bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of psychological attachment on the relationship between periodontal health and dental fear in patients with versus without psoriasis: a questionnaire-based, cross-sectional study
Authors: Graetz Christian , Woeste Sirka , Mrowietz Ullrich , Ehrenthal Johannes C. 
Published: March 2021

Abstract
Background
While there is increasing evidence for the relevance of psychosocial variables such as dental fear or psychological attachment in dentistry, much less is known about the mechanisms that determine the strength of those associations. One potential moderator is the occurrence of a comorbid chronic disease such as psoriasis, which is linked to relevant disease parameters such as periodontal inflammation. The aim of the study was to test a moderation model of the relationship between dental fear, psychological attachment and psoriasis on periodontal health.

Methods
A total of 201 patients (100 with psoriasis, 101 without psoriasis) were included in a questionnaire-based, cross-sectional study. Dental status was measured with the Community Periodontal Index (CPI), dental fear was measured with the Hierarchical Anxiety Questionnaire (HAQ), and psychological attachment was measured with the Relationship Questionnaire (RQ). In addition to the examination of main effects, bootstrapping-based analyses were conducted to test the moderating influence of psychological attachment on the association between CPI and dental fear, gain moderated by group (with vs. without psoriasis).

Results
Controlling for several covariates, higher CPI scores were associated with higher levels of dental fear only in individuals without psoriasis under conditions of higher levels of psychological attachment anxiety and lower levels of attachment avoidance.

Conclusion
In individuals without psoriasis, psychological attachment can moderate the association between periodontal health and dental fear. This may provide a useful framework for reducing dental fear through interventions on the level of the dentist-patient relationship.
Accuracy of self-perceived risk perception of breast cancer development in Iranian women
Authors: Hajian-Tilaki Karimollah , Nikpour Maryam 
Published: March 2021

AbstractBackgroundThe accuracy of subjective risk perception is a matter of concern in breast cancer development. The objective of this study was to evaluate the accuracy of self-perceived risk assessment of breast cancer development and compared to actual risk in Iranian women.MethodsThe demographic, clinical, and reproductive characteristics of 800 women aged 35–85 years were collected with an in-person interview. The self-perceived risk and the actual risk were assessed using the visual analog scale (VAS) and he Gail model respectively. Gail’s cutoff of 1.66% risk was used to categorize the estimated 5-year actual risk as low/average risk (< 1.66%) and high risk (≥ 1.66). In low/average risk, if the self-perceived risk > actual risk, then individuals were considered as overestimating. Similarly, in high-risk women, if the perceived risk < actual risk, then, the subjects were labeled as under-estimate; otherwise, it was labeled as accurate. The Kappa statistics were used to determine the agreement between self-perceived risk and actual risk. ROC analysis was applied to determine the accuracy of self-perceived risk in the prediction of actual risk.ResultsThe perceived risk was significantly higher than actual risk (p = 0.001, 0.01 for 5-year and lifetime risk respectively). Both in low and high-risk groups about half of the women over-estimate and underestimate the risk by subjective risk perception. For a 5-year risk assessment, there was no agreement between perceived risk and actual risk (Kappa = 0.00,p = 0.98) but a very low agreement between them in lifetime risk assessment (Kappa = 0.09,p = 0.005). The performance of accuracy of risk perception versus actual risk was very low (AUC = 0.53, 95% CI 0.44–0.61 and AUC = 0.58, 95% CI 0.54–0.62 for the 5-year risk and lifetime risk respectively).ConclusionThe clinical performance of risk perception based on VAS is very poor. Thus, the efforts of the public health education program should focus on the correct perception of breast cancer risk among Iranian women.
Histological diagnostic criterion for chronic endometritis based on the clinical outcome
Authors: Hirata Kimiko , Kimura Fuminori , Nakamura Akiko , Kitazawa Jun , Morimune Aina , Hanada Tetsuro , Takebayashi Akie , Takashima Akiko , Amano Tsukuru , Tsuji Shunichiro , Kaku Shoji , Kushima Ryoji , Murakami Takashi 
Published: March 2021

Abstract
Background
The diagnostic criteria of chronic endometritis remain controversial in the treatment for infertile patients.

Methods
A prospective observational study was conducted in a single university from June 2014 to September 2017. Patients who underwent single frozen-thawed blastocyst transfer with a hormone replacement cycle after histological examination for the presence of chronic endometritis were enrolled. Four criteria were used to define chronic endometritis according to the number of plasma cells in the same group of patients: 1 or more (≥ 1) plasma cells, 2 or more (≥ 2), 3 or more (≥ 3), or 5 or more (≥ 5) in 10 high-power fields. Pregnancy rates, live birth rates, and miscarriage rates of the non-chronic endometritis and the chronic endometritis groups defined with each criterion were calculated. A logistic regression analysis was performed for live births using eight explanatory variables (seven infertility factors and chronic endometritis). A receiver operating characteristic curve was drawn and the optimal cut-off value was calculated.

Results
A total of 69 patients were registered and 53 patients were finally analyzed after exclusion. When the diagnostic criterion was designated as the presence of ≥ 1 plasma cell in the endometrial stroma per 10 high-power fields, the pregnancy rate, live birth rate, and miscarriage rate were 63.0% vs. 30.8%, 51.9% vs. 7.7%, and 17.7% vs. 75% in the non-chronic and chronic endometritis groups, respectively. This criterion resulted in the highest pregnancy and live birth rates among the non-chronic endometritis and the smallest P values for the pregnancy rates, live birth rates, and miscarriage rates between the non-chronic and chronic endometritis groups. In the logistic regression analysis, chronic endometritis was an explanatory variable negatively affecting the objective variable of live birth only when chronic endometritis was diagnosed with ≥ 1 or ≥ 2 plasma cells per 10 high-power fields. The optimal cut-off value was obtained when one or more plasma cells were found in 10 high-power fields (sensitivity 87.5%, specificity 64.9%).

Conclusions
Chronic endometritis should be diagnosed as the presence of ≥ 1 plasma cells in 10 high-power fields. According to this diagnostic criterion, chronic endometritis adversely affected the pregnancy rate and the live birth rate.
Association of decreased grip strength with lower urinary tract symptoms in women: a cross‐sectional study from Korea
Authors: Yang Su-Jin , Park Jung Ha , Oh Yunhwan , Kim Hyeonju , Kong Mihee , Moon Jihyun 
Published: March 2021

AbstractBackgroundLower urinary tract symptoms (LUTS) including frequency, nocturia, urgency, and incontinence, are common in women and cause significant discomfort in daily life. However, diagnosis and treatment of LUTS are often delayed because many patients with such symptoms do not complain to the physician of discomfort and do not seek medical attention. LUTS are known to be associated with muscle weakness. We investigated the association between grip strength and LUTS in women of different ages.MethodsThis study included 4225 women (mean age 48.6 years) who underwent self-referred health screening between April 2015 and December 2019. LUTS were evaluated using a self-reported questionnaire, and the overactive bladder symptom score was used to screen for an overactive bladder. Low muscle strength was defined as a hand grip strength of < 18 kg (decreased grip strength).ResultsWe observed decreased grip strength in 13.7% (n = 580) of the participants. Nocturia, urgency, incontinence, and overactive bladder were more common in women with decreased grip strength than in women with normal grip strength. After adjusting for age, comorbidities (hypertension, diabetes, hyperlipidemia), smoking status, alcohol consumption, regular exercise, and stress, nocturia (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.01–1.52), urinary incontinence (OR 1.32, 95% CI 1.01–1.72), and an overactive bladder (OR 1.75, 95% CI 1.35–2.27) were significantly associated with decreased grip strength.ConclusionsThe findings suggest that LUTS, especially nocturia, incontinence, and an overactive bladder are associated with decreased grip strength in women. Therefore, physicians should be aware that patients may not seek help, even if they are uncomfortable, and it is important to obtain a detailed medical history and perform additional tests, even in the absence of complaints, in patients with low grip strength, who are at high risk of LUTS.
A large ovarian steroid cell tumor‐not otherwise specified with a unique combination of benign and malignant features as a challenging cause of oligomenorrhea and hirsutism in a 21‐year‐old Syrian female: a case report
Authors: Ismail Sawsan , Hraib Munawar , Issa Rana , Alassi Thanaa , Alshehabi Zuheir 
Published: March 2021

Abstract
Background
Ovarian steroid cell tumors represent a rare category of sex cord-stromal tumors that constitute less than 0.1% of all ovarian tumors. These neoplasms are classified into three main subtypes according to the cell of origin: Leidyg cell tumors, stromal luteomas, and steroid cell tumors not otherwise specified (SCTs-NOS). The latter subtype is defined as a neoplasm of an uncertain lineage that mostly affects middle-aged women, whereas it’s rare in younger ages.

Case presentation
We report a case of a 21-year-old virgin female who presented to our hospital with complaints of mild abdominal pain, hirsutism, and oligomenorrhea for more than a year. Before her current admission, the patient had attended an external gynecologic clinic where she had been prescribed oral contraceptives to regulate her periods. Nevertheless, on presentation to our institution, physical examination revealed abdominal tenderness with a palpable pelvic mass and mild hirsutism in the thigh. Ultrasonography demonstrated a large left ovarian mass measuring 154 × 104 mm, and compressing the uterus. Therefore, a unilateral salpingo-oophorectomy was performed, and interestingly, pathologic examination of the large aforementioned mass alongside with immunohistochemical correlation revealed the diagnosis of a large ovarian steroid cell tumor-not otherwise specified with a unique combination of benign and malignant features.

Conclusions
Although ovarian steroid cell tumors represent a rare category, they must be considered in the differential diagnosis for mild virilization symptoms in young females due to the importance of early diagnosis and management. In this manuscript, we aimed to present the first case report from Syria that highlights the crucial role of detailed morphological examination for challenging cases despite the difficulties in differential diagnosis, and the absence of ancillary techniques. Furthermore, we managed to discuss a brief review of diagnostic methods, histological characteristics, and treatment recommendations.
What is the impact of the Rashomon approach in primary care education?: An educational case report of implementing dialogue and improvisation into medical education
Authors: Takamura Akiteru , Imafuku Rintaro 
Published: March 2021

Abstract
Background
The excessive sub-divided or concrete pre-determined objectives found in the technological approach in contemporary medical education curricula may hinder the students’ spontaneous learning about diverse needs and values in care. However, medical professionals must learn the diversity for care or a variety of social factors of the patients influencing decision making in daily practice.

Methods
We introduced a new method of curriculum development called the Rashomon approach. For testing the Rashomon approach, educational activities to teach the diversity in primary care were developed in four modules: 1) explication of the competency without specifying sub-objectives; 2) dialogue among multiple professional students; 3) visits and interviews of the patients; 4) dialogue with teachers’ improvisation. The students’ outcomes and responses were quantitatively and qualitatively analyzed.

Results
A total of 135 medical students joined this study in 2017. The descriptive data suggested that the key concepts of diversity in primary care were fully recognized and that the pre-determined general goals were achieved. Scores on the understanding of social factors in medicine, respect for other professionals, professional identity, and satisfaction with the course were very high.

Conclusion
Instead of the technological approach, the Rashomon approach, in which only a general goal guides educational activities was used in this research. Improvisation and dialogue fit the approach and were potentially effective activities to learn the multifaceted practice of medicine. In an era of competency-based education, the Rashomon approach could be a very useful framework in primary care education.
Cost of childhood acute otitis media in primary care in the Netherlands: economic analysis alongside a cluster randomised controlled trial
Authors: van Uum Rick T. , Venekamp Roderick P. , Pasmans Clémence T. B. , de Wit G. Ardine , Sjoukes Alies , van der Pol Alma C. , Damoiseaux Roger A. M. J. , Schilder Anne G. M. 
Published: March 2021

Abstract
Background
Acute otitis media (AOM) is among the most common paediatric conditions managed in primary care. Most recent estimates of the cost of AOM date from a decade ago and lack a full societal perspective. We therefore explored the societal cost of childhood AOM in the Netherlands within the setting of a trial comparing the effectiveness of an intervention aimed at educating general practitioners (GPs) about pain management in AOM compared to usual care.

Methods
Economic analysis alongside a cluster randomised controlled trial conducted between February 2015 and May 2018 in 37 practices (94 GPs). In total, 224 children with AOM were included of which 223 (99%) completed the trial (intervention: n = 94; control: n = 129). The cost of AOM due to health care costs, patient and family costs, and productivity losses by parent caregivers were retrieved from study diaries and primary care electronic health records, during 28-day follow-up. We calculated mean cost (€ and $) per AOM episode per patient with standard deviations (SD, in €) regardless of study group assignment because there was no clinical effect of the trial intervention. In sensitivity analysis, we calculated cost in the intervention and usual care group, after exclusion of extreme outliers.

Results
Mean total AOM cost per patient were €565.93 or $638.78 (SD €1071.01); nearly 90% of these costs were due to productivity losses experienced by parents. After exclusion of outliers, AOM cost was €526.70 or $594.50 (SD €987.96) and similar in the intervention and usual care groups: €516.10 or $582.53 (SD €949.69) and €534.55 or $603.36 (SD €920.55) respectively.

Conclusions
At €566 or $639 per episode, societal cost of AOM is higher than previously known and mainly driven by productivity losses by children’s parents. Considering its high incidence, AOM poses a significant economic burden that extends beyond direct medical costs.

Trial registration
Netherlands Trial Register no. NTR4920: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4920.
TMEFF2 promoter hypermethylation is an unfavorable prognostic marker in gliomas
Authors: Xie Sidi , Zhang Yunxiao , Peng Tao , Guo Jinglin , Cao Yongfu , Guo Jing , Shi Xiaofeng , Li Yaqin , Liu Yawei , Qi Songtao , Wang Hai 
Published: March 2021

Abstract
Background
Transmembrane protein with EGF-like and two follistatin-like domains 2 (TMEFF2) is a transmembrane protein in the tomoregulin family. Little research has been performed to determine whether TMEFF2 methylation is a prognostic marker in adult diffuse gliomas.

Methods
In this study, we investigated TMEFF2 expression in surgical glioma tissue samples. In addition, we conducted bisulfite amplicon sequencing (BSAS) and methylation-specific PCR (MSP) to evaluate TMEFF2 methylation in glioblastoma (GBM) cells. Subsequently, we investigated the biological function of TMEFF2 in GBM cells. Moreover, we explored the prognostic significance of TMEFF2 in gliomas by analysing a cohort dataset from TCGA.

Results
Immunohistochemistry analysis of 75 paired glioma tumour and peritumoural tissues demonstrated that glioma tumour tissues expressed lower TMEFF2 levels than peritumoural tissues (P < 0.001). TMEFF2 promoter methylation levels were increased in glioblastoma cells compared with SVG p12 cells (P < 0.001). Inhibition of methylation reduced TMEFF2 methylation and increased its expression in LN229 and T98G cells (P < 0.05). Knockdown of TMEFF2 expression significantly promoted the proliferation of U87MG cells and primary GBM cells (P < 0.05). TMEFF2 methylation is negatively associated with IDH1, ATRX and TP53 mutations, and the subtype of glioma harbouring combined IDH1/ATRX/TP53 mutations was associated with low TMEFF2 methylation levels. Survival analysis confirmed that low TMEFF2 methylation levels are associated with good prognosis in glioma patients.

Conclusions
Our results suggest that TMEFF2 DNA methylation might be associated with glioma tumour progression and could serve as a valuable prognostic marker for adult diffuse gliomas.
LncRNA-SNHG6 promotes the progression of hepatocellular carcinoma by targeting miR-6509-5p and HIF1A
Authors: Fan Xiaoxi , Zhao Zhongwei , Song Jingjing , Zhang Dengke , Wu Fazong , Tu Jianfei , Xu Min , Ji Jiansong 
Published: March 2021

AbstractBackgroundAccumulating evidences have been reported that long noncoding RNAs play crucial roles in the progression of hepatocellular carcinoma (HCC). SnoRNA host gene 6 (SNHG6) is believed to be involved in several human cancers, but the specific molecular mechanism of SNHG6 in HCC is not well studied.MethodsIn this study, we experimentally down-regulated the SNHG6 in two hepatocellular carcinoma cell lines invitro, and then measured the proliferation, migration and invasion abilities and the apoptotic levels. Also, we performed the xenograft assay to investigate the function of SNHG6 during the tumor growth in vivo.ResultsWe found SNHG6 was highly expressed in HCC tissues. Next, using Hep3B and Huh7 cells, we confirmed knockdown of SNHG6 reduced the proliferation, migration and invasion abilities invitro. Also, by bioinformatics analysis, further molecular and cellular experiments, we found miR-6509-5p bound to SNHG6 directly, and the expression level of HIF1A was regulated through SNHG6/miR-6509-5p axis. Finally, we found that down-regulation of SNHG6 dramatically reduced the tumor growth ability of Huh7 cells invivo.ConclusionsWe concluded that SNHG6/miR-6509-5p/HIF1A axis functioned in the progression of hepatocellular carcinoma, and could be the promising therapeutic targets during the development of hepatocellular carcinoma drugs.
Challenges of applying multicellular tumor spheroids in preclinical phase
Authors: Han Se Jik , Kwon Sangwoo , Kim Kyung Sook 
Published: March 2021

AbstractThe three-dimensional (3D) multicellular tumor spheroids (MCTs) model is becoming an essential tool in cancer research as it expresses an intermediate complexity between 2D monolayer models and in vivo solid tumors. MCTs closely resemble in vivo solid tumors in many aspects, such as the heterogeneous architecture, internal gradients of signaling factors, nutrients, and oxygenation. MCTs have growth kinetics similar to those of in vivo tumors, and the cells in spheroid mimic the physical interaction of the tumors, such as cell-to-cell and cell-to-extracellular matrix interactions. These similarities provide great potential for studying the biological properties of tumors and a promising platform for drug screening and therapeutic efficacy evaluation. However, MCTs are not well adopted as preclinical tools for studying tumor behavior and therapeutic efficacy up to now. In this review, we addressed the challenges with MCTs application and discussed various efforts to overcome the challenges.
Circular RNA circCSPP1 knockdown attenuates doxorubicin resistance and suppresses tumor progression of colorectal cancer via miR-944/FZD7 axis
Authors: Xi Lanlan , Liu Quanlin , Zhang Wei , Luo Linshan , Song Jingfeng , Liu Ruitao , Wei Shue , Wang Yong 
Published: March 2021

AbstractBackgroundCircular RNAs (circRNAs) have been reported to play vital roles in colorectal cancer (CRC). However, only a few circRNAs have been experimentally validated and functionally described. In this research, we aimed to reveal the functional mechanism of circCSPP1 in CRC.Methods36 DOX sensitive and 36 resistant CRC cases participated in this study. The expression of circCSPP1, miR-944 and FZD7 were detected by quantitative real time polymerase chain reaction (qRT-PCR) and the protein levels of FZD7, MRP1, P-gp and LRP were detected by western blot. Cell proliferation, migration, invasion, and apoptosis were assessed by 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2-H-tetrazolium bromide (MTT) assay, transwell assay, or flow cytometry analysis, respectively. The interaction between miR-944 and circCSPP1 or frizzled-7 (FZD7) was predicted by Starbase 3.0 and verified by the dual luciferase reporter assay, RNA immunoprecipitation (RIP) assay and RNA pull down assay. Xenograft tumor assay was performed to examine the effect of circCSPP1 on tumor growth in vivo.ResultsThe expression of circCSPP1 and FZD7 was upregulated while miR-944 expression was downregulated in doxorubicin (DOX)-resistant CRC tissues and cells. CircCSPP1 knockdown significantly downregulated enhanced doxorubicin sensitivity, suppressed proliferation, migration, invasion, and induced apoptosis in DOX-resistant CRC cells. Interestingly, we found that circCSPP1 directly downregulated miR-944 expression and miR-944 decreased FZD7 level through targeting to 3′ untranslated region (UTR) of FZD7. Furthermore, circCSPP1 mediated DOX-resistant CRC cell progression and doxorubicin sensitivity by regulating miR-944/FZD7 axis. Besides, circCSPP1 downregulation dramatically repressed CRC tumor growth in vivo.ConclusionOur data indicated that circCSPP1 knockdown inhibited DOX-resistant CRC cell growth and enhanced doxorubicin sensitivity by miR-944/FZD7 axis, providing a potential target for CRC therapy.