bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of COVID-19-related care disruptions on blood pressure management and control in community health centers
Authors: Meador Margaret , Coronado Fátima , Roy Debosree , Bay R. Curtis , Lewis Joy H. , Chen Jessica , Cheung Rachel , Utman Christopher , Hannan Judith A. 
Published: December 2022

Abstract
Background
Uncontrolled hypertension is a leading risk factor for cardiovascular disease. To ensure continuity of care, community health centers (CHCs) nationwide implemented virtual care (telehealth) during the pandemic. CHCs use the Centers for Medicare & Medicaid Services (CMS) 165v8 Controlling High Blood Pressure measure to report blood pressure (BP) control performance. CMS 165v8 specifications state that if no BP is documented during the measurement period, the patient’s BP is assumed uncontrolled.

Methods
To examine trends in BP documentation and control rates in CHCs as telehealth use increased during the pandemic compared with pre-pandemic period, we assessed documentation of BP measurement and BP control rates from December 2019 - October 2021 among persons ages 18-85 with a diagnosis of hypertension who had an in-person or telehealth encounter in 11 CHCs. Rates were compared between CHCs that did and did not implement self-measured BP monitoring (SMBP).

Results
The percent of patients with hypertension with no documented BP measurement was 0.5% in December 2019 and increased to 15.2% (overall), 25.6% (non-SMBP CHCs), and 11.2% (SMBP CHCs) by October 2021. BP control using CMS 165v8 was 63.5% in December 2019 and decreased to 54.9% (overall), 49.1% (non-SMBP), and 57.2% (SMBP) by October 2021. When assessing BP control only in patients with documented BP measurements, CHCs largely maintained BP control rates (63.8% in December 2019; 64.8% (overall), 66.0% (non-SMBP), and 64.4% (SMBP) by October 2021).

Conclusions
The transition away from in-person to telehealth visits during the pandemic likely increased the number of patients with hypertension lacking a documented BP measurement, subsequently negatively impacting BP control using CMS 165v8. There is an urgent need to enhance the flexibility of virtual care, improve EHR data capture capabilities for patient-generated data, and implement expanded policy and systems-level changes for SMBP, an evidence-based strategy that can build patient trust, increase healthcare engagement, and improve hypertension outcomes.
Hooked embracing plate for Rolando fracture fixation: a preliminary result
Authors: Tsai Yueh-Ju , Yeh Jui-Po , Lin Tsen-Hung , Lin Tsan-Shiun , Hsieh Ching-Hua 
Published: December 2022

Abstract
Background
Rolando fracture is a comminuted, intra-articular fracture over the metacarpal bone base of the thumb which often leads to joint instability and requirement of surgery. The aim of this study is to evaluate the radiological and functional outcomes of Rolando fracture following surgical fixation with a hooked embracing plate (Acumed, 1.3 mm, Rolando Fracture Hooked Plate) designed for Rolando fracture.

Method
We retrospectively reviewed a consequence of patients between 2018 and 2022 with Rolando fracture who received open reduction internal fixation with hooked embracing plates. Primary endpoints were the quality of radiologic reduction after the operation and peri-operative complications. Secondary outcomes were bone union, pinch and grip strength, palmar abduction, opposition and radiographic osteoarthritis over the trapeziometacarpal (TMC) joint.

Results
A total of 5 patients were included. All patients had good quality of radiological reduction without peri-operative complications. The opposition, abduction, pinch and grip strength were nearly full-recovered for all patients with fine bone unions after 3 months follow-up.

Conclusion
The hooked embracing plate is a good and safe option for surgical fixation in patients with Rolando fracture. Compared with traditional method such as lag screw or mini-plate fixation, the hooked embracing plate could provide rigid fixation with fine radiologic and functional outcomes with early mobilization.
Mapping the evidence for monitoring fluoride exposure in community prevention programmes for oral health using nail clippings and spot urine samples: a scoping review
Authors: Kumah Elizabeth Adjoa , Eskandari Fatemeh , Azevedo Liane B. , John Sherley , Zohoori Fatemeh Vida 
Published: December 2022

AbstractBackgroundThere is an increased interest in identifying practical and accurate biomarkers for fluoride exposure. Due to the narrow ‘dose-gap’ between the benefit of caries reduction and the risk of dental fluorosis, monitoring of fluoride exposure is vital when introducing any fluoridation programme for the prevention of dental caries. This scoping review aimed to ascertain the nature and extent of the available evidence on how spot urine and nail clippings are used to measure fluoride intake/exposure, by using a unique approach of mapping the studies according to population, setting, type of study design, methodology and analytical approach in community prevention programmes.MethodsMultiple relevant databases were searched up to July 2021 for any study designs, including randomised controlled studies, quasi-experimental studies, surveys, retrospective and prospective cohort studies, case studies, phenomenological studies, and expert opinions.ResultsThe search retrieved 9,222 studies of which 155 met the inclusion criteria. A high proportion of the studies (25.2%) originated from Latin America and the Caribbean continent subregion. However, per country, China recorded the highest number, followed by India and Mexico. The majority (62.6%) employed a cross-sectional study design, and 65.8% combined participants from different age groups. Of the included studies, 82.6% used spot urine samples as a biomarker for assessing fluoride intake/exposure. Water fluoride concentration was reported in 66.5% of the studies with 46.6% of all included studies reporting a water fluoride concentration of > 1.2 mg/L. The methods used in assessing oral hygiene and dietary intake were not reported in 72.3% and 71.0% of the included studies, respectively. Only 35.5% of the included studies assessed the relationship between fluoride exposure and excretion.ConclusionsThis review revealed a large variability in the way in which spot urine samples and/or nail clippings are used to measure fluoride exposure in different settings and situations. Particularly, there are inconsistencies in the methodologies and the analytical approaches used in assessing fluoride exposure. Therefore, there is a need for more rigorous primary research studies using standardised approaches to determine the suitability of spot urine samples and nail clipping as biomarkers for monitoring fluoride exposure.
Effects of exercise on inflammatory factors and IGF system in breast cancer survivors: a meta-analysis
Authors: Zhou Yanan , Jia Ningxin , Ding Meng , Yuan Kai 
Published: December 2022

Abstract
Background
At present, there are multiple hypotheses regarding the mechanisms underlying the effect of exercise on the postoperative inflammatory factors and the IGF system among breast cancer patients, especially. To determine the underlying mechanisms, prevent the recurrence of breast cancer and improve its prognosis, this paper will systematically evaluate the impact of exercise on inflammatory factors and the IGF system in breast cancer survivors.

Methods
The PubMed, Embase, Web of Science, CNKI, Wanfang and VIP (Chinese scientific and technical journals) databases were systematically searched until April 2021. The search terms included 'exercise', 'inflammatory factor', 'IGF system' and 'breast cancer'. A total of 1066 relevant articles were retrieved. The articles were screened according to inclusion and exclusion criteria, such as study population, intervention method and type of experiment, and 11 articles were ultimately included. All statistical results were analysed using STATA 14.0 and Rstudio 4.1.1.

Results
We found that exercise significantly reduced the level of IGF-1 (WMD, -19.947 ng/ml; 95% CI, -22.669 to -17.225; P = 0.000). Subgroup analysis showed that in the studies with an intervention period > 12 weeks, exercise significantly reduced IL-6 levels (WMD, -0.761 pg/ml; 95% CI, -1.369 to -0.153; p = 0.014), while in the studies with an intervention period ≤ 12 weeks, exercise significantly reduced CRP (WMD, -2.381 mg/L; 95% CI, -4.835 to 0.073, P = 0.001) and IL-10 levels (WMD, -7.141 pg/ml, 95% CI, -10.853 to -3.428; P = 0.000). In addition, aerobic exercise plus resistance training significantly reduced IL-6 levels (WMD, -1.474 pg/ml; 95% CI, -1.653 to -1.296; P = 0.000). The results of the sensitivity analysis showed that after excluding the studies with high heterogeneity, exercise significantly reduced the TNF-α levels in patients with breast cancer (WMD, -1.399 pg/ml; 95% CI, -1.718 to -1.080; P = 0.000).

Conclusion
Exercise reduces the postoperative levels of IGF-1, IL-6, CRP, IL-10 and TNF-α among patients with breast cancer, which may have a significant impact on inhibiting breast cancer recurrence and improving its prognosis. Future studies should examine the effects of different durations and types of exercise to develop individualized exercise prescriptions for breast cancer patients.
Determining the readiness of patients with renal failure to use health information technology
Authors: Tabas Raana Younesi , Ahmadian Leila , Samadbeik Mahnaz , Arian Anahita , Ameri Arefeh 
Published: December 2022

Abstract
Introduction
Using information technology (IT) for purposes such as patient education and disease prevention and management is effective when patients are ready to use it. The objective of this study was to determine the readiness of patients with renal failure to use health IT.

Methods
This study was performed on all dialysis patients in South Khorasan province (n = 263) using a 28-item questionnaire. The questionnaire consisted of (1) demographic information of participants and (2) questions concerning eight main factors including the need for information, desire to receive information, ability to use computers and the Internet, computers and the Internet anxiety, communication with physicians, using mobile phones and concerns about security and confidentiality of information. Descriptive statistics and Mann–Whitney and Kruskal–Wallis statistical tests were used to analyze the data.

Results
About 15% of the participants stated that they do not want to receive information from the Internet. Anxiety and concern about Internet security and confidentiality were higher in women, married people, people over 60, villagers, and illiterate people (p < 0.05). Married people and people over 60 years had a higher desire to get information (p < 0.05). The rate of computer anxiety and Internet privacy concern was higher than average (p < 0.001). Most patients (34.2%) could only send text messages using mobile phones.

Conclusion
Despite the need of most patients to online health information, they do not use this information due to a lack of skills and experience to use IT. Therefore, the ability of users should be considered when developing IT-based interventions. Due to patients' concerns about Internet privacy, it is required to teach patients how to protect their privacy while using the Internet.
Economic hardship among principal family caregivers of cancer patients at Khartoum oncology hospital 2020: a cross-sectional study
Authors: Elgadi Ammar , Hisham Aseel , Ahmed Hayat A. , Elzaki Hiba Ali , shaaban Kamil Merghani Ali , Dafaalla Ola , Elkhidir Osama Ahmed , Alrawa Salma S. , Mahmoud Tahani Amin , Wadidi Waad 
Published: December 2022

Abstract
Background
The impact of cancer extends beyond patients and consumes their families. Family members are widely recognized as informal caregivers. The economic burden on family caregivers is increased with new treatments, prolonged survival, and reduced stay in the acute care setting. This is especially true in African countries where family bonds are sacred and health system is fragile that they need to pay out of pocket for care.
The aim of this study is to estimate the perceived caregivers’ economic burden in the subsequent aspects: financial strain, inability to make ends meet, not enough money for necessities, and economic adjustments/cutbacks.

Method
This study was a quantitative, descriptive cross-sectional study conducted at Khartoum oncology hospital. Included 143 caregivers of cancer patients. Data were collected through face-to-face interviews using the socio-demographic Questionnaire and Economic Hardship Questionnaire (EHQ).

Results
One hundred forty-three cancer patients and their caregivers were included. 56.6% of patients were females, and about 32.2% were aged 51–65 years. The most common cancer types were breast cancer and leukemia. Roughly 33% of patients had stage IV cancer on presentation, and about 53.9% received chemotherapy. Unlike cancer patients, (47.6%) of family caregivers were aged 18–34 years, yet they were mainly females (54.4%). Most of them (34.3%) were unemployed, with a mean monthly gross income of 53.3 dollars, while the mean household monthly gross income was 113.0 dollars. The mean score of the economic hardship scale was 35.8 out of 64. Most of the caregivers experience no difficulties affording necessities. However, they experience difficulties with medical and leisure activities.
There was no significant association between caregiver economic hardship and cancer patient characteristics (patients' age, cancer stage, and treatment type). However, there was a significant association between caregivers' economic hardships and their gender, marital status, educational level, occupation, caregiver monthly gross income, and household monthly gross income.

Conclusion
The study findings suggest a moderate financial burden among cancer caregivers. The predicting factors include being single, a student, male, of higher educational level, and lower income. Financial difficulties are associated with maladaptive behavior and should come to light.
A multi-center, single-arm, phase II study of anlotinib plus paclitaxel and cisplatin as the first-line therapy of recurrent/advanced esophageal squamous cell carcinoma
Authors: Li Ning , Wu Tao , Hong Yong-Gui , Guo Yan-Zhen , Cheng Yu-Feng , Ma Yi-Jie , Bie Liang-Yu , Cui Dong-Hai , Gao Xiao-Hui , Tan Bing-Xu , Li Bao-Sheng , Luo Su-Xia , Wang Jun-Sheng 
Published: December 2022

Abstract
Background
Anlotinib, a tyrosine kinase inhibitor, has shown encouraging anti-tumor activity in esophageal squamous cell carcinoma (ESCC). This study was designed to assess the efficacy and safety of anlotinib plus paclitaxel and cisplatin (TP) as first-line therapy for advanced ESCC.

Methods
In a multi-center, single-arm, phase II clinical trial, patients (aged > 18 years) with ESCC, which was judged to be locally advanced, recurrent, or metastatic, received 10 mg oral anlotinib once daily on days 1–14, 135 mg/m2 intravenous paclitaxel on day 1, and 60–75 mg/m2 intravenous cisplatin on days 1–3 every 3 weeks for a maximum of 4–6 cycles as the initial therapy in five centers in China. Subsequently, patients received anlotinib monotherapy (10 mg) as maintenance therapy until tumor progression or intolerable toxicity. The primary endpoint was progression-free survival (PFS).

Results
Forty-seven patients were enrolled in this study between October 2019 and March 2021. The median follow-up was 14.04 months (IQR, 9.30–19.38). Of 46 with assessable efficacy, the median PFS and median overall survival were 8.38 months (95% CI, 6.59–10.17) and 18.53 months (95% CI, 13.11–23.95), respectively. The objective response rate was 76.1% (95% CI, 61.2–87.4%), with 4 (8.7%) complete responses and 31 (67.4%) partial responses. The disease control rate was 91.3% (95% CI, 79.2–97.6%). The median duration of response was 6.80 months (95% CI, 4.52–9.08), and 1 patient had an ongoing response for 23 months. Subgroup analysis revealed no association between clinical factors and survival or response. Of the 47 patients with assessable safety, the main grade ≥ 3 treatment-emergent adverse events (TEAEs) were neutropenia (17.0%), bone marrow suppression (12.8%), and vomiting (10.6%). No treatment-related deaths or serious TEAEs were observed. Notably, higher c-Kit levels were an independent factor for superior PFS (HR = 0.032; 95% CI, 0.002–0.606; P = 0.022).

Conclusions
The study demonstrated a manageable safety profile and durable clinical response of anlotinib plus TP as first-line therapy in advanced ESCC, which suggested a potential therapeutic option for this population.

Trial registration
ClinicalTrials.gov NCT04063683. Registered 21 August 2019.
Tumor PKCδ instigates immune exclusion in EGFR-mutated non–small cell lung cancer
Authors: Zuo Yi-Han , Gao Wei-Na , Xie Ya-Jia , Yang Sheng-Yong , Zhou Jin-Tai , Liang Hai-Hai , Fan Xing-Xing 
Published: December 2022

Abstract
Background
The recruitment of a sufficient number of immune cells to induce an inflamed tumor microenvironment (TME) is a prerequisite for effective response to cancer immunotherapy. The immunological phenotypes in the TME of EGFR–mutated lung cancer were characterized as non-inflamed, for which immunotherapy is largely ineffective.

Methods
Global proteomic and phosphoproteomic data from lung cancer tissues were analyzed aiming to map proteins related to non-inflamed TME. The ex vivo and in vivo studies were carried out to evaluate the anti-tumor effect. Proteomics was applied to identify the potential target and signaling pathways. CRISPR-Cas9 was used to knock out target genes. The changes of immune cells were monitored by flow cytometry. The correlation between PKCδ and PD-L1 was verified by clinical samples.

Results
We proposed that PKCδ, a gatekeeper of immune homeostasis with kinase activity, is responsible for the un-inflamed phenotype in EGFR-mutated lung tumors. It promotes tumor progression by stimulating extracellular matrix (ECM) and PD-L1 expression which leads to immune exclusion and assists cancer cell escape from T cell surveillance. Ablation of PKCδ enhances the intratumoral penetration of T cells and suppresses the growth of tumors. Furthermore, blocking PKCδ significantly sensitizes the tumor to immune checkpoint blockade (ICB) therapy (αPD-1) in vitro and in vivo model.

Conclusions
These findings revealed that PKCδ is a critical switch to induce inflamed tumors and consequently enhances the efficacy of ICB therapy in EGFR-mutated lung cancer. This opens a new avenue for applying immunotherapy against recalcitrant tumors.

Graphical Abstract
Frailty and risk of microvascular complications in patients with type 2 diabetes: a population-based cohort study
Authors: Wu Yuanjue , Xiong Ting , Tan Xiao , Chen Liangkai 
Published: December 2022

Abstract
Background
Cross-sectional studies found that frailty was associated with prevalent diabetic microvascular complications (DMC). Longitudinal evidence in this regard is inconclusive and insufficient. We aimed to prospectively evaluate the association of pre-frailty and frailty with DMC in patients with type 2 diabetes (T2D).

Methods
We included 18,062 adults (mean age 59.4 ± 7.2 years, 37.4% female) with T2D at baseline in the UK Biobank. Frailty was defined using the frailty phenotype according to five components (weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength). DMC, defined as diabetic nephropathy, diabetic neuropathy, or diabetic retinopathy, was identified using hospital inpatient records and death registries. Cox proportional hazard regression models considering competing risks were used to evaluate the associations of frailty phenotype with overall DMC events and subtypes.

Results
Among all participants, 6101 (33.8%) were classified as non-frail, 10,073 (55.8%) were classified as pre-frail, and 1888 (10.4%) were classified as frail. During a median follow-up of 12.0 years, 3678 DMC cases were documented, including 2213 diabetic nephropathy, 1520 diabetic retinopathy, and 673 diabetic neuropathy events. In the multivariable-adjusted model, compared with participants with non-frail, both pre-frailty and frailty were significantly associated with increased risk of overall DMC (HR 1.10, 95% CI: [1.02, 1.18] for pre-frailty and HR 1.52 [95% CI: 1.36, 1.69] for frailty). Similar results were observed in the subtypes of DMC. For each one-point increase in frailty phenotype score, the risk of overall DMC, diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy event increased by 13%, 16%, 10%, and 20%, respectively.

Conclusions
Both pre-frailty and frailty were associated with an increased risk of DMC in patients with T2D. These findings have important implications for integrating early assessment and surveillance of frailty in diabetes and may favor the identification of at-risk patients.
Time series evaluation of condemnation at poultry slaughterhouses enable to export in Southeastern Brazil (2009–2019): a tool for optimizing resources in the poultry production chain
Authors: Hortêncio Maria Carolina , Costa Letícia Roberta Martins , de Souza Maria Victória Pereira , de Freitas Weslley Domenicci , Fonseca Belchiolina Beatriz , Silva Marcelo José Barbosa , Cossi Marcus Vinícius Coutinho 
Published: December 2022

AbstractBackgroundEven with the technological advances in management, health and genetics applied to poultry farming worldwide, there is still a high rate of carcasses condemnation at slaughterhouses, which result in losses for the poultry production chain. Thus, this work aimed to evaluate the condemnation occurrence index (COI) and adjusted seasonal index (ASI) of poultry (turkey, griller, and heavy chicken) between 2009 and 2019, in a slaughterhouse enable to export in southeastern Brazil. Data were obtained from official spreadsheets from the Brazilian Federal Inspection Service (FIS) and used to calculate the COI, correlation analysis between the main causes of condemnation, and ASI assessments throughout the year.ResultsSeven percent (55,594,318) of the poultry carcasses were condemned (partial or total), and the most frequent causes, contamination, and contusion/traumatic injury, amounted to 63.5% of the total condemnation. There was a trend of increasing condemnation throughout the time series evaluated, with COI varying between 45,282–149,809 condemnations per 1,000,000 poultry slaughtered. Considering the ASI, it was identified that for ascitic syndrome, July has a higher index value (1.63) than the months between January–June (P < 0.05).ConclusionsThe main causes of condemnation were contamination and contusion/traumatic injury, both technological causes. ASI showed that in July there is a greater carcasses condemnation due to ascitic syndrome than in the months between January and June. The variations observed in the ASIs can provide subsidies for preventive measures and optimization of human and financial resources, generating positive impacts on food safety, productivity, and profitability of the sector.