Measuring Productivity and Relative Efficiency of Public Tertiary Traditional Chinese Medicine Hospitals in Hubei, China.

Improving the productivity and relative efficiency of traditional Chinese medicine (TCM) hospitals is pivotal for hospital managers and policymakers to optimize the utilization of TCM resources in China. This study aimed to measure the productivity and relative efficiency of public tertiary TCM hospitals in Hubei Province. The input and output indicators data were extracted from the Health Commission of Hubei Province (HCHP) from 2019 to 2021. The Bootstrap-Malmquist-DEA model was employed to measure the productivity and relative efficiency of the hospitals. The statistical significance was set at P < .05. The numbers of total diagnostic patients and discharged patients declined by 23.44% and 28.34% from 2019 to 2020, and then increased by 25.76% and 20.44% respectively from 2020 to 2021. The average bias-corrected technical efficiency (TE) scores of the TCM hospitals from 2019 to 2021 were 0.8391, 0.8048, and 0.8559, indicating good efficiency. The average total factor productivity (TFP) in 2020 and 2021 decreased compared to that in 2019, with scores of 0.7479 and 0.8996, respectively. Between 2019 and 2020, the TFP changes among 19 out of 21 (90.48%) TCM hospitals and the technological changes (TC) among 20 out of 21 (95.24%) were less than 1.0000 (P < .05). The TFP changes of 17 out of 21 (80.95%) TCM hospitals and the TC of 20 out of 21 (95.24%) were less than 1.0000 (P < .05) between 2019 and 2021. COVID-19 might have constrained the provision of healthcare services by the public tertiary TCM hospitals in Hubei Province. Priority should be given to the utilization of healthcare resources, performance evaluation, information system strengthening, and internal hospital management to boost technical efficiency. TCM hospitals need to focus further on technology innovation to improve their technological progress.

Pathways and mechanisms by which biochar application reduces nitrogen and phosphorus runoff losses from a rice agroecosystem.

Biochar application has the potential to reduce nitrogen (N) and phosphorus (P) losses in agricultural runoff, but little is known about how and to what extent biochar is effective in rice agroecosystems. In this study, in a typical double-rice cropping system, N and P runoff losses and soil carbon (C), N, and P contents (soil CNP contents) were observed under three different biochar application rates (0, 24, and 48 t ha-1, which were defined as CK, LB, and HB, respectively) from 2017 to 2019. The results showed that the two-year averages of soil total organic C (TOC), total N (TSN), total P (TSP), available P (Olsen P), microbial biomass N (MBN), and microbial biomass P (MBP) contents were generally higher in the biochar treatments than in CK (P < 0.05). Specifically, the TSP, TOC, and MBN contents increased with the increasing biochar application rate, thus demonstrating the significant effects of biochar application on the paddy soil CNP contents and composition. The HB and LB treatments reduced the seasonal mean runoff flow-weighted total N (TN_wc) and total P (TP_wc) concentrations by 32.4% and 42.1%, respectively, compared to CK. Structural equation modeling (SEM) further revealed that the paths and mechanisms by which biochar reduced the TN_wc and TP_wc were different, depending on the different application rates. HB reduced the TN_wc mainly through the direct absorption of N, followed by the indirect inhibition of N mineralization, whereas LB decreased the TP_wc mainly through the strong P sorption capacity of the biochar. The direct effect of HB on the TN_wc was 1.58 times as strong as the indirect effect (path coefficients: -0.68 vs. 0.43, respectively), and the direct effect of LB on the TP_wc was 1.78 times as strong as the indirect effect (path coefficients: -0.89 vs. 0.50, respectively). Given the distinct pathways and mechanisms by which biochar reduced NP runoff losses, in practice, the biochar application rate should be optimized according to a targeted priority of reducing either N or P runoff losses in rice agroecosystems.

The Efficacy and Treatment Fidelity of Kinesiology Taping in Conjunction With Conservative Treatment Interventions Among Individuals With Shoulder Pain: A Systematic Review with Meta-Analysis.

PURPOSE: Kinesiology taping is a common intervention used to treat individuals with shoulder pain. While there have been several studies published to date evaluating the effectiveness of this intervention, a systematic review with meta-analysis synthesizing the collective effectiveness of kinesiology taping is not available. Therefore, the purpose of this study was to perform a systematic review with meta-analysis investigating the efficacy and treatment fidelity of kinesiology taping (KT) in combination with conservative interventions for shoulder pain. METHODS: Databases (PubMed, EMBASE, SportDiscus, CINAHL) of studies published in English meeting criteria were searched to October 2019. Methodologic quality was assessed utilizing the Modified Downs and Black checklist. Treatment fidelity was evaluated using a modified fidelity tool. Random effects meta-analyses were performed when an outcome (disability, pain, range of motion (ROM)) was reported by two or more studies. Overall effect size (pooled random effects) was estimated for studies with acceptable clinical homogeneity. RESULTS: When KT was used with conservative treatments, meta-analysis revealed large effect sizes for improvements in disability (standard mean difference (SMD) = -1.35; 95% CI, -2.09 to -0.60) and ROM (SMD = 0.96; 95% CI, 0.60-1.33) with no significant effects for pain. The average Modified Downs & Black score for bias was 11.5 ± 3.9. Of 10 retained studies, only two had good treatment fidelity. CONCLUSIONS: Adding KT to interventions performed in clinical settings appears to demonstrate efficacy regarding disability and ROM when compared to conservative interventions alone. However, despite reasonably good methodologic quality, fidelity was lacking in a majority of studies. Because of its impact on the implementation of evidence-based practice, lower fidelity should be considered when interpreting results.

Effects of Radiation Therapy and Comorbidity on Health-Related Quality of Life and Mortality Among Older Women With Low-Risk Breast Cancer: Protocol for a Retrospective Cohort Study.

BACKGROUND: The National Comprehensive Cancer Network Breast Cancer Guidelines Committee suggests that the omission of adjuvant radiation therapy (RT) after breast-conserving surgery can be a reasonable option among older women with low-risk breast cancer (early-stage, estrogen receptor-positive, and node-negative) if they are treated with endocrine therapy. However, RT usage in this group of women still exceeds 50%. Conversely, older women tend to forego RT (even when necessary) due to cost, inconvenience, and potential adverse responses associated with RT. Understanding health-related quality of life (HRQOL) change with receipt of RT among older women in the modern era is limited due to the under-representation of this population in clinical trials. OBJECTIVE: The proposed study aims to examine the associations of RT with HRQOL trajectories as well as survival outcomes among older women with 5-10 years of follow-up. We will also assess whether prediagnosis comorbidity burden influences receipt of RT and whether the associations between RT and HRQOL trajectory and survival outcomes are modified by the comorbidity burden. METHODS: We will use a retrospective cohort study design with the population-based Surveillance, Epidemiology, and End-Results database linked to the Medicare Health Outcomes Survey (SEER-MHOS). Older women (≥65 years) who were diagnosed with low-risk breast cancer in 1998-2014, received breast-conserving surgery, and participated in MHOS 1998-2016 are eligible for this analysis. The latent class analysis clustering method will be used to identify each patient's prediagnosis comorbidity burden, and HRQOL will be evaluated using the Short Form 36/Veterans RAND 12-Item Health Survey scales. The inverse-weighted estimates of the probability of treatment will be included to control for treatment selection bias and confounding effects in subsequent analysis. The association of RT with HRQOL trajectory will be evaluated using inverse-weighted multilevel growth mixture models. The inverse-weighted Cox regression model will be used to obtain hazard ratios with 95% CIs for the association of RT with survival outcomes. Differential effects of RT on both outcomes according to comorbidity burden class will also be evaluated. RESULTS: As of October 2020, the study was approved by the institutional review board, and SEER-MHOS data were obtained from the National Cancer Institute. Women with low-risk breast cancer who met inclusion and exclusion criteria have been identified, and prediagnosis comorbidity burden class has been characterized using latent class analysis. Further data analysis will begin in November 2020, and the first manuscript will be submitted in a peer-reviewed journal in February 2021. CONCLUSIONS: This research can potentially improve clinical outcomes of older women with low-risk breast cancer by providing them additional information on the HRQOL trajectories when they make RT treatment decisions. It will facilitate informed, shared treatment decision making and cancer care planning to ultimately improve the HRQOL of older women with breast cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/18056.

Dynamics and underlying mechanisms of N2O and NO emissions in response to a transient land-use conversion of Masson pine forest to tea field.

Nowadays, there has been a rapid expansion of tea field converted from forestry for pursuing higher economic benefits. However, few researches focus on the effects of transient land-use conversion from Masson pine forest to artificial tea fields on soil N2O and NO emissions and the underlying mechanisms. A parallel field experiment was conducted from Masson pine forest and a newly converted tea plantation from Masson pine forest from 2013 to 2017 in subtropical central China. Masson pine forest conversion to tea field dramatically increased soil N2O and NO emissions (up to 4.00 ±â€¯0.43 and 1.93 ±â€¯0.45 kg N ha-1 yr-1, respectively) in the first year possibly due to enhanced soil organic N mineralization. With the extension of tea planting age, N2O and NO emissions showed an upward trend (ranged from 1.19 to 5.28, and 0.15 to 1.78 kg N ha-1 yr-1, respectively) influenced by fertilization and soil organic matter accumulation. The direct emission factors for N2O and NO in the newly converted tea fields were the largest in the first year (2.64 and 1.07%, respectively) after land-use conversion, and higher than the default value recommended by IPCC. The NO/N2O ratio was mainly lower than 1 in the fertilized tea field, and soil N2O and NO emission peaks mainly occurred in tea-growing season (wet season) with higher soil moisture and NH4+-N concentrations, and dominated by amoA-containing bacteria (AOB), suggesting nitrifier-denitrification could be the dominant process involved in soil nitrogenous gases emissions in tea field. These results can be summarized as dramatically increased soil N2O and NO emissions during the transient land-use conversion from Masson pine forest to tea field were possibly due to the substantial net soil organic N mineralization and the enhanced abundance of nitrification functional genes (AOB).

Compound Phyllanthus urinaria L Inhibits HBV-Related HCC through HBx-SHH Pathway Axis Inactivation.

Compound Phyllanthus urinaria L (CP) is a traditional formula widely used in clinical practice for hepatocellular carcinoma (HCC), especially HBV-related HCC. HBx, HBV X gene encoded X protein, has positive correlation with the abnormal SHH pathway in HBV-related HCC. So, we predicted that CP has the capability of anti-HBV-related HCC maybe via inactivating the HBx-Hedgehog pathway axis. HepG2-HBx cells, HBx overexpression, were treated with CP (70µg/ml and 35 µg/ml, respectively) for 48 hours and the mice which received the HepG2-HBx cells were treated with CP (625mg/kg and 300 mg/kg, respectively) for 17 days to evaluate the effect of CP on HBV-related HCC. HBx could accelerate HepG2 cells proliferation, clone formation, and migration in vitro and also could strengthen tumor growth in mice. However, CP could significantly decrease HepG2-HBx cells proliferation, clone formation, and migration in vitro and also could inhibit tumors growth in mice in a dose-dependent manner. Mechanism studies suggested that HBx upregulated the mRNA and proteins expression of Sonic hedgehog (SHH), transmembrane receptor patched (PTCH-1), smoothened (SMO), oncogene homolog transcription factors-1 (GLI-1), and oncogene homolog transcription factors-2 (GLI-2), which are compositions of the SHH pathway. CP could inhibit the mRNA and proteins expression of SHH, PTCH-1, GLI-1, and HBx. It may be one of the underlying mechanisms of CP to delay the HBV-related HCC development through the HBx-SHH pathway axis inactivation.

Intake of polyunsaturated fatty acids and risk of preclinical and clinical type 1 diabetes in children-a systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: The association between the intake of polyunsaturated fatty acids (PUFAs) and the risk of preclinical and clinical type 1 diabetes (T1D) in children has generated conflicting results. Thus, we aimed to evaluate the definite effects of PUFAs on the risk of preclinical and clinical T1D. SUBJECTS/METHODS: Three databases were systematically searched up to July 18, 2017 to identify relevant observational studies, without language restriction. Any study included should report the risk of preclinical or clinical T1D in children with PUFAs supplementation compared with the controls, and report relative risks (RRs) or odds ratios (ORs) or provide data for estimation. Pooled RRs (or ORs) with 95% confidence intervals (CI) were calculated using random-effects models irrespective of statistical heterogeneity assessed by I2 statistic. RESULTS: We identified seven studies (three prospective cohort studies and four case-control studies) on PUFAs intake during pregnancy or during early life in children. The pooled RR between the risk of preclinical T1D and n-3 PUFAs supplementation against controls was 0.98 (95%CI, 0.85-1.13), with no heterogeneity. The results were similar after the intake during pregnancy, but not during early life in children (pooled RR, 0.45; 95%CI, 0.21-0.96; P = 0.039). N-3 PUFAs supplementation was not associated with a significant reduction in the risk of clinical T1D in children (pooled RR, 0.87; 95%CI, 0.71-1.08), with substantial heterogeneity(I2 = 64.7%). No association was also found between n-6 PUFAs intake and the risk of preclinical (1.07; 0.97-1.017) or clinical T1D (1.05; 0.92-1.20) in children. CONCLUSIONS: The result of the meta-analysis does not support that n-3 or n-6 PUFAs supplementation in children affects the overall risk of preclinical or clinical T1D. However, n-3 PUFAs intake in early life might reduce the risk of preclinical T1D. Therefore, this finding should be verified by more and well-designed prospective research in the future.

Effect of controlled-release fertilizer on N2O emissions and tea yield from a tea field in subtropical central China.

Tea (Camellia sinensis L.), a perennial leaf-harvested crop, favors warm/humid climate and acidic/well-drained soils, and demands high nitrogen (N) fertilizer inputs which lead to significant emissions of N2O. Potential mitigation options should be adopted to improve N use efficiency (NUE) and reduce environmental pollution in tea field system. A 3-year field experiment was carried out in a tea field in southern China from January 2014 to December 2016 to investigate the effect of controlled-release fertilizer (CRF) application on N2O emissions in tea field system. Three practices, namely conventional treatment (CON, 105 kg N-oilcake ha-1 year-1 + 345 kg N-urea ha-1 year-1), treatment with a half amount of the N fertilizer (CRF50%, 105 kg N-oilcake ha-1 year-1 + 120 kg N CRF ha-1 year-1) and full amount of N fertilizer (CRF100%, 105 kg N-oilcake ha-1 year-1 + 345 kg N CRF ha-1 year-1) were used. Compared with the CON, our results showed that CRF50% reduced the N2O emissions by 26.2% (p > 0.05) and increased the tea yield by 31.3% (p > 0.05), while CRF100% significantly increased the N2O emissions by 96.7% (p < 0.05) and decreased the tea yield by 6.77% (p > 0.05). Overall, yield-scaled N2O emissions of tea were reduced by 44.5% (p > 0.05) under CRF50% and significantly increased by 100% (p < 0.05) under CRF100%, compared with CON. Based on the gross margin analysis, CRF50% obtained the highest net economic profit. Our findings suggest that reducing N input of CRF (CRF50%) is necessary and feasible for adoption in the current tea plantation system.

Response of regional agricultural soil phosphorus status to net anthropogenic phosphorus input (NAPI) determined by soil pH value and organic matter content in subtropical China.

Exploring the relationship between net anthropogenic phosphorus input (NAPI) and soil available P (SAP) content could inform applied issues related to environmental quality and agronomic productivity and increase our knowledge of element biogeochemical cycles. Here, the NAPI was estimated and the SAP content determined in eight counties in subtropical China from 1980 to 2010. It is suggested that the NAPI ranging 318-924 km-2 yr-1 in 1980 had increased substantially to 865-3601 km-2 yr-1 in 2010 across the eight counties, in which the P fertilizer application was estimated to represent the largest individual source of NAPI, accounting for an average of 36.1-74.6% of the NAPI. The NAPI in agricultural land (NAPIa) was the largest component of the NAPI, and 60.7-77.1% of the NAPIa accumulated in the upper 20 cm layer of agricultural soils, which significantly increased soil total-P (TP) and SAP contents. The increases in SAP, resulting from 10,000 kg P km-2 of the NAPIa (IOPNAPI), were estimated to be 1.61-4.36 mg P kg-1 in the counties. Both the correlation and variation partitioning analyses (VPAs) suggested that the soil pH and organic matter content (SOM) were the most important factors influencing the variations of IOPNAPI (determination coefficient: 72.5%). Therefore, the contribution of soil pH and SOM should be considered in enriching soil SAP levels and implementing optimal P management strategies to improving the agronomic effectiveness of P fertilization and further reduce the environmental risk of P loss in subtropical region.

The effects of a standardized belly dance program on perceived pain, disability, and function in women with chronic low back pain.

BACKGROUND: An alternative approach to facilitate movement and control through the trunk and pelvis is belly dancing. Investigations of belly dancing mechanics indicate similar muscular activation patterns of those known to influence chronic low back pain (cLBP). However, no documented studies have examined its effectiveness as a treatment for cLBP. OBJECTIVE: The purpose of this study was to investigate the influence of a standardized belly dance program in women with cLBP. METHODS: A single subject design was used to evaluate weekly outcomes during a three-week baseline period, six-week belly dance program, and again at a two-month follow-up. Outcome measures for pain, disability, function, and fear-avoidance beliefs were utilized. RESULTS: Two subjects completed the program. No significant differences were noted during the baseline assessment period. At two months, subject one demonstrated change scores of -1.12, -1%, and 2.2 for pain, disability, and function respectively while subject two demonstrated change scores of 5.4, 5%, and 1.1 for pain, disability, and function, respectively. Subject one showed a clinically significant change score for both fear avoidance of work and physical activity, with score changes of 4 and 3.3, respectively. CONCLUSION: The results of this study suggest a standardized belly dance program may positively influence pain and function in women with cLBP.

Relating land use patterns to stream nutrient levels in red soil agricultural catchments in subtropical central China.

Land use has obvious influence on surface water quality; thus, it is important to understand the effects of land use patterns on surface water quality. This study explored the relationships between land use patterns and stream nutrient levels, including ammonium-N (NH4 (+)-N), nitrate-N (NO3 (-)-N), total N (TN), dissolved P (DP), and total P (TP) concentrations, in one forest and 12 agricultural catchments in subtropical central China. The results indicated that the TN concentrations ranged between 0.90 and 6.50 mg L(-1) and the TP concentrations ranged between 0.08 and 0.53 mg L(-1), showing that moderate nutrient pollution occurred in the catchments. The proportional areal coverages of forests, paddy fields, tea fields, residential areas, and water had distinct effects on stream nutrient levels. Except for the forest, all studied land use types had a potential to increase stream nutrient levels in the catchments. The land use pattern indices at the landscape level were significantly correlated to N nutrients but rarely correlated to P nutrients in stream water, whereas the influence of the land use pattern indices at the class level on stream water quality differentiated among the land use types and nutrient species. Multiple regression analysis suggested that land use pattern indices at the class level, including patch density (PD), largest patch index (LPI), mean shape index (SHMN), and mean Euclidian nearest neighbor distance (ENNMN), played an intrinsic role in influencing stream nutrient quality, and these four indices explained 35.08 % of the variability of stream nutrient levels in the catchments (p<0.001). Therefore, this research provides useful ideas and insights for land use planners and managers interested in controlling stream nutrient pollution in subtropical central China.

Efficacy of early treatment on 52 patients with preneoplastic hepatitis B virus-associated hepatocellular carcinoma by compound Phyllanthus Urinaria L.

OBJECTIVE: To observe the change in the number of antibodies of preneoplastic hepatocellular carcinoma (HCC) using early treatment by Compound Phyllanthus Urinaria L. (CPUL) on patients with preneoplastic hepatitis B virus (HBV)-associated HCC. METHODS: A total of 102 cirrhosis patients with regenerative or dysplastic nodules whose sera were tested positive for at least one of these six proteins (five up-regulated genes URG4, URG7, URG11, URG12 and URG19, and one down-regulated gene DRG2) were assigned randomly to two groups using continual random codes by SPSS software. Fifty-two patients were in the treatment group and 50 patients were in the control group. CPUL was used in the treatment group for 3 years, while the control group did not receive any treatment. The changes in HBV-DNA level, number of antibodies, and hepatocarcinogenesis occurred were observed. Patients who did not develop HCC were followed up for another 2 years. RESULTS: HBV-DNA levels decreased ⩾2log in 22.2% (10/45) of patients in the treatment group in contrast to only 5.0% (2/40) of patients in the control group (P=0.0228). The number of antibodies that were tested positive in the treatment group (1.08±1.01) was significantly lower compared with the control group (2.11±1.12) after 24 months of drug treatment (P<0.01). Both the positive rates of anti-URG11 (33/52) and anti-URG19 (31/52) were over 60% at baseline in the two groups, and were decreased to 48.1% (25/52) and 46.2% (24/52) respectively at 36 months of drug treatment, while the rates increased to 68.0% (34/50) and 66.0% (33/50) respectively (P=0.0417, P=0.0436) in the control group. The positive rate of anti-DRG2 was increased to 55.8% (29/52) at 36 months of drug treatment, while in the control group was decreased to 36.0% (18/50, P=0.0452). Among the 102 patients who developed HCC, 2 were in the treatment group and 9 were in the control group, meaning that a significant difference between the two groups (P=0.0212). In 11 patients who developed HCC, anti-URG11 and anti-URG19 were always positive, while anti-DRG2 was negative. Patients newly developing HCC were 6 (20.0%) in the control group, and only one (2.5%) in the treatment group (P=0.0441) during 2-year follow-up after the end of the treatment. CONCLUSIONS: Anti-URG11, anti-URG19 and anti-DRG2 could be used as early markers in the prediction of the therapeutic efficacy of CPUL in treating preneoplastic HCC. CPUL is useful in preventing or delaying the development of HBV-associated cirrhosis to HCC.

Efficacy and safety of a chinese herbal formula (invigorating kidney and strengthening spleen) in chronic hepatitis B virus carrier: results from a multicenter, randomized, double-blind, and placebo-controlled trial.

A Chinese Herbal Formula (CHF) has acquired a certain therapeutic effect on chronic HBV infection. To assess the efficacy and safety of CHF on HBV replication in chronic HBV carriers, we performed a randomized, double-blind, and placebo-controlled trial involving patients from 16 centers. A total of 300 confirmed chronic HBV carriers were randomized at baseline in a ratio of 2 : 1 to receive either CHF or placebo for 52 weeks. The results showed that a greater proportion of CHF than placebo treated patients achieved virological response at week 52; the mean decline of serum HBsAg levels in the CHF group dropped more obviously than that in the control group at all stages of the treatment; however, the rates of HBeAg loss and seroconversion had no difference between the two groups. Meanwhile, were presented significant increases in IFN- γ ; IL-2 levels and reductions in IL-4 and IL-10 levels in the treatment group compared to the control group at week 52. There were no drug-related serious adverse events. In conclusion, the treatment with 52-week CHF is safe and effective in inhibiting HBV replication in chronic HBV carriers. The ability of the compound to modulate host immune function probably contributed to this effect.

[Change characteristics of soil available nitrogen and phosphorus and heavy metal contents after long-term cultivation of vegetables].

Soil samples were collected from three vegetable fields under different years of cultivation in Changsha suburbs of Hunan Province, South-central China to study the accumulation characteristics, risks, and sources of soil available nitrogen and phosphorus and heavy metals in the fields. With the increasing year of vegetable cultivation, the soil NO3(-)-N, Olsen-P, and heavy metals contents in the fields increased significantly. The average contents of soil NO3(-)-N, Olsen-P, and Cd in the vegetable fields having been cultivated for 1-2 years in Ningxiang County, 10-15 years in Changsha County, and 30 years in Kaifu District were 21.1, 31.9 and 0.33 mg x kg(-1), 42.0, 146.9 and 0.52 mg x kg(-1), and 49.5, 219.9 and 1.40 mg x kg(-1), respectively. The cumulative index (CI) of soil heavy metals generally followed the sequence of Cd >> Cu > Pb > Ni > Zn. Principal component analysis and cluster analysis showed that compared with soil NH4 OAc-extracted potassium, pH, organic matter and NH4(+)-N, that were dominated by natural factors, the soil Olsen-P and NO3(-)-N had the similar accumulation characteristics with the soil heavy metals, being mainly controlled by fertilization. It was considered that the soil environment and health quality of the vegetable fields in Changsha suburbs were not optimistic. The longer the cultivation year of vegetables, the more the soil NO3(-)-N, Olsen-P, and heavy metals accumulated in the fields. The accumulation of these elements in the fields could be primarily due to the long-term fertilization.