The association between short-term exposure to ambient air pollution and blood pressure has been inconsistent, as reported in the literature.This study aimed to investigate the relationship between short-term ambient air pollution exposure and patient-level home blood pressure (HBP).2, particulate matter with a diameter of <10 µm, particulate matter with a diameter of <2.5 µm, and SO2) during the same time period were obtained from the Central Weather Bureau and the Environmental Protection Administration in Taiwan, respectively. A stepwise multivariate repeated generalized estimating equation model was used to assess the significant factors for predicting systolic and diastolic blood pressure (SBP and DBP).Patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital were enrolled as the study population. HBP was measured by patients or their caregivers. Hourly meteorological data  and ambient air pollution monitoring data . All 5 air pollutants evaluated in this study showed a significant, nonlinear association with both home SBP and DBP. Compared with demographic and clinical factors, environmental factors  played a minor yet significant role in the regulation of HBP.Short-term exposure to ambient air pollution significantly affects HBP in patients with chronic cardiovascular disease. Hypertension is among the most prominent risk factors contributing to cardiovascular diseases, and the potential detrimental effect of air pollution on blood pressure (BP) is considered one of the mechanisms underlying the exacerbation in cardiovascular outcomes. However, the association between short-term or long-term exposure to ambient air pollution and BP has been inconsistent in previous studies, and most of these studies were epidemiological [Air pollution is a great hazard to public health -5. Previological -12. In tWe retrospectively enrolled patients with chronic cardiovascular diseases (CVDs) who participated in telehealth care at National Taiwan University Hospital (NTUH), Taipei, Taiwan, between January 2009 and December 2013 as the study population. We excluded patients who did not reside in Taipei City during the study period. Informed consent was obtained from all participants. The study was approved by the institutional review board of NTUH. Chronic CVDs included coronary artery disease, prior myocardial infarction, heart failure, peripheral artery disease, prior stroke, and hypertension.In this study, we used a fourth-generation telehealth program developed by Anker et al . The pro2, PM10, PM2.5, and SO2) during the same study period were obtained from the Environmental Protection Administration, Taiwan.Demographic, clinical (diagnosis of specific diseases), and medication data were obtained from the electronic database of NTUH. All biometric data were measured at home and automatically transmitted to the NTUH server. Biometric data were meant to be measured at least twice daily, ideally after waking up and before sleeping, but each patient or caregiver could have his/her own habit to select a time point and interval within a day to measure biometric parameters. We used the AViTA BPM65ZB sphygmomanometer (AViTA Corp), which is an electronic digital upper arm BP monitor. Hourly meteorological data  of Taipei City during the study period were obtained from the Central Weather Bureau, Taiwan. Hourly ambient air pollution monitoring data  and median (IQR) values, and categorical variables are presented as frequencies and percentages. The differences in the distributions of continuous variables between male and female subjects were examined using the Wilcoxon rank-sum test. Differences in the distributions of categorical variables were compared using the Fisher exact test. Multivariate analysis was conducted by fitting multiple linear regression models to estimate the adjusted effects of age, sex, comorbidities , heart rate, antihypertensive agents, seasons, meteorological factors, air pollutants, and other predictors of home systolic and diastolic blood pressure (SBP and DBP).Statistical analysis was performed using the R software . In statistical testing, a 2-sided Since the use of antihypertensive agents, values of meteorological factors, and concentrations of air pollutants varied over time, we defined and included the following three groups of time-dependent covariates in our linear regression analyses:Antihypertensive agents: among the 6 most common classes of antihypertensive drugs, we considered the classes of antihypertensive medications and the number of classes of antihypertensive medications used on the day of BP measurement.Meteorological factors: these included hourly averaged outdoor temperature, relative humidity, and wind speed within the hour of BP measurement.2, PM10, PM2.5, and SO2) and the amount of rainfall within the hour of BP measurement, where the distances were calculated from each patient’s home location to the 6 air quality monitoring stations in Taipei City, based on the corresponding latitudes and longitudes. Instant and cumulated air pollutant concentrations at hours 0, 3, 6, 12, and 18 and days 1, 2, 3, 4, 5, 6, and 7 were included in the multivariate analysis to evaluate the possible lag effect of each pollutant.Air pollutants: we determined hourly inverse-distance weighted mean concentrations of 5 air pollutants  were fitted to assess the nonlinear effects of continuous covariates and identify appropriate cut-off points for discretizing continuous covariates, if necessary, during stepwise variable selection. Further details on statistical analysis are provided in 2, PM10, PM2.5, CO, and SO2 were 23.67 (SD 6.80) ppb, 46.83 (SD 21.03) μg/m3, 27.96 (SD 10.77) μg/m3, 0.74 (SD 0.25) ppm, and 3.05 (SD 1.19) ppb, respectively. The air quality standards recommended by the World Health Organization for these pollutants, during the study period, were based on the 2005 version of the update [A total of 253 patients with CVD who participated in the NTUH Telehealth Care Program from January 2009 to December 2013 were enrolled in this study. A total of 110,715 HBP measurements were carried out accordingly for these patients. The details of this patient population, including the per-patient and per-measurement demographics and clinical characteristics, have already been reported previously . The dat.05 SD 1. ppb, res2, SO2, PM2.5, and PM10 concentrations were significantly correlated with home SBP and DBP, and the effects were considered nonlinear. The cut-off points for discretizing the continuous covariates with nonlinear effects on the mean values of SBP and DBP (mmHg) were determined objectively, using the corresponding GAM plots during stepwise variable selection. The GAM plots representing the relationships between SBP and different environmental factors are shown in Multivariate analysis was conducted by fitting multiple linear regression models to estimate the adjusted effects of demographic, clinical, and meteorological factors and air pollutants on home SBP and DBP measurements. The use of antihypertensive agents, values of meteorological factors, and concentrations of air pollutants were all defined and computed as time-dependent covariates. Multivariate analysis of the predictors for SBP and DBP on fitting 1 multiple linear regression model with the stepwise variable selection procedure is shown in R2=0.1286) indicates that the Pearson correlation coefficient between the observed value of SBP and the model-predicted value of SBP was 0.1286½=0.3586, and that for DBP  indicates that the Pearson correlation coefficient between the observed value of DBP and the model-predicted value of DBP was 0.2219½=0.4711.The multiple linear regression model for SBP  altering the autonomic nervous system to favor a sympathetic tone [2.5 and BP, which has been reported before, but the effect was inconsistent. To date, 4 meta-analyses have addressed this issue. Liang et al [2.5, SBP, and DBP. Zhang et al [2.5, while a high DBP is only associated with the exposure to PM10, but not PM2.5. Cai et al [2, PM2.5, and PM10 was significantly associated with an increased risk of hypertension. The association between BP and air pollutants other than PM has not been investigated in detail. In a recent meta-analysis by Yang et al [10, PM2.5, SO2, and NO2), SBP (PM2.5 and SO2), and DBP . However, these meta-analyses were mainly performed on the basis of epidemiological studies. To our knowledge, our study is the first to investigate the relationships among demographic, clinical, meteorological factors, air pollutants, and HBP at the patient level.Human health is significantly correlated with genomic and environmental factors. Wild  defined ok et al  adequatetic tone , (2) inctic tone ,23, (3) tic tone ,25, and tic tone ,27. Manyng et al  reportedng et al  reportedai et al  reportedng et al , short-t10, PM2.5, SO2, NO2, and CO) that were included in this study. The association between HBP and ambient air pollution was surprisingly nonlinear, given that most previous studies used a linear model to evaluate the effect of ambient air pollution on BP and hypertension. Yang et al [There are some notable findings in this study. First, at the patient level, ambient air pollution was significantly associated with HBP, both SBP and DBP, and the culprit pollutants included all of the 5 pollutants  had significant effects on human health at the patient level and should be considered in future studies on abiotic exposure among exposomes. Fourth, the possible interactions among air pollutants, including synergistic effects and collinearity, were not addressed in this study. Fifth, this study reports a nonlinear relationship between BP and ambient air pollutants, but further evaluation of the dose-effect curve was limited by the current statistical methods. Similarly, the interactions between ambient air pollution and other environmental factors, such as meteorological factors, were not addressed in this study. Multiscale entropy is a novel nonlinear method that has been applied to predict outcomes in a few clinical settings, including trauma [This study has a few limitations. First, this was a retrospective registry with a relatively small number of patients. Second, the study population comprised patients with chronic CVD with great adherence and health insights as they opted to participate in a telehealth care program. Thus, whether the study results can be extrapolated to other patient populations should be carefully considered. Third, individual ambient air pollutant concentrations were calculated using a spatial model that might not reflect true personal exposure. Jiang et al  reportedg trauma , after cg trauma , acute sg trauma , and autg trauma . Furtherg trauma -38. HoweShort-term exposure to ambient air pollution significantly affects both home SBP and DBP in patients with chronic CVD, and the relationship between ambient air pollution and HBP is nonlinear.


R2 = 0.43, p = 0.008) in factors and single-leg hop  in components were associated with patient-oriented outcomes, respectively. In conclusion, the functional task and single-leg hop may be used for providing valuable information about knee joints to patients and clinicians.Although the Lower-Extremity Assessment Protocol (LEAP) assesses multidimensional aspects of a patient with anterior cruciate ligament (ACL) injury, there is a need to reduce the dimensionality of LEAP items to effectively assess patients. Therefore, the present study aimed to establish the validity of LEAP and to determine associated factors and components in a relationship between LEAP and the International Knee Documentation Committee (IKDC) questionnaire. Fifteen patients who had ACL reconstruction more than 1 year and less than 5 years earlier were recruited. Patients performed LEAP, including muscular strength, fatigue index, static balance, drop landing, and functional hopping assessment. They also completed the IKDC questionnaire and the Tegner Activity Score. Factor analysis and stepwise regression analysis were performed. The 14 components of LEAP were categorized into four factors , which accounted for 83.8% of the cumulative variance by factor analysis. In the stepwise regression analysis, the functional task ( Anterior cruciate ligament (ACL) injury is a common sports-related musculoskeletal issue, not only in professional/elite athletes but also in recreational players ,2. ACL iBased on these factors, ACL reconstruction (ACLR) surgery is performed on patients who want to restore the altered movement patterns and function of their knee joints, increase the possibility of return to play (RTP), and reduce the possibility of post-traumatic osteoarthritis . As a reThere are several deficiencies that can occur after ACLR when compared with the patient’s condition before the injury. For instance, common symptoms after ACLR include atrophy, strength deficit of quadriceps and hamstring, and decreased neuromuscular control ,22,23,24Recently, Difabio et al.  have useSubjective self-reported pain and function are the indicators that best represent the patient’s experience ; thus, patient-oriented outcomes are investigated through questionnaires and used as the evidence and/or criteria for determining RTP for patients with ACL injuries ,28. For This study was a descriptive and cross-sectional design in a laboratory setting.Aged 19 to 40 years;More than 1 year and less than 5 years after ACLR ; andDamage or impairment affecting the muscle and nerve function.Participants excluded from the study had the following:All participants were informed of the study method and procedure and signed an informed consent form approved by the Institutional Review Board of Yonsei University (7001988-201804-HR-356-02).Each participant performed LEAP, including functional hopping task, muscle strength, fatigue index, LESS, and static single-leg balance. Participants completed the IKDC questionnaire to assess the functional status and pain level of the knee joint during activities of daily life and sports activities. In addition, the Tegner Activity Score was used to determine whether the participant had already successfully returned to their daily activities or sports activities and to measure their current physical activity level.After warming up for 10 min, the isokinetic and isometric strength of the knee joint were measured using an isokinetic dynamometer . Participants were tested in a sitting position, according to the manual of the dynamometer manufacturer A. The upParticipants were instructed to perform maximal voluntary isometric contractions while fixing their chest on the dynamometer and holding hands to measure isometric muscle strength and fatigue index of quadriceps and hamstrings. While participants were performing isometric muscle contractions of knee flexion and extension, the peak torque value was recorded to identify isometric muscle strength. All values of muscle strength were normalized with respect to each participants’ body weight. An isometric contraction for 30 s was measured, and muscle strength for the first 5 s was compared with that for the last 5 s to identify how long the muscle could maintain its strength (muscle fatigue index). Participants were given advance verbal instructions and encouragement to push or pull as hard as possible to facilitate maximal effort during muscle strength assessment.The functional test consisted of four types of hopping tasks: (1) single hop for distance, (2) triple hop for distance, (3) cross-over hop for distance, and (4) 6-m timed hop . All comThe single-leg standing assessment was carried out to determine the center of pressure velocity on the force plate  using analysis software . Participants stood on a single leg in the center of the plate for 10 s with their eyes closed and their hands on their hips C. After The LESS is a cost-effective clinical assessment tool to determine the potential risks of a jump landing task . Two vidAssessment items included lower extremity and trunk positioning at the time of initial contact: (1) maximum knee flexion (less than 30° = error score 1); (2) hip flexion (thigh was in line with the trunk = error score 1); (3) trunk flexion ; (4) ankle plantar flexion (foot lands heel to toe or with a flat foot = error score 1); (5) medial knee position ; (6) lateral trunk flexion (midline of the trunk is flexed to the left or the right = error score 1); (7) stance width, i.e., wide or narrow, (feet are positioned greater or less than acromion process = error score 1); (8) toe in or out ; (9) symmetric initial foot contact (both feet did not land at the same time or landing pattern of each foot was not the same = error score 1) . FurtherThe lower-extremity landing strategies for the hips, knees, and trunk that could be a risk factor for the knee joint were evaluated through various aspects in the front and side views. The evaluator used motion-analysis Kinovea software (version 0.8.15) for scoring.Exploratory factor analysis was performed for the 14 components of LEAP, namely, the single hop, the triple hop, the cross-over hop, the 6 m timed hop, isokinetic flexion 180°/s, isokinetic extension 180°/s, isokinetic flexion 90°/s, isokinetic extension 90°/s, isometric contraction of quadriceps, isometric contraction of hamstring, single-leg balance, LESS, the hamstring fatigue index, and the quadriceps fatigue index. LEAP was validated by grouping similar variables into dimensions. Pearson’s correlation analysis was conducted using the 14 components of LEAP. Within each of the four factors, the corresponding raw data were added, and stepwise regression analysis was used to determine the factor that most affected the IKDC. Then, stepwise regression analysis was once again conducted to detect the most important components to simplify the assessment procedure within the strongest factor. All statistical analyses were conducted using SPSS statistics program version 25.0 . The alpha level for all analyses was set at 0.05.All independent variables of LEAP were analyzed using factor analysis because there were no items that inhibited validity. Therefore, the 14 components of LEAP were the factors analyzed using principal components analysis with Varimax rotation. The factor loadings were all above 0.5, satisfying the validity of the overall LEAP components. The analysis yielded four factors that explained 85.315% of the variance for the entire set of variables . The firF = 9.88, p = 0.008), with an R2 of 0.43 . However, only the functional hopping task factor was inputted, and the other predictors were excluded. A significant regression equation was found  = 12.57, p = 0.004), with an R2 of 0.49 . Functional hopping and the single-hop task have been reported as the strongest factor and component, respectively, on patient-oriented outcomes after ACLR.The findings of the present study were consistent with those mentioned in previous studies, in that the “functional task” was one of the strongest predictors of patient-oriented outcomes. Logerstedt et al.  reportedThe results of this study demonstrate that the strongest component in the four functional tasks is the single-hop task. These findings correspond with the results of previous studies that have reported that the single-leg hop task correlated with results of isokinetic knee extension/flexion strength after ACLR ,35. LikeAfter ACL injury or ACLR, all lower-extremity muscles should be included in the assessment, but the quadriceps muscle should be highlighted because it has a direct connection tissue with the knee joint through the patella tendon. Furthermore, quadriceps muscle weakness and atrophy are common symptoms after ACL injury or ACLR ,21. ConsAfter ACLR, neuromuscular control during dynamic movement, such as a landing task, is altered ,43,44. AThe ability to adapt and overcome muscle fatigue is one of the factors to be considered before determining RTP. Previous studies have shown that muscular fatigue not only decreases the ability to detect joint motion but also exhausts the afferent and efferent pathways, interrupting the compensatory stabilizing mechanism of the knee joint and force production ,46. ThesThis study has some limitations that must be recognized. First, despite graft selection being one of the factors that affects recovery progress, especially for the strength of knee joint , graft tLEAP for RTP is categorized into four factors, and the functional tasks of hopping and the single-leg hop task are the strongest factor and component, respectively, for function and pain in patients after ACLR. These results suggest that the functional task of hopping and the single-leg hop task may be used to provide valuable information to both patients and clinicians, because the function and pain of the patient should be considered first when the clinician determines RTP after ACLR. In addition, since the functional task is the strongest factor, it is necessary to review dynamic tasks for patients after ACLR in a future study.


To assess the reporting quality of randomised controlled trials (RCTs) of massage, particularly whether necessary elements related to massage interventions were adequately reported.A total of 8 electronic databases were systematically searched for massage RCTs published in English and Chinese from the date of their inception to June 22, 2020. Quality assessment was performed using three instruments, namely the CONSORT  2010 Checklist (37 items), the CONSORT Extension for NPT (Nonpharmacologic Treatments) 2017 checklist (18 items), and a self-designed massage-specific checklist (16 items) which included massage rationale, intervention and control group details. Descriptive statistics were additionally used to analyse the baseline characteristics of included trials.A total of 2,447 massage RCTs were identified, of which most (96.8%) were distributed in China. For the completeness of CONSORT, NPT Extension, and massage-specific checklists, the average reporting percentages were 50%, 10% and 45%, respectively. Of 68 assessed items in total (exclusion of 3 repeated items on intervention), 42 were poorly presented, including 18 CONSORT items, 15 NPT items, and 9 massage-specific items. Although the overall quality of reporting showed slightly improvement in articles published after 2010, the international (English) journals presented a higher score of the CONSORT and NPT items, while the Chinese journals were associated with the increased score of massage-specific items.The quality of reporting of published massage RCTs is variable and in need of improvement. Reporting guideline “CONSORT extension for massage” should be developed.The online version contains supplementary material available at 10.1186/s13020-021-00475-6. Massage therapy (MT), an ancient form of medical technique, can be defined as a systematic manipulation of soft tissues of the body for pain reduction or other therapeutic purposes . ArchaeoRecently, there is an increasing number of clinical trials on massage. These studies suggested that MT has been notably effective in enhancing the growth of infants, increasing attentiveness, decreasing depression and aggression, alleviating motor problems, reducing pain, and enhancing immune function . HoweverTherefore, in this review, the assessments of reporting quality of massage trials were not only based on the checklists of CONSORT 2010 and NPT Extension 2017, but also on a self-designed massage-specific checklist . The objectives of this study were as follows: (a) to summarize the general characteristics of published RCTs on massage; (b) to assess their reporting quality based on the standard CONSORT and NPT checklists; and (c) to evaluate whether necessary information related to massage interventions were adequately reported according to the massage-specific items.This study included RCTs with massage intervention(s) published in English and Chinese up to 22 June 2020. We included a wide range of massage therapy, such as Chinese massage (Tuina), Swedish massage, Thai massage, Malay massage, ice massage, oil massage, infant massage, abdomen massage, and foot massage. Massage intervention(s) may have been administered alone or in combination with other interventions of conventional Western medicine or CAM. There were no limitations in the types of participants and controls in the included studies. Repeat publications, non-randomised or non-controlled trials, non-massage interventional trials, comprehensive interventions not focused on massage treatment, study protocols, reviews, observational studies, case reports, abstracts or full-text reports not found, non-human studies, and non-English or non-Chinese language reports were excluded.The following eight databases, EMBASE, MEDLINE, Evidence-Based Medicine (EBM) Reviews, Allied and Complementary Medicine (AMED), The China National Knowledge Infrastructure (CNKI), VIP database, Wanfang database, and WHO International Clinical Trials Registry Platform (including 17 registries updated in June 2020), were searched from the date of their inception to June 22, 2020. Languages were restricted to English and Chinese. The search terms were “massage”, “Chinese medicine”, “manipulative”, “reflexion therapy”, “physical contact”, “randomised”, “randomisation”, “randomized”, and “clinical trial”, etc. The detailed search strategy is given in Additional file The titles and abstracts of the records were independently screened by two authors (LZ and WFX) based on selection criteria, and the full texts of potentially suitable articles were retrieved for further assessment. Disagreements, if any, were resolved by discussion or consultation with the third author (XZ).Two authors (LZ and XZ) independently extracted details on a number of general characteristics of included studies, mainly involving publication years and journals, authors’ information, type of studied diseases, interventions and outcomes, and study design . To ensure consistency in the data extraction process, criteria for the extraction items and typical examples were developed and used on twenty articles  for testing, and then subsequently used to extract data from all included records. When there was any uncertainty regarding a particular article, the data extracted were checked and resolved by the third researcher (ZXB).The reporting quality of included trials was evaluated according to (1) the 37-item (including sub-items) of the CONSORT 2010 checklist; (2) the 18-item of the CONSORT Extension for Trials of Nonpharmacologic Treatments (NPTs) 2017 checklist; and (3) the 16-item of a self-designed massage-specific checklist. This massage-related checklist was developed by three researchers  based on a discussion about (1) the key elements of massage in clinical practice; (2) transparent reporting of massage details in the clinical trials, such as the treatment posture, media used, location selected, manipulations and procedures, patients’ responses, and adverse effects; (3) the rationale of why massage intervention(s) was selected; and (4) relevant items from the CONSORT Extensions for Chinese herbal medicine (CHM) formula, acupuncture, moxibustion, and cupping –16. AimiThere is a total of 71 items  in the above evaluation tools. As the massage-specific checklist was focused on an extension for the details of intervention, we thereby did not assess the three generalised items in the CONSORT and NPT Extension which with the same contents of the intervention, namely item 5 intervention of the CONSORT, and item 5a and 5b of NPT Extension. Therefore, a total of 68 items  were actually assessed in this study. Each item/question was scored as ‘‘yes’’ if it was fully reported  or ‘‘no’’ if it was incompletely reported or absent . The details of scoring rules are presented in Additional file For each assessed item, the number (n) and percentage (%) of trials that completely reported the item were provided. The reporting percentages were arbitrarily categorized as excellent (>85%), good (between 50% and 85%), and poor (< 50%). The mean overall CONSORT and NPT scores , and massage-specific scores  were calculated by subgroups and recorded as mean and standard deviations (SD). As indicated in the previous studies, the development of reporting guideline is closely related to the reporting quality of clinical trials . Some scThe initial search identified a total of 12,851 records, of which 8,691 relevant studies were retained after excluding duplicates and screening the titles and abstracts. After reviewing the full text of these articles, we identified 2,447 RCTs of massage for inclusion in our final analysis  were published during 2017–2019 Fig. .Fig. 2NuMost of the included trials (96.8%) were published in Chinese journals, of these journals, only 29.6% were classified as medical core journals. The number of authors was mainly 1–5 (87.5%), but 36.8% of articles reported only one author. The most common condition studied is the disease of musculoskeletal system or connective tissue (44.1%). Commonly, massage RCTs were performed in a single centre (97.6%), with a sample size of 51–100 (56.5%), and with two assignment groups (95.7%). Of 2,447 trials, 45.3% did not obtain or provide ethical approval, and 23.5% did not declare a conflict of interest. Few trials used the blinding methods (3.2%) for massage interventions, and less than 15% of trials adopted the CM pattern (or other CM-related indicators) in the assessed conditions and outcomes. 72.1% of articles have been cited less than five times  for CONSORT, 10% (0.04–57%) for NPT Extension, and 45% (1.8–94.4%) for massage-specific items, respectively. For all 68 assessed items, reporting quality of 29% (20 items) was “excellent” (> 85%) and of 9% (6 items) was “good” (50 85%); but 62% (42 items) were poorly reported (< 50%). Specifically, the poor reporting referred to 18 CONSORT items, 15 NPT items, and 9 massage-specific items. Details are provided in Tables –99.8% foIn the subgroup of before and after the year of 2010, the overall reporting scores increased slightly for both CONSORT and NRT items, and massage-specific items from 19.6 (2.9) to 19.8 (2.8), out of 52 in total, and from 7.3 (1.9) to 7.6 (1.9), out of 16 in total. In the comparison of journals, the international (English) group showed a higher score of 22.7 (3.7) in the CONSORT and NRT items, and the Chinese journals associated with the increased score of 7.6 (1.9) in the massage-specific items Table .Table 4.This study provides a literature review of the reporting characteristics and quality of massage RCTs in the past 30 years, which have identified a remarkable increase in the number of publications since 2017. Although RCT is regarded as the gold standard among different types of clinical studies, the quality of massage RCTs included in this review appears to be far from optimal. Incomplete or absent reporting of key trial information leads to some difficulties for assessing the quality of the whole study, easily inviting skepticism as to its results. Similar problems were also found in the previous study examining systematic reviews of massage treatments .In this study, we found several problems in the characteristics of articles reporting massage RCTs. First, few studies were published in relatively high-quality journals. For the 96.8% of trials published in Chinese journals, only 702 articles were published in the “Chinese Medical Core Journals” . For theThe reporting quality of massage RCTs was assessed by three instruments in this review, including the CONSORT checklist, the CONSORT Extension for NPT checklist, and a self-designed massage-specific checklist. Our checklist of message-specific information was designed to identify the critical elements in the rationale for choosing massage as a therapy, the details of massage techniques, and the design of a control for massage interventions. The overall quality of reporting has been unsatisfactory, although a slight improvement has been seen after the CONSORT was updated and issued in 2010.With regard to the completeness of the CONSORT items, the average reporting rate was 50% (ranging from 0.2 to 99.8%). 18 items were reported poorly (< 50%), of which most  related to key methodological domains, such as trial design (item 3a), sample size (items 7a and 7b), sequence generation (items 8a and 8b), allocation concealment mechanism (item 9), implementation (item 10), blinding (item 11b), and additional analyses (item 12b). Previous studies have indicated that the methodology-related items are crucial for the assessment of bias risk and of the reliability of reported effects –27. OtheAt the same time, we identified a considerable number of NPT Extension items that were missing or incompletely reported; the average reporting rate was only 10%, with a range of 0.04% to 57%. Nonpharmacological treatments frequently involve multicomponent interventions delivered by multiple care providers, and each component or provider may influence the success of the overall intervention. Even though the CONSORT NPT Extension was developed in 2008 and updated in 2017 , the comFor massage- specific items, the average reporting rate was 45%, with a range of 1.8% to 94.4%. The least well reported information about massage interventions can be summarised in the following aspects: (1) the rationale of why the massage was being used and why the comparison was selected; (2) some details of procedure, particular in individualised massage treatments, media used (if any), responses sought of patients, and management for adverse events; and (3) the background of treatment provider(s). In practice, massage is very much practitioner and experience-dependent, thus, precise and complete details of the manipulation and related factors are essential for the transparency and replication of trials. Some previous analyses suggested that “post-2010 publication years” can be used as an independent predictor of the high reporting quality of RCTs , but no Given the deficiencies of reporting identified in this study, specific improvements are needed. Previous findings confirm that guidelines do help improve the quality of reporting , 33. TheThis study has some limitations. First, this review identified massage RCTs published up to 22 June 2020 in the targeted eight databases. Any records which had not been included in these databases by that cut-off period have not been included. In addition, we included only articles in English and Chinese because of language limitations. As such, we may not have captured otherwise eligible trials published in other languages. Second, we assessed each item with a ‘‘1’’ or ‘‘0’’ score according to whether the author had reported the detailed information listed in the proposed items. All incomplete reporting  was given as “0”; and some “not applicable” reporting  was categorized as “1”. This over-simplifies the actual situation. Third, we did not assess the methodology quality  of each included trial as the primary objective of this study focused on the reporting characteristics. Although the results of this review may not necessarily be comprehensive, we do believe that the general trends indicated by this study are valid.Without complete and transparent reporting of how a massage RCT was designed and implemented, it is difficult for readers to assess the reliability and validity of trial findings. Although the CONSORT Statement and NPT Extension are key tools through which adequate reporting can be achieved, the quality of massage RCTs still needs improvement in terms of meeting quality standards and sufficient reporting of massage-specific information. Development of the reporting guideline for massage RCTs, as an extension of CONSORT, should be an effective strategy to improve the current situation.Additional file 1. Search strategy. S2. Quality assessment rules of included trials.


Recently, a significant relationship between stress and reproductive failure in women was reported; being one of the possible causes of infertility. The World Health Organization recognizes infertility as a global public health issue; therefore, the interest in understanding the main causes of this issue has increased over the last few decades. Thus, many studies have reported that stress can adversely alter the functionality of the hypothalamic-pituitary-gonadal axis; as well as being one of the reasons of subfertility in patients undergoing in vitro fertilization. Therefore, it can be assumed that stress is closely related to poor in vitro fertilization outcomes. In chronically stressed female rats, irregular estrous cyclicity, increased corticosterone levels, decreased oocyte viability, and increased percentage of abnormal oocytes were obtained in all estrous cycle phases, resulting in reduced oocyte maturation during proestrus. Oocyte maturation disturbed by chronic stress is a crucial factor by which chronic stress disrupts female reproduction.Background: Stress has been considered as one of the causes of decreased reproductive function in women. However, direct evidence of the effect of chronic stress on oocytes depending on estrous cycle phases is limited. Objective: The present study aimed to evaluate the impact of chronic stress on the viability, integrity, and maturation of rat oocytes depending on estrous cycle phases, specifically proestrus, estrus, and diestrus. Methods: For this purpose, adult female rats were stressed daily by cold water immersion (15 °C) for 30 consecutive days. Results: In chronically stressed female rats, irregular estrous cyclicity, increased corticosterone levels, decreased oocyte viability, and an increased percentage of abnormal oocytes were obtained in all the estrous cycle phases, resulting in reduced oocyte maturation during proestrus. Conclusion: Oocyte maturation disturbed by chronic stress is a crucial factor by which chronic stress disrupts female reproduction Stress is defined as a disruption in an organism’s homeostasis, and the stress response depends on the intensity and duration of the stimuli (stressor). Stress, both acute or chronic forms, can result in physical or physiological disorders. Recently, a significant relationship between stress and reproductive failure in women was reported ,2,3; bei2), which, subsequently, impairs the normal development of human oocytes [Stressors cause the over-activation of the hypothalamic-pituitary-adrenal (HPA) axis and, subsequently, increase cortisol (in humans) or corticosterone (in rodents) secretion. The activation of this axis, both acutely or chronically, has been shown to impair female reproduction, directly via hypothalamic, pituitary, ovarian, and uterine levels, or indirectly through neuroendocrine related routes . In fema oocytes . Further oocytes . Chronic oocytes  and repe oocytes .A study of the effects produced by stress on female reproduction is difficult to achieve because the precise determination of the estrous cycle phases is required; also, the fluctuating sex hormones per phase increases the number of animals used . HormonaThe present study was approved by the Health and Biological Sciences Division Ethics Committee at Autonomous Metropolitan University-Iztapalapa Campus. Animal management and experiments were performed under the official Mexican regulations (NOM-062-ZOO-1999) and the domestic and laboratory animal regulations published in the Ethical Conduct Guidelines for Research, Teaching, and Outreach of the Health and Biological Sciences Division.n = 45) or stress (n = 45) groups. Animals were maintained in acrylic cages (10 per cage), with an inverted light/dark cycle , and food and water were ad libitum. To ensure proper cycling in all females, daily vaginal smears were obtained and assessed for two weeks before experiment [Nighty healthy mature Female Wistar rats  were obtained from the Autonomous Metropolitan University vivarium. Females were assigned to control  for 15 min. Rats remained in an upright position, keeping their head above water level . At the Estrous cycles were evaluated using vaginal smears in all females from the control and stress groups for 30 days . The smen = 15; stress n = 15), estrus , and diestrus . In the rat, the metestrus phase is also known as diestrus 1, in which hormone levels are similar to those of the diestrus. The transition from diestrus 1 to diestrus 2 is very fast, which makes it difficult to find enough females in this phase. For this reason, we do not include the metestrus in further evaluations. The total number of evaluated oocytes was proestrus , estrus , and diestrus . Trunk blood was also collected (2–3 mL) from each rat for corticosterone assay.After 30 days of stress, vaginal smears were obtained to identify the estrous cycle phases. Then, females were rapidly euthanized, and ovaries were obtained from females in proestrus (control v/v), as an internal standard, were added to serum (1 mL) and mixed. Corticosterone was extracted into 5 mL of diethyl ether:dichloromethane  by vortex mixing and immediately centrifuged . The organic phase was obtained, vortex mixed with 1 mL of HPLC-grade water, and centrifuged. Afterward, the organic phase was obtained (3 mL); after evaporation at room temperature, the residue was re-dissolved in 100 mL of methanol:water . Chromatographic system [v/v) at a flow rate of 0.4 mL/min. Separations were made at 40 °C in a Waters Symmetry C18 column . A Waters 600-MS system controller was used for flushing the mobile phase, and the steroids were assessed using a 486 Water UV absorbance detector (fitted at 250 nm). Finally, the obtained results were analyzed using the Millennium 32 software . The detection limit of the assay for corticosterone was 5 ng/mL.Corticosterone was extracted from serum and quantified using high performance liquid chromatography (HPLC) . Brieflyc system . The guaUnless otherwise stated, all chemicals were purchased from Sigma Chemical Co. . For cumulus-oocyte complexes’ (COCs) collection, ovaries from control and stressed rats in proestrus, estrus, and diestrus were collected in a Petri dish containing Tyrode modified medium supplemented with 10 mM sodium lactate, 10 mM HEPES, and 1 mg/mL polyvinyl alcohol (PVA) (TL-HEPES-PVA) at pH 7.3–7.4 tempered to 37 °C. COCs were collected in the different phases of the estrous cycle; at the time of collection, the stage of maturation of the oocytes was evaluated to ensure that induction of maturation was not performed in vitro nor by hormonal stimulation. To obtain the COCs, all the ovarian follicles were torn using two insulin needles (8 mm). All observed COCs were collected. For evaluation, approximately 30–40 COCs per group and estrous cycle phase were placed in each well of a four-well dish  containing 100 μL of tissue culture media (TCM-199) and 0.1% hyaluronidase for less than 5 min for denudation. Then, oocytes were transferred to a TCM-199 hyaluronidase-free media for evaluation.2 in air and humidity at saturation [Viability was measured immediately after oocyte denudation (T0). Oocytes were added to a 100-microliter drop of 0.5 mg/mL methyl-thiazolyl-tetrazolium (MTT) diluted in phosphate-buffered saline solution (PBS) and incubated at 37 °C with 5% COturation . After 3After the removal of cumulus cells, under an inverted microscope using the bright field, the oocyte maturation stages were evaluated , followed by the Newman–Keuls post hoc test. Percentage of oocyte viability, in vivo maturation, and abnormal oocytes from control and stressed females were analyzed using the chi-square test followed by post hoc Fisher’s exact test. Differences were considered significant when p < 0.05, and data are expressed as Mean ± SEM. Data analyses were performed using Prism 8 for macOS, version 8.2.1 software.The number of estrous cycles and estrous phases was analyzed using Student’s p < 0.0001).The vaginal smears from the control and stress females showed differences in their estrous cycle. All the control females presented normal estrous cycles with a duration of 4–5 days and a normal progression of all the phases. The average number of estrous cycles in 30 days was 7.1 ± 0.17 in the control group. Stressed females showed irregular and prolonged estrous cycles, increasing the number of consecutive days (3 days) in proestrus, estrus, and diestrus . The avep < 0.0001).When the effect of chronic stress on oocyte viability was evaluated, we found that it was significantly reduced in all the estrous cycle phases  compared to the control  (p < 0.0001); however, no significant differences were observed during estrus and diestrus at the MII stage. Accordingly, the percentage of oocytes at the germinal vesicle (GV) stage increased in stressed females during proestrus 46.3 ± 11.26% and diestrus 64.3 ± 9.81% compared to those in the control groups . However, no significant differences were observed during estrus at the GV stage. The percentage of oocytes that reached the MI stage decreased significantly during estrus 29.3 ± 8.43% and diestrus 23 ± 12.41% compared to the control females  (p < 0.05).Regarding oocyte in vivo maturation, the percentage of oocytes that reached the MII stage decreased up to 7.3 ± 3.48% in the stressed females during proestrus, compared to 52 ± 9.83% in the control (p < 0.05). Some of the abnormalities observed in the oocytes are shown in The percentage of abnormal oocytes was higher in the stressed females in proestrus 5.3 ± 0.33%, estrus 18 ± 2%, and diestrus 12 ± 6.65% than in the control rats   during proestrus, affecting the ovulation rate and fertility [2 levels decreased significantly during proestrus and diestrus  compared to the control . In addition, we found that the progesterone levels in the stressed rats decreased significantly during diestrus (12 ng/mL) compared to the control (22 ng/mL). Therefore, with these results, we set out to evaluate the effect of chronic stress in oocytes since, if during the proestrus phase there is a decrease in E2, this may have an impact at the follicular level, affecting oocyte maturation.The results showed considerable alterations in the estrous cycle of the stressed rats; the females remained in the diestrus and estrus phases for up to three consecutive days, lengthening their estrous cycle duration. This effect has been previously reported in other studies using different stress paradigms ,19,20. T2 and progesterone in chronically stressed female rats [2 and androgen receptors, stimulating GnRH release [In the present study, we observed that in female rats chronically stressed by cold water immersion (15 °C), corticosterone levels increased significantly in all the phases of the estrous cycle compared with that in the control group. Additionally, in stressed females, oocyte viability significantly decreased in all the estrous cycle phases compared with the control rats. In this regard, we previously reported a decrement in the hypothalamic content of Kisspeptin and gonadotropin-releasing hormone (GnRH), reduced LH levels, and consequently, a reduction in the serum concentrations of Eale rats . The repale rats . Kisspep release . Quite t release  in rats  release , adverse release . During  release . Additio release , thus coAs mentioned above, Kisspeptin is involved in the onset of puberty, as well as in the regulation of LH and FSH secretion during the estrous cycle. However, in stressed female rats, Kisspeptin decreases in the anteroventral periventricular nucleus (AVPV) during proestrus and diestrus, decreasing the GnRH content in female rats . It was 2. During follicular development and oogenesis, gonadotropins have receptors on theca and mural granulosa cells to synthesize steroid hormones. The cumulus granulosa cells surrounding the oocyte in response to gonadotropins, mainly by the action of LH, promote meiotic resumption [2 [In the present study, when evaluating oocyte maturation rates, we found that during proestrus, chronic stress significantly decreased the meiotic progression of oocytes to the MII stage, and most of them remained arrested at the GV stage. In the control animals, during proestrus, a higher percentage of oocytes were obtained in MII, which would be ovulated during estrus . As mentsumption . The presumption . Considesumption , crucialsumption ,35. The ption [2 .2 biosynthesis, and finally inducing oocyte apoptosis [On the other hand, the percentage of oocytes in MI was lower in chronically stressed rats during estrus and diestrus than in the controls. However, in proestrus and diestrus, a higher percentage of oocytes in GV was observed as compared with that in the control group. It was recently reported that chronic stress by maternal separation increased the reactive oxygen species (ROS) levels in oocytes, affecting the development of subsequent in vitro embryos . In thispoptosis . To our poptosis . Recentlpoptosis  have rep2, and progesterone levels, leading to reproductive organ dysfunction [It is also well-known that temperature alterations, either hot  or cold function . Additiofunction . Anotherfunction . FurtherThe present study showed that in the stressed females, a higher percentage of abnormal oocytes is observed compared to the control rats. The percentage of abnormal oocytes in proestrus, estrus, and diestrus was 6, 18, and 12%, respectively. To our knowledge, this is the first study evaluating the effect of chronic stress by cold water immersion on the morphology and in vivo maturation of rat oocytes recovered in the different estrous cycle phases. More studies have also reported that stress can cause a lengthening of the estrous cycle, increasing the number of days in estrus and diestrus ,20. In tIn oocytes, ROS formation is notably increased in response to various conditions, including stress . AlthougStress has been linked to fertility impairment. This study showed that chronic stress affects oocyte developmental potential in the estrous cycle phases. Additionally, chronic stress disrupted estrous cyclicity, decreased oocyte viability, and increased abnormal oocyte production in all the estrous cycle phases, which resulted in a reduced oocyte maturation during proestrus. These results highlight some of the alterations produced in oocytes by which stress alters female reproduction.


Five different ultrafine milled flours (UMFs) were prepared from Tartary buckwheat via airflow ultrafine-grinding at different grinding pressures. The airflow ultrafine-grinding resulted in marked differences in particle size (from 100 to 10 μm). The UMFs were all brighter in appearance (higher L*) than Tartary buckwheat common flour (TBCF). Illustrated by the example of 70 °C, the UMFs were also found to have a greater water holding capacity (from 4.42 g/g to 5.24 g/g), water solubility (from 12.57% to 14.10%), and water solubility index (from 5.11% to 6.10%). Moreover, as the particle sizes reduced, the moisture content decreased (from 10.05 g/100 g DW to 7.66 g/100 g DW), as did the total starch content (from 68.88 g/100 g DW to 58.24 g/100 g DW) and the protein content (from 13.16% to 12.04%). However, the grinding process was also found to have negative effects on the mineral content of the Tartary buckwheat. Additionally, several substantial variations were found in their hydration properties along with grinding pressure changes in the differently ground UMFs. Consequently, fine Tartary buckwheat powders of a bright yellow color, with superior food processing properties, were prepared in this study by airflow ultrafine-grinding. Buckwheat is a gluten-free pseudocereal belonging to the Polygonaceae family of plants. It contains protein of a high nutritional value, dietary fiber, vitamins, and minerals ,2,3. TarIn comparison to buckwheat, Tartary buckwheat has attracted more food science research interest due to its unique chemical composition and high efficiency as a functional food, including its anti-oxidative, anti-cancer, anti-hypertension, and anti-diabetic properties . TartarySuperfine grinding technology, which is developing rapidly in food processing, can produce powder with superior properties to conventional particles and it is, thus, being used increasingly with a variety of food materials to improve the quality of powder . MicroniThe aim of this work is, thus, to investigate the application of airflow ultrafine-grinding technology on Tartary buckwheat. In this paper, five different ultrafine milled flours (UMFs) were prepared from Tartary buckwheat via airflow ultrafine-grinding at different grinding pressures. The particle size analysis and morphological observation were firstly conducted. Furthermore, the physicochemical characteristics of obtained different particles were analyzed, including chemical composition, hydration properties, and mineral content, in comparison to those of commonly ground Tartary buckwheat particles.p > 0.05) differences between the samples at a grinding pressure at 0.1 MPa (No. 1 and No. 2), and when the grinding pressure changed by 0.2 MPa, the particle sizes of the UMF showed a significant (p < 0.05) decline. These results indicated that the increase in grinding pressure produced a finer UMF comprised of small particles, while the uniformity of the powder was also improved.Analysis of the distribution of the UMF particle sizes obtained via the airflow ultrafine-grinding methods  showed tTo further understand the morphological properties of Tartary buckwheat powders, the samples in this study were analyzed using SEM and differences were found in the shapes, sizes, and granule surfaces of the powders with and without the ultrafine milling treatment. As shown in Ultrafine grinding technology can improve the structural characteristics of Tartary buckwheat powders by reducing their particle size, and the morphology of Tartary buckwheat flour is also changed by different grinding pressures . In our Ultrafine grinding was applied in this study. In general, the higher the pressure, the smaller the particle size . As expep < 0.05) from 88.95 to 93.37, whereas ‘a’ and ‘b’ values decreased markedly (p < 0.05) from 2.36 to 1.70, and 22.07 to 17.29, respectively. These results indicate that ultrafine grinding improved the color of the Tartary buckwheat flour, making it appear brighter, while the appearance of the TBCF was a dim yellow in comparison. Moreover, as shown in Color and particle size are important qualities in food powders. Color is an important parameter for most food products and is usually a consideration for consumers in their evaluation and selection of products. The investigation by Hu et al. indicated that particle size had a significant effect on green tea powders . The infIn this investigation work, the brightness of Tartary buckwheat flour was negatively correlated with particle size. The smaller the particle size, the greater the relative surface area, the better the reflective effect, and the greater the brightness value. Therefore, Tartary buckwheat flour with the highest level of brightness was obtained by the airflow ultrafine-grinding treatments. Moreover, the grinding treatments’ improvement of the color of the Tartary buckwheat may be due to the fact that surface area increased with the decrease in particle size, and the internal structure of the cellulose and hemicellulose were exposed, which affected the color of the powder . The samp < 0.05) lower than that of the TBCF (10.05 g/100 g). A significant difference (p < 0.05) was also observed in the protein content among all samples. The crude fiber content of the UMF could not be determined because of their particle size; thus, there was no significant difference (p > 0.05) in the crude fat content of the UMF and TBCF. Moreover, the total starch content, which accounted for the proportion of TBCF, was approximately 84.55% in the UMF. Furthermore, changes in the mineral content of the Tartary buckwheat flour were evaluated after the airflow ultrafine-grinding treatments. As shown in p < 0.05) lower than that in the TBCF, as was the content of Fe, with the exception of No. 1. There were no obvious increasing or decreasing trends in the Mn, Zn, or Cu contents among the UMFs treated by different grinding pressures. However, the contents of protein and total starch decreased with increasing grinding pressure, from 13.16 to 12.04% and from 67.64 g/100 g DW to 58.24 g/100 g DW, respectively.The effects of airflow ultrafine-grinding on the chemical compositions of the flour samples are summarized in The variations in the composition of the samples may be attributed to different operating conditions. Tartary buckwheat flour is influenced by the heat produced by the machine during milling and it is, therefore, likely that there would be changes in the contents of fat, starch, protein, and moisture during the grinding process. These results are consistent with a study by Liu et al., who found that the quality of protein and lipids could be changed by high temperatures during milling . In addiThe water holding capacity (WHC) of the five different particle-sized UMFs and TBCF sample are shown in WHC refers to the quantity of water that is bound to the fibers without the application of any external force (except for gravity and atmospheric pressure) . AirflowSolubility and the degree of expansion during steaming treatment reflect the quality of Tartary buckwheat flour. The swelling power of TBCF and ultrafine Tartary buckwheat flour at different temperatures (from 50 °C to 90 °C) are shown in Water solubility and swelling power provide a measure of the degree of reciprocal action between starch chains in the amorphous and crystalline domains ,48,49. IIt is worth noting that not all samples showed higher hydration properties after superfine grinding at the same temperature, with the exception of a No. 1 sample (prepared under the maximum pressure of 0.8 MPa). Generally speaking, with the increase in grinding pressure, the particle sizes in the ultrafine powder decreased. This is mainly because, at a certain range, the increase in grinding pressure improves the velocity of airflow at the outlet of the nozzle, causing the material to gain more kinetic energy. When particle sizes decrease to a certain value, the particles agglomerate with the increase in the powder surface energy. This may explain why the hydration properties of No. 1 sample were almost the same as those of the TBCF after ultrafine grinding. Therefore, the surface properties of powder may change dramatically after superfine grinding under high crushing pressure .The Tartary buckwheat powder used in this work was produced by Huantai Biotechnology Co., Ltd. . Sodium hydroxide, petroleum ether, sulfuric acid, hydrochloric acid, anhydrous ethanol, and nitric acid were purchased from Cologne Co., Ltd. , among which the nitric acid was of guaranteed grade. Iron (Fe), calcium (Ca), zinc (Zn), copper (Cu), and other standard solutions were obtained from the National Research Center for Standard Materials.Tartary buckwheat common flour (TBCF) was passed through a 120-mesh sieve, and then dried in a constant temperature blast oven at 50 °C for 1 h. The TBCF was further pulverized using an airflow pulverization instrument , and the grinding pressure was variously regulated to 0.4 MPa, 0.5 MPa, 0.6 MPa, 0.7 MPa, and 0.8 MPa, finally resulting in five different ultrafine milled flours (UMF), correspondingly labeled No. 5, No. 4, No. 3, No. 2, and No. 1, respectively. The TBCF was used as the control sample, labeled No. 6.Moisture, protein, and crude fiber in all samples were determined using the method described by Pandord, with some modifications . MoisturThe starch in Tartary buckwheat (which accounts for approximately 70% of its content) is particularly important in determining the textural properties of its products . In thisMinerals play an important role in the physiological functioning of the body, especially in the growth and metabolic regulation process . The minThe particle size distribution of the Tartary buckwheat flour samples was determined using a laser particle size analyzer  in the wet method mode. In addition, the morphological characterization of Tartary buckwheat flour particles was performed on images acquired using a scanning electron microscope (SEM)  at an accelerating voltage of 1.00 kV. A small amount of Tartary buckwheat flour adhered to the surface of the double-sided conductive carbon adhesive tape and an aurilave was used to remove those particles. The sample was then subjected to a gold spray treatment under vacuum conditions prior to testing.The colors of the different Tartary buckwheat flour samples were determined using the VeriVide DigiEye system , and the device was calibrated with a standard white surface calibration plate. Six varieties of Tartary buckwheat flour were placed on a plate and then selected randomly. The L*, a*, and b* values for each sample, indicating lightness, redness (+)/(−) greenness, and yellowness (+)/(−) blueness, respectively, were recorded.1) was weighed, and the collected supernatant was transferred to the pre-weighed weighing bottle, dried at 105 °C until the mass difference between the two was no more than 2 mg, and then weighed (m2). It was finally weighted (m3) after the supernatant had been discarded. The WHC, WS, and SPI were calculated by the following equation:The water holding capacity (WHC), water solubility (WS) and water solubility index (SPI) of the Tartary buckwheat flour were measured using the method reported by Tsai, Li, and Lii . ApproxiAll data were presented as the mean standard deviation of at least three replicates and analysis performed was one-way analysis of variance (ANOVA) followed by the Duncan’ s multiple comparison test using SPSS version 25.0 software.In this study, airflow ultrafine-grinding treatment was found to exert significant influence on the physicochemical characteristics and mineral content of Tartary buckwheat powder. Smaller and brighter Tartary buckwheat powders, with greater food processing properties, were obtained after superfine grinding. With increases in grinding pressure, the particle sizes of the Tartary buckwheat powder decreased and reached equilibrium finally. Moreover, the superfine grinding process decreased moisture content, crude fat content, and protein content, which is beneficial for health and weight loss. The ultrafine Tartary buckwheat powder was found to retain the essential nutritional characteristics of the original Tartary buckwheat; however, its mineral content was affected and it is, therefore, important to consider both nutrition and the cost of the product when processing ultrafine Tartary buckwheat powder. Hydration properties were significantly improved in the superfine Tartary buckwheat powder and the increase in swelling power could benefit satiation; however, the higher water solubility also suggests that the superfine powder is more likely to create a soup paste during cooking. Further studies could be conducted on the polyphenol and lipid content obtained from Tartary buckwheat powders with different particle sizes. Superfine grinding technology could be used to broaden the application of Tartary buckwheat powders in functional foods.


The dietary intake was estimated by the Nutrition Data System for Research (NDS-R). The sources of fiber were determined for the major food groups. Significantly more total dietary fiber was consumed by HLF at every post-randomization time point, and, at 12 m, was 23.04 ± 9.43 g vs. 18.61 ± 8.12 g for HLF vs. HLC, respectively, p < 0.0001. In both diet groups at 12 months, the highest amount of dietary fiber came from non-starchy vegetables (4.13 ± 3.05 g and 5.13 ± 3.59 g). The other primary sources of fiber at 12 months for the HLF group were from whole grains (3.90 ± 3.13 g) and fruits (3.40 ± 2.87 g), and, for the HLC group, were from plant protein and fat sources, such as nuts and seeds, their butters, and avocados (2.64 ± 2.64 g). In the DIETFITS study, the difference in the total fiber intake for the HLF vs. HLC groups was more modest than expected. The HLC group consumed reasonably high amounts of fiber from high-protein and high fat plant-based sources. The daily intake of dietary fiber is well below the recommended levels in the US. The effect of adopting a low-fat vs. a low-carbohydrate weight loss diet on fiber intake is of interest but not well-documented, especially when both approaches promote high-quality food choices. The objective of this paper is to compare the quantity and sources of dietary fiber between a healthy low-fat (HLF) vs. healthy low-carbohydrate (HLC) diet group when consumed over 12 months in a weight loss diet study. In this secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) study, the amount and sources of dietary fiber were examined in generally healthy adults, 18–50 years of age, Body Mass Index (BMI) 28–40 kg/m Studies show that high-fiber intakes are associated with reduced rates of cardiovascular disease, cancer, inflammation, diabetes, and obesity ,2,3,4. DThe general approaches to low-fat vs. low-carb diets, two of the most commonly practiced approaches to weight loss, involve distinct differences regarding the food groups that are the main contributors to dietary fiber ,11. HighOur analysis included data from the Diet Intervention Examining the Factors Interacting with Treatment Success (DIETFITS) weight loss study, a 12-month intervention that utilized a healthy low-fat (HLF) vs. a healthy low-carb (HLC) approach to weight loss in generally healthy adults who were overweight or obese . Both ap2 (n = 609), 3 months (n = 549), 6 months (n = 491), and 12 months (n = 449) in a linear mixed effects model. All study participants provided written informed consent. The study was approved by the Stanford University Human Subjects Committee [Participants in the DIETFITS study, a 12-month weight loss trial, were generally healthy adults, 18–50 years of age, with a BMI between 28–40 kg/m2 . They weommittee . This trThe diet strategy for DIETFITS has been described elsewhere in detail  and willThe intervention involved twenty-two evening group classes led by study Health Educators. Both groups received similar instructions to choose whole foods over processed foods, to include vegetables, and to avoid refined grains and added sugars. For the first eight weeks of the study, HLF participants were instructed to strictly avoid all major dietary sources of fat. After the first eight weeks, when participants were working to design their own long-term, sustainable dietary strategies, they were allowed to slowly add limited amounts of fat to their diet while still maintaining the lowest fat content possible. HLF participants were instructed to consume whole grains, including steel cut oats, barley, quinoa, brown rice, and wild rice, and to choose a wide range of legumes, fresh fruit, and also low-fat dairy products. Similarly, for the first eight weeks of the study, HLC participants were instructed to avoid major sources of carbohydrates. Participants were instructed to consume nuts, seeds, avocados, and other sources of dietary fat, such as fatty fish, full fat dairy, and oils. HLC participants were instructed to avoid all legumes, fruit, grains, and starchy vegetables. After the first eight weeks, when participants were working to design their own long-term, sustainable dietary strategies, they were allowed to slowly add limited amounts of these carbohydrate sources. Dietary intake was assessed using 3 unannounced 24-h multiple-pass dietary recall interviews (2 on weekdays and 1 on a weekend day) within a two-week window at four data collection time points  for a total of 12 recalls. To determine shifts in sources of dietary fiber based on dietary assignment and changes in eating behavior, we investigated food categories modified from the University of Minnesota Nutrition Coordinating Center (NCC) Food Group Serving Count System consumed over the study period . Data wen (%) for categorical variables by randomized diet (HLF or HLC). NDSR provided estimates of total fiber consumed and servings consumed from 168 food groups. The 168 food groups were aggregated into 10 categories: fruits, vegetables, legumes, starches, whole grains, some whole grains, refined grains, protein foods, fats, and beverages, as summarized in Demographic data are summarized using means (standard deviations) for continuous variables and A linear regression model was employed to estimate fiber per serving in each of the 168 food groups. Then, total grams of fiber per 168 food group for each participant at each available timepoint was estimated by multiplying servings consumed and the estimated fiber per serving (from the linear regression model). Total grams of fiber for each participant at each timepoint for the 10 categories was estimated by summing total grams of fiber for the food groups corresponding to each category.Change in fiber per category over time  by diet (HLF or HLC) was estimated using a linear mixed effects model with main effects for diet, time, and diet by time interaction, and a random effect for participant . Linear 2.The baseline characteristics of the two diet groups are presented in The main DIETFITS study reported that, after 12 months, the participants in the HLC group were ingesting a mean of 1697.1 (±32.1) Kcals, 132.4 (±4.2) g of carbohydrates and 86.2 (±2.0) g of fat. The HLF group averaged 1716.1 (±34.5) Kcals, 212.9 (±5.0) g of carbohydrates and 57.3 (±1.7) g of fat . Furthern = 609), 3 months (n = 549), 6 months (n = 491), and 12 months (n = 449) were entered into the linear mixed effects model to estimate the change over time.The results show that the baseline fiber intake for the combined 609 participants included in the analysis was 21.82 ± 9.20. The estimated fiber intakes at the baseline (p < 0.001).From the baseline to 12 months, the HLF group increased their total fiber by +0.33  g/day , while the HLC group decreased their fiber intake by −3.29  g/day . The changes in the fiber intake per 1000 kcal/day were +3.13  and +1.14  for the HLF and HLC groups, respectively. The differences in the total fiber intake between the two diet arms were statistically significant at all three post-randomization time points, as presented in Both groups increased the amount of fiber they ingested from non-starchy vegetables and decreased their intake of fiber from refined grains. Although not statistically significant, in absolute numbers, the increase at 12 months relative to the baseline for the HLC group was more than double that for the HLF group for fiber from non-starchy vegetables. At 12 months, the decrease in fiber from refined grains was similar and not significantly different between the HLF and HLC groups and was the largest source of decrease for both groups from any of the food categories, as seen in At twelve months, the changes from the baseline in the categories of whole grains and some whole grains were higher for the HLF group and lower for the HLC group . For botSmall amounts of fiber from a wide range of foods and beverages contributed modestly or negligibly to the overall fiber intake in both diet groups See .In this secondary analysis of the DIETFITS 12-month weight loss study, the total fiber intake was consistently higher at 3, 6, and 12 months for the HLF diet group relative to the HLC diet group. The total fiber intake remained relatively stable for the HLF group, while it decreased for the HLC group during the study in the context of reduced calorie intake. In the context of energy-adjusted, rather than total, intake, the HLF group increased their fiber intake per 1000 kcal despite substantial reductions in the total and proportional carbohydrate intake, while the HLC group roughly maintained their fiber intake per 1000 kcal. Given that most of the major sources of dietary fiber are carbohydrate-rich foods, it was expected that the fiber intake would be higher in a higher vs. a lower carbohydrate diet. In this study, the total fiber difference between the two diet arms at 12 months, on average, was less than four grams, a relatively modest difference. However, closer investigation revealed that there were notable differences in the changes in the fiber intake for the specific food groups between the two diet groups; most prominently, the HLC group reported more than double the increase in fiber from vegetable intake compared to the HLF group, and increases in the fiber contribution from nuts, seeds, and avocados were significantly higher for HLC compared to HLF.Given the increase in the vegetable fiber intake and the decrease in the refined grain fiber intake in both diet groups, this secondary analysis supports that participants were following the study instructions to follow both a healthy low-fat diet and healthy low-carb diet, respectively. As a consistent message throughout the study was to eat high-quality foods, most of the grains consumed were whole grains. Whole grains are a reliable source of dietary fiber, and many Americans consume grains as their primary source of fiber, but a diversity of dietary fiber from different plant sources is ideal for both gastrointestinal and overall health . The souAn emerging area of interest in the field of nutrition is the dietary regulation of the gut microbiome. A healthy microbiome is considered to play an important role in immune function and in preventing systemic inflammation ,31. One Different types of dietary fiber have been linked to support for a healthy intestinal microbiota ,35,36,37This analysis has several strengths. First, the original DIETFITS study involves a relatively large sample size for a diet intervention, with high retention across multiple data collection time points over a 12-month period using an RCT design. Second, the study utilizes multiple interviewer-administered 24-h recalls using NDSR for diet data collection and database analysis purposes. While DIETFITS is not the first to analyze the differences between a low-carbohydrate and low-fat diet, this study is unique in its comparison of the fiber quantity and sources from the data obtained under these conditions.There are also limitations to this analysis. Diet assessment that relies on self-reporting involves some degree of inaccuracy . There iQuality food sources of fiber can be found in both low-fat and low-carbohydrate diets. Throughout the 12-month DIETFITS study, the participants in both diet groups were encouraged to eat healthy, high-quality foods. The emphasis on quality during the study provides insight into the specific differential food sources of dietary fiber in low-fat vs. low-carbohydrate diets. The HLF diet group significantly increased their fiber intake throughout the study since they could include whole grains, which are a commonly consumed fiber source. These findings suggest that there are multiple strategies available for maximizing the intake of amounts and types of dietary fiber from the intake of whole and plant-based foods. A large proportion of fiber for both diet types was from non-starchy vegetables. In addition, the information from this analysis may be helpful in better understanding how to support a healthy microbiome through personalized nutrition, and how to help prevent and treat disease states through improved food choices.


SETMAR is a protein lysine methyltransferase that is involved in several DNA processes, including DNA repair via the non-homologous end joining (NHEJ) pathway, regulation of gene expression, illegitimate DNA integration, and DNA decatenation. However, SETMAR is an atypical protein lysine methyltransferase since in anthropoid primates, the SET domain is fused to an inactive DNA transposase. The presence of the DNA transposase domain confers to SETMAR a DNA binding activity towards the remnants of its transposable element, which has resulted in the emergence of a gene regulatory function. Both the SET and the DNA transposase domains are involved in the different cellular roles of SETMAR, indicating the presence of novel and specific functions in anthropoid primates. In addition, SETMAR is dysregulated in different types of cancer, indicating a potential pathological role. While some light has been shed on SETMAR functions, more research and new tools are needed to better understand the cellular activities of SETMAR and to investigate the therapeutic potential of SETMAR. In eukaryotes, DNA is wrapped around proteins called histone to form the chromatin, a nucleoprotein structure. The basic unit of chromatin is the nucleosome, which is composed of 147 base pairs (bp) and eight histone proteins: two histones H2A, two H2B, two H3, and two H4 .SETMAR was found to be one of the 47 genes containing or derived from a domesticated transposable element [Dimethylation of H3K36 (H3K36me2) is associated with regulation of gene expression and DNA damage repair . The int element . Later w element ,9,10,11. element . Since i element ,19,20,21 element ,28,29,30SETMAR is composed of two domains, the protein lysine methyltransferase (SET) domain and the DNA transposase (MAR) domain A. The pr2+ [The DNA transposase domain of SETMAR is catalytically inactive, as several inactivating mutations in the catalytic subdomain have neutralized the DNA transposition activity of SETMAR ,11,34. I2+ , and to 2+ ,40,41. SETMAR gene encodes eight different mRNA isoforms in human tissues with variable combinations of domains and subdomains  .Excluding the regulation of SETMAR expression by the Notch signaling pathway in colon cancer stem cells , SETMAR Dimethylation of H3K36 is associated with several chromatin processes, including regulation of gene expression through controlling the distribution of H3K27me3 and DNA methylation , and DNAIn mouse, where SETMAR contains only the SET domain, homozygous deletion is associated with several phenotypic defects in vision/eye, behavior/neurological phenotype, metabolism, pigmentation, skeleton phenotype, and immune system, indicating a developmental role for the SET domain . In humaThe NHEJ pathway is one of the four pathways used by a cell to resolve DSBs but, in comparison to homologous recombination, can result in mutations and insertions-deletions . IllegitSETMAR has also been proposed to act in DNA replication and cell cycle regulation A. KnockdCordaux et al. proposed in one of the first papers published on SETMAR that the remnants of the Hsmar1 transposable element, including SETMAR and the Hsmar1 binding sites scattered across the genome, could represent a case of a new gene regulatory network with SETMAR binding Hsmar1 ITRs to regulate gene expression via histone methylation ,67. ThisSETMAR in different cancers (SETMAR [While some mutations have been found in  cancers A, no rec (SETMAR . Of note (SETMAR ,20,21, wDysregulation of SETMAR expression has been associated with several cancers, including glioblastoma, leukemia, hematologic neoplasms, breast and colon cancer, and mantle cell lymphoma B 16,22,,28,29,30On the treatment side, knockdown of SETMAR increases the sensitivity of leukemia cell lines to etoposide  and of bAfter ~15 years of investigation on SETMAR functions, many questions remain unanswered. While specific antibodies against SETMAR are available ,74, a maCurrent efforts in targeting SETMAR has found ciprofloxacin as an inhibitor of SETMAR transposase domain , but theAs SETMAR is known to form a dimer and that out of the four most expressed isoforms, three are able to dimerize, a better understanding of the isoforms combination that are present in SETMAR dimers is required. Another significant question is why two out of the four expressed isoforms encodes only for the DNA transposase domain? With the exception of the viral vSET , human hAnother question is whether SETMAR could be involved in pre-mRNA splicing and/or alternative splicing. In addition to methylating snRNP70, which is part of the U1 snRNP that recognizes the 5′ splice site , SETMAR More research is also needed to determine whether SETMAR could be involved in development. In mice, SETMAR homozygous knockout results in developmental defects . In huma


Objective: Along with the rapid spread of the COVID-19 pandemic around the globe, a proliferation of mass media information exposed the population to an infodemic with various implications documented worldwide. The present study analyzed Romanian healthcare practitioners’ (HCPs) appraisal of COVID-19 mass media information and governmental measures throughout 2020, ranking vaccination priorities and moral values. Methods: 97 HCP completed a cross-sectional survey with items referring to the COVID-19 pandemic in 2020. Results: Findings were consistent with other studies, indicating an overall negative appraisal of mass media information, which predicted anxiety and relaxation difficulties. Unlike other studies, our sample reported a moderate level of satisfaction with official measures in 2020, which was not related to their view on mass media information. The ranking of population categories in the vaccination order showed similarities with the governmental vaccination program in 2021. Despite placing freedom third after health and love in the hierarchy of values, HCPs showed a high tendency of limiting individual liberty for the common good. Conclusions: Results showed a dissociation between the overall negative appraisal of mass media information and the satisfaction with governmental measures in 2020. Romanian HCPs shared a secular perspective on moral values and assumed an authoritarian position. According to the World Health Organization, the COVID-19 pandemic has generated an infodemic  ,3,4,5,6.Since mass administration of anti-COVID-19 vaccines is the most effective weapon against the pandemic, public vaccination acceptance is key to a successful immunization campaign. Emergent research has shown that, around the world, misinformation has negatively impacted vaccination adherence ,23,24, bNumerous studies have shown that COVID-19 related fake news on social media or information overload have had a negative impact on the population’s mental health, causing, among others, anxiety or panic ,31,32,33Confronted with the surge of COVID-19 patients and a plethora of professional challenges, HCPs had to manage the growing body of information regarding the virus, treatment methods, and ways to stay safe. Research on various cultures has revealed similarities and differences in HCPs’ approach to the infodemic. For instance, a qualitative study on US participants  found thIn Romania, interesting results published by previous studies encourage further research. For instance, results of a qualitative pilot study on the characteristics of fake online news about COVID-19  revealed(1)To explore the appraisal of mass media information by Romanian HCPs and its relation to stress-related variables;(2)To investigate the position of Romanian HCPs towards governmental measures, vaccination priority, and values.In this framework, more research is needed on the appraisal of mass media information by Romanian HCPs and its impact on their well-being and stress. In addition, while many studies have focused on stress-related symptoms, not many have considered the axiological level  related to COVID-19. Therefore, we formulated the following research objectives:The present study is part of a project exploring the challenges of HCPs during the COVID-19 pandemic. We designed a cross-sectional survey with 18 items distributed into five sections: (1) demographic data, (2) personal experience with COVID-19, (3) stress and well-being in 2020, (4) ethical principles, and (5) appraisal of mass media information, governmental measures, vaccination priority, and values. The first survey topics were presented in a different article . For theFor the construction of the questionnaire, the authors  generateThe targeted population consisted of healthcare professionals who were active throughout 2020, including doctors, nurses, physical therapists, managers, pharmacists, pharmaceutical representatives, psychologists, technicians, and researchers. Respondents were recruited by convenience sampling  and snowball sampling . Despite its shortcomings, this non-probability sampling methodology was considered appropriate for data collection since it facilitated the relatively rapid access to competent HCPs active during 2020 and interested in completing the survey. To avoid a community bias risk, we recruited two initial members from each HCP category who were asked to distribute the survey to other members of their networks. The questionnaire was distributed via social media  and email to respondents, who completed it from 03 July 2021 to 05 September 2021. The participants’ anonymity was guaranteed, and no gender and age information were requested. An a priori power analysis using G*Power  revealed that a sample of 122 respondents would be required to achieve a medium effect size and a power of 0.95 for linear regressions .f2) were computed to show the effect of information appraisal on well-being and stress [W coefficients [We used SPSS for Windows to analyze results . Power analyses were conducted with G*Power. We computed multiple-choice questions as categorical variables and reported frequencies of responses. Central tendencies  and standard deviations were calculated for continuous variables. Linear regression equations were conducted to show relations between variables, and effect sizes . The years of experience in the medical field varied from 0–5 (22.7%), 5–10 (11.3%), 10–20 (22.7%), 20–30 (27.8%) to over 30 years of experience (15.5%). Approximately half of the sample (51.5%) worked in inpatient settings, and one quarter (25.8%) in outpatient facilities (see ).Frequencies of participants’ responses reflected our sample’s general appraisal of mass media information in 2020, with a considerable proportion attributing negative connotations see : mass meSymptoms of stress related to COVID-19 were analyzed and discussed in a different article. Our sample reported a moderate level of well-being and overall moderate levels of irritability, anxiety, and concern, with seldom relaxation difficulties and anticipation of negative events .p = 0.764, R2 = 0.053), irritability  = 0.902, p = 0.185, R2 = 0.117), anticipation of a negative event  = 1.379, p = 0.217, R2 = 0.111), and concern  = 1.167, p = 0.079, R2 = 0.144). On the other hand, significant regression equations and medium effect sizes were found for relaxation difficulties  = 2.195, p = 0.035, R2 = 0.166; f2 = 0.2) and anxiety  = 2.732, p = 0.005, R2 = 0.213; f2 = 0.27). At our sample size (n = 97), post hoc analyses showed that the achieved power was 0.87 for an effect size of 0.2, and 0.96 for an effect size of 0.27. The negative relations showed that finding mass media information insufficient was associated with less relaxation difficulties, and appraising information as useful was associated with lower levels of anxiety. On the other hand, perceiving information as not good positively predicted relaxation difficulties.We computed multiple linear regressions to investigate whether the appraisal of mass media predicted the perceived stress throughout 2020 see . No signp = 0.097, R2 = 0.371).Respondents were asked to appraise the probability of recommending to another state the measures taken by the Romanian government during the pandemic in 2020 on a 1 to 100 scale, 1 indicating the least probability (1%) and 100 indicating the highest probability (100%). The central tendency of the answers was 54.04, with an SD of 27.825, suggesting a moderate level of satisfaction with local measures. A regression equation was performed between the appraisal of mass-media information and the evaluation of governmental measures and showed no significant relations between the variables  = 1.755, Respondents were required to imagine being in a leadership position and rate on a 1 to 100 scale their willingness to sacrifice individual liberty for the common interest in the event of a pandemic. The mean was 71.84, with an SD of 26.578, pointing to our sample’s propensity towards restricting individual rights for the common good.2(9) = 394.028, p = 0.000), reflecting a moderate agreement among our respondents in attributing vaccination priority . A linear regression equation was computed to verify the relation between vaccination priority and the degree of satisfaction with official measures. No significant relations were found  = 1.743, p = 0.091, R2 = 0.391).Another item requested participants to rank vaccination priority for nine categories of citizens (1 = first to 10 = last). χ2(10) = 243.663, p = 0.000) and a moderate agreement among our participants in ranking these values . A linear regression equation was computed to show whether the values predicted the tendency of limiting individual freedom, and no significant relations were found  = 1.204, p = 0.300, R2 = 0.350).The final item required participants to rank eleven values according to their importance (1 = most important to 11 = least important). Health was ranked as the most important (mean rank = 2.95), love as the second (mean rank = 4.16), and freedom as the third most important value (mean rank = 5.13). Spiritual and religious values such as faith in God and living without sin were ranked among the least important values see b. Again,p < 0.001) among the first options, and for safety and vaccinating industry personnel . On the other hand, ranking wisdom correlated negatively with vaccinating government officials . Ranking faith in God among the least important values correlated negatively with vaccinating women and children . Wealth  and living without sin  were ranked as the least important values, which correlated negatively with placing HCPs as the first population category to receive the vaccine.Pearson correlations were computed between the rankings of values and vaccination priority see . SignifiThe present study analyzed results from a cross-sectional survey administered to Romanian healthcare professionals (HCPs) containing items on several issues related to the COVID-19 pandemic in 2020. For the present objectives, we analyzed responses concerning the appraisal of mass media information on COVID-19, the reported symptoms of stress, the evaluation of governmental measures, and the ranking of vaccination priority and moral values.In line with studies highlighting the overwhelming or inaccurate character of information on public health issues in the COVID-19 era ,12,13,34In addition, unlike other studies reporting relations between trust in official sources and the appraisal of information ,22,25,26Unlike studies indicating high levels of distrust in official or governmental policies in some populations  ,22,25,26The ranking of population categories in the order of vaccination priority revealed our sample’s consistency in choosing healthcare workers as the first option, indicating the prioritization of self-protection in the work field. This finding may point to a self-conserving safety attitude of HCPs, previously found to be negatively linked to symptoms of burnout and stress ,43. NextSeveral values showed a common variance with the ranking of vaccinating population categories: ranking health and vaccinating old and sick people among the first options indicated that, in our sample, maintaining health as a primordial value was linked to prioritizing the vaccination of vulnerable categories, such as old and sick people. Safety appeared to share a common variance with vaccinating industry personnel, despite their different hierarchical positions . Two relatively antagonistic values that were ranked last  correlated negatively with prioritizing HCP vaccination. Such findings indicate that, as the need for self-protection increased, our sample gave less value to wealth and living without sin. Living without sin and faith in God were ranked among the least important values, which may point to a secular status of the medical professions reflected by our sample. However, no consistent relations between values and vaccination categories could be assumed due to the small number of scattered correlations.From an ethical perspective, the high tendency of our HCP sample to limit individual autonomy for protecting the common interest may signal an authoritarian position. Such a position could be related to assuming the healer role on a personal level, or it could be maintained by a patriarchal medical system that encouraged the patients’ obedience towards the doctor’s authority . These fSeveral important limitations are to be mentioned in our study. The first set of limitations is related to our sampling methodology, which restrains result extrapolation to a larger population. The sample size was too small to allow the generalization of results to the entire population of Romanian HCPs. In addition, the fact that most respondents were from the Western part of Romania offers a regional rather than a national perspective on how HCPs appraised the investigated variables. The high proportion of doctors in our sample further restricts result generalizability to other HCP categories. Future studies are encouraged to recruit larger samples of HCPs active nationwide using probability sampling methods , to test our results or compare categories within the healthcare professions.Second, the cross-sectional design of this study limits the investigation of the appraisal of these variables over time. In this regard, future research could employ longitudinal designs to explore possible shifts in Romanian HCPs’ vision on mass media or vaccination as the COVID-19 pandemic unfolds.Third, using an online survey to retrospectively investigate the appraisal of mass media, stress, and governmental measures in 2020 might have contributed to increased subjectivity in our sample’s view of last year’s course of events. Other intra-subjective factors like desirability or discounting the importance of questions might have influenced responses. Therefore, future studies could employ psychometric instruments to measure stress and other constructs in Romanian HCPs.Another limitation of our study is that we did not explore causal relations between variables. Therefore, we cannot infer an influence of mass media information on the mental health status of our respondents. Such relations could be addressed by future studies employing longitudinal or experimental designs to explain human behavior in this period characterized by an abundance of information needing to be filtered.In the present study, we analyzed the results of a cross-sectional survey concerning the vision of Romanian HCPs on mass media information related to COVID-19 and the appraisal of governmental measures in 2020. We also investigated the ranking of values and how they related to the hierarchization of population categories in the order of vaccination.Consistent with previous international and Romanian studies, our sample attributed mostly negative connotations to mass media information on COVID-19 throughout 2020, finding it exaggerated, confusing, false, or not good. While the appraisal of information was not significantly related to the rating of general well-being throughout 2020, it significantly predicted anxiety and relaxation difficulties. Nevertheless, unlike other studies, our HCPs showed a moderate satisfaction with governmental measures during the pandemic in 2020, which in return appeared unrelated to the appraisal of mass media information. Respondents in our sample consistently placed HCPs, old and sick people, and education workers first when evaluating vaccination priority, a ranking showing similarities with the Romanian governmental vaccination program in 2021. Spiritual and religious values were ranked among the last, reflecting a secular status of the healthcare professions. A high tendency to limit individual liberty for the common good appeared in stark contrast with placing freedom third in the hierarchy of values. Such findings indicate an authoritarian position assumed by Romanian HCPs in our sample.