bluuebunny/crossref_metadata_2025 huggingface dataset:
Late Toxicities, Failure Patterns, Local Tumor Control, and Survival of Esophageal Squamous Cell Carcinoma Patients After Chemoradiotherapy With a Simultaneous Integrated Boost: A 5-Year Phase II Study
Authors: Chen Chuangzhen , Chen Jianzhou , Luo Ting , Wang Siyan , Guo Hong , Zeng Chengbing , Wu Yanxuan , Liu Weitong , Huang Ruihong , Zhai Tiantian , Chen Zhijian , Li Derui
Published: November 2021

Purpose

We aimed to evaluate the long-term outcomes of concurrent chemoradiotherapy (CCRT) with a simultaneous integrated boost (SIB) of radiotherapy for esophageal squamous cell carcinoma (ESCC).

Methods and Materials

Eighty-seven patients with primary ESCC enrolled in this phase II trial. The majority (92.0%) had locoregionally advanced disease. They underwent definitive chemoradiotherapy. The radiotherapy doses were 66 Gy for the gross tumor and 54 Gy for the subclinical disease. Doses were simultaneously administered in 30 fractions over 6 weeks. The patients also underwent concurrent and adjuvant chemotherapy, which comprised cisplatin and fluorouracil. The study end points were acute and late toxicities, first site of failure, locoregional tumor control, and overall survival rates.

Results

The median follow-up time was 65.7 (range, 2.2-97.5) months for all patients and 81.5 (range, 19.4-97.5) months for those alive. There were 17 cases (19.5%) of severe late toxicities, including four cases (4.6%) of grade 5 and seven (8.0%) of grade 3 esophageal ulceration, four (4.6%) of grade 3 esophageal stricture, and two (2.3%) of grade 3 radiation-induced pneumonia. Twenty-three (26.4%) patients had locoregional disease progression. Most (86.7%) locally progressive lesions were within the dose-escalation region in the initial radiation plan, while majority of the recurrent lymph nodes were found out-of-field (83.3%) and in the supraclavicular region (75.0%). The 1-, 2-, 3-, and 5-year locoregional tumor control and overall survival rates were 79.2%, 72.4%, 72.4%, 70.8%, and 82.8%, 66.6%, 61.9%, 58.4%, respectively. Incomplete tumor response, which was assessed immediately after CCRT was an independent risk predictor of disease progression and death in ESCC patients.

Conclusions

CCRT with SIB was well tolerated in ESCC patients during treatment and long-term follow-up. Moreover, patients who underwent CCRT with SIB exhibited improved local tumor control and had better survival outcomes compared to historical data of those who had standard-dose radiotherapy.
Biopsy Artifact in Laser Interstitial Thermal Therapy: A Technical Note
Authors: Noh Thomas , Juvekar Parikshit , Huang Raymond , Lee Gunnar , Ogasawara Christian T. , Golby Alexandra J.
Published: November 2021

Purpose

The safety and effectiveness of laser interstitial thermal therapy (LITT) relies critically on the ability to continuously monitor the ablation based on real-time temperature mapping using magnetic resonance thermometry (MRT). This technique uses gradient recalled echo (GRE) sequences that are especially sensitive to susceptibility effects from air and blood. LITT for brain tumors is often preceded by a biopsy and is anecdotally associated with artifact during ablation. Thus, we reviewed our experience and describe the qualitative signal dropout that can interfere with ablation.

Methods

We retrospectively reviewed all LITT cases performed in our intraoperative MRI suite for tumors between 2017 and 2020. We identified a total of 17 LITT cases. Cases were reviewed for age, sex, pathology, presence of artifact, operative technique, and presence of blood/air on post-operative scans.

Results

We identified six cases that were preceded by biopsy, all six had artifact present during ablation, and all six were noted to have air/blood on their post-operative MRI or CT scans. In two of those cases, the artifactual signal dropout qualitatively interfered with thermal damage thresholds at the borders of the tumor. There was no artifact in the 11 non-biopsy cases and no obvious blood or air was noted on the post-ablation scans.

Conclusion

Additional consideration should be given to pre-LITT biopsies. The presence of air/blood caused an artifactual signal dropout effect in cases with biopsy that was severe enough to interfere with ablation in a significant number of those cases. Additional studies are needed to identify modifying strategies.
Automated Classification of Papillary Renal Cell Carcinoma and Chromophobe Renal Cell Carcinoma Based on a Small Computed Tomography Imaging Dataset Using Deep Learning
Authors: Zuo Teng , Zheng Yanhua , He Lingfeng , Chen Tao , Zheng Bin , Zheng Song , You Jinghang , Li Xiaoyan , Liu Rong , Bai Junjie , Si Shuxin , Wang Yingying , Zhang Shuyi , Wang Lili , Chen Jianhui
Published: November 2021

Objectives

This study was conducted in order to design and develop a framework utilizing deep learning (DL) to differentiate papillary renal cell carcinoma (PRCC) from chromophobe renal cell carcinoma (ChRCC) using convolutional neural networks (CNNs) on a small set of computed tomography (CT) images and provide a feasible method that can be applied to light devices.

Methods

Training and validation datasets were established based on radiological, clinical, and pathological data exported from the radiology, urology, and pathology departments. As the gold standard, reports were reviewed to determine the pathological subtype. Six CNN-based models were trained and validated to differentiate the two subtypes. A special test dataset generated with six new cases and four cases from The Cancer Imaging Archive (TCIA) was applied to validate the efficiency of the best model and of the manual processing by abdominal radiologists. Objective evaluation indexes [accuracy, sensitivity, specificity, receiver operating characteristic (ROC) curve, and area under the curve (AUC)] were calculated to assess model performance.

Results

The CT image sequences of 70 patients were segmented and validated by two experienced abdominal radiologists. The best model achieved 96.8640% accuracy (99.3794% sensitivity and 94.0271% specificity) in the validation set and 100% (case accuracy) and 93.3333% (image accuracy) in the test set. The manual classification achieved 85% accuracy (100% sensitivity and 70% specificity) in the test set.

Conclusions

This framework demonstrates that DL models could help reliably predict the subtypes of PRCC and ChRCC.
Identification of a N6-Methyladenosine (m6A)-Related lncRNA Signature for Predicting the Prognosis and Immune Landscape of Lung Squamous Cell Carcinoma
Authors: Weng Chengyin , Wang Lina , Liu Guolong , Guan Mingmei , Lu Lin
Published: November 2021

Background

m6A-related lncRNAs emerged as potential targets for tumor diagnosis and treatment. This study aimed to identify m6A-regulated lncRNAs in lung squamous cell carcinoma (LUSC) patients.

Materials and Methods

RNA sequencing and the clinical data of LUSC patients were downloaded from The Cancer Genome Atlas (TCGA) database. The m6A-related lncRNAs were identified by using Pearson correlation assay. Univariate and multivariate Cox regression analyses were utilized to construct a risk model. The performance of the risk model was validated using Kaplan–Meier survival analysis and receiver operating characteristics (ROC). Immune estimation of LUSC was downloaded from TIMER, and the correlations between the risk score and various immune cells infiltration were analyzed using various methods. Differences in immune functions and expression of immune checkpoint inhibitors and m6A regulators between high-risk and low-risk groups were further explored. Finally, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were utilized to explore the biological functions of AL122125.1.

Results

A total of 351 m6A-related lncRNAs were obtained from TCGA. Seven lncRNAs demonstrated prognostic values. A further multivariate Cox regression assay constructed a risk model consisting of two lncRNAs (AL122125.1 and HORMAD2-AS1). The Kaplan–Meier analysis and area under the curve indicated that this risk model could be used to predict the prognosis of LUSC patients. The m6A-related lncRNAs were immune-associated. There were significant correlations between risk score and immune cell infiltration, immune functions, and expression of immune checkpoint inhibitors. Meanwhile, there were significant differences in the expression of m6A regulators between the high- and low-risk groups. Moreover, GO and KEGG analyses revealed that the upregulated expression of AL122125.1 was tumor-related.

Conclusion

In this study, we constructed an m6A-related lncRNA risk model to predict the survival of LUSC patients. This study could provide a novel insight to the prognosis and treatment of LUSC patients.
Circulating Tumor DNA and Minimal Residual Disease (MRD) in Solid Tumors: Current Horizons and Future Perspectives
Authors: Peng Yan , Mei Wuxuan , Ma Kaidong , Zeng Changchun
Published: November 2021

Circulating tumor DNA (ctDNA) is cell-free DNA (cfDNA) fragment in the bloodstream that originates from malignant tumors or circulating tumor cells. Recently, ctDNA has emerged as a promising non-invasive biomarker in clinical oncology. Analysis of ctDNA opens up new avenues for individualized cancer diagnosis and therapy in various types of tumors. Evidence suggests that minimum residual disease (MRD) is closely associated with disease recurrence, thus identifying specific genetic and molecular alterations as novel MRD detection targets using ctDNA has been a research focus. MRD is considered a promising prognostic marker to identify individuals at increased risk of recurrence and who may benefit from treatment. This review summarizes the current knowledge of ctDNA and MRD in solid tumors, focusing on the potential clinical applications and challenges. We describe the current state of ctDNA detection methods and the milestones of ctDNA development and discuss how ctDNA analysis may be an alternative for tissue biopsy. Additionally, we evaluate the clinical utility of ctDNA analysis in solid tumors, such as recurrence risk assessment, monitoring response, and resistance mechanism analysis. MRD detection aids in assessing treatment response, patient prognosis, and risk of recurrence. Moreover, this review highlights current advancements in utilizing ctDNA to monitor the MRD of solid tumors such as lung cancer, breast cancer, and colon cancer. Overall, the clinical application of ctDNA-based MRD detection can assist clinical decision-making and improve patient outcomes in malignant tumors.
TGFβ Signaling in Myeloid Cells Promotes Lung and Liver Metastasis Through Different Mechanisms
Authors: Stefanescu Cristina , Van Gogh Merel , Roblek Marko , Heikenwalder Mathias , Borsig Lubor
Published: November 2021

TGFβ overexpression is commonly detected in cancer patients and correlates with poor prognosis and metastasis. Cancer progression is often associated with an enhanced recruitment of myeloid-derived cells to the tumor microenvironment. Here we show that functional TGFβ-signaling in myeloid cells is required for metastasis to the lungs and the liver. Myeloid-specific deletion of Tgfbr2 resulted in reduced spontaneous lung metastasis, which was associated with a reduction of proinflammatory cytokines in the metastatic microenvironment. Notably, CD8+ T cell depletion in myeloid-specific Tgfbr2-deficient mice rescued lung metastasis. Myeloid-specific Tgfbr2-deficiency resulted in reduced liver metastasis with an almost complete absence of myeloid cells within metastatic foci. On contrary, an accumulation of Tgfβ-responsive myeloid cells was associated with an increased recruitment of monocytes and granulocytes and higher proinflammatory cytokine levels in control mice. Monocytic cells isolated from metastatic livers of Tgfbr2-deficient mice showed increased polarization towards the M1 phenotype, Tnfα and Il-1β expression, reduced levels of M2 markers and reduced production of chemokines responsible for myeloid-cell recruitment. No significant differences in Tgfβ levels were observed at metastatic sites of any model. These data demonstrate that Tgfβ signaling in monocytic myeloid cells suppresses CD8+ T cell activity during lung metastasis, while these cells actively contribute to tumor growth during liver metastasis. Thus, myeloid cells modulate metastasis through different mechanisms in a tissue-specific manner.
When Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base
Authors: Orlandi Ester , Ferrari Marco , Lafe Elvis , Preda Lorenzo , Benazzo Marco , Vischioni Barbara , Bonora Maria , Rampinelli Vittorio , Schreiber Alberto , Licitra Lisa , Nicolai Piero
Published: November 2021

Internal or common carotid artery encasement (CAE) is observed in almost 2-7% of head and neck cancers (HNC) and designates the tumor with the T4b category. This clinical scenario is associated with a dismal prognosis, owing to the risk for thrombosis and bleeding that usually characterizes such an advanced cancer. Standardized radiological criteria to infer invasion of the carotid artery are lacking. Complete surgical resection in the context of a multimodality treatment is supposed to offer the greatest chances of cure. Surgery can either be carotid-sparing or include carotidectomy. Data on probability of cerebrovascular and non-cerebrovascular complications, risk of carotid blowout, poor oncologic outcomes, and less-than-certain efficacy of diagnostic and interventional preventive procedures against cerebral infarction make it difficult to define surgery as the recommended option among other therapeutic strategies. Non-surgical therapies based on radiation therapy possibly combined with chemotherapy are more frequently employed in HNC with CAE. In this context, carotid blowout is the most feared complication, and its probability increases with tumor stage and cumulative radiation dose received by the vessel. The use of highly conformal radiotherapies such as intensity-modulated particle therapy might substantially improve the manageability of HNC with CAE by possibly reducing the risk of late sequalae. Despite evidence is frail, it appears logical that a case-by-case evaluation through multidisciplinary decision making between head and neck surgeons, radiation oncologists, medical oncologists, diagnostic and interventional radiologists, and vascular surgeons are of paramount value to offer the best therapeutic solution to patients affected by HNC with CAE.
The Pharmacological Mechanism of Guchangzhixie Capsule Against Experimental Colitis
Authors: Yan Jing , Yu Wei , Lu Chang , Liu Chen , Wang Guoliang , Jiang Lu , Jiang Zizheng , Qin Zheng
Published: November 2021

Ulcerative colitis (UC) is the major type of inflammatory bowel disease (IBD) characterized by an overactive immune response and destruction of colorectal epithelium with intricate pathological factors. Guchangzhixie (GCZX) capsule, included in the Chinese Pharmacopoeia 2020, has been widely utilized against UC. However, the underlying molecular mechanisms have not been elucidated. In the present study, a murine model of experimental colitis was established by orally feeding 4% dextran sodium sulfate (DSS) for 5 days and subsequently subjecting to GCZX treatment for another 15 days. Network pharmacology analysis was performed to predict the pertinent mechanisms of GCZX capsule. Cellular experiments examining the functional changes of intestinal organoids (IOs), macrophages (Mφs), and human colon epithelial cell cells (NCM460 cell line) after GCZX therapy were performed. Sequencing of 16S rRNA was conducted on the stools from the mouse model. Liquid chromatography-mass spectrometry (LC–MS) was utilized to detect serum metabolites. As a result, DSS induced experimental colitis, and this induction was alleviated by GCZX treatment, as evidenced by rescued pathological symptoms in UC mouse models, such as rectal bleeding stopping, decreased levels of albumin, interleukin-17, as well as chemokine (C-X-C motif) ligand 1 (CXCL1), and reduction in colon length. Network pharmacology analysis showed that GCZX-target genes were enriched in pathogen-induced infections, inflammatory pathways, as well as neoplastic processes. DSS treatment decreased microbial diversity and led to the accumulation of pathological bacterial, which was reversed by GCZX capsule. PICRUSt2 (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States) based on profiles of microbiota composition demonstrated a decreased incidence of infectious disease and cancers after GCZX therapy. In full accordance with these data, GCZX administration suppressed Mφ transition to pro-inflammatory phenotype, alleviated tumor necrosis factor-α (TNFα)-compromised IOs functions, and decreased the recruitment of Mφs by epithelial cells. We conclude that GCZX capsule is an effective drug for UC and its pharmacological mechanisms involve re-establishing an anti-inflammatory milieu and favoring mucosal healing.
Immunological and Preventive Effects of Hochuekkito and Kakkonto Against Coronavirus Disease in Healthcare Workers: A Retrospective Observational Study
Authors: Ogawa-Ochiai Keiko , Ishikawa Hideki , Li Hongyang , Vu Quang Lam , Kimoto Izumi , Takamura Mitsuyuki , Hongawa Tetsuya , Hane Yasuyuki , Suzuki Susumu , Okajima Masaki , Mori Keita , Ito Masanori , Takami Akiyoshi
Published: November 2021

Amid the global outbreak of coronavirus disease 2019 (COVID-19), it may be expected that low-toxicity natural compounds, such as Kampo formulas, will have a preventive effect on COVID-19. Although the biological properties and safety of the representative Kampo compounds, hochuekkito (HET) and kakkonto (KKT), have been confirmed in various animal model experiments, clinical studies, and a few human studies to induce biological effects on various infectious diseases without significant toxicity, it is unclear whether HET and KKT are safe and effective for COVID-19 prevention. The study population included healthcare workers (HCWs), as they are at a higher risk of infection than the other populations. We retrospectively investigated the immunological and preventive effects of HET and KTT against COVID-19. We included 27 HCWs (aged 21–72 years, F:M = 18:9) from hospitals and clinics of the Hokuriku-Tokai region. The HCWs received HET and KKT for general fatigue and myalgia during this period for 28 days. We obtained patient clinical data from electronic medical records. We analyzed the changes in immunomodulation before and after the administration of the formulas from residual specimens based on the expression of relevant surface markers. The specimens were also tested for the presence of antibodies against severe acute respiratory syndrome coronavirus 2. The following side effects were reported: abdominal discomfort in five patients, diarrhea in two, and loose or soft stool in three. All 27 HCWs tested negative for COVID-19 antibodies. HET and KKT administration significantly increased the absolute number of circulating lymphocytes expressing the activating receptors NKp46, NKp30, and suppressing receptor NKG2A. There was also a significant increase in the absolute number of circulating lymphocytes expressing the receptors TLR4, OX40, 4–1BB, GITR, PD-1, and ICOS. These data indicate that HET and KKT can enhance and modulate NK activity in circulating human immune cells. The immunomodulatory effects, such as activation and regulation of T cells, are consistent with a putative improvement in infectious immunosurveillance. An increase in the number of T cells and CD4/CD8-positive cells indicates an enhanced ability to protect against infection. HET and KKT may prevent the onset or worsening of COVID-19 through their immunomodulatory effects.
The Contribution of Dietary Fructose to Non-alcoholic Fatty Liver Disease
Authors: Yu Siyu , Li Chunlin , Ji Guang , Zhang Li
Published: November 2021

Fructose, especially industrial fructose (sucrose and high fructose corn syrup) is commonly used in all kinds of beverages and processed foods. Liver is the primary organ for fructose metabolism, recent studies suggest that excessive fructose intake is a driving force in non-alcoholic fatty liver disease (NAFLD). Dietary fructose metabolism begins at the intestine, along with its metabolites, may influence gut barrier and microbiota community, and contribute to increased nutrient absorption and lipogenic substrates overflow to the liver. Overwhelming fructose and the gut microbiota-derived fructose metabolites (e.g., acetate, butyric acid, butyrate and propionate) trigger thede novolipogenesis in the liver, and result in lipid accumulation and hepatic steatosis. Fructose also reprograms the metabolic phenotype of liver cells (hepatocytes, macrophages, NK cells, etc.), and induces the occurrence of inflammation in the liver. Besides, there is endogenous fructose production that expands the fructose pool. Considering the close association of fructose metabolism and NAFLD, the drug development that focuses on blocking the absorption and metabolism of fructose might be promising strategies for NAFLD. Here we provide a systematic discussion of the underlying mechanisms of dietary fructose in contributing to the development and progression of NAFLD, and suggest the possible targets to prevent the pathogenetic process.
Transcriptome and microRNA Sequencing Identified miRNAs and Target Genes in Different Developmental Stages of the Vascular Cambium in Cryptomeria fortunei Hooibrenk
Authors: Hu Hailiang , Guo Zhenhao , Yang Junjie , Cui Jiebing , Zhang Yingting , Xu Jin
Published: November 2021

Cryptomeria fortunei Hooibrenk is an important fast-growing coniferous timber species that is widely used in landscaping. Recently, research on timber quality has gained substantial attention in the field of tree breeding. Wood is the secondary xylem formed by the continuous inward division and differentiation of the vascular cambium; therefore, the development of the vascular cambium is particularly important for wood quality. In this study, we analyzed the transcriptomes of the cambial zone in C. fortunei during different developmental stages using Illumina HiSeq sequencing, focusing on general transcriptome and microRNA (miRNA) data. We performed functional annotation of the differentially expressed genes (DEGs) in the different stages identified by transcriptome sequencing and generated 15 miRNA libraries yielding 4.73 Gb of clean reads. The most common length of the filtered miRNAs was 21nt, accounting for 33.1% of the total filtered reads. We annotated a total of 32 known miRNA families. Some miRNAs played roles in hormone signal transduction (miR159, miR160, and miR166), growth and development (miR166 and miR396), and the coercion response (miR394 and miR395), and degradome sequencing showed potential cleavage sites between miRNAs and target genes. Differential expression of miRNAs and target genes and functional validation of the obtained transcriptome and miRNA data provide a theoretical basis for further elucidating the molecular mechanisms of cellular growth and differentiation, as well as wood formation in the vascular cambium, which will help improve the wood quality of C. fortunei.
The Endoplasmic Reticulum Role in the Plant Response to Abiotic Stress
Authors: Reyes-Impellizzeri Sofía , Moreno Adrian A.
Published: November 2021

The endoplasmic reticulum (ER) is the organelle where one third of the proteins of a cell are synthetized. Several of these proteins participate in the signaling and response of cells, tissues, or from the organism to the environment. To secure the proper synthesis and folding of these proteins, or the disposal of unfolded or misfolded proteins, the ER has different mechanisms that interact and regulate each other. These mechanisms are known as the ER quality control (ERQC), ER-associated degradation (ERAD) and the unfolded protein response (UPR), all three participants of the maintenance of ER protein homeostasis or proteostasis. Given the importance of the client proteins of these ER mechanisms in the plant response to the environment, it is expected that changes or alterations on their components have an impact on the plant response to environmental cues or stresses. In this mini review, we focus on the impact of the alteration of components of ERQC, ERAD and UPR in the plant response to abiotic stresses such as drought, heat, osmotic, salt and irradiation. Also, we summarize findings from recent publications looking for a connection between these processes and their possible client(s) proteins. From this, we observed that a clear connection has been established between the ERAD and UPR mechanisms, but evidence that connects ERQC components to these both processes or their possible client(s) proteins is still lacking. As a proposal, we suggest the use of proteomics approaches to uncover the identity of these proteins and their connection with ER proteostasis.
The Physiological Effect of a Holoparasite Over a Cactus Along an Environmental Gradient
Authors: Ossa Carmen Gloria , Aros-Mualin Daniela , Mujica María Isabel , Pérez Fernanda
Published: November 2021

Echinopsis chiloensis is an endemic cactus from Chile, distributed in a temperature and rainfall gradient between 30° and 35° South latitude, with mean temperatures increasing and precipitation decreasing toward the north. It is the main host of the mistletoe Tristerix aphyllus, a holoparasite completely dependent on the cactus for water, carbon, and minerals. In this study, we investigated the consequences of parasitism over the fitness and physiology of this cactus throughout its distribution range and how it is affected by the environment. We measured five functional traits in eight populations latitudinally distributed, the first three only for the host: reproductive fitness, stomatal traits (density and size), and photosynthesis (during winter and summer); and the last two for the host and parasite: stable isotopes (∂13C and ∂15N), and nutrients (carbon and nitrogen content). The results showed a negative effect of parasitism over fitness of infected cacti. However, the higher nitrogen concentrations in cactus tissues toward the south improved overall fitness. Regarding photosynthesis, we only observed a negative effect of parasitism during the dry season (summer), which is also negatively affected by the increase in summer temperatures and decrease in winter rainfall toward the north. There were no differences in nutrient concentration or in the isotopic signature of healthy and infected cacti. Conversely, we observed a higher carbon and lower nitrogen concentration in mistletoes than in cacti regardless of latitude. The loss of temperature seasonality toward the north increases the C:N ratio, and the values between the parasite and its host diverge. ∂15N was similar between parasites and hosts while ∂13C of the parasite was enriched when compared to its host. Overall, the infection by T. aphyllus affects Echinopsis chiloensis fitness but showed no strong effects over the cactus physiology, except for the summer photosynthesis. Therefore, our data revealed that E. chiloensis response to T. aphyllus infection is sensitive to environmental changes in a way that could be strongly impacted by the desertification projected for this area due to climate change.
Interpretation Bias in Breast Cancer Survivors Experiencing Fear of Cancer Recurrence
Authors: Tuman Malwina , Roberts Kailey E. , Corner Geoffrey , Beard Courtney , Fadalla Carol , Coats Taylor , Slivjak Elizabeth , Schofield Elizabeth , Lichtenthal Wendy G.
Published: November 2021

Introduction: Fear of cancer recurrence (FCR) is a prevalent and persistent challenge that many cancer survivors endure. While the role of interpretation bias, a tendency to perceive ambiguous situations as threatening, has been established in the onset and maintenance of FCR, few studies have examined cancer-related interpretation bias specifically. Grounded in the cognitive formulation of FCR, the current study aimed to fill this gap by investigating the relationship between cancer-related interpretation bias, FCR, and somatic symptoms, and examining whether bias mediates the relationship between somatic symptoms and FCR.

Materials and Methods: This study used baseline data from a randomized controlled trial of a cognitive bias modification intervention. Breast cancer survivors (n = 110) provided demographic and medical background information as well as self-report measures of FCR and severity of somatic symptoms. A computer-based assessment of interpretation bias was used to measure cancer-related interpretation bias on several bias indices: percentage of cancer-related threat endorsement, and percentage of benign endorsement; mean reaction time (RT) for threat, and mean RT for benign endorsement.

Results: Higher threat endorsement was linked to higher Overall Fear and emerged as a mediator of the relationship between overall somatic symptoms and Overall Fear. We also found that older age was related to longer benign endorsement RT.

Conclusion: This study contributes understanding of factors related to cancer-related interpretation bias and provides evidence that bias may influence the relationship between somatic symptoms and FCR in cancer survivors.
Analyzing the Stressors for Frontline Soldiers Fighting Against Coronavirus Disease 2019 Pandemic
Authors: Shaukat Muhammad Zeeshan , Scholz Miklas , Qazi Tehmina Fiaz , Niazi Abdul Aziz Khan , Basit Abdul , Mahmood Asif
Published: November 2021

This study aimed to analyze stressors to which medical staff is vulnerable due to the coronavirus disease 2019 (COVID-19) pandemic. It also imposes a hierarchy on complex relations among stressors for excavating underlying structure and builds a model of interrelationships contrasting reality. The design of this study comprises a literature survey, data collection from primary sources, and analysis. Stressors have been explored from within current published/unpublished literature and validated by experts through approval vote. Data were collected from the focus group (panel of experts), and interpretive structural modeling (ISM) was used as the research methodology. Findings of ISM are avowed through “cross-impact matrix multiplication applied to classification” (MICMAC) analysis. As a result of the literature survey, a list of stressors was generated, and a total of 19 stressors qualified as representative of the phenomenon. The results of ISM show that two stressors (i.e., “unavailability of proper personal protective equipment (PPE)” and “lack of proper communication”) emerged as the most critical stressors since they occupy the bottom of the model, whereas, four stressors (i.e., “anxious about isolation/quarantine,” “subject to violent crimes,” “feeling frustrated and powerless,” and “exhausting shifts/hours without clear end”) are relatively less critical since they occupy the top of the model. The rest of the stressors occupy the middle of the model and therefore, have moderate-severe effects on frontline soldiers. The results of MICMAC show that the stressor “subject to violent crimes” is classified in the dependent cluster and the remaining fall in the linkage cluster but no stressor falls in independent and autonomous. Overall results indicate that all stressors are relevant to the phenomenon under this study, but they are currently not settled. This study is invaluable for policymakers, frontline soldiers, researchers, the international community, and society since it provides a lot of new information that is helpful in refining strategies and combating influential stressors.
Defining Spirituality in Healthcare: A Systematic Review and Conceptual Framework
Authors: de Brito Sena Marina Aline , Damiano Rodolfo Furlan , Lucchetti Giancarlo , Peres Mario Fernando Prieto
Published: November 2021

Objective: To investigate the definitions of spirituality in the healthcare field, identifying its main dimensions and proposing a framework that operationalizes the understanding of this concept.

Methods: This is a systematic review following the PRISMA guideline (PROSPERO: CRD42021262091), searching for spirituality definitions published in scientific journals. Searches were carried out in PubMed (all articles listed up to October 2020) and in the reference lists of the articles found in the database, followed by selection under specific eligibility criteria.

Results: From a total of 493 articles, 166 were included in the final analysis, showing that there is a large body of scientific literature proposing and analyzing spirituality definitions. In these articles, 24 spirituality dimensions were found, most commonly related to the connectedness and meaning of life. Spirituality was presented as a human and individual aspect. These findings led us to construct a framework that represents spirituality as a quantifiable construct.

Conclusions: Understanding spirituality is an important aspect for healthcare research and clinical practice. This proposed framework may help to better understand the complexity of this topic, where advances are desirable, given the relevance it has acquired for integral health care.
iCCareD: The Development of an Algorithm to Identify Factors Associated With Distress Among Caregivers of Children and Youth Referred for Mental Health Services
Authors: Stewart Shannon L. , Toohey Ashley , Poss Jeffrey W.
Published: November 2021

Caregiver well-being plays an important role in children's development and a number of factors have been found to impact distress levels among caregivers of children and youth referred for mental health services. Further, caregiver distress impacts youth psychopathology, its acuity as well as related mental health interventions. The purpose of this study was to develop and validate an algorithm for identifying caregivers who are at greatest risk of experiencing caregiver distress. This algorithm was derived from, and will be embedded in, existing comprehensive interRAI child and youth instruments. Ontario data based on the interRAI Child and Youth Mental Health assessment instruments (ChYMH and ChYMH-DD) were analyzed to identify predictors of distress among caregivers of children and youth ages 4–18 years. Starting with proactive aggression, the algorithm uses 40 assessment items to assign one of 30 nodes that are grouped into five levels of risk. The interRAI ChYMH Caregiver Distress (iCCareD) algorithm was validated using longitudinal data from mental health agencies across Ontario and was found to be a good predictor among this sample with a c-statistic of 0.71 for predicting new or ongoing caregiver distress and 65% for both sensitivity and specificity using algorithm values of 3 or greater. This algorithm provides an evidence-based decision-support tool embedded within a comprehensive assessment tool that may be used by clinicians to inform their selection of supports and services for families.
Sociodemographic Correlates of Organized Sports Participation in a Sample of Middle School Students in China
Authors: Ren Tao , Yan Jin , Sun Qiang
Published: November 2021

Background: Organized sport participation (OSP) is considered as one method with the potential to increase overall physical activity (PA) levels in young people. It is essential to understand the correlates of OSP to inform future PA interventions.

Purpose: This study aimed to explore the sociodemographic correlates of OSP among middle school students from the Nanjing City of China.

Methods: A total of 7,097 adolescents (50.1% girls) aged 12–15 years from Nanjing, China, were recruited in this survey. Self-reported data on sex, grade, race, residence areas, proficient sport skills, and parental highest education were obtained. OSP was assessed by the question asked in the questionnaire on whether participants were involved in any “sports club or team” with the binary answer options of “yes” and “no,” for statistical analysis purposes. Generalized linear models were used to determine the correlates of OSP.

Results: Only 16.6% reported participating in any organized sport over the past whole year, while boys (OR = 1.34, 95% CI: 1.18–1.53) and 7th graders (OR = 1.40, 95% CI: 1.18–1.65) were more likely to participate in organized sport. Adolescents being Han ethnicity were less likely to either participate in organized sport (OR = 0.60, 95% CI: 0.40–0.92), or masterless (one or two) proficient sport skills [OR (one) = 0.27, 95%CI: 0.20–0.37; OR (two) = 0.43, 95% CI: 0.36–0.50]. Besides, both residence area and parental highest education were not significantly associated with OSP among the participating adolescents.

Conclusion: The current study confirmed that only one-sixth of adolescents participate in the organized sport over the past year. At-risk population subgroups include girls, older adolescents, being Han ethnicity, and those proficient in fewer sport skills. Sex, grades, race, and proficient sport skills were significant correlates of OSP. School, community, and families need to provide more resources and support for disadvantaged populations in OSP.
Knowledge and Challenges Associated With Hearing Impairment in Affected Individuals From Cameroon (Sub-Saharan Africa)
Authors: Wonkam-Tingang Edmond , Kengne Kamga Karen , Adadey Samuel Mawuli , Nguefack Seraphin , De Kock Carmen , Munung Nchangwi Syntia , Wonkam Ambroise
Published: November 2021

Background: This study aimed to gain an understanding of the challenges faced by people with hearing impairment (HI) in Cameroon, their understanding of the causes of HI, and how challenges could be remedied to improve the quality of life of persons with HI.

Methods: Semi-structured one-on-one in-depth interviews and observation of participant behaviour when answering questions were used to collect data from 10 HI professionals (healthcare workers and educationists), and 10 persons affected by HI (including caregivers).

Results: The results show that the different groups associate the causes of HI to genetics, environmental factors, and a spiritual curse. There were reported cases of stigma and discrimination of persons with HI, with people sometimes referring to HI as an “intellectual disorder.” Interviewees also highlighted the difficulty persons with HI have in accessing education and healthcare services and suggested the need for the government and health researchers to develop strategies for the prevention and early diagnosis of HI. These strategies include (1) the awareness of the general population regarding HI, (2) the development of facilities for the proper management and new-born screening of HI, and (3) the implementation of a premarital screening to reduce the burden of HI of genetic origin.

Conclusions: This study confirms the difficult social interaction and access to proper management faced by persons with HI in Cameroon and further highlights the need to educate populations on the causes of HI for a better acceptance of individuals with HI in the Cameroonian society.
Visitors' Perceptions of Urban Green Spaces: A Study of Lisbon's Alameda and Estrela Parks
Authors: Viebrantz Petra , Fernandes-Jesus Maria
Published: November 2021

Urban Green Spaces (UGSs) play a key role in people's well-being, particularly in highly urbanized contexts and possess several elements that may be attractive to visitors. This study focuses on the views and perceptions of visitors of two UGSs located in Lisbon and aimed to determine how they evaluated two different green spaces (Estrela Park and Alameda Park) in terms of physical/natural characteristics, structures, accessibility, surrounding areas, motives for use and importance. Secondly, it sought to explore how people evaluate UGSs in Lisbon in terms of quality and quantity. A total of 188 people responded to a questionnaire composed of close-and open-ended questions. The study revealed that Estrela Park was more valued for its green space characteristics and conservation aspects than accessibility and sports adaptability. Participants visited Estrela Park for its landscape and restful environment and considered the park important to their lives. Although they visited Estrela Park less often, they stayed longer compared to those who visited Alameda Park. Furthermore, regarding the participants' overall perceptions of the UGSs in Lisbon, many participants mentioned the need for more parks and wanted better preservation and distribution around the city. Most importantly, they valued these spaces and believed that UGS helped them to feel more relaxed and balanced, facilitating socialization, recreation and physical activities. In conclusion, this study suggests that green and quiet urban parks in Lisbon are valued by the city's population but they would like to see regular maintenance/cleaning as well as the provision of leisure activities.
Building a Global Food Systems Typology: A New Tool for Reducing Complexity in Food Systems Analysis
Authors: Marshall Quinn , Fanzo Jessica , Barrett Christopher B. , Jones Andrew D. , Herforth Anna , McLaren Rebecca
Published: November 2021

Food systems have a profound impact on diets, nutrition, health, economic development, and environmental sustainability. Yet their complexity poses a persistent challenge in identifying the policy actions that are needed to improve human and planetary health outcomes. Typologies are a useful classification tool to identify similarities and differences among food systems, while reducing this analytical complexity. This study presents a new food system typology, implemented at the country level using parsimonious data that characterize food supply chains, food environments, consumer-related factors, and key outcomes, including dietary intake, nutritional status, health, and environmental impacts. Five food system types are identified: rural and traditional; informal and expanding; emerging and diversifying; modernizing and formalizing; and industrial and consolidated. Patterns across the five system types in key outcome variables align with narratives provided by the food systems and nutrition transition literature, demonstrating the usefulness of this classification method. Substantial heterogeneity nonetheless still exists within individual food system types. Therefore, the recommended use of the typology is in early stages of hypothesis generation, to identify potential risk factors or constraints in the food system that can be explored further at national and sub-national levels.
Adapting to Climate Change Through Conservation Agriculture: A Gendered Analysis of Eastern Zambia
Authors: Umar Bridget Bwalya
Published: November 2021

This study explored the use of conservation agriculture (CA) as a climate adaptation strategy among smallholder farmers in Eastern Zambia. Using 761 household interviews and 33 focus group discussions (FGDs) with smallholder farmers from six districts, data was collected on how smallholder farmers in the region experience climate change, what CA practices they had adopted, and benefits and challenges associated with CA practice. Results show that men and women farmers had similar experiences of climate change, namely late onset of a shortened rainy season, intra-seasonal drought and higher temperatures. Farmers' perceptions of gender-mediated effects of climate change had important nuances. The three most cited effects of climate change on women mentioned by women were lower crop yields, outbreaks of armyworms and reduced livestock fodder. The men thought women were most affected by increased hunger, lower crop yields and reduced domestic water sources. According to the women FGDs, men were most affected through reduced crop yields, increases in livestock diseases and increased hunger. The men self-reported reduced crop yields, reduced water for livestock and outbreaks of armyworms. Both men and women saw CA as having climate change adaptation benefits. For the women, men most benefitted from CA through the high moisture holding capacity of basins, higher crop yields and reduced labor requirements through use of oxen ripping. The men most appreciated the high crop yields, improved soil fertility and reduced costs as less fertilizer is used. The women cited the high moisture holding capacity of basins, high crop yields and improved soil fertility as benefits they most commonly derived from CA, while the men thought the women most benefitted from CA through the higher crop yields, improved soil fertility and crop tolerance to droughts. The study concludes that there is room for CA to serve as a climate smart agricultural system for both men and women smallholder farmers in Eastern Zambia. However, this will require addressing important challenges of high weed pressure, high labor demands, and low access to manure, and CA farming implements. The CA package for Zambia should include access to timely climate information and climate informed crop choices.
Indicators of Health-Related Quality of Life in Cats With Degenerative Joint Disease: Systematic Review and Proposal of a Conceptual Framework
Authors: Yeowell Gillian , Burns Danielle , Fatoye Francis , Gebrye Tadesse , Wright Andrea , Mwacalimba Kennedy , Odeyemi Isaac
Published: November 2021

Objectives: The assessment of health-related quality of life (HRQoL) is becoming increasingly important in companion animals. This study describes a systematic review and development of a proposed conceptual framework to assess HRQoL in cats with osteoarthritis (OA).

Methods: The conceptual framework was developed according to published guidelines. A comprehensive search of the CAB Direct, Scopus, PubMed, and Web of Science databases was carried out for publications in English from inception to November 12, 2019. Search words used were “cat”, “feline”, “chronic pain”, “pain”, and “quality of life”. Publications were selected if they were full-text and peer-reviewed, based on primary data, and identified or measured behavioral symptoms of chronic musculoskeletal pain in cats. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A data extraction form was developed from categories identified in the literature review and piloted on a small number of studies to ascertain the appropriateness for relevant data extraction. Categories were then finalized, and key domains were identified. The domains were then synthesized to develop a conceptual framework.

Results: A total of 454 studies were identified, of which 14 met the eligibility criteria and were included in the meta-synthesis. All 14 were assessed to be of good quality. Seven domains related to HRQoL in cats with OA were thematically identified from the data: mobility, physical appearance, energy and vitality, mood, pain expression, sociability, and physical and mental wellbeing. The three main HRQoL domains were pain expression, mobility, and physical and mental wellbeing, which impacted all the others. Pain and mobility impacted all six other domains, with increased pain and decreased mobility negatively impacting physical appearance, energy and vitality, mood, sociability, and physical and mental wellbeing.

Conclusions and Relevance: This is the first study to develop an evidence-based conceptual framework for the assessment of HRQoL in cats with OA. The proposed conceptual framework suggests that effective management of chronic pain in cats may improve their overall HRQoL.