Publications by authors named "X Wang"

126,740 Publications

Examining concurrent validity between COMLEX-USA Level 2-Cognitive Evaluation and COMLEX-USA Level 2-Performance Evaluation.

J Osteopath Med 2021 May 13. Epub 2021 May 13.

Midwestern University, Glendale, AZ, USA.

Context: The Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) is a three level examination used as a pathway to licensure for students in osteopathic medical education programs. COMLEX-USA Level 2 includes a written assessment of Fundamental Clinical Sciences for Osteopathic Medical Practice (Level 2-Cognitive Evaluation [L2-CE]) delivered in a computer based format and separate performance evaluation (Level 2-Performance Evaluation [L2-PE]) administered through live encounters with standardized patients. L2-PE was designed to augment L2-CE. It is expected that the two examinations measure related yet distinct constructs.

Objectives: To explore the concurrent validity of L2-CE with L2-PE.

Methods: First attempt test scores were obtained from the National Board of Osteopathic Medical Examiners database for 6,639 candidates who took L2-CE between June 2019 and May 2020 and matched to the students' L2-PE scores. The sample represented all colleges of osteopathic medicine and 97.5% of candidates who took L2-CE during the complete 2019-2020 test cycle. We calculated disattenuated correlations between the total score for L2-CE, the L2-CE scores for the seven competency domains (CD1 through CD7), and the L2-PE scores for the Humanistic Domain (HM) and Biomedical/Biomechanical Domain (BM). All scores were on continuous scales.

Results: Pearson correlations ranged from 0.10 to 0.88 and were all statically significant (p<0.01). L2-CE total score was most strongly correlated with CD2 (0.88) and CD3 (0.85). Pearson correlations between the L2-CE competency domain subscores ranged from 0.17 to 0.70, and correlations which included either HM or BM ranged from 0.10 to 0.34 with the strongest of those correlations being between BM and L2-CE total score (0.34) as well as between HM and BM (0.28).The largest increase between corresponding Pearson and disattenuated correlations was for pairs of scores with lower reliabilities such as CD5 and CD6, which had a Pearson correlation of 0.17 and a disattenuated correlation of 0.68. The smallest increase in correlations was observed in pairs of scores with larger reliabilities such as L2-CE total score and HM, which had a Pearson correlation of 0.23 and a disattenuated correlation of 0.28. The reliability of L2-CE was 0.87, 0.81 for HM, and 0.73 for BM. The reliabilities for the L2-CE competency domain scores ranged from 0.22 to 0.74. The small to moderate correlations between the L2-CE total score and the two L2-PE support the expectation that these examinations measure related but distinct constructs. The correlations between L2-PE and L2-CE competency domain subscores reflect the distribution of items defined by the L2-PE blueprint, providing evidence that the examinations are performing as designed.

Conclusions: This study provides evidence supporting the validity of the blueprints for constructing COMLEX-USA Levels 2-CE and 2-PE examinations in concert with the purpose and nature of the examinations.
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http://dx.doi.org/10.1515/jom-2021-0007DOI Listing
May 2021

Comparison of Insulin, Metformin, and Glyburide on Perinatal Complications of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Gynecol Obstet Invest 2021 May 12:1-13. Epub 2021 May 12.

Department of Endocrinology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Aim: This systematic and meta-analysis was conducted to evaluate the efficacy and safety of insulin, metformin, and glyburide on perinatal complications for gestational diabetes mellitus (GDM).

Methods: Medline (PubMed), EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials [CENTRAL], and Cochrane Methodology Register), Web of Science (Science and Social Science Citation Index), and ClinicalTrials (Clinicaltrials.gov) were searched, as well as manual searching. We included randomized controlled trials comparing efficacy and safety of metformin versus glyburide, metformin versus insulin, and glyburide versus insulin in patients with GDM.

Results: We included 32 articles including 5,964 patients published from inception to July 2020. Compared with insulin, metformin was more effective at lower incidence of macrosomia (RR: 0.66, 95% CI: 0.50-0.88, p = 0.005), lower incidence of neonatal intensive care unit admission (RR: 0.78, 95% CI: 0.67-0.91, p = 0.002), less neonatal hypoglycemia (RR: 0.67, 95% CI: 0.56-0.80, p < 0.0001), decreased birth weight (BW) (SMD: -0.37, 95% CI: -0.62 to -0.12, p = 0.004), lower incidence of large for gestational age (RR: 0.76, 95% CI: 0.50-0.90, p = 0.002), shorter gestation age at delivery (MD: -0.22, 95% CI: -0.34 to -0.10, p = 0.0002), lower maternal weight gain (MD: -1.41, 95% CI: -2.28 to -0.55, p = 0.001), less incidence of caesarean section delivery (RR: 0.86, 95% CI: 0.78-0.95, p = 0.0004), lower maternal postprandial blood glucose (SMD: -0.41, 95% CI: -0.72 to -0.11, p = 0.008), and lower incidence of pregnancy-induced hypertension (RR: 0.47, 95% CI: 0.27-0.83, p = 0.01). However, glyburide, compared with insulin, was associated with higher BW (MD: 54.95, 95% CI: 3.87-106.03, p = 0.03) and increased the incidence of neonatal hypoglycemia (RR: 1.52, 95% CI: 1.12-2.07, p = 0.007). Meanwhile, compared to glyburide, metformin was associated with higher maternal fasting blood glucose (SMD: 0.20, 95% CI: 0.05-0.36, p = 0.01) and lower incidence of induction of labor (RR: 0.76, 95% CI: 0.59-0.97, p = 0.03).

Conclusions: This review suggests that metformin can decrease the incidence of perinatal complications, and it should be considered as a generally safe alternative to insulin.
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http://dx.doi.org/10.1159/000515893DOI Listing
May 2021

Assessing Agreement between Frequency-Specific Chirp Auditory Steady-State Response and Pure Tone Audiometry in Adults by Intraclass Correlation Coefficient.

ORL J Otorhinolaryngol Relat Spec 2021 May 12:1-9. Epub 2021 May 12.

Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Introduction: Chirp auditory steady-state response (ASSR) can be used to assess frequency-specific hearing thresholds. However, its reliability has not been confirmed yet. The purpose of this proposed study is to analyze the agreement of thresholds measured by chirp-ASSR and pure tone audiometry (PTA) to investigate the value of chirp-ASSR in hearing threshold evaluation.

Methods: Participants with normal hearing (age: 18-66, 108 ears) and patients with sensorineural hearing loss (age: 22-82, 75 ears) were tested using PTA and chirp-ASSR at 0.5, 1, 2, and 4 kHz, respectively. Intraclass correlation coefficient (ICC) and Bland-Altman plot were introduced to analyze the agreement between the 2 methods.

Results: One-hundred eight participants underwent both chirp-ASSR and PTA to estimate their thresholds. The ICCs yielded by these 2 methods are 0.757, 0.893, 0.883, and 0.921 (p < 0.001) at 0.5, 1, 2, and 4 kHz carrier frequency, respectively. However, there is a significant difference between the 2 methods at 2 kHz: the mean value of the ASSR thresholds is 5.27 dB HL higher than the value of PTA thresholds. Additionally, the 95% limits of agreement range from -27.48 to 26.66 dB HL at 0.5 kHz, from -18.19 to 17.87 dB HL at 1 kHz, from -12.01 to 22.55 dB HL at 2 kHz, and from -21.29 to 19.17 dB HL at 4 kHz, which are large enough to affect clinical decision-making.

Conclusion: In this study, we have confirmed good to excellent correlation between chirp-ASSR and PTA in threshold estimation for adults with and without hearing loss. The degree of correlations is higher for participants with hearing loss and for measurements at high frequencies. However, significant systematic difference and large limits of agreement between the 2 methods have been found. These findings show that chirp-ASSR can be treated as a supplementary method to PTA when evaluating the hearing level, but the 2 methods are not interchangeable due to their systematic difference and large limits of agreement.
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http://dx.doi.org/10.1159/000515237DOI Listing
May 2021

Combined healthy lifestyle and depressive symptoms: a meta-analysis of observational studies.

J Affect Disord 2021 Apr 26;289:144-150. Epub 2021 Apr 26.

Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan. Electronic address:

Background: To systematically summarize the association between combined lifestyle (at least three factors, including but not limited to smoking, drinking, physical activity, body mass index, diet) and depressive symptoms by a meta-analysis in general populations.

Methods: Multiple electronic databases were searched for observational studies investigating combined lifestyle factors and depressive symptoms published before September 2020. Pooled risk estimates were calculated using random-effects models. Publication bias was conducted using the Egger's and Begg's tests.

Results: A total of 12 studies with 185,899 participants were included. The pooled OR of depressive symptoms in meta-analysis of 7 cross-sectional studies was 0.53 (0.39, 0.72), I = 83.6%, P for heterogeneity <0.001 and the pooled RR was 0.33 (0.12, 0.89), I = 95.3%, P for heterogeneity <0.001 in meta-analysis of 5 cohort studies for people with the highest versus lowest score of heathy lifestyles. In sensitivity analyses, the heterogeneity was significantly reduced in cross-sectional studies (pooled OR = 0.74 [0.65, 0.85], I = 21.7%, P for heterogeneity = 0.27) and cohort studies (pooled RR = 0.53 [0.38, 0.74], I = 15.2%, P for heterogeneity = 0.32). The publication bias corrected by "trim-and-fill" analysis yielded unchanged results.

Limitations: Limitations included residual confounding in original studies, heterogeneity between studies, and potential publication bias in the analysis of cross-sectional studies.

Conclusion: The healthy lifestyle was associated with a reduced risk of depressive symptoms. Adherence to overall healthy lifestyles is essential for the primary prevention of depression in general populations.
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http://dx.doi.org/10.1016/j.jad.2021.04.030DOI Listing
April 2021

Resident memory T cells in tumor-distant tissues fortify against metastasis formation.

Cell Rep 2021 May;35(6):109118

Department of Immunology, Duke University Medical Center, Durham, NC 27710, USA. Electronic address:

As a critical machinery for rapid pathogen removal, resident memory T cells (Ts) are locally generated after the initial encounter. However, their development accompanying tumorigenesis remains elusive. Using a murine breast cancer model, we show that Ts develop in the tumor, the contralateral mammary mucosa, and the pre-metastatic lung. Single-cell RNA sequencing of Ts reveals two phenotypically distinct populations representing their active versus quiescent phases. These Ts in different tissue compartments share the same TCR clonotypes and transcriptomes with a subset of intratumoral effector/effector memory T cells (Ts), indicating their developmental ontogeny. Furthermore, CXCL16 is highly produced by tumor cells and CXCR6 Ts are the major subset preferentially egressing the tumor to form distant Ts. Functionally, releasing CXCR6 retention in the primary tumor amplifies tumor-derived Ts in the lung and leads to superior protection against metastases. This immunologic fortification suggests a potential strategy to prevent metastasis in clinical oncology.
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http://dx.doi.org/10.1016/j.celrep.2021.109118DOI Listing
May 2021