bluuebunny/crossref_metadata_2025_split huggingface dataset:
MRI-based radiomics model and nomogram for predicting the outcome of locoregional treatment in patients with hepatocellular carcinoma
Authors: Wang Yuxin , Liu Zhenhao , Xu Hui , Yang Dawei , Jiang Jiahui , Asayo Himeko , Yang Zhenghan 
Published: May 2023

Abstract
Background
Prediction of locoregional treatment response is important for further therapeutic strategy in patients with hepatocellular carcinoma. This study aimed to investigate the role of MRI-based radiomics and nomogram for predicting the outcome of locoregional treatment in patients with hepatocellular carcinoma.

Methods
The initial postoperative MRI after locoregional treatment in 100 patients with hepatocellular carcinoma was retrospectively analysed. The outcome was evaluated according to mRECIST at 6 months. We delineated the tumour volume of interest on arterial phase, portal venous phase and T2WI. The radiomics features were selected by using the independent sample t test or nonparametric Mann‒Whitney U test and the least absolute shrinkage and selection operator. The clinical variables were selected by using univariate analysis and multivariate analysis. The radiomics model and combined model were constructed via multivariate logistic regression analysis. A nomogram was constructed that incorporated the Rad score and selected clinical variables.

Results
Fifty patients had an objective response, and fifty patients had a nonresponse. Nine radiomics features in the arterial phase were selected, but none of the portal venous phase or T2WI radiomics features were predictive of the treatment response. The best radiomics model showed an AUC of 0.833. Two clinical variables (hCRP and therapy method) were selected. The AUC of the combined model was 0.867. There was no significant difference in the AUC between the combined model and the best radiomics model (P = 0.573). Decision curve analysis demonstrated the nomogram has satisfactory predictive value.

Conclusions
MRI-based radiomics analysis may serve as a promising and noninvasive tool to predict outcome of locoregional treatment in HCC patients, which will facilitate the individualized follow-up and further therapeutic strategies guidance.
Optimal sequencing of the first- and second-line target therapies in metastatic renal cell carcinoma: based on nationally representative data analysis from the Korean National Health Insurance System
Authors: Kang Dong Hyuk , Lee Joo Yong , Lee Yunhee , Ha U-Syn 
Published: May 2023

Abstract
Background
The authors intend to compare the effects of each targeted therapy (TT) in the treatment of patients with metastatic renal cell carcinoma (mRCC) using big data based on the Korean National Health Insurance System (NHIS) and determine the optimal treatment sequence.

Methods
Data on the medical use of patients with kidney cancer were obtained from the NHIS database from January 1, 2002, to December 31, 2020. Patient variables included age, sex, income level, place of residence, prescribing department, and duration from diagnosis to the prescription date. The primary outcome was overall survival (OS) for each drug and sequencing. We performed propensity score matching (PSM) according to age, sex, and Charlson Comorbidity Index based on the primary TTs.

Results
After 1:1 PSM, the sunitinib (SUN) (n = 1,214) and pazopanib (PAZ) (n = 1,214) groups showed a well-matched distribution across the entire cohort. In the primary treatment group, PAZ had lower OS than SUN (HR, 1.167; p = 0.0015). In the secondary treatment group, axitinib (AXI) had more favorable OS than cabozantinib (CAB) (HR, 0.735; p = 0.0118), and everolimus had more adverse outcomes than CAB (HR, 1.544; p < 0.0001). In the first to second TT sequencing, SUN–AXI had the highest OS; however, there was no statistically significant difference when compared with PAZ–AXI, which was the second highest (HR, 0.876; p = 0.3312). The 5-year survival rate was calculated in the following order: SUN–AXI (51.44%), PAZ–AXI (47.12%), SUN–CAB (43.59%), and PAZ–CAB (34.28%). When the four sequencing methods were compared, only SUN–AXI versus PAZ–CAB (p = 0.003) and PAZ–AXI versus PAZ–CAB (p = 0.017) were statistically significant.

Conclusions
In a population-based RWD analysis of Korean patients with mRCC, SUN-AXI sequencing was shown to be the most effective among the first to second TT sequencing methods in treatment, with a relative survival advantage over other sequencing combinations. To further support the results of this study, risk-stratified analysis is needed.
Identification of urgent gaps in public and policymaker knowledge of heart failure: Results of a global survey
Authors: Lam Carolyn S. P. , Harding Ed , Bains Marc , Chin Alex , Kanumilli Naresh , Petrie Mark C. , Pohja-Hutchison Paula , Yang Jiefu , Butler Javed 
Published: May 2023

Abstract
Background
Despite advances in the treatment of heart failure (HF) with reduced ejection fraction, people with HF continue to have a high risk of mortality and hospitalisation. Patients also suffer from poor quality of life, with reduced societal and economic participation. The burden of HF on patients and healthcare systems is extraordinary, yet awareness remains low. This survey was conducted to identify gaps in general public and policymaker knowledge around HF.

Methods
A closed-question web-based survey of the general public and policymakers was conducted between February and October 2020. Study outcomes assessed the participants’ awareness and understanding of HF symptoms, risk factors and mortality, and views around hospital admissions in their country. Responses were collected using multiple-choice questions.

Results
The survey was completed by 26,272 general public respondents in 13 countries and 281 government and public sector policymakers in nine countries. While 99% of general public respondents had heard of HF, their understanding of the condition and its symptoms was poor, and only 6% identified that shortness of breath, fatigue, and leg swelling were the main symptoms of HF. Of policymaker respondents, 14% identified HF as the leading cause of avoidable hospitalisations, and only 4% recognised that ~ 87% of government spending on HF is related to hospitalisations.

Conclusions
Major gaps were identified in the understanding of HF and the burden it places on patients and their caregivers, healthcare systems and society. This study confirms an ongoing need for national policy strategies and investment to raise awareness of the importance of HF prevention, early diagnosis, and implementation of effective treatments to reduce hospitalisations and death.
Hurricanes Irma and Maria and Diabetes incidence in Puerto Rico
Authors: Martínez-Lozano Marijulie , Noboa Carlamarie , Alvarado-González Gerardo , Joshipura Kaumudi J. 
Published: May 2023

Abstract
Objective
To evaluate the impact of Hurricanes Irma/Maria on diabetes incidence in Puerto Rico. Mortality increased substantially after the hurricanes, but morbidity was not assessed.

Methods
We recruited 364 participants from the San Juan Overweight Adults Longitudinal Study (SOALS) aged 40–65 years who completed a three-year follow-up and were free of diabetes. We conducted additional questionnaires 1.7–2.5 years after hurricanes. Glycosylated hemoglobin (HbA1c), fasting glucose and insulin were assessed at all three visits. We compared diabetes incidence between pre-hurricane visits and between visits spanning the hurricanes using Generalized Estimating Equation (GEE) adjusting for within person repeated measures, age, and body mass index (BMI).

Results
Diabetes incidence was significantly higher spanning the hurricanes than pre-hurricane (multivariate GEE model: IRR = 2.1; 95% CI: 1.4–3.1). There was a significantly higher increase spanning the hurricanes compared to pre-hurricanes for Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (median: 0.3 uIU/mL vs. 0.2 uIU/mL). HbA1c levels increased by 0.4% spanning the hurricanes.

Conclusion
Increases in diabetes incidence, HOMA-IR and HbA1c were higher spanning the hurricanes compared to the pre-hurricanes period. The increase in diabetes incidence remains significant after adjusting for age and BMI.
Cross-sectional survey of attitudes and beliefs towards dementia risk reduction among Australian older adults
Authors: Siette Joyce , Dodds Laura , Deckers Kay , Köhler Sebastian , Armitage Christopher J. 
Published: May 2023

AbstractBackgroundLittle is known about what drives older adults’ motivation to change their behaviour and whether that is associated with their personal dementia risk profile. Our aims were to (i) understand what sociodemographic factors are associated with older Australians’ motivation to change behaviour to reduce their dementia risk, and (ii) explore the relationship between socio-demographic factors and motivation to reduce dementia risk with health- and lifestyle-based dementia risk scores in older adults.MethodsA cross-sectional online postal or telephone survey was administered to community-dwelling older adults in New South Wales, Australia between January and March 2021. Measures included socioeconomic status, locality, and health status, the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) scale and the lifestyle-based dementia risk score (LIBRA index). Multiple linear regression analyses were used to explore the associations for (i) sociodemographic factors and motivation to reduce dementia risk (MCLHB-DRR scales) and (ii) sociodemographic factors and motivation to reduce dementia risk with health- and lifestyle-based dementia risk (LIBRA index).ResultsA total of 857 older adults (mean age 73.3 years, SD = 6.0, range 65–94; 70% women; 34.6% less than grade 6 education) completed the survey. Respondents reported high levels of motivation to adopt behaviour changes, agreeing on the importance of good health. Individuals who were younger were more likely to have greater motivation to modify lifestyle to reduce dementia risk and had higher perceived benefits to gain by adopting a healthy lifestyle. Dementia risk scores were moderately low (mean LIBRA index =− 2.8 [SD = 2.0], range − 5.9–3.8), indicating relatively moderate-to-good brain health. Men with low socioeconomic status and higher perceived barriers to lifestyle change had higher dementia risk scores.ConclusionsPublic health campaigns need to overcome motivational barriers to support reductions in dementia risk. A multifaceted and inclusive approach targeting both sociodemographic differences and impediments to brain healthy lifestyles is required to achieve genuine change.Trial registrationACTRN12621000165886, Date of registration: 17/02/2021.
Translation, cultural adaptation and validity assessment of the Dutch version of the eHealth Literacy Questionnaire: a mixed-method approach
Authors: Poot Charlotte C. , Meijer Eline , Fokkema Marjolein , Chavannes Niels H. , Osborne Richard H. , Kayser Lars 
Published: May 2023

Abstract
Background
The digitalization of healthcare requires users to have sufficient competence in using digital health technologies. In the Netherlands, as well as in other countries, there is a need for a comprehensive, person-centered assessment of eHealth literacy to understand and address eHealth literacy related needs, to improve equitable uptake and use of digital health technologies.

Objective
We aimed to translate and culturally adapt the original eHealth Literacy Questionnaire (eHLQ) to Dutch and to collect initial validity evidence.

Methods
The eHLQ was translated using a systematic approach with forward translation, an item intent matrix, back translation, and consensus meetings with the developer. A validity-driven and multi-study approach was used to collect validity evidence on 1) test content, 2) response processes and 3) internal structure. Cognitive interviews (n = 14) were held to assess test content and response processes (Study 1). A pre-final eHLQ version was completed by 1650 people participating in an eHealth study (Study 2). A seven-factor Confirmatory Factor Analysis (CFA) model was fitted to the data to assess the internal structure of the eHLQ. Invariance testing was performed across gender, age, education and current diagnosis.

Results
Cognitive interviews showed some problems in wording, phrasing and resonance with individual’s world views. CFA demonstrated an equivalent internal structure to the hypothesized (original) eHLQ with acceptable fit indices. All items loaded substantially on their corresponding latent factors (range 0.51–0.81). The model was partially metric invariant across all subgroups. Comparison of scores between groups showed that people who were younger, higher educated and who had a current diagnosis generally scored higher across domains, however effect sizes were small. Data from both studies were triangulated, resulting in minor refinements to eight items and recommendations on use, score interpretation and reporting.

Conclusion
The Dutch version of the eHLQ showed strong properties for assessing eHealth literacy in the Dutch context. While ongoing collection of validity evidence is recommended, the evidence presented indicate that the eHLQ can be used by researchers, eHealth developers and policy makers to identify eHealth literacy needs and inform the development of eHealth interventions to ensure that people with limited digital access and skills are not left behind.
Supporting intersecting cultural needs of gender and age by increasing cultural safety and humility for Housing First initiatives
Authors: Fang Mei Lan , Canham Sarah L. , Battersby Lupin 
Published: May 2023

Abstract
Background
To sufficiently house and support persons experiencing homelessness (PEH), deeper understandings of the cultural appropriateness and responsiveness of community resources and the service delivery system is essential. In the case of Metro Vancouver, Canada, the cultural appropriateness and responsiveness of Housing First as a service model for supporting PEH was explored.

Methods
Local service providers and stakeholders (n = 52) participated in three full day service-mapping workshops to identify Housing First supports for older adults, youth, and women experiencing homelessness, as part of a municipal-wide participatory and action-oriented study. Data were analyzed using a structured framework thematic analysis approach and cultural safety and humility lenses.

Results
We generated three key themes: (i) insufficient built environments create challenges across gender and age, (ii) cultural safety and humility concerns at the intersection of gender and age, and (iii) implications for a culturally-responsive Housing First implementation.

Conclusions
Findings informed the development of a Culturally-Responsive Planning resource to support housing, health, and social service providers who are implementing Housing First initiatives.
Between guidelines and clinical trials: evidence-based advice on the pharmacological management of non-specific chronic low back pain
Authors: Migliorini Filippo , Vaishya Raju , Pappalardo Gaetano , Schneider Marco , Bell Andreas , Maffulli Nicola 
Published: May 2023

AbstractThe pharmacological management of nonspecific chronic low back pain (NCLBP) aims to restore patients’ daily activities and improve their quality of life. The management of NCLBP is not well codified and extremely heterogeneous, and residual symptoms are common. Pharmacological management should be considered as co-adjuvant to non-pharmacological therapy, and should be guided by the symptoms reported by the patients. Depending on the individual severity of NCLPB, pharmacological management may range from nonopioid to opioid analgesics. It is important to identify patients with generalized sensory hypersensitivity, who may benefit from dedicated therapy. This article provides an evidence-based overview of the principles of pharmacological management of NCLPB.
A solitary osteolytic lesion with pathological fracture in the cervical spine - a case report
Authors: Kuang Guan-Ming , Loo Nga-Nuen , Gao Qingpeng , Li Jishi , Luo Lin , Chen Shuang , Cheung Jason Pui Yin , Cheung Kenneth M.C. 
Published: May 2023

Abstract
Background
Langerhans cell histiocytosis (LCH) is a rare disorder. The treatment options vary depending on how many organs are involved and how extensive the disease is. In this report, a case of LCH with isolated 6th cervical vertebra (C6) collapse was presented. This case was treated with anterior corpectomy and instrumented fusion, followed by local radiotherapy (RT), with a good clinical outcome up to postoperative six months.

Case presentation
This was a 47-year-old female patient with a complaint of neck pain and bilateral shoulder pain for two months before consultation. She was initially treated with analgesics, but the pain was persistent. Further radiological evaluations revealed an osteolytic lesion within the C6 vertebral body with a pathological fracture. Magnetic resonance imaging (MRI) with contrast of the cervical spine revealed diffused hypointense signal changes on the T1-weighted images and hyperintense signal changes on the T2-weighted images in the C6 vertebral body, with significant contrast-enhanced infiltration signals. Furthermore, in positron emission tomography-computed tomography (PET-CT), focal hypermetabolism and abnormal uptake signals were seen only in the C6 vertebral body. The patient underwent an anterior cervical corpectomy with instrumented fusion. The histopathological results confirmed the diagnosis of LCH. The patient reported significant pain relief on postoperative day one. Moreover, she was treated by local RT at postoperative one month. Good clinical outcomes were achieved in the form of no pain and recovery in neck mobility up to postoperative six months. No evidence of recurrence was observed at the final follow-up.

Conclusions
This case report describes a treatment option for a solitary C6 collapse with LCH managed by anterior corpectomy and instrumented fusion, followed by local RT, with a good clinical outcome at postoperative six months. More studies are needed to elucidate whether such a treatment strategy is superior to surgery or RT alone.
Knowledge of Saudi dental students and interns towards luting cements and their applications in fixed prosthodontics
Authors: Ellakany Passent , Abualsaud Reem , Gad Mohammed M. , Atteya Sara , El Meligy Omar A. , Qutub Osama A. , Mahrous Amr A. 
Published: May 2023

Abstract
Background
Enhancement of students’ knowledge is essential in improving their clinical skills and performance. Thus, the curriculum should be prepared to achieve a better outcome. The current study aimed to determine the dental students’ and interns’ basic knowledge towards dental luting cements and their application in dental practice to improve the theoretical and clinical training sections.

Materials and methods
A cross–sectional study was conducted among dental students and interns at three Colleges of Dentistry in the Kingdom of Saudi Arabia between September 2019–June 2020. An online questionnaire was used which included demographic data, questions about luting cement usage, cementation techniques, and commonly used cements in dental clinics. Descriptive analysis and chi–square test were used to show the association between level of dental education and the use of dental cements using SPSS software. The significance level was set at 5%.

Results
The total respondents were 626 dental students/interns of whom 78.8% were undergraduate dental students. Participants who reported undergraduate studies as the source of information were 79.7%. The type of restoration was the main factor in luting cement selection (62.6%). Concerning the isolation technique in cementing laminate veneers, 49.7% used dri–angles, cotton rolls and saliva ejectors. Dual–cure resin cement was the most common cement used in all the mentioned restorations except in pressed porcelain laminate veneers and cement–retained implant–supported restorations.

Conclusions
Students’ knowledge and practice in managing dental implants and porcelain laminate veneers need to be improved. The selection of a luting agent for a given restoration by students and interns was based on the basic knowledge, available cement, and the type of restoration. Awareness towards the management of short prepared teeth and custom-made cast posts and cores is also limited.
Association between quality antenatal care and low birth weight in Rwanda: a cross-sectional study design using the Rwanda demographic and health surveys data
Authors: Uwimana Gérard , Elhoumed Mohamed , Gebremedhin Mitslal Abrha , Azalati Mougni Mohamed , Nan Lin , Zeng Lingxia 
Published: May 2023

Abstract
Background
Low birth weight (LBW) is an important factor influencing infant morbidity and mortality. Pregnant women should receive a variety of interventions during antenatal care (ANC) that are crucial in improving birth weight. ANC visits alone do not promise that women have received all recommended antenatal services. However, there are limited evidence of the relationship between ANC quality and LBW in Rwanda. Therefore, the purpose of this study was to assess the association between quality ANC and LBW along with the factors influencing LBW and how quality ANC affects LBW in Rwandan pregnant women.

Methods
The Demographic and Health Surveys (DHS) are cross-sectional, nationally representative household surveys that collect population, health, and nutrition. In this Study we used three waves of Rwanda Demographic and Health Surveys 2010,2014-5 and 2019-20. A total of 16,144 women aged 15 to 49 years who had live births in the five years preceding each survey were included in this study. A stratified two-stage sampling methods was used to select the participants. The first stage involves selecting clusters (villages) from a list of all clusters in the country. The second stage involves selecting households within each cluster. A survey adjusted for clusters at multiple level and a bivariate and multivariable logistic regression was used to estimate adjusted odds ratios(aOR) and 95% confidence intervals to assess the association between the outcome and independent variables.

Results
The utilization of a high-quality ANC increased slightly over the three survey years and LBW had a slow decline. Out of 5813 women;201(3.45%) had high-quality ANC in the 2010 survey, and out of 5813 newborns,180(3.10%) were LBW. Out of 5404 women;492(9.11%) had high-quality ANC in 2015, and out of 5404 newborns,151(2.79% were LBW). Out of 5203 women,776(14.92%) had high-quality ANC in the 2020 survey year, and out of the 5206 newborns,139(2.67%) were LBW. In multivariable analysis, at a borderline limit high quality ANC was negatively associated with LBW(aOR:0.67;95%CI:0.43,1.05) compared to low-quality ANC. Higher birth orders of the newborn were negatively associated with LBW (aOR:0.63;95%CI:0.49,0.82 and aOR:0.44;95%CI:0.32,0.61 for 2nd -3rd and 4th and above respectively) compared to 1st orders newborn. Newborns from rich households were less likely to experience LBW than those from poor households (aOR:0.71;95%CI:0.55,0.91). Female newborns were associated with an increase of LBW (aOR:1.43;95% CI:1.18,1.73) than male newborns.

Conclusion
The findings confirm the fundamental importance of a high-quality ANC on LBW. The findings could be utilized to develop monitoring strategies and assess pregnancy health assistance programs with a focus on LBW reduction.