Transgenerational Effects of Di(2-Ethylhexyl) Phthalate on Anogenital Distance, Sperm Functions and DNA Methylation in Rat Offspring.

Di(2-ethylhexyl) phthalate (DEHP) is widely used as a plasticizer in the manufacture of polyvinylchloride plastics and has been associated with concerns regarding male reproductive toxicity. In this study, we hypothesized that maternal exposure to DEHP induces transgenerational inheritance of adult-onset adverse reproductive outcomes through the male germline in the F1, F2, and F3 generations of male offspring. Pregnant rats were treated with 5 or 500 mg of DEHP/kg/day through gavage from gestation day 0 to birth. The offspring body weight, anogenital distance (AGD), anogenital index (AGI), sperm count, motility, and DNA fragmentation index (DFI) were measured for all generations. Methyl-CpG binding domain sequencing was performed to analyze sperm DNA methylation status in the F3. DEHP exposure at 500 mg/kg affected AGD, AGI, sperm count, mean DFI, and %DFI in the F1; AGD, sperm count, and mean DFI in the F2; and AGD, AGI, mean DFI, and %DFI in the F3. DEHP exposure at 5 mg/kg affected AGD, AGI, sperm count, and %DFI in the F1; sperm count in the F2; and AGD and AGI in F3. Compared with the control group, 15 and 45 differentially hypermethylated genes were identified in the groups administered 5 mg/kg and 500 mg/kg DEHP, respectively. Moreover, 130 and 6 differentially hypomethylated genes were observed in the groups administered 5 mg/kg and 500 mg/kg DEHP. Overall, these results demonstrated that prenatal exposure to DEHP caused transgenerational epigenetic effects, which may explain the observed phenotypic changes in the male reproductive system.

Indium acetate toxicity in male reproductive system in rats.

Indium, a rare earth metal characterized by high plasticity, corrosion resistance, and a low melting point, is widely used in the electronics industry, but has been reported to be an environmental pollutant and a health hazard. We designed a study to investigate the effects of subacute exposure of indium compounds on male reproductive function. Twelve-week old male Sprague-Dawley rats were randomly divided into test and control groups, and received weekly intraperitoneal injections of indium acetate (1.5 mg/kg body weight) and normal saline, respectively, for 8 weeks. Serum indium levels, cauda epididymal sperm count, motility, morphology, chromatin DNA structure, mitochondrial membrane potential, oxidative stress, and testis DNA content were investigated. The indium acetate-treated group showed significant reproductive toxicity, as well as an increased percentage of sperm morphology abnormality, chromatin integrity damage, and superoxide anion generation. Furthermore, positive correlations among sperm morphology abnormalities, chromatin DNA damage, and superoxide anion generation were also noted. The results of this study demonstrated the toxic effect of subacute low-dose indium exposure during the period of sexual maturation on male reproductive function in adulthood, through an increase in oxidative stress and sperm chromatin DNA damage during spermiogenesis, in a rodent model.

Hospitalization for Inflammatory Bowel Disease is Associated with Increased Risk of Breast Cancer: A Nationwide Cohort Study of an Asian Population.

PURPOSE: To learn whether women with inflammatory bowel disease (IBD) exhibit a higher risk of breast cancer. METHODS: We identified 4,856 women with IBD symptoms from 1998 to 2008 and 19,424 control patients without the disorder, frequency matched by age, sex, and admission year. Both cohorts were followed-up until the end of 2010 to estimate the risk of breast cancer. RESULTS: Overall, the incidence of breast cancer was similar in the IBD and control cohorts (1.31 vs. 1.25 per 1,000 person-years). The adjusted hazard ratio of breast cancer was 0.95 (95 % confidence interval 0.66-1.36) for the IBD patients. Further analysis revealed that neither Crohn disease nor ulcerative colitis was associated with the risk of developing breast cancer in women. The age-specific analysis indicated that the incidence of breast cancer was highest in the 45- to 65-year-old age group in both cohorts. The incidence of breast cancer was significantly increased in patients who required hospitalization twice or more per year, compared with the control cohort (adjusted hazard ratio 8.45; 95 % confidence interval 4.64-15.4). Moreover, age-specific analysis showed that patients aged less than 65 years old (≤44 or 45-65 years of age) exhibited a strong association between IBD hospitalization and breast cancer risk. CONCLUSIONS: The risk of breast cancer was positively proportional to the frequency of admission for IBD. Therefore, careful surveillance of breast cancer should be sought for female IBD patients with 2 or more annual hospitalizations.

Overexpression of DNAJC12 predicts poor response to neoadjuvant concurrent chemoradiotherapy in patients with rectal cancer.

Genes associated with protein folding have been found to have certain prognostic significance in a subset of cancers. The aim of this study is to evaluate the clinical impact of DNAJC12 expression in patients with rectal cancers receiving neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgery. Through data mining from a public transcriptomic dataset of rectal cancer focusing on genes associated with protein folding, we found that DNAJC12, a member of the HSP40/DNAJ family, was the most significant such gene correlated with the CCRT response. We further evaluated the expression of DNAJC12 by immunohistochemistry in the pre-treatment tumor specimens from 172 patients with rectal cancers. From this set, we statistically analyzed the association of DNAJC12 expression with various clinicopathological factors, tumor regression grade, overall survival (OS), disease-free survival (DFS) and local recurrence-free survival (LRFS). High expression of DNAJC12 was significantly associated with advanced pre- and post-treatment tumor status (P<0.001), advanced pre- and post-treatment nodal status (P<0.001), increased vascular invasion (P=0.015), increased perineural invasion (P=0.023) and lower tumor regression grade (P=0.009). More importantly, high expression of DNAJC12 was found to be correlated with poor prognosis for OS (P=0.0012), DFS (P<0.0001) and LRFS (P=0.0001). In multivariate analysis, DNAJC12 overexpression still emerged as an independent prognosticator for shorter OS (P=0.040), DFS (P<0.001) and LRFS (P=0.016). The data indicate that DNAJC12 overexpression acts as a negative predictive factor for the response to neoadjuvant CCRT and was significantly associated with shorter survival in patients with rectal cancers receiving neoadjuvant CCRT followed by surgery.

Fecal Incontinence and Quality of Life in Adults With Rectal Cancer After Lower Anterior Resection.

PURPOSE: The purpose of this study was to explore the prevalence of fecal incontinence (FI) and its impact on health-related quality of life in rectal cancer patients following low anterior resection surgery for colorectal cancer. DESIGN: Descriptive, cross-sectional study. SUBJECTS AND SETTING: Patients who were diagnosed with rectal cancer and underwent low anterior resection were recruited from a 1264-bed hospital in southern Taiwan. Potential participants were mailed a questionnaire survey. They were followed up 8 to 16 months postoperatively. Some clinical data were collected via retrospective review of their medical records. METHODS: Questionnaires were mailed to 172 patients, and 71 with colorectal cancer underwent low anterior resection and agreed to participate and completed questionnaires in the research, reflecting a return rate of 41%. Data were collected on demographic characteristics and disease-related variables. Participants were asked if they had experienced FI during the past week. Fecal incontinence health-related quality of life was measured using the Cleveland Clinic Incontinence Score (CCIS) and the Fecal Incontinence Quality of Life Index. Completion of the questionnaire required approximately 15 minutes. RESULTS: More than half of the 71 participants (n = 45; 63.4%) experienced incontinence of flatus, 42.3% (n = 30) reported incontinence of liquid stool, and 14.1% (n = 10) stated that they experienced incontinence of solid stool. Based on mean CCIS scores, 35.2% (n = 25) experienced moderate to severe FI. One-third wore pads to contain FI and 21.1% changed daily activities because of FI. Nearly two-thirds reported FI during the week prior to completing the research questionnaire. The average Fecal Incontinence Quality of Life Index cumulative score was significantly lower in the FI group (2.62 ± 0.61) than in the without-FI group (3.32 ± 0.77; P < .001), as were all subscale mean scores (all P < .01-.001). CONCLUSIONS: Fecal incontinence is prevalent among persons undergoing low anterior resection for colorectal cancer. Persons with FI report poor health-related quality of life compared to persons who retained fecal continence. Health care providers should assess these patients for FI and treat or refer those who experience this common problem.

Shorter daily dwelling time in peritoneal dialysis attenuates the epithelial-to-mesenchymal transition of mesothelial cells.

BACKGROUND: Peritoneal dialysis (PD) therapy is known to induce morphological and functional changes in the peritoneal membrane. Long-term exposure to conventional bio-incompatible dialysate and peritonitis is the main etiology of inflammation. Consequently, the peritoneal membrane undergoes structural changes, including angiogenesis, fibrosis, and hyalinizing vasculopathy, which ultimately results in technique failure. The epithelial-to-mesenchymal transition (EMT) of mesothelial cells (MCs) plays an important role during the above process; however, the clinical parameters associated with the EMT process of MCs remain to be explored. METHODS: To investigate the parameters impacting EMT during PD therapy, 53 clinical stable PD patients were enrolled. EMT assessments were conducted through human peritoneal MCs cultured from dialysate effluent with one consistent standard criterion (MC morphology and the expression of an epithelial marker, cytokeratin 18). The factors potentially associated with EMT were analyzed using logistic regression analysis. Primary MCs derived from the omentum were isolated for the in vitro study. RESULTS: Forty-seven percent of the patients presented with EMT, 28% with non-EMT, and 15% with a mixed presentation. Logistic regression analysis showed that patients who received persistent PD therapy (dwelling time of 24 h/day) had significantly higher EMT tendency. These results were consistent in vitro. CONCLUSIONS: Dwelling time had a significant effect on the occurrence of EMT on MCs.

Mediating Roles of Psychological Distress, Insomnia, and Body Image Concerns in the Association Between Exercise Addiction and Eating Disorders.

Purpose: Exercising can promote good health. However, excessive exercising may have downsides. This study examined the association between exercise addiction and eating disorders and whether the identified association was mediated by psychological distress, insomnia (including sleep quality), and body image concern. Methods: A total of 2088 adolescents (mean age of 15.3 years) participated in this cross-sectional study by questions assessing exercise addiction, eating disorders, psychological distress, insomnia, sleep quality, and body image concern. Results: There were significantly positive relationships between the variables (r=0.12-0.54, p<0.01) with effect sizes from small to large. The four potential mediators (ie, insomnia, sleep quality, psychological distress, and body image concern), individually and in total, significantly mediated the association between exercise addiction and eating disorders. Conclusion: The findings suggest that exercise addiction in adolescents may influence eating disorders through multiple pathways, such as insomnia, psychological distress, and body image concerns. Future research should examine these relationships longitudinally and use gathered information to inform intervention development. Clinicians and healthcare workers are encouraged to assess exercise addiction when treating individuals with eating disorders.

The tendency to avoid physical activity and sport scale (TAPAS): Rasch analysis with differential item functioning testing among a Chinese sample.

BACKGROUND: The benefits of physical activity are well-known to prevent multiple long-term health conditions. Physical appearance and weight-related stigma may influence individuals' decision to engage in physical activity and sport. Therefore, the present study examined the psychometric properties of a newly developed instrument, the Tendency to Avoid Physical Activity and Sport Scale (TAPAS), using modern test theory. METHODS: A total of 2319 university students were recruited from mainland China and they completed the TAPAS. Rasch analysis was used to examine the TAPAS' rating scaling functioning, test unidimensionality, item hierarchy, ceiling and floor effects, and differential item functioning (DIF). Moreover, the concurrent validity of the TAPAS was examined using the Weight Self-Stigma Questionnaire (WSSQ), Weight Bias Internalization Scale (WBIS), and body mass index (BMI). RESULTS: Unidimensionality was confirmed except for one item. Items corresponding to attitude toward physical activity were more easily adopted compared to items corresponding to actual behavioral aspects. No ceiling and floor effects were found. No DIF existed in the TAPAS items. The TAPAS was strongly correlated with both the WSSQ and WBIS, but not BMI. CONCLUSION: The study showed that overall, the TAPAS has robust psychometric properties. However, future research needs to address the misfit item and explore the feasibility of applying the TAPAS to other populations including wider ethnic groups, age ranges, and life stages.

Long-term DEHP/MEHP exposure promotes colorectal cancer stemness associated with glycosylation alterations.

Plasticizers are considered as environmental pollution released from medical devices and increased potential oncogenic risks in clinical therapy. Our previous studies have shown that long-term exposure to di-ethylhexyl phthalate (DEHP)/mono-ethylhexyl phthalate (MEHP) promotes chemotherapeutic drug resistance in colorectal cancer. In this study, we investigated the alteration of glycosylation in colorectal cancer following long-term plasticizers exposure. First, we determined the profiles of cell surface N-glycomes by using mass spectrometry and found out the alterations of α2,8-linkages glycans. Next, we analyzed the correlation between serum DEHP/MEHP levels and ST8SIA6 expression from matched tissues in total 110 colorectal cancer patients. Moreover, clinical specimens and TCGA database were used to analyze the expression of ST8SIA6 in advanced stage of cancer. Finally, we showed that ST8SIA6 regulated stemness in vitro and in vivo. Our results revealed long-term DEHP/MEHP exposure significantly caused cancer patients with poorer survival outcome and attenuated the expression of ST8SIA6 in cancer cells and tissue samples. As expected, silencing of ST8SIA6 promoted cancer stemness and tumorigenicity by upregulating stemness-associated proteins. In addition, the cell viability assay showed enhanced drug resistance in ST8SIA6 silencing cells treated with irinotecan. Besides, ST8SIA6 was downregulated in the advanced stage and positively correlated with tumor recurrence in colorectal cancer. Our results imply that ST8SIA6 potentially plays an important role in oncogenic effects with long-term phthalates exposure.

The Associations between Sibling Victimization, Sibling Bullying, Parental Acceptance-Rejection, and School Bullying.

Bullying has been identified as the most common form of aggression experienced by school-age youth. However, it is still unclear about the family's influence on school bullying. Therefore, the current study aimed to explore the associations between sibling bullying and school bullying, sibling victimization and school victimization, and parental acceptance-rejection and school bullying victimization. The study was cross-sectional and conducted on a sample of students aged between 11 and 20 years recruited from middle schools in Algeria. The study used a survey adopted from the scale of Sibling Bullying, Student Survey of Bullying Behavior-Revised 2, and the Survey of parental acceptance-rejection in collecting the data. The model's results assessing the association between sibling bullying and school bullying demonstrated that the effect of sibling physical and sibling verbal victims on school victimization was statistically significant. Despite the non-significant effect of sibling emotional victims on school victimization, the effect of sibling physical and sibling verbal bullying on school bullying was statistically significant. However, the effect of sibling emotional bullying on school bullying was not statistically significant. The direct effect of parental acceptance on school victimization was not statistically significant, whereas the effect of parental rejection on school victimization was statistically significant. The direct effect of parental acceptance on school bullying was not statistically significant, while the effect of parental rejection on school bullying was statistically significant. Based on the results, this study provides insights into the understanding of how the family and siblings contribute to school bullying. In particular, sibling victimization, sibling bullying, and parental acceptance-rejection are predictive factors of school bullying among adolescents. Future research should take into account factors based on family to explore the risks of school bullying.

Predictors of COVID-19 Stress and COVID-19 Vaccination Acceptance among Adolescents in Ghana.

Coronavirus disease 2019 (COVID-19) continues to ravage world economies, and with its recent mutations, countries worldwide are finding ways of ramping up their vaccination programmes. This cross-sectional design study, therefore, examined the predictors of COVID-19 stress and COVID-19 vaccination acceptance among adolescents in Ghana. A total of 817 participants were conveniently selected to respond to measures on fear of COVID-19, perceived stigma from COVID-19, self-stigma from COVID-19, believing COVID-19 information, COVID-19 infection prevention behaviours, COVID-19 stress, and COVID-19 vaccination acceptance. It was found that females believed COVID-19 information and accepted COVID-19 vaccination more than males did. Moreover, there were significant relationships between the majority of the COVID-19-related variables. Furthermore, fear of COVID-19, self-stigma from COVID-19, and COVID-19 infection prevention behaviours were found to be significant predictors of COVID-19 stress. Additionally, believing COVID-19 information, danger and contamination fears (a subscale of COVID-19 stress), and traumatic stress (a subscale of COVID-19 stress) were significant predictors of COVID-19 vaccination acceptance. These findings imply that different factors influence different COVID-19 variable. Therefore, careful considerations and research should be employed by health authorities and policymakers in preparing COVID-19 information to target different age groups and for different COVID-19 purposes.

Surveillance of Adenovirus and Norovirus Contaminants in the Water and Shellfish of Major Oyster Breeding Farms and Fishing Ports in Taiwan.

The enteric viruses, including adenovirus (AdVs) and norovirus (NoVs), in shellfish is a significant food safety risk. This study investigated the prevalence, seasonal occurrence, genetic diversity, and quantification of AdVs and NoVs in the water and cultured shellfish samples at the four major coastal oyster breeding farms (COBF), five major fishing ports (FP), and their markets in Taiwan. The AdVs/NoVs in the water and shellfish samples were isolated by the membrane filtration and direct elution methods. The RNA of NoVs was reverse-transcribed into complementary DNA through reverse transcription reaction. Further NoVs and AdVs were detected using nested PCR. A higher detection rate was recorded in the low-temperature period than high-temperature. Detection difference was noted between nested PCR and qPCR outcomes for AdVs. The total detection rate of AdVs was higher in the water samples (COBF-40.6%, FP 20%) than the shellfish samples (COBF-11.7% and FP 6.3%). The AdVs load in the water and shellfish samples ranged from 1.23 × 103 to 1.00 × 106 copies/L and 3.57 × 103 to 4.27 × 104 copies/100g, respectively. The total detection of NoVs was highest in the water samples of the FP and their market shellfish samples (11.1% and 3.2%, respectively). Genotyping and phylogenetic analysis were identified as the prevalent AdVs and NoVs genotypes in the water and shellfish samples: A species HAdVs serotype 12; F species HAdVs serotype 41; and C species PAdVs serotype 5 (NoVs GI.2, GI.3 and GII.2). No significant differences were observed between the presence of AdVs, and all of the water quality parameters evaluated (heterotrophic plate count, water temperature, turbidity, pH, salinity, and dissolved oxygen). The virus contamination occurs mainly due to the direct discharge of domestic sewage, livestock farm, and fishing market wastewater into the coastal environment. Thus, this study suggested framing better estuarine management to prevent AdVs/NoVs transmission in water and cultured/distributed shellfish.

Comparisons of psychological distress and self-stigma among three types of substance use disorders receiving treatment-as-usual approaches: real-world data from a 9-month longitudinal study.

Background: Substance use is an important issue worldwide and people with substance use disorders (SUDs) have been reported to have high levels of psychological distress and self-stigma. Therefore, psychological distress and self-stigma in people with SUDs are considerable. Objective: The present study used a longitudinal design to examine whether treatment-as-usual approaches in Taiwan improve psychological distress and self-stigma among people with three types of SUDs (heroin, amphetamine, and alcohol use disorders). Design: A 9-month longitudinal design involving four assessments spaced 3 months apart. Methods: Convenience sampling was used to recruit people with heroin (n = 112), amphetamine (n = 151), and alcohol (n = 56) use disorders from outpatient psychiatric center in Southern Taiwan. Psychological distress was assessed using the Depression, Anxiety, Stress Scale (DASS-21), and self-stigma was assessed using the Self-Stigma Scale-Short (SSS-S). Generalized estimating equation (GEE) models were constructed to understand between-group differences in psychological distress and self-stigma over time. Results: Patients with heroin and amphetamine use disorders had lower levels of psychological distress as compared with those with alcohol use disorder. Levels of psychological distress were lower at Time 2 to Time 4 as compared with Time 1. Patients with heroin and amphetamine use disorders had higher levels of self-stigma as compared with those with alcohol use disorder. Self-stigma levels remained stable over time. The dropout rate of receiving treatment-as-usual approach in the 9-month study was 60%. Conclusion: Treatment as usual for SUDs among outpatients in Taiwan may decrease psychological distress but not self-stigma. However, such effects need to be further examined given the high drop-out rates and absence of a control condition. The findings suggest that self-stigma may warrant additional treatment for patients with SUDs.

Cyberchondria, Fear of COVID-19, and Risk Perception Mediate the Association between Problematic Social Media Use and Intention to Get a COVID-19 Vaccine.

Vaccination is the most effective way to control the COVID-19 pandemic, but vaccination hesitancy threatens this effort worldwide. Consequently, there is a need to understand what influences individuals' intention to get a COVID-19 vaccine. Restriction of information gathering on societal developments to social media may influence attitudes towards COVID-19 vaccination through exposure to disinformation and imbalanced arguments. The present study examined the association between problematic social media use and intention to get the COVID-19 vaccine, taking into account the mediating roles of cyberchondria, fear of COVID-19, and COVID-19 risk perception. In a cross-sectional survey study, a total of 10,843 residents of Qazvin City, Iran completed measures on problematic social media use, fear of COVID-19, cyberchondria, COVID-19 risk perception, and intention to get a COVID-19 vaccine. The data were analyzed using structural equation modeling (SEM). The results showed that there was no direct association between problematic social media use and intention to get a COVID-19 vaccine. Nonetheless, cyberchondria, fear of COVID-19, and COVID-19 risk perception (each or serially) mediated associations between problematic social media use and intention to get a COVID-19 vaccine. These results add to the understanding of the role of problematic social media use in COVID-19 vaccine hesitancy, i.e., it is not the quantity of social media use per se that matters. This knowledge of the mediating roles of cyberchondria, fear of COVID-19, and COVID-19 risk perception can be used by public health experts and policymakers when planning educational interventions and other initiatives in COVID-19 vaccination programs.

Effects of sleep quality on the association between problematic internet use and quality of life in people with substance use disorder.

BACKGROUND: Problematic internet use, especially in people with substance use disorder, may negatively affect their quality of life (QoL). However, it is unclear whether sleep quality is a key mediator in the association between problematic internet use and QoL among people with substance use disorder. AIMS: This study aimed to investigate the relationship between problematic internet use and QoL and how sleep quality may mediate the association between these two variables. METHOD: Overall, 319 people (85% male) with substance use disorder (mean age 42.2 years, s.d. 8.9) participated in a cross-sectional study in Taiwan. The Smartphone Application-Based Addiction Scale, Bergan Social Media Addiction Scale, Internet Gaming Disorder-Short Form, Pittsburgh Sleep Quality Index and World Health Organization Quality of Life Questionnaire Brief Version were used. RESULTS: The prevalence of sleep problems was 56%. There were significant and direct associations between sleep quality and two types of problematic internet use, and between sleep quality and different dimensions of QoL. All types of problematic internet use were significantly and negatively correlated with QoL. Mediated effects of sleep quality in relationships between the different types of problematic internet use and all dimensions of QoL were significant, except for problematic use of social media. CONCLUSIONS: Different types of problematic internet use in people with substance use disorder may be directly associated with reduced QoL. Sleep quality as a significant mediator in this association may be an underlying mechanism to explain pathways between problematic internet use and QoL in this population.

Impact on inadequate lymph node harvest on survival in T4N0 colorectal cancer: A would-be medical center experience in Taiwan.

Insufficient lymph node harvest (< 12) may lead to incorrect classification of stage I and II disease. Many studies have indicated a poor prognosis with inadequate lymph node harvest in stages I to III, but few studies have demonstrated the relationship between low lymph node harvest and T4 disease. This study aimed to identify the influence of insufficient number of lymph nodes harvested on survival in T4N0 colorectal cancer. We enrolled patients with T4N0 colorectal cancer who underwent radical resection between 2010 and 2016. A total of 155 patients were divided into 2 groups; 142 patients had ≥ 12 harvested lymph nodes, and the other 13 had < 12 lymph nodes. All patients were followed up for at least 5 years. The primary outcome was the impact of the number of lymph nodes harvested on disease-free survival and overall survival, which were investigated using Kaplan-Meier survival techniques. There were no significant differences in recurrence rate, emergent or elective surgery, laparoscopic or open surgery, or chemotherapy between the 2 groups. Kaplan-Meier analyses showed no statistical differences in 5-year disease-free survival (P = .886) and 5-year overall survival (P = .832) between the groups. There were no significant differences in disease-free survival and overall survival between patients with adequate (≥ 12) and inadequate (< 12) lymph node harvest in T4N0 colorectal cancers.

High Expression of Folate Receptor Alpha (FOLR1) is Associated With Aggressive Tumor Behavior, Poor Response to Chemoradiotherapy, and Worse Survival in Rectal Cancer.

Objectives: Recently, molecular medicine targeting Folate Receptor Alpha (FOLR1), which mediates intracellular folate uptake and tumor cell proliferation, has been identified in several malignancies. However, the association between FOLR1 expression and rectal cancer remains unclear. Methods: Immunostaining of FOLR1 was performed on biopsy specimens from 172 rectal cancer patients undergoing preoperative chemoradiotherapy (CRT). FOLR1 expression was measured and divided into low (0+-2+) or high (3+-4+) level. Correlations between FOLR1 status and clinicopathologic features, tumor regression grade, disease-specific survival (DSS), local recurrence-free survival, and metastasis-free survival (MeFS) were analyzed, retrospectively. Results: High FOLR1 expression was significantly associated with advanced post-treatment tumor and nodal status (T3-4; N1-2, P = .001), vascular invasion (P = .042), perineural invasion (P = .012), and poor regression change after CRT (P = .001). In uni- and multi-variable survival analysis, FOLR1 overexpression remained a significant predictor of lower DSS (hazard ratio [HR], 2.328; 95% confidence interval [CI], 1.014-5.344; P = .046) and MeFS (HR, 2.177; 95% CI, 1.000-1.1286; P = .050). Conclusion: These results indicate that high FOLR1 status is associated with aggressive tumor behavior, poor response to CRT, and worse survival. Therefore, FOLR1 expression at initial biopsy may be useful in predicting outcomes and also be a target for the exploration of FOLR1-based therapeutic agents.

The Mediating Role of Selfitis in the Associations between Self-Esteem, Problematic Social Media Use, Problematic Smartphone Use, Body-Self Appearance, and Psychological Distress among Young Ghanaian Adults.

Selfie-related activities have become pervasive to the point that they may affect the mental health of people who engage in them. To ascertain this mechanism, this study examined the mediating role of selfitis in the associations between self-esteem, problematic social media use, problematic smartphone use, body-self appearance, and psychological distress among young Ghanaian adults. A total of 651 participants completed a questionnaire with measures on self-esteem, body-self appearance, problematic social media use, problematic smartphone use, depression, anxiety, stress, coping skills, and selfitis. There were direct associations between all the variables except between self-esteem and selfitis. In addition, selfitis mediated the associations between problematic social media use, problematic smartphone use, body-self appearance, and psychological distress except between self-esteem and psychological distress. These findings suggest that selfitis can serve as a pathway by which people who overly engage in problematic social media use, problematic smartphone use, and have poor body-self appearance may experience psychological distress. Hence, there is a need for health communicators, school authorities, and opinion leaders to educate young adults on the consequences of the problematic use of technology, especially for selfitis behaviour. Future studies can examine the factors that predict selfitis behaviour among adults.

The Mediating Roles of Anxiety, Depression, Sleepiness, Insomnia, and Sleep Quality in the Association between Problematic Social Media Use and Quality of Life among Patients with Cancer.

The present study examined the mediating role of anxiety, depression, sleepiness, insomnia, and sleep quality in the association between problematic social media use and quality of life (QoL) among patients with cancer. This cross-sectional survey study recruited 288 patients with cancer to respond to measures on anxiety, depression, sleepiness, insomnia, sleep quality, problematic social media use, and QoL. Structural Equation Modeling was used for the mediation analysis. There were significant relationships between all of the variables used in the study. It was revealed that problematic social media use did not directly influence the QoL of patients with cancer except via anxiety, depression, sleepiness, and insomnia. Sleep quality did not mediate the association between problematic social media use and QoL. Healthcare workers managing cancer should pay attention to the mental health needs of their patients even as they treat their cancer so as to improve their quality of life. Future studies may examine other variables that affect the QoL of patients with cancer as well as other mediating and moderating variables.

An Observational Study of Trifluridine/Tipiracil-Containing Regimen Versus Regorafenib-Containing Regimen in Patients With Metastatic Colorectal Cancer.

Background: There are no randomized control trials comparing the efficacy of trifluridine/tipiracil and regorafenib in patients with metastatic colorectal cancer (mCRC). Herein, we conducted an observational study to compare the oncologic outcomes of trifluridine/tipiracil-containing regimen (TAS-102) and regorafenib-containing regimen (REG) in patients with mCRC. Material and method: Patients who were diagnosed to have mCRC in 2015 to 2021 and treated with TAS-102-containing regimen or REG-containing regimen were recruited. Monotherapy or combination therapy were all allowed in this study. Oncologic outcomes were presented with progression-free survival (PFS), overall survival (OS), overall response rate (ORR) and disease control rate (DCR). Results: A total of 125 patients were enrolled into our study, accounting for 50 patients with TAS-102 and 75 patients with REG. Of these patients, 64% were treated with TAS-102 or REG monotherapy, while the remaining were treated with TAS-102 combination or REG combination. In general, the median PFS and OS were 3.7 versus 2.0 months (P = 0.006) and 9.2 versus 6.8 months (P = 0.048) in TAS-102 and REG, respectively. The ORR and DCR were 44% versus 20% (P < 0.001) and 72% versus 43% (P < 0.001) in TAS-102 and REG, respectively. As for treatment strategies, the survival were significantly longer in combination than in monotherapy, no matter in TAS-102 or REG group. Multivariate analysis showed TAS-102 and combination therapy were independent predictor associated with better survival. Conclusions: Our results suggested that TAS-102 had better oncologic outcomes than REG in patients with mCRC, especially in combination. Further prospective trials are warranted to confirm our results.