bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is the flipped classroom more effective than the traditional classroom in clinical medical education: a systematic review and meta-analysis
Authors: Shi Xu-Ying , Yin Qing , Wang Qiu-Wen , Lu Bing-Rui , Li Guo-Xiang , Huang Shu-Hong , Sun Zhi-Gang 
Published: January 2025

BackgroundThe flipped classroom teaching method has been increasingly adopted in recent years for teaching clinical medical specialties in medical schools around the world. However, the outcomes of this approach have not been systematically and quantitatively assessed. This meta-analysis aims to rigorously compare the effects of flipped classroom (FC) and traditional classroom (TC) teaching models on students’ learning in clinical medicine.MethodsWe conducted a systematic search for all randomized and quasi-randomized controlled trials (RCTs/Q-RCTs) comparing traditional classrooms and flipped classrooms in the context of clinical medical education. The literature search included the Cochrane Library, PubMed, Embase, and Web of Science, with the final retrieval conducted on October 26, 2024. We screened the literature based on predefined inclusion and exclusion criteria. The quality of each study was assessed using RevMan (Version 5.4). The outcome indicators included theoretical scores, composite scores, skills scores, and student satisfaction. Data extraction and subsequent meta-analysis were performed using Stata 17.0 software.ResultsA total of 12 studies were included in the analysis. The meta-analysis revealed that the flipped classroom (FC) group exhibited significantly higher theoretical scores (SMD = 0.481, 95% CI: 0.214 to 0.748, p = 0.000), composite scores (SMD = 0.642, 95% CI: 0.273 to 1.011, p = 0.001), and skills scores (SMD = 0.660, 95% CI: 0.312 to 1.008, p = 0.000) compared to the traditional classroom (TC) group. However, no statistically significant difference was observed in student satisfaction (SMD = −0.195, 95% CI: −1.081 to 0.691, p = 0.667).ConclusionThe flipped classroom teaching method is more effective in enhancing the theoretical scores, composite scores, and skill scores of clinical medicine students compared to the traditional classroom teaching method. However, there was no statistically significant difference in student satisfaction between the two teaching approaches. Due to the limitations of the included studies, further robust randomized controlled trials (RCTs) across diverse educational contexts are necessary to validate these findings.
Emirates consensus recommendations on cardiovascular risk management in type 2 diabetes
Authors: Sabbour Hani , Almahmeed Wael , Alawadi Fatheya , Shehab Abdullah , Al Zubaidi Abdulamjeed , Bashier Alaaeldin , Ghulam Abdul Rauf , Rashid Fauzia , Zaky Hosam , Heshmat Kassemn Hussien , Adi Jamila Bin , Tahir Juwairia , Hafidh Khadija , Farghali Mohammed , Hassanien Mohamed , Januzzi James 
Published: January 2025

BackgroundThe combination of cardiovascular disease and diabetes is a highly prevalent condition in the United Arab Emirates. Development and dissemination of evidence-based regional recommendations for optimal screening, treatment and referrals of people with diabetes and high cardiovascular risk is an important priority.Consensus panelAn expert panel of diabetologists, endocrinologists and cardiologists from the Emirates Cardiac Society and Emirates Diabetes and Endocrine Society as well as different entities in the UAE, discussed and reviewed evidence and also a consensus report from the American Diabetes Association to formulate contextualized recommendations that could be applied for optimal management of cardiovascular risk in people with diabetes in the UAE.Consensus findingsThe combination of heart failure and other cardiovascular risks is a highly prevalent finding among people with diabetes in the United Arab Emirates. The causal inter-relationships between diabetes and heart failure are multifactorial and regular assessments of symptoms and steps for mitigation of risk factors are an important priority. The universal definition and classification of heart failure provides a useful framework for recommending optimal screening, treatment, and referral strategies to diabetic individuals at various stages of the cardiovascular continuum. Routine measurement (at least yearly) of natriuretic peptides and high-sensitivity troponins can help identify patients requiring cardiac imaging referrals. However, recommending routine measurements of natriuretic peptides and/or high-sensitivity troponins to all diabetic individuals must balance clinical judgment and cost implications. While SGLT2i must be an important part of the standard of care, insulin, GLP1 receptor agonists and/or metformin can be useful for additional glycemic control.ConclusionThe consensus panel hopes that the recommendations presented herein can offer guidance for optimal screening, treatment and referral of people with a concomitance of diabetes and high cardiovascular risk in the United Arab Emirates.
Acute management of massive pulmonary embolism in pregnancy
Authors: Qadri Shahin , Bilagi Ashwini , Sinha Abha , Connolly Derek , Murrin Richard , Bakour Shagaf 
Published: January 2025

Key content•Massive pulmonary embolism (PE) during pregnancy or the postpartum period is a rare but potentially lethal event.•Physiological changes in the coagulation system during pregnancy and puerperium would lead to a hypercoagulable state.•Diagnosis of PE in pregnancy remains a challenge due to physiological changes in pregnancy. There are no validated scoring systems for assessing pregnant/postpartum women with suspected PE. Massive PE should be suspected in all cases with haemodynamic instability in pregnancy.•The Management of massive pulmonary embolism should be timely and aggressive. Thrombolysis for massive PE during pregnancy and the postpartum period has shown to be associated with high maternal and fetal survival (94% and 88%). But other therapeutic options such as (catheter [or surgical] thrombectomy, ECMO) should be considered in the postpartum period, given the high risk of major bleeding with thrombolysis.•Thrombolysis remains the most-used and reasonably successful modality of treatment in pregnancy but should be avoided in the postpartum period as it can cause life-threatening haemorrhage. During the post-partum period, thrombectomy is the treatment of choice.Learning objectives•To understand the pathophysiology of massive PE.•To appreciate the treatment options in pregnancy and postpartum period and their pros and cons.•To understand the need for further work in this area especially in creating a validated algorithm for diagnosing PE in pregnancy and postpartum period.
Integrating WHO thinking healthy programme for maternal mental health into routine antenatal care in China: a randomized-controlled pilot trial
Authors: Nisar Anum , Yin Juan , Zhang Jingjun , Qi Wenli , Yu Jie , Li Jiaying , Li Xiaomei , Rahman Atif 
Published: January 2025

BackgroundWomen with perinatal depression and their children are at increased risk of poor health outcomes. Integrating evidence based non-stigmatizing interventions within existing health systems is crucial to reducing psychosocial distress during pregnancy and preventing perinatal depression. This study aimed to evaluate the feasibility of the World Health Organization (WHO) endorsed cognitive-behavior therapy-based Thinking Healthy Programme (THP), delivered by antenatal nurses in China.MethodsA two-arm pilot randomized controlled pilot trial was conducted to assess the feasibility and of the adapted Chinese version of the Thinking Healthy Programme (THP) among various stakeholders. We recruited pregnant women between 25- and 34-weeks' gestation from two pregnancy schools within the two public sector Hospitals in Xian. Participants in the intervention group attended five face to face sessions of THP facilitated by antenatal nurses. This intervention used cognitive behavior therapy principles to offer psychoeducation, behavioral activation, problem-solving strategies, and social support. In the control group, participants received standard care, which included routine pregnancy education classes led by antenatal nurses. We assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) at baseline, after the intervention and 4–6 weeks post-intervention, along with evaluations of anxiety, perceived social support, and health-related quality of life.ResultsAmong the 737 pregnant women screened, 267 (30.26%) scored ≥5 on the PHQ-9. Out of these, 85 were eligible and consented to participate, with 42 assigned to the intervention group and 43 to the control group. Eighty participants (94.1%) completed the final assessments. Our primary findings indicated that this nurse-delivered intervention was feasible to integrate into routine antenatal care and was well-received by both the women and the delivery agents. Although the study was not designed to detect differences between the intervention and control groups, we observed positive trends towards reductions in anxiety and depressive symptoms favoring the intervention arm. No serious adverse events were reported. This trial is registered in the Chinese Clinical Trial Registry with the registration number ChiCTR1900028114.ConclusionsWe conclude that this intervention, grounded in the well-established WHO Thinking Healthy Programme, is both feasible and acceptable to stakeholders. It merits a definitive randomized trial to assess its effectiveness and cost-effectiveness across various settings.Clinical Trial RegistrationChiCTR1900028114.
A gram-positive enhancer matrix particles vaccine displaying swine influenza virus hemagglutinin protects mice against lethal H1N1 viral challenge
Authors: Zhang Yufei , Zhang Pei , Du Xiaoyue , Shi Xiaona , Wang Jinling , Liu Shuying 
Published: January 2025

IntroductionAnimal influenza viruses pose a danger to the general public. Eurasian avian-like H1N1 (EA H1N1) viruses have recently infected humans in several different countries and are often found in pigs in China, indicating that they have the potential to cause a pandemic. Therefore, there is an urgent need to develop a potent vaccine against EA H1N1.MethodsIn this study, we report the effective intramuscular (i.m.) and/or intranasal (i.n.) vaccination of mice with a subunit influenza vaccine utilizing safe adjuvant gram-positive enhancer matrix (GEM) particles derived from the food-grade bacterium Lactococcus lactis. The hemagglutinin (HA)-protein anchor (PA) subunit vaccine can be simply mixed with GEM particles to produce vaccines.ResultsAfter two booster injections, the i.m.+i.n. administered GEM subunit vaccine achieved hemagglutination inhibition titers in the serum that were equivalent to those observed using the conventional i.m. method. The mucosal and Th1-biased immune responses generated by the i.m. administered subunit vaccine alone were inferior to those induced by the i.n. and i.m.+i.n. administered subunit vaccines. Vaccinated mice were challenged with live viruses (G4 EA H1N1 and A/PR/8/34) to determine whether the adjuvant combination protected against the virus after vaccination with the influenza subunit vaccine. Compared to mice inoculated with HA alone, mice immunized with i.m.+i.n. or i.n. HA-PA-GEM displayed undetectable viral titers in the lungs, at 5 d after challenge.DiscussionOverall, this study not only offers other potential platforms for the generation of swine influenza vaccines, but also a theoretical foundation for vaccine vector platforms that can be utilized for future research on other infections.
Single-cell sequencing analysis reveals cancer-associated pericyte subgroup in esophageal squamous cell carcinoma to predict prognosis
Authors: Xiong Kai , Pan Bing , Fang Hao , Tao Ziyou 
Published: January 2025

BackgroundThe role of cancer-associated pericytes (CAPs) in tumor microenvironment (TME) suggests that they are potential targets for cancer treatment. The mechanism of CAP heterogeneity in esophageal squamous cell carcinoma (ESCC) remains unclear, which has limited the development of treatments for tumors through CAPs. Therefore, a comprehensive understanding of the classification, function, cellular communication and spatial distribution of CAP subpopulations in ESCC is urgently needed.MethodsThis study used large-sample single-cell transcriptome sequencing (scRNA-seq) data to investigate pericytes’ subpopulation characteristics, functions, upstream and downstream regulation and interactions with other components of the TME in the ESCC, and analyzed prognostically in conjunction with Bulk RNA-seq data. In addition, pericyte subpopulations were validated and their spatial distribution in the ESCC TME was observed by multiplex immunofluorescence. Drug prediction and molecular docking was further used to validate the medicinal value of drug targets.ResultsCAPs in the ESCC TME were found to be highly heterogeneous, and we identified six pericyte subtypes: c1_ARHGDIB, c2_BCAM, c3_LUM, c4_SOD2, c5_TYMS, and c6_KRT17, which have commonality in a part of their functions, and each of them has a major function to play, by having different strengths of interaction with different components in the TME. In addition, we found that c4_SOD2 was negatively correlated with prognosis, conversely, c5_TYMS was positively correlated with prognosis. The drug with a better effect on c5_TYMS was docetaxel (binding energy = -8.1, -8.7 kcal/mol); raloxifene may be more effective against c4_SOD2, although raloxifene has a slightly lower binding energy to SOD2 (-6.4 kcal/mol), it has a higher binding energy to PDGFRβ (-8.1 kcal/mol).ConclusionThe present study identified and discovered pericyte subpopulations that were significantly associated with prognosis, which provides new biomarkers for predicting patient prognosis and adds usable targets for immunotherapy, and it is also important for gaining insights into the composition of the TME in ESCC.
Interleukin-32 positive immune and resident cells in kidney samples from lupus patients: a pilot study
Authors: Truglia Simona , Ciccia Francesco , Mancuso Silvia , Capozzi Antonella , Rizzo Aroldo , Spinelli Francesca Romana , Ceccarelli Fulvia , Colasanti Tania , Garufi Cristina , Miranda Francesca , Sorice Maurizio , Alessandri Cristiano , Conti Fabrizio 
Published: January 2025

IntroductionLupus nephritis (LN), caused by immune complexes produced in situ or deposited from the bloodstream, is one of the most severe features of Systemic Lupus Erythematosus (SLE) leading to an increased morbidity and mortality. Toll like receptors (TLRs), such as TLR3, TLR7 and TLR9, may play a key role in its pathogenesis. Interleukin-32 (IL-32), a cytokine involved in both innate and adaptive immune responses, has been widely considered in autoimmune-inflammatory rheumatic diseases. This study aims to evaluate the IL-32 role in LN, also investigating the effect of LN patients IgG (LN-IgG) on IL-32 production via TLR3.MethodsIn LN patients, IL-32 was detected in sera samples by ELISA KIT and in kidney tissue by immunohistochemistry. HEK293/T3 cells were incubated with LN-IgG and analyzed for TBK1, phospho-p65 NF-κB and IL-32 by Western blot.ResultsWe demonstrated IL-32 presence in LN patients compared to SLE patients without renal involvement, observing a direct correlation between IL-32 serum levels and disease duration (p=0.02; r 0.2978). Moreover, IL-32 was strongly expressed in renal samples of LN patients. Phosphorylation of TBK1 resulting in NF-κB activation and IL-32 increase was observed in HEK293/T3 cells following LN-IgG treatment, TLR3 inhibitor using induced a significant reduction in the expression of these molecules.DiscussionThese results showed that IL-32 is up-regulated in the kidney of LN patients suggesting that in renal tissue IL-32 expression could be induced through TLR3 activation by the LN patients’ antibodies. This study may indicate a possible role for IL-32 in the pathogenesis of LN.
A nomogram model based on albumin-bilirubin score for predicting 90-day prognosis in patients with acute-on-chronic liver failure
Authors: Ding Wei , Shen Jiandong , Zhang Li , Shao Jianguo , Bian Zhaolian , Xue Hong 
Published: January 2025

ObjectiveTo develop a nomogram model based on the albumin-bilirubin (ALBI) score for predicting the 90-day prognosis of patients with acute-on-chronic liver failure (ACLF) and to evaluate its predictive efficacy.MethodsClinical data of 290 ACLF patients at the Third People’s Hospital of Nantong City, collected from December 2020 to December 2023, were analyzed. The data were divided into a training set (n = 200) and a validation set (n = 90), with August 2022 as the cut-off date. Patients in the training set were categorized into an improvement group (n = 133) and a mortality group (n = 67) based on their 90-day outcomes. The predictive power of baseline parameters was assessed using univariate and multivariate logistic regression to construct model. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA) and the Hosmer-Lemeshow test.ResultsCreatinine (CR) [odds ratio (OR) = 1.013, 95% confidence interval (CI): 1.004–1.022], ALBI (OR = 10.831, 95% CI: 4.009–33.247), Gender (OR = 1.931, 95% CI: 0.973–3.870) and ascites (OR = 3.032, 95% CI: 1.249–8.178) were identified as independent prognostic factors. The prognostic model formula was derived as prognostic index (PI) = –0.591 + 0.658 × Gender + 1.109 × ascites + 0.012 × CR + 2.382 × ALBI. The area under the curve (AUC) was 0.804 (95% CI: 0.741–0.866), with a specificity of 85.0% and a sensitivity of 65.7% at a cut-off of 0.425. The AUC of the validation set was 0.811 (95% CI: 0.697–0.926). The Hosmer-Lemeshow test indicated a good model fit with a p-value of 0.287 for the training set and 0.423 for the validation set. Calibration curves demonstrated the accuracy of the model, and DCA results suggested that the model was clinically useful when the threshold was below 0.6.ConclusionThe nomogram model incorporating ALBI with CR, Gender and ascites can predict the 90-day prognosis of ACLF patients, potentially helping to optimize treatment strategies and improve patient outcomes.
A bibliometric analysis of optic atrophy from 2003 to 2023: research trends and hot spots
Authors: Wang Liyuan , Yu Tianyang , Wang Runze , Fu Lijuan , Dong Feixue , Zhao Shuang , Sun He , Gao Yang 
Published: January 2025

BackgroundOptic atrophy (OA) is primarily caused by damage to the retinal pathway system, including widespread degeneration of retinal ganglion cells and axons, leading to visual impairment and blindness. Despite its clinical significance and diverse etiological factors, there is currently a lack of comprehensive bibliometric analyses exploring research trends and hotspots within this field.MethodThis study retrieved relevant literature on OA published between 2003 and 2023 from the Web of Science Core Collection database. We conducted a bibliometric analysis using tools such as CiteSpace, VOSviewer, and SCImago Graphica to examine annual publication trends, co-occurrence patterns, collaborative networks among countries and institutions, and the evolution of research hotspots of OA.ResultsA total of 5,274 publications were included in the bibliometric analysis, comprising 4,561 research articles and 713 review articles. The United States emerged as the leading country in OA research, followed by Germany and China. Over the past two decades, the primary research hotspots focused on “mitochondrial dysfunction,” “hereditary optic neuropathy,” “ocular hypertension” and “diagnostic techniques.” Future research trends are likely to revolve around “molecular mechanisms” and “therapeutic targets.”ConclusionThis bibliometric analysis provides an overview of research developments in OA over the past 20 years, highlighting the emphasis on the pathological basis of OA and advancements in diagnostic and therapeutic approaches. Future studies should continue to explore the molecular basis of mitochondrial dysfunction to identify potential gene therapy targets for treating OA.
Robot-assisted upper limb therapy for personalized rehabilitation in children with cerebral palsy: a systematic review
Authors: Cardone Daniela , Perpetuini David , Di Nicola Marta , Merla Arcangelo , Morone Giovanni , Ciancarelli Irene , Moretti Antimo , Gimigliano Francesca , Cichelli Alice , De Flaviis Francesco , Martino Cinnera Alex , Paolucci Teresa 
Published: January 2025

IntroductionCerebral palsy (CP) is a group of permanent disorders of movement development that may cause activity limitations. In this context, robot-assisted therapy might play a key role in clinical management. This comprehensive systematic review aimed to investigate the efficacy of robotic systems in improving upper limb (UL) functions in children with CP.MethodsPubMed, EMBASE, Scopus, and PEDro were searched from inception to February 2024. The risk of bias was assessed with the Joanna Briggs Institute critical appraisal tools battery.ResultsOf 756 articles identified, 14 studies involving 193 children with CP with a judged to be of good methodological quality, but with a lack in the study design, were included in the final synthesis. In the included studies a wide range of devices was used, both exoskeletons and end-effectors, both wearable and non-wearable. The CP children who underwent robot-assisted therapy reported a significant overall increase in clinical assessment, specifically in UL movements and manual dexterity. The clinical improvement was often accompanied by a gain also in instrumental assessments (i.e., kinematic analysis, EMG).DiscussionThe present review suggested that robot-assisted therapy can improve UL motor functions in children with CP. Moreover, the availability of different devices with adjustable parameters can represent an important resource in proposing patient-centered-personalized rehabilitation protocols to enhance the efficacy of rehabilitation and integration into daily life. However, the limited sample size and lack of standardized and clearly reproducible protocols impose to recommend the use of robot-assisted therapy as an integration to usual rehabilitation and not as a replacement.Systematic review registrationhttps://osf.io/a78zb/.