bluuebunny/crossref_metadata_2025 huggingface dataset:
The unbearable (technical) unreliability of automated facial emotion recognition
Authors: Cabitza Federico , Campagner Andrea , Mattioli Martina
Published: October 2022

Emotion recognition, and in particular acial emotion recognition (FER), is among the most controversial applications of machine learning, not least because of its ethical implications for human subjects. In this article, we address the controversial conjecture that machines can read emotions from our facial expressions by asking whether this task can be performed reliably. This means, rather than considering the potential harms or scientific soundness of facial emotion recognition systems, focusing on the reliability of the ground truths used to develop emotion recognition systems, assessing how well different human observers agree on the emotions they detect in subjects’ faces. Additionally, we discuss the extent to which sharing context can help observers agree on the emotions they perceive on subjects’ faces. Briefly, we demonstrate that when large and heterogeneous samples of observers are involved, the task of emotion detection from static images crumbles into inconsistency. We thus reveal that any endeavour to understand human behaviour from large sets of labelled patterns is over-ambitious, even if it were technically feasible. We conclude that we cannot speak of actual accuracy for facial emotion recognition systems for any practical purposes.
Scent-delivery devices as a digital healthcare tool for olfactory training: A pilot focus group study in Parkinson's disease patients
Authors: Desai Neel , Maggioni Emanuela , Obrist Marianna , Orlu Mine
Published: October 2022

Parkinson's disease (PD) patients display a combination of motor and non-motor symptoms. The most common non-motor symptom is scent (olfactory) impairment, occurring at least four years prior to motor symptom onset. Recent and growing interest in digital healthcare technology used in PD has resulted in more technologies developed for motor rather than non-motor symptoms. Human–computer interaction (HCI), which uses computer technology to explore human activity and work, could be combined with digital healthcare technologies to better understand and support olfaction via scent training – leading to the development of a scent-delivery device (SDD). In this pilot study, three PD patients were invited to an online focus group to explore the association between PD and olfaction, understand HCI and sensory technologies and were demonstrated a new multichannel SDD with an associated mobile app. Participants had a preconceived link, a result of personal experience, between olfactory impairment and PD. Participants felt that healthcare professionals did not take olfactory dysfunction concerns seriously prior to PD diagnosis. Two were not comfortable with sharing scent loss experiences with others. Participants expected the multichannel SDD to be small, portable and easy-to-use, with customisable cartridges to deliver chosen scents and the mobile app to create a sense of community. None of the participants regularly performed scent training but would consider doing so if some scent function could be regained. Standardised digital SDDs for regular healthcare check-ups may facilitate improvement in olfactory senses in PD patients and potential earlier PD diagnosis, allowing earlier therapeutic and symptomatic PD management.
Growth in the development of health and fitness mobile apps amid COVID-19 pandemic
Authors: Kalgotra Pankush , Raja Uzma , Sharda Ramesh
Published: October 2022

Objectives

Technology in the form of mobile apps has played an essential role in facilitating, tracking, and maintaining health and fitness activities during the pandemic. When countries opted for partial or complete lockdowns to contain the spread of the coronavirus disease 2019 virus, it led to people working on their health and fitness-related activities from their homes, just as they continued working from home. This paper aims to quantify the impact of coronavirus disease 2019 on the development of health and fitness mobile apps. Specifically, we compute the effect of coronavirus disease 2019 on the growth of different sub-categories of health and fitness apps.

Methods

We scraped data about a population of 78,890 health and fitness apps from the iOS App Store. First, categories of health and fitness apps are identified using text analysis on the descriptions of apps. Second, the rise in the development of new apps is analyzed. To quantify the impact of coronavirus disease 2019 on the growth of the health and fitness apps, multiple time-series forecasting models are created for different categories of health and fitness apps.

Results

The text analysis identified twelve different types of health and fitness apps on the app market. Our models estimated that the number of health and fitness apps on the iOS app market exceeded the expected growth by 29.9% after the pandemic. The results of all categories of health and fitness are discussed in the paper.

Conclusions

Our analysis found significant growth in the development of new health and fitness apps after the pandemic outbreak. The post hoc study of the population of health and fitness apps presented the current state of this particular area of the app market. In addition, it provided potential growth areas in app markets where there are fewer apps.
Effect of a model based on education and teleassistance for the management of obstetric emergencies in 10 rural populations from Colombia
Authors: Escobar María Fernanda , Echavarria María Paula , Gallego Juan Carlos , Riascos Natalia , Vasquez Hilda , Nasner Daniela , Pabon Stephanie , Castro Zindy Alexandra , Cardona Didier Augusto , Castro Ana Milena , Ramos Isabella , Hincapie María Antonia , Kusanovic Juan Pedro , Martínez-Ruíz Diana Marcela , Carvajal Javier Andrés
Published: October 2022

Introduction

Pregnant women and health providers in rural areas of low-income and middle-income countries face multiple problems concerning high-quality obstetric care. This study was performed to identify changes in maternal and perinatal indicators after implementing a model based on education and telecare between a high-complexity hospital in 10 low-complexity hospitals in a southwestern region of Colombia.

Methods

A quasiexperimental study with a historic control group and without a pretest was conducted between 2017 and 2019 to make comparisons before and after obstetric emergency care through the use of teleassistance from 10 primary care centers to the referral center (Fundación Valle del Lili, FVL).

Results

A total of 470 patients were treated before teleassistance implementation and 154 patients were treated after teleassistance implementation. After program implementation, the maternal clinical indicators showed a 65% reduction in the number of obstetric patients who were referred with obstetric emergencies. The severity of maternal disease that was measured at the time of admission to level IV through the Modified Early Obstetric Warning System score was observed to decrease.

Conclusion

The implementation of a model based on education and teleassistance between low-complexity hospitals and tertiary care centers generated changes in indicators that reflect greater access to rural areas, lower morbidity at the time of admission, and a decrease in the total number of emergency events.
Use of rapid response system afferent limb to recognize and respond to deteriorating patients: An action research study
Authors: Julnes Signe Gunn , Reitan Laila Solli , Myrvang Tove , Rønning Gry , Vatne Solfrid
Published: October 2022

Failure to recognize the deterioration of hospital patients has led to the implementation of a system known as the Rapid Response System. The aim was to explore nurses’ use of the afferent limb of the Rapid Response System to recognize and respond to deteriorating patients. Data were collected via video recordings with observations of 20 registered nurses (RNs) from general wards performing scenarios in a simulation laboratory with focus group interviews. Data were analyzed using systematic text condensation. COREQ were followed. In the first scenario, nurses did not apply ABCDE or ISBAR, and the use of NEWS was insufficient. Completing an education program led to evident improvement in the use of the tools during the second scenario. Nurses initially viewed their new competency as useful, but it was not sustained a year later. Customized education programs and fidelity-scale simulations are suited but not sufficient to change clinical competency without management anchoring.
Making Drug use Dangerous for Black Men: Race, Drugs, Violence, and Criminal Justice
Authors: Seffrin Patrick , Teeple Joseph
Published: October 2022

Differential treatment under the law has historically been the case for African Americans. The current study theorized that the War on Drugs, which was waged disproportionately in majority Black communities, had the unintended effect of making drug use riskier for Black men by limiting the supply of drugs to high-risk populations who commit far more serious and violent criminal offenses. A subsample of the Add Health data containing Black and White male survey participants were compared with respect to drug use, violence, and criminal justice involvement. Drug use was found to be less prevalent, overall, for Black men but its association with violence was greater for Black men than White men. Differential legal treatment for violence and drugs was found to be greater for Black men than White men and had diminishing returns for deterring violence and negative returns for drugs by predicting greater use. Accounting for differential legal treatment did not significantly reduce predicted racial disparities in violence or drug use. Implications of these findings are discussed.
Triage Knowledge and Practice and Associated Factors Among Emergency Department Nurses
Authors: AlShatarat Mohammad , Rayan Ahmad , Eshah Nidal F. , Baqeas Manal Hassan , Jaber Mohammad Jamil , ALBashtawy Mohammed
Published: October 2022

Objective

The study aims at assessing the triage knowledge and practices and their associated factors among emergency department nurses employed in King Fahad Medical City (KFMC), Saudi Arabia.

Method

The study employed a cross-sectional, descriptive, and correlational design. Data collection was carried out from February 11, 2021, until April 27, 2021. The study included all emergency department nurses who were working in the KFMC during the data collection period and excluded those who were on leave at the time of data collection. A self-reported questionnaire with adequate validity and reliability was used. Statistical analysis was performed using the IBM SPSS Version 25 employing descriptive statistics, independent t-test, one-way ANOVA, and Pearson correlation test.

Results

A total of 147 emergency department nurses completed the study. Participants demonstrated generally high levels of triage knowledge and triage practice. However, knowledge deficit and incorrect practice related to some aspects were noted. There were no significant differences in triage knowledge and practice according to participants’ demographics including gender, job title, qualification, emergency nursing training, and previous training in triage ( P > 0.05). Most participants ( n = 141, 95.9%) had access to their triage systems and the majority ( n = 79, 53.7%) utilize triage systems on a daily basis. Half said that only professional nurses performed the triage role ( n = 69, 46.9%). There was a significant positive relationship between triage knowledge and practice (r = 0.486, P < 0.01).

Conclusion

The respondents had a high level of triage knowledge and practice. However, they have some areas of knowledge deficit and some deficiencies in the conversion of their knowledge into practice. The study recommends the development of further training and education in emergency nursing to address knowledge deficits and incorrect triage practices.
Politics of Development in Bundelkhand Region of Northern India: Analysing Role of (Un)Civil Society
Authors: Suthar Sudhir Kumar
Published: October 2022

This study is an attempt to understand how development politics followed by the civil society organisations (CSOs) (with special reference to non-governmental organisations (NGOs) in India can be analysed in view of the social character of such organisations. The findings of this study are based on field work conducted in the northern Indian region of Bundelkhand. Bundelkhand is an economically underdeveloped, poverty ridden and draught-prone region located in the northern states of Uttar Pradesh (UP) and Madhya Pradesh (MP). The region suffers from deep-rooted social hierarchies and discrimination based on caste. Prevalence of such conditions of underdevelopment has also resulted in the emergence of vibrant CSOs in the region. However, the developmental agenda pursued by these organisations is largely confined to the questions of economic development including poverty alleviation, distribution of benefits of various state policies or raising concerns of depletion of natural resources especially of water scarcity. Larger structural questions of social justice, inclusion or participation of socially marginalised groups, especially of the scheduled castes (SC) and scheduled tribes (ST), have not received adequate attention in the agenda of most of these organisations. This study attempts to argue that what can explain this non-political nature of developmental agenda pursued by these CSOs is the social character of their leadership. A major reason behind the question of representation of social marginalised groups not being the core agenda of development is the continued dominance of social and economically dominant castes in managing these organisations. Though these groups do raise concerns of social equality and justice, it does not form the core agenda of development of the region. The state machinery or international aid agencies continue to work with the dominant sections as the agenda setters, while the representatives of marginalised communities continue to function at the margins of developmental agenda for the region.
Mechanical optimization of an Al-Al2O3 composite nanowire via molecular dynamics simulation and metaheuristic optimization
Authors: Pakray Mohammad , Hayati Sajad , Jalali Seyed Kamal
Published: October 2022

In the present study, mechanical properties optimization is investigated for an Al-Al2O3 composite nanostructure. The Al-Al2O3 composite nanostructure is considered an Aluminum nanowire reinforced by spherical Al2O3 particles. The structure tensile test is simulated via molecular dynamics simulation using LAMMPS. The mechanical properties of the composite are extracted from the obtained stress-strain curve of the composite. The important mechanical properties include maximum stress and toughness. An optimization process is then applied to maximize the mechanical properties of the composite via metaheuristic optimization algorithms including Genetic Algorithm (GA), Ant Colony (ACO), and Grey Wolf Optimizer (GWO). Since the studied nanostructure is mono crystal, the reinforcing mechanism differs from that of a grained macro material. Therefore, the optimization variables are not confined to size and volume fraction but they also include the location of the particles. The optimization is performed for 0.05 and 0.10 volume fractions and different particle sizes with respect to the location of particles. Applying the optimization process, the mechanical properties of the studied composite nanowire are substantially improved for tensile loading. The results reveal that the placement of the particles has a considerable effect on the improvement of mechanical characteristics. At last, a pattern is presented for the placement of particles to achieve the highest tensile characteristics of Al-Al2O3 composite nanowires.
Pathogenic proliferations: Salmon aquaculture, industrial viruses, and toxic geographies of settler-colonialism
Authors: Evans Darcey
Published: October 2022

In this article, I ask how a virus associated with Atlantic salmon farms in British Columbia (BC) can reveal geographies of aquaculture, ecological encounters, and colonial entanglements within the bodies and blood cells of fish. Piscine orthoreovirus (PRV) travels through supply chains, ocean currents, and ecological interactions, and causes salmon to become at risk of ruptured blood cells and organ damage. This article proposes that PRV can be interpreted as a form of industrial waste that reinforces geographies of toxicity across multiple scales. I first situate the emergence of aquaculture in BC within colonial histories that continue to transform the coastal straits into contested sites of state-making. I then outline how multiple forms of life, ecological encounters, and unique hydrological conditions become entangled with industrial practices, giving rise to novel pathogenic proliferations. I end by describing how the appearance of yellow salmon hints at the potentially far-reaching presence of PRV, and I look to the bodies of salmon to consider how the expanding PRV footprint transforms regional ecologies and contributes to emergent toxic geographies of settler-colonialism. In forging connections between settler-colonialism, industrial landscape-making, and pathogenicity, I highlight how microbes can reflect and reinforce settler-colonial structures of dispossession. Moreover, in proposing that pathogens can be understood as components of industrial toxicity, I contribute to a reimagining of what industrial toxicants are and the forms they might take.
Criminal records, discrimination, and Aboriginal communities: Enhancing employment opportunities
Authors: Naylor Bronwyn , Heydon Georgina
Published: October 2022

Criminal record checking is now widespread in Australia. Aboriginal people are disproportionately represented in the criminal justice system, for a range of reasons including historic levels of disadvantage due to colonisation. They are therefore disproportionately likely to be negatively affected by criminal record checking when seeking employment, when taking on community governance roles, when being considered as kinship carers and so on. At the same time, productive and rewarding employment, and engagement in governance roles, are vital aspects of Aboriginal people's participation, contribution and engagement across all parts of the Australian community. This article examines practices, protocols and experiences of employers, employment agencies and government organisations in Western Australia and the Northern Territory managing the potential impact of a criminal record on Aboriginal employment. The article identifies four fields that can give rise to good employment practice: Background Checking; Recruitment; Risk Management; and Support and Engagement.
A Longitudinal Comparison of Pharmacy Documentation Platforms Using the Technology Acceptance Model: Experiences With Opioid Risk Screening
Authors: Frenzel Oliver C. , Strand Mark , Welsh Allison , Eukel Heidi , Skoy Elizabeth , Steig Jayme , Werremeyer Amy
Published: October 2022

Background: Pharmacy practice continues to expand in scope, and technology platforms to assist with meeting the standards for documentation of billable services are needed. The ONE Program (Opioid and Naloxone Education) is an initiative centered on the community pharmacy focused on opioid risk screening for patients receiving opioid prescriptions. Objective: Opioid risk screening results and pharmacist interventions were documented using first REDCap and later the DocStation platforms. This study compared pharmacy staff experience with these 2 platforms. Methods: A survey using the Technology Acceptance Model (TAM) was designed to compare usability, ease of use, social influence, and facilitating conditions. Results: Analyses using descriptive statistics and open-ended responses showed similar results for each platform; however, pharmacy staff indicated that REDCap required less time when entering information, whereas the DocStation platform offered elevated pharmacy practice service opportunities, management support, and available informational technology support services. Conclusion: Health care technology continues to advance in meeting the needs of expanded service provision through pharmacy. This longitudinal study shows the value of the TAM framework in identifying efficiencies and deficiencies of health care technology systems.
iPromoter-Seqvec: identifying promoters using bidirectional long short-term memory and sequence-embedded features
Authors: Nguyen-Vo Thanh-Hoang , Trinh Quang H. , Nguyen Loc , Nguyen-Hoang Phuong-Uyen , Rahardja Susanto , Nguyen Binh P.
Published: October 2022

Background

Promoters, non-coding DNA sequences located at upstream regions of the transcription start site of genes/gene clusters, are essential regulatory elements for the initiation and regulation of transcriptional processes. Furthermore, identifying promoters in DNA sequences and genomes significantly contributes to discovering entire structures of genes of interest. Therefore, exploration of promoter regions is one of the most imperative topics in molecular genetics and biology. Besides experimental techniques, computational methods have been developed to predict promoters. In this study, we propose iPromoter-Seqvec – an efficient computational model to predict TATA and non-TATA promoters in human and mouse genomes using bidirectional long short-term memory neural networks in combination with sequence-embedded features extracted from input sequences. The promoter and non-promoter sequences were retrieved from the Eukaryotic Promoter database and then were refined to create four benchmark datasets.

Results

The area under the receiver operating characteristic curve (AUCROC) and the area under the precision-recall curve (AUCPR) were used as two key metrics to evaluate model performance. Results on independent test sets showed that iPromoter-Seqvec outperformed other state-of-the-art methods with AUCROC values ranging from 0.85 to 0.99 and AUCPR values ranging from 0.86 to 0.99. Models predicting TATA promoters in both species had slightly higher predictive power compared to those predicting non-TATA promoters. With a novel idea of constructing artificial non-promoter sequences based on promoter sequences, our models were able to learn highly specific characteristics discriminating promoters from non-promoters to improve predictive efficiency.

Conclusions

iPromoter-Seqvec is a stable and robust model for predicting both TATA and non-TATA promoters in human and mouse genomes. Our proposed method was also deployed as an online web server with a user-friendly interface to support research communities. Links to our source codes and web server are available at https://github.com/mldlproject/2022-iPromoter-Seqvec.
SPARC plays an important role in the oviposition and nymphal development in Nilaparvata lugens Stål
Authors: Wang Weixia , Zhu Tingheng , Wan Pinjun , Wei Qi , He Jiachun , Lai Fengxiang , Fu Qiang
Published: October 2022

Background

The brown planthopper (Nilaparvata lugens Stål)is a notorious rice pest in many areas of Asia. Study on the molecular mechanisms underlying its development and reproduction will provide scientific basis for effective control. SPARC (Secreted Protein, Acidic and Rich in Cysteine) is one of structural component of the extracellular matrix, which influences a diverse array of biological functions. In this study, the gene for SPARC was identified and functionally analysed from N.lugens.

Results

The result showed that the NlSPARC mRNA was highly expressed in fat body, hemolymph and early embryo. The mortality increased significantly when NlSPARC was downregulated after RNA interference (RNAi) in 3 ~ 4th instar nymphs. Downregulation of NlSPARC in adults significantly reduced the number of eggs and offspring, as well as the transcription level of NlSPARC in newly hatched nymphs and survival rate in progeny. The observation with microanatomy on individuals after NlSPARC RNAi showed smaller and less abundant fat body than that in control. No obvious morphological abnormalities in the nymphal development and no differences in development of internal reproductive organ were observed when compared with control.

Conclusion

NlSPARC is required for oviposition and nymphal development mainly through regulating the tissue of fat body in N.lugens. NlSPARC could be a new candidate target for controlling the rapid propagation of N.lugens population. Our results also demonstrated that the effect of NlSPARC RNAi can transfer to the next generation in N.lugens.
Effects of genotype and ecological environment on the community structure and function of symbiotic bacteria in rhizosphere of ginseng
Authors: Zhang Jiyue , Liu Pin , Nie Botao , Liu Xinxin , Zhang Zhen , He Runlong , Dong Weiwei , Ji Wenxiu
Published: October 2022

Background

Ginseng, an important traditional Chinese medicine and a new resource food, has two production modes: farmland ginseng and forestland ginseng. Ginseng faces many problems such as high soil bulk density, easy hardening, low nutrient content, reduced porosity and increased soil acidification because of continuous cropping. Increasing studies indicate that plant rhizosphere symbiotic bacteria have an important effect on plant growth and development. We speculate that differences in microbial community may play an important role in promoting ginseng growth, development and health. To reveal the differences between farmland and forestland ginseng cultivation, and to address problems associated with continuous ginseng cropping, we investigated the effects of differences in plant rhizosphere symbiotic bacterial communities in promoting ginseng growth, development, and health.

Result

In the present study, the microbial communities in the rhizosphere of different genotypes and ecological environments were analyzed using the high-throughput sequencing platform Illumina, phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt), and other technologies. The organic matter, total nitrogen, available nitrogen, and available phosphorus contents in forestland soil were significantly different from those in farmland. The bacterial communities of ginseng in forestland, farmland, and greenhouse environments have specific dominant groups at the phylum and genus levels. There were differences in the gene functions of ginseng root-related bacterial communities between forestland and farmland. There were significant differences in the abundance distribution of rhizosphere bacteria among the different genotypes at the phylum and genus levels.

Conclusions

There is a close relationship between the ecological environment and bacterial population structure, and the ecological environment of forestland is more conducive to the formation of rich rhizosphere bacterial populations; additionally, the genetic diversity is richer than that of farmland. The rhizosphere bacterial community structure of ginseng was influenced by genotype, and there was a correlation between the distance between ginseng genotypes and the stratified clustering of its rhizosphere bacterial community structure.
Teenage first-time mothers’ perceptions about their health care needs in the immediate and early postpartum period in Uganda
Authors: Namutebi Mariam , Kabahinda Dorcus , Mbalinda Scovia Nalugo , Nabunya Racheal , Nanfuka Dorothy Gingo , Kabiri Lydia , Ngabirano Tom Denis , Muwanguzi Patience A.
Published: October 2022

Background

Teenagers have higher risks for complications during the intrapartum and postpartum periods. Although facility-based postpartum care focusses on preventing complications in mothers and babies, it is not understood what teenage-mothers’ perceptions are about their health care needs in the early postpartum period.

Methods

An exploratory descriptive qualitative study was conducted in four health facilities in Uganda. In-depth interviews with 42 first-time teenage mothers aged 14 to 19 years were conducted between March and April 2020. Thematic analysis was done.

Results

Two themes emerged, Health promotion and Rehabilitation and counseling. Teenage first time mothers desired to receive information about key issues like self and newborn care, breast feeding, immunization and family planning. They noted that health workers need to monitor their vital signs which aids in early diagnosis of complications, disease prevention/treatment of current conditions. Others felt that health workers are key in arbitrating between them and their estranged parents and also help to link them to community based organizations that can provide them with counseling and life skills.

Conclusions

Teenage first-time mothers have many health care needs during the immediate and early postpartum period. This is a missed opportunity to provide health education and link them to sexual reproductive health services including family planning, breastfeeding clinics and other community based programs which provide life skills or continuing education for girls. Focusing on these needs and integration of services is key in providing holistic care to the teenagers. We propose that further research be done to explore how their health care needs change at 6 months post-delivery.
Overall survival in patients with re-excision of positive microscopic margins of limb and trunk wall soft tissue sarcoma operated outside of a reference center: a nationwide cohort analysis
Authors: Gouin Francois , Stoeckle Eberhard , Honoré Charles , Ropars Mickael , Jafari Mehrdad , Mattei Jean Camille , Rochwerger Alexandre , Carrere Sébastien , Waast Denis , Ferron Gwenaël , Machiavello Jean-Christophe , Anract Philippe , Marchal Frédéric , Sirveaux François , Marco Oren , Guiramand Jérôme , Paquette Brice , Di Marco Antonio , Causeret Sylvain , Guilloit Jean-Marc , Soibinet Pauline , Tzanis Dimitri , Gimbergues Pierre , Fiorenza Fabrice , Dujardin Franck , Le Nail Louis R. , Ruzic Jean-Christophe , Chemin-Airiau Claire , Morelle Magali , Meeus Pierre , Karanian Marie , Le Loarer François , Vaz Gualter , Blay Jean-Yves ,   on behalf of the NETSARC/RREPS and French Sarcoma Group-Groupe d’Etude des Tumeurs Osseuses (GSF-GETO) networks
Published: October 2022

Background

This French nationwide NETSARC exhaustive prospective cohort aims to explore the impact of systematic re-excision (RE) as adjuvant care on overall survival (OS), local recurrence free survival (LRFS), and local and distant control (RFS) in patients with soft tissue sarcoma (STS) with positive microscopic margins (R1) after initial resection performed outside of a reference center.

Methods

Eligible patients had experienced STS surgery outside a reference center from 2010 to 2017, and had R1 margins after initial surgery. Characteristics and treatment comparisons used chi-square for categorical variables and Kruskall-Wallis test for continuous data. Survival distributions were compared in patients reexcised (RE) or not (No-RE) using a log-rank test. A Cox proportional hazard model was used for subgroup analysis.

Results

A total of 1,284 patients had experienced initial STS surgery outside NETSARC with R1 margins, including 1,029 patients with second operation documented. Among the latter, 698 patients experienced re-excision, and 331 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, tumor size, tumor depth, and histotype in the population of patients re-excised (RE) or not (No-RE). The study identified RE as an independent favorable factor for OS (HR 0.36, 95%CI 0.23–0.56, p<0.0001), for LRFS (HR 0.45, 95%CI 0.36–0.56, p<0.0001), and for RFS (HR 0.35, 95%CI 0.26–0.46, p<0.0001).

Conclusion

This large nationwide series shows that RE improved overall survival in patients with STS of extremities and trunk wall, with prior R1 resection performed outside of a reference center. RE as part of adjuvant care should be systematically considered.

Level of evidence II
Evaluating the efficacy and microenvironment changes of HER2 + gastric cancer during HLX02 and Endostar treatment using quantitative MRI
Authors: Liang Jianye , Dai Wei , Li Zhipeng , Liang Xiangjing , Xiao Mingjia , Xie Chuanmiao , Li Xinming
Published: October 2022

Background and objectives

Trastuzumab is an important targeted drug for HER2-positive gastric cancer. The treatment efficacy of a more cost-effective and accessible trastuzumab biosimilar, HLX02, was not well investigated, especially when combined with antiangiogenic treatment. In addition, the tumour microenvironment detected by functional MRI was still unclear during treatment. This study attempts to evaluate the therapeutic effect of antiangiogenic agents combined with HLX02 in a HER2-positive gastric cancer xenograft model and to detect microenvironmental changes using intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI).

Materials and methods

We subcutaneously injected MKN-45 human gastric cancer cells into BALB/C nude mice to establish a tumour model. Twenty-eight mice were divided into four groups and treated with saline (Group 1), Endostar (Group 2), trastuzumab biosimilar HLX02 (Group 3), or the combination of Endostar and HLX02 (Group 4). We then performed IVIM-DWI before and at different time points after treatment. HE, HER2, TUNEL, E-cadherin staining, and α-SMA and CD31 double-staining were used to confirm the pathological changes.

Results

Group 4 demonstrated the smallest tumour volume at the end of treatment. The D value in Group 4 increased more dramatically, with the highest value on Day 20, compared with the other groups. Perfusion-related parameters (D* and f values) in Groups 2 and 4 increased initially and reversed after Day 10. Group 4 showed the lowest CD31 and HER2 and the highest TUNEL- and E-cadherin-positive staining rates. The D value was positively correlated with TUNEL but negatively correlated with HER2 staining. The D* and f values had positive correlations with CD31 and E-cadherin expression and the vessel maturity index.

Conclusions

The trastuzumab biosimilar drug HLX02 exhibited good treatment efficacy in HER2-positive gastric cancer, especially when combined with Endostar. IVIM-DWI can noninvasively monitor the process of vascular normalization and reflect the treatment effect early at the molecular level.
Comparisons of the energy efficiency and intraocular safety of two torsional phacoemulsification tips
Authors: Sun Yan-Xiu , Cao Rong , Liu Zi-Yuan , Xia Hua-Qin , Cen Yu-Jie , Gao Lu , Shi Dan-Dan
Published: October 2022

Background

During cataract phacoemulsification surgery, an Intrepid® balanced (IB) tip can achieve a larger amplitude, which may lead to higher energy efficiency than a Kelman (K) tip when paired with a torsional phaco platform. In this retrospective cohort study, we compared their energy efficiency and damage to the cornea under a new energy setting.

Methods

The medical records of 104 eyes of 79 patients were reviewed, with 47 eyes belonging to the IB group and 57 eyes belonging to the K group. All surgeries were performed on an Alcon Centurion® platform with gravity infiltration. Surgical parameters, visual outcome, central corneal thickness (CCT) changes, and endothelial cell density (ECD) loss rate were recorded and calculated.

Results

No significant differences in postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), total ultrasound time, estimated fluid aspirated, CCT changes, or ECD loss rate were observed between the two groups. We divided the included eyes into soft nucleus and hard nucleus subgroups and found lower cumulative dissipated energy (CDE, 8.15 ± 8.02 vs 14.82 ± 14.16, P = 0.023), cumulative torsional energy (CTE, 8.06 ± 7.87 vs 14.13 ± 13.02, P = 0.027), and cumulative longitudinal energy (CLE, 0.09 ± 0.17 vs 0.69 ± 1.37, P = 0.017) in the IB group than in the K group, implying less energy used and higher energy efficiency of the IB tip.

Conclusion

Lower CLE in the IB group indicates fewer phaco tip obstructions and a significantly higher capability to conquer hard nuclei with IB tips with statistical significance. With an ultra-perfusion cannula, the balanced tip does not cause more corneal damage.
Nutrition-related diseases and cardiovascular mortality in American society: national health and nutrition examination study, 1999–2006
Authors: Chen Weihua , Shi Shanshan , Tu Jiabin , Liao Lihua , Liao Ying , Chen Kaihong , Chen Liling , Huang Rongchong
Published: October 2022

Background

Despite many significant advances in treatment and management, cardiovascular disease remains the main cause of the global disease burden. Nutrition-related disease is a modifiable cardiovascular risk factor. However, few studies have examined the relationship between nutrition-related diseases and cardiovascular mortality.

Objective

We aimed to investigate the association of nutrition-related diseases with cardiovascular mortality based on a large nationally representative community population.

Design

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999–2006 with mortality follow-up through December 31, 2015. Finally, 12,469 participants were analyzed. Each participant was assigned to one of four groups: normal nutrition without sarcopenia, sarcopenia with normal nutrition, malnutrition without sarcopenia, and malnutrition-sarcopenia syndrome. Survival curves and Cox regressions based on the NHANES recommended weights were used to assess the association between nutrition-related diseases and cardiovascular mortality.

Results

Of the 12,469 patients included in the study and divided into four groups, malnutrition-sarcopenia syndrome had the highest 5- and 10-year cardiovascular mortality rates. After adjustment for related factors, sarcopenia with normal nutrition (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.28–2.06; P < 0.001), malnutrition without sarcopenia (HR: 1.28, 95% CI:1.03–1.58; P = 0.024), and malnutrition-sarcopenia syndrome (HR: 2.66, 95% CI:1.89 − 3.74; P < 0.001) were significantly associated with increased risk of all-cause mortality. Malnutrition-sarcopenia syndrome remained associated with an increased risk of cardiovascular mortality (HR: 3.56, 95% CI: 1.17 − 10.84; P < 0.001).

Conclusions

Malnutrition-sarcopenia syndrome was highly prevalent among community-dwelling adults in the United States and was a strong prognostic factor for cardiovascular mortality in the community setting. Randomized clinical trials are needed to demonstrate whether prevention or treatment of malnutrition-sarcopenia syndrome in community populations can reduce global cardiovascular mortality.
The effects of nutritional support team intervention on postoperative immune function, nutritional statuses, inflammatory responses, clinical outcomes of elderly patients with gastric cancer
Authors: Chen Jiansheng , Zou Liling , Sun Wenxing , Zhou Junfeng , He Qingliang
Published: October 2022

Background

To explore the effects of nutrition support team (NST) intervention on elderly patients with gastric cancer (GC).

Methods

The elderly GC patients (tumor stage I/II/III), admitted to our department from January 2015 to September 2021, were retrospectively analyzed and divided into NST group and traditional nutrition (TN) group according to nutritional management methods. The immune, inflammatory, nutrition-related indices, postoperative recovery and long-term prognosis of two groups were analyzed.

Results

A total of 258 elderly GC patients were included (NST group, n = 125; TN group, n = 133). After propensity score matching (PSM) in ratio of 1:1, 73 pairs of patients were matched. There were statistically significant differences in CD3 and CD4 level postoperative one month and IgG level postoperative one week between NST group and TN group (P < 0.05). There was no significant differences in serum CRP and IL-6 levels preoperative one day, postoperative one week and one month between two groups (P > 0.05). There were significant differences in body mass index (BMI) between the two groups postoperative one month (P < 0.05). The rate of infectious complications in TN group was significantly higher than that in NST group (P < 0.05). There was no statistically significant differences in 3-year relapse-free survival (RFS) or 3-year overall survival (OS) between NST group and TN group (P > 0.05).

Conclusions

Compared with TN management, NST intervention might be benefit to the immune function recovery and nutritional status, but there was no evidence that NST could improve the prognosis of elderly GC patients.
Palliative care in the Eastern Mediterranean: comparative analysis using specific indicators
Authors: Sánchez-Cárdenas Miguel Antonio , Pourghazian Nasim , Garralda Eduardo , van Steijn Danny , Slama Slim , Benítez Edgar , Bouësseau Marie-Charlotte , Centeno Carlos
Published: October 2022

Background

Monitoring the development of palliative care (PC) illustrates the capacity of health systems to respond to the needs of people experiencing serious health-related suffering.

Aim

To analyse comparatively the situation of PC in the countries of the Easter Mediterranean region using context-specific indicators.

Method

An online questionnaire with 15 context-specific PC indicators investigating service provision, use of medicines, policy, education, and vitality was designed. Authors Institution 1 nominated in-country experts to complete the survey. Data were analysed using a comparative description of indicators per domain and a multivariate analysis.

Results

In-country experts were identified in 17/22 countries. 12/17 contributed to the survey. In total, 117 specialized PC services were identified. Specialized services per population ranges from 0.09 per 100,000 inhabitants in Lebanon and Saudi Arabia, Qatar and Kuwait; to zero services in the Occupied Palestinian Territories. On average, opioid consumption was 2.40 mg/capita/year. National PC strategies were reported in nine countries. In six countries, PC is officially accredited either as a specialty or sub-specialty, and PC mandatory courses are implemented in 36% of medical schools and 46% of nursing schools. National PC associations were documented in six countries. A higher pattern of development was identified in Jordan, Kuwait, Saudi Arabia, Oman, Lebanon, Qatar.

Conclusions

Despite a higher development in the Arabian Peninsula, the region is characterised by a very low provision of specialized PC services and opioid consumption. Policy improvements represent an opportunity to improve access to PC.
A phase Ib study of camrelizumab in combination with apatinib and fuzuloparib in patients with recurrent or metastatic triple-negative breast cancer
Authors: Zhang Qingyuan , Shao Bin , Tong Zhongsheng , Ouyang Quchang , Wang Yuting , Xu Guoying , Li Shaorong , Li Huiping
Published: October 2022

Background

Strategies to improve activity of immune checkpoint inhibitors for triple-negative breast cancer (TNBC) are needed. Preclinical studies showed that antiangiogenic agents and poly (ADP-ribose) polymerase (PARP) inhibitors might sensitize tumors to immunotherapy. Here, we investigated the tolerability, safety, and preliminary antitumor activity of camrelizumab, an anti-PD-1 antibody, in combination with apatinib, a vascular endothelial growth factor receptor-2 inhibitor, and fuzuloparib, a PARP inhibitor, in patients with recurrent or metastatic TNBC.

Methods

This phase Ib study included a dose-finding part and a dose-expansion part. In the dose-finding part, a 3 + 3 dose escalation scheme was introduced. Patients were given camrelizumab (200 mg every 2 weeks) plus apatinib (375 mg or 500 mg once daily) and fuzuloparib (starting dose 100 mg twice daily) every 28-day cycle. After evaluation of the tolerability and safety of the dosing regimens, a clinical recommended dose was determined for the dose-expansion part. The primary endpoint was dose-limiting toxicity (DLT).

Results

A total of 32 patients were enrolled. Three patients received camrelizumab 200 mg + apatinib 375 mg + fuzuloparib 100 mg, and 29 received camrelizumab 200 mg + apatinib 500 mg + fuzuloparib 100 mg (clinical recommended dose). No DLTs were observed in either group. The most common grade ≥ 3 treatment-related adverse events were decreased white blood cell count (20.7%), hypertension (13.8%), decreased neutrophil count (10.3%), and increased aspartate aminotransferase (10.3%). Two patients discontinued study treatment due to immune-mediated hepatitis (n = 1) and anemia, decreased platelet count, decreased white blood cell count, increased alanine aminotransferase, increased aspartate aminotransferase, and increased γ-glutamyltransferase (n = 1). One patient died of unknown cause. Two (6.9% [95% CI, 0.9–22.8]) of 29 patients with camrelizumab 200 mg + apatinib 500 mg + fuzuloparib 100 mg had objective response. The disease control rate was 62.1% (95% CI, 42.3–79.3). The median progression-free survival was 5.2 months (95% CI, 3.6–7.3), and the 12-month overall survival rate was 64.2% (95% CI, 19.0–88.8).

Conclusions

Combination of camrelizumab plus apatinib and fuzuloparib showed manageable safety profile and preliminary antitumor activity in patients with recurrent or metastatic TNBC.

Trial registration

ClinicalTrials.gov NCT03945604 (May 10, 2019).
Short-chain fatty acid concentrations in the incidence and risk-stratification of colorectal cancer: a systematic review and meta-analysis
Authors: Alvandi Ehsan , Wong Wilson K. M. , Joglekar Mugdha V. , Spring Kevin J. , Hardikar Anandwardhan A.
Published: October 2022

Background

The beneficial role of gut microbiota and bacterial metabolites, including short-chain fatty acids (SCFAs), is well recognized, although the available literature around their role in colorectal cancer (CRC) has been inconsistent.

Methods

We performed a systematic review and meta-analysis to examine the associations of fecal SCFA concentrations to the incidence and risk of CRC. Data extraction through Medline, Embase, and Web of Science was carried out from database conception to June 29, 2022. Predefined inclusion/exclusion criteria led to the selection of 17 case-control and six cross-sectional studies for quality assessment and analyses. Studies were categorized for CRC risk or incidence, and RevMan 5.4 was used to perform the meta-analyses. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using a random-effects model. Studies lacking quantitation were included in qualitative analyses.

Results

Combined analysis of acetic, propionic, and butyric acid revealed significantly lower concentrations of these SCFAs in individuals with a high-risk of CRC (SMD = 2.02, 95% CI 0.31 to 3.74, P = 0.02). Additionally, CRC incidence was higher in individuals with lower levels of SCFAs (SMD = 0.45, 95% CI 0.19 to 0.72, P = 0.0009), compared to healthy individuals. Qualitative analyses identified 70.4% of studies reporting significantly lower concentrations of fecal acetic, propionic, butyric acid, or total SCFAs in those at higher risk of CRC, while 66.7% reported significantly lower concentrations of fecal acetic and butyric acid in CRC patients compared to healthy controls.

Conclusions

Overall, lower fecal concentrations of the three major SCFAs are associated with higher risk of CRC and incidence of CRC.