bluuebunny/crossref_metadata_2025_split huggingface dataset:
Repairing the Deltoid Ligament in Ankle Fractures Is it time for a Paradigm Shift?
Authors: Van den Berg Joy , Penning Diederick , Baumbach Sebastian , Schepers Tim 
Published: January 2025

Background It remains unclear whether repairing the deltoid ligament (DL) is beneficial in acute ankle fractures. The aim of this review is to critically review the developments in deltoid ligament repair (DLR) in ankle fractures over the course of 44 years. Method An electronic search was conducted on the PubMed and Embase database including comparative studies evaluating the effect of performing DLR in adults suffering from a closed acute ankle fracture with suspected rupture of the DL. Results A total of 27 studies were retrieved, of which only one was a randomized study. A total of 1327 patients were reviewed (663 undergoing DLR and 664 receiving non-DLR treatment for an acute ankle fracture). Although earlier studies concluded that DLR holds little necessity in ankle fracture treatment if the anatomy of the ankle is restored, more recent studies support DLR due to more favorable clinical and radiographic outcomes. Discussion All studies agree that restoration of the ankle anatomy to its pre-fracture state is necessary to achieve the best clinical outcome. However, there is still controversy in whether to standardize DLR in ankle fracture treatment. The literature shows a clear shift toward more frequent restoration of the DL, and in light of improved surgical techniques and implants, there is a need for more rigorous studies to provide a clear indication for DLR in acute ankle fracture treatment. Level of Evidence: III
Prognostic significance of MRD and its correlation with arsenic concentration in pediatric acute promyelocytic leukemia: a retrospective study by SCCLG-APL group
Authors: Fan Zhong , Yang Liang-Chun , Chen Yi-Qiao , Wan Wu-Qing , Zhou Dun-Hua , Mai Hui-Rong , Li Wan-Li , Yang Li-Hua , Lan He-Kui , Chen Hui-Qin , Guo Bi-Yun , Zhen Zi-Jun , Liu Ri-Yang , Chen Guo-Hua , Feng Xiao-Qin , Liang Cong , Wang Li-Na , Yu-Li  , Luo Jie-Si , Huang Dan-Ping , Luo Xue-Qun , Li Bin , Huang Li-Bin , Zhang Xiao-Li , Tang Yan-Lai 
Published: January 2025

Background: Treatment outcomes for acute promyelocytic leukemia (APL) have improved with all-trans-retinoic acid and arsenic trioxide, yet relapse remains a concern, especially in pediatric patients. The prognostic value of minimal residual disease (MRD) post-induction and the impact of arsenic levels during induction on MRD are not fully understood. Objectives: To evaluate the relationship between post-induction MRD levels and relapse-free survival (RFS) in pediatric APL patients, and to investigate the correlation between blood arsenic concentration levels during induction therapy and MRD status. Design: A retrospective analysis of pediatric APL patients enrolled in a clinical trial from September 2011 to July 2020. Methods: We assessed the relationship between RFS and post-induction MRD levels using the log-rank test. The optimal MRD cut-off was determined using the “surv_cutpoint” function in the survminer R package. Arsenic concentration levels were monitored in 16 patients on days 7 and 14 of induction therapy, and Spearman correlation was used to analyze the relationship between arsenic concentrations and MRD levels. Results: Among 176 pediatric APL patients, with a median follow-up of 6 years, 4 relapsed. Patients with MRD >3.1% had significantly lower RFS compared to those with MRD ⩽3.1% (94.6% vs 100%, p = 0.023). In addition, a negative correlation was found between blood arsenic concentration levels and post-induction MRD levels. Lower arsenic concentrations were associated with higher MRD levels, with significant correlations observed for trough concentrations ( R = −0.666, p = 0.005) and peak concentrations ( R = −0.499, p = 0.049) on day 7. Conclusion: Our study highlights the prognostic significance of post-induction MRD assessment in pediatric APL. We also demonstrate a negative correlation between blood arsenic concentration levels and MRD, suggesting that lower arsenic concentrations during induction therapy may contribute to a higher MRD burden. These findings may inform strategies to optimize treatment and improve outcomes in pediatric APL. Trial registration: www.clinicaltrials.gov (NCT02200978).
Characterization of children’s prospective prescription review and exploration of factors influencing the success of interventions
Authors: Wen Qiang , Yang Chuang , Deng Bangjian , Zhang Yi , Song Lin 
Published: January 2025

Background: Medication safety is crucial in clinical care. Although many hospitals have implemented prospective prescription review systems to manage medication use, the impact of these systems on pediatric patients is not yet fully understood. Objectives: We explore the characteristics and economic impacts of pediatric prospective prescription review and identify factors influencing intervention success rates. Design: This study adopted a cross-sectional design. Methods: Prospective prescription review tasks were compared in the outpatient of our hospital between 2021 and 2023 to assess medication rationalization rates and cost variability. Data were collected using the PASS PharmReview system, including patient information, medication indications, prescribing physicians, intervention pharmacists, prescription rationality rate, and medication costs. SPSS 26.0 software was used to compare changes in medication rationality and medication costs between the initial (2021) and stable (2023) periods and to analyze factors affecting intervention success during the stable period by the logistic regression model. Results: The study included 11,533,807 prospective prescription review tasks. The medication rationalization rate increased from 92.0% to 95.7% ( p < 0.05) between the initial ( n = 5,392,551) and stabilization periods ( n = 6,141,256). Outpatient medication costs per capita decreased by 3.2%, from ¥320.7 to ¥310.5. Factors influencing intervention success included the following: the greater age is negatively associated with success( p < 0.001, odds ratio (OR) = 0.98); internal medicine demonstrates a superior intervention success rate compared to the surgical department ( p < 0.001, OR = 1.37); higher physician titles were associated with lower success rates ( p < 0.001, OR = 0.59); and success increased with pharmacists of higher educational levels ( p < 0.001, OR = 1.18). Conclusion: Implementing a prospective prescription review system in pediatric outpatient settings improves medication rationality and reduces errors and costs, with intervention success influenced by patient age, department, physician titles, and the educational level of pharmacists.
A comprehensive review of digital twin in healthcare in the scope of simulative health-monitoring
Authors: Nadeem Mubaris , Kostic Sascha , Dornhöfer Mareike , Weber Christian , Fathi Madjid 
Published: January 2025

Objective Digital twins (DTs) emerged in the wake of Industry 4.0 and the creation of cyber-physical systems, motivated by the increased availability and variability of machine and sensor data. DTs are a concept to create a digital representation of a physical entity and imitate its behavior, while feeding real-world data to the digital counterpart, thus allowing enabling digital simulations related to the real-world entity. The availability of new data sources raises the potential for developing structured approaches for prediction and analysis. Similarly, in the field of medicine and digital healthcare, the collection of patient-focused data is rising. Medical DTs, a new concept of structured, exchangeable representations of knowledge, are increasingly used for capturing personal health, targeting specific illnesses, or addressing complex healthcare scenarios in hospitals. Methods This article surveys the current state-of-the-art in applying DTs in healthcare, and how these twins are generated to support smart, personalized medicine. These concepts are applied to a DT for a simulated health-monitoring scenario. Results The DT use case is implemented using AnyLogic multi-agent simulation, monitoring the patient’s personal health indicators and their development. Conclusion The results indicate both possibilities and challenges and provide important insights for future DT implementations in healthcare. They have the potential to optimize healthcare in various ways, such as providing patient-centered health-monitoring.
Unpacking the Rejection of L2 Students Toward ChatGPT-Generated Feedback: An Explanatory Research
Authors: Chen (陈子淇) Ziqi , Wei (韦卫) Wei , Zhu (祝新华) Xinhua , Yao (姚远) Yuan 
Published: January 2025

Purpose Drawing on the Unified Theory of Acceptance and Use of Technology (UTAUT), this sequential mixed-method study explored L2 learners’ challenges in seeking corrective feedback in an AI-assisted educational environment. Design/Approach/Methods The data was collected from 45 university students in a Computer Science program who were encouraged to seek corrective feedback from ChatGPT for their argumentative writing report. Self-reflection data were qualitatively and quantitatively analyzed. Findings Findings suggested that 45.9% of the AI-generated feedback was rejected by students, with a higher rejection rate observed for content-focused feedback (58.7%) compared to form-focused feedback (41.3%). AI-generated content-focused feedback was rejected due to misalignments between expected and received feedback, anticipated high workload to respond, mismatch between feedback from AI and external references, and impeding conditions for students to engage with the feedback. Meanwhile, the rejection of form-focused feedback was largely associated with the high level of expected effort. Originality/Value This study is one of the few existing studies on the L2 learners’ challenges in seeking corrective feedback from generative AI systems. Notably, the study differentiates between form-focused and content-focused feedback and identifies the distinct challenges and learning opportunities that impact students’ rejection of AI feedback.
Predicting pain and its association with mortality in patients with stroke
Authors: Viktorisson Adam , Hashem Aref Haj , S Sunnerhagen Katharina , Abzhandadze Tamar 
Published: January 2025

Abstract
Background and objectives
Poststroke pain (PSP) is a prevalent and severe consequence of stroke, encompassing central, neuropathic, and nonneuropathic pain. In this study, we aimed to investigate clinical factors associated with PSP three months after stroke and concurrently explore the association between PSP and one-year mortality.

Methods
This registry-based study comprised data from stroke patients admitted to three hospitals in Sweden between November 2014 and June 2019. The outcome was PSP three months after stroke. Twelve (out of 28) predictor variables were selected by three machine learning methods, and a multivariable binary logistic regression model was fitted for predicting PSP. The association between PSP and one-year poststroke mortality was examined using Cox proportional hazards models.

Results
Among 4,160 stroke patients participating in the three-month follow-up, 54.7% reported PSP. Antiplatelet use, diabetes, hemiparesis, sensory deficits, and need for assistance before stroke were significant predictors of PSP. Male sex, being born in Sweden, higher income, and regular prestroke physical activity predicted the absence of PSP. After adjustment for age, sex, region of birth, and stroke severity, patients experiencing PSP had a significantly higher one-year mortality rate than those without pain, and the most severe level of pain (constant pain) was associated with the highest cumulative mortality.

Conclusion
The study findings indicate treatable factors associated with PSP, which highlight areas of improvement in management strategies. Clinicians should recognize that PSP is associated with increased one-year mortality, emphasizing the importance of pain prevention and treatment for enhanced poststroke outcomes.
Environmental burden of disease resulting from long-term nitrogen dioxide exposure in Germany
Authors: Sell Paulina , Plass Dietrich , Kienzler Sarah , Zeeb Hajo 
Published: January 2025

Abstract
Background
Exposure to nitrogen dioxide (NO2) is associated with an increased risk of cardiovascular, respiratory, and other diseases and health outcomes. Although NO2 emissions have decreased in Germany, concentrations currently observed still pose a threat to population health. The aim of this study is to estimate the environmental burden of disease (EBD) resulting from long-term NO2 exposure in Germany from 2010 to 2021.

Methods
To estimate the attributable disease burden, World Health Organization’s EBD approach was used. We first conducted a systematic literature review to identify exposure–response functions (ERFs) which mathematically represent the association between NO2 exposure and the health outcomes: asthma, chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus (T2DM), ischemic heart disease, lung cancer, stroke, and cardiovascular and respiratory mortality. Then, we estimated the years of life lost (YLL), years lived with disability (YLD) and, where possible, disability-adjusted life years (DALYs) due to these health outcomes in Germany, using mostly publicly available data. In a third step, using the ERFs and modelled ambient NO2 exposure data, the fraction of the disease burden attributable to NO2 exposure was estimated for each health outcome and year, stratified by sex.

Results
The systematic review yielded recent ERFs for some exposure-outcome pairs, but not always for both mortality and morbidity outcomes. A full DALY calculation was possible for COPD and T2DM. For the other outcomes, either only YLL or YLD were calculated. Summing up the estimated YLD and YLL of all outcomes, the burden of disease due to NO2 exposure in Germany decreased from 261,503 (95% UI 69,290–489,273) lost healthy years in 2010 to 100,032 (95% UI 24,558–191,715) in 2021.

Conclusions
Although the burden of disease attributable to NO2 exposure decreased from 2010 to 2021, NO2 still poses a threat to population health in Germany. While the current legal concentration limit was generally not exceeded in Germany in 2021, stricter new values proposed by WHO were frequently surpassed. When comparing the results to a previous assessment, it was obvious how strongly different input data impact the results. Transparent reporting of input data and discussing potential challenges when interpreting EBD results are critical.
Examining associations between oral cancer mortality and economic development of 13 European countries: an ecological and correlational study
Authors: Boruzs Klára , Bán Eszter Barbara , Dombrádi Viktor , Bányai Gábor , Szőllősi Gergő József , Bíró Klára 
Published: January 2025

Abstract
Background
Cancer is a significant public health issue all over the world. The diagnosis, treatment and follow-up of cancer patients are a huge health, economic and social burden for societies. The link between the state of health of a country and its economic performance has been proven by numerous studies. The aim of this study was to examine the age-standardized death rate of oral cancer in relation to the economic development of 13 European countries.

Methods
Aggregated data were collected from the European Health for All (HFA-DB) database until 2019 and analysed using second degree polynomial functions and correlation analyses, followed by time-series analysis involving vector autoregressive models.

Results
We found that in 10 of the 13 surveyed countries, the age-standardized death rate of oral cancer initially increased with GDP growth and then showed a downward trend above a certain level of economic development. Austria had a weak but significant positive effect with the second lag of GDP, Hungary had a significant negative effect with the first lag of GDP, and Italy had a significant negative effect with the second lag of GDP. In most cases, both the first and second lags of GDP changes were not statistically significant, indicating that short-term fluctuations in GDP do not directly influence changes in oral cancer mortality rates. Overall, while there are clear long-term associations between GDP and oral cancer mortality rates, the immediate causal effects of GDP changes on mortality rates are limited, suggesting that other factors and longer-term dynamics could play a more crucial role in this relationship.

Conclusions
An increase in a country’s economic development alone does not guarantee a decrease in the number of oral cancer patients. Therefore, in order to reduce the number of cases of oral cancer, strengthening education and prevention are essential.
Navigating the fear: assessing nursing students’ concerns and preventive practices in response to Monkeypox in Egypt
Authors: Amin Shaimaa Mohamed , Demerdash Doaa El , El-Sayed Mona Metwally , Salama Tasneem Ragab Ahmed , Elsehrawy Mohamed Gamal , Atta Mohamed Hussein Ramadan 
Published: January 2025

Abstract
Background
Monkeypox has emerged as a global health concern, necessitating preventive measures and awareness among healthcare students. Understanding nursing students’ fears, concerns, and preventive practices regarding Monkeypox can help improve preparedness and response strategies.

Aim
This study aimed to assess the levels of fear, concerns, and preventive practices related to monkeypox among nursing students at Beni Suef University, Egypt, during the 2024–2025 academic year.

Methods
A cross-sectional descriptive design was employed, involving 505 nursing students systematically randomized recruited. Data collection utilized three validated tools: the Monkeypox Fear Scale, Monkeypox Concern Scale, and Monkeypox Preventive Practices Scale. Reliability was confirmed with Cronbach’s alpha values ranging from 0.87 to 0.94. Data analysis included descriptive statistics, Spearman correlation, and multiple linear regression using SPSS Version 23.

Results
Most (56.2%) students rarely worried about Monkeypox infection, though 49.2% reported anxiety influenced by media coverage. High preventive practices were noted, with 60.6% frequently practicing hygiene measures. A strong positive correlation between Monkeypox concern and fear (r = 0.646, p < 0.001) and a moderate positive correlation between Monkeypox concern and preventive practices (r = 0.229, p = 0.001). Fear was also significantly correlated with preventive practices (r = 0.432, p < 0.001). Multiple linear regression analysis (R² = 0.216, F = 22.633, p < 0.001) revealed that fear was a strong positive predictor of preventive practices, while Monkeypox concern had a positive but non-significant effect (B = 0.138, p = 0.156). Age was not a significant predictor (B = 0.251, p = 0.637), whereas family income showed a significant negative association (B = -1.885, p = 0.010).

Conclusion
The study revealed moderate fear and concerns among nursing students, with generally high adherence to preventive practices.

Implication
Findings suggest the need for targeted health education programs to address monkeypox-related concerns and enhance preventive measures, thus improving nursing students’ readiness to respond to emerging health threats.
Knowledge, attitude and practice of family caregivers on pressure injury prevention for community-dwelling older adults: a cross-sectional study in an Indonesia City
Authors: Sari Sheizi Prista , Everink Irma H. J. , Lohrmann Christa , Amir Yufitriana , Sari Eka Afrima , Halfens Ruud J. G. , Schols Jos M. G. A. 
Published: January 2025

Abstract
Background
Older adults in Indonesia are mostly living at home with their families. Informal care provided by family caregivers is essential to prevent older adults from getting pressure injuries (PIs). The objectives of this study were to examine the knowledge, attitude and practice of family caregivers regarding PI prevention among community-dwelling older adults in Indonesia.

Methods
A cross-sectional survey was conducted involving 267 family caregivers randomly selected from a population list provided by municipalities in Bandung, West Java, Indonesia. The study utilized the paper-based Knowledge, Attitude, and Practice on Pressure Injury (KAP-PI) questionnaire. Descriptive analyses (i.e. percentage, mean and standard deviation) were used to present participants’ scores in each domain based on their characteristics or categories and scores in every single item of questions or statements. Bivariate comparison analyses were conducted using independent t-test or ANOVA test to compare scores and a Chi-square was run to check correlations between knowledge, attitude and practice domains.

Results
This study show that more than half of the participants (61.0%) had insufficient knowledge about PI prevention, but nearly all participants (94.4%) had a positive attitude toward PI prevention for their older relatives. Still, 41.2% of the participants had inadequate practice on PI prevention. A correlation analysis revealed that having sufficient knowledge and a positive attitude towards PI prevention were positively correlated with practice (p < .05).

Conclusion
This study highlights a significant gap in family caregivers’ knowledge and practice regarding pressure injury (PI) prevention, despite their generally positive attitudes toward the care of older relatives. The findings are the initial diagnosis to guide educational strategies. Research should be performed to explore effective educational materials and an education program and also the necessary professional support to strengthen family caregivers’ role in PI prevention.
Reversal gene expression assessment for drug repurposing, a case study of glioblastoma
Authors: Sun Shixue , Shyr Zeenat , McDaniel Kathleen , Fang Yuhong , Tao Dingyin , Chen Catherine Z. , Zheng Wei , Zhu Qian 
Published: January 2025

Abstract
Background
Glioblastoma (GBM) is a rare brain cancer with an exceptionally high mortality rate, which illustrates the pressing demand for more effective therapeutic options. Despite considerable research efforts on GBM, its underlying biological mechanisms remain unclear. Furthermore, none of the United States Food and Drug Administration (FDA) approved drugs used for GBM deliver satisfactory survival improvement.

Methods
This study presents a novel computational pipeline by utilizing gene expression data analysis for GBM for drug repurposing to address the challenges in rare disease drug development, particularly focusing on GBM. The GBM Gene Expression Profile (GGEP) was constructed with multi-omics data to identify drugs with reversal gene expression to GGEP from the Integrated Network-Based Cellular Signatures (iLINCS) database.

Results
We prioritized the candidates via hierarchical clustering of their expression signatures and quantification of their reversal strength by calculating two self-defined indices based on the GGEP genes’ log2 foldchange (LFC) that the drug candidates could induce. Among five prioritized candidates, in-vitro experiments validated Clofarabine and Ciclopirox as highly efficacious in selectively targeting GBM cancer cells.

Conclusions
The success of this study illustrated a promising avenue for accelerating drug development by uncovering underlying gene expression effect between drugs and diseases, which can be extended to other rare diseases and non-rare diseases.