bluuebunny/crossref_metadata_2025_split huggingface dataset:
A multilevel model of the help-seeking behaviors among adolescents with mental health problems
Authors: Zhao Mei , Hu Mi 
Published: September 2022

Objective:Mental health problems are highly prevalent among adolescents yet the utilization of mental health services among such a population is very low. This study was conducted to examine mental health problems and related help-seeking behaviors among a Chinese sample of adolescents.MethodsA total of 3,480 students were recruited from four middle- and high schools in Changsha City, Hunan province, and completed an online questionnaire that assessed their general information, mental health problems including depression, anxiety, self-harm, and suicide ideation, as well as their help-seeking behaviors from both formal (including psychological teachers and mental health professionals) and informal sources (including family, friends, and teachers).ResultsThe participants had a prevalence of 13.7% for depression, 11.5% for anxiety, 9.8% for self-harm, and 9.1% for suicide ideation. Although a high rate of help-seeking behaviors was observed (73.0%), most were concentrated in informal sources (99.3%), while only a small portion of participants resorted to formal sources (13.9%). Being female (OR: 1.45, 95% CI: 1.15–1.83), higher grade (OR: 1.32, 95% CI: 1.01–1.73), school mental health resources not available (OR: 1.39, 95% CI: 1.02–1.88), without suicide ideation (OR: 2.03, 95% CI: 1.42–2.90) were all associated with increased likelihood of formal help-seeking behaviors. On the other hand, complete middle school (OR: 0.36, 95% CI: 0.22–0.59), the middle level of academic ranking (OR: 0.64, 95% CI: 0.42–0.97), and higher father education levels (OR: 0.54–0.56, 95% CI: 0.33–0.90) were all associated with a decreased likelihood of formal help-seeking behaviors.ConclusionOur results showed a higher prevalence of help-seeking behavior for emotional or psychological problems during the past year. Compared to the high rate of informal help-seeking behaviors, students showed a lower propensity to seek formal help for their mental health problems, which may be explained by individual-level, family-level, and school-level factors. Our findings provide important implications for the development and popularization of targeted, needs-based mental health promotion and education programs in the future.
The atherogenic index of plasma: A novel factor more closely related to non-alcoholic fatty liver disease than other lipid parameters in adults
Authors: Liu Jia , Zhou Liyuan , An Yu , Wang Ying , Wang Guang 
Published: September 2022

Background and aimsThe relationship of non-alcoholic fatty liver disease (NAFLD) with the atherogenic index of plasma (AIP) is unclear. This study aims to detect the association between AIP and NAFLD, compare the discriminative power of AIP with other lipid parameters for NAFLD, and establish a discriminant model using physical examination data.MethodsParticipants aged over 20 years who underwent routine physical examination in Beijing Chaoyang Hospital from April 2016 to August 2020 were included. We categorized subjects based on hepatic ultrasound results and analyzed the association between NAFLD risk and AIP, conventional plasma lipids, remnant cholesterol (RC), triglyceride and glucose (TyG) index, and other atherogenic indices (n = 112,200) using logistic regression, restricted cubic spline regression, and receiver operating characteristic curve.ResultsOut of the 112,200 subjects, 30.4% had NAFLD. The body weight index, plasma glucose, conventional lipids, TyG index, AIP, atherogenic coefficient (AC), and coronary risk index (CRI) were significantly higher, while HDL-C was lower (p &lt; 0.001) in patients with NAFLD than those without NAFLD (all p &lt; 0.001). Compared with conventional lipids, RC, TyG index, AC, and CRI, AIP had a stronger correlation with the risk of NAFLD (OR 6.71, 95% CI 6.23–7.22, p &lt; 0.001) after adjusting confounders and presented a non-linear dose–response relationship (p &lt; 0.0001). The optimal cut-off value of AIP was 0.05 and the area under the curve (AUC) was 0.82 (95% CI: 0.81–0.82) with high sensitivity and specificity. The AUC of the simplified three-variable NAFLD discriminant model was 0.90 in both the training set and the validation set.ConclusionAIP was significantly associated with NAFLD and showed superior discriminative performance to other lipid parameters. These findings might help screen NAFLD in high-risk individuals and reduce the prevalence of NAFLD.
Adherence to mediterranean diet and the risk of differentiated thyroid cancer in a European cohort: The EPIC study
Authors: Llaha Fjorida , Cayssials Valerie , Farràs Marta , Agudo Antonio , Sandström Maria , Eriksen Anne Kirstine , Tjønneland Anne , Boutron-Ruault Marie-Christine , Laouali Nasser , Truong Thérèse , Le Cornet Charlotte , Katzke Verena , Schulze Matthias , Palli Domenico , Krogh Vittorio , Signoriello Simona , Tumino Rosario , Ricceri Fulvio , Skeie Guri , Jensen Torill Miriam Enget , Chen Sairah Lai Fa , Lasheras Cristina , Rodriguez-Barranco Miguel , Amiano Pilar , Huerta José María , Guevara Marcela , Almquist Martin , Nilson Lena Maria , Hennings Joakim , Papier Keren , Heath Alicia , Weiderpass Elisabete , Rinaldi Sabina , Zamora-Ros Raul 
Published: September 2022

BackgroundThe Mediterranean diet (MD) has been proposed as a healthy diet with a potential to lower the incidence of several types of cancer, but there is no data regarding thyroid cancer (TC). We investigated the association between MD adherence, and its components, and the differentiated TC risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.MethodsOver 450,000 men and women from nine European countries were followed up for a mean of 14.1 years, during which 712 differentiated TC cases were identified. Adherence to MD was estimated using the relative MD (rMED) score, an 18-point scale including alcohol, and the adapted rMED (arMED) score, a 16-point scale excluding alcohol. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models adjusted for potential confounding factors.ResultsAdherence to the arMED score was not associated with the risk of differentiated TC (HRhigh vs. low adherence = 0.94, 95% CI: 0.70–1.25; p-trend 0.27), while a suggestive, but non-statistically significant inverse relationship was observed with rMED (HRhigh vs. low adherence = 0.88, 95% CI: 0.68–1.14; p-trend 0.17). Low meat (HRlow vs. high meat intake = 0.81, 95% CI: 0.67–0.99; p-trend = 0.04) and moderate alcohol (HRmoderate vs. non−moderate intake = 0.88, 95% CI: 0.75–1.03) intake were related with lower differentiated TC risk.ConclusionsOur study shows that a high adherence to MD is not strongly related to differentiated TC risk, although further research is required to confirm the impact of MD and, especially, meat intake in TC risk.
Real-world clinical treatment outcomes in Chinese non-small cell lung cancer with EGFR exon 20 insertion mutations
Authors: Shi Chao , Xing Ruyue , Li Mengmeng , Feng Junnan , Sun Rui , Wei Bing , Guo Yongjun , Ma Jie , Wang Huijuan 
Published: September 2022

BackgroundEGFR exon 20 insertions (EGFR ex20ins) constitute a heterogeneous subset of EGFR-activating alterations. However, the effectiveness of standard therapy in patients with EGFR ex20ins remains poor.MethodsIn our study, we retrospectively collected next-generation sequencing (NGS) data from 7,831 Chinese NSCLC patients and analyzed the relationship between EGFR ex20ins variations and medical records.ResultsOur data showed that EGFR ex20ins account for up to 3.5% of all EGFR mutation non-small-cell lung cancer (NSCLC) patients and 1.6% of all NSCLC patients in China. Thirty-eight different variants of EGFR ex20ins were identified in 129 NSCLC patients. We observed that the patients with EGFR ex20ins may benefit from the anti-angiogenesis agents significantly (P = 0.027). In the EGFR ex20ins near-loop group, patients who received second-/third-generation EGFR-TKI therapy treatment as first-line treatment had a longer median progression-free survival (PFS) than those who initiated treatment with first-generation EGFR-TKI or chemotherapy. Patients with co-mutations of EGFR ex20ins near-loop and TP53 tended to have a shorter OS in second-/third-generation EGFR-TKI therapy (P = 0.039). Additionally, median PFS was significantly longer in patients harboring EGFR ex20ins far-loop variants who received chemotherapy as a first-line setting (P = 0.037).ConclusionsOverall survival was significantly longer in EGFR ex20ins patients with anti-angiogenesis agents. For the choice of first-line strategy, NSCLC with EGFR ex20ins near-loop variants may benefit from second-/third-generation EGFR-TKI, while patients harboring EGFR ex20ins far-loop variants might have better outcomes from chemotherapy. TP53 could serve as a potential predictive marker in poor prognosis for EGFR ex20ins near-loop patients.
3D-printed bolus ensures the precise postmastectomy chest wall radiation therapy for breast cancer
Authors: Wang Xiran , Zhao Jianling , Xiang Zhongzheng , Wang Xuetao , Zeng Yuanyuan , Luo Ting , Yan Xi , Zhang Zhuang , Wang Feng , Liu Lei 
Published: September 2022

PurposeTo investigate the values of a 3D-printed bolus ensuring the precise postmastectomy chest wall radiation therapy for breast cancer.Methods and materialsIn the preclinical study on the anthropomorphic phantom, the 3D-printed bolus was used for dosimetry and fitness evaluation. The dosimetric parameters of planning target volume (PTV) were assessed, including Dmin, Dmax, Dmean, D95%, homogeneity index (HI), conformity index (CI), and organs at risk (OARs). The absolute percentage differences (|%diff|) between the theory and fact skin dose were also estimated, and the follow-up was conducted for potential skin side effects.ResultsIn preclinical studies, a 3D-printed bolus can better ensure the radiation coverage of PTV (HI 0.05, CI 99.91%), the dose accuracy (|%diff| 0.99%), and skin fitness (mean air gap 1.01 mm). Of the 27 eligible patients, we evaluated the radiation dose parameter (median(min–max): Dmin 4967(4789–5099) cGy, Dmax 5447(5369–5589) cGy, Dmean 5236(5171–5323) cGy, D95% 5053(4936–5156) cGy, HI 0.07 (0.06–0.17), and CI 99.94% (97.41%–100%)) and assessed the dose of OARs (ipsilateral lung: Dmean 1341(1208–1385) cGy, V5 48.06%(39.75%–48.97%), V20 24.55%(21.58%–26.93%), V30 18.40%(15.96%–19.16%); heart: Dmean 339(138–640) cGy, V30 1.10%(0%–6.14%), V40 0.38%(0%–4.39%); spinal cord PRV: Dmax 639(389–898) cGy). The skin doses in vivo were Dtheory 208.85(203.16–212.53) cGy, Dfact 209.53(204.14–214.42) cGy, and |%diff| 1.77% (0.89–2.94%). Of the 360 patients enrolled in the skin side effect follow-up study (including the above 27 patients), grade 1 was the most common toxicity (321, 89.2%), some of which progressing to grade 2 or grade 3 (32, 8.9% or 7, 1.9%); the radiotherapy interruption rate was 1.1%.ConclusionA 3D-printed bolus can guarantee the precise radiation dose on skin surface, good fitness to skin, and controllable acute skin toxicity, which possesses a great clinical application value in postmastectomy chest call radiation therapy for breast cancer.
Effect of circumferential resection margin status on survival and recurrence in esophageal squamous cell carcinoma with neoadjuvant chemoradiotherapy
Authors: Gu Yi-Min , Yang Yu-Shang , Kong Wei-Li , Shang Qi-Xin , Zhang Han-Lu , Wang Wen-Ping , Yuan Yong , Che Guo-Wei , Chen Long-Qi 
Published: September 2022

BackgroundThe aim of this study was to investigate whether circumferential resection margin (CRM) status has an impact on survival and recurrence in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy.MethodsWe screened patients with esophageal squamous cell carcinoma who underwent esophagectomy from January 2017 to December 2019. The CRM was reassessed. Patients were grouped into a CRM of 1 mm or less (0 &lt; CRM ≤ 1 mm) and a CRM greater than 1 mm (CRM&gt;1 mm). The impact of CRM on survival was investigated using Kaplan–Meier analysis and Cox regression modeling. The optimal CRM cut point was evaluated using restricted cubic spline curve.ResultsA total of 89 patients were enrolled in this study. The CRM status was an independent risk factor for the prognosis (HR: 0.35, 95% CI: 0.16-0.73). Compared with a CRM of 1 mm or less, a CRM greater than 1 mm had better overall survival (HR: 0.35, 95% CI: 0.16-0.73, log-rank P = 0.011), longer disease-free survival (HR: 0.51, 95% CI: 0.27-0.95, log-rank P = 0.040), and less recurrence (HR: 0.44, 95% CI: 0.23-0.85, log–rank P = 0.015). We visualized the association between CRM and the hazard ratio of survival and identified the optimal cut point at 1 mm.ConclusionsA CRM greater than 1 mm had better survival and less recurrence compared to a CRM of 1 mm or less. A more radical resection with adequate CRM could benefit survival in patients with esophageal squamous cell carcinoma after neoadjuvant therapy.
Survival and clinicopathological significance of PYCR1 expression in cancer: A meta-analysis
Authors: Li Yue , Xu Jiahuan , Bao Pengchen , Wei Zhijing , Pan Lei , Zhou Jiawei , Wang Wei 
Published: September 2022

BackgroundProline metabolism is closely related to the occurrence and development of cancer. Δ1-Pyrroline-5-carboxylate reductase (PYCR) is the last enzyme in proline biosynthesis. As one of the enzyme types, PYCR1 takes part in the whole process of the growth, invasion, and drug resistance of cancer cells. This study investigated PYCR1 expressions in cancers together with their relationship to clinical prognosis.MethodsA thorough database search was performed in PubMed, EMBASE, and Cochrane Library. RevMan5.3 software was used for the statistical analysis.ResultsEight articles were selected, and 728 cancer patients were enrolled. The cancer types include lung, stomach, pancreatic ductal adenocarcinoma, hepatocellular carcinoma, and renal cell carcinoma. The meta-analysis results showed that the expression of PYCR1 was higher in the clinical stage III–IV group than that in the clinical stage I–II group (OR = 1.67, 95%CI: 1.03–2.71), higher in the lymph node metastasis group than in the non-lymph node metastasis group (OR = 1.57, 95%CI: 1.06–2.33), and higher in the distant metastasis group than in the non-distant metastasis group (OR = 3.46, 95%CI: 1.64–7.29). However, there was no statistical difference in PYCR1 expression between different tumor sizes (OR = 1.50, 95%CI: 0.89–2.53) and degrees of differentiation (OR = 0.82, 95%CI: 0.54–1.24).ConclusionPYCR1 had a high expression in various cancers and was associated with cancer volume and metastasis. The higher the PYCR1 expression was, the poorer the cancer prognosis was. The molecular events and biological processes mediated by PYCR1 might be the underlying mechanisms of metastasis.
Endoscopic transorbital avenue to the skull base: Four-step conceptual analysis of the anatomic journey
Authors: Guizzardi Giulia , Di Somma Alberto , de Notaris Matteo , Corrivetti Francesco , Sánchez Juan Carlos , Alobid Isam , Ferres Abel , Roldan Pedro , Reyes Luis , Enseñat Joaquim , Prats-Galino Alberto 
Published: September 2022

BackgroundIn the last decades, skull base surgery had passed through an impressive evolution. The role of neuroanatomic research has been uppermost, and it has played a central role in the development of novel techniques directed to the skull base. Indeed, the deep and comprehensive study of skull base anatomy has been one of the keys of success of the endoscopic endonasal approach to the skull base. In the same way, dedicated efforts expended in the anatomic lab has been a powerful force for the growth of the endoscopic transorbital approach to the lateral skull base.Therefore, in this conceptual paper, the main steps for the anatomic description of the endoscopic transorbital approach to the skull base have been detailed.MethodsThe anatomic journey for the development of the endoscopic transorbital approach to the skull base has been analyzed, and four “conceptual” steps have been highlighted.ResultsAs neurosurgeons, the eyeball has always represented a respectful area: to become familiar with this complex and delicate anatomy, we started by examining the orbital anatomy on a dry skull (step 1). Hence, step 1 is represented by a detailed bone study; step 2 is centered on cadaveric dissection; step 3 consists in 3D quantitative assessment of the novel endoscopic transorbital corridor; and finally, step 4 is the translation of the preclinical data in the real surgical scenario by means of dedicated surgical planning.ConclusionsThe conceptual analysis of the anatomic journey for the description of the endoscopic transorbital approach to the skull base resulted in four main methodological steps that should not be thought strictly consequential but rather interconnected. Indeed, such steps should evolve following the drives that can arise in each specific situation. In conclusion, the four-step anatomic rehearsal can be relevant for the description, diffusion, and development of a novel technique in order to facilitate the application of the endoscopic transorbital approach to the skull base in a real surgical scenario.
Hypertensive disorders of pregnancy and neonatal outcomes in twin vs. singleton pregnancies after assisted reproductive technology
Authors: Liu Ting , Gao Rui , Liu Yong , Zhao Ke , Su Xiaolin , Wong Hin Ching , Li Luyao , Xie Binbin , Huang Yuanyan , Qiu Chuhui , He Jiang , Liu Chaoqun 
Published: September 2022

ObjectiveHypertensive disorders of pregnancy (HDP) are associated with an increased risk of adverse neonatal outcomes. Although twin pregnancies had a higher risk of developing HDP, it is not known whether HDP in twins will increase the risk of adverse neonatal outcomes. We aimed to assess whether this association differed in singleton and twin pregnancies in women who conceived with assisted reproductive technology (ART).MethodsWe finally included 193,590 live births born via ART from the National Vital Statistics System (NVSS) for the years 2015–2019. We used Log-binomial regression to evaluate the associations between HDP and the risk of adverse neonatal outcomes in ART mothers.ResultsAmong 193,590 ART-treated mothers, there were 140,870 and 52,720 mothers who had singleton pregnancies and twin pregnancies, respectively. Those ART mothers with twin pregnancies had a higher rate of HDP than singleton pregnancies (20.5% vs. 11.0%). In singleton pregnancies, the risks of preterm birth [adjusted risk ratio (aRR)): 2.80, 95% CI 2.67–2.93], low birth weight (aRR: 2.80, 95% CI 2.67–2.93), small for gestational age (aRR: 1.41, 95% CI 1.34–1.49), 5 min Apgar &lt;7 (aRR: 1.66, 95% CI 1.50–1.83) and cesarean section (aRR: 1.23, 95% CI 1.21–1.25) were significantly higher in HDP mothers than in non-HDP mothers respectively. However, in contrast to singleton pregnancies, these associations were weak or reversed in twin pregnancies, after adjusting for confounding factors.ConclusionIn ART-treated women, although twin pregnancies had a higher HDP rate, the risk of adverse neonatal outcomes associated with HDP was lower than that of singletons.
Effective delivery of osteopontin small interference RNA using exosomes suppresses liver fibrosis via TGF-β1 signaling
Authors: Tang Min , Guo Cheng , Sun Mengxue , Zhou Hao , Peng Xin , Dai Jianli , Ding Qin , Wang Ying , Yang Changqing 
Published: September 2022

Objective and aims: Osteopontin (OPN), an oxidant stress sensitive cytokine, plays a central role in liver fibrosis. While OPN expression can be reduced by small interfering RNA (siRNA), the challenge to deliver siRNA safely and effectively into liver remains unresolved. Exosomes are promising natural nanocarriers for drug delivery that are able to enter cells with different biological barriers efficiently. In this study, we used exosomes as a delivery vehicle to target OPN in liver fibrosis.Methods: Exosomes selectively home to fibrotic liver according to small animal imaging system. Electroporation technique was used to engineer exosomes to carry siRNA targeting OPN (ExosiRNA−OPN). Primary hepatic stellate cells (HSCs) were isolated and treated with ExosiRNA−OPN to assess the effect on activated HSCs (aHSCs). Immunofluorescence for α−SMA, an aHSCs marker, and sirius red staining were performed to assess ECM deposition. Finally, plasma OPN from patients with liver fibrosis was identified by ELISA assay.Results: Exosome-mediated siRNA delivery systems show high uptake and low toxicity. Besides, ExosiRNA−OPN suppressed HSCs activation and ECM deposition and more efficiently improved liver function when compared to naked siRNA-OPN. Moreover, ExosiRNA−OPN was assumed inhibiting TGF-β1 signaling activation, along with other fibrotic-related genes based on a GEO datasheet of liver fibrosis samples for correlation analyzes. ExosiRNA−OPN inhibited TGF-β1 signaling by decreasing high-mobility group box-1 (HMGB1). Plasma proteins from chronic HBV-induced fibrosis patients were identified that patients with high OPN expression correlates with more advanced fibrosis progression.Discussion: This study shows that exosome-mediated siRNA-OPN delivery may be an effective option for the treatment of liver fibrosis.
Efficacy and safety of Chinese herbal medicine for pneumonia convalescence in children: A systematic review and meta-analysis
Authors: Guo Jian-Ning , Bai Xue , Zhang Hong-Xian , Zhang Ning , Liang Jun-Ming , Guo Zi-Yi , Cui Xia 
Published: September 2022

Background: Chinese herbal medicine (CHM) has advantages in treating sequela symptoms of pediatric pneumonia convalescence. Hence, this study aims to evaluate the efficacy and safety of CHM using a meta-analysis approach.Methods: The randomized controlled trials (RCTs) that met the search strategy were selected from seven databases from the inception date to December 17, 2021. Based on the Cochrane handbook, the quality of the selected studies was assessed using the risk of bias. Data were expressed as relative risk (RR) or mean difference (MD) and with 95% confidence interval (CI). Subgroup analyses and sensitivity analyses were performed. The Grading Recommendation Assessment, Development, and Evaluation (GRADE) method was used to assess the evidence certainty.Result: Twenty RCTs with 2,241 participants were identified using the search criteria. CHMs included Danshen injection, Liujunzi decoction, Qingfei Tongluo decoction, Yiqi Huoxue decoction, Yupingfeng granule, XiaoErFeiKe granule, Sha-Sheng-Mai-Dong decoction, and so on. Results indicated that CHM combined with Western medicine (WM) or CHM alone improved the total clinical effective rate (RR = 1.22; 95% CI: 1.15–1.29), reduced cough relief time (MD = −2.16; 95% CI: −2.46 to −1.85), lung rales disappearance time (MD = −1.82; 95% CI: −2.17 to −1.47), and length of hospital stay (MD = −2.01, 95% CI: −3.81 to −0.22) in the treatment of pneumonia convalescence in children. However, there was no significant statistical difference regarding the incidence of adverse reactions (RR = 0.57; 95% CI: 0.23–1.43).Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/; Identifier CRD42022298936