bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hu'po Anshen decoction promotes fracture healing in mice with traumatic brain injury through BMP2‐COX2‐ATF4 signaling pathway
Authors: Ding WeiHang , Ji RuiQing , Yao Sai , Ruan PengFei , Ye Fei , Lou XiuLong , Ni LiPing , Ji YuChi , Chen Jie , Ji WeiFeng 
Published: May 2023

AbstractHu'po Anshen decoction (HPASD), a traditional Chinese medicine used to treat concussion and fracture, could regulate the expression of bone morphogenetic protein 2 (BMP2). However, whether HPASD affects the fracture healing of traumatic brain injury (TBI) combined with a fracture through BMP2 and its downstream signals remains obscure. The chondrocyte‐specific BMP2 conditional knockout mice and chondrocyte‐specific cyclooxygenase‐2 (COX2) overexpression mice were generated. BMP2 conditional knockout mice were treated with fracture surgery, fracture combined with TBI, or fracture combined with TBI followed by different doses of HPASD (2.4, 4.8, and 9.6 g/kg), respectively. TBI was induced by Feeney's weight‐drop technique. The fracture callus formation and fracture sites were determined by X‐ray, micro‐CT, and histological analyses. The expressions of chondrocyte‐, osteoblast‐, and BMP2/COX2 signal‐related targets were determined by quantitative reverse transcription‐polymerase chain reaction (qRT‐PCR) and western blot assays. The specific absence of BMP2 in chondrocytes led to the prolonged formation of cartilage callus, a delay in the osteogenesis initiation and the downregulation of RUNX2, Smad1/5/9, EP4, ERK1/2, RSK2, ATF4. Overexpression of COX2 partially reverses the effects of chondrocyte‐specific BMP2 knockout mice. HPASD promoted cartilage callus formation and osteogenesis initiation, as accompanied by upregulated expression levels of RUNX2, Smad1/5/9, EP4, ERK1/2, RSK2, and ATF4 in a time‐dependent and concentration‐dependent manner in chondrocyte‐specific BMP2 knockout mice. Overall, our findings demonstrated that HPASD induced COX2 transcription through the BMP2‐Smad1/5/9‐RUNX2 axis, and then affected fracture healing through the COX2‐mediated EP4‐ERK1/2‐RSK2‐ATF4 axis.
A LGR5 reporter pig model closely resembles human intestine for improved study of stem cells in disease
Authors: Schaaf Cecilia R. , Polkoff Kathryn M. , Carter Amber , Stewart Amy S. , Sheahan Breanna , Freund John , Ginzel Joshua , Snyder Joshua C. , Roper Jatin , Piedrahita Jorge A. , Gonzalez Liara M. 
Published: May 2023

AbstractIntestinal epithelial stem cells (ISCs) are responsible for intestinal epithelial barrier renewal; thereby, ISCs play a critical role in intestinal pathophysiology research. While transgenic ISC reporter mice are available, advanced translational studies lack a large animal model. This study validates ISC isolation in a new porcine Leucine Rich Repeat Containing G Protein‐Coupled Receptor 5 (LGR5) reporter line and demonstrates the use of these pigs as a novel colorectal cancer (CRC) model. We applied histology, immunofluorescence, fluorescence‐activated cell sorting, flow cytometry, gene expression quantification, and 3D organoid cultures to whole tissue and single cells from the duodenum, jejunum, ileum, and colon of LGR5‐H2B‐GFP and wild‐type pigs. Ileum and colon LGR5‐H2B‐GFP, healthy human, and murine biopsies were compared by mRNA fluorescent in situ hybridization (FISH). To model CRC, adenomatous polyposis coli (APC) mutation was induced by CRISPR/Cas9 editing in porcine LGR5‐H2B‐GFP colonoids. Crypt‐base, green fluorescent protein (GFP) expressing cells co‐localized with ISC biomarkers. LGR5‐H2B‐GFPhi cells had significantly higher LGR5 expression (p < .01) and enteroid forming efficiency (p < .0001) compared with LGR5‐H2B‐GFPmed/lo/neg cells. Using FISH, similar LGR5, OLFM4, HOPX, LYZ, and SOX9 expression was identified between human and LGR5‐H2B‐GFP pig crypt‐base cells. LGR5‐H2B‐GFP/APCnull colonoids had cystic growth in WNT/R‐spondin‐depleted media and significantly upregulated WNT/β‐catenin target gene expression (p < .05). LGR5+ ISCs are reproducibly isolated in LGR5‐H2B‐GFP pigs and used to model CRC in an organoid platform. The known anatomical and physiologic similarities between pig and human, and those shown by crypt‐base FISH, underscore the significance of this novel LGR5‐H2B‐GFP pig to translational ISC research.
Clinical Improvement After Lumbar Fusion
Authors: Shaikh Hashim J.F. , Cady-McCrea Clarke I. , Menga Emmanuel N. , Haddas Ram , Molinari Robert N. , Mesfin Addisu , Rubery Paul T. , Puvanesarajah Varun 
Published: May 2023

Study Design.
Retrospective review of a single institution cohort.

Objective.
The goal of this study is to identify features that predict delayed achievement of minimum clinically important difference (MCID) following elective lumbar spine fusion using Patient-Reported Outcomes Measurement Information System (PROMIS) surveys.

Summary of Background Data.
Preoperative prediction of delayed recovery following lumbar spine fusion surgery is challenging. While many studies have examined factors impacting the achievement of MCID for patient-reported outcomes in similar cohorts, few studies have assessed predictors of early functional improvement.

Methods.
We retrospectively reviewed patients undergoing elective one-level posterior lumbar fusion for degenerative pathology. Patients were subdivided into two groups based on achievement of MCID for each respective PROMIS domain either before six months (“early responders”) or after six months (“late responders”) following surgical intervention. Multivariable logistic regression analysis was used to determine features associated with odds of achieving distribution-based MCID before or after six months follow up.

Results.
147 patients were included. The average age was 64.3±13.0 years. At final follow-up, 57.1% of patients attained MCID for PI and 72.8% for PF. However, 42 patients (49.4%) reached MCID for PI by six months, compared to 44 patients (41.1%) for PF. Patients with severe symptoms had the highest probability of attaining MCID for PI (OR 10.3; P=0.001) and PF (OR 10.4; P=0.001) Preoperative PROMIS symptomology did not predict early achievement of MCID for PI or PF. Patients who received concomitant iliac crest autograft during their lumbar fusion had increased odds of achieving MCID for PI (OR 8.56; P=0.001) before six months.

Conclusion.
Our study demonstrated that the majority of patients achieved MCID following elective one-level lumbar spine fusion at long-term follow-up, although less than half achieved this clinical benchmark for each PROMIS metric by six months. We also found that preoperative impairment was not associated with when patients would achieve MCID. Further prospective investigations are warranted to characterize the trajectory of clinical improvement and identify the risk factors associated with poor outcomes more accurately.
Incidence and Recurrence of Deep Spine Surgical Site Infections
Authors: Freire-Archer Millaray , Sarraj Mohamed , Koziarz Alex , Thornley Patrick , Alshaalan Fawaz , Alnemari Haitham , Kachur Edward , Bhandari Mohit , Oitment Colby 
Published: May 2023

Study Design.
Systematic review and meta-analysis.

Objective.
To determine a pooled incidence rate for deep surgical site infection (SSI) and compare available evidence for deep SSI management among instrumented spinal fusions.

Summary of Background Data.
Deep SSI is a common complication of instrumented spinal surgery associated with patient morbidity, poorer long-term outcomes, and higher health care costs.

Materials and Methods.
We systematically searched Medline and Embase and included studies with an adult patient population undergoing posterior instrumented spinal fusion of the thoracic, lumbar, or sacral spine, with a reported outcome of deep SSI. The primary outcome was the incidence of deep SSI. Secondary outcomes included persistent deep SSI after initial debridement, mean number of debridements, and microbiology. The subsequent meta-analysis combined outcomes for surgical site infection using a random-effects model and quantified heterogeneity using the χ2 test and the I
2 statistic. In addition, a qualitative analysis of management strategies was reported.

Results.
Of 9087 potentially eligible studies, we included 54 studies (37 comparative and 17 noncomparative). The pooled SSI incidence rate was 1.5% (95% CI, 1.1%–1.9%) based on 209,347 index procedures. Up to 25% of patients (95% CI, 16.8%–35.3%), had a persistent infection. These patients require an average of 1.4 (range: 0.8–1.9) additional debridements. Infecting organisms were commonly gram-positive, and among them, staphylococcus aureus was the most frequent (46%). Qualitative analysis suggests implant retention, especially for early deep SSI management. Evidence was limited for other management strategies.

Conclusions.
The pooled incidence rate of deep SSI post-thoracolumbar spinal surgery is 1.5%. The rate of recurrence and repeat debridement is at least 12%, up to 25%. Persistent infection is a significant risk, highlighting the need for standardized treatment protocols. Our review further demonstrates heterogeneity in management strategies. Large-scale prospective studies are needed to develop better evidence around deep SSI incidence and management in the instrumented thoracolumbar adult spinal fusion population.
Tropifexor plus cenicriviroc combination versus monotherapy in nonalcoholic steatohepatitis: Results from the phase 2b TANDEM study
Authors: Anstee Quentin M. , Lucas Kathryn J. , Francque Sven , Abdelmalek Manal F. , Sanyal Arun J. , Ratziu Vlad , Gadano Adrian C. , Rinella Mary , Charlton Michael , Loomba Rohit , Mena Edward , Schattenberg Jörn M. , Noureddin Mazen , Lazas Donald , Goh George B.B. , Sarin Shiv K. , Yilmaz Yusuf , Martic Miljen , Stringer Rowan , Kochuparampil Jossy , Chen Li , Rodriguez-Araujo Gerardo , Chng Elaine , Naoumov Nikolai V. , Brass Clifford , Pedrosa Marcos C. 
Published: May 2023

Background and Aims:
With distinct mechanisms of action, the combination of tropifexor (TXR) and cenicriviroc (CVC) may provide an effective treatment for NASH. This randomized, multicenter, double-blind, phase 2b study assessed the safety and efficacy of TXR and CVC combination, compared with respective monotherapies.

Approach and Results:
Patients (N = 193) were randomized 1:1:1:1 to once-daily TXR 140 μg (TXR140), CVC 150 mg (CVC), TXR 140 μg + CVC 150 mg (TXR140 + CVC), or TXR 90 μg + CVC 150 mg (TXR90 + CVC) for 48 weeks. The primary and secondary end points were safety and histological improvement, respectively. Rates of adverse events (AEs) were similar across treatment groups. Pruritus was the most frequently experienced AE, with highest incidence in the TXR140 group (40.0%). In TXR and combination groups, alanine aminotransferase (ALT) decreased from baseline to 48 weeks (geometric mean change: −21%, TXR140; −16%, TXR140 + CVC; −13%, TXR90 + CVC; and +17%, CVC). Reductions in body weight observed at week 24 (mean changes from baseline: TXR140, −2.5 kg; TXR140 + CVC, −1.7 kg; TXR90 + CVC, −1.0 kg; and CVC, −0.1 kg) were sustained to week 48. At least 1-point improvement in fibrosis stage/steatohepatitis resolution without worsening of fibrosis was observed in 32.3%/25.8%, 31.6%/15.8%, 29.7%/13.5%, and 32.5%/22.5% of patients in the TXR140, CVC, TXR140 + CVC, and TXR90 + CVC groups, respectively.

Conclusions:
The safety profile of TXR + CVC combination was similar to respective monotherapies, with no new signals. TXR monotherapy showed sustained ALT and body weight decreases. No substantial incremental efficacy was observed with TXR + CVC combination on ALT, body weight, or in histological end points compared with monotherapy.
The puzzle of extensive tinea incognito with a young woman: a case report a tinea incognito with Cushing’s disease
Authors: Xiao Yu , Peng Shanshan , Lin Jie , Hu Youhong , Ye Wenzheng 
Published: May 2023

Introduction:

Tinea incognito is a rare condition commonly found in abused topical or systemic steroids. Considering their immunosuppression status, Cushing’s syndrome predisposes patients to infectious diseases. Most patients of Cushing’s syndrome are as a result of adrenocorticotropic hormone production from a pituitary adenoma, which is referred to as Cushing’s disease.
Here, we reported a rare co-occurrence of tinea incognito and Cushing’s syndrome secondary to a giant pituitary tumor.

Case presentation:
Extensive cutaneous and nail lesions were diagnosed with the tinea incognito and tinea unguium, and endocrine or rheumatic disorders were considered as underlying disease-causing extensive tinea incognito. A series of laboratory and imaging tests were performed. We found that a giant pituitary tumor was the primary etiology of multiple cutaneous appearances and secondary disorders. There was an exceptionally unusual co-occurrence of extensive tinea incognito and pituitary adenoma in our case.

Discussion:
We observed a rare co-occurrence of extensive tinea incognito and pituitary adenoma, which should be taken into consideration in the urgent diagnostic criterion of tinea incognito given the potential underlying condition.

Conclusion:

Tinea incognito is not only associated with a history of topical or systemic steroid use, but also the association that underlying diseases related to excessive endogenous steroid production are supported to be taken into account.
Organ preservation strategies after neoadjuvant chemoimmunotherapy in resectable non-small cell lung cancer: a multicenter retrospective cohort study
Authors: Hui Bengang , Wang Xun , Wang Xin , Qiao Bowei , Duan Jiangnan , Shang Rongxin , Yang Weibo , Wang Jun , Chen Kezhong , Yang Fan , Jiang Tao , Lei Jie 
Published: May 2023

Background:
Neoadjuvant chemoimmunotherapy has shown a good therapeutic effect on non-small cell lung cancer (NSCLC), which also opens up the possibility of applying organ preservation strategies. This study investigated the feasibility of modified surgery after potent neoadjuvant chemoimmunotherapy in central type NSCLC.

Methods:
In this multicenter retrospective cohort study, patients with central type NSCLC who received 2–4 cycles of neoadjuvant chemoimmunotherapy between January 2019 and June 2022 at Air Force Medical University Tangdu Hospital and Peking University People's Hospital were eligible. Patients were divided into modified and nonmodified groups according to the extent of surgery, after which, the safety and long-term prognosis of surgery were investigated.

Results:
A total of 84 patients were enrolled. Of 36 (42.9%) patients who underwent modified surgery, 21 patients underwent lobectomy, 12 patients underwent lobectomy with bronchoplasty, 2 patients underwent sleeve lobectomy, and 1 patient underwent bilobectomy. The modification rate for the initially estimated pneumonectomy, sleeve lobectomy, and bilobectomy was 48.6, 44.8, and 30%, respectively. Grades II–V postoperative complications were found in 5 (13.9%) patients in the modified group and 17 (35.4%) patients in the nonmodified group (relative risk, 0.393; 95% CI, 0.016–0.963; P=0.026). No significant difference was observed regarding the surgical approach, operative duration, blood loss, or R0 resection rate. The 2-year local recurrence rate was 3.7% (95% CI, 0.004–0.175) and 5.2% (95% CI, 0.012–0.168) in the modified group and nonmodified group, respectively. The 1-year PFS rate of modified and nonmodified groups was 97.1% (95% CI, 83.7–99.8) and 86.9% (95% CI, 73.4–94.4), respectively, while 2-year PFS were 89.8% (95% CI, 74.1–96.9) and 71.8% (95% CI, 56.7–83.4), respectively.

Conclusion:
Applying organ preservation strategies, that is, undergoing modified surgery after neoadjuvant chemoimmunotherapy, is feasible for selected central type NSCLC patients with favorable safety and long-term survival.
Nursing Roles in Cancer Rehabilitation
Authors: Justesen Rikke M. , Ikander Tine M. , Thomsen Thora G. , Dieperink Karin B. 
Published: May 2023

Background
Because of cancer survivors’ increased need for help and support, cancer rehabilitation should be an essential part of cancer treatment, where focusing on patients’ individual needs is essential.

Objective
To provide an overview of existing evidence about nurses’ roles and participation in cancer rehabilitation, based on both nurses’ and patients’ perspectives.

Methods
A systematic search was conducted in PubMed, CINAHL, EMBASE and Cochrane databases for studies published from January 2001–January 2022. Whittemore and Knafl’s methodology for data extraction and synthesis was used, and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. The review was registered in PROSPERO (CRD42021223683).

Results
Ten qualitative studies and 7 quantitative studies were included, encompassing 306 patients and 1847 clinicians (1164 nurses). Three nursing roles emerged: (1) relationship-forming, in which nurses described ongoing involvement in patients’ rehabilitation and patients described nurses as trusted partners; (2) coordinating, in which nurses described a lack of time and resources and a focus on medical treatment, and patients described nurses as expert coordinators; and (3) follow-up, in which patients described nurses as good communicators and trusted partners in their follow-up, and nurses described their natural interest in patients’ rehabilitation outcomes during follow-up.

Conclusions
Patients were comfortable with nurses as trusted partners during cancer rehabilitation. Significant barriers such as lack of time, resources, and education about rehabilitation may negatively influence rehabilitation planning, implementation, and monitoring.

Implications for Practice
Clinicians can use the findings to improve cancer rehabilitation with the nurse as a central provider and conduct further research on the coordinating and follow-up roles.
Interactive Health Literacy and Symptom Self-management in Patients With Lung Cancer
Authors: Campbell Julie K. , Erickson Jeanne M. 
Published: May 2023

Background
Patients with lung cancer experience multiple symptoms requiring self-management. Little is known about how self-management is influenced by interactive health literacy, defined as communicating with healthcare providers to obtain and process information.

Objective
This study explored how interactive health literacy relates to symptom self-management among patients with lung cancer. A second aim explored how interactive health literacy might be integrated into the Individual and Family Self-management Theory.

Methods
This study used a cross-sectional mixed-methods design. Quantitative data included demographics, the All Aspects of Health Literacy Scale, and the Memorial Symptom Assessment–Short Form. Qualitative data were collected using semistructured interviews. Data analysis followed a critical realist model.

Results
Twelve adults who recently received treatment for lung cancer reported an average of 14 symptoms that caused moderate distress. Average interactive health literacy of the sample was in the moderate range. Participants’ experiences of self-management differed based on their interactive health literacy. A generative mechanism proposes that those with higher interactive health literacy who accessed online information used this information as a basis for engaging with providers regarding potential symptom self-management strategies.

Conclusions
Interactive health literacy skills may play a role in patients’ ability and confidence in symptom self-management through interactions with oncology providers. Further research should clarify the relationship between interactive health literacy, self-efficacy, and collaboration with oncology providers.

Implications for Practice
The patient-provider relationship is a key factor influencing how patients obtain and process symptom self-management information. Oncology providers should implement patient-centered strategies to engage patients in symptom self-management.
Appropriateness of Diagnosis and Management for Otitis Media With Effusion in Pediatric Urgent Care Clinics
Authors: Wyly Donna R. , DeSchepper Ashley , Nedved Amanda , Lee Brian R. , El Feghaly Rana E. 
Published: May 2023

Background
Otitis media with effusion (OME)’s clinical presentation is often confused with acute otitis media (AOM) by clinicians. Despite OME guidelines recommending watchful waiting with no antibiotics, rates of antibiotic use remain elevated. The aim of this study was to determine the clinician diagnosis validity and the rates of antibiotics prescribed among pediatric OME patients evaluated in 3 urgent care clinics within a pediatric health care system.

Methods
We retrospectively reviewed a random sample of encounters for children aged 0 to 18 years with a billing diagnosis of OME in 2019. We recorded clinical symptoms, antibiotic prescribed, and the clinicians' diagnosis. We used the American Academy of Pediatrics guidelines to assign an AOM diagnosis and compared those with the clinicians' final diagnoses using Pearson χ2.

Results
Of the 912 eligible charts, clinicians' final diagnoses were as follows: AOM for 271 (29.7%) patients, OME for 638 (70.0%) patients, and no ear pathology for 3 (0.3%) patients. Antibiotics were prescribed for 519 (56.9%) patients; of those, only 242 (46.6%) had a final clinician diagnosis of AOM. Antibiotic prescribing rates were higher when a clinician diagnosed AOM compared with OME (89.3% vs 43.2%; P < 0.001). Per American Academy of Pediatrics guidelines, up to 273 (29.9%) patients qualified for an AOM diagnosis, but those were not the same as those diagnosed with AOM by clinicians (P < 0.001).

Conclusions
When evaluating children with a billing diagnosis of OME, a third fit a diagnosis of AOM. Clinicians commonly misdiagnosed AOM, but also prescribed antibiotics to almost half of those they diagnose with OME.
Brief Report: Task-Shifting “Gold Standard” Clinical Assessment and Safety Planning for Suicide Risk Among People Living With HIV: A Feasibility and Fidelity Evaluation in Tanzania
Authors: Knettel Brandon A. , Amiri Ismail , Minja Linda , Martinez Alyssa J. , Knippler Elizabeth T. , Madundo Kim , Staton Catherine , Vissoci Joao Ricardo N. , Mwobobia Judith , Mmbaga Blandina T. , Kaaya Sylvia , Relf Michael V. , Goldston David B. 
Published: May 2023

Background:
Suicide is a leading cause of death among people living with HIV (PLWH) worldwide, with suicide deaths occurring twice as frequently among PLWH than among the general public. In Tanzania, resources for mental health care are sorely lacking, with 55 psychiatrists and psychologists providing treatment for 60 million people. In light of this shortage, nonspecialists play a crucial role. The objective of this study was to assess feasibility of implementing task-shifted screening, assessment, and safety planning for suicide risk among PLWH.

Setting:
Two adult HIV clinics in Kilimanjaro, Tanzania.

Methods:
Registered professional nurses in the HIV clinics were trained to administer brief screening of suicidal ideation in the past month. Patients experiencing suicidal ideation were referred to bachelor's-level counselors for further assessment and safety planning, supervised by specialist providers who reviewed audio recordings for quality assurance.

Results:
During 180 days of implementation, nurses screened patients attending 2745 HIV appointments. Sixty-one (2.2%) endorsed suicidal ideation and were linked to further assessment and safety planning. We cross-checked screening with clinic attendance logs on 7 random days and found high fidelity to screening (206 of 228 screened, 90%). Quality assurance ratings demonstrated key assessment pieces were consistently completed (mean = 9.3/10 possible), with “Good” to “Excellent” counseling skills (mean = 23.7/28) and “Good” to “Excellent” quality (mean = 17.1/20), including appropriate referral for higher levels of care.

Conclusions:
Brief screening can be implemented and paired with task-shifted counseling to facilitate high-quality assessment of suicide risk. This model shows excellent potential to extend mental health services for PLWH in low-resource settings.