bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Urine Biomarkers With Acute Kidney Injury and Fluid Overload in Infants After Cardiac Surgery: A Single Center Ancillary Cohort of the Steroids to Reduce Systemic Inflammation After Infant Heart Surgery Trial
Authors: Thompson Elizabeth J. , Chamberlain Reid C. , Hill Kevin D. , Sullenger Rebecca D. , Graham Eric M. , Gbadegesin Rasheed A. , Hornik Christoph P.
Published: May 2023

OBJECTIVES:

To examine the association between three perioperative urine biomarker concentrations (urine cystatin C [uCysC], urine neutrophil gelatinase-associated lipocalin [uNGAL], and urine kidney injury molecule 1 [uKIM-1]), and cardiac surgery-associated acute kidney injury (CS-AKI) and fluid overload (FO) in infants with congenital heart disease undergoing surgery on cardiopulmonary bypass. To explore how urine biomarkers are associated with distinct CS-AKI phenotypes based on FO status.

DESIGN:

Ancillary prospective cohort study.

SETTING:

Single U.S. pediatric cardiac ICU.

PATIENTS:

Infants less than 1 year old enrolled in the Steroids to Reduce Systemic Inflammation after Infant Heart Surgery trial (NCT03229538) who underwent heart surgery from June 2019 to May 2020 and opted into biomarker collection at a single center. Infants with preoperative CS-AKI were excluded.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Forty infants met inclusion criteria. Median (interquartile) age at surgery was 103 days (5.5–161 d). Modified Kidney Disease Improving Global Outcomes-defined CS-AKI was diagnosed in 22 (55%) infants and 21 (53%) developed FO. UCysC and uNGAL peaked in the early postoperative period and uKIM-1 peaked later. In unadjusted analysis, bypass time was longer, and Vasoactive-Inotropic Score at 24 hours was higher in infants with CS-AKI. On multivariable analysis, higher uCysC (odds ratio [OR], 1.023; 95% CI, 1.004–1.042) and uNGAL (OR, 1.019; 95% CI, 1.004–1.035) at 0–8 hours post-bypass were associated with FO. UCysC, uNGAL, and uKIM-1 did not significantly correlate with CS-AKI. In exploratory analyses of CS-AKI phenotypes, uCysC and uNGAL were highest in CS-AKI+/FO+ infants.

CONCLUSIONS:

In this study, uCysC and uNGAL in the early postoperative period were associated with FO at 48 hours. UCysC, uNGAL, and uKIM-1 were not associated with CS-AKI. Further studies should focus on defining expected concentrations of these biomarkers, exploring CS-AKI phenotypes and outcomes, and establishing clinically meaningful endpoints for infants post-cardiac surgery.
Association of hormone preparations with bone mineral density, osteopenia, and osteoporosis in postmenopausal women: data from National Health and Nutrition Examination Survey 1999-2018
Authors: Wang Yiran , Sun Chao
Published: May 2023

Objective

This study aimed to evaluate the associations of hormone preparations with lumbar spine bone mineral density (BMD), osteopenia, and osteoporosis in postmenopausal women, and whether these impacts persisted after hormone preparations were discontinued.

Methods

A total of 6,031 postmenopausal women were enrolled and divided into seven groups based on the types of hormone preparations. Among them, 1,996 participants were further divided into a current users (CU) group and a past users (PU) group. Multivariable linear regression models or logistic regression models were used to evaluate the associations of hormone preparation with lumbar spine BMD, osteopenia, and osteoporosis.

Results

Combined oral contraceptive pills, estrogen-only pills, estrogen/progestin combo pills, estrogen-only patches, or the use of more than two kinds of hormone preparations were positively associated with lumbar spine BMD (all P < 0.05). Except for estrogen-only patches, other hormone preparations also had a protective effect against osteopenia (all OR < 1, all P < 0.05), but none of them were associated with osteoporosis prevalence (all P > 0.05). The BMD increased by 0.10 and 0.04 g/cm2 in the CU and PU groups, respectively, compared with the nonusers group (all P < 0.05). In both the CU and PU groups, the risk of osteopenia was reduced (OR, 0.34 and 0.57, respectively).

Conclusions

Hormone preparations increase lumbar spine BMD in postmenopausal women and exert a protective effect against osteopenia. These impacts persisted after hormone preparations were discontinued. Hormone preparations, however, were not associated with osteoporosis prevalence.
Effects of topical dehydroepiandrosterone therapy in women after pelvic organ prolapse surgery
Authors: Nowakowski Łukasz , Gałczyński Krzysztof , Dybowski Michał , Typek Rafał , Dawidowicz Andrzej , Miotła Paweł , Olcha Piotr , Rechberger Tomasz
Published: May 2023

Objective

Pelvic organ prolapse (POP) occurs predominantly in postmenopausal women. Restoration of the proper estrogenization of vaginal mucosa is important in preoperative and postoperative treatment, increasing the effectiveness of this approach. The objective of this study was the development of intravaginal vaginal suppositories containing DHEA and comparison of the clinical effects of vaginal topical therapy with DHEA, estradiol, or antibiotic after POP surgery.

Method

Nine types of vaginal suppositories containing 6.5 mg DHEA in different bases were prepared to find optimal formulation for the vaginal conditions. Ninety women referred for POP surgery were randomly assigned to one of three groups receiving topical treatment in the postoperative period (estradiol, DHEA, or antibiotic). On admission to hospital and during follow-up vaginal pH, vaginal maturation index and vaginal symptoms were assessed.

Results

Vaginal suppositories with the base made from polyethylene glycol 1,000 without surfactants characterized the highest percentage of the released DHEA. In women treated with topical estradiol or DHEA a significant decrease in the number of parabasal cells, increase in superficial and intermediate cells in the vaginal smears, decrease in vaginal pH, and reduction of vaginal symptoms were observed.

Conclusions

The use of topical therapy with DHEA or the use of topical therapy with estradiol in the postoperative period were both shown to improve maturation index, vaginal pH, and vaginal symptoms. The benefits of topical therapy with DHEA after pelvic organ prolapse repair brings similar results as estradiol, without potential systemic exposure to increased concentrations of sex steroids above levels observed in postmenopausal women.
Early menopause and cardiovascular risk factors: a cross-sectional and longitudinal study
Authors: Roa-Díaz Zayne Milena , Wehrli Faina , Lambrinoudaki Irene , Gebhard Catherine , Baumgartner Iris , Marques-Vidal Pedro , Bano Arjola , Raguindin Peter Francis , Muka Taulant
Published: May 2023

Objective

The aim of the study is to evaluate the cross-sectional and longitudinal association of early natural menopause with changes in cardiovascular risk factors (CVRFs).

Methods

Postmenopausal women from the Swiss CoLaus study, reporting age at natural menopause (ANM) and having CVRFs measurements (blood lipids, blood pressure, glucose, homeostatic model assessment for insulin resistance [HOMA-IR], and inflammatory markers) at baseline (2003-2006) and first follow-up (2009-2012) were eligible for analysis. Age at natural menopause was analyzed as a continuous variable and in categories (ANM <45 and ≥45 y old). Linear regression analysis and linear mixed models were used to assess whether ANM is associated cross-sectionally and longitudinally with changes in CVRFs. Models were adjusted for demographic characteristics, lifestyle-related factors, time since menopause, medication, and clinical conditions.

Results

We analyzed 981 postmenopausal women. The cross-sectional analysis showed that women with ANM younger than 45 years had lower diastolic blood pressure (β = −3.76 mm Hg; 95% confidence interval [CI] = −5.86 to −1.65) compared with women whose ANM was 45 years or older. In the longitudinal analysis, ANM younger than 45 years was associated with changes in log insulin (β = 0.26; 95% CI = 0.08 to 0.45) and log homeostatic model assessment for insulin resistance levels (β = 0.28; 95% CI = 0.08 to 0.48). No associations were found between ANM and other CVRFs.

Conclusions

Early menopause may be associated with changes in glucose metabolism, while it may have little to no impact on other CVRFs. Larger longitudinal studies are needed to replicate our findings.
Placenta Accreta Spectrum and Postpartum Hemorrhage
Authors: Abdelwahab Mahmoud , Cackovic Michael
Published: May 2023

Placenta accreta spectrum is a group of disorders involving abnormal trophoblastic invasion to the deep layers of endometrium and myometrium. Placenta accrete spectrum is one of the major causes of severe maternal morbidity, with increasing incidence in the past decade mainly secondary to an increase in cesarean deliveries. Severity varies depending on the depth of invasion, with the most severe form, known as percreta, invading uterine serosa or surrounding pelvic organs. Diagnosis is usually achieved by ultrasound, and MRI is sometimes used to assess invasion. Management usually involves a hysterectomy at the time of delivery. Other strategies include delayed hysterectomy or expectant management.
Evaluation During Postpartum Hemorrhage
Authors: Turkoglu Onur , Friedman Perry
Published: May 2023

Postpartum hemorrhage is an obstetric emergency that is the leading and the most preventable cause of maternal death that occurs on the day of birth. The treatment of postpartum hemorrhage in a timely fashion is crucial to prevent morbidity and mortality. The accurate assessment of blood loss during delivery and the postpartum period remains a major challenge. Hence, it is imperative to have a standardized evaluation strategy for accurate assessment of blood loss, adequate classification of hemorrhage, and timely initiated interventions. The multidisciplinary evaluation strategy should be in place regardless of the delivery route.
Sutimlimab for the Treatment of Cold Agglutinin Disease
Authors: Berentsen Sigbjørn
Published: May 2023

Cold agglutinin disease (CAD) is a rare autoimmune hemolytic anemia and a bone marrow clonal lymphoproliferative disorder. Hemolysis in CAD is complement-dependent and mediated by the classical activation pathway. Patients also frequently suffer from fatigue and cold-induced circulatory symptoms. Although not all patients need treatment, the symptom burden has previously been underestimated. Effective therapies target the clonal lymphoproliferation or the complement activation. Sutimlimab, a humanized monoclonal IgG4 antibody that binds and inactivates complement protein C1s, is the most extensively investigated complement inhibitor for the treatment of CAD. This review addresses the preclinical studies of sutimlimab and the studies of pharmacokinetics and pharmacodynamics. We then describe and discuss the prospective clinical trials that established sutimlimab as a rapidly acting, highly efficacious, and low-toxic therapeutic agent. This complement inhibitor does not improve the cold-induced circulatory symptoms, which are not complement-mediated. Sutimlimab is approved for the treatment of CAD in the US, Japan, and the European Union. A tentative therapeutic algorithm is presented. The choice of therapy for CAD should be based on an individual assessment, and patients requiring therapy should be considered for inclusion in clinical trials.
Better baseline vision leads to better outcomes after the 0.19-mg fluocinolone acetonide intravitreal implant in diabetic macular edema
Authors: Gonzalez Victor H. , Luo Caesar , Almeida David R.P. , Cutino Antonio , Coughlin Brandon , Kasper Jonathan , Kiernan Daniel F. ,   on behalf of the PALADIN Study Group
Published: May 2023

Purpose:

Analysis of a three-year, phase 4, open-label, observational study evaluating the association of baseline best-corrected visual acuity (BCVA) with visual, treatment burden, and retinal thickness variability (RTV) outcomes and intraocular pressure (IOP)-related events following the 0.19-mg fluocinolone acetonide (FAc) intravitreal implant

Methods:

Data from patients with diabetic macular edema (DME) who did not have a clinically significant rise in IOP following previous corticosteroid treatment (N=202 eyes from 159 patients) were segregated by baseline BCVA of ≥20/40 or <20/40 and analyzed for BCVA, number of yearly supplemental DME treatments, RTV, and incidence of IOP-related event

Results:

At 36 months post-FAc, eyes with better baseline BCVA (≥20/40) maintained baseline BCVA, while vision in eyes with worse baseline BCVA (<20/40) increased by approximately 7 letters to 61.34 letters (Snellen equivalent approximately 20/60; P<0.05). Treatment burden and RTV decreased post-FAc regardless of baseline BCVA. Eyes with better baseline BCVA (≥20/40) had numerically fewer IOP-related events post-FAc vs eyes with worse baseline BCVA (<20/40), including a lower incidence of incisional IOP-lowering surgery

Conclusions:

The 0.19-mg FAc implant improved RTV and treatment burden regardless of baseline BCVA. Better baseline BCVA (≥20/40) was associated with long-term BCVA maintenance. Though eyes with worse baseline BCVA (<20/40) experienced significantly improved BCVA, it never rose to the level of those with better baseline BCVA. These data indicate that early, effective intervention in DME, before significant vision loss occurs, is key to maintaining visual outcomes
Condom Use Among Male Sex Workers With Their Male Clients in Mombasa, Kenya: Results of a Sub-analysis of a Pilot, Multilevel, Structural, HIV Risk-Reduction Intervention
Authors: Rael Christine Tagliaferri , Sandfort Theo G. M. , Gichangi Peter , Lafort Yves , Mantell Joanne E.
Published: May 2023

Despite the advent of preexposure prophylaxis, consistent condom use continues to be recommended because preexposure prophylaxis does not prevent sexually transmitted infections. This is important for high-risk populations (e.g., male sex workers; MSW) in low-resource, high-HIV/sexually transmitted infection prevalence settings, such as the Mombasa region in Kenya. This study aimed to examine the relationship between MSW's condom use, and their knowledge, beliefs, and attitudes about condoms. MSW (N = 158) completed surveys on their sexual behaviors/practices/attitudes. We used multiple regressions to identify associations between condom use, HIV knowledge/attitudes, and self-efficacy. Three quarters of participants reported always using condoms in the past week, and 64.3% reported always using condoms in the past month with male clients. Mean scores for knowledge and attitudes/self-efficacy toward condoms/safer sex were positively associated with condom use. Interventions to build self-efficacy, such as condom negotiation, and/or bringing up condom use with clients may be useful for Kenyan MSW.
Evaluation of the Association Between Hearing Aids and Reduced Cognitive Decline in Older Adults with Hearing Impairment
Authors: Ganbo Tetsuya , Sashida Jun , Saito Miwako
Published: May 2023

Objective

We investigated whether hearing aids (HAs) for hearing impairment may reduce cognitive decline in older adults.

Study Design

Retrospective cohort.

Setting

Ambulatory for medical checkup.

Patients

Comprised 1,453 older adults aged 65 to 90 years.

Intervention

HAs were recommended for hearing impairment with thresholds of ≥40 dB.

Main Outcome Measures

The Mini-Mental State Examination (MMSE) and pure-tone audiometry were performed. Over 2 years, multivariate logistic regression analysis was used to assess the effects of sex, age, hearing, HAs, hypertension, diabetes, cerebrovascular disease, smoking, and drinking on MMSE scores.

Results

Of 1,453 participants who underwent MMSE, 1,320 who underwent audiometry in the first-year included 99 HA users. Of the 1,320 participants, 858 (89 HA users) were followed longitudinally for 1 year and 672 (66 HA users) for 2 years. In the first-year cross-sectional study, the risk ratios (RRs) for hearing impairment (≥25 dB) when the MMSE scores were ≤23 and ≤27 points were 2.97 (1.40–6.28) and 1.34 (1.01–1.79), respectively. For moderate (40–<70 dB) and moderate to severe (≥40 dB) hearing impairment, the RRs for HA use were 0.30 (0.11–0.86) and 0.50 (0.22–1.13), respectively, when the MMSE scores were ≤23. A 2-year follow-up of participants with moderate hearing impairment yielded hazard ratios for MMSE score decrease of 0.30 (0.11–0.82) after 1 year and 0.16 (0.04–0.64) after 2 years in HA users.

Conclusions

HA use may be associated with reducing MMSE score decrease in older adults with moderate hearing impairment.
Effects of Fetal Growth Restriction on Postnatal Gut Microbiota in a Rat Model
Authors: Arai Yoshiteru , Shoji Hiromichi , Santosa Irena , Awata Kentaro , Tokita Kazuhide , Shimizu Toshiaki
Published: May 2023

Objective:

Fetal growth restriction (FGR) indicates increased risks of lifestyle-related diseases in adulthood. Previous studies showed the association between human gut dysbiosis and various diseases. However, reports examining the relationship between FGR and gut microbiota are scarce. Herein, we hypothesized that FGR may cause gut dysbiosis and analyzed the gut microbiota in a FGR rat model by restricting maternal protein intake during pregnancy.

Methods:

The FGR group was developed by feeding pregnant Sprague Dawley rats a diet containing 7% protein until birth. Control rats were fed 21% protein. Fecal samples of 2–11-week-old pups were collected weekly. DNA was extracted from each sample and subjected to polymerase chain reaction (PCR) amplification and sequencing. Additionally, short-chain fatty acids in the cecum were analyzed at 2 weeks of age, when there were differences in the occupancy of the gut microbiota.

Results:

Comparative analysis of the gut microbiota showed differences only at 2 weeks of age. Verrucomicrobia was significantly more abundant in the control group (q < 0.1), whereas pathogenic bacteria, including Enterococcus and Enterobacteriaceae, tended to increase in the FGR group. The abundance of acetic and butyric acid-producing bacteria also differed between groups. Acetic acid in the cecum was considerably decreased in the FGR group, while butyric acid was increased compared to that in the control group.

Conclusions:

Normalizing the alteration of FGR on postnatal gut microbiota may have beneficial effects for the host, since the FGR group caused gut dysbiosis.
Interspecific host competition and parasite virulence evolution
Authors: Hasik Adam Z. , King Kayla C. , Hawlena Hadas
Published: May 2023

Virulence, the harm to hosts caused by parasite infection, can be selected for by several ecological factors acting synergistically or antagonistically. Here, we focus on the potential for interspecific host competition to shape virulence through such a network of effects. We first summarize how host natural mortality, body mass changes, population density and community diversity affect virulence evolution. We then introduce an initial conceptual framework highlighting how these host factors, which change during host competition, may drive virulence evolution via impacts on life-history trade-offs. We argue that the multi-faceted nature of both interspecific host competition and virulence evolution still requires consideration and experimentation to disentangle contrasting mechanisms. It also necessitates a differential treatment for parasites with various transmission strategies. However, such a comprehensive approach focusing on the role of interspecific host competition is essential to understand the processes driving the evolution of virulence in a tangled bank.
Monitoring the battleground: Antimicrobial resistance, antibiofilm patterns, and virulence factors of wound bacterial isolates from patients in hospital system.
Authors: Awuor Silas Onyango , Omwenga Eric O. , Mariita Richard M. , Musyoki Stanslaus , Musila Jonathan
Published: May 2023

Extensive use of antibiotics in the treatment of bacterial infections has led to a challenge of antibiotic resistance, contributing to morbidity and mortality.  Herein, evaluation of bacterial isolates from patients with wound discharge was performed and drug susceptibility patterns examined, with a goal of deciphering antibacterial resistance. A cross-sectional study was conducted between May to August 2022, in which samples were collected from patients with chronic wounds and were inoculated into appropriate media for identification and characterization. The bacterial pathogens were identified using standard microbiological methods. The majority of wound isolates showed positive growth in microbial analysis with high prevalence in male candidates. Further, Staphylococcus aureus 28 (20.7%) was identified as the most predominant pathogen followed by Klebsiella spp. 20 (14.8%), P. aeruginosa spp. 10 (14.8%) and lastly E. coli 6 (4.4%) bacteria in the wound isolates while cotrimoxazole 13 (48.1%) followed by clindamycin 7 (25.9%) and erythromycin 7 (25.9%) were the most antibacterial resistant drugs to both Gram positive and Gram-negative bacteria. Out of the four isolates, 3 (75%) isolates were able to produce the haemolysin and protease and 2 (50%) isolates were able to produce the lipase and phospholipase.   The findings herein form a clinical basis for identification of antimicrobial resistance in chronic wounds that can be applied in responsible use of antibacterial in chronic wound management and as an illumination in development of more potent antibiotics for chronic wound treatment.
Lederbergia citrea sp. nov., isolated from citrus rhizosphere
Authors: Han Shuang , Narsing Rao Manik Prabhu , Yang Shang , Xie Cheng-Jie , Liu Guo-Hong , Zhou Shun-Gui
Published: May 2023

Three Gram-positive-staining strains FJAT-49754T, FJAT-49682 and FJAT-49731 were isolated from the citrus rhizosphere soil sample. These strains showed the highest 16S rRNA gene sequence similarity with the type strain of

Lederbergia panacisoli

(97.8–97.9 %). The 16S rRNA gene sequence similarities between strains FJAT-49754T, FJAT-49682, and FJAT-49731 were 99.9 %. The average nucleotide identity (ANI) values between strains FJAT-49754T, FJAT-49682 and FJAT-49731 were above 96 %, while the ANI values with the members of the genus

Lederbergia

were below 95 %, which were below the cut-off level for prokaryotic species delineation. The above results suggest that strains FJAT-49754T, FJAT-49682 and FJAT-49731 belong to a novel species of the genus

Lederbergia

. Growth of strain FJAT-49754T was observed at 10–40 °C (optimum at 30 °C, pH 6.0–10.0 (optimum at pH 8.0), and NaCl tolerance up to 7 % (w/v) (optimum at 1 %). MK-7 was the only menaquinone detected in strain FJAT-49754T, and the main polar lipids were diphosphatidylglycerol, phosphatidylglycerol and phosphatidylethanolamine. The major fatty acids of strain FJAT-49754T were anteiso-C15 : 0, iso-C15 : 0, and C16 : 0. The genomic DNA G+C content of strain FJAT-49754T was 38.7 %. Based on the above results, strain FJAT-49754T represents a novel species of the genus

Lederbergia

, for which the name Lederbergia citrea sp. nov., is proposed. The type strain is FJAT-49754T (=CCTCC AB 2019211T=LMG 31589T).
Demographic Influence on the Effectiveness of England’s SARS-CoV-2 Policies
Authors: Dhada Maharshi , Montes Jazmin Labra
Published: May 2023

Health data is key for the development of medicinal drugs, treatments, and policy-planning to control the spread of infectious diseases. However, the collection, curation, and interpretation of health data is often biased. This paper discusses England-wide impact of public policies to control the spread of SARS-CoV-2 (Covid-19) infections, based on the recorded per-capita infection cases between July 2020 to January 2023. The analysis presented herewith highlights the disparities across the upper local tier authorities, in the number of Covid-19 cases recorded in response to the policies. This paper further presents the correlation between the Covid-19 cases count and demographic factors, thus highlighting the key factors determining the effectiveness of the NHS policies, and therefore the need for incorporating demographic imbalance in the policy planning process. It is concluded that the upper local tier authorities comprise of three clusters of low, mid, and high prevalence of Covid-19 infections. Where the regions with high prevalence of Covid-19 cases are also the ones with higher proportions of Black/ Mixed racial groups, amongst a mid-range and low internal Migrations.
Spike ripples localize the epileptogenic zone better than other leading biomarkers: a multicenter intracranial study
Authors: Shi Wen , Shaw Dana , Walsh Katherine G. , Han Xue , Eden Uri T. , Richardson Robert M. , Gliske Stephen V. , Jacobs Julia , Brinkmann Benjamin H. , Worrell Gregory A. , Stacey William C. , Kramer Mark A. , Chu Catherine J.
Published: May 2023

Objective

We evaluated whether the combination of epileptiform spikes and ripples (spike ripples) outperformed other leading biomarkers in identifying the epileptogenic zone across subjects in a multicenter international study.

Methods

We validated and applied an automated spike ripple detector on intracranial EEG recordings in subjects from 4 centers who subsequently underwent surgical resection with known 1-year seizure outcomes. We evaluated the spike ripple rate in subjects cured after resection (ILAE 1 outcome) and those with persistent seizures (ILAE 2-5) across sites and recording types. We also evaluated spike, wideband HFO (80-500 Hz), fast ripple (250-500 Hz), and ripple (80-250 Hz) rates using validated automated detectors. The proportion of resected events was computed and compared across subject outcomes and biomarkers.

Results

109 subjects were included. The majority of spike ripples were removed in subjects with ILAE 1 outcome (p = 1e-6), and this was qualitatively observed across the four sites (p = 0.032, p = 0.092, p = 0.0005, p = 0.003) and the two electrode types (p = 0.01, p = 7e-6). A higher proportion of spike ripples were removed in subjects with ILAE 1 outcomes compared to ILAE 2-5 outcomes (p = 0.02). Among ILAE 1 subjects, the proportion of spike ripples removed was higher than the proportion of spikes (p = 0.0004), wideband HFOs (p = 0.0004), fast ripples (p = 0.008), and ripples (p = 0.008) removed. At the individual level, more subjects with ILAE 1 outcome had the majority of spike ripples removed (40/48, 83%) than spikes (69%, p = 0.04), wideband HFOs (63%, p = 0.009), fast ripples (36%, p = 2e-5), or ripples (45%, p = 0.0007) removed.

Interpretation

When surgical resection was successful, the majority of spike ripples were removed. Automatically detected spike ripples have improved specificity for epileptogenic tissue compared to spikes, wideband HFOs, fast ripples, and ripples.
Plasma soluble triggering receptor expressed on myeloid cells 2 is associated with depression after acute ischemic stroke
Authors: Huang Tiansheng , Zhu Yinwei , Lu Yaling , Zhang Qi , Fang Chongquan , Ju Zhong , He Jiang , Zhang Yonghong , Xu Tan , Zhong Chongke
Published: May 2023

Background

Previous studies suggested that elevated levels of plasma soluble triggering receptor expressed on myeloid cells 2 (sTREM2) was related to increased risk of death, cardiovascular events and cognitive impairment after stroke. We aimed to prospectively investigate the association between plasma sTREM2 levels and post-stroke depression (PSD).

Methods

We measured plasma sTREM2 levels in 590 ischemic stroke patients from the China Antihypertensive Trial in Acute Ischemic Stroke. The 24-item Hamilton Rating Scale for Depression was used to assess depression at 3 months after ischemic stroke onset, and PSD was defined as a score of ≥8. Logistic regression analysis was performed to evaluate the risk of PSD associated with plasma sTREM2 levels, and net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated to assess the predictive value of sTREM2.

Results

Of the 590 participants, 229 (38.8%) patients experienced PSD. The risk of PSD elevated significantly with plasma sTREM2 levels (Pfor trend=0.034). After adjusting for several covariates, the odds ratio for the highest quartile of sTREM2 compared with the lowest quartile was 2.41 (95% CI=1.35-4.31) for PSD. Multiple adjusted spline regression analysis further confirmed the linear dose-response relationship between sTREM2 levels and PSD (Pfor linearity=0.024). The addition of sTREM2 to a conventional model notably improved the risk prediction for PSD (category-free NRI=21.50%, 95% CI=5.92%-37.07%,P=0.011; IDI=1.43%, 95% CI=0.45%-2.42%,P=0.005).

Conclusions

The present study demonstrated that elevated plasma sTREM2 levels were associated with increased risk of PSD, suggesting that sTREM2 may be a promising prognostic biomarker for PSD.

Registration

URL:https://www.clinicaltrials.gov; Unique identifier:NCT01840072.
The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study
Authors: Mendelsohn Estera , Honeyford Kate , Brittin Andy , Mercuri Luca , Klaber Robert Edward , Expert Paul , Costelloe Céire
Published: May 2023

Background

The architectural design of hospitals worldwide is centred around individual departments, which require the movement of patients between wards. However, patients do not always take the simplest route from admission to discharge, but can experience convoluted movement patterns, particularly when bed availability is low. Few studies have explored the impact of these rarer, atypical trajectories.

Methods

Using a mixed-method explanatory sequential study design, we firstly used three continuous years of electronic health record data prior to the Covid-19 pandemic, from 55,152 patients admitted to a London hospital network to define the ward specialities by patient type using the Herfindahl-Hirschman index. We explored the impact of ‘regular transfers’ between pairs of wards with shared specialities, ‘atypical transfers’ between pairs of wards with no shared specialities and ‘site transfers’ between pairs of wards in different hospital site locations, on length of stay, 30-day readmission and mortality. Secondly, to understand the possible reasons behind atypical transfers we conducted three focus groups and three interviews with site nurse practitioners and bed managers within the same hospital network.

Results

We found that at least one atypical transfer was experienced by 12.9% of patients. Each atypical transfer is associated with a larger increase in length of stay, 2.84 days (95%CI: 2.56-3.12), compared to regular transfers, 1.92 days (95%CI: 1.82-2.03). No association was found between odds of mortality, or 30-day readmission and atypical transfers after adjusting for confounders. Atypical transfers appear to be driven by complex patient conditions, a lack of hospital capacity, the need to reach specific services and facilities, and more exceptionally, rare events such as major incidents.

Conclusion

Our work provides an important first step in identifying unusual patient movement and its impacts on key patient outcomes using a system-wide, data-driven approach. The broader impact of moving patients between hospital wards, and possible downstream effects should be considered in hospital policy and service planning.
Factors associated with excess skin after bariatric surgery: A mixed method study
Authors: Baillot Aurélie , Brunet Jennifer , Lemelin Lucie , Gabriel Shaina A. , Langlois Marie-France , Tchernof André , Biertho Laurent , Rabasa-Lhoret Rémi , Garneau Pierre Y. , Aimé Annie , Bouchard Stéphane , Romain Ahmed J. , Bernard Paquito
Published: May 2023

Introduction

After metabolic and bariatric surgery (MBS), many patients have excess skin (ES), which can cause inconveniences. Identifying factors related to ES quantity and inconveniences is crucial to inform interventions. The aim of this study was to identify sociodemographic, physical, psychosocial, and behavioral factors associated with ES quantity and inconveniences.

Methods

A mixed-method study with a sequential explanatory design was conducted with 124 adults (92% women, Mage46.5±9.9 years, Mtimepost-MBS34.2±27.6 months). During Phase I, ES quantity (arms, abdomen, thighs) and inconveniences, sociodemographic, anthropometric, clinical and behavioral outcomes were assessed. In Phase II, 7 focus groups were performed with 37 participants from Phase I. A triangulation protocol was completed to identify convergences, complementarities, and dissonances from quantitative and qualitative data.

Results

Quantitative data indicate only ES quantity on arms was associated with ES inconveniences on arms (r=.36, p<.01). Total ES quantity was associated with maximal body mass index (BMI) reached pre-MBS (r=.48, p<.05) and current BMI (r=.35, p<.05). Greater ES inconveniences was associated with higher social physique anxiety and age (R2=.50, p<.01). Qualitative data were summarized into 4 themes: psychosocial experiences living with ES, physical ailments due to ES, essential support and unmet needs, and beliefs of ES quantity causes.

Conclusions

Measured ES quantity is related to higher BMI, but not reported inconveniences. Greater self-reported ES quantity and inconveniences were associated with body image concerns.
The potential benefits of delaying seasonal flu vaccine selections: a retrospective modeling study
Authors: Lee Kyueun , Williams Katherine , Englund Janet
Published: May 2023

Backgrounds and Purpose

Antigenic match between selected vaccine virus and circulating virus crucial to achieve high vaccine effectiveness for seasonal flu. Due to the time-consuming process of producing eggs, vaccine candidate viruses are currently selected 5-6 months ahead of the flu season. New non-egg-based vaccine production technologies have emerged with the potential to improve production efficiency and to revise current vaccine formulation schedules. In this study, we aim to 1) identify the past flu seasons where the opportunity to improve vaccine decision existed if rapid vaccine production were available and to 2) quantify the impact of revising the current vaccine decision schedule, where new vaccine production technologies allow more time for specimen collection prior to vaccine virus selection.

Methods

We extracted the trend in the viral activity of season-predominant strain in three data points: when vaccine decision was made, in between vaccine decision and season starts, and after season starts. Between 2012 and 2020, we first identified the past flu seasons where the season-dominant strains presented increasing activity only after vaccine decisions had already been made in February for the Northern Hemisphere. Using an epidemiological model (SEIR) of season flu in the US, we evaluated the impact of updating vaccine decisions on the epidemic size and the number of flu hospitalizations in the United States.

Results

In the past flu seasons between 2012 and 2020, the timing when the clades or subclades that predominantly circulated during flu season emerged varied by season. In particular, in 2013/14, season-dominant H3N2 subclade emerged after vaccine decisions were made, contributing to the mismatch between vaccine and circulating virus. If the H3N2 component of the vaccine were updated given the additional viral activity data collected after February, our simulation model showed that the updated vaccine could have averted 5,000-65,000 flu hospitalizations, depending on how much vaccine effectiveness could improve with matching vaccine virus. On the other hand, updating the B/Victoria vaccine component did not yield substantial change in flu burden in the 2019/20 season.

Conclusions

With rapid vaccine production, revising the timeline for vaccine selection can result in substantial epidemiological benefits, particularly at times when additional data help improve the vaccine effectiveness through better match between vaccine and circulating viruses.
Phenotyping and prediction of paediatric abdominal pain: A machine learning approach
Authors: Takahashi Kazuya , Lubiatowska Michalina , Shehwana Huma , Ruffle James K. , Williams John A , Acharjee Animesh , Terai Shuji , Gkoutos Georgios V , Satti Humayoon , Aziz Qasim
Published: May 2023

Due to patient heterogeneity, the exact mechanisms of paediatric abdominal pain (AP) remain unknown. We sought to resolve this by identifying paediatric AP phenotypes and developing predictive models to determine their associated factors. In 13,790 children from a large birth cohort, the frequencies of paediatric and maternal demographics and comorbidities were catalogued from general practitioner records. Unsupervised machine learning clustering was used to identify phenotypes of paediatric AP with shared characteristics. Predictive paediatric AP models were constructed using paediatric and maternal demographics and comorbidities.

1,274 children experienced AP (9.2 %) (average age: 8.4 ± 1.1 years old, male/female: 615/659), who clustered into 3 distinct phenotypes: phenotype 1 with an allergic predisposition (n = 137), phenotype 2 with maternal comorbidities (n = 676), and phenotype 3 with minimal other comorbidities (n = 340). As the number of allergic diseases or maternal comorbidities increased, so did the frequency of AP, with 17.6% of children with ≥ 3 allergic diseases and 25.6% of children with ≥ 3 maternal comorbidities. Furthermore, in high-risk children who met both ≥ 3 allergic diseases and ≥ 3 maternal comorbidities, 30.8% had AP. Predictive models demonstrated modest fidelity in predicting paediatric AP (AUC 0.66), showing that a child’s ethnicity and paediatric/maternal comorbidities were strongly predictive factors. Our findings reveal distinct phenotypes and associated factors of paediatric AP, suggesting targets for future research to elucidate the exact mechanisms of paediatric AP related to allergic diseases, ethnicity, and maternal comorbidities.
Associations between early in-hospital medications and the development of delirium in patients with stroke
Authors: Ryan Sophia L. , Liu Xiu , McKenna Vanessa , Ghanta Manohar , Muniz Carlos , Renwick Rachel , Westover M. Brandon , Kimchi Eyal Y.
Published: May 2023

Objectives

Patients hospitalized with stroke develop delirium at higher rates than general hospitalized patients. While several medications are associated with existing delirium, it is unknown whether early medication exposures are associated with subsequent delirium in patients with stroke. Additionally, it is unknown whether delirium identification is associated with changes in the prescription of these medications.

Materials and Methods

We conducted a retrospective cohort study of patients admitted to a comprehensive stroke center, who were assessed for delirium by trained nursing staff during clinical care. We analyzed exposures to multiple medication classes in the first 48 hours of admission, and compared them between patients who developed delirium >48 hours after admission and those who never developed delirium. Statistical analysis was performed using univariate testing and multivariable logistic regression.

Results

1,710 unique patients were included in the cohort, of whom 471 (27.5%) developed delirium >48 hours after admission. Delirium was associated with prior exposure to antipsychotics, sedatives, opiates, and antimicrobials, even after accounting for several clinical covariates. Usage of these medications decreased in the 48 hours following delirium identification, except for atypical antipsychotics, whose use increased. Other medication classes such as steroids, benzodiazepines, and sleep aids were not initially associated with subsequent delirium, but prescription patterns still changed after delirium identification.

Conclusions

Early exposure to multiple medication classes is associated with the subsequent development of delirium in patients with stroke. Additionally, prescription patterns changed following delirium identification, suggesting that these medication classes may be modifiable targets for future delirium prevention strategies.

140-character message

Early exposure to specific medication classes is associated with delirium in patients with stroke & may be targets for future prevention.

@SophiaLRyan, @ekimchi, @MGHNeurology, @MSHSNeurology, @NMNeurology
Dengue in Cambodia 2002-2020: Cases, Characteristics and Capture by National Surveillance
Authors: Yek Christina , Li Yimei , Pacheco Andrea R. , Lon Chanthap , Duong Veasna , Dussart Philippe , Chea Sophana , Lay Sreyngim , Man Somnang , Kimsan Souv , Huch Chea , Leang Rithea , Huy Rekol , Brook Cara E. , Manning Jessica E.
Published: May 2023

Objective

Data from 19 years of national dengue surveillance in Cambodia (2002-2020) were analyzed to describe trends in dengue case characteristics and incidence.

Methods

Generalized additive models were fitted to dengue case incidence and characteristics (mean age, case phenotype, fatality) over time. Dengue incidence in a pediatric cohort study (2018-2020) was compared to national data during the same period to evaluate disease under-estimation by national surveillance.

Findings

During 2002-2020, there were 353,270 cases of dengue (average age-adjusted incidence 1.75 cases/ 1,000 persons/ year) recorded in Cambodia, with an estimated 2.1-fold increase in case incidence between 2002 and 2020 (slope = 0.0058, SE = 0.0021, p = 0.006). Mean age of infected individuals increased from 5.8 years in 2002 to 9.1 years in 2020 (slope = 0.18, SE = 0.088, p <0.001); case fatality rates decreased from 1.77% in 2002 to 0.10% in 2020 (slope = - 0.16, SE = 0.0050, p <0.001). When compared to cohort data, national data under-estimated clinically apparent dengue case incidence by 5.0-fold (95% CI 0.2 – 26.5), and overall dengue case incidence (both apparent and inapparent cases) by 33.6-fold (range: 18.7-53.6).

Conclusion

Dengue incidence in Cambodia is increasing and disease is shifting to older pediatric populations. National surveillance continues to under-estimate case numbers. Future interventions should account for disease under-estimation and shifting demographics for scaling and to target appropriate age groups.
Understanding ethnic diversity in open dementia neuroimaging datasets
Authors: Heng Nicholas , Rittman Timothy
Published: May 2023

Introduction

Ethnic differences in dementia are increasingly recognised in epidemiological measures and diagnostic biomarkers. Nonetheless, ethnic diversity remains limited in many study populations Here we provide insights into ethnic diversity in open access neuroimaging dementia datasets.

Methods

Datasets comprising dementia populations who underwent neuroimaging assessment with available data on ethnicity were included. Statistical analyses of sample and effect sizes were based on the Cochrane Handbook.

Results

14 databases were included, with 12 studies of healthy and MCI groups, and 11 of dementia groups. Combining all studies, the largest ethnic group was Caucasian (21,512 participants) with the next most common being Afro-Caribbean (1,960), followed by Asian (780). The smallest effect size detectable within the Caucasian group was 0.03, compared to Afro-Caribbean (0.1) and Asian (0.16).

Discussion

Our findings quantify the lack of ethnic diversity in openly available neuroimaging dementia datasets. More representative data would facilitate the development and validation of neuroimaging biomarkers relevant across ethnicities.
Genome-Wide Determinants of Cellular Immune Responses to Mumps Vaccine
Authors: Ovsyannikova Inna G. , Haralambieva Iana H. , Schaid Daniel J. , Warner Nathaniel D. , Poland Gregory A. , Kennedy Richard B.
Published: May 2023

Background

We have previously described genetic polymorphisms in candidate genes that are associated with inter-individual variations in antibody responses to mumps vaccination. To expand upon our previous work, we performed a genome-wide association study (GWAS) to discover host genetic variants associated with mumps vaccine-induced cellular immune responses.

Methods

We performed a GWAS of mumps-specific immune response outcomes (11 secreted cytokines/chemokines) in a cohort of 1,406 subjects.

Results

Among the 11 cytokine/chemokines we studied, four (IFN-γ, IL-2, IL-1β, and TNFα) demonstrated GWAS signals reaching genome-wide significance (p<5 x 10-8). A genomic region (encoding Sialic acid-binding immunoglobulin-type lectins/SIGLEC) located on chromosome 19q13 (p<5×10-8) was associated with both IL-1β and TNFα responses. The SIGLEC5/SIGLEC14 region contained 11 statistically significant single nucleotide polymorphisms (SNPs), including the intronic SIGLEC5 rs872629 (p=1.3E-11) and rs1106476 (p=1.32E-11) whose alternate alleles were significantly associated with decreased levels of mumps-specific IL-1β (rs872629, p=1.77E-09; rs1106476, p=1.78E-09) and TNFα (rs872629, p=1.3E-11; rs1106476, p=1.32E-11) production.

Conclusions

Our results suggest that SNPs in the SIGLEC5/SIGLEC14 genes play a role in cellular and inflammatory immune responses to mumps vaccination. These findings motivate further research into the functional roles of SIGLEC genes in the regulation of mumps vaccine-induced immunity.
Associations of alcohol consumption with left atrial morphology and function in a population at high cardiovascular risk
Authors: Alam Aniqa B. , Toledo-Atucha Estefania , Romaguera Dora , Alonso-Gómez Angel M. , Martínez-Gonzalez Miguel A. , Tojal-Sierra Lucas , Mora Marta Noris , Mas-Llado Caterina , Li Linzi , Gonzalez-Casanova Ines , Salas-Salvadó Jordi , Fitó Montserrat , Alonso Alvaro
Published: May 2023

Background

Excessive alcohol consumption has been associated with increased risk of atrial fibrillation, though the underlying mechanisms remain unclear. An enlarged left atrium and impaired left atrial function may lead to atrial fibrillation. The association of alcohol consumption with structural and functional left atrial measures, however, has received limited attention.

Methods

We studied a subset of 515 participants from the PREDIMED-Plus trial, a Spanish ongoing, multi-center randomized trial testing an intensive life weight loss intervention (ILI) with an energy reduced Mediterranean diet and physical activity promotion versus usual care andad libitumMediterranean diet recommendations for the primary prevention of cardiovascular disease in adults with the metabolic syndrome. Participants underwent transthoracic echocardiography (TTE) at baseline, year 3, and year 5 of the study. Outcomes of interest included volumetric (volume index) and functional (reservoir, conduit, and contractile strains) measures of the left atrium. Alcohol consumption was calculated through the use of validated food frequency questionnaires repeatedly collected every year and presented as drinks consumed per day (1 drink = 14 grams of alcohol). Confounder-adjusted multiple linear regression and mixed models were used to estimate the association of alcohol consumption (at baseline and over 5-years of follow-up) with left atrial volume and function at baseline and over the 5-year follow-up.

Results

Mean alcohol consumption among 515 eligible participants (mean age: 65 years, 40% female) was 1.6 drinks/day. Cross-sectionally, higher alcohol consumption (modeled in 1 drink/day increases) was associated with larger left atrial volume (0.6 ml/m2, 95% CI 0.2, 1.1) and lower left atrial reservoir and contractile strain (-0.4%, 95% CI -0.8, 0.0, and -0.4, 95% CI -0.7, -0.1). Baseline alcohol consumption was not associated with changes in left atrial structure and function, but an increase in alcohol consumption (per 1 drink/day increase) during follow-up was associated with left atrial enlargement (0.7 mL/m2, 95% CI 0.2, 1.2) and, to a lesser extent, left atrial strain worsening (-0.3%, 95% CI -0.8, 0.2) over 5 years.

Conclusion

In a population at high risk of cardiovascular disease, an increase of alcohol consumption was associated with left atrial volume enlargement and worsening atrial function, suggesting mechanistic information about potential pathways linking excessive alcohol consumption with atrial fibrillation risk.