bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relation between ocular paraneoplastic syndromes and Immune Checkpoint Inhibitors (ICI): review of literature
Authors: Casselman Pauline , Jacob Julie , Schauwvlieghe Pieter-Paul 
Published: April 2023

Abstract
Purpose
To describe different ocular paraneoplastic syndromes in patients treated with Immune Checkpoint Inhibitors (ICI), its relation with different types of ICI and different types of tumors, and its implications for treatment.

Methods
A comprehensive review of the literature was performed.

Results
Patients treated with ICI can present with different ocular paraneoplastic syndromes, such as Carcinoma Associated Retinopathy (CAR), Melanoma Associated Retinopathy (MAR) and paraneoplastic Acute Exudative Polymorphous Vitelliform Maculopathy (pAEPVM). In literature, the different types of paraneoplastic retinopathy are mostly related to different types of primary tumors, with MAR and pAEPVM seen in melanoma, and CAR in carcinoma. Visual prognosis is limited in MAR and CAR.

Conclusion
Paraneoplastic disorders result from an antitumor immune response against a shared autoantigen between the tumor and ocular tissue. ICI enhance the antitumor immune response, which can lead to increased cross-reaction against ocular structures and unmasking of a predisposed paraneoplastic syndrome. Different types of primary tumors are related to different cross-reactive antibodies. Therefore, the different types of paraneoplastic syndromes are related to different types of primary tumors and are probably unrelated to the type of ICI. ICI-related paraneoplastic syndromes often lead to an ethical dilemma. Continuation of ICI treatment can lead to irreversible visual loss in MAR and CAR. In these cases overall survival must be weighed against quality of life. In pAEPVM however, the vitelliform lesions can disappear with tumor control, which may involve continuation of ICI.
Using sensitivity analyses to understand bistable system behavior
Authors: Sreedharan Vandana , Bhalla Upinder S. , Ramakrishnan Naren 
Published: April 2023

Abstract
Background
Bistable systems, i.e., systems that exhibit two stable steady states, are of particular interest in biology. They can implement binary cellular decision making, e.g., in pathways for cellular differentiation and cell cycle regulation. The onset of cancer, prion diseases, and neurodegenerative diseases are known to be associated with malfunctioning bistable systems. Exploring and characterizing parameter spaces in bistable systems, so that they retain or lose bistability, is part of a lot of therapeutic research such as cancer pharmacology.

Results
We use eigenvalue sensitivity analysis and stable state separation sensitivity analysis to understand bistable system behaviors, and to characterize the most sensitive parameters of a bistable system. While eigenvalue sensitivity analysis is an established technique in engineering disciplines, it has not been frequently used to study biological systems. We demonstrate the utility of these approaches on a published bistable system. We also illustrate scalability and generalizability of these methods to larger bistable systems.

Conclusions
Eigenvalue sensitivity analysis and separation sensitivity analysis prove to be promising tools to define parameter design rules to make switching decisions between either stable steady state of a bistable system and a corresponding monostable state after bifurcation. These rules were applied to the smallest two-component bistable system and results were validated analytically. We showed that with multiple parameter settings of the same bistable system, we can design switching to a desirable state to retain or lose bistability when the most sensitive parameter is varied according to our parameter perturbation recommendations. We propose eigenvalue and stable state separation sensitivity analyses as a framework to evaluate large and complex bistable systems.
Preliminary clinical observation of double C-arm digital subtraction angiography guidance during transjugular intrahepatic portosystemic shunt placement
Authors: Chen Jianqiao , Bai Xiao , Wang Chunyan , Li Jihua , Xu Weiguo 
Published: April 2023

Abstract
Background
This study aimed to investigate the safety, preliminary clinical experience, and technical advantages of double C-arm digital subtraction angiography -assisted portal vein puncture for transjugular intrahepatic portosystemic shunt.

Methods
Clinical data of 25 patients with portal hypertension caused by liver cirrhosis were retrospectively analyzed from January 2021 to June 2022. The fluoroscopy time, puncture time, mean portosystemic pressure gradient, dose area product, and intraoperative and postoperative complications were recorded.

Results
Transjugular intrahepatic portosystemic shunt was performed in all 25 patients, with a success rate of 100%. The fluoroscopy time, puncture time, and dose area product were 33.6 ± 8.5 min, 9.1 ± 5.7 min, and 126 ± 53 Gy·cm2, respectively. The mean portosystemic pressure gradient decreased from 22.5 ± 6.3 mmHg to 10.5 ± 2.3 mmHg (p < 0.01). No serious intraoperative and postoperative complications were found.

Conclusion
Double C-arm digital subtraction angiography-assisted portal vein puncture is safe and feasible in transjugular intrahepatic portosystemic shunt operation. It can reduce the difficulty of the operation and possesses evident technical advantages.
Disseminated cryptococcosis with gastrointestinal involvement and false-negative cryptococcal antigen testing due to postzone phenomenon: a case report and review of the literature
Authors: Zimmet Alex N. , Cullen Grace D. , Mische Leah , Deftos Michael , Bogler Yael , Nguyen Nang L. , Ray Manoj 
Published: April 2023

Abstract
Background
Cryptococcosis is an increasingly common infection given the growing immunocompromised population worldwide. Cryptococcal antigen (CrAg) testing demonstrates excellent sensitivity and specificity and is the mainstay of diagnosis. However, there may be rare instances in which false-negative CrAg results can delay diagnosis and early treatment, which are critical to ensure positive outcomes.

Case presentation
A 31-year-old man living with HIV/AIDS who was not taking antiretroviral therapy was hospitalized with fever, diarrhea, and headaches. CD4 count on presentation was 71 cells/uL, and HIV viral load was 3,194,949 copies/mL. Serum CrAg testing was initially negative, however CSF CrAg performed several days later was positive at 1:40 and blood and CSF cultures grew Cryptococcus neoformans. Colonoscopy revealed mucosal papules throughout the sigmoid colon, and tissue biopsy showed yeast within the lamina propria consistent with GI cryptococcosis. Given the high burden of disease, the original serum CrAg specimen was serially diluted and subsequently found to be positive at 1:2,560, confirming the postzone phenomenon.

Conclusion
Cryptococcosis has a wide array of presentations including intraluminal GI disease, as seen in this patient. While serum CrAg testing displays excellent test characteristics, it is important for clinicians to be aware of the rare instances in which false-negative results may occur in the presence of excess antigen, as in this case.
Effects of temperature, rainfall, and El Niño Southern Oscillations on dengue-like-illness incidence in Solomon Islands
Authors: Andhikaputra Gerry , Lin Yu-Han , Wang Yu-Chun 
Published: April 2023

Abstract
Background
This study investigated associations between climate variables (average temperature and cumulative rainfall), and El Niño Southern Oscillation (ENSO) and dengue-like-illness (DLI) incidence in two provinces (Western and Guadalcanal Provinces) in Solomon Islands (SI).

Methods
Weekly DLI and meteorological data were obtained from the Ministry of Health and Medical Services SI and the Ministry of Environment, Climate Change, Disaster Management and Meteorology from 2015 to 2018, respectively. We used negative binomial generalized estimating equations to assess the effects of climate variables up to a lag of 2 months and ENSO on DLI incidence in SI.

Results
We captured an upsurge in DLI trend between August 2016 and April 2017. We found the effects of average temperature on DLI in Guadalcanal Province at lag of one month (IRR: 2.186, 95% CI: 1.094–4.368). Rainfall had minor but consistent effect in all provinces. La Niña associated with increased DLI risks in Guadalcanal Province (IRR: 4.537, 95% CI: 2.042–10.083), whereas El Niño associated with risk reduction ranging from 72.8% to 76.7% in both provinces.

Conclusions
Owing to the effects of climate variability and ENSO on DLI, defining suitable and sustainable measures to control dengue transmission and enhancing community resilience against climate change in low- and middle-developed countries are important.
Trends in Neisseria meningitidis serogroups amongst patients with suspected cerebrospinal meningitis in the meningitis belt of Ghana: a 5-year retrospective study
Authors: Azure Stebleson , Abdul-Karim Abass , Abubakari Braimah Baba , Eleeza John B. , Agboyie Daron Davies A. , Weyori Enoch Weikem , Choi Jun Yong 
Published: April 2023

Abstract
Background
Serogroup A Neisseria meningitidis was the major cause of meningococcal meningitis epidemics in the African meningitis belt before 2010 when the monovalent meningococcal A conjugate vaccine (MenAfriVac) was introduced in the region. Therefore, this study aimed to establish the trends in N. meningitidis serogroups from 2016 to 2020 in Ghana’s meningitis belt.

Methods
Polymerase chain reaction (PCR) confirmed laboratory results of suspected cases of cerebrospinal meningitis from January, 2016 to March, 2020 were obtained from the Tamale Public Health Laboratory. The data were subjected to trend analysis using Statistical Package for the Social Sciences version 25. Differences between discrete variables were analyzed using the Cochran–Armitage trend test.

Results
Of the 2,426 suspected cases, 395 (16.3%) were confirmed positive for N. meningitidis using PCR. Serogroup X showed a significant upward trend (P < 0.01), and serogroup W showed a downward trend (P < 0.01). However, no significant trend was observed for any other serogroup.

Conclusion
This study showed the emergence of serogroup X, a non-vaccine type, as the predominant N. meningitidis serogroup in the wake of a declining serogroup W in Ghana’s meningitis belt.
Coexistence of COVID-19, Pseudomonas, and thoracic actinomycosis in a cystic bronchiectasis case
Authors: Afsin Emine , Kucuk Furkan , Ozcelik Hüsna , Haktanır Muhammed Yavuz 
Published: April 2023

AbstractActinomycosis often leads to cervicofacial infections, but thoracic involvement may also occur. However, the development of empyema is rare. While being followed up with the diagnosis of asthma and bronchiectasis, our case was hospitalized for infected bronchiectasis. As empyema developed in the follow-up, the pleural effusion was drained by tube thoracostomy. Actinomycosis was diagnosed through pleural effusion cytology. Growth of Pseudomonas aeruginosa was observed in sputum culture, and SARS-CoV2 RT-PCR was also positive in nasopharyngeal sampling. Polymicrobial agents can often be detected in actinomycosis. Actinomycosis cases have also been reported in the post-COVID period. Our case is presented since it would be the first in the literature regarding the coexistence of COVID-19, Pseudomonas, and thoracic Actinomycosis (empyema).
The effects of the prognostic biomarker SAAL1 on cancer growth and its association with the immune microenvironment in lung adenocarcinoma
Authors: Tong Song , Jiang Ni , Wan Jun-Hao , Chen Chong-Rui , Wang Si-Hua , Wu Chuang-Yan , Guo Qiang , Xiao Xiao-Yue , Huang Huan , Zhou Ting 
Published: April 2023

Abstract
Background
Inhibition of Serum Amyloid A-like 1 (SAAL1) expression could inhibit cancer progression and improve the prognosis of cancer patients. At present, the correlation between SAAL1 and lung adenocarcinoma (LAC) remains unclear. Therefore, this study surveyed the worth and pathway of SAAL1 in LAC progression and immunity.

Methods
Bioinformatics and immunohistochemistry were used to identify the SAAL1 expression in LAC. The roles of SAAL1 expression in the existence values of LAC patients were explored, and the nomograms were constructed. Clinical values of SAAL1 co-expressed genes were evaluated by COX regression, survival, and Receiver operating characteristic (ROC) analysis. EDU and western blotting methods were used to inquiry the functions and pathways of the SAAL1 in cell growths. The correlation between the SAAL1 level and immune microenvironment was visualized using correlation research.

Results
SAAL1 level was elevated in LAC tissues, and was observed in cancer tissues of dead patients. SAAL1 overexpression had something to do with shorter overall survival, progression-free interval, and disease-specific survival in LAC. The area under the curve of SAAL1 was 0.902 in normal tissues and cancer tissues. Inhibition of SAAL1 expression could inhibit cancer cell proliferation, which may be related to the decreased expression of cyclin D1 and Bcl-2 proteins. In LAC, SAAL1 level had something to do with stromal, immune, and estimate scores, and correlated with macrophages, T cells, Th2 cells, CD8 T cells, NK CD56dim cells, DC, eosinophils, NK CD56bright cells, pDC, iDC, cytotoxic cells, Tgd, aDC cells, B cells, Tcm, and TFH levels. SAAL1 overexpression had something to do with existence values and the immunity in LAC.

Conclusions
Inhibition of SAAL1 expression could regulate cancer growth via cyclin D1 and Bcl-2. SAAL1 is a promising prognostic biomarker in LAC patients.
Effect of eye shield and ear muffs on pain intensity during venous blood sampling in premature infants: a clinical trial study
Authors: Shykhveisi Fatemeh , Jafarian Amiri Roghayeh , Zabihi Ali , Haghshenas Mojaveri Mohsen , Arzani Afsaneh , Chehrazi Mohammad , Chari Zahra Valizadeh 
Published: April 2023

Abstract
Background
Today, due to the side effects of drugs, there is a greater desire to use non-pharmacological interventions to relieve pain caused by painful procedures. Using non-pharmacological interventions in combination is more effective than using them alone in relieving the pain of infants. Reducing sensory and environmental stimuli such as visual and auditory stimuli is one of the non-pharmacological methods to relieve pain. The aim of this study was to investigate the effect of using eye shield and ear muffs on pain intensity during venous blood sampling of premature infants.

Methods
In this clinical trial study, 148 premature neonates admitted to the Neonatal Intensive Care Unit of Rouhani and Children Hospitals in Babol were randomly assigned to four groups of 37. Fifteen minutes before intravenous blood sampling until 15 min later, in the first group, eye shield; in the second group, ear muffs, and in the third group, eye shield plus ear muffs were used. In the fourth group (control), blood sampling was performed routinely. NIPS pain scale and demographic questionnaire were used to collect the data.

Results
The results showed that during the venous blood sampling was a significant difference between the mean pain intensity of neonatal in the eye shield plus ear muffs group (3.14 ± 0.71), the ear muffs group (4.43 ± 1.21), the eye shield group (5.41 ± 1.04).) and the control group (5.94 ± 0.84) (P = 0.001). Moreover, after the venous blood sampling, there was a significant difference between the mean neonatal pain intensity in the eye shield plus ear muffs group (1.19 ± 0.39), the ear muffs group (1.43 ± 0.50), the eye shield group (1.33 ± 0.37) and the control group (1.89 ± 0.90) (P = 0.001).

Conclusions
In this study, the pain severity during and after venous blood sampling in the ear muffs plus eye shield was lower than in other groups. Therefore, a combination of ear muffs and eye shield is recommended as a better pain reliever when performing venous blood sampling in premature infants.
Comparison of mothers’ perceptions of hunger cues in 3-month-old infant under different feeding methods
Authors: Zhao Fenghua , Sun Yijie , Zhang Yue , Xu Tao , Wang Nianrong , Yan Shuangqin , Zeng Ting , Zhang Fenghua , Gao Jie , Yue Qing , Rozelle Scott 
Published: April 2023

Abstract
Background
Mothers’ perception of infant hunger cues is a critical content of responsive feeding, which is central to the promotion of early childhood development. However, only a few studies have examined responsive feeding in China, especially lacking the studies on perceptions of infant hunger cues. Consider the cultural differences, the aim of this study was to describe the perceptions of infant hunger cues of Chinese mothers for infants aged 3 months, and explore the relationship between maternal perceptions of infant hunger cues and different feeding methods.

Methods
A cross-sectional study was conducted with a sample of 326 mothers of healthy 3-month-old infants, including 188 exclusive breastfeeding (EBF) mothers and 138 formula feeding (FF) mothers. It was implemented in four provincial and municipal maternal and child health hospitals. The mothers’ perceptions of infant hunger cues were surveyed by self-reporting questionnaires. Chi-square tests and logistic analysis were applied to analyze the differences in maternal perceptions of infant hunger cues, including the number of hunger cues and the specific cues, between EBF group and FF group by controlling sociodemographic variables and the daily nursing indicators.

Results
We found that a higher proportion of EBF mothers could perceive multiple hunger cues (≥ 2) than FF mothers (66.5% vs.55.1%). For specific cues, the EBF mothers had higher perceptions of infant’s “hand sucking” (67.6% vs. 53.6%) and “moving head frantically from side to side” (34.6% vs. 23.9%), all p < 0.05. Regression analysis revealed that EBF might support mothers to perceive infant hunger cues than FF mothers, with the number of infant hunger cues (OR = 1.70, 95% CI: 1.01–2.85), “hand sucking” (OR = 1.72, 95% CI: 1.04–2.87), “moving head frantically from side to side” (OR = 2.07, 95% CI: 1.19–3.62). The number of infant hunger cues perceived by mothers was also associated with their educational level and family structure.

Conclusion
EBF mothers of 3-month-old infants may be more likely to perceive infant hunger cues than FF mothers in China. It is necessary to increase the health education about infant hunger and satiety cues to caregivers in China, especially among mothers with lower education levels, mothers living in nuclear families, and FF mothers.
The big squeeze: a product content and labelling analysis of ready-to-use complementary infant food pouches in Australia
Authors: Brunacci Kaitlyn A , Salmon Libby , McCann Jennifer , Gribble Karleen , Fleming Catharine A.K. 
Published: April 2023

Abstract
Background
Encouraging the early development of healthy eating habits prevents diet-related chronic disease. It is well understood that highly processed foods with high amounts of sugars, salt and fats are a risk factor for non-communicable diseases. Commercial baby foods in ready-to-use squeeze pouches emerged in the global food market around 2012. The long-term effects of this now ubiquitous packaging on the quality of infant diets, baby food consumption and marketing are unknown. This study aimed to conduct a rigorous mixed-methods audit of squeeze pouches in Australia to inform product regulation and policy.

Methods
Nutritional and marketing data were sourced from products available in Australian retailers. Analysis of nutritional content, texture and packaging labelling and serving size was conducted. Pouches were given a Nutrition Profile Index (NPI) score and compared with the Australian Infant Feeding Guidelines. Marketing text was thematically analysed and compared to existing infant nutrition policy around regulation of marketing claims.

Results
276 products from 15 manufacturers were analysed, targeting infants from 4 + to 12 + months. Total sugar content ranged 0.8-17.5 g/100 g, 20% (n = 56) of products had added sugars, 17% (n = 46) had added fruit juice, 71% (n = 196) had added fruit puree. Saturated fat content ranged from 0.0 to 5.0 g/100 g, sodium 0.0-69 mg/100 g and dietary fibre 0.0-4.3 g/100 g. Only two products were nutritionally adequate according to a nutrient profiling tool. Marketing messages included ingredient premiumisation, nutrient absence claims, claims about infant development and health, good parenting, and convenience. Claims of ‘no added sugar’ were made for 59% of pouches, despite the addition of free sugars.

Conclusions
Squeeze pouch products available in Australia are nutritionally poor, high in sugars, not fortified with iron, and there is a clear risk of harm tothe health of infant and young children if these products are fed regularly. The marketing messages and labelling on squeeze pouches are misleading and do not support WHO or Australian NHMRC recommendations for breastfeeding or appropriate introduction of complementary foods and labelling of products. There is an urgent need for improved regulation of product composition, serving sizes and labelling to protect infants and young children aged 0–36 months and better inform parents.
Application of flipped classroom based on CDIO concept combined with mini-CEX evaluation model in the clinical teaching of orthopedic nursing
Authors: Su Xinyang , Ning Huaxiu , Zhang Fang , Liu Li , Zhang Xiaoling , Xu Hongmei 
Published: April 2023

Abstract
Background
After the COVID-19 epidemic, the state has paid more attention to the clinical teaching function of affiliated hospitals of colleges and universities. Strengthening the integration of medicine and education and improving the quality and effect of clinical practice teaching are critical challenges facing medical education. The difficulty of orthopedic teaching lies in the characteristics of a wide variety of diseases, strong professionalism, and relatively abstract characteristics, which affect the initiative, enthusiasm, and learning effect of nursing students. In this study, a flipped classroom teaching plan based on the CDIO (conceive–design–implement–operate) concept was constructed and practiced in the orthopedic nursing student training course to improve the effect of practical teaching, and it is convenient for teachers to implement more effective and targeted teaching in the flipped classroom of nursing education and even medical education in the future.

Methods
Fifty undergraduate nursing students who practiced in the Orthopedics Department of a tertiary hospital in June 2017 were enrolled in the control group, while 50 undergraduate nursing students who practiced in the same department in June 2018 were enrolled in the intervention group. The intervention group adopted the flipped classroom teaching mode of the CDIO concept, whereas the control group adopted the traditional teaching mode. After finishing the department practice task, the students in the two groups completed the evaluation of theory, operation skills, independent learning ability, and critical thinking ability. They completed the evaluation of clinical practice ability in eight dimensions, including four processes of nursing procedures, humanistic care ability, and evaluation of clinical teaching quality for two groups of teachers.

Results
After teaching, the clinical practice ability, critical thinking ability, autonomous learning ability, theoretical and operational performance, and evaluation of clinical teaching quality in the intervention group were significantly higher than those in the control group (all p < 0.05).

Conclusion
The CDIO-based teaching mode can stimulate the independent learning ability and critical thinking ability of nursing interns, promote the organic combination of theory and practice, improve their ability to comprehensively use theoretical knowledge to analyze and solve practical problems, and improve teaching effectiveness.