Prospective Longitudinal Assessment of Quality of Life After Stereotactic Ablative Radiotherapy for Oligometastases: Analysis of the Population-based SABR-5 Phase II Trial.

AIMS: To evaluate longitudinal patient-reported quality of life (QoL) in patients treated with stereotactic ablative radiotherapy (SABR) for oligometastases. MATERIALS AND METHODS: The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases, conducted in six regional cancer centres in British Columbia, Canada from 2016 to 2020. Prospective QoL was measured using treatment site-specific QoL questionnaires at pre-treatment baseline and at 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. Patients with bone metastases were assessed with the Brief Pain Inventory (BPI). Patients with liver, adrenal and abdominopelvic lymph node metastases were assessed with the Functional Assessment of Chronic Illness Therapy-Abdominal Discomfort (FACIT-AD). Patients with lung and intrathoracic lymph node metastases were assessed with the Prospective Outcomes and Support Initiative (POSI) lung questionnaire. The two one-sided test procedure was used to assess equivalence between the worst QoL score and the baseline score of individual patients. The mean QoL at all time points was used to determine the trajectory of QoL response after SABR. The proportion of patients with 'stable', 'improved' or 'worsened' QoL was determined for all time points based on standard minimal clinically important differences (MCID; BPI worst pain = 2, BPI functional interference score [FIS] = 0.5, FACIT-AD Trial Outcome Index [TOI] = 8, POSI = 3). RESULTS: All enrolled patients with baseline QoL assessment and at least one follow-up assessment were analysed (n = 133). On equivalence testing, the patients' worst QoL scores were clinically different from baseline scores and met MCID (BPI worst pain mean difference: 1.8, 90% confidence interval 1.19 to 2.42]; BPI FIS mean difference: 1.68, 90% confidence interval 1.15 to 2.21; FACIT-AD TOI mean difference: -8.76, 90% confidence interval -11.29 to -6.24; POSI mean difference: -4.61, 90% confidence interval -6.09 to -3.14). However, the mean FIS transiently worsened at 9, 18 and 21 months but eventually returned to stable levels. The mean FACIT and POSI scores also worsened at 36 months, albeit with a limited number of responses (n = 4 and 8, respectively). Most patients reported stable QoL at all time points (range: BPI worst pain 71-82%, BPI FIS 45-78%, FACIT-AD TOI 50-100%, POSI 25-73%). Clinically significant stability, worsening and improvement were seen in 70%/13%/18% of patients at 3 months, 53%/28%/19% at 18 months and 63%/25%/13% at 36 months. CONCLUSIONS: Transient decreases in QoL that met MCID were seen between patients' worst QoL scores and baseline scores. However, most patients experienced stable QoL relative to pre-treatment levels on long-term follow-up. Further studies are needed to characterise patients at greatest risk for decreased QoL.

Health inequalities of global protein-energy malnutrition from 1990 to 2019 and forecast prevalence for 2044: data from the Global Burden of Disease Study 2019.

OBJECTIVES: Protein-energy malnutrition poses a serious medical problem worldwide. This study aims to describe the global burden, trends, and health inequalities of protein-energy malnutrition and forecasts for future prevalence. STUDY DESIGN: This was a comprehensive analysis based on data provided by the Global Burden of Disease Study 2019. METHODS: Data were obtained from the Global Health Data Exchange query tool, including prevalence, deaths, disability-adjusted life years (DALYs) and sociodemographic index (SDI). The estimated annual percentage changes were calculated to evaluate temporal trends. We quantified cross-country inequalities in protein-energy malnutrition burden and predicted the prevalence number and rate to 2044. RESULTS: Globally, there were 147,672,757 (130,405,923 to 167,471,359) cases of protein-energy malnutrition in 2019, with 212,242 (185,403 to 246,217) deaths. Eastern Sub-Saharan Africa had the highest age-standardised death and DALY rates in 2019. From 1990 to 2019, the global age-standardised prevalence rate of protein-energy malnutrition showed an upward trend, while the age-standardised death rate showed a downward trend. A significant decline occurred in SDI-related health inequality, from 2126.1 DALYs per 100,000 persons between the poorest and richest countries in 1990 to 357.9 DALYs per 100,000 persons in 2019. There was a trend of decreasing age-standardised death and DALY rates along with increases in the SDI. Frontier analyses showed that there is much room for improving the current situation of protein-energy malnutrition in some countries. In the next 35 years, the prevalence of protein-energy malnutrition will continue to increase. CONCLUSION: Although the disease burden of protein-energy malnutrition has greatly decreased since 1990 and health inequalities between countries are shrinking, the prevalence in Asian and African countries may continue to increase. Focussing on regional differences and strengthening the nutritional intake of people in underdeveloped areas are necessary to reduce future burdens.

[Effects of short-term intervention of walking on body mass index, waist circumference, and related indicators of working population].

Objective: To quantify the effects of short-term walking intervention on body mass index (BMI), waist circumference, and related indicators of working population. Methods: The China Motivational Healthy Walking Program in 2016 recruited 29 224 individuals from 139 demonstration areas for comprehensive prevention and control of chronic and non-communicable diseases at the national level and 70 areas at the provincial level. All subjects volunteered to participate into this program. The intervention lasted 100 days from June to September 2016. The walking behavior, height, weight and waist circumference of subjects were measured using a uniform pedometer, body composition tester, height tester and waist-to-hip caliper before and after the intervention. Daily average steps, daily average effective steps, and the percent of fulfilling continuous walking per day were used as main indicators in this study. Self-administered questionnaires were used to collect demographic characteristics, behaviors and chronic diseases. With the adjustment of potential confounding factors, multilevel regression was used to quantify the effect of walking on BMI and waist circumference, and multilevel logistic regression was used to quantify the effect on overweight or obesity and central obesity. Results: A total of 12 368 subjects completed walking interventions and all measurements included in this study. The mean±SD age of all subjects was (41.19±8.99) years, and 5 155 (59.17%) of them were women. After 100-day intervention, all outcome variables decreased significantly. For every additional 1 000 steps per day, subjects would have extra decrease in BMI of 0.023 kg/m(2) [ß (95%CI): -0.023 (-0.030, -0.017)], in waist circumference of 0.046 cm [ß (95%CI): -0.046 (-0.071, -0.020)], and the likelihood for becoming overweight or obesity was 0.97 times [OR (95%CI): 0.97 (0.95, 0.98)] that of before intervention. With additional 1 000 effective steps per day, the difference between baseline and endpoint increased by 0.028 kg/m(2) [ß (95%CI): -0.028 (-0.035, -0.020)] in BMI and 0.062 cm [ß (95%CI): -0.062 (-0.091, -0.033)] in waist circumference. The likelihood of progressing into overweight or obesity was 0.97 times [OR (95%CI): 0.97(0.95, 0.98)] that of before-intervention, and the likelihood of becoming central obesity was 0.98 times [OR (95%CI): 0.98(0.96, 0.99)] that of before-intervention. Compared to subjects with low level percent of fulfilling continuous walking per day, those with high level would have an extra decrease in BMI by 0.150 kg/m(2) [ß (95%CI): -0.150 (-0.22, -0.079)], in waist circumference by 0.340 cm [ß (95%CI): -0.340 (-0.620, -0.064)], and the likelihood of becoming overweight or obesity decreased to 0.74 times that of the low level group [OR (95%CI): 0.74(0.62, 0.89)] and the likelihood of becoming central obesity decreased to 0.78 times that of the low level group [OR (95%CI): 0.78 (0.68, 0.91)]. Conclusion: Strengthening walking exercise in the short term has a positive effect on promoting working population to reduce BMI and waist circumference, and prevent overweight, obesity and central obesity.

[Effects and the associated factors of the 2016 China Motivational Healthy Walking Program among occupational population].

Objective: To examine the effects and associated factors of the China Motivational Healthy Walking Program among occupational population. Methods: The 2016 China Motivational Healthy Walking Program recruited 29 224 participants from 139 demonstration areas for comprehensive prevention and control of chronic and non-communicable disease at national level and 70 at provincial level. Intervention on walking was carried out by adopting group and individual motivating measures. Walking steps were recorded by electronic pedometer. We used percent of days achieving 10 000 steps (P10 000), percent of days fulfilling continuous walking (PCW), and proportion of valid walking (PVW) steps to reflect walking quantity, pattern and quality of participants. Motivation intensity was measured by summing up scores of each motivating activity. Questionnaire-based online survey collected information about demographic characteristics, lifestyle risk factors and chronic diseases. This study finally included 12 368 individuals in the analysis. Multilevel logistic regression model was used to assess the effect of group and individual motivating measures on walking activity and corresponding associated factors. Results: Age of the study sample was (41.2±8.99) years, and 58.17% (7 194) of them were female. After 100-day intervention, the P10 000, PCW and PVW of all participants were 93.89%±14.42%,92.01%±15.97% and 81.00%±7.45%, respectively. The mean P10 000 and PCW increased with rising group-motivated scores, self-motivated scores and individual-activity scores (P<0.001 for all). The mean PVW decreased with both higher group-motivated scores and self-motivated scores (both P<0.05), and varied little among groups with different level individual-activity scores (P=0.525). According to the results from the multilevel model, those who had greater group-motivated scores and self-motivated scores tended to have more likelihood of high-level of P10 000 and PCW. Age, sex, smoking status, education attainment and alcohol drinking were associated with P10 000 and PCW (P<0.05 for all). Conclusion: The Motivational Healthy Walking Program had positive effect on promoting healthy walking among occupational population. Group-motivated and self-motivated activities were associated with healthy walking.

[Qualitative pathological assessment of liver fibrosis regression after antiviral therapy in patients with chronic hepatitis B].

Objective: To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression. Methods: Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment. Results: A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness. Conclusion: This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.

Assessment of dentinal tubule invasion capacity of Enterococcus faecalis under stress conditions ex vivo.

AIM: To investigate the dentinal tubule invasion capacity of Enterococcus faecalis under alkaline and energy starvation stress conditions. METHODOLOGY: The root canals from human single-rooted teeth (n = 40) were infected with E. faecalis under alkaline (pH 9, 10, 11 and 12) and energy starvation (no glucose, 0.05% glucose and 0.15% glucose) stress conditions. The root canals were prepared in a standard manner and treated to remove the smear layer before incubation. After 4 weeks of cultivation, the roots were split vertically into two halves: one half was processed for biofilm formation analysis using a scanning electron microscope; the other half was stained with fluorescent DNA-binding reagents, washed thoroughly and sectioned (100 µm thick), and the depth of tubule invasion by the microorganism was examined by confocal laser-scanning microscopy. The extent of dentine tubule invasion was analysed statistically. RESULTS: The E. faecalis strain resulted in biofilm formation and dentine tubules invasion under all of the stress conditions, except for pH 11 and 12 conditions. However, the tubule penetration distance was markedly reduced in these stress conditions (P < 0.01) compared with in tryptic soy broth (TSB) or pH 7 medium. The invasion depth in the middle root dentine was significantly higher than in the apical sections in TSB and energy starvation medium (P < 0.01). CONCLUSIONS: Ex vivo E. faecalis formed biofilms and colonized dentine under alkaline and glucose starvation stress conditions, but its ability to invade dentine tubules was significantly decreased.

Effectiveness and safety assessment of lamotrigine monotherapy for treatment of epilepsy.

BACKGROUND: Epilepsy is a recurrent chronic nervous system disease. A correct choice of antiepileptic drug is the key to control seizures and improve patient's life quality. AIM: To study the effectiveness and safety of lamotrigine monotherapy for treatment of epilepsy, systemic evaluation was carried out on published comparative trials between lamotrigine and carbamazepine. METHODS: The retrieval method referred to the search strategy developed by Cochrane Epilepsy Group and software Rev.Man 5 was used for META analysis and forest plots. The Odds ratio (OR) was selected as the effect size and funnel plot was used to analyze the publication bias. RESULTS: A total of 9 studies and 2269 cases of patients were included in the analysis. There was no significant difference between lamotrigine and carbamazepine for treatment of epilepsy as the OR was 1.17, 95% confidence interval (CI) [0.88, 1.54]. However, lamotrigine had advantages in the overall withdrawal rate and withdrawal rate due to side effects as the ORs were 0.57, 95% CI [0.47, 0.69] and 0.41, 95% CI [0.32, 0.52]. CONCLUSIONS: Lamotrigine has certain advantages over carbamazepine for treatment of epilepsy as it has less side effects and higher tolerability. In addition, the quality of such clinical trials should be further improved to have a more comprehensive understanding.

Interactive image processing system for assessment of cell movement.

The study of cancer cell motility is considered to be important in understanding cancer metastasis. The movement behaviour of cells within clustered cell colonies is of particular interest. Changes in cell movement, area and velocity can be an indicator of cell spreading. The aim of the study is to develop and apply a computerised interactive image processing system to quantify the movement of cells within cell clusters. A semi-automatic boundary description method based on two-dimensional rendering is devised. The system is later combined with image-processing methods that facilitate the relocation of the cell boundary over time; this forms a new approach to assessing cell movement. These methods are incorporated into a software system, enabling an interactive procedure to define and monitor the movement of single cells in cell clusters from digitised microscope images. Validation of the method shows a maximum error of 10% in defining the area through a cubic spline interpolation. The system is applied to analyse the movement and area of HT115 human colon cancer cells. The system provides tools for the analysis of movement, area and velocity of single cells in cancer cell colonies and may thus be of value in further understanding cancer cell motility.

Effects of bilateral lesions of the dorsolateral funiculi and dorsal columns at the level of the low thoracic spinal cord on the control of locomotion in the adult cat. I. Treadmill walking.

1. A quantitative and longitudinal analysis of locomotion was made after bilateral lesions of the dorsolateral funiculi (DLF) and/or the dorsal columns (DC) in the lower thoracic cord (T12 or T13) in five adult cats. All cats were chronically implanted several weeks before the spinal cord lesion to permit the recording of electromyographic (EMG) activity from selected flexor and extensor muscles of the fore- and hindlimbs of each side. This allowed each cat to act as its own control when comparing the pattern and amplitude of EMG activity before and after the lesion. All experiments were also videotaped to allow an analysis of the kinematic changes before and after the lesions. Kinematic data were only analyzed for the side of the cat facing the camera; for all cats this was the left side. 2. After recovery periods of 2-5 mo, wheat-germ-agglutinated horseradish peroxidase (WGA-HRP) was injected caudal to the lesion site (normally at L2). The extent of the lesion was verified both histologically and by evaluating the number of HRP-labeled neurons in different supraspinal structures. These analyses showed that the cortico- and rubrospinal tracts (CST and RST, respectively) were completely interrupted, bilaterally, in two of five of the cats; in one of these cats the DCs were also interrupted. In the other three cats there was more variable damage, and the CST and RST were only completely interrupted on the right side of one of these animals. The DCs were completely sectioned in two of these cats. 3. During the 1st wk subsequent to the lesion, most cats had difficulty in supporting their weight and in walking. However, within 10 days all were able to walk, unaided, for extended periods on the treadmill at speeds of at least 0.35 m/s. In the two cats with the complete, bilateral DLF lesions, the animals dragged both their left and right hindpaws along the treadmill belt during the swing phase of the step cycle (paw drag) throughout the testing period of 3-5 mo. In the other three cats, paw drag in either hindlimb was only seen in the 1st 2-3 wk after the lesions, with the exception of the cat with the complete lesion of the DLF on the right side, which showed sustained paw drag in the right hindlimb throughout the testing period. 4. Significant increases in step cycle and swing duration following the lesion were observed only in the two cats with the largest lesions. In all five cats, statistical comparisons of the slopes from a linear regression analysis showed that the relationship between swing and step cycle duration was unchanged by the lesions. 5. Joint angles in the left hindlimb of the two cats with the largest lesions were generally smaller (more flexed) than in the prelesion controls. This was particularly true for the knee and ankle joints. The other three cats showed changed joint angle values for the hip, knee, and ankle only in the 1st 2-3 wk after the lesions. All of the cats, except the one with the least damage to the left DLF, exhibited increased joint excursions at the metatarsophalangeal (MTP) joint of the left limb throughout the recovery period. 6. There were sustained changes in the coupling between the hip and the knee of the left limb, together with smaller changes in the coupling of the knee and ankle in the two cats with the complete lesions of the DLF. In contrast to the prelesion controls, flexion at the ankle occurred before swing onset in these same two cats. The changes in the coordination between the hip and the knee were associated with changes in the temporal coupling between the hip flexor, sartorius (Srt), and the knee flexor, semitendinosus (St). Despite some improvement, the coupling between these two muscles never fully recovered to the prelesion values. Similar, but smaller, changes in the delay between Srt and St were also seen in two of the other three cats. (ABSTRACT TRUNCATED)

A comparative study of the modes of transference of surplus labor in China's countryside.

PIP: The problems posed by the recent development of a surplus labor force in rural areas of China are examined. Separate consideration is given to ways to absorb this surplus both within and outside the agricultural sector, agricultural labor migration to other rural areas, and rural-urban migration. The implications for urbanization and migration policy are reviewed.^ieng