bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic value of tumor markers in identifying favorable or unfavorable subsets in patients with cancer of unknown primary: a retrospective study
Authors: Takamizawa Shigemasa , Shimoi Tatsunori , Yoshida Masayuki , Tokura Momoko , Yazaki Shu , Mizoguchi Chiharu , Saito Ayumi , Kita Shosuke , Yamamoto Kasumi , Kojima Yuki , Sumiyoshi-Okuma Hitomi , Nishikawa Tadaaki , Noguchi Emi , Sudo Kazuki , Yonemori Kan 
Published: April 2022

Abstract
Background
Routine measurement of tumor markers is not recommended in daily clinical practice for patients with cancer of unknown primary (CUP). We evaluated the diagnostic value of tumor markers in identifying favorable or unfavorable subsets in patients with CUP.

Methods
We retrospectively reviewed the medical records of patients who were diagnosed with CUP between October 2010 and July 2015 at the National Cancer Center Hospital. The tumor markers of the patients were examined, including squamous cell carcinoma antigen, cytokeratin fraction, carcinoembryonic antigen, sialyl Lewis X, neuron-specific enolase, pro-gastrin-releasing peptide, α-fetoprotein, protein induced by vitamin K absence or antagonist II, prostate-specific antigen, soluble interleukin-2 receptor, carbohydrate antigen 19–9, cancer antigen 125, cancer antigen 15–3, NCC-ST-439 (ST439), elastase-1, human chorionic gonadotropin, and sialyl-Tn (STN).

Results
Among 199 patients with suspected CUP, 90 were diagnosed with confirmed CUP (12 in the favorable subset and 78 in the unfavorable subset). No tumor markers showed 100% sensitivity for unfavorable subsets. ST439 (p = 0.03) and STN (p = 0.049) showed 100% specificity for unfavorable subsets.

Conclusions
For patients with suspected CUP who show elevated ST439 or STN levels, the treatment strategy should be based on the premise that the patient is likely to be placed in the unfavorable subset.
Reversed scleral tunnel technique for repair of iridodialysis after blunt force trauma: a retrospective clinical study
Authors: Lin Zushun , Song Zongming , Zhao Zhenquan , Ke Zhisheng 
Published: April 2022

Abstract
Background
To investigate the efficacy and safety of reversed scleral tunnel technique for repairing iridodialysis after blunt force trauma.

Methods
A total of 51 eyes of 51 patients with iridodialysis undergoing surgery were included in this study. Patients were divided into 2 groups: group A (the reversed scleral tunnel technique) and group B (the control group). Before the procedure and at 1, 3, and 6 months afterward, data on the patients’ age, gender, treatments, diagnosis, mechanism of injury, best-corrected visual acuity (BCVA), intraocular pressure (IOP), degree of iridodialysis, lens status, concomitant ocular damage, number of sutures, complications, and follow-up time were collected and compared between the 2 groups.

Results
Iridodialysis was repaired and the pupil shape was restored to nearly round in all eyes. Standard phacoemulsification or lens removal was performed in all eyes. A final BCVA ≥20/60 was achieved in 13 eyes (48.1%) in Group A and 13 eyes (54.2%) in Group B. The IOP remained stable during the follow-up period in all eyes except 2 eyes (7.4%) in Group A and 3 eyes (12.5%) in Group B with angle recession. There were no statistically significant differences in BCVA and IOP between group A and group B. Intraoperatively, A significantly lower percentage of extensive subconjunctival hemorrhage occurred in Group A compared to Group B (1 eye versus 24 eyes, χ2 = 47.1, P = 0.00). Hyphema was observed in 2 eyes (7.4%) in Group A and 1 eye (4.2%) in Group B. Postoperatively, two eyes (7.4%) in Group A and 2 eyes (8.3%) in Group B developed retinal detachment. No other complications were noted during the follow-up period.

Conclusions
The reversed scleral tunnel technique is a safe and effective approach for repairing iridodialysis after blunt force trauma with few complications, favorable cosmetic and visual outcomes.
Domestic violence and associated factors during COVID-19 epidemic: an online population-based study in Iran
Authors: Bagheri Lankarani Kamran , Hemyari Camellia , Honarvar Behnam , Khaksar Elahe , Shaygani Fatemeh , Rahmanian Haghighi Mohammad Reza , Shaygani Mohammad Reza 
Published: April 2022

Abstract
Background
The novel coronavirus disease 2019 has severely affected communities around the world. Fear and stress of being infected, along with pressure caused by lockdown, prevention protocols, and the economic downturn, increased tension among people, which consequently led to the rise of domestic violence (DV). Therefore, this study was conducted to determine the rate of change in DV and its associated factors during the COVID-19 epidemic in Shiraz, Iran.

Methods
In this cross-sectional study, 653 individuals with the age of over 15 years from Shiraz were participated through snowball sampling and filled out an online questionnaire through the WhatsApp platform. A 51-item, self-administered and multidimensional (knowledge, attitude, and practice) questionnaire was designed and assessed 653 participants. The gathered data was analyzed using SPSS software (version 25), and variables with a p-value of less than 0.05 were considered statistically significant.

Results
In this study, 64.2% of the respondents were within the age range of 31–50 years, and 72.6% of the subjects were female. Furthermore, 73.8 and 73.0% of the individuals were married and educated for over 12 years, respectively. The DV increased by 37.5% during the quarantine period, compared to before the pandemic. The emotional type was the most common type of violence; the sexual type was the least frequent. Multivariate analysis indicated that infection with COVID-19, drug use, high level of co-living observation of anti-COVID prevention protocols, and lower level of physical activity during the quarantine period had a positive and significant association with the occurrence of DV.

Conclusion
Based on the obtained results, it is required to implement effective harm-reduction policies and measures in the community due to the increasing rate of DV during the COVID-19 epidemic.
Factors contributing to household wealth inequality in under-five deaths in low- and middle-income countries: decomposition analysis
Authors: Fagbamigbe Adeniyi Francis , Adeniji Folashayo Ikenna Peter , Morakinyo Oyewale Mayowa 
Published: April 2022

Abstract
Background
The burden of under-5 deaths is disproportionately high among poor households relative to economically viable ones in developing countries. Despite this, the factors driving this inequality has not been well explored. This study decomposed the contributions of the factors associated with wealth inequalities in under-5 deaths in low- and middle-income countries (LMICs).

Methods
We analysed data of 856,987 children from 66,495 neighbourhoods across 59 LMICs spanning recent Demographic and Health Surveys (2010-2018). Under-5 mortality was described as deaths among live births within 0 to 59 months of birth and it was treated as a dichotomous variable (dead or alive). The prevalence of under-five deaths was stratified using household wealth status. A Fairlie decomposition analysis was utilized to investigate the relative contribution of the factors associated with household wealth inequality in under-5 deaths at p<0.05. The WHO health equity assessment toolkit Plus was used to assess the differences (D) ratios (R), population attributable risk (PAR), and population attributable fraction (PAF) in household wealth inequalities across the countries.

Results
The proportion of children from poor households was 45%. The prevalence of under-5 deaths in all samples was 51 per 1000 children, with 60 per 1000 and 44 per 1000 among children from poor and non-poor households (p<0.001). The prevalence of under-5 deaths was higher among children from poor households than those from non-poor households in all countries except in Ethiopia, Tanzania, Zambia, Lesotho, Gambia and Sierra Leone, and in the Maldives. Thirty-four of the 59 countries showed significantly higher under-5 deaths in poor households than in non-poor households (pro-non-poor inequality) and no significant pro-poor inequality. Rural-urban contexts, maternal education, neighborhood socioeconomic status, sex of the child, toilet kinds, birth weight and preceding birth intervals, and sources of drinking water are the most significant drivers of pro-poor inequities in under-5 deaths in these countries.

Conclusions
Individual-level and neighbourhood-level factors were associated with a high prevalence of under-5 deaths among poor households in LMICs. Interventions in countries should focus on reducing the gap between the poor and the rich as well as improve the education and livelihood of disadvantaged people.
Examining the sustainability and effectiveness of co-created physical activity interventions in vocational education and training: a multimethod evaluation
Authors: Grüne Eva , Popp Johanna , Carl Johannes , Semrau Jana , Pfeifer Klaus 
Published: April 2022

Abstract
Background
Co-creation approaches are increasingly used in physical activity promotion to develop interventions tailored to the target group and setting. The resulting complexity of such interventions raises challenges in evaluation. Accordingly, little is known about the effectiveness of co-created interventions and the underlying processes that impact their sustainable implementation. In this study, we attempt to fill this gap by evaluating co-created multi-component physical activity interventions in vocational education and training in nursing care and automotive mechatronics regarding (1) their sustainable implementation at the institutional level and (2) the effectiveness of single intervention components at the individual level.

Methods
Following a multimethod design, we conducted a questionnaire survey (n = 7) and semi-structured interviews (n = 4) to evaluate the sustainability of the interventions. Quantitative data were analyzed descriptively, and qualitative data were analyzed using qualitative content analysis. To examine the interventions’ effectiveness, we conducted two non-randomized controlled trials (n = 111). Analysis of variance was used to examine differences between groups.

Results
At the institutional level, long-term implementation of single intervention components in nursing care was observed; in contrast, long-term implementation in automotive mechatronics was not observed. In this context, various factors at the outer contextual (e.g., COVID-19 pandemic), inner contextual (e.g., health-promoting leadership), intervention (e.g., acceptance), and personal levels (e.g., champion) influenced sustainability. At the individual level, no significant intervention effects were found for changes in physical activity behavior and physical activity-related health competence.

Conclusion
The role of co-creation on the effectiveness and sustainability of physical activity promotion in vocational education and training cannot be answered conclusively. Only in the nursing care sector, a co-creation approach appeared promising for long-term intervention implementation. Sustainable implementation depends on various influencing factors that should be considered from the outset. Demonstrating effectiveness at the individual level was challenging. To conclusively clarify both the role and impact of co-creation, methodologically complex and elaborate evaluation designs will be required in future research projects.

Trial registration
This study was retrospectively registered at clinicaltrials.gov on 24/08/2021 (NCT05018559).
Association between maternal exposure to indoor air pollution and offspring congenital heart disease: a case–control study in East China
Authors: Sun Jing , Wang Jian , Yang Jing , Shi Xin , Li Shujing , Cheng Jinping , Chen Sun , Sun Kun , Wu Yurong 
Published: April 2022

Abstract
Background
Previous research suggested an association between maternal exposure to ambient air pollutants and the risk of congenital heart disease (CHD). However, the effect of individual prenatal exposure to indoor air pollutants on CHD occurrence was not reported.

Methods
We performed a hospital-based case–control study to investigate the association between personal air pollution exposure during pregnancy and the risk of CHD in offspring. A total of 44 cases and 75 controls were included from two hospitals in East China. We investigated maternal and residential environmental characteristics using a questionnaire and obtained personal indoor air samples to assess particulate matter (PM) and volatile organic compounds (VOCs) from 22–30 gestational weeks. Formaldehyde, benzene, toluene, xylene, total volatile organic compounds (TVOCs), PM2.5, and PM10 were assessed. Logistic regression was performed to assess associations and interactions between individual indoor air pollutants and CHD after adjusting for confounders. The potential residential environmental factors affecting the risks of indoor air pollutants on CHD were also assessed.

Results
Median TVOC (0.400 vs. 0.005 mg/m3, P < 0.001) exposure levels in cases were significantly higher than controls. A logistic regression model adjusted for confounders revealed that exposure to high levels of indoor TVOCs (AOR 7.09, 95% CI 2.10–23.88) during pregnancy was associated with risks for CHD and the occurrence of some major CHD subtype in offspring. These risk effects were enhanced in pregnant women living in a newly renovated house but were mitigated by household use of smoke ventilators when cooking. We observed a positive interaction of maternal exposure to TVOCs and PM2.5 and the risk for CHD.

Conclusions
Maternal exposure to indoor VOCs and PMs may increase the risk of giving birth to foetuses with CHD.
Development and validation of an occlusal cant index
Authors: Alhuwaish Hessah A. , Almoammar Khalid A. 
Published: April 2022

Abstract
Background
Occlusal cant (OC) is a malocclusion trait lacking indexing or classification that describes the extent and severity of tilt in the occlusal plane. The aims of this study were to develop an occlusal cant index (OCI) based on the degree of OC detection among orthodontists and laypeople and to validate the newly developed OCI by a panel of experts using content validity.

Methods
The ability to perceive OC was assessed in 134 participants (orthodontists = 67 and laypeople = 67). A frontal photograph of a model with an ideal smile with 0° of OC was obtained and manipulated to create various degrees of OC from 1–5° at the right and left sides. A set of 11 electronic photographs was displayed to the participants. The participants were asked to report whether they detected an OC in each photograph. The collected data was used as a baseline to develop an OCI. Then, a content validation of the OCI was performed using a questionnaire provided to a panel of experts comprising ten orthodontists.

Results
The OCI was designed based on the threshold of OC detection. In both orthodontists and laypeople, the accuracy of OC detection increased as the amount of tilt increased. The threshold point of OC detection in orthodontists was at 2°, while in laypeople it was at 4°. There was a significant difference between orthodontists and laypeople in their ability to detect OC at 2–3° of tilt. The content validity index (CVI) showed excellent validity between the item-level CVI and the scale-level CVI of the OCI.

Conclusion
The OCI was developed and implemented for diagnostic, communication, and research purposes. The index showed strong evidence supporting content validity.
Regulatory emotional self-efficacy and psychological distress among medical students: multiple mediating roles of interpersonal adaptation and self-acceptance
Authors: Zhang Xuemin , Yue Heng , Sun Junfang , Liu Min , Li Cuiyun , Bao Hugejiletu 
Published: April 2022

Abstract
Background
Psychological distress (depression, anxiety and stress) is more common among medical students than in the general population, and is an important cause of insomnia, internet addiction, substance abuse, decreased academic performance and increased suicidality in medical students.

Methods
To examine the mechanism by which regulatory emotional self-efficacy affects medical students' psychological distress, a questionnaire of 539 medical students using an interpersonal adaptability scale, regulatory emotional self-efficacy scale, self-acceptance scale and depression-anxiety-stress scale was conducted.

Results
① Regulatory emotional self-efficacy, interpersonal adaptability and self-acceptance are positively correlated, but they are negatively correlated with psychological distress. ② The mediation model shows that interpersonal adaptation and self-acceptance are the mediation variables of the effect of regulatory emotional self-efficacy on psychological distress, and the total mediation effect value is -0.37, accounting for 86.05% of the total effect (-0.43). Specifically, the effect involves three paths: first, regulatory emotional self-efficacy indirectly affects psychological distress through interpersonal adaptation (effect value-0.24); second, regulatory emotional self-efficacy indirectly affects psychological distress through interpersonal adaptation and self-acceptance (effect value-0.08); and third, regulatory emotional self-efficacy indirectly affects psychological distress through self-acceptance (effect value -0.05).

Conclusions
Interpersonal adaptation and self-acceptance have a significant mediating effect between regulatory emotional self-efficacy and psychological distress, and the chain mediating effect of interpersonal adaptation and self-acceptance is also significant.
A pattern-discovery-based outcome predictive tool integrated with clinical data repository: design and a case study on contrast related acute kidney injury
Authors: Li Yuxi , Chan Tak-Ming , Feng Jinghan , Tao Liang , Jiang Jie , Zheng Bo , Huo Yong , Li Jianping 
Published: April 2022

Abstract
Background
Clinical data repositories (CDR) including electronic health record (EHR) data have great potential for outcome prediction and risk modeling. We built a prediction tool integrated with CDR based on pattern discovery and demonstrated a case study on contrast related acute kidney injury (AKI).

Methods
Patients undergoing cardiac catheterization from January 2015 to April 2017 were included. AKI was identified based on Acute Kidney Injury Network definition. Predictive model including 16 variables covered in existing AKI models was built. A visual analytics tool based on pattern discovery was trained on 70% data up to August 2016 with three interactive knowledge incorporation modes to develop 3 models: (1) pure data-driven, (2) domain knowledge, and (3) clinician-interactive, which were tested and compared on 30% consecutive cases dated afterwards.

Results
Among 2560 patients in the final dataset, 189 (7.3%) had AKI. We measured 4 existing models, whose areas under curves (AUCs) of receiver operating characteristics curve for the test dataset were 0.70 (Mehran's), 0.72 (Chen's), 0.67 (Gao's) and 0.62 (AGEF), respectively. A pure data-driven machine learning method achieves AUC of 0.72 (Easy Ensemble). The AUCs of our 3 models are 0.77, 0.80, 0.82, respectively, with the last being top where physician knowledge is incorporated.

Conclusions
We developed a novel pattern-discovery-based outcome prediction tool integrated with CDR and purely using EHR data. On the case of predicting contrast related AKI, the tool showed user-friendliness by physicians, and demonstrated a competitive performance in comparison with the state-of-the-art models.
Allergens sensitization among children with allergic diseases in Shanghai, China: age and sex difference
Authors: Ying Xiaolan , Qi Xinyi , Yin Yong , Wang Hongmei , Zhang Hao , Jiang Haohua , Yang Lin , Wu Jinhong 
Published: April 2022

Abstract
Background
The distribution of allergens has geographic characteristics. Local epidemiological data provides evidence-based strategies for the prevention and management of allergic diseases. Age and sex differences may exist in the prevalence of sensitivity to various allergens. We investigated the distribution of common allergens in allergic children in Shanghai, southeastern China.

Methods
39,926 children 1 month to 18 years of age diagnosed with allergic diseases were tested for the presence of serum-specific Immunoglobulins E (sIgE) to 17 allergens common to this region, using a reversed enzyme allergosorbent test.

Results
25,757 (64.5%) of the subjects showed elevated sIgE to at least one of the tested allergens. House mite and dust mite were the most common aeroallergens, while egg and milk were the most common food allergens. The most common aeroallergens and food allergens were similar among each allergic disease. By age-group analysis, the positive rates of aeroallergens were higher at older age. Several peaks of sensitization to food allergens were observed in children between 1 and 3 years of age for eggs, milk, nut, crab and shrimp. In addition, the sensitization to beef and mango was highest in children 3–6 years of age. The rate of positive sIgE detection was higher in males than females for all the tested allergens except cockroach, trees and beef. Considering the interplay between sex and ages and other related components (including season, monthly temperature, humidity, air quality index, test rate of patients), the sIgE positive rates of the main aeroallergens increased with age, while the main food allergens decreased; males are more sensitive to several aeroallergens (including dust mite, house mite, cat epithelium, dog epithelium and mulberry).

Conclusions
House mite, dust mite, milk, and egg are major allergens in Shanghai. Children at younger age are more sensitive to food allergens, while increasing overall prevalence of sensitization can be found with increasing age. Boys have higher positive rates of sIgE responses than girls. Knowledge of the prevalence of allergen sensitization in different age groups and sex may help facilitate diagnosis and intervention efforts to mitigate the impact of allergic diseases in this large geographical region. This approach may be extrapolated to other regions.
Endoplasmic reticulum stress downregulates PGC-1α in skeletal muscle through ATF4 and an mTOR-mediated reduction of CRTC2
Authors: Montori-Grau Marta , Aguilar-Recarte David , Zarei Mohammad , Pizarro-Delgado Javier , Palomer Xavier , Vázquez-Carrera Manuel 
Published: April 2022

Abstract
Background
Peroxisome proliferator-activated receptor γ (PPARγ) coactivator 1α (PGC-1α) downregulation in skeletal muscle contributes to insulin resistance and type 2 diabetes mellitus. Here, we examined the effects of endoplasmic reticulum (ER) stress on PGC-1α levels in muscle and the potential mechanisms involved.

Methods
The human skeletal muscle cell line LHCN-M2 and mice exposed to different inducers of ER stress were used.

Results
Palmitate- or tunicamycin-induced ER stress resulted in PGC-1α downregulation and enhanced expression of activating transcription factor 4 (ATF4) in human myotubes and mouse skeletal muscle. Overexpression of ATF4 decreased basal PCG-1α expression, whereas ATF4 knockdown abrogated the reduction of PCG-1α caused by tunicamycin in myotubes. ER stress induction also activated mammalian target of rapamycin (mTOR) in myotubes and reduced the nuclear levels of cAMP response element-binding protein (CREB)-regulated transcription co-activator 2 (CRTC2), a positive modulator of PGC-1α transcription. The mTOR inhibitor torin 1 restored PCG-1α and CRTC2 protein levels. Moreover, siRNA against S6 kinase, an mTORC1 downstream target, prevented the reduction in the expression of CRTC2 and PGC-1α caused by the ER stressor tunicamycin.

Conclusions
Collectively, these findings demonstrate that ATF4 and the mTOR-CRTC2 axis regulates PGC-1α transcription under ER stress conditions in skeletal muscle, suggesting that its inhibition might be a therapeutic target for insulin resistant states.