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Purpose – Hotels offer high-quality guest experiences to positively impact their emotions, satisfaction, perceived value, word-of-mouth (WOM) and electronic word-of-mouth (eWOM). This study aims to investigate the impacts of the quality perceived by hotel guests on their positive emotions, negative emotions, perceived value and satisfaction; verify the impacts of the price on perceived value and satisfaction; examine the impacts of satisfaction on WOM and eWOM; and test the moderating effect of hotel guests’ behavioural engagement on social networking sites (HGBE-SNS) on the relationship between satisfaction and eWOM. Design/methodology/approach – This survey included 371 guests who assessed their experiences at three Brazilian hotels. Structural equation modelling tested the hypothetical model supported by the stimulus-organism-response (S-O-R) theory (Mehrabian and Russell, 1974). Findings – The quality perceived by hotel guests (stimulus) positively impacts perceived value, positive emotions and satisfaction and negatively affects negative emotions (organism). Price (stimulus) negatively impacts perceived value but does not affect satisfaction. Perceived value positively impacts satisfaction. Satisfaction positively impacts WOM and eWOM (responses). The HGBE-SNS moderates the relationship between satisfaction and eWOM. Originality/value – To the best of the authors’ knowledge, this study is the first that simultaneously demonstrates the relationships between perceived quality, price, perceived value, positive and negative emotions, satisfaction, WOM, eWOM and HGBE-SNS. Hotels must offer their guests high-quality services to positively impact’ perceived value, positive emotions, satisfaction and WOM. Low prices boost the perceived value but do not directly increase guest satisfaction. Satisfied hotel guests share their experiences via WOM, but high HGBE-SNS is crucial to boost eWOM. Objetivo – Los hoteles ofrecen experiencias de alta calidad a sus huéspedes para influir positivamente en sus emociones, satisfacción, valor percibido, boca a boca (WOM) y boca a boca electrónico (eWOM). Este estudio tiene como objetivo a) investigar el impacto de la calidad percibida por los huéspedes del hotel en sus emociones positivas, emociones negativas, valor percibido y satisfacción; b) verificar el impacto del precio en el valor percibido y la satisfacción; c) examinar el impacto de la satisfacción en el WOM y eWOM; d) probar el efecto moderador del compromiso conductual de los huéspedes del hotel en las redes sociales (HGBE-SNS) en la relación entre satisfacción y eWOM. Diseño/metodología/enfoque – En esta encuesta participaron 371 huéspedes que evaluaron sus experiencias en tres hoteles brasileños. La modelización de ecuaciones estructurales puso a prueba el modelo hipotético apoyado en la teoría estímulo-organismo-respuesta (S-O-R) (Mehrabian y Russell, 1974). Resultados – La calidad percibida por los clientes del hotel (estímulo) influye positivamente en el valor percibido, las emociones positivas y la satisfacción, y negativamente en las emociones negativas (organismo). El precio (estímulo) afecta negativamente al valor percibido, pero no a la satisfacción. El valor percibido afecta positivamente a la satisfacción. La satisfacción afecta positivamente al WOM y al eWOM (respuestas). El HGBE-SNS modera la relación entre satisfacción y eWOM. Originalidad/valor – Este estudio es el primero que demuestra simultáneamente las relaciones entre calidad percibida, precio, valor percibido, emociones positivas y negativas, satisfacción, WOM, eWOM y HGBE-SNS. Los hoteles deben ofrecer a sus clientes servicios de alta calidad para influir positivamente en el valor percibido, las emociones positivas, la satisfacción y el WOM. Los precios bajos aumentan el valor percibido pero no incrementan directamente la satisfacción de los huéspedes. Los huéspedes satisfechos comparten sus experiencias a través del WOM, pero un alto nivel de HGBE-SNS es crucial para impulsar el eWOM. 目的 – 酒店提供高质量的宾客体验, 对宾客的情绪、满意度、感知价值、口碑（WOM）和电子口碑（eWOM）产生积极影响。本研究旨在 a) 调查酒店客人感知到的质量对其积极情绪、消极情绪、感知价值和满意度的影响; b) 验证价格对感知价值和满意度的影响; c) 检验满意度对 WOM 和电子口碑的影响; d) 检验酒店客人在社交网站上的行为参与（HGBE-SNS）对满意度和电子口碑之间关系的调节作用。 设计 – 本次调查包括 371 位客人, 他们对自己在巴西三家酒店的入住体验进行了评估。结构方程模型检验了由刺激-组织-反应（S-O-R）理论（Mehrabian 和 Russell, 1974 年）支持的假设模型。 研究结果 – 酒店客人感知到的质量（刺激因素）对感知价值、积极情绪和满意度有积极影响, 而对消极情绪（有机体）有消极影响。价格（刺激因素）对感知价值有负面影响, 但不影响满意度。感知价值对满意度有积极影响。满意度对 WOM 和 eWOM（反应）产生积极影响。HGBE-SNS 可调节满意度与网络口碑之间的关系。 原创性/价值 – 本研究首次同时展示了感知质量、价格、感知价值、积极和消极情绪、满意度、WOM、eWOM 和 HGBE-SNS 之间的关系。酒店必须为客人提供高质量的服务, 才能对 “感知价值"、"积极情绪"、"满意度 “和 “WOM “产生积极影响。低价会提升感知价值, 但不会直接提高客人满意度。满意的酒店客人会通过 WOM 分享他们的体验, 但高 HGBE-SNS 对促进 eWOM 至关重要。

Exposure to polycyclic aromatic hydrocarbons (PAHs), ubiquitously environmental contaminant, leads to the development of major toxic effects on human health, such as carcinogenic and immunosuppressive alterations reported for the most studied PAH, i.e., benzo(a)pyrene (B(a)P). In order to assess the risk associated with this exposure, it is necessary to have predictive biomarkers. Thus, extracellular vesicles (EVs) and their microRNA (miRNA) contents, have recently been proposed as potentially interesting biomarkers in Toxicology. Our study here explores the use of vesicles secreted and found in blood fluids, and their miRNAs, as biomarkers of exposure to B(a)P alone and within a realistic occupational mixture. We isolated EVs from primary human cultured blood mononuclear cells (PBMCs) and rat plasma after PAH exposure and reported an increased EV production by B(a)P, used either alone or in the mixture, in vitro and in vivo. We then investigated the association of this EV release with the blood concentration of the 7,8,9,10-hydroxy (tetrol)-B(a)P reactive metabolite, in rats. By performing RNA-sequencing (RNA-seq) of miRNAs in PBMC-derived EVs, we analyzed miRNA profiles and demonstrated the regulation of the expression of miR-342–3p upon B(a)P exposure. We then validated B(a)P-induced changes of miR-342–3p expression in vivo in rat plasma-derived EVs. Overall, our study highlights the feasibility of using EVs and their miRNA contents, as biomarkers of PAH exposure and discusses their potential in environmental Toxicology.

Abstract Background This single-centered randomized controlled clinical trial aimed to evaluate the effectiveness of micro-osteoperforations (MOPs) in accelerating the orthodontic retraction of maxillary incisors. Methods Forty-two patients aged 16–40 were recruited and randomly assigned into two groups, one which underwent MOPs (MOPG) in the buccal and palatal region of all maxillary incisors immediately before the start of retraction and one which did not (CG). Eligibility criteria included the orthodontic need for maxillary first premolars extraction and space closure in two phases. The primary outcome of the study consisted of measuring the rate of space closure and, consequently, the rate of incisors’ retraction using digital model superimposition 14 days later and monthly thereafter for the next 4 months. The secondary outcomes included measuring anchorage loss, central incisors’ inclination, and root length shortening, analyzed using cone beam computed tomography scans acquired before retraction and 4 months after retraction. Randomization was performed using QuickCalcs software. While clinical blinding was not possible, the image’s examinator was blinded. Results Twenty-one patients were randomly assigned to each group. However, due to various reasons, a total of 37 patients (17 male and 20 female) were analyzed (mean age: 24.3 ± 8.1 years in the MOPG; 22.2 ± 4.2 years in the CG) during the trial. No statistically significant difference was found between the MOPG and the CG regarding the incisors’ retraction measured at different time points at the incisal border (14 days, 0.4 mm vs. 0.5 mm; 1 month, 0.79 mm vs. 0.77 mm; 2 months, 1.47 mm vs. 1.41 mm; 3 months, 2.09 mm vs. 1.88 mm; 4 months, 2.62 mm vs. 2.29 mm) and at the cervical level (14 days, 0.28 mm vs. 0.30 mm; 1 month, 0.41 mm vs. 0.32 mm; 2 months, 0.89 mm vs. 0.61 mm; 3 months, 1.36 mm vs. 1.10 mm; 4 months, 1.73 mm vs. 1.39 mm). Similarly, no statistically significant differences were detected in the space closure, anchorage loss, central incisors’ inclination, and radicular length between groups. No adverse effect was observed during the trial. Conclusions MOPs did not accelerate the retraction of the maxillary incisors, nor were they associated with greater incisor inclination or root resorption. Trial registration ClinicalTrials.gov NCT03089996. Registered 24 March 2017— https://clinicaltrials.gov/ct2/show/NCT03089996 .

Abstract Objective To compare the effects on facial soft tissues produced by maxillary expansion generated by rapid maxillary expansion (RME) versus slow maxillary expansion (SME). Materials and methods Patients in the mixed dentition were included with a transverse discrepancy between the two arches of at least 3 mm. A conventional RME screw was compared to a new expansion screw (Leaf expander) designed to produce SME. Both screws were incorporated in a fixed expander. The primary outcome was the difference of the facial tissue changes in the nasal area measured on facial 3D images captured immediately before application of the expander (T0) and after one year of retention, immediately after the expander removal (T1). Secondary outcomes were soft tissue changes of other facial regions (mouth, lips, and chin). Analysis of covariance was used for statistical analysis. Results Fourteen patients were allocated to the RME group, and 14 patients were allocated to the SME group. There were no dropouts. Nasal width change showed a difference between the two groups (1.3 mm greater in the RME group, 95% CI from 0.4 to 2.2, P = 0.005). Also, intercanthal width showed a difference between treatments (0.7 mm greater in the RME group, 95% CI from 0.0 to 1.3, P = 0.044). Nasal columella width, mouth width, nasal tip angle, upper lip angle, and lower lip angle did not show any statistically significant differences. The Y-axis (anterior–posterior) components of the nasal landmark showed a statistically significant difference between the two groups (0.5 mm of forward displacement greater in the RME group, 95% CI from 0.0 to 1.2, P = 0.040). Also, Z-axis (superior-inferior) components of the lower lip landmark was statistically significant (0.9 mm of downward displacement in favor of the RME group, 95% CI from 0.1 to 1.7, P = 0.027). All the other comparisons of the three-dimensional assessments were not statistically significant. Conclusions RME produced significant facial soft tissue changes when compared to SME. RME induced greater increases in both nasal and intercanthal widths (1.3 mm and 0.7 mm, respectively). These findings, though statistically significant, probably are not clinically relevant. Trial registration ISRCTN, ISRCTN18263886. Registered 8 November 2016, https://www.isrctn.com/ISRCTN18263886?q=Franchi&filters=&sort=&offset=2&totalResults=2&page=1&pageSize=10

Objective The C reactive protein polymyalgia rheumatica activity score (CRP-PMR-AS) is a composite index that includes CRP levels and was developed specifically for PMR. As treatments such as interleukin-6 antagonists can normalise CRP levels, the erythrocyte sedimentation rate (ESR) of PMR-AS, the clinical (clin)-PMR-AS and the imputed-CRP (imp-CRP)-PMR-AS have been developed to avoid such bias. Our primary objective was to measure the correlation of these activity scores. Our secondary objective was to evaluate the concordance between different cutoffs of the PMR-ASs.Method Data from the Safety and Efficacy of tocilizumab versus Placebo in Polymyalgia rHeumatica With glucocORticoid dEpendence (SEMAPHORE) trial, a superiority randomised double-blind placebo-controlled trial, were subjected to post hoc analysis to compare the efficacy of tocilizumab versus placebo in patients with active PMR. The CRP-PMR-AS, ESR-PMR-AS, clin-PMR-AS and imp-CRP-PMR-AS were measured at every visit. The concordance and correlation between these scores were evaluated using kappa correlation coefficients, Bland-Altman correlations, intraclass correlation coefficients (ICCs) and scatter plots.Results A total of 101 patients were included in the SEMAPHORE trial, and 100 were analysed in this study. The correlation between the PMR-ASs was excellent, as the ICC and kappa were >0.85 from week 4 until week 24 (CRP-PMR-AS ≤10 or >10). Bland-Altman plots revealed that the differences between the CRP-PMR-AS and the other threescores were low. The cut-off values for the clin-PMR-AS were similar to those for the CRP-PMR-AS 86% of the time.Conclusion The correlation between all the PMR-ASs was excellent, reflecting the low weight of CRP. In clinical trials using drugs that have an impact on CRP, the derived activity scores can be used.Trial registration number NTC02908217.

Background: Research background shows the crucial role of emotion regulation strategies in couples' adjustment. Furthermore, lifestyle can influence the relationship between factors that affect couples' adjustment. Studying the structural relationships between these factors in reconciling couples' infidelity and exploring lifestyle as a mediating factor can enrich this research area. Aims: The aim of this study is to investigate the role of cognitive emotion regulation strategies in the context of marital adjustment as mediated by lifestyle. Methods: The research method is descriptive-correlation. The statistical population includes all married clients in counseling centers in Tehran during the first six months of 2021. By applying the rule of tens for each measured variable, the sample size was determined to be 247 participants. Multi-stage cluster sampling was selected using the random sampling method. Modified paired adjustment questionnaire, Cognitive Emotion Regulation Questionnaire (CERQ) and Lifestyle Questionnaire (LSQ) were used to collect data. Data analysis was performed through descriptive statistics and structural equation modeling by maximum likelihood estimation. Results: The results show that there is a direct relationship between adaptive strategies (p= 0.001, β= 0.47) and non-adaptive strategies (p= 0.004, β= 0.24) and lifestyle. There is an indirect relationship between adaptive strategies (p= 0.012, β= 0.226) and non-adaptive strategies (p= 0.027, β = -0.117) and marital adjustment. The research model is consistent with the collected data (RMSEA= 0.052, CFI= 0.959). Conclusion: Cognitive emotion regulation and lifestyle are key factors in predicting marital adjustment. Therefore, it is vital to consider how these variables play a part in increasing marital adjustment.

Background. New-onset systolic heart failure (HF) after liver transplantation (LT) is a significant cause of morbidity and mortality; however, its characteristics are still insufficiently delineated. HF may involve the left ventricle (LV), right ventricle (RV), or both ventricles. We explored the incidence, characteristics, etiologies, risks, involved cardiac chambers, and outcomes of HF after LT. Methods. This study included 528 adult patients with preoperative LV ejection fraction ≥ 55% who underwent LT between 2016 and 2020. The primary outcome was new-onset systolic HF, defined by the presence of clinical signs, symptoms, and echocardiographic evidence of reduced LVejection fraction

Abstract Objective To perform a case series analysis of the changes in the pulmonary artery systolic pressure (PASP), nasal inspiratory flow (NIF), upper airway volume, obstructive apnea/hypopnea index (OAHI), and the maxillomandibular three-dimensional (3D) morphology after adenotonsillectomy (T&A) of obstructive sleep apnea children (OSA). Materials and methods Retrospective assessment of files from 1002 children screened between 2012 and 2020 in a hospital-based mouth-breather referral center. From this universe, 15 obstructive sleep apnea children (7 females; 8 males), ages 4.1 to 8.9 years old (mean age of 5.4 years ± 1.3), who presented indications of tonsillectomy and/or adenoidectomy were selected. The complete baseline examination (T0) was carried out before T&A and a second complete examination (T1) was made 18.7-month follow-up after T&A (ranging from 12 to 30 months). Eleven patients were submitted to T&A, and four patients had indications but did not receive authorization for surgery from the public health system. According to the protocol of the outpatient clinic for OSA patients, Doppler echocardiography, polysomnography, rhinomanometry, and computed tomography imaging was performed at (T0) and (T1). Results PASP decreased 16.6% after T&A. NIF increased more in T&A children (40.3%) than in non-T&A children (16.8%). The upper airway volume increased in T&A and non-T&A children, but greater volumetric gain (45.6%) was found in the nasopharynx of T&A patients. OAHI did not change in six T&A children (55%) and three non-T&A children (75%). The maxilla displaced downward and backward relative to the cranial base in six T&A children (55%) and two untreated children (50%). Nine of the T&A children (85%) and three untreated children (75%) presented extensive condylar growth and increased mandibular length. The qualitative 3D assessment showed similar morphological 3D changes in T&A and non-T&A patients. Conclusion Pulmonary artery systolic pressure decreased, nasal inspiratory flow increased, and nasopharynx volume increased following adenotonsillectomy, but obstructive apnea/hypopnea index and maxillomandibular morphology were similar in surgical and non-surgical patients.

Abstract Background Atrial fibrillation (AF) may cause cerebral and systemic embolism. An increased D-dimer level indicates hyperactivation of secondary fibrinolysis, resulting in predilection for thrombosis. To clarify the differential effects of anticoagulation therapy, we compared the D-dimer levels in peripheral and left atrial (LA) blood of atrial fibrillation patients scheduled for ablation. Methods We analyzed 141 patients with non-valvular AF (dabigatran, n = 30; apixaban, n = 47; edoxaban, n = 64; mean age: 68 years, male: 60%). Peripheral venous blood and LA blood was collected before pulmonary vein isolation. We examined the laboratory and echocardiographic parameters. Results After adjusting for baseline characteristics, D-dimer level in the LA was significantly higher in patients treated with edoxaban than that in those on apixaban (0.77 ± 0.05 vs. 0.60 ± 0.05 μg/mL, P = 0.047), although there were no significant differences in peripheral D-dimer levels. We classified the D-dimer value of the LA into a normal group (