bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of partner’s behaviour on pregnancy related outcomes and safe child-birth in Pakistan
Authors: Atif Muhammad , Farooq Muhammad , Shafiq Muhammad , Ayub Gohar , Ilyas Muhammad 
Published: July 2023

Abstract
Background
Pakistan is one of the nations with the worst statistics for pregnancy-related outcomes. Health programmes in underdeveloped nations frequently ignore the role of partners in maternal health, which is a crucial contributing factor in these worst situations. This research study aims to explore the role of husbands in maternity care and safe childbirth in Pakistan.

Methods
The data for this study comes from the Pakistan Maternal Mortality Survey 2019. The k-Modes clustering algorithm was implemented to generate clusters from the dataset. Cluster profiling was used to identify the problems in pregnancy-related outcomes in cases where women live away from their partners. The chi-square test and logistic regression model were fitted to identify the significant factors associated with women’s health and safe childbirth.

Results
The finding of the study reveals that the partner’s support during and after pregnancy plays a vital role in maternal health and safe child-birth. It was revealed that the women living away from their partners have certain health problems during pregnancy. These problems include Vaginal bleeding, Excessive vomiting, Chest pain, Cough, High B.P, Excessive weight gain, Body aches, Swelling of feet, and Swelling of the face. This also leads to complications and health problems in the postpartum period. Due to a lack of antenatal care from the spouse during pregnancy, the women who lived away from their partners lost their pregnancies.

Conclusion
The study concludes that the husband’s emotional and financial support substantially impacts the overall health of expecting mothers and the safety of delivery in Pakistan. Given its potential advantages for mother and child health outcomes, male engagement in health education must be acknowledged and addressed. The finding of the study is of immense importance, as it guides the policymakers to arrange various awareness programs for the male partners to support their pregnant spouse and provide proper antenatal care.
Risk factors for postoperative recurrence in patients with stage II colorectal cancer
Authors: Xiong Zhi-Zhong , Xie Ming-Hao , Li Xian-Zhe , Jin Long-Yang , Zhang Feng-Xiang , Yin Shi , Chen Hua-Xian , Lian Lei 
Published: July 2023

Abstract
Background
Recurrences are the main reasons for unfavorable outcomes for patients with stage II colorectal cancer (CRC). To obtain a clear understanding of the high-risk factors, further investigation is warranted. The present study aimed to analyze the risk factors associated with postoperative recurrence in patients with stage II CRC.

Methods
Eligible patients with pathologically confirmed stage II CRC were enrolled in the study retrospectively based on a prospectively maintained database from April 2008 to March 2019. The Kaplan–Meier method were used to calculate the overall survival (OS) rate and the cumulative recurrence rate. Univariate and multivariable Cox regression analyses were performed to identify risk factors for recurrence.

Results
There were 2515 patients included, of whom 233 (9.3%) developed local or distant recurrence. Recurrence was associated with a significantly worse 5-year OS (45.4% vs. 95.5%, p < 0.0001). The 5-year cumulative recurrence rate was 13.0% in patients with stage II CRC. On multivariable Cox analysis, tumor size (Hazard Ratio (HR) [95% confidence interval (CI)] = 1.79[1.38, 2.33]), preoperative carbohydrate antigen (CA) 125 level (HR [95% CI] = 1.78[1.17, 2.70]), preoperative CA 199 level (HR [95% CI] = 1.56[1.09, 2.22]), and ulcerating tumor (HR [95% CI] = 1.61[1.19, 2.17]) were found to be associated with postoperative recurrence. Adjuvant chemotherapy was associated with a lower cumulative recurrence rate in patients with these risk factors (p = 0.00096).

Conclusion
The tumor diameter, preoperative CA125 level, preoperative CA199 level, and an ulcerative tumor can predict postoperative recurrence in patients with stage II CRC, and postoperative chemotherapy could reduce the cumulative recurrence rate in patients with these high-risk factors.
The effect of topical ketorolac tromethamine on macular thickening after phacoemulsification in diabetic patients
Authors: Mohammad-Rabei Hossein , Sabbaghi Hamideh , Emamverdi Mehdi , Karimi Saeed , Ramezani Alireza , Nikkhah Homayoun , Kheiri Bahareh , Yaseri Mehdi , Sheibani Kourosh , Bahreini Razieh 
Published: July 2023

Abstract
Background
To determine the effect of ketorolac tromethamine 0.5% in preventing post-phacoemulsification macular thickening. This randomized clinical trial. patients randomized 1:1 to receive either topical ketorolac three times a day or a placebo.

Methods
A total of 101 eyes of 101 diabetic patients who were scheduled for phacoemulsification and had normal macular contour and thickness enrolled consecutively. The topical ketorolac and placebo were prescribed on the day before surgery and continued up to 4 weeks after surgery. Patients with proliferative diabetic retinopathy, a history of intravitreal injection in less than three months, a history of macular photocoagulation in less than 6 months, and any other concomitant ocular pathologies were excluded. Central macular thickness (CMT) and best corrected visual acuity (BCVA) was recorded in the follow-ups of 6, 12, and 24 weeks after the surgery and compared with the controls.

Results
49 eyes in the case group and 52 eyes in the control group were analyzed. Mean BCVA was significantly improved in both groups at all follow-ups (P < 0.001 for all). There was no statistically significant difference regarding the BCVA in different time points except week 12 (P = 0.028) among the study group. In the case and control groups, CMT was increased at all follow-ups (P < 0.05). There was no statistically significant difference when comparing the two groups regarding the mean of CMT at any time point postoperatively (P > 0.05 for all).

Conclusion
Based on our findings, topical ketorolac tromethamine 0.5% is not effective in the prevention of post-phacoemulsification macular thickening in diabetic patients.

Trail registration
The study protocol was registered into www.clinicaltrial.gov with the RCT registration number NCT03551808. (2018/06/11 )

Clinical trial registration number
NCT03551808.
Relationship between animal health and livestock farmers’ wellbeing in Ghana: beyond zoonoses
Authors: Nuvey Francis Sena , Haydon Daniel T. , Hattendorf Jan , Addo Kennedy Kwasi , Mensah Gloria Ivy , Fink Günther , Zinsstag Jakob , Bonfoh Bassirou 
Published: July 2023

Abstract
Introduction
Livestock production is a key livelihood source for many people in developing countries. Poor control of livestock diseases hamper livestock productivity, threatening farmers’ wellbeing and food security. This study estimates the effect of livestock mortalities attributable to disease on the wellbeing of livestock farmers.

Methods
Overall, 350 ruminant livestock farmers were randomly selected from three districts located in the north, middle and southern belts of Ghana. Mixed-effect linear regression models were used to estimate the relationship between animal health and farmer wellbeing. Farmer wellbeing was assessed using the WHOQOL-BREF tool, as the mean quality-of-life in four domains (physical, psychological, social, and environmental). Animal health was assessed as annual livestock mortalities to diseases adjusted for herd size, and standardized in tropical livestock units to account for different ruminant livestock species. We adjusted for the potential confounding effect of farmers’ age, sex, educational attainment, farmland size, socio-economic status, perception of disease risk to herd, satisfaction with health, previous experience of disease outbreaks in herds, and social support availability by including these as fixed effects, and community as random effects, in a pre-specified model.

Results
Our results showed that farmers had a median score of 65.5 out of 100 (IQR: 56.6 to 73.2) on the wellbeing scale. The farmers’ reported on average (median) 10% (IQR: 0 to 23) annual herd mortalities to diseases. There was a significantly negative relationship between increasing level of animal disease-induced mortality in herds and farmers’ wellbeing. Specifically, our model predicted an expected difference in farmers’ wellbeing score of 7.9 (95%CI 1.50 to 14.39) between a farmer without any herd mortalities to diseases compared to a (hypothetical) farmer with 100% of herd mortalities caused by diseases in a farming year. Thus, there is a reduction of approximately 0.8 wellbeing points of farmers, for the average of 10% disease-induced herd mortalities experienced.

Conclusions
Disease-induced livestock mortalities have a significant negative effect on farmers’ wellbeing, particularly in the physical and psychological domains. This suggests that veterinary service policies addressing disease risks in livestock, could contribute to improving the wellbeing of livestock dependent populations, and public food security.
Efficacy of continuous positive airway pressure on NT-pro-BNP in obstructive sleep apnea patients: a meta-analysis
Authors: Wu Qinqin , Ma Xiaojun , Wang Yanyan , Jin Jianfeng , Li Jia , Guo Shuming 
Published: July 2023

Abstract
Background
N-terminal probrain natriuretic peptide (NT-pro-BNP) and BNP are well-known markers for the diagnosis and prognostic of heart failure. Until now, it was not clear whether BNP levels are influenced by events occurring within Obstructive sleep apnea–hypopnea syndrome (OSAHS) with continuous positive airway pressure (CPAP).

Methods
A thorough search in PubMed, EMBASE, Google Scholar, and Web of Science databases up to October 24, 2022, and a meta-analysis aimed to explore further accurate estimates of the effects of BNP on OSAHS after CPAP treatment to assess the strength of the evidence.

Results
The forest plot outcome indicated that CPAP therapy did not change the BNP level in patients with OSAHS, with a weighted mean difference (WMD) of -0.47 (95% CI: -1.67 to 2.62; P = 0.53] based on the random effect model because of high significant heterogeneity (I2 = 80%) among the studies. Subgroup analysis also explored the changes in BNP levels in patients with OSAHS. Begg’s test (P = 0.835) and Egger’s test (P = 0.245) suggested significant negative publication bias.

Conclusion
Our meta-analysis suggests that CPAP therapy does not change the BNP level in patients with OSAHS; therefore, it is not accurate to use BNP level as an index to evaluate heart function in patients with OSAHS, but more related research should be conducted.
Perioperative risk factors related to complications of lumbar spine fusion surgery in elderly patients
Authors: Liu Chenjun , Guo Chen , Meng Fanqi , Zhu Zhenqi , Xia Weiwei , Liu Haiying 
Published: July 2023

Abstract
Purpose
To analyze the perioperative risk factors related to lumbar spine fusion surgery in elderly patients.

Methods
202 elderly patients (age range 77–92 years old) who have underwent lumbar spinal fusion surgeries between January 2019 and June 2021 were retrospectively investigated. Information of age, sex, comorbidity, fixation segments, operation time, surgical blood loss and perioperative complications during hospitalization were collected. Risk factors for complications were analyzed. Student’s t-test, chi-square test, Mann-Whitney U‑test and multivariate generalized linear models were used.

Results
In this study, 31 patients presented complications (15.3%) in these elderly patients with an average age of 79.1 years, including 1 patient with intraoperative complication and 30 patients with postoperative complications; and 2 out of 31 patients (1%) died. The elderly patients were divided into group A (24 patients) with major postoperative complications and group B (178 patients) without major postoperative complications. Major postoperative complications were significantly associated with age (univariate analysis, t = 3.92, P < 0.001; multivariate analysis, OR = 1.323, 95%CI 1.126–1.554, P = 0.001), but not significantly associated with other factors tested (sex, comorbidity, fixation segments, operation time, surgical blood loss). Then 173 patients (range 77–81 years) were selected and the rate of major postoperative complications of each age from 78 to 81 years was compared with that of 77 years patients, respectively. We found that the ratios of complications at 80 years (OR = 10.000, P = 0.019) and 81 years (OR = 10.000, P = 0.009) were higher than the ratio at 77 years.

Conclusions
Although with great progress of medical technology, increasing age was still the independent risk factor for major postoperative complications in elderly patients undergoing lumbar spinal fusion surgery. As for the incidence of major postoperative complications, 80 and 81 years old patients was 10 folds higher than that of 77 years old patients, reminding us to pay more attention to 80 years old and even older patients.
Klotho reduces the risk of osteoporosis in postmenopausal women: a cross-sectional study of the National Health and Nutrition Examination Survey (NHANES)
Authors: Jiang Jialin , Liu Qinyu , Mao Yaqian , Wang Nengyin , Lin Wei , Li Liantao , Liang Jixing , Chen Gang , Huang Huibin , Wen Junping 
Published: July 2023

Abstract
Background
Osteoporosis (OP) is one of the diseases that endanger the health of the elderly population. Klotho protein is a hormone with anti-aging effects. A few studies have discussed the relationship between Klotho and OP. However, there is still a lack of research on larger populations. This study aims to evaluate the association between OP and Klotho in American postmenopausal women.

Methods
This is a retrospective study. We searched the National Health and Nutrition Examination Survey (NHANES) database and collected data of 3 survey cycles, finally involving 871 postmenopausal women over 50 years old in the present study. All participants took dual-energy X-ray absorptiometry examination and serum Klotho testing at the time of investigation. After adjusting the possible confounding variables, a multivariate regression model was employed to estimate the relationship between OP and Klotho proteins. Besides, the P for trend and restricted cubic spline (RCS) were applied to examine the threshold effect and calculate the inflection point.

Results
Factors influencing the occurrence of OP included age, ethnicity, body mass index and Klotho levels. Multivariate regression analysis indicated that the serum Klotho concentration was lower in OP patients than that in participants without OP (OR[log2Klotho] = 0.568, P = 0.027). The C-index of the prediction model built was 0.765, indicating good prediction performance. After adjusting the above-mentioned four variables, P values for trend showed significant differences between groups. RCSs revealed that when the Klotho concentration reached 824.09 pg/ml, the risk of OP decreased drastically.

Conclusion
Based on the analysis of the data collected from the NHANES database, we propose a correlation between Klotho and postmenopausal OP. A higher serum Klotho level is related to a lower incidence of OP. The findings of the present study can provide guidance for research on diagnosis and risk assessment of OP.
Effect evaluation of a tele-neurologic intervention in primary care in a rural area in Germany—the NeTKoH study protocol of a stepped-wedge cluster randomized trial
Authors: Wainwright Kerstin , Mayer Imke , Oliveira Gonçalves Ana S. , Schulz Ricarda S. , Kiel Simone , Chenot Jean-François , Flöel Agnes , von Podewils Felix , Angermaier Anselm , Kurth Tobias ,   the NeTKoH Consortium
Published: July 2023

Abstract
Background
Neurological disorders account for a large and increasing proportion of the global burden of disease. Therefore, it is important to strengthen the management of neurologic care, particularly in rural areas. The use of tele-neurology in primary care in rural areas is internationally considered to have the potential to increase access to health care services and improve the quality of care in these underserved areas. NeTKoH aims to address the existing knowledge gap regarding the effects of a tele-neurologic intervention in primary care under real-world conditions in a rural area in Germany.

Methods
NeTKoH is a cluster-randomized controlled trial with a stepped-wedge design involving 33 outpatient general practitioner’s (GP) offices (clusters) in a rural area in Northeast Germany. During 11 predetermined steps, all clusters are randomized before they cross over into groups from the control to the intervention arm. The targeted sample size is 1,089 patients with neurologic symptoms that are continuously being recruited. In the intervention arm, tele-neurologic consultations will be provided via a face-to-face video conferencing system with a neurologic expert at a university hospital. The control arm will receive usual care. The primary outcome is the proportion of neurologic problems being solved at the GP’s office. Secondary outcomes will comprise hospital stays and days, time until neurologic specialist appointments and diagnostics, patients’ health status and quality of life, outpatient and inpatient referrals.
A concurrent observational study, together with a process, implementation, and health economic evaluation, will also be conducted.

Discussion
Using a stepped-wedge cluster design in a real-life situation can help with logistic challenges and enhance the motivation of the participating GPs, as all, at some point, will be in the intervention phase. With the additional implementation evaluation pertaining to external validity, an observational study, and a health economic evaluation, NeTKoH will be able to provide an extensive evaluation for health policy decision-makers regarding the uptake into standard care.

Trial registration
German Clinical Trials Register (DRKS00024492). Date registered: September 28, 2021. Date and protocol version: June 2023, version 1.
CD44 regulates Epac1-mediated β-adrenergic-receptor-induced Ca2+-handling abnormalities: implication in cardiac arrhythmias
Authors: Chan Yi-Hsin , Tsai Feng-Chun , Chang Gwo-Jyh , Lai Ying-Ju , Chang Shang-Hung , Chen Wei-Jan , Yeh Yung-Hsin 
Published: July 2023

Abstract
Background
Sustained, chronic activation of β-adrenergic receptor (β-AR) signaling leads to cardiac arrhythmias, with exchange proteins directly activated by cAMP (Epac1 and Epac2) as key mediators. This study aimed to evaluate whether CD44, a transmembrane receptor mediating various cellular responses, participates in Epac-dependent arrhythmias.

Methods
The heart tissue from CD44 knockout (CD44−/−) mice, cultured HL-1 myocytes and the tissue of human ventricle were used for western blot, co-immunoprecipitaiton and confocal studies. Line-scanning confocal imaging was used for the study of cellular Ca2+ sparks on myocytes. Optical mapping and intra-cardiac pacing were applied for arrhythmia studies on mice’s hearts.

Results
In mice, isoproterenol, a β-AR agonist, upregulated CD44 and Epac1 and increased the association between CD44 and Epac1. Isoproterenol upregulated the expression of phospho-CaMKII (p-CaMKII), phospho-ryanodine receptor (p-RyR), and phospho-phospholamban (p-PLN) in mice and cultured myocytes; these effects were attenuated in CD44−/− mice compared with wild-type controls. In vitro, isoproterenol, 8-CPT-cAMP (an Epac agonist), and osteopontin (a ligand of CD44) significantly upregulated the expression of p-CaMKII, p-RyR, and p-PLN; this effect was attenuated by CD44 small interfering RNA (siRNA). In myocytes, resting Ca2+ sparks were induced by isoproterenol and overexpressed CD44, which were prevented by inhibiting CD44. Ex vivo optical mapping and in vivo intra-cardiac pacing studies showed isoproterenol-induced triggered events and arrhythmias in ventricles were prevented in CD44−/− mice. The inducibility of ventricular arrhythmias (VAs) was attenuated in CD44−/− HF mice compared with wild-type HF controls. In patients, CD44 were upregulated, and the association between CD44 and Epac1 were increased in ventricles with reduced contractility.

Conclusion
CD44 regulates β-AR- and Epac1-mediated Ca2+-handling abnormalities and VAs. Inhibition of CD44 is effective in reducing VAs in HF, which is potentially a novel therapeutic target for preventing the arrhythmias and sudden cardiac death in patients with diseased hearts.
Overexpression of POLA2 in hepatocellular carcinoma is involved in immune infiltration and predicts a poor prognosis
Authors: Liu Long , Wang Qi , Wu Linjun , Zhang Lele , Huang Yuxi , Yang Haihua , guo Le , Fang Zheping , Wang Xuequan 
Published: July 2023

Abstract
Background
Hepatocellular carcinoma (HCC) is the second malignancy worldwide. POLA2 initiates DNA replication, regulates cell cycle and gene repair that promote tumorigenesis and disease progression. However, the prognostic and biological function roles of POLA2 in HCC had not been conclusively determined.

Methods
The expression levels and prognosis role of POLA1 and POLA2 in HCC were analyzed based on TCGA-LIHC database and recruited 24 HCC patients. Gene mutations were analyzed using “maftools” package. POLA2 and immune cells correlations were analyzed by TIMER. POLA2 co-expressed genes functional enrichment were evaluated using Metascape. The mRNA and protein level of POLA2 was detected in HCC cells and tissues. Cell migration, invasion, proliferation, cell cycle and HCC cell lines derived xenograft model were performed to investigate POLA2 biological function.

Results
POLA2 was significantly high expressed in HCC than in normal liver tissue in both TCGA-LIHC and our collected HCC samples. In validation cohort, POLA2 significantly related to tumor differentiation, tumor size and Ki-67 (p < 0.05). In TCGA-LIHC cohort, overexpression of POLA2 predicted a low OS and associated with different clinical stages. Multivariate Cox regression showed overexpression of POLA2 effectively distinguished the prognosis at different T, N, M, stages and grades of HCC. POLA2 expression correlated with mutation burden, immune cells infiltration and immune-associated genes expression of HCC. Functional enrichment revealed that POLA2 co-expressed genes were linked to cellular activity, plasma membrane protein complex and leukocyte activity, immune response-regulated cell surface receptor signaling pathway, and immune response-regulated signaling pathway. Moreover, POLA2 was also positively co-expressed with some immune checkpoints (CD274, CTL-4, HAVCR2, PDCD1, PDCD1LG2, TIGIT, and LAG3) (p < 0.001). Gene knockdown revealed that POLA2 promoted proliferation, migration, invasion, and cell cycle of SMMC-7721 and HepG2. The HCC xenograft tumor model also demonstrated remarkably tumor size inhibition, tumor proliferation inhibtion and tumor necrosis promotion when POLA2 knockdown.

Conclusions
POLA2 influenced immune microenvironment and tumor progression of HCC indicated that it might be a potential molecular marker for prognostic evaluation or a therapeutic target for HCC.