bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral Health Needs and Barriers among Children in Saudi Arabia
Authors: Sabbagh Heba Jafar , Aljehani Sarah Abdullah , Abdulaziz Bayan Mohammed , Alshehri Nada Zafer , Bajkhaif Maryam Omar , Alrosini Shatha Khalid , Al-Amoudi Reham Mohammed , Elkhodary Heba Mohamed
Published: October 2022

(1) Background: Understanding oral health needs and barriers is important to overcome the oral disease burden, especially after the COVID-19 pandemic. The aim of this study was to assess oral health needs and barriers among Saudi children after the COVID-19 pandemic wave started. (2) Methods: Parents of healthy children aged 3–11 years from five regions of Saudi Arabia were surveyed using an electronically administered validated questionnaire from Febuary-2021 to July-2021. Oral lesions/manifestations during the last 12 months reported by parents included tooth discoloration, ulcers, abscess, swelling of the gingiva, halitosis, gingival bleeding, dry mouth, pain while eating, difficulty in speaking or eating, burning sensation, and white spots. Barriers were assessed according to the WHO Oral Health Questionnaire. (3) Results: Children experiencing toothaches were reported by 1098 (72.4%) respondents. When reported, oral manifestations and lesions were associated with a higher inability to visit a dentist (p < 0.001). Barriers to dental care were more frequent among parents with lower education (p < 0.001; adjusted-odds ratio (AOR), 1.815) and a greater number of children (p < 0.001; AOR, 1.197). (4) Conclusion: Parents reported a high frequency of unmet oral health needs. Education could play an important role in improving oral health care in children and as a predictor of public health concerns.
The Impact of China’s Legal System on Public Health and Quality of Life during the COVID-19 Pandemic: An Empirical Study
Authors: Duan Weiwei , Qin Tianbao
Published: October 2022

(1) Background: During the COVID-19 pandemic, the methods used to ensure the quality of public health and life changed. This study used empirical research methods to analyze the development of China’s legal system during the COVID-19 pandemic and its impact on the quality of public health and life and to clarify its importance in ensuring the quality of public health and life. (2) Materials and Methods: This study analyzed the development of China’s rule of law system during the COVID-19 pandemic by using two authoritative databases, the Peking University Magic Key Database and the China Judicial Documents Network, and examined the scope of public health and quality of life under this system. (3) Results: During the COVID-19 pandemic, China’s rule of law system, with the main objective of controlling the pandemic, developed rapidly, effectively ensuring the quality of public health and life in different areas. As part of this system, the administrative activities of government departments played a key role. (4) Conclusions: During the period of the COVID-19 pandemic, China’s legal system protected the quality of public health and life from the impact of the pandemic in many areas. Meanwhile, along with the important role of government administrative law enforcement activities in the prevention and control of a pandemic, the quality of public health and life should also be protected against illegal administrative acts in the future.
Health Care Accessibility and Breast Cancer Mortality in Europe
Authors: Ciuba Agata , Wnuk Katarzyna , Nitsch-Osuch Aneta , Kulpa Marta
Published: October 2022

Background: Breast cancer is the most common cause of death, due to malignant neoplasms in women worldwide. The nature of the symptoms associated with breast cancer depends on the stage of the disease. In this case, any cancerous changes in the initial phase of the disease can only be detected during imaging tests. Participation in mammography screening can reduce breast cancer mortality by up to 40%, if only 70% of the eligible population participates in preventive programs. The purpose of the study was to assess the impact of accessibility to health care resources on breast cancer mortality. Methods: Eurostat aggregated health care data was extracted. Hierarchical cluster analysis of average breast cancer mortality identified four groups of countries with similar mortality rates and trends. The data was then analyzed, in terms of access to health care. Results: It was observed that the higher the financial expenditure on health care and the better the health care accessibility, the lower the mortality rates of breast cancer. Conclusions: There are examples indicating that the studied elements are not the only factors affecting the improvement of population health. The authors would like to emphasize the need to influence lifestyle factors, direct cancer risk, and introduce a multidisciplinary approach to breast cancer prevention.
Relationship between Oral Health Status and Oropharyngeal Dysphagia in Older People: A Systematic Review
Authors: Drancourt Noemie , El Osta Nada , Decerle Nicolas , Hennequin Martine
Published: October 2022

The purpose of this review is to investigate the relationship between oral health status and oropharyngeal dysphagia (OD) in older people and to collect a list of oral health indicators that can enable carers and health professionals to screen for risk of dysphagia in older people during oral examinations. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P 2015) guidelines. The analysis methods and inclusion criteria were documented in a protocol published in the Prospective International Register of Systematic Reviews (PROSPERO) under the registration number CRD42020140458. A total of 19 articles published between 2002 and 2020 were retained by the search criteria for the qualitative synthesis. Eighteen studies demonstrated at least one positive association between an oral health component (dental, salivary and/or muscular) and dysphagia. This review highlights that oral health and OD are associated but was not able to determine causality. The lack of scientific evidence could be explained by the observational approach of the majority of the studies and the irrelevant choice of oral health indicators. A relationship may exist between oral health and dysphagia, but this review highlights the lack of valid and standardized oral health indicators that would be needed to assess the impact of oral health on the overall health status of individuals.
Does the Establishment of National New Areas Improve Urban Ecological Efficiency? Empirical Evidence Based on Staggered DID Model
Authors: Wang Jingbin , Qiao Huiling , Liu Jing , Li Bo
Published: October 2022

The environmental effects of national new areas have been an important topic but received little attention in academia. This study conducts a quasi-natural experiment using panel data of China’s 282 prefecture-level cities from 2006 to 2019, and evaluates the establishment of national new areas on urban ecological efficiency using the staggered difference-in-difference (DID) method, tests the robustness, and further examines the influential mechanism and urban heterogeneity of the empirical results. The results show that the establishment of national new areas has significantly improved urban eco-efficiency. Moreover, the mechanism analysis of the influences shows that national new areas improve urban eco-efficiency by improving urbanization level and urban transportation infrastructure. In addition, the heterogeneity analysis of cities shows that national new areas of cities in eastern and central regions are both significantly improving urban eco-efficiency, while those in western and northeastern regions are not. Furthermore, the promotion effect in the regions of “one new area in one city” model is better than that in “one new area in two cities” model; national new areas in non-resource-based cities show more positive effects on promoting urban eco-efficiency than those in resource-based cities. The conclusions reliably evaluate the results of the current construction of national new areas and provide feasible suggestions for further implementation of the related policy to balance economic development and environmental protection.
A Comparison of Bioimpedance Analysis vs. Dual X-ray Absorptiometry for Body Composition Assessment in Postpartum Women and Non-Postpartum Controls
Authors: Garr Barry Valene , Martin Samantha L. , Chandler-Laney Paula , Carter Ebony B. , Worthington Camille S.
Published: October 2022

Postpartum fat mass (FM) and fat-free mass (FFM) may be informative predictors of future disease risk among women; hence, there is growing use of bioelectrical impedance analysis (BIA) to quantify FFM and FM among postpartum women due to the quick, non-invasive, and inexpensive nature of BIA. Despite this, very few studies have examined BIA’s performance, and it remains unclear as to whether specific BIA equations are needed for postpartum women. To explore these questions, we measured total body FFM and FM with a multi-frequency, segmental BIA, and dual-X-ray absorptiometry (DXA) in (1) women at one and four months postpartum (n = 21); and (2) height- and weight-matched non-postpartum women (controls, n = 21). BIA was compared to DXA using Deming regression models, paired t-tests, and Bland–Altman plots. Between-group comparisons were performed using an analysis of variance models. The mean difference between DXA and BIA was 1.2 ± 1.7 kg FFM (p < 0.01) and −1.0 ± 1.7 kg FM (p < 0.05) in postpartum women at both time points. The measurements of longitudinal changes in FFM and FM were not significantly different between BIA and DXA. Furthermore, there was no significant difference in BIA’s performance in postpartum vs. non-postpartum women (p = 0.29), which suggests that population-specific equations are not needed for postpartum women. The results of this study suggest that BIA is a suitable method to assess postpartum body composition among women at one and four months postpartum, using existing age-, race-, and sex-adjusted equations.
The Use of Mobile Health Interventions for Outcomes among Middle-Aged and Elderly Patients with Prediabetes: A Systematic Review
Authors: Jeem Yaltafit Abror , Andriani Russy Novita , Nabila Refa , Emelia Dwi Ditha , Lazuardi Lutfan , Koesnanto Hari
Published: October 2022

Background: There are currently limited systematic reviews of mobile health interventions for middle-aged and elderly patients with prediabetes from trial studies. This review aimed to gather and analyze information from experimental studies investigating the efficacy of mobile health usability for outcomes among middle-aged and elderly patients with prediabetes. Methods: We conducted a literature search in five databases: Clinicaltrials.gov, the International Clinical Trials Registry Platform (ICTRP), PubMed, ProQuest, and EBSCO, with a date range of January 2007 to July 2022 written in English, following a registered protocol on PROSPERO (CRD42022354351). The quality and possibility of bias were assessed using the Jadad score. The data extraction and analysis were conducted in a methodical manner. Results: A total of 25 studies were included in the qualitative synthesis, with 19 studies using randomized trial designs and 6 studies with non-randomized designs. The study outcomes were the incidence of diabetes mellitus, anthropometric measures, laboratory examinations, measures of physical activity, and dietary behavior. During long-term follow-up, there was no significant difference between mobile health interventions and controls in reducing the incidence of type 2 diabetes. The findings of the studies for weight change, ≥3% and ≥5% weight loss, body mass index, and waist circumference changes were inconsistent. The efficacy of mobile health as an intervention for physical activity and dietary changes was lacking in conclusion. Most studies found that mobile health lacks sufficient evidence to change hbA1c. According to most of these studies, there was no significant difference in blood lipid level reduction. Conclusions: The use of mobile health was not sufficiently proven to be effective for middle-aged and elderly patients with prediabetes.
Topological Access Methods for Spatial and Spatiotemporal Data
Authors: Jahn Markus Wilhelm , Bradley Patrick Erik
Published: October 2022

In order to perform topological queries on geographic data, it is necessary to first develop a topological access method (TOAM). Using the fact that any (incidence or other binary) relation produces a topology which includes the common usage of topology for spatial or spatiotemporal data, here, such a TOAM is developed on the basis of the previously applied concept of Property Graph used in order to manage topological information in data of any dimension, whether time dependent or not. As a matter of fact, it is necessary to have a TOAM in order to query such a graph, and also to have data which are topologically consistent in a certain sense. While the rendering of topological consistency was the concern of previous work, here, the aim is to develop a methodology which builds on this concept. In the end, an experimental test of this approach on a small city model is performed. It turned out that the Euler characteristic, a well-known topological invariant, can be helpful for the initial data validation. Practically, this present theoretical work is seen to be necessary in view of future innovative applications, e.g., in the context of city model simulations, including distributed geo-processing.
Predisposing Factors, Clinical Picture, and Outcome of B-Cell Non-Hodgkin’s Lymphoma in Sjögren’s Syndrome
Authors: Stergiou Ioanna E. , Goules Andreas V. , Voulgarelis Michael , Tzioufas Athanasios G.
Published: October 2022

Among other systemic autoimmune diseases, primary Sjögren syndrome (pSS) bears the highest risk for lymphoma development. In pSS, chronic antigenic stimulation gradually drives the evolution from polyclonal B-cell expansion to oligoclonal/monoclonal B-cell predominance to malignant B-cell transformation. Thus, most pSS-related lymphomas are B-cell non-Hodgkin lymphomas (NHLs), with mucosa-associated lymphoid tissue (MALT) lymphomas predominating, followed by diffuse large B-cell lymphomas (DLBCLs) and nodal marginal zone lymphomas (NMZLs). Since lymphomagenesis is one of the most serious complications of pSS, affecting patients’ survival, a plethora of possible predisposing factors has been studied over the years, ranging from classical clinical, serological, hematological, and histological, to the more recently proposed genetic and molecular, allowing clinicians to timely detect and to closely follow-up the subgroup of pSS patients with increased risk for lymphoma development. Overall predisposing factors for pSS-related lymphomagenesis reflect the status of B-cell hyperactivity. Different clinical features have been described for each of the distinct pSS-related B-cell NHL subtypes. While generally pSS patients developing B-cell NHLs display a fairly good prognosis, outcomes in terms of treatment response and survival rates seem to differ depending on the lymphoma subtype, with MALT lymphomas being characterized by a rather indolent course and DLBCLs gravely affecting patients’ survival.
Deep Cross-Dimensional Attention Hashing for Image Retrieval
Authors: Chao Zijian , Li Yongming
Published: October 2022

Nowadays, people’s lives are filled with a huge amount of picture information, and image retrieval tasks are widely needed. Deep hashing methods are extensively used to manage such demands due to their retrieval rate and memory consumption. The problem with conventional deep hashing image retrieval techniques, however, is that high dimensional semantic content in the image cannot be effectively articulated due to insufficient and unbalanced feature extraction. This paper offers the deep cross-dimensional attention hashing (DCDAH) method considering the flaws in feature extraction, and the important points of this paper are as follows. This paper proposes a cross-dimensional attention (CDA) module embedded in ResNet18; the module can capture the cross-dimension interaction of feature maps to calculate the attention weight effectively because of its special branch. For a feature map acquired by a convolutional neural network (CNN), each branch takes different rotation measurements and residual transformations to process it. To prevent the DCDAH model from becoming too complex, the CDA module is designed to have the characteristics of low computational overhead. This paper introduces a scheme to reduce the dimension of tensors, which can reduce computation and retain abundant representation. For a dimension of a feature map, the Maxpool and Avgpool are performed, respectively, and the two results are connected. The DCDAH method significantly enhances image retrieval performance, according to studies on the CIFAR10 and NUS-WIDE data sets.
Association of Health Status Metrics with Clinical Outcomes in Patients with Adult Congenital Heart Disease and Atrial Arrhythmias
Authors: Baroutidou Amalia , Kartas Anastasios , Papazoglou Andreas S. , Kosmidis Diamantis , Moysidis Dimitrios V. , Otountzidis Nikolaos , Doundoulakis Ioannis , Despotopoulos Stefanos , Vrana Elena , Koutsakis Athanasios , Rampidis Georgios P. , Ntiloudi Despoina , Liori Sotiria , Avramidis Dimosthenis , Karagiannidis Efstratios , Nikolopoulos Theodoros Thomas , Apostolopoulou Sotiria , Frogoudaki Alexandra , Tzifa Afrodite , Karvounis Haralambos , Giannakoulas George
Published: October 2022

The prognostic value of health status metrics in patients with adult congenital heart disease (ACHD) and atrial arrhythmias is unclear. In this retrospective cohort study of an ongoing national, multicenter registry (PROTECT-AR, NCT03854149), ACHD patients with atrial arrhythmias on apixaban are included. At baseline, health metrics were assessed using the physical component summary (PCS), the mental component summary (MCS) of the Short-Form-36 (SF-36) Health Survey, and the modified European Heart Rhythm Association (mEHRA) score. Patients were divided into groups according to their SF-36 PCS and MCS scores, using the normalized population mean of 50 on the PCS and MCS as a threshold. The primary outcome was the composite of mortality from any cause, major thromboembolic events, major/clinically relevant non-major bleedings, or hospitalizations. Multivariable Cox-regression analyses using clinically relevant parameters (age greater than 60 years, anatomic complexity, ejection fraction of the systemic ventricle, and CHA₂DS₂-VASc and HAS-BLED scores) were performed to examine the association of health metrics with the composite outcome. Over a median follow-up period of 20 months, the composite outcome occurred in 50 of 158 (32%) patients. The risk of the outcome was significantly higher in patients with SF-36 PCS ≤ 50 compared with those with PCS > 50 (adjusted hazard ratio (aHR), 1.98; 95% confidence interval [CI], 1.02–3.84; p = 0.04) after adjusting for possible confounders. The SF-36 MCS ≤ 50 was not associated with the outcome. The mEHRA score was incrementally associated with a higher risk of the composite outcome (aHR = 1.44 per 1 unit increase in score; 95% CI, 1.03–2.00; p = 0.03) in multivariable analysis. In ACHD patients with atrial arrhythmias, the SF-36 PCS ≤ 50 and mEHRA scores predicted an increased risk of adverse events.
Randomized Controlled Trials on Renin Angiotensin Aldosterone System Inhibitors in Chronic Kidney Disease Stages 3–5: Are They Robust? A Fragility Index Analysis
Authors: Capuano Ivana , Buonanno Pasquale , Riccio Eleonora , Bianco Antonio , Pisani Antonio
Published: October 2022

Inhibition of the renin-angiotensin-aldosterone system (RAAS) is broadly recommended in many nephrological guidelines to prevent chronic kidney disease (CKD) progression. This work aimed to analyze the robustness of randomized controlled trials (RCTs) investigating the renal and cardiovascular outcomes in CKD stages 3–5 patients treated with RAAS inhibitors (RAASi). We searched for RCTs in MEDLINE (PubMed), EMBASE databases, and the Cochrane register. Fragility indexes (FIs) for every primary and secondary outcome were calculated according to Walsh et al., who first described this novel metric, suggesting 8 as the cut-off to consider a study robust. Spearman coefficient was calculated to correlate FI to p value and sample size of statistically significant primary and secondary outcomes. Twenty-two studies met the inclusion criteria, including 80,455 patients. Sample size considerably varied among the studies (median: 1693.5, range: 73–17,276). The median follow-up was 38 months (range 24–58). The overall median of both primary and secondary outcomes was 0 (range 0–117 and range 0–55, respectively). The median of FI for primary and secondary outcomes with a p value lower than 0.05 was 6 (range: 1–117) and 7.5 (range: 1–55), respectively. The medians of the FI for primary outcomes with a p value lower than 0.05 in CKD and no CKD patients were 5.5 (range 1–117) and 22 (range 1–80), respectively. Only a few RCTs have been shown to be robust. Our analysis underlined the need for further research with appropriate sample sizes and study design to explore the real potentialities of RAASi in the progression of CKD.
Left Ventricular Myocardial and Cavity Velocity Disturbances Are Powerful Predictors of Significant Coronary Artery Stenosis
Authors: Bytyçi Ibadete , Alves Liliana , Alves Oscar , Lopes Carla , Bajraktari Gani , Henein Michael Y.
Published: October 2022

Background and Aim: Dobutamine stress echocardiography (DSE) is a well-established noninvasive investigation for significant coronary artery disease (CAD). The aim of this study was to evaluate the accuracy of cardiac Doppler parameters in predicting CAD. Methods: We prospectively studied 103 consecutive patients with suspected CAD based on typical symptoms; 59 proved to have CAD, and 44 patients proved to have no-CAD (n = 44). All patients underwent a complete stress Doppler echocardiographic examination. Total isovolumic time (T-IVT) as a marker of cavity dyssynchrony and wall motion score index (WMSI) were also calculated. Results: At peak dobutamine stress, the compromised LV longitudinal excursion (MAPSE), systolic septal and lateral velocities (s’), and diastolic indices were more pronounced in the CAD patients compared with those without CAD, but LV dimension did not differ between groups (p > 0.05). The WMSI was higher and t-IVT more prolonged in patients with CAD (p < 0.01 for both). Similarly, the changes were more pronounced in patients with significant CAD compared with insignificant CAD. On multivariate model, Δ mean s’, OR 2.016 (1.610 to 3.190; p < 0.001), Δ E velocity OR 2.502 (1.179 to 1.108; p < 0.001), Δ t-IVT 2.206 (1.180 to 2.780; p < 0.001) and Δ WMSI OR 1.911 (1.401 to 3.001; p = 0.001) were the most powerful independent predictors of the presence of CAD, particularly when significant (>75%). Δ mean s’ < 5.0 was 85% sensitive, 89% specific with AUC 0.92. Respective values for Δ E velocity <6.0 cm/s were 82%, 90% and 0.91; for Δ t-IVT > 4.5, 78%, 77% and 0.81 and for Δ FT ≥ 150 ms, 76%, 78% and 0.84 in predicating significant CAD. WMSI ≥ 0.7 was 75% sensitive, 77% specific with AUC of 0.81 in predicting significant CAD. The accuracy of DSE was higher in significant CAD compared to insignificant CAD (80% vs. 74%; p = 0.03). Conclusions: Compromised LV longitudinal systolic function, lower delta E wave, prolonged t-IVT, and increased WMSI were the most powerful independent predictors of the presence and significance of CAD. These finding strengthen the role of comprehensive DSE analysis in diagnosing ischemic disturbances secondary to significant CAD.
Relationship between Pulmonary Regurgitation and Ventriculo–Arterial Interactions in Patients with Post-Early Repair of Tetralogy of Fallot: Insights from Wave-Intensity Analysis
Authors: Arya Nikesh , Schievano Silvia , Caputo Massimo , Taylor Andrew M. , Biglino Giovanni
Published: October 2022

This study aimed to investigate the effect of pulmonary regurgitation (PR) on left ventricular ventriculo–arterial (VA) coupling in patients with repaired tetralogy of Fallot (ToF). It was hypothesised that increasing PR severity results in a smaller forward compression wave (FCW) peak in the aortic wave intensity, because of right-to-left ventricular interactions. The use of cardiovascular magnetic resonance (CMR)-derived wave-intensity analysis provided a non-invasive comparison between patients with varying PR degrees. A total of n = 201 patients were studied and both hemodynamic and wave-intensity data were compared. Wave-intensity peaks and areas of the forward compression and forward expansion waves were calculated as surrogates of ventricular function. Any extent of PR resulted in a significant reduction in the FCW peak. A correlation was found between aortic distensibility and the FCW peak, suggesting unfavourable (VA) coupling in patients that also present stiffer ascending aortas. Data suggest that VA coupling is affected by increased impedance.
Histomorphometrical and CBCT Evaluation of Tissue Loss Progression Induced by Consecutive, Alternate Ligatures in Experimental Peri-Implantitis in a Dog Model: A Pilot Study
Authors: Boldeanu Lucia-Camelia , Boariu Marius , Rusu Darian , Vaduva Adrian , Roman Alexandra , Surlin Petra , Martu Ioana , Dragoi Razvan , Popa-Wagner Aurel , Stratul Stefan-Ioan
Published: October 2022

Objectives: Soft and hard tissue breakdown was histologically and radiologically assessed around implants with alternate, consecutively placed ligatures on the same edentulous dog hemimandible. The influence of ligatured implants (LI) on adjacent non-ligatured implants (NLI, as a possible naturally induced peri-implantitis) was also evaluated. Material and Methods: Three months after tooth extraction, five dental implants were placed in the dog hemimandible. Two months after abutment placement, ligatures were placed subsequently two months apart on alternate implants, while both intermediate implants were left without ligatures. Ligatures were kept in place during the entire experiment, and no plaque control measures were taken. Eleven months post-implantation, the animal was sacrificed. Undecalcified ground sections were cut, stained with Masson Goldner and MOVAT Pentachrome and evaluated by light microscopy. Soft and hard tissue loss was assessed using histomorphometric and CBCT parameters. Results: All NLI presented deep false peri-implant pockets on the oral aspect and pronounced vertical bone resorption on the buccal aspect. After 2, 4 and 6 months, during the breakdown period, more than 30% of the bone was lost in LI in all directions, while, despite immediate vicinity, NLI displayed less destruction. Intense inflammation, typical for induced peri-implantitis, was present, with similar intensity in LI as NLI, but in different parts of the lesions. Morphometry confirmed intense soft tissue inflammation, more bone resorption and higher amounts of infiltrated connective tissue in LI when compared with NLI. Conclusion: Within the limits of the present pilot study, the adequacy of the experimental dog model based on ligature-induced peri-implantitis was able to be successfully challenged by non-ligature models of spontaneously occurring peri-implant inflammation, while meeting the requirements for experimental designs with a very small numbers of animals. The influence of implants with severe peri-implantitis on adjacent implants resulted in less than expected tissue loss in the latter accession numbers.
Hospitalisation Is Prognostic of Survival in Chronic Thromboembolic Pulmonary Hypertension
Authors: Jansa Pavel , Ambrož David , Aschermann Michael , Černý Vladimír , Dytrych Vladimír , Heller Samuel , Kunstýř Jan , Lindner Jaroslav , Linhart Aleš , Nižnanský Matúš , Paďour Michal , Prskavec Tomáš , Širanec Michal , Edwards Susan , Gressin Virginie , Kuhn Matyáš , Di Scala Lilla
Published: October 2022

This analysis investigated the prognostic value of hospitalisation in chronic thromboembolic pulmonary hypertension (CTEPH) using data from the Czech Republic, wherein pulmonary endarterectomy (PEA) was the only targeted treatment option until 2015. Using a landmark method, this analysis quantified the association between a first CTEPH-related hospitalisation event occurring before 3-, 6-, 9-, and 12-month landmark timepoints and subsequent all-cause mortality in adult CTEPH patients diagnosed between 2003 and 2016 in the Czech Republic. Patients were stratified into operable and inoperable, according to PEA eligibility. CTEPH-related hospitalisations were defined as non-elective. Hospitalisations related to CTEPH diagnosis, PEA, balloon pulmonary angioplasty, or clinical trial participation were excluded. Of 436 patients who survived to ≥3 months post diagnosis, 309 were operable, and 127 were inoperable. Sex- and age-adjusted hazard ratios (HRs) showed CTEPH-related hospitalisation was a statistically significant prognostic indicator of mortality at 3, 9, and 12 months in inoperable patients, with an approximately 2-fold increased risk of death in the hospitalisation group (HRs [95% CI] ranging from 1.98 [1.06–3.70] to 2.17 [1.01–4.63]). There was also a trend of worse survival probabilities in the hospitalisation groups for operable patients, with the difference most pronounced at 3 months, with a 76% increased risk of death (adjusted HR [95% CI] 1.76 [1.15–2.68]). This first analysis on the prognostic value of CTEPH-related hospitalisations demonstrates that a first CTEPH-related hospitalisation is prognostic of mortality in CTEPH, particularly for inoperable patients. These patients may benefit from medical and/or interventional therapy.
11β-Hydroxysteroid Dehydrogenase Type 1 as a Potential Treatment Target in Cardiovascular Diseases
Authors: Kupczyk Daria , Studzińska Renata , Kołodziejska Renata , Baumgart Szymon , Modrzejewska Martyna , Woźniak Alina
Published: October 2022

Glucocorticoids (GCs) belong to the group of steroid hormones. Their representative in humans is cortisol. GCs are involved in most physiological processes of the body and play a significant role in important biological processes, including reproduction, growth, immune responses, metabolism, maintenance of water and electrolyte balance, functioning of the central nervous system and the cardiovascular system. The availability of cortisol to the glucocorticoid receptor is locally controlled by the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). Evidence of changes in intracellular GC metabolism in the pathogenesis of obesity, metabolic syndrome (MetS) and cardiovascular complications highlights the role of selective 11β-HSD1 inhibition in the pharmacotherapy of these diseases. This paper discusses the role of 11β-HSD1 in MetS and its cardiovascular complications and the importance of selective inhibition of 11β-HSD1.
Inflammatory Cytokines Associated with Diagnosis, Tumor Grade and Prognosis in Patients with Neuroendocrine Tumors
Authors: Geisler Lukas , Hellberg Teresa , Lambrecht Joeri , Jann Henning , Knorr Jana , Eschrich Johannes , Loosen Sven H. , Wree Alexander , Hammerich Linda , Krieg Andreas , Luedde Tom , Tacke Frank , Roderburg Christoph , Mohr Raphael
Published: October 2022

Background and aims: Inflammatory cytokines represent diagnostic and prognostic biomarkers in manifold cancers. Recent data suggest a pivotal role of these cytokines in different biological processes involved in the development of neuroendocrine tumors (NETs). However, their role as biomarkers in NETs is only poorly understood. Methods: We analyzed serum concentrations of 13 inflammation-related cytokines at different time points in 43 patients with well-differentiated gastroenteropancreatic NETs (G1/G2) treated at Charité Berlin and compared them to 40 healthy controls. The results were correlated with clinical records. Results: Serum concentrations (Median (Interquartile Range (IQR)) in pg/mL) of IL-1β (124 (82) vs. 68 (61) pg/mL; p = 0.0003), IL-6 (111(122) vs. 88 (32) pg/mL; p = 0.0086), IL-8 (1058 (768) vs. 210 (90) pg/mL; p < 0.0001), IL-18 (2936 (1723) vs. 1590 (704) pg/mL; p < 0.0001), and TNF (271 (260) vs. 42 (25) pg/mL; p < 0.0001) were significantly elevated in NET patients, whereas IL-10 (43 (44) vs. 105 (48) pg/mL; p < 0.0001) showed lower concentrations in NETs when compared to controls. Cytokine levels significantly correlated with tumor grade (IL-6; p = 0.0070), prevalence of distant metastasis (IL-18; p = 0.0313), and disease progression over time (IL-10; p = 0.0033) but not tumor location. Chromogranin A (CgA) and the NETest are currently used to monitor treatment response. A more accurate prediction could possibly be achieved by employing a subset of cytokines. Our data clearly warrants further functional investigation into the role of the immune response and cytokine release in NETs. Conclusion: A biologically plausible panel of cytokines might be added to the diagnostic and prognostic tools currently employed in patients with NETs. Combining different markers into a score would elevate diagnostic accuracy compared to single markers.
The BE COOL Treatments (Batroxobin, oxygEn, Conditioning, and cOOLing): Emerging Adjunct Therapies for Ischemic Cerebrovascular Disease
Authors: Song Siying , Wu Hao , Ji Xunming , Meng Ran
Published: October 2022

Ischemic cerebrovascular disease (ICD), the most common neurological disease worldwide, can be classified based on the onset time (acute/chronic) and the type of cerebral blood vessel involved (artery or venous sinus). Classifications include acute ischemic stroke (AIS)/transient ischemic attack (TIA), chronic cerebral circulation insufficiency (CCCI), acute cerebral venous sinus thrombosis (CVST), and chronic cerebrospinal venous insufficiency (CCSVI). The pathogenesis of cerebral arterial ischemia may be correlated with cerebral venous ischemia through decreased cerebral perfusion. The core treatment goals for both arterial and venous ICDs include perfusion recovery, reduction of cerebral ischemic injury, and preservation of the neuronal integrity of the involved region as soon as possible; however, therapy based on the current guidelines for either acute ischemic events or chronic cerebral ischemia is not ideal because the recurrence rate of AIS or CVST is still very high. Therefore, this review discusses the neuroprotective effects of four novel potential ICD treatments with high translation rates, known as the BE COOL treatments (Batroxobin, oxygEn, Conditioning, and cOOLing), and subsequently analyzes how BE COOL treatments are used in clinical settings. The combination of batroxobin, oxygen, conditioning, and cooling may be a promising intervention for preserving ischemic tissues.
Relationship between Testosterone and Sarcopenia in Older-Adult Men: A Narrative Review
Authors: Shigehara Kazuyoshi , Kato Yuki , Izumi Kouji , Mizokami Atsushi
Published: October 2022

Age-related decline in testosterone is known to be associated with various clinical symptoms among older men and it is possible that the accompanying decline in muscle mass and strength might lead to a decline in motor and physical functions. Sarcopenia is an important pathophysiological factor associated with frailty in older adults and is diagnosed in older adults as a decrease in muscle strength, muscle mass, and walking speed, which can lead to a significant decline in the quality of life and shortened healthy life expectancy. Testosterone directly interacts with the androgen receptor expressed in myonuclei and satellite cells and is also indirectly associated with muscle metabolism through various cytokines and molecules. Currently, significant correlations between testosterone and frailty in men have been confirmed by numerous cross-sectional studies. Many randomized control studies have also supported the beneficial effect of testosterone replacement therapy (TRT) on muscle volume and strength among men with low to normal testosterone levels. In the world’s aging society, TRT can be a tool for preventing the onset of sarcopenia in older-adult men. This narrative review aims to show the relationship between the decline in testosterone with age, sarcopenia, and frailty, as well as the effects of testosterone replacement therapy on muscle mass and strength.
EUCAST Ibrexafungerp MICs and Wild-Type Upper Limits for Contemporary Danish Yeast Isolates
Authors: Jørgensen Karin M. , Astvad Karen M. T. , Hare Rasmus K. , Arendrup Maiken C.
Published: October 2022

Ibrexafungerp is a novel triterpenoid antifungal that inhibits glucan synthase and thus fungal cell wall synthesis. We examined the in vitro activity against contemporary clinical yeast, investigated inter-laboratory and intra-laboratory variability, suggested wild-type upper-limit values (WT-UL), and compared in vitro activity of ibrexafungerp to five licensed antifungals. Susceptibility to ibrexafungerp and comparators was investigated prospectively for 1965 isolates (11,790 MICs) and repetitively for three QC strains (1764 MICs) following the EUCAST E.Def 7.3.2 method. Elevated ibrexafungerp/echinocandin MICs prompted FKS sequencing. Published ibrexafungerp EUCAST MIC-distributions were retrieved and aggregated for WT-UL determinations following EUCAST principles. Ibrexafungerp MICs were ≤2 mg/L except against C. pararugosa, Cryptococcus and some rare yeasts. Modal MICs (mg/L) were 0.06/0.125/0.25/0.5/0.5/0.5/0.5/1/2 for C. albicans/C. dubliniensis/C. glabrata/C. krusei/C. parapsilosis/C. tropicalis/S. cerevisiae/C. guilliermondii/C. lusitaniae and aligned within ±1 dilution with published values. The MIC ranges for QC strains were: 0.06–0.25/0.5–1/0.125–0.5 for CNM-CL-F8555/ATCC6258/ATCC22019. The WT-UL (mg/L) were: 0.25/0.5/1/1/2 for C. albicans/C. glabrata/C. krusei/C. parapsilosis/C. tropicalis. Adopting these, non-wild-type rates were 0.3%/0.6%/0%/8%/3% for C. albicans/C. glabrata/C. krusei/C. parapsilosis/C. tropicalis and overall lower than for comparators except amphotericin B. Five/six non-wild-type C. albicans/C. glabrata were echinocandin and Fks non-wild-type (F641S, F659del or F659L). Eight C. parapsilosis and three C. tropicalis non-wild-type isolates were echinocandin and Fks wild-type. Partial inhibition near 50% in the supra-MIC range may explain variable MICs. Ibrexafungerp EUCAST MIC testing is robust, although the significance of paradoxical growth for some species requires further investigation. The spectrum is broad and will provide an oral option for the growing population with azole refractory infection.
Research on the Satisfaction of Beijing Waterfront Green Space Landscape Based on Social Media Data
Authors: Cheng Siya , Zhai Zheran , Sun Wenzhuo , Wang Yuan , Yu Rui , Ge Xiaoyu
Published: October 2022

Urban blue–green space is essential to the normal functioning of the urban landscape ecosystem, and it is also a significant metric for assessing the quality of urban human settlements. In China’s territorial space planning, the overall planning strategy’s implementation depends on constructing the blue–green space network in the urbanized construction area. This paper used 85 typical riverside parks in Beijing’s blue–green space as the research object, collecting and analyzing multiple social media user data. It explored the main factors that influenced people’s satisfaction with the landscape design and sensory perception of urban waterfront green space from the perspectives of parks beside different river systems, parks of different types, and parks in different districts. The distinction between urban waterfront green space evaluation was further discussed through variance analysis. The research revealed the following findings: (1) by comparing the total number of park reviews in different seasons, it could be observed that tourists evidently preferred the spring landscape, and the winter landscape construction of waterfront green space needs to be improved. (2) By comparing the review stars of different parks, it could be observed that tourists appreciated parks with multiple functions, excellent recreation facilities, complete management services and parks close to the city center. Functions and services became important influencing factors for park evaluation. (3) There was room for improvement in water ecology in the river landscapes of parks adjacent to various river systems, and people paid more attention to the level of service facilities. (4) According to different categories of parks, people’s demand for service facilities, activity organization, cultural displays and other aspects was different. (5) Among parks in different districts, people preferred the distinctive animal and plant landscapes and recreational activities of parks in districts on the outskirts of the city. According to the conclusions, suggestions were made for optimizing and improving Beijing’s waterfront green space, providing managers with technical support and a basis for decision-making.
Analysis of the Image of Global Glacier Tourism Destinations from the Perspective of Tourists
Authors: Tang Fan , Yang Jianping , Wang Yanxia , Ge Qiuling
Published: October 2022

Glaciers are attracting increasing attention in the context of climate change, and glacier tourism has also become a popular tourist product. However, few studies have been conducted concerning the image of glacier tourism destinations. To address this gap in the literature, in this study, we extracted destination images from 138,709 visitor reviews of 107 glacier tourism destinations on TripAdvisor using latent Dirichlet allocation (LDA) topic modeling, identified destination image characteristics using salience−valence analysis (SVA), and analyzed the differences in glacier tourism destination image characteristics across seasons and regions. According to the findings, the image of a glacier tourism destination consists of 14 dimensions and 53 attributes, with landscapes and specific activities representing the core image and viewing location and necessity representing the unique image. We identified significant seasonal and regional differences in the image of glacier tourism destinations. Finally, we discussed the unique image of glacier tourism destinations, the reasons for differences in the images, and the characteristics of different glacier tourism regions. This research could assist in the scientific management of their core images by glacier tourism destinations, as well as in the rational selection of destinations and travel timing by glacier tourists.
Spatial Estimates of Soil Moisture for Understanding Ecological Potential and Risk: A Case Study for Arid and Semi-Arid Ecosystems
Authors: O’Donnell Michael S. , Manier Daniel J.
Published: October 2022

Soil temperature and moisture (soil-climate) affect plant growth and microbial metabolism, providing a mechanistic link between climate and growing conditions. However, spatially explicit soil-climate estimates that can inform management and research are lacking. We developed a framework to estimate spatiotemporal-varying soil moisture (monthly, annual, and seasonal) and temperature-moisture regimes as gridded surfaces by enhancing the Newhall simulation model. Importantly, our approach allows for the substitution of data and parameters, such as climate, snowmelt, soil properties, alternative potential evapotranspiration equations and air-soil temperature offsets. We applied the model across the western United States using monthly climate averages (1981–2010). The resulting data are intended to help improve conservation and habitat management, including but not limited to increasing the understanding of vegetation patterns (restoration effectiveness), the spread of invasive species and wildfire risk. The demonstrated modeled results had significant correlations with vegetation patterns—for example, soil moisture variables predicted sagebrush (R2 = 0.51), annual herbaceous plant cover (R2 = 0.687), exposed soil (R2 = 0.656) and fire occurrence (R2 = 0.343). Using our framework, we have the flexibility to assess dynamic climate conditions (historical, contemporary or projected) that could improve the knowledge of changing spatiotemporal biotic patterns and be applied to other geographic regions.
The Impact of the Regional Differentiation of Land Supply on Total Factor Productivity in China: From the Perspective of Total Factor Productivity Decomposition
Authors: Yang Lili , Wang Jian , Feng Yuhao , Wu Qun
Published: October 2022

Increasing total factor productivity is the key to promoting high-quality economic development. This paper starts with land supply as an institutional source factor and discusses the impact of the regional differentiation of land supply on total factor productivity in China. Based on the panel data of 273 cities in China from 2003 to 2017, this paper measures total factor productivity (TFP) using the DEA-Malmquist index, decomposes it into technical progress (TE), pure technical efficiency (PE) and scale efficiency (SE), and analyzes the effect of the regional differentiation of land supply on TFP using the spatial Durbin model and mediating model. This study finds the following: (1) At the national level, the tilting of land supply to the central and western regions leads to a contradiction between land supply and demand, which hinders TFP by suppressing TE, PE and SE. (2) At the regional level, the reduction in land supply in the eastern region expands the technological substitution rate, induces the substitution effect of enterprise innovation, and thus promotes TE, but inhibits PE and SE under the resource constraint and congestion effect, which hinders the improvement of TFP. The estimates for the central and western regions are generally consistent with the national results; again, as land supply increases, this hinders TFP by suppressing TE, PE and SE. (3) In terms of the mechanism of influence, the decrease in land supply in the eastern region promotes TE and TFP by promoting urban innovation and inhibiting SE through productive services agglomeration; the increase in land supply in the central and western regions hinders TE and TFP by inhibiting urban innovation, and hinders SE through manufacturing agglomeration. The conclusion of this paper has great significance for deepening the structural reform of land supply and promoting high-quality economic development.
Designing Perennial Landscapes: Plant Form and Species Richness Influence the Gaze Perception Associated with Aesthetic Preference
Authors: Shi Yangyang , Zhang Jiao , Shen Xinyue , Chen Liang , Xu Yunchen , Fu Rui , Su Yang , Xia Yiping
Published: October 2022

The up-close experience of perennial landscapes has been shown to enhance residents’ perception of naturalness in the context of increasing small-scale vegetation landscapes. This study explored how formal aesthetic characteristics were related to landscape perception and whether landscape preference correlated with eye movements. We created a series of photomontages showing perennial combinations that contained different plant forms, degrees of species richness, and plant arrangements and recorded 73 participants’ eye movements during 10 s of free viewing in Experiment A and task-oriented viewing in Experiment B and ratings of landscape preference collected through rating scales. We found that the effects of plant form and species richness were significant for gaze behavior, while arrangement showed no significant effect. We also found that landscape preference was positively correlated with fixation count but negatively correlated with mean fixation duration and total fixation duration. Additionally, women had more but shorter fixations than men while viewing these photomontages, and the difference in aesthetic preferences between men and women was not significant. Concerning the different professional background groups, no significant gaze behavior difference between professionals and nonprofessionals was detected, but compared with professionals, nonprofessionals tended to give strongly higher preference ratings. The outcomes shed light on the influence of formal aesthetic characteristics on gaze behavior and advanced the application of eye-tracking technology in perennial landscape studies. Our findings also confirmed the efficiency of vegetation landscapes designed based on public preferences for providing restoration from stress or fatigue.