bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic assisted trans-scrotal orchiopexy versus traditional orchiopexy for inguinal cryptorchidism: a retrospective study based on 154 patients
Authors: Guo Qiang , Zhang Yifei , Lai Huajian , Zhong WenWen , Qiu Jianguang , Wang Dejuan 
Published: May 2023

AbstractBackgroundThe purpose of this study was to investigate the clinical effect of laparoscopic assisted trans-scrotal orchiopexy versus traditional orchiopexy for inguinal cryptorchidism.MethodsA retrospective analysis of cryptorchidism patients who were admitted to our hospital from July 2018 to July 2021. The patients were divided into the laparoscopic assisted trans-scrotal surgery group (n = 76) and the traditional surgery group (n = 78) according to the surgical method.ResultsAll patients were successfully operated. There was no significant difference in operation time between the laparoscopic assisted trans-scrotal group and the traditional group (P>0.05). Although there was no significant difference in the postoperative hospital stay between the two groups, the time of postoperative hospital stay of the laparoscopic assisted trans-scrotal surgery group was lower than that in the traditional surgery group (P = 0.062). Additionally, there was no significant difference in discharge rate on the first day after surgery between the two groups, but the discharge rate on the first day after surgery was more than 90% in both groups. In terms of postoperative complications, there were no cases of testicular retraction, testicular atrophy, inguinal hernia, or hydrocele that occurred in both groups. There was no significant difference in the incidence of scrotal hematoma between the two groups(P>0.05). Although there was no significant difference in the incidence of poor wound healing between the two groups(P>0.05), the incidence in the laparoscopic assisted trans-scrotal surgery group was lower than that in the traditional surgery group (2.6% vs. 6.4%).ConclusionLaparoscopic assisted trans-scrotal surgery is as safe and effective method as traditional surgery for patients with inguinal cryptorchidism, and could also provide a good appearance.
Diode laser in management of loss of taste sensation in patients with post-COVID syndrome: a randomized clinical trial
Authors: Shabaan Alshaimaa Ahmed , Kassem Islam , Mahrous Aliaa Ibrahium , aboulmagd Inass , Badrah Mai , Attalla Mohamed , Refahee Shaimaa Mohsen 
Published: May 2023

Abstract
Objective
Loss of taste (ageusia) is a symptom observed following recovery from COVID-19 infection. The loss of taste and smell sensation may negatively affect patients’ quality of life (QoL). The present study aimed to evaluate the effectiveness of the Diode Laser in managing loss of taste sensation in patients with post-COVID syndrome versus the placebo.

Material and method
The study sample was 36 patients who complained of persistent loss of taste sensation following COVID-19. The patients were randomly assigned to one of the two groups according to the received treatment: Group I (laser treatment) and Group II (light treatment), with each patient receiving a diode laser treatment or placebo from the same operator. Taste sensation was subjectively measured after treatment for four weeks.

Results
The results demonstrated a significant difference between both groups regarding taste restoration after one month (p = 0.041), with Group II having a significantly higher percentage of cases 7 (38.9%) with partial taste restoration. In contrast, a significantly higher proportion of Group I 17 cases (94.4%) had complete taste restoration (p < 0.001).

Conclusion
The present study concluded that using a Diode laser 810 nm aided in a more rapid recovery from loss of taste dysfunction.
A narrative review of evidence to support increased domestic resource mobilization for family planning in Nigeria
Authors: Mbachu Chinyere Ojiugo , Agu Ifunanya Clara , Ekwueme Chinazom N. , Ndu Anne , Onwujekwe Obinna 
Published: May 2023

Abstract
Background
Family planning (FP) is an important public health intervention that is proven to reduce unplanned pregnancies, unsafe abortions, and maternal mortality. Increasing investments in FP would ensure stability and better maternal health outcomes in Nigeria. However, evidence is needed to make a case for more domestic investment in family planning in Nigeria. We undertook a literature review to highlight the unmet needs for family planning and the situation of its funding landscape in Nigeria. A total of 30 documents were reviewed, including research papers, reports of national surveys, programme reports, and academic/research blogs. The search for documents was performed on Google Scholar and organizational websites using predetermined keywords. Data were objectively extracted using a uniform template. Descriptive analysis was performed for quantitative data, and qualitative data were summarized using narratives. Frequencies, proportions, line graphs and illustrative chart were used to present the quantitative data.
Although total fertility rate declined over time from 6.0 children per woman in 1990 to 5.3 in 2018, the gap between wanted fertility and actual fertility increased from 0.2 in 1990 to 0.5 in 2018. This is because wanted fertility rate decreased from 5.8 children per woman in 1990 to 4.8 per woman in 2018. Similarly, modern contraceptive prevalence rate (mCPR) decreased by 0.6% from 2013 to 2018, and unmet need for family planning increased by 2.5% in the same period. Funding for family planning services in Nigeria comes from both external and internal sources in the form of cash or commodities. The nature of external assistance for family planning services depends on the preferences of funders, although there are some similarities across funders. Irrespective of the type of funder and the length of funding, donations/funds are renewed on annual basis. Procurement of commodities receives most attention for funding whereas, commodities distribution which is critical for service delivery receives poor attention.

Conclusion
Nigeria has made slow progress in achieving its family planning targets. The heavy reliance on external donors makes funding for family planning services to be unpredictable and imbalanced. Hence, the need for more domestic resource mobilization through government funding.
Protective effects of the Terminalia bellirica tannin-induced Nrf2/HO-1 signaling pathway in rats with high-altitude pulmonary hypertension
Authors: Aimaier Salamaiti , Tao Yang , Lei Fang , Yupeng Zhang , Wenhui Shi , Aikemu Ainiwaer , Maimaitiyiming Dilinuer 
Published: May 2023

Abstract
Background
Oxidative stress and endothelial cell dysfunction induced by high-altitude hypoxia have important roles in the pathological process of high-altitude pulmonary hypertension (HAPH). Tannins present in Terminalia bellirica (Gaertn.) Roxb. (TTR) have pharmacological activities that produce oxidation resistance and exert anti-inflammatory effects. Whether TTR exerts a protective effect on HAPH remains unknown.

Methods
A rat model of HAPH was established. The mean pulmonary arterial pressure (mPAP) of the animals was measured, the serum levels of SOD, MDA, and GSH-Px were measured using ELISA, and the expression of Bax, Bcl-2, Nrf2, and HO-1 proteins in the lung tissue of each group of rats was measured using Western blotting. Pathological changes in the lung tissue were also observed. A model of damage to H2O2-induced pulmonary artery endothelial cells (PAECs) was generated, and cell proliferation was measured using CCK-8 assays. Flow cytometry was used to measure ROS levels in PAECs. Western blotting was used to detect the expression of Bax, Bcl-2, Nrf2, and HO-1 proteins in PAECs.

Results
The hemodynamic and pathologic findings showed that the mPAP of HAPH rats increased markedly, and the vascular wall thickness increased (P < 0.05). TTR reduced mPAP, alleviated or slowed pulmonary arterial remodeling, increased GSH-Px and SOD activity, lowered the level of MDA (P < 0.05), and downregulated the expression of Bax in the lung tissues of HAPH rats, while the expression of Bcl-2, Nrf2, and HO-1 was upregulated (P < 0.05). The results of the cell experiments showed that TTR inhibited H2O2-induced PAEC apoptosis and ROS production (P < 0.05), downregulated the expression of Bax in PAECs, and upregulated the expression of Bcl-2, Nrf2, and HO-1 (P < 0.05).

Conclusion
The results suggest that TTR reduces pulmonary arterial pressure, decreases oxidative stress during HAPH, and exerts protective effects in rats with HAPH and that its mechanism of action is related to regulation of the Nrf2/HO-1 signaling pathway.
The PEST (Pathology, Epidemiology, Severity, Treatment) approach to optimizing antimicrobial therapy
Authors: Davar Kusha , Vijayan Tara 
Published: May 2023

Abstract
Background
Selecting an empiric antimicrobial regimen can be difficult for early learners and misuse of antibiotics can lead to adverse events and antimicrobial resistance. There have been few interventions that have focused on improving antibiotic decision making, as a form of therapeutic reasoning, for post-graduate trainees. We describe here an approach to aid internal medicine interns in their therapeutic reasoning, particularly when it comes to diagnosing and empirically treating infections.

Methods
The PEST (pathology, epidemiology, severity, treatment) model was created as a four-step approach to therapeutic reasoning and choosing an appropriate antimicrobial regimen for a given infectious disease syndrome. In February 2020, we conducted two independent teaching sessions for interns on the PEST approach. We assessed pre-and post-teaching responses to five clinical vignette-based questions. Results were presented as a percentage of interns who chose an appropriate antibiotic and provided sufficient therapeutic reasoning as defined by using at least three out of the four PEST criteria. Statistical analysis occurred via Fischer’s exact test to determine the level of statistical significance between responses.

Results
Twenty-seven interns participated in the activity. At baseline, several interns had incorporated aspects of the PEST approach in their pre-teaching responses. Ten interns commented on the usefulness of such a systematic approach. While there was no statistically significant difference in antibiotic selection, the teaching session demonstrated a trend towards significance in improving therapeutic reasoning as defined by the PEST strategy.

Conclusion
Our results suggested an improvement in using a structured cognitive tool such as the PEST approach to reinforce therapeutic reasoning, but the method did little to improve antibiotic selection. Some interns used select “PEST” concepts prior to the intervention suggesting that the PEST approach may enhance prior knowledge or clinical reasoning skills. Continued incorporation of the PEST approach using a case-based framework may solidify conceptual and practical knowledge of antimicrobial selection. Further studies are needed to assess the impact of such teaching interventions.
Symptom prevalence, severity, distress and management among patients with chronic diseases
Authors: ALHosni Fatima , Al Qadire Mohammad , Omari Omar Al , Al Raqaishi Huda , Khalaf Atika 
Published: May 2023

Abstract
Background
Advanced knowledge, technology, and treatment approaches resulted in longer survival rates for patients suffering from chronic diseases. However, symptoms of these diseases persist and affect the individual’s entire life and normal functioning.

Aim
To assess symptoms prevalence, severity, distress, and management among patients with chronic obstructive pulmonary diseases (COPD), chronic heart failure (CHF), and end-stage renal disease (ESRD) in Oman.

Design
A descriptive cross-sectional design was used.

Sample and settings
The study sample comprised 340 participants who were recruited between May and December 2021 from two referral hospitals and one large dialysis unit in the Sultanate of Oman, Muscat Governate using a convenience sampling technique.

Results
The highly prevalent symptoms among patients with selected chronic diseases were lack of energy (60.9%), pain (57.4%), numbness (53.2%), difficulty sleeping (49.4%), and shortness of breath (45.9%). The most severe symptoms were shortness of breath (53.2%), problems with urination (51.9%), constipation (50.8%), difficulty sleeping (49.7%), and pain (46.2%). The symptom “problems with sexual interests or activity” was found to be the most frequently occurring and highly distressing symptom out of all reported symptoms.

Conclusions
The current study’s findings showed that symptoms were prevalent and that some symptoms were frequent, severe, and highly distressing. In addition, patients perceived symptom treatment as inadequate. Psychological symptoms received less treatment attention compared with physical symptoms. One of the mainstays for managing symptoms can be the introduction of palliative care. Providing palliative care to these patients can alleviate their suffering and improve their quality of life. In addition, designing chronic disease self-management programmes can make a difference in patients’ life.
Nurses’ clinical competency and its correlates: before and during the COVID-19 outbreak
Authors: Hui Tian , Zakeri Mohammad Ali , Soltanmoradi Yaser , Rahimi Neda , Hossini Rafsanjanipoor Sayed Mortaza , Nouroozi Majid , Dehghan Mahlagha 
Published: May 2023

Abstract
Background
Clinical competency is the ability to integrate knowledge, skills, attitudes and values into a clinical situation and it is very important in nursing education, clinical settings, nursing management, and crises. This study aimed to investigate nurses’ professional competence and its correlates before and during the COVID-19 pandemic.

Methods
We conducted this cross-sectional study before and during the COVID-19 outbreak and recruited all nurses working in hospitals affiliated to Rafsanjan University of Medical Sciences, southern Iran, so we included 260 and 246 nurses in the study before and during the COVID-19 epidemic, respectively. Competency Inventory for Registered Nurses (CIRN) was used to collect data. After inputting the data into SPSS24, we analysed them using descriptive statistics, chi-square and multivariate logistic tests. A significant level of 0.05 was considered.

Results
The mean clinical competency scores of nurses were 156.97 ± 31.40 and 161.97 ± 31.36 before and during the COVID-19 epidemic, respectively. The total clinical competency score before the COVID-19 epidemic was not significantly different from that during the COVID-19 epidemic. Interpersonal relationships (p = 0.03) and desire for research/critical thinking (p = 0.01) were significantly lower before the COVID-19 outbreak than during the COVID-19 outbreak. Only shift type had an association with clinical competency before the COVID-19 outbreak, while work experience had an association with clinical competency during the COVID-19 epidemic.

Conclusion
The clinical competency among nurses was moderate before and during the COVID-19 epidemic. Paying attention to the clinical competence of nurses can improve the care conditions of patients, and nursing managers should improve the clinical competence of nurses in different situations and crises. Therefore, we suggest further studies identifying factors improving the professional competency among nurses.
The Alberta Neonatal Abstinence Syndrome Mother-Baby Care ImprovEmeNT (NASCENT) program: protocol for a stepped wedge cluster randomized trial of a hospital-level Neonatal Abstinence Syndrome rooming-in intervention
Authors: Wine Osnat , McNeil Deborah , Kromm Seija K. , Foss Karen , Caine Vera , Clarke Denise , Day Nathaniel , Johnson David W. , Rittenbach Katherine , Wood Stephen , Hicks Matt 
Published: May 2023

Abstract
Background
Neonatal Abstinence Syndrome (NAS), a problem common in newborns exposed to substances in-utero, is an emerging health concern. In traditional models of care, infants with NAS are routinely separated from their mothers and admitted to the Neonatal Intensive Care Unit (NICU) with long, expensive length of stay (LOS). Research shows a rooming-in approach (keeping mothers and infants together in hospital) with referral support is a safe and effective model of care in managing NAS. The model’s key components are facilitating 24-h care by mothers on post-partum or pediatric units with support for breastfeeding, transition home, and access to Opioid Dependency Programs (ODP). This study will implement the rooming-in approach at eight hospitals across one Canadian Province; support practice and culture shift; identify and test the essential elements for effective implementation; and assess the implementation’s impact/outcomes.

Methods
A stepped wedge cluster randomized trial will be used to evaluate the implementation of an evidence-based rooming-in approach in the postpartum period for infants born to mothers who report opioid use during pregnancy. Baseline data will be collected and compared to post-implementation data. Six-month assessment of maternal and child health and an economic evaluation of cost savings will be conducted. Additionally, barriers and facilitators of the rooming-in model of care within the unique context of each site and across sites will be explored pre-, during, and post-implementation using theory-informed surveys, interviews, and focus groups with care teams and parents. A formative evaluation will examine the complex contextual factors and conditions that influence readiness and sustainability and inform the design of tailored interventions to facilitate capacity building for effective implementation.

Discussion
The primary expected outcome is reduced NICU LOS. Secondary expected outcomes include decreased rates of pharmacological management of NAS and child apprehension, increased maternal ODP participation, and improved 6-month outcomes for mothers and infants. Moreover, the NASCENT program will generate the detailed, multi-site evidence needed to accelerate the uptake, scale, and spread of this evidence-based intervention throughout Alberta, leading to more appropriate and effective care and use of healthcare resources.

Trial registration
ClinicalTrials.gov, NCT0522662. Registered February 4th, 2022.
Down-regulation of WWP2 aggravates Type 2 diabetes mellitus-induced vascular endothelial injury through modulating ubiquitination and degradation of DDX3X
Authors: You Shilong , Xu Jiaqi , Yin Zeyu , Wu Boquan , Wang Pengbo , Hao Mingjun , Cheng Cheng , Liu Mengke , Zhao Yuanhui , Jia Pengyu , Jiang Hongkun , Li Da , Cao Liu , Zhang Xingang , Zhang Ying , Sun Yingxian , Zhang Naijin 
Published: May 2023

Abstract
Background
Endothelial injury caused by Type 2 diabetes mellitus (T2DM) is considered as a mainstay in the pathophysiology of diabetic vascular complications (DVCs). However, the molecular mechanism of T2DM-induced endothelial injury remains largely unknown. Here, we found that endothelial WW domain-containing E3 ubiquitin protein ligase 2 (WWP2) act as a novel regulator for T2DM-induced vascular endothelial injury through modulating ubiquitination and degradation of DEAD-box helicase 3 X-linked (DDX3X).

Methods
Single-cell transcriptome analysis was used to evaluate WWP2 expression in vascular endothelial cells of T2DM patients and healthy controls. Endothelial-specific Wwp2 knockout mice were used to investigate the effect of WWP2 on T2DM-induced vascular endothelial injury. In vitro loss- and gain-of-function studies were performed to assess the function of WWP2 on cell proliferation and apoptosis of human umbilical vein endothelial cells. The substrate protein of WWP2 was verified using mass spectrometry, coimmunoprecipitation assays and immunofluorescence assays. The mechanism of WWP2 regulation on substrate protein was investigated by pulse-chase assay and ubiquitination assay.

Results
The expression of WWP2 was significantly down-regulated in vascular endothelial cells during T2DM. Endothelial-specific Wwp2 knockout in mice significantly aggravated T2DM-induced vascular endothelial injury and vascular remodeling after endothelial injury. Our in vitro experiments showed that WWP2 protected against endothelial injury by promoting cell proliferation and inhibiting apoptosis in ECs. Mechanically, we found that WWP2 is down-regulated in high glucose and palmitic acid (HG/PA)-induced ECs due to c-Jun N-terminal kinase (JNK) activation, and uncovered that WWP2 suppresses HG/PA-induced endothelial injury by catalyzing K63-linked polyubiquitination of DDX3X and targeting it for proteasomal degradation.

Conclusion
Our studies revealed the key role of endothelial WWP2 and the fundamental importance of the JNK-WWP2-DDX3X regulatory axis in T2DM-induced vascular endothelial injury, suggesting that WWP2 may serve as a new therapeutic target for DVCs.
Benchmark dose calculations for PFAS exposure based on two data sets on immunotoxic effects
Authors: Budtz-Jørgensen Esben , Grandjean Philippe 
Published: May 2023

Abstract
Background
Exposure to perfluorinated alkylate substances (PFAS) is associated with harmful effects on human health, including developmental immunotoxicity. This outcome was chosen as the critical effect by the European Food Safety Authority (EFSA), which calculated a new joint reference dose for four PFAS using a Benchmark Dose (BMD) analysis of a study of 1-year old children. However, the U.S. Environmental Protection Agency (EPA) recently proposed much lower exposure limits.

Methods
We explored the BMD methodology for summary and individual data and compared the results with and without grouping for two data sets available. We compared the performance of different dose-response models including a hockey-stick model and a piecewise linear model. We considered different ways of testing the assumption of equal weight-based toxicity of the four PFAS and evaluated more flexible models with exposure indices allowing for differences in toxicity.

Results
Results relying on full and decile-based data were in good accordance. However, BMD results for the larger study were lower than observed by EFSA for the smaller study. EFSA derived a lower confidence limit for the BMD of 17.5 ng/mL for the sum of serum-PFAS concentration, while similar calculations in the larger cohort yielded values of about 1.5 ng/mL. As the assumption of equal weight-based toxicity of the four PFAS seems questionable, we confirmed dose-dependencies that allowed potency differences between PFAS. We also found that models linear in the parameters for the BMD analysis showed superior coverage probabilities. In particular, we found the piecewise linear model to be useful for Benchmark analysis.

Conclusions
Both data sets considered could be analyzed on a decile basis without important bias or loss of power. The larger study showed substantially lower BMD results, both for individual PFAS and for joint exposures. Overall, EFSA’s proposed tolerable exposure limit appears too high, while the EPA proposal is in better accordance with the results.