bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leukoplakia: An Invasive Cancer Hidden within the Vocal Folds. A Multivariate Analysis of Risk Factors
Authors: Klimza Hanna , Pietruszewska Wioletta , Rosiak Oskar , Morawska Joanna , Nogal Piotr , Wierzbicka Małgorzata 
Published: December 2021

IntroductionDiscerning the preoperative nature of vocal fold leukoplakia (VFL) with a substantial degree of certainty is fundamental, seeing that the histological diagnosis of VFL includes a wide spectrum of pathology and there is no consensus on an appropriate treatment strategy or frequency of surveillance. The goal of our study was to establish a clear schedule of the diagnostics and decision-making in which the timing and necessity of surgical intervention are crucial to not miss this cancer hidden underneath the white plaque.Material and MethodsWe define a schedule as a combination of procedures (white light and Narrow Band Imaging diagnostic tools), methods of evaluating the results (a combination of multiple image classifications in white light and Narrow Band Imaging), and taking into account patient-related risk factors, precise lesion location, and morphology. A total number of 259 patients with 296 vocal folds affected by leukoplakia were enrolled in the study. All patients were assessed for three classifications, in detail according to Ni 2019 and ELS 2015 for Narrow Band Imaging and according to Chen 2019 for white light. In 41 of the 296 folds (13.9%), the VFL specimens in the final histology revealed invasive cancer. We compared the results from the classifications to the final histology results.ResultsThe results showed that the classifications and evaluations of the involvement of anterior commissure improve the clinical utility of these classifications and showed improved diagnostic performance. The AUC of this model was the highest (0.973) with the highest sensitivity, specificity, PPV, and NPV (90.2%, 89%, 56.9%, and 98.3%, respectively).ConclusionThe schedule that combines white light and Narrow Band Imaging, with a combination of the two classifications, improves the specificity and predictive value, especially of anterior commissure involvement.
In Silico Feasibility Study of Carbon Ion Radiotherapy With Simultaneous Integrated Boost for Head and Neck Adenoid Cystic Carcinoma
Authors: Mastella Edoardo , Molinelli Silvia , Magro Giuseppe , Russo Stefania , Bonora Maria , Ronchi Sara , Ingargiola Rossana , Jensen Alexandra D. , Ciocca Mario , Vischioni Barbara , Orlandi Ester 
Published: December 2021

PurposeIn carbon ion radiotherapy (CIRT), a simultaneous integrated boost (SIB) approach has not been fully exploited so far. The feasibility of a CIRT-SIB strategy for head and neck adenoid cystic carcinoma (ACC) patients was investigated in order to improve treatment planning dose distributions.Methods and MaterialsCIRT plans of 10 ACC patients treated at the National Center for Oncological Hadrontherapy (CNAO, Pavia, Italy) with sequential boost (SEQ) irradiation and prescription doses of 41.0 Gy [relative biological effectiveness (RBE)]/10 fractions to low-risk (LR) clinical target volume (CTV) plus 24.6 Gy(RBE)/6 fractions to the high-risk (HR) CTV were re-planned with two SIB dose levels to the LR-CTV, namely, 48.0 Gy(RBE) and 54.4 Gy(RBE). While planning with SIB, the HR-CTV coverage had higher priority, with fixed organ-at-risk dose constraints among the SIB and SEQ plans. The homogeneity and conformity indexes were selected for CTV coverage comparison. The biologically effective dose (BED) was calculated to compare the different fractionation schemes.ResultsComparable HR-CTV coverage was achieved with the treatment approaches, while superior conformality and homogeneity were obtained with the SIB technique in both CTVs. With the SEQ, SIB48.0, and SIB54.4, the LR-CTV median doses were respectively 50.3%, 11.9%, and 6.0% higher than the prescriptions. Significant reductions of the median and near-maximum BEDs were achieved with both SIB dose levels in the LR-CTV.ConclusionsThe SIB approach resulted in highly conformal dose distributions with the reduction of the unintended dose to the LR-CTV. A prescription dose range for the LR-CTV will be clinically defined to offer tailored personalized treatments, according to the clinical and imaging characteristics of the patients.
Clinical and Physiologic Factors Associated With Mode of Death in Pediatric Severe TBI
Authors: Baird Talia D. , Miller Michael R. , Cameron Saoirse , Fraser Douglas D. , Tijssen Janice A. 
Published: December 2021

Aims and Objectives: Severe traumatic brain injury (sTBI) is the leading cause of death in children. Our aim was to determine the mode of death for children who died with sTBI in a Pediatric Critical Care Unit (PCCU) and evaluate factors associated with mortality.Methods: We performed a retrospective cohort study of all severely injured trauma patients (Injury Severity Score ≥ 12) with sTBI (Glasgow Coma Scale [GCS] ≤ 8 and Maximum Abbreviated Injury Scale ≥ 4) admitted to a Canadian PCCU (2000–2016). We analyzed mode of death, clinical factors, interventions, lab values within 24 h of admission (early) and pre-death (48 h prior to death), and reviewed meeting notes in patients who died in the PCCU.Results: Of 195 included patients with sTBI, 55 (28%) died in the PCCU. Of these, 31 (56%) had a physiologic death (neurologic determination of death or cardiac arrest), while 24 (44%) had withdrawal of life-sustaining therapies (WLST). Median (IQR) times to death were 35.2 (11.8, 86.4) hours in the physiologic group and 79.5 (17.6, 231.3) hours in the WLST group (p = 0.08). The physiologic group had higher partial thromboplastin time (PTT) within 24 h of admission (p = 0.04) and lower albumin prior to death (p = 0.04).Conclusions: Almost half of sTBI deaths in the PCCU were by WLST. There was a trend toward a longer time to death in these patients. We found few early and late (pre-death) factors associated with mode of death, namely higher PTT and lower albumin.
Tanyu Tongzhi Formula Delays Atherosclerotic Plaque Progression by Promoting Alternative Macrophage Activation via PPARγ and AKT/ERK Signal Pathway in ApoE Knock-Out Mice
Authors: Ma Lan , Dai Xiaoce , Wu Chenxia , Li Mingshuang , Sheng Hongzhuan , Mao Wei 
Published: December 2021

We previously demonstrated that the Tanyu Tongzhi Formula (TTF) significantly alleviated the clinical symptoms of patients with coronary heart disease and lowered serum lipid and inflammatory factor levels in patients with coronary heart disease and atherosclerosis model rats. However, the mechanism underlying TTF remains unknown. In this study, we examined the effect of TTF on atherosclerotic plaques in ApoE-/- mice and underlying mechanisms involved in macrophage polarization. Sixty male ApoE-/- mice were randomly divided into four groups. Mice in the control group were fed a regular diet, whereas experimental mice were fed a high-fat diet and received either saline (HFD group) or TTF at concentrations of 0.60 (TTF-L group) or 2.25 g/ml (TTF-H group) by daily oral gavage for 16 weeks. In the TTF-L and TTF-H groups, the levels of serum cholesterol, triglyceride, interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α were decreased, lipid content was significantly decreased, and percentage area of collagen/lipid increased in atherosclerotic plaque compared to in the HFD group. Moreover, we found TTF promoted the expression of alternative macrophage markers (Fizz1, Arg1, and Mrc) and suppressed the expression of M1 macrophage markers (TNF-α, IL-1β, and IL-6) by regulating peroxisome proliferator-activated receptor γ (PPARγ) expression and AKT/extracellular signal-regulated kinase (ERK) activation. We further investigated whether alternative macrophage was reduced when PPARγ was inhibited or the AKT/ERK signaling pathway was activated. TTF delayed atherosclerotic plaque progression by promoting alternative macrophage activation through increasing PPARγ expression and inhibiting AKT/ERK phosphorylation, providing a theoretical basis for its clinical application.
Cost-Effectiveness of Nivolumab Plus Cabozantinib Versus Sunitinib as a First-Line Treatment for Advanced Renal Cell Carcinoma in the United States
Authors: Li SiNi , Li JianHe , Peng LiuBao , Li YaMin , Wan XiaoMin 
Published: December 2021

Background: In a recent randomized, phase 3 trial (CheckMate 9ER), nivolumab combined with cabozantinib significantly improved patient outcomes compared with sunitinib. However, the cost-effectiveness of these novel agents for untreated advanced renal cell carcinoma (aRCC) remains unknown.Materials and Methods: We constructed a microsimulation decision-analytic model to measure the healthcare costs and outcomes of nivolumab plus cabozantinib compared with those of sunitinib for patients with aRCC. The transition probability of patients was calculated from CheckMate 9ER using parametric survival modeling. Lifetime direct medical costs, life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated for nivolumab-plus-cabozantinib treatment compared with sunitinib from a US payer perspective. We conducted one-way and probabilistic sensitivity analyses and a series of scenario analyses to evaluate model uncertainty.Results: Nivolumab plus cabozantinib was associated with an improvement of 0.59 LYs and 0.56 QALYs compared with sunitinib. However, incorporating nivolumab plus cabozantinib into first-line treatment was associated with significantly higher lifetime costs ($483,352.70 vs. $198,320.10), causing the incremental cost-effectiveness ratio for nivolumab plus cabozantinib to be $508,987/QALY. The patients’ age of treatment, first-line utility, and cost of nivolumab had the greatest influence on the model. The outcomes were robust when tested in sensitivity and scenario analyses.Conclusion: For aRCC, substituting nivolumab plus cabozantinib in the first-line setting is unlikely to be cost-effective under the current willingness-to-pay threshold ($150,000/QALY). Significant price decreases for nivolumab used in first-line therapy would be needed to drop ICERs to a more diffusely acceptable value.
The Role of Problematic Smartphone Uses and Psychological Distress in the Relationship Between Sleep Quality and Disordered Eating Behaviors Among Chinese College Students
Authors: Wu Ruipeng , Guo Lan , Rong Hao , Shi Jingming , Li Wenyan , Zhu Minxia , He Yongjun , Wang Wanxin , Lu Ciyong 
Published: December 2021

Background: Sleep problems and eating disorders (EDs) are both serious public health concerns often seen in young adults. Yet, the underlying mechanisms for such associations are largely unknown. This study aims to examine potential serial multiple mediation effects of problematic smartphone use (PSU) and psychological distress (i.e., depressive and anxiety symptoms) in the relationship between sleep quality and disordered eating behaviors/attitudes (DEBs).Methods: A total of 4,325 students from two Tibet universities in China (2,657 females and 1,668 males) completed an online survey that included the following measurements: Eating Attitude Test-26 for disordered eating behaviors/attitudes, the Chinese Version of Pittsburgh Sleep Quality Index (CPSQI), Smartphone Addiction Scale—Short Version (SAS-SV) for problematic smartphone use, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) for psychological distress.Results: While the direct path linking sleep quality and DEBs was not found to be significant (Standardized β = 0.006, 95% CI = −0.0667~0.0970), both PSU (Standardized β = 0.016, 95% CI = 0.0256~0.0591) and anxiety symptoms (Standardized β = 0.014, 95% CI = 0.0203~0.0526) may mediate a link between sleep quality and DEBs; serial multiple mediation analysis revealed that a serial indirect pathway of “sleep quality -&gt; PSU -&gt; anxiety symptoms -&gt; DEBs” existed(Standardized β = 0.001, 95% CI = 0.0002~0.0012). Similarly, while the direct path linking sleep quality and DEBs was not found to be significant (Standardized β = 0.006, 95% CI = −0.0667~0.0970), both PSU (Standardized β = 0.020, 95% CI = 0.0337~0.0692) and depressive symptoms (Standardized β = 0.015, 95% CI = 0.0139~0.0652) may mediate a link between sleep quality and DEBs; serial multiple mediation analysis revealed that a serial indirect pathway of “sleep quality -&gt; PSU -&gt; depressive symptoms -&gt; DEBs” existed (Standardized β = 0.001, 95% CI = 0.0006~0.0038).Conclusions: Psychological and behavioral factors may comprehensively work together, leading to flow-on effects from sleep problems to disordered eating behaviors among university students. Appropriate interventions that target problematic smartphone use could thus potentially reduce anxiety and depression levels, which in turn will provide a buffer against the negative impact of poor sleep quality on eating disorder symptoms.
Dietary Patterns and Changes in Weight Status Among Chinese Men and Women During the COVID-19 Pandemic
Authors: Xu Xiaoyue , Yan Alice F. , Wang Youfa , Shi Zumin 
Published: December 2021

Aims: To identify dietary patterns during the coronavirus disease-2019 (COVID-19) pandemic and to examine their association with changes in weight status in the Chinese population.Methods: The 2020 China COVID-19 cross-sectional survey is an anonymous 74-item survey administered via social media across 31 provinces in mainland China between April and May 2020. Dietary data were assessed by a Food Frequency Questionnaire and the changes in weight status were self-reported. Exploratory factor analysis using the principal component analysis method was applied to identify dietary patterns. The multinomial regression models were conducted, and forest plots were used to present the associations between dietary patterns and changes in weight status.Results: Of a total of 10,545 adults (aged ≥18 years), more than half of participants reported to have weight gain, with 18.6% of men and 16.3% of women having weight gain &gt;2.5 kg. Approximately 8% of participants reported to have weight loss, with 2.1% of men and 2.5% women having weight loss &gt;2.5 kg. Two dietary patterns, namely, the modern and prudent dietary patterns, were identified during the COVID-19 pandemic. The modern dietary pattern was loaded heavily with soft drinks, fried foods, pickles, and inversely with fresh vegetables. The prudent dietary pattern was characterized by high intake of fresh fruits, vegetables, and inversely with soft drinks and fried food. The modern dietary pattern was positively associated with weight gain in men and women, while the prudent dietary pattern was negatively associated with both weight gain and loss in men and women during the COVID-19 pandemic.Conclusion: Dietary patterns during COVID-19 are significantly associated with the changes in weight status, which may subsequently increase the risk of diet-related non-communicable disease among the Chinese population.
Efficacy of Acupuncture in Post-partum With Diastasis Recti Abdominis: A Randomized Controlled Clinical Trial Study Protocol
Authors: Liu Yan , Zhu Ying , Jiang Liyuan , Lu Chao , Xiao Lijuan , Chen Jiayu , Wang Ting , Deng Lujun , Zhang Haida , Shi Yingying , Zheng Tingting , Feng Min , Ye Tiantian , Wang Jing 
Published: December 2021

Background: Diastasis rectus abdominis (DRA) is one of the common complications during pregnancy and post-partum, which has psychological and physical effects on post-partum women. Acupuncture, a worldwide alternative therapy, has attracted wide attention in preventing and treating diseases related to pregnancy and childbirth. This study aims to evaluate the efficacy of acupuncture combined with physical training in treating post-partum rectus muscle dissociation.Methods: This is a randomized, controlled trial of DRA in post-partum conducted at Hangzhou Hospital of Traditional Chinese Medicine Affiliated with Zhejiang University of Chinese Medicine. The primary purpose is to evaluate the effectiveness of acupuncture and physical training on DRA in post-partum women. The study will be conducted from March 2022 to March 2023. The acupuncture group received acupuncture and physical training (n = 48), the sham acupuncture group received sham acupuncture and physical training (n = 48), and the physical training group received physical training (n = 48). These experiments perform once/day, five times a week for 2 weeks, followed up for half a year after the end of the course of treatment. Our tests perform a course of treatment, which includes a total of 10 consecutive treatments. Furthermore, the patient will be followed up for half a year after the treatment. Primary and secondary indicators, including inter recti distance (IRD), linea alba (LA) tension, the MOS item short-form health survey (SF-36), short-form McGill pain questionnaire-2 (SF-MPQ-2), body mass index (BMI), waist-to-hip ratio (WHR), leeds dyspepsia questionnaire (LDQ), menstrual distress questionnaire (MDQ), 10 items of edinburgh post-natal depression scale (EPDS-10), the modified body self-image scale (MBIS), international consultation incontinence questionnaire short-form (ICIQ-SF) and hernia-related quality-of-life survey (HerQles), which will be evaluated before and after treatment and half a year after treatment. Adverse events and side effects during each treatment will be collected and recorded.Discussion: There is evidence that acupuncture and physical training can treat DRA in post-partum. In this study, we evaluate the effectiveness of acupuncture in post-partum with DRA.
The Impact of COVID-19 on Physical Performance and Mental Health—A Retrospective Case Series of Belgian Male Professional Football Players
Authors: Wagemans Jente , Catteeuw Peter , Vandenhouten Jan , Jansen Jordi , de Corte Xander , Ceusters Ciesse , Vissers Dirk 
Published: December 2021

Rationale: As every season, physical performance of players of Royal Antwerp FC's first team was regularly tested and mental well-being and mood were assessed during football season 2020–2021. Just like in the general population, several professional athletes were infected by SARS-CoV-2 during that season. COVID-19 is a complex disorder affecting multiple body systems, potentially damaging lungs, affecting the cardiovascular system or causing muscle weakness. Therefore, the impact of COVID-19 on performance was a major concern for the affected football players and their entourage.Objectives: To retrospectively examine the influence of COVID-19 on physical performance and mental health in professional football athletes during the season 2020–2021.Methods: Thirty-three professional athletes (age: 25.37 ± 4.11 years; height: 182.75 ± 7.62 cm; weight: 78.90 ± 8.97 kg) of a Belgian first division football club were assessed weekly during the 2020-2021 season. Weekly assessments comprised strength values of the hamstrings, hip abductors and hip adductors, jump performance, a modified Hooper questionnaire to assess mental status and nose swab PCR tests for COVID-19. Data analysis was performed from 2 weeks prior to COVID-19 contamination up to 8 weeks after the first positive test. Post-hoc Bonferroni correction was applied when performing statistical analysis.Results: Eleven players tested positive for COVID-19. Duration of contamination was 13 ± 7 days. There was no statistically significant difference before and after COVID-19 infection for jump performance, and adductor and abductor muscle strength (p &gt; 0.05). Functional hamstring strength improved significantly 2 weeks (MD: 41.48; 95%CI: −3.79 to 86.75; p = 0.009) and 4 weeks (MD: 34.76; 95%CI: −8.91 to 78.42; p = 0.019) after COVID-19, whereas mood (MD: −0.60; 95%CI: −1.46 to 0.26; p = 0.041), stress levels (MD: −0.83; 95%CI: −1.85 to 0.20; p = 0.020) and total wellness (MD: −2.41; 95%CI: −5.25 to 0.43; p = 0.015) showed a significant reduction 8 weeks after confirmed COVID-19.Conclusion: Physical performance varied considerably across outcomes before and 8 weeks after COVID-19 contamination in a sample of first division football players. However, affected football players' overall well-being, stress levels and mood diminished after a positive COVID-19 test.
Control Potentials of Three Entomopathogenic Bacterial Isolates for the Carob Moth, Ectomyelois ceratoniae (Lepidoptera: Pyralidae) in Pomegranates
Authors: Alotaibi Saqer S. , Darwish Hadeer , Alharthi Sarah , Alghamdi Akram , Noureldeen Ahmed , Fallatah Ahmed M. , Fodor András , Al-Barty Amal , Albogami Bander , Baazeem Alaa 
Published: December 2021

Ectomyelois ceratoniae (Lepidoptera: Pyralidae) is the primary pest of pomegranates in Saudi Arabia and is mostly controlled using broad-spectrum pesticides. Providing environmentally sound choices to limit reliance on chemical management is a major challenge in the control of E. ceratoniae and, as a consequence, in the protection of pomegranate crops from its invasion. Entomopathogenic bacteria (EPB) symbiotically associated with entomopathogenic nematodes (EPNs) are well-known biocontrol agents of soil-dwelling or aerial pests. The bacterium symbiont (EPB) is the real insect-killing biocontrol agent, while the nematode (EPN) serves as a vector. We wondered whether the EPB vector, which is extremely vulnerable to adverse environmental conditions, like drought, high temperatures, and repellent soil microorganisms, could be omitted. We intended to evaluate the biocontrol potential of directly applied EPB cells and cell-free culture media (CFCM) on the larval instar E. ceratoniae. Xenorhabdus budapestensis DSM 16342 (EMA), X. szentirmaii DSM 16338 (EMC), and Photorhabdus luminescens ssp. laumondi (TT01) strains were used. After three days of exposure, the cells of EMA, EMC, and TT01 strains resulted in 100%, 88%, and 79.3% larval mortality rates, respectively. The applied EMA CFCM resulted in 53.7% larval mortality, indicating the presences of (at least) one extremely strong component produced by EMA. We concluded that the direct application of either the EPB cells or the CFCM must be a prospective alternative biocontrol of E. ceratoniae, especially to protect the important fruit (pomegranate, Punica granatum) cultivars. Especially, newly identified local EPB isolates could be applied as bio-pesticides for integrated management practices or organic pomegranate production.