bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Cancer Treatment “Out-of-Pocket” Costs on the Mental Health of Chemotherapy Patients: A Comparative Study
Authors: Artioli Thiago , Turke Karine Corcione , Sarafyan Aline Hernandez Marquez , Ortolani Beatriz Boos , von Schmadel Ingrid Victoria Maria Biondo Edle , Ferreira Lucas Alves Domiciano , Silva Eduardo Couto , Cruz Isabel Pinho Mariano da , Pagani Julye Tainah de Fatima Seminari , Monteiro Pamela dos Santos , Turke Camille Corcione , Cubero Daniel de Iracema , Sette Cláudia Vaz de Melo , Giglio Auro del 
Published: September 2021

Abstract
Introduction: Anxiety and depression are prevalent comorbidities in cancer patients. Although cancer treatment is funded by the Brazilian Unified Health System (SUS), economic burden is also borne by patients through out-of-pocket costs. Our study sought to evaluate the impact of out-of-pocket costs of cancer treatment on depression, anxiety and stress levels in cancer patients.Methods: Observational, cross-sectional and analytical study conducted in 2021. Patients undergoing chemotherapy were being treated at tertiary hospital affiliated with the SUS and enrolled in research protocols at research center. To evaluate out-of-pocket costs, we used a socioeconomic questionnaire to identify costs and time spent by patients. Primary outcomes were prevalence of depression and anxiety, as determined by the Hospital Anxiety and Depression Scale (HADS), and prevalence of stress, as determined using a stress thermometer.Results: 195 patients were included. Among included patients, 61% were female, and mean age was 57 years. Patients' median overall out-of-pocket costs was R$ 453.80 (US$ 78.92). Based on the HADS, 62.1% of patients had possible or probable depression/anxiety. There was no correlation between overall out-of-pocket spending and levels of depression/anxiety. However, when stratified by cost-time variables, there was a negative correlation between spending on telephones and HADS (rho = -0.140; P = 0.049) and positive correlations between spending on medications (rho = 0.140; P = 0.05) and time spent purchasing medications (rho = 0.157; P = 0.029) with HADS.Conclusion: Although overall spending was not directly correlated with mental health, specific costs impacted levels of anxiety, depression and stress.
Comparing Clinical Outcomes in Patients With Diabetes Undergoing Coronary Artery Bypass Graft and Percutaneous Coronary Intervention
Authors: Arabi Arezo , Naghshtabrizi Behshad , Baradaran Hamid Reza , Moradi Yousef , Asadi-Lari Mohsen 
Published: September 2021

Abstract
Background Coronary artery bypass graft (CABG) is generally regarded as the treatment option for coronary artery disease (CAD) in patients with diabetes. In recent years, with the advent of drug-eluting stents (DES), percutaneous coronary intervention (PCI) was introduced as a suitable alternative for CABG. The aim of this study was to compare the incidence of major adverse cardiac and cerebrovascular event (MACCE) during mid-term period in patients with diabetes treated with 2 revascularization strategies.Methods We achieved this historical cohort study on 750 consecutives patients with diabetes in a single cardiovascular center from July 2009 to March 2012. We included patients with diabetes with positive history of consumption antidiabetics agent or FBS>125 during hospitalization who were revascularized by 2 strategies. We excluded those patients whose follow-up was not possible. ResultsFinally, out of 697 eligible patients, 355 patients underwent a CABG and 342 underwent a PCI: 53 patients were lost to follow-up (27 in CABG and 26 in PCI groups). The mean follow-up time was 900.68 ± 462.03 days in the CABG and 782.60 ± 399.05 in PCI groups. There were 17 (9.13%) cardiac deaths in the CABG group and 8 (4.45%) in the PCI group; this difference was not significant (P = .11). There was 14 (7.58%) cerebrovascular accident in the CABG group and 4 (2.31%) in the PCI group; this difference was significant (P = .04). Moreover, the frequency of the target vessel revascularization in the CABG and PCI groups was 6 (3.32%) and 31 (17.11%) (P < .001), respectively. Myocardial infarction in the CABG group was 5 (2.77%) and 14 (7.86%) in the PCI group (P = .009). Finally, the frequency of MACCE in the CABG and PCI groups was 41(20.70%) and 47(24.16%) respectively; this difference was not statistically significant (P = .195). ConclusionThis study showed that PCI with drug-eluting stent could be a suitable alternative for CABG in revascularization of patients with diabetes.
Energetics of water in the Solar System
Authors: Rao Akshay , Das Abhimanyu , Li Owen , Warsinger David 
Published: September 2021

Abstract
Water is vital for space exploration, from drinking to fuel reformation, and is naturally abundant in the Solar System [1–16]. While in-situ resource utilization (ISRU) requires vastly less energy than transporting resources, the energetics has scarcely been explored besides on Earth and limited analysis on Mars’ vapor. Here, we develop a thermodynamic framework to quantify the energy requirements for resource extraction from 18 water sources on 11 planetary bodies. We find that desalinating saline liquid brines, where available, could be the most energetically favorable option and the energy required to access water vapor can be four to ten times higher than accessing ice deposits. While desalination energetics are highly sensitive to salt concentration, we show that desalination energetics only vary by a factor of 2 with respect to the type of salt present. Additionally, unlike chemical mixtures, the minimum energetics are insensitive to composition in physical mixtures (e.g., ice-regolith and inert vapor mixtures). Additionally, by deriving and computing the equation-of-state for pure water, we extend the least work estimates of atmospheric water harvesting by 94°C lower than previous studies that depend on predetermined databases. The presented approach and data may inform decisions regarding water harvesting, habitation, and resource reformation.
Enhancing grid flexibility under scenarios of a renewable-dominant power system in China
Authors: Lin Jiang , Abhyankar Nikit , He Gang , Liu Xu , Yin Shengfei 
Published: September 2021

Abstract
Renewable energy is poised to play a major role in achieving China's carbon neutrality goal by 2060; however, reliability and flexibility are a big concern of a renewable-dominant power system. Various strategies of enhancing flexibility are under discussion to ensure the reliability of such a system, but no detailed quantitative analysis has been reported yet in China. Here we combine the advantages of a capacity expansion model, SWITCH-China, with a production simulation model, PLEXOS, and analyze flexibility options under different scenarios of a renewable-dominant power system in China. We find that a larger balancing area offers direct flexibility benefits. Regional balancing could reduce the renewable curtailment rate by 5%-7%, compared with a provincial balancing strategy. National balancing could further reduce the power cost by about 16%. However, retrofitting coal power plants for flexible operation would only improve the system flexibility marginally.
Eosinophilic Pneumonia in a Patient With Ulcerative Colitis Treated With Mesalazine: a Case Report
Authors: Hu Yizhou , Chen Yan 
Published: September 2021

Abstract
Background: Mesalazine, also known as mesalamine or 5-ASA, is considered a safe drug and thus widely prescribed for Inflammatory bowel disease (IBD) patients. Mesalazine was previously recognized as a drug that can rarely cause pneumonia because lacking a sulfa component. Nevertheless, although still a rare complication, more and more cases have been reported nowadays. Case presentation: We describe the case of eosinophilic pneumonia (EP) in a 39-year-old woman with ulcerative colitis during treatment with mesalazine. We discontinued mesalazine after drug-induced EP was identified, and she made a prompt recovery.Conclusions: The diagnosis of EP is readily missed due to the rarity and the pulmonary complications of IBD. Since the treatment of pulmonary complications of IBD and EP varies, it is crucial to differentiate them. A prompt recovery can be expected in patients with EP after discontinuing the causative drug.
Emodin Inhibits the Growth and Invasion and Induces Apoptosis and Autophagy in Hepatocellular Carcinoma via PI3K/AKT/mTOR and Wnt/β-catenin Pathway
Authors: qin binyu , Zeng Zhili , Xu Jianliang , Shangwen Jing , Ye Zeng Jie , Wang Shutang , Wu Yanheng , Peng Gongfeng , Wang Qi , Gu Wenyi , Tang Ying 
Published: September 2021

Abstract
Background: Previous studies reported that emodin extracted from Rheum palmatum L. exerts antiproliferation and antimetastatic effects in a variety of human cancer types. However, the role of emodin in hepatocellular carcinoma (HCC) remain unknown.Methods: EdU and colony formation assays were performed to evaluate the effects of emodin on proliferation. The mobility capacities of HCC treated with emodin were evaluated using wound healing assay. Transwell invasion and migration assays were performed to evaluate anti-migratory and anti-invasive effects of emodin on HCC. Annexin V-FITC/PI was performed to analyze the apoptosis. PI stain was performed to analyze cell cycle. RNA sequencing technology was used to identify the differentially expressed genes (DEGs) induced by emodin in HCC. The impact of emodin on autophagic flux in HepG2 cells was examined by mCherry-GFP-LC3 analysis. Western blot was used to assess the protein expressions of epithelial-mesenchymal transition (EMT), autophagy, PI3K/AKT/mTOR and Wnt/β-catenin signaling pathway.Results: We found that emodin inhibited the growth of HepG2 cells in a dose- and time-dependent manner. In addition, emodin inhibited cell proliferation, induced S and G2/M phases arrest, and promoted apoptosis in HepG2 cells. The migration and invasion of HepG2 cells were also suppressed by emodin. Enrichment analysis revealed that DEGs involved in cell adhesion, cancer metastasis and cell cycle arrest. Moreover, western blot and bioinformatics analysis indicated that emodin induced autophagy and inhibited the EMT in part through suppression of the PI3K/AKT/mTOR and Wnt/β-catenin pathways. Conclusion: Our study indicated that emodin inhibited cell metastasis in HCC via the crosstalk between autophagy and EMT.
Independent Effects of Kidney Function and Cholesterol Efflux on Cardiovascular Mortality
Authors: Ritsch Andreas , Hunjadi Monika , Stojakovic Tatjana , Zewinger Stephen , Speer Thimoteus , Scherberich Jürgen E. , Silbernagel Guenther , Scharnagl Hubert , Kleber Marcus E. , März Winfried 
Published: September 2021

Abstract
BackgroundImpaired renal function is associated with cardiovascular and all-cause mortality. In the general population, HDL-cholesterol is associated with cardiovascular events, which is not true in patients with chronic kidney disease (CKD). This has been attributed to abnormal HDL function in CKD.MethodsIn this study, we analyzed the association between kidney function, cholesterol efflux capacity as one of the major HDL functions and cardiovascular mortality in 2469 patients of the Ludwigshafen Risk and Cardiovascular Health Study who all underwent coronary angiography.ResultsWe found a strong association between cholesterol efflux capacity and kidney function. Additionally, a genetic score of 53 SNPs associated with GRF and the uromodulin SNP rs12917707 was correlated inversely with cholesterol efflux. However, adjustment for eGFR and uromodulin as markers of kidney function did not affect the relationship between cholesterol efflux and cardiovascular mortality.ConclusionsWe suggest that impaired renal function lowers cholesterol efflux, but that this is not mediating the effects of impaired kidney function on cardiovascular mortality. Other mechanisms of low cellular cholesterol efflux may causally be involved in adverse cardiovascular outcomes.Trial registrationThe study was approved by the Ethics Committee at the “Aerztekammer Rheinland-Pfalz” and was performed conform to the declaration of Helsinki (837.255.97 [1394], approved January 8th, 1999).
5-Azacytidine Increases Tanshinone Production in Salvia miltiorrhiza Hairy Roots Through Epigenetic Modulation
Authors: Yang Bo-Cheng , Lee Meng-Shiou , Lin Ming-Kuem , Chang Wen-Te 
Published: September 2021

Abstract
Recent studies have indicated strong connections between epigenetic modulation and secondary metabolites in plants. It is vital to understand the roles of epigenetics in the production of secondary metabolites. In this study, the DNA demethylation agent 5-azacytidine (5-Az) was used on the hairy roots of the medicinal crop Salvia miltiorrhiza to investigate its effect on secondary metabolite production, gene expression, and methylation levels in gDNA and promoter regions. Our results showed that the contents of tanshinones in S. miltiorrhiza hairy roots increased by 1.5 to 5 times, and most genes in the MEP pathway showed an upward trend. According to our NGS analysis, the methylation pattern in the copalyl diphosphate synthase (CPS) promoter was altered, and 51 out of 145 cytosines were demethylated during 5-Az treatment. A total of 36 different transcription factors (TFs) were identified in these demethylation sites. Among these TFs, NF-Y and MYB were frequently found in our results. This is the first report to demonstrate a possible mechanism of DNA methylation participating in tanshinone biosynthesis in S. miltiorrhiza hairy roots by modulating the CPS promoter and TFs.
Recurrence of Lymphedema and Related Characteristics in Discharged Breast Cancer Patients During The COVID-19 Pandemic: A Multicenter, Cross-Sectional Survey
Authors: PENG Xin , Chen Renwang , Rao Zhenli , Yang Yi , Yan Yunli , Xia Ying , Wang Ting , Wang Jianying , Lu Fang , Pan Hong , Liu Yan , He Qin , Chen Jing 
Published: September 2021

Abstract
BackgroundTo evaluate recurrence of lymphedema and its influencing factors in discharged breast cancer patients with treated lymphedema during the COVID-19 pandemic and to propose feasible improvements. MethodsA multicenter, cross-sectional, hospital-based survey of discharged breast cancer patients was conducted during the COVID-19 pandemic in eight first-class hospitals in Wuhan city, China. Norman Questionnaire was used for assessing lymphedema, and multivariable binary logistic regression was performed to risk factors of moderate or severe lymphedema. Difference in living characteristics, anxiety and depression between no or mild group and moderate or severe group were compared. Preference in management of lymphedema were collected. Results 202 valid patients were included. 191 participants reported recurred lymphedema (prevalence: 94.6%, 95%CI 90.5% to 97.3%). 134 of them was mild and 57 were moderate/severe. In the 191 patients, the main symptom was swelling (140, 69.3%) and pain (56, 27.7%). Multivariable regression showed that age (odds ratio, 1.06, 95%CI: 1.02-1.10), radical surgery (OR=4.35, 95%CI: 1.54-12.50) and fully complete radiotherapy (OR=2.62, 95%CI: 1.17-5.87, P=0.019) was associated with the risk of moderate or severe lymphedema. No significant difference in lifestyles was observed but moderate or severe group experienced higher rate of anxiety and depression. patients preferred treatment in hospital and self-care at home equally.Conclusion The high recurrence rate of lymphedema in breast cancer patients with during COVID-19 should draw our great attention, continuous efforts should be made to identify patient at risk of lymphedema and distribute feasible guidance and education for self-management for these patients.
Differential Transcription Profiling in Bone Marrow Mononuclear Cells Between Myasthenia Gravis Patients With or Without Thymoma
Authors: Tang Jingqun , Ye Ziming , Liu Yi , Zhou Mengxiao , qin chao 
Published: September 2021

Abstract
PurposeDefective stem cells have been recognized as being associated with autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, autoimmune cytopenias and myasthenia gravis (MG). However, the differential gene expression profile of bone marrow mononuclear cells (BMMCs) and the molecular mechanisms underlying MG pathogenesis have not been fully elucidated. Therefore, we investigated the abnormal expression and potential roles and mechanisms of mRNAs in BMMCs among patients with MG with or without thymoma.MethodsTranscription profiling of BMMCs in patients with MG without thymoma (M2) and patients with thymoma-associated MG (M1) was undertaken by using high-throughput RNA sequencing (RNA-Seq), and disease-related differentially expressed genes were validated by quantitative real-time polymerase chain reaction (qRT-PCR).ResultsRNA-Seq demonstrated 60 significantly upregulated and 65 significantly downregulated genes in M2 compared with M1. Five disease-related differentially expressed genes were identified and validated by qRT-PCR analysis. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed to predict the functions of aberrantly expressed genes. Recombination activating 1 (RAG1), RAG2, BCL2-like 11, phosphatidylinositol 4,5-bisphosphate 3-kinase catalytic subunit alpha isoform and repressor element-1-silencing transcription factor might play roles in MG pathogenesis involving the primary immunodeficiency signaling pathway, signaling pathways regulating pluripotency of stem cells and forkhead box O signaling pathway.ConclusionThe aberrantly expressed genes of BMMCs in M1 or M2 patients demonstrate the underlying mechanisms governing the pathogenesis of MG.
Analysis of Immune Dysfunction and Predictors of Poor Prognosis in Patients with Alzheimer's Disease
Authors: Liu Lei , Zeng Hongmei , Zhang Qifang , Deng Feifei , Bai Hua 
Published: September 2021

Abstract
Background: Alzheimer’s disease (AD) is a serious disease causing human dementia and social problems. The quality of life and prognosis of AD patients have attracted much attention. The role of chronic immune inflammation in the pathogenesis of AD is becoming more and more important. It is necessary to study the relationship among cognitive dysfunction, abnormal cellular immune function, neuroimaging results and poor prognostic factors in patients. Methods: A retrospective analysis of 62 hospitalized patients clinical diagnosed with AD who were admitted to our hospital from November 2015 to November 2020. Collect cognitive dysfunction performance characteristics, laboratory test data and neuroimaging data from medical records within 24 hours of admission, including MMSE score, drawing clock test (CTD), blood T lymphocyte subsets, and neutrophils and lymphocyte ratio (NLR), disturbance of consciousness, extrapyramidal symptoms, electroencephalogram (EEG) and head nucleus magnetic spectroscopy (MRS) and other data. Multivariate logistic regression analysis was used to determine independent prognostic factors. the modified Rankin scale (mRS) was used to determine whether the prognosis was good. The correlation between drug treatment and prognostic mRS score was tested by the rank sum test. Results: Univariate analysis showed that abnormal cellular immune function, extrapyramidal symptoms, obvious disturbance of consciousness, abnormal EEG, increased NLR, abnormal MRS, and complicated pneumonia were related to the poor prognosis of AD patients. Multivariate logistic regression analysis showed that the decrease in the proportion of T lymphocytes in the blood after abnormal cellular immune function [OR:2.078, 95%CI :1.156-3.986, P <0.05] was an independent risk factor for predicting the poor prognosis of AD. The number of days of donepezil treatment to improve cognitive function was negatively correlated with mRS score (r= 0.578, P＜0.05). Conclusion: The decrease in the proportion of T lymphocytes may have predictive value for the poor prognosis of AD. It is recommended that the proportion of T lymphocytes <55% is used as the cut-off threshold for predicting the poor prognosis of AD. The early and continuous drug treatment is associated with a good prognosis.
Association between the type of thyroid dysfunction induced by immune checkpoint inhibitors and prognosis in cancer patients
Authors: Baek Han-sang , Jeong Chaiho , Shin Kabsoo , Lee Jaejun , Lim Dong-Jun , Kang Moo Il , Ha Jeonghoon 
Published: September 2021

Abstract
Background

Immune checkpoint inhibitors (ICIs) cause thyroid immune-related adverse effects (irAEs). However, associations between each type of thyroid immune-related adverse effect (irAE) and the anti-tumor effect of ICI remains unknown. This study aimed to determine the effects of each type of thyroid dysfunction on patient survival.
Methods

Patients who initiated ICI treatment from January 2015 to December 2019 in Seoul St. Mary’s Hospital were retrospectively analyzed. Thyroid dysfunction was classified into four types: newly developed overt or subclinical hypothyroidism, thyrotoxicosis, worsened hypothyroidism, and subclinical hyperthyroidism. Patients were divided into two groups according to the presence or absence of thyroid dysfunction.
Results

Among the 196 patients, 66 (33.7%) developed thyroid irAEs. There was no significant difference in age, sex, or cancer type between the two groups. The overall survival in patients with thyroid irAEs was significantly higher than that in patients without thyroid irAEs (38 months vs. 13 months, respectively, p = 0.005). After adjusting for confounding factors, the hazard ratio for mortality in the thyroid irAE group compared to the no thyroid irAE group was 0.520 (p = 0.007). Newly developed overt or subclinical hypothyroidism patients showed a significantly lower hazard ratio for morbidity of 0.309 (p = 0.001). Patients with thyrotoxicosis showed a worse hazard ratio for morbidity than those without thyroid irAE, although the difference was not statistically significant.
Conclusions

It was verified that ICI treatment-induced thyroid dysfunction was associated with better survival, even in the real-world practice. Thus, endocrinologists should cooperate with oncologists to monitor patients treated with ICIs.