bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognosis and Influencing Factors of ER-positive, HER2-low Patients with Residual Diseases after Neoadjuvant Chemotherapy: A Retrospective Study
Authors: Tang Lingfeng , Jiang Linshan , Jin Yudi , Shu Xiujie , Xu Yingkun , Yu Haochen , Liu Shengchun 
Published: July 2023

Abstract
Background
Previously, we found that estrogen receptor (ER)-positive, HER2-low patients is insensitive to neoadjuvant chemotherapy (NACT). And the outcomes of patients with residual diseases were worse than that of patients who achieved pathological complete response (pCR) after NACT. The purpose of this study is to explore the prognosis and influencing factors of these patients .
Methods
A total of 618 ER-positive breast cancer patients who received thrice-weekly standard NACT were enrolled, including 411 ER-positive, HER2-low cases. Clinicopathological features before and after NACT of these patients were collected. Univariate and multivariate COX regression analyses were used to find the independent factors of 5-year disease-free survival (DFS).
Results
Of the ER-positive, HER2-low patients, 49 cases (11.9%) attained pCR after NACT. A significant survival difference was shown in patients with or without residual diseases after NACT. Level changes in immunohistochemical markers and tumor stages before and after NACT were significant. According to univariate and multivariate analyses, we found that significant associations between cN_stage (P = 0.002), ER (P = 0.002) and Ki67 (P = 0.023) expression before NACT with 5-year DFS, while pT_stage (P = 0.015), pN_stage (P = 0.029), ER (P = 0.020) and Ki67 (P ༜0.001) after NACT was related to 5-year DFS in ER-positive, HER2-low patients with residual diseases.
Conclusion
Our study suggested that pre- and post-NACT high proliferation, low ER expression level and advanced stage both were associated with poor prognosis, which provides a reference for developing long-term treatment strategies for ER-positive, HER2-low patients with residual diseases in the future.
Emergency endoscopic interventions in acute upper gastrointestinal bleeding: a cohort study
Authors: Mackiewicz-Pracka Anna , Nehring Piotr , Przybyłkowski Adam 
Published: July 2023

Abstract
Introduction: Acute upper gastrointestinal bleeding frequently leads to emergency department admissions. The standard approach for diagnosing and treating acute upper gastrointestinal bleeding involves endoscopy of the upper gastrointestinal tract. While daytime emergency endoscopy has been well-studied, there is limited evidence regarding its effectiveness during nighttime procedures
Patientes and Methods: We conducted a retrospective cohort study at a single center, analyzing adult patients referred for emergency endoscopy outside of regular hospital hours due to AUGIB. Endoscopic hemostatic methods were employed, and patients were categorized into day-hours and night-hours groups based on the timing of their procedures. The primary clinical endpoint was 120-day all-cause mortality, with secondary endpoints including haemostasis and recurrence.
Results: Among the 752 enrolled patients with acute upper gastrointestinal bleeding symptoms, 592 underwent endoscopy during the day, while 160 had procedures performed at night. In the day-hours group, the median time from symptom onset to endoscopy was 10 hours (IQR 6-15h), compared to 6 hours (IQR 4-16h) in the night-hours group. Intervention times were significantly shorter during the night hours (P < 0.001). In both groups, endoscopic intervention after the 6th hour from symptom onset yielded improved outcomes, while treatment before the 5th hour resulted in poorer outcomes. Although the night-hours group had higher 120-day all-cause mortality, the difference was not statistically significant.
Conclusion: Our findings indicate that emergency endoscopic intervention for acute upper gastrointestinal bleeding is similarly effective during both day and night hours, particularly when performed after the 6th hour from symptom onset.
An Auto-Encoder of Inscription Character Inpainting based on Branch Convolutional Channel Attention Module
Authors: Zhao Long , Yuan Zonglong , Lou Yuhao , Xu Qingyu , Qiao Xinxiao 
Published: July 2023

Abstract
Many inscriptions suffer severe damage as a result of artificial or natural causes, necessitating computer repair and protection. There isn’t a publicly accessible dataset of inscriptions, and the majority of character inpainting algorithms that are currently in use are directly derived from common image inpainting algorithms , which have insufficient feature extraction capabilities for the character of inscriptions and don’t have metrics for the weights of obscured and unobscured regions. We developed a Character Auto-Encoder (CAE) to improve the inpaint-ing capabilities of inscription characters and solve the aforementioned issues. The down-sampling module is replaced by the Branch Convolutional Channel Attention Module (BCCAM), which employs a branching structure to enhance the model’s capacity for representation and weights various areas of the character. First, we compared other inpainting models using the inscription dataset, and the CAE’s peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) increased by 0.82 and 0.016, respectively, compared to the baseline model. Next, we compared the Handwritten Chinese Character Inpainting Generative Adver-sarial Network (HCCI-GAN) with the handwritten Chinese character dataset, and the CAE’s design was relatively more ingenious and simpler.
Realities of modern urate-reducing therapy for gout
Authors: Krasivina I. G. , Dolgova L. N. , Dolgov N. V. , Bakhvalova D. Yu. 
Published: July 2023

Introduction. In the treatment of a patient with gout, it is important to achieve the target level of uric acid (UA) < 360 μmol/l, which reduces the frequency of acute attacks of arthritis and improves the prognosis of comorbid diseases. Relief of acute gouty arthritis causes much less difficulty compared with the appointment of urate-l owering therapy (UST). The reasons for not achieving the target level of MC can be both objective and subjective.Aim. To analyze the objective and subjective components of the activity and effectiveness of UST in real outpatient practice.Material and methods. A cross- sectional study of 117 randomly selected outpatient records of patients diagnosed with gout. Mean age 58.6 ± 13.1, mean UA level 423.7 ± 122.4 μmol/L. Additionally, an anonymous survey of doctors and patients with gout was conducted on the issues of UST.Results. Patients with gout in the analyzed group were characterized by a high degree of polymorbidity: women and men, respectively, had arterial hypertension in 100 and 79%, type 2 diabetes mellitus in 39 and 23%, osteoarthritis in 73 and 57%. With inevitable polypharmacy, UST was prescribed in 37.6% of patients. Achievement of target levels of UA was registered in 23.8% of men and 39.4% of women. Failure to achieve the target sUA was associated with diuretics, elevated creatinine, and body mass index. Physicians were more than 70% active in prescribing UST, but knowledge of a single target UA level was demonstrated by 6 to 13%, depending on work experience, with an excessive assumption of UST use during an acute gout attack (19 to 36.5%). Conclusion. All components of the diagnostic and therapeutic process of curing a gouty patient need to be improved.
Potential for sustaining remission in ankylosing spondylitis patients upon netakimab discontinuation
Authors: Lapshina S. A. , Garaeva A. R. , Gabdullina Z. N. , Sukhorukova E. V. , Abdulganieva D. I. 
Published: July 2023

Introduction. Biological disease modifying drugs (bDMARD) in the treatment of ankylosing spondylitis (AS) have shown good results with the achievement and long-term preservation of remission. There is a discussion about the withdrawal of drugs without loss of effect in order to reduce the economic burden, drug load, adverse events, the possibility of interrupting therapy during surgical treatment.Aim. To evaluate the potential for sustaining the therapeutic effect of netakimab (NTK) after its discontinuation in patients with AS who have achieved remission.Materials and methods. A cohort of 11 patients diagnosed with ankylosing spondylitis (AS) who had achieved remission was included in this study. The patients were closely observed for 52 weeks after discontinuing NTK treatment. AS exacerbations, pain intensity, disease activity scores (BASDAI, ASDAS), enthesitis evaluations (MASES), functional impairments (BASMI and BASFI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were documented, as well as radiographic and MRI assessments of the sacroiliac joints and spine were performed.Results. Out of the 11 patients, 5 (45.5%) experienced AS exacerbations within the 12-month observation period. Patients who developed flare-ups had higher baseline levels of BASDAI, ASDAS, BASMI, and CRP at the time of NTK discontinuation. They also had a longer disease duration and were older compared to patients without relapse (p < 0.05). The presence of flare-ups was significantly associated (p < 0.05) with a history of peripheral arthritis, previous treatment with IFN-alpha, and the number of comorbidities. By week 52 of the observation period, patients demonstrated a deterioration in both activity and functional limitations (p < 0.05). Elevated ASDAS-CRP levels were found to be correlated (p < 0.05) with higher radiographic stages of sacroiliitis, the presence of syndesmophytes, functional limitations based on BASMI at the time of drug discontinuation, and the absence of continuous NSAID use. Significant prolongation of remission was associated with a substantial decline in ASDAS-CRP under NTK treatment (rSp = 0.996; p < 0.05), especially among younger patients (rSp = 0.607; p < 0.05).Conclusions. Approximately half of the patients who discontinued NTK therapy after achieving clinical and laboratory remission were able to sustain it. Maintenance of remission for 1 year was more prevalent in younger patients with shorter duration of AS, achieving inactive disease status based on ASDAS-CRP, fewer functional limitations, absence of peripheral arthritis, and comorbidities. Nevertheless, regular patient monitoring is necessary to promptly identify disease recurrence.
Blepharospasm: an analysis of typical medical practice and the effectiveness of therapy
Authors: Tolmacheva V. A. , Romanov D. V. 
Published: July 2023

Introduction. Blepharospasm (BS) is a form of focal dystonia in which botulinum therapy (BT) has been used successfully, however, data on typical practice of patient management and the effectiveness of long-term BT in BS in our country are insufficient.Aim. To analyse the typical medical practice of management of patients with BS and the effectiveness of long-term BT.Materials and methods. A total of 50 patients with idiopathic BS, mean age 58 years (of which 37 were women) were included in the study. All patients were treated with botulinum toxin type A. Typical medical practice, erroneous diagnosis, time required to reach a correct diagnosis, severity of dystonia, and quality of life before BT and during a three-year prospective observation were analysed. The severity of dystonia was determined using the BS Disability Index (BSDI), and the quality of life was measured using the EQ-5D questionnaire.Results. The correct diagnosis was reached, on average, in 3 years. Upon onset of symptoms the majority of patients (84%) visited an ophthalmologist. Eye diseases and myasthenia gravis were the most common primary erroneous diagnosis in BS, which were treated with inadequate symptomatic therapy. After one-month BT, it was noted that the disability index decreased from an average of 13.6 ± 5.1 to 2.7 ± 2.3 scores (p < 0.001) according to BSDI and the quality of life increased from 59.9 ± 8.2 to 82.6 ± 6.4 scores (p < 0.001) according to the results of EQ-5D. Repeated BT injections (2–6 times a year) conducted for 3 years also resulted in essentially positive effect without significant adverse events. At the end of three years, the disability index decreased to 10.7 ± 4.7 scores, and the improvement in the quality of life reached 81.8 ± 5.9 scores according to the results of EQ-5D (p < 0.001).Conclusion. The low awareness of doctors, especially ophthalmologists, about the symptoms of BS and the widespread use of ineffective drugs was noted. The long-term regular (2–6 times a year) use of BT reduces the symptoms of the disease, improves the quality of life of patients and has no significant side effects.
Predictors of repeated and first-time low-energy fractures in patients with rheumatoid arthritis
Authors: Kovalenko P. S. , Dydykina I. S. , Postnikova P. S. , Glukhova S. I. 
Published: July 2023

Introduction. Low-energy fractures in patients with rheumatoid arthritis (RA) occur more often than in the general population, reduce the quality and life expectancy of patients. Establishment of predictors of fractures will allow to personalize treatment and preventive measures.Aim. To study the frequency, structure, predictors of new and repeated low-energy fractures that occurred in patients with RA during long-term prospective follow-up.Materials and methods. 123 women with RA, aged 63.7 ± 8.3 years, were included in an open, prospective, non-interventional study, the follow-up period was 9.4 ± 1.8 years. Initially and in dynamics, laboratory and X-ray examinations were performed (X-ray morphometry of the spine, X-ray densitometry of the lumbar spine (L1-4) and femoral neck (SB)).Results. During the follow-up period, 101 low-energy fractures occurred in 63 (51%) patients: in 33 (52%) people – for the first time, in 25 (48%) – again. Two or more fractures occurred in 25 (39%) patients. There were 32 (32%) peripheral fractures, 69 (68%) vertebral fractures. A direct relationship was established between fractures and a longer duration of RA course (r = 0.231, p < 0.05), with X-ray stage of RA at baseline (r = 0.280, p < 0.05) and over time (r = 0.819, p < 0.05), intake of glucocorticoids (GC) initially (r = 0.202, p < 0.05) and over time (r = 0.308, p < 0.05), cumulative dose of GC initially (r = 0.239, p < 0.05) and over time (r = 0.268, p < 0.05), duration of GC use (r = 0.270, p < 0.05), history of low-energy fractures (r = 0.291, p < 0.05), and feedback with OP in SB (r = -0.190, p < 0.05).Conclusions. А high frequency of repeated and first-time low-energy fractures was established in patients with RA, among which fractures of the vertebrae, distal forearm, humerus and lower leg bones predominated. Fracture predictors: GC intake, history of low-energy fractures, baseline radiological stage of RA. A mathematical model for assessing the risk of fractures with good predictive ability has been developed.
La intención de compra en la generación Z en el mercado de moda
Authors: Lima-Vargas Alvaro Enrique , Cervantes-Aldana Fernando Javier , Lima-Vargas Suemi 
Published: July 2023

<p>Este estudio cuantitativo explora como las actitudes y las normas subjetivas hacia el mercado de la moda por parte de la generación Z influyen en la intención de compra. Se analiza la inteligencia emocional, la percepción de calidad y el género como variables independientes de las actitudes y la inteligencia emocional de las normas subjetivas. Los hallazgos mostraron que la Teoría de Acción Razonada (TRA) explica la intención de compra en el mercado de la moda por parte de la generación Z. Los hallazgos revelaron que el género no influye en el desarrollo de actitudes, las cuales son generadas por la percepción de calidad y la inteligencia emocional. Por su parte, las normas subjetivas no son inducidas por la inteligencia emocional. Esta investigación contribuirá las empresas del mercado de la moda a generar estrategias de mercado específicas para impulsar la intención de compra por parte de la generación Z.</p>
Anástasis del diorama de la cacería del mamut
Authors: Rojas Chávez Juan Martín , Medina González José Humberto , Ballester Franzoni Carlos Enrique 
Published: July 2023

Durante cincuenta y nueve años (1964–2023) el Diorama de la Cacería del Mamut –que hasta hoy se exhibe en sala “Poblamiento de América” (antes Orígenes)– del Museo Nacional de Antropología de México– es uno de los apoyos museográficos que más han impactado a los miles de visitantes nacionales y extranjeros que año con año visitan este recinto. Esta dramática pieza escultórica creada por la artista Carmen Carrillo de Antúnez y su equipo de escultores puede ser considerada un poderoso icono de cómo pudo ser en la prehistoria del centro de México la práctica de caza de los grandes animales que vivieron en la Edad del Hielo. El objetivo de este artículo es comprender –con base en la información recuperada hasta los inicios de la segunda mitad del siglo XX por las investigaciones realizadas por la geología, la paleontología y la arqueología en los yacimientos donde se encontraron restos de mamutes en el área de Tepexpan (principalmente Santa Isabel II) y en la Cuenca de México–, cómo se construyó esa imagen de la prehistoria mexicana que quedó plásticamente materializada en este diorama. A partir de una crítica de la narrativa arqueológica que se construyó de esas investigaciones y de la revisión de los datos recuperados de esos yacimientos, el artículo postula contenidos que preponderan el aprovechamiento del mamut más que el de la cacería especializada como se planteaba antes desde una perspectiva que integra a la arqueología, el arte y la museografía. Se propone crear dos nuevos dioramas, que junto con el de la artista Carrillo de Antúnez, dialoguen dentro de la sala “Poblamiento de América” en un solo conjunto llamado “Diorama de Dioramas”.
The Impact of Tele-Education on Family Medicine Clerkship Students’ Learning Outcomes
Authors: Unger Kendra , Bors Kathleen , Xiang Jun , Lapp Madison , Oreskovich Jason , Higinbotham Ashley , Snyder Telista , Hanks Heather , Ashcraft Amie M. 
Published: July 2023

Background and Objectives: The COVID-19 pandemic necessitated rapid changes to medical education for student and patient protection. A dearth of published US studies examine resulting clinical education outcomes due to pandemic-induced curricula changes. We describe adaptations made to a family medicine clerkship to move it from traditional in-person delivery to virtual only, and then from virtual to hybrid; and compare educational outcomes of students across delivery types.
Methods: We stratified 386 medical students in their third year completing their 8-week family medicine clerkship by type of content delivery, including in person, virtual only, and hybrid instruction. We examined the impact of these changes on three clerkship learning outcomes: the midblock assessment score, the National Board of Medical Examiners (NBME) exam score, and the final numeric score (FNS).
Results: In our sample, 164 (42.5%) received content in person, 36 (9.3%) received virtual only, and 186 (48.2%) received hybrid content. Students receiving virtual only (M=76.4, SD=9.1) had significantly higher midblock assessment scores (F=8.06, df=2, P=.0004) than students receiving hybrid (M=71.7, SD=8.8) and in-person training (M=74.5, SD=7.2). No significant differences existed in students’ NBME exam scores or FNSs across delivery types.
Conclusions: Students receiving virtual-only or hybrid content performed at least as well on three clerkship-related educational outcomes as their pre-COVID peers participating in person. Further research is needed to understand how changes to medical education affected student learning and skill development.
THE EFFECT OF SELF-EFFICACY ON MATHEMATICAL COMMUNICATION ABILITY OF JUNIOR HIGH SCHOOL STUDENTS ON THE PYTHAGOREAN THEOREM
Authors: Purwandari Andriana Siwi , Maya Rippi 
Published: July 2023

AbstractÂ This study aims to analyze and examine the mathematical communication ability that are influenced by junior high school students self-efficacy. The method in this study uses a correlational method with quantitative approach. The population in this study were students of junior high school in Cimahi City, with a sample of 36 students who were determined by purposive sampling technique at one of junior high school in Cimahi City. The instrument used in this study is a communication ability test that consisting of 5 essays and a studentsâ€™ self-efficacy scale that consisting of 25 statements scales. The results showed that students communication ability was positively influenced by self-efficacy of 19.1%, while 80.9% was influenced by factors other than studentsâ€™ self-efficacy. The correlation between self-efficacy and mathematical communication skills of students is included in the medium category.Â Keywords: Â Mathematical Communication, Self-Efficacy
The Effect Contextual Teaching-Learning Approach on Improving Studentsâ€™ Mathematical Reasoning Ability and Self Concept
Authors: Alamsyah Toni , Sumarmo Utari , Kustiana Asep 
Published: July 2023

The goal of this research is to examineÂ the role of contextual teaching-learning Â approach (CTLA) towardÂ studentsâ€™ mathematical reasoning ability (MRA) and self concept in mathematics (MSC). The research involves 66 eighth grade students, a MRAÂ test,Â a MSC scale. Findings of this research were:Â students getting CTLA reached MRA at better grade than the grade of students who get SA learning, even if those grades were at low level. However, there was no difference grades on studentsâ€™ MSC in both teaching approaches, and those grades were at fairly good level. Students in both teaching approaches encountered difficulties in solving MRA tasks such as on analogical reasoning about position of two lines,Â solving tangent equation on a curve problem, and writing down the formula involved in a calculation.Â Beside that, there was association between MRA and MSC, and students performed active learning during CTLA lessons.Keyword: contextual teaching-learning, mathematical reasoning, mathematcal self concept.
Defragmenting Studentâ€™s Thinking Structures in Solving Mathematical Problems on PISA Model
Authors: Supiarmo M. Gunawan 
Published: July 2023

Problem solving is defined as a series of activities that allow students to find solutions to problems. Students' thinking processes occur when processing data or information to solve problems. One way to help students maximize the thinking skillsÂ is to make theirÂ experience when solving problemsÂ withÂ PISA model.Â But in reality, StudentsÂ madeÂ many mistakes and have difficulty understanding the problem, making a settlement plan, lack knowledge of the prerequisite material, and have not been able to describe the reasons in detail regarding the solutions found. One of the possible solutions to improve and complete the structure of students' thinking in solving mathematical problems on the PISA model HOTS questions is defragmenting. This study aims to describeÂ theÂ changes of students' thinkingstructure in solving mathematical problemsÂ through defragmenting. This type of research is descriptive research with a qualitative approach. The research data consisted of students' answers, the results of thinking aloud, and the results of semi-structured interviews. The results showed that students experienced assimilation at the stage of understanding the problem, while at the stage of formulating strategies, implementing plans, and re-examining students' thinking processes, they experienced accommodation. This is because students need defragmenting to connect mathematical concepts to solve problems, correct errors, and complete incomplete problem solving steps.