bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of dietary inflammatory index with all-cause and cardiovascular disease mortality in hyperuricemia population: A cohort study from NHANES 2001 to 2010
Authors: Huang Jingda , Zhang Yandong , Li Jiajie , Li Huimin , Wei Yihui , Sun Mindan
Published: December 2023

Dietary management is a crucial component of non-pharmacological treatment for hyperuricemia, yet there is a paucity of research on the impact of dietary habits on the survival outcomes of individuals with hyperuricemia. The objective of this study is to examine the association between dietary inflammatory index (DII) and the all-cause and cardiovascular disease (CVD) mortality in individuals with hyperuricemia. This study included 3093 adult participants from National Health and Nutrition Examination Survey (NHANES) 2001 to 2010. Participants were categorized into 4 groups based on quartiles of DII to demonstrate data characteristics, with sample weights considered. The relationship between DII and the risk of hyperuricemia was examined using multivariable logistic regression models. Kaplan–Meier models and Cox proportional hazards models were employed to assess the relationship between DII levels and the all-cause mortality in individuals with hyperuricemia, with the non-linear relationship tested using restricted cubic splines (RCS). Competing risk models were employed to investigate the association between DII levels and the CVD mortality in individuals diagnosed with hyperuricemia. Subgroup and sensitivity analysis were performed to confirm the robustness and reliability of the findings. Among the participants, 47.95% were aged over 60 years. A positive association observed between the highest quartile of DII level and the incidence of hyperuricemia (OR: 1.34, CI [1.13, 1.57]). Elevated DII levels were correlated with increased all-cause mortality (P value < .001) and CVD mortality (P value < .001) in participants. In comparison to the lowest quartile, the highest quartile of DII exhibited a 31% rise in all-cause mortality (HR: 1.31, CI [1.01, 1.68]) and a 50% increase in CVD mortality (HR: 1.50, CI [1.00, 2.26]). No indication of a nonlinear association between DII levels and all-cause mortality (p-non-linear = .43). These findings indicate a positive correlation between the pro-inflammatory diet and the incidence of hyperuricemia. Additionally, a pro-inflammatory diet may elevate the all-cause and CVD mortality in individuals with hyperuricemia.
Global trends and research hotspots of stroke and magnetic resonance imaging: A bibliometric analysis
Authors: Zhang Yuting , Chen Mengtong , Liu Chunlong , He Bingjie , Dang Hongbin , Li Jiamin , Chen Hanwei , Liang Zhenzhong
Published: December 2023

Background:

In this study, we used CiteSpace and VOSviewer to create a bibliometric visualization of research papers relating to stroke and magnetic resonance imaging (MRI) between 2000 and 2022. To fully understand the trends and hotspots in MRI and stroke research and provide new perspectives for future studies.

Methods:

The Web of Science Core Collection was selected as the source of data for this paper. Using CiteSpace and VOSviewer, publications were analyzed for authors, countries, institutions, journals, references, and keywords.

Results:

We found 1423 papers after searching and removing duplicates, which indicated an upward trend over the previous 23 years. Fiebach J.B. is the most published author (21 publications), Hacke W. is the most cited author (213 citations), and the United States (449 publications) and Harvard University (86 publications) are the most prolific nations and institutions. Stroke is the journal with the most co-citations (1275) and the most papers (171) published. The most representative reference was the 1995 article by Marler et al, which received 115 citations and had the top 3 co-occurring keywords: stroke, magnetic resonance imaging, and MRI. The article by Nogueria et al showed the strongest citation burst at the end of 2022 (strength = 17.32). High-frequency keywords in recent years are time, association, functional connectivity, thrombectomy, and rehabilitation.

Conclusion:

This study provides a scientific perspective on stroke and MRI research, provides valuable information for researchers to understand the current status of research, hotspots, and trends, and guides future research directions.
Effectiveness of e-learning to promote oral health education: A systematic review and meta-analysis
Authors: Kaneyasu Yoshino , Shigeishi Hideo , Sugiyama Masaru , Ohta Kouji
Published: December 2023

Background:

In recent times during and after the COVID-19 pandemic, e-learning is increasingly being used to give oral health education. However, the efficacy of e-learning in improving and promoting the oral hygiene and oral health knowledge, attitude and practice is unclear. Therefore, this systematic review and meta-analysis aim to clarify the effectiveness of e-learning compared to other conventional education methods for providing oral health.

Methods:

An electronic database search was performed on PubMed-Medline, Scopus, and CENTRAL (Central Register Cochrane of Controlled trials). Randomized controlled trials (RCTs), including cluster or group RCTs, were collected in this study. The risk of bias was assessed with the Cochrane Handbook for Systematic Reviews of Interventions. Five different meta-analyses were conducted for plaque index, gingival index, oral health knowledge, oral health attitude, and oral health practice using a random effects model.

Results:

A total of 282 articles were found through the database search; 19 articles were included in the qualitative synthesis and 9 articles in the quantitative synthesis. The meta-analysis found that compared with conventional education, e-learning exhibited no positive effect. However, the use of e-learning was superior to conventional education methods for oral health practice for adults in subgroup analysis.

Conclusions:

This paper could not indicate the effectiveness of e-learning in comparison with conventional education for oral health in total. However, for adults, it may be effective to get the oral health practice compared to the conventional education. Our study limitation is that there are only few studies that have assessed the effectiveness of e-learning. Therefore, numerous further high-quality studies should be conducted regarding the efficacy of e-learning compared with conventional education methods for oral health promotion.
Application of intravitreal aflibercept to treat bilateral exudative retinal detachment secondary to retinitis pigmentosa: Case report and review of literature
Authors: Kao Chia-Chen , Chen Kuo-Jen , Cheng Kai-Chun
Published: December 2023

Rationale:

Exudative retinal detachment with macular edema is one of the complications of retinitis pigmentosa (RP). In this report, we present a case who treated with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) in RP-related exudative retinal detachment and subsequently improved with favorable outcome.

Patient Concern:

A 49-year-old man, with a history of RP, had persistent blurred vision and was newly diagnosed with bilateral shallow exudative retinal detachment and macular edema.

Diagnosis:

Fluorescein angiography showed bilateral diffuse dye leakage with macular pooling, and systemic survey excluded the possibility of infection or autoimmune disease.

Interventions:

The patient was treated with intravitreal injection of aflibercept, one of the anti-VEGF agents, for bilateral eyes. Recurrent exudative retinal detachment and macular edema were noted, and repeated intravitreal injections of aflibercept in bilateral eyes were then arranged. Subsequently, bilateral macular edema and exudative retinal detachment subsided again, and the treatment course lasted for approximately 1 year.

Outcomes:

After 1 year, the exudative retinal detachment with macular edema was much improved. In the meanwhile, visual functional improvement was also achieved.

Lessons:

This case illustrated the possibility of intravitreal injection of anti-VEGF therapy for the treatment of this rare complication of RP, and it may be a newly explored alternative treatment.
Identification of potential key genes for colorectal cancer based on bioinformatics analysis
Authors: Li Chongyang , Cao Shengqin , Guo Mingxiao , Guo Aihong , Sun Xuedi
Published: December 2023

This study aimed to explore key genes as potential biomarkers for colorectal cancer (CRC) diagnosis and prognosis in order to improve their clinical utility. To identify and screen candidate genes involved in CRC carcinogenesis and disease progression, we downloaded the microarray datasets GSE143939, GSE196006, and GSE200427 from the GEO database and applied the GEO2R tool to obtain differentially expressed genes (DEGs) between colorectal cancer tissue samples and normal tissue samples. Differentially expressed genes were analyzed using the DAVID online database for gene ontology and Kyoto encyclopedia of genes and genomes pathway enrichment analyses. Protein-protein interaction network was constructed and related module analysis was performed using STRING and Cytoscape. In total, 241 DEGs were identified, including 127 downregulated and 114 upregulated genes. DEGs enriched functions and pathways included cellular response to chemical stimulus, extracellular region, carbonate dehydratase activity, cell division, spindle, and cell division. The abundant functions and pathways of DEGs included cellular response to chemical stimulus, extracellular region, carbonate dehydratase activity, cell division, spindle, cell adhesion molecule binding, Aldosterone-regulated sodium reabsorption, and Cell cycle-related processes. Fifteen key genes were identified, and bioprocess analyses showed that these genes were mainly enriched in cell cycle, cell division, mitotic spindle, and tubulin binding processes. It was found that CDK1, CEP55, MKI67, and TOP2A may be involved in CRC cancer invasion and recurrence. The pivotal genes identified in this study contribute to our understanding of the molecular and pathogenic mechanisms of CRC carcinogenesis and progression, and provide possible biomarkers for the diagnosis and treatment of CRC.
Risk factors of systemic lupus erythematosus patients with pulmonary arterial hypertension: A systematic review and meta-analysis
Authors: Lun Xueping , Yang Jianguo , Liu Ying , Zhao Fuyu , Wei Zhiliang , Sun Yuying , Zhou Xinpeng
Published: December 2023

Background:

To investigate the risk factors for the development of pulmonary arterial hypertension (PAH) in patients with systemic lupus erythematosus (SLE).

Methods:

The literature related to risk factors for the development of PAH in SLE patients was searched by the computer on China national knowledge infrastructure (CNKI), PubMed, and Embase, and the literature search was limited to the period of library construction to October 2022. Two researchers independently performed literature screening and literature information extracting, including first author, publication time, case collection time, sample size, and study factors, and used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of the literature. The relationship between each clinical manifestation and laboratory index and the occurrence of PAH in SLE patients was evaluated based on the ratio (OR value) and its 95% CI.

Results:

A total of 24 publications were included, including 23 case-control studies and 1 cohort study with NOS ≥ 6, and the overall quality of the literature was high. The risk of PAH was higher in SLE patients who developed Raynaud phenomenon than in those who did not [OR = 2.39, 95% CI (1.91, 2.99), P < .05]; the risk of PAH was higher in SLE patients who were positive for anti-RNP antibodies than in those who were negative for anti-RNP antibodies [OR = 1.77, 95% CI (1.17, 3.2.65), P < .05]; the risk of PAH was higher in SLE patients with interstitial lung lesions than in those without combined interstitial lung lesions [OR = 3.28, 95% CI (2.37, 4.53), P < .05]; the risk of PAH was higher in SLE patients with combined serositis than in those without serositis [OR = 2.28, 95% CI (1.83, 2.84), P < .05]. The risk of PAH was higher in SLE patients with combined pericardial effusion than in those without pericardial effusion [OR = 2.97, 95% CI (2.37, 3.72), P < .05]; the risk of PAH was higher in SLE patients with combined vasculitis than in those without vasculitis [OR = 1.50, 95% CI (1.08, 2.07), P < .05]; rheumatoid factor-positive SLE patients had a higher risk of PAH than those with rheumatoid factor-negative [OR = 1.66, 95% CI (1.24, 2.24), P < .05].

Conclusion:

Raynaud phenomenon, vasculitis, anti-RNP antibodies, serositis, interstitial lung lesions, rheumatoid factor, and pericardial effusion are risk factors for the development of PAH in patients with SLE.
Acute severe hypoglycemia immediately after induction of anesthesia in an elderly patient with type 2 diabetes mellitus: A case report
Authors: Tian Qin , Yi Ming Liang , Wan Jia Lu , Yin Hong
Published: December 2023

Rationale:

Acute severe hypoglycemia immediately following anesthesia induction is a rare but life-threatening complication that is frequently underdiagnosed due to insufficient awareness. Among the various physiological processes influenced by opioids, alterations in blood glucose levels induced by opioids are a side effect that is commonly overlooked. The significance of this report lies in emphasizing the neglected association between opioids and hypoglycemia and highlighting the importance of close glucose monitoring to prevent hypoglycemic events in the perioperative setting.

Patient concerns:

An 89-year-old man with type 2 diabetes mellitus experienced acute severe hypoglycemic episode immediately after general anesthesia induction. Baseline blood glucose level before starting anesthesia induction was 4.0 mmol/L. However, it decreased substantially to 0.96 mmol/L immediately after anesthesia induction.

Diagnosis:

The patient exhibited normal serum insulin, C-peptide, and cortisol levels, alongside unremarkable renal and hepatic function. After excluding other causes of hypoglycemia, we speculate that opioids were the culprits due to the temporal association and the rapid decline in blood glucose levels.

Interventions:

Forty milliliters of 50% dextrose were administered intravenously followed by an infusion of 5% dextrose.

Outcomes:

Recovery from anesthesia, extubation, and postoperative recovery were unremarkable. No further hypoglycemic episodes occurred during hospitalization.

Lessons:

A precipitous and rapid decline in blood glucose following anesthesia induction is extremely uncommon. When a clinical anesthesiologist detects an abnormally low bispectral index during general anesthesia, hypoglycemia should be suspected. Instituting glucose monitoring in these situations can enable a timely diagnosis, forestalling the onset of life-threatening severe hypoglycemia.
Sudden bilateral deafness in a patient with vertebrobasilar artery occlusion: A case report
Authors: Zhang Ying , Zhao Xin , Zhou Ming , Chang Pengfei , Liu Tao , Li Yang
Published: December 2023

Rationale:

Sudden bilateral deafness is often associated with serious systematic conditions such as neoplasms, vascular events, autoimmune diseases, infections, and iatrogenic injury, but very rarely to cerebrovascular disease. This is a rare case of sudden bilateral deafness in a patient with the vertebrobasilar artery occlusion.

Patient concerns:

A 46-year-old man was admitted to a local hospital for sudden bilateral deafness, the patient suffered inarticulate speech and walking unsteadily 6 days later.

Diagnoses:

Difusion-weighted magnetic resonance imagin demonstrated acute cerebral infarction in the pons and bilateral cerebellum; Magnetic resonance angiography showed vertebrobasilar artery occlusion.

Interventions:

Aspirin and clopidogrel were given for antiplatelet therapy, revascularization was obtained by endovascular treatment.

Outcomes:

The symptoms of dysarthria, ataxia and weakness gradually improved and were discharged 14 days after admission revascularization. After 3 months telephone followed-up the patient was self-cared.

Lessons:

Deafness sometimes can be an early warning sign of impending vertebrobasilar ischemic stroke. Early recognition of deafness with acute ischemic stroke should allow special management, and misdiagnosis may result in significant morbidity, or even mortality.
Analysis of competing risks of cardiovascular death in patients with hepatocellular carcinoma: A population-based study
Authors: Cao Lizhi , Wang Xiaoying , Yan Yuzhong , Ning Zhongping , Ma Linlin , Li Yanfei
Published: December 2023

Clinical data has shown that cardiovascular diseases (CVDs) have emerged as a prominent cause of mortality in individuals with hepatocellular carcinoma (HCC). This research aimed to reveal the comorbid effects of CVDs in patients with HCC. The cardiovascular mortality of patients diagnosed with HCC between 2000 and 2014 was compared to that of the general US population. Standardized mortality ratios were calculated to quantify the relative risk of cardiovascular mortality in HCC patients. The cumulative incidence of cardiovascular death (CVD) was estimated using Fine-Gray testing, and independent risk factors for CVD were determined using competing risk models. The results were analyzed using the Kaplan–Meier analysis. The overall SMR for CVD in HCC patients was 11.15 (95% CI: 10.99–11.32). The risk of CVD was significantly higher in patients aged < 55 years (SMR: 56.19 [95% CI: 54.97–57.44]) compared to those aged ≥ 75 years (SMR: 1.86 [95% CI: 1.75–1.97]). This study suggests that patients with HCC are at significant risk of developing CVD. Competing risk analyses indicated that age, grade, tumor size, surveillance, epidemiology, and end results stage, and surgical status were independent risk factors for CVD in patients with HCC. Therefore, patients with HCC require enhanced preventive screening and management of CVDs during and after treatment to improve patient survival.
The risk factors for miscarriage of viable intrauterine pregnancies in patients with heterotopic pregnancy after surgical intervention
Authors: Ruan Heng-chao , Zhang Yan-hua , Chen Lu , Zhou Wei-xiao , Lin Jun , Wen Hong
Published: December 2023

To summarize the clinical characteristics and explore the risk factors for miscarriage of a viable intrauterine pregnancy following surgical intervention in patients with heterotopic pregnancy (HP). A total of 106 women diagnosed with HP that underwent surgical intervention in the Women’s Hospital School of Medicine Zhejiang University between January 2014 and December 2021 were included in this retrospective study. They were divided into a miscarriage group (n = 13) and an ongoing pregnancy group (n = 93) according to the outcomes of the HP within 2 weeks after surgery. Data regarding clinical characteristics, surgical conditions, postoperative recovery, and complications were collected and compared between the groups. Logistic multivariate analysis was performed to explore the risk factors for miscarriage in patients with HP within 2 weeks of surgical intervention. Among the 106 women with HP, 80 had tubal HP, 8 had cornual HP, and 18 had interstitial HP. Eighty-seven (82.1%) patients developed clinical symptoms that manifested primarily as abnormal vaginal bleeding and/or abdominal pain, whereas 19 (17.9%) patients had no clinical symptoms. The mean gestational age on the day of surgery was 7.2 weeks (inter-quartile range, 6.4–8.3). The miscarriage rate within 2 weeks of surgical intervention was 12.3% in patients with HP. Compared to the ongoing pregnancy group, the miscarriage group had a higher body mass index, earlier gestational age at treatment, and higher volume of hemoperitoneum (P < .05 for all). Logistic multivariate analysis indicated that the women with a hemoperitoneum volume > 200 mL had significantly higher risk of miscarriage after adjusting covariates [OR (odds ratio) = 5.285, 95% CI (confidence interval) (1.152–24.238), P < .05]. Hemoperitoneum volume was independently associated with miscarriage of viable intrauterine pregnancies in patients with HP within 2 weeks of surgical intervention.
Risk analysis of breast cancer and breast fibrocystic change in female primary Sjögren’s syndrome patients
Authors: Chen Hsin-Yu , Chung Jui-Yuan , Lin Shih-Chang
Published: December 2023

Sjögren’s syndrome is an autoimmune disease with the chronic inflammation of glandular tissues, typically salivary and lacrimal glands. Since mammary tissue shares the glandular structure, Sjögren’s syndrome may also target mammary tissue to cause breast diseases. We therefore determined whether primary Sjögren’s syndrome (pSS) is associated with the increased risk of breast cancer (BC) and breast fibrocystic change (FC). Total 282 female patients with pSS were recruited from a medical center in Taiwan, and patients’ medical records were reviewed to identify BC and ultrasonographic breast FC. The prevalence, incidence and risk factors for BC and breast FC in pSS patients were determined, and the risk factors for these breast diseases were subsequently analyzed. Our results showed that pSS patients had the increased prevalence and incidence of BC, and high anti-SSA(Ro) antibody titers were found to be associated with the increased risk of BC. Breast FC was also found highly prevalent in these patients. Comorbidity analysis as risk factor for BC in pSS patients showed diabetes mellitus was strongly associated with the increased risk of BC (odds ratio = 10.4, P = .0006), whereas breast FC was inversely associated with the risk of BC (odds ratio = 0.077 P = .0158). These data indicated that pSS is association with the increased risk of BC and with the high prevalence of ultrasonographic breast FC. Our results also suggest that, in pSS patients, the high anti-SSA(Ro) antibody titers and diabetes mellitus confer the increased risk of BC, whereas the absence of ultrasonographic breast FC predicts the higher risk of BC.
A bidirectional two-sample Mendelian randomization using the gut microbiota to reveal potential therapeutic targets for primary sclerosing cholangitis
Authors: Liang Xiru , Wang Ziwei , Shu Qiuai , Huang Xindi , Wang Jinhai , Wu Jian , Liu Na , Xie Ning
Published: December 2023

Background

Previous studies indicate that gut microbiota correlates to primary sclerosing cholangitis (PSC), but the causation is still unclear. We sought to reveal the causal relationship between gut microbiota and PSC with a bidirectional two-sample Mendelian randomization (MR) analysis.

Methods

The large-scale genome-wide association study (GWAS) summary statistics and a bidirectional two-sample MR study were used to assess the causality between gut microbiota and PSC. Multiple sensitivity analyses were used to identify the robustness of our results.

Results

Three microbial taxa causally correlated to PSC. Genus Ruminococcaceae UCG002 (OR: 1.855, 95% CI: 1.068–3.220, P = 0.028) increased the risk of PSC. Class Betaproteobacteria (OR: 0.360, 95% CI: 0.171–0.758, P = 0.007), and genus Ruminiclostridium6 (OR: 0.474, 95% CI: 0.219–0.820, P = 0.011) had protective effects on PSC. In addition, we found the causal relationship of PSC with higher abundance of genus Dialister (beta: 0.059, 95% CI: 0.017–0.102, P = 0.006), genus Veillonella (beta: 0.065, 95% CI: 0.016–0.113, P = 0.009), class Melainabacteria (beta: 0.073, 95% CI: 0.012–0.133, P = 0.019), and order Gastranaerophilales (beta: 0.072, 95% CI: 0.011–0.113, P = 0.133).

Conclusion

Our study reveals the causality between gut microbiota and PSC, providing new insights into the pathological mechanisms of PSC and facilitating the development of novel biomarkers and disease-modifying therapeutics for PSC from the perspective of gut microbiota.
Factors associated with delays in presentation and treatment of gonorrhea, Massachusetts 2015-2019
Authors: Elder Heather , Platt Laura , Leach Dylan , Sheetoh Cordelia , Ramirez Victor M. , Molotnikov Lauren , Hernandez Brenda , Roosevelt Kathleen , Hsu Katherine K.
Published: December 2023

Background

Rates of gonorrhea are increasing across the United States. Understanding and addressing contributing factors associated with longer time to diagnosis and treatment may shorten the duration of infectiousness which in turn may limit transmission.

Methods

We used Massachusetts data from the CDC Sexually Transmitted Disease Surveillance Network collected between July 2015 and September 2019, along with routinely reported surveillance data, to assess time from gonorrhea symptom onset to presentation to care, and time from presentation to care to receipt of treatment. Factors associated with longer time to presentation (TTP) and time to treatment (TTT) were assessed using Cox proportional hazard models with a constant time variable.

Results

Among symptomatic patients (n = 672), 31% did not receive medical care within 7 days of symptom onset. Longer TTP was associated with younger age, female gender, reporting cost as a barrier to care, and provider report of proctitis. Among patients with symptoms and/or known contact to gonorrhea (n = 827), 42% did not receive presumptive treatment. Longer TTT was associated with female gender, non-Hispanic Other race/ethnicity, and clinics with less gonorrhea treatment experience. Among asymptomatic patients without known exposure to STI (n = 235), 26% did not receive treatment within 7 days. Longer TTT was associated with STD clinic/family planning/reproductive health clinics and a test turnaround time of ≥3 days.

Conclusions

Delays in presentation to care and receipt of treatment for gonorrhea are common. Factors associated with longer TTP and TTT highlight multiple opportunities for reducing the infectious period of patients with gonorrhea.
Rapid antiretroviral therapy in primary HIV-1 infection enhances immune recovery
Authors: Thornhill John Patrick , Fox Julie , Martin Genevieve Elizabeth , Hall Rebecca , Lwanga Julianne , Lewis Heather , Brown Helen , Robinson Nicola , Kuldanek Kristen , Kinloch Sabine , Nwokolo Nneka , Whitlock Gary , Fidler Sarah , Frater John
Published: December 2023

Objective:

We present findings from a large cohort of individuals treated during primary HIV infection (PHI) and examine the impact of time from HIV-1 acquisition to antiretroviral therapy (ART) initiation on clinical outcomes. We also examine the temporal changes in the demographics of individuals presenting with PHI to inform HIV-1 prevention strategies.

Methods:

Individuals who fulfilled the criteria of PHI and started ART within 3 months of confirmed HIV-1 diagnosis were enrolled between 2009 and 2020. Baseline demographics of those diagnosed between 2009 and 2015 (before preexposure prophylaxis (PrEP) and universal ART availability) and 2015–2020 (post-PrEP and universal ART availability) were compared. We examined the factors associated with immune recovery and time to viral suppression.

Results:

Two hundred four individuals enrolled, 144 from 2009 to 2015 and 90 from 2015 to 2020; median follow-up was 33 months. At PHI, the median age was 33 years; 4% were women, 39% were UK-born, and 84% were MSM. The proportion of UK-born individuals was 47% in 2009–2015, compared with 29% in 2015–2020. There was an association between earlier ART initiation after PHI diagnosis and increased immune recovery; each day that ART was delayed was associated with a lower likelihood of achieving a CD4+ cell count more than 900 cells/μl [hazard ratio 0.99 (95% confidence interval, 95% CI 0.98–0.99), P = 0.02) and CD4/CD8 more than 1.0 (hazard ratio 0.98 (95% CI 0.97–0.99).

Conclusion:

Early initiation of ART at PHI diagnosis is associated with enhanced immune recovery, providing further evidence to support immediate ART in the context of PHI. Non-UK-born MSM accounts for an increasing proportion of those with primary infection; UK HIV-1 prevention strategies should better target this group.
HIGH AND UNSUSTAINABLE COST OF CONTROLLING THE DENGUE VECTOR AEDES AEGYPTI IN THE PERUVIAN AMAZON
Authors: Durand Salomón , Paredes Arles , Pacheco Carlos , Fernandez Ray , Herrera Jose , Cabezas Cesar
Published: December 2023

Objectives

Vector control is the method of prevention and control of dengue outbreaks used in Peru. With the objective of calculating the costs incurred in vector control, an estimation of the costs ofAedes aegypticontrol of the Regional Health Directorate of Loreto, during the execution of the regional plan for surveillance and control ofA. aegyptiwas carried out.

Materials and methods

Documentation was reviewed, and interviews were conducted with stakeholders about the costs ofA. aegypticontrol interventions in its adult and larval stages, during 2017 and 2018.

Results

It was found that the costs incurred in the control of the dengue vector in the Loreto Region in the two years studied amount to: 3,807,858 and 4,066,380 soles during 2017 and 2018 respectively, 1’175,264 and 1’1210,232 dollars at the exchange rate of 2017 and 2018, however, the effect of the control activities is short-lived.

Conclusions

The high cost involved in vector control with the methods currently used and the short duration of its effect makes it unsustainable so studies should be conducted to find other more efficient methods of dengue control.
Excessive daytime sleepiness among dental students: A meta-analysis of prevalence
Authors: Wilches-Visbal Jorge Homero , Angulo-Luna Alex Antonio , Campo-Arias Adalberto
Published: December 2023

Introduction

Excessive daytime sleepiness is highly prevalent and variable in health students. However, a meta-analysis that synthesizes the prevalence of this symptom in dental students has yet to be reported.

Objective

To compute the pooled prevalence of sleepiness in dental students.

Method

A systematic review and meta-analysis of studies published between 2000 and 2023 was developed in Spanish, English, and Portuguese, with the keywords sleepiness, excessive drowsiness, Epworth scale for drowsiness, and dental students in all three languages. Original articles and degree theses that reported the frequency of sleepiness with a cut-off point for the Epworth scale for sleepiness greater than ten were included. The sample sizes and the number of students positive for sleepiness were observed, and the prevalence, raw and adjusted for sample size, was calculated.

Results

Seven articles were included with participant samples between 128 and 325 students, totaling 1,546. Students were positive on the Epworth scale for sleepiness between 43 and 189, with a sum of 671. The pooled prevalence was 42.7% (95% CI 40.3-45.2).

Conclusions

drowsiness is present in four out of ten dental students. It is necessary to systematize the factors associated with drowsiness and establish a relationship with the academic performance of dental students.
Fracture risk among stroke survivors according to post-stroke disability status and stroke type
Authors: Lee Dagyeong , Cho In Young , Chang Won Hyuk , Yoo Jung Eun , Choi Hea Lim , Park Jun Hee , Shin Dong Wook , Han Kyungdo
Published: December 2023

Background

Stroke survivors face physical and cognitive challenges, including impaired coordination and balance, which can lead to an increased dependency and a higher risk of falls. We aimed to investigate the impact of post-stroke disability status and stroke type on the risk of fracture at various sites compared to a matched comparison group.

Method

This retrospective cohort study used data from the Korean National Health Insurance System database (2010-2018) and included a total of 223,358 stroke patients and a 1:1 matched comparison group. Stroke survivors were grouped based on the presence and severity of their post-stroke disability and stroke type. The primary outcome was the incidence of newly diagnosed fracture. Cox proportional hazard regression analyses were used to calculate the hazard ratios of fractures after adjusting for potential confounders.

Results

Stroke survivors had an increased risk of overall fractures compared to the matched comparison group (adjusted hazard ratio [aHR] 1.40, 95% confidence interval [CI] 1.37-1.43). Specifically, the risk of hip fractures was even greater for stroke survivors: aHR 2.42, 95% CI 2.30-2.55. The risk of vertebral fractures (aHR 1.29, 95% CI 1.25-1.34) and other fractures (aHR 1.19, 95% CI 1.15-1.23) also was higher than that of the control group. The risk of hip fractures was highest among stroke survivors with severe post-stroke disability (aHR 4.82, 95% CI 4.28-5.42), while the risk of vertebral or other fractures was highest among those with mild post-stroke disability. There was no significant difference in fracture risk between hemorrhagic and ischemic stroke survivors when stratified by disability status.

Conclusion

Our findings showed an increased risk of subsequent fractures among stroke survivors, particularly those with post-stroke disability and for hip fracture. Bone health assessment and treatment should be emphasized as an essential part of stroke management.
FRISTS: Interpretable Time Series-Based Heart Failure Risk Prediction
Authors: Lin Sophia , Dong Xinyu , Wang Fusheng
Published: December 2023

Abstract

Heart failure is an incurable medical condition that affects millions of people globally. Developing prediction models is crucial to prevent patients from progressing to heart failure. Current heart failure prediction models struggle with achieving interpretability, a mandatory trait that allows the model to be applied in healthcare, while possessing high real-world accuracy. We introduce FRISTS, a novel HF prediction approach leveraging sequential times series-based modeling, such as long short-term memory (LSTM) networks, and feature selection. Our study utilized an extensive electronic health record (EHR) database and found that FRISTS outperformed traditional AI models (e.g., Random Forest Classifier, Logistic Regression, and Decision Tree) and more complex machine learning techniques (e.g., XGBoost, LSTM), yielding an average F1 score of 0.805 and receiver operating characteristic area under the curve (ROC AUC) value of 0.990. Our SHAP-inspired permutation method enables interpretation of the feature ranking, enhancing the result transparency and paving the way for a new class of interpretable models. This approach holds promise in enhancing clinical decision-making and patient care in the context of heart failure prevention.
Is metacarpophalangeal joint restriction an indicator of blood pressure?
Authors: Shah Rohan , Phatak Sanat , Jadhav Sarita , Bhalerao Aboli , Mehra Shreya , Dhadge Smita , Ingram Jennifer , Yajnik Chittaranjan
Published: December 2023

Arterial wall stiffness is implicated in the etiopathogenesis of hypertension, reflecting medial stiffness and atherosclerotic plaques. In individuals with diabetes, musculoskeletal phenotypes like limited joint mobility (LJM) in the hands suggests soft tissue fibrosis and could mirror internal organ fibrosis including arterial stiffness.

In Quantifying hand stiffness, mean extension at the metacarpophalangeal (MCP) joint emerges as a promising metric. In a type 1 diabetes cohort, this correlated with structural fibrotic changes on MRI. The study introduces a clinically scalable methodology for measuring joint stiffness, with implications for community screening programs for hypertension.

In an ongoing study with 1885 participants, MCP extension showed a significant association with SBP (p <0.001). Linear regression, adjusted for age, gender, and diabetes status, reveals a negative correlation between average MCP extension and SBP. These pilot findings support earlier associations with an easier methodology. Future work involves establishing cutoffs in mean MCP extension for optimized screening algorithms, considering potential confounders like physical activity.
Effects of interval treadmill training on spatiotemporal parameters in children with cerebral palsy: a machine learning approach
Authors: Caskey Charlotte D. , Shrivastav Siddhi R. , Spomer Alyssa M. , Bjornson Kristie F. , Roge Desiree , Moritz Chet T. , Steele Katherine M.
Published: December 2023

Background

Children with cerebral palsy (CP) have reduced step length, reduced symmetry, and greater step width compared to their peers. Short-burst interval locomotor treadmill training (SBLTT) is a novel rehabilitation paradigm for children with CP that may improve spatiotemporal outcomes. However, for interventions like SBLTT, quantifying rehabilitation responses and optimizing therapy parameters remains challenging. Machine learning and causal modeling provide a platform to quantify step-by-step changes during gait training to understand mechanisms driving individual responses.

Research question

What is the direct effect of SBLTT on step length, asymmetry, and step width in children with CP?

Methods

We recruited four children with spastic CP, ages 4-13. Each participant received 24 sessions of SBLTT over 8-12 weeks, with spatiotemporal outcomes monitored with an instrumented treadmill. We used Bayesian Additive Regression Trees (BART) to model the direct effect of therapy parameters on step length, step length asymmetry, and step width. Additionally, we generatedin silicodata for 150 virtual participants to quantify the quality of BART models to capture rehabilitation progression.

Results

After SBLTT, participants’ step lengths increased by 26 ± 13% (pre-post effect). Controlling for treadmill speed, time in session, limb, and treadmill incline with BART demonstrated that SBLTT directly increased step length for three participants (direct effect: 13.5 ± 4.5%), while one participant decreased step length (−11.6%). SBLTT had minimal effects on step length asymmetry and step width. Virtual datasets demonstrated that BART could accurately predict step length progression (R2= 0.73) and plateaus in progression (R2= 0.87), with better model fit for participants with less step-to-step variability.

Significance

Tools such as BART can leverage step-by-step data collected during gait training to monitor progression and optimize rehabilitation protocols. This work can help personalize rehabilitation and understand the causal mechanisms driving individual responses.
A 17-month longitudinal environmental sampling study carried out on public transport vehicles operating in England during the COVID-19 pandemic identified low levels of SARS-CoV-2 RNA contamination
Authors: Aranega-Bou Paz , Pottage Thomas , Fenwick Abigail , D’Costa Wilhemina , Brown Natalie F. , Yaxley Nicola , King Marco-Felipe , Parker Simon T. , Miller Daniel , López-García Martín , Noakes Catherine J. , Moore Ginny , Bennett Allan
Published: December 2023

Aims

To monitor severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA contamination in vehicles operating in England during the pandemic, to better understand transmission risk of SARS-CoV-2 on public transport.

Methods and Results

We collected 1,314 surface samples between December 2020 and April 2022 on trains and buses managed by five different transport operators. The presence of SARS-CoV-2 RNA was investigated through reverse transcription polymerase chain reaction (RT-PCR). SARS-CoV-2 RNA was found on 197 (15%) of the 1,314 surfaces sampled, including seat head rests, handholds, and air extract grilles, but the levels of RNA recovered on those samples (median value of 23.4, inter-quartile range: 14.3-35.4,Ngene copies per extraction) made the presence of infectious virus at the time of sampling extremely unlikely. However, detection rates varied over time with peaks broadly coinciding with times of high community transmission, suggesting that people infected with SARS-CoV-2 when travelling on public transport could create opportunities for transmission.

Conclusion

During the pandemic, and as in other public spaces, low levels of SARS-CoV-2 RNA were found on surfaces associated with public transport.

Impact statement

The results of this study will inform modelling approaches and the implementation of mitigation strategies to minimise the risk of transmission of respiratory viruses in public transport.
Age- and disease severity-associated changes in the nasopharyngeal microbiota of COVID-19 patients
Authors: Pérez-Sanz Fernando , Tyrkalska Sylwia D. , Álvarez-Santacruz Carmen , Moreno-Docón Antonio , Mulero Victoriano , Cayuela María L. , Candel Sergio
Published: December 2023

Dysbiosis has been linked to the pathogenesis of multiple diseases. Although dozens of publications have associated changes in the nasopharyngeal microbiota to patient’s susceptibility to COVID-19, results from these studies are highly variable and contradictory in many cases. Addressing the limitations in previous research responsible for that variability, this study uses 16S rRNA gene sequencing to analyse the nasopharyngeal microbiota of 395 subjects, 117 uninfected controls and 278 COVID-19 patients, of different age groups that cover the entire lifespan and across varying disease severities. Importantly, our results reveal that bacterial diversity decreases progressively throughout life but only in severely ill COVID-19 patients, in whose nasopharynx, moreover, the opportunistic pathogen bacterial generaStaphylococcus,Corynebacterium,Streptococcus,Prevotella,Acinetobacter, andPseudomonasare overrepresented. Notably,Scardovia wiggsiaeappears only in severe COVID-19 patients over 60 years of age, suggesting a potential utility of this bacterial species as a COVID-19 severity biomarker in the elderly, who are the most susceptible individuals to suffer from serious forms of the disease and the age group that presents more differences in comparison with the other age groups according to the majority of the parameters analysed in this study. Our results provide valuable insights into age-associated dynamics within nasopharyngeal microbiota during severe COVID-19, offering potential avenues for further exploration and therapeutic interventions.
Gazing Down Has benefits Unrelated To Visual Input
Authors: Koren Yogev , Goldhamer Noy , Shmuelof Lior , Bar-Haim Simona
Published: December 2023

Recent reports have revealed that downward gazing enhances postural control. The mechanism underlying this phenomenon is currently unknown, yet there are several plausible explanations. In this study, we attempt to provide evidence to support the hypothesis that this effect is primarily derived from altered visual flow caused by gazing down.

To this end, we quantified standing postural sway of 20 healthy participants and 20 people with stroke who were instructed to stand as still as possible under different conditions: while gazing forward and gazing down, with their eyes open and eyes closed.

Both the horizontal gaze angle and the lack of visual input had a negative effect on participants’ ability to attenuate their body sway. Yet, the effect of gaze angle was constant regardless of the presence or absence of visual input. Also, people with stroke swayed more than their healthy counterparts and were more sensitive to the effect of gaze angle, but not to that of visual input.

The results of this study indicate that downward gazing enhances postural control even in the absence of visual input and do not support our main hypothesis. Also, it seems that the effect of downward gazing on postural control is greater in unstable people (people with stroke) than that observed in healthy adults, which might explain less stable individuals’ tendency to gaze down while walking. Furthermore, these results might suggest that downward gazing behavior does not necessarily indicate an attempt to acquire visual information of any kind but instead serves to modulate some other sensory input helpful for postural control.
Rare disease gene association discovery from burden analysis of the 100,000 Genomes Project data
Authors: Cipriani Valentina , Vestito Letizia , Magavern Emma F , Jacobsen Julius OB , Arno Gavin , Behr Elijah R , Benson Katherine A , Bertoli Marta , Bockenhauer Detlef , Bowl Michael R , Burley Kate , Chan Li F , Chinnery Patrick , Conlon Peter , Costa Marcos , Davidson Alice E , Dawson Sally J , Elhassan Elhussein , Flanagan Sarah E , Futema Marta , Gale Daniel P , García-Ruiz Sonia , Corcia Cecilia Gonzalez , Griffin Helen R , Hambleton Sophie , Hicks Amy R , Houlden Henry , Houlston Richard S , Howles Sarah A , Kleta Robert , Lekkerkerker Iris , Lin Siying , Liskova Petra , Mitchison Hannah , Morsy Heba , Mumford Andrew D , Newman William G , Neatu Ruxandra , O’Toole Edel A , Ong Albert CM , Pagnamenta Alistair T , Rahman Shamima , Rajan Neil , Robinson Peter N , Ryten Mina , Sadeghi-Alavijeh Omid , Sayer John A , Shovlin Claire L , Taylor Jenny C , Teltsh Omri , Tomlinson Ian , Tucci Arianna , Turnbull Clare , van Eerde Albertien M , Ware James S , Watts Laura M , Webster Andrew R , Westbury Sarah K , Zheng Sean L , Caulfield Mark , Smedley Damian
Published: December 2023

To discover rare disease-gene associations, we developed a gene burden analytical framework and applied it to rare, protein-coding variants from whole genome sequencing of 35,008 cases with rare diseases and their family members recruited to the 100,000 Genomes Project (100KGP). Followingin silicotriaging of the results, 88 novel associations were identified including 38 with existing experimental evidence. We have published the confirmation of one of these associations, hereditary ataxia withUCHL1, and independent confirmatory evidence has recently been published for four more. We highlight a further seven compelling associations: hypertrophic cardiomyopathy withDYSFandSLC4A3where both genes show high/specific heart expression and existing associations to skeletal dystrophies or short QT syndrome respectively; monogenic diabetes withUNC13Awith a known role in the regulation of β cells and a mouse model with impaired glucose tolerance; epilepsy withKCNQ1where a mouse model shows seizures and the existing long QT syndrome association may be linked; early onset Parkinson’s disease withRYR1with existing links to tremor pathophysiology and a mouse model with neurological phenotypes; anterior segment ocular abnormalities associated withPOMKshowing expression in corneal cells and with a zebrafish model with developmental ocular abnormalities; and cystic kidney disease withCOL4A3showing high renal expression and prior evidence for a digenic or modifying role in renal disease. Confirmation of all 88 associations would lead to potential diagnoses in 456 molecularly undiagnosed cases within the 100KGP, as well as other rare disease patients worldwide, highlighting the clinical impact of a large-scale statistical approach to rare disease gene discovery.