bluuebunny/crossref_metadata_2025_split huggingface dataset:
The prevalence and possible risk factors of gaming disorder among adolescents in China
Authors: Zhang Lina , Han Jiaqi , Liu Mengqi , Yang Cheng , Liao Yanhui 
Published: May 2024

Abstract
Background
Nowadays, moderate gaming behaviors can be a pleasant and relaxing experiences among adolescents. However, excessive gaming behavior may lead to gaming disorder (GD) that disruption of normal daily life. Understanding the possible risk factors of this emerging problem would help to suggest effective at preventing and intervening. This study aimed to investigate the prevalence of GD and analyze its possible risk factors that adolescents with GD.

Methods
Data were collected between October 2020 and January 2021. In total, a sample of 7901 students (4080 (52%) boys, 3742 (48%) girls; aged 12–18 years) completed questionnaires regarding the Gaming-Related Behaviors Survey, Gaming Disorder Symptom Questionnaire-21 (GDSQ-21); Behavioral Inhibition System and Behavioral Activation System Scale (BIS/BAS Scale); Emotion Regulation Questionnaire (ERQ); Short-form Egna Minnenav Barndoms Uppfostran for Chinese (s-EMBU-C); and Adolescent Self-Rating Life Events Checklist (ASLEC).

Results
The prevalence of GD was 2.27% in this adolescent sample. The GD gamers were a little bit older (i.e., a higher proportion of senior grades), more boys, with more gaming hours per week in the last 12 months, with more reward responsiveness, maternal rejecting and occurrence of negative life events (e.g., interpersonal relationships, being punished and bereavement factors).

Conclusion
These possible risk factors may influence the onset of GD. Future research in clinical, public health, education and other fields should focus on these aspects for provide target prevention and early intervention strategies.
NGEF is a potential prognostic biomarker and could serve as an indicator for immunotherapy and chemotherapy in lung adenocarcinoma
Authors: Chen Xin , Zhang Tao , He Yan-qiu , Miao Ti-wei , Yin Jie , Ding Qian , Yang Mei , Chen Fang-ying , Zeng Hong-ping , Liu Jie , Zhu Qi 
Published: May 2024

Abstract
Background
Neuronal guanine nucleotide exchange factor (NGEF) plays a key role in several cancers; however, its role in lung adenocarcinoma (LUAD) remains unclear. The aim of this study was to evaluate the efficacy of NGEF as a prognostic biomarker and potential therapeutic target for LUAD.

Methods
NGEF expression data for multiple cancers and LUAD were downloaded from multiple databases. The high- and low-NGEF expression groups were constructed based on median NGEF expression in LUAD samples, and then performed Kaplan–Meier survival analysis. Differentially expressed genes (DEGs) from the two NGEF expression groups were screened and applied to construct a protein-protein interaction network. The primary pathways were obtained using gene set enrichment analysis. The associations between NGEF expression and clinical characteristics, immune infiltration, immune checkpoint inhibitors (ICIs), sensitivity to chemotherapy, and tumor mutation burden (TMB) were investigated using R. Levels of NGEF expression in the lung tissue was validated using single-cell RNA sequencing, quantitative polymerase chain reaction (qPCR), immunohistochemical staining, and western blot analysis.

Results
The expression of NGEF mRNA was upregulated in multiple cancers. mRNA and protein expression levels of NGEF were higher in patients with LUAD than in controls, as validated using qPCR and western blot. High NGEF expression was an independent prognostic factor for LUAD and was associated with advanced tumor stage, large tumor size, more lymph node metastasis, and worse overall survival (OS). A total of 182 overlapping DEGs were screened between The Cancer Genome Atlas and GSE31210, among which the top 20 hub genes were identified. NGEF expression was mainly enriched in the pathways of apoptosis, cell cycle, and DNA replication. Moreover, elevated NGEF expression were associated with a high fraction of activated memory CD4+ T cells and M0 macrophages; elevated expression levels of the ICIs: programmed cell death 1 and programmed cell death 1 ligand 1 expression; higher TMB; and better sensitivity to bortezomib, docetaxel, paclitaxel, and parthenolide, but less sensitivity to axitinib and metformin.

Conclusion
NGEF expression is upregulated in LUAD and is significantly associated with tumor stages, OS probability, immune infiltration, immunotherapy response, and chemotherapy response. NGEF may be a potential diagnostic and prognostic biomarker and therapeutic target in LUAD.
Monitoring COPD patients: systemic and bronchial eosinophilic inflammation in a 2-year follow-up
Authors: Pignatti Patrizia , Visca Dina , Zappa Martina , Zampogna Elisabetta , Saderi Laura , Sotgiu Giovanni , Centis Rosella , Migliori Giovanni Battista , Spanevello Antonio 
Published: May 2024

Abstract
Background
High blood eosinophils seem to predict exacerbations and response to inhaled corticosteroids (ICS) treatment in patients with chronic obstructive pulmonary disease (COPD). The aim of our study was to prospectively evaluate for 2 years, blood and sputum eosinophils in COPD patients treated with bronchodilators only at recruitment.

Methods
COPD patients in stable condition treated with bronchodilators only underwent monitoring of lung function, blood and sputum eosinophils, exacerbations and comorbidities every 6 months for 2 years. ICS was added during follow-up when symptoms worsened.

Results
63 COPD patients were enrolled: 53 were followed for 1 year, 41 for 2 years, 10 dropped-out. After 2 years, ICS was added in 12/41 patients (29%) without any statistically significant difference at time points considered. Blood and sputum eosinophils did not change during follow-up. Only FEV1/FVC at T0 was predictive of ICS addition during the 2 year-follow-up (OR:0.91; 95% CI: 0.83–0.99, p = 0.03). ICS addition did not impact on delta (T24-T0) FEV1, blood and sputum eosinophils and exacerbations. After 2 years, patients who received ICS had higher blood eosinophils than those in bronchodilator therapy (p = 0.042). Patients with history of ischemic heart disease increased blood eosinophils after 2 years [p = 0.03 for both percentage and counts].

Conclusions
Blood and sputum eosinophils remained stable during the 2 year follow-up and were not associated with worsened symptoms or exacerbations. Almost 30% of mild/moderate COPD patients in bronchodilator therapy at enrollment, received ICS for worsened symptoms in a 2 year-follow-up and only FEV1/FVC at T0 seems to predict this addition. History of ischemic heart disease seems to be associated with a progressive increase of blood eosinophils.
Early cartilage lesion and 5-year incident joint surgery in knee osteoarthritis patients: a retrospective cohort study
Authors: Xiao-feng Liu , Jin-shan Zhang , Yong-qiang Zheng , Ze-feng Wang , Yong-quan Xu , Yang-zhen Fang , Zhen-yu Lin , Liang Lin , Hong-peng Zhang , Xiao-peng Huang 
Published: May 2024

Abstract
Objective
to investigate the association between cartilage lesion-related features observed in knee osteoarthritis (OA) patients’ first MRI examination and incident knee surgery within 5 years. Additionally, to assess the predictive value of these features for the incident knee surgery.

Methods
We identified patients diagnosed with knee OA and treated at our institution between January 2015 and January 2018, and retrieved their baseline clinical data and first MRI examination films from the information system. Next, we proceeded to determine joint space narrowing grade, cartilage lesion size grade, cartilage full-thickness loss grade and cartilage lesion sum score for the medial and lateral compartments, respectively. Generalized linear regression models examined the association of these features with 5-year incident knee surgery. Positive and negative predictive values (PPVs and NPVs) were determined referring to 5-year incident knee surgery.

Results
Totally, 878 participants (knees) were found eligible to form the study population. Within the 5 years, surgery was performed on 61 knees. None of the cartilage-related features had been found significantly associated with incident surgery. The results were similar for medial and lateral compartments. The PPVs were low for all the features.

Conclusions
Among symptomatic clinically diagnosed OA knees, cartilage lesions observed in the first MRI examinations were not found to be associated with the occurrence of joint surgery within a 5-year period. All these cartilage-related features appear to have no additional value in predicting 5-year incident joint surgery.
The influence of gender and sport on popliteal angle and dorsiflexion in junior high school students
Authors: Pietrzak Krzysztof , Bania Artur , Nowocień Krzysztof , Kraszewski Bartosz , Wiernicka Marzena 
Published: May 2024

Abstract
Background
The aim of the study was to assess factors affecting the popliteal angle and foot dorsiflexion, in particular gender. The subjects were 142 students from the 2nd and 3rd year of Poznań junior high schools.

Methods
The participants included 57 girls and 87 boys. Three raters examined each subject: a specialist in orthopaedics, a resident doctor and a physical therapy student.
Foot dorsal flexion was tested in a supine position with lower limbs extended. Next, dorsal flexion was evaluated with the knee and hip in 90 degrees of flexion. Finally, a passive knee extension (PKE) test was carried out. The significance of the PKE test is that the lower the angle the more flexible the hamstrings. This is because the PKE measurement is the distance to the right angle, that is a full knee extension with the hip flexed.

Results
The non-parametric test (Mann–Whitney) and the Student’s t-test showed differences between the female and male gender in the measurements of the popliteal angle (p < .05000). The correlation was negative, which means that the hamstrings are more flexible in girls. No differences were found between gender and passive foot dorsiflexion and dorsiflexion with a flexed hip and knee. No differences were found between the group with the extended PE curriculum and the group with the standard number of PE classes in the range of motion of foot dorsiflexion and the value of the popliteal angle.

Conclusions
Girls between 13 and 15 years old have a significantly larger hamstring flexibility, which is confirmed by the tests of the popliteal angle. No differences were found in dorsiflexion between girls and boys who have not been trained using a training model.
Accuracy and efficiency of dynamic navigated root-end resection in endodontic surgery: a pilot in vitro study
Authors: Liu Si-Min , Peng Li , Zhao Yi-Jiao , Han Bing , Wang Xiao-Yan , Wang Zu-Hua 
Published: May 2024

Abstract
Background
The operation accuracy and efficiency of dynamic navigated endodontic surgery were evaluated through in vitro experiments. This study provides a reference for future clinical application of dynamic navigation systems in endodontic surgery.

Materials and methods
3D-printed maxillary anterior teeth were used in the preparation of models for endodontic surgery. Endodontic surgery was performed with and without dynamic navigation by an operator who was proficient in dynamic navigation technology but had no experience in endodontic surgery. Optical scanning data were applied to evaluate the length and angle deviations of root-end resection. And the operation time was recorded. T tests were used to analyze the effect of dynamic navigation technology on the accuracy and duration of endodontic surgery.

Results
With dynamic navigation, the root-end resection length deviation was 0.46 ± 0.06 mm, the angle deviation was 2.45 ± 0.96°, and the operation time was 187 ± 22.97 s. Without dynamic navigation, the root-end resection length deviation was 1.20 ± 0.92 mm, the angle deviation was 16.20 ± 9.59°, and the operation time was 247 ± 61.47 s. Less deviation was achieved and less operation time was spent with than without dynamic navigation (P < 0.01).

Conclusion
The application of a dynamic navigation system in endodontic surgery can improve the accuracy and efficiency significantly for operators without surgical experience and reduce the operation time.
A polyphenol fraction from Rosa multiflora var. platyphylala reduces body fat in overweight humans through appetite suppression – a randomized, double-blind, placebo-controlled trial
Authors: Sudeep Heggar Venkataramana , Prithviraj Puwar , Jestin Thomas V , Shyamprasad Kodimule 
Published: May 2024

Abstract
Background
Rosa species are rich sources of polyphenols with physiological functions. In this study a polyphenol-rich Rosa multiflora (var. platyphylala) petal extract (RoseFit™) was investigated for weight loss in humans.

Methods
In a randomized, placebo-controlled, parallel-group, double-blind clinical trial seventy overweight male and female subjects (20–50 years) with body mass index (BMI) 25–30 kg/m2 were randomly allocated to the active treatment group (RoseFit) and placebo group in a 1:1 ratio. The subjects received 300 mg capsules twice daily for 12 weeks. The primary efficacy outcome measures included body weight, BMI, and body composition, as determined using Dual-energy X-ray absorptiometry (DEXA). Secondary measures consisted of serum lipid profile and appetite marker (leptin and ghrelin) analyses. Safety analyses included biochemical and hematological assessments.

Results
At the end of the study, a marked reduction in body weight (-1.20 ± 2.62 kg, p < 0.05) and BMI from baseline was observed in the RoseFit group. In addition, the body fat % (RoseFit = -1.69 ± 2.59%, placebo = 0.96 ± 3.21%; p < 0.001) and fat mass (RoseFit = -1.75 ± 1.80 kg, placebo = 1.61 ± 3.82 kg; p < 0.001) were significantly abated in RoseFit group. Importantly, the lean mass was maintained during the intervention. RoseFit ingestion significantly increased the serum leptin levels compared to the placebo (4.85%; p < 0.05). Further, RoseFit group showed reduction in the hunger hormone ghrelin level (2.27%; p < 0.001) from baseline to the end of study, compared to the placebo. The subjective evaluation of appetite using visual analog scale (VAS) questionnaires further confirmed the appetite-suppression effects of RoseFit. The lipid profile significantly improved in RoseFit-treated subjects. No serious adverse events were observed during the study, indicating the tolerability of RoseFit.

Conclusions
Supplementation with RoseFit significantly impacts body weight management and can thus be a potential nutraceutical ingredient for sustainable weight loss.

Trial registration
CTRI/2019/10/021584 dated 09/10/2019
Patient self-referral patterns in a developing country: characteristics, prevalence, and predictors
Authors: Hasan Mohammad Jahid , Rafi Md. Abdur , Nishat Nahida Hannan , Islam Ima , Afrin Nusrat , Ghosh Bikona , Kabir Etminan , Akhter Samiha Zaman , Poushi Maisha Zaman , Shahnoor Saadi Abdullah Bin , Fardous Jannatul , Tabassum Tamanna , Islam Sadia , Kalam Sumiya Bent , Aslam Mehjabeen Tasnuva , Joarder Taufique 
Published: May 2024

Abstract
Background
Efficient healthcare delivery and access to specialized care rely heavily on a well-established healthcare sector referral system. However, the referral system faces significant challenges in developing nations like Bangladesh. This study aimed to assess self-referral prevalence among patients attending tertiary care hospitals in Bangladesh and identify the associated factors.

Methods
This cross-sectional study was conducted at two tertiary care hospital, involving 822 patients visiting their outpatient or inpatient departments. A semi-structured questionnaire was used for data collection. The patients’ mode of referral (self-referral or institutional referral) was considered the outcome variable.

Results
Approximately 58% of the participants were unaware of the referral system. Of all, 59% (485 out of 822) of patients visiting tertiary care hospitals were self-referred, while 41% were referred by other healthcare facilities. The primary reasons for self-referral were inadequate treatment (28%), inadequate facilities (23%), critical cases (14%), and lack of expert physicians (8%). In contrast, institutional referrals were mainly attributed to inadequate facilities to treat the patient (53%), inadequate treatment (47%), difficult-to-treat cases (44%), and lack of expert physicians (31%) at the time of referral. The private facilities received a higher proportion of self-referred patients compared to government hospitals (68% vs. 56%, p < 0.001). Among patients attending the study sites through institutional referral, approximately 10% were referred from community clinics, 6% from union sub-centers, 25% from upazila health complexes, 22% from district hospitals, 22% from other tertiary care hospitals, and 42% from private clinics. Patients visiting the outpatient department (adjusted odds ratio [aOR] 3.3, 95% confidence interval [CI] 2.28–4.82, p < 0.001), residing in urban areas (aOR 1.29, 95% CI 1.04–1.64, p = 0.007), belonging to middle- and high-income families (aOR 1.34, 95% CI 1.03–1.62, p = 0.014, and aOR 1.98, 95% CI 1.54–2.46, p = 0.005, respectively), and living within 20 km of healthcare facilities (aOR 3.15, 95% CI 2.24–4.44, p-value < 0.001) exhibited a higher tendency for self-referral to tertiary care facilities.

Conclusions
A considerable number of patients in Bangladesh, particularly those from affluent urban areas and proximity to healthcare facilities, tend to self-refer to tertiary care centers. Inadequacy of facilities in primary care centers significantly influences patients to opt for self-referral.
Comprehensive insights into AML relapse: genetic mutations, clonal evolution, and clinical outcomes
Authors: Kim Namsoo , Hahn Seungmin , Choi Yu Jeong , Cho Hyunsoo , Chung Haerim , Jang Ji Eun , Lyu Chuhl Joo , Lee Seung-Tae , Choi Jong Rak , Cheong June-Won , Shin Saeam 
Published: May 2024

Abstract
Introduction
Acute myeloid leukemia (AML) is a complex hematologic malignancy characterized by uncontrolled proliferation of myeloid precursor cells within bone marrow. Despite advances in understanding of its molecular underpinnings, AML remains a therapeutic challenge due to its high relapse rate and clonal evolution.

Methods
In this retrospective study, we analyzed data from 24 AML patients diagnosed at a single institution between January 2017 and August 2023. Comprehensive genetic analyses, including chromosomal karyotyping, next-generation sequencing, and gene fusion assays, were performed on bone marrow samples obtained at initial diagnosis and relapse. Clinical data, treatment regimens, and patient outcomes were also documented.

Results
Mutations in core genes of FLT3, NPM1, DNMT3A, and IDH2 were frequently discovered in diagnostic sample and remained in relapse sample. FLT3-ITD, TP53, KIT, RUNX1, and WT1 mutation were acquired at relapse in one patient each. Gene fusion assays revealed stable patterns, while chromosomal karyotype analyses indicated a greater diversity of mutations in relapsed patients. Clonal evolution patterns varied, with some cases showing linear or branching evolution and others exhibiting no substantial change in core mutations between diagnosis and relapse.

Conclusions
Our study integrates karyotype, gene rearrangements, and gene mutation results to provide a further understanding of AML heterogeneity and evolution. We demonstrate the clinical relevance of specific mutations and clonal evolution patterns, emphasizing the need for personalized therapies and measurable residual disease monitoring in AML management. By bridging the gap between genetics and clinical outcome, we move closer to tailored AML therapies and improved patient prognoses.
Pharmacokinetics of tenofovir alafenamide, emtricitabine, and dolutegravir in a patient on peritoneal dialysis
Authors: Massih Sandra Abdul , Atta Mohamed G. , Thio Chloe L. , Tornheim Jeffrey A. , Fuchs Edward J. , Bakshi Rahul P. , Marzinke Mark A. , Hendrix Craig W. , Weld Ethel D. 
Published: May 2024

Abstract
Introduction
Peritoneal dialysis (PD) is an effective renal replacement modality in people with HIV (PWH) with end-stage kidney disease (ESKD), particularly those with residual kidney function. Data on pharmacokinetics (PK) of antiretrovirals in patients on peritoneal dialysis are limited.

Methods
A single-participant study was performed on a 49-year-old gentleman with ESKD on PD and controlled HIV on once daily dolutegravir (DTG) 50 mg + tenofovir alafenamide (TAF) 25 mg / emtricitabine (FTC) 200 mg. He underwent serial blood plasma, peripheral blood mononuclear cell, and urine PK measurements over 24 h after an observed DTG + FTC/TAF dose.

Results
Plasma trough (Cmin) concentrations of TAF, tenofovir (TFV), FTC, and DTG were 0.05, 164, 1,006, and 718 ng/mL, respectively. Intracellular trough concentrations of TFV-DP and FTC-TP were 1142 and 11,201 fmol/million cells, respectively. Compared to published mean trough concentrations in PWH with normal kidney function, observed TFV and FTC trough concentrations were 15.5- and 20-fold higher, while intracellular trough concentrations of TFV-DP and FTC-TP were 2.2-fold and 5.4-fold higher, respectively. TFV and FTC urine levels were 20 times lower than in people with normal GFR.

Conclusions
In a single ESKD PWH on PD, daily TAF was associated with plasma TFV and intracellular TFV-DP trough concentrations 15-fold and 2-fold higher than those of people with uncompromised kidney function, potentially contributing to nephrotoxicity. This suggests that TFV accumulates on PD; thus, daily TAF in PD patients may require dose adjustment or regimen change to optimize treatment, minimize toxicity, and preserve residual kidney function.
The ethnobotanical heritage of Lotkuh, a high-altitude tribal haven of Chitral, the Eastern Hindu Kush, Pakistan
Authors: Ullah Hafiz , Badshah Lal 
Published: May 2024

Abstract
Background
In northwestern Pakistan, Lotkuh is a high-altitude terrain nestled within the eastern Hindu Kush region. Enclaved by towering peaks and harboring a unique culture, the region mirrors the geographical and cultural diversity of Pakistan. In this geographically isolated region, a treasure trove of ethnobotanical knowledge unfolds through generations of interaction between the inhabitants and indigenous plants, resulting in a profound understanding of the plant uses in nutritional, medicinal, cultural, and ritual contexts. Thus, the study seeks to gather, analyze, and document the indigenous knowledge of plant utilization of the distinct tribal culture.

Methods
Through semi-structured questionnaires, inventory interviews, and participatory workshops, data were collected by engaging a cohort of 120 local respondents. The collected data were then classified into nine distinct use categories, following which quantitative indices were calculated.

Results
The research identified a total of 150 plant species spanning across 59 different families and categorized them into 9 distinct usage groups. Among these, Astragalus oihorensis, Astragalus owirensis, Cicer nuristanicum, Geranium parmiricum, and Rochelia chitralensis stand out as novel species with distinctive applications. Notably, medicinal use garnered 600 reports, while animal feed, veterinary applications, human consumption, and toxicity recorded 500, 450, 425, and 104 reports, respectively. Informant consensus was high ranging between 0.8 and 0.9 with most agreement on human food and animal feed category. Platanus orientalis and Juglans regia, with RFC 0.91, were the most cited. The Family Importance Value (FIV) of Juglandaceae and Platanaceae, each with an FIV of 0.91, and Capparidaceae with an FIV of 0.83 indicate the intricate role the families play.

Conclusions
In this study, we explore 150 ethnobotanical species, uncovering novel entries within ethnobotanical literature. Among these, several species showcase unique uses previously undocumented in Pakistani literature. Our research sheds light on the intricate interaction between plants and the distinct cultural landscape of the Lotkuh region.