The aim of this study was to explore the clinical effects of metronidazole vaginal effervescent tablets combined with Kushen suppository in the treatment of Trichomonas vaginitis. n = 45) treated with metronidazole vaginal effervescent tablets and an experimental group (n = 45) treated with Kushen suppository on top of the control group using the random number table method. The clinical effects, inflammatory factors, and microcirculation indexes were compared. We assessed patient's vaginal health by Vaginal Health Score Scale (VHS) before and after treatment and estimated their quality of life according to Generic Quality of Life Inventory-74 (GQOLI-74). A follow-up visit was conducted to compare patient's recurrence 3 months after treatment.  Ninety patients with trichomoniasis admitted to our hospital from January 2019 to January 2020 were prospectively analyzed and randomly divided into a control group (P < 0.05); the serum level of inflammatory factors of the experimental group was dramatically lower than that of the control group after treatment (P < 0.001); the experimental group experienced a favorable microcirculation index in comparison with the control group (P < 0.001); superior VHS (P < 0.001) and GQOLI-74 (P < 0.05) scores of the experimental group after treatment compared to those of the control group were observed; the recurrence rate of the experimental group 3 months after treatment was significantly decreased in comparison with that of the control group (P < 0.05).  Distinctly higher total clinical effective of the experimental group compared with that of the control group was obtained ( Metronidazole vaginal effervescent tablets combined with Kushen suppository can effectively improve the clinical symptoms of patients with trichomonas vaginitis, abate patient's inflammatory reaction, and raise their quality of life, which is worthy of promotion. Trichomonas vaginalis, wherein clinical symptoms will appear such as mucosal redness, swelling, pruritus vulvae, and painful intercourse [Trichomonas vaginitis, as a common gynecological disease, is the female vaginal infection on account of ercourse –3. Unsafercourse , 5. Accoercourse , 7.Bitter ginseng root contains bitter ginseng alkaloids and chrysophanes, which are used to clear heat and dampness, antibacterial, anti-inflammatory, stomachic, and anthelmintic effects, commonly used to treat itchy skin, neurasthenia, indigestion, and constipation. Kushen suppository is mainly used for the treatment of cervical erosion, red and white leucorrhoea, vaginal trichomoniasis, or gynecological inflammation caused by mycobacterial infection. It has anti-inflammatory and antipruritic properties. Animal studies have confirmed that the application of Kushen suppository can lead to a reduction or disappearance of inflammation, as well as a relief of the resulting itching. It should not be used in women with severe allergies or in menstruating patients, except during pregnancy. Clinical research shows that the introduction of Kushen suppository based on this treatment can effectively promote patient's clinical indicators and has a marked improvement on trichomonas vaginitis , 9. Tricn = 45) and a control group (n = 45) using a random number table hair. The experiment was approved by the ethics committee of The Fourth Hospital of Shijiazhuang for implementation, Approval no. 29791-03.Ninety patients with trichomoniasis admitted to our hospital from January 2019 to January 2020 were recruited for a prospective analysis and randomly divided into an experimental group  were given once or twice a day for seven days. During the medication period, it is important to prohibit sexual intercourse for the time being and keep the vulva clean and dry. Individuals may experience a burning sensation, which may vary in intensity and will disappear after discontinuation of the drug.∗6 capsules) based on the control group, administrated vaginally at a dose of 1 capsule per time, once daily. Both group were treated for 15 days.The experimental group was treated with Kushen suppository , interleukin 8 (IL-8), and interleukin 1β (IL-1β) in the samples was carried out in strict accordance with the ELISA kit instructions and protocols.Blood was collected from the patient's fasting elbow vein in the morning. The serum was separated after centrifugation and the supernatant was taken. All serum samples were placed at −80°C. The determination of tumor necrosis factor-The blood perfusion, erythrocyte aggregation, and the diameter of capillary of microcirculation indexes before and after treatment of the two groups were detected by a microcirculation microscope .The Vaginal Health Scale (VHS)  was usedGeneral Quality of Life Inventory 74 (GQOLI-74) [Quality of life after the intervention was assessed according to the QOLI-74) , which sRecurrence was recorded in both groups at a 3-month follow-up observation after treatment.χ2 test, t-test, and normality test. A P value of 0.05 or lower was claimed as statistically significant.All data analysis was done by SPSS20.0, and the graphics were plotted by GraphPad Prism 7 . The counting data and measurement data were examined by No significant difference in age, BMI, courses, SAS score, SDS score, disease manifestation, and residence of the two groups was found as shown in P < 0.05) after treatment. See The experimental group witnessed a much more remarkable improvement as compared to the control group (P < 0.05) as shown in A significantly lower serum level of inflammatory factors of the experimental group than that of the control group was observed (P < 0.05).P < 0.001); see A superior VHS score of the experimental group after treatment to the control group was obtained (P < 0.05) as shown in The GQOLI-74 score of the experimental group after treatment was observably higher than that of the control group (P < 0.05).Trichomonas vaginalis and is a common sexually transmitted disease characterized by vulvar itching and a foamy, yellowish-white, and thin discharge [Trichomoniasis is a common vaginal inflammatory disease caused by ischarge . The disischarge . Trichomischarge , 14. Curischarge –17. Metrischarge , 19. Kusischarge .P < 0.05), which received metronidazole vaginal effervescent tablets treatment only. The results showed that the combined drug treatment was more effective than single drug treatment. In addition, the vagina, as a female physiological organ, has a unique physiological structure that tends to cause dysbiosis of the vaginal flora, causing various inflammatory reactions and leading to a decrease in vaginal immunity. The results showed that the serum inflammatory factor level was significantly lower in the experimental group than in the control group after treatment (P < 0.05), suggesting that metronidazole vaginal effervescent tablets combined with Kushen suppository can mitigate patient's inflammatory reaction and inhibit the development of the disease, which is conducive to the recovery of patients with vaginal diseases.In this study, the total clinical effective of the experimental group, which was treated with metronidazole vaginal effervescent tablets combined with Kushen suppository, was evidently higher compared with that of the control group (P < 0.05), which may be attributed to the Chinese herb substances in Kushen suppository. Modern pharmacological studies have manifested that matrine in Kushen suppository has antibacterial, anti-inflammatory, diuretic, and liver protective effects, and it can restrain vaginal fungal infection in some degree, simultaneously. Furthermore, this combination therapy can also interfere with microbial sugar metabolism, make the vaginal pH value return to the normal level, improve the vaginal self-purification effect, and help patients to maintain vaginal health for a long time. In addition, in our results, the recurrence rate was significantly lower in the experimental group compared to the control group (P < 0.05), which is in line with the findings of Chlebicz et al. (2016) [x2 = 4.547, P=0.033”, clearly indicating that metronidazole vaginal tablets combined with bitter ginseng alkaloids can inhibit bacterial growth, improve vaginal cleanliness, and reduce recurrence in patients. The combination of metronidazole vaginal effervescent tablets and bitter ginseng alkaloids clearly demonstrated that metronidazole vaginal effervescent tablets inhibited bacterial growth, improved vaginal cleanliness, improved vaginal environment, and reduced the recurrence rate of patients.Vaginal diseases can lead to microcirculatory abnormalities at the site of the patient's lesion. Blood perfusion, red blood cell aggregation, and capillary diameter are important indicators of local microcirculation , 22. In . (2016) . The stuIn TCM, trichomoniasis is mainly considered to be caused by a deficiency of the spleen and dampness, resulting in damp-heat downward injection, or a deficiency of the liver and kidneys, resulting in increased vulvar discharge, vulvar itching, and burning pain . TherefoHowever, there are some limitations to our experiments. First, the sample and the scope of our experiment are too small, which may lead to large errors. Second, trichomoniasis requires long-term treatment and the duration of our trial was too short to demonstrate long-term efficacy. Therefore, in a follow-up trial, we will need a large number of follow-up visits to determine long-term efficacy and prognosis.In conclusion, for patients with trichomonas vaginitis, metronidazole vaginal effervescent tablets combined with Kushen suppository can engender an outstanding effect in ameliorating the vaginal environment, abating the recurrence rate, repressing inflammatory reaction, and improving the quality of life, which is worthy of promotion and application.


Increasing the water use efficiency of crops is an important agricultural goal closely related to the root system —the primary plant organ for water and nutrient acquisition. In an attempt to evaluate the response of root growth and development of soybean to water supply levels, 200 genotypes were grown in a sandy field for 3 years under irrigated and non-irrigated conditions, and 14 root traits together with shoot fresh weight and plant height were investigated. Three-way ANOVA revealed a significant effect of treatments and years on growth of plants, accounting for more than 80% of the total variability. The response of roots to irrigation was consistent over the years as most root traits were improved by irrigation. However, the actual values varied between years because the growth of plants was largely affected by the field microclimatic conditions . Therefore, the best linear unbiased prediction values for each trait were calculated using the original data. Principal component analysis showed that most traits contributed to principal component (PC) 1, whereas average diameter, the ratio of thin and medium thickness root length to total root length contributed to PC2. Subsequently, we focused on selecting genotypes that exhibited significant improvements in root traits under irrigation than under non-irrigated conditions using the increment (I-index) and relative increment (RI-index) indices calculated for all traits. Finally, we screened for genotypes with high stability and root growth over the 3 years using the multi-trait selection index (MTSI).Six genotypes namely, GmJMC130, GmWMC178, GmJMC092, GmJMC068, GmWMC075, and GmJMC081 from the top 10% of genotypes scoring MTSI less than the selection threshold of 7.04 and 4.11 under irrigated and non-irrigated conditions, respectively, were selected. The selected genotypes have great potential for breeding cultivars with improved water usage abilities, meeting the goal of water-saving agriculture. Merr.), the most important leguminous crop, is cultivated globally for human food, animal feed, and biofuel  was applied once 2 weeks before sowing. Details of fertilization, including fertilizer types and ingredients, are provided in In this study, we used a diverse soybean panel consisting of 200 accessions . Field tA drip irrigation system was installed in the field by laying pipes  in the middle of the growing bed under mulch sheets Figure 12.2We used a self-designed tool that consists of a cylindrical blade  with a handle , the two treatments (T), and the interaction between genotypes and treatments (GxT). In addition, three-way ANOVA was also performed to evaluate the effects of genotype (G), treatment (T), and year (Y) across the three years of field experimentation.We used the Shannon Weaver diversity index calculated based on estimated values obtained from the best linear unbiased prediction (BLUP) to compare the diversity of studied phenotypes within the whole panel and between the JMC and WMC collections. The “lme4” package in R  was usedik is the trait studied, μ is the overall mean, Gi is the ith genotypic effect, Yk is the effect of the kth year, GYik is the interaction of genotype × year, and ϵik is the residual error.where YH’) according to The BLUP values were used to classify the genotypes into three categories based on the overall mean and standard deviation: (i) genotypes with low trait values (BLUP ≤ µ-SD); (ii) genotypes with average trait values (µ-SD< BLUP ≤ µ+SD); and (iii) genotypes with high trait values (BLUP > µ-SD). The frequency of genotypes in each category was used to calculate the Shannon–Weaver diversity index (where Pi is the frequency of genotypes grouped in each category and n is the number of categories for a given trait (n = 3 in this study).2.3.2Pearson correlations were also calculated among root and shoot traits recorded in the two irrigation treatments using BLUP values. PCA using the prcomp function in R (version 4.0.5) was conducted on scaled BLUP values to understand the inter-relations among studied traits in the field.2.3.3In order to identify genotypes with improved root architectural traits under irrigated treatment, we calculated the increment (I) index using the following formula:irrigated is the phenotype value of the irrigated test genotype, and Ynon-irrigated is the phenotype value of the non-irrigated test phenotype.where YWe also evaluated the increment in root traits and root performance values. For this, we considered calculating the stress tolerance index suggested by irrigated is the phenotype value of the test genotype under irrigated conditions, Ynon-irrigated is the phenotype value of test phenotype under non-irrigated conditions, and Xnon-irrigated is the mean phenotype of test genotypes under non-irrigated conditions. The I-index and RI-index values calculated using BLUP data from 16 traits were then used for PCA in R software.where Y2.3.4The analysis was conducted based on the singular value decomposition (SVD) of the matrix of BLUPs for the genotype-environment interaction effects (GEIs) obtained from a mixed linear model (LMM) to quantify the genotypic stability. This allows the selection of genotypes based on either only stability by quantifying the weighted average of absolute scores  from the SVD or estimating the WAASBY index, which allows the weighting between the mean performance (Y) and stability (WAASB). In this study, we chose to use simultaneous selection for both performance and stability (WAASBY), considering the ratio of 60% and 40% for mean performance and stability, respectively, prioritizing mean performance over stability  were observed for Avd, Tips, and SLRD each year. Most of the root traits showed significant differences between the two treatments each year, except for ThickRL_rate in 2019 and ThickRL, ThickRL_rate, ThinRL_rate, and nodule number in 2020. In addition, irrigation significantly improved plant biomass-related traits, including RDW and SFW. SFW was more sensitive to water content in the soil as an increase with a high significance level was observed each year, compared with PH, which only showed an increase in 2017 and 2019 under irrigation conditions.Sandy soils cannot retain water, and without irrigation, the soil moisture content gradually decreased in the sandy field of ALRC. However, irrigation quickly restored the moisture content in the irrigated field Figure 23.32 =r0.67 in 2017, 2 =r0.76 in 2019, 2 =r0.58 in 2020). The BLUP data also showed large variations among genotypes  are shown in H’ > 0.8) across the panel under both irrigated and non-irrigated conditions. No noticeable differences in the H’ values were found between the irrigation treatments. Higher H’ values were found in the WMC genotypes for most traits. Notably, the variation in H’ values between the mini-core collections was largely seen in TRL, Tips, and ThinRL. For instance, in the case of TRL, the H’ values were 0.81 and 0.79 for TRL in WMC compared with 0.70 and 0.69 for JMC under irrigated and non-irrigated conditions, respectively. The larger diversity in TRL was also reflected in the variation in the ranges of TRL in the two mini-core collections, especially in non-irrigated treatments. The TRL ranged from 691.48 to 2592.61 cm  in WMC, whereas a smaller range of 267% (from 1065.91–2843.25 cm) was observed in JMC. In addition to observing variations in the H’ values between the two mini-core collections, we investigated the variations in TRL and SFW among different groups based on the origin of accessions (The 3.4p<0.01) were observed in most of the pairs (r > 0.9) under both irrigated and non-irrigated conditions (r > 0.8) and ThickRL (r > 0.7), in both treatments. While positive correlations were found in most of the pairs of studied traits, ThinRL_rate was negatively correlated with most of the traits, especially with Avd. No noticeable difference in correlations among studied traits was found between the two irrigation treatments, except for the correlations between Avd and RDW and between Avd and Vol  explained approximately 83.2% of the total variation among all accessions in the experiment Figure 53.5Both the I- and RI-indices showed high variation between the genotypes, but there was no consistency between these indices  contributed to PC1. In contrast, Avd, ThinRL_rate, and MidRL_rate mainly contributed to PC2. The above traits were the most important and explained most of the total phenotypic variation between tested genotypes. These results are in agreement with those from previous studies , suggest4.2H’, which has been widely used to assess the diversity of root traits in various crops such as rice  under both irrigation treatments, the differences in the H’ values between the treatments were not significant for most traits, suggesting that our soybean panel is genetically diverse, resulting in high root plasticity in response to soil water content in the soil. Variations in root traits were also detected in soybean accessions from different origins. Soybean from the JMC collection had larger root systems compared with soybean from the WMC collection. In Japan, the breeding programs for soybean are mostly focused on seed quality and food quality treats, such as large seeds and high protein content (Natural variation in root traits has been exploited to improve the root system in soybean . The res as rice , maize ( as rice , wheat ( as rice , and cow as rice . Althoug content . Soybean content .With the recent availability of large root phenomes, screening for the desired root phenotype within many genotypes should be easy, rapid, and inexpensive . The plaSelecting promising genotypes with high stability and growth across diverse environments is fundamental for adapting to climate change. Recently, the use of the MTSI suggested by 5Large-scale field root phenotyping was applied in our study to evaluate the effects of field irrigation and genetic variation in root traits in a 200-genotype panel of soybean across 3 years. The growth of soybean root and shoot was significantly affected by irrigation treatments. The responses of root traits to irrigation treatments were consistent across the years, as most of the studied traits showed an increase under irrigated conditions. Among them, root dry weight, total root length, and root volume were the key traits contributing to the variation among the whole panel. Moreover, significant differences between irrigation treatments were observed each year in root average diameter, total number of root tips, and secondary lateral root density, suggesting that these traits as indicators for the early response of root traits to irrigation conditions. We also found a high diversity in root traits across the whole panel. It is worth noting that higher diversity in root traits was recorded in genotypes from the world mini-core collection, which can be exploited to broaden the genetic base of Japanese soybean through selection and breeding programs. Given the high diversity in root traits, we attempted to select promising genotypes using different approaches. While the selection of genotypes based on the increment index highlighted accessions with high plasticity toward irrigation conditions and can be used for parental lines for breeding or the mapping of quantitative trait locus for root trait improvement, genotypes with high relative increment in root traits had high values of root traits as well as underwent great improvement in root traits with irrigation. Specifically, the selection based on the multi-trait selection index yielded some shared genotypes under irrigated and non-irrigated conditions. These genotypes showed high stability and showed high growth performance across the two irrigation treatments in the 3 years of experimentation. One of the limitations of our study is that the root sampling was only done at an early growth stage of soybean to optimize for the most intact roots. To overcome this, future studies can be extended to the latter growth stages with analysis of yield and yield-related traits to determine whether the high performance and high stability of root traits are also related to high and stable crop yield.The original contributions presented in the study are included in the article/KTB, TN, HY, YT, YO, MT, AK, YY, HTs, YI, MH, TF, HI, MM, HTa, and MN contributed to the field experiment in ALRC. KTB, HTa, and MN prepared the manuscript, and all authors advised on the preparation of the manuscript. All authors have reviewed and approved the final manuscript.


N = 859 participants) showed that included predictors explained a total of 46% of the variance of believing in COVID-19 conspiracy theories, with only gender, overconfidence, and trust in science yielding significance. Trust in science was the strongest predictor, implying that campaigns aimed at enhancing public trust in both science as a process, and scientists as individuals conducting it, might contribute to the reduction in susceptibility to pseudoscientific claims. Furthermore, overconfidence in one’s own reasoning abilities was negatively correlated with an objective measure of reasoning (syllogisms test) and positively correlated with the endorsement of conspiracy theories, indicating that the so-called Dunning-Kruger effect plays a role in pseudoscientific conspiratorial thinking regarding COVID-19.Epistemically suspect beliefs, such as endorsement of conspiracy theories or pseudoscientific claims, are widespread even among highly educated individuals. The phenomenon of conspiratorial thinking is not new, yet the COVID-19 pandemic, causing a global health crisis of an unprecedented scale, facilitated the emergence and rapid spread of some rather radical health-related pseudoscientific fallacies. Numerous correlates of the tendency to endorse conspiracy theories have already been addressed. However, many of them are not subject to an intervention. In this study, we have tested a model that includes predictors ranging from stable characteristics such as demographics , less stable general traits such as conservatism and overconfidence in one’s own reasoning abilities, to relatively changeable worldviews such as trust in science. A hierarchical regression analysis ( Conspiracies thrive in times of crisis. A reason behind this surge is the illusion of control, i.e., the soothing effect of reassuring oneself that troubles do not happen at random, but rather in a meaningful order. Endorsement of conspiracies occurs when official narratives are experienced as deficient and lip-deep, while events are viewed as deceitful, with non-conclusive explanations . EpistemSurveys worldwide show that a steady 20–30% of respondents believe that there is more to COVID-19 than meets the eye e.g., . RegardiToday’s society is characterized by a strong partisan division in terms of whom and what to believe in, and is faced with public mistrust in government, scientific endeavors, and medical/pharmaceutical corporations, as well as the media. Rebuilding this trust is a societal imperative. Research emerging within the inoculation theory e.g.,  highlighThe variation in the degree to which individuals endorse conspiracy theories is attributable either to individual characteristics, such as demographics, personality, or one’s beliefs/attitudes, or to various social factors (group identity and trust in authorities). A recent review of 43 primary studies has highlighted individual variables related to the endorsement of COVID-19 conspiracies, yet overall results are sometimes conflicting . While fStudies often find that younger people are more inclined toward COVID-19 conspiracy beliefs, although opposite findings are evidenced in some cultures. While some find no gender differences in COVID-19-related conspiracy beliefs , others A reliable and consistent individual difference in generalized predispositions to endorse conspiracy theories seems to exist. While some individuals deliberately propagate misleading and partial information, some believe that any reasonable person, given enough study time and literature, is capable of insights regardless of the topic and expertise. Such superficial understanding of complex causal relations consequently leads to an overestimation of the quality and depth of one’s knowledge –a bias kThis inflated and unwarranted self-confidence might propagate conspiracy beliefs . People Understanding COVID-19 requires an understanding of complex biomedical mechanisms and dynamic statistical visualizations. Scientific communication on COVID-19 has changed alongside our understanding of the disease. The apparent inconsistencies have, in turn, spurred mistrust in scientists/science; COVID-19 conspiracies are often centered around the dismissal of scientific research e.g., . Higher Studies have identified a variety of correlates of conspiratorial thinking that could predict conspiratorial thinking. To further investigate the endorsement of COVID-19 conspiracy theories, we have proposed a model that includes various predictors of endorsement of COVID-19 conspiracy theories ranging from stable characteristics, such as demographics, through less stable general traits such as conservatism and overconfidence , to relavia mailing lists, social networks, and forums during the first 2 weeks of June 2020. This period was particularly convenient since the first wave had just ended, the number of daily new cases was very low, and the public was not convinced that the second wave of the pandemic was unavoidable. This context was fruitful in endorsing false beliefs about COVID-19, such as those claiming the disease is harmless or that it was engineered to make money from the vaccine.Link to the online survey was distributed On providing informed consent participants have proceeded to the instruments: (1) sociodemographic information, (2) syllogisms test and the estimation of one’s own performance, (3) trust in science and scientist inventory, (4) beliefs in COVID-19 conspiracy theory scale, and (5) conservatism scale.M = 27.86, SD = 11.73). Regarding education, 55.5% had elementary/high school grade, 21.7% BA degree, 17% MA/MS degree, and 5.8% PhD. While 58.3% lived in the cities, 41.7% lived in smaller towns or villages.A total of 859 participants clicked on the survey link, 837 agreed to participate, and 755 participants  finished the survey. Their age ranged 16–69 .Conservatism. A 12-item Social and Economic Conservatism Scale . The reliability of the scale was satisfactory (α = 0.88).tem form . ParticiSyllogisms Test and Overconfidence in One’s Own Reasoning Abilities. Participants were given 16 syllogisms to rate their validity, i.e., to respond to whether the conclusion is correct/logical, regardless of its factual correctness. The syllogisms were taken from the Endorsement of COVID-19 Conspiracy Theories. A 12-item scale was developed within this study to investigate the endorsement of various conspiracies regarding COVID-19. Participants indicated their agreement with the statements on a 5-point Likert scale . The scale yielded a high internal consistency (α = 0.90).Endorsement of COVID-19 theories, as well as the example in the syllogisms test, are available at the following link: https://osf.io/35zay/?view_only=b64c694b5cd94035a0cd61f244c0cac4.The full scale and descriptive statistics for M = 10.23, SD = 4.09). The correlation between the syllogisms test score and overconfidence score was significant , rendering the measure a good proxy of the Dunning-Kruger effect. For more details, refer to Descriptive statistics and correlations are shown in The overall level of conspiracy endorsement was low. However, the total theoretical range was observed, and 17.4% of participants scored >3, indicating endorsement of at least some claims. Given their highly improbable nature  and the educational level of our sample, any level of endorsement would suggest susceptibility to conspiracies. The overall level of trust in science was rather high, which opens the possibility that a certain proportion of participants trusts science but lacks the tools to differentiate scientific from pseudoscientific claims.Regarding our main hypothesis, we have predicted that sociodemographics, conservatism, overconfidence, and trust in science/scientists can significantly contribute to individual differences in the endorsement of COVID-19 conspiracies. Therefore, a three-step multiple regression analysis with belief in COVID-19 conspiracy theories as the criterion variable was conducted .F = 12.5; p < 0.001]. More conservative and overconfident participants were also more prone to conspiracies. Finally, trust in science/scientists (3rd step) accounted for an additional 38% of the variance , revealing that participants who trust science/scientists are less likely to endorse conspiracy theories. The final model accounted for 46% of the variance of believing in conspiracy theories with only gender, overconfidence, and trust in science being significant predictors.Sociodemographics were entered in the first step and have accounted for 5% of the variation in the belief in COVID-19 conspiracies. These were more often endorsed by women and participants from smaller areas. Contrary to our predictions, education was not related to the endorsement of conspiracy theories. Conservatism and overconfidence in one’s reasoning (2nd step) have explained an additional 3% of the variance. This change in the explained variance was significant [p < 0.01), as well as the standardized direct effect (c’ = 0.06: p < 0.05).Conservatism ceased to be a significant predictor in the third step, suggesting a potential mediating role of the trust in science/scientists in the relation between conservatism and conspiratorial thinking. To address this, we conducted the mediation analysis, which revealed that the relation between conservatism and conspiratorial beliefs is partially mediated by lower trust in science. The significance of the indirect effect was tested using 5,000 bootstrapped samples. The standardized indirect effect was significant (ab = 0.10: This study aimed to investigate the predictors of endorsement of the COVID-19 conspiracy theories grouped as (1) demographics (stable characteristics), (2) conservatism and overconfidence , and (3) trust in science (easy-to-change worldview). The results of the HRA showed that women and participants from smaller areas were more likely to endorse COVID-19 conspiracy theories (5% of variance), more conservative and overconfident participants were more likely to endorse conspiracies (3% of variance), and participants who trust science are less likely to endorse COVID-19 conspiracies (38% of variance). Conservatism ceased to be a significant predictor in the third step of the analysis, suggesting a potential mediating role of the trust in science/scientists in the relationship between conservatism and conspiratorial thinking. The final model accounted for 46% of the variance of believing in COVID-19 conspiracy theories with gender, overconfidence in one’s own reasoning, and trust in science/scientists as significant predictors.overestimating one’s own abilities has an adaptive value: it protects one’s self-esteem, prevents the negative consequences of adverse events, protects mental health, and potentially helps in deceiving others (Our findings suggest that this widespread gullibility  even amog others . Nonetheg others .The notion that overconfidence plays a significant role in the inability to differentiate between science and pseudoscience (the “I did my own research” dictum) tackles cognitive mechanisms, which might serve as a tool when planning interventions aimed at raising public understanding of complex phenomena such as the spread of a viral disease and mitigation methods. For example, in the context of the unintentional spreading of fake news on social media, it has been shown that nudging people to think about the accuracy of the shared content is a simple way to improve choices about what to share . An easyconservatism, which is often reported as an important predictor of conspiratorial thinking  amount of new knowledge. Another point, which is also not systematically addressed, is the fact that the scientific consensus about any given matter is not instantly shattered when the findings of a single study are not in accordance with the findings of numerous others. For those members of the general public who are not more deeply acquainted with a certain area, conflicting results of scientific studies, being readily available, and disseminated A key limitation inherent to online surveys is a non-representative sample, which might have been biased in terms of some relevant personality characteristics; participants higher on conscientiousness and agreeableness are more likely to participate in online studies. However, we have recruited a rather diverse sample in terms of age , a balanced proportion of men (44%) to women, and despite the disproportionately high number of educated participants, the overall education level ranged from elementary school only to Ph.D. Furthermore, 87.7% of participants answered all of the questions.Conspiratorial and biased thinking has been implicated in numerous fallacies, which are deeply rooted in the popular narrative. We have shown that the overestimation of one’s own reasoning, alongside the lack of trust in science, contributes to the endorsement of epistemically suspect beliefs regarding the pandemic. Such beliefs have the opportunity to incur damage on a large scale. Their direct debunking rarely yields success, so determining and addressing the precursors of such beliefs might prove to be more opportune. Given a large amount of variance in COVID-19-related conspiratorial thinking explained by the (mis)trust in science/scientists, it seems that restoring this trust is the most promising route for planning interventions. However, in the case of COVID-19, it might be too late for the implementation of such a large-scale top-down intervention. Another possible route involves a bottom-up mechanism and relies more on the individual psychological precursors, such as the self-deceptive nature of the assessments people make regarding their own abilities. Even though the share of variance of conspiratorial thinking explained by overconfidence is smaller than the one explained by mistrust in science, in the current situation when health officials are operating in the “damage-control” mode, such an intervention, alongside other psychological inoculation techniques, might offer an inexpensive and useful solution.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Ethical Committee of the Department of Psychology, University of Zagreb. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.MT has analyzed the data. MT and IH have interpreted the data. AV has drafted the manuscript. All authors have designed the study and revised the final version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Previous evidence suggests a link between diet quality and breast cancer (BrCa); however, the link between the Lifelines Diet Score (LLDS)—a fully food-based score that uses the 2015 Dutch Dietary Guidelines—and risk of BrCa has not yet been evaluated. Therefore, the aim of this study was to observe the relationship between adherence to an LLDS and risk of BrCa in Iranian adults.  In the hospital-based case-control study, 253 patients with BrCa and 267 non-BrCa controls were enrolled. Individual's food consumption was recorded to calculate LLDS using a semiquantitative food frequency questionnaire. In adjusted models, the association between the inflammatory potential of the diet and the risk of BrCa was estimated by using binary logistic regression. D supplements and anti-inflammatory drugs in the case group was significantly lower than the control group. Furthermore, after adjusted potential confounders, individuals in the highest vs. lowest quartiles of LLDS showed statistically significant lower risk of BrCa in overall population , premenopausal , and post-menopausal women .  Compared with control individuals, BrCa patients significantly had higher waist circumference (WC), first pregnancy age, abortion history, and number of children. In addition, the mean intake of vitamin  Findings of this study reflected that higher LLDS decreased risk of BrCa, but need further investigation in later studies. Breast cancer (BrCa) is one of the most common cancers in women that rapidly increasing worldwide . One in α) rate of 5% [The type of study is a case-control study. The target population of this study was 520 samples (two hundred and fifty-three people diagnosed with BrCa and two hundred and sixty-seven people without the disease). It should be noted that this number of samples were selected from “Hazrat Rasoul and Taleghani Hospital, Tehran, Iran,” in a period of one year between the years 2019 and 2020. The minimum required sample size was calculated based on the ability to detect an OR of 2 with a case to control ratio of 1 : 1, 90% power, and a type I error (te of 5% .BrCa patients were newly (<6 months) diagnosed with histologically confirmed BrCa by an oncologist. Patients with a history of other cancers, hormone-related diseases such as PCOS (polycystic ovary syndrome) or endometriosis, and occurrence of metastasis were also excluded from our study. The control group was selected from other parts of the hospital such as eye; ear, nose, and throat; skin; and beauty; did not have any history of cancer , inflammatory disease, and hormone-related diseases; and for the past 6 months, they have had a regular diet. Matching between two groups was done based on age and BMI. The control group was selected from other departments of the hospital, such as ophthalmology, otolaryngology, dermatology, and aesthetics. The group did not have any history of cancer , inflammatory disease, and hormone-related diseases. Also, each member of the control group included in the study was examined for inflammation by an internal medicine specialist and laboratory results to ensure the absence of inflammation. In order to determine the level of physical activity of individuals, a valid short form of the International Physical Activity Questionnaire (short IPAQ) was used, and informed written consent was obtained from all patients. Finally, it is important to note that this study was accepted via the Research Council and the Ethics Committee of Iran University of Medical Sciences, Tehran, Iran.A valid questionnaire of semiquantitative food frequency (including 168 food items) was used to determine food consumption compared to last year . The maiA skilled questioner managed all other questionnaires. So, all the attendee answered properly to the study queries. Overall appearances and medical data gathered through FFQ, consisted of age (years), age at 1st pregnancy (years), menopausal status (premenopause or postmenopause), literacy status, oral contraceptive medicines intake history (month), history of benign breast illness (yes or no), family history of cancer (yes or no), BrCa household history (yes or no), bra wearing at night (yes or no), smoking (yes or no), supplement consumption , NSAIDs usage (yes or no), and contact to sunlight throughout the day ((1) less than half an hour a day, (2) between half an hour and one hour a day, (3) between one and two hours a day, (4) more than two hours a day). Anthropometric quantities were gotten by means of standardized procedures. Weight was measured while patients wearing comfortable clothes, barefooted by a digital Seca scale (made in Germany) with the precision of one hundred grams. Height was obtained in a standing position barefooted, by means of a tape meter. Body mass index (BMI) was considered as weight (kg) divided by the square of height (m2). Waist circumference (WC) was obtained by means of nonelastic tap at the slimmest level deprived of any heaviness to body surface.LLDS was computed originated from the process described in the study by Vinke et al. . In thisP < 0.05.Statistical analysis was performed using SPSS 20 software . The normalcy of variables was considered by Shapiro–Wilk exams. Mean values of more than 2 groups were evaluated by means of a nalysis of variance (ANOVA) for normal distribution variables. Furthermore, the chi-square test was intended for comparing categorical variables. The risk of breast cancer (OR) and respective 95% confidence interval (95%CI) were estimated by binary logistic regression analysis with adjustment for confounders. In order to calculate ORs and 95% CIs, we classified all subjects based on the LLDS score into quartile ranges using the rank cases and then entered into the logistic regression as a categorical variable. The overall Ptrend across increasing quartiles was examined by considering the median score in each category as a continuous variable. We adjusted the results in three models using a priori selected potential confounders, which included model 1—age and BMI, model 2—additional adjustment for waist circumference, energy, first pregnancy age, number of children, history of abortion, hormone replacement therapy, use of anti-inflammatory drugs, and vitamin D supplementation. The data were presented as mean ± standard deviation, and statistical significance was accepted, a priori, at The mean ± SD for the age and BMI of the study population was 47.92 ± 10.33 years and 29.43 ± 5.51 kg.m2, respectively.Demographic characteristics, lifestyle, and medical history of study participants among case and control groups as well as across quartiles of LLDS are shown in The mean dietary intake of the participants in the study based on case and control groups as well as quartiles of LLDS is shown in D supplementation in the finally adjusted model, individuals in the highest vs lowest quartiles of LLDS showed statistically significant lower risk of BrCa in all three categories .The Odds ratios (ORs) and 95% confidence intervals (CIs) for BrCa patients according to quartiles of LLDS gives in The aim of our study was to investigate the relationship between the adherence to the LLDS and risk of BrCa. The results showed that adherence to a diet with a higher LLDS, which is high in vegetables, fruits, and legumes and nuts can reduce risk of BrCa in in the overall population. Also, in the highest quartile compared to the lower quartile of LLDS, a 74 and 80% reduction in the risk of BrCa was observed in premenopausal and post-menopausal women, respectively. Which, this risk reduction was greater in post-menopausal women.Although our study examined association of LLDS and BrCa for the first time, a similar study with the same root mechanism of action was performed in relation to LLDS and risk of type 2 diabetes by Vinke et al. The result of this study indicated that LLDS can decrease the risk of type 2 diabetes in the Dutch Lifelines cohort . Khani evs the bottom quartile 1.46 (95% CI 1.06–2.01)), especially in premenopausal women [vs the bottom quartile 0.56 (95% CI 0.40–0.79)) was associated with a lower risk of this disease [Previous studies have also shown an association between MED and HEI dietary pattern indices, which in most respects are similar to LLDA, with a reduced risk of chronic diseases such as BrCa. Although, due to the differences that mentioned above between these indices with LLDS, the results cannot be fully generalized to our work. However, a case-control study by Turati et al. in 2018 years in Italy and Switzerland, the results showed that adherence to the Mediterranean diet significantly reduced the risk of BrCa in pre- and post-menopausal women . In anot14–2.67) . In cont disease . A meta- disease . Further disease  conducte disease , 28.ptrend = 0.006), was associated with a significant reduction in BrCa [According to result of our study, BrCa patients significantly had lower consumption of healthy food groups including vegetables, fruits, and legumes and nuts and higher intake of coffee. In line with our study, recently in NHS Health  and NHSII (1991–1991) study on 182,145 women with BrCa, the results showed that consuming more fruits and vegetables, especially cruciferous and yellow/orange vegetables  . Howeverα in the body that causes inflammation and tissue damage, and the body's cells are prone to various cancers, including BrCa [Among the negative components of this score, red and processed meat and sugar-sweetened beverages intake were significantly higher in the case group than the control group as mentioned in our study. It is more commonly consumed in BrCa patients. Sugar-sweetened beverages in these diets also increase insulin secretion. Insulin increases the secretion of growth-promoting substances such as IGF-1 (insulin like growth factor-1) causes higher growth of tumor and cancer cells, thus increasing the risk of cancer . The higing BrCa –47. HoweThe current study has several strengths. To the best of our knowledge, it is the first case-control study assessing the association between LLDS with risk of BrCa, which skilled people were used to interview and collect food frequency questionnaires. Our sample size was sufficient, and we tried to eliminate the effect of confounders as far as possible, by adjusting wide range of variables, and a validated questionnaire has been used. However, despite the novelty of this study, there are some limitations that should be noted. Despite the possible confounders considered in this study when analyzing, some confounders may not have been considered. Although we found evidence of an association between LLDS and BrCa, due to the retrospective design utilized in this study, we cannot prove causality of the observed associations; therefore, future prospective studies and RCTs need to confirm the veracity of this finding. In addition, data were collected using self-report modalities, which are known to be associated with over- or under-reporting. However, we sought to ameliorate this by using trained interviewers and robustly validated tools.Adherence to a diet with a higher LLDS decreased the odds of BrCa, which this risk reduction was greater in postmenopausal women. However, due to the mentioned limitations, other prospective studies in this area have been suggested to be able to measure communication more fully.


The effect of metabolic factors on the risk of bacterial infections (BIs) in patients with hepatitis B virus (HBV)-related cirrhosis has not been demonstrated. This study aimed to explore specific metabolic factors associated with the BIs in these patients.A population-based cohort of 471 patients with HBV-related cirrhosis was retrospectively enrolled between 2009 and 2019. The primary end point was the incidence of BIs during hospitalization, which were compared according to the metabolism-related indicators, namely, presence of diabetes, level of high-density lipoprotein cholesterol (HDLC) and triglyceride, and body mass index (BMI). The propensity score matching (PSM) was adopted to eliminate baseline discrepancies.p = 0.029 and p = 0.027). Similar results were found in the low HDLC group as compared with the normal HDLC group before and after PSM (p < 0.001 and p = 0.025). Further analysis showed that the incidences of BIs in patients with low HDLC alone were lower than patients with both low HDLC and diabetes before and after PSM (p = 0.003 and p = 0.022). Similarly, the incidence of BIs in patients with diabetes alone was lower than those in patients with both low HDLC and diabetes both before and after PSM (p = 0.002 and p = 0.018). However, neither triglyceride nor BMI level was related to BIs in our cohort.Compared with the non-diabetic group, the incidences of BIs were higher in the diabetic group before and after PSM (In patients with HBV-related cirrhosis, the presence of diabetes and low level of HDLC were risk factors of BIs, showing a synergistic effect. Given tchanisms . Therefochanisms .The liver is the central organ of metabolism, participating in a variety of biological processes including glucose and lipid metabolisms, coagulation function regulation, and detoxification . The preAlterations of liver function are associated with modifications of circulating lipids. Progressive dyslipidemia occurs in liver cirrhosis and is related to increased mortality. The prevalence of the fatty liver disease is approximately one-quarter of the general population , 10. WheThis study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Ethics Review Committee of Sir Run Run Shaw Hospital, Zhejiang University, China. We retrospectively enrolled a population-based cohort of 471 patients with HBV-related cirrhosis in the Sir Run Run Shaw hospital between 2009 and 2019. Retrospectively, demographic and clinical data of patients meeting the inclusion criteria were collected from our database . The dia2 for Asian patients; (b) hypertriglyceridemia, defined as a serum triglyceride (TG) level ≥ 150 mg/dl; (c) DM, defined as a fasting glucose level of ≥ 126 mg/dl or prior diagnosis of DM and/or treatment with antidiabetic agent or insulin; (d) decrease of HDL level, defined as a serum HDL level ≤ 35 mg/dl. Extrahepatic diseases included cardiovascular, respiratory, and/or kidney diseases. All the enrolled patients were reviewed by two investigators, and any discrepancy between the two investigators was referred to a senior liver disease specialist for adjudication. The PSM with a ratio of 1:2 was adopted to eliminate baseline discrepancies and avoid losing too many samples. Eventually, the types of BIs were also compared.Demographic characteristics, medical history, laboratory outcomes, metabolism-related indicators, and model for end-stage liver disease (MELD) scores were recorded. The primary end point was the incidence of BIs during hospitalization, which was diagnosed according to the conventional criteria  14). In. In14). U-test was used to compare continuous variables, while the Pearson’s chi-squared test or Fisher’s test was used to compare categorical data as appropriate. The p-value less than 0.05 in two-tailed analyses was defined as statistical significance. All statistical analyses were performed using R software (Version 3.4.1).1The continuous variables were expressed as medians with ranges, while categorical data were presented as numbers with proportions. Correspondingly, the Mann-Whitney p = 0.020 and p < 0.001, p = 0.683 and p = 0.963, Totally, 471 patients were enrolled in this study. The demographic characteristics, metabolism-related indicators, laboratory results, and features of BIs were summarized in p = 0.029 and p = 0.027). With regard to HDLC, the incidences of BIs were 22.4% in the low HDLC group (n = 277) and 9.8% in the normal HDLC group (n = 194), respectively (p < 0.001). Adjusted by age, sex, presence of hepatocellular carcinoma, level of triglycerides, laboratory investigations, and MELD score, the incidence of BIs remained to be higher in the low HDLC group (17.8%) than that in the normal HDLC group (9.1%) (p = 0.025)  . As expe= 0.025) , 4.n = 277), there were 218 patients without diabetes and 59 patients with diabetes, respectively (p = 0.003 and p = 0.022). Likewise, the incidence of BIs (7.3%) in patients with diabetes alone (n = 41) was dramatically lower than 18.3% in patients with low HDLC and diabetes (n = 59) (p = 0.002) (n = 40) and diabetic group and 6.5% in the diabetic group alone (n = 31), respectively (p = 0.018).Given that the aforementioned results suggested that both diabetes and low level of HDLC were associated with increased risk of BIs, further investigations were performed to explore whether the synergistic effect existed. In patients with a low level of HDLC (ectively . The inc= 0.002) . To exclp = 0.025 and p = 0.006). Compared with those with low HDLC alone, patients with coexisting diabetes and low HDLC were found to have an increased risk of abdomen infections both before and after PSM (p = 0.022 and p = 0.044). Nonetheless, the types of BIs were comparable in patients with diabetes with or without the low level of HDLC.Subsequently, types of BIs were analyzed in patients with diabetes and/or low HDLC . IntriguAccumulative studies indicate that BIs are common in patients with cirrhosis and account for all-cause mortality . Not onlIn this study, metabolic risk factors of BIs, namely diabetes and low level of HDLC, were identified. Compared with individuals with diabetes or a low level of HDLC alone, patients with coexisting diabetes and a low level of HDLC showed higher risks of BIs. In line with previous reports , 8, 19, Of note, the increased incidence of BIs in patients with a low level of HDLC in this study is worthy of attention. In line with previous studies showing that patients with a low level of HDLC displayed a higher probability of BIs , our stuIntriguingly, no relationship between TG and BIs was observed in our cohort. Triglyceride, a component of blood lipids related to cardiovascular disease and diabetes, is influenced by lifestyle, diet, age, sex, and fluctuated widely and individually . We specAdditionally, obesity implies a chronic metabolic disturbance with excessive body fat accumulation, which is one of the most prevalent manifestations of metabolic syndrome . Some stAt present, the Child-Turcotte-Pugh (CTP) score and the model for end-stage liver disease (MELD) scores are considered as the optimal tools for predicting mortality in patients with cirrhosis. Despite both scores simply obtained from clinical and laboratory data, one of the limitations of these scores is the lack of assessment of metabolic status. Further studies are warranted to confirm whether the incorporation of specific metabolic factors would improve the clinical utility of prognostic scores in predicting the outcome of patients with cirrhosis. In addition, glucose and lipid assessment should be started early and may be mandatory in the disease course in any patients with cirrhosis.It is important to emphasize that patients with liver cancer in this cohort accounted for a higher proportion than expected. The authors feel that the management of the major complications of cirrhosis should not only be the job of internists. Patients with hepatectomy for HCC also require optimal management of cirrhotic complications in addition to assessing tumor recurrence. Blood glucose and HDLC level should be under careful supervision to prevent further decompensated cirrhosis caused by BIs. Therefore, the inclusion of patients with stable HCC with HBV-related cirrhosis fits with real-world conditions and facilitates comprehensive management of patients with cirrhosis. This research would help to improve current care pathways and the overall outcomes in these patients.via minimizing the impacts of confounding factors. This study excluded patients with missing data, which also introduce selection bias. Second, too much data on mortality were missing. The differences in mortality between groups were not analyzed. Third, patients enrolled in this study were HBV-related cirrhosis; whether these findings can be replicated in patients with other etiologies of cirrhosis remain to be further investigated. Finally, the relationships between metabolism factors and length of stay and the long-term prognosis of these patients should be further investigated.Some limitations of this study should be acknowledged. As a single-center retrospective study over a 10-year period, selected bias could not be completely avoided, although PSM enables the accurate assessment In conclusion, our study found that diabetes and low level of HDLC were the risk factors of BIs in patients with HBV-related cirrhosis. Moreover, the coexistence of diabetes and a low level of HDLC further enhanced the risk of BIs. Screening for glucose and lipid metabolism should be initiated during hospitalization in these patients.The original contributions presented in the study are included in the article/The Ethics Code: No. 20200522-28, approved by the Ethics Review and Scientific Investigation Board of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University . Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.FL and QY conceived and designed the manuscript. YT and HY collected and analyzed the data. QY and YT wrote the manuscript. BP and FL revised and checked the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The 11th revision of the International Classification of Diseases has endorsed substantial changes in Post-Traumatic Stress Disorder (PTSD) and has introduced Complex PTSD (cPTSD). The objective of this study was to assess the symptom and network structure of PTSD and cPTSD using the International Trauma Questionnaire- Italian version (ITQ) and the prevalence of PTSD and cPTSD in a community sample of late adolescents enriched with exposure to a destructive earthquake. A 1,010 high school students participated to the study. Confirmatory Factor Analysis supports that a six first-order correlated factors was the best fitting model of ICD-11 PTSD/cPTSD. The network analysis supports a clear separation between core PTSD symptoms and disturbances in self-organization (DSO) symptoms, avoidance, and negative self-concept were the most central items. The prevalence of PTSD and cPTSD was 9.11 and 4.06%, respectively. Female participants reported higher rates of both PTSD and cPTSD. This is the first study to report on ICD-11 PTSD and cPTSD rates on an Italian adolescence community sample. Consistent with other community samples, we found higher rates of PTSD compared to cPTSD. The results confirmed the factorial validity of the ITQ. The network structure highlights the importance of negative self-concept in cPTSD and avoidance in PTSD. Exposure to traumatic experiences (TE) is common in the general population with 70% of people globally reporting at least one potential TE in their lifetime, and 30% reporting four or more TEs . The preThe 11th revision of the World Health Organization’s (WHO) International Classification of Diseases (ICD-11) included substantial changes to the “Disorders Specifically Associated with Stress” section, including a revised definition of PTSD and the introduction of Complex PTSD . In theThe International Trauma Questionnaire (ITQ)  is a selThis study has two main objectives. The first aim is to assess the factor and symptom structure model of the Italian version of the ITQ using a factor and network analysis. In recent years a number of studies have addressed the network structure of DSM-IV- and DSM-5-defined PTSD . EvidencThe second purpose is to assess the prevalence of PTSD and cPTSD in a sample of Italian late adolescents exposed 10 years earlier to a destructive earthquake together with any gender differences. This population is characterized by collective exposure to an unintentional traumatic event in the form of a natural disaster during a critical developmental period. In this respect, we sought to extend upon current knowledge about the type of traumatic events that are associated with meeting the diagnostic criteria for PTSD and cPTSD by assessing the association between intentional and unintentional TEs with PTSD and cPTSD. In particular, the secondary hypothesis that intentional TEs would be more strongly associated with meeting criteria for cPTSD compared to unintentional TEs, which include the exposure to a natural disaster. Our expected results are that intentional TEs would exert a more relevant impact on PTSD and DSO symptoms, compared to unintentional TE.The participants in the present study were enrolled in the first time point of the Dual Trauma study at the University of L’Aquila. Dual trauma is a longitudinal study started in 2019 that focused on a target population comprising all of the late adolescents and young adults attending the last year of high school in the province of L’Aquila, central Italy, during the academic year 2019–2020. The estimated target population size is 2000. This population is of particular interest as virtually all of the population from L’Aquila and its surroundings, estimated half of the total target population, were directly exposed to the 2009 earthquake when they were between 7 and 10 years old. Most of the remaining target population coming from the surroundings of Avezzano and Sulmona were not directly exposed to this event. Inclusion criteria were attending the last year of high school and being > 18 years old at the time of the enrollment. Enrollment was limited to students > 18 who were chosen in order to not introduce any selection bias deriving from parental consensus. Exclusion criteria included being on supported teaching as a proxy of mild to severe cognitive impairment.A clustered sampling was conducted based on geographical area , school and class. In the area, 12 out of 14 high schools were identified and invited to participate; two schools did not provide consent to participate. In the remaining ten schools, 50 to 100% of the last-year classes were allowed to participate by the headmasters. Individual written consent was provided by the participants. Questionnaires were collected in paper and pencil form by the University staff.The local ethics committee at the University of L’Aquila provided approval to the study . This study adheres to the declaration of Helsinki.Recruitment and data collection took place between November 2019 and January 2020. A total of 1010 adolescents participated in the study, 506 (50.15%) males, mean age 18.7 (sd = 0.65). Geographical area was distributed as follows: 418 (41.39%) from L’Aquila surroundings, 306 (30.30%) from Avezzano surroundings and 286 (28.32%) from Sulmona surroundings. 694 (68.71%) participants reported being directly exposed to the 2009 central Italy earthquake.Of the 1,010 initial sample, eighteen participants had complete missing data on the ITQ and were thus excluded. The final analysis was performed on 992 subjects.https://www.traumameasuresglobal.com to the research and clinical communities and may be used without permission. For the purpose of this study, the following modifications were introduced: for each TE, the respondent was asked to rate whether the TE had occurred during childhood, adolescence, or in the last 6 months. Each TE was classified as intentional or unintentional by two independent psychiatrists with expertise in trauma-related research that were blind to all the study objectives and variables. The results were checked and discussed with the original authors of the ITEM. During the classification process, three TE were excluded because deemed not pertinent as intentional nor unintentional TE. Full ITEM questions, their lifetime endorsement by participants, and their classification as intentional or unintentional are reported in The ITEM  is a 21-The ITQ  is a selA diagnosis of PTSD requires that a person was trauma exposed, the endorsement  of at least one of two symptoms in each one of the three symptoms cluster plus endorsement (defined as a score ≥ 2) of at least one indicator of functional impairment. A diagnosis of cPTSD requires the endorsement of one of two symptoms from each of the three PTSD symptoms clusters and one of two symptoms from each of the three Disturbances in Self-Organization (DSO) clusters. The functional impairment must be identified where at least one indicator of functional impairment is endorsed related to the PTSD symptoms, and one indicator of functional impairment is endorsed related to the DSO symptoms. An individual can receive either a diagnosis of PTSD or cPTSD, not both. In our sample, reliability was α = 0.88 for the PTSD subscale and α = 0.88 for the DSO subscale.https://www.traumameasuresglobal.com/itq.The translation process followed standard back-translation procedures, with two psychiatrists providing a draft English-to-Italian translation, a third psychiatrist produced a joint version of the two drafts, and a native English speaker provided a back-translated version that was approved by the authors. The English and Italian versions of the ITQ are freely downloadable at ® v.16 (StataCorp (The weighted least squares (WLS) Confirmatory Factor Analysis (CFA) was conducted to evaluate the fit of four different models already presented in the literature. WLS provides accurate parameter estimates, standard error and test statistics for ordinal indicators. Based on previous findings , 23–29, tataCorp ).A network analysis on the 12 ITQ symptoms items was conducted using an Extended Bayesian Information Criterion Graphical Least Absolute Shrinkage and Selection Operator (EBICglasso) estimator. EBICglasso  is a parFinally, prevalence estimates for PTSD and cPTSD were estimated, together with gender differences. Association with traumatic experiences and a screened diagnosis of PTSD or cPTSD was assessed using multinomial logistic regression models, with ITQ categorical results  modeled as dependent variable, and intentional and unintentional TEs experienced during childhood, adolescence or during the last 6 months were jointly modeled as independent variables in order to correct their effects for each other. Afterward, analyses were adjusted by gender, parental education, and nationality.®, except for the network analysis that was conducted using JASP®.All of the statistical analyses were conducted using Stata 16A total of 1,010 subjects participated to the study, 999 of which provided complete data – 498 (49.85%) female and 501 (50.15%) males. Mean age was 18.7 (sd = 0.63). 418 (41.39%), 306 (30.30%), and 286 (28.32%) were, respectively, from the L’Aquila, Avezzano and Sulmona areas.2χ = 1903.43, RMSEA = 0.188, CFI = 0.619, TLI = 0.535, SRMR = 0.109, CD = 0.868, BIC = 32985.043) and 3  showed poor fit indices, while Model 2  and 4  showed good fit indices, although the χ2 statistic was significant due to the large sample size , while no gender differences were reported for unintentional TE. In particular, female participants reported higher rates of sexual assault and harassment, bullying, humiliation and neglect. Male participants reported higher rates of being threatened with a weapon and being physically assaulted by a non-parent.Detailed rates of traumatic experiences and psychopathology separated by gender are reported in 2χ = 15.712, p < 0.001 and 2χ = 10.897, p < 0.001).International Trauma Questionnaire prevalence rates are reported in Logistic regression analyses are reported in The present study is the first to report on prevalence rates of ICD-11 PTSD and cPTSD within an Italian late adolescent sample primarily exposed to trauma in the form of a natural disaster, and their association with different types of TEs. Additionally, this study adds to the existing literature on the factorial and network structure of the ICD-11 PTSD and cPTSD on an Italian late adolescent/young adult population.The ITQ is a brief, highly reproducible instrument that allows to jointly screen for PTSD and cPTSD according to the ICD-11 criteria. In our sample, PTSD was nearly twice as frequent as cPTSD, and both diagnoses were more frequent among female participants. This finding is in line with previous reports from a nationally representative Israeli sample of a higher prevalence of PTSD compared to cPTSD , 24, 34.In the present study, regression analyses support that both intentional and unintentional TEs are associated with a diagnosis of cPTSD, although intentional TEs show a stronger association with cPTSD. Conversely, we failed to demonstrate an association between unintentional TE and a diagnosis of PTSD. These results could be explained by the fact that a TE screener such as the ITEM may effectively screen for the presence of any TE, but it may fail to separate those TE that had a relevant psychological impact from those that didn’t. In our sample, which is enriched with youngsters that experienced a massively destructive earthquake during childhood, unintentional TE had a lifetime prevalence of 82% and a 6-months prevalence of 15.35%, compared to a PTSD prevalence of 9.11%. It follows that the vast majority of those experiencing unintentional TEs do not develop PTSD or, in other words, the vast majority of unintentional TE is not inherently associated with a relevant psychological burden sufficient for a diagnosis of PTSD.As opposite, intentional TEs were strongly associated with both PTSD and cPTSD.The present CFA results support a latent structure representative of six first-order correlated factors. The second best-fitting model was a two-factor second-order model. According to a recent systematic review , these tFinally, using a network analysis approach, we replicated the network structure of ICD-11 PTSD and cPTSD previously presented in other studies with the ITQ , 19. GivThis study has several limitations. First, one third of this sample consists of late adolescents that were exposed to a natural disaster during childhood, making the generalizability of these findings limited. Second, this study relies on self-report measures that could be affected by different biases. In particular, despite a TEs screener was available, too little is known about the putative TEs subsiding the self-report measures of post-traumatic symptoms, in terms of subjective emotional impact and relative importance of the TEs. It is difficult to imagine how to overcome these issues connected with self-report measures. However, the ITEM checklist is a useful tool to separate childhood, adolescence and recent TEs and to classify them into different types .The present study reports a prevalence rate Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (cPTSD) of 9.11 and 4.06%, respectively, in a sample of Italian adolescents exposed 10 years earlier to a destructive earthquake. The factor and network structure of the Italian version of the International Trauma Questionnaire (ITQ) confirmed the factorial validity of the questionnaire, highlighting the importance of avoidance in PTSD and negative self-concept in cPTSD.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Internal Review Board of the University of L’Aquila. The patients/participants provided their written informed consent to participate in this study.RR: conceptualization, methodology, software, validation, formal analysis, investigation, data curation, and writing – original draft. VS: data curation, writing, editing, and review. FP, CC, AR, and PH: writing, editing, and review. GD: conceptualization and supervision. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Previous studies have found some influencing factors of cyberbullying. However, little is known about how cyberbullying victimization and social responsibility influence college students' cyberbullying perpetration or about the mediating and moderating mechanisms underlying these relationships. Social responsibility involves not only individuals' deep cognition and special emotional identification of social responsibility but also their firm attitude and responsible actions. The purpose of this study is to investigate the relationship between college students' cyberbullying victimization and cyberbullying perpetration and whether this relationship is moderated by social responsibility. The study sample consisted of 1,016 Chinese college students  ranging in age from 19 to 25 (mean age 22). All participants completed questionnaires on cyberbullying victimization, cyberbullying perpetration and social responsibility. The results indicated that cyberbullying victimization is positively related to cyberbullying perpetration and that this relationship is mediated by social responsibility. This study highlights the harmful impact of cyberbullying victimization on college students, more notably, the underlying mechanisms between cyberbullying victimization and cyberbullying perpetration are explored, revealing that social responsibility can reduce the promoting effect of cyberbullying victimization on cyberbullying perpetration. In the era of social media, in which new media platforms and communication methods change with each passing day, with the impact of the Internet on social development, the phenomenon of cyberbullying has quietly emerged. Since 2006, incidents of cyberbullying in China have involved social ethics, legal justice, the gap between rich individuals and poor individuals, and many other aspects, gradually leading to the spread of anger on the Internet and pollution of the Internet ecological environment. Examples include the case of Peng Yu in Nanjing in 2007Cyberbullying is typically defined as aggression that is intentionally and repeatedly carried out in an electronic context  against a person who cannot easily defend him- or herself , 2. The Some researchers have summarized the internal motivation for college students' cyberbullying. First, cyberbullying is the individual's cognitive dissonance caused by the emotional intensity of pure malicious attacks. The reality of experiencing past violence on social network platforms might induce a sense of frustration and anger, which in turn might drive individuals to engage in cyberbullying as an act of revenge. However, the relationship between cyberbullying victimization and cyberbullying perpetration among college students needs to be confirmed. According to a survey released by Chinese researchers in 2021, 21.72% of Chinese college students think they are victims of cyberbullying, 13.86% have played the role of perpetrator of cyberbullying, and 8.04% of college students think they have played the dual role of victim and perpetrator of online violence . “Pure eAccording to the general aggression model, individuals' aggression behavior is mainly affected by individual factors and environmental factors. Individual factors include personality traits, attitudes, motives, gender, beliefs, values, long-term goals, behavioral scripts, and any other consistent characteristics that the individual brings to the situation. On the other hand, environmental factors are characteristics of the environment and include aggressive cues, provocation, sources of frustration, drugs, external sanctions, and incentives. Environmental factors also include the degree to which the social situation restricts or offers an opportunity to act aggressively . In addiBased on the general aggression model, whether it is a vindictive or an irrational moral judgment of online violence, individuals' aggressive behaviors are closely related to their values and perceptions. Past studies have consistently held that the tendency of moral disengagement is the most significant personality trait leading to youth cyberbullying , 16. MorIn conclusion, at present, there are few empirical studies on the phenomenon of cyberbullying among Chinese college students, and there is also a lack of empirical studies to directly prove the relationship between cyberbullying victimization and cyberbullying perpetration of college students, as well as the role of social responsibility in this relationship. Considering that the method of experimental research is limited by the sample size and there is no mature research paradigm for cyberbullying at present, the method of investigation is adopted in this study. Therefore, this study focuses on Chinese college students and conducts a questionnaire survey to explore the impact of individuals' social responsibility on their online violence behavior, especially the relationship between cyberbullying victimization, cyberbullying perpetration and social responsibility. In view of the findings and conclusions of previous studies, the following basic hypotheses are proposed: 1. Cyberbullying victimization can positively predict the tendency toward cyberbullying perpetration. 2. Social responsibility can negatively predict the tendency toward cyberbullying. 3. The impact of cyberbullying victimization on cyberbullying perpetration is influenced by social responsibility.A total of 1,331 national college students were recruited to voluntarily participate in the survey, and the data of 115 subjects were excluded (data missing), for a questionnaire recovery rate of 90%. The remaining 1,016 subjects  were aged between 19 and 25 (mean average 22). In order to avoid the subjects filling out the questionnaire out of the social approval tendency, we did not inform the subjects of the nature of the questionnaire and the purpose of the test, and the questionnaire was conducted anonymously. After completing the survey, each subject was paid 15–20 RMB. The questionnaire was approved and tested by the Academic Ethics Committee of Fujian Agriculture and Forestry University.The Cyberbullying Questionnaire developed by Doane et al.  was tranThis research adopts the Social Responsibility Scale of College Students formulated by Wei . This inN = 1,000) method was employed to estimate the confidence interval (CI) of the indirect effect of perpetration. The model was estimated by a robust maximum likelihood estimation procedure. Several fit statistics and the criteria of the model evaluation were as follows: GFI and AGFI ≥ 0.80, CFI, TLI and RFI ≥0.90, and RMSEA ≤0.08  was employed to examine the hypothesized model. In the model, social responsibility, cyberbullying perpetration, and cyberbullying victimization were considered latent variables, and their measurement indicators were parceled using an isolated approach. The bias-corrected bootstrapping  = −3.12, p < 0.01, d = 0.20; social responsibility cognition: t(1014) = −3.13, p < 0.01, d = 0.20; social responsibility identification: t(1014) = −2.03, p < 0.05, d = 0.13; social responsibility action: t(1014) = −3.14, p < 0.01, d = 0.20]. In terms of the scores on cyberbullying perpetration and its dimensions, males were significantly higher than females in the total score of cyberbullying, malice, unwanted contact and public humiliation . In terms of the total score on cyberbullying victimization and its dimensions, males were significantly higher than females .The show see  that in t–test results with students' place of birth as the independent variable (see t(1014) = −3.10, p < 0.01, d = 0.20; social responsibility cognition: t(1014) = −3.35, p < 0.01, d = 0.21; social responsibility identification: t(1014) = −2.29, p < 0.05, d = 0.15; social responsibility action: t(1014) = −2.67, p < 0.01, d = 0.17]. In terms of the score on cyberbullying perpetration and its dimensions, the malice of rural students is significantly higher than that of urban students .The able see  show that–test results with students' position as the independent variable (see t(1014) = 1.70, p = 0.09, d = 0.11; social responsibility cognition: t(1014) = 2.26, p < 0.05, d = 0.15; social responsibility action: t(1014) = 1.86, p = 0.06, d = 0.12]. In terms of the scores on cyberbullying perpetration and its dimensions, the deception level of student cadres is significantly higher than that of nonstudent cadres . In terms of the total score on cyberbullying victimization and its dimensions, the level of deception and publicly humiliation of student cadres is significantly higher than that of nonstudent cadres .The able see  show thaps < 0.01). The total score on cyberbullying perpetration  and its dimensions were significantly positively correlated with the total score on cyberbullying victimization and its factors  (ps < 0.01)  the total score on cyberbullying perpetration and its various dimensions , and the total score on cyberbullying victimization and its dimensions  were all significantly negatively correlated (.01) see .Confirmatory factor analysis was conducted on the factors of cyberbullying perpetration, social responsibility and cyberbullying victimization, and the results are shown in Based on existing theories and research, this study assumes that cyberbullying victimization can directly affect cyberbullying perpetration and indirectly affect cyberbullying perpetration through social responsibility, which directly affects cyberbullying perpetration see .M.I. = 118.54, r = 0.71, p < 0.01) and the “deception” factor of cyberbullying victimization and cyberbullying perpetration are significantly correlated . The variations of the latent variables of cyberbullying victimization and cyberbullying perpetration also have variations among factors. The “malice” and “deception” factors of cyberbullying victimization , the “deception” and “public humiliation” factors of cyberbullying victimization , the “unwanted contact” and “public humiliation” factors of cyberbullying victimization , the “deception” and “unwanted contact” factors of cyberbullying perpetration , and the “unwanted contact” and “public humiliation” factors of cyberbullying perpetration  are significantly correlated. The final model was obtained by adding two-edged arrows representing the homogeneity of the models , so the chi-square test is not an important index of model fit. The fitting results show that the model is basically acceptable , RFI = 0.97, TLI = 0.98]. It can be seen that, except for the chi-square test, the other model fitting indexes all indicate that the model has a good degree of fit. The fitting indexes and evaluation criteria are shown in Maximum likelihood (ML) estimation was used for the continuous fitting of the initial model, and modification indexes (M.I.) were comprehensively considered. According to the M.I. and theoretical basis, the factors of cyberbullying victimization and cyberbullying perpetration have potential variations . That ise models . When thSE = 0.04, p < 0.01). Social responsibility has a direct negative effect on cyberbullying perpetration . Cyberbullying victimization has a positive and direct effect on cyberbullying perpetration . The standardized indirect effect is 0.18, the total effect of cyberbullying victimization on cyberbullying perpetration (ES = 0.74 +0.18 = 0.92), the direct effect accounts for 80.06%, and the indirect effect of cyberbullying victimization accounts for 19.93%. The moderated mediating effect was also tested. The bias-corrected percentile bootstrap method  was used to test the mediating effect and to observe the upper limit and lower limit of the 95% CI with bias correction. It was found that the lower limit of the indirect effect of cyberbullying victimization on cyberbullying perpetration was 0.093 and that the upper limit was 0.153. Therefore, the CI did not include 0. Part of the mediating effect through social responsibility is significant , and the mediating effect accounted for 19.93% of the total effect.Cyberbullying victimization has a negative and direct effect on social responsibility  than other countries that emphasize individualism. In sum, we extend previous studies by confirming the mediating effect of social responsibility on the relationship between cyberbullying victimization and cyberbullying perpetration, these results not only conducive to in-depth research on the generation of cyberbullying, but also has a practical guiding role for how to intervene and reduce cyberbullying, For example, both school education and family education should pay attention to reducing or eliminating the negative influence of the past experience of online victimization, and add training for improving the attitude, cognition and behavior of social responsibility in the moral course of college students.This study has some limitations. First, the questionnaire survey and subjective reports of cyberbullying victimization, cyberbullying perpetration and social responsibility do not fully reflect the individual's actual state. It is necessary to adopt an experimental research paradigm and combine evaluation-related physiological indicators  to further study the psychological and brain mechanisms of cyberbullying. Second, this study does not exclude the influence of college students' personality and other personal traits on the research results. Past studies have consistently found that a person with an aggressive personality is more likely to commit online violence. It is necessary to take stable traits such as people's personality, mental health level and emotional regulation ability as control variables or research variables in future studies to repeatedly verify the internal relationship between cyberbullying victimization, cyberbullying perpetration and social responsibility. Third, this study did not consider the potential impact of cultural differences on the research results. Individuals in Chinese culture tend to take responsibility for other people and external phenomena, while individuals in Western culture tend to take responsibility only for themselves. Chinese culture has always stressed individual social responsibility, emphasizing that “everyone is responsible for the rise and fall of the world”. However, in Western culture, individual responsibility is self-centered, and if one is required to undertake social responsibilities and obligations, doing so is regarded as an obstacle to becoming a well-functioning person . TherefoThis study focuses on the relationship between cyberbullying victimization, cyberbullying perpetration and social responsibility among Chinese college students. The results show that the level of cyberbullying victimization and its dimensions can positively predict cyberbullying perpetration and its dimensions. In addition, consistent with the hypothesis, social responsibility fully mediates the relationship between college students' cyberbullying victimization and cyberbullying perpetration. Another interesting finding is that cyberbullying victimization is significantly associated with college students' cyberbullying perpetration. Therefore, this study suggests that cyberbullying victimization does not necessarily lead to cyberbullying perpetration, and the key lies in whether students have a high sense of social responsibility to regulate aggressive cognition and behavioral tendencies. That is, improving social responsibility plays an important role in reducing cyberbullying perpetration among Chinese college students. At the same time, the results also show that male college students not only carry out more cyberbullying than female college students but also suffer more cyberbullying. The social responsibility of females is significantly higher than that of males. Compared with urban students, rural students have more malicious online behaviors and less sense of social responsibility. Compared with nonstudent cadres, student cadres have more social responsibility performance, more online deception behavior, and more experience of being deceived and being publicly humiliated on the Internet.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Ethics Committee of Fujian Agriculture and Forestry University. The patients/participants provided their written informed consent to participate in this study.JZ and YY conceived of the presented idea. RL developed the theory, performed the computations, and verified the analytical methods. RL encouraged JZ and YY to investigate a specific aspect and supervised the findings of this work. All authors discussed the results and contributed to the final manuscript.This work was supported by the Humanities and Social Science Project of the Ministry of Education (19YJC710100), Research on the Construction of Grassroots Teaching Organization in colleges and universities from the perspective of group dynamics (112-111420047), and the Outstanding Youth Program of Fujian Agriculture and Forestry University (XJQ201931).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.