bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of combination therapy with GABA, a DPP-4i and a PPI as an adjunct to insulin therapy in patients with type 1 diabetes
Authors: Rabinovitch Alexander , Koshelev Daniil , Lagunas-Rangel Francisco Alejandro , Kosheleva Liudmila , Gavra Tali , Schiöth Helgi B. , Levit Shmuel 
Published: May 2023

IntroductionThe purpose of this retrospective clinic chart review study was to determine the potential of a combination therapy (CT) consisting of γ-aminobutyric acid (GABA), a dipeptidyl peptidase-4 inhibitor (DPP-4i), and a proton pump inhibitor (PPI) to improve glycemic control as an adjunct to insulin therapy in patients with type 1 diabetes (T1D).Research design and methodsNineteen patients with T1D on insulin therapy were treated with additional CT in oral form. Fasting blood glucose (FBG), HbA1c, insulin dose-adjusted HbA1c (IDA-A1c), daily insulin dose, insulin/weight ratio (IWR), and fasting plasma C-peptide were measured after 26-42 weeks of treatments.ResultsFBG, HbA1c, IDA-A1c, insulin dose and IWR were all significantly decreased while plasma C-peptide was significantly increased by the CT. Treatment outcomes were further analyzed by separation of the 19 patients into two groups. One group started on the CT within 12 months of insulin treatment (early therapy, 10 patients) and another group started on this therapy only after 12 months of insulin treatment (late therapy, 9 patients). FBG, IDA-A1c, insulin dose, and IWR decreased significantly in both the early and late CT groups, however to a better extent in the early therapy group. Moreover, plasma C-peptide increased significantly only in the early therapy group, and 7 of the 10 patients in this group were able to discontinue insulin treatment while maintaining good glycemic control to study end compared with none of the 9 patients in the late therapy group.ConclusionThese results support the concept that the combination of GABA, a DPP-4i and a PPI as an adjunct to insulin therapy improves glycemic control in patients with T1D, and that the insulin dose required for glycemic control can be reduced or even eliminated in some patients receiving this novel therapy.
Elevated road segment (ERS) passage design may provide enhanced connectivity for amphibians, reptiles, and small mammals
Authors: Brehme Cheryl S. , Barnes Stephanie , Ewing Brittany , Gould Philip , Vaughan Cassie , Hobbs Michael , Tornaci Charles , Holm Sarah , Sheldon Hanna , Fiutak Jon , Fisher Robert N. 
Published: May 2023

IntroductionDesigns for safe and effective road crossing structures for small animals are typically under-road microtunnels and culverts which have varying levels of effectiveness reported in the scientific literature. Many species, particularly migratory amphibians, may have limited ability to find and use passages if they are too far apart, resulting in substantial barrier effects.MethodsWe designed a novel open elevated passage (elevated road segment: ERS), similar to a low terrestrial bridge, that could theoretically be built to any length based upon species needs and movement characteristics. A 30 m length prototype ERS was installed along a forest road with a history of amphibian road mortality in Sierra National Forest, Fresno County, CA, USA. From 2018 to 2021, we monitored small animal activity under the ERS in relation to surrounding roadside and forest habitats using active infrared cameras.ResultsWe documented a total of 8,815 unique use events, using species specific independence criteria, across 22 species of amphibians (3), reptiles (4), and small mammals (15). Poisson regression modeling of taxonomic group activity under the ERS, roadside and forest, showed that amphibian activity was highest in the forest habitat, no differences were observed for reptiles, and small mammal activity was highest under the ERS. However, mean activity estimates under the ERS were equal to or greater than the open roadside habitat for all 22 species, suggesting that adding cover objects, such as downed logs and vegetation may further enhance passage use.DiscussionOverall, results showed that the design of the ERS crossing has potential to provide high connectivity for a wide range of amphibian, reptile, and small mammal species while reducing road mortality. ERS systems can also be used in areas with challenging terrain and other hydrological and environmental constraints. Incorporating current road ecology science, we provide supplemental ERS concept designs for secondary roads, primary roads and highways to help increase the options available for road mitigation planning for small animals.
Self-monitoring of blood glucose levels among pregnant individuals with gestational diabetes: a systematic review and meta-analysis
Authors: Yeh Ping Teresa , Kennedy Caitlin Elizabeth , Rhee Dong Keun , Zera Chloe , Tunçalp Özge , Lucido Briana , Gomez Ponce de Leon Rodolfo , Narasimhan Manjulaa 
Published: May 2023

IntroductionThe World Health Organization (WHO) recommends treatment and management of gestational diabetes (GD) through lifestyle changes, including diet and exercise, and self-monitoring blood glucose (SMBG) to inform timely treatment decisions. To expand the evidence base of WHO's guideline on self-care interventions, we conducted a systematic review of SMBG among pregnant individuals with GD.SettingFollowing PRISMA guidelines, we searched PubMed, CINAHL, LILACS, and EMBASE for publications through November 2020 comparing SMBG with clinic-based monitoring during antenatal care (ANC) globally.Primary and secondary outcome measuresWe extracted data using standardized forms and summarized maternal and newborn findings using random effects meta-analysis in GRADE evidence tables. We also reviewed studies on values, preferences, and costs of SMBG.ResultsWe identified 6 studies examining SMBG compared to routine ANC care, 5 studies on values and preferences, and 1 study on costs. Nearly all were conducted in Europe and North America. Moderate-certainty evidence from 3 randomized controlled trials (RCTs) showed that SMBG as part of a package of interventions for GD treatment was associated with lower rates of preeclampsia, lower mean birthweight, fewer infants born large for gestational age, fewer infants with macrosomia, and lower rates of shoulder dystocia. There was no difference between groups in self-efficacy, preterm birth, C-section, mental health, stillbirth, or respiratory distress. No studies measured placenta previa, long-term complications, device-related issues, or social harms. Most end-users supported SMBG, motivated by health benefits, convenience, ease of use, and increased confidence. Health workers acknowledged SMBG's convenience but were wary of technical problems. One study found SMBG by pregnant individuals with insulin-dependent diabetes was associated with decreased costs for hospital admission and length of stay.ConclusionSMBG during pregnancy is feasible and acceptable, and when combined in a package of GD interventions, is generally associated with improved maternal and neonatal health outcomes. However, research from resource-limited settings is needed.Systematic Review RegistrationPROSPERO CRD42021233862.
Improved clinical outcomes in response to a 12-week blended digital and community-based long-COVID-19 rehabilitation programme
Authors: Smith Jemma L. , Deighton Kevin , Innes Aidan Q. , Holl Marc , Mould Laura , Liao Zhining , Doherty Patrick , Whyte Greg , King James A. , Deniszczyc Davina , Kelly Benjamin M. 
Published: May 2023

IntroductionTwo million people in the UK are experiencing long COVID (LC), which necessitates effective and scalable interventions to manage this condition. This study provides the first results from a scalable rehabilitation programme for participants presenting with LC.Methods601 adult participants with symptoms of LC completed the Nuffield Health COVID-19 Rehabilitation Programme between February 2021 and March 2022 and provided written informed consent for the inclusion of outcomes data in external publications. The 12-week programme included three exercise sessions per week consisting of aerobic and strength-based exercises, and stability and mobility activities. The first 6 weeks of the programme were conducted remotely, whereas the second 6 weeks incorporated face-to-face rehabilitation sessions in a community setting. A weekly telephone call with a rehabilitation specialist was also provided to support queries and advise on exercise selection, symptom management and emotional wellbeing.ResultsThe 12-week rehabilitation programme significantly improved Dyspnea-12 (D-12), Duke Activity Status Index (DASI), World Health Orginaisation-5 (WHO-5) and EQ-5D-5L utility scores (all p &lt; 0.001), with the 95% confidence intervals (CI) for the improvement in each of these outcomes exceeding the minimum clinically important difference (MCID) for each measure (mean change [CI]: D-12: −3.4 [−3.9, −2.9]; DASI: 9.2 [8.2, 10.1]; WHO-5: 20.3 [18.6, 22.0]; EQ-5D-5L utility: 0.11 [0.10, 0.13]). Significant improvements exceeding the MCID were also observed for sit-to-stand test results (4.1 [3.5, 4.6]). On completion of the rehabilitation programme, participants also reported significantly fewer GP consultations (p &lt; 0.001), sick days (p = 0.003) and outpatient visits (p = 0.007) during the previous 3 months compared with baseline.DiscussionThe blended and community design of this rehabilitation model makes it scalable and meets the urgent need for an effective intervention to support patients experiencing LC. This rehabilitation model is well placed to support the NHS (and other healthcare systems worldwide) in its aim of controlling the impacts of COVID-19 and delivering on its long-term plan.Clinical trial registrationhttps://www.isrctn.com/ISRCTN14707226, identifier 14707226.
A low-cost and portable wrist exoskeleton using EEG-sEMG combined strategy for prolonged active rehabilitation
Authors: Yang Shiqi , Li Min , Wang Jiale , Shi Zhilei , He Bo , Xie Jun , Xu Guanghua 
Published: May 2023

IntroductionHemiparesis is a common consequence of stroke that severely impacts the life quality of the patients. Active training is a key factor in achieving optimal neural recovery, but current systems for wrist rehabilitation present challenges in terms of portability, cost, and the potential for muscle fatigue during prolonged use.MethodsTo address these challenges, this paper proposes a low-cost, portable wrist rehabilitation system with a control strategy that combines surface electromyogram (sEMG) and electroencephalogram (EEG) signals to encourage patients to engage in consecutive, spontaneous rehabilitation sessions. In addition, a detection method for muscle fatigue based on the Boruta algorithm and a post-processing layer are proposed, allowing for the switch between sEMG and EEG modes when muscle fatigue occurs.ResultsThis method significantly improves accuracy of fatigue detection from 4.90 to 10.49% for four distinct wrist motions, while the Boruta algorithm selects the most essential features and stabilizes the effects of post-processing. The paper also presents an alternative control mode that employs EEG signals to maintain active control, achieving an accuracy of approximately 80% in detecting motion intention.DiscussionFor the occurrence of muscle fatigue during long term rehabilitation training, the proposed system presents a promising approach to addressing the limitations of existing wrist rehabilitation systems.
Stroke burden and attributable risk factors in China, 1990–2019
Authors: Tian Wenxin , Zhu Guanghan , Xiao Wenbo , Gao Bei , Lu Wenli , Wang Yuan 
Published: May 2023

Background and purposeUnderstanding the temporal trends of stroke burden and its attributable risk factors are essential for targeted prevention strategies. We aimed to describe the temporal trends and attributable risk factors of stroke in China.MethodsData on the stroke burden [incidence, prevalence, mortality, and disability-adjusted life years (DALYs)] and the population-attributable fraction for stroke risk factors from 1990 to 2019 were obtained from the Global Burden of Disease Study 2019 (GBD 2019). We analyzed trends in the burden of stroke and its attributable risk factors from 1990 to 2019, and the characteristics of stroke-attributable risk factors by sex, age group, and stroke subtype.ResultsFrom 1990 to 2019, the age-standardized incidence, mortality, and DALY rates for total stroke decreased by 9.3% (3.3, 15.5), 39.8% (28.6, 50.7), and 41.6% (30.7, 50.9) respectively. The corresponding indicators all decreased for intracerebral hemorrhage and subarachnoid hemorrhage. The age-standardized incidence rate of ischemic stroke increased by 39.5% (33.5 to 46.2) for male patients and by 31.4% (24.7 to 37.7) for female patients, and the age-standardized mortality and DALY rates remained almost unchanged. The three leading stroke risk factors were high systolic blood pressure, ambient particulate matter pollution, and smoking. High systolic blood pressure has remained the leading risk factor since 1990. The attributable risk of ambient particulate matter pollution shows a clear upward trend. Smoking and alcohol consumption were important risk factors for men.ConclusionThis study reinforced the findings of an increased stroke burden in China. Precise stroke prevention strategies are needed to reduce the disease burden of stroke.
Improved HHT-microstate analysis of EEG in nicotine addicts
Authors: Xiong Xin , Feng Jiannan , Zhang Yaru , Wu Di , Yi Sanli , Wang Chunwu , Liu Ruixiang , He Jianfeng 
Published: May 2023

BackgroundSubstance addiction is a chronic disease which causes great harm to modern society and individuals. At present, many studies have applied EEG analysis methods to the substance addiction detection and treatment. As a tool to describe the spatio-temporal dynamic characteristics of large-scale electrophysiological data, EEG microstate analysis has been widely used, which is an effective method to study the relationship between EEG electrodynamics and cognition or disease.MethodsTo study the difference of EEG microstate parameters of nicotine addicts at each frequency band, we combine an improved Hilbert Huang Transformation (HHT) decomposition with microstate analysis, which is applied to the EEG of nicotine addicts.ResultsAfter using improved HHT-Microstate method, we notice that there is significant difference in EEG microstates of nicotine addicts between viewing smoke pictures group (smoke) and viewing neutral pictures group (neutral). Firstly, there is a significant difference in EEG microstates at full-frequency band between smoke and neutral group. Compared with the FIR-Microstate method, the similarity index of microstate topographic maps at alpha and beta bands had significant differences between smoke and neutral group. Secondly, we find significant class × group interactions for microstate parameters at delta, alpha and beta bands. Finally, the microstate parameters at delta, alpha and beta bands obtained by the improved HHT-microstate analysis method are selected as features for classification and detection under the Gaussian kernel support vector machine. The highest accuracy is 92% sensitivity is 94% and specificity is 91%, which can more effectively detect and identify addiction diseases than FIR-Microstate and FIR-Riemann methods.ConclusionThus, the improved HHT-Microstate analysis method can effectively identify substance addiction diseases and provide new ideas and insights for the brain research of nicotine addiction.
Adjuvant TACE may not improve recurrence-free or overall survival in HCC patients with low risk of recurrence after hepatectomy
Authors: Feng Long-Hai , Zhu Yu-Yao , Zhou Jia-Min , Wang Miao , Xu Wei-Qi , Zhang Ti , Mao An-Rong , Cong Wen-Ming , Dong Hui , Wang Lu 
Published: May 2023

BackgroundTo identify whether adjuvant transarterial chemoembolization (TACE) can improve prognosis in HCC patients with a low risk of recurrence (tumor size ≤ 5 cm, single nodule, no satellites, and no microvascular or macrovascular invasions) after hepatectomy.MethodsThe data of 489 HCC patients with a low risk of recurrence after hepatectomy from Shanghai Cancer Center (SHCC) and Eastern Hepatobiliary Surgery Hospital (EHBH) were retrospectively reviewed. Recurrence-free survival (RFS) and overall survival (OS) were analyzed with Kaplan-Meier curves and Cox proportional hazards regression models. The effects of selection bias and confounding factors were balanced using propensity score matching (PSM).ResultsIn the SHCC cohort, 40 patients (19.9%, 40/201) received adjuvant TACE, and in the EHBH cohort, 113 patients (46.2%, 133/288) received adjuvant TACE. Compared to the patients without adjuvant TACE after hepatectomy, patients receiving adjuvant TACE had significantly shorter RFS (P=0.022; P=0.014) in both cohorts before PSM. However, no significant difference existed in OS (P=0.568; P=0.082). Multivariate analysis revealed that serum alkaline phosphatase and adjuvant TACE were independent prognostic factors for recurrence in both cohorts. Furthermore, significant differences existed in tumor size between the adjuvant TACE and non-adjuvant TACE groups in the SHCC cohort. There were differences in transfusion, Barcelona Clinic Liver Cancer stage and tumor-node-metastasis stage in the EHBH cohort. These factors were balanced by PSM. After PSM, patients with adjuvant TACE after hepatectomy still had significantly shorter RFS than those without (P=0.035; P=0.035) in both cohorts, but there was no difference in OS (P=0.638; P=0.159). Adjuvant TACE was the only independent prognostic factor for recurrence in multivariate analysis, with hazard ratios of 1.95 and 1.57.ConclusionsAdjuvant TACE may not improve long-term survival and might promote postoperative recurrence in HCC patients with a low risk of recurrence after hepatectomy.
Prevalence and associating factors of long COVID in pediatric patients during the Delta and the Omicron variants
Authors: Lokanuwatsatien Tananya , Satdhabudha Araya , Tangsathapornpong Auchara , Bunjoungmanee Pornumpa , Sinlapamongkolkul Phakatip , Chaiyakulsil Chanapai , Sritipsukho Paskorn , Tantiyavarong Pichaya 
Published: May 2023

IntroductionThe number of pediatric COVID-19 infections is increasing; however, the data on long COVID conditions in children is still limited. Our study aimed to find the prevalence of long COVID in children during the Delta and Omicron waves, as well as associated factors.MethodsA single-center prospective cohort study was conducted. We included 802 RT-PCR-confirmed COVID-19 pediatric patients in the Delta and Omicron periods. Long COVID was defined as having symptoms for ≥3 months after infection. Parents and/or patients were interviewed by phone. Multivariable logistic regression was performed to find associated factors with long COVID.ResultsThe overall prevalence of long COVID was 30.2%. The Delta period had more prevalence than the Omicron (36.3% vs. 23.9%). Common symptoms for patients 0–3 years’ old were loss of appetite, rhinorrhea, and nasal congestion. Conversely, patients 3–18 years’ old had hair loss, dyspnea on exertion, rhinorrhea, and nasal congestion. However, there was no significant negative impact on daily life. Most symptoms improved after a 6-month follow-up. Factors associated with long COVID-19 conditions were infection during the Omicron period (adjusted OR: 0.54; 95% CI: 0.39–0.74, P &lt; 0.001), fever (adjusted OR: 1.49, 95% CI: 1.01–2.20, P = 0.04) and rhinorrhea (adjusted OR: 1.47, 95% CI: 1.06–2.02, P = 0.02).ConclusionInfection during the Omicron wave has a lower prevalence of long COVID. The prognosis is often favorable, and most symptoms gradually become less. However, pediatricians may schedule appointments to surveil long COVID in children with fever or rhinorrhea as an initial symptom.
Factors predicting general health concerns and atypical behaviours in children with prenatal alcohol exposure and other adverse exposures
Authors: MacEachern Sarah J. , Kar Preeti , Nakhid Daphne , Mitevska Elena , Tortorelli Christina , Forkert Nils D. , Lebel Catherine , McMorris Carly A. , Gibbard W. Ben 
Published: May 2023

BackgroundPrenatal alcohol exposure (PAE) can have significant negative consequences on the health outcomes of children. Children with PAE often experience other prenatal and postnatal adverse exposures. Increased rates of general health concerns and atypical behaviours are seen in both children with PAE as well as with other patterns of adverse exposures, although these have not been systematically described. The association between multiple adverse exposures and adverse health concerns and atypical behaviours in children with PAE is unknown.MethodsDemographic information, medical history, adverse exposures, health concerns, and atypical behaviours were collected from children with confirmed PAE (n = 22; 14 males, age range = 7.9–15.9 years) and their caregivers. Support vector machine learning classification models were used to predict the presence of health concerns and atypical behaviours based on adverse exposures. Associations between the sums of adverse exposures, health concerns, and atypical behaviours were examined using correlation analysis.ResultsAll children experienced health concerns, the most common being sensitivity to sensory inputs (64%; 14/22). Similarly, all children engaged in atypical behaviours, with atypical sensory behaviour (50%; 11/22) being the most common. Prenatal alcohol exposure was most important factor for predicting some health concerns and atypical behaviours, and alone and in combination with other factors. Simple associations between adverse exposures could not be identified for many health concerns and atypical behaviours.ConclusionChildren with PAE and other adverse exposures experience high rates of health concerns and atypical behaviours. This study demonstrates the complex effects of multiple adverse exposures on health and behaviour in children.
A new technology for pacifier weaning: a thematic analysis
Authors: Al Hariri Ahmed 
Published: May 2023

IntroductionBabies and toddlers often become accustomed to using baby pacifiers. However, pacifiers may harm children's health and lead to various problems, such as less frequent breastfeeding, shorter breastfeeding duration, dental deformities, tooth decay, recurrent acute otitis media, sleep disorders, and the potential for accidents. This study aims to introduce new technology that may prevent babies from becoming used to a pacifier (patent titled “Prevents Getting Used to Pacifier Baby, Number SA10609, Saudi Authority for Intellectual Property”). This study used a descriptive qualitative design.MethodsThe participants included three pediatricians, three psychologists, three dentists, three family doctors, and three mothers of babies and toddlers, with a mean age of 42.6 years old (SD = 9.51). Semi-structured interviews were used, and thematic analysis was conducted to generate a thematic tree.Results and DiscussionThe thematic analysis resulted in three themes: (1) the disadvantages of pacifier use, (2) the introduction of new technology for the patent, and (3) the expectations for this technology. The results showed that a pacifier might negatively affect the health of babies and toddlers. However, the new technology may prevent children from becoming used to pacifiers and protect them from any possible physical or mental issues.