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Objective: To examine the renoprotective effects of metabolic surgery in patients with established chronic kidney disease (CKD). Background: The impact of metabolic surgery compared with glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with established CKD has not been fully characterized. Methods: Patients with obesity (body mass index =30 kg/m²), type 2 diabetes, and baseline estimated glomerular filtration rate (eGFR) 20-60 mL/min/1.73 m² who underwent metabolic bariatric surgery at a large US health system (2010-2017) were compared with nonsurgical patients who continuously received GLP-1RA. The primary end point was CKD progression, defined as a decline of eGFR by =50% or to <15 mL/min/1.73 m2, initiation of dialysis, or kidney transplant. The secondary end point was the incident kidney failure (eGFR <15 mL/min/1.73 m2, dialysis, or kidney transplant) or all-cause mortality. Results: 425 patients, including 183 patients in the metabolic surgery group and 242 patients in the GLP-1RA group, with a median follow-up of 5.8 years (IQR, 4.4-7.6), were analyzed. The cumulative incidence of the primary end point at 8 years was 21.7% (95% CI: 12.2-30.6) in the surgical group and 45.1% (95% CI: 27.7 to 58.4) in the nonsurgical group, with an adjusted hazard ratio of 0.40 (95% CI: 0.21 to 0.76), P=0.006. The cumulative incidence of the secondary composite end point at 8 years was 24.0% (95% CI: 14.1 to 33.2) in the surgical group and 43.8% (95% CI: 28.1 to 56.1) in the nonsurgical group, with an adjusted HR of 0.56 (95% CI: 0.31 to 0.99), P= 0.048. Conclusions: Among patients with type 2 diabetes, obesity, and established CKD, metabolic surgery, compared with GLP-1RA, was significantly associated with a 60% lower risk of progression of kidney impairment and a 44% lower risk of kidney failure or death. Metabolic surgery should be considered as a therapeutic option for patients with CKD and obesity. [ABSTRACT FROM AUTHOR]

Abstract Background Tissue microarray (TMA) data are commonly used to validate the prognostic accuracy of tumor markers. For example, breast cancer TMA data have led to the identification of several promising prognostic markers of survival time. Several studies have shown that TMA data can also be used to cluster patients into clinically distinct groups. Here we use breast cancer TMA data to cluster patients into distinct prognostic groups. Methods We apply weighted correlation network analysis (WGCNA) to TMA data consisting of 26 putative tumor biomarkers measured on 82 breast cancer patients. Based on this analysis we identify three groups of patients with low (5.4%), moderate (22%) and high (50%) mortality rates, respectively. We then develop a simple threshold rule using a subset of three markers (p53, Na-KATPase-β1, and TGF β receptor II) that can approximately define these mortality groups. We compare the results of this correlation network analysis with results from a standard Cox regression analysis. Results We find that the rule-based grouping variable (referred to as WGCNA*) is an independent predictor of survival time. While WGCNA* is based on protein measurements (TMA data), it validated in two independent Affymetrix microarray gene expression data (which measure mRNA abundance). We find that the WGCNA patient groups differed by 35% from mortality groups defined by a more conventional stepwise Cox regression analysis approach. Conclusions We show that correlation network methods, which are primarily used to analyze the relationships between gene products, are also useful for analyzing the relationships between patients and for defining distinct patient groups based on TMA data. We identify a rule based on three tumor markers for predicting breast cancer survival outcomes.

Abstract Background The protein AGR2 is a putative member of the protein disulfide isomerase family and was first identified as a homolog of the Xenopus laevis gene XAG-2. AGR2 has been implicated in a number of human cancers. In particular, AGR2 has previously been found to be one of several genes that encode secreted proteins showing increased expression in prostate cancer cells compared to normal prostatic epithelium. Methods Gene expression levels of AGR2 were examined in prostate cancer cells by microarray analysis. We further examined the relationship of AGR2 protein expression to histopathology and prostate cancer outcome on a population basis using tissue microarray technology. Results At the RNA and protein level, there was an increase in AGR2 expression in adenocarcinoma of the prostate compared to morphologically normal prostatic glandular epithelium. Using a tissue microarray, this enhanced AGR2 expression was seen as early as premalignant PIN lesions. Interestingly, within adenocarcinoma samples, there was a slight trend toward lower levels of AGR2 with increasing Gleason score. Consistent with this, relatively lower levels of AGR2 were highly predictive of disease recurrence in patients who had originally presented with high-stage primary prostate cancer (P = 0.009). Conclusions We have shown for the first time that despite an increase in AGR2 expression in prostate cancer compared to non-malignant cells, relatively lower levels of AGR2 are highly predictive of disease recurrence following radical prostatectomy.

Language teacher immunity, as a new notion in language teacher psychology, is a strong indicator of how teachers behave when dealing with difficulties and challenges; and it has a profound effect on teachers' careers. Research on language teacher immunity is in its nascent stage. This study employed an explanatory sequential mixed-methods design to explore the changes in EFL teachers' immunity for a semester in the COVID-19 era. In so doing, the language teacher immunity questionnaire (Language Immunity Questionnaire; Hiver [2016. Tracing the Signature Dynamics of L2 Teacher Immunity: A Retrodictive Qualitative Modeling Study." Unpublished Ph.D. thesis, University of Nottingham, England]) was administered to 30 male and female Iranian EFL teachers using SHAD application (an Iranian application developed to address the emergency remote teaching need to be created by the COVID-19 crisis) in the beginning, middle, and at the end of the Fall semester 2020. After that, follow-up interview data were collected to help explain the results of the quantitative phase. The results of the repeated-measures ANOVA indicated that there were differing changes in different aspects of participants' immunity. The follow-up qualitative data analysis showed that the changes in teachers' immunity were mainly due to familiarity with online teaching, scepticism of online learning, and limited student participation. The implications for future research in the field are discussed. [ABSTRACT FROM AUTHOR]

Structural equation modeling (SEM) is a statistical method used for testing and estimating causal relations using a combination of statistical data and qualitative causal assumptions. This paper reports two studies done by the researchers through the application of SEM. In the first study the relationship between EFL learners' affective constructs and their English achievement was assessed using SEM. Since both Structural coefficient and Goodness of fit are high, we conclude that not only is the model accepted but also the relationship between EFL learners' affective constructs and their English achievement is statistically significant. The second study investigated the relationship between Affective constructs and Study Process of EFL learners through the application of SEM. In this study the Goodness of Fit Index (GFI) turned out to be 0.99. Again like the previous study, since the Goodness of Fit Index (GFI) and structural coefficient are high, we conclude that there is a statistically strong relationship between affective constructs and study process of EFL learners.

Language teachers often encourage L2 readers to guess the meaning of unknown words in texts. This paper argues that before any statements about the value of guessing can be made, it is necessary to show how reliable learners' guesses are. To this end, the present study investigates how accurately EFL learners assess their understanding of unknown words, and whether language proficiency and gender influence their self-assessment. The study was carried out in three phases. In phase one, participants (N = 110) took a proficiency test and were asked to study a text in which 40 items were highlighted by the researcher on the basis of words that were unfamiliar to them. They were required to assess their understanding of the meaning of unknown words on a four-point scale. In phase two, they provided a translation, synonym, antonym, or an explanation of the unknown words. In phase three, they received the same self-assessment sheet to reassess their understanding of unknown words. The results indicated that learners' assessments are not reliable. Moreover, it was found that proficiency in the L2 and gender influence learners' self-assessment. (Contains 6 tables.)

Fluid shear stress modulates vascular production of endothelial superoxide anion ([[O.sub.2].sup.-]) and nitric oxide (NO). Whether the characteristics of shear stress influence the spatial variations in mitochondrial manganese superoxide dismutase (Mn-SOD) expression in vasculatures is not well defined. We constructed a three-dimensional computational fluid dynamics model simulating spatial variations in shear stress at the arterial bifurcation. In parallel, explants of arterial bifurcations were sectioned from the human left main coronary bifurcation and right coronary arteries for immunohistolocalization of Mn-SOD expression. We demonstrated that Mn-SOD staining was prominent in the pulsatile shear stress (PSS)-exposed and atheroprotective regions, but it was nearly absent in the oscillatory shear stress (OSS)-exposed regions and lateral wall of arterial bifurcation. In cultured bovine aortic endothelial cells, PSS at mean shear stress ([[tau].sub.ave]) of 23 dyn/[cm.sup.2] upregulated Mn-SOD mRNA expression at a higher level than did OSS at [[tau].sub.ave] = 0.02 dyn/[cm.sup.2] [+ or -] 3.0 dyn x [cm.sup.-2] x [s.sup.-1] and at 1 Hz (PSS by 11.3 [+ or -] 0.4-fold vs. OSS by 5.0 [+ or -] 0.5-fold vs. static condition; P < 0.05, n = 4). By liquid chromatography and tandem mass spectrometry, it was found that PSS decreased the extent of low-density lipoprotein (LDL) nitration, whereas OSS increased nitration (P < 0.05, n = 4). In the presence of LDL, treatment with Mn-SOD small interfering RNA increased intracellular nitrotyrosine level (P < 0.5, n = 4), a fingerprint for nitrotyrosine formation. Our findings indicate that shear stress in the atheroprone versus atheroprotective regions regulates spatial variations in mitochondrial Mn-SOD expression with an implication for modulating LDL nitration. superoxide dismutase; superoxide anion; nitric oxide; nitrotyrosine; low-density lipoprotein

ABSTRACT Using PCR-based methodologies, we surveyed triploid Crassostrea ariakensis (Fujita 1913), introduced in experimental trials in the Chesapeake Bay, for parasites endemic to the native oyster and for Bonamia ostreae. [...]

Polymer-modified bitumen binders have been dramatically used over the last decade to combat the increasing weight and volume of heavy vehicle traffic and to reduce the pavement maintenance cost. This paper provides the findings of a study performed to evaluate new polymer composites to be used in bitumen modification. The proposed polymer is an Elastomer–Plastomer Vulcanised (EPV) nanocomposite containing low-density polyethylene (LLDPE), styrene butadiene rubber and a type of nanoclay and a small amount of bitumen binder. An example of bitumen binder was modified with 2%, 4%, and 6% of different EPV types and the storage stability and morphology of modified binders were evaluated to select the optimum EPV type. Further rheological analyses were conducted on modified binders containing 2%, 4%, and 6% of the selected EPV. It has been found that modification of bitumen with 4% of the selected EPV resulted in increasing the stiffness and elastic properties at the range of intermediate to high in-service temperatures. The viscosity of modified binders also increased at elevated production temperatures. [ABSTRACT FROM AUTHOR]