboxylic acid) cycle was reduced in MSTRG.22563 transgenic seeds. The expression of genes involved in fatty acid synthesis and seed embryonic development (e.g., LEC1) was increased, but genes related to TAG assembly was decreased in MSTRG.86004 transgenic seeds.

Conclusion
Our results suggest that MSTRG.22563 might impact seed oil content by affecting the respiration and TCA cycle, while MSTRG.86004 plays a role in prolonging the seed developmental time to increase seed oil accumulation.
Delayed diagnosis of bacterial cervical lymphadenitis in the tropics: a case report
Authors: Olaniyi Oladosu , Ayotunde Ojo , Christabel Thomas , Idowu Odediran 
Published: February 2023

Abstract
Background
Lymphadenopathy refers to any disease process involving lymph nodes that are abnormal in size and consistency. There are multiple etiologies in the setting of a diseased lymph node, including conditions of infection, autoimmune diseases, and neoplasia. Lymphadenitis is a term that refers to lymphadenopathies that are due to inflammatory processes and can represent an acute bacterial infection resulting from streptococcal pharyngitis or a prior viral upper respiratory infection. Cervical lymphadenopathy refers to nodal swelling in the neck region. While cervical lymphadenitis is a common clinical finding in the setting of a transient response to a benign local or generalized infection, it may evade detection sometimes and thus account for a percentage of misdiagnosis or delayed diagnosis in the tropics. This case report is aimed at increasing the awareness about the presentation of bacterial cervical lymphadenitis and how it can sometimes mimic the presentation that is typical and regularly found with plasmodiasis. It contributes to improved awareness and high index of suspicion in clinic when dealing with patients in the tropics.

Case presentation
We present a case of delayed diagnosis of bacterial cervical lymphadenitis that initially presented with typical features of malaria from Plasmodium falciparum. A 26-year-old Nigerian woman presented to the outpatient department following complaints of a recurring fever of a month’s duration and bilateral neck swelling of about 2 weeks prior to presentation.

Conclusion
In the setting of a busy clinic, details are easily missed and salient features in the presentation of a patient that are needed for accurate diagnosis and management could go unrecognized. Hence, this case report highlights the importance of proper examination particularly of lymph nodes and use of different diagnostic modalities for the exact diagnosis of disease.
Relationship between occupational and leisure-time physical activity and the need for recovery after work
Authors: Karihtala Tiina , Valtonen Anu M. , Kautiainen Hannu , Hopsu Leila , Halonen Janne , Heinonen Ari , Puttonen Sampsa 
Published: February 2023

Abstract
Background
Health benefits of physical activity are very well acknowledged but the role of both occupational physical activity (OPA) and leisure time physical activity (LTPA) in recovery after work is not thoroughly understood. The purpose of this study was to investigate the association between accelerometer-measured OPA and LTPA and the need for recovery after work (NFR) in early childhood education and care (ECEC) professionals.

Methods
The study participants were 217 female ECEC professionals aged 17–64. Physical activity was recorded with a three-axis accelerometer (ActiGraph GT9X Link, ActiGraph, USA) for seven consecutive days. Separate analyses were conducted for both OPA and LTPA and reported as hours/day based on different intensity levels (light, moderate, vigorous, very vigorous). The NFR was measured with the Need For Recovery (NFR) scale (0%–100%).

Results
Participants’ average physical activity for both OPA and LTPA was about 4 h/day, and the mean NFR score was 38.4%. OPA was significantly associated with the NFR but not with LTPA. The relationship remained significant after adjustments for age, body mass index, work ability, mental health status, and sleep difficulties (p < 0.024).

Conclusion
According to this study, the OPA level is related to the level of the NFR in female ECEC professionals. Based on the results, it seems that LTPA has no relevance to the NFR. Results suggest that long-lasting OPA, even without strenuous physical activity at work, may predispose individuals to a high NFR.
The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China
Authors: Xue Qingping , Xu Dong Roman , Cheng Terence C. , Pan Jay , Yip Winnie 
Published: February 2023

Abstract
Background
Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparities in health care quality and medical expenses among public, private not-for-profit, and private for-profit hospitals.

Methods
A total of 64,171 inpatients (51,933 for pneumonia (PNA), 9,022 for heart failure (HF) and 3,216 for acute myocardial infarction (AMI)) who were admitted to 528 secondary hospitals in Sichuan province, China, during the fourth quarters of 2016, 2017, and 2018 were selected for this study. Multilevel logistic regressions and multilevel linear regressions were utilized to assess the relationship between hospital ownership types and in-hospital mortality, as well as medical expenses for PNA, HF, and AMI, after adjusting for relevant hospital and patient characteristics, respectively.

Results
The private not-for-profit (adjusted OR, 1.69; 95% CI, 1.08, 2.64) and for-profit (adjusted OR, 1.67; 95% CI, 1.06, 2.62) hospitals showed higher in-hospital mortality than the public ones for PNA, but not for AMI and HF. No significant differences were found in medical expenses across hospital ownership types for AMI, but the private not-for-profit was associated with 9% higher medical expenses for treating HF, while private not-for-profit and for-profit hospitals were associated with 10% and 11% higher medical expenses for treating PNA than the public hospitals. No differences were found between the private not-for-profit and private for-profit hospitals both in in-hospital mortality and medical expenses across the three conditions.

Conclusion
The public hospitals had at least equal or even higher healthcare quality and lower medical expenses than the private ones in China, while private not-for-profit and for-profit hospitals had similar performances in these aspects. Our results added evidences on hospitals’ performances among different ownership types under China’s context, which has great potential to inform the optimization of healthcare systems implemented among developing countries confronted with similar challenges.
Identifying and addressing challenges to antimicrobial use surveillance in the human health sector in low- and middle-income countries: experiences and lessons learned from Tanzania and Uganda
Authors: Kiggundu Reuben , Lusaya Edgar , Seni Jeremiah , Waswa J. P. , Kakooza Francis , Tjipura Dinah , Kikule Kate , Muiva Cecilia , Joshi Mohan P. , Stergachis Andy , Kitutu Freddy Eric , Konduri Niranjan 
Published: February 2023

Abstract
Background
Antimicrobial resistance (AMR) is a global health security threat and is associated with increased morbidity and mortality. One of the key drivers of AMR is the inappropriate use of antibiotics. A key component of improving antibiotic use is conducting antimicrobial use (AMU) surveillance.

Methods
USAID Medicines Technologies and Pharmaceutical Services Program has supported the implementation of antimicrobial stewardship activities, including setting up systems for AMU surveillance in Tanzania and Uganda. Results from both countries have been previously published. However, additional implementation experience and lessons learned from addressing challenges to AMU surveillance have not been previously published and are the subject of this narrative article.

Results
The team identified challenges including poor quality data, low digitalization of tools, and inadequate resources including both financial and human resources. To address these gaps, the Program has supported the use of continuous quality improvement approaches addressing gaps in skills, providing tools, and developing guidelines to fill policy gaps in AMU surveillance. Recommendations to fill these gaps, based on the Potter and Brough systematic capacity building model have been proposed.

Conclusions
Strengthening AMU surveillance through using a capacity-building approach will fill gaps and strengthen efforts for AMR control in both countries.
Childbirth-related post-traumatic stress disorder symptoms and mother–infant neurophysiological and behavioral co-regulation during dyadic interaction: study protocol
Authors: Pinto Tiago Miguel , Jongenelen Inês , Lamela Diogo , Pasion Rita , Morais Ana , Costa Raquel 
Published: February 2023

Abstract
Background
Mother’s childbirth-related posttraumatic stress disorder (PTSD) symptoms have a negative impact on mother and infant’s behaviors during dyadic interactions which may increase mother–infant neurophysiological and behavioral co-regulation difficulties, leading to dysregulated mother–infant interactions. This study was specifically designed to analyze: (1) the sociodemographic and obstetric factors associated with mother’s childbirth-related PTSD symptoms; (2) mother–infant neurophysiological functioning and behavioral co-regulation during dyadic interaction; (3) the impact of mother’s childbirth-related PTSD symptoms on neurophysiological and behavioral mother–infant co-regulation during dyadic interaction; (4) the moderator role of previous trauma on the impact of mother’s childbirth-related PTSD symptoms on neurophysiological and behavioral mother–infant co-regulation during dyadic interaction; and (5) the moderator role of comorbid symptoms of anxiety and depression on the impact of mother’s childbirth-related PTSD symptoms on neurophysiological and behavioral mother–infant co-regulation during dyadic interaction.

Methods
At least 250 mothers will be contacted in order to account for refusals and dropouts and guarantee at least 100 participating mother–infant dyads with all the assessment waves completed. The study has a longitudinal design with three assessment waves: (1) 1–3 days postpartum, (2) 8 weeks postpartum, and (3) 22 weeks postpartum. Between 1 and 3 days postpartum, mothers will report on-site on their sociodemographic and obstetric characteristics. At 8 weeks postpartum, mothers will complete online self-reported measures of birth trauma, previous trauma, childbirth-related PTSD, anxiety, and depressive symptoms. At 22 weeks postpartum, mothers will complete online self-reported measures of childbirth-related PTSD, anxiety, and depressive symptoms. Mothers and infants will then be home-visited to observe and record their neurophysiological, neuroimaging and behavioral data during dyadic interactions using the Still-face Paradigm. Activation patterns in the prefrontal cortices of mother and infant will be recorded simultaneously using hyperscanning acquisition devices. Unadjusted and adjusted multilevel linear regression models will be performed to analyze objectives 1 to 3. Moderation models will be performed to analyze objectives 4 and 5.

Discussion
Data from this study will inform psychological interventions targeting mother–infant interaction, co-regulation, and infant development. Moreover, these results can contribute to designing effective screenings to identify mothers at risk of perinatal mental health problems and those who may need specialized perinatal mental health care.