bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using graphic medicine in teaching multicultural nursing: a quasi-experimental study
Authors: Lesińska-Sawicka Małgorzata 
Published: April 2023

Abstract
Background
Comics, as an art form that combines words and images, can be used with great success in teaching nursing students. Teaching content on multicultural issues is not easy, especially since, in addition to knowledge, it is important to pay attention to communication skills, attitudes of respect, openness or empathy, among others. It is difficult to recognize or discuss these attitudes without student involvement. Graphic stories, comic strips provide such opportunities and facilitate learning new content, even those difficult to communicate naturally and spontaneously. The aim of this paper is to present the possibilities of using the graphic method, in particular comics and graphic novels, in teaching nursing, based on the example of multicultural nursing.

Methods
Quasi-experimental intervention study with a quantitative approach, guided by the STROBE tool The survey was conducted March–May 2022 among State University of Applied Sciences in Piła students. First, students’ knowledge of cultural issues was assessed, then they were randomly assigned to two groups. One group had classes using a comic book, and the other group had classes using traditional methods. After the class, the students’ knowledge was assessed again. Descriptive statistical analyses were performed to obtain the mean, median, standard deviation (SD). Data followed a normal distribution. Data was verified by the t-Students test for independent groups.

Results
Respondents’ knowledge on cultural issues before taking the course was satisfactory, with a mean score of 19.1. After completing the course, knowledge on cultural issues increased and was rated as very good and the mean score for all respondents was 26.9. Statistical analysis showed that there was statistical significance between the groups and the number of points achieved in the posttest. Respondents in the intervention group scored higher than those in the comparsion group.

Conclusion
The use of the graphic method, which is one of the forms of active learning, in teaching cultural content to nursing students has positive didactic effects. Students achieve better learning outcomes in terms of knowledge, skills and attitudes in a way that is more engaging. This makes learning difficult topics, such as a cultural issue, more effective.
It would be worth considering using this method for other courses and/or at other universities as well.
The effectiveness of teaching complementary and alternative medicine based on the components of theory of planned behavior on nutrition students: multicenter research study
Authors: Mahmoodi Mohammad Reza , Shafian Sara , Alinaghizade Manizhe Shaban 
Published: April 2023

Abstract
Objective
Safe and beneficial use of complementary and alternative medicine (CAM) modalities results from integrating CAM education into curricula and increasing CAM knowledge. We sought how much teaching CAM procedures in a virtual environment can influence the components of the theory of planned behavior (TPB), including knowledge, attitude, behavioral intention, and behavior of nutrition students.

Methods
This cross-sectional descriptive-analytic study was conducted on 162 undergraduate nutrition students were selected through convenience sampling based on inclusion criteria in 2021–2022. Data were collected through a validated researcher-made CAM questionnaire that was designed based on TPB questionnaire that consisted of four constructs (knowledge, attitude, behavioral intention, and behavior). The content validity index and content validity ratio of the questionnaire were evaluated.

Results
Our results revealed that students who significantly scored the highest scores in attitude, behavioral intention, and behavior constructs were the students who claimed that “teaching two credits of CAM for nutrition students is not enough” (p. value =  < 0.001, < 0.001, and 0.005, respectively). In addition, these students used treatment methods of CAM for themselves, suggested treatment methods of CAM to others, and followed the recommendations of the CAM specialists (for three pairwise comparisons: p. value =  < 0.001, < 0.001, and < 0.001, respectively). The attitude could predict 70% of behavioral intention. However, attitude and behavioral intention could predict 90% of behavior.

Conclusion
Attitude was the most critical determinant influencing behavioral intention and behavior. CAM teaching using evidence-based CAM-ITM principles with a succinct, concerted, and collaborative curriculum, integration of CAM into continuing education, and integration of educational CAM programs continuously for several years into the academic curriculum in the actual setting influence the success of the educational CAM program.
Secretory expression of recombinant small laccase genes in Gram-positive bacteria
Authors: Välimets Silja , Pedetti Patricia , Virginia Ludovika Jessica , Hoang Mai Ngoc , Sauer Michael , Peterbauer Clemens 
Published: April 2023

AbstractBackgroundLaccases are multicopper enzymes that oxidize a wide range of aromatic and non-aromatic compounds in the presence of oxygen. The majority of industrially relevant laccases are derived from fungi and are produced in eukaryotic expression systems such asPichia pastorisandSaccharomyces cerevisiae. Bacterial laccases for research purposes are mostly produced intracellularly inEscherichia coli, but secretory expression systems are needed for future applications. Bacterial laccases fromStreptomycesspp. are of interest for potential industrial applications because of their lignin degrading activities.ResultsIn this study, we expressed small laccases genes fromStreptomyces coelicolor,Streptomyces viridosporusandAmycolatopsis75iv2 with their native signal sequences in Gram-positiveBacillus subtilisandStreptomyces lividanshost organisms. The extracellular activities ofScLac,SvLac andAmLac expressed inS. lividansreached 1950 ± 99 U/l, 812 ± 57 U/l and 12 ± 1 U/l in the presence of copper supplementation. The secretion of the small laccases was irrespective of the copper supplementation; however, activities upon reconstitution with copper after expression were significantly lower, indicating the importance of copper during laccase production. The production of small laccases inB. subtilisresulted in extracellular activity that was significantly lower than inS. lividans. Unexpectedly,AmLac andScLac were secreted without their native signal sequences inB. subtilis, indicating thatB. subtilissecretes some heterologous proteins via an unknown pathway.ConclusionsSmall laccases fromS. coelicolor,S. viridosporusandAmycolatopsis75iv2 were secreted in both Gram-positive expression hostsB. subtilisandS. lividans, but the extracellular activities were significantly higher in the latter.
Carcinogenic effect of arsenic in digestive cancers: a systematic review
Authors: Kasmi Sophie , Moser Laureline , Gonvers Stéphanie , Dormond Olivier , Demartines Nicolas , Labgaa Ismail 
Published: April 2023

Abstract
Background
The carcinogenic effect of arsenic (As) has been documented in lung, bladder and skin cancers but remains unclear for digestive cancers, although metabolic pathways of As and recent data suggest that it may be an important determinant in these malignancies as well.

Objective
This study aimed to systematically review the available literature investigating the potential association between As and digestive cancers.

Methods
An extensive search was conducted in Medline Ovid SP, Cochrane, PubMed, Embase.com, Cochrane Library Wiley, Web of Science and Google Scholar. Studies providing original data in humans, with As measurement and analysis of association with digestive cancers including esogastric cancers (esophagus and stomach), hepato-pancreatico-biliary (HPB) cancers (including biliary tract, liver and pancreas) and colorectal cancers were eligible.

Results
A total of 35 studies were identified, 17 ecological, 13 case–control and 5 cohort studies. Associations between As and digestive cancers were reported for both risks of incidence and cancer-related mortality. Overall, 43% (3/7) and 48% (10/21) studies highlighted an association between As and the incidence or the mortality of digestive cancers, respectively.

Conclusions
A substantial proportion of studies exploring the potential link between As and digestive cancers suggested an association, particularly in HPB malignancies. These findings emphasize the need to further investigate this topic with dedicated and high-quality studies, as it may have an important impact, including for prevention strategies.
Phase-transition nanodroplets with immunomodulatory capabilities for potentiating mild magnetic hyperthermia to inhibit tumour proliferation and metastasis
Authors: Qin Qiaoxi , Zhou Yang , Li Pan , Liu Ying , Deng Ruxi , Tang Rui , Wu Nianhong , Wan Li , Ye Ming , Zhou Hong , Wang Zhiming 
Published: April 2023

Abstract
Background
Magnetic hyperthermia (MHT)-mediated thermal ablation therapy has promising clinical applications in destroying primary tumours. However, traditional MHT still presents the challenges of damage to normal tissues adjacent to the treatment site and the destruction of tumour-associated antigens due to its high onset temperature (> 50 °C). In addition, local thermal ablation of tumours often exhibits limited therapeutic inhibition of tumour metastasis.

Results
To address the above defects, a hybrid nanosystem (SPIOs + RPPs) was constructed in which phase transition nanodroplets with immunomodulatory capabilities were used to potentiate supermagnetic iron oxide nanoparticle (SPIO)-mediated mild MHT (< 44 °C) and further inhibit tumour proliferation and metastasis. Magnetic-thermal sensitive phase-transition nanodroplets (RPPs) were fabricated from the immune adjuvant resiquimod (R848) and the phase transition agent perfluoropentane (PFP) encapsulated in a PLGA shell. Because of the cavitation effect of microbubbles produced by RPPs, the temperature threshold of MHT could be lowered from 50℃ to approximately 44℃ with a comparable effect, enhancing the release and exposure of damage-associated molecular patterns (DAMPs). The exposure of calreticulin (CRT) on the cell membrane increased by 72.39%, and the released high-mobility group B1 (HMGB1) increased by 45.84% in vivo. Moreover, the maturation rate of dendritic cells (DCs) increased from 4.17 to 61.33%, and the infiltration of cytotoxic T lymphocytes (CTLs) increased from 10.44 to 35.68%. Under the dual action of mild MHT and immune stimulation, contralateral and lung metastasis could be significantly inhibited after treatment with the hybrid nanosystem.

Conclusion
Our work provides a novel strategy for enhanced mild magnetic hyperthermia immunotherapy and ultrasound imaging with great clinical translation potential.
Health-related quality of life among patients with end-stage renal disease undergoing hemodialysis in Ethiopia: a cross-sectional survey
Authors: Gebrie Mignote Hailu , Asfaw Hussen Mekonnen , Bilchut Workagegnehu Hailu , Lindgren Helena , Wettergren Lena 
Published: April 2023

Abstract
Background
Measurement of health-related quality of life (HRQOL) enables identification of treatment-related side effects of a disease. Such aspects may negatively impact on patients’ lives and should be taken into consideration in medical decision-making. In sub-Saharan Africa, research from the perspective of patients with chronic kidney disease is scarce, and it is almost non-existent in patients undergoing hemodialysis. We aimed to determine HRQOL among end-stage renal disease patients undergoing maintenance hemodialysis in Ethiopia and to identify factors associated with HRQOL.

Methods
A multi-center cross-sectional study was conducted in Addis Ababa, Ethiopia directed to all patients receiving hemodialysis due to kidney failure at 11 randomly-selected government and private hospitals/dialysis centers in the capital of Ethiopia. Data were collected by trained nurses using the KDQOL-36 instrument with five subscales measuring generic and disease-specific HRQOL. Study-specific items were used to collect socio-demographic and clinical data. Factors associated with HRQOL were examined using multivariable linear regression models.

Results
Four hundred eighty-one patients completed the survey through face-to-face interviews (response rate 96%; mean age 45.34 ± 14.67). The mean scores of the subscales ranged from 25.6 to 66.68 (range 0–100), with higher scores reflecting better health. Factors associated with low HRQOL included older age, female sex, no formal education, poor medication adherence, > 2 hemodialysis sessions/week, lower body mass index (< 18.5), longer duration of hemodialysis treatment (≥ 12 months), and poor social support.

Conclusion
Patients with kidney failure undergoing hemodialysis in Addis Ababa, Ethiopia, had low HRQOL across all subscales compared to previous studies. Therefore, the implementation of guidelines is crucial to improve patients’ adherence to their prescribed medications. Furthermore, establishing patient support groups and encouraging patients to use the available support resources from family members, neighbors, and friends have the potential to improve patients’ HRQOL.
Current perspectives on cell-assisted lipotransfer for breast cancer patients after radiotherapy
Authors: Wu Qiuwan , Chen Shuai , Peng Wuyun , Chen Donghan 
Published: April 2023

AbstractBackgroundCell-assisted lipotransfer (CAL), a technique of autologous adipose transplantation enriched with adipose-derived stem cells (ADSCs), has the potential to improve cosmetic outcomes at irradiated sites. However, many concerns have been raised about the possibility of ADSCs increasing oncological risk in cancer patients. With the increasing demand for CAL reconstruction, there is an urgent need to determine whether CAL treatment could compromise oncological safety after radiotherapy, as well as to evaluate its efficacy in guiding clinical decisions.MethodsA PRISMA-compliant systematic review of the safety and efficacy of CAL in breast cancer patients after radiotherapy was conducted. The PubMed, Ovid, Cochrane Library, and ClinicalTrials.gov databases were comprehensively searched from inception to 31 December 2021.ResultsThe search initially yielded 1185 unique studies. Ultimately, seven studies were eligible. Based on the limited outcome evidence, CAL did not increase recurrence risk in breast cancer patients but presented aesthetic improvement and higher volumetric persistence in a long-term follow-up. Although breast reconstruction with CAL also had oncological safety after radiotherapy, these patients needed more adipose tissue and had relatively lower fat graft retention than the non-irradiated patients (P < 0.05).ConclusionsCAL has oncological safety and does not increase recurrence risk in irradiated patients. Since CAL doubles the amount of adipose required without significantly improving volumetric persistence, clinical decisions for irradiated patients should be made more cautiously to account for the potential costs and aesthetic outcomes. There is limited evidence at present; thus, higher-quality, evidence-based studies are required to establish a consensus on breast reconstruction with CAL after radiotherapy.
Noninvasive ultrasound stimulation to treat myocarditis through splenic neuro-immune regulation
Authors: Liu Tianshu , Fu Yanan , Shi Jiawei , He Shukun , Chen Dandan , Li Wenqu , Chen Yihan , Zhang Li , Lv Qing , Yang Yali , Jin Qiaofeng , Wang Jing , Xie Mingxing 
Published: April 2023

Abstract
Background
The cholinergic anti-inflammatory pathway (CAP) has been widely studied to modulate the immune response. Current stimulating strategies are invasive or imprecise. Noninvasive low-intensity pulsed ultrasound (LIPUS) has become increasingly appreciated for targeted neuronal modulation. However, its mechanisms and physiological role on myocarditis remain poorly defined.

Methods
The mouse model of experimental autoimmune myocarditis was established. Low-intensity pulsed ultrasound was targeted at the spleen to stimulate the spleen nerve. Under different ultrasound parameters, histological tests and molecular biology were performed to observe inflammatory lesions and changes in immune cell subsets in the spleen and heart. In addition, we evaluated the dependence of the spleen nerve and cholinergic anti-inflammatory pathway of low-intensity pulsed ultrasound in treating autoimmune myocarditis in mice through different control groups.

Results
The echocardiography and flow cytometry of splenic or heart infiltrating immune cells revealed that splenic ultrasound could alleviate the immune response, regulate the proportion and function of CD4+ Treg and macrophages by activating cholinergic anti-inflammatory pathway, and finally reduce heart inflammatory injury and improve cardiac remodeling, which is as effective as an acetylcholine receptor agonists GTS-21. Transcriptome sequencing showed significant differential expressed genes due to ultrasound modulation.

Conclusions
It is worth noting that the ultrasound therapeutic efficacy depends greatly on acoustic pressure and exposure duration, and the effective targeting organ was the spleen but not the heart. This study provides novel insight into the therapeutic potentials of LIPUS, which are essential for its future application.

Graphical Abstract
Application of four-dimensional cone beam computed tomography in lung cancer radiotherapy
Authors: Abulimiti Muyasha , Yang Xu , Li Minghui , Huan Fukui , Zhang Yanxin , Jun Liang 
Published: April 2023

Abstract
Objective
This study explored the application of four-dimensional cone beam computed tomography (4D CBCT) in lung cancer patients, seeking to improve the accuracy of radiotherapy and to establish a uniform protocol for the application of 4D CBCT in radiotherapy for lung cancer.

Methods
4D CBCT was applied to evaluate tumor volume response (TVR), motion, and center coordinates during radiotherapy in 67 eligible individuals with lung cancer diagnoses. The differences between 4D CBCT and 3D CBCT in different registration methods were compared.

Results
TVR was observed during treatment in 41% of patients (28/67), with a mean volume reduction of 41.7% and a median time to TVR of 19 days. Tumor motion was obvious in 16 patients, with a mean value of 0.52 cm (0.22 to 1.34 cm), and in 3 of 6 tumors close to the diaphragm (0.28 to 0.66 cm). Gray value registration based on mean density projection could still achieve close results to the 4D gray value registration. However, when the registration was based on bone alone, partial off-targeting occurred in the treatment in 41.8% of cases. The off-target rate was 19.0% when the tumor motion was ≤ 0.5 cm and 52.2% when the motion was > 0.5 cm.

Conclusion
Tumor volume and motion of intrapulmonary lesions in individuals diagnosed with lung cancer varied significantly in the third week of radiotherapy. 4D CBCT may be more advantageous for isolated lesions without reference to relative anatomical structures or those near the diaphragm. Grayscale registration based on mean density projection is feasible.
Redo mitral surgery after coronary artery bypass grafts under hyperkalemic hypothermia using thoracotomy and axillary artery cannulation in a patient with functioning bilateral internal thoracic arteries and atheromatous aorta
Authors: Suzuki Ryo , Akita Masafumi , Itohara Takaki , Komatsu Takuya 
Published: April 2023

Abstract
Background
Redo mitral valve surgery using resternotomy after coronary artery bypass grafting (CABG) is challenging as previous CABG with patent internal thoracic artery (ITA) poses a risk of injury due to dense adhesion. It is paramount to have alternative method to minimize this risk.

Case presentation
: We report a case of redo mitral and tricuspid valve repair via right thoracotomy under hypothermia and systemic potassium administration with axillary artery cannulation in a patient after CABG with patent bilateral ITA grafts crossing over the sternum. Herein, critical dissection around the aorta and functioning ITA grafts was avoided by performing the procedure under systemic hypothermia via thoracotomy. Furthermore, considering the presence of atheroma in the aorta, the axillary artery was used as a perfusion route to prevent stroke events. Postoperative course was uneventful and echocardiography demonstrated preserved cardiac function.

Conclusion
Performing axillary artery cannulation and right thoracotomy under hypothermic cardiac arrest with systemic hyperkalemia without clamping the patent bilateral ITAs and aorta allowed us to perform redo mitral valve surgery after CABG without major postoperative cardiac or cerebral complications.
Ruptured mycotic aneurysm of intercostal arteries associated with vertebral osteomyelitis: a case report
Authors: Tsukamoto Masatsugu , Morimoto Tadatsugu , Yoshihara Tomohito , Mawatari Masaaki 
Published: April 2023

Abstract
Background
Here, we report a rare case of massive hemothorax caused by rupture of an intercostal artery pseudoaneurysm associated with pyogenic spondylodiscitis, which was successfully treated with endovascular intervention.

Case presentation
A 49-year-old man with schizophrenia, idiopathic esophageal rupture, postoperative mediastinal abscess, and pyothorax, diagnosed with pyogenic spondylodiscitis caused by methicillin-resistant Staphylococcus aureus. Magnetic resonance imaging and computed tomography (CT) showed extensive vertebral body destruction. The patient underwent a two-stage operation: anterior vertebral debridement and fixation with iliac bone graft and 10 days after first surgery, posterior fixation with instrumentation. Seven days after second surgery, the patient’s right chest pain increased, his blood pressure dropped, and he had shock. Chest X-ray showed massive hemothorax in the right lung. Chest CT and subsequent intercostal arteriography showed a pseudoaneurysm in the right T8 intercostal artery and active contrast extravasation from it. This seemed ruptured mycotic aneurysms involving intercostal vessels. These vessels were successfully embolized using micro-coils. Then, the patient completed the prescribed antimicrobial therapy in the hospital without any complications.

Conclusions
Intercostal artery aneurysms are rare vascular abnormalities. They have the risk of rupture and may sometimes cause hemothorax and can be potentially life-threatening. Ruptured intercostal artery pseudoaneurysms are a good indication of endovascular intervention, and prompt embolization saved the life of the patient in this case report. This case report highlights the possibility of a ruptured intercostal mycotic aneurysm in patients with pyogenic spondylodiscitis and reminds physicians to be alert of this rare but potentially fatal complication.