Startseite Medizin Social networks and eating disorders during the Covid-19 pandemic
Artikel Open Access

Social networks and eating disorders during the Covid-19 pandemic

  • Concetta M. Vaccaro ORCID logo EMAIL logo , Giulia Guarino , Dario Conte , Emanuela Ferrara , Laura Dalla Ragione und Renata Bracale
Veröffentlicht/Copyright: 24. August 2021
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Open Medicine
Aus der Zeitschrift Open Medicine Band 16 Heft 1

Abstract

Objective

The purpose of this study is to assess the increase both in the use of the Internet and social media and in Google searches regarding eating disorders (ED) in Italy during the Covid-19 pandemic. Our aim is also to verify the possible impact of such an increase on ED, since patients treated for ED by the National Health Service (NHS) have increased in the first 6 months of 2020 as well.

Method

We used data from Wearesocial surveys on Internet users in the first 6 months of 2020 and the Google searches related to the query of “food disorders” and “body shaming.” The first results of a project of the Italian Ministry of Health on ED have been considered too.

Results

The social media users in July 2020 increased to 60% of the Italian population; a tendential increase in Google searches on these issues has emerged. Finally, new patients of NHS with ED showed a high increase in the first 6 months of 2020 (+40.9%).

Conclusion

Considering the contents diffused on the Internet, it is fundamental to watch over net usage in the adolescent population and those with ED, because massive access to social media can be considered almost as a risk factor.

Keywords: social network; ED; Covid-19; body shaming

1 Introduction

Coronavirus 2 (SARS-COV-2) is responsible for acute respiratory syndrome; in March 2020, the World Health Organization (WHO) declared it a pandemic [1]. To avoid the diffusion of the virus and an increase in cases in Italy, the Government has approved the Decree-Law “I stay at home” [2]; it declared every type of public gathering is forbidden and thus closed many public and workplaces. Going out is allowed only for reasons of necessity. Consequently, digital platforms have offered a strategic opportunity for communicating with the outside world. Even before the lockdown, social media had been fundamental in our everyday lives (for example, Facebook, Instagram, Twitter, and YouTube) [3,4]. They are sources of information but also sharing tools [5] that have grown in importance due to the rarefaction of social interactions following the emergency. This is true also for the people affected by eating disorders (ED) who could have experienced a worsening of symptoms related to living alone. On the contrary, they could become very close to their families or, again, develop a change in their food habits [6,7].

Anorexia, bulimia, and binge eating are the three principal disorders, all connected to each other; the subject can migrate from one disorder to another [8]. The web can be also used as a tool for sharing different experiences in regards to different types of ED. Social networks can, in fact, amplify Body shaming [9]. More generally, during the lockdown, social networks have represented a tool through which people could shield themselves from a weight gain induced by their excessive sedentary lifestyle [6]. The aim of this study is that of evidencing the increase, during the lockdown, in the use of the Internet, in the time spent on social networks, and in the Google searches regarding ED in Italy during the Covid-19 pandemic. Our aim is also to verify its possible impact on these disorders, using as an indicator the increase of new patients treated by Public services for ED. In addition to the increased sedentary lifestyle, the contents of much of the online communication may have had a negative impact on the people who are most fragile and sensitive to this issue.

Together with the general data on Internet users, the data on Google searches related to food disorders in the same period have served to understand the trend of online searches on such issues. Finally, the data relating to patients with ED analyzed in a study of the National Center for Disease Prevention and Control (CCM) of the Italian Ministry of Health, concerning new patients treated by Public services for ED, confirm a relevant increase of them during the first months of lockdown [10].

2 Methods

This research used data from Wearesocial (results of GlobalWebIndex international surveys in different years among 1,010 Italian Internet users aged 16–64) on the increase in the number of Internets and social media users over the last years and particularly in the first 6 months of 2020 [5].

It added other data from a survey from the same source (GlobalWebIndex survey among samples of about 1,000 responses per country of Internet users aged 16–64 years), concerning the time spent on social networks by the Internet users of the principal European countries in the first months of 2020 due to the Covid-19 emergency. Moreover, it considered the frequency of some keywords related to food disorders in the Google searches in Italy between 4 August, 2019, and 26 July, 2020. Finally, we have analyzed the data of the CCM national study, by the Italian Ministry of Health, “Platform for fighting malnutrition in all its forms (triple burden: malnutrition by defect, by excess and by micro-nutrients).” The first part of the project concerning patients of public services for ED was coordinated by the Umbria region (scientific coordinator of the project Dr. Dalla Ragione) [10]. The observational study concerning patients obtained the approval of the ethics committee of Umbria Region (protocol CER (Comitato Etico Regionale) Umbria N.20032/20/ON of 19/11/2020). More specifically, among the objectives of the project, there was the realization of a national “survey” which collected activity data of all the services/districts/SIAN (food and nutrition hygiene services)/hospitals of the national territory dealing with malnutrition, as well as SDO (hospital discharge form) data relating to hospital admissions of such patients. The data were collected in an ad hoc platform and those reported are some first results, related to the first 6 months of 2020.

3 Results

All the analyses on web usage trends in Italy, in the last years, agree in highlighting its increase. Wearesocial data underline a 19% increase in net users between 16 and 64 years old among the total population from 01 January, 2016, to 01 January, 2020. In absolute value, we have switched from 37.63 million to 43.48 million people (82% of the total). Social media users have greatly increased from 47 to 58% (35 million). The average time of net usage per day has increased from a little more than 4 h to the current 6 h (Table 1).

Table 1

Internet and social media users in Italy (16–64 age) (absolute values and %)

Internet users Social media users Average Internet usage time per day
Absolute values in millions (%) Absolute values in millions (%)
1/1/2016 37.63 63 28.00 47 4H01M†
1/1/2017 39.21 66 31.00 52 N.A.
1/1/2018 43.21 73 34.00 57 6H08M
1/1/2019 54.80 92 35.00 59 6H04M
1/1/2020 43.48 82 35.00 58 6H00M

†Data referred to computer access (2H02M on mobile).

Source: Wearesocial data processing (GlobalWebIndex international surveys in different years among 1.010 Italian Internet users aged 16–64 years).

Furthermore, there has been an increase in Internet usage during the Covid-19 emergency [5]. The data on social network users of July 2020 have raised to 60% of the total population considered. A survey on Internet users in the first months of 2020 has shown that Italian Internet users who have affirmed to spend more time on social media due to the emergency are 43%, similar to Spain, compared to 31% in France and the UK and 19% in Greece (GlobalWebIndex survey among samples of about 1,000 responses per country of Internet users aged 16–64 years) [5].

The frequency of Google search queries on “ED” between 4 August, 2019, and 26 July, 2020, was hence assessed to verify the quantitative dimension and the variations in the interest of web users on the topic in the first months of 2020 (Figure 1).

Figure 1 Frequency of Google searches of the query “ED” by Italian users (4/08/19–26/07/20) (index numbers). Source: Google trends.
Figure 1

Frequency of Google searches of the query “ED” by Italian users (4/08/19–26/07/20) (index numbers). Source: Google trends.

Figure 1 highlights a quite fluctuating frequency that tends to stabilize, starting from February 2020, with peaks during the first months of 2020 until the end of July. The analysis of the search frequency of the query “body shaming” on Google has a much more clear-cut trend. Starting right from February, there are strong peaks in its searches on the net. Some increase in frequency is also present in the most recent of weeks, and the data are generally slightly on the rise (Figure 2).

Figure 2 Frequency of Google searches of the query “body shaming” by Italian users (4/08/19–26/07/20) (index numbers). Source: Google trends.
Figure 2

Frequency of Google searches of the query “body shaming” by Italian users (4/08/19–26/07/20) (index numbers). Source: Google trends.

Moreover, a general impact of the first lockdown period can be reflected in the 40.9% increase of new patients treated by public services for ED in the first 6 months of 2020 compared to the same period of 2019 (from 163.547 new patients in the first semester of 2019 to 230.458 in the first semester of 2020).

4 Discussion

This historical time is pervaded with anxiety, fear, and loss of control. The fear of contracting the illness can be associated with a loss of control, which people suffering from anorexia or bulimia try to compensate for by further increasing food restrictions. On the contrary, the same loss of control could trigger more frequent episodes of binge eating for those who suffer from such a disorder [6]. During the lockdown period, people being treated for ED, who may have taken months to find the courage to ask for help and embark on a path or may have waited months for hospitalization, have found themselves having to stop treatment or not being able to start it, increasing the risk of aggravation, chronicity, or relapse of the disorder [11].

Nevertheless, a significant increase in new patients has occurred, and this may be linked to the worsening of problems and/or emergencies.

The tedious household routine forces adolescents to spend the great majority of their time closed in their rooms while surfing the Internet. Wearesocial data from July 2020 underline that social media users have reached 60% of the total population. Furthermore, the Italian net users declared that they keep spending more and more time on social media during this period due to the emergency (43%). Our results have also shown that the Google search frequency of the query “ED” by Italian users is increasing despite fluctuations. Moreover, the search frequency of the query “body shaming” has shown an increase starting right from February with a first peak in the same month (100 in the chart of Google trends) and the second one in May. Some increase in frequency is also present in the last weeks, and data are generally slightly on the rise. While in the first case “ED,” there is a great number of searches directed to the gathering of information on this phenomenon (with some references also to local news), in the second, the search for information and the increase in communication are referred essentially to celebrity VIPs and their latest news. Adolescents have shown the tendency to use the Web not only as a leisure platform but also, more and more frequently, as an information tool [12]. Digital platforms are the fertile ground upon which to cultivate the myth of a slender and ideally perfect physique through the sharing of images, photos, and videos. This has led, directly or indirectly, to the spread of common stereotypes according to which overweight people are deemed lazy and lack self-control. At the same time, they help promote unrealistic physical appearances and extreme methods of weight control typical of nervous anorexia [13]. There are many examples of this tendency: Instagram and Facebook profiles with pictures of skinny bodies and phrases that praise resisting hunger. In this virtual reality where “thin is beautiful,” younger people who do not mirror this perspective are bound to be isolated from the masses and often bullied. There is a high risk of losing self-confidence and of interiorizing the idea that it is necessary to appear always as one’s perfect version. Adding up to this, virtual reality grows in importance over real life. As a consequence, physical appearance becomes the first thing to consider when relating with others [14]. In the most vulnerable subjects, adolescents, it can lead to the onset of ED.

Food becomes a means for handling emotions, especially during a global pandemic, when anxiety, stress, sadness, and loneliness have become constants in their everyday life [7]. On one hand, this means that social networks can serve as a tool to avoid complete isolation; on the other hand, if not utilized correctly, they can work as risk factors in the development of dysfunctional eating habits or pathologies with dire consequences on health.

It has never been as important as it is today, now that the Web has grown to be the principal instrument to feel close, despite being far, to watch over those who make the greatest use of these tools, the adolescents.

In fact, the new spread habits regarding web accessibility represent one of the key aspects relating to lifestyles that can impact health conditions, up to the point of becoming risk factors.

Families and schools must promote healthy and conscious use of the Internet, especially when dealing with the crucial theme of one’s physical perception.

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Acknowledgments

We would like to thank Dr Tancredi Maria Anzalone for his review.

  1. Funding information: Funds only for editorial publishing by Department of Medicine and Sciences for Health, Molise University, Campobasso, Italy.

  2. Conflict of interest: The authors declare that they have no known conflict of interest or personal relationships that could have appeared to influence the work reported in this paper.

  3. Data availability statement: The datasets analyzed during the current study related to the CCM national study, by the Italian Ministry of Health, “Platform for fighting malnutrition in all its forms (triple burden: malnutrition by defect, by excess and by micro-nutrients)” are available in the “Unità sanitaria locale 1 dell’Umbria” repository laura.dallaragione@uslumbria1.it. All data analyzed during this study related to Internet use are included in this published article.

References

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Received: 2021-01-25
Revised: 2021-04-15
Accepted: 2021-04-27
Published Online: 2021-08-24

© 2021 Concetta M. Vaccaro et al., published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  168. miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
  169. MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
  170. Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
  171. miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
  172. Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
  173. MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
  174. Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
  175. circATP2A2 promotes osteosarcoma progression by upregulating MYH9
  176. Prognostic role of oxytocin receptor in colon adenocarcinoma
  177. Review Articles
  178. The function of non-coding RNAs in idiopathic pulmonary fibrosis
  179. Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
  180. Role of cesarean section in the development of neonatal gut microbiota: A systematic review
  181. Small cell lung cancer transformation during antitumor therapies: A systematic review
  182. Research progress of gut microbiota and frailty syndrome
  183. Recommendations for outpatient activity in COVID-19 pandemic
  184. Rapid Communication
  185. Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
  186. Use of microspheres in embolization for unruptured renal angiomyolipomas
  187. COVID-19 cases with delayed absorption of lung lesion
  188. A triple combination of treatments on moderate COVID-19
  189. Social networks and eating disorders during the Covid-19 pandemic
  190. Letter
  191. COVID-19, WHO guidelines, pedagogy, and respite
  192. Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
  193. COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
  194. What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
  195. Case Report
  196. Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
  197. CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
  198. Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
  199. Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
  200. Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
  201. Pulmonary parenchymal involvement caused by Tropheryma whipplei
  202. Mediastinal mixed germ cell tumor: A case report and literature review
  203. Ovarian female adnexal tumor of probable Wolffian origin – Case report
  204. Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
  205. Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
  206. Primary orbital ganglioneuroblastoma: A case report
  207. Primary aortic intimal sarcoma masquerading as intramural hematoma
  208. Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
  209. Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
  210. Chondroblastoma of mandibular condyle: Case report and literature review
  211. Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
  212. Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
  213. Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
  214. High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
  215. Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
  216. Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
  217. Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
  218. Retraction
  219. Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
  220. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
  221. An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
  222. Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
https://doi.org/10.1515/med-2021-0291
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Artikel in diesem Heft

  1. Research Articles
  2. Identification of ZG16B as a prognostic biomarker in breast cancer
  3. Behçet’s disease with latent Mycobacterium tuberculosis infection
  4. Erratum
  5. Erratum to “Suffering from Cerebral Small Vessel Disease with and without Metabolic Syndrome”
  6. Research Articles
  7. GPR37 promotes the malignancy of lung adenocarcinoma via TGF-β/Smad pathway
  8. Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
  9. Additional baricitinib loading dose improves clinical outcome in COVID-19
  10. The co-treatment of rosuvastatin with dapagliflozin synergistically inhibited apoptosis via activating the PI3K/AKt/mTOR signaling pathway in myocardial ischemia/reperfusion injury rats
  11. SLC12A8 plays a key role in bladder cancer progression and EMT
  12. LncRNA ATXN8OS enhances tamoxifen resistance in breast cancer
  13. Case Report
  14. Serratia marcescens as a cause of unfavorable outcome in the twin pregnancy
  15. Spleno-adrenal fusion mimicking an adrenal metastasis of a renal cell carcinoma: A case report and embryological background
  16. Research Articles
  17. TRIM25 contributes to the malignancy of acute myeloid leukemia and is negatively regulated by microRNA-137
  18. CircRNA circ_0004370 promotes cell proliferation, migration, and invasion and inhibits cell apoptosis of esophageal cancer via miR-1301-3p/COL1A1 axis
  19. LncRNA XIST regulates atherosclerosis progression in ox-LDL-induced HUVECs
  20. Potential role of IFN-γ and IL-5 in sepsis prediction of preterm neonates
  21. Rapid Communication
  22. COVID-19 vaccine: Call for employees in international transportation industries and international travelers as the first priority in global distribution
  23. Case Report
  24. Rare squamous cell carcinoma of the kidney with concurrent xanthogranulomatous pyelonephritis: A case report and review of the literature
  25. An infertile female delivered a baby after removal of primary renal carcinoid tumor
  26. Research Articles
  27. Hypertension, BMI, and cardiovascular and cerebrovascular diseases
  28. Case Report
  29. Coexistence of bilateral macular edema and pale optic disc in the patient with Cohen syndrome
  30. Research Articles
  31. Correlation between kinematic sagittal parameters of the cervical lordosis or head posture and disc degeneration in patients with posterior neck pain
  32. Review Articles
  33. Hepatoid adenocarcinoma of the lung: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database
  34. Research Articles
  35. Thermography in the diagnosis of carpal tunnel syndrome
  36. Pemetrexed-based first-line chemotherapy had particularly prominent objective response rate for advanced NSCLC: A network meta-analysis
  37. Comparison of single and double autologous stem cell transplantation in multiple myeloma patients
  38. The influence of smoking in minimally invasive spinal fusion surgery
  39. Impact of body mass index on left atrial dimension in HOCM patients
  40. Expression and clinical significance of CMTM1 in hepatocellular carcinoma
  41. miR-142-5p promotes cervical cancer progression by targeting LMX1A through Wnt/β-catenin pathway
  42. Comparison of multiple flatfoot indicators in 5–8-year-old children
  43. Early MRI imaging and follow-up study in cerebral amyloid angiopathy
  44. Intestinal fatty acid-binding protein as a biomarker for the diagnosis of strangulated intestinal obstruction: A meta-analysis
  45. miR-128-3p inhibits apoptosis and inflammation in LPS-induced sepsis by targeting TGFBR2
  46. Dynamic perfusion CT – A promising tool to diagnose pancreatic ductal adenocarcinoma
  47. Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches
  48. Review Articles
  49. The ambiguous role of mannose-binding lectin (MBL) in human immunity
  50. Case Report
  51. Membranous nephropathy with pulmonary cryptococcosis with improved 1-year follow-up results: A case report
  52. Fertility problems in males carrying an inversion of chromosome 10
  53. Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature
  54. Metastatic renal Ewing’s sarcoma in adult woman: Case report and review of the literature
  55. Burkitt-like lymphoma with 11q aberration in a patient with AIDS and a patient without AIDS: Two cases reports and literature review
  56. Skull hemophilia pseudotumor: A case report
  57. Judicious use of low-dosage corticosteroids for non-severe COVID-19: A case report
  58. Adult-onset citrullinaemia type II with liver cirrhosis: A rare cause of hyperammonaemia
  59. Clinicopathologic features of Good’s syndrome: Two cases and literature review
  60. Fatal immune-related hepatitis with intrahepatic cholestasis and pneumonia associated with camrelizumab: A case report and literature review
  61. Research Articles
  62. Effects of hydroxyethyl starch and gelatin on the risk of acute kidney injury following orthotopic liver transplantation: A multicenter retrospective comparative clinical study
  63. Significance of nucleic acid positive anal swab in COVID-19 patients
  64. circAPLP2 promotes colorectal cancer progression by upregulating HELLS by targeting miR-335-5p
  65. Ratios between circulating myeloid cells and lymphocytes are associated with mortality in severe COVID-19 patients
  66. Risk factors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation
  67. Clinical features of hypertensive patients with COVID-19 compared with a normotensive group: Single-center experience in China
  68. Surgical myocardial revascularization outcomes in Kawasaki disease: systematic review and meta-analysis
  69. Decreased chromobox homologue 7 expression is associated with epithelial–mesenchymal transition and poor prognosis in cervical cancer
  70. FGF16 regulated by miR-520b enhances the cell proliferation of lung cancer
  71. Platelet-rich fibrin: Basics of biological actions and protocol modifications
  72. Accurate diagnosis of prostate cancer using logistic regression
  73. miR-377 inhibition enhances the survival of trophoblast cells via upregulation of FNDC5 in gestational diabetes mellitus
  74. Prognostic significance of TRIM28 expression in patients with breast carcinoma
  75. Integrative bioinformatics analysis of KPNA2 in six major human cancers
  76. Exosomal-mediated transfer of OIP5-AS1 enhanced cell chemoresistance to trastuzumab in breast cancer via up-regulating HMGB3 by sponging miR-381-3p
  77. A four-lncRNA signature for predicting prognosis of recurrence patients with gastric cancer
  78. Knockdown of circ_0003204 alleviates oxidative low-density lipoprotein-induced human umbilical vein endothelial cells injury: Circulating RNAs could explain atherosclerosis disease progression
  79. Propofol postpones colorectal cancer development through circ_0026344/miR-645/Akt/mTOR signal pathway
  80. Knockdown of lncRNA TapSAKI alleviates LPS-induced injury in HK-2 cells through the miR-205/IRF3 pathway
  81. COVID-19 severity in relation to sociodemographics and vitamin D use
  82. Clinical analysis of 11 cases of nocardiosis
  83. Cis-regulatory elements in conserved non-coding sequences of nuclear receptor genes indicate for crosstalk between endocrine systems
  84. Four long noncoding RNAs act as biomarkers in lung adenocarcinoma
  85. Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens
  86. Relation between IL-8 level and obstructive sleep apnea syndrome
  87. circAGFG1 sponges miR-28-5p to promote non-small-cell lung cancer progression through modulating HIF-1α level
  88. Nomogram prediction model for renal anaemia in IgA nephropathy patients
  89. Effect of antibiotic use on the efficacy of nivolumab in the treatment of advanced/metastatic non-small cell lung cancer: A meta-analysis
  90. NDRG2 inhibition facilitates angiogenesis of hepatocellular carcinoma
  91. A nomogram for predicting metabolic steatohepatitis: The combination of NAMPT, RALGDS, GADD45B, FOSL2, RTP3, and RASD1
  92. Clinical and prognostic features of MMP-2 and VEGF in AEG patients
  93. The value of miR-510 in the prognosis and development of colon cancer
  94. Functional implications of PABPC1 in the development of ovarian cancer
  95. Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy
  96. Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis
  97. Prediction of improvement after anterior cruciate ligament reconstruction
  98. Effluent Osteopontin levels reflect the peritoneal solute transport rate
  99. circ_0038467 promotes PM2.5-induced bronchial epithelial cell dysfunction
  100. Significance of miR-141 and miR-340 in cervical squamous cell carcinoma
  101. Association between hair cortisol concentration and metabolic syndrome
  102. Microvessel density as a prognostic indicator of prostate cancer: A systematic review and meta-analysis
  103. Characteristics of BCR–ABL gene variants in patients of chronic myeloid leukemia
  104. Knee alterations in rheumatoid arthritis: Comparison of US and MRI
  105. Long non-coding RNA TUG1 aggravates cerebral ischemia and reperfusion injury by sponging miR-493-3p/miR-410-3p
  106. lncRNA MALAT1 regulated ATAD2 to facilitate retinoblastoma progression via miR-655-3p
  107. Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study
  108. Analysis of COVID-19 outbreak origin in China in 2019 using differentiation method for unusual epidemiological events
  109. Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
  110. Travelers’ vaccines and their adverse events in Nara, Japan
  111. Association between Tfh and PGA in children with Henoch–Schönlein purpura
  112. Can exchange transfusion be replaced by double-LED phototherapy?
  113. circ_0005962 functions as an oncogene to aggravate NSCLC progression
  114. Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
  115. Serum intact fibroblast growth factor 23 in healthy paediatric population
  116. Algorithm of rational approach to reconstruction in Fournier’s disease
  117. A meta-analysis of exosome in the treatment of spinal cord injury
  118. Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
  119. Dexmedetomidine may decrease the bupivacaine toxicity to heart
  120. Hypoxia stimulates the migration and invasion of osteosarcoma via up-regulating the NUSAP1 expression
  121. Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
  122. External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
  123. miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
  124. HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
  125. Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
  126. Cell population data in identifying active tuberculosis and community-acquired pneumonia
  127. Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
  128. Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
  129. 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
  130. Association of gene polymorphisms with women urinary incontinence
  131. Influence of COVID-19 pandemic on stress levels of urologic patients
  132. miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
  133. miR-519d downregulates LEP expression to inhibit preeclampsia development
  134. Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
  135. Fluorescent light energy modulates healing in skin grafted mouse model
  136. Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
  137. Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
  138. Severe postoperative hyperbilirubinemia in congenital heart disease
  139. Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
  140. Clinical factors predicting ureteral stent failure in patients with external ureteral compression
  141. Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
  142. Triple-Endobutton and clavicular hook: A propensity score matching analysis
  143. Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
  144. Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
  145. miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
  146. Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
  147. The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
  148. Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
  149. No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
  150. circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
  151. Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
  152. Educational program for orthopedic surgeons’ influences for osteoporosis
  153. Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
  154. GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
  155. lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
  156. Anticoagulation is the answer in treating noncritical COVID-19 patients
  157. Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
  158. Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
  159. VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
  160. Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
  161. Treatment of osteoporosis with teriparatide: The Slovenian experience
  162. New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
  163. Superenhancer–transcription factor regulatory network in malignant tumors
  164. β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
  165. Clinical features of atypical tuberculosis mimicking bacterial pneumonia
  166. Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
  167. Effect of electromagnetic field on abortion: A systematic review and meta-analysis
  168. miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
  169. MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
  170. Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
  171. miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
  172. Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
  173. MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
  174. Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
  175. circATP2A2 promotes osteosarcoma progression by upregulating MYH9
  176. Prognostic role of oxytocin receptor in colon adenocarcinoma
  177. Review Articles
  178. The function of non-coding RNAs in idiopathic pulmonary fibrosis
  179. Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
  180. Role of cesarean section in the development of neonatal gut microbiota: A systematic review
  181. Small cell lung cancer transformation during antitumor therapies: A systematic review
  182. Research progress of gut microbiota and frailty syndrome
  183. Recommendations for outpatient activity in COVID-19 pandemic
  184. Rapid Communication
  185. Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
  186. Use of microspheres in embolization for unruptured renal angiomyolipomas
  187. COVID-19 cases with delayed absorption of lung lesion
  188. A triple combination of treatments on moderate COVID-19
  189. Social networks and eating disorders during the Covid-19 pandemic
  190. Letter
  191. COVID-19, WHO guidelines, pedagogy, and respite
  192. Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
  193. COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
  194. What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
  195. Case Report
  196. Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
  197. CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
  198. Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
  199. Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
  200. Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
  201. Pulmonary parenchymal involvement caused by Tropheryma whipplei
  202. Mediastinal mixed germ cell tumor: A case report and literature review
  203. Ovarian female adnexal tumor of probable Wolffian origin – Case report
  204. Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
  205. Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
  206. Primary orbital ganglioneuroblastoma: A case report
  207. Primary aortic intimal sarcoma masquerading as intramural hematoma
  208. Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
  209. Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
  210. Chondroblastoma of mandibular condyle: Case report and literature review
  211. Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
  212. Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
  213. Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
  214. High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
  215. Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
  216. Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
  217. Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
  218. Retraction
  219. Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
  220. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
  221. An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
  222. Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
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