bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-course radiotherapy combined with CAPOX and Toripalimab for the total neoadjuvant therapy of locally advanced rectal cancer: a randomized, prospective, multicentre, double-arm, phase II trial (TORCH)
Authors: Wang Yaqi , Shen Lijun , Wan Juefeng , Zhang Hui , Wu Ruiyan , Wang Jingwen , Wang Yan , Xu Ye , Cai Sanjun , Zhang Zhen , Xia Fan 
Published: March 2022

Abstract
Background
For patients with locally advanced (T3-4/N +) rectal cancer (LARC), the standard treatment is neoadjuvant chemoradiotherapy combined with total mesorectal resection, which greatly decreases local recurrence but does not improve overall survival. For patients who achieve a complete clinical response (cCR) after nCRT, a “Watch & Wait” (W&W) approach can be received to improve quality of life. Currently, total neoadjuvant therapy (TNT) has been demonstrated to increase the complete response rate and achieve early control of distant metastasis. Recent studies have shown promising synergistic effects of the combination of immunotherapy (PD-1/PD-L1 antibodies) and radiotherapy. Thus, for LARC patients, the combination of immunotherapy and TNT is likely to further improve the rate of complete response and prognosis. The disparities between induction therapy and consolidation therapy need to be investigated.

Methods
TORCH is a randomized, prospective, multicentre, double-arm, phase II trial of short-course radiotherapy (SCRT) combined with chemotherapy and immunotherapy in LARC. 130 LARC patients will be treated with the TNT approach and assigned to the consolidation arm and induction arm. The consolidation arm will receive SCRT, followed by 6 cycles of capecitabine plus oxaliplatin (CAPOX) and Toripalimab. The induction arm will first receive 2 cycles of CAPOX and Toripalimab, then receive SCRT, followed by 4 cycles of CAPOX and Toripalimab. Both groups will receive curative surgery or the W&W strategy. The primary endpoint is the complete response rate (rate of pCR plus cCR). The secondary endpoints include the grade 3–4 acute adverse effects rate, 3-year disease-free survival (DFS) rate, 3-year local recurrence-free survival (LRFS) rate, 3-year OS rate, rate of surgical complications and quality of life (QoL) scores. The “pick the winner” method is used to investigate the better treatment regimen. The trial was opened on 13th April 2021, and the first patient was recruited on 6th May 2021.

Discussion
TORCH will investigate whether SCRT combined with chemotherapy and Toripalimab can achieve better complete response rates, good tolerance and prognosis in LARC patients. This is the first clinical trial to compare the efficacy of induced immunotherapy and consolidative immunotherapy based on the TNT strategy.

Trial registration
Trial Registration Number and Date of Registration: ClinicalTrials.gov NCT04518280, August 15, 2020.
Mendelian randomization study of circulating lipids and biliary tract cancer among East Asians
Authors: Wang Jun , Zhuge Jinke , Feng Dongxu , Zhang Bo , Xu Jianying , Zhao Dongkang , Fei Zhewei , Huang Xia , Shi Wenjie 
Published: March 2022

Abstract
Background
Associations of High-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol (CHL), and triglyceride (TRG) concentrations with risk of biliary tract cancer (BtC) were conflicting in observational studies. We aim to investigate the causal link between circulating lipids and BtC using genetic information.

Methods
Single nucleotide polymorphisms of the four circulating lipids (n = 34,421) and BtC (418 cases and 159,201 controls) were retrieved from two independent GWAS studies performed in East Asian populations. Two-sample univariate and multivariate Mendelian Randomization (MR) analyses were conducted to determine the causal link between circulating lipids and BtC.

Results
No significant horizontal pleiotropy was detected for all circulating lipids according to the MR-PRESSO global test (P = 0.458, 0.368, 0.522, and 0.587 for HDL, LDL, CHL, and TRG, respectively). No significant evidence of heterogeneity and directional pleiotropy was detected by the Cochran’s Q test and MR-Egger regression. Univariate MR estimates from inverse variance weighting method suggested that one standard deviation (1-SD) increase of inverse-normal transformed HDL (OR = 1.38, 95% CI 0.98–1.94), LDL (OR = 1.46, 95% CI 0.96–2.23), and CHL (OR = 1.34, 95% CI 0.83–2.16) were not significantly associated with BtC risk. Whereas 1-SD increase of inverse-normal transformed TRG showed a significantly negative association with BtC risk (OR = 0.48, 95% CI 0.31–0.74). In multivariate MR analyses including all the four lipid traits, we found that 1-SD increase of LDL and TRG was significantly associated with elevated (OR = 1.32, 95% CI 1.04–2.01) and decreased (OR = 0.54, 95% CI 0.42–0.68) risk of BtC, respectively.

Conclusion
Circulating lipids, particularly LDL and TRG, may have roles in the development of BtC. However, the results of this study should be replicated in MR with larger GWAS sample sizes for BtC.
Emotional distress in COVID-19 patients in Maldives
Authors: Dey Rajib Kumar , Mansoor Shanooha , Hilmy Abdullah Isneen , Moosa Sheena , Rahman Shiraany Abdul , Latheef Raishan , Rasheed Nihla , Hassan Fathimath Guraishaa , Zaadhee Ali , Ibrahim Afa , Usman Sofoora Kawsar 
Published: March 2022

Abstract
Background and objectives
Researchers are exploring the epidemiology, clinical characteristics, treatment, vaccination and the challenges faced by healthcare authorities. However less focus is being paid towards the impact of COVID-19 on mental health of the patients. This study is a cross-sectional study, measuring the prevalence of emotional distress among patients with COVID-19 in the Maldivian population.

Methods
This study was conducted in Maldivian nations above 18 of age with COVID-19 who were admitted in isolation facilities. Patients who were on treatment for any other chronic medical conditions, severe and critical COVID-19 disease were excluded. This study was conducted over a period of 2 months by administering a local translated version of DASS21 questionnaire.

Results
The total of 195 patients were included in this study. The mean age of the patients was 40 (CI at 95% 38–42) years. The respondents were 48.7% men and 51.3% women. Overall, 9% of patients with COVID-19 had depression while 23% of patients had anxiety and 12% of the patients had stress. There was a statistically significant relationship between gender and depression, anxiety and stress (p < 0.01). Symptomatic cases had a significantly higher level of stress than asymptomatic patients (p < 0.05), but no significant association was observed with symptomatic status and anxiety or depression.

Conclusion
The management of patients with COVID-19 should be multi-disciplinary with special focus on the mental wellbeing of our patients. We should aim to establish proper communication with the patients in order to identify emotional distress and provide appropriate mental health care.
Impact of the first national COVID-19 lockdown on referral of women experiencing domestic violence and abuse in England and Wales
Authors: Panovska-Griffiths Jasmina , Szilassy Eszter , Johnson Medina , Dixon Sharon , De Simoni Anna , Wileman Vari , Dowrick Anna , Emsley Elizabeth , Griffiths Chris , Barbosa Estela Capelas , Feder Gene 
Published: March 2022

Abstract
Background
The lockdown periods to curb COVID-19 transmission have made it harder for survivors of domestic violence and abuse (DVA) to disclose abuse and access support services. Our study describes the impact of the first COVID-19 wave and the associated national lockdown in England and Wales on the referrals from general practice to the Identification and Referral to Improve Safety (IRIS) DVA programme. We compare this to the change in referrals in the same months in the previous year, during the school holidays in the 3 years preceding the pandemic and the period just after the first COVID-19 wave. School holiday periods were chosen as a comparator, since families, including the perpetrator, are together, affecting access to services.

Methods
We used anonymised data on daily referrals received by the IRIS DVA service in 33 areas from general practices over the period April 2017–September 2020. Interrupted-time series and non-linear regression were used to quantify the impact of the first national lockdown in March–June 2020 comparing analogous months the year before, and the impact of school holidays (01/04/2017–30/09/2020) on number of referrals, reporting Incidence Rate Ratio (IRR), 95% confidence intervals and p-values.

Results
The first national lockdown in 2020 led to reduced number of referrals to DVA services (27%, 95%CI = (21,34%)) compared to the period before and after, and 19% fewer referrals compared to the same period in the year before. A reduction in the number of referrals was also evident during the school holidays with the highest reduction in referrals during the winter 2019 pre-pandemic school holiday (44%, 95%CI = (32,54%)) followed by the effect from the summer of 2020 school holidays (20%, 95%CI = (10,30%)). There was also a smaller reduction (13–15%) in referrals during the longer summer holidays 2017–2019; and some reduction (5–16%) during the shorter spring holidays 2017–2019.

Conclusions
We show that the COVID-19 lockdown in 2020 led to decline in referrals to DVA services. Our findings suggest an association between decline in referrals to DVA services for women experiencing DVA and prolonged periods of systemic closure proxied here by both the first COVID-19 national lockdown or school holidays. This highlights the need for future planning to provide adequate access and support for people experiencing DVA during future national lockdowns and during the school holidays.
Exploring perceived risk for COVID-19 and its role in protective behavior and COVID-19 vaccine hesitancy: a qualitative study after the first wave
Authors: Patterson Naomi J. , Paz-Soldan Valerie A. , Oberhelman Richard , Moses Lina , Madkour Aubrey , Miles Thomas T. 
Published: March 2022

Abstract
Background
The novel coronavirus pandemic (COVID-19) has had severe impacts on morbidity and mortality globally.

Methods
This study was set in rural central Kentucky and included participants recruited from public spaces. Fifteen qualitative interviews about personal experiences during the COVID-19 pandemic were conducted by phone from July 3 to July 24, 2020. Interviews were recorded, transcribed, and coded using a grounded theory approach.

Results
Participants who perceived COVID-19 to be a severe risk tended to have personal health concerns and therefore reported taking protective measures for themselves. A slightly smaller proportion of participants reported taking measures to protect others (particularly family). A minority of participants had an ambivalent attitude towards the risk and only took measures if required. COVID-19 vaccine acceptability was low with most participants expressing concerns regarding their need for a vaccine, safety of this vaccine, the value of personal rights, or future vaccine supply.

Conclusions
Most participants perceived some risk of COVID-19 and took steps to prevent infections in themselves and others. Mandates for mask use in certain locations were additionally useful for those who had an ambivalent attitude towards the risk of illness. There was surprisingly little connection between perceiving COVID-19 risk and a desire for the COVID-19 vaccine. In this setting, vaccine acceptability was low, with vaccine concerns outweighing perceived potential benefits. In conclusion, because the risk was often constructed in terms of worries for themselves and others, the framing of health education materials for protective behaviors in these terms may be effective. Furthermore, future COVID-19 vaccine education should address vaccine knowledge and concerns, such as the need for a vaccine and its safety, and emphasize how a vaccination would reduce their chances of severe disease if they were to get sick.
Association between smokeless tobacco use and cigarette smoking amount by age
Authors: Noh Jin-Won , Kim Min-Hee , Lee Yejin , Kwon Young Dae , Kim Kyoung-Beom , Lee Hae-Jeung , Yoo Ki-Bong 
Published: March 2022

Abstract
Background
The use of smokeless tobacco has increased worldwide among young people. This study aimed to investigate the association between smokeless tobacco use and cigarette smoking amount in adult smoker groups stratified by age.

Method
2013–2015 National Health Interview Survey was used. A total of 19,635 subjects were included in our analysis. Propensity score matching was used to adjust for selection and any other bias. Generalized estimating equation was used to analyze the association between smokeless tobacco use and cigarette smoking amount by age.

Results
All 580 smokeless tobacco users were matched to 2,900 non-smokeless tobacco users. Among those who were aged under 30, smokeless tobacco use was positively associated with the number of cigarettes used per day. Smokeless tobacco users who were aged under 30 and tried quitting smoking used more cigarettes than those who did non-smokeless tobacco users.

Conclusions
The present study revealed that among those who were aged under 30, smokeless tobacco use was positively associated with the number of cigarettes used per day. This study could contribute to understand the behaviors and tendencies of smoking in young adulthood and to establish effective smoking cessation methods for their age.
The effect of smartphones on the self-rated health levels of the elderly
Authors: Liang Xian , Xiong Feixue , Xie Fangting 
Published: March 2022

Abstract
Background
Due to the penetration of Internet use and the popularity of “Internet + elderly care” among seniors in recent years, the elderly are gradually integrating into the information society. This study examined the impact of smartphones on the self-rated health levels of the elderly.

Methods
We studied 3042 elderly people over 55 years of age in Jiangxi, China in 2018. The effect of smartphones was measured from three aspects: smartphone usage, smartphone usage ability, and smartphone usage purpose, and the multivariate ordered logistic model was applied. Furthermore, considering the potential endogeneity of the smartphone usage of elderly people, the propensity score matching (PSM) method was used to analyze the net effect of smartphones on the health levels of the elderly.

Results
(1) The use of smartphones had a significant positive impact on the self-rated health levels of the elderly, with its significance being at the level of 1%. Smartphone usage ability, and using smartphone to learn or search for health information, had significant positive impacts (at the level of 5%) on the self-rated health levels of the elderly. (2) The k-nearest neighbor matching, kernel matching and radius matching methods were used to calculate the net effect of smartphone usage on the self-rated health levels of the elderly. The results were 13.26, 15.33 and 14.80%, respectively. (3) The age of the participants significantly (at the level of 1%) negatively affected their self-rated health levels. Other characteristics of the elderly, including income, education level, living with children or spouse and children’s living conditions, significantly (all at the level of 1%) positively affected their self-rated health levels.

Conclusions
Smartphone usage, smartphone usage ability, and smartphone usage purposes all improved the self-rated health of the elderly. The Internet factor should be focused on in the process of active aging. We should improve the Internet use ability of the elderly through voluntary training or public lectures.
Patients with combined pelvic and spinal injuries have worse clinical and operative outcomes than patients with isolated pelvic injuries analysis of the German Pelvic Registry
Authors: Navas Luis , Mengis Natalie , Zimmerer Alexander , Rippke Jules-Nikolaus , Schmidt Sebastian , Brunner Alexander , Wagner Moritz , Höch Andreas , Histing Tina , Herath Steven C. , Küper Markus A. , Ulmar Benjamin 
Published: March 2022

AbstractBackgroundPelvic fractures are often associated with spine injury in polytrauma patients. This study aimed to determine whether concomitant spine injury influence the surgical outcome of pelvic fracture.MethodsWe performed a retrospective analysis of data of patients registered in the German Pelvic Registry between January 2003 and December 2017. Clinical characteristics, surgical parameters, and outcomes were compared between patients with isolated pelvic fracture (group A) and patients with pelvic fracture plus spine injury (group B). We also compared apart patients with isolated acetabular fracture (group C) versus patients with acetabular fracture plus spine injury (group D).ResultsSurgery for pelvic fracture was significantly more common in group B than in group A (38.3% vs. 36.6%;p = 0.0002), as also emergency pelvic stabilizations (9.5% vs. 6.7%;p < 0.0001). The mean time to emergency stabilization was longer in group B (137 ± 106 min vs. 113 ± 97 min;p < 0.0001), as well as the mean time until definitive stabilization of the pelvic fracture (7.3 ± 4 days vs. 5.4 ± 8.0 days;p = 0.147). The mean duration of treatment and the morbidity and mortality rates were all significantly higher in group B (p < 0.0001). Operation time was significantly shorter in group C than in group D (176 ± 81 min vs. 203 ± 119 min,p < 0.0001). Intraoperative blood loss was not significantly different between the two groups with acetabular injuries. Although preoperative acetabular fracture dislocation was slightly less common in group D, postoperative fracture dislocation was slightly more common. The distribution of Matta grades was significantly different between the two groups. Patients with isolated acetabular injuries were significantly less likely to have neurological deficit at discharge (94.5%;p < 0.0001). In-hospital complications were more common in patients with combined spine plus pelvic injuries (groups B and D) than in patients with isolated pelvic and acetabular injury (groups A and C).ConclusionsDelaying definitive surgical treatment of pelvic fractures due to spinal cord injury appears to have a negative impact on the outcome of pelvic fractures, especially on the quality of reduction of acetabular fractures.
Effect of loading history on material properties of human heel pad: an in-vivo pilot investigation during gait
Authors: Teng Zhao-lin , Yang Xiong-gang , Geng Xiang , Gu Yan-jie , Huang Ran , Chen Wen-ming , Wang Chen , Chen Li , Zhang Chao , Helili Maimaitirexiati , Huang Jia-zhang , Wang Xu , Ma Xin 
Published: March 2022

AbstractBackgroundThis study was aimed to develop a novel dynamic measurement technique for testing the material properties and investigating the effect of continuous compression load on the structural and mechanical properties of human heel pad during actual gait.MethodsThe dual fluoroscopic imaging system (DFIS) and dynamic foot-ground contact pressure-test plate were used for measuring the material properties, including primary thickness, peak strain, peak stress, elastic modulus, viscous modulus and energy dissipation rate (EDR), both at time zero and following continuous loading. Ten healthy pilot subjects, aged from 23 to 72 (average: 46.5 ± 17.6), were enrolled. A “three-step gait cycle” is performed for all subjects, with the second step striking at a marked position on the force plate with the heel to maintain the location of the tested foot to be in the view of fluoroscopes. The subjects were measured at both relaxed (time-zero group) and fatigue (continuous-loading group) statuses, and the left and right heels were measured using the identical procedures.ResultsThe peak strain, peak stress, elastic modulus, and EDR are similar before and after continuous load, while the viscous modulus was significantly decreased (median: 43.9 vs. 20.37 kPa•s;p < 0.001) as well as primary thicknesses (median: 15.99 vs. 15.72 mm;p < 0.001). Age is demonstrated to be moderately correlated with the primary thicknesses both at time zero (R = -0.507) and following continuous load (R = -0.607). The peak stress was significantly correlated with the elastic modulus before (R = 0.741) and after continuous load (R = 0.802). The peak strain was correlated with the elastic modulus before (R = -0.765) and after continuous load (R = -0.801). The correlations between the viscous modulus and peak stress/ peak strain are similar to above(R = 0.643, 0.577, − 0.586 and − 0.717 respectively). The viscous modulus is positively correlated with the elastic modulus before (R = 0.821) and after continuous load (R = 0.784).ConclusionsBy using dynamic fluoroscopy combined with the plantar pressure plate, the in vivo viscoelastic properties and other data of the heel pad in the actual gait can be obtained. Age was negatively correlated with the primary thickness of heel pad and peak strain, and was positively correlated with viscous modulus. Repetitive loading could decrease the primary thickness of heel pad and viscous modulus.
Study of occlusal acoustic parameters in assessing masticatory performance
Authors: Xia Yue , Wang Lu 
Published: March 2022

Abstract
Background
Previous masticatory studies have focused on a variety of measurements of foods and boluses or kinematic parameters and sound during mastication. To date, the masticatory sound research of has been limited due to the difficulties of sound collection and accurate analysis. Therefore, significant progress in masticatory sound has not been made. Meanwhile, the correlation between acoustic parameters and mastication performance remains unclear. For the purpose of exploring the acoustic parameters in measuring mastication performance, the bone-conduction techniques and sound analysis were used, and a statistical analysis of acoustic and occlusal parameters were conducted.

Methods
The gnathosonic and chewing sounds of fifty-six volunteers with healthy dentate were recorded by a bone-conduction microphone and further analyzed by Praat 5.4.04 when intercuspally occluding natural foods (peanuts) were consumed. The granulometry of the expectorated boluses from the peanuts was characterized by the median particle size of the whole chewing sequence (D50a) and the median particle size during the fixed chewing strokes (D50b). The chewing time of the whole chewing sequence (CTa), the chewing time of the fixed chewing strokes (CTb), the chewing cycles (CC), and the chewing frequency (CF) were recorded and analyzed by the acoustic software. The acoustic parameters, including gnathosonic pitch, gnathosonic intensity, mastication sound pitch of the whole chewing sequence (MPa), mastication sound pitch of the fixed chewing strokes (MPb), mastication sound intensity of the whole chewing sequence (MIa) and mastication sound intensity of the fixed chewing strokes (MIb), were analyzed. Independent sample t-test, Spearman and Pearson correlation analyses were used where applicable.

Results
Significant difference in parameters CC, MIa, CF and D50a were found by sex (t-test, p < 0.01). The masticatory degree of the test foods was higher in women (CC, 24.25 ± 5.23; CF, 1.70 ± 0.21 s−1; D50a, 1655.07 ± 346.21 μm) than in men (CC, 18.14 ± 6.38; CF, 1.48 ± 0.18 s−1; D50a, 2159.21 ± 441.26 μm). In the whole chewing sequence study, a highly negative correlation was found between MIa and D50a, and a highly positive correlation was found between MIa and CF (r =  − 0.94, r = 0.82, respectively, p < 0.01). No significant correlation was found between the remaining acoustic parameters and mastication parameters. In the fixed chewing strokes study, a highly negative correlation was found between MIb and D50b (r =  − 0.85, p < 0.01). There was no significant correlation between the rest of the acoustic parameters and the mastication parameters.

Conclusions
Mastication sound intensity may be a valuable indicator for assessing mastication. Acoustic analysis can provide a more convenient and quick method of assessing mastication performance.