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COVID-19 fear, post-traumatic stress, growth, and the role of resilience

  • Edita Fino EMAIL logo , Denis Mema and Valbona Treska
Published/Copyright: April 1, 2022
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Open Medicine
From the journal Open Medicine Volume 17 Issue 1

Abstract

Understanding the factors through which pandemic fear may be associated not just with distress, but also with growth outcomes is crucial to informing interventions across population groups and cultural settings. To achieve this aim, in a cross-sectional study, we examined the relationship between the fear of COVID-19, post-traumatic stress and post-traumatic growth while assessing the moderating role of trait resilience. Findings showed that fear of COVID-19 was associated with both stress and growth outcomes and that resilience was a significant moderator of these effects. Specifically, trait resilience acted as a buffer against post-traumatic stress and as a booster factor for appreciation for life. Given the imbalance between needs and resources in times of global pandemic, interventions promoting psychological wellbeing should leverage existing resources and consider psychological resilience as a valuable target to protect against negative and optimise positive outcomes.

Keywords: COVID-19 fear; post-traumatic growth; posttraumatic stress; trait resilience

1 Introduction

Pandemics are known to elicit high levels of fear and distress [1–3] but positive reactions might also be involved as individuals strive to make sense of and adjust to adversity [4,7]. Retrospective analysis of three landmark narratives of great plagues from different historical eras has revealed common patterns in people’s responses, which included worry and distress but also a higher appreciation of relationships with others, social cohesion, and personal strength [8]. Though fear and anxiety are hallmark reactions to global pandemics, the centrality of the interpersonal and social dimension implicated in pandemic fear may cause individuals’ concerns to gravitate on affiliative and caring relationships with others [9], giving rise to a plethora of socially attuned behaviours, also known as the tend-and-befriend response to threat [10]. Caregiving relationships and social affiliation may importantly calibrate the stress response and buffer against negative effects of stress-system activation in a global pandemic context [10]. In addition, individual traits such as resilience, or one’s ability to flexibly adapt to hardship situations are believed to play a role in modulating reactions to pandemic fear and act as a protective factor for psychological wellbeing [4–7,10]. Unfortunately, most of the COVID-19 research has one-sidedly focused on the negative outcomes, leaving unexplored the examination of positive outcomes that may be associated with pandemic fear. We address this issue by examining the relationship between fear of COVID-19 with both post-traumatic stress and growth outcomes while assessing the role of trait resilience in moderating this relationship. We expected fear of pandemic to be strongly associated not only with stress but also with growth outcomes and predicted that highly resilient individuals would report lower levels of stress and higher levels of growth compared to the low resilient ones.

2 Method

2.1 Participants

A cross-sectional study was conducted from 16 to 30 December 2020 in the general population of Albania during the lockdown. Participants (18–65 years old) were invited to complete an online questionnaire investigating risk and protective factors for mental health outcomes during the lockdown. Inclusion criteria were being an adult and lacking any major physical and/or psychiatric condition. A snowball technique was employed to potentiate outreach amongst the general population. All measures used in the study were translated and back-translated from English into Albanian by accredited translators following gold standard translation practices and potential discrepancies were rectified jointly by the research team and independent bilingual individuals with work experience in psychological wellbeing issues. The study protocol and procedure were approved by the local ethics committee and all participants provided informed consent.

2.2 Measures

Fear of COVID-19 pandemic was measured through an adaptation of the SARS Fear Scale, [11] examining areas related to (a) the perceived risk of infection; (b) concerns about lack of healthcare due to overwhelmed facilities; and (c) concerns about restriction measures and potential consequences. In addition, items measuring concerns about psychosocial consequences of prolonged lockdown were added (sample items included “worries about the duration of quarantine”; “worries about the future” and “fear about mine/my family members’ livelihood if quarantine is prolonged”). An English version of the scale can be found here [9]. Respondents were asked to indicate the extent to which they experienced the target concerns during the last month with response options ranging from 1 (not at all) to 5 (very much/extremely). Responses were summed into a single score, with higher scores indicating higher levels of pandemic fear. The scale demonstrated a high internal consistency with Cronbach’s α = 0.95.

Post-traumatic stress was assessed with the post-traumatic stress disorder (PTSD) checklist for DSM-5 (PCL-5) [12] which was a 20 items scale tapping on the symptoms of post-traumatic stress (feeling very upset when something reminded you of the stressful experience and avoiding thinking about or talking about the stressful experience or avoiding having feelings related to it). Responses were rated on a 0 (not at all) to 4 (extremely) scale and were summed to provide a total severity score in the range 0–80 of PTSD symptoms. The scale demonstrated high internal consistency with Cronbach’s α = 0.92.

Post-traumatic growth was measured with the Post-traumatic Growth Inventory (PTGI) [13] which includes 21 items that loaded on five factors: New Possibilities (I established a new path for my life); Relating to Others (I have a greater sense of closeness with others); Personal Strength (I discovered that I’m stronger than I thought I was); Spiritual Change (I have a better understanding of spiritual matters), and Appreciation of Life (I can better appreciate each day). Respondents are asked to indicate for each item the degree of change occurring in their life as a result of the pandemic from 0 (I did not experience this change as a result of the pandemic) to 5 (I experienced this change to a very great degree as a result of the crisis), with higher scores indicating higher levels of growth. The scale showed good internal consistency with Cronbach’s α of 0.87 for Relating to Others, 0.85 for New Possibilities, 0.83 for Personal Strength, 0.63 for Spiritual Change, and 0.77 for Appreciation of Life.

To measure trait resilience, we used the Brief Resilience Scale (BRS) [14], which is a 6-item self-report scale with responses ranging from 1 (strongly disagree) to 5 (strongly agree). Item samples include (I tend to bounce back quickly after hard times; I have a hard time making it through stressful events). Factorial analyses assessing the dimensionality of the scale revealed a two-factor structure, with items divided according to positive/negative wording (Cronbach’s α of 0.60 and 0.75, respectively). The three negatively framed items were reverse-scored and summed to the rest to yield a total score with higher levels indicating a higher degree of resilience.

2.3 Statistical analysis

Descriptive statistics were computed to characterise the sample. To identify potential covariates to be included in subsequent analyses, differences between gender and age groups were assessed using analysis of variance. To investigate the relationship between COVID-19 fear with both stress and growth outcomes under the influence of trait resilience, we performed moderation analysis with PROCESS macro for SPSS (Model 1, with 10,000 bootstrap sampling and bias-corrected confidence intervals). The statistical significance level was set at p < 0.05. Analysis performed with G-Power software to determine the minimum total sample size for a medium-size effect (f 2 = 0.015) for the moderation analysis (with p = 0.05 and actual power = 105 0.95) was 119 participants.

3 Results

A total of 230 respondents completed the questionnaire. Participant characteristics for the entire sample and separately for males and females are provided in Table 1. Compared to male, female respondents reported higher levels of fear, higher levels of PTSD symptoms, and posttraumatic growth in all five dimensions.

Table 1

Sociodemographic and clinical characteristics of the sample

Mean (SD); no (%)
Total sample (n = 230) Males (n = 62) Females (n = 189) F p
Age 39.9 (11.3) 39.5 (10.8) 40.1 (11.5) 0.101 0.741
Civil status 2.283 0.684
 Single 105 (45.5) 26 (41.9) 78 (46.7)
 In a relationship 22 (9.5) 4 (6.4) 18 (10.6)
 Married 95 (41.1) 30 (48.3) 65 (38.4)
 Divorced/widowed 9 (3.9) 2 (3.2) 7 (4.1)
Education 13.393 0.004
 High school 21 (9.7) 12 (19.3) 9 (5.3)
 University 113 (48.9) 32 (51.6) 81 (47.9)
 Post graduate 97 (42.0) 18 (29.0) 78 (46.7)
Fear of COVID-19 60.1 (13.1) 55.4 (12.5) 61.8 (13.0) 11.022 0.001
Post-traumatic stress (PCL_5) 19.0 (13.5) 14.8 (9.9) 20.6 (14.4) 7.921 0.005
Relationships with others (PTGI) 18.8 (7.8) 16.5 (8.3) 19.6 (7.5) 7.145 0.008
 New possibilities (PTGI) 12.2 (5.8) 10.3 (5.6) 12.9 (5.8) 8.733 0.003
 Personal strength (PTGI) 11.6 (4.9) 10.1 (5.0) 12.1 (4.7) 6.968 0.009
 Spirituality (PTGI) 5.2 (2.8) 4.2 (2.5) 5.5 (2.8) 10.023 0.002
 Appreciation for life (PTGI) 8.1 (3.4) 6.6 (3.5) 8.6 (3.2) 16.892 <0.001
Trait Resilience (BRS) 3.5 (0.6) 3.5 (0.6) 3.5 (0.6) 0.283 0.595

Note: PCL-5: Post-traumatic stress Checklist for DSM-5; PTGI: Post-traumatic Growth Index; BRS: Brief Resilience Scale.

Moderation analyses were separately performed with post-traumatic stress and post-traumatic growth set as the outcome (Y) respectively, COVID-19-related fear set as the predictor (X) and trait resilience set as moderator (M), controlling for gender and age. The full model was significant for PTSD: R 2 = 0.48, MSE = 95.936, F 3,227 = 66.385, p < 0.0001 and the interaction between COVID-19 fear and resilience was significant: β = −0.231, SE = 0.0661, t = −3.463, p < 0.001; 95% CI [−0.362, −0.099]. As indicated by respective slopes in Figure 1a, the higher the level of trait resilience, the lower the level of PTSD symptoms. Notably, as fear of COVID-19 increases, the protective role of trait resilience becomes crucial in discriminating those more susceptible to developing clinically relevant symptoms of PTSD (cut off ≥ 31) from those that don’t.

Figure 1 Trait resilience moderates the relationship between COVID-19 fear with both (a) post-traumatic stress and (b) and post-traumatic growth.
Figure 1

Trait resilience moderates the relationship between COVID-19 fear with both (a) post-traumatic stress and (b) and post-traumatic growth.

The same analysis performed with post-traumatic growth subscales set as outcome variables yielded a significant full model for Appreciation for Life: R 2 = 0.21, MSE = 9.445, F 3,227 = 19.049, p < 0.0001. The trait resilience by fear of COVID-19 interaction was significant: β = −0.045, SE = 0.021, t = −2.132, p = 0.03; 95% CI [−0.086, −0.003]. Respective slopes shown in Figure 1b indicate that trait resilience has a significant impact on post-traumatic growth across levels of pandemic fear – that is, higher the resilience, stronger the appreciation for life.

4 Discussion

There is a heightened interest in understanding the factors through which pandemic fear may lead not just to negative but also positive outcomes across population groups and cultural settings to better inform community-based interventions [15]. In this study, we found that fear of COVID-19 was associated with both stress and growth outcomes and this relationship was moderated by trait resilience. Specifically, highly resilient individuals reported lower levels of PTSD and higher levels of appreciation for life during the lockdown. These findings advance current knowledge on the role of resilience as a protective factor for psychological wellbeing in the context of adversity [11] and global pandemics [4–7], by examining pathways from pandemic fear to both stress and growth outcomes in the general population. However, some limitations should be mentioned. For instance, the convenience sample and cross-sectional nature of the study might limit the generalizability of the results. The fact that our sample was composted by mostly female participants, who were on average rather young and well-educated may have further influenced our results. Notwithstanding these limitations, this study importantly suggests that in a pandemic, fear and distress can be high but there is also a potential for growth.

While the role of pandemic fear as a risk factor for distress should not be overlooked, the role of protective factors in harnessing the potential for growth in the face of adversity should also be considered. Considering the imbalance between needs and resources in times of global pandemic, community-based interventions promoting psychological wellbeing should leverage existing resources and consider psychological resilience as a valuable target to protect against negative and optimise positive outcomes.

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Acknowledgments

We are thankful to all participants in our study for their precious contribution.

  1. Funding information: Authors state no funding involved.

  2. Conflict of interest: Authors state no conflict of interest.

  3. Data availability statement: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Received: 2021-09-29
Revised: 2022-02-17
Accepted: 2022-02-19
Published Online: 2022-04-01

© 2022 Edita Fino et al., published by De Gruyter

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

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  146. Meta-analysis of early-life antibiotic use and allergic rhinitis
  147. Marital status and its correlation with age, race, and gender in prognosis of tonsil squamous cell carcinomas
  148. HPV16 E6E7 up-regulates KIF2A expression by activating JNK/c-Jun signal, is beneficial to migration and invasion of cervical cancer cells
  149. Amino acid profiles in the tissue and serum of patients with liver cancer
  150. Pain in critically ill COVID-19 patients: An Italian retrospective study
  151. Immunohistochemical distribution of Bcl-2 and p53 apoptotic markers in acetamiprid-induced nephrotoxicity
  152. Estradiol pretreatment in GnRH antagonist protocol for IVF/ICSI treatment
  153. Long non-coding RNAs LINC00689 inhibits the apoptosis of human nucleus pulposus cells via miR-3127-5p/ATG7 axis-mediated autophagy
  154. The relationship between oxygen therapy, drug therapy, and COVID-19 mortality
  155. Monitoring hypertensive disorders in pregnancy to prevent preeclampsia in pregnant women of advanced maternal age: Trial mimicking with retrospective data
  156. SETD1A promotes the proliferation and glycolysis of nasopharyngeal carcinoma cells by activating the PI3K/Akt pathway
  157. The role of Shunaoxin pills in the treatment of chronic cerebral hypoperfusion and its main pharmacodynamic components
  158. TET3 governs malignant behaviors and unfavorable prognosis of esophageal squamous cell carcinoma by activating the PI3K/AKT/GSK3β/β-catenin pathway
  159. Associations between morphokinetic parameters of temporary-arrest embryos and the clinical prognosis in FET cycles
  160. Long noncoding RNA WT1-AS regulates trophoblast proliferation, migration, and invasion via the microRNA-186-5p/CADM2 axis
  161. The incidence of bronchiectasis in chronic obstructive pulmonary disease
  162. Integrated bioinformatics analysis shows integrin alpha 3 is a prognostic biomarker for pancreatic cancer
  163. Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway
  164. Comparison of hospitalized patients with severe pneumonia caused by COVID-19 and influenza A (H7N9 and H1N1): A retrospective study from a designated hospital
  165. lncRNA ZFAS1 promotes intervertebral disc degeneration by upregulating AAK1
  166. Pathological characteristics of liver injury induced by N,N-dimethylformamide: From humans to animal models
  167. lncRNA ELFN1-AS1 enhances the progression of colon cancer by targeting miR-4270 to upregulate AURKB
  168. DARS-AS1 modulates cell proliferation and migration of gastric cancer cells by regulating miR-330-3p/NAT10 axis
  169. Dezocine inhibits cell proliferation, migration, and invasion by targeting CRABP2 in ovarian cancer
  170. MGST1 alleviates the oxidative stress of trophoblast cells induced by hypoxia/reoxygenation and promotes cell proliferation, migration, and invasion by activating the PI3K/AKT/mTOR pathway
  171. Bifidobacterium lactis Probio-M8 ameliorated the symptoms of type 2 diabetes mellitus mice by changing ileum FXR-CYP7A1
  172. circRNA DENND1B inhibits tumorigenicity of clear cell renal cell carcinoma via miR-122-5p/TIMP2 axis
  173. EphA3 targeted by miR-3666 contributes to melanoma malignancy via activating ERK1/2 and p38 MAPK pathways
  174. Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block
  175. miRNA-130a-3p targets sphingosine-1-phosphate receptor 1 to activate the microglial and astrocytes and to promote neural injury under the high glucose condition
  176. Review Articles
  177. Current management of cancer pain in Italy: Expert opinion paper
  178. Hearing loss and brain disorders: A review of multiple pathologies
  179. The rationale for using low-molecular weight heparin in the therapy of symptomatic COVID-19 patients
  180. Amyotrophic lateral sclerosis and delayed onset muscle soreness in light of the impaired blink and stretch reflexes – watch out for Piezo2
  181. Interleukin-35 in autoimmune dermatoses: Current concepts
  182. Recent discoveries in microbiota dysbiosis, cholangiocytic factors, and models for studying the pathogenesis of primary sclerosing cholangitis
  183. Advantages of ketamine in pediatric anesthesia
  184. Congenital adrenal hyperplasia. Role of dentist in early diagnosis
  185. Migraine management: Non-pharmacological points for patients and health care professionals
  186. Atherogenic index of plasma and coronary artery disease: A systematic review
  187. Physiological and modulatory role of thioredoxins in the cellular function
  188. Case Reports
  189. Intrauterine Bakri balloon tamponade plus cervical cerclage for the prevention and treatment of postpartum haemorrhage in late pregnancy complicated with acute aortic dissection: Case series
  190. A case of successful pembrolizumab monotherapy in a patient with advanced lung adenocarcinoma: Use of multiple biomarkers in combination for clinical practice
  191. Unusual neurological manifestations of bilateral medial medullary infarction: A case report
  192. Atypical symptoms of malignant hyperthermia: A rare causative mutation in the RYR1 gene
  193. A case report of dermatomyositis with the missed diagnosis of non-small cell lung cancer and concurrence of pulmonary tuberculosis
  194. A rare case of endometrial polyp complicated with uterine inversion: A case report and clinical management
  195. Spontaneous rupturing of splenic artery aneurysm: Another reason for fatal syncope and shock (Case report and literature review)
  196. Fungal infection mimicking COVID-19 infection – A case report
  197. Concurrent aspergillosis and cystic pulmonary metastases in a patient with tongue squamous cell carcinoma
  198. Paraganglioma-induced inverted takotsubo-like cardiomyopathy leading to cardiogenic shock successfully treated with extracorporeal membrane oxygenation
  199. Lineage switch from lymphoma to myeloid neoplasms: First case series from a single institution
  200. Trismus during tracheal extubation as a complication of general anaesthesia – A case report
  201. Simultaneous treatment of a pubovesical fistula and lymph node metastasis secondary to multimodal treatment for prostate cancer: Case report and review of the literature
  202. Two case reports of skin vasculitis following the COVID-19 immunization
  203. Ureteroiliac fistula after oncological surgery: Case report and review of the literature
  204. Synchronous triple primary malignant tumours in the bladder, prostate, and lung harbouring TP53 and MEK1 mutations accompanied with severe cardiovascular diseases: A case report
  205. Huge mucinous cystic neoplasms with adhesion to the left colon: A case report and literature review
  206. Commentary
  207. Commentary on “Clinicopathological features of programmed cell death-ligand 1 expression in patients with oral squamous cell carcinoma”
  208. Rapid Communication
  209. COVID-19 fear, post-traumatic stress, growth, and the role of resilience
  210. Erratum
  211. Erratum to “Tollip promotes hepatocellular carcinoma progression via PI3K/AKT pathway”
  212. Erratum to “Effect of femoral head necrosis cystic area on femoral head collapse and stress distribution in femoral head: A clinical and finite element study”
  213. Erratum to “lncRNA NORAD promotes lung cancer progression by competitively binding to miR-28-3p with E2F2”
  214. Retraction
  215. Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
  216. Retraction to “miR-519d downregulates LEP expression to inhibit preeclampsia development”
  217. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part II
  218. Usefulness of close surveillance for rectal cancer patients after neoadjuvant chemoradiotherapy
https://doi.org/10.1515/med-2022-0458
Keywords for this article
COVID-19 fear; post-traumatic growth; posttraumatic stress; trait resilience
Creative Commons
BY 4.0

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  22. lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells
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  47. hsa-miR-340-5p inhibits epithelial–mesenchymal transition in endometriosis by targeting MAP3K2 and inactivating MAPK/ERK signaling
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  67. Low expression of miR-27b in serum exosomes of non-small cell lung cancer facilitates its progression by affecting EGFR
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  78. circRNF20 aggravates the malignancy of retinoblastoma depending on the regulation of miR-132-3p/PAX6 axis
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  107. lncRNA HAGLR modulates myocardial ischemia–reperfusion injury in mice through regulating miR-133a-3p/MAPK1 axis
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  112. Correlation of cardiac troponin T and APACHE III score with all-cause in-hospital mortality in critically ill patients with acute pulmonary embolism
  113. LncRNA LINC01857 reduces metastasis and angiogenesis in breast cancer cells via regulating miR-2052/CENPQ axis
  114. Endothelial cell-specific molecule 1 (ESM1) promoted by transcription factor SPI1 acts as an oncogene to modulate the malignant phenotype of endometrial cancer
  115. SELENBP1 inhibits progression of colorectal cancer by suppressing epithelial–mesenchymal transition
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  122. TGF-β1 upregulates Sar1a expression and induces procollagen-I secretion in hypertrophic scarring fibroblasts
  123. Antisense lncRNA PCNA-AS1 promotes esophageal squamous cell carcinoma progression through the miR-2467-3p/PCNA axis
  124. NK-cell dysfunction of acute myeloid leukemia in relation to the renin–angiotensin system and neurotransmitter genes
  125. The effect of dilution with glucose and prolonged injection time on dexamethasone-induced perineal irritation – A randomized controlled trial
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  128. lncRNA NORAD promotes lung cancer progression by competitively binding to miR-28-3p with E2F2
  129. Noninvasive diagnosis of AIH/PBC overlap syndrome based on prediction models
  130. lncRNA FAM230B is highly expressed in colorectal cancer and suppresses the maturation of miR-1182 to increase cell proliferation
  131. circ-LIMK1 regulates cisplatin resistance in lung adenocarcinoma by targeting miR-512-5p/HMGA1 axis
  132. LncRNA SNHG3 promoted cell proliferation, migration, and metastasis of esophageal squamous cell carcinoma via regulating miR-151a-3p/PFN2 axis
  133. Risk perception and affective state on work exhaustion in obstetrics during the COVID-19 pandemic
  134. lncRNA-AC130710/miR-129-5p/mGluR1 axis promote migration and invasion by activating PKCα-MAPK signal pathway in melanoma
  135. SNRPB promotes cell cycle progression in thyroid carcinoma via inhibiting p53
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  137. Serpin family A member 1 is an oncogene in glioma and its translation is enhanced by NAD(P)H quinone dehydrogenase 1 through RNA-binding activity
  138. Silencing of CPSF7 inhibits the proliferation, migration, and invasion of lung adenocarcinoma cells by blocking the AKT/mTOR signaling pathway
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  140. Relationship of plasma MBP and 8-oxo-dG with brain damage in preterm
  141. Identification of a novel necroptosis-associated miRNA signature for predicting the prognosis in head and neck squamous cell carcinoma
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  143. The expression of ASAP3 and NOTCH3 and the clinicopathological characteristics of adult glioma patients
  144. Longitudinal analysis of factors related to Helicobacter pylori infection in Chinese adults
  145. HOXA10 enhances cell proliferation and suppresses apoptosis in esophageal cancer via activating p38/ERK signaling pathway
  146. Meta-analysis of early-life antibiotic use and allergic rhinitis
  147. Marital status and its correlation with age, race, and gender in prognosis of tonsil squamous cell carcinomas
  148. HPV16 E6E7 up-regulates KIF2A expression by activating JNK/c-Jun signal, is beneficial to migration and invasion of cervical cancer cells
  149. Amino acid profiles in the tissue and serum of patients with liver cancer
  150. Pain in critically ill COVID-19 patients: An Italian retrospective study
  151. Immunohistochemical distribution of Bcl-2 and p53 apoptotic markers in acetamiprid-induced nephrotoxicity
  152. Estradiol pretreatment in GnRH antagonist protocol for IVF/ICSI treatment
  153. Long non-coding RNAs LINC00689 inhibits the apoptosis of human nucleus pulposus cells via miR-3127-5p/ATG7 axis-mediated autophagy
  154. The relationship between oxygen therapy, drug therapy, and COVID-19 mortality
  155. Monitoring hypertensive disorders in pregnancy to prevent preeclampsia in pregnant women of advanced maternal age: Trial mimicking with retrospective data
  156. SETD1A promotes the proliferation and glycolysis of nasopharyngeal carcinoma cells by activating the PI3K/Akt pathway
  157. The role of Shunaoxin pills in the treatment of chronic cerebral hypoperfusion and its main pharmacodynamic components
  158. TET3 governs malignant behaviors and unfavorable prognosis of esophageal squamous cell carcinoma by activating the PI3K/AKT/GSK3β/β-catenin pathway
  159. Associations between morphokinetic parameters of temporary-arrest embryos and the clinical prognosis in FET cycles
  160. Long noncoding RNA WT1-AS regulates trophoblast proliferation, migration, and invasion via the microRNA-186-5p/CADM2 axis
  161. The incidence of bronchiectasis in chronic obstructive pulmonary disease
  162. Integrated bioinformatics analysis shows integrin alpha 3 is a prognostic biomarker for pancreatic cancer
  163. Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway
  164. Comparison of hospitalized patients with severe pneumonia caused by COVID-19 and influenza A (H7N9 and H1N1): A retrospective study from a designated hospital
  165. lncRNA ZFAS1 promotes intervertebral disc degeneration by upregulating AAK1
  166. Pathological characteristics of liver injury induced by N,N-dimethylformamide: From humans to animal models
  167. lncRNA ELFN1-AS1 enhances the progression of colon cancer by targeting miR-4270 to upregulate AURKB
  168. DARS-AS1 modulates cell proliferation and migration of gastric cancer cells by regulating miR-330-3p/NAT10 axis
  169. Dezocine inhibits cell proliferation, migration, and invasion by targeting CRABP2 in ovarian cancer
  170. MGST1 alleviates the oxidative stress of trophoblast cells induced by hypoxia/reoxygenation and promotes cell proliferation, migration, and invasion by activating the PI3K/AKT/mTOR pathway
  171. Bifidobacterium lactis Probio-M8 ameliorated the symptoms of type 2 diabetes mellitus mice by changing ileum FXR-CYP7A1
  172. circRNA DENND1B inhibits tumorigenicity of clear cell renal cell carcinoma via miR-122-5p/TIMP2 axis
  173. EphA3 targeted by miR-3666 contributes to melanoma malignancy via activating ERK1/2 and p38 MAPK pathways
  174. Pacemakers and methylprednisolone pulse therapy in immune-related myocarditis concomitant with complete heart block
  175. miRNA-130a-3p targets sphingosine-1-phosphate receptor 1 to activate the microglial and astrocytes and to promote neural injury under the high glucose condition
  176. Review Articles
  177. Current management of cancer pain in Italy: Expert opinion paper
  178. Hearing loss and brain disorders: A review of multiple pathologies
  179. The rationale for using low-molecular weight heparin in the therapy of symptomatic COVID-19 patients
  180. Amyotrophic lateral sclerosis and delayed onset muscle soreness in light of the impaired blink and stretch reflexes – watch out for Piezo2
  181. Interleukin-35 in autoimmune dermatoses: Current concepts
  182. Recent discoveries in microbiota dysbiosis, cholangiocytic factors, and models for studying the pathogenesis of primary sclerosing cholangitis
  183. Advantages of ketamine in pediatric anesthesia
  184. Congenital adrenal hyperplasia. Role of dentist in early diagnosis
  185. Migraine management: Non-pharmacological points for patients and health care professionals
  186. Atherogenic index of plasma and coronary artery disease: A systematic review
  187. Physiological and modulatory role of thioredoxins in the cellular function
  188. Case Reports
  189. Intrauterine Bakri balloon tamponade plus cervical cerclage for the prevention and treatment of postpartum haemorrhage in late pregnancy complicated with acute aortic dissection: Case series
  190. A case of successful pembrolizumab monotherapy in a patient with advanced lung adenocarcinoma: Use of multiple biomarkers in combination for clinical practice
  191. Unusual neurological manifestations of bilateral medial medullary infarction: A case report
  192. Atypical symptoms of malignant hyperthermia: A rare causative mutation in the RYR1 gene
  193. A case report of dermatomyositis with the missed diagnosis of non-small cell lung cancer and concurrence of pulmonary tuberculosis
  194. A rare case of endometrial polyp complicated with uterine inversion: A case report and clinical management
  195. Spontaneous rupturing of splenic artery aneurysm: Another reason for fatal syncope and shock (Case report and literature review)
  196. Fungal infection mimicking COVID-19 infection – A case report
  197. Concurrent aspergillosis and cystic pulmonary metastases in a patient with tongue squamous cell carcinoma
  198. Paraganglioma-induced inverted takotsubo-like cardiomyopathy leading to cardiogenic shock successfully treated with extracorporeal membrane oxygenation
  199. Lineage switch from lymphoma to myeloid neoplasms: First case series from a single institution
  200. Trismus during tracheal extubation as a complication of general anaesthesia – A case report
  201. Simultaneous treatment of a pubovesical fistula and lymph node metastasis secondary to multimodal treatment for prostate cancer: Case report and review of the literature
  202. Two case reports of skin vasculitis following the COVID-19 immunization
  203. Ureteroiliac fistula after oncological surgery: Case report and review of the literature
  204. Synchronous triple primary malignant tumours in the bladder, prostate, and lung harbouring TP53 and MEK1 mutations accompanied with severe cardiovascular diseases: A case report
  205. Huge mucinous cystic neoplasms with adhesion to the left colon: A case report and literature review
  206. Commentary
  207. Commentary on “Clinicopathological features of programmed cell death-ligand 1 expression in patients with oral squamous cell carcinoma”
  208. Rapid Communication
  209. COVID-19 fear, post-traumatic stress, growth, and the role of resilience
  210. Erratum
  211. Erratum to “Tollip promotes hepatocellular carcinoma progression via PI3K/AKT pathway”
  212. Erratum to “Effect of femoral head necrosis cystic area on femoral head collapse and stress distribution in femoral head: A clinical and finite element study”
  213. Erratum to “lncRNA NORAD promotes lung cancer progression by competitively binding to miR-28-3p with E2F2”
  214. Retraction
  215. Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
  216. Retraction to “miR-519d downregulates LEP expression to inhibit preeclampsia development”
  217. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part II
  218. Usefulness of close surveillance for rectal cancer patients after neoadjuvant chemoradiotherapy
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