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Abstract Background Shoulder function complications are common after treatment for breast cancer. Quite a few survivors still report a limited shoulder range of motion, even though the free range-of-motion upper limb exercise is helpful to restore shoulder function. Mirror therapy (MT) is a classical and effective rehabilitation technique to recover motor and sensory function for the limbs; in addition, studies have reported that MT has an influence on patients with shoulder functional dysfunction including increasing shoulder range of motion, improving shoulder function scores, and decreasing pain scores. Here, we describe a protocol of a randomized controlled trial to explore if free range-of-motion upper limb exercise based on MT has efficacy on shoulder function in survivors after surgery of breast cancer. Methods/design This is a prospective, single-blind, two-arm randomized controlled trial. An estimated 70 participants will be randomly allocated to (1) the MT group or (2) the control group. The participants in the control group receive free range-of-motion upper limb exercise, and participants in the MT group will engage in free range-of-motion upper limb exercise based on MT. The intervention will start on the first day after surgery and be completed at 8 weeks after surgery. The primary outcome in this protocol is shoulder range of motion (ROM), while the Constant-Murley Score (CMS); Disability of the Arm, Shoulder, and Hand Questionnaire (DASH); Tampa Scale of Kinesiophobia (13-item TSK); visual analog scale (VAS); grip strength; arm circumference; and lymphedema are the secondary outcomes. Assessment will be conducted before allocation (baseline) and at 2 weeks, 4 weeks, and 8 weeks after surgery. Discussion Based on the results that MT has an influence on shoulder function immediately after intervention in patients without nerve injury, this randomized controlled trial is to observe the efficacy of MT on shoulder function after a long-term intervention in breast cancer survivors. We look forward to the innovation of this study for both breast cancer rehabilitation and MT. Trial registration Chinese Clinical Trial Registry ( ChiCTR ) ChiCTR2000033080. Registered on 19 May 2020

Abstract Background More than 50% cognitive impairment was reported by cancer patients before and after medical treatment. However, there are no effective interventions to manage the cognitive problem in women with breast cancer. This pilot study was designed to evaluate the protective effect of Baduanjin exercise on cognitive function and cancer-related symptoms in women with early-stage breast cancer undergoing chemotherapy. Method A single-blinded, randomized control trial was designed. The trial will recruit 70 patients with early-stage breast cancer scheduled to receive chemotherapy from Shanghai in China. All participants will be randomly assigned to (1:1) the supervised Baduanjin group (5 times/week, 30 min each time) or the wait-list control group for 3 months. The effect of Baduanjin exercise intervention will be evaluated by outcome measures including subjective and objective cognitive function, symptoms (fatigue, depression, and anxiety), and health-related quality of life at pre-intervention (T0), 8 weeks (T1), and 12 weeks (T2). The PCI score in the FACT-Cog as the primary cognitive outcome will be reported descriptively, while effect sizes and 95% confidence intervals (CIs) will be calculated. The collected data will be analyzed by using an intention-to-treat principle and linear mixed-effects modeling. Discussion This is the first randomized clinical trial to investigate whether Baduanjin exercise will have a positive role in improving cognitive function in women with breast cancer receiving chemotherapy. If possible, Baduanjin exercise will be a potential non-pharmacological intervention to manage cognitive dysfunction and promote survivorship care among breast cancer survivors. Trial registration Chinese Clinical Trial Registry (ChiCTR) ChiCTR2000033152 . Registered on 22 May 2020

Pancreatic adenocarcinoma (PAAD), the most common subtype of pancreatic cancer, is a highly lethal disease. In this study, we integrated the expression profiles of splicing factors (SFs) of PAAD from RNA-sequencing data to provide a comprehensive view of the clinical significance of SFs. A prognostic index (PI) based on SFs was developed using the least absolute shrinkage and selection operator (LASSO) COX analysis. The PI exhibited excellent performance in predicting the status of overall survival of PAAD patients. We also used the percent spliced in (PSI) value obtained from SpliceSeq software to quantify different types of alternative splicing (AS). The prognostic value of AS events was explored using univariate COX and LASSO COX analyses; AS-based PIs were also proposed. The integration of prognosis-associated SFs and AS events suggested the potential regulatory mechanisms of splicing processes in PAAD. This study defined the markedly clinical significance of SFs and provided novel insight into their potential regulatory mechanisms.

Abstract Background Allergic rhinitis (AR) is a worldwide health problem. Allergen avoidance is strongly recommended for AR patients. Air purification can reduce concentrations of particles in indoor air, including those of allergens. Air purifiers have been recommended by clinicians for AR patients, but few studies have focused on the removal of airborne allergens from home environments. Such studies have been limited by a lack of blinding, small samples, or a failure to measure allergen levels, disease activity, or a combination of these factors. This study investigates the efficacy of a high-efficiency air purifier in reducing disease activity in the homes of AR patients sensitive to the allergens produced by Artemisia (mugwort) pollen. Methods This is a randomized, double-blind, clinical controlled trial that will test active and inactive versions of an air purifier (Atmosphere®; Amway China). Sixty AR patients sensitive to the allergens produced by Artemisia pollen will be assigned randomly to two groups of equal numbers. All patients will undergo a 4-week treatment period and a 4-week observation period. Evaluation will be conducted at baseline (day 0) and on days 7, 14, 21, 28, and 56. The primary outcome measure will be the difference in visual analog scale scores from baseline. Secondary outcomes will be changes from baseline in nasal symptoms, allergy symptom scores, responses to the Rhinoconjunctivitis Quality of Life Questionnaire, Epworth Sleepiness Scale scores, and tolerability scores for the air purifier. Side effects of treatment will be recorded. Discussion Reducing exposure to allergens can reduce the risk of conditions such as AR. We hypothesise that AR patients sensitive to the allergens produced by Artemisia pollen will not suffer symptoms in a pollen-free environment. AR patients can remove pollen from their homes using air purifiers, decreasing the risk of symptoms. We expect that our study results will provide reliable evidence for determining the effects of air-purification therapy. Trial registration ChiCTR-INR-17012481. (Retrospectively registered 26 August 2017).

In order to modify in-situ synthesized Mg2Si particles in Mg2Si/Mg-4Si composite, the modification effect of calcium-magnesia phosphate fertilizer on primary Mg2Si phase in Mg2Si/Mg-4Si composite was investigated by means of X-ray diffraction (XRD), optical microscopy (OM), scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) analysis. The results indicate that the morphology of the primary Mg2Si phase apparently changes from coarse dendrites to fine dispersive polygonal particles, and the mean size is decreased from 277 μm to 17 μm. With the addition of 4.0wt.% calcium-magnesia phosphate fertilizer as a modifier, the ultimate tensile strength and elongation of the Mg2Si/Mg-4Si composite are increased from 78.7 MPa and 2.1% to 105.2 MPa and 2.6%, as compared to those of the base composite, which is probably attributed to the formation of the phosphorous compound and the cluster of Ca compounds that acted as the heterogeneous nucleation substrates of the primary Mg2Si particles, resulting in a refined distribution of these precipitates.

The modification effects of ytterbium (Yb), Na3PO4 and Yb + Na3PO4 on primary Mg2Si phase in Mg-4Si alloys were investigated by means of X-ray diffraction (XRD), optical microscopy (OM), scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) analysis in this work. The results indicate that the morphology of the primary Mg2Si phase apparently changes from coarse dendrites to fine dispersive polygonal particles and the mean size decreases from 276.6 μm to 7.1 μm, with combined modification of 0.8wt.% Yb and 2.64wt.% Na3PO4. Such a morphological evolution results in improvement in the ultimate tensile strength and elongation of the alloys as compared to the base alloy. This may be attributed to the formation of the YbP particles that acted as the heterogeneous nucleation substrates for the primary Mg2Si particles, resulting in a refined distribution of these precipitates. The results of XRD examination show that there was no reaction between Si and Yb or Na3PO4. Solo addition of Yb or Na3PO4 into the melt has no real modification effect on the microstructure, but the primary Mg2Si particles and α-Mg phases become coarser than that in the unmodified alloy.

In order to modify in-situ synthesized Mg2Si particles in Mg2Si/Mg-4Si composite, the modification effect of calcium-magnesia phosphate fertilizer on primary Mg2Si phase in Mg2Si/Mg-4Si composite was investigated by means of X-ray diffraction (XRD), optical microscopy (OM), scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) analysis. The results indicate that the morphology of the primary Mg2Si phase apparently changes from coarse dendrites to fine dispersive polygonal particles, and the mean size is decreased from 277 µm to 17 µm. With the addition of 4.0wt.% calcium-magnesia phosphate fertilizer as a modifier, the ultimate tensile strength and elongation of the Mg2Si/Mg-4Si composite are increased from 78.7 MPa and 2.1% to 105.2 MPa and 2.6%, as compared to those of the base composite, which is probably attributed to the formation of the phosphorous compound and the cluster of Ca compounds that acted as the heterogeneous nucleation substrates of the primary Mg2Si particles, resulting in a refined distribution of these precipitates. [ABSTRACT FROM AUTHOR]

The modification effects of ytterbium (Yb), Na3PO4 and Yb + Na3PO4 on primary Mg2Si phase in Mg- 4Si alloys were investigated by means of X-ray diffraction (XRD), optical microscopy (OM), scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) analysis in this work. The results indicate that the morphology of the primary Mg2Si phase apparently changes from coarse dendrites to fine dispersive polygonal particles and the mean size decreases from 276.6 µm to 7.1 µm, with combined modification of 0.8wt.% Yb and 2.64wt.% Na3PO4. Such a morphological evolution results in improvement in the ultimate tensile strength and elongation of the alloys as compared to the base alloy. This may be attributed to the formation of the YbP particles that acted as the heterogeneous nucleation substrates for the primary Mg2Si particles, resulting in a refined distribution of these precipitates. The results of XRD examination show that there was no reaction between Si and Yb or Na3PO4. Solo addition of Yb or Na3PO4 into the melt has no real modification effect on the microstructure, but the primary Mg2Si particles and α-Mg phases become coarser than that in the unmodified alloy. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetSyn) increases the incidence of cardiovascular disease. Information on changes in prevalence of MetSyn in developing countries is limited. This study aims to compare MetSyn prevalence and its associated vascular risk over the period between 2002 and 2010 in a population which has had the world’s fastest economic development over the past three decades. Methods: Two health surveys were conducted by using the multistage cluster random sampling method in a Chinese population of 85 million in southern China. The participants received a full medical check-up, including measurement of blood pressure (BP), obesity indices, fasting lipids and glucose levels. Data describing socio-economic status and lifestyle factors were also collected through interview. Metabolic syndrome was defined in accordance with the International Diabetes Federation criteria. Results: A total of 3,561 participants from Survey 2010 were included in the data analysis. Women had a significantly higher prevalence of MetSyn than men. Comparison between the two surveys shows that age-standardized prevalence of MetSyn increased fourfold (from 5.4% in 2002 to 21.3% in 2010) in those ≧ 20 years. Among the MetSyn components, prevalence of hyperglycaemia has increased most (from 9.1% to 53.1%). The age-standardized prevalence of central obesity, hypertension, hypertriglyceridaemia and low HDL-cholesterol increased from 13.5% to 25.4%, from 23.6% to 40.8%, from 12.1% to 17.4% and from 32.1% to 71.1%, respectively. Differences between rural and urban residents in the prevalence in MetSyn and its components narrowed in 2010. Conclusions: Cardiovascular risk escalated dramatically in this population between 2002 and 2010. The escalation may relate to the rapid economic development, which led to accelerating changes in nutrition, lifestyle, and socio-economic status. Our findings suggest that health transition in rapidly developing second- and third-world countries may be much faster than what has been observed in Western countries. [ABSTRACT FROM AUTHOR]

PURPOSE Current health care reforms in China have an overall goal of strengthening primary care through the establishment and expansion of primary care networks based on community health centers (CHCs). Implementation in urban areas has led to the emergence of different models of ownership and management. The objective of this study was to evaluate the primary care experiences of patients in the Pearl River Delta as measured by the Primary Care Assessment Tool (PCAT) and the relationships with ownership and management in the 3 different models we describe. METHODS This cross-sectional study was conducted on-site at CHCs in 3 cities within the Pearl River Delta, China, using a multistage cluster sampling method. A validated Mandarin Chinese version of the PCAT-Adult Edition (short version) was adopted to collect information from adult patients regarding their experiences with primary care sources. PCAT scores for individual primary care attributes and total primary care assessment scores were assessed with respect to sociodemographic characteristics, health characteristics, and health care service utilization across 3 primary care models. RESULTS One thousand four hundred forty (1,440) primary care patients responded to the survey, for an overall response rate of 86.1%. Respondents gave government-owned and -managed CHCs the highest overall PCAT scores when compared with CHCs either managed by hospitals (95.18 vs 90.81; P = .005) or owned by private and social entities (95.18 vs 90.69; P = .007) as a result of better first-contact care (better first-contact utilization) and coordination of care (better service coordination and information system). Factors that were positively and significantly associated with higher overall assessment scores included the presence of a chronic condition (P <.001), having medical insurance (P = .006), and a self-reported good health status (P <.001). CONCLUSIONS This study suggests that government-owned and -managed CHCs may be able to provide better first-contact care in terms of utilization and coordination of care, and may be better at solving the problem of underutilization of the CHCs as the first-contact point of care, one key problem facing the reforms in China. [ABSTRACT FROM AUTHOR]

First-principles calculations are performed to study the modulation of energy gaps in nitrogen delta-doping (N δ-doping) graphene and armchair-edge graphene nanoribbons (AGNRs). The energy gap of graphene only opens at a large nitrogen doping content. For AGNRs, the energy gaps tend to decrease with the N δ-doping, and an interesting transition from direct to indirect bandgap is observed. Moreover, the effects of N δ-doping on energy gaps incline to decease with the reduction of the doping content. Our results may help to design novel graphene-based nanoelectronics devices by controlling N δ-doping of graphene. [ABSTRACT FROM AUTHOR]

Using Green's function method, electron transport in graphene folding junctions (GFJs) are studied. All of these junctions are bilayer structures with AA or AB stacking. As for the AA-stacking GFJs, their transport properties are strongly dependent on the edge form and folding angle. The armchair GFJs (AGFJs) with a folding angle of 60° have high reflection to electrons, while those with a folding angle of 120° are nearly reflectionless and transparent. The zigzag GFJs (ZGFJs) show an opposite transport behavior: The junctions with a folding angle of 60° are nearly transparent while those of folding angle 120° have high reflection. As for the AB-stacking GFJs, their transport properties are insensitive to the edge form or folding angle, and all junctions exhibit less reflection to electrons. In addition, interesting edge states different from those in the unfolded nanoribbons are found in the GFJs. Our results indicate that GFJs can be served either as resistors for tuning attenuation of currents or as interconnects for changing directions of current in all graphene-based nanoelectronics. [ABSTRACT FROM AUTHOR]

Purpose: Obesity has been recognized as a significant risk factor for postmenopausal breast cancer. The aim of this study is to investigate the prognostic significance of body mass index (BMI) in hormone receptor-positive, operable breast cancer. Methods: In this retrospective cohort study, 1,192 consecutive patients with curative resection of primary breast cancer were enrolled. Patients were assigned to two groups according to BMI: normal or underweight (BMI < 23.0 kg/m²) and overweight or obese (BMI ≥ 23.0 kg/m²). Associations among BMI and clinicopathological characteristics and prognosis of patients were assessed. Results: A high BMI was significantly (P < 0.01) correlated with age, nodal stage, ALNR, ER positivity, PR positivity and menopausal status at diagnosis. Univariate analysis revealed that BMI, pathologic T stage, nodal stage, axillary lymph node ratio (ALNR) and adjuvant radiotherapy history were significantly (P < 0.05) associated with disease-free survival and overall survival, irrespective of tumour hormone receptor status. Multivariate analysis revealed BMI as an independent prognostic factor in all cases and in hormone receptor-positive cases. Conclusion: A high BMI (≥ 23.0 kg/m²) is independently associated with poor prognosis in hormone receptor-positive breast cancer. [ABSTRACT FROM AUTHOR]

Introduction: Influenza has been linked to the crowding in emergency departments (ED) across the world. The impact of the Coronavirus Disease 2019 (COVID-19) pandemic on China EDs has been quite different from those during past influenza outbreaks. Our objective was to determine if COVID-19 changed ED visit disease severity during the pandemic., Methods: This was a retrospective cross sectional study conducted in Nanjing, China. We captured ED visit data from 28 hospitals. We then compared visit numbers from October 2019 to February 2020 for a month-to-month analysis and every February from 2017 to 2020 for a year-to-year analysis. Inter-group chi-square test and time series trend tests were performed to compare visit numbers. The primary outcome was the proportion of severe disease visits in the EDs., Results: Through February 29 th 2020, there were 93 laboratory-confirmed COVID-19 patients in Nanjing, of which 40 cases (43.01%) were first seen in the ED. The total number of ED visits in Nanjing in February 2020, were dramatically decreased (n = 99,949) in compared to January 2020 (n = 313,125) and February 2019 (n = 262,503). Except for poisoning, the severe diseases in EDs all decreased in absolute number, but increased in proportion both in year-to-year and month-to-month analyses. This increase in proportional ED disease severity was greater in higher-level referral hospitals when compared year by year., Conclusion: The COVID-19 outbreak has been associated with decreases in ED visits in Nanjing, China, but increases in the proportion of severe ED visits., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To investigate the effects and mechanisms of hydroxytyrosol (HT) during the pathogenesis of myocardial ischemia reperfusion (I/R) in rat hearts., Methods: The rats were randomized into five groups: sham group, I/R group, HT+I/R group, HT+LY294002+I/R group, and LY+I/R group. Myocardial infarct size, markers of oxidative stress, extent of myocardial apoptosis, echocardiographically assessed cardiac function, and expression of Akt and GSK 3β were measured in each group., Results: Prereperfusion administration of HT was associated with a significantly smaller area of myocardial infarction and remarkably decreased level of myocardial apoptosis and necrosis, as evidenced by a lower apoptotic index, reduced cleaved caspase-3, and the serum activities of lactate dehydrogenase and creatinine kinase MB. Moreover, HT also attenuated the impairment of cardiac systolic function. However, cotreatment with LY294002 and HT completely abolished the above cardioprotective effects of HT. A subsequent mechanistic study revealed that the cardioprotective effects of HT during the process of I/R of the myocardium were dependent on the activation of the Akt/GSK3β pathway., Conclusion: Pretreatment with HT may have antiapoptotic and cardioprotective effects against myocardial I/R injury, and these effects seem to be related to the activation of the Akt/GSK3β pathway in the myocardium.