bluuebunny/crossref_metadata_2025 huggingface dataset:
Herbal Medicine and COVID-19: Characteristics and Methodological Quality of Published Reviews
Authors: Lim Xin Yi , Sa’at Muhammad Nor Farhan , Mohd Rahim Nur Salsabeela , Tan Terence Yew Chin
Published: September 2023

The literature on coronavirus disease 2019 (COVID-19) treatments, including herbal medicine, has expanded rapidly due to intense global interest. We conducted this scoping review to map the characteristics and assess the quality of systematically conducted reviews of herbal medicine and COVID-19 published during the pandemic era. Electronic databases were searched to identify published systematic reviews and other research synthesis articles relating to herbal medicine vis-a-vis COVID-19 from 2020 to 2022. Forty-eight articles were included. Most were systematic reviews (SR) and/or meta-analyses (MA) on Chinese herbal medicine for clinical treatment during the acute phases of COVID-19 (44%). Regarding adherence to a measurement tool to assess systematic reviews (AMSTAR-2) critical items, only one-third ( n = 15) reported an a priori protocol, while 21% ( n = 10) presented a comprehensive literature search strategy. When analysed by type of review, SR/MA ( n = 23) of clinical interventions had better than the overall average adherence rate in having a pre-registered protocol (87%, n = 20) and comprehensive literature search strategy (45%, n = 9). Exploratory analysis showed that most articles reported search results from at least two established electronic databases. Risk of bias assessment was performed in almost all SR/MA though there was limited exploration of any potential sources of heterogeneity. Overall, there is a need to improve the methodological design and implementation of systematically conducted reviews of herbal medicine in general to enhance the robustness and reliability of findings, especially given the rapid expansion of literature during unique circumstances such as the COVID-19 pandemic.
Warm-up exercises reduce music conservatoire students’ pain intensity when controlling for mood, sleep and physical activity: A pilot study
Authors: Austen Claire , Redman Drusilla , Martini Matteo
Published: September 2023

Introduction

Playing-related musculoskeletal pain is highly prevalent among classical music students, affecting them physically and psychologically. Unlike athletes or dancers, musicians’ pain often goes untreated due to stigma and lack of specialised healthcare. While warm-up exercises are common practice in sports and dance, there is a lack of empirical research regarding physical warm-ups for musicians’ pain. This study aimed to investigate the effects of a 2-week daily warm-up exercise intervention on conservatoire students’ pain intensity, interference and psychological distress, at day 0 and after 2 weeks.

Methods

Two groups were considered: an exercise ( n = 9) and a waitlist control ( n = 7) group. Data were collected using online Qualtrics surveys at three different stages.

Results

2 × 2 mixed ANOVAs indicated no significant effects on any of the outcome variables. However, when controlling for sleep, anxiety, depression and physical activity, the analyses revealed a significantly greater decrease in pain intensity in the exercise group compared to the control. In addition, bivariate correlations indicated that pain interference, anxiety and depression delta scores were significantly correlated for the exercise but not the control group. Anxiety and pain intensity delta scores were significantly correlated in both groups.

Conclusions

These findings suggest that daily warm-up exercises have the potential to reduce musicians’ pain intensity but only if certain variables are factored in. This pilot study highlights the multifactorial nature of musicians’ pain and unveils the role that mood, sleep and physical activity level may have when assessing the efficacy of interventions based on warm-up exercises.
Interventions for malaria prevention in pregnancy; factors influencing uptake and their effect on pregnancy outcomes among post-natal women in a tertiary facility in the Volta Region of Ghana
Authors: Ampofo Gifty Dufie , Ahiakpa Abraham Kwadzo , Osarfo Joseph
Published: September 2023

Objectives:

Malaria in pregnancy is associated with adverse pregnancy outcomes including maternal anaemia and low birthweight. Uptake of preventive interventions is sub-optimal in sub-Saharan Africa including Ghana. Understanding local-level factors that influence uptake of these interventions can enhance control. The study assessed uptake of intermittent preventive treatment of malaria during pregnancy using sulphadoxine-pyrimethamine (IPTp-SP) and insecticide-treated net (ITN) use, their determinants and effects on pregnancy outcomes.

Methods:

A cross-sectional study involving 349 post-partum women was conducted from 25 August 2022 to 9 October 2022 at the Ho Teaching Hospital. A structured questionnaire was used to collect data on participant socio-demographics, ITN use, number of doses of sulphadoxine-pyrimethamine received, knowledge of malaria in pregnancy, haemoglobin levels and birth weight among others. Summary statistics were reported as frequencies, percentages and means. Associations between exposure and outcome variables were assessed using logistic regression methods and odds ratios reported with 95% confidence intervals. Statistical significance was concluded at p < 0.05.

Results:

More than 80% (291) of respondents received ⩾3 doses of intermittent preventive treatment using sulphadoxine-pyrimethamine and 64.8% (226) slept under ITNs the night before the survey. Age >25 years, employment, good knowledge of malaria in pregnancy, parity ⩾2 and initiating antenatal care visits in the first trimester facilitated the uptake of these interventions. Receiving ⩾3 doses of sulphadoxine-pyrimethamine was associated with having normal-weight babies (adjusted odds ratio 2.80, 95% CI: 1.07, 7.34; p = 0.036) while ITN use was associated with having term babies (adjusted odds ratio 2.72, 95% CI: 1.24, 5.90; p = 0.013) and normal maternal haemoglobin concentration at term (adjusted odds ratio 1.57, 95% CI: 1.01, 2.47; p = 0.044).

Conclusions:

The interventions were beneficial against low birthweight and preterm births which predispose to neonatal deaths and poor cognitive function in children. Malaria in pregnancy health campaigns should be intensified, especially among younger-aged primigravidae, to increase their knowledge of the condition as a way to further improve uptake of these preventive interventions.
Categories and Institutional Change: Contesting the Uncontested Space Through National Rankings
Authors: Khalil Syed Haider , Shah Syed Mohsin Ali , Sultan Fahad , Khan Muhammad Ibrahim , Nawaz Sher
Published: September 2023

The current study aims to examine how and why actors contest the business education field through rankings. Inspired by the field structuration process and field level change, we argue that categorization systems, in this case, rankings, construct boundaries of the business education field and redefine authority and elites for the field. Ten highly ranked Pakistani business schools were selected through a purposive sampling method. For the thematic analysis adopted in the current study, we collected empirical evidence mainly through interviews with the directors of accreditation and ranking bodies, deans, and marketing directors of business schools. The interview data was also supplemented by secondary data such as internal student surveys, business school’s annual reports, and other relevant sources of data. The current study showed institutional work in the business education field. Through categorization systems, actors use their authority to challenge the existing social order and define the uncontested space of the business education field in developing countries. Actors then populate the uncontested space with new members thus legitimizing new rules and standards for the field and promoting new elites for the field thus creating new social order.
Managing the COVID-19 Crisis Through Social Media: An Analysis From Sports Organizations Perspective
Authors: Solanellas Francesc , Romero-Jara Edgar , Muñoz Joshua
Published: September 2023

The COVID-19 pandemic has impacted directly on sports competitions, redirecting strategies to adapt to changes and giving prominence to a new ally: social media. The objective of this research is to analyze how top-level sports organizations managed their social media in pre-pandemic (from April 1 to 14, 2019) and pandemic (from April 1 to 14, 2020) periods. This study is based on the design and implementation of an observation instrument, applied to Facebook, Instagram, and Twitter posts. A total of 5,512 posts from LaLiga (LL), ACB League (ACB), UEFA Champions League (UCL), Euroleague (EL), and NBA League (NBA) have been analyzed. The results show a slight decrease in the total frequency of posts between both periods, but with a more homogeneous distribution over the days. Sports organizations adopted different approaches while posting on social media during these two periods. At the beginning of the pandemic, they prioritized “Social initiatives” and “Engagement” categories while their format preferences have generally migrated from text and image to audio-visual resources during the pandemic.
Stand-Alone Anchored Spacer vs Anterior Plate Construct in the Management of Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis of Comparative Studies
Authors: Aldahamsheh Osama , Alhammoud Abduljabbar , Halayqeh Sereen , Jacobs W. Bradley , Thomas Kenneth C. , Nicholls Fred , Evaniew Nathan
Published: September 2023

Study Design

Systematic Review and Meta-Analysis.

Objectives

This study aimed to evaluate the clinical and radiological outcomes of surgically treated adjacent segment disease (ASDis) following ACDF with either anterior plate construct (APC) or stand-alone anchored spacers (SAAS).

Method

Multiple databases were searched until December 2022 for pertinent studies. The primary outcome was health-related quality of life outcomes [JOA, NDI, and VAS], whereas, the secondary outcomes included operative characteristics [estimated blood loss (EBL) and operative time (OT)], radiological outcomes [C2-C7 Cobb angle, disc height index (DHI) changes, fusion rate], and complications.

Results

A total of 5 studies were included, comprising 210 patients who had been surgically treated for cervical ASDis. Among them, 113 received APC, and 97 received SAAS. Postoperative dysphagia was significantly higher in the APC group [47% vs 11%, OR = 7.7, 95% CI = 3.1-18.9, P < .05]. Similarly, operative time and blood loss were higher in the APC group compared to the SAAS group; [MD = 16.96, 95% CI = 7.87-26.06, P < .05] and [MD = 5.22, 95% CI = .35 - 10.09, P < .05], respectively. However, there was no difference in the rate of prolonged dysphagia and clinical outcomes in terms of JOA, NDI, and VAS. Furthermore, there was no difference in the radiological parameters including the C2-7 Cobb angle and DHI as well as the fusion rate.

Conclusion

Our meta-analysis demonstrated that both surgical techniques (APC and SAAS) are effective in treating ASDis. However, with low certainty of the evidence, considering patients are at high risk of dysphagia following revision cervical spine surgery SAAS may be the preferred choice.
The case for small-scale, community-integrated, therapeutic facilities: Utility and feasibility for policy transfer to the Victorian youth justice system
Authors: Oostermeijer Sanne , Souverein Fleur , Popma Arne , Ross Stuart , Johns Diana , van Domburgh Lieke , Mulder Eva
Published: September 2023

Several jurisdictions around the world have recognised that meaningful youth justice reform is more likely to be achieved when moving away from the reliance on large-scale conventional youth justice detention institutions. Small-scale, community-integrated, therapeutic facilities (referred to as “community-integrated facilities”) are more likely to provide an opportunity to facilitate systemic reforms that are necessary to improve outcomes for justice-involved young people, reduce institutional violence, and ultimately improve public safety. Based on recent reforms in the Netherlands, this article aims to describe the potential benefits and feasibility of implementing community-integrated facilities with a specific focus on Victoria, Australia. We will do so by considering the key operational elements and facilitators to implementation as identified previously in an evaluation of the Dutch reforms. While this article involves a single specific context, as a case study it may nevertheless illuminate implications for other jurisdictions considering similar policy transfer activities.
Splenic iron decreases without change in volume or liver parameters during luspatercept therapy
Authors: Denton Christopher C. , Vodala Sadanand , Veluswamy Saranya , Hofstra Thomas C. , Coates Thomas D. , Wood John C.
Published: September 2023

Splenic iron decreased whereas liver iron was stable during luspatercept therapy in some individuals with thalassemia. This suggests a reduction of ineffective erythropoiesis changes the organ distribution of iron and demonstrates that liver iron concentration alone may not accurately reflect total body iron content. This article describes data from subjects enrolled in BELIEVE (NCT02604433) and BEYOND (NCT03342404).
Quercetin inhibits the metabolism of arachidonic acid by inhibiting the activity of CYP3A4, thereby inhibiting the progression of breast cancer
Authors: Tang Huaming , Kuang Yuanli , Wu Wan , Peng Bing , Fu Qianmei
Published: September 2023

Background

Recent years have witnessed impressive growth in applying natural medicine in tumor treatment. Saffron is reported to elicit an inhibitory property against BC. Herein, we sought to explore the specific components and mechanistic basis of saffron’s anti-breast carcinoma (BC) function.

Methods

Bioinformatics analysis was employed to analyze saffron components' anti-BC activity and screen the corresponding target genes involved in BC. Then, the roles of the main saffron ingredient quercetin in the activity of BC cells were examined using CCK-8, MTS, flow cytometry, colony formation, Transwell, and Gelatin zymogram assays. Additionally, the interactions among Quercetin, EET, and Stat3 were assessed by immunofluorescence and Western blot, and LC–MS/MS determined the levels of AA, EETs, and CYP3A. Finally, BC xenograft mouse models were established to verify the anti-BC function of Quercetin in vivo.

Results

Quercetin, the main active component of saffron, inhibited BC progression. Quercetin suppressed BC cell growth, migration, and invasion and inhibited CYP3A4 expression and activity in BC. Mechanistically, Quercetin down-regulated CYP3A4 to block the nuclear translocation of Stat3 by decreasing the metabolization of AA to EETs, thereby alleviating BC. Moreover, exogenously added EETs counteracted the anti-tumor effect of Quercetin on BC. Quercetin also inhibited the tumor growth of tumor-bearing nude mice.

Conclusion

Quercetin could inhibit the activity of CYP3A to down-regulate AA metabolites EETs, consequently hampering p-Stat3 and nuclear translocation, thus impeding BC development.
Immune Activation Effects at Different Irradiated Sites and Optimal Timing of Radioimmunotherapy in Patients with Extensive-Stage Small Cell Lung Cancer: a Real-World Analysis
Authors: Wu Min , Wu Shihao , Chen Yuetong , Sun Liangchao , Zhou Jundong
Published: September 2023

Background

In view of the limited data on radiotherapy (RT) combined with immunotherapy in patients with extensive-stage small cell lung cancer (ES-SCLC), this study aimed to identify the immune activation effect on different sites and the survival outcomes of radioimmunotherapy at different treatment stages.

Methods

Forty-five patients diagnosed with ES-SCLC were included in this retrospective analysis. We collected the overall survival (OS) of the patients,, recorded the blood cell counts before, during, and after RT, and derived blood index ratios such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). The datasets were analyzed using the Spearman rank correlation test, Kruskal–Wallis rank sum test and logistic regression.

Results

Among the selected blood indices, the delta-NLR/PLR/Sll correlated with different irradiated organs, and the mean ranks of these three indices were the lowest in the brain-irradiated group during immunotherapy. Additionally, adjunct first-line immunotherapy with RT demonstrated a significant improvement compared to second- or third-line therapy and subsequent therapies.

Conclusion

Our findings suggest that compared to other organs, the strongest immune activation effect occurs with brain RT, and ES-SCLC patients who received radioimmunotherapy (RIT) earlier achieved higher OS rates.
Comparative analysis of microbial community structure in different times of Panax ginseng Rhizosphere microbiome and soil properties under larch forest
Authors: Aizi Tong , Lijuan Liu , Lihua Liu , Wei Liu , Jiamei Qin
Published: September 2023

Background

Panax ginseng cultivated under the forest is popular because its shape and effective ingredients are similar to wild ginseng. The growth of P. ginseng in the larch forest is generally better than in the broad-leaved forest, and the incidence rate of diseases is low. Therefore, the selection of forest species is one of the basic factors in the successful cropping of P. ginseng.

Methods

Illumina HiSeq high-throughput sequencing was used to analyze the 16S rRNA/ITS gene sequence of P. ginseng rhizosphere soil under larch forest to study the rhizosphere microbiome's diversity and community composition structure.

Results

The species classification and richness of rhizosphere bacterial and fungal communities in the same-aged P. ginseng were similar. Consistent with the soil system of commonly cultivated crops, Proteobacteria, Actinobacteriota, Acidobacteriota, Verrucomicrobiota, Chloroflexi, and Basidiomycota, Ascomycota were the dominant phylum of bacteria and fungi, respectively. Compared with the soil without planting P. ginseng, the diversity of microorganisms and community structure of continuous planting for 2 years, 5 years, and 18 years of P. ginseng rhizosphere soil had little change. The accumulation levels of Ilyonectria, Fusarium, Gibberella, and Cylindrocarpon were not significantly increased with planting P. ginseng and the increased age of cropping P. ginseng.

Conclusions

The results of this study showed that the soil function of the larch forest was good, which provided a theoretical basis for the land selection and soil improvement of cultivating P. ginseng under the larch forest.
Physiological, metabolomic, and transcriptomic reveal metabolic pathway alterations in Gymnocypris przewalskii due to cold exposure
Authors: Liu Sijia , Tian Fei , Qi Delin , Qi Hongfang , Wang Yang , Xu Shixiao , Zhao Kai
Published: September 2023

Teleost fish have evolved various adaptations that allow them to tolerate cold water conditions. However, the underlying mechanism of this adaptation is poorly understood in Tibetan Plateau fish. RNA-seq combined with liquid chromatography‒mass spectrometry (LC‒MS/MS) metabolomics was used to investigate the physiological responses of a Tibetan Plateau-specific teleost, Gymnocypris przewalskii, under cold conditions. The 8-month G. przewalskii juvenile fish were exposed to cold (4 ℃, cold acclimation, CA) and warm (17 ℃, normal temperature, NT) temperature water for 15 days. Then, the transcript profiles of eight tissues, including the brain, gill, heart, intestine, hepatopancreas, kidney, muscle, and skin, were evaluated by transcriptome sequencing. The metabolites of the intestine, hepatopancreas, and muscle were identified by LC‒MS/MS. A total of 5,745 differentially expressed genes (DEGs) were obtained in the CA group. The key DEGs were annotated using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analysis. The DEGs from the eight tissues were significantly enriched in spliceosome pathways, indicating that activated alternative splicing is a critical biological process that occurs in the tissues to help fish cope with cold stress. Additionally, 82, 97, and 66 differentially expressed metabolites were identified in the intestine, hepatopancreas, and muscle, respectively. Glutathione metabolism was the only overlapping significant pathway between the transcriptome and metabolome analyses in these three tissues, indicating that an activated antioxidative process was triggered during cold stress. In combination with the multitissue transcriptome and metabolome, we established a physiology-gene‒metabolite interaction network related to energy metabolism during cold stress and found that gluconeogenesis and long-chain fatty acid metabolism played critical roles in glucose homeostasis and energy supply.
A spine segmentation method based on scene aware fusion network
Authors: Yilizati-Yilihamu Elzat Elham , Yang Jintao , Yang Zimeng , Rong Feihao , Feng Shiqing
Published: September 2023

Background

Intervertebral disc herniation, degenerative lumbar spinal stenosis, and other lumbar spine diseases can occur across most age groups. MRI examination is the most commonly used detection method for lumbar spine lesions with its good soft tissue image resolution. However, the diagnosis accuracy is highly dependent on the experience of the diagnostician, leading to subjective errors caused by diagnosticians or differences in diagnostic criteria for multi-center studies in different hospitals, and inefficient diagnosis. These factors necessitate the standardized interpretation and automated classification of lumbar spine MRI to achieve objective consistency. In this research, a deep learning network based on SAFNet is proposed to solve the above challenges.

Methods

In this research, low-level features, mid-level features, and high-level features of spine MRI are extracted. ASPP is used to process the high-level features. The multi-scale feature fusion method is used to increase the scene perception ability of the low-level features and mid-level features. The high-level features are further processed using global adaptive pooling and Sigmoid function to obtain new high-level features. The processed high-level features are then point-multiplied with the mid-level features and low-level features to obtain new high-level features. The new high-level features, low-level features, and mid-level features are all sampled to the same size and concatenated in the channel dimension to output the final result.

Results

The DSC of SAFNet for segmenting 17 vertebral structures among 5 folds are 79.46 ± 4.63%, 78.82 ± 7.97%, 81.32 ± 3.45%, 80.56 ± 5.47%, and 80.83 ± 3.48%, with an average DSC of 80.32 ± 5.00%. The average DSC was 80.32 ± 5.00%. Compared to existing methods, our SAFNet provides better segmentation results and has important implications for the diagnosis of spinal and lumbar diseases.

Conclusions

This research proposes SAFNet, a highly accurate and robust spine segmentation deep learning network capable of providing effective anatomical segmentation for diagnostic purposes. The results demonstrate the effectiveness of the proposed method and its potential for improving radiological diagnosis accuracy.
Fitness changes in wild soybean caused by gene flow from genetically modified soybean
Authors: Zhang Li , Liu Laipan , Fang Zhixiang , Shen Wenjing , Dai Ying , Jia Ruizong , Liang Jingang , Liu Biao
Published: September 2023

Background

Crop-wild hybridization has generated great concerns since gene flow can be an avenue for transgene escape. However, a rather limited number of studies on risk assessment regarding the dispersion of transgenes from GM soybean to populations of its wild relatives have been previously conducted.

Results

The results of the 3-year experiment demonstrated that hybrids between GM soybeans and wild soybean had lower seed germination and higher seed productivity than GM soybean. Both of these features of hybrid (especially F2 and F3) were similar to those of wild soybean. Furthermore, the foreign protein was stably expressed in hybrid EPSPS positive plants; however, no difference was observed in agronomic measurements between hybrids that are glyphosate sensitive or resistant, homozygous or heterozygous for the transgene, indicating that the presence of the EPSPS transgene does not affect the vigor of hybrid. In contrast, hybridization between GM soybean and wild soybean may have more impact on hybrid growth and fecundity, this increase in biomass and yield confers a potential competition benefit to hybrids.

Conclusions

Gene flow from GM soybean to wild soybean has the potential to promote the adaptability of hybrids and may increase the possibility of dispersal of transgenes in wild soybean relatives.
Perceptions of the influence of a mobile phone-based messaging platform on caregiver ECD knowledge, attitudes and practices: a qualitative exploration in an informal settlement in Nairobi
Authors: Wambui Elizabeth , Nampijja Margaret , Okelo Kenneth Odhiambo , Muendo Ruth , Onyango Silas , Kimani-Murage Elizabeth W. , Kitsao-Wekulo Patricia
Published: September 2023

Background

Programs supporting initiatives for children younger than three years are inadequate and not accessible to many families, particularly in resource-limited settings. Many primary caregivers have little knowledge on how to monitor the development of their children or the importance of engaging children in stimulative activities during the course of early development. Health system limitations make it difficult for health workers to educate and demonstrate stimulative engagement to caregivers. The massive use of technology can be used to facilitate access to growth and development programs for children. We developed and implemented a mobile phone technology to help caregivers monitor and stimulate their children’s development in real-time. This study explored the influence that this intervention had on the caregivers’ early child development (ECD) knowledge, attitudes and practices.

Methods

In this qualitative cross-sectional study, we conducted interviews through eight (8) focus group discussions, three (3) key informant interviews and 9 indepth interviews among a total of 111 participants including primary caregivers (n = 87), community health volunteers (CHVs) (n = 21) health managers and workers (n = 3) to determine their attitudes and experience with the intervention with regards to improving their KAP. Interviews were audio-recorded, transcribed, and analyzed thematically.

Results

Caregivers and CHVs reported that the intervention had provided them with new knowledge that positively influenced their ECD caregiving attitudes and practices. CHVs and health workers and managers reported that the intervention had provided caregivers with confidence in caring for their children while increasing their knowledge on how to monitor and stimulate their children’s development.

Conclusion

Mobile phone technology can be effectively used to enhance caregivers’ knowledge of ECD and enable them to monitor and support their children’s development in real-time.

Trial registration

The trial was registered with the Pan African Clinical Trial Registry (www.pactr.org) database (ID number: PACTR201905787868050 Date: 6/05/2019.
Radiotherapy versus low-dose tamoxifen following breast-conserving surgery for low-risk and estrogen receptor-positive breast ductal carcinoma in situ: an international open-label randomized non-inferiority trial (TBCC-ARO DCIS Trial)
Authors: Kuo Sung-Hsin , Tseng Ling-Ming , Chen Shou-Tung , Sagara Yasuaki , Chang Yuan-Ching , Yeh Hsien-Tang , Kuo Yao-Lung , Hung Chih-Chiang , Lu Tzu-Pin , Lee Yi-Hsuan , Toi Masakazu , Huang Chiun-Sheng
Published: September 2023

Background

Radiotherapy (RT) following breast-conserving surgery (BCS) is mainly used to decrease the rate of ipsilateral breast tumor recurrence (IBTR) in women with breast ductal carcinoma in situ (DCIS). Recent studies have demonstrated that low-dose tamoxifen significantly reduces IBTR in breast DCIS. Here, we aim to determine whether the administration of low-dose tamoxifen is non-inferior to RT in preventing IBTR in patients with low-risk characteristics of breast DCIS.

Methods/design

This is a prospective, international, open-label, randomized, non-inferiority trial. Patients with low-risk clinicopathologic features (> 40 years old, low risk of breast cancer susceptibility gene (BRCA) 1andBRCA2mutations, mammographically detected unicentric and non-mass lesions, low- or intermediate-grade without comedo or necrosis, measuring < 2.5 cm with margins ≥ 3 mm, and estrogen receptor-positive status) of DCIS who underwent BCS will be randomized at a 1:1 ratio to either receive tamoxifen (5 mg/day) for 5 years or undergo RT with conventional fractions (50 Gy in 25 fractions) or hypofractionations (40.05 Gy in 15 fractions). Randomization will be stratified by the Taiwan Breast Cancer Consortium. As approximately 5% of patients cannot tolerate the side effects of low-dose tamoxifen and will receive RT, we estimate that 405 patients will be randomized to a low-dose tamoxifen arm and 405 patients to the RT arm, according to a non-inferiority margin within 5% of IBTR difference and 90% β-power noticing non-inferiority. The primary endpoints are breast tumor recurrence, including ipsilateral, regional, contralateral, and distant recurrence of breast DCIS or invasive cancer. The secondary endpoints are overall survival and adverse effects of RT and tamoxifen. Translational studies will also be conducted for this trial.

Discussion

This is the first non-inferiority trial on breast DCIS. This study will provide an important recommendation for clinical physicians on whether to use low-dose adjuvant tamoxifen for patients with low-risk breast DCIS who do not want to receive adjuvant RT.

Trial registration

ClinicalTrials.gov, ID: NCT04046159, Registered on April 30, 2019.
Impact of primary glaucoma on health-related quality of life in China: the handan eye study
Authors: Song Di , Fan Sujie , Zhou Qiang , Yang Xiaohui , Li Sizhen , Lohfeld Lynne , Zhou Weihe , Congdon Nathan , Liang Yuanbo , Wang Ningli
Published: September 2023

Background

We assessed health-related quality of life (HRQOL) and its determinants among rural glaucoma participants compared to age-matched normal controls in the population-based Handan Eye Study (HES), in rural Yongnian County, northern China.

Methods

We enrolled 99 adults with glaucoma (mean age 63.0 ± 11.0 years), including primary open-angle glaucoma (POAG, n = 67) and primary angle-closure glaucoma (PACG, n = 32) and 102 controls (mean age 58.5 ± 5.3 years) with normal visual acuity and visual field and no history of glaucoma. Results of ophthalmic examinations and socioeconomic data were recorded. HRQOL was measured using the EQ-5D (converted to utility valves, UVs), and visual function (VF) and vision-related quality of life (VRQOL) were evaluated using the visual function-quality of life (VF-QOL) instrument.

Primary and secondary outcome measures

EQ-5D and VF-QOL scores.

Results

The mean UVs, VF, and VRQOL scores for glaucoma cases were 0.98 ± 0.04, 87.9 ± 15.2, and 95.5 ± 12.8, respectively, significantly worse than VF (94.4 ± 4.4) and VRQOL (100.0 ± 0.0) among controls, even after adjusting for age, gender, educational level, and family income (P = 0.015, P = 0.033). UVs were significantly lower among glaucoma participants with impaired VRQOL (55.4 ± 11.5) compared to those with normal VRQOL scores (99.1 ± 2.8) (UVs: 0.92 ± 0.08 vs. 0.99 ± 0.03, P = 0.036), also after adjustment for age and family income (P = 0.006). Participants with PACG had significantly lower VF and VRQOL scores compared to POAG (77.8 ± 21.4 vs. 92.9 ± 6.8, P < 0.001; 89.0 ± 18.1 vs. 98.7 ± 7.5, P < 0.001).

Conclusion

Participants with glaucoma have worse visual function and related quality of life compared to age-matched normal population controls. Participants with PACG have lower VF and VRQOL compared to those with POAG. UVs can be used for cost-effectiveness research and to support public health strategies for glaucoma in rural China.
Environmental and life-style risk factors for esophageal squamous cell carcinoma in Africa: a systematic review and meta-analysis
Authors: Simba Hannah , Kuivaniemi Helena , Abnet Christian C. , Tromp Gerard , Sewram Vikash
Published: September 2023

Background

The African Esophageal Squamous Cell Carcinoma (ESCC) corridor, which spans from Ethiopia down to South Africa, is an esophageal cancer hotspot. Disproportionately high incidence and mortality rates of esophageal cancer have been reported from this region. The aim of this study was to systematically assess the evidence on environmental and life-style risk factors associated with ESCC in African populations.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and carried out a comprehensive search of all African published studies up to March 2023 using PubMed, Embase, Scopus, and African Index Medicus databases.

Results

We identified 45 studies with measures of association [odds ratio (OR), relative risk (RR), and 95% confidence intervals (95%CI)], which reported on several environmental and lifestyle risk factors for ESCC in Africa. We performed a meta-analysis on 38 studies investigating tobacco, alcohol use, combined tobacco and alcohol use, polycyclic aromatic hydrocarbon exposure, hot food and beverages consumption (which served as a proxy for esophageal injury through exposure to high temperature), and poor oral health. We found significant associations between all the risk factors and ESCC development. Analysis of fruit and vegetable consumption showed a protective effect. Using population attributable fraction (PAF) analysis, we calculated the proportion of ESCC attributable to tobacco (18%), alcohol use (12%), combined tobacco and alcohol use (18%), polycyclic aromatic hydrocarbon exposure (12%), hot food and beverages intake (16%), poor oral health (37%), and fruit and vegetable consumption (-12%).

Conclusions

Tobacco smoking and alcohol consumption were the most studied risk factors overall. Areas where there is an emerging body of evidence include hot food and beverages and oral health. Concurrently, new avenues of research are also emerging in PAH exposure, and diet as risk factors. Our results point to a multifactorial etiology of ESCC in African populations with further evidence on prevention potential.
Lifestyle behaviors and stress are risk factors for overweight and obesity in healthcare workers: a cross-sectional survey
Authors: Guo Xinyue , Gong Shaoqing , Chen Ying , Hou Xiaohui , Sun Tong , Wen Jianqiang , Wang Zhiyao , He Jingyang , Sun Xuezhu , Wang Sufang , Feng Xue , Tian Xiangyang
Published: September 2023

Background

Overweight and obesity have become major public health concerns worldwide. Persistent stress can activate the human hypothalamic‒pituitary‒adrenal axis (HPA) and increase the intake of “self-rewarding food”, thereby raising the incidence of obesity. Health care workers (HCWs) experience higher workloads and mental stress than workers in many other industries, which may put them at increased risk for overweight/obesity. However, few studies have been carried out on overweight and obesity among HCWs in China, and the overall scenario and behind-the-scenes factors of their overweight and obesity are unknown. The aim of this study is to understand the epidemic of overweight and obesity and risk factors among Chinese HCWs.

Methods

Based on a cross-sectional web survey design, 23,234 HCWs from 100 health institutions in 5 provinces/autonomous regions/municipalities across China were sampled to answer a self-administered questionnaire that was purposely developed using a multi-staged clustered random-sampling method. Chi-square test and ANOVA were performed to compare variables between two or more groups. Univariate analyses were conducted to identify the influence of self-reported persistent stress and/or recurrent anxiety/depressed mood on lifestyle behaviors. A multivariate binary logistic regression model was used to analyse the risk factors of overweight/obesity.

Results

Among the respondents, 34.26% were overweight, and 11.22% were obese. Most of the respondents had regular exercise habits (68.17%), had habitually stayed-up late (65.06%) and had been affected by persistent stress and/or recurrent anxiety/depressed mood (62.04%). A higher proportion of those with persistent stress and/or recurrent anxiety/depressed mood than those without habitually staying-up late (76.18%); consumed take-out food (54.92%), fried food (49.93%), snacks or desserts (50.51%); drank sugary drinks (46.57%); smoked (14.27%); and drank alcohol (23.34%). Gender (Female) (OR: 0.314, 95%CI: 0.292–0.336), age (OR: 1.742–2.334, 95%CI: 1.544–2.858), education (OR: 0.620–0.728, 95%CI: 0.445–0.973), living and working area (OR: 1.271, 95%CI: 1.192–1.355), breakfast (OR: 0.898, 95%CI: 0.839–0.960), fried food (OR: 1.133, 95%CI: 1.048–1.224), and alcohol consumption (OR: 1.111, 95%CI: 1.017–1.214) were factors for overweight/obesity. All of the aforementioned results were significant (P < 0.05).

Conclusions

The overweight/obesity rate of Chinese HCWs is rather high, which might be directly associated with lifestyle behaviors. However, these behaviors fundamentally originated from persistent stress and/or recurrent anxiety/depression, mediated by lifestyle behaviors. Substantial measures should be taken for stress reduction and mental health promotion for overweight/obesity prevention and control among HCWs.
Relationship between plasma circulating cell-free DNA concentration and treatment outcomes including prognosis in patients with advanced non-small cell lung cancer
Authors: Peng Wei-Wei , Liu Ying , Sha Huan-Huan , Wen Shao-Di , Fang Ying , Zhou Guo-Ren
Published: September 2023

Background

Some research found that elevated plasma cell-free DNA (cfDNA) concentrations and poor prognosis are associated in non-small cell lung cancer (NSCLC). However, more studies need to be carried out to verify this conclusion. Therefore, this study investigated the relationship between cfDNA concentration and treatment outcomes including prognosis in patients with advanced NSCLC.

Methods

We retrospectively collected medical records and cfDNA data from 160 patients with advanced NSCLC. Progression-free survival (PFS) were calculated using the Kaplan-Meier method and were compared between groups using the log rank test. Cox regression analysis was used for estimating the independent predictors of PFS. And we used logistic regression to evaluate the relationship between baseline biomarkers and efficacy. In our study, BT1 cfDNA, BT2 cfDNA, and BT3 cfDNA were defined as cfDNA concentration before the first treatment (baseline cfDNA concentration), cfDNA concentration before the second treatment, and cfDNA concentration before the third treatment, respectively.

Results

Patients with low cfDNA (BT1 cfDNA < 15 (ng/mL)) were reported a significantly prolonged median progression-free survival (mPFS) compared with patients with patients with high cfDNA (BT1 cfDNA ≥ 15(ng/mL)) (mPFS: 14.6 vs. 8.3 months, P = 0.002), as well as patients with neutrophil/lymphocyte ratio (NLR)<2.98 (mPFS: 13.1 vs. 7.9 months, P = 0.023). In addition, Cox proportional hazards regression analysis identified independent indicators associated with PFS including BT1 cfDNA ≥ 15 (ng/mL), NLR ≥ 2.98 and extrapulmonary metastasis. The best cut-off value for BT3 cfDNA for predicting disease progression is 41.46 (ng/mL) (Area Under the Curve (AUC): 0.652, 95%CI: 0.516–0.788), achieving 90.7% sensitivity and 37.5% specificity for the prediction of disease progression. BT3 cfDNA (OR = 6.08, 95% CI: 1.94–19.57, P = 0.002) was an independent factor for disease progression in patients with advanced NSCLC.

Conclusions

BT1 cfDNA may be a biomarker to assess the prognosis of advanced NSCLC. Patients with advanced NSCLC with lower cfDNA and NLR before treatment had a better prognosis. Increased BT3 cfDNA concentration was an independent factor of disease progression in advanced NSCLC patients. These findings may assist in identifying high-risk patients and guiding treatment strategies.
Periodontitis contributes to COPD progression via affecting ferroptosis
Authors: Xiong Kaixin , Yang Peng , Wei Wei , Li Jia , Cui Yujia , Li Yan , Tang Boyu
Published: September 2023

Background

Periodontitis has emerged as a potential risk factor for chronic obstructive pulmonary disease (COPD). However, the precise mechanism through which periodontitis influences the progression of COPD requires further investigation. Ferroptosis is one of the crucial pathogenesis of COPD and recent researches suggested that periodontitis was associated with ferroptosis. Nonetheless, the relationship among periodontitis, COPD and ferroptosis remains unclear. This study aimed to elucidate whether periodontitis contributes to COPD exacerbation and to assess the potential impact of ferroptosis on periodontitis affecting COPD.

Methods

The severity of COPD was assessed using Hematoxylin and eosin (H&E) staining and lung function tests. Iron assays, malondialdehyde (MDA) measurement and RT-qPCR were used to investigate the potential involvement of ferroptosis in the impact of periodontitis on COPD. Co-cultures of periodontitis associated pathogen Phophyromonas gingivalis (P. gingivalis) and lung tissue cells were used to evaluate the effect of P. gingivalis on inducing the ferroptosis of lung tissue via RT-qPCR analysis. Clinical Bronchoalveolar Lavage Fluid (BALF) samples from COPD patients were collected to further validate the role of ferroptosis in periodontal pathogen-associated COPD.

Results

Periodontitis aggravated the COPD progression and the promotion was prolonged over time. For the first time, we demonstrated that periodontitis promoted the ferroptosis-associated iron accumulation, MDA contents and gene expressions in the COPD lung with a time-dependent manner. Moreover, periodontitis-associated pathogen P. gingivalis could promote the ferroptosis-associated gene expression in single lung tissue cell suspensions. Clinical BALF sample detection further indicated that ferroptosis played essential roles in the periodontal pathogen-associated COPD.

Conclusion

Periodontitis could contribute to the exacerbation of COPD through up-regulating the ferroptosis in the lung tissue.
Constructing validity evidence from a pilot key-features assessment of clinical decision-making in cerebral palsy diagnosis: application of Kane’s validity framework to implementation evaluations
Authors: McNamara LM , Scott KM , Boyd RN , Farmer EA , Webb AE , Novak IE
Published: September 2023

Background

Physician decision-making skills training is a priority to improve adoption of the cerebral palsy (CP) clinical guideline and, through this, lower the age of CP diagnosis. Clinical guideline implementation aims to improve physician practice, but evaluating meaningful change is complex. Limitations in the validity evidence of evaluation instruments impact the evidence base. Validity frameworks, such as Kane’s, enable a targeted process to gather evidence for instrument scores, congruent to context and purpose. Yet, application of argument-based methodology to implementation validation is rare. Key-features examination methodology has established validity evidence supporting its use to measure decision-making skills, with potential to predict performance. We aimed to apply Kane’s framework to evaluate a pilot key-features examination on physician decision-making in early CP diagnosis.

Methods

Following Kane’s framework, we evaluated evidence across inferences of scoring, generalisation, extrapolation and implications in a study design describing the development and pilot of a CP diagnosis key-features examination for practising physicians. If found to be valid, we proposed to use the key-feature scores as an outcome measure of decision-making post education intervention to expedite CP diagnosis and to correlate with real-world performance data to predict physician practice.

Results

Supporting evidence for acceptance of scoring inferences was achieved through examination development with an expert group (n = 10) and pilot results (n = 10): (1) high internal consistency (0.82); (2) acceptable mean item-discrimination (0.34); and (3) acceptable reliability of examination scorers (95.2% congruence). Decreased physician acceptance of examination time (70%) was identified as a threat and prioritised in case reduction processes. Partial acceptance of generalisation, extrapolation and implications inferences were defensible with: (1) accumulated development evidence following established key-features methodology; (2) high pilot acceptance for authenticity (90%); and (3) plausibility of assumptions of score correlation with population register data.

Conclusions

Kane’s approach is beneficial for prioritising sources of validity evidence alongside the iterative development of a key-features examination in the CP field. The validity argument supports scoring assumptions and use of scores as an outcome measure of physician decision-making for CP guideline education implementation interventions. Scoring evidence provides the foundation to direct future studies exploring association of key-feature scores with real-world performance.
Efficacy of high-fidelity simulation in advanced life support training: a systematic review and meta-analysis of randomized controlled trials
Authors: Zeng Qin , Wang Kai , Liu Wei-xin , Zeng Jiu-zhi , Li Xing-lan , Zhang Qing-feng , Ren Shang-qing , Xu Wen-ming
Published: September 2023

Background

Simulation is an increasingly used novel method for the education of medical professionals. This study aimed to systematically review the efficacy of high-fidelity (HF) simulation compared with low-fidelity (LF) simulation or no simulation in advanced life support (ALS) training.

Methods

A comprehensive search of the PubMed, Chinese Biomedicine Database, Embase, CENTRAL, ISI, and China Knowledge Resource Integrated Database was performed to identify randomized controlled trials (RCTs) that evaluated the use of HF simulation in ALS training. Quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions version 5.0.1. The primary outcome was the improvement of knowledge and skill performance. The secondary outcomes included the participants’ confidence and satisfaction at the course conclusion, skill performance at one year, skill performance in actual resuscitation, and patient outcomes. Data were synthesized using the RevMan 5.4 software.

Results

Altogether, 25 RCTs with a total of 1,987 trainees were included in the meta-analysis. In the intervention group, 998 participants used HF manikins, whereas 989 participants received LF simulation-based or traditional training (classical training without simulation). Pooled data from the RCTs demonstrated a benefit in improvement of knowledge [standardized mean difference (SMD) = 0.38; 95% confidence interval (CI): 0.18–0.59, P = 0.0003, I2 = 70%] and skill performance (SMD = 0.63; 95% CI: 0.21–1.04, P = 0.003, I2 = 92%) for HF simulation when compared with LF simulation and traditional training. The subgroup analysis revealed a greater benefit in knowledge with HF simulation compared with traditional training at the course conclusion (SMD = 0.51; 95% CI: 0.20–0.83, P = 0.003, I2 = 61%). Studies measuring knowledge at three months, skill performance at one year, teamwork behaviors, participants’ satisfaction and confidence demonstrated no significant benefit for HF simulation.

Conclusions

Learners using HF simulation more significantly benefited from the ALS training in terms of knowledge and skill performance at the course conclusion. However, further research is necessary to enhance long-term retention of knowledge and skill in actual resuscitation and patient’s outcomes.