IntroductionContracture is a pathological scar tissue resulting from local skin tissue damage, secondary to different local factors. It can restrict joint mobility, resulting in deformity and disability. This study aimed to investigate the outcomes of skin grafts compared to local flaps to reconstruct post-burn elbow contractures. These parameters included regaining function, range of movement, recurrence, and local wound complications.MethodologyA retrospective study reviewed 21 patients for elbow reconstruction over 12 months. Only patients with post-burn elbow contracture were included. Other causes, including previous corrective surgery, associated elbow stiffness, and patients who opted out of post-operative physiotherapy, were excluded. Patients were categorized according to the method of coverage into three groups: graft alone (G1), local flap (G2), or combined approach (G3). ResultsFemales were three times at higher risk to suffer a burn injury, while almost half of the cases were children. Scald injury represented 81% of burn causes. G1,2,3 were used in 47.6%, 42.9% and 9.5% of cases retrospectively. The overall rate of infection was 28.6%. Hundred percent graft taken was recorded in 83.3 % of cases; however, flap take was 91.1%. After 12 months of follow-up, re-contracture was 60% and 22.8% in G1 and G2; however, the satisfaction rate was 70% and 100% in both groups retrospectively. The overall satisfaction was 85.7% in all groups.ConclusionGrafts and local flaps are reasonable options for post contracture release; however, flaps are superior. Coverage selection depends on the lost tissue area and exposure of underlying deep structures. Physiotherapy and patient satisfaction are crucial in the outcomes.  Contracture is a pathological outcome resulting from tissue damage of a large skin surface and resulting in scar formation. The fibrous scar tissue retracts and tethers the surrounding healthy skin, causing skin tightness. This process, in turn, can affect muscle function and joint mobility, resulting in deformity and disability .Elbow joint is a complex joint between the arm and forearm. Its range of movement is 0′-145′ for the extension/flexion motion and 50′-50′ for supination/pronation action. Usually, most activities require a 100′ arc of motion at the elbow to be considered functional. A 30-degree loss of extension can be well managed and compensated. The elbow functions to move, position, and fix the hand in space. Elbow motion is essential to position the hand correctly for daily activities and functions .There are broad causes for elbow contracture/stiffness, which can be extrinsic or intrinsic. The local pathological causes of elbow contracture include; burn, trauma, inflammation, local malignancies, fracture malunion, ligaments contracture, or capsular adhesions .Burn represents the second most common cause of trauma-related deaths in developing countries. An extensive burn can lead to death if not initially managed adequately. However, survival is the immediate concern, restoration of the pre-injury status and return to the routine activities are crucial for the patient and his treating team .Post-burn scarring after deep burn leads to contracture and skin tightness. Pathologically, this can be explained by the over-proliferation of myofibroblasts causing pathological contracture .Management of contracture may improve with time, but it does not resolve on its own. In typical situations, it mandates physiotherapy and/or reconstructive surgery. The main issue that usually concerns surgeons is the methods to cover the raw area after releasing a contracture which varies between skin grafts and different types of local flaps .This study aims to analyse the outcomes of skin grafts compared to local flaps in the reconstruction of post-burn elbow contractures. These parameters included regaining function, range of movement, recurrence, and post-operative local complications, such as infection and graft rejection.A retrospective study reviewed 21 patients admitted for elbow reconstruction in EL Taqwa specialized Hospital over 12 months from September 2017 to September 2018. Only patients with post-burn elbow contracture were included. Elbow contracture for any other reasons, previous corrective surgery, and associated elbow stiffness (pre-operatively) were excluded from this study. Patients who did not receive early post-operative physiotherapy were also excluded. Early post-operative physiotherapy was defined as the therapy starting immediately after four weeks. In this cohort of patients, three operative techniques were used to cover the raw area after releasing the elbow contracture; split-thickness skin graft (STSG) alone, flap, or combined (flap + STSG). Patients who had skin grafts only were categorized as group 1 (G1), patients who had flap only were tagged as group 2 (G2), and group 3 (G3) for the combined approach. The coverage method was based on the intra-operative surgeons' assessment. Flaps were essential for any exposed tendon, nerve, blood vessel, or bone). the use of STSG was either for a superficial raw area or for completion in the areas where the flap coverage was not satisfactory. The hospital records were reviewed to extract the relevant data  to this work. Ethical approval was obtained locally from EL Taqwa Specialized Hospital's ethical committee.The preoperative protocol was as follows: (1) History talking: Each patient's medical history was carefully reviewed regarding the time of burn, time of first hospital admission, the physiotherapy patient received afterburn and the history of previous operations. (2) Examination: The patients were assessed regarding (A) the scar's Shape. (B) Type, degree, and severity of the contracture. (C) Elbow joint examination, including the range of movement. (D) Presence of surrounding healthy skin. (E) Vascular and neurological examination of the upper limb. (3) Investigations: (A) Routine blood tests including complete blood counts, coagulation profiles, blood grouping, liver and kidney functions (B) Plain x-ray in two different positions for the elbow region to exclude the preoperative stiffness. (C) Pre- and post-operative photographing of the contracture. On reviewing the operative technique, two plastic surgeons were the primary operators. It was as follows: (A) All patients were operated on under general anaesthesia and received preoperative antibiotics according to the local guidelines. (B)Transverse incision at the anterior joint aspect at the joint line level . (C) Gentle extension of the joint up to the entire possible range  followed by proper haemostasis. Three different techniques were used to cover the raw area after the complete release of the contracture; STSG alone, flap alone or flap + STSG (combined) Figures -1C. The Post-operatively, the first graft dressing was done five days after the operation with normal saline and antibiotic ointment (Garamycine ointment); however, the dressing for patients with only flaps was done after two days. The stitches were removed after two weeks, and the donor site was exposed after three weeks.The range of movement was measured intra-operatively (after correction of the elbow contracture) and in the follow-up appointments . The measurement was as follows; first, the patient was positioned supine with the arm at the side, straightened elbow, and supinated hand. Then a protractor was used to measure the angle between the longitudinal axis of the forearm and the horizon. The range of movement was divided post-operatively into three groups; Group A (0-<30), Group B (30-< 50), and Group C (> 50) degrees.All patients in this study were subjected to a three-month post-operative physiotherapy programme. This protocol entailed continuous passive movement two times per day while the limb was in a splint, from day 1 post-surgery. The splint was removed after four weeks, and the patient was referred to the hospital physiotherapy unit to start comprehensive physiotherapy three months after slab removal. The follow-up period was at three, six, and 12 months when the range of extension of all patients was measured, and the patient satisfaction status was documented (patient satisfaction was measured as the patient's ability to perform the daily activities according to the patient's routine). On reviewing the follow-up documentation, we found the patient had a different extension range; therefore, data were categorized into three groups; Group A (0-<30), Group B (30-<50), and Group C (>50) degrees, according to the degree of extension.Twenty-one patients met our inclusion criteria. Female patients were nearly triple the number of male patients (16 and five retrospectively). The mean age was 23.95 (range 8-38) , were caused by scald (liquid) burn; however, the flame burn was represented by only four cases (19%). STSG was the only way of coverage in 47.6% of cases; however, 42.9% of the patients were reconstructed using the only flap option . Different types of contractures and the way of intervention are shown in Table Different types of flaps are used to reconstruct the raw area after the release of the contracture Figure . The oveAt three-month follow-up, 16 (76.2%) of patients had a standard range of extension; however, this percentage decreased to 66.7% and 57.1 % at six and 12 months retrospectively. The rate of patient satisfaction after 12 months of follow-up was 85.7%; however, two patients (9.5%) required re-operation  Table .The main target of contracture treatment is to establish an acceptable range of movement to restore patients’ function without causing any pain or instability. Post-burn contractures are distressingly common and severe in developing nations and significant problems in developed countries ,7.Different methods have been used to correct this problem. Non-surgical measures, such as splinting and external fixation systems plus physiotherapy can achieve acceptable results. The principle of all surgical interventions is to excise the scar tissue, release the joint and cover the defect with skin grafts, flaps, or combined, according to the depth and size of the raw area and the exposure of the neurovascular structures .Skin grafts and skin flaps are widely used in plastic reconstructive surgeries, especially post-burn scars and deformities. Skin grafts are composed of a thin epidermal layer  and a portion of the dermis, which is a fibrous layer formed mainly of collagen and elastin. The skin grafts do not have their blood supply, and they depend on the vascularity of the wound bed to receive their nutrition. Skin grafts take occur through three steps; inhibition, inosculation, and revascularization. Skin grafts are an essential part of the reconstructive ladder. Skin grafts are indicated to cover deep partial-thickness skin defects, full-thickness skin defects when simple measures, such as primary closure and secondary healing, are not feasible. Wounds with active infection and known cancers are an absolute contraindication to skin grafts on top. On the other hand, skin flaps are more useful than grafts on mobile areas, joints, and sphincters. They are considered superior because they do not cause secondary contracture, and they match the same colour and texture of the surroundings -11.Local skin flaps can simply be classified according to sliding, and lifting tissue movements are praised. Flaps include advancement, pivotal, transpositional, rhombic, and bilobed flaps. In this research, advancement flaps were the most popular method to cover the resultant wound bed. These types of flaps have linear or rectangular configurations. They are subdivided into single pedicle, bipedicle, and V-Y flaps. Flaps have reliable perfusion; thus, flaps can be used to cover successfully, relatively avascular areas such as cartilage and bones, with an excellent rapid healing process. In a skilfully implanted skin flap, the rate of complications and morbidity should be equal to those after skin grafting. However, there are potential negative outcomes to consider when choosing skin flaps as a reconstructive modality. Ischemia of the flap is the most feared for all surgeons that can result in a non-viable flap with a large and complex wound, protracted healing course, and a poor aesthetic outcome. Other side effects include failure, haemorrhage, and infection ,13.Post-operative physiotherapy should be mandatory to achieve the best outcomes and decrease the rate of failure and recurrence. There are still some arguments about the best regimen to adopt after surgical correction of contracted joints. Continuous passive movement is routinely added as a post-operative program . HoweverThis retrospective study investigated 21 cases with post-burn elbow contracture without any degree of elbow stiffness. Scald burn was the most leading cause for elbow contracture (81%). Contracture in females was threefolds higher than that in males. It is noticed that children were the most affected group in this cohort, with almost half of the set (47.6%) injured, the percentage decreased as the age increased, to reach 19.1% in the eldest age group (30-38 years old). Thus, in this research, it is found that children can suffer domestic elbow injuries that can complicate with elbow disability. In 2019, Mary et al. noticed that flame injury was most popular in adult groups in their study . This caIn this study, skin grafts were used in 10 cases (47.6%), while local skin flaps were used in nine cases (42.9%). In two cases, both grafts and local flaps were combined to reconstruct the elbow after excision of the scar tissue. Flaps were used when the raw area was deep, and the neurovascular bundle, tendons, or bone were exposed. Lateral arm flap, medial arm flap, and Z-plasty were used in two, two and five patients, respectively. The take rate for grafts was (100%); however, when looking at the patients who had grafts as coverage (G1 & 3), two cases developed partial graft loss (16.7%). On the other hand, the take of the flaps (in G2 & 3) was (91.1%), as one case developed partial distal necrosis; these partial losses were managed conservatively with the help of tissue viability nurses. Nevertheless, the overall complication rate was 28.6%. The rate of complications was higher in the graft subgroup (four cases). The adverse events were as follow; infection (two cases for grafts and one for combined flap/graft group), bleeding (zero case), a slough of the graft . Serious flap complications, such as flap rejection or ischemia, were not witnessed in this experience. In the following appointments at first, third, and sixth months, and with the physiotherapy protocol, the incidence of overall contracture recurrence was 42.9% (nine cases had post-operative re-contracture >30′). The recurrence rate in the grafted elbows was threefolds higher than the elbows reconstructed with flaps. The incidence of recurrence started to be witnessed in the clinic appointments, after three months of total five cases , seven patients at six months , and peaked to nine cases at 12th months . The degrees for re-contracture were divided into three groups; A (0-<30), B (30-<50), and C (>50). Patients in group A (57.1%) were reassured and asked to go back to their daily routine as long as their daily activities were not affected. Group B (28.6%) patients were asked to continue a comprehensive physiotherapy course for six months and be reassessed after that period; however, they were satisfied with the final outcome as it did not affect their daily routine. While in group C (14.3%), the patients were not satisfied with the final outcome at 12 months; thus, they had to undergo re-do surgery.Sanjay , in his Our work, supported by the comparisons of other studies, goes with the literature that skin grafts and flaps are feasible options for post-burn skin contracture to restore elbow function and range of motion. Incidence of rejections, graft loss, and contracture rates are higher in grafts than in flaps. Local skin flaps are reliable for soft tissue replacement. Flaps are classified according to composition, transfer method, shape, and blood supply, which is considered the most vital factor for its outcome -21.A limitation in this study was not including the long-term outcomes (>12 months) for the recurrent contractures, especially those in group C and was scheduled for re-do surgery. Therefore, a different study is recommended with further inclusion and exclusion criteria to concentrate on managing elbow-contracture recurrence.According to this experience, scald burn was the most common cause of post-burn elbow contracture, especially in children. Excellent results can be achieved by using either STSG or local flaps. Local flaps are superior to STSG in terms of the outcomes; however, coverage selection depends on the lost tissue area, depth, and the exposure of underlying deep structures. Physiotherapy is recommended to achieve the best results, and patient satisfaction is crucial in the final decision.


According to the 8th edition AJCC staging manual, a least of 16 lymph nodes retrieval (LNRs) is the minimal requirement for lymph nodes (LNs) dissection of gastric cancer surgery. Previous studies have shown that increasing the number of LNRs (≥30) prolongs survival for selected patients. However, the necessity of retrieving 30 or more LN for stage II gastric cancer patients is still under debate.This study aims to explore the impact of retrieving 30 or more lymph nodes on the survival of stage II cancer patients.A total of 1,177 patients diagnosed with stage II gastric cancer were enrolled in this study. The clinicopathological parameters and the impact of different LNRs (<30 or ≥30) and positive lymph node ratio (NR) on overall survival (OS) were retrospectively analyzed.The mean number of LNRs was 34 ± 15. A total of 44%  of patients had an LNRs <30, while 56%  of patients had an LNRs ≥30. The 5-year survival rate was 81% for all patients, 76% for the LNRs <30 group, and 86% for LNRs ≥30 group, respectively (P = 0.003). The survival benefit of retrieving 30 lymph nodes was significant in certain subgroups: age >60 years/male/underwent total gastrectomy/stage IIB. For N+ patients, higher NR was significantly correlated with poor survival.The survival benefit of retrieving 30 LNs varies in different subgroups. An LNRs of 30 is mandatory for selected stage II gastric cancer patients. All available clinical information was retrieved from the database, including general patient demographics, tumor location, differentiation, tumor size, resection extent, LNRs, tumor stage, and survival. The patient information is listed in All patients received total or subtotal gastrectomy with D2 lymphadenectomy following the guidelines of the Japanese Gastric Cancer Association  . The hazard ratio (HR) and the 95% confidence interval (95% CI) were calculated by the Cox proportional hazards model, upon which a forest plot was built to visualize the impact on survival. A P value < 0.05 was considered statistically significant. Statistical analysis was performed with SPSS version 25.0 for Windows .The clinicopathological characteristics were compared using χ2 tests for categorical variables and analysis of variance (ANOVA) for continuous variables, as appropriate. Patients were divided into different subgroups according to the clinicopathological features . For each subgroup, the Kaplan-Meier method and log-rank test were used to assess the survival impact of different lymph node retrievals . Nearly half of the tumors were located in the distal part of the stomach, also half of the tumors were poorly differentiated, other details are depicted in The mean number of LNRs was 34 ± 15, with a range from 3 to 101. Numbers of patients with LNRs <30  and LNRs ≥30  were roughly balanced. The distribution of LNRs and numbers of positive lymph nodes are shown in Up to January 2020, in a median follow-up time of 44 months, a total of 168 tumor-related death events were observed in the 1,177 patients. The 5-year survival rate was 81% for all patients, 76% for the LNRs <30 group, and 86% for LNRs≥30 group, respectively (P = 0.003). The survival and hazard ratios adjusted by subgroups are depicted in th edition of the AJCC staging manual, retrieval of at least 16 LNs is the minimal requirement after curative resection surgery  in stage II patients  of patients had an LNRs ≥16, and 53.4%  had an LNRs ≥30, which is superior to previous reports, in which only 23–45% of patients had an LNRs >16  could potentially overcome the bias of inaccurate N staging, which is in concordance with the previous reports , 18. NevAnother important finding of our study is that the survival benefit of LNRs ≥30 varies between different subgroups. For patients who underwent total gastrectomy, lymphadenectomy must be more extended according to the Japanese gastric cancer treatment guidelines . Thus, pThere are a few limitations to our research. First, owing to the nature of the retrospective study design and the different origins of the data sets, treatment bias was inevitable. Second, the effect of confounding factors could not be eliminated in the subgroup analysis. Third, selection bias was also not neglectable because all patients enrolled were from three high-volume gastric cancer centers, and the high number of LNRs and ideal OS may not be easily reproducible in all centers.Retrieval of 30 lymph nodes is mandatory for selected stage II gastric cancer patients.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the ethics committee of Sun Yat-Sen University Sixth Affiliated Hospital. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.J-SP and SC designed the study; Y-HC, JL and R-CN acquired the data; Y-HC analyzed, interpreted the data, and drafted the initial manuscript. DL made substantial revisions to the manuscript. A-HL, Z-JD, X-JC, JX, Y-BC, and C-MH helped with interpreting the data. Y-HC, JL, and R-CN contributed equally to this work.Supported by Guangzhou Science and Technology Project (grant number 201803010040) and Nation Key Clinical Discipline.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The purpose of the current study was to analyze the influence of radiological “disappearing liver metastasis” (DLM) on the efficacy and prognosis of patients with colorectal liver metastases (CRLM) undergoing conversion therapy.  Patients with CRLM by the multidisciplinary team (MDT) of the First Affiliated Hospital of Chongqing Medical University were retrospectively enrolled from January 2014 to January 2021. The relationship between the occurrence and recurrence of DLM and different clinical factors was analyzed. P < 0.001). There were significant differences between <5 mm group and >10 mm group on occurrence of DLM（76.7% vs. 30.4%, P < 0.001) and between 5-10 mm group and >10 mm group also . Through univariate and multivariate analyses, it was concluded that age  and treatment regimens  had a significant influence on the progression-free survival (PFS) time of DLM.  Thirty-five of the 113 patients (31.0%) with initially unresectable CRLM developed DLM, and of the 361 lesions, 177 disappeared (49.0%). Within 6 months, 6-12 months, and 12-24 months groups, the recurrence rate was 3.4%, 16.8%, and 34.8%, but there is no recurrence in after 24 months group. There was a statistical difference between chemotherapy alone and chemotherapy combined with the targeted therapy group on the occurrence of DLM (58.3% vs. 37.1%,  Younger patients, who use chemotherapy alone to achieve a therapeutic effect, might have better survival benefits when the lesions do not progress within 2 years after the appearance of DLMs. Colorectal cancer (CRC) is the third most common malignant tumor globally, and its incidence and mortality rank fifth in the world . About 5Conversion therapy is expected to transform the unresectable CRLM into resectable status, including chemotherapy, targeted therapy, and radiofrequency ablation . PreviouThis study retrospectively analyzed the clinical data, follow-up time, and tumor changes recorded in imaging of single liver metastatic lesion of CRC with DLM after chemotherapy and/or targeted therapy and analyzed the correlation factors with the appearance and recurrence of DLM. The purpose of the current study was to analyze the influence of radiological DLM on the efficacy and prognosis of patients with CRLM undergoing conversion therapy.Patients with CRC were enrolled from January 2014 to January 2021 who were discussed by the multidisciplinary team (MDT) composed of the gastrointestinal surgery department and related departments of the First Affiliated Hospital of Chongqing Medical University. This study was approved by the ethics committee (2021-521), and all patients signed the informed consent. The inclusion criteria were as follow: (1) pathologically confirmed CRC and (2) initially unresectable liver metastasis lesions. The exclusion criteria were as follow: (1) no pathologically confirmed CRC; (2) initially resectable or potentially resectable liver metastases; (3) undergoing neoadjuvant therapy; and (4) no DLM after conversion therapy or have DLM after interventional or ablative therapy .The clinical data corresponding each liver metastasis was analyzed among the patients screened according to the inclusion and exclusion criteria. Some liver metastases in a few patients were too many to be accurately counted but isolated and dense, so the number of the lesions was set at 30, among which only the disappearing lesions and their corresponding clinical data were analyzed. In the statistics of the number of DLMs, some lesions were not included in the statistics because patients gave up treatment after the initial diagnosis of DLM.Many studies have shown that both computed tomography (CT) and magnetic resonance imaging (MRI) may be more than 90% sensitive for detecting liver lesions larger than 1 cm . MRI detIn this study, the treatment regimens included chemotherapy alone, targeted therapy alone, and chemotherapy combined with targeted therapy. The chemotherapy regimen included oxaliplatin-based chemotherapy and irinotecan-based chemotherapy. The targeted drugs were bevacizumab and cetuximab.When CRLM, in initial diagnosis, was assessed that cannot guarantee enough liver parenchyma during surgery or technically completely resected, the lesions were defined as the initially unresectable liver metastasis lesions –21. The The number of effective lesions in each period was calculated according to the total number of lesions, of lost lesions in the period, and of all recurrent and lost before the period. The lesion, not recurrent but lost to follow-up period or surgically removed during follow-up, was defined as the lost lesion.Progression-free survival (PFS) time was defined as the time interval from the occurrence of a single DLM to recurrence. The follow-up time nodes were as follows: (a) the time of initial diagnosis of liver metastasis; (b) the occurrence time of each DLM; and (c) the time of recurrence of each DLM.The clinical baseline information was retrospectively collected, including gender, age, site of primary tumor, body mass index (BMI), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), simultaneous/metachronous liver metastasis, extrahepatic metastasis, conversion treatment regimens, and lymph node metastasis of primary tumor. The imaging information included the time of initial diagnosis, the size, number, and segment of liver metastasis. Each follow-up period information had follow-up time, the disappearance of liver metastasis lesions, disappearing time of the lesions, segment of the DLM, size of the DLM at initial diagnosis, number of DLM, recurrence of DLM, time of recurrence of the DLM, segment, and the number of recurrent DLM.χ2 test. Progression-free survival (PFS) time was analyzed by the Kaplan-Meier method and Log-rank test, and multivariate analysis was by Cox proportional regression model. P < 0.05 was considered as a statistically significant difference.SPSS 22.0 software was used for statistical analysis. Count data were compared by Three hundred forty-five patients were identified as CRC from January 2014 to January 2021. According to the inclusion and exclusion criteria, 113 patients with CRLM were included. According to the imaging data analysis, 35 patients (31.0%) had DLM in 113 patients, and there were more than 361 liver metastasis lesions in total. Of the 361 liver lesions, 177 lesions showed radiologic disappearance (49.0%), known as DLM. Two patients had too many liver metastases not to count accurately, so we excluded the number of liver lesions in these two patients, a total of 60, in which there were 32 DLM . Of the P < 0.001).According to the time of the remaining disappeared status, the liver lesions were divided into five groups, including 6 months, 6-12 months, 12-24 months, 24-36 months, and 36 months to present. Among them, the number of the recurrence of DLM within 6 months was 5 (3.4%), 6-12 months group was 20 (16.8%), and 12-24 months group was 24 (34.8%), but of the 24-36 months group and 36 months to present group, there was no recurrence ; the difP < 0.001) (P < 0.001), while there was neither difference between the chemotherapy alone group and the targeted therapy alone group (P = 1.000) nor between the targeted therapy alone group and chemotherapy combined with the targeted therapy group (P = 0.268)  . There w= 0.268) .P = 0.330). There were statistical differences among the three groups in the size of liver metastasis lesions on the occurrence of DLM (P < 0.001) (P < 0.001); however, there was no statistical difference between the <5 mm group and 5-10 mm group (P = 0.478)   in which= 0.478) .Sex, age, site of the primary tumor, BMI, CEA, CA19-9 at admission, simultaneous/metachronous liver metastasis, size of liver metastasis, extrahepatic metastasis, conversion treatment regimens, and lymph node metastasis of the primary tumor were analyzed and compared. Finally, age, sex, and treatment regimens were thought to influence the PFS time of DLM. After that, the relevant factors were incorporated into COX multivariate regression equation, and age and treatment regimens were analyzed as independent influencing factors . Then, tConversion therapy for initially unresectable liver metastasis of CRC patients has a significant role. Some studies have claimed that in the process of conversion therapy, some liver lesions of 9-37% patients with CRLM are not visible on the radiology, known as DLM , 21–23. In time groups, we can conclude that the recurrence rate of the DLM is rising year by year within two years, which is similar to some studies mentioning that recurrence rates of patients with DLM are higher in the two years . But theSome studies have shown that oxaliplatin-based chemotherapy regimen is more prone to the occurrence of disappearing lesions . In our The segment of liver metastasis does not correlate with the occurrence of DLM, but the size of liver lesions is correlated. Some studies have claimed that less than 20 mm liver lesions in the treatment process are more prone to make lesions disappear . But ourUnivariate analysis shows that gender, age, and different treatment regimens impact the PFS time of the disappearing liver metastasis lesions. The age and treatment regimens are independent factors in PFS time for patients through the COX multivariate regression equation. We can see from the K-M survival analysis curve that PFS time is higher in younger patients (<52) and treated with chemotherapy or targeted therapy alone.There are some limitations of this study as well. First, it is a single-center retrospective study with 113 patients, which is relatively small. Second, due to the external factors of the patients themselves, they could not meet the 5-year follow-up in our study. Therefore, multicenter and large sample randomized controlled trials (RCTs) with patients with DLM are needed in the future experiments.In conclusion, patients with CRLM who are younger (<52) and treated with chemotherapy have higher PFS time. And chemotherapy alone is more likely to have DLM for the patients. And if DLMs have no recurrence within 2 years, the lesions might be considered to have complete pathological disappearance. So in this study, we think that younger patients, who used chemotherapy alone to achieve a therapeutic effect, might have better survival benefits when the lesions do not progress within 2 years after the appearance of DLMs.


Ovibos moschatus), as the biggest herbivore in the High Arctic, has been enduring the austere arctic nutritional conditions and has evolved to ingest and digest scarce and high lignified forages to support the growth and reproduce, implying probably harbor a distinct microbial reservoir for the deconstruction of plant biomass. Therefore, metagenomics approach was applied to characterize the rumen microbial community and understand the alteration in rumen microbiome of muskoxen fed either triticale straw or brome hay. The difference in the structure of microbial communities including bacteria, archaea, fungi, and protozoa between the two forages was observed at the taxonomic level of genus. Further, although the highly abundant phylotypes in muskoxen rumen fed either triticale straw or brome hay were almost the same, the selective enrichment different phylotypes for fiber degrading, soluble substrates fermenting, electron and hydrogen scavenging through methanogenesis, acetogenesis, propionogenesis, and sulfur-reducing was also noticed. Specifically, triticale straw with higher content of fiber, cellulose selectively enriched more lignocellulolytic taxa and electron transferring taxa, while brome hay with higher nitrogen content selectively enriched more families and genera for degradable substrates-digesting. Intriguingly, the carbohydrate-active enzyme profile suggested an over representation and diversity of putative glycoside hydrolases (GHs) in the animals fed on triticale straw. The majority of the cellulases belonged to fiver GH families  and were primarily synthesized by Ruminococcus, Piromyces, Neocallimastix, and Fibrobacter. Abundance of major genes coding for hemicellulose digestion was higher than cellulose mainly including GH8, GH10, GH16, GH26, and GH30, and these enzymes were produced by members of the genera Fibrobacter, Ruminococcus, and Clostridium. Oligosaccharides were mainly of the GH1, GH2, GH3, and GH31 types and were associated with the genera Prevotella and Piromyces. Our results strengthen metatranscriptomic evidence in support of the understanding of the microbial community and plant polysaccharide response to changes in the feed type and host animal. The study also establishes these specific microbial consortia procured from triticale straw group can be used further for efficient plant biomass hydrolysis.Muskox ( It is well established that the bioconversion of feed stuffs and energy outflow are synergistically conducted by various microbial populations dwelling in the rumen, including prokaryotes (bacteria and archaea) and eukaryotes (protozoa and fungi), with approximate 80% of the degradative activity contributed by bacteria and fungi, and 20% by protozoa . Those mOvibos moschatus) as the largest herbivore has been enduring the austere arctic nutritional conditions and has evolved to ingest and digest scarce and high lignified forages to support the growth and reproduction [The symbiotic microbial communities residing inside the rumen are characteristic of both, the concerned animal species, and their diet. In the High Arctic, Muskoxen  rRNA gene sequence analysis have demonstrated the inability of culture-dependent methods due to failed to discover the whole microbial structure and underestimate the diversity of the entire microbiota. Up to now, most of the investigations on the structure and composition of rumen microbiota have been conducted using SSU rRNA gene sequencing based on DNA-derived amplicons, such as prokaryotes ,20,21, eAll the animals involving were cared in agreement with the protocol of by the Institutional Animal Care and Use Committee at the University of Alaska Fairbanks and fed at the Robert G. White Large Animal Research Station, Fairbanks, AK, USA. (No. 139821).ad libitum fed with triticale  straw as a low-quality diet or brome (Bromus spp.) hay as a medium-quality diet from August to September , and eptember . The cheBefore the morning feeding on the fourth day of sampling week, solid content was collected from different site of rumen and was filtered out the rumen fluid using a coffee filter plunger . Subsamples of solid digests (about 5 g) were obtained according to Meng Qi’s method  and froz® Reagent  was added into. RNA isolation was carried out according to protocol of Trizol® Reagent. Small fragments and contaminants in the extracted total RNA samples were removed using MEGAclearTM kit  and OneStepTM PCR Inhibitor Removal Kit . The integrity and concentration of the purified RNA were assessed using a high-sensitivity Agilent 2100 bioanalyzer  with Agilent RNA 6000 Nano kit under manufacturer’s recommendation.To mostly efflux the total RNA, a modification of the method described by Wang  was used100 ng of total RNA of each sample was prepared for sequencing according to the protocols supplied with the Illumina TruSeq RNA Sample Prep Kit-v2, Set A and B , with jumping the steps for the enrichment of mRNA or PolyA selection. The barcodes targeted metatranscriptomic cDNA libraries were detected using the DNA 1000 kit (Agilent Technologies) and quantified using the KAPA SYBR Fast qPCR kit for illumina Technologies . All the sample libraries were multiplexed into one pool after being normalized based on the qPCR results. All the barcoded fragments were sequenced in the way of paired end (2 × 300 bp) sequencing on all Illumina MiSeq platform using a MiSeq Reagent v3 600 cycle kit .The output sequence profiles of the MiSeq platform were analyzed using a pipeline developed in house to obtain a snapshot of the microbial community of the rumen and a comparison file of community composition of the two treatments. A merged read/sample was generated after blasting and assembly paired-end reads (R1&R2) based on the barcodes, from which, rRNA was identified using the rRNA-HMM tool  of the RmRNA-Seq libraries and sequence analysis were constructed according to Meng Qi’s method . A metagAnnotation information of all randomly picked reads was profiled and a comparison file was presented for all 14 samples. Relative expression values for a taxonomic phylotype in a sample was defined as the ratio of the number of reads assigned to this phylotype to the number of reads assigned to the corresponding kingdom. Means of relative expression value of each taxonomic phylotype was calculated for each treatment. We examined the effects of forage, stage, and feeding sequence on the diversity and abundance of rumen microbial populations, including all bacteria, archaea, fungi and protozoa, under a crossover design. Statistical power of 0.80 (80%) was obtained in this study when the minimally detectable effect size was 1.0 and the significance level was 0.05. A paired t-test was used to determine significant differences for pairwise comparisons between the two forages, two stages, and feeding sequences, statistical significance was noted as Ptr, Pst, and Pco, respectively. Statistically significant differences were further filtered using a relative abundance cutoff of 0.01% for each phylotype and being detected in at least half of the samples for at least one treatment. It meant that a phylotype statistically more abundant in the triticale straw compared with brome hay would be ignored unless it contributed at least 0.01% of the reads assigned to the triticale straw feeding community and was detected in at least half of triticale straw samples. Based on the phylotype-related relative abundances, between-classes principal component analysis (PCA)  was takeUnder a crossover design, although one animal was removed from trial due to an infection of the horn boss, Illumina next generation sequencing led to the thorough elucidation of rumen microbial diversity and their functional capacity to hydrolyze lignocellulosic biomass in muskoxen rumen under different (roughage) feeding scenario. Metatranscriptomics sequence from 14 biologically independent samples generated about 11,044,327 effective reads having an average of 788,881 effective read. The number of large subunits SunUnitrRNA (LSU) reads was slightly higher than that in small subunit (SSU) rRNA (49.74% vs. 50.19%). In addition, 0.07% of reads could not be classified into LSU rRNA and SSU rRNA clusters .P > 0.05). The relative abundance of the archaea was significant higher in triticale straw feeding group than that of brome hay (P = 0.037).The results of β-diversity analysis showed that different feeding stages and feeding order had no significant microbial diversity, while forage type result in a notably difference in rumen microbiome structure and composition A. SpecifP < 0.05). Comparison was also performed at the genus level for bacteria, archaea, fungi, and protozoa separately (P < 0.05).As showed in parately F. It indTreponema and Fibrobacter contributed most to their respective phyla, whereas the representations of Firmicutes and Bacteroidetes were more diverse. Major contributions of Firmicutes came from RFN8-YE57, IS_C_leptum_sporosph, Ruminococcus, vadinHA42 and Butyrivibrio_fibrisolvens, and major contributions of Bacteroidetes came from Prevotella, Prevotellaceae_uncultured, RC9_gut_group. Most of the major phylotypes, in particular at the higher taxonomic levels, were of high consistency across environments. In muskoxen rumen fed either triticale straw or brome hay, 15 phyla of bacteria were detected, and the most abundant bacteria was Firmicutes, followed by Bacteroidetes, Spirochaetes, Fibrobacteres, Proteobacteria, Actinobacteria A. At theRegarding archaea, five genera of archaea, i.e., Methanomicrobium, Methanobrevibacter, Methanospaera, Methanonacterium, and Thermoplasmatales were observed A. All orRhizophydium and Spizellomyces, which belonged to phylum Chytridiomycota, three genera Neocallimastix, Cyllamyces, and Piromyces were included and Neocallimastix and Cyllamyces were the major contributions for the two forages. Six genera of Entodiniomorphid protozoa in the family of Ophryoscolecidae , two genera of holotrich protozoa in the family of Isotrichidae (Isotricha and Dasytricha), and an uncultured group in the subclass of Trichostomatia were observed in this study. Entodiniomorphid protozoa Entodinium and Polyplastron were predominant at the genus level for the two forages.As illustrated in Fervidicella, Desulfoluna, Thermoactinomycetaceae, Seinonella, Nonlabens, SP3-e02-2, Betaproteobacteria, Desulfobacteraceae, IS_C_leptum_sporosph, Thermobrachium, and Anaerovirgula. Selenomonas was only detected in brome hay, so it was strongly selected by brome hay. Besides Selenomonas, other bacteria taxa such as Rhodospirillales, Rhodospirillaceae, Roseburia, Quinella, and Xylanibacter were strongly selected by brome hay. The selection of fungi by forages included the Cyllamyces and Spizellomyces, which were selected by triticale straw and brome hay, respectively , Chlamydiae, Synergistetes (including Synergistia) CandidatedivisionOD1, Cytophagia, Actinobacteria, Flavobacteria, and Bacilli (named as FTs1_1). Similarly, Firmicutes such as Clostridia, Bacteroidia, Coriobacteria, Archaea, Eukaryotes also were significantly related (named as FTs1_2). Besides, there was a significant negative correlation between FTs1_1 and FTs1_2, for instance, Firmicutes/Proteobacteria (r = −0.85), Archaea/Proteobacteria (r = −0.97), Archaea/ Cytophagia (r = −0.95) and Eukaryota/Actinobacteria (r = −0.89)  A. In bro= −0.89) B.Ruminococcus (70.8 ± 16.6), Piromyces (58.8 ± 8.1), Neocallimastix (36.5 ± 8.6), Fibrobacter (32.5 ± 6.0), Epidinium (19.5 ± 7.0), and Polyplastron (18.0 ± 3.6). Abundance of major genes coding for hemicellulose digestion was higher than cellulose, and included GH8, GH10, GH11, GH16, GH26, GH30, GH51, GH74, GH114 and GH115. These enzymes were related with Fibrobacter (49.7 ± 6.5), Ruminococcus (29.0 ± 3.9), Clostridium (14.2 ± 3.5), Piromyces (13.2 ± 5.2). Enzymes dedicated for hydrolysis of oligosaccharides  were associated with Prevotella (24.0 ± 11.5), Piromyces (19.2 ± 4.3), Butyrivibrio (14.5 ± 3.4), Bacteroides (14.0 ± 2.5), Cellulosilyticum (12.3 ± 3.0), and Fibrobacter (11.0 ± 4.1). In addition, starch degrading enzymes encoded by GH13, GH77, and GH119, which were concerned with Oxytricha (26.5 ± 7.4) and Eudiplodinium (11.3 ± 3.8).The total number of hits obtained for CAZymes classes were 2131–2886 corresponding to 159–184 families. Out of the total CAZymes, GHs were the most abundant class (45.87% to 51.01%) followed by CBMs (20.41% to 22.63%), CEs (10.09% to 18.70%), GTs (5.70% to 12.26%), and PLs (1.97% to 3.07%) A. FurtheIntranmacronulceata of protozoa actively expressed 542 folds compared with its low relative abundance on a DNA basis [Ruminants utilize carbohydrate-rich agricultural waste residues such as triticale straw as substantial energy resources. The host itself is unable to synthesize any enzymes required for deconstructing the plant biomass and primarily depend on rumen microbiota to liberate the energy from plant polysaccharides in the form of carbohydrates and sugars. Muskox, as the biggest herbivore in the High Arctic, has been enduring the austere arctic nutritional conditions and has evolved to ingest and digest scarce and high lignified forages to support the growth and reproduce, which could be an outstanding animal to characterize the alteration in rumen microbiome with forage. The SSU rRNA reads identified by rRNA-HMM were separated into bacteria, archaea, and eukaryotes. Of note, the relative abundance of eukaryotic population was proximate to that of bacteria in solid digesta of muskoxen rumen at the transcription level regardless feeding scenario, which was more different than the proportion estimated by traditional technologies ,45, indiNA basis . It indiFor comparing the composition and structure of microbial community in muskoxen rumen fed triticale straw or brome hay, our data showed that feeding scenario had no effect on the prokaryotic and eukaryotic population at the phylum level. However, at the genus level, difference of either prokaryotes or eukaryotes between the two forages was visualized and Monte-Carlo test indicated the difference was significant, implying that selection of rumen microbiomes was largely forage specific at the genus level. The difference in the content of NDF, ADF and cellulose between the two forages probably contributed to this selection. In addition, Statistical student t -test under a crossover design showed no significant difference for relative abundance of total genotypes of either bacteria or eukaryota in muskoxen rumen fed triticale straw and brome hay, while archaea were striking affected by forages in muskoxen rumen, and was higher in triticale straw than brome hay, indicated that there was correlation between the methane emission and quality of diets in ruminant, more methane producing in lower quality diet .Ruminococcus spp., Fibrobacter spp., and Cytophaga spp. clearly played important roles in fiber degradation [Fibrobacter between triticale straw and brome hay. However, diverse genera in families of Ruminococcaceae and Cytophagaceae had selectively enriched by triticale straw. Prevotellaceae, Veillonellaceae, Coriobacteriaceae, and Succinivibrionaceae were selectively enriched by brome hay. Those groups seemed to play pivotal roles in the degradation of corresponding forage and most of those phylotypes had been only detected in the rumen of Angus heifer fed forage other than high grain [Prevotellaceae, Rikenellaceae, Peptococcaceae, Veillonellaceae, Succinivibrionaceae, and Lachnospiraceae [Prevotellaceae and its two genera (Prevotella and Xylanibacter), genus of hoa5-07d05_gut_group of Rikenellaceae, Veillonellaceae and its genera (Quinella and Selenomonas), some genera of Lachnospiraceae , and Succinivibrionaceae were selectively enriched by brome hay. Similarly, Rikenellaceae and its genera (RC9_gut_group and SP3-e08), Peptococcaceae, Propionispira of Veillonellaceae, two genera of Lachnospiraceae (Parasporobacterium and Sporobacterium) were selectively enriched by triticale straw. These data indicated that triticale straw and brome hay could share with homologous non-cellulolytic families to ferment of oligosaccharides, starch, sugar for energy production in muskoxen.Concerning the relationship between forages and microbial community, it was established that the rumen flora is dynamic and known to adapt to changes in the host diet ,47,48. Rradation ,53,54,55gh grain . In addipiraceae ,56,57,58Acetonema [Acetitomaculum [Propionispira [Of note, the accumulating of electron and hydrogen generated in the fermentation would inhibit hydrogenase activity and the oxidation of sugar and would be transferred to acceptors other than oxygen under the anaerobic conditions in rumen. Acetogens would dispose hydrogen with carbon dioxide to produce acetate by the acetyl-CoA pathway . This iscetonema  and Acetomaculum , did notonispira  was seleonispira  and bromDesulfobacterales, Desulfobacteraceae, Desulfoluna, Desulfovibrionales, Desulfovibrionaceae, and Desulfovibrio), were selectively enriched by triticale straw. Coupling with the reduction of oxidized sulphate to sulphide, organic moleculars were oxidized and energy was transferred. Sporobacterium spp. were identified as possessing the ability to degrade aromatic compound [Clostridiaceae , Geosporobacter ,67 and Tbrachium  were alsMethanobrevibacter sp and Ruminococcus flavefaciens to new born lambs increased the population of R. flavefaciens, the straw degradation, the activity of some glycoside and polysaccharide hydrolases of the adherent microbial populations and the concentration of acetate in ruminal contents [Methanobrevibacter and Thermoplasmatales were selectively enriched by brome hay, while the Methanomicrobium was strongly selectively enriched by triticale straw, which contributed to the difference in the total abundance of archaea between the two forages. In rumen, Methanobrevibacter spp. metabolically preferred to the CO2 or formate, and H2 [Methanomicrobium spp. preferred to use acetate as substrate [Methanogens would sink hydrogen with carbon dioxide to produce methane through methanogenesis . Althougcontents . Thus, t, and H2  that pro, and H2 ,72. Whilubstrate . It indiubstrate  and tritCyllamyces  was related to fiber degradation [Cyllamyces was strongly selected by triticale straw in this study. Spizellomyces is in the phylum Chytridiomycota, which is essentially ubiquitous zoospore-producing fungi. Like all chytrids, Spizellomyces might be related to the degradation cellulose degradation through producing GH [Spizellomyces probably was important for the degradation of triticale straw. As far as protozoa is concerned, in addition to degrade the plant cell walls and cell wall fragments by the excreted extracellular enzymes, protozoa also acted as predators of bacteria and fungi, and were responsible for the protein turnover in rumen. Particularly, the small Entodinium spp contributed to much of the bacterial predation and protein turnover [Entodinium contributed the majority in muskoxen rumen. The outcomes of the selection of protozoa by forages showed that Dasytricha and Diplodinium were selected by brome hay, while Entodinium was enriched by triticale straw. Study that focused on ruminal fermentation and microbial community responding to four typical subtropical forages in vitro indicated that the most abundance of Entodinium was observed with cassava residues when compared to corn straw silage and elephant grass [With regard to fungi and protozoa, most of the recognized so far anaerobic fungi in ruminant is that they could produce a wide range of high cellulolytic and xylanolytic enzymes to degrade the high-fiber feed particles, which were found to associated with the rhizomycellium and excreted into the surrounding microenvironment, and were known to preferentially adhere to the lignin rich regions and acted as the primary invader to initiate the degradation of fibrous feed particles . Cyllamyradation , which pradation . For thiucing GH . The speturnover . In the nt grass . The altRumen microbes harbor complex array of enzymes which work synergistically for plant fiber degradation, including GHs, CBMs, CEs, GTs, PLs, etc. Of various CAZyme family, GHs are the most abundant and diverse group of enzymes accountable for hydrolyzing glycosidic bonds of carbohydrates in plant polysaccharide . Date frFibrobacteraceae, Clostridiaceae, Ruminococcaceae, Prevotellaceae, Bacteroidaceae, and Lachnospiraceae have been reported to be the major fiber degrading microbes in muskoxen [Prevotella has been identified closely related with GHs involved in the degradation of oligosaccharides and hemicelluloses [Ruminococcus and Fibrobacter affiliated to the majority of the putative cellulases belonged to GH families, especially GH5, GH9, GH45, and GH48 [Ruminococcus is proficient in the deconstruction of cellulose and hemicellulose [Bacteroides, Butyrivibrio, Cellulosilyticum, Clostridium, Fibrobacter, Prevotella, Ruminococcus, etc. contributed to GHs. It is well-known that cellulose and hemicellulose in plant biomass are considered as one of the prevalent renewable resources of fermentable sugars that could be utilized further in numerous industrial processes, like ethanol generation. Therefore, the distinct microbial reservoir in muskoxen reflects its efficiency for the deconstruction of plant biomass. Nonetheless, further research is required to explore the rumen microbiome and the way it carries out fiber deconstructionRumen microbes like muskoxen . Accordilluloses . Ruminocand GH48 . Perhapsellulose . In the Ruminants harbor a vast and diverse microbial community that functions in the utilization of fibrous feedstuffs. In the present study, comparative metatranscriptomics approach was employed to portray the rumen microbial diversity and define the relationship between fiber digestion and microbial communities of muskoxen fed on either triticale straw or brome hay. The global effects of triticale straw and brome hay on the prokaryotic and eukaryotic population, and of the lower clade  were observed at the lower taxonomic level of genus, indicating more detailed selection in the degradation of two forages original from the same gramineae. Further analysis revealed that triticale straw with higher content of NDF, ADF, cellulose selectively enriched more lignocellulolytic taxa and electron transferring taxa, while brome hay with higher N content selectively enriched more families and genera for degradable substrates-digesting. Further analysis revealed the existence of enormously diverse CAZyme belonging to classes: GHs, CBMs, CEs, GTs, and PLs, with the dominance of GHs. Of the total GHs identified were found to be responsible for direct plant polysaccharide deconstruction, especially cellulose and hemicellulose. The presence of higher bacterial population and its close connection with CAZyme concludes that the rumen of muskoxen as an important converser of plant biomass to high-value products.


A global target of the World Health Organization (WHO) is to reduce physical inactivity among all adults and adolescents by approximately fifteen percent by 2030. Social media could have an impact in this effort because of its enormous reach, potentially addressing underserved populations in need for physical activity (PA) interventions. This scoping review provides a broad overview of social media-based interventions and systematically maps the evidence regarding their effectiveness for PA promotion and other health outcomes. Scopus and Medline were searched using the terms “physical activity” and “social media” and the names of key social media platforms. Following the PRISMA guidelines for scoping reviews, abstracts and full texts were screened for eligibility. In total, 12,321 publications were identified and 53 met the inclusion criteria. The use of Facebook was most prevalent in PA interventions, followed by study-specific platforms. More than one third of the studies revealed positive effects regarding the promotion of PA. Additionally, social media-based interventions positively affected other physical dimensions of health . Results pertaining to feasibility were heterogeneous. Social media seems to be a promising tool for increasing PA at the population level. Future studies should take the abundance of platforms into account and select social media platforms consciously. Physical inactivity is a leading risk factor for mortality worldwide and contributes to the etiology and progression of non-communicable diseases (NCDs), such as cardiovascular disease, type 2 diabetes, various types of cancer, and chronic respiratory diseases. Seventy-one percent of all global deaths in 2016 were attributed to NCDs .A status update of the WHO from 2020 suggests that, while some progress has been made to reduce the burden of NCDs , further effort is required to reduce physical inactivity because of an insufficient success in equally addressing all NCD risk factors, as indicated by a rising prevalence of obesity .Social media holds great potential for the accessible promotion of physical activity (PA). Based on the synthesis of definitions of social media appearing from 2007 onwards, Mróz-Gorgoń and colleagues 2016) defined social media as “network community communication channels” p. 38), which allow the exchange of information, interaction and integration on a private and commercial domain . Due to  defined , which aBeyond that, social media has an enormous reach; it is estimated that the number of active social media users worldwide reached more than 3.6 billion users in 2020, and this trend is continuing to rise . Due to Although previous evidence indicates that social media-based interventions for the promotion of PA achieve high levels of engagement and retention , resultsIdentify which social media platforms are used in interventions for the promotion of PA to date.Systematically map the evidence regarding their effectiveness for PA promotion.Determine which dimensions of health are captured as secondary outcomes in the studies included in the scoping review.Summarize the evidence regarding the impact of social media-based PA interventions on these secondary health outcomes.Summarize the evidence regarding acceptability, use, and usability of social media-based PA interventions.This scoping review was conducted in order to:According to the PRISMA guidelines for scoping reviews (PRISMA-ScR) , a protoDue to the relatively broad nature of a scoping review and the explorative review questions, all published literature on social media based-interventions promoting PA was included. Social media based-interventions encompass all interventions delivered via any type of social media or at least incorporate one social media component of either existing, popular platforms or stand-alone platforms  to promote PA.All studies that compared the social media-based condition to either (A) a non-social media-based intervention , (B) a control group not exposed to any intervention, or (C) a no-comparator condition were included. Additionally, articles needed to address PA  as a primary outcome to be included, regardless of whether PA was assessed using objective or subjective methods of measurement. PA outcomes were considered as measures of PA volume reported in various units .All types of studies carried out on the research topic, so far, were eligible for inclusion . Furthermore, inclusion was restricted neither to any specific population, as long as study participants were human beings, nor to contexts in which studies were conducted. Conference proceedings, abstracts without full texts, and study protocols without results were excluded from this review. In addition, systematic reviews that did not provide complementary information, because they contained only a few studies on social media-based interventions, which were already included in the data extraction for this scoping review, were excluded.To identify relevant literature, the electronic databases Scopus and Medline via PubMed were searched on 4 May and 12 May 2020 by the two authors LG and SS. The search was comprehensive and limited by neither publication date nor publication type or any other filters. Reference lists of the included full texts were scanned for potentially relevant other articles.The search strategy was peer-reviewed and refined by an information scientist from the Cochrane Metabolic and Endocrine Disorders Group before implementation. We searched the concepts “physical activity” and “social media” as MeSH terms or index terms and key words, as well as their appropriate synonyms. In addition, we searched key social media platforms from 2014–2020 by name . The seaThe selection of sources of evidence was executed in two steps after all identified records had been exported to EndNote X9.1 and Rayyan. First, two authors  screened titles and abstracts of all identified records independently, using the web app Rayyan. Disagreements concerning inclusion/exclusion for full text screening were discussed with a third author (CRP) until they were resolved. Second, full texts of all records that were deemed relevant after screening phase one, were obtained. Whenever a full text was not accessible, the corresponding author was contacted for retrieval. Then, the two authors LG and SS independently screened all full texts for eligibility. Any discrepancies were resolved via discussion with the third reviewer (CRP).For the extraction of all relevant information from the included sources, a data charting sheet was developed similar to the one provided by Elm and colleagues, 2019 [Data on the general information of the reference , evidence source characteristics , the intervention , outcomes , and results  were captured. Additional information, such as the key conclusion of the study, notes or correspondence with the lead or senior authors, was provided at the end of the charting form.p values for in-between group differences or withingroup differences from baseline to follow-up). Secondary health outcomes were grouped into various dimensions of health examined and by effectiveness. Additionally, the evidence on feasibility was summarized, .First, the included references were grouped by study type . Additionally, articles were grouped by type of social media to obtain an overview of studies using social media platforms as stand-alone interventions, specifically designed for the purpose of the study, versus those which incorporated well-known social media applications into interventions but also included other components. Along with the main objective of this scoping review, data on how PA was quantified were charted, and studies were summarized according to their effectiveness for improving PA (dependent on reported n = 21), no social-media based intervention was examined (n = 14), and the publication type was wrong . After completion of the screening process, 53 articles referring to 43 studies/trials were included in this scoping review. For detailed information about the selection process, see The initial database search generated 12,321 hits. Another 319 records were found via search alerts in the two databases before the screening process ended and were added to the final results. A total of 2064 duplicates were detected by Endnote and deleted before uploading the remaining records in Rayyan. Via a manual search, another 513 duplicates were identified by the two authors LG and SS during the screening process and subsequently deleted. This resulted in 10,063 total records, which were screened by title and abstract. After the first screening phase, 9945 records were excluded, and the full texts of the remaining 118 publications were screened for eligibility. Throughout this second screening phase, another 65 articles were excluded, with the most common reasons for exclusion being: PA was not a primary outcome  ,37,38,39Overall, the 43 studies included 11,469 participants, ranging from a minimum of 10 to a maximum of 5010 individuals ,56. PartMaher et al., 2014, included a total sample of 113,988 participants across ten studies in their systematic review . The othn = 18) [n = 1) in combination with Facebook [n = 1) [n = 1) [In 28 studies, a pre-existing social-media platform was used for intervention delivery ,56,57,58n = 18) ,51,53,54Facebook , Meetup  [n = 1) , and the [n = 1) ,40. Of t [n = 1) ,37,47,52 [n = 1) ,22,39. T [n = 1) ,42. The  [n = 1) ,46, one  [n = 1) . Another [n = 1) ,57. In t [n = 1) , summari [n = 1) ,60.n = 14) [n = 7) [n = 3) [n = 8) [n = 7) [The RCTs conducted were either two-armed n = 14) ,34,35,36 ,34,35,3 [n = 7) ,33,37,39 [n = 3) ,24,38 in [n = 8) ,51,52,53 [n = 7) ,49,50,54Two observational studies tracked data of users and non-users of Pokémon Go ,57, an aIn the one and only quasi-experimental study, a YouTube exercise video was delivered to both the intervention and control group. The intervention group obtained additionally motivation via Instagram .Of the three systematic reviews, two summarized evidence on the effectiveness of interventions delivered via a social media platform for changing PA and other health outcomes, such as diet and weight ,60, and n = 23) reported the minutes of PA executed at a certain level of intensity, better known as time spent with moderate to vigorous PA (MVPA) or sedentary time; time spent on either light, moderate, or vigorous PA; and total weekly PA [n = 1) [n = 3) [n = 1) [n = 2) [n = 5) [n = 1) [In all of the included articles, PA was the primary outcome, but it was captured in numerous ways. Most of the studies n =  reportedeekly PA ,53,54,55eekly PA ,53,56,57eekly PA ,35,38,48 [n = 1) , number  [n = 3) ,58, phys [n = 1) , and exe [n = 2) ,22. Some [n = 5) ,29,44,55 [n = 1) . In mostAcross the three systematic reviews, only Peterson et al., 2019, reported the PA outcomes of interest in this scoping review in detail  , whereasn = 10) [n = 11) [n = 8) [n = 6) [n = 4) [n = 2) [n = 1) [n = 1) [n = 1) [Secondary health outcomes were measured in 30 studies investigating between one and eleven outcomes. The majority of studies captured aspects of physical health via anthropometric measures, such as height and weight in order to determine body-mass index (n = 10) ,47,53,55[n = 11) ,49,50,53 [n = 8) ,48,49,50 [n = 6) ,32,47,53 [n = 4) ,46,47,53 [n = 2) ,23. Phys [n = 2) ,48,49,50 [n = 2) ,32 and o [n = 2) . Another [n = 2) . Eleven  [n = 2) ,47,48,51 [n = 1) , attentin = 11) [n = 10) [n = 8) was commonly determined via rating scales or evaluation forms mainly focused on tracking how easy the intervention (component) was to use [Overall, 29 studies examined the use, acceptability, and usability of the interventions ,56,58,61n = 11) ,53,54,58[n = 10) ,49,50,53s to use ,61. In ts to use ,59.Individual results on PA and the dimensions of health captured as secondary outcomes in the included studies are displayed in In total, 24 studies demonstrated positive effects concerning PA ,56,57,58Conversely, in the WALK 2.0 study , PA incrn = 3) than conventional standalone apps (n = 7) [Considering the evidence reported in the three systematic reviews included in this scoping review, Petersen et al., 2019, showed in their systematic review that combined social networking apps were less effective in increasing PA ( (n = 7) . In the  (n = 7) , only on (n = 7) .Physical aspects of health, such as weight , BMI 4747,67, boOnly one study found significant effects of an exercise program that was supplemented by a social network on health-related quality of life . A seconSummarized evidence on secondary health outcomes analyzed in the three included systematic reviews was marginal. Whereas Williams et al., 2014, found that dietary fat consumption decreased significantly in social media-supported study conditions , Maher eTwo-third of the included studies and two of the systematic reviews reported results pertaining to feasibility. Due to the great heterogeneity in the assessment of acceptability, use, and usability across the different references, pooling of the data was difficult. Nevertheless, it was noticeable that across six studies the use of Facebook as a motivator for PA was rated positively by study participants ,50,53,62Descriptively reported results regarding the primary or secondary outcomes are shown in This scoping review identified 53 publications with findings from 43 studies and three systematic reviews on the promotion of PA via social media-based interventions. Social networking sites were used most frequently for the promotion of PA. In the twenty-eight studies and the three systematic reviews evaluating the role of pre-existing social networking sites, the use of Facebook was most prevalent. Secondly, the incorporation of a developed standalone, health-focused online social network was very common. Four studies combined the use of a study-specific social networking site with Facebook. Regarding the other types of social media, only pre-existing applications were utilized, in particular, Twitter, Pokémon Go, and YouTube. Most studies included in this scoping review were RCTs followed by pilot studies, of which 34 were at least two-armed and compared their intervention content ranging from simple recommendations for PA to fostering social interactions facilitating PA or making PA enjoyable and measurable, to another condition or a waitlisted control group. Comparator conditions usually consisted of identical intervention content without the social media  component. Additionally, three systematic reviews were included in this scoping review. In sum, more than three quarter of the studies employed study designs allowing for an estimation of intervention effects.More than one third of the studies revealed positive effects on PA. Most frequently, PA was improved due to a social media-based intervention when compared to an alternative intervention in eleven cases, and five studies showed increases in PA in comparison to a waitlisted control group. Evidence from the systematic review was, in part, inconclusive. Here, only seven studies were identified in which PA was effectively increased through social media, whereas seven studies found effects in favor of conventional apps.Nearly two-thirds of the articles included covered other dimensions of health as secondary outcomes. These addressed, in addition to the physical dimension, psychosocial and mental aspects of health. Here, social media-based interventions had the most positive impact on physical parameters of health related to weight/body composition or cardiovascular parameters, as they were predominantly captured. Psychosocial parameters of health were less frequently measured, and results were contradictory. Only a handful of studies could demonstrate that social media-based interventions had beneficial effects on PA by fostering motivation, social support, and self-efficacy. A positive effect on psychological and health-related quality of life, the most recorded mental health outcome, was evident in only one study that incorporated social media.A range of results concerning acceptability, use, and usability of social media-based PA interventions were uncovered in this scoping review and it is impossible to draw any generic conclusion regarding the feasibility of such interventions. The results should be interpreted study by study and with caution taking their different ways of assessing feasibility into account.One of the main findings, of this work is that the most commonly incorporated platform in PA interventions is Facebook. Given the rapid development of a variety of social media platforms during the last decade, it can be argued that a broad spectrum of innovative social media have not yet been incorporated and scientifically tested. Future intervention studies should take advantage of this abundance of platforms and select them consciously, according to the requirements, needs, and preferences of the individual target populations. This is supported by a scoping review of Lee and colleagues, 2019, concluding that mobile apps that focus on health behavior change have to be appropriate for their target sample . In lineIt is important to emphasize that there is no fundamental need for the development of new platforms, but relying on pre-existing applications and using them purposefully will be sufficient for future health behavior change interventions. Emerging evidence provides some indication that social media can be effective for improving PA and other physical parameters of health. However, there is limited research about the efficacy of social media concerning other secondary health outcomes necessitating additional research.Despite those positive findings, the utilization of social media in health care and prevention should be very carefully considered and always critically questioned. Although the availability of the internet has increased widely worldwide, mostly via technological improvements  , social A key limitation of the scoping review is the heterogeneity of the included literature concerning methodology and outcome measures used in the studies. This resulted in difficulties in pooling quantitative data and evaluating them appropriately as envisaged to understand the effects of social media-based interventions on PA and health, and, in particular, interpreting their feasibility. Furthermore, it could be argued that restricting the search to two literature databases is another limitation, because relevant studies may have been missed. Because a scoping review does not assess the risk of bias, conclusions about the quality of the included sources of evidence cannot be drawn, and the generalizability of the described findings remains unclear. Another limitation is that the included studies were conducted prior to the emergence of the COVID-19 pandemic. The role of social media for PA promotion may have somewhat changed under pandemic conditions, possibly even becoming increasingly important, as gyms and sports facilities were temporarily closed during lockdowns. However, this aspect will have to be analyzed in future scoping reviews, including studies conducted and published after the spring of 2020.To our knowledge, this is the first scoping review which provides a broad overview of the incorporation of the latest social media technologies in research on PA promotion. Taking into account key social media platforms from 2014–2020, this work is up-to-date concerning recent Web 2.0 approaches to prevent and minimize the burden of physical inactivity and NCDs, but continuous updates will be essential considering the fact that social media is a quickly evolving field. Future effort in this line of research is required to attain an increased standardization of these indicators and measures and an overarching public health framework that can be used to appraise the feasibility of future social media interventions in health promotion and care.


We retrospectively analyzed a total of 166 patients with GGN who underwent PET/CT examination from January 2012 to October 2019. There were 113 women and 53 men, with an average age of 60.8 ± 9.1 years old. A total of 192 GGNs were resected and confirmed by pathology, including 22 in benign group and 170 in adenocarcinoma group. They were divided into three groups according to SUV index tertiles: Tertile 1 (0.14–0.54), Tertile 2 (0.55–1.17), and Tertile 3 (1.19–6.78), with 64 GGNs in each group. The clinical and imaging data of all patients were collected and analyzed. After adjusting for the potential confounding factors, we found that the malignancy risk of GGN significantly decreased as the SUV index increased , the average probability of malignant GGN was 89.1% , 80.5% , and 34.3%  for Tertile 1 to Tertile 3. And the increasing trend of SUV index was significantly correlated with the reduction of malignant risk , especially between Tertile 3 versus Tertile 1 . Curve fitting showed that the SUV index was linearly and negatively correlated with the malignant risk of GGN. SUV index is an independent correlation factor for malignancy risk of GGN, the higher the SUV index, the lower the probability of GGN malignancy.To explore the association between  Several studies have found that the biological behavior of GGN is significantly different from solid lung nodules. GGN has a higher risk of malignancy than solid nodules, especially persistent GGN , 2, but max) >2.5 was used as the diagnostic standard, with a sensitivity of 79–100% and a specificity of 60–100% (max of 1.9 (range: 0.5–6.0). On the other hand, more and more studies have found that benign GGN often exhibits “pseudo” tumor features, showing high FDG uptake. McDermott et al.  as the PET metabolic parameter to analyze the correlation between SUV index and malignant status of GGN.In this study, we retrospectively analyzed the clinical data of patients with suspected lung adenocarcinoma manifesting as GGN who underwent 18F-FDG PET/CT examination in our hospital from January 2012 to October 2019. Persistent GGNs were defined as GGNs with no change or minor changes after CT follow-up for more than 3 months , and five atypical adenomatous hyperplasias (AAH).A total of 166 patients were included in the study, of which 113 were female, and 53 were male, with an average age of (60.8 ± 9.1) years old. There were 110 cases with single GGN and 56 cases with multiple GGN. A total of 192 GGNs were surgically resected and confirmed by pathology: 22 were in benign group including two organizing pneumonia, one interstitial pneumonia, one pulmonary alveoli epithelium bronchial metaplasia, four fungal infections, three granulomas, and 11 other benign lesions; 170 were in adenocarcinoma group, including 143 invasive adenocarcinomas (IAC), 17 minimally invasive adenocarcinomas (MIA), five adenocarcinomas 18F-FDG, 3.70–5.55 MBq/kg) injection, and was imaged first with low-dose CT and then PET scan. PET imaging was performed at 2 min/bed, about six to seven beds per patient according to their heights. The TrueX + TOF (ultraHD-PET) method was used for image reconstruction, with two iterations and 21 subsets; the matrix was 200 × 200, and the image acquisition mode was 3D. The post-processing workstation TrueD system (Siemens) was used for image evaluation .Imaging equipment: German Siemens Biograph mCT (64) PET/CT scanner. Image acquisition: the patients were required to fast for 4–6 h before examination, and the height, weight, and blood sugar on the day of examination were recorded; PET/CT whole-body imaging was performed 1 h after the imaging agent  was selected, which completely covered the nodule. For liver SUVmean measurement, a circular ROI with a diameter of about 60 mm was selected on the right liver lobe. SUV index was the ratio of nodule SUVmax to liver SUVmean.All images were examined and recorded by two nuclear medicine physicians with more than five years of work experience without knowing the pathology. When their opinions were not unified, they would discuss together to reach the consensus. PET image indicators include nodule SUVGGN, the largest cross-sectional diameter of the nodules), diameter of nodule solid component , proportion of solid components , the average CT value of ground glass component , the average CT value of normal lung parenchyma , ΔCTGGO-LP (difference between CTGGO and CTLP). All the average value of the measurements from two physicians was recorded. Three typical cases are shown in HRCT indicators include: nodule number , nodule location , nodule type , margin , shape , abnormal air bronchogram , vacuolar sign, pleural indentation, vascular convergence, nodule diameter , one-way ANOVA , and Kruskal–Wallis test (skewed continuous variable) were used to analyze the differences between groups. The intraclass correlation coefficient (ICC) was used to analyze the data consistency between the two observers.P <0.1). We calculated the odds ratio (OR) and 95% confidence interval (CI). Tertile 1 of SUV index was used as the reference.Univariate logistic regression analysis was used to calculate the relationship between different nodule features and the malignancy risk of GGN. The generalized linear models with a logit link were used to test the independent and comprehensive effects of SUV index on GGN malignant status (binary variables). We calculated unadjusted and adjusted estimates using exact methods and asymptotic methods, respectively. Covariates were included as potential confounders in the final models if they changed the estimates of SUV index on malignant risk of GGN by more than 10% or were significantly associated with malignant risk of GGN (http://www.R-project.org). P <0.05 was considered statistically significant.Stratified analysis was used to assess further the association between SUV index and malignant risk of GGN in each subgroup. Generalized additive models (GAM) were used to test the nonlinear relationship between the malignant risk of GGN and SUV index. It helped to find the nonlinear relationship, and determine whether there was a threshold effect and whether it was appropriate to use general linear regression. All data were analyzed using R software  KD 013] and did not require informed consent.P >0.05); while smoking history, nodules types, shapes, margins, abnormal air bronchogram, vacuolar sign, pleural indentation, vascular convergence, DGGN, Dsolid, CTR, CTGGO, and ΔCTGGO-LP showed significant differences between groups . The GGN malignancy probability of the entire cohort in this study was 88.5%. From SUV index Tertile 1 to Tertile 3, the malignant proportions of GGN were 89.1, 95.3, and 81.2%, respectively, which were not significantly different (P = 0.05). Two observers had great consistency in the results of PET/CT and HRCT parameter measurement .192 GGNs were divided into three groups according to SUV index tertiles: Tertile 1 (0.14–0.54), Tertile 2 (0.55–1.17), and Tertile 3 (1.19–6.78), with 64 GGNs in each group. The clinical characteristics and PET/CT parameters across different groups were compared and listed in GGN, and SUV index were all possible related factors of early lung adenocarcinoma . The specific data are shown in We used malignant GGN (early lung adenocarcinoma) as the dependent variable (Y = 1) and 21 nodular features, including SUV index as the independent variables to perform the univariate logistic regression analysis. The results showed that age, gender, smoking history, pleural indentation, DGGN, and fully adjusted (Adjust II) covariates included age, gender, smoking history, margin, abnormal air bronchogram, pleural indentation, and DGGN. In the regression equations of Non-adjusted, Adjust I and Adjust II covariates for continuous variables, the increase of SUV index significantly reduced the malignant risk of GGN, with ORs of 0.547, 0.378 and 0.245, respectively ; however, for the SUV index tertile-group, the increasing trend of SUV index was not significantly correlated with the reduction of GGN malignant risk (P = 0.101). In the regression equations of only Adjust I and Adjust II covariates, the increasing trend of SUV index was significantly correlated with the reduction of GGN malignant risk , especially comparing Tertile 3 versus Tertile 1 .GGN, the probability of malignant GGN gradually decreased with the increase of SUV index, and they showed approximate linear relationship   significantly changed the association between SUV index and GGN malignant status (7–1.000) Figure 418F-FDG PET/CT scan has high application value in tumor diagnosis, staging, prognosis, and efficacy evaluation . Thus, we reasoned that the smoking history, pleural indentation, and DGGN, which affected both SUV index and malignant status of GGN, were the potential confounding factors. This might be the reason why there was no significant statistical difference in the probability of GGN malignancy among the three tertile groups.Univariate analysis showed that age, gender, smoking history, pleural indentation, D reports , 14. DGGe et al. , 16. Thee et al.  also poiIn order to control the influence of confounding factors, we established multiple regression equations. After fully correcting for the confounding factors, we finally confirmed that the SUV index was an independent factor for malignant status of GGN: the risk of malignant GGN significantly reduced with the increase of SUV index. Curve fitting showed an approximately linear negative correlation between SUV index and malignant status of GGN, and this correlation was not affected by age, GGN number, GGN type, shape, vacuolar sign, and CTR level.18F-FDG, as a glucose analog, has an affinity for glucose receptors on the cell surface. Due to the increased expression of glucose transporter-1 in diseased tissues, the FDG uptake of cells is also increased : Since the enrolled cases were all patients with clinically suspected lung adenocarcinoma, not from screening data, the benign GGN sample size was relatively small. In future studies, the number of benign cases should be further expanded; (2) Although this study confirmed that there was a negative linear correlation between SUV index and malignant status of GGN, there were many confounding factors. Thus, for GGN diagnosis, it is still necessary to combine SUV index with a variety of clinical and imaging features for comprehensive evaluation; (3) It is worth noting that, although AAH was benign, this study classified it into adenocarcinoma group. The reason is that AAH is different from general inflammation and does not disappear after follow-up. It has been shown  that AAH18F-FDG PET/CT imaging of persistent GGN, the SUV index was an independent correlation factor for malignancy risk of GGN, the higher the SUV index, the lower the probability of malignancy. When the SUV index ≥1.19, GGN was more likely to be benign lesions. Understanding and recognizing the relationship between SUV index and malignant status of GGN, which helps to improve the accuracy of diagnosis. PET/CT may be helpful in the diagnosis of persistent GGN or GGN patients seeking active treatment.In conclusion, this study showed that, in the The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding authors.This study was approved by the institutional ethics committee for retrospective analysis [(2018) KD 013] and did not require informed consent. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.RN and XNS contributed to the study concepts and to the study design. RN and ZXJ contributed to data acquisition and reconstructions. XLS, RN, XNS, ZXJ, and JFW contributed to the data analyses and interpretation. XNS contributed to the statistical analysis. XNS, RN, and YTW contributed to the manuscript preparation and manuscript editing and reviewing. All authors read and approved the final manuscript. All authors contributed to the article and approved the submitted version.This study was supported by Young Talent Development Plan of Changzhou Health Commission (CZQM2020012); Key Laboratory of Changzhou High-tech Research Project (Grant No. CM20193010); and Changzhou Sci&Tech Program (Grant No. CJ20180022).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.