bluuebunny/crossref_metadata_2025 huggingface dataset:
A digital health profile & maturity assessment toolkit: cocreation and testing in the Pacific Islands
Authors: Liaw Siaw-Teng , Zhou Rui , Ansari Sameera , Gao Jun
Published: September 2020

Introduction

Countries need to determine their level of digital health capability maturity to assess and mobilize their knowledge, skills, and resources to systematically develop, implement, evaluate, scale up and maintain large-scale implementations of standards-based interoperable digital health tools.

Objective

Develop a Digital Health Profile and Maturity Assessment Toolkit (DHPMAT) to assist Pacific Island Countries (PICs) to harness digital tools to support national health priorities.

Materials and Methods

A literature review guided the development of the conceptual framework to underpin the DHPMAT. Key informants collaborated to collect key digital health features and indicators to inform their country’s digital health maturity assessment. The DHPMAT was tested with country stakeholders at a Pacific Health Information Network workshop in 2019.

Results

A comprehensive list of indicators to describe country digital health profiles (DHP). A digital health maturity assessment tool that uses criteria codeveloped with country stakeholders to assess essential digital health foundations and quality improvement. DHPs created and maturity assessed and packaged into individualized DHPMATs for 13 PICs. PIC users perceived the DHPMAT as useful, especially the congruence with the 2017 WHO WPRO Regional Strategy but noted a “cognitive overload” from a plethora of complex digital health toolkits.

Conclusions

The cocreation approach optimized currency, accuracy, and appropriateness of information in the DHP, understanding, and use of the DHPMAT to facilitate informed iterative discussion by PICs on their digital health maturity to harness digital tools to strengthen country health systems. The DHPMAT can rationalize the choice and use of existing tools and reduce cognitive overload.
Xylanase supplementation in corn-based swine diets: a review with emphasis on potential mechanisms of action
Authors: Petry Amy L , Patience John F
Published: September 2020

Corn is a common energy source in pig diets globally; when financially warranted, industrial corn coproducts, such as corn distiller’s dried grains with solubles (DDGS), are also employed. The energy provided by corn stems largely from starch, with some contribution from protein, fat, and non-starch polysaccharides (NSP). When corn DDGS are used in the diet, it will reduce starch within the diet; increase dietary protein, fat, and NSP levels; and alter the source profile of dietary energy. Arabinoxylans (AXs) comprise the majority of NSP in corn and its coproducts. One strategy to mitigate the antinutritive effects of NSP and improve its contribution to energy is by including carbohydrases within the diet. Xylanase is a carbohydrase that targets the β-1,4-glycosidic bonds of AX, releasing a mixture of smaller polysaccharides, oligosaccharides, and pentoses that could potentially be used by the pig. Xylanase is consistently effective in poultry production and moderately consistent in wheat-based swine diets, but its efficacy in corn-based swine diets is quite variable. Xylanase has been shown to improve the digestibility of various components of swine-based diets, but this seldom translates into an improvement in growth performance. Indeed, a review of xylanase literature conducted herein suggests that xylanase improves the digestibility of dietary fiber at least 50% of the time in pigs fed corn-based diets, but only 33% and 26% of the time was there an increase in average daily gain or feed efficiency, respectively. Intriguingly, there has been an abundance of reports proposing xylanase alters intestinal barrier integrity, inflammatory responses, oxidative status, and other health markers in the pig. Notably, xylanase has shown to reduce mortality in both high and low health commercial herds. These inconsistencies in performance metrics, and unexpected health benefits, warrant a greater understanding of the in vivo mechanism(s) of action (MOA) of xylanase. While the MOA of xylanase has been postulated considerably in the literature and widely studied in in vitro settings, in wheat-based diets, and in poultry, there is a dearth of understanding of the in vivo MOA in pigs fed corn-based diets. The purpose of this review is to explore the role of xylanase in corn-based swine diets, discuss responses observed when supplemented in diets containing corn-based fiber, suggest potential MOA of xylanase, and identify critical research gaps.
Morphology of gastric mills and mandibles of New Guinean parastacid crayfishes, with comparisons with other Astacidea (Decapoda)
Authors: Kawai Tadashi , Patoka Jiří
Published: September 2020

Knowledge of the morphological features of crayfishes native to New Guinea is limited in many cases, the internal morphology, gastric mills, and mandibles of six species of Cherax species (Decapoda: Astacidea: Parastacidae) from this island were described and illustrated. The measurements were compared with those of parastacid crayfish from Madagascar and New Zealand, with Enoplometopoidea from coral reefs, and Nephropidea from deep sea. Characters peculiar to the family Parastacidae were found both in gastric mills and mandibles, and differences between the morphology of mandibles in freshwater and marine species from the infraorder Astacidea were found. Relationships between functional morphology and feeding behaviour were discussed.
Decentralized Finance
Authors: Zetzsche Dirk A , Arner Douglas W , Buckley Ross P
Published: September 2020

DeFi (‘decentralized finance’) has joined FinTech (‘financial technology’), RegTech (‘regulatory technology’), cryptocurrencies, and digital assets as one of the most discussed emerging technological evolutions in global finance. Yet little is really understood about its meaning, legal implications, and policy consequences. In this article we introduce DeFi, put DeFi in the context of the traditional financial economy, connect DeFi to open banking, and end with some policy considerations. We suggest that decentralization has the potential to undermine traditional forms of accountability and erode the effectiveness of traditional financial regulation and enforcement. At the same time, we find that where parts of the financial services value chain are decentralized, there will be a reconcentration in a different (but possibly less regulated, less visible, and less transparent) part of the value chain. DeFi regulation could, and should, focus on this reconcentrated portion of the value chain to ensure effective oversight and risk control. Rather than eliminating the need for regulation, in fact DeFi requires regulation in order to achieve its core objective of decentralization. Furthermore, DeFi potentially offers an opportunity for the development of an entirely new way to design regulation: the idea of ‘embedded regulation’. Regulatory approaches could be built into the design of DeFi, thus potentially decentralizing both finance and its regulation, in the ultimate expression of RegTech.
Interrogating Genomic-Scale Data to Resolve Recalcitrant Nodes in the Spider Tree of Life
Authors: Kulkarni Siddharth , Kallal Robert J , Wood Hannah , Dimitrov Dimitar , Giribet Gonzalo , Hormiga Gustavo
Published: September 2020

Genome-scale data sets are converging on robust, stable phylogenetic hypotheses for many lineages; however, some nodes have shown disagreement across classes of data. We use spiders (Araneae) as a system to identify the causes of incongruence in phylogenetic signal between three classes of data: exons (as in phylotranscriptomics), noncoding regions (included in ultraconserved elements [UCE] analyses), and a combination of both (as in UCE analyses). Gene orthologs, coded as amino acids and nucleotides (with and without third codon positions), were generated by querying published transcriptomes for UCEs, recovering 1,931 UCE loci (codingUCEs). We expected that congeners represented in the codingUCE and UCEs data would form clades in the presence of phylogenetic signal. Noncoding regions derived from UCE sequences were recovered to test the stability of relationships. Phylogenetic relationships resulting from all analyses were largely congruent. All nucleotide data sets from transcriptomes, UCEs, or a combination of both recovered similar topologies in contrast with results from transcriptomes analyzed as amino acids. Most relationships inferred from low-occupancy data sets, containing several hundreds of loci, were congruent across Araneae, as opposed to high occupancy data matrices with fewer loci, which showed more variation. Furthermore, we found that low-occupancy data sets analyzed as nucleotides (as is typical of UCE data sets) can result in more congruent relationships than high occupancy data sets analyzed as amino acids (as in phylotranscriptomics). Thus, omitting data, through amino acid translation or via retention of only high occupancy loci, may have a deleterious effect in phylogenetic reconstruction.
Chemical Elements in Electronic Cigarette Solvents and Aerosols Inhibit Mitochondrial Reductases and Induce Oxidative Stress
Authors: Williams Monique , Ventura Jesse , Loza Antonio , Wang Yuhuan , Talbot Prue
Published: September 2020

Introduction

Chemical elements and their toxicity were evaluated in electronic cigarette (EC) solvents, fluids, and aerosols.

Aims and Methods

Element identification and quantification in propylene glycol (PG), glycerin (G), refill fluids before and after use, and aerosols was done using inductively coupled plasma optical emission spectrometry. Cytotoxicity and oxidative stress were evaluated using in vitro assays.

Results

Seven elements were present in PG, G, and popular refill fluids, and they transferred to aerosols made with ECs. Selenium was in all products (0.125–0.292 mg/L), while arsenic, aluminum, and tin were frequently in solvent and refill fluid samples at lower concentrations. Iron, chromium, copper, nickel, zinc, and lead were only detected in fluid after EC use, indicating they came from heated atomizers. Elements transferred most efficiently to aerosols made with second-/third-generation ECs. Of the elements in fluid, selenium and arsenic were the most cytotoxic to human bronchial epithelial cells (BEAS-2B) and pulmonary fibroblasts in the 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide assay. Selenium increased superoxide production in mitochondria and nucleoli and elevated selenoprotein H in nucleoli of BEAS-2B cells at concentrations found in EC aerosols (10 nM or 0.002 mg/L).

Conclusions

Elements in EC aerosols came from both e-fluids and atomizing units. Within second-/third-generation products, transfer became more efficient as power increased. In vitro responses occurred at concentrations of selenium found in some EC aerosols. Human exposure to chemical elements in ECs could be reduced by regulating (decreasing) allowable EC power and by improving the purity of PG and G.

Implications

PG, G, refill fluids, and e-fluids contained potentially toxic chemical elements that transferred to aerosols. Transfer was more efficient in second- and third-generation EC products and increased as power increased. Selenium and arsenic were the most cytotoxic of the elements tested in the 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide assay. Selenium tetrachloride-induced oxidative stress in BEAS-2B cells, but not in human pulmonary fibroblasts. All fluids contained selenium above the concentration that induced oxidative stress in human bronchial epithelial cells. Selenium increased superoxide in mitochondria and nucleoli and increased selenoprotein H, a redox responsive DNA-binding protein that is upregulated by superoxide and an indicator of nucleolar stress. EC users are exposed to elements in aerosols, which may with chronic exposure contribute to diseases associated with oxidative stress.
The effect of front-of-package labels or point-of-sale signage on consumer knowledge, attitudes and behavior regarding sugar-sweetened beverages: a systematic review
Authors: Gupta Adyya , Billich Natassja , George Neetu Abey , Blake Miranda R , Huse Oliver , Backholer Kathryn , Boelsen-Robinson Tara , Peeters Anna
Published: September 2020

Context

Globally, the use of labels or signage targeting SSBs remains in its infancy and there is limited evidence available regarding its ability to decrease purchase and consumption of SSBs.

Objective

This systematic review aimed to synthesize the evidence on the effect of sugar- or health-related sugar-sweetened beverage (SSB) warning labels or signage on knowledge, attitudes, and beliefs, and SSB purchase and consumption.

Data sources

Nine databases – Ovid Medline, Emerald Insight, Scopus, Informit, Business Source Complete, CINAHL, Global Health, PsychINFO, and SocIndex – were searched along with grey literature from inception to December 2019. The PRISMA guidelines were applied for reporting this systematic review.

Study Selection

Studies examining the impact of front of pack (FOP) labels and/or point of sale (POS) signage highlighting added sugar content or its health risks were included.

Data extraction

Two authors independently extracted data on items, including study details, study design, population characteristics, intervention label details (type, duration, and settings), and outcomes measures. The Effective Public Health Practice Project tool was used to assess the study quality.

Data analysis

Findings were synthesized narratively.

Results

Twenty-one studies published between 1992 and 2019 were included. Of these, 16 studies examined the impact of FOP labels and 5 studies examined the impact of POS signage. Both FOP labels and POS signage were associated with improved health knowledge, attitudes, and beliefs regarding SSBs and reduced SSB purchases. Warning labels with diet-related health consequences were found to be particularly effective. Overall quality of studies was assessed as mixed.

Conclusion

Health- or sugar-related FOP labels and POS signage for SSBs are promising public health measures and may improve consumers’ health behaviors toward reduced SSB purchase and consumption.
Agricultural Land Abandonment
Authors: Prishchepov Alexander V.
Published: September 2020

Agricultural land abandonment is increasingly a global land-cover change phenomenon that has strong implications for the environment (e.g., biodiversity, carbon sequestration, novel ecosystems, wildfires) and societal well-being (livelihood, agricultural landscapes). Agricultural land abandonment is often referred to as the cessation of farming and giving away land for natural succession, such as grasses, shrubs, and trees on former agricultural lands, but may also result in land degradation. Agricultural land abandonment can be a more complex land-change transition, including the cessation of agricultural activity in favor of land uses other than agricultural ones, such as forestry, construction of dwellings, game reserves, and tourism. Studies have shown that agricultural land abandonment often is driven by rational decision-making and profit maximization, including weighing up opportunity costs and alternative livelihood strategies. However, the conditions of institutions, which are supposed to govern land use, and the personal characteristics of those involved in agricultural activities, are playing a vital role in the decision of abandonment. It should also be noted that the decision on abandonment or maintenance of farming can be quite complex and driven by non-economic factors, such as personal predisposition to farming, education, ethnicity, religion, age, and availability of successors. The progress of studying land abandonment and existing research gaps are highlighted in the text.
The Health Systems of Low- and Middle-Income Countries
Authors: Mills Anne
Published: September 2020

“Health system” is a term generally considered to be relatively recent. It is defined as all organizations, institutions, and resources that produce actions whose primary purpose is to improve health, whether these be targeted at individuals (such as health-care delivery) or populations (such as public health measures). Health-care and public health institutions have a long history, but the notion of an organized “health system” is a relatively recent development (dating from the mid-20th century). In low- and middle-income countries (LMICs), Western medicine was often introduced by former colonial authorities through the construction of public hospitals, health centers, and training schools, with church authorities also making a major contribution. As in high-income countries, there was a gradual process over the latter half 20th century to construct an organized and coordinated national health system. However, health systems became a key focus of international attention only in the late 1990s, when it became apparent that achieving the health-related Millennium Development Goals (e.g., reduction of child and maternal mortality; control of HIV, TB, and malaria) was threatened less by the availability of technical solutions and more by the ability of health systems to put them into practice. More recently, the Ebola epidemic in West Africa highlighted the critical importance of health systems in ensuring health security. In response to the increased awareness of the role of health systems, significant attention has been paid to defining the health system and its goals, categorizing its elements, assessing problems and testing solutions, and seeking to identify the relationship between different health system configurations and overall performance. Over time, specific issues within the general area of health systems have received special attention, including achieving universal health coverage (where the whole population of a country has access to health care and protection against its costs), the role of primary health care, the relative merits of different ways of financing a health system, the relative roles of public and private health sectors, and the appropriate mix of different types of health worker. Many disciplines can contribute to improved understanding of health systems, including economics, sociology, anthropology, history, political science, and management science. Until recently, the discipline of economics has tended to dominate the study of health systems. However, with the emergence of health policy and systems research as an important area of study, other disciplines have been making growing contributions, especially political science and the behavioral sciences concerned with the behavior of both individuals and organizations.
Legendrian Hopf Links
Authors: Geiges Hansjörg , Onaran Sinem
Published: September 2020

We completely classify Legendrian realizations of the Hopf link, up to coarse equivalence, in the 3-sphere with any contact structure.
REDUCING ABSORBED DOSE TO THYROID IN NECK CT EXAMINATIONS: THE EFFECTS OF SABA SHIELDING
Authors: Saba Valiallah , Shuraki Jalal Kargar , Valizadeh Abdollah , Zahedinia Mohsen , Barkhordari Maziar
Published: September 2020

Bi shielding has been used for the protection of radiosensitive organs during computed tomography (CT) for 20 years. In 2017, American Association of Physicists in Medicine recommended against Bi shielding due to its degrading effects on image quality. Saba shielding introduced recently protecting organs as Bi shielding without degrading image quality. In this study, the Saba shield was modified and primary radiation attenuation values of the shields and entrance skin dose (ESD) on the thyroid were measured with and without shielding. Furthermore, the quality of images obtained using Saba shielding was investigated quantitatively and qualitatively. Saba and Bi shielding reduced the ESD on the thyroid by about 50%. Saba shielding had about 5–7 HU less noise and about 51–65 HU less CT numbers shift in comparison with Bi shielding at a distance of 1 cm from the shields. Saba shielding had no degrading effects on image quality in the patient study.
The personality dispositions and resting-state neural correlates associated with aggressive children
Authors: Li Qingqing , Xiao Mingyue , Song Shiqing , Huang Yufei , Chen Ximei , Liu Yong , Chen Hong
Published: September 2020

Despite aggression being detrimental to children’s physical health, mental health and social development, the dispositional and neurological antecedents of aggression in the child are poorly understood. Here we examined the relationship between trait aggression as measured by Buss and Warren’s Aggression Questionnaire and personality traits measured with Big Five Questionnaire for Children in 77 primary-school children and recorded resting-state brain activity (fractional amplitude of low-frequency fluctuations [fALFF]) and resting-state functional connectivity (rsFC) using functional magnetic resonance imaging. The present results showed that trait aggression was negatively correlated with agreeableness and positively correlated with neuroticism. The brain analyses showed that children with a higher propensity for aggression had a lower fALFF mainly in the left superior temporal gyrus, right parahippocampal gyrus and left supramarginal gyrus. Physical and total aggressions were negatively associated with rsFC between the right parahippocampal gyrus and the right putamen. Further analysis revealed that this rsFC could moderate the influence of neuroticism on total aggression. Moreover, the results suggest the presence of a sex difference in the neurodevelopmental mechanisms underlying aggression in middle childhood. Overall, our findings indicate that aggressive children have lower agreeableness and higher neuroticism, and the underlying neural systems are mainly implicated in social judgment and empathy.
A Time-Series Analysis of Contextual-Level Effects on Hate Crime in The Netherlands
Authors: Jacobs Laura , van Spanje Joost
Published: September 2020

Nowadays, registered hate crimes are on the rise in many Western societies. What explains temporal variation in the incidence of hate crimes? Combining insights from the grievance model and the opportunity model, we study the role of three types of contextual factors: security (terrorism), media (news about terrorism and immigration), and political factors (speech by anti-immigration actors, hate speech prosecution, and high-profile anti-immigration victories). We apply time-series analysis to our original dataset of registered hate crimes in the Netherlands, 2015–2017 (N = 7,219). Findings indicate that terrorist attacks, (both print and online) news on refugees, immigration, and terrorism boost nonviolent hate crime. Similarly, news of the hate speech prosecution of Freedom Party leader Geert Wilders increases nonviolent crime as well. Tentative evidence points to a contagion effect of speech by anti-immigration actors. With regard to violent hate crime, only terrorist attacks had an effect. This effect was modest and only found in one of our models. Hence, the grievance and the opportunities model each partially explain nonviolent hate crime, although the security and media context seem most influential. Our findings help to identify the contextual factors contributing to a climate for hate and suggest that perceived threats play a key role.
Gender Knowledge and Gender Expertise: The Implementation of Gender Mainstreaming in Swedish State Agencies
Authors: Freidenvall Lenita
Published: September 2020

Through an analysis of the Swedish government development program for gender mainstreaming in state agencies—the JIM (Jämställdhet i myndigheter)program—this article analyzes how gender equality is constructed (gender knowledge) and what role specialized knowledge (gender expertise) has in policy implementation. The article claims that even in best-case scenarios, such as Sweden, where intensive efforts to integrate a gender perspective have been undertaken, gender knowledge is based on visions and strategies that do not question prevailing policy paradigms. However, cross-cutting and intersectional conceptualizations of gender equality have created epistemic space for transformative interventions on the part of gender experts.
Original Research: Suicide Among RNs: An Analysis of 2015 Data from the National Violent Death Reporting System
Authors: Patrician Patricia A. , Peterson Cora , McGuinness Teena M.
Published: September 2020

Background:

Suicide is now the 10th leading cause of death in the United States. Suicide rates for health care providers are thought to be higher than for people in other occupations because of job strain and burnout. Despite the National Academy of Medicine's Action Collaborative on Clinician Well-Being and Resilience, which focuses on reducing stress and preventing suicide, a shortage of data limits our understanding of nurse suicide. Neither employers nor professional nursing associations track suicide data.

Purpose:

To determine the number of suicides and estimated rate of suicide among RNs, using data from the National Violent Death Reporting System (NVDRS).

Methods:

We extracted data from the NVDRS, which is based on death certificates, coroner reports, and law enforcement reports, for the year 2015. The National Institute for Occupational Safety and Health's Industry and Occupation Computerized Coding System was used to code the data. Industry and occupation coding experts reviewed the coding for accuracy.

Results:

Analysis of 2015 NVDRS data from 17 states showed that among civilian employed nurses ages 16 to 64 years, the estimated suicide rates for female and male nurses (11.4 and 29.3 per 100,000 nurses, respectively) were each higher than the rates for the comparable total population (8.2 and 26.1 per 100,000 people, respectively).

Conclusions:

Our findings indicate that RNs may die by suicide at higher rates than the total employed population in the 16-to-64-year age range. Implementation of evidence-based approaches to prevent suicide are warranted.
Behind the Scenes of an Educational Escape Room
Authors: Hawkins Janice Evans , Wiles Lynn L. , Tremblay Beth , Thompson Beth A.
Published: September 2020

Educational versions of interactive escape room games can be used to teach and reinforce knowledge and clinical skills. In this article, the authors describe their experience creating, piloting, implementing, and evaluating a safe medication educational escape room for first-year nursing students. They highlight the steps needed to develop an effective learning experience and provide insight into lessons they've learned throughout this process.
How Does Research Start?
Authors: Capili Bernadette
Published: September 2020

Editor's note: This is the first article in a new series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice—from research design to data interpretation. The articles will also be accompanied by a podcast offering more insight and context from the author.
Early Warning Scoring Systems May not Capture Nurses' Judgments of Patient Risk
Authors: Rosenberg Karen
Published: September 2020

According to this study:

Nurses' ratings of patients' risk of deterioration at change-of-shift handoff showed greater agreement with other nurses than with commonly used early warning scores.
Evaluating waiting time with real-world health information in a high-volume cancer center
Authors: Kim Kyu-pyo , Park Yu Rang , Lee Jung Bok , Kim Hae Reong , Lyu Yongman , Kim Jeong-Eun , Hong Yong Sang , Lee Jae-Lyun , Kim Tae Won
Published: September 2020

Wait time and scheduling for outpatient chemotherapy administration depends on various factors including infusion room hours of operation, availability of oncologists, nursing and pharmacy staffing, and physical space limitations. The aim of this study was to use the electronic event log of patients on health information system (HIS) to map and analyze patient flow in advanced metastatic colorectal patients at an academic cancer center. From January 2009 to December 2014, patients who were diagnosed with metastatic colorectal cancer and received outpatient chemotherapy confined to FOLFIRI (fluorouracil, leucovorin, and irinotecan) or FOLFOX (folinic acid, fluorouracil, and oxaliplatin) were identified. From the HIS, patient flow was mapped by collection of event records including blood collection and pretreatment laboratory test, arrival to outpatient clinics, outpatient session (interview, drug accountability and appointment scheduling), and initiation of chemotherapy. A total of 10,638 patients were analyzed for 136,281 outpatient visits. The total office stay time from outpatient registration to initiation of chemotherapy was 92.58 ± 87.96 (mean ± standard deviation) minutes. Each outpatient session lasted 23.75 ± 51.55 minutes. After completing the outpatient session, patients waited 1,657.23 ± 3,027.65 minutes before chemotherapy and 46.66 ± 75.94 minutes within infusion room. Compared to the prior first come first serve rule, the new reservation system showed an improvement in overall waiting time from 2,432.3 ± 4,822.9 to 2,386.7 ± 143.4 minutes; however, waiting time within infusion room slightly increased from 36.68 ± 49.33 to 48.13 ± 46.32 minutes. Our findings indicate that transaction data analytics from HIS can be used to evaluate patient flow within oncology outpatient practice based on real-world hospital data.
Prognostic significance of tumor-associated macrophages in patients with nasopharyngeal carcinoma
Authors: Chen Ya-Lian
Published: September 2020

Background:

To explore the prognostic value of diverse subsets of tumor-associated macrophages (TAMs) in prognosis in patients with nasopharyngeal carcinoma (NPC) using meta-analysis.

Methods:

Relevant studies were searched in the database of PubMed, Web of Science, Embase, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI), and Wanfang till November 2019. The relationship between TAMs and survival outcomes was estimated by pooling hazard ratios (HRs) and 95% confidence intervals (CIs); and the correlation of TAMs and clinicopathological factors was evaluated by using odds ratios (ORs) and 95%CIs.

Results:

Six studies with 1549 patients were included in this meta-analysis. The high expression of CD68+ TAMs was associated with favorable disease-free survival (DFS) (HR = 0.66, 95%CI = 0.50–0.88, P = .005), whereas the density of M2-like TAMs (CD163+, CD68+CCL18+, and CD206+) was correlated to poor overall survival (OS) (HR = 1.77, 95%CI = 1.22–2.56, P = .003) and DFS (HR = 1.96, 95%CI = 1.00–3.85, P = .050) in patients with NPC.

Conclusions:

CD68+ TAM density is associated with superior DFS, while CD163+ M2-like TAMs predicted poor prognosis in patients with NPC.
Evaluation of the impact of Tacrolimus-based immunosuppression on Heidelberg liver transplant cohort (HDTACRO)
Authors: Khajeh Elias , Polychronidis Georgios , Ramouz Ali , Alamdari Parnian , Lemekhova Anastasia , Saracevic Melisa , Ali-Hasan-Al-Saegh Sadeq , Ghamarnejad Omid , Majlesara Ali , Abbasi Dezfouli Sepehr , Nickkholgh Arash , Weiss Karl Heinz , Rupp Christian , Mehrabi Arianeb , Mieth Markus
Published: September 2020

Background:

Tacrolimus-based immunosuppression has resulted in enormous improvements on liver transplantation (LTx) outcomes. However, dose adjustment and medication adherence play a key role in post-transplant treatment success. The aim of the present study is to assess the trough levels and the need for adaptation of therapeutic doses in de novo LTx patients treated with Tacrolimus in the clinical routine, without any intervention to the treatment regimen.

Methods and analysis:

This is a pilot, prospective, exploratory, monocentric, non-interventional and non-randomized investigator-initiated study. Prospectively maintained data of 100 patients treated with various oral Tacrolimus-based immunosuppressants (Prograf or Envarsus) will be analyzed. The number of required dose adjustments of Tacrolimus formulations used in clinical routine for achieving the target trough level, Tacrolimus trough level, Tacrolimus dosing, concentration/dose ratio, routine laboratory tests, efficacy data (incl. survival, acute rejection, re-transplantation), patients therapy adherence, and infections requiring the need to reduce individual immunosuppressant dosing will be evaluated for each patient.

Result:

This study will evaluate the trough levels and the need for adaptation of therapeutic doses in de novo LTx patients treated with Tacrolimus in the clinical routine, without any intervention to the treatment regimen.

Conclusion:

The HDTACRO study will be the first study to systematically and prospectively evaluate various oral Tacrolimus-based immunosuppressants in de novo liver transplanted patients. If a difference between the therapy-subgroups is evident at the end of the trial, a randomized control trial will eventually be designed. Registration number: ClinicalTrials.gov: NCT04444817.
Acupuncture and related techniques for restless legs syndrome
Authors: Xiang Jie , Li Honglian , Xiong Jun , Hua Fanghui , Huang Shouqiang , Jiang Yunfeng , Qiang Hailiang , Xie Fan , Wang Min
Published: September 2020

Background:

Restless legs syndrome (RLS) is a common sensory disorder of the nervous system, which often affects the sleep quality of patients. Acupuncture and related techniques are increasingly used to treat neurological diseases, but their efficacy and safety for RLS are yet to be established. The purpose of this study is to summarize the effectiveness and safety of acupuncture and related techniques for RLS.

Methods:

We will conduct a comprehensive data retrieval, and the electronic databases will include PubMed, Embase, Cochrane Library, WangFang Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, from establishment to October 2020. We will also manually search unpublished studies and references, and contact lead authors. Randomized clinical trials (RCTs) of acupuncture and related techniques for RLS will be included. The outcomes of interest include: The total effective rate and International Restless Leg Syndrome rating scale (IRLS), Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), adverse events, quality of life. To assess the methodological quality, we will use the Cochrane risk assessment tool. RevMan 5.3.5 software will be used to conduct data synthesis. The evidence quality of each outcome will be appraised according to Grades of Recommendation, Assessment, Development, and Evaluation (GRADE).

Results:

The results will be published in a peer-reviewed journal.

Conclusion:

This study will provide a high-quality evidence to evaluate the efficacy and adverse reactions of acupuncture and related techniques for RLS.

PROSPERO registration number:

CRD42020157957.
Short stature is associated with higher pulse wave velocity in subjects without overt cardiovascular disease
Authors: Moon Jeonggeun , Hwang In Cheol , Han Seung Hwan
Published: September 2020

Short stature is reportedly associated with cardiovascular disease (CVD). However, the mechanism underlying this intriguing epidemiological finding is unclear. Pulse wave velocity (PWV), a marker of vascular stiffness, is a predictor of future CVD. Therefore, PWV may be affected by height even before overt CVD occurs. Here, we investigated the association between adult height and PWV in subjects without overt CVD.

A total of 1019 subjects (48 ± 12 years old; 509 men, 21 with diabetes mellitus, 209 with hypertension) without overt CVD were enrolled, all of whom underwent brachial-ankle PWV (baPWV) measurements. The subjects were divided into 3 groups by height. A multiple regression model was used to estimate baPWV values among heights after the adjustment for confounders.

Mean baPWV value was highest in the group with the shortest height for both sexes (both P < .001). Bivariate correlation analysis between height and baPWV showed significant correlations in men (r = –0.131, P = .003) and women (r = –0.180, P < .001). In the multiple regression analysis with adjustment for identified confounders, group height was a predictor of baPWV (P for trend = .003) in younger men (<50 years old) but not in older men, while group height was correlated with baPWV in older women (≥50 years old, P for trend = .014) but not in younger women.

Height is inversely correlated with baPWV in subjects without overt CVD, especially in younger men and older women. This may explain the historical epidemiological observation of an inverse relationship between height and CVD.
Association between treatment package time and clinical predictors in oropharyngeal cancer
Authors: Suzuki Hidenori , Tamaki Tsuneo , Tsuzuki Hidenori , Nishio Masami , Nishikawa Daisuke , Beppu Shintaro , Hanai Nobuhiro
Published: September 2020

The aim of the present study is to investigate the association of treatment package time with the survival outcomes and clinical parameters in patients with oropharyngeal squamous cell carcinoma.

A total of 49 patients who underwent definitive treatment were enrolled. The treatment package time was calculated in days from the start of any treatment to the completion of all treatments, including postoperative treatment and salvage surgery for residual tumor.

On univariate analyzes, treatment package time ≥118 days, sake index ≥60, Brinkman index ≥450, maximum standardized uptake value ≥42.45, and the presence of synchronous cancer were significantly associated with shorter oropharyngeal squamous cell carcinoma-specific survival. Moreover, a treatment package time of ≥118 days was significantly correlated with shorter overall survival and distant metastasis-free survival. On multivariate analyzes, Brinkman index ≥450 was significantly associated with shorter oropharyngeal squamous cell carcinoma-specific and locoregional recurrence-free survival, and the presence of synchronous cancer was significantly associated with shorter overall and distant metastasis-free survival.

In conclusion, a relatively long treatment package time was a predictor of low survival outcomes in oropharyngeal squamous cell carcinoma by univariate analysis.
Autologous full-thickness skin graft for treating squamous carcinoma in a patient with psoriasis
Authors: Zhang Guiyun , Bu Wenbo , Wang Shuang , Li Xue , Wang Shu , Li Fuqiu , Yao Chunli
Published: September 2020

A 31-year-old male patient with psoriasis received administration of traditional Chinese medicine (TCM) during a disease course of 14 years. He showed multiple keratoma together with squamous cell carcinoma (SCC) in left lower limbs. After admission, the conditions were stable after treatment, and received surgery for treating SCC. The skin defect was treated using full-thickness skin graft. The postoperative survival of the flap was satisfactory, and the conditions of psoriasis were well controlled. In this case, we presented the feasibility of graft in the donor site from a psoriatic lesion. Besides, we analyzed the possibility of SCC and keratinizing lesions.
Moxibustion for the treatment of diabetic peripheral neuropathy
Authors: Tan Yumeng , Hu Jun , Pang Bing , Du Lijuan , Yang Yanan , Pang Qing , Zhang Meizhen , Wu Qian , Zhang Yi , Ni Qing
Published: September 2020

Background:

At present, the effect of western-medicine (WM) therapy to treat diabetic peripheral neuropathy (DPN) is limited. Moxibustion is a representative external treatment in traditional Chinese medicine that has been beneficial to DPN. We aim to systematically assess the efficacy and safety of moxibustion in treating DPN, following PRISMA guidelines.

Methods:

Eight electronic databases were searched to acquire information on eligible trials published from inception to June 1, 2019. We included randomized controlled trials (RCTs) applying moxibustion therapy with a minimum of 14-days treatment duration for DPN patients compared with placebo, no intervention, or conventional WM interventions. The primary outcomes in our study include the sensory-nerve conduction velocity (SNCV) and motor-nerve conduction velocity (MNCV). We used the Cochrane Collaboration Risk of Bias tool to assess the methodological quality of eligible RCTs. Statistical analyses were conducted using Review Manager 5.3. Risk ratios (RR) and mean differences (MD) were calculated with a 95% confidence interval (CI). The χ
2 test was applied to assess the heterogeneity.

Results:

In total, 11 RCTs were included that involved 927 DPN patients. Compared with the control group, there was an increase in median MNCV (MD = 6.26, 95% CI 2.64–9.89, Z = 3.39, P = .0007) and peroneal MNCV (MD = 6.45, 95% CI 5.30–7.61, P < .00001). There was also an increase in median SNCV (MD = 6.64, 95% CI 3.25–10.03, P = .0001) and peroneal SNCV (MD = 3. 57, 95% CI 2.06–5.09, Z = 4.63, P < .00001) in the treatment groups. The treatment groups receiving moxibustion therapy indicated a more significant improvement in total effectiveness rate (RR = 0.25, 95% CI 0.18–0.37, Z = 7.16, P < .00001). Toronto Clinical Scoring System indicated a significant decrease in the treatment groups (MD = −2.12, 95% CI −2.82 to 1.43, P < .00001). Only 1 study reported that treatment groups experienced no adverse reactions. The other 10 studies did not mention adverse events.

Conclusions:

Moxibustion therapy may be an effective and safe option for DPN patients but needs to be verified in further rigorous studies.
External treatment of traditional Chinese medicine for COVID-19
Authors: Wu Liu , Yuan Qiang , Kuang Yongbing , Chen Yong , Li Jin , Feng Yinhao , Luo Jian
Published: September 2020

Background:

There is a worldwide outbreak of COVID-19, as the number of patients increases. External treatment of traditional Chinese medicine includes acupuncture, massage, fire needle, cupping, and other alternative therapies. Currently, there are no relevant articles for systematic review.

Methods:

We will search the randomized controlled trials related to the external treatment of traditional Chinese medicine (such as, acupuncture, massage, etc) and COVID-19 from inception to June 2020. The following database is our focus area: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wan-Fang Database. All published randomized controlled trials in English or Chinese related to massage for COVID-19 will be included. Primary outcomes include the influence of external treatment of traditional Chinese medicine on the patients with COVID-19. Secondary outcomes include accompanying symptoms (such as myalgia, expectoration, stuffiness, runny nose, pharyngalgia, anhelation, chest distress, dyspnea, crackles, headache, nausea, vomiting, anorexia, diarrhea) disappear rate, negative COVID-19 results rate on 2 consecutive occasions (not on the same day), average hospitalization time, Clinical curative effect, and improved quality of life.

Results:

The results will provide a high-quality synthesis of current evidence for researchers in this subject area.

Conclusion:

The conclusion of our study will provide evidence to judge whether external treatment of traditional Chinese medicine is an effective intervention on the patients with COVID-19.

PROSPERO registration number:

CRD42020181336
Oral plasmablastic lymphoma
Authors: Zizzo Maurizio , Zanelli Magda , Martiniani Roberta , Sanguedolce Francesca , De Marco Loredana , Martino Giovanni , Parente Paola , Annessi Valerio , Manzini Lorenzo , Ascani Stefano
Published: September 2020

Introduction:

Plasmablastic lymphoma (PBL) is an uncommon and aggressive large B-cell lymphoma commonly diagnosed in human immunodeficiency viruses -positive patients. Oral cavity is the most commonly PBL affected site. Most oral PBLs presented as asymptomatic swellings, frequently associated with ulcerations and bleeding. Most cases lacked B-symptoms, suggesting a more local involvement of the disease. No standard treatment is yet for oral PBL. Five-year survival rate recorded no more than 33.5%.

Patient concerns:

A 39-year-old male presented to Dental Clinic with 1 month swelling of the oral cavity, in absence of any other symptoms or signs. He followed antibiotic therapy just on suspicion of an oral abscess and later oral surgical treatment on suspicion of bone neoplasm.

Diagnosis:

Surgical specimen analysis highlighted a diffuse infiltrate of large-sized atypical cells with plasmablastic appearance and plasma cell phenotype. Oral cavity PBL was diagnosed. Blood tests recorded mild lymphopenia and positive human immunodeficiency viruses serology.

Interventions:

Patient underwent chemotherapy including intrathecal methotrexate prophylaxis, in addition to a highly active antiretroviral therapy.

Outcomes:

At 12 months from diagnosis, patient recorded complete hematological remission.

Conclusions:

Oral PBL diagnosis requires a high level of suspicion and awareness both by physicians and pathologists. They should be aware of the extent of such disease which is often mistaken as oral abscess or infected tooth, thus leading to delay the most appropriate diagnostic evaluation. As PBL is an aggressive non-Hodgkin lymphoma, a delayed diagnosis might negatively impact on both treatment and survival.
Perioperative analgesia after intrathecal morphine or local infiltration anesthesia for total knee replacement
Authors: Qi Zhengrong , Guo Ai , Ma Lifeng , Li Zhiyao , Yang Bo , Zhang Jingxin
Published: September 2020

Objective:

We perform this protocol for randomized controlled trial to compare the efficacy of intrathecal morphine and local infiltration anesthesia (LIA) in the treatment of the postoperative pain after total knee replacement (TKR).

Methods:

This is a randomized controlled, single center trial which was performed from March 2019 to March 2020. This trial is conducted according to the SPIRIT Checklist of randomized researches. It is authorized via the Ethics Committee of Beijing Friendship Hospital (2019-P2-050-01). Eighty participants who undergo TKR were randomized into 2 groups. Intrathecal morphine group: 0.1 mg of the morphine was intrathecally injected, and the spinal anesthetic was injected at the same time in the group LIA; In the LIA group: the knee joint was infiltrated with epinephrine, ketorologic acid and ropivacaine in the process of operation, and the identical mixture was injected 2 bolus through the intraarticular catheter after operation. The main outcome variables were the visual analog scale and the consumption amount of opioid every 6-hour interval within 2 days postoperatively. The secondary outcome variables were the side effects associated with opioid, the length of hospital stay, motion range, and the loss of blood collected by the closed suction drainage. All the required analyses were carried out via applying the SPSS for Windows Version 19.0.

Results:

The clinical outcome variables between groups were shown in Table 1.

Conclusion:

This protocol will provide the evidence on which technique can achieve better analgesia after TKR.