bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of whey protein on glycemic control and serum lipoproteins in patients with metabolic syndrome and related conditions: a systematic review and meta-analysis of randomized controlled clinical trials
Authors: Amirani Elaheh , Milajerdi Alireza , Reiner Željko , Mirzaei Hamed , Mansournia Mohammad Ali , Asemi Zatollah 
Published: September 2020

Abstract
Background
This systematic review and meta-analysis aimed to assess the effects of whey protein on serum lipoproteins and glycemic status in patients with metabolic syndrome (MetS) and related disorders.

Methods
Online databases, such as Web of Science, Cochrane Library, PubMed and Scopus were systematically searched by two independent authors from inception until 30th April 2020 for English randomized clinical trials investigating the efficacy of whey protein administration in subjects with Mets or related conditions on the parameters of glycemic and lipid control compared to certain control. In order to evaluate the included studies’ methodological quality, Cochrane Collaboration risk of bias tool was applied. Using Cochrane’s Q test and I-square (I2) statistic, the included trials’ heterogeneity was also examined. Using a random-effects model, data were pooled, and weighted mean difference (WMD) was considered as the overall effect size.

Results
Twenty-two studies were selected to be included in this meta-analysis. Consumption of whey protein resulted in significant reduction of HbA1c (WMD: -0.15; 95% CI: − 0.29, − 0.01) insulin (WMD: -0.94; 95% CI: − 1.68, − 0.21) and homeostasis model assessment-estimated insulin resistance (HOMA-IR) (WMD: -0.20; 95% CI: − 0.36, − 0.05). A significant reduction in triglycerides levels (WMD: -17.12; 95% CI: − 26.52, − 7.72), total cholesterol (WMD: -10.88; 95% CI -18.60, − 3.17), LDL-cholesterol levels (WMD: -8.47 95% CI: − 16.59, − 0.36) and total cholesterol/HDL-cholesterol ratio (WMD: -0.26; 95% CI: − 0.41, − 0.10) was found as well.

Conclusions
This meta-analysis suggests that supplementation with whey protein had beneficial effect on several indicators of glycemic control and lipid parameters in patients with MetS and related conditions.
Laparoscopic procedure is associated with lower morbidity for simultaneous resection of colorectal cancer and liver metastases: an updated meta-analysis
Authors: Pan Long , Tong Chenhao , Fu Siyuan , Fang Jing , Gu Qiuxia , Wang Shufeng , Jiang Zhiyu , Juengpanich Sarun , Cai Xiujun 
Published: September 2020

Abstract
Background
It has been demonstrated that simultaneous resection of both primary colorectal lesion and metastatic hepatic lesion is a safe approach with low mortality and postoperative complication rates. However, there are some controversies over which kind of surgical approach is better. The aim of study was to compare the efficacy and safety of laparoscopic surgeries and open surgeries for simultaneous resection of colorectal cancer (CRC) and synchronous colorectal liver metastasis (SCRLM).

Methods
A systemic search of online database including PubMed, Web of Science, Cochrane Library, and Embase was performed until June 5, 2019. Intraoperative complications, postoperative complications, and long-term outcomes were synthesized by using STATA, version 15.0. Cumulative and single-arm meta-analyses were also conducted.

Results
It contained twelve studies with 616 patients (273 vs 343, laparoscopic surgery group and open surgery group, respectively) and manifested latest surgical results for the treatment of CRC and SCRLM. Among patients who underwent laparoscopic surgeries, they had lower rates of postoperative complications (OR = 0.66, 95% CI: 0.46 to 0.96, P = 0.028), less intraoperative blood loss (weight mean difference (WMD) = − 113.31, 95% CI: − 189.03 to − 37.59, P = 0.003), less time in the hospital and recovering after surgeries (WMD = − 2.70, 95% CI: − 3.99 to − 1.40, P = 0.000; WMD = − 3.20, 95% CI: − 5.06 to − 1.34, P = 0.001), but more operating time (WMD = 36.57, 95% CI: 7.80 to 65.35, P = 0.013). Additionally, there were no statistical significance between two kinds of surgical approaches in disease-free survival and overall survival. Moreover, cumulative meta-analysis indicated statistical difference in favor of laparoscopic surgery in terms of morbidity was firstly detected in the 12th study in 2018 (OR = 0.66, 95% CI: 0.46 to 0.96, P = 0.028) as the 95% CI narrowed.

Conclusion
Compared with open surgeries, laparoscopic surgeries are safer (postoperative complications and intraoperative blood loss) and more effective (length of hospital stay and postoperative stay), and it can be considered as the first option for management of SCRLM in high-volume laparoscopic centers.

Trial registration
CRD42020151176
Modern work patterns of “classic” versus millennial family doctors and their effect on workforce planning for community-based primary care: a cross-sectional survey
Authors: Hedden Lindsay , Banihosseini Setareh , Strydom Nardia , McCracken Rita 
Published: September 2020

Abstract
Background
There are ongoing accessibility challenges in primary care in British Columbia, Canada, with 17% of the population not having a regular source of care. Anecdotal evidence suggests that physicians are moving away from a community-based comprehensive practice model, which could contribute to shortages. Thus, we aimed to identify and describe how family physicians are currently organizing their primary care practices in a large health region in British Columbia and to examine differences between newer graduates and more established physicians.

Methods
Data for this cross-sectional study were drawn from an annual physician privileging survey. N = 1017 physicians were invited to participate. We categorized practice style into five distinct groupings and compared features across respondent groups, including personal and practice location characteristics, hospital and teaching work, payment and appointment characteristics, and scope of practice. We discuss the implications of styles of practice and associated characteristics on health workforce policy and planning.

Results
We received responses from 525 (51.6%) physicians. Of these, 355 (67.6%) reported doing at least some community-based primary care. However, only 112 (21.3%) provided this care full time. Most respondents supplemented community-based work with part-time hours in focused practice, hospitals, or inpatient facilities. We found diversity in the scope and style of practice across practice models. Compared to established physicians, new graduates (in practice less than 10 years) work more weekly hours (more patient care, and paperwork in particular). However, we found no difference between new and established physicians in the odds of providing any or full-time community-based primary care.

Conclusions
Despite a lack of formalized structural reform in British Columbia’s primary care system, most physicians are finding alternative ways to model their practice and shifting away from work at single-location, community-based clinics. This shift challenges assumptions that are relied on for workplace planning that is intended to ensure adequate access to longitudinal, community-based family medicine.
The use and misuse of ratio and proportion exposure measures in food environment research
Authors: Thornton Lukar E. , Lamb Karen E. , White Simon R. 
Published: September 2020

Abstract
Background
The food stores within residential environments are increasingly investigated as a possible mechanism driving food behaviours and health outcomes. Whilst increased emphasis is being placed on the type of study designs used and how we measure the outcomes, surprisingly little attention gets diverted to the measures of the food environment beyond calls for standardised approaches for food store coding and geographic scales of exposure. Food environments are a challenging concept to measure and model and the use of ratio and proportion measures are becoming more common in food environment research. Whilst these are seemingly an advance on single store type indicators, such as simply counting the number of supermarkets or fast food restaurants present, they have several limitations that do not appear to have been fully considered.

Main body
In this article we report on five issues related to the use of ratio and proportion food environment measures: 1) binary categorisation of food stores; 2) whether they truly reflect a more or less healthy food environment; 3) issues with these measures not reflecting the quantity of food stores; 4) difficulties when no stores are present; and 5) complications in statistical treatment and interpretation of ratio and proportion measures. Each of these issues are underappreciated in the literature to date and highlight that ratio and proportion measures need to be treated with caution.

Conclusion
Calls for the broader adoption of relative food environment measures may be misguided. Whilst we should continue to search for better ways to represent the complexity of food environments, ratio and proportion measures are unlikely to be the answer.
Dose-response association of implantable device-measured physical activity with long-term cardiac death and all-cause mortality in patients at high risk of sudden cardiac death: a cohort study
Authors: Li Xiaoyao , Zhao Shuang , Chen Keping , Hua Wei , Su Yangang , Yang Jiefu , Liang Zhaoguang , Xu Wei , Zhang Shu 
Published: September 2020

Abstract
Background
Cardiovascular implantable electronic devices (CIEDs) with physical activity (PA) recording function can continuously and automatically collect patients’ long-term PA data. The dose-response association of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRTD)-measured PA with cardiovascular outcomes in patients at high risk of sudden cardiac death (SCD) was investigated.

Methods
In total, 822 patients fulfilling the inclusion criteria were included and divided into three groups according to baseline PA tertiles: tertile 1 (< 8.04%, n = 274), tertile 2 (8.04–13.24%, n = 274), and tertile 3 (> 13.24%, n = 274). The primary endpoint was cardiac death, the secondary endpoint was all-cause mortality.

Results
During a mean follow-up of 59.7 ± 22.4 months, cardiac death (18.6% vs 8.8% vs 5.5%, tertiles 1–3, P < 0.001) and all-cause mortality (39.4% vs 20.4% vs 9.9%, tertiles 1–3, P < 0.001) events decreased according to PA tertiles. Compared with patients younger than 60 years old, older patients had a lower average PA level (9.6% vs 12.8%, P < 0.001) but higher rates of cardiac death (13.2% vs 8.1%, P = 0.024) and all-cause mortality (28.4% vs 16.7%, P < 0.001) events. Adjusted multivariate Cox regression analyses showed that a higher tertile of PA was associated with a lower risk of cardiac death (hazard ratio (HR) 0.41, 95% confidence interval (CI): 0.25–0.68, tertile 2 vs tertile 1; HR 0.28, 95% CI: 0.15–0.51, tertile 3 vs tertile 1, Ptrend < 0.001). Similar results were observed for all-cause mortality. The dose-response curve showed an inverse non-linear pattern, and a significant reduction in endpoint risk was observed at the low-moderate PA level. The HR for cardiac death was reduced by half with 12.32% PA (177 min), and the HR for all-cause mortality was reduced by half with 11.92% PA (172 min). Subgroup analysis results indicated that older adults could benefit from PA and the range for achieving optimal benefits might be lower.

Conclusions
PA monitoring may aid in long-term management of patients at high risk of SCD. More PA will generate better survival benefits, but even low-moderate PA is already good especially for older adults, which is relatively easy to achieve.
Development and validation of a cancer stem cell-related signature for prognostic prediction in pancreatic ductal adenocarcinoma
Authors: Feng Zengyu , Shi Minmin , Li Kexian , Ma Yang , Jiang Lingxi , Chen Hao , Peng Chenghong 
Published: September 2020

Abstract
Background
Cancer stem cells (CSCs) are crucial to the malignant behaviour and poor prognosis of pancreatic ductal adenocarcinoma (PDAC). In recent years, CSC biology has been widely studied, but practical prognostic signatures based on CSC-related genes have not been established or reported in PDAC.

Methods
A signature was developed and validated in seven independent PDAC datasets. The MTAB-6134 cohort was used as the training set, while one local Chinese cohort and five other public cohorts were used for external validation. CSC-related genes with credible prognostic roles were selected to form the signature, and their predictive performance was evaluated by Kaplan–Meier survival, receiver operating characteristic (ROC), and calibration curves. Correlation analysis was employed to clarify the potential biological characteristics of the gene signature.

Results
A robust signature comprising DCBLD2, GSDMD, PMAIP1, and PLOD2 was developed. It classified patients into high-risk and low-risk groups. High-risk patients had significantly shorter overall survival (OS) and disease-free survival (DFS) than low-risk patients. Calibration curves and Cox regression analysis demonstrated powerful predictive performance. ROC curves showed the better survival prediction by this model than other models. Functional analysis revealed a positive association between risk score and CSC markers. These results had cross-dataset compatibility.
Impact
This signature could help further improve the current TNM staging system and provide data for the development of novel personalized therapeutic strategies in the future.
β-Hydroxybutyrate inhibits inflammasome activation to attenuate Alzheimer’s disease pathology
Authors: Shippy Daniel C. , Wilhelm Connor , Viharkumar Patel A. , Raife Thomas J. , Ulland Tyler K. 
Published: September 2020

AbstractAlzheimer’s disease (AD) is a progressive, late-onset dementia with no effective treatment available. Recent studies suggest that AD pathology is driven by age-related changes in metabolism. Alterations in metabolism, such as placing patients on a ketogenic diet, can alter cognition by an unknown mechanism. One of the ketone bodies produced as a result of ketogenesis, β-hydroxybutyrate (BHB), is known to inhibit NLRP3 inflammasome activation. Therefore, we tested if BHB inhibition of the NLRP3 inflammasome reduces overall AD pathology in the 5XFAD mouse model of AD. Here, we find BHB levels are lower in red blood cells and brain parenchyma of AD patients when compared with non-AD controls. Furthermore, exogenous BHB administration reduced plaque formation, microgliosis, apoptosis-associated speck-like protein containing a caspase recruitment domain (Asc) speck formation, and caspase-1 activation in the 5XFAD mouse model of AD. Taken together, our findings demonstrate that BHB reduces AD pathology by inhibiting NLRP3 inflammasome activation. Additionally, our data suggest dietary or pharmacological approaches to increase BHB levels as promising therapeutic strategies for AD.
Bigger doesn’t mean bolder: behavioral variation of four wild rodent species to novelty and predation risk following a fast-slow continuum
Authors: Best Ian Nicholas , Shaner Pei-Jen Lee , Lo Hsuan-Yi , Pei Kurtis Jai-Chyi , Kuo Chi-Chien 
Published: September 2020

Abstract
Background
Understanding how wild species respond to novel situations with associated risk can provide valuable insights for inter-specific behavioral variation and associations with pace-of-life (POL). Rodents, a globally distributed and diverse taxonomic group, have been the subjects of countless studies emulating risky situations. Controlled laboratory experiments with a focus on wild-caught species provide the opportunity to test fine-scale behavioral responses to contexts of risk with ecological implications. For example, assessing the importance of predator cues eliciting antipredator responses, as well as whether wild rodents embody behavioral plasticity and repertoires, illustrated by habituation and variation in behavioral traits, respectively.

Results
In this comparative study, we examined multiple behavioral responses of four rodent species in eastern Taiwan (three native species Mus caroli, Apodemus agrarius, Rattus losea, and one invasive, Rattus exulans) exposed to an unfamiliar microenvironment and novel cue from an allopatric predator, the leopard cat (Prionailurus bengalensis). All wild-caught animals were subjected to two consecutive nights of experimental trials in a laboratory setting. Behavioral responses to a novel situation during the first trial differed between species; smaller species investing more time in non-defensive behaviors compared to the larger species. More specifically, the smaller species M. caroli and A. agrarius allocated more time to exploration and foraging, whereas the larger rat species R. exulans and R. losea spent more time motionless or concealing. During the second trial, the addition of leopard cat cues did not elicit antipredator behaviors, but rather, rodents were found to exhibit increased non-defensive behaviors, specifically foraging efforts.

Conclusions
Our results suggest that these four species do largely follow a behavioral fast-slow continuum with the two smaller mice species demonstrating increased boldness in a novel context compared to the larger rat species. Also, the wild populations of rodents in eastern Taiwan may be naïve to leopard cats. Finally, the rodents in our study demonstrated habituation to the microenvironment, indicating they possess adaptive capacity.
Mitigating violence against women and young girls during COVID-19 induced lockdown in Nepal: a wake-up call
Authors: Dahal Minakshi , Khanal Pratik , Maharjan Sajana , Panthi Bindu , Nepal Sushil 
Published: September 2020

AbstractNepal, a South Asian country, was in nationwide lockdown for nearly three months in 2020 with partial restrictions still in place. Much worryingly, COVID-19 induced restrictions have confined women and young girls in their home, increasing the risk of domestic violence. The available support system to respond to violence against women and girls (VAWG) has also been disrupted during this period. The figures of violence against women, and child sexual abuse are increasingly being reported during the lockdown and thereafter. To mitigate this, a response against VAWG should not be a missing agenda. This commentary focuses on the situation of VAWG during COVID-19 induced restrictions in Nepal and offers a way forward for addressing the issue.
Single-wall carbon nanotubes improve cell survival rate and reduce oxidative injury in cryopreservation of Agapanthus praecox embryogenic callus
Authors: Ren Li , Deng Shan , Chu Yunxia , Zhang Yiying , Zhao Hong , Chen Hairong , Zhang Di 
Published: September 2020

Abstract
Background
Cryopreservation is the best way for long-term in vitro preservation of plant germplasm resources. The preliminary studies found that reactive oxygen species (ROS) induced oxidative stress and ice-induced membrane damage are the fundamental causes of cell death in cryopreserved samples. How to improve plant cryopreservation survival rate is an important scientific issue in the cryobiology field.

Results
This study found that the survival rate was significantly improved by adding single-wall carbon nanotubes (SWCNTs) to plant vitrification solution (PVS) in cryopreservation of Agapanthus praecox embryogenic callus (EC), and analyzed the oxidative response of cells during the control and SWCNTs-added cryopreservation protocol. The SWCNTs entered EC at the step of dehydration and mainly located around the cell wall and in the vesicles, and most of SWCNTs moved out of EC during the dilution step. Combination with physiological index and gene quantitative expression results, SWCNTs affect the ROS signal transduction and antioxidant system response during plant cryopreservation. The EC treated by SWCNTs had higher antioxidant levels, like POD, CAT, and GSH than the control group EC. The EC mainly depended on the AsA-GSH and GPX cycle to scavenge H2O2 in the control cryopreservation, but depended on CAT in the SWCNTs-added cryopreservation which lead to low levels of H2O2 and MDA. The elevated antioxidant level in dehydration by adding SWCNTs enhanced cells resistance to injury during cryopreservation. The ROS signals of EC were balanced and stable in the SWCNTs-added cryopreservation.

Conclusions
The SWCNTs regulated oxidative stress responses of EC during the process and controlled oxidative damages by the maintenance of ROS homeostasis to achieve a high survival rate after cryopreservation. This study is the first to systematically describe the role of carbon nanomaterial in the regulation of plant oxidative stress response, and provided a novel insight into the application of nanomaterials in the field of cryobiology.
Applying population health approaches to improve safe anticoagulant use in the outpatient setting: the DOAC Dashboard multi-cohort implementation evaluation study protocol
Authors: Barnes Geoffrey D. , Sippola Emily , Dorsch Michael , Errickson Joshua , Lanham Michael , Allen Arthur , Spoutz Patrick , Sales Anne E. , Sussman Jeremy 
Published: September 2020

Abstract
Background
Use of direct oral anticoagulants (DOAC) is rapidly growing for treatment of atrial fibrillation and venous thromboembolism. However, incorrect dosing of these medications is common and puts patients at risk of adverse drug events. One way to improve safe prescribing is the use of population health tools, including interactive dashboards built into the electronic health record (EHR). As such tools become more common, exploring ways to understand which aspects are effective in specific settings and how to effectively adapt and implement in existing anticoagulation clinics across different health systems is vital.

Methods
This three-phase project will evaluate a current nation-wide implementation effort of the DOAC Dashboard in the Veterans Health Administration (VHA) using both quantitative and qualitative methods. Informed by this evaluation, the DOAC Dashboard will be implemented in four new health systems using an implementation strategy derived from the VHA experience and interviews with providers in those new health systems. Quantitative evaluation of the VHA and non-VHA implementation will follow the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Qualitative interviews with stakeholders will be analyzed using the Consolidated Framework for Implementation Research and Technology Acceptance Models to identify key determinants of implementation success.

Discussion
This study will (1) evaluate the implementation of an EHR-based population health tool for medication management within a large, nation-wide, highly integrated health system; (2) guide the adoption in a set of four different health systems; and (3) evaluation that multi-center implementation effort. These findings will help to inform future EHR-based implementation efforts in a wide variety of health care settings.