bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emotional states of different obesity phenotypes: a sex-specific study in a west-Asian population
Authors: Mehrabi Fahimeh , Amiri Parisa , Cheraghi Leila , Kheradmand Ali , Hosseinpanah Farhad , Azizi Fereidoun 
Published: March 2021

AbstractBackgroundThe present study aimed to investigate the associations of obesity phenotypes with depression, anxiety, and stress symptoms among adults in the Tehran Lipid and Glucose Study (TLGS).MethodsDepression, anxiety, and stress levels of participants from the TLGS were examined among different obesity phenotypes in this cross-sectional study.Obesity was defined as body mass index (BMI) ≥30 kg/m2, and metabolically unhealthy status based on having metabolic syndrome (MetS) or type 2 diabetes. Four obesity phenotypes were defined: 1) Metabolically Healthy Non-Obese (MHNO), 2) Metabolically Healthy Obese (MHO) 3) Metabolically Unhealthy Non-Obese (MUNO), and 4) Metabolically Unhealthy Obese (MUO). Emotional states of different obesity phenotypes were assessed by the Persian version of depression, anxiety, and stress scale-21 items (DASS-21). Ordinal logistic regression analysis was used to compare sex-specific odds ratios of depression, anxiety, and stress in different obesity phenotypes.ResultsThe mean age of 2469 men and women was 46.2 ± 15.9 and 45.6 ± 14.7, respectively. In total, women were more likely to experience higher levels of depression (30.5%), anxiety (44.2%), and stress (43.5%) symptoms compared to men. After adjusting for potential confounders, compared to MHNO men, the odds of experiencing higher anxiety levels were significantly greater in metabolically unhealthy men whether they were obese (OR: 1.78, 95% CI: 1.25–2.54;P = < 0.001) or non-obese (OR: 1.61, 95% CI: 1.17–2.21;P = < 0.001), and also in MUO women (OR: 1.73, 95% CI: 1.28–2.34;P = < 0.001) compared to MHNO women. Moreover, the odds of experiencing higher stress levels were significantly greater in MUNO men (OR: 1.40, 95% CI: 1.02–1.90;P = 0.04) compared to MHNO men and in MUO women (OR: 1.45, 95% CI: 1.07–1.96;P = 0.02) compared to MHNO women. No difference in depression levels was observed in either sex.ConclusionsOur results showed that men and women with various obesity phenotypes experienced different anxiety and stress levels. While MUO women and all metabolically unhealthy men experienced more anxiety and stress levels than MHNO individuals, none of the obesity phenotypes were associated with depression. These findings provide insight into recognizing the psychological consequences of different phenotypes of obesity in both sexes and utilizing future health promotion planning.
An unusual case of reactivated latent pulmonary cryptococcal infection in a patient after short‐term steroid and azathioprine therapy: a case report
Authors: Pan Wei-Gang , Chen Bao-Chung , Li Yao-Feng , Wu Rui-Xin , Wang Ching-Hsun 
Published: March 2021

Abstract
Background
Cryptococcus is one of the major fungal pathogens infecting the lungs. Pulmonary cryptococcal infection is generally considered a community-acquired condition caused by inhalation of dust contaminated with fungal cells from the environment. Here, we report a case developing pulmonary cryptococcosis 3 months after hospital admission, which has rarely been reported before.

Case presentation
A 73-year-old female patient who was previously immunocompetent experienced persistent dry cough for 2 weeks, 3 months after admission. Chest computed tomography (CT) showed a new solitary pulmonary nodule developed in the upper lobe of the left lung. Staining and culture of expectorated sputum smears were negative for bacteria, acid-fast bacilli, or fungus. The patient then underwent biopsy of the lesion. Histopathology findings and a positive serum cryptococcal antigen titer (1:8) indicated pulmonary cryptococcosis. Daily intravenous 400 mg fluconazole was administered initially followed by oral fluconazole therapy. Follow-up chest CT after 3 months of antifungal therapy showed complete disappearance of the pulmonary nodule. Respiratory symptoms of the patient also resolved. A complete investigation excluded the possibility of a patient-to-patient transmission or primarily acquiring the infection from the hospital environment. Based on the patient’s history of exposure to pigeons before admission and recent steroid and azathioprine use after admission for the treatment of myasthenic crisis, reactivation of a latent pulmonary cryptococcal infection acquired before admission, in this case, is impressed.

Conclusions
Although rarely reported, pulmonary cryptococcal infection should be included in the differential diagnosis of hospitalized patients with respiratory symptoms, especially in those with predisposing risk factors. Chest image studies and further surgical biopsy are needed for confirmation.
Nomogram to predict the risk of acute kidney injury in patients with diabetic ketoacidosis: an analysis of the MIMIC-III database
Authors: Fan Tingting , Wang Haosheng , Wang Jiaxin , Wang Wenrui , Guan Haifei , Zhang Chuan 
Published: March 2021

AbstractBackgroundThis study aimed to develop and validate a nomogram for predicting acute kidney injury (AKI) during the Intensive Care Unit (ICU) stay of patients with diabetic ketoacidosis (DKA).MethodsA total of 760 patients diagnosed with DKA from the Medical Information Mart for Intensive Care III (MIMIC-III) database were included and randomly divided into a training set (70%,n = 532) and a validation set (30%,n = 228). Clinical characteristics of the data set were utilized to establish a nomogram for the prediction of AKI during ICU stay. The least absolute shrinkage and selection operator (LASSO) regression was utilized to identified candidate predictors. Meanwhile, a multivariate logistic regression analysis was performed based on variables derived from LASSO regression, in which variables withP < 0.1 were included in the final model. Then, a nomogram was constructed applying these significant risk predictors based on a multivariate logistic regression model. The discriminatory ability of the model was determined by illustrating a receiver operating curve (ROC) and calculating the area under the curve (AUC). Moreover, the calibration plot and Hosmer-Lemeshow goodness-of-fit test (HL test) were conducted to evaluate the performance of our newly bullied nomogram. Decision curve analysis (DCA) was performed to evaluate the clinical net benefit.ResultsA multivariable model that included type 2 diabetes mellitus (T2DM), microangiopathy, history of congestive heart failure (CHF), history of hypertension, diastolic blood pressure (DBP), urine output, Glasgow coma scale (GCS), and respiratory rate (RR) was represented as the nomogram. The predictive model demonstrated satisfied discrimination with an AUC of 0.747 (95% CI, 0.706–0.789) in the training dataset, and 0.712 (95% CI, 0.642–0.782) in the validation set. The nomogram showed well-calibrated according to the calibration plot and HL test (P > 0.05). DCA showed that our model was clinically useful.ConclusionThe nomogram predicted model for predicting AKI in patients with DKA was constructed. This predicted model can help clinical physicians to identify the patients with high risk earlier and prevent the occurrence of AKI and intervene timely to improve prognosis.
Incidence of microcarcinoma and non‐microcarcinoma in ultrasound‐found thyroid nodules
Authors: Chen Zhi , Mosha Singla Sethiel , Zhang Tong , Xu Ming , Li Yanli , Hu Zhuoqing , Liang Weiqiang , Deng Xiaoyi , Ou Tingting , Li Ling , Li Wangen 
Published: March 2021

Abstract
Backgrounds
The incidence of thyroid nodules is increasing year by year around the world. However, ultrasound is not recommended as a screening test for the general population or patients with a normal thyroid on palpation by the American Association of Clinical Endocrinologists (AACE). In practice, some individuals with normal thyroid palpation have nodules that can just be found out by ultrasound. No studies have directly described the risk of nodules found by ultrasound or by palpation up to now. More evidence is needed to carry out for helping us balance the over diagnosis and missed diagnosis of malignant lesions. Therefore, we carried out a retrospective study to investigate the incidence of malignant lesions in ultrasound-found nodules in a large cohort.

Methods
We conducted a retrospective analysis involving 2957 patients who underwent thyroid ultrasound evaluation and fine-needle aspiration (FNA) between Jan 2013 and Dec 2019. The cytologic examinations were analyzed based on the Bethesda system. For nodules suspected to be follicular neoplasm or other malignant tumors by cytological tests, patients were recommended for surgery and histopathology examinations.

Results
Compared with palpation-found nodules, ultrasound-found nodules were presenting less as purely cystic nodules (10.1 % vs. 39.9 %, x2 = 355.69, p = 0.000), smaller size (17.5 ± 9.9 mm vs. 28.0 ± 12.5 mm, t = 23.876 p = 0.000), and higher TI-RADS score (5.5 ± 2.9 vs. 3.4 ± 3.3, t = 18.084, p = 0.000), respectively. More ultrasound-found nodules were diagnosed as carcinoma by histology examinations [136 (11.2 %) nodules found by ultrasound vs. 68 (3.9 %) by palpation, x2 = 59.737, p = 0.000], and 88 (64.7 %) nodules found by ultrasound were non-microcarcinoma. Among the malignant nodules confirmed by histopathology, a higher proportion of microcarcinoma was detected in ultrasound-found nodules [35.3 % (48/136) vs. 16.2 % (11/68), x2 = 8.183, p = 0.004].

Conclusions
In view of the results observed in our research, malignant nodules were more common in nodules screened out by ultrasound, and nearly two thirds of them were non-microcarcinoma. We suggest the recommendation against screening thyroid nodules by ultrasound needs to be re-evaluated.
A dietary pattern rich in fruits and dairy products is inversely associated to gestational diabetes: a case-control study in Iran
Authors: Roustazadeh Abazar , Mir Hamed , Jafarirad Sima , Mogharab Farideh , Hosseini Seyed Ahmad , Abdoli Amir , Erfanian Saiedeh 
Published: March 2021

Abstract
Background
Gestational diabetes mellitus (GDM) causes many problems for mother and her neonate. A healthy diet plays an important role in preventing GDM. This study aimed to investigate the relationship between major dietary patterns and the GDM.

Methods
386 healthy and 306 GDM pregnant women (total 693) completed this case-control study. Basic information and anthropometric indices were recorded, and a food frequency questionnaire was completed. For extracting major dietary patterns, the principal component analysis was performed. Multivariable logistic regression models were used to examine whether specific dietary patterns are associated to the GDM.

Results
Four dietary patterns were identified: “fruits and dairy products”, “red meat and plant-based foods”, “snacks and high-fat foods” and “carbohydrate-rich foods”. Among these major extracted dietary patterns, “fruits and dairy products” showed an inverse association to the GDM (odds ratio adjusted for confounders: 0.50, confidence interval: 0.284–0.882, p-trend = 0.019, for highest vs. lowest quartile).

Conclusions
It seems using a healthy dietary pattern such as “fruits and dairy products” may decrease GDM risk.

Graphical abstract
Association between dental fear and eating disorders and Body Mass Index among Finnish university students: a national survey
Authors: Sharifian Mohammad Jalil , Pohjola Vesa , Kunttu Kristina , Virtanen Jorma I. 
Published: March 2021

Abstract
Background
Little is known about the association between eating disorders (ED) and dental fear. This study investigated the association between dental fear and EDs through body mass index (BMI), and SCOFF (sick, control, one stone, fat, food) questionnaire among Finnish university students. We hypothesised that dental fear is associated with EDs and BMI.

Methods
We used the latest data from the Finnish University Student Health Survey 2016. This survey targeted undergraduate Finnish students (n = 10,000) of academic universities and universities of applied sciences. We enquired about e.g. age, gender, height, weight, educational sector and perceived mental well-being. We used the SCOFF questionnaire to assess those at risk for developing EDs. The question ‘Do you feel scared about dental care?’ enquired about dental fear. We used the chi-square test and gender-specific logistic regression to analyse the associations between dental fear, EDs and BMI controlling for age, educational sector and mental well-being.

Results
In total, 3110 students participated in the study. Overall 7.2% of the students reported high dental fear and 9.2% scored SCOFF positive; more women than men reported high dental fear (11.2% vs. 3.8%, p < 0.001) and scored positive on SCOFF (14.2% vs. 3.6%, p < 0.001). Gender modified the association between dental fear and EDs and BMI. Among females, when controlling for educational sector and BMI, those with positive SCOFF score were more likely to have high dental fear than those with negative SCOFF score (OR = 1.6; CI = 1.0–2.4). After adding perceived mental well-being to the gender-specific regression analyses, overweight and obese males, BMI ≥ 25 (OR = 2.4; CI 1.3–4.4) and females with poor to moderate mental well-being (OR = 2.1; CI 1.4–2.9) were more likely than their counterparts to have high dental fear.

Conclusions
Among the Finnish university students BMI in males and problems of mental well-being in females were positively associated with high dental fear. The results of this study support possible common vulnerability factors that dental fear and other psychological disorders may share.
Quantitative analysis on the wear of monolithic zirconia crowns on antagonist teeth
Authors: Tang Zhenyu , Zhao Xinyi , Wang Hui 
Published: March 2021

Abstract
Background
The present study aimed to quantitate the wear of the highly transparent Yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) ceramic monolithic zirconia crown on the enamel in vivo and discuss the prone position of the wear and the underlying mechanism.

Methods

A total of 43 patients with 43 posterior teeth were selected for full zirconia crown restoration and examined immediately, at 6 months, and at 1 year after restoration. During the follow-up visit, the fine impression of the patients’ monolithic zirconia crowns, the antagonist teeth, the corresponding contralateral natural teeth, the super plaster cast, and epoxy resin model was ontained. The model of epoxy resin was observed under a stereo microscope, and the microstructure parts were observed under a scanning electron microscope.

Results
After 1 year, the mean depth and volume of wearing of the monolithic zirconia crown were the smallest (all P < 0.01), while those of the antagonist teeth were significantly larger than those of the natural teeth (P < 0.0001), and no significant difference was found among the natural teeth (P = 0.3473, P = 0.6996). The amount of wear after one year was remarkably higher than that at 6 months (P < 0.0001). The microscopic observation revealed the tendency of wearing of the monolithic zirconia crown on the antagonist teeth at the protruding early contact points. Electron micrographs of tooth scars showed that the wearing mechanism of the monolithic zirconia crown on natural teeth was mainly abrasive and fatigue wear.

Conclusions
Although the self-wearing is insignificant, the monolithic zirconia crown can cause wear of the antagonist teeth via occlusal or early contact significantly; the amount of wearing is higher than that of natural teeth and increases over time. The wearing mechanism is mainly abrasive and fatigue wear.
Exploring the differences between men’s and women’s perceptions of gender-based violence in rural Tajikistan: a qualitative study
Authors: Wood Elizabeth A. , Wilson Karina E. , Jacobs K. D. 
Published: March 2021

Abstract
Background
Most women living in rural provinces of Tajikistan, specifically Khatlon, experience little to no opportunities for education and economic growth, making them vulnerable to gender-based violence (GBV). Unfortunately due to social norms that are bolstered by a patriarchal society, GBV has become tolerated and even normalized in rural areas. This study looks to investigate the differences in perceptions of violence as it relates to empowerment among men and women in rural Tajikistan.

Methods
Data collection was done through participatory workshops and semi-structured interviews (SSI) that were led by Extension Home Economists, which lectured on gender, violence, and empowerment. Community Empowerment Drawings is a novel tool that has been used to further gather sensitive information that was not previously discussed. During this process, participant groups were asked to draw their perception of empowered versus disempowered women, later explaining the different characteristics and traits of both. Random participants across both genders were later contacted for a SSI to triangulate the data from the participatory workshops. This qualitative study implemented qualitative content analysis to explore the data inductively. Analysis of the drawings and transcripts from the workshops and SSIs included two researchers coding through an iterative process. Themes were stratified by men’s and women’s perceptions and codebooks were compared to ensure consensus.

Results
Men and women from 12 villages participated in the Community Empowerment Drawings within each workshop, with 234 participants total. Results were stratified into two categories which were later broken down into notable themes: education, employment, decision-making, marital status, relationship wellness and respect, violence, mental health, and substance abuse. Major findings illustrated how disempowered women were perceived to have more exposure to men who experience alcohol abuse. This study found that differences in perceptions of empowerment between men and women remain—with men still holding onto the traditional power structure within a household and women challenging gender roles and mobility.

Conclusion
Future studies may find engaging communities through drawings will yield more information regarding sensitive topics rather than traditional instruments. More support and advocacy are needed in areas of mental, neurological, and substance abuse disorders throughout rural Tajikistan.
Thymoquinone inhibited vasculogenic capacity and promoted mesenchymal-epithelial transition of human breast cancer stem cells
Authors: Haiaty Sanya , Rashidi Mohammad-Reza , Akbarzadeh Maryam , Bazmani Ahad , Mostafazadeh Mostafa , Nikanfar Saba , Zibaei Zohre , Rahbarghazi Reza , Nouri Mohammad 
Published: March 2021

Abstract
Background
Vasculogenic mimicry (VM) is characterized by the formation of tubular structure inside the tumor stroma. It has been shown that a small fraction of cancer cells, namely cancer stem cells (CSCs), could stimulate the development of vascular units in the tumor niche, leading to enhanced metastasis to the remote sites. This study aimed to study the inhibitory effect of phytocompound, Thymoquinone (TQ), on human breast MDA-MB-231 cell line via monitoring Wnt/PI3K signaling pathway.

Methods
MDA-MB-231 CSCs were incubated with different concentrations of TQ for 48 h. The viability of CSCs was determined using the MTT assay. The combination of TQ and PI3K and Wnt3a inhibitors was examined in CSCs. By using the Matrigel assay, we measured the tubulogenesis capacity. The percent of CD24− CSCs and Rhodamine 123 efflux capacity was studied using flow cytometry analysis. Protein levels of Akt, p-Akt, Wnt3a, vascular endothelial-cadherin (VE-cadherin), and matrix metalloproteinases-2 and -9 (MMP-2 and -9) were detected by western blotting.

Results
TQ decreased the viability of CSCs in a dose-dependent manner. The combination of TQ with PI3K and Wnt3a inhibitors reduced significantly the survival rate compared to the control group (p < 0.05). TQ could blunt the stimulatory effect of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), fibroblast growth factor (FGF) on CSCs (p < 0.05). The vasculogenic capacity of CSCs was reduced after being-exposed to TQ (p < 0.05). Western blotting revealed the decrease of CSCs metastasis by suppressing MMP-2 and -9. The protein level of VE-cadherin was also diminished in TQ-treated CSCs as compared to the control cell (p < 0.05), indicating inhibition of mesenchymal-endothelial transition (MendT). TQ could suppress Wnt3a and PI3K, which coincided with the reduction of the p-Akt/Akt ratio. TQ had the potential to decrease the number of CD24− CSCs and Rhodamine 123 efflux capacity after 48 h.

Conclusion
TQ could alter the vasculogenic capacity and mesenchymal-epithelial transition of human breast CSCs in vitro. Thus TQ together with anti-angiogenic therapies may be a novel therapeutic agent in the suppression of VM in breast cancer.
Québec health care professionals’ perspectives on organ donation after medical assistance in dying
Authors: Allard Julie , Ballesteros Fabian , Fortin Marie-Chantal 
Published: March 2021

Abstract
Background
Medical assistance in dying (MAID) has been legal in Québec since December 2015 and in the rest of Canada since July 2016. Since then, more than 60 people have donated their organs after MAID. Such donations raise ethical issues about respect of patients’ autonomy, potential pressure to choose MAID, the information given to potential donors, the acceptability of directed donations in such a context and the possibility of death by donation. The objective of this study was to explore Québec professionals’ perspectives on the ethical issues related to organ donation after MAID.

Methods
We conducted semi-directed interviews with 21 health care professionals involved in organ donation such as intensivists and intensive care nurses, operating room nurses, organ donation nurses and coordinators.

Results
The participants were all favourable to organ donation after MAID in order to respect patients’ autonomy. They also favoured informing all potential donors of the possibility of donating organs. They highlighted the importance of assessing donors’ reasons for requesting MAID during the assessment. They were divided on directed donation, living donation before MAID and death by donation.

Conclusion
Organ donation after MAID was widely accepted among the participants, based on the principle of respect for the donor’s autonomy. The findings of this study only provide the perspectives of Québec health care professionals involved in organ donation. Future studies are needed to gather other stakeholders’ perspectives on this issue as well as patients’ and families’ experiences of organ donation after MAID.
First-line management of canine status epilepticus at home and in hospital-opportunities and limitations of the various administration routes of benzodiazepines
Authors: Charalambous Marios , Volk Holger A. , Van Ham Luc , Bhatti Sofie F. M. 
Published: March 2021

AbstractStatus epilepticus (SE) or prolonged epileptic seizure activity is a common neurological emergency with a high mortality rate and, if left untreated, can lead to irreversible cerebral damage and systemic complications. Fast and effective first-line management is of paramount importance, particularly in the at-home management of seizures where drug administration routes are limited. Benzodiazepines (BZDs) have been exclusively used in veterinary medicine for decades as first-line drugs based on their high potency and rapid onset of action. Various administration routes exist in dogs, such as oral, intravenous, intramuscular, rectal, and intranasal, all with different advantages and limitations. Recently, intranasal drug delivery has become more popular due to its unique and favourable characteristics, providing potential advantages over other routes of drug administration in the management of canine SE. This narrative review provides an outline of the management of SE at home and in a hospital setting, discusses considerations and challenges of the various routes of BZD administration, and evaluates the impact of intranasal drug administration (nose-brain pathway) for controlling canine SE at home and within hospital settings.