Health and care workers in long-term care facilities and their role in preventing emerging infectious diseases: A scoping review.

BACKGROUND: The COVID-19 pandemic has had a tremendous impact on healthcare systems worldwide. In particular, long-term care facilities have proved more susceptible to infection as they care for vulnerable populations at high risk of chronic illness. How this impacts the role and core competencies of health and care workers in these facilities remains less understood. AIM: Describe how health and care workers contribute to the prevention of emerging infectious diseases in long-term care facilities. DESIGN: A scoping review. METHODS: A systematic search of literature dating from 2002 to 2022 was conducted in the following databases: EMBASE, Medline (Ovid), Cochrane Library, CINAHL Plus with Full Text (EBSCOhost), Web of Science, and AgeLine. Studies were selected if they focused on health and care workers in long-term care facilities, offered a perspective on the prevention of emerging infectious diseases or infection prevention and control, and were original qualitative or quantitative studies in English. Data were extracted, cross-checked and analyzed by two researchers, and any difference in views regarding the appropriateness of literature would be resolved by consulting a third researcher. An inductive descriptive approach was applied for the analysis of results, and themes were established via consensus meetings. RESULTS: A total of fourteen studies from Asia, Europe, and the Americas were included. Three themes emerged from the review: "The roles of health and care workers evolve with the times", "The core competencies of health and care workers are essential for preventing emerging infectious diseases in long-term care facilities" and "The key to successful prevention of emerging infectious diseases in long-term care facilities is through a systematic, comprehensive effort that mobilize health and care workers at all levels". Health and care workers had to take on increasingly complex roles and rely on their core competencies to cope with epidemic changes, and facility resources, employee quality and management models were found to have significantly improved infection prevention and control outcomes. CONCLUSIONS: The roles of health and care workers are evolving, and effective infection prevention within long-term care facilities depends on their ability to perform core competencies with skill and confidence. Moreover, a systematic, comprehensive framework, for which this paper proposes three guidelines, is urgently needed to ensure consistent policy implementation within the facility as well as support and access to resources for health and care workers. CLINICAL RELEVANCE: Infection prevention efforts within long-term care facilities must take into account the evolving roles of health and care workers, with a focus on guaranteeing access to resources, training and support that will help them gain the core competencies necessary for juggling those roles. In addition, there is an urgent need for research instruments that will help assess those competencies and identify areas of improvement.

Effectiveness of sound and darkness interventions for critically ill patients' sleep quality: A systematic review and component network meta-analysis.

BACKGROUND: Noise and lighting are prime factors of poor sleep quality in critically ill patients, which impair recovery and increase the risk of delirium or complications. AIM: To identify and rank the effectiveness of sound and darkness interventions on the sleep quality of critically ill patients. STUDY DESIGN: This systematic review and component network meta-analysis was based on the Preferred Reporting Items for Systematic Reviews incorporating the Network Meta-Analyses (PRISMA-NMA) Statement. The Embase, MEDLINE, Cochrane CENTRAL, CINAHL, Airiti Library, and Google Scholar databases were searched from inception to August 10, 2021, for randomized controlled trials (RCTs) on sound and darkness interventions targeting critically ill patients' sleep quality. We applied standard and component NMA to determine the effects of interventions. The certainty of evidence was evaluated using the Cochrane risk-of-bias tool (V.2.0) and the online Confidence in Network Meta-Analysis (CINeMA) application. RESULTS: Twenty-four RCTs with 1507 participants who used combined interventions constituting seven competing interventions were included in the standard NMA. The combination of earplugs, eye masks, and music; eye masks alone; earplugs combined with eye masks; and music alone had beneficial intervention effects. The combination of earplugs, eye masks, and music was the best intervention, and these components had no interaction effect. An eye mask had the best relative effect, followed by music, quiet time, and earplugs. CONCLUSIONS: This study provides clinical evidence of the effectiveness of using eye masks, music, and earplugs to improve sleep quality in critically ill patients. We also recommend future research using bedtime music, nocturnal eye masks, and quiet time, which had the best relative effects on sleep quality. RELEVANCE TO CLINICAL PRACTICE: This study provides recommendations for interventions that nurses can use to improve critically ill patients' sleep quality.

"Bone-SASP" in Skeletal Aging.

Senescence is a complex cell state characterized by stable cell cycle arrest and a unique secretory pattern known as the senescence-associated secretory phenotype (SASP). The SASP factors, which are heterogeneous and tissue specific, normally include chemokines, cytokines, growth factors, adhesion molecules, and lipid components that can lead to multiple age-associated disorders by eliciting local and systemic consequences. The skeleton is a highly dynamic organ that changes constantly in shape and composition. Senescent cells in bone and bone marrow produce diverse SASP factors that induce alterations of the skeleton through paracrine effects. Herein, we refer to bone cell-associated SASP as "bone-SASP." In this review, we describe current knowledge of cellular senescence and SASP, focusing on the role of senescent cells in mediating bone pathologies during natural aging and premature aging syndromes. We also summarize the role of cellular senescence and the bone-SASP in glucocorticoids-induced bone damage. In addition, we discuss the role of bone-SASP in the development of osteoarthritis, highlighting the mechanisms by which bone-SASP drives subchondral bone changes in metabolic syndrome-associated osteoarthritis.

Efficacy of brief behavioural therapy for insomnia in older adults with chronic insomnia: a systematic review and meta-analysis from randomised trials.

BACKGROUND: chronic insomnia is a highly prevalent and persistent health concern among older adults, and it has significant adverse effects on cognitive function and physical health. OBJECTIVES: the study aimed to evaluate the efficacy of a brief 4-week behavioural therapy for insomnia (BBTi) on insomnia remission in older adults with chronic insomnia. DESIGN: a systematic review and meta-analysis were conducted. SUBJECTS: adults aged 60 years or older. METHODS: eight electronic databases were systematically searched through the end of March 2022. Studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. RESULTS: four randomised controlled trials (190 subjects) were included. The mean age of the participants was 69.06 (65.10-71.65), and 29.9% (27.3-32.3%) were male. Older adults who received the BBTi showed a significant insomnia remission (standardised mean differences, -1.07; 95% confidence interval, -1.43 to -0.71; I2, 0%). Sleep parameters measured by actigraphy revealed that in older adults, the BBTi program significantly improved total sleep time, wake after sleep onset (WASO), sleep onset latency (SOL) and sleep efficacy (SE) compared to the controls. For the subjective sleep parameters measured the by sleep diary, older adults who received BBTi obtained a more effective improvement in WASO, SE and SOL. The overall risk of bias was mostly low or of some concern due to the difficulty of blinding participants and assessors. CONCLUSIONS: a 4-week BBTi program can be considered an effective and nonselective intervention for insomnia remission among older adults with chronic insomnia and thereby has the potential to ameliorate WASO, SE and SOL.

Effectiveness of outpatient geriatric evaluation and management intervention on survival and nursing home admission: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The benefit of inpatient comprehensive geriatric assessment on patient survival and function has been demonstrated among frail older patients. However, the influence of outpatient geriatric evaluation and management (GEM) on clinical outcomes remains debated. This study aimed to update the research evidence detailing the effect of outpatient GEM on survival and nursing-home admission through a comparison with conventional care. METHODS: Cochrane Library, EMBASE, and MEDLINE databases were searched up to January 29th, 2022, to identify randomized controlled trials (RCTs) including older people over age 55 that compared outpatient GEM with conventional care on mortality (primary outcome) and nursing-home admission (secondary outcome) during a follow-up period of 12 to 36 months. RESULTS: Nineteen reports from 11 studies that recruited 7,993 participants (mean age 70-83) were included. Overall, outpatient GEM significantly reduced mortality (risk ratio (RR) = 0.87, 95% confidence interval (CI) = 0.77-0.99, I2 = 12%). For the subgroup analysis categorized by different follow-up periods, its prognostic benefit was only disclosed for 24-month mortality (RR = 0.68, 95% CI = 0.51-0.91, I2 = 0%), but not for 12- or 15 to 18-month mortality. Furthermore, outpatient GEM had significantly trivial effects on nursing-home admission during the follow-up period of 12 or 24 months (RR = 0.91, 95% CI = 0.74-1.12, I2 = 0%). CONCLUSIONS: Outpatient GEM led by a geriatrician with a multidisciplinary team improved overall survival, specifically during the 24-month follow-up period. This trivial effect was demonstrated in rates of nursing-home admission. Future research on outpatient GEM involving a larger cohort is warranted to corroborate our findings.

Effect of massage therapy on sleep quality in critically ill patients: A systematic review and meta-analysis.

AIM: The aim of the study was to compare the effects of massage interventions on sleep quality among patients in the adult critical care unit. BACKGROUND: Massage interventions have positive effects when applied to manage sleep quality in critical care units. However, research identifying the effect of massage intervention is limited. DESIGN: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHODS: Five databases were searched from their inception to 15 April 2022 (the last search was conducted on 15 November 2022, but it yielded no additional eligible studies). The literature search was conducted using Embase, MEDLINE, the Cochrane Library, CINAHL, PsycINFO and additional sources such as Google Scholar. The Cochrane risk of bias tool for randomised trials (RoB 2.0) was used to assess the risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system assessed the certainty of evidence and recommendations. RESULTS: In total, ten randomised controlled trials comprising 569 participants were used in the systematic review, and eight trials were included in the meta-analysis. Subgroup analysis revealed significant effects of foot reflexology massage on subjective sleep quality. Massage therapy for a two-night duration in cardiac care unit patients exhibited a significant effect on subjective sleep quality. The overall GRADE certainty of evidence was low. CONCLUSION: Massage intervention, particularly foot reflexology massage, with a two-night duration showed improvement in subjective sleep quality among critically ill patients. Although evidence quality was low, the results suggest that massage interventions provide a non-invasive, low-cost and effective way to promote sleep quality in critically ill adult patients. RELEVANCE TO CLINICAL PRACTICE: Massage interventions can enable nurses to recommend and implement strategies promoting and improving sleep quality among critically ill patients. STUDY REGISTRATION: The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.York.ac.uk/Prospero with the registration number # CRD42022332371). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution if such details are not necessary or do not apply to your work and state why.

Combined Left Ventricular Ejection Fraction and N-Terminal pro-B-type Natriuretic Peptide after Sacubitril/Valsartan for Predicting Outcomes in Patients with Heart Failure with Reduced Ejection Fraction.

Background: The aim of this study was to determine whether a combined increase of ≥ 10% in left ventricular ejection fraction (LVEF) and decrease in N-terminal pro-B-type natriuretic peptide (NT pro-BNP) to < 1000 pg/mL after treatment with sacubitril/valsartan (SAC/VAL) in patients with heart failure with reduced ejection fraction (HFrEF) translated to better treatment outcomes in a real-world Taiwanese population. Methods: This is a single-center, prospective, non-randomized, observational study. Consecutive patients with HFrEF were treated with SAC/VAL and followed up for at least 12 months. The primary endpoint was a change in LVEF and reduction in NT pro-BNP at 12 months. The secondary outcomes were death and heart failure (HF) rehospitalization. Results: A total of 105 patients were analyzed after 12 months of SAC/VAL treatment. The mean age was 66.0 ± 11.6 years, and the mean LVEF and NT pro-BNP were 33.6 ± 6.7% and 4462.7 ± 5851.7 pg/mL respectively. The mean LVEF significantly increased to 50.5 ± 10.3% (p < 0.001), while NT pro-BNP decreased to 1270.3 ± 2368.2 pg/mL (p = 0.001) at 12 months, with the greatest changes occurring in the first 3 months of treatment (p < 0.001). Five patients died and 12 were rehospitalized for HF. None of the patients in the responder group died compared to 5 deaths in the non-responder group (p = 0.039). Combined ≥ 10% LVEF increase and NT pro-BNP of < 1000 pg/mL was an independent predictor of death and HF rehospitalization (p = 0.019). Conclusions: SAC/VAL treatment resulted in significant improvements in LVEF, reduced NT pro-BNP level, death and HF hospitalization. Taken separately, an NT pro-BNP level of < 1000 pg/mL was a better predictor than ≥ 10% LVEF increase. Combining both variables predicted fewer deaths and HF rehospitalizations. Even with failure to reach the target dose, SAC/VAL still had significantly beneficial treatment outcomes in Taiwanese patients.

Effect of Vitamin B2 supplementation on migraine prophylaxis: a systematic review and meta-analysis.

OBJECTIVE: Migraine is a common disease worldwide and migraine prevention is primarily currently based on pharmaceuticals. The mechanism of Vitamin B2 may positively contribute to migraine. This systematic review and meta-analysis aimed to evaluate the impact of Vitamin B2 supplementation on the days, duration, frequency, and pain score of the migraine attack. METHODS: : The PRISMA guideline was used for the studying process. Five electronic databases, PubMed, Embase, Cochrane, CINAHL, and CEPS were searched from 1990 to March 2019. The search terms were Vitamin B2, migraine, and prophylactic. A meta-analysis was performed using Comprehensive Meta-Analysis (CMA) version. RESULTS: : Nine articles were included in systemic review and finally meta-analysis. Eight randomized controlled trials and one controlled clinical trial with 673 subjects were analyzed using meta-analysis. Vitamin B2 supplementation significantly decreased migraine days (p = .005, I2 = 89%), duration (p = .003, I2 = 0), frequency (p = .001, I2 = 65%), and pain score (p = .015, I2 = 84%). CONCLUSIONS: A pooled analysis of available randomized controlled clinical trials demonstrated that Vitamin B2 400 mg/day for three months supplementation had significant effect on days, duration, frequency, and pain score of migraine attacks.

On-Demand Energy Transfer and Energy-Aware Polling-Based MAC for Wireless Powered Sensor Networks.

To improve the performance of the wireless powered sensor network (WPSN), this paper proposes a frequency division duplex (FDD)-based on-demand energy transfer protocol and an energy-aware polling-based medium access control (MAC) protocol, called composite energy and data first (CEDF), by using the numbers of data packets and energy packets to determine polling priorities. The performance of the proposed MAC protocol, i.e., CEDF, along with the on-demand energy transfer protocol was evaluated through simulations, with comparison to the closely related protocols such as the round robin (RR) and data first (DF) polling protocols. Compared with RR and DF, our proposed CEDF performs much better in terms of throughput, data packet loss rate, and delay. Additionally, the doubly near-far problem in WPSNs under our proposed on-demand energy transfer protocol and CEDF was investigated to come up with good solutions to alleviate such a problem.

A study of regular exercise, social support and depression in the community-dwelling older people.

AIMS: This study aims to explore the relationship between regular exercise, social support and depression in community-dwelling older people and find out the predictors of depression. METHODS: Cross-sectional and correlation designs were used. The participants were recruited from August to October in 2020. The STROBE was used as a checklist for this study. RESULTS: The study found that female gender, older age, poor sleep quality, irregular exercise and low social support were the main predictors of depression among the community-dwelling older people. CONCLUSION: It is suggested that healthcare professionals motivate the older people to exercise regularly in the community using individualized exercise routines designed according to their physical conditions such as different types, frequencies and intensity of exercise. Providing social support to each other at the community care site should be encouraged, and regular assessment of the mental health of community-dwelling older people should be done. It is also recommended to organize a timely depression-related education course for older people in the community.

The effects of exercise on chemotherapy-induced peripheral neuropathy symptoms in cancer patients: a systematic review and meta-analysis.

PURPOSE: To conduct a systematic review and meta-analysis of current studies to determine whether exercise affects chemotherapy-induced peripheral neuropathy (CIPN) symptoms in cancer patients. DESIGN: The Medline, Embase, Cochrane Library, CINAHL, PubMed, and National Central Library databases, and the reference lists of the included studies were surveyed. The Consolidated Standards of Reporting Trials (CONSORT) extension checklist for non-pharmacologic treatment was used to evaluate the literature. SETTING AND PARTICIPANTS: Exercise interventions offered in hospitals or at home. A total of 178 participants from 5 studies were assessed in the meta-analysis, with their mean age ranging from 48.56 to 71.82 years. METHODS: The randomized control trials were summarized in a systematic review. The effects of the exercise interventions were compiled for meta-analysis. A forest plot was constructed using a fixed effect model to obtain a pooled mean difference. RESULTS: The pooled results indicated that exercise interventions significantly improved the CIPN symptoms of the participants (mean difference: 0.5319; 95% confidence interval: 0.2295 to 0.8344; Z = 3.45; P = 0.0006). A combination of exercise protocols including a nerve gliding exercise intervention was found to have improved CIPN symptoms. In addition, a sensorimotor-based exercise intervention was found to have reduced CIPN-induced loss of postural stability. CONCLUSIONS AND IMPLICATIONS: The findings indicated that the effects of exercise could improve CIPN symptoms in cancer patients. Nevertheless, further investigations of different exercise protocols and intensity of intervention utilizing larger sample sizes and more specific outcome measures will further inform the best practices for cancer patients.

Effect of earplugs and eye masks on the sleep quality of intensive care unit patients: A systematic review and meta-analysis.

AIMS: To evaluate the effect of earplugs and eye masks on the sleep quality of patients in intensive care unit (ICU). DESIGN: Systematic review and meta-analysis. DATA SOURCES: Randomized controlled trial studies conducted before May 5, 2020 were searched for in Embase, MEDLINE, Cochrane Library, CINAHL and Index to Taiwan Periodical Literature System databases. REVIEW METHODS: Analyses in this study were according to the PRISMA statement. The heterogeneity of the data was investigated through sub-group analysis while a meta-analysis was performed using the Review Manager 5.3 software. RESULTS: A total of 797 patients from 13 studies were included in this study. Without considering alone or combined use of earplugs and eye masks, the meta-analysis supported that there was a significant effect on self-reported sleep quality. The overall standardized mean difference of the effect size was 1.44 (95% confidence interval [CI]: [0.80, 2.09]). Sub-group analysis indicated that the use of earplugs alone had no significant effect on sleep quality (effect size: 0.07, 95% [CI]: [-0.50, 0.64]). The use of eye masks alone had a significant effect on sleep quality (effect size: 1.56, 95% [CI]: [1.08, 2.05]). The use of both earplugs and eye masks proved to have the largest effect size on sleep quality (effect size: 2.08, 95% [CI]: [0.95, 3.21]). CONCLUSION: The combined use of earplugs and eye masks or the standalone use of eye masks is a non-invasive, economical and effective way to promote sleep quality in adult ICU patients. IMPACT: Clinical nurses could use this meta-analysis as it recommends that nurses provide adult ICU patients with either one or both earplugs and eye masks to improve the patients' sleep quality. STUDY REGISTRATION: The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.York.ac.uk/Prospero with the registration number # CRD42021221185).

Long-Term Clinical Outcomes of New-Generation Drug-Eluting Stents in Coronary Artery Disease: A Real-World Observational Study.

BACKGROUND: Treating vessels with a very small reference vessel diameter (RVD) in coronary artery disease is challenging. OBJECTIVE: Long-term evaluation of new-generation drug-eluting stents (DESs) for the treatment of coronary lesions with different RVDs. METHODS: From April 2009 to March 2019, 780 patients who underwent single coronary stenting were divided into ≤ 2.25 (very small), 2.5-3.0 (small), and ≥ 3.5 mm (large) DES groups after 1:2:2 propensity score matching. The primary endpoint was target lesion failure (TLF), and the secondary endpoints were major adverse cardiac events (MACEs) and stent thrombosis (ST). RESULTS: During 3 years after new-generation DES implantation, TLF and MACE rates were significantly lower in the very small DES group. The risk of TLF was significantly lower in the very small DES group compared to the small DES group [very small vs. small: TLF, adjusted hazard ratio (HR) = 0.282, p = 0.040]. The risks of MACEs and all-cause mortality were significantly lower in the very small DES group compared to the small DES group (very small vs. small: MACEs, adjusted HR = 0.215, p = 0.001; all-cause mortality, adjusted HR = 0.181, p = 0.005). The cumulative incidence rates of TLF-free (log-rank test p = 0.001) and MACE-free (log-rank test p < 0.001) survival were significantly different among the groups, and the very small DES group had a high event-free survival rate. No cases of ST occurred in any group. CONCLUSIONS: Our results indicate that the use of new-generation DESs for treating coronary lesions in very small vessels is safe and effective.

Changing Treatment Patterns in Patients With Venous Thromboembolism in Taiwan.

BACKGROUND: In Asia, little information is available about contemporary real-world treatment patterns for venous thromboembolism (VTE).Methods and Results:Consecutive patients (n=11,414) from the Taiwan National Health Insurance Research Database with initial VTE and taking oral anticoagulants between May 1, 2014 and June 30, 2016 were included. The temporal trends of using oral anticoagulants and pharmacomechanical therapy during the study period were evaluated. The efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) vs. warfarin were compared. Propensity score analysis (NOACs n=3,647 vs. warfarin n=3,647) was used to balance covariates between groups, and Cox proportional hazards models with adjustment were used to estimate the risks of clinical outcomes. The use of NOACs increased from 0.3% to 60.2% for VTE treatment during the study period. Pharmacomechanical therapy was used in 9.60%, 8.22%, and 5.63% from 2014 through 2016. NOACs were associated with a 16% risk reduction (adjusted hazard ratio [aHR] 0.84, 95% confidence interval [CI] 0.77-0.93) in all-cause mortality and a 21% risk reduction (aHR 0.79, 95% CI 0.65-0.96) in recurrent VTE vs. warfarin. Overall, NOACs were associated with a lower risk of major bleeding compared with warfarin (aHR 0.804, 95% CI 0.648-0.998). CONCLUSIONS: In real-world practice, NOACs have become the major anticoagulant used for Asians with VTE. Although NOACs had a lower risk of recurrent VTE and major bleeding compared with warfarin in Taiwan, we still need a large-scale randomized controlled trial to confirm the findings.

Urodynamic Assessment of Neuronal Intranuclear Inclusion Disease.

Neuronal intranuclear inclusion disease (NIID) is a disease that causes leukoencephalopathy (dementia) and peripheral neuropathy (variable manifestation including bladder dysfunction). This is the first urodynamic report to show that bladder dysfunction in NIID is a combination of detrusor overactivity, decreased bladder sensation, large post-void residual, and neurogenic changes in the sphincter electromyogram. This report will help managing bladder dysfunction in NIID.

Student nurses' bullying, social support and their health status during clinical practicum programmes.

AIMS: This study was to explore the student nurses' bullying, social support and their health status during clinical practicum programmes and the predictors of health status among student nurses during clinical practicum programmes. METHODS: A cross-sectional design with structured questionnaires was used, recruiting 200 student nurses in a 5-year junior college programme in south Taiwan. RESULTS: The significant predictors of nursing students' health status during clinical practicum programmes were 'whether experiencing bullying situations during clinical practicum' and 'low social support'. CONCLUSION: In order to prevent bullying during clinical practicum, encouraging nursing students to report all the clinical practicum bullying incidents, providing counselling to nursing students and arranging clinical practicum bullying prevention courses to students were important. Moreover, providing instructors and nursing staff with teaching, communication and feedback skills might help nursing students prevent bullying incidents during clinical practicum programmes. A longitudinal study design was suggested for the future study in order to assess the cause-effect relationship of the bullying and social support on health among students during clinical practicum.

Sacubitril/Valsartan Improves Left Ventricular Ejection Fraction and Reverses Cardiac Remodeling in Taiwanese Patients with Heart Failure and Reduced Ejection Fraction.

BACKGROUND: The angiotensin receptor-neprilysin inhibitor sacubitril/valsartan is known to improve outcomes of cardiac death and hospitalization due to heart failure in patients with heart failure and reduced ejection fraction (HFrEF). However, data on improvements in ejection fraction after using sacubitril/valsartan are still lacking in Taiwan. METHODS: We conducted this prospective, single armed, observation cohort study to evaluate changes in left ventricular ejection fraction (LVEF) in patients with heart failure and reduced LVEF treated with sacubitril/valsartan. This was an all-comer study. We prescribed sacubitril/valsartan as both first-line and second-line therapy to every eligible patient regardless of whether they were already on standard therapy or newly-diagnosed with HFrEF. The primary outcome was improvements in LVEF. We also collected data about changes in left ventricular chamber size, blood pressure, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and renal function according to serum creatinine level. RESULTS: During March 2016 to April 2018, 93 patients were enrolled. The mean LVEF improved from 35 ± 6.1% to 50 ± 8.8% at 6 months use of sacubitril/valsartan (p < 0.001). The left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and left atrial diameter all decreased. The average NT-proBNP level decreased from 6379 pg/mL to 1661 pg/dL. CONCLUSIONS: Sacubitril/valsartan demonstrated a significant effect in improving LVEF, left ventricular reverse remodeling, and reduction of NT-proBNP in this Taiwanese cohort.

Attentional Bias, "Cool" and "Hot" Executive Functions in Obese Patients: Roles of Body Mass Index, Binge Eating, and Eating Style.

PURPOSE/BACKGROUND: Obesity is recognized as an important risk factor for many chronic diseases and is a major health issue. The current study examined attentional bias to food and the "cool" (inhibitory control and mental flexibility) and "hot" (affective decision making) executive functions (EFs) in obese patients preparing for bariatric surgery. In addition to body mass index (BMI), this study examined the impact of the binge-eating tendency and eating styles. METHODS: The study population comprised 21 morbidly obese patients preparing to undergo bariatric surgery (BMI ≥30 kg/m) and 21 normal-weight controls (24 kg/m > BMI ≥ 18.5 kg/m). The Visual Probe Task was adopted to examine attentional bias toward food-related cues. The Stop-Signal Task and the Color Trails Test were used to assess inhibitory control and mental flexibility, respectively. The Iowa Gambling Task was administered to assess the affective decision making. RESULTS: (1) The obese patients showed poorer performances on cool EFs (for Color Trails Test, P = 0.016, ηp = 0.136; for Stop-Signal Task, P = 0.049, ηp = 0.093) and hot EF (for Iowa Gambling Task, normal controls showed progressed performance, P = 0.012, ηp = 0.077, but obese patients did not show this progress, P = 0.111, ηp = 0.089) compared with the normal controls; (2) participants with low binge-eating tendency had larger attentional biases at 2000 milliseconds than at 200 milliseconds on food-related cues (P = 0.003, ηp = 0.363); and (3) low-restrained participants exhibited attentional bias toward the low-calorie food cues, compared with the high-restrained group (P = 0.009, ηp = 0.158). CONCLUSIONS: The current study contributes to the development of a different therapeutic focus on obese patients and binge eaters.

Zinc supplementation in patients with cirrhosis and hepatic encephalopathy: a systematic review and meta-analysis.

BACKGROUND: Low serum zinc level is associated with hepatic encephalopathy (HE), but the efficacy of zinc supplementation remains uncertain. This study aimed to investigate the effects of zinc supplementation on HE treatment in patients with cirrhosis. METHODS: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane CENTRAL) and Scopus from inception to December 2018; without publication date or language restrictions. Randomized controlled trials of zinc supplementation versus placebo or other treatment for the management of HE in adult patients with cirrhosis were selected. The primary outcome was the degree of HE as assessed by clinical signs or specialized psychometric tests. The secondary outcomes included serum ammonia levels, adverse events, or the length of hospital stay and costs. We carried out a meta-analysis with random effects model and summarized continuous outcomes using standardized mean differences (SMD) or mean differences (MD) with 95% confidence intervals (95% CI). The risk of bias was assessed using the Cochrane risk of bias tool, and the certainty of evidence for each outcome was evaluated with the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: Four trials with 247 patients were included. In patients with cirrhosis who had mild HE (≤ grade II), the available evidence suggested that the combination treatment of zinc supplementation and lactulose over 3 to 6 months significantly improved performance in the number connection test (SMD: -0.97; 95% CI: - 1.75 to - 0.19; P = 0.01; moderate certainty), reported in three trials (n = 227). However, compared with lactulose therapy alone, additional zinc supplementation demonstrated no significant difference in the digit symbol test (SMD: 0.44; 95% CI: - 0.12 to 1.00; P = 0.12; very low certainty) or serum ammonia levels (MD: -10.86; 95% CI: - 25.73 to 4.01; P = 0.15; very low certainty), reported in two trials (n = 137). None of the included trials reported adverse events or effects on hospitalization. CONCLUSIONS: In conclusion, a combination of zinc supplementation and lactulose over 3 to 6 months may improve the number connection test in cirrhotic patients with low grade HE, compared with lactulose only. TRIAL REGISTRATION: PROSPERO: CRD42017080955 . Registered 23 November 2017.

The Marine Boundary Layer Height over the Western North Pacific Based on GPS Radio Occultation, Island Soundings, and Numerical Models.

This paper estimates marine boundary layer height (MBLH) over the western North Pacific (WNP) based on Global Positioning System Radio Occultation (GPS-RO) profiles from the Formosa Satellite Mission 3 (FORMOSAT-3)/Constellation Observing System for Meteorology, Ionosphere, and Climate (COSMIC) satellites, island soundings, and numerical models. The seasonally-averaged MBLHs computed from nine years (2007⁻2015) of GPS-RO data are inter-compared with those obtained from sounding observations at 15 island stations and from the European Centre for Medium-Range Weather Forecasts (ECMWF) Reanalysis (ERA-Interim) and National Centers for Environmental Prediction Global Forecast System (NCEP GFS) data over the WNP from 2012 to 2015. It is found that the MBLH using nine years of GPS-RO data is smoother and more consistent with that obtained from sounding observations than is the MBLH using four years of GPS-RO data in a previous study. In winter, higher MBLHs are found around the subtropical latitudes and over oceans east of Japan, which are approximately located within the paths of the North Equatorial Current and the Kuroshio Current. The MBLH is also significantly higher in winter than in summer over the WNP. The above MBLH pattern is generally similar to those obtained from the analysis data of the ERA-Interim and NCEP GFS, but the heights are about 200 m higher. The verification with soundings suggests that the ERA-Interim has a better MBLH estimation than the NCEP GFS. Thus, the MBLH distributions obtained from both the nine-year GPS-RO and the ERA-Interim data can represent well the climatological MBLH over the WNP, but the heights should be adjusted about 30 m lower for the former and ~200 m higher for the latter. A positive correlation between the MBLH and the instability of the lower atmosphere exists over large near-shore areas of the WNP, where cold air can move over warm oceans from the land in winter, resulting in an increase in lower-atmospheric instability and providing favorable conditions for convection to yield a higher MBLH. During summer, the lower-atmospheric instability becomes smaller and the MBLH is thus lower over near-shore oceans.