Children with autism spectrum disorder (ASD) are at elevated risk for psychiatric problems in response to the COVID‐19 pandemic. This risk is due to their high rates of pre‐pandemic psychiatric comorbidities and the pandemic's disruption to routines and access to necessary supports. Prior research has indicated that children with ASD may experience a worsening of specific psychiatric symptoms in response to COVID‐19, though this body of work is limited in scope. The present study expands this literature by examining specific types of psychiatric problems that emerged about 2 months after the onset of the pandemic, and risk factors predicting changes in these psychiatric symptoms. Parents of children with a confirmed ASD diagnosis ( N = 257), who enrolled in a clinic registry at an outpatient specialty autism center, were included in this study. All data were gathered online via customized and standardized questionnaires. Results showed that 59% of children experienced either a worsening of their pre‐pandemic psychiatric diagnoses and/or the development of new psychiatric symptoms during the pandemic. Multivariable regression models indicated that risk factors for increased psychiatric problems included child understanding of COVID‐19, COVID‐19 illness in the family, low family income, and elevated parental depression and anxiety symptoms (all p < 0.05). Findings from this study emphasize the urgent need to provide effective and accessible psychiatric services for children with ASD and their families during and after the pandemic. Lay summary Children with ASD are at high risk for psychiatric problems during the COVID‐19 pandemic. We found that 59% of children in our clinical sample are experiencing increased psychiatric problems. The child's understanding of COVID‐19, COVID‐19 illness in the family, low family income, and depression and anxiety symptoms in the parent increase the risk for poor mental health during the pandemic. These findings indicate the importance of helping children with ASD access mental health treatment during COVID‐19.

PurposeHypoxia, which is a loss of oxygen in tissues, is a common condition in solid tumors due to the tumor outgrowing existing vasculature. Under hypoxic conditions, hypoxia-inducible factor (HIF)-1α rapidly accumulates and transactivates hundreds of genes, such as matrix metalloproteinases (MMPs). MMPs contribute to invasion and metastasis of tumor cells by degrading the surrounding basement membrane and extracellular matrix barriers, which enables the easy migration and spread of cancer cells. We examined whether hypoxia increases tumor cell invasion, and whether increased invasiveness was due to HIF-1α and MMP-9 expression.MethodsTranswell invasion assays were performed to demonstrate whether hypoxia enhance tumor invasion by use of MDA-MB-231 breast cancer cells. An immunofluorescence assay was used to demonstrate expression of HIF-1α and MMP-9 under hypoxic conditions. Luciferase and ChiP assays were performed to demonstrate that MMP-9 promoter activity was regulated by HIF-1α.ResultsHIF-1α was stabilized under hypoxic conditions and stimulated MMP-9 expression, which affected the tumor invasiveness of breast cancer cells. HIF-1α transactivated the MMP-9 promoter by forming a transcriptional unit with p300, thus increasing expression of MMP-9 transcripts. Zymography indicated that MMP-9 had more gelatinase activity under hypoxic conditions than normoxic conditions. Furthermore, the small GTPase Ras was also activated in response to hypoxia, which then aids stabilization of HIF-1α, and in turn upregulates MMP-9 expression. We also demonstrate that MMP-9 is upregulated concurrently with HIF-1α in tumor tissues from patients with breast cancer.ConclusionThese results suggest that HIF-1α promotes cell invasion through a MMP-9-dependent mechanism and that future antitumor agents could be used to target HIF-1α and MMP-9.

Although prior research in Western societies has revealed an association between self-efficacy and both self-management behaviours and better health status, little is known about the applicability of this association in Korean populations. We examined the differences in self-management behaviours and health status among three groups according to the level of self-efficacy (high, moderate and low). We used a descriptive and correlational design, and administrated a questionnaire to 322 Korean patients with diabetes mellitus, hypertension or arthritis at three ambulatory clinics in a university medical centre. We performed the Pearson chi-square test to test for differences in proportions, and the Kruskall-Wallis and Mann-Whitney U-tests for non-parametric measures. The level of self-efficacy was associated with self-management behaviours (P < 0.05) and with better health status indices (P < 0.001) except fatigue (P < 0.277). The mean age (Mean ± standard deviation, 53.71 ± 12.60), the percentage of high level of education (62.4%) and the level of employment (51.4%) were significantly higher in high self-efficacy group than in low self-efficacy group or moderate self-efficacy group. Further study of the potential factors affecting any relationship between self-efficacy and fatigue is recommended. Self-efficacy-enhancing interventions can be beneficial for Korean chronic patients to improve their self-management behaviours and health status.

For both conventional and self-adhesive dual-cure resin cements, insufficient light exposure (20 seconds of light-curing time) through thick ceramic restoration (4 mm thick) resulted in a DC even lower than that of self-curing alone.