bluuebunny/crossref_metadata_2025 huggingface dataset:
A Cross-Cultural Study on Attachment and Adjustment Difficulties in Adolescence: The Mediating Role of Self-Control in Italy, Spain, China, and Poland
Authors: Mancinelli Elisa , Liberska Hanna D. , Li Jian-Bin , Espada José P. , Delvecchio Elisa , Mazzeschi Claudia , Lis Adriana , Salcuni Silvia
Published: August 2021

From a socio-ecological perspective, individuals are influenced by the interplay of individual, relational, and societal factors operating as a broader system. Thereby, to support youth adjustment during the critical adolescence period, the interplay between these factors should be investigated. This study aimed to investigate cross-cultural differences in adolescents’ maternal and paternal attachment, adolescents’ adjustment difficulties and self-control, and in their association. N = 1000 adolescents (mean (M) age = 16.94, SD = 0.48; 45.90% males) from China, Italy, Spain, and Poland participated by completing self-report measures. Results showed cross-country similarities and differences among the considered variables and their associative pattern. Moreover, conditional process analysis evaluating the association between maternal vs. paternal attachment and adjustment difficulties, mediated by self-control, and moderated by country, was performed. Maternal attachment directly, and indirectly through greater self-control, influenced adjustment difficulties in all four countries. This association was stronger among Spaniards. Paternal attachment influenced directly, and indirectly through self-control, on adolescents’ adjustment difficulties only in Italy, Spain, and Poland, and was stronger among Polish adolescents. For Chinese adolescents, paternal attachment solely associated with adjustment difficulties when mediated by self-control. Thus, results highlighted both similarities and differences across countries in the interplay between maternal vs. paternal attachment and self-control on adolescents’ adjustment difficulties. Implications are discussed.
The Role of Coping Strategies in Post-Traumatic Growth among Syrian Refugees: A Structural Equation Model
Authors: Acar Busra , Acar İbrahim H. , Alhiraki Omar A. , Fahham Ola , Erim Yesim , Acarturk Ceren
Published: August 2021

The Syrian conflict has led to a mass migration of Syrians to other countries and exposed them to many possible traumatic events and stressors in their country of origin and in the resettlement process. The possibility of positive psychological effects of adverse life events is less documented among Syrian refugees. Thus, the current study aimed to develop preliminary evidence for the identifying factors: traumatic experiences, post-migration stressors and coping strategies that are associated with post-traumatic growth (PTG) of Syrian refugees residing in Turkey. Structural equation modeling (SEM) was used in the current study to assess the associations among these factors. Data were obtained from Syrian refugees residing in the governorates of Hatay and Mardin. A total of 528 Syrians, aged between 18–77 years (M = 35.60, SD = 11.65) participated in this cross-sectional study. Results from the SEM indicated that past traumatic experiences and post-migration stressors were indirectly related to PTG. The results from the current study provide support for that the association between refugees’ traumatic experiences, post-migration stressors and PTG appear to be explained through the presence of coping strategies which could be addressed in the psychotherapies and psychosocial interventions for refugees to promote positive psychological change. Future studies should address the effects of post-migration stressors on PTG in detail.
The Effect of the COVID-19 Pandemic on Total Hip and Knee Arthroplasty Surgical Volume in 2020 in Poland
Authors: Czubak-Wrzosek Maria , Czubak Jarosław , Grzelecki Dariusz , Tyrakowski Marcin
Published: August 2021

The aim of this study was to analyse the effect of the first year of the COVID-19 pandemic on total hip arthroplasty (THA) and total knee arthroplasty (TKA) surgical volume in Poland. A retrospective analysis of data concerning THA and TKA collected by the National Health Fund in Poland in 2019 and in 2020 has been conducted. The number of primary hip or knee arthroplasties in 2020 was around 71% and 67% of the number registered in 2019, respectively. There was also a decline in the volume of revision arthroplasties observed, with 65% and 63% of THA and TKA revisions performed in 2019. The most significant decrease was observed in April and May, and during the second wave of the pandemic in November 2020, with a decline of 87%, 55% and 56%, respectively. The results of this study show the significant impacts that the COVID-19 pandemic had on the volume of elective hip and knee arthroplasties in Poland in 2020. In comparison with 2019, a decrease of around 30% for primary and of 40% for revision arthroplasties was observed. The most significant decline was observed in April and May 2020, and during the second wave of the COVID-19 pandemic in Poland in November 2020.
Predictors of Depressive Symptoms in Caregivers of Children with Attention-Deficit/Hyperactivity Disorder: A One-Year Follow-Up Study
Authors: Chou Wen-Jiun , Hsiao Ray C. , Chang Chih-Cheng , Yen Cheng-Fang
Published: August 2021

This 1-year follow-up study examined the predictive values of the demographics, depressive symptoms, stress-coping orientations, and perceived family support of caregivers as well as the internalizing, externalizing and ADHD symptoms of children with attention-deficit/hyperactivity disorder (ADHD) at baseline on the depressive symptoms of the caregivers after 1 year. A total of four hundred caregivers of children with ADHD were recruited. The baseline levels of the caregivers’ depressive symptoms, stress-coping orientations, and perceived family support and the internalizing and externalizing problems of the children were assessed using the Center for Epidemiological Studies Depression Scale, the Coping Orientation to Problems Experienced, Family Adaptation, Partnership, Growth, Affection, Resolve Index, and the Child Behavior Checklist For Ages 6–18, respectively. Their predictions for the caregiver’s depressive symptoms 1 year after the baseline were examined using linear regression analysis. In total, 382 caregivers of children with ADHD underwent the follow-up assessment 1 year from the baseline. A marital status of being separated or divorced, less effective coping and depressive symptoms orientation, and children with internalizing problems and ADHD symptoms at baseline were positively associated with the caregivers’ depressive symptoms at follow-up, whereas the caregivers’ perceived family support and an emotion-focused coping orientation at baseline were negatively associated with depressive symptoms at follow-up. Multiple characteristics of the caregivers and children with ADHD at baseline predicted the caregivers’ depressive symptoms 1 year later.
COVID-19 Vaccine Hesitancy among the Public in Kuwait: A Cross-Sectional Survey
Authors: Alibrahim Jumana , Awad Abdelmoneim
Published: August 2021

Vaccine hesitancy (uncertainty or unwillingness to receive vaccinations) is a major barrier to manage the COVID-19 pandemic in the long term. This study aimed to explore the prevalence of COVID-19 vaccine hesitancy among the public in Kuwait, to understand their attitudes towards vaccines in general, and to identify predictors of COVID-19 vaccine hesitancy. A cross-sectional study was conducted among 4147 adults aged ≥ 18 years. The snowball sampling strategy was used for data collection through social media and e-mails. A total of 3061 (73.8%) respondents indicated that they were vaccinated or intending to be vaccinated against the COVID-19 infection, while 1086 (26.2%) expressed their vaccine hesitancy. The most common reasons for vaccine hesitancy were the concerns about the vaccine’s possible side effects, its rushed development, and its efficacy in preventing the infection. Over half (57.2%) of respondents expressed intermediate to high levels of negative attitude towards vaccines in general. On the multivariable logistic regression analysis, the findings revealed that vaccine hesitancy was significantly more prevalent among respondents aged 30–64 years; females; married or divorced; residents of Hawalli, Al-Farwaniyah, Al-Jahra, and Mubarak Al-Kabeer; had intermediate monthly average income; non-smokers; not feeling worried about catching the infection; do not know whether any of their family members have been infected or died because of COVID-19 infection; do not have a large extent of confidence in the Kuwait health system’s ability to handle the pandemic; did not receive influenza vaccine during the last year; refused or elected to forego a doctor-recommended vaccine; did not receive adequate information from the public health authorities/healthcare providers about the COVID-19 vaccines; none of their first-degree family members received or were intending to receive the vaccine; and expressed intermediate to high levels of negative attitudes towards vaccines in general. The present findings provide a steer as to the groups that most need to be reached to increase the rates of vaccine uptake.
Early Childhood Caries in Obese Children: The Status and Associated Factors in the Suburban Areas in Hanoi, Vietnam
Authors: Hung Ha Van , Ngoc Vo Truong Nhu , Vu Thi Hue , Chu Dinh-Toi
Published: August 2021

Obesity and early childhood caries are two prominent health problems affecting the majority of children worldwide. Thus, early childhood caries in obese children must be studied. This study was conducted to investigate the status of early childhood caries in obese children in Hanoi, Vietnam, and its associated factors. A cross-sectional study was conducted on 234 obese children, 234 normal children (non-obese) aged 36 to 71 months, and their mothers at some kindergartens in Hanoi. Study subjects were randomly selected with similarities in age, gender, and study location. Decayed tooth of children was detected by clinical examination and Diagnodent Kavo 2190 machine of Germany. In addition, a questionnaire for their mothers was used to find out related factors. We found that, in the Obese Group, the rate of early childhood caries (ECC), severe-early childhood caries (S-ECC), dmft index (the number of decayed teeth, teeth lost due to cavities, filled decayed teeth or filled cavity), and dmfs index (the number of surfaces of the teeth decay, surfaces of teeth were lost due to cavities, surfaces of filled decayed teeth) were 82.91%, 59.83%, 6.84 ± 4.92, and 9.10 ± 7.48, respectively. In the Normal Group, these rates were smaller than in the Obese Group, but the difference was not statistically significant. Regarding related factors, the hobby of drinking soft drinks, the habits and frequency of drinking milk at night and eating sweet marshmallows were associated with ECC in the Obese Group with p < 0.05. In conclusion, the higher rates of ECC were seen in obese children, with eating hobbies and habits being the related factors. Therefore, it is necessary to have appropriate policies and effective communication strategies to minimize ECC in the future.
Trends and Patterns of Knee Osteoarthritis in China: A Longitudinal Study of 17.7 Million Adults from 2008 to 2017
Authors: Chen Hongbo , Wu Junhui , Wang Zijing , Wu Yao , Wu Tao , Wu Yiqun , Wang Mengying , Wang Siyue , Wang Xiaowen , Wang Jiating , Yu Huan , Hu Yonghua , Shang Shaomei
Published: August 2021

Background: Knee osteoarthritis (KOA) provides many challenges on the healthcare system. However, few studies have reported the epidemiology, particularly in a large population. Our study aimed to estimate the prevalence, incidence, trends, and patterns of diagnosed KOA in China. Methods: This was a longitudinal study. We used health insurance claims of 17.7 million adults from 2008–2017 to identify people with KOA. Trends in prevalence and incidence were analyzed using joinpoint regression. Results: We identified 2,447,990 people with KOA in Beijing, 60% of which were women. The 10-year average age-standardized prevalence and incidence of KOA was, respectively, 4.6% and 25.2 per 1000 person-years. Prevalence increased with age, surging after 55 years old. The average crude prevalence was 13.2% for people over 55 years old. The prevalence showed an increasing trend from 2008 to 2017, including a period of rapid rise from 2008 to 2011 (p < 0.05); the increase in prevalence was greatest in people under 35 years old (p < 0.05). Conclusion: Our analyses showed that the annual prevalence rate of KOA increased significantly from 2008 to 2017 in China. We need to increase our attention to women and the elderly over 55 years old, and also be alert to the younger trend of incidence of KOA.
An Integrative Review of Recovery Services to Improve the Lives of Adults Living with Severe Mental Illness
Authors: Badu Eric , O’Brien Anthony Paul , Mitchell Rebecca
Published: August 2021

There is an increasing call for recovery-oriented services but few reviews have been undertaken regarding such interventions. This review aims to synthesize evidence on recovery services to improve the lives of adults living with severe mental illness. An integrative review methodology was used. We searched published literature from seven databases: Medline, EMBASE, PsycINFO, CINAHL, Google Scholar, Web of Science, and Scopus. Mixed-methods synthesis was used to analyse the data. Out of 40 included papers, 62.5% (25/40) used quantitative data, 32.5% used qualitative and 5% (2/40) used mixed methods. The participants in the included papers were mostly adults with schizophrenia and schizoaffective disorder. This review identified three recovery-oriented services—integrated recovery services, individual placement services and recovery narrative photovoice and art making. The recovery-oriented services are effective in areas such as medication and treatment adherence, improving functionality, symptoms reduction, physical health and social behaviour, self-efficacy, economic empowerment, social inclusion and household integration. We conclude that mental health professionals are encouraged to implement the identified recovery services to improve the recovery goals of consumers.
Attention Bias and Recognition of Sexual Images in Depression
Authors: Novák Ondřej , Bártová Klára , Klapilová Kateřina
Published: August 2021

Depression greatly affects sexuality. Theoretical and empirical evidence account for the existence of attention bias to sex-related stimuli. This attention bias might be impaired in depression, resulting in sexual problems. A sample of 13 patients with depression and 13 matched healthy controls were tested using the dot-probe and picture recognition task to measure attention to erotic images. No difference in attention to sex-related stimuli (ω2 = 0, p = 0.22) and in memory bias (ω2 = 0, p = 0.72) was found between the two groups. Explorative analyses were conducted to identify the sexual content-induced delay effect in the data, assess variability differences, and compare trial-level bias score-based indexes between groups. Across all analyses, there was little evidence for depression affecting sexual-related cognitive processing, and even this might be explained by other means. Our results suggest that restrained attention is probably not the main factor behind sexual problems in depression.
Defining a Model for Integrating Indoor and Outdoor Network Data to Support Seamless Navigation Applications
Authors: Claridades Alexis Richard C. , Lee Jiyeong
Published: August 2021

Spaces are continuous realms where human beings freely navigate, such as from indoor to outdoor and optionally to another indoor space. However, currently available data models to represent space for navigation do not entirely reflect this continuity of freedom and movement. Data conversion or complications in implementation hinder current approaches to link indoor space with outdoor space due to the variety of present data models. Furthermore, this representation of indoor–outdoor connection becomes oversimplified during the integration process. Consequently, location-based applications based on these datasets are limited in conveying mobility within these spaces and aiding navigation activity. This paper defines a framework for integrating indoor and outdoor navigable space to enable seamless navigation. This model enables the connection between indoor and outdoor navigation networks. We describe the connections between these networks through spatial relationships, which can be generalized to represent various cases of indoor–outdoor transitional spaces. Using sample datasets, we demonstrate the framework’s potential to provide a seamless connection between indoor and outdoor space in a route analysis experiment.
An In-Depth Analysis of Parking Patterns in a Typical Chinese Danwei via Customized Data Collection App
Authors: Kong Wenyuan , Liao Caiying , Xu Qian , Wang Jiabei , Fei Teng
Published: August 2021

The danwei is a distinctive spatial unit in China, as a legacy of the Maoist era. In a danwei, state-owned enterprises supplied a full set of facilities, such that people’s daily activities did not often extend beyond their danweis. However, with the rapid alteration of civic social space in Chinese cities, many employees are no longer tied to a particular danwei. Traditional Chinese danweis have suddenly been faced with a shortage of car-parking space. In the context of the municipal call for danweis to “dismantle the walls and open up for traffic microcirculation”, this study aims to propose a practical approach that analyzes the parking status in a typical danwei. Based on both the parking data collected via a self-designed smartphone application and the survey data collected via questionnaires, the approach analyzes the parking situation in terms of four aspects, including hot parking zones, dynamic parking demand, vehicle parking behaviors, and perceptions of the parking situation. We conducted the experiment on the Information Department Campus of Wuhan University, which is a typical Chinese danwei with complicated surroundings. The results indicate non-negligible issues in the current parking situation, such as vulnerabilities in parking resource management, and a contradiction between supply and demand. Based on the results, we recommend possible strategies to alleviate the tense parking situation and we are confident of the feasibility of opening danwei roads first instead of opening parking facilities, as a response to “open up” the danweis. This study may serve as a representative example of how danweis should analyze their current parking situation and how to respond to the municipality’s suggestions: using modern technology to conduct data collection, perform in-depth and detailed analysis, and synthesize explicit localized policy.
Exploring the Planning and Configuration of the Hospital Wayfinding System by Space Syntax: A Case Study of Cheng Ching Hospital, Chung Kang Branch in Taiwan
Authors: Chen Ming-Shih , Ko Yao-Tsung , Hsieh Wen-Che
Published: August 2021

With regard to the outpatient areas of a hospital, the smoothness of the route is now taken into consideration in the process of configuring the wayfinding system. As patients often spend time on ineffective wayfinding processes, and there is limited manpower at hospitals and a lack of clarity in the information provided by the wayfinding system, it is difficult to provide effective and timely consultation services for patients. This study was conducted at Cheng Ching Hospital, Chung Kang Branch (CCH/CKB) in Taiwan. This study attempts to investigate the relationships between the wayfinding system of the outpatient areas and the patients’ behaviors in the hospital. Depthmap software based on space syntax is adopted to assist in the route analysis and wayfinding behaviors. It integrates axial mapping analysis and isovist analysis and gives suggestions on the location, format and content of the wayfinding system. The final results of the study show that in the wayfinding task experiment gender has no significant impact on the effect of wayfinding efficiency, while a significant difference is found for age. Older people need more time to complete the wayfinding task, which means that they have poorer performance in wayfinding efficiency. The analysis of the results of space syntax shows that a good wayfinding system should be a symmetric tree-branch structure rather than circular structure in a medical building, that areas where it is easy to become lost should have a clear signage guiding system planning and configuration, and that clear guidance information should be provided to the patients to achieve the goal of saving consultation time and improving the quality of the medical environment.
Combined Transcriptomic Analysis and RNA Interference Reveal the Effects of Methoxyfenozide on Ecdysone Signaling Pathway of Spodoptera exigua
Authors: Zhang Zhixian , Ma Yajie , Ma Xiaoyan , Hu Hongyan , Wang Dan , Song Xianpeng , Ren Xiangliang , Ma Yan
Published: August 2021

Spodoptera exigua is a worldwide pest afflicting edible vegetables and has developed varying levels of resistance to insecticides. Methoxyfenozide (MET), an ecdysteroid agonist, is effective against lepidopteran pests such as S. exigua. However, the mechanism of MET to S. exigua remains unclear. In this study, we analyzed the expression patterns of genes related to the ecdysone signaling pathway in transcriptome data treated with sublethal doses of MET and analyzed how expression levels of key genes affect the toxicity of MET on S. exigua. Our results demonstrated that 2639 genes were up-regulated and 2512 genes were down-regulated in S. exigua treated with LC30 of MET. Of these, 15 genes were involved in the ecdysone signaling pathway. qPCR results demonstrated that ecdysone receptor A (EcRA) expression levels significantly increased in S. exigua when treated with different doses of MET, and that the RNAi-mediated silencing of EcRA significantly increased mortality to 55.43% at 72 h when L3 S. exigua larvae were exposed to MET at the LC30 dose. Additionally, knocking down EcRA suppressed the most genes expressed in the ecdysone signaling pathway. The combination of MET and dsEcRA affected the expression of E74 and enhanced the expression of TREA. These results demonstrate that the adverse effects of sublethal MET disturb the ecdysone signaling pathway in S. exigua, and EcRA is closely related to MET toxic effect. This study increases our collective understanding of the mechanisms of MET in insect pests.
Interference Alignment Inspired Opportunistic Communications in Multi-Cluster MIMO Networks with Wireless Power Transfer
Authors: Ren Yuan , Zhang Xuewei , Makhanbet Meruyert
Published: August 2021

In this work, we jointly investigate the issues of node scheduling and transceiver design in a sensor network with multiple clusters, which is endowed with simultaneous wireless information and power transfer. In each cluster of the observed network, S out of N nodes are picked, each of which is capable of performing information transmission (IT) via uplink communications. As for the remaining idle nodes, they can harvest energy from radio-frequency signals around their ambient wireless environments. Aiming to boost the intra-cluster performance, we advocate an interference alignment enabled opportunistic communication (IAOC) scheme. This scheme can yield better tradeoffs between IT and wireless power transfer (WPT). With the aid of IAOC scheme, the signal projected onto the direction of the receive combining vector is adopted as the accurate measurement of effective signal strength, and then the high-efficiency scheduling metric for each node can be accordingly obtained. Additionally, an algorithm, based on alternative optimization and dedicated for transceiver design, is also put forward, which is able to promote the achievable sum rate performance as well as the total harvested power. Our simulation results verify the effectiveness of the designed IAOC scheme in terms of improving the performance of IT and WPT in multi-cluster scenarios.
Making Information Measurement Meaningful: The United Nations’ Sustainable Development Goals and the Social and Human Capital Protocol
Authors: Wilson John P.
Published: August 2021

Drucker’s saying that “What gets measured gets managed” is examined in the context of corporate social responsibility. The United Nations’ Sustainable Development Goals have encouraged sustainability reporting, and a reporting tool, the Social and Human Capital Protocol, has been developed to assist measurement and provide information to support the achievement of sustainability. This information should be valid and reliable; however, it is not easy to measure social and human capital factors. Additionally, companies use a large number of methodologies and indicators that are difficult to compare, and they may sometimes only present positive outcomes as a form of greenwashing. This lack of full transparency and comparability with other companies has the potential to discredit their reports, thereby supporting the claims of climate change deniers, free-market idealogues and conspiracy theorists who often use social media to spread their perspectives. This paper will describe the development of environmental reporting and CSR, discuss the natural capital protocol, and assess the extent to which the Social and Human Capital Protocol is able to fulfil its purpose of providing SMART objective measurements. It is the first academic article to provide a detailed examination of the Social and Human Capital Protocol.
Effect of Soy Leaf Flavonoids on Pea Aphid Probing Behavior
Authors: Stec Katarzyna , Kordan Bożena , Gabryś Beata
Published: August 2021

Flavonoids detected in soybean Glycine max (L.) Merr. (Fabaceae) cause various alterations in the metabolism, behavior, and development of insect herbivores. The pea aphid Acyrthosiphon pisum (Harris) (Hemiptera: Aphididae) poses potential threat to soybeans, but the effect of individual flavonoids on its feeding-associated behavior is relatively unknown. We monitored probing behavior (stylet penetration activities) of A. pisum on its preferred host plant, Pisum sativum L. untreated (control) and treated with 0.1% ethanolic solutions of flavonoids apigenin, daidzein, genistein, and kaempferol. We applied the electrical penetration graph (electropenetrography, EPG) technique, which visualizes the movements of aphid stylets within plant tissues. None of the applied flavonoids affected the propensity to probe the plants by A. pisum. However, apigenin enhanced the duration of probes in non-phloem tissues, which caused an increase in the frequency and duration of stylet mechanics derailment and xylem sap ingestion but limited the ingestion of phloem sap. Daidzein caused a delay in reaching phloem vessels and limited sap ingestion. Kaempferol caused a reduction in the frequency and duration of the phloem phase. Genistein did not affect aphid probing behavior. Our findings provide information for selective breeding programs of resistant plant cultivars to A. pisum.
Nutritional Composition of Honey Bee Drones of Two Subspecies Relative to Their Pupal Developmental Stages
Authors: Ghosh Sampat , Herren Pascal , Meyer-Rochow Victor Benno , Jung Chuleui
Published: August 2021

We examined the contents of nutritional importance, i.e., amino acids, fatty acids and minerals of different developmental stages of drones of two honey bee subspecies, namely Apis mellifera carnica and A. m. mellifera. The results revealed that, in general, individual amino acid amounts and therefore the total protein increased along with the developmental stages of the drones. No statistically significant differences were found between the same developmental stages of the two subspecies. The reverse, i.e., a decrease with developmental stage occurred in relation to the fatty acid composition. Most of the minerals were higher at advanced developmental stages. Overall, the high protein content (31.4–43.4%), small amount of fat (9.5–11.5%) and abundance of minerals such asiron and zinc, make drones a suitable nutritional resource. Even though nutrient content, especially protein, was higher in the pupae than the prepupae, we propose prepupae also as a commercial product based on their higher biomass production. Provided standard production protocols maintaining hygiene and safety will be adhered to, we propose that drone honey bees can be utilized as human food or animal feed.
Efficacy of Sirolimus Treatment in PEComa–10 Years of Practice Perspective
Authors: Świtaj Tomasz , Sobiborowicz Aleksandra , Teterycz Paweł , Klimczak Anna , Makuła Donata , Wągrodzki Michał , Szumera-Ciećkiewicz Anna , Rutkowski Piotr , Czarnecka Anna M.
Published: August 2021

Perivascular epithelioid cell tumors (PEComa) represent a family of rare mesenchymal tumors resultant from deregulation in mTOR pathway activity. The aim of this study is to evaluate the long-term efficacy of targeted PEComa treatment. We reviewed all consecutive patients with PEComa who started systemic treatment with sirolimus in our reference sarcoma center between January 2011 and August 2020. Histopathology of PEComa was reviewed and confirmed in all cases by a designated sarcoma pathologist. Any surviving progression-free patients were censored at the last follow-up (31 March 2021). Survival curves were calculated according to Kaplan–Meier method and compared with the log-rank test or a Cox proportional hazard model. Fifteen (12 females and 3 males) consecutive PEComa patients were treated. The median age of patients treated systemically was 50 years. Median progression-free survival (PFS) was 4.9 months (95% CI: 3.8-NA) for first-line chemotherapy and was not reached (95% CI: 42.0-NA) for sirolimus as first-line therapy. There was one objective response (OR) in the chemotherapy group. The OR rate reached 73% (11/15 cases) for sirolimus regardless of the treatment line. All patients archived disease control. Three patients died due to disease progression after 55, 32, and 32 months since metastatic disease diagnosis. After a median follow-up of 55.7 (range: 3.2–220) months, the 5 yr OS was 65% (CI 95% 39–100). Our study is the largest single-institution report on PEComa systemic targeted therapy and fills the gap in the field of advanced PEComa care since the FDA/EMEA approval of sirolimus.
Immunophenotype Rearrangement in Response to Tumor Excision May Be Related to the Risk of Biochemical Recurrence in Prostate Cancer Patients
Authors: Bosas Paulius , Zaleskis Gintaras , Dabkevičiene Daiva , Dobrovolskiene Neringa , Mlynska Agata , Tikuišis Renatas , Ulys Albertas , Pašukoniene Vita , Jarmalaitė Sonata , Jankevičius Feliksas
Published: August 2021

Background: Prostate cancer (PCa) is known to exhibit a wide spectrum of aggressiveness and relatively high immunogenicity. The aim of this study was to examine the effect of tumor excision on immunophenotype rearrangements in peripheral blood and to elucidate if it is associated with biochemical recurrence (BCR) in high risk (HR) and low risk (LR) patients. Methods: Radical prostatectomy (RP) was performed on 108 PCa stage pT2–pT3 patients. Preoperative vs. postoperative (one and three months) immunophenotype profile (T- and B-cell subsets, MDSC, NK, and T reg populations) was compared in peripheral blood of LR and HR groups. Results: The BCR-free survival difference was significant between the HR and LR groups. Postoperative PSA decay rate, defined as ePSA, was significantly slower in the HR group and predicted BCR at cut-off level ePSA = −2.0% d−1 (AUC = 0.85 (95% CI, 0.78–0.90). Three months following tumor excision, the LR group exhibited a recovery of natural killer CD3 − CD16+ CD56+ cells, from 232 cells/µL to 317 cells/µL (p < 0.05), which was not detectable in the HR group. Prostatectomy also resulted in an increased CD8+ population in the LR group, mostly due to CD8+ CD69+ compartment (from 186 cells/µL before surgery to 196 cells/µL three months after, p < 001). The CD8+ CD69+ subset increase without total T cell increase was present in the HR group (p < 0.001). Tumor excision resulted in a myeloid-derived suppressor cell (MDSC) number increase from 12.4 cells/µL to 16.2 cells/µL in the HR group, and no change was detectable in LR patients (p = 0.12). An immune signature of postoperative recovery was more likely to occur in patients undergoing laparoscopic radical prostatectomy (LRP). Open RP (ORP) was associated with increased MDSC numbers (p = 0.002), whereas LRP was characterized by an immunity sparing profile, with no change in MDSC subset (p = 0.16). Conclusion: Tumor excision in prostate cancer patients results in two distinct patterns of immunophenotype rearrangement. The low-risk group is highly responsive, revealing postoperative restoration of T cells, NK cells, and CD8+ CD69+ numbers and the absence of suppressor MDSC increase. The high-risk group presented a limited response, accompanied by a suppressor MDSC increase and CD8+ CD69+ increase. The laparoscopic approach, unlike ORP, did not result in an MDSC increase in the postoperative period.
Bone Cuts Accuracy of a System for Total Knee Arthroplasty including an Active Robotic Arm
Authors: Cosendey Killian , Stanovici Julien , Mahlouly Jaad , Omoumi Patrick , Jolles Brigitte M. , Favre Julien
Published: August 2021

Introduction: This study aimed to assess the bone cuts accuracy of a system for total knee arthroplasty including an active robotic arm. A second objective was to compare the accuracy among orthopaedic surgeons of different levels of experience. Methods: Three orthopaedic surgeons cut 10 sawbone knees each. Planned and actual bone cuts were compared using computed tomography. Difference with respect to the planning was expressed as three position and three orientation errors following the anatomical planes. Statistical tests were performed to detect bias and compare surgeons. Results: None of the 30 knees presented an outlier error, meaning an error ≥3 mm or ≥3°. The root-mean-square values of the 12 error types were below 0.8 mm or 0.8°, except for the femoral proximal–distal errors (1.7 mm) and the tibial anterior-posterior errors (1.4 mm). Biases were observed, particularly in femoral proximal–distal and tibial anterior–posterior positions. Median differences between surgeons were all lower than 0.8 mm and 0.5°, with statistically significant differences among surgeons in the femoral proximal–distal errors and the tibial anterior–posterior errors. Conclusions: The system tested in this study achieved accurate bone cuts independently of the surgeon’s level of experience. Biases were observed, suggesting that there might be options to improve the accuracy, particularly in proximal–distal position for the femur and in anterior–posterior position for the tibia.
Clinical Evaluation of Different Treatment Strategies for Motor Recovery in Poststroke Rehabilitation during the First 90 Days
Authors: Koroleva Ekaterina S. , Kazakov Stanislav D. , Tolmachev Ivan V. , Loonen Anton J. M. , Ivanova Svetlana A. , Alifirova Valentina M.
Published: August 2021

Background: Motor recovery after stroke is based on neuronal plasticity and the structural reorganization of the brain. Questions are debated about the proper moment to start rehabilitation in the acute period of stroke, the significance of rehabilitation interventions during the so-called “plastic window”, and the advantages of modern and traditional programs. The aims of this study were to evaluate the role of different rehabilitation strategies and their combinations for motor recovery and the impact on functional disability by way of neurological and functional outcomes 3 months after ischemic stroke. Methods: We used three rehabilitation approaches: early rehabilitation from the first day of stroke (Phase I), traditional exercise programs (Phase II), and an author’s new method of biofeedback rehabilitation using motion sensors and augmented reality (AR) rehabilitation (Phase III). Clinical and functional outcomes were measured on the 90th day after stroke. We developed algorithms for quantifying the quality of movements during the execution of tasks in the motor domains of the AR rehabilitation program. Results: Phase I of rehabilitation led to an improvement in functional independence, and the recovery of motor functions of the extremities with an absence of mortality and clinical deterioration. AR rehabilitation led to significant improvement both with respect to clinical and functional scores on scales and to variables reflecting the quality of movements. Patients who were actively treated during Phases II and III achieved the same final level of motor recovery and functional outcomes as that of participants who had only received AR rehabilitation during Phase III. Patients who underwent outpatient observation after Phase I showed a deficit of spontaneous motor recovery on the 90th day after stroke. Conclusions: Early rehabilitation was successful but was not enough; rehabilitation programs should be carried out throughout the entire “sensitive period” of poststroke plasticity. The newly developed AR biofeedback motion training is effective and safe as a separate rehabilitation method in the early recovery period of moderately severe, hemiparalytic, and ischemic stroke. These two rehabilitation approaches must be applied together or after each other, not instead of each other, as shown in clinical practice.
Discriminant Analysis of Main Prognostic Factors Associated with Hemodynamically Significant PDA: Apgar Score, Silverman–Anderson Score, and NT-Pro-BNP Level
Authors: Permyakova Anna V. , Porodikov Artem , Kuchumov Alex G. , Biyanov Alexey , Arutunyan Vagram , Furman Evgeniy G. , Sinelnkov Yuriy S.
Published: August 2021

Hemodynamically significant patent ductus arteriosus (hsPDA) in premature newborns is associated with a risk of PDA-related morbidities. Classification into risk groups may have a clinical utility in cases of suspected hsPDA to decrease the need for echocardiograms and unnecessary treatment. This prospective observational study included 99 premature newborns with extremely low body weight, who had an echocardiogram performed within the first three days of life. Discriminant analysis was utilized to find the best combination of prognostic factors for evaluation of hsPDA. We used binary logistic regression analysis to predict the relationship between parameters and hsPDA. The cohort’s mean and standard deviation gestational age was 27.6 ± 2.55 weeks, the mean birth weight was 1015 ± 274 g. Forty-six (46.4%) infants had a PDA with a mean diameter of 2.78 mm. Median NT-pro-BNP levels were 17,600 pg/mL for infants with a PDA and 2773 pg/mL in the non-hsPDA group. The combination of prognostic factors of hsPDA in newborns of extremely low body weight on the third day of life was determined: NT-pro-BNP, Apgar score, Silverman–Anderson score (Se = 82%, Sp = 88%). A cut-off value of NT-pro-BNP of more than 8500 pg/mL can predict hsPDA (Se = 84%, Sp = 86%).
Novel Iron Parameters in Patients with Type 2 Diabetes Mellitus in Relation to Kidney Function
Authors: Zapora-Kurel Agnieszka , Kuźma Łukasz , Zakrzewska Magdalena , Żórawski Marcin , Dobrzycki Sławomir , Twardowska-Kawalec Małgorzata , Małyszko Jolanta
Published: August 2021

Background/aims: Anemia of chronic disease is a common feature in diabetes and chronic kidney disease. Hepcidin is the key element involved in iron metabolism; however, studies on new indices of iron status are still ongoing. The aim of the study was to assess novel iron parameters in patients with type 2 diabetes mellitus in relation to kidney function. Methods: The study included 80 type 2 diabetic patients and 23 healthy volunteers. Standard laboratory measurements were used to measure the iron status, complete blood count, creatinine, the estimated glomerular filtration rate (eGFR), serum lipids, and brain natriuretic peptides (BNPs). Commercially available kits were used to measure hepcidin-25, the soluble transferrin receptor (sTfR), growth differentiation factor-15 (GDF-15), and hypoxia-inducible factor-1 alpha. Results: Anemia was present in 65% of the studied patients. The control group was found to have significantly higher hepcidin, sTfR, and GDF-15, and lower hemoglobin and iron. When compared with patients with eGFR values ≥60 mL/min/1.73 m2 and <60 mL/min/1.73 m2, we found that patients with higher eGFR had higher hemoglobin, ferritin, and HIF-1 alpha, lower BNP, and were younger. We found that levels of HIF-1 alpha are negligible in the studied population and were related to age only in patients with eGFR values ≥60 mL/min/1.73 m2. Conclusion: A comprehensive assessment of iron status is rarely performed. Novel biomarkers of iron metabolism are not generally related to kidney function. Whether the assessment of HIF-1 alpha would be a marker of efficient anemia therapy with HIF-prolyl hydroxylase inhibitors is still a matter for further study.
Arterial Hypertension and Diabetes Mellitus in COVID-19 Patients: What Is Known by Gender Differences?
Authors: Ciarambino Tiziana , Ciaburri Filippina , Paoli Venere Delli , Caruso Giuseppe , Giordano Mauro , D’Avino Maria
Published: August 2021

Background. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected >160 million people around the world. Hypertension (HT), chronic heart disease (CHD), and diabetes mellitus (DM) increase susceptibility to SARS-CoV-2 infection. Aims. We designed this retrospective study to assess the gender differences in hypertensive diabetic SARS-CoV-2 patients. We reported data, by gender differences, on the inflammatory status, on the hospital stays, intensive care unit (ICU) admission, Rx and CT report, and therapy. Methods. We enrolled 1014 patients with confirmed COVID-19 admitted into different Hospitals of Campania from 26 March to 30 June, 2020. All patients were allocated into two groups: diabetic-hypertensive group (DM-HT group) that includes 556 patients affected by diabetes mellitus and arterial hypertension and the non-diabetic- non-hypertensive group (non-DM, non-HT group) comprising 458 patients. The clinical outcomes (i.e., discharges, mortality, length of stay, therapy, and admission to intensive care) were monitored up to June 30, 2020. Results. We described, in the DM-HT group, higher proportion of cardiopathy ischemic (CHD) (47.5% vs. 14.8%, respectively; p < 0.0001) and lung diseases in females compared to male subjects (34.8% vs. 18.5%, respectively; p < 0.0001). In male subjects, we observed higher proportion of kidney diseases (CKD) (11% vs. 0.01%, respectively; p < 0.0001), a higher hospital stay compared to female subjects (22 days vs. 17 days, respectively, p < 0.0001), a higher admission in ICU (66.9% vs. 12.8%, respectively, p < 0.0001), and higher death rate (17.3% vs. 10.7%, respectively, p < 0.0001). Conclusion. These data confirm that male subjects, compared to female subjects, have a higher hospital stay, a higher admission to ICU, and higher death rate.
Criterion-Related Validity of Field-Based Fitness Tests in Adults: A Systematic Review
Authors: Castro-Piñero Jose , Marin-Jimenez Nuria , Fernandez-Santos Jorge R. , Martin-Acosta Fatima , Segura-Jimenez Victor , Izquierdo-Gomez Rocio , Ruiz Jonatan R. , Cuenca-Garcia Magdalena
Published: August 2021

We comprehensively assessed the criterion-related validity of existing field-based fitness tests used to indicate adult health (19–64 years, with no known pathologies). The medical electronic databases MEDLINE (via PubMed) and Web of Science (all databases) were screened for studies published up to July 2020. Each original study’s methodological quality was classified as high, low and very low, according to the number of participants, the description of the study population, statistical analysis and systematic reviews which were appraised via the AMSTAR rating scale. Three evidence levels were constructed (strong, moderate and limited evidence) according to the number of studies and the consistency of the findings. We identified 101 original studies (50 of high quality) and five systematic reviews examining the criterion-related validity of field-based fitness tests in adults. Strong evidence indicated that the 20 m shuttle run, 1.5-mile, 12 min run/walk, YMCA step, 2 km walk and 6 min walk test are valid for estimating cardiorespiratory fitness; the handgrip strength test is valid for assessing hand maximal isometric strength; and the Biering–Sørensen test to evaluate the endurance strength of hip and back muscles; however, the sit-and reach test, and its different versions, and the toe-to-touch test are not valid for assessing hamstring and lower back flexibility. We found moderate evidence supporting that the 20 m square shuttle run test is a valid test for estimating cardiorespiratory fitness. Other field-based fitness tests presented limited evidence, mainly due to few studies. We developed an evidence-based proposal of the most valid field-based fitness tests in healthy adults aged 19–64 years old.
The Association between Peri-Transplant RBC Transfusion and Graft Failure after Kidney Transplantation: A Nationwide Cohort Study
Authors: Lee Kyungho , Lee Seohee , Jang Eun Jin , Kim Ga Hee , Yoo Seokha , Lee Minkyoo , Jang Hye Ryoun , Ryu Ho Geol
Published: August 2021

Background: Patients undergoing kidney transplantation (KT) often receive red blood cell (RBC) transfusion during admission for KT which may increase the risk of allosensitization. The association between peri-transplant RBC transfusion and graft survival was evaluated using a nationwide cohort. Methods: This retrospective study analyzed 13,871 patients who underwent KT in Korea between 2007 and 2015. The outcomes were graft failure rate and overall patient survival depending on the amount of RBC transfusion. Results: The overall graft failure rate was 15.5%. Compared to the graft failure rate of 13.5% in the no transfusion group, the graft failure rate was 15.4% in the 1–2 units group (sHR 1.06 (95% CI 0.97–1.17), p = 0.216), 21.4% in the 3–5 units group (sHR 1.39 (1.21–1.61), p < 0.001), and 35.3% in the 6 or more units group (sHR 2.20 (1.70–2.85), p < 0.001). The overall survival rate was 97.5% in the no transfusion group, compared to 95.9% in the 1–2 units group (HR 1.50 (1.22–1.83), p < 0.001), 92.0% in the 3–5 units group (HR 2.43 (1.87–3.15), p < 0.001), and 67.5% in the 6 or more units group (HR 6.81 (5.03–9.22), p < 0.001). Conclusions: Peri-transplant RBC transfusion was independently associated with the increased risk of renal allograft failure and death in KT patients.
Pelvic Organ Prolapse Is Associated with Osteoporosis in Korean Women: Analysis of the Health Insurance Review and Assessment Service National Patient Sample
Authors: Ko Yoo-Ra , Lee Sa-Ra , Kim Sung-Hoon , Chae Hee-Dong
Published: August 2021

Background and Objectives: Pelvic organ prolapse (POP) and osteoporosis are major disease entities in older women that have the same epidemiology and might also have the same molecular physiology. However, few data have been reported on the relationship between POP and osteoporosis. We designed this study to examine the association between POP and osteoporosis in Korean women. Materials and Methods: We used the Health Insurance Review and Assessment Service 2015 to 2017 National Patient Sample (HIRA-NPS). A total of 4,368,141 individuals were included in this study, and a total of 842,228 individuals aged 50 years and above were included in the final analysis. POP patients were defined by the Korean Informative Classification of Diseases (KOICD) codes (KCD-7, N81, or N99.3) and patients who underwent a pelvic reconstructive procedure. The osteoporosis patients were defined by KOICD (KCD-7, R4113, R3620, R0402,) who were prescribed osteoporosis medication. A 1:10 age-stratified matching and chi-squared test were used for statistical analysis, and p < 0.05 was considered as significant. Results: A total of 7359 women were included in this analysis. Advanced POP was correlated with osteoporosis in Korean women aged 50 years and above in 2015–2017 (p < 0.0001). After adjusting for age, advanced POP was correlated with osteoporosis in the 2015, 2016, and 2017 dataset (p = 0.013, 0.0009, 0.0119, respectively). Conclusions: Advanced POP is correlated with osteoporosis in Korean women aged 50 years and above. Evaluation for osteoporosis and education about bone health can be especially important, even in relatively young women, aged 50–59 years, and POP patients.