bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between Osteoporosis and Previous Statin Use: A Nested Case-Control Study
Authors: Kim So Young , Yoo Dae Myoung , Min Chanyang , Kim Ji Hee , Kwon Mi Jung , Kim Joo-Hee , Choi Hyo Geun
Published: November 2021

The relationship between statin use and osteoporosis is controversial; therefore, this study aimed to investigate this association. The ≥40-year-old population of the Korean National Health Insurance Service Health Screening Cohort was enrolled. The 68,592 osteoporosis patients were matched 1:1 with control participants for age, sex, income, and region of residence using propensity score matching. The histories of statin use for two years before the diagnosis of osteoporosis (index date) in the osteoporosis and control groups were compared using conditional/unconditional logistic regression. An increased number of days of statin use was not associated with osteoporosis (adjusted OR (aOR) = 0.97, 95% confidence interval (95% CI) = 0.94–1.00, p = 0.052). In the subgroup analyses, a large number of days of statin use was related to a reduced rate of osteoporosis in the <60-year-old female group, while the opposite was true in the ≥60-year-old female group. Both lipophilic and hydrophilic statins were related to a decreased rate of osteoporosis in the <60-year-old female group. Lipophilic statins, but not hydrophilic statins, were associated with an increased rate of osteoporosis in the ≥60-year-old female group. Statin use showed different associations in middle-aged and elderly women.
Expectations for the Development of Health Technology Assessment in Brazil
Authors: Simões Corrêa Galendi Julia , Caramori Carlos Antonio , Lemmen Clarissa , Müller Dirk , Stock Stephanie
Published: November 2021

The implementation of health technology assessment (HTA) in emerging countries depends on the characteristics of the health care system and the needs of public health care. The objective of this survey was to investigate experts’ expectations for the development of HTA in Brazil and to derive measures to strengthen the impact of HTA in Brazil on health care decisions. Based on a scoping literature review, a questionnaire was developed proposing eight theses for seven domains of HTA: (i) capacity building, (ii) public involvement, (iii) role of cost-effectiveness analysis (CEA), (iv) institutional framework, (v) scope of HTA studies, (vi) methodology of HTA, and (vii) HTA as the basis for jurisdiction. Thirty experts responded in full to the survey and agreed to five of the eight theses proposed. Experts suggested several measures to promote HTA within the scope of each domain, thus addressing capacity building related to HTA, availability, and reliability of population data, and legal endowment of the HTA system. Finally, HTA processes in Brazil should also address public health issues (e.g., appraisal of interventions directed at chronic diseases).
Cooling Island Effect of Blue-Green Corridors: Quantitative Comparison of Morphological Impacts
Authors: Jiang Yunfang , Huang Jing , Shi Tiemao , Li Xiaolin
Published: November 2021

The patterns of green corridors in urban riverfront districts provide different synergistic cooling effects of blue-green space in urban areas. The purpose of this study is to quantify the spatial morphological impact of green corridors in riverfront block-scale area on the cooling effect. Three representative patterns (radiate, grid and dendritic) were selected in the study. The comprehensive influences analysis between multi-dimensional factors of spatial structure and morphology of green corridors and Ta (air temperature) distribution are processed by Envi-met4.4.5 simulation data and statistical analysis methods, such as regression tree model (BRT), were combined. The results showed that the D (distance from riverbank) has the greatest impact on the cooling effect of each belt green space. The D in the range of 600–750 m was affected by the cooling effect of blue-green space; The orientation with parallel to (southeast–northwest) or roughly the same as the prevailing wind direction (north–south) green corridors had relatively better cooling effect. When the width of green corridor was 20–25 m, the ME (marginal effect) of cooling was the largest; at 30–35 m (corridor width), the overall ME of cooling was the best; When the dPC (decreased probability connectivity, here the index was adapted to describe the connectivity degree) of green corridors was in the range of 0.5–1.5, the cooling effect of green corridor could be significantly improved. When dPC is 1.5, its marginal effect on temperature reached the maximum. The study provided a quantitative correlation technology for the morphological influence of blue-green space on the distribution of UCI (urban cooling island), which can guide the spatial layout control of green corridors in the planning and design of urban riverfront district.
Spiritual Well-Being for Croatian Cancer Patients: Validation and Applicability of the Croatian Version of the EORTC QLQ-SWB32
Authors: Dabo Ivana , Skočilić Iva , Vivat Bella , Belac-Lovasić Ingrid , Sorta-Bilajac Turina Iva
Published: November 2021

Spiritual well-being is a recognized predictor of health-related quality of life in palliative patients. No research in Croatia has yet addressed this field. This study, the first of its kind in Croatia, validated a Croatian translation of the EORTC QLQ-SWB32 measure of spiritual well-being with curative Croatian oncology patients and assessed its use and value. The study was conducted between July 2019 and January 2020 at the Department of Radiotherapy and Oncology, University Hospital Rijeka, with 143 cancer patients, using the linguistically validated Croatian version of the measure. All patients found the measure acceptable. Confirmatory factor analysis aligned with the structure found in previous studies. Cronbach’s alpha confirmed internal consistency. Female participants scored higher on the RSG (Relationship with Someone or Something Greater), RG (Relationship with God), and EX (Existential) scales, and on Global-SWB. Patients with breast and gynecological tumors scored higher on RG. Older patients scored lower on RSG, RG and EX. Retirees and those with below-average incomes scored lower on EX. Participants who identified as having no religion scored lower on RSG. Stage I cancer patients scored higher on RG. The Croatian version of the EORTC QLQ-SWB32 is an acceptable, valid, and reliable measure of SWB for Croatian cancer patients.
Lifestyle Modification Program on a Metabolically Healthy Elderly Population with Overweight/Obesity, Young-Old vs. Old-Old. CONSEQUENCES of COVID-19 Lockdown in This Program
Authors: Cobos-Palacios Lidia , Muñoz-Úbeda Mónica , Ruiz-Moreno Maria Isabel , Vilches-Perez Alberto , Vargas-Candela Antonio , Benítez-Porres Javier , Navarro-Sanz Ana , Lopez-Carmona Maria Dolores , Pérez-Belmonte Luis Miguel , Sanz-Canovas Jaime , Gomez-Huelgas Ricardo , Bernal-Lopez Maria Rosa
Published: November 2021

The SARS-CoV-2 pandemic led to lockdowns, which affected the elderly, a high-risk group. Lockdown may lead to weight gain due to increased food intake and reduced physical activity (PA). Our study aimed to analyze the impact of a 12-month lifestyle intervention on a metabolically healthy overweight/obese elderly (MHOe) population and how the lockdown by COVID-19 affected this program. Methods: MHOe participants (65–87 years) were recruited to participate in a lifestyle modification intervention based on the Mediterranean diet (MedDiet) and regular PA. Participants were classified into two groups: young-old (<75 years) or old-old (≥75 years). Anthropometric and clinical characteristics, energy intake, and energy expenditure were analyzed at baseline and after 12 months of intervention. Results: The final sample included 158 MHOe participants of both sexes (age: 72.21 ± 5.04 years, BMI: 31.56 ± 3.82 kg/m2): 109 young-old (age: 69.26 ± 2.83 years, BMI: 32.0 ± 3.85 kg/m2) and 49 old-old (age: 78.06 ± 2.88 years, BMI: 30.67 ± 3.64 kg/m2). After 12 months of intervention and despite lockdown, the young-old group increased MedDiet adherence (+1 point), but both groups drastically decreased daily PA, especially old-old participants. Fat mass significantly declined in the total population and the young-old. Depression significantly increased (26.9% vs. 21.0%, p < 0.0001), especially in the old-old (36.7% vs. 22.0%, p < 0.0001). No significant changes were found in the glycemic or lipid profile. Conclusions: This study indicates that ongoing MedDiet intake and regular PA can be considered preventative treatment for metabolic diseases in MHOe subjects. However, mental health worsened during the study and should be addressed in elderly individuals.
Communication of Uncertainty about Preliminary Evidence and the Spread of Its Inferred Misinformation during the COVID-19 Pandemic—A Weibo Case Study
Authors: Lu Jiahui , Zhang Meishan , Zheng Yan , Li Qiyu
Published: November 2021

The rapid spread of preliminary scientific evidence is raising concerns on its role in producing misinformation during the COVID-19 pandemic. This research investigated how the communication of uncertainty about preliminary evidence affects the spread of its inferred misinformation in a Weibo case study. In total, 3439 Weibo posts and 10,380 reposts regarding the misinformation of pets transmitting COVID-19 were analyzed. The results showed that attitude ambiguity toward the preliminary evidence and the stage when the evidence was first released with uncertainty were associated with higher numbers of likes and retweets of misinformation posts. Our study highlights the internal sources of misinformation and revisits the contextual perspective in misinformation studies.
Prevalence of Untreated Early Childhood Caries of 5-Year-Old Children in Hong Kong: A Cross-Sectional Study
Authors: Zheng Faith Miaomiao , Yan Iliana Gehui , Duangthip Duangporn , Gao Sherry Shiqian , Lo Edward Chin Man , Chu Chun Hung
Published: November 2021

This cross-sectional survey investigated untreated early childhood caries (ECC) and its associated factors among 5-year-old children in Hong Kong. Children were recruited using a multistage sampling method. One dentist examined the children in kindergarten to diagnose untreated ECC (dt) at the cavitation level. Each child’s demographic information, snacking behaviour, and oral health-related practice were collected using a parental questionnaire. The relationships between the untreated ECC and demographic information, snacking behaviours, and oral health-–related practice were analysed by zero-inflated negative binomial (ZINB) regression analysis. This survey recruited 404 children. Their dt score was 2.8 ± 3.8. The significant untreated ECC (SiUC) index, which was one-third of the children with the highest dt score, was 7.1 ± 3.6. Their untreated ECC prevalence was 57%, which was associated with the district the child lived in. Most children with untreated ECC (71%, 164/231) had never visited a dentist. Children who brushed without toothpaste had more untreated ECC. Children coming from low-income families and with a lower maternal education level had a higher risk of ECC. In conclusion, untreated ECC was prevalent and unevenly distributed among 5-year-old children in Hong Kong. Its prevalence was associated with toothpaste use, family income, maternal education level and the district they lived in.
Is 20 Hz Whole-Body Vibration Training Better for Older Individuals than 40 Hz?
Authors: Tseng Shiuan-Yu , Ko Chung-Po , Tseng Chin-Yen , Huang Wei-Ching , Lai Chung-Liang , Wang Chun-Hou
Published: November 2021

In recent years, whole-body vibration (WBV) training has been used as a training method in health promotion. This study attempted to use WBV at three different frequencies (20, 30, and 40 Hz) with subjects from different age groups to analyze the activation of the rectus femoris muscle. The subjects included 47 females and 51 males with an average age of 45.1 ± 15.2 years. Results indicated significant differences in subjects from different age groups at 20 Hz WBV. Muscle contraction was greater in the subjects who were older (F(4,93) = 82.448, p < 0.001). However, at 30 Hz WBV, the difference was not significant (F(4,93) = 2.373, p = 0.058). At 40 Hz WBV, muscle contraction was less in the older subjects than in the younger subjects (F(4,93) = 18.025, p < 0.001). The spectrum analysis also indicated that at 40 Hz there was less muscle activity during WBV in the older subjects than in the younger ones. Therefore, age was found to have a significant effect on muscle activation during WBV at different frequencies. If the training is offered to elderly subjects, their neuromuscular responses to 20 Hz WBV will be more suitable than to 40 Hz WBV.
The Internal Connection Analysis of Information Sharing and Investment Performance in the Venture Capital Network Community
Authors: Feng Bing , Sun Kaiyang , Zhong Ziqi , Chen Min
Published: November 2021

In order to explore the internal connection between information sharing and investment performance in the venture capital network community, this study took environmental-governance start-ups as the research object and used the 2009–2020 environmental-social enterprise start-up venture capital investment events as a data sample. The successful exit rate of the venture capital portfolio and the successful listing rate of investment ventures were used as the measurement criteria. Combined with regression analysis, the relationship between information sharing and investment performance in the venture capital network community was analyzed in detail. Research shows that there are differences between the ways of information sharing in the venture capital network communities. In the regression results, all coefficients are less than 0.01. There is a positive correlation between information sharing and investment performance in the venture capital network community. With the increase in enterprise characteristic variables, the degree of enterprise risk information sharing is getting higher and higher. This ultimately leads to more and more frequent corporate investment performance and a higher possibility of acquisition. Among them, the degree of information sharing in the venture capital network community is relatively high, and venture capital companies that are supported by corporate venture capital institutions will benefit even more from listed capital. Not only was the analysis of the relationship between finance and investment in the venture capital network community pointed out in this research, but also the investment development of entrepreneurial enterprises was also provided with feasible suggestions.
Illegal Drug Use and Risk of Hearing Loss in the United States: A National Health and Nutrition Examination Survey
Authors: Lin Po-Ting , Li I-Hsun , Yang Hui-Wen , Chiang Kuan-Wei , Wang Chih-Hung , Kao Li-Ting
Published: November 2021

The use of illegal drugs may be a risk factor of hearing loss. However, very few studies with large sample size have investigated the relationship between illegal drug use and hearing loss. Therefore, to evaluate the association between illegal drug use and hearing loss, this cross-sectional population-based study collected data from the US National Health and Nutrition Examination Survey 2011. The study included 1772 participants aged 20 to 59 years who underwent the Drug Use Questionnaire and Audiometry Examination. Of the 1772 participants in this study, 865 were men (48.8%) and 497 were illegal drug users. The mean (SD) age of the patients was 40.0 (11.4) years. After considering age, sex, and comorbidities, the participants who used illegal drugs were found to have higher risks of high-frequency hearing loss (adjusted odds ratio (OR), 1.69; 95% confidence interval (CI), 1.35–2.10) and overall hearing loss (adjusted OR, 1.69; 95% CI, 1.36–2.12) as compared with the nonusers. In the second analysis, the participants who used ≥ 2 types of illegal drugs were associated with higher risks of high-frequency hearing loss (adjusted OR, 1.57; 95% CI, 1.06–2.32) and overall hearing loss (adjusted OR, 1.60; 95% CI, 1.08–2.37). In the third analysis, cocaine use was associated with increased risks of high-frequency hearing loss (adjusted OR, 1.34; 95% CI, 1.01–1.77) and overall hearing loss (adjusted OR, 1.38; 95% CI, 1.04–1.82). The adjusted OR for overall hearing loss in the methamphetamine users was 1.54 (95% CI, 1.05–2.27) as compared with that in the nonusers. This study shows that illegal drug users might have a higher risk of overall hearing loss than nonusers. In addition, the analysis results demonstrated that the more kinds of illegal drugs used, the higher the risk of hearing loss. Further experimental and longitudinal research studies are required to confirm the causal relationship between illegal drug use and hearing loss.
Factors Influencing Regular Exercise Habits of Women in Taiwan
Authors: Liu Chia-Che , Tsai Liang-Ting
Published: November 2021

This study employed Taiwanese women aged ≥18 years as the population and investigated their exercise habits, as well as the behavioral factors affecting such habits. In research on exercise, the relationship between exercise and sex is a crucial topic, and this relationship affects exercise promotion. Women’s exercise habits are influenced by traditional gender ideology, and women have long been excluded and treated unfairly in the realm of exercise. The study data were collected from a representative sample of 1113 Taiwanese women who participated in the 2011 Taiwan Social Change Survey (sixth phase, second wave). After removing missing values, the data of 1028 participants (46.39 ± 16.90 years) were analyzed. The results indicated that nearly half of the women had an exercise habit (48.3%). Those who were older, lived in a city (i.e., an area with a high level of urbanization), had a full-time job, had more favorable self-reported physical condition, and had enough income to meet their daily needs, were more likely to have an exercise habit.
The Quality Evaluation of Rare Disease Registries—An Assessment of the Essential Features of a Disease Registry
Authors: Ali Salma Rashid , Bryce Jillian , Kodra Yllka , Taruscio Domenica , Persani Luca , Ahmed Syed Faisal
Published: November 2021

Rare disease (RD) registries aim to promote data collection and sharing, and facilitate multidisciplinary collaboration with the overall aim of improving patient care. Recommendations relating to the minimum standards necessary to develop and maintain high quality registries are essential to ensure high quality data and sustainability of registries. The aim of this international study was to survey RD registry leaders to ascertain the level of consensus amongst the RD community regarding the quality criteria that should be considered essential features of a disease registry. Of 35 respondents representing 40 RD registries, over 95% indicated that essential quality criteria should include establishment of a good governance system (ethics approval, registry management team, standard operating protocol and long-term sustainability plan), data quality (personnel responsible for data entry and procedures for checking data quality) and construction of an IT infrastructure complying with Findable, Accessible, Interoperable and Reusable (FAIR) principles to maintain registries of high quality, with procedures for authorized user access, erasing personal data, data breach procedures and a web interface. Of the 22 registries that performed a self-assessment, over 80% stated that their registry had a leader, project management group, steering committee, active funding stream, website, and user access policies. This survey has acceptability amongst the RD community for the self-quality evaluation of RD registries with high levels of consensus for the proposed quality criteria.
Correlation between Neck Circumference and Other Anthropometric Measurements in Eight Latin American Countries. Results from ELANS Study
Authors: Liria-Domínguez Reyna , Pérez-Albela Marcela , Vásquez María-Paz , Gómez Georgina , Kovalskys Irina , Fisberg Mauro , Cortés Lilia Yadira , Yépez García Martha Cecilia , Herrera-Cuenca Marianella , Rigotti Attilio , Ferrari Gerson , Pareja Rossina G. ,   on behalf of the ELANS Study Group
Published: November 2021

Neck circumference (NC) is being used to identify the risk of chronic diseases. There is a high prevalence of overweight and obesity in Latin America, and neck circumference is a simple and practical measurement to assess this, especially in primary health centers. We analyzed the correlation between the NC anthropometric indicator and other anthropometric measurements such as BMI and waist circumference (WC) in eight Latin American cities. We applied Pearson’s correlation to identify the correlate NC with the other anthropometric variables stratified by sex; the sensitivity (Se) and specificity (Sp) by sex were evaluated according to the cut-off established with the Youden Index. The strongest correlations between NC and WC were found when stratified by sex (women: r = 0.71; men: r = 0.69, respectively) followed by the correlation between NC and BMI (r = 0.65, both sex). NC cut-off points of 39.0 cm in men and 32.9 cm in women identified those individuals with an increased WC and 39.8 and 33.7 cm, respectively, for a substantial increase in WC. For BMI ≥ 25.0 kg/m2 for men, the cut-off point was 37.5 cm, and for women, it was 33.1 cm, and for BMI ≥ 30 kg/m2, the cut-off points were 39.2 and 34.2 cm, for men and women, respectively. Conclusion: NC proved to be a useful, practical, and inexpensive tool that can be used to identify, evaluate, and monitor overweight and obese individuals.
Assessment of a Rock Pillar Failure by Using Change Detection Analysis and FEM Modelling
Authors: Vanneschi Claudio , Mastrorocco Giovanni , Salvini Riccardo
Published: November 2021

In this paper, various methods have been used to control and evaluate engineering difficulties in mining accurately. Different unstable scenarios occurring at the surfaces of underground mine walls, have been identified by comparing 3D terrestrial laser scanning surveys and subsequent point cloud 3D analysis. These techniques, combined with a change detection analysis approach and the integration of rock mechanics’ modelling, represent an asset for the assessment and management of the risk in mining. The change detection analysis can be used as control of mining and industrial processes as well as to identify valid model scenarios for establishing possible failure causes. A pillar spalling failure has been identified in an Italian underground marble quarry and this topic represents the basis of the present paper. A Finite-Element Method was used to verify the occurrence of relatively high-stress concentrations in the pillar. The FEM modelling revealed that stresses in the proximity of the pillar may have sufficient magnitude to induce cracks growth and spalling failure.
The First Record of Teredidae (Coleoptera, Coccinelloidea) from China, with Description of a New Species of Teredus Dejean, 1835
Authors: Liu Zhenhua , Lin Wei , Li Zhiqiang
Published: November 2021

Teredus Dejean is a genus of the poorly known family Teredidae, which, historically, includes only two species, restricted to Europe and North Africa. Teredus chinensis sp. nov. is here described, representing the first member of Teredidae found in China, which significantly extends the distribution of Teredus to East Asia. The diagnostic characters and information about the wood boring beetles associated with the new species are provided.
Phantosmia, Parosmia, and Dysgeusia Are Prolonged and Late-Onset Symptoms of COVID-19
Authors: Schambeck Sophia E. , Crowell Claudia S. , Wagner Karolin I. , D’Ippolito Elvira , Burrell Teresa , Mijočević Hrvoje , Protzer Ulrike , Busch Dirk H. , Gerhard Markus , Poppert Holger , Beyer Henriette
Published: November 2021

Deficiencies in smell and taste are common symptoms of COVID-19. Quantitative losses are well surveyed. This study focuses on qualitative changes such as phantosmia (hallucination of smell), parosmia (alteration of smell), and dysgeusia (alteration of taste) and possible connections with the adaptive immune system. Subjective experience of deficiency in taste and smell was assessed by two different questionnaires after a median of 100 and 244 days after first positive RT-PCR test. SARS-CoV-2-specific antibody levels were measured with the iFlash-SARS-CoV-2 assay. After 100 days a psychophysical screening test for olfactory and gustatory dysfunction was administered. 30 of 44 (68.2%) participants reported a chemosensory dysfunction (14 quantitative, 6 qualitative, 10 quantitative, and qualitative) during COVID-19, eleven (25.0%) participants (1 quantitative, 7 qualitative, 3 quantitative, and quantity) after 100 days, and 14 (31.8%) participants (1 quantitative, 10 qualitative, 3 quantitative and qualitative) after 244 days. Four (9.1%) participants, who were symptom-free after 100 days reported now recently arisen qualitative changes. Serological and T-cell analysis showed no correlation with impairment of taste and smell. In conclusion, qualitative changes can persist for several months and occur as late-onset symptoms months after full recovery from COVID-19-induced quantitative losses in taste and smell.
Inflammatory Markers and Thromboembolic Risk in Patients with Non-Muscle-Invasive Bladder Cancer
Authors: Balan Daniel , Vartolomei Mihai Dorin , Magdás Annamária , Balan-Bernstein Noemi , Voidăzan Septimiu Toader , Mártha Orsolya
Published: November 2021

Introduction: Patients with bladder cancer have a high risk of venous thrombosis that represents a key challenge for physicians in the decision-making for initiating anticoagulation therapy. Non-muscle-invasive bladder cancer (NMIBC) represents more than 70% of all diagnosed bladder malignancies; therefore, we aimed to evaluate the relationship of the neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and risk of thrombosis by using the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score as well as the risk of bleeding by using the IMPROVE Bleeding Risk Assessment Score in a study cohort. Material and Methods: This was a retrospective observational study involving 130 patients who met the inclusion criteria: age > 18 years, stage pTa-pT1 NMIBC. The exclusion criteria were age < 18 years; stage pT2 or higher; or a presentation of metastasis, inflammatory, liver or autoimmune diseases, or other systemic neoplasms. In order to evaluate the risk of thromboembolic events as well as those of bleeding, the IMPROVE scores were calculated for each patient. Subjects were categorized in a Low IMPROVE group (< 4 points) or a High IMPROVE group. By using uni- and multivariate regression models, we analyzed CBC-derived parameters which could be associated with a higher risk of venous thrombosis in subjects with low or high IMPROVE scores. Results: Patients with IMPROVE score greater than 4 were associated with higher NLR, LMR and lymphocyte values (p < 0.05). In a multivariate regression model, the IMPROVE score was significantly influenced by lymphocyte count (p = 0.007) as well as the NLR value (p < 0.0001). Conclusions: In our study population, subjects with NMIBC with low lymphocytes and NLR > 3 were at a higher risk of developing venous thromboembolic events, reflected by an IMPROVE score of greater than 4. The IMPROVE and IMPROVE Bleeding Risk Assessment Scores are easy to use, and, complemented with the CBC-derived lymphocyte to monocyte ratio as a prothrombotic marker, could aid in the decision of prophylactic anticoagulation therapy during admission.
The Predictive Value of Systemic Immune-Inflammation Index on Bladder Recurrence on Upper Tract Urothelial Carcinoma Outcomes after Radical Nephroureterectomy
Authors: Chien Tsu-Ming , Li Ching-Chia , Lu Yen-Man , Chou Yii-Her , Chang Hsueh-Wei , Wu Wen-Jeng
Published: November 2021

Background: This study aimed to assess the prognostic significance of pre-treatment lymphocyte-related systemic inflammatory biomarkers in upper tract urothelial carcinoma (UTUC) patients. Methods: This study included non-metastatic UTUC patients treated at our hospital between 2001 and 2013. The receiver operating characteristic curve was used to obtain the optimal neutrophile-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Multivariate logistic regression was performed to investigate the relationship between NLR, PLR, and SII and clinical pathologic characteristics. The Kaplan–Meier method was used to calculate the metastasis-free survival (MFS), cancer-specific survival (CSS), and bladder recurrence-free survival (BRFS), and the log-rank test was used to compare the survival rate. Results: Overall, 376 patients were included in the current study. An elevated SII was associated with symptomatic hydronephrosis, bladder cancer history, advanced pathologic tumor stage, lymph node invasion, adjuvant chemotherapy and concomitant carcinoma in situ (CIS); high NLR was associated with older age, symptomatic hydronephrosis, hemodialysis status, anemia, multifocal tumor, advanced pathologic tumor stage, and adjuvant chemotherapy; and high PLR was associated with older age, anemia, advanced pathologic tumor stage, and adjuvant chemotherapy. The Kaplan–Meier analysis indicated that patients exhibiting higher NLR, PLR, and SII showed significantly poor MFS and CSS rates. Only high SII showed significantly worse BRFS rates. Conclusions: The NLR, PLR, and SII were independent predictive factors for both MFS and CSS in UTUC patients. Among the factors, only elevated SII can predict bladder recurrence. Therefore, the patients might need close bladder monitoring during the follow-up.
Clinical Significance of Serum Lactate in Acute Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study
Authors: Park Ik Hyun , Cho Hyun Kyu , Oh Ju Hyeon , Chun Woo Jung , Park Yong Hwan , Lee Mirae , Kim Min Sun , Choi Ki Hong , Kim Jihoon , Song Young Bin , Hahn Joo-Yong , Choi Seung-Hyuk , Lee Sang-Chol , Gwon Hyeon-Cheol , Choe Yeon Hyeon , Jang Woo Jin
Published: November 2021

Little is known about causality and the pathological mechanism underlying the association of serum lactate with myocardial injury in patients with acute myocardial infarction (AMI). We evaluated data from 360 AMI patients undergoing percutaneous coronary intervention (PCI) using cardiovascular magnetic resonance imaging (CMR). Of these, 119 patients had serum lactate levels > 2.5 mmol/L on admission (high serum lactate group), whereas 241 patients had serum lactate levels ≤ 2.5 mmol/L (low serum lactate group). We compared the myocardial infarct size assessed by CMR between the two groups and performed inverse probability of treatment weighting (IPTW). In CMR analysis, myocardial infarct size was significantly greater in the high serum lactate group than in the low serum lactate group (22.0 ± 11.4% in the high serum lactate group vs. 18.9 ± 10.5% in the low serum lactate group; p = 0.011). The result was consistent after IPTW adjustment (21.5 ± 11.1% vs. 19.2 ± 10.4%; p = 0.044). In multivariate analysis, high serum lactate was associated with larger myocardial infarct (odds ratio 1.59; 95% confidence interval 1.00–2.51; p = 0.048). High serum lactate could predict advanced myocardial injury in AMI patients undergoing PCI.
The Use of Chitotriosidase as a Marker of Active Sarcoidosis and in the Diagnosis of Fever of Unknown Origin (FUO)
Authors: Di Francesco Angela Maria , Verrecchia Elena , Sicignano Ludovico Luca , Massaro Maria Grazia , Antuzzi Daniela , Covino Marcello , Pasciuto Giuliana , Richeldi Luca , Manna Raffaele
Published: November 2021

Sarcoidosis is a multi-organ inflammatory granulomatosis with a lung-predominant involvement. The aim of this study was to investigate the use of serum chitotriosidase (CHIT1) in patients with fever of unknown origin (FUO); the patients with confirmed diagnosis of active sarcoidosis were compared with ones affected by inactive or treated sarcoidosis. CHIT1 activity was evaluated in 110 patients initially admitted at the hospital as FUOs. The overall performance of CHIT1 for active sarcoidosis diagnosis was assessed by performing an area under the receiver operating characteristic curve analysis (AUROC). The sarcoidosis patients were significantly older than the FUO patients not affected by sarcoidosis (p < 0.01). CHIT1 showed a good accuracy as a biomarker for active sarcoidosis in patients explored for FUO (AUROC 0.955; CI 95% 0.895–0.986; p < 0.001). A CHIT1 value >90.86 showed 96.8% sensitivity (84.2–99.9) and 85.5% specificity (75–92.8) in discriminating active sarcoidosis from other causes of FUO. CHIT1 significantly discriminated active versus inactive/under treatment sarcoidosis patients (with lower enzyme activity) (ROC analysis, sensitivity: 96.9%, specificity: 94.7%, value >83.01 nmol/mL/h, AUROC: 0.958, 0.862–0.994, p < 0.001) compared to ACE (ROC analysis, sensitivity: 25.8%, specificity: 93.7%, value >65 UI/L). In conclusion, CHIT1 is a reliable/sensitive biomarker of active sarcoidosis, with values significantly decreasing in remitted/treated patients. It significantly discriminates active sarcoidosis from FUO patients, providing a useful tool in the diagnosis-assessing process.
Artificial Intelligence, Heuristic Biases, and the Optimization of Health Outcomes: Cautionary Optimism
Authors: Feehan Michael , Owen Leah A. , McKinnon Ian M. , DeAngelis Margaret M.
Published: November 2021

The use of artificial intelligence (AI) and machine learning (ML) in clinical care offers great promise to improve patient health outcomes and reduce health inequity across patient populations. However, inherent biases in these applications, and the subsequent potential risk of harm can limit current use. Multi-modal workflows designed to minimize these limitations in the development, implementation, and evaluation of ML systems in real-world settings are needed to improve efficacy while reducing bias and the risk of potential harms. Comprehensive consideration of rapidly evolving AI technologies and the inherent risks of bias, the expanding volume and nature of data sources, and the evolving regulatory landscapes, can contribute meaningfully to the development of AI-enhanced clinical decision making and the reduction in health inequity.
Fragility Index and Fragility Quotient in Randomized Controlled Trials on Corticosteroids in ARDS Due to COVID-19 and Non-COVID-19 Etiology
Authors: Vargas Maria , Marra Annachiara , Buonanno Pasquale , Coviello Antonio , Iacovazzo Carmine , Servillo Giuseppe
Published: November 2021

Background: The effectiveness of corticosteroids in acute respiratory distress syndrome (ARDS) and COVID-19 still remains uncertain. Since ARDS is due to a hyperinflammatory response to a direct injury, we decided to perform a meta-analysis and an evaluation of robustness of randomised clinical trials (RCTs) investigating the impact of corticosteroids on mortality in ARDS in both COVID-19 and non-COVID-19 patients. We conducted a systematic search of the literature from inception up to 30 October 2020, using the MEDLINE database and the PubMed interface. We evaluated the fragility index (FI) of the included RCTs using a two-by-two contingency table and the p-value produced by the Fisher exact test; the fragility quotient (FQ) was calculated by dividing the FI score by the total sample size of the trial. Results: Thirteen RCTs were included in the analysis; five of them were conducted in COVID-19 ARDS, including 7692 patients, while 8 RCTS were performed in non-COVID ARDS with 1091 patients evaluated. Three out of eight RCTs in ARDS had a FI > 0 while 2 RCTs out of five in COVID-19 had FI > 0. The median of FI for ARDS was 0.625 (0.47) while the median of FQ was 0.03 (0.014). The median of FI for COVID-19 was 6 (2) while the median of FQ was 0.059 (0.055). In this systematic review, we found that FI and FQ of RCTs evaluating the use of corticosteroids in ARDS and COVID-19 were low.
Diagnostic Benefit of High b-Value Computed Diffusion-Weighted Imaging in Patients with Hepatic Metastasis
Authors: Ablefoni Maxime , Surup Hans , Ehrengut Constantin , Schindler Aaron , Seehofer Daniel , Denecke Timm , Meyer Hans-Jonas
Published: November 2021

Diffusion-weighted imaging (DWI) has rapidly become an essential tool for the detection of malignant liver lesions. The aim of this study was to investigate the usefulness of high b-value computed DWI (c-DWI) in comparison to standard DWI in patients with hepatic metastases. In total, 92 patients with histopathologic confirmed primary tumors with hepatic metastasis were retrospectively analyzed by two readers. DWI was obtained with b-values of 50, 400 and 800 or 1000 s/mm2 on a 1.5 T magnetic resonance imaging (MRI) scanner. C-DWI was calculated with a monoexponential model with high b-values of 1000, 2000, 3000, 4000 and 5000 s/mm2. All c-DWI images with high b-values were compared to the acquired DWI sequence at a b-value of 800 or 1000 s/mm2 in terms of volume, lesion detectability and image quality. In the group of a b-value of 800 from a b-value of 2000 s/mm2, hepatic lesion sizes were significantly smaller than on acquired DWI (metastases lesion sizes b = 800 vs. b 2000 s/mm2: mean 25 cm3 (range 10–60 cm3) vs. mean 17.5 cm3 (range 5–35 cm3), p < 0.01). In the second group at a high b-value of 1500 s/mm2, liver metastases were larger than on c-DWI at higher b-values (b = 1500 vs. b 2000 s/mm2, mean 10 cm3 (range 4–24 cm3) vs. mean 9 cm3 (range 5–19 cm3), p < 0.01). In both groups, there was a clear reduction in lesion detectability at b = 2000 s/mm2, with hepatic metastases being less visible compared to c-DWI images at b = 1500 s/mm2 in at least 80% of all patients. Image quality dropped significantly starting from c-DWI at b = 3000 s/mm2. In both groups, almost all high b-values images at b = 4000 s/mm2 and 5000 s/mm2 were not diagnostic due to poor image quality. High c-DWI b-values up to b = 1500 s/mm2 offer comparable detectability for hepatic metastases compared to standard DWI. Higher b-value images over 2000 s/mm2 lead to a noticeable reduction in imaging quality, which could hamper diagnosis.
Are Aortic Root and Ascending Aorta Diameters Measured by the Pediatric versus the Adult American Society of Echocardiography Guidelines Interchangeable?
Authors: Servato Maria Luz , Teixidó-Turá Gisela , Sabate-Rotes Anna , Galian-Gay Laura , Gutiérrez Laura , Valente Filipa , Fernandez-Galera Ruben , Casas Guillem , López-Sainz Angela , González-Alujas M. Teresa , Sao-Aviles Augusto , Ferreira Ignacio , Rodríguez-Palomares Jose , Evangelista Arturo
Published: November 2021

Ascending aorta diameters have important clinical value in the diagnosis, follow-up, and surgical indication of many aortic diseases. However, there is no uniformity among experts regarding ascending aorta diameter quantification by echocardiography. The aim of this study was to compare maximum aortic root and ascending aorta diameters determined by the diastolic leading edge (DLE) and the systolic inner edge (SIE) conventions in adult and pediatric patients with inherited cardiovascular diseases. Transthoracic echocardiograms were performed in 328 consecutive patients (260 adults and 68 children). Aorta diameters were measured twice at the root and ascending aorta by the DLE convention following the 2015 American Society of Echocardiography (ASE) adult guidelines and the SIE convention following the 2010 ASE pediatric guidelines. Comparison of the diameters measured by the two conventions in the overall population showed a non-significant underestimation of the diameter measured by the SIE convention at root level of 0.28 mm (CI −1.36; 1.93) and at tubular ascending aorta level of 0.17 mm (CI −1.69; 2.03). Intraobserver and interobserver variability were excellent. Maximum aorta diameter measured by the leading edge convention in end-diastole and the inner edge convention in mid-systole had similar values to a mild non-significant underestimation of the inner-to-inner method that permits them to be interchangeable when used in clinical practice.
Laser Ablation Treatment of Recurrent Lymph Node Metastases from Papillary Thyroid Carcinoma
Authors: Offi Chiara , Misso Claudia , Antonelli Giovanni , Esposito Maria Grazia , Brancaccio Umberto , Spiezia Stefano
Published: November 2021

(1) Background: The incidence of papillary thyroid cancers is increasing. Papillary neoplasm metastasizes to the central and lateral lymph nodes of the neck. The recurrence rate is less than 30%. The gold standard of treatment for lymph node recurrences is surgery, but surgery is burdened by a high rate of complications. Therefore, laser ablation of recurrent lymph nodes has been recognized as an alternative treatment with minimal invasiveness, a low complication rate and a curative effect. (2) Methods: We analyzed 10 patients who underwent a total thyroidectomy and metabolic radiotherapy and who developed a lymph node recurrence in the laterocervical compartment in the following 12–18 months. (3) Results: Patients developed lymph node recurrence at IV and Vb levels in 70% and 30% of cases, respectively. All patients were treated with a single laser ablative session. Hydrodissection was performed in all patients. The energy delivered was 1120 ± 159.3 Joules and 3–4 Watts in 362 ± 45.7 s. No complications were reported. All patients underwent a 6-month follow-up. A volumetric reduction of 40.12 ± 2.2%, 49.1 ± 2.13% and 59.8 ± 3.05%, respectively at 1-, 3- and 6-months of follow-up was reported. (4) Conclusions: At 6 months, a fine needle aspiration was performed, which was negative for malignant cells and negative for a dosage of Thyroglobulin in eluate. The laser ablation is an effective alternative to surgical treatment.
Social Inequities in the Impact of COVID-19 Lockdown Measures on the Mental Health of a Large Sample of the Colombian Population (PSY-COVID Study)
Authors: Sanabria-Mazo Juan P. , Useche-Aldana Bernardo , Ochoa Pedro P. , Rojas-Gualdrón Diego F. , Mateo-Canedo Corel , Carmona-Cervelló Meritxell , Crespo-Puig Neus , Selva-Olid Clara , Muro Anna , Méndez-Ulrich Jorge L. , Feliu-Soler Albert , Luciano Juan V. , Sanz Antoni
Published: November 2021

The identification of general population groups particularly vulnerable to the impact of COVID-19 lockdown measures on mental health and the development of healthcare policies are priority challenges in the current and future pandemics. This study aimed to identify the personal and social determinants of the impact of COVID-19 lockdown measures on mental health in a large sample of the Colombian population. In this cross-sectional study, an anonymous online survey was answered by 18,061 participants from the general population residing in Colombia during the first wave of the COVID-19 outbreak (from 20 May to 20 June 2020). The risk of depression, anxiety, and somatization disorders were measured using the Patient Health Questionnaire (PHQ-2), Generalized Anxiety Disorder Scale (GAD-2), and Somatic Symptom Questionnaire (SSQ-5), respectively. Overall, 35% of participants showed risk of depression, 29% of anxiety, and 31% of somatization. According to the analysis of social determinants of health, the most affected groups were people with low incomes, students, and young adults (18–29 years). Specifically, low-income young females were the most at-risk population group. These findings show how the lockdown measures affected the general population’s mental health in Colombia and highlight some social risk factors in health.
Long-Term Symptoms among Hospitalized COVID-19 Patients 48 Weeks after Discharge—A Prospective Cohort Study
Authors: Mølhave Martin , Leth Steffen , Gunst Jesper Damsgaard , Jensen-Fangel Søren , Østergaard Lars , Wejse Christian , Agergaard Jane
Published: November 2021

Follow-up studies of COVID-19 survivors have been performed to characterize persistence of long-term symptoms, but data are scarce on one year of follow-up. This study provides data from 48 weeks of follow-up after discharge. All patients discharged from the Department of Infectious Diseases at Aarhus University Hospital, Denmark between 1 March and 1 July 2020 were followed for 48 weeks. In total, 45 of 66 eligible patients were interviewed after 48 weeks. The median age was 57 (IQR 51–70) years, the majority were female (53%) and Caucasian (87%). Median BMI was 28.1 (IQR 24.8–32.6) kg/m2. One or more comorbidities were registered among 62% of the patients. In total, 39 out of 45 (87%) interviewed patients reported persistence of at least one symptom 48 weeks after hospitalization with COVID-19. Most frequently reported symptoms were fatigue, dyspnea, and concentration difficulties. This study provides new long-term data following COVID-19, contributing to the accumulating data of COVID-19 sequelae. Many patients suffer long-term sequelae and further research is urgently needed to gain further knowledge of the duration and therapeutic options.
Treatment of Macular Edema in Vascular Retinal Diseases: A 2021 Update
Authors: Grzybowski Andrzej , Markeviciute Agne , Zemaitiene Reda
Published: November 2021

Macular edema (ME) is associated with various conditions; however, the main causes of ME are retinal vein occlusion (RVO) and diabetes. Laser photocoagulation, formerly the gold standard for the treatment of ME, has been replaced by anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections. Despite its efficiency, this treatment requires frequent injections to preserve the outcomes of anti-VEGF therapy, and as many patients do not sufficiently respond to the treatment, ME is typically a chronic condition that can lead to permanent visual impairment. Generalized recommendations for the treatment of ME are lacking, which highlights the importance of reviewing treatment approaches, including recent anti-VEGFs, intravitreal steroid implants, and subthreshold micropulse lasers. We reviewed relevant studies, emphasizing the articles published between 2019 and 2021 and using the following keywords: macular edema, diabetic macular edema, retinal vein occlusion, laser photocoagulation, anti-VEGF, and intravitreal injections. Our results revealed that a combination of different treatment methods may be beneficial in resistant cases. Additionally, artificial intelligence (AI) is likely to help select the best treatment option for patients in the near future.