bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal near miss as a predictor of adverse perinatal outcomes: findings from a prospective cohort study in southwestern Uganda
Authors: Jjuuko Mark , Lugobe Henry Mark , Migisha Richard , Agaba David Collins , Tibaijuka Leevan , Kayondo Musa , Ngonzi Joseph , Kalyebara Paul Kato , Kanyesigye Hamson
Published: January 2024

Background

Despite efforts, Uganda has not met the World Health Organization target of < 12 newborn deaths per 1,000 live births. Severe maternal morbidity or ‘near miss’ is a major contributor to adverse perinatal outcomes, particularly in low-resource settings. However, the specific impact of maternal near miss on perinatal outcomes in Uganda remains insufficiently investigated. We examined the association between maternal near miss and adverse perinatal outcomes at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda.

Methods

We conducted a prospective cohort study among women admitted for delivery at MRRH’s maternity ward from April 2022 to August 2022. We included mothers at ≥ 28 weeks of gestation with singleton pregnancies, while intrauterine fetal death cases were excluded. For the near-miss group, we consecutively included mothers with any one of the following: antepartum hemorrhage with shock, uterine rupture, hypertensive disorders, coma, and cardiac arrest; those without these complications constituted the non-near-miss group. We followed the mothers until delivery, and their infants until seven days postpartum or death. Adverse perinatal outcomes considered were low birth weight (< 2,500 g), low Apgar score (< 7 at five minutes), intrapartum stillbirths, early neonatal death, or admission to neonatal intensive care unit. Multivariable log-binomial regression was used to determine predictors of adverse perinatal outcomes.

Results

We enrolled 220 participants (55 maternal near misses and 165 non-near misses) with a mean age of 27 ± 5.8 years. Most of the near misses were pregnancies with hypertensive disorders (49%). Maternal near misses had a four-fold (adjusted risk ratio [aRR] = 4.02, 95% CI: 2.32–6.98) increased risk of adverse perinatal outcomes compared to non-near misses. Other predictors of adverse perinatal outcomes were primigravidity (aRR = 1.53, 95%CI: 1.01–2.31), and gestational age < 34 weeks (aRR = 1.81, 95%CI: 1.19–2.77).

Conclusion

Maternal near misses, primigravidity, and preterm pregnancies were independent predictors of adverse perinatal outcomes in this study. We recommend implementing maternal near-miss surveillance as an integral component of comprehensive perinatal care protocols, to improve perinatal outcomes in Uganda and similar low-resource settings. Targeted interventions, including specialized care for women with maternal near misses, particularly primigravidas and those with preterm pregnancies, could mitigate the burden of adverse perinatal outcomes.
Appropriate feeding practices and associated factors during diarrheal disease among children aged 6 to 23 months in Sub-Saharan Africa: a multilevel analysis of the recent demographic and health survey
Authors: Workneh Belayneh Shetie , Mekonen Enyew Getaneh , Zegeye Alebachew Ferede
Published: January 2024

Background

Diarrhea is the second leading cause of morbidity and mortality for under-five children which cause about 525,000 deaths annually. Even though diarrheal diseases have decreased substantially at the global level, low-income countries are still faced with a huge number of diarrheal diseases. Thus, our aim was to assess the child feeding practices during diarrheal diseases and associated factors among children aged 6 to 23 months in Sub-Saharan African countries using the recent demographic and health survey.

Methods

The appended and most recent demographic and health survey (DHS) dataset of 19 Sub-Saharan African countries from 2015 to 2020 was used for data analysis. A total of 64,628 living children aged 6–23 months with diarrhea were used as a weighted sample. The determinants of appropriate feeding practice were determined using a multilevel mixed-effects logistic regression model. Significant factors associated with appropriate feeding practice in the multilevel mixed-effect logistic regression model were declared significant at p-values < 0.05. The adjusted odds ratio (AOR) and confidence interval (CI) were used to interpret the results.

Result

The overall prevalence of appropriate child feeding practice during diarrhea in this study was 6.24% (95% CI: 6.06, 6.43). Maternal age (15 to 19 years and 20 to 35 years) (AOR = 1.32, 95%CI: 1.12, 1.55 and AOR = 1.14, 95%CI: 1.03, 1.27), mothers education (primary and secondary level) (AOR = 1.23, 95%CI: 1.12, 1.35 and AOR = 1.28, 95%CI: 1.15, 1.43), having media exposure(AOR = 1.36, 95%CI: 1.26, 1.46), being married (AOR = 1.18, 95%CI: 1.01, 1.38), currently working (AOR = 1.08, 95%CI:1.00, 1.15), vaccinated for Rotavirus (AOR = 1.30, 95%CI:1.19, 1.43) and living in Central and eastern African countries (AOR = 1.82, 95%CI: 1.12, 2.97) and (AOR = 2.23, 95%CI: 1.37, 3.61) respectively were significantly associated with appropriate feeding practice.

Conclusion

The prevalence of appropriate feeding practice during child diarrheal disease aged 6–23 months of age was strictly low which implies that child diarrhea and appropriate feeding practice is still a great issue in in Sub-Saharan African countries. Enhancing maternal education, strengthening media exposure and vaccination for rotavirus, and designing interventions that address the mother’s marital status, mother’s work status, and country category are recommended to enhance appropriate feeding practices. Furthermore, special consideration should be given to older mothers to increase appropriate feeding practices during diarrheal disease.
The use of technology to address loneliness and social isolation among older adults: the role of social care providers
Authors: Grey Elisabeth , Baber Fran , Corbett Estelle , Ellis David , Gillison Fiona , Barnett Julie
Published: January 2024

Background

Addressing loneliness and social isolation among older adults remains a public health priority. The restrictions enforced during the COVID-19 pandemic simultaneously heightened the need for services to overcome social isolation and reduce loneliness among older adults, while also limiting social care providers’ ability to deliver these. The aim of this study was to explore the experiences of social care providers in using technology to address loneliness and social isolation among older adults during the pandemic.

Methods

This was a mixed methods study involving an online survey and interviews with providers of older adult social care in Wales, UK. Invitations to participate were sent to commissioners and providers of adult social care services, including those working in the voluntary and community sectors, across all local authorities in Wales. Data was collected between September 2021 and January 2022.

Results

Sixty-one service providers completed the survey, 19 of whom also took part in an interview. Addressing loneliness and isolation among older adults was reported as a key concern by nearly all survey respondents. While telephone calls were the most common means of facilitating social interaction, many service providers also tried to support older adults to make more use of devices that they already had (e.g., smartphones to hold video calls). Where funding was available, organisations purchased devices, such as tablets and smart speakers, for older adults. Analysis of interviews resulted in three themes: (1) The potential and limitations of technology; (2) Individuals’ capabilities, confidence, motivations and values; and (3) The wider system.

Conclusions

Technology was employed in a variety of ways during the pandemic to address loneliness and social isolation among older adults; many service providers continue to use technology in a hybrid system of care now that pandemic-related social restrictions have been lifted. Our findings emphasise a need for technology-assisted interventions to be designed and deployed in alignment with service users’ values, motivations and capabilities. Further, there is a need to better support service providers to assess loneliness and social isolation among older adults, and to acknowledge the important role providers play in helping older adults to adopt technology-assisted interventions.
The global, regional, and national disease burden of breast cancer attributable to tobacco from 1990 to 2019: a global burden of disease study
Authors: Guo Qiusheng , Lu Yunyan , Liu Weiguo , Lan Gaochen , Lan Tian
Published: January 2024

Objective

Tobacco has been identified as a significant contributory element to the development of breast cancer. Our objective was to evaluate the spatiotemporal trends of tobacco-related breast cancer at the global, regional, and national scales during 1990–2019.

Methods

We extracted data on mortality, disability adjusted of life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) from the Global Burden of Disease (GBD) study 2019. Estimated annual percentage change (EAPC) was computed to assess the temporal change in ASDR and ASMR.

Results

In 2019, the deaths and DALYs attributed to tobacco-related breast cancer were estimated to be 35,439 (95% UI: 22,179–48,119) and 1,060,590 (95% UI: 622,550–1,462,580), respectively. These figures accounted for 5.1% and 5.2% of the total burden of breast cancer. ASMR and ASDR increased in low SDI regions, remained stable in low-middle and middle SDI regions and declined in high and high-middle SDI regions. The burden of breast cancer attributable to tobacco varied notably among regions and nations. Oceania, Southern Latin America, and Central Europe were the GBD regions with the highest number of ASMR and DALYs. There was a positive relationship between age-standardized rate and SDI value in 2019 across 204 nations or territories. A negative association was observed between the EAPC in ASMR or ASDR and the human development index (HDI) in 2019 (R = -0.55, p < 0.01 for ASMR; R = -0.56, p < 0.01 for ASDR).

Conclusion

Tobacco is one important and modifiable risk factor for breast cancer. The heterogeneity in both the spatial and temporal distribution can be attributed to factors such as aging, population growth, and SDI. These findings substantiate the necessity of expediting the enforcement of tobacco-free legislation in order to safeguard populations from the detrimental effects of tobacco.
Persistence of severe global inequalities in the burden of Hypertension Heart Disease from 1990 to 2019: findings from the global burden of disease study 2019
Authors: Lu Mengkai , Li Dongxiao , Hu Yuanlong , Zhang Lei , Li Yuan , Zhang Zhiyuan , Li Chao
Published: January 2024

Aims

Assessing the global burden and health inequalities of Hypertension Heart Disease (HHD) during the period from 1990 to 2019.

Methods

Secondary analysis of the Global Burden of Disease (GBD) study in 2019, focusing on the burden of diseases, injuries, and risk factors worldwide. Disability-Adjusted Life Years (DALYs) data related to HHD are extracted from the 2019 GBD. Inequality Slope Index (SII) and Concentration Index are calculated to assess health inequalities across regions and countries.

Results

The total DALYs for HHD reached 21.51 million, demonstrating a substantial increase of 54.25% compared to the figures recorded in 1990, while the age-standardized DALY rates per 100,000 population for HHD in 2019 showed a notable decline to 268.19 (95% UI 204.57, 298.07), reflecting a significant decrease of 26.4% compared to the rates observed in 1990. The DALYs rate of hypertensive heart disease increases with age. Countries with moderate SDI accounted for 38.72% of the global burden of HHD in terms of DALYs. The highest age-standardized DALY rates (per 100,000) are predominantly concentrated in underdeveloped areas. In 1990 and 2019, the SII (per 100,000 population) for DALYs were − 121.6398 (95% CI -187.3729 to -55.90684) and − 1.592634 (95% CI -53.11027 to 49.925) respectively. The significant decline suggests a reduction in the inequality of age-standardized burden of HHD between high-income and low-income countries during this period.

Conclusion

The unequal prevalence of HHD across different populations can hinder the achievement of the “health for all” objective. Persistent disparities in HHD have been observed globally over the past thirty years. It is crucial to prioritize efforts towards reducing avoidable health inequalities associated with hypertension-related heart disease, particularly in low-income and middle-income countries.
The association between interest of nutritional supplements and COVID-19 pandemic - evidence from Google Trends
Authors: Lin Li-Yin , Husnayain Atina , Chen Yi-Tui , Kuo Chao-Yang
Published: January 2024

Background

Due to the spread of the coronavirus disease 2019 (COVID-19) pandemic in 2020, the interest of nutritional supplements has emerged. Limited data are available on how the COVID-19 pandemic affects the search interest in nutritional supplements in Taiwan and worldwide. The study aims to investigate changes in public search interest of nutritional supplements pre- and during the COVID-19 pandemic.

Methods

Our World in Data dataset was used to collect both global and local (Taiwan) number of COVID-19 newly confirmed cases and deaths. Google Trends search query was being used to obtain relative search volumes (RSVs) covering a timeframe between 2019 to 2022. Spearman’s rank-order correlation coefficients were used to measure relationships between confirmed new cases and deaths and RSVs of nutritional supplements. Multivariate analysis was conducted to examine the effect of domestic and global new cases and deaths on the RSVs of nutritional supplements.

Results

The mean RSVs for nutritional supplements were higher during the COVID-19 pandemic period (between 2020 to 2022) compared to the pre-pandemic period (year of 2019) for both Taiwan and worldwide. In terms of seasonal variations, except for vitamin D, the mean RSVs of probiotics, vitamin B complex, and vitamin C in winter were significantly lower compared to other seasons in Taiwan. The RSVs of nutritional supplements were not only affected by domestic cases and deaths but also by global new cases and deaths.

Conclusions

The interests in nutritional supplements had substantially increased in response to the COVID-19 pandemic. The RSVs of nutritional supplements in Taiwan were not only influenced by global and domestic pandemic severity but also by seasons.
Prognostic significance of surgery and radiotherapy in elderly patients with localized prostate cancer: establishing and time-based external validation a nomogram from SEER-based study
Authors: Zhanghuang Chenghao , Zhu Jianjun , Li Ye , Wang Jinkui , Ma Jing , Li Li , Yao Zhigang , Ji Fengming , Wu Chengchuang , Tang Haoyu , Xie Yucheng , Yan Bing , Yang Zhen
Published: January 2024

Objective

Prostate cancer (PC) is a significant disease affecting men’s health worldwide. More than 60% of patients over 65 years old and more than 80% are diagnosed with localized PC. The current choice of treatment modalities for localized PC and whether overtreatment is controversial. Therefore, we wanted to construct a nomogram to predict the risk factors associated with cancer-specific survival (CSS) and overall survival (OS) in elderly patients with localized PC while assessing the survival differences in surgery and radiotherapy for elderly patients with localized PC.

Methods

Data of patients with localized PC over 65 years were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression models were used to determine independent risk factors for CSS and OS. Nomograms predicting CSS and OS were built using multivariate Cox regression models. The consistency index (C-index), the area under the subject operating characteristic curve (AUC), and the calibration curve were used to test the accuracy and discrimination of the prediction model. Decision curve analysis (DCA) was used to test the potential clinical value of this model.

Results

A total of 90,434 patients over 65 years and diagnosed with localized PC from 2010 to 2018 were included in the study. All patients were randomly assigned to the training set (n = 63,328) and the validation set (n = 27,106). Univariate and multivariate Cox regression model analysis showed that age, race, marriage, T stage, surgical, radiotherapy, prostate-specific antigen (PSA), and Gleason score (GS) were independent risk factors for predicting CSS in elderly patients with localized PC. Age, race, marriage, surgery, radiotherapy, PSA, and GS were independent risk factors for predicting OS in elderly patients with localized PC. The c-index of the training and validation sets for the predicted CSS is 0.802(95%CI:0.788–0.816) and 0.798(95%CI:0.776–0.820, respectively). The c-index of the training and validation sets for predicting OS is 0.712(95%:0.704–0.720) and 0.724(95%:0.714–0.734). It shows that the nomograms have excellent discriminatory ability. The AUC and the calibration curves also show good accuracy and discriminability.

Conclusion

We have developed new nomograms to predict CSS and OS in elderly patients with localized PC. After internal validation and external temporal validation with reasonable accuracy, reliability and potential clinical value, the model can be used for clinically assisted decision-making.
Do patients with cN0 oral squamous cell carcinoma benefit from elective neck dissection? A large-scale population-based study
Authors: Wu Qiuyu , Xia Yuanhang , Qiu Ling , Wen Shuqiong , Li Qunxing , Gao Xiang , Jiang Wenrong , Wang Tao , Ji Ping , Ou Zhanpeng
Published: January 2024

Background

The neck management of clinical-nodal negative (cN0) oral squamous cell carcinoma (OSCC) remains controversial. Elective neck dissection (END) and observation are the main strategies, but it is still not clear who could benefit the most from END. The purpose of this study was to clarify the potential clinical factors that affect the therapeutic value of END and to explore the actual characteristics associated with benefit from END.

Methods

Patients with cN0 OSCC were identified in the SEER database from 2000 to 2019. 5-year Overall survival (OS) and disease-specific survival (DSS) were analyzed using the Kaplan‒Meier method, and the hazard ratios (HRs) for survival were estimated using the Cox regression model. Multiple subgroup analyses of DSS and OS among different factors, comparing END and No END, were performed.

Results

A total of 17,019 patients with cN0 OSCC were included. The basic survival analysis and Cox regression model showed that END increased the probability of 5-year DSS and OS and was an independent prognostic factor. However, among patients who underwent only primary tumor surgery, no significant differences were found between the END and No END groups in 5-year DSS (P = 0. 585) and OS (P = 0.465). Further subgroup analysis showed that primary sites and T stage, but not other factors, might influence the benefit of END. Significant differences were found for T1 (P < 0.001 for OS) and T2 (P = 0.001 for DSS and < 0.001 for OS) tongue squamous cell carcinoma (TSCC) but not for other primary tumor sites.

Conclusion

This large-scale retrospective population-based cohort study suggests that not all patients with cN0 OSCC could benefit from END. Patients with cN0 TSCC are recommended to undergo END, especially with early-stage tumors.
Assessing the impact of occlusal plane rotation on facial aesthetics in orthodontic treatment: a machine learning approach
Authors: Cai Jingyi , Min Ziyang , Deng Yudi , Jing Dian , Zhao Zhihe
Published: January 2024

Background

Adequate occlusal plane (OP) rotation through orthodontic therapy enables satisfying profile improvements for patients who are disturbed by their maxillomandibular imbalance but reluctant to surgery. The study aims to quantify profile improvements that OP rotation could produce in orthodontic treatment and whether the efficacy differs among skeletal types via machine learning.

Materials and methods

Cephalometric radiographs of 903 patients were marked and analyzed by trained orthodontists with assistance of Uceph, a commercial software which use artificial intelligence to perform the cephalometrics analysis. Back-propagation artificial neural network (BP-ANN) models were then trained based on collected samples to fit the relationship among maxillomandibular structural indicators, SN-OP and P-A Face Height ratio (FHR), Facial Angle (FA). After corroborating the precision and reliability of the models by T-test and Bland-Altman analysis, simulation strategy and matrix computation were combined to predict the consequent changes of FHR, FA to OP rotation. Linear regression and statistical approaches were then applied for coefficient calculation and differences comparison.

Results

The regression scores calculating the similarity between predicted and true values reached 0.916 and 0.908 in FHR, FA models respectively, and almost all pairs were in 95% CI of Bland-Altman analysis, confirming the effectiveness of our models. Matrix simulation was used to ascertain the efficacy of OP control in aesthetic improvements. Intriguingly, though FHR change rate appeared to be constant across groups, in FA models, hypodivergent group displayed more sensitive changes to SN-OP than normodivergent, hypodivergent group, and Class III group significantly showed larger changes than Class I and II.

Conclusions

Rotation of OP could yield differently to facial aesthetic improvements as more efficient in hypodivergent groups vertically and Class III groups sagittally.
A mixed methods evaluation of the effectiveness of an oral health training program for disability care workers in Burkina Faso
Authors: Põld Ave , Kientega Dan Filwendé , Garé Jocelyne Valérie , Listl Stefan
Published: January 2024

Background

While efforts to improve the oral health of vulnerable populations have received little attention in general, the situation of children with disabilities in low- income countries (LICs) remains especially challenging. The present study evaluated the effectiveness of an oral health training provided to disability care workers in Ouagadougou, Burkina Faso thereby contributing to closing the knowledge gap in disability research in relation to oral health in LICs.

Methods

This was a single-arm pre-post study following an embedded mixed methods design using the New World Kirkpatrick training effectiveness evaluation model. For the purposes of this study, three levels of the Kirkpatrick (KP) evaluation were considered: reaction, learning and behaviour.

Results

A total of 44 care workers from 6 disability centres participated in the study. Care worker post-training scores (Md = 17) were significantly higher compared to pre-training scores (Md = 13) [Wilcoxon signed-ranks test: Z= -5.53, p < .001, r = .59.] The median value for care worker confidence in applying training material in their everyday job was 7 out of 10 points (IQR = 3). At the 1-month training follow-up, 3 centres had implemented daily toothbrushing for people with disabilities.

Conclusion

These findings suggest that tailored training led to an increase in care worker confidence and motivation to implement oral health activities, in knowledge about oral health and a partial implementation uptake of daily toothbrushing in disability centres. Further long-term evaluations with dental care provision in rural and urban settings are needed to lower the high oral disease burden of people with disabilities in Burkina Faso.
Applying the structural equation model approach to study the simultaneous relationship between women’s empowerment and mental disorder in Egypt
Authors: Zaky Hassan H.M. , Armanious Dina M. , Kalliny Maria A.
Published: January 2024

Purpose

The main purpose of this paper is to examine whether women’s empowerment and mental disorder affect each other in a one-way or two-way simultaneous relationship. Accordingly, the study fills a gap in the literature since it is the first attempt to examine the simultaneous relationship between women’s empowerment and mental disorder in Egypt. To achieve this, the study aims to examine the most important dimensions of women’s empowerment and mental disorder that affect each other simultaneously, and the most important determinants affecting women’s empowerment and mental disorder.

Design/methodology/approach

The study depends on the cross-sectional data from the “Survey of Young People in Egypt” implemented in 2014. Married women aged 14–35 are included in the analysis (N = 3052). Recursive and nonrecursive structural equation models are used to examine the simultaneous relationship between women’s empowerment and mental disorder using AMOS, which stands for Analysis of Moment Structures (Version 22).

Results

Women’s education has a positive significant impact on women’s empowerment and mental health. Violence has a positive significant impact on mental disorder, while it has a negative impact on women’s empowerment. Sexual harassment has a negative impact on treatment with spouse dimension. Regarding the one-way relationship, the results show that the more empowered the woman, the better her mental health is. Considering the two-way simultaneous relationship, the findings show that there is a partial two-way simultaneous relationship.

Conclusion

There is a relationship between women’s empowerment and mental health, indicating that they affect each other simultaneously. Awareness of the importance of psychological counselling and treatment for mental disorders in women is needed.
PHLPP1 inhibits the growth and aerobic glycolysis activity of human ovarian granular cells through inactivating AKT pathway
Authors: Yang Xiaoyan , A Min , Gegen Tana , Daoerji Badema , Zheng Yue , Wang Aiming
Published: January 2024

Background

Polycystic ovary syndrome (PCOS) is a disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphologic features, and PCOS is associated with infertility. PH domain Leucine-rich repeat Protein Phosphatase 1 (PHLPP1) has been shown to regulate AKT. The aim of present study is to investigate the role of PHLPP1 in PCOS.

Methods

The expression levels of PHLPP1 in dihydrotestosterone (DHT)-treated human ovarian granular KGN cells were determined by qRT-PCR and Western blot. PHLPP1 was silenced or overexpressed using lentivirus. Cell proliferation was detected by CCK-8. Apoptosis and ROS generation were analyzed by flow cytometry. Glycolysis was analyzed by measuring extracellular acidification rate (ECAR).

Results

DHT treatment suppressed proliferation, promoted apoptosis, enhanced ROS, and inhibited glycolysis in KGN cells. PHLPP1 silencing alleviated the DHT-induced suppression of proliferation and glycolysis, and promotion of apoptosis and ROS in KGN cells. PHLPP1 regulated cell proliferation and glycolysis in human KGN cells via the AKT signaling pathway.

Conclusions

Our results showed that PHLPP1 mediates the proliferation and aerobic glycolysis activity of human ovarian granular cells through regulating AKT signaling.
Towards the implementation of law n. 219/2017 on informed consent and advance directives for patients with psychiatric disorders and dementia. Physicians’ knowledge, attitudes and practices in four northern Italian health care facilities
Authors: Porteri Corinna , Ienco Giulia , Piccinni Mariassunta , Pasqualetti Patrizio
Published: January 2024

Background

On December 2017 the Italian Parliament approved law n. 219/2017 “Provisions for informed consent and advance directives” regarding challenging legal and bioethical issues related to healthcare decisions and end-of life choices. The law promotes the person’s autonomy as a right and provides for the centrality of the individual in every scenario of health care by mean of three tools: informed consent, shared care planning and advance directives. Few years after the approval of the law, we conducted a survey among physicians working in four health care facilities specific for the care of people suffering from psychiatric disorders, cognitive disorders and dementia located in the North of Italy aiming to investigate their perceived knowledge and training need, attitudes regarding law n. 219/2017 provisions, and practices of implementation of the law.

Methods

A semi-structured questionnaire was developed on an online platform. The invitation to participate in the survey was sent by email to the potential participants. Information was collected by means of the online platform (Google Forms) which allows to export data in a spreadsheet (Windows Excel) to perform basic statistical analysis (frequency distributions, bar chart representation).

Results

Twenty-five out of sixty physicians participated in the survey. None of the respondents value their knowledge of the law as very good, 10 good, 13 neither poor nor good, 1 poor and 1 very poor. All the respondents want to learn more about the law (21 yes and 4 absolutely yes). The majority of respondents agrees with the content of the law as a whole (3 absolutely agree, 13 agree), and on each provision. The question on the clarity of the concept of capacity in the law received mixed answers and this impacted on the physicians’ opinion regarding the legitimacy in principle for our groups of patients to realize shared care planning and write advance directives. Thirteen physicians neither introduced the theme of shared care planning nor arranged for shared care planning and the main reason for this was that no patient was in a clinical situation to require it. When shared care planning is realized, a variability in terms of type and number of meetings, mode of tracking and communication is registered.

Conclusions

Our survey results indicate a need for more clarity regarding the interpretation and implementation of the law in the patient groups under study. There are in particular two related areas that deserve further discussion: (1) the question of whether these patient groups are in principle legitimized by the law to realize shared care planning or write advance directives; (2) the notion of capacity required by the law and how this notion can be declined in real-life situations.
Molecular characterization and antibiotics resistance of Aeromonas species isolated from farmed African catfish Clarias gariepinus Burchell, 1822
Authors: Adah Deborah Arimie , Saidu Lawal , Oniye Sonnie Joshua , Adah Adakole Sylvanus , Daoudu Oluwafemi Babatunde , Ola-Fadunsin Shola David
Published: January 2024

Background

Aeromonas species are one of the most important etiologies of diseases in fish farms, leading to clinical manifestation and mortality and are associated with public health risks. This study aimed to investigate the prevalence, phenotypic and molecular characteristics of Aeromonas species isolated from farmed Clarias gariepinus using 16 S rRNA sequencing. Additionally, their antibiogram and multiple antibiotic resistance index were determined using a disc diffusion test.

Results

A total of 230 Aeromonas strains were isolated from Clarias gariepinus with 40.9% obtained from diseased fish, and 25% isolated from apparently healthy ones. Five different species including Aeromonas caviae, Aeromonas veronii, Aeromonas hydrophila, Aeromonas dhakensis and Aeromonas enteropelogenes were fully identified and genetically characterized. Based on the available literature, this is the first report of Aeromonas enteropelogenes from the study area. The phylogenetic analysis showed genetic heterogeneity and distance within the species and the reference strains. The multiple resistant Aeromonas species were susceptible to ciprofloxacin, gentamycin, and florfenicol. The Aeromonas species’ multiple antibiotic resistance index values varied between 0.20 and 0.80 and were isolated from the farms where antibiotics were intensively used.

Conclusions

The diversity of multidrug-resistant Aeromonas species isolated from fish farms is a major threat to fish production giving us more understanding of epidemiology and the multidrug Aeromonas species with a MAR index of greater than 0.2 were isolated from farms where antibiotic use was widespread. As a result, a considerably increased danger of multiple antibiotic resistance spreading to the fish culture environment may impact aquaculture production. Hence there is a need for appropriate and monitored drug usage.
Implantable cardioverter defibrillator and cardiac resynchronization treatment in people with type 2 diabetes: a comparison with age- and sex matched controls from the general population
Authors: Rautio Elina , Gadler Fredrik , Gudbjörnsdottir Soffia , Franzén Stefan , Rydén Lars , Savarese Gianluigi , Svensson Ann-Marie , Mellbin Linda G.
Published: January 2024

Background

Increased risk of severe tachyarrhythmias is reported in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to explore if treatment with cardiac implantable electronic device (CIED) such as implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy- pacemaker and -defibrillator (CRT-P/CRT-D) differed in patients with vs. without T2DM. A secondary aim was to identify patient characteristics indicating an increased CIED treatment.

Method

416 162 adult patients with T2DM from the Swedish National Diabetes Registry and 2 081 087 controls from the Swedish population, matched for age, sex and living area, were included between 1/1/1998 and 31/12/2012 and followed until 31/12/2013. They were compared regarding prevalence of ventricular tachycardia (VT) at baseline and the risk of receiving a CIED during follow-up. Multivariable Cox regression analysis was performed to estimate the risk of CIED-treatment and factors identifying patients with such risk.

Results

Ventricular fibrillation (VF) (0.1% vs 0.0004%) and (VT) (0.2% vs. 0.1%) were more frequent among patients with T2DM compared to controls. CIED-treatment was significantly increased in patients with T2DM both in unadjusted and adjusted analyses. HR and 95% CI, after adjustment for sex, age, marital status, income, education, country of birth, coronary artery disease and congestive heart failure, were 1.32 [1.21–1.45] for ICD, 1.74 [1.55–1.95] for CRT-P and 1.69 [1.43–1.99] for CRT-D. Blood-pressure and lipid lowering therapies were independent risk factors associated to receiving CIED, while female sex was protective.

Conclusions

Although the proportion of VT/VF was low, patients with T2DM had a higher prevalence of these conditions and increased risk for treatment with CIED compared to controls. This underlines the importance of recognizing that T2DM patients have an increased need of CIED.
Characterizing the metabolic divide: distinctive metabolites differentiating CAD-T2DM from CAD patients
Authors: Liu Yingjian , Liu Ju-e , He Huafeng , Qin Min , Lei Heping , Meng Jinxiu , Liu Chen , Chen Xiaoping , Luo Wenwei , Zhong Shilong
Published: January 2024

Objective

To delineate the metabolomic differences in plasma samples between patients with coronary artery disease (CAD) and those with concomitant CAD and type 2 diabetes mellitus (T2DM), and to pinpoint distinctive metabolites indicative of T2DM risk.

Method

Plasma samples from CAD and CAD-T2DM patients across three centers underwent comprehensive metabolomic and lipidomic analyses. Multivariate logistic regression was employed to discern the relationship between the identified metabolites and T2DM risk. Characteristic metabolites' metabolic impacts were further probed through hepatocyte cellular experiments. Subsequent transcriptomic analyses elucidated the potential target sites explaining the metabolic actions of these metabolites.

Results

Metabolomic analysis revealed 192 and 95 significantly altered profiles in the discovery (FDR < 0.05) and validation (P < 0.05) cohorts, respectively, that were associated with T2DM risk in univariate logistic regression. Further multivariate regression analyses identified 22 characteristic metabolites consistently associated with T2DM risk in both cohorts. Notably, pipecolinic acid and L-pipecolic acid, lysine derivatives, exhibited negative association with CAD-T2DM and influenced cellular glucose metabolism in hepatocytes. Transcriptomic insights shed light on potential metabolic action sites of these metabolites.

Conclusions

This research underscores the metabolic disparities between CAD and CAD-T2DM patients, spotlighting the protective attributes of pipecolinic acid and L-pipecolic acid. The comprehensive metabolomic and transcriptomic findings provide novel insights into the mechanism research, prophylaxis and treatment of comorbidity of CAD and T2DM.
Early left ventricular microvascular dysfunction in diabetic pigs: a longitudinal quantitative myocardial perfusion CMR study
Authors: Jiang Li , Yan Wei‑Feng , Zhang Lu , Xu Hua‑Yan , Guo Ying‑Kun , Li Zhen-Lin , Liu Ke-Ling , Zeng Ling-Ming , Li Yuan , Yang Zhi-Gang
Published: January 2024

Background

Microvascular pathology is one of the main characteristics of diabetic cardiomyopathy; however, the early longitudinal course of diabetic microvascular dysfunction remains uncertain. This study aimed to investigate the early dynamic changes in left ventricular (LV) microvascular function in diabetic pig model using the cardiac magnetic resonance (CMR)-derived quantitative perfusion technique.

Methods

Twelve pigs with streptozotocin-induced diabetes mellitus (DM) were included in this study, and longitudinal CMR scanning was performed before and 2, 6, 10, and 16 months after diabetic modeling. CMR-derived semiquantitative parameters (upslope, maximal signal intensity, perfusion index, and myocardial perfusion reserve index [MPRI]) and fully quantitative perfusion parameters (myocardial blood flow [MBF] and myocardial perfusion reserve [MPR]) were analyzed to evaluate longitudinal changes in LV myocardial microvascular function. Pearson correlation was used to analyze the relationship between LV structure and function and myocardial perfusion function.

Results

With the progression of DM duration, the upslope at rest showed a gradually increasing trend (P = 0.029); however, the upslope at stress and MBF did not change significantly (P > 0.05). Regarding perfusion reserve function, both MPRI and MPR showed a decreasing trend with the progression of disease duration (MPRI, P = 0.001; MPR, P = 0.042), with high consistency (r = 0.551, P < 0.001). Furthermore, LV MPR is moderately associated with LV longitudinal strain (r = − 0.353, P = 0.022), LV remodeling index (r = − 0.312, P = 0.033), fasting blood glucose (r = − 0.313, P = 0.043), and HbA1c (r = − 0.309, P = 0.046). Microscopically, pathological results showed that collagen volume fraction increased gradually, whereas no significant decrease in microvascular density was observed with the progression of DM duration.

Conclusions

Myocardial microvascular reserve function decreased gradually in the early stage of DM, which is related to both structural (but not reduced microvascular density) and functional abnormalities of microvessels, and is associated with increased blood glucose, reduced LV deformation, and myocardial remodeling.
The association between triglyceride-glucose index and its combination with obesity indicators and cardiovascular disease: NHANES 2003–2018
Authors: Dang Keke , Wang Xuanyang , Hu Jinxia , Zhang Yuntao , Cheng Licheng , Qi Xiang , Liu Lin , Ming Zhu , Tao Xinmiao , Li Ying
Published: January 2024

Background

In the American population, the relationship between the triglyceride-glucose (TyG) index and TYG combined with indicators of obesity and cardiovascular disease (CVD) and its mortality has been less well studied.

Methods

This cross-sectional study included 11,937 adults from the National Health and Nutrition Examination Survey (NHANES) 2003–2018. Cox proportional hazards model, binary logistic regression analyses, restricted cubic spline (RCS), and receiver operating characteristic (ROC) were used to analyze the relationship between TyG and its combined obesity-related indicators and CVD and its mortality. Mediation analysis explored the mediating role of glycated hemoglobin and insulin in the above relationships.

Results

In this study, except for no significant association between TyG and CVD mortality, TyG, TyG-WC, TyG-WHtR, and TyG-BMI were significantly and positively associated with CVD and CVD mortality. TyG-WHtR is the strongest predictor of CVD mortality (HR 1.66, 95% CI 1.21–2.29). The TyG index correlated better with the risk of coronary heart disease (OR 2.52, 95% CI 1.66–3.83). TyG-WC correlated best with total CVD (OR 2.37, 95% CI 1.77–3.17), congestive heart failure (OR 2.14, 95% CI 1.31–3.51), and angina pectoris (OR 2.38, 95% CI 1.43–3.97). TyG-WHtR correlated best with myocardial infarction (OR 2.24, 95% CI 1.45–3.44). RCS analyses showed that most of the above relationships were linear (P-overall < 0.0001, P-nonlinear > 0.05). Otherwise, ROC curves showed that TyG-WHtR and TyG-WC had more robust diagnostic efficacy than TyG. In mediation analyses, glycated hemoglobin mediated in all the above relationships and insulin-mediated in partial relationships.

Conclusions

TyG-WC and TyG-WtHR enhance CVD mortality prediction, diagnostic efficacy of CVD and its mortality, and correlation with some CVD over and above the current hottest TyG. TyG-WC and TyG-WtHR are expected to become more effective metrics for identifying populations at early risk of cardiovascular disease and improve risk stratification.
GLP-1 receptor agonists-SGLT-2 inhibitors combination therapy and cardiovascular events after acute myocardial infarction: an observational study in patients with type 2 diabetes
Authors: Marfella Raffaele , Prattichizzo Francesco , Sardu Celestino , Rambaldi Pier Francesco , Fumagalli Carlo , Marfella Ludovica Vittoria , La Grotta Rosalba , Frigé Chiara , Pellegrini Valeria , D’Andrea Davide , Cesaro Arturo , Calabrò Paolo , Pizzi Carmine , Antonicelli Roberto , Ceriello Antonio , Mauro Ciro , Paolisso Giuseppe
Published: January 2024

Background

Few studies explored the effect of the combination of glucose sodium-cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) on the incidence of cardiovascular events in patients with type 2 diabetes (T2D) and acute myocardial infarction (AMI).

Methods

We recruited patients with T2D and AMI undergoing percutaneous coronary intervention, treated with either SGLT-2i or GLP-1RA for at least 3 months before hospitalization. Subjects with HbA1c < 7% at admission were considered in good glycemic control and maintained the same glucose-lowering regimen, while those with poor glycemic control (HbA1c ≥ 7%), at admission or during follow-up, were prescribed either a SGLT-2i or a GLP-1RA to obtain a SGLT-2i/GLP-1RA combination therapy. The primary outcome was the incidence of major adverse cardiovascular events (MACE) defined as cardiovascular death, re-acute coronary syndrome, and heart failure related to AMI during a 2-year follow-up. After 3 months, the myocardial salvage index (MSI) was assessed by single-photon emission computed tomography.

Findings

Of the 537 subjects screened, 443 completed the follow-up. Of these, 99 were treated with SGLT-2i, 130 with GLP-1RA, and 214 with their combination. The incidence of MACE was lower in the combination therapy group compared with both SGLT-2i and GLP-1RA treated patients, as assessed by multivariable Cox regression analysis adjusted for cardiovascular risk factors (HR = 0.154, 95% CI 0.038–0.622, P = 0.009 vs GLP-1RA and HR = 0.170, 95% CI 0.046–0.633, P = 0.008 vs SGLT-2i). The MSI and the proportion of patients with MSI > 50% was higher in the SGLT-2i/GLP-1RA group compared with both SGLT-2i and GLP-1RA groups.

Interpretation

The combination of SGLT-2i and GLP-1RA is associated with a reduced incidence of cardiovascular events in patients with T2D and AMI compared with either drug used alone, with a significant effect also on peri-infarcted myocardial rescue in patients without a second event.

Trial registraition ClinicalTrials.gov ID: NCT06017544.
RORα inhibits gastric cancer proliferation through attenuating G6PD and PFKFB3 induced glycolytic activity
Authors: Wang Xiaoshan , Zhang Junyi , Wu Yuwei , Zhang Yuqing , Zhang Siyuan , Li Angqing , Wang Jian , Wang Zhengguang
Published: January 2024

Background

Glycolysis is critical for harvesting abundant energy to maintain the tumor microenvironment in malignant tumors. Retinoic acid-related orphan receptor α (RORα) has been identified as a circadian gene. However, the association of glycolysis with RORα in regulating gastric cancer (GC) proliferation remains poorly understood.

Methods

Bioinformatic analysis and retrospective study were utilized to explore the role of RORα in cell cycle and glycolysis in GC. The mechanisms were performed in vitro and in vivo including colony formation, Cell Counting Kit-8 (CCK-8), Epithelial- mesenchymal transition (EMT) and subcutaneous tumors of mice model assays. The key drives between RORα and glycolysis were verified through western blot and chip assays. Moreover, we constructed models of high proliferation and high glucose environments to verify a negative feedback and chemoresistance through a series of functional experiments in vitro and in vivo.

Results

RORα was found to be involved in the cell cycle and glycolysis through a gene set enrichment analysis (GSEA) algorithm. GC patients with low RORα expression were not only associated with high circulating tumor cells (CTC) and high vascular endothelial growth factor (VEGF) levels. However, it also presented a positive correlation with the standard uptake value (SUV) level. Moreover, the SUVmax levels showed a positive linear relation with CTC and VEGF levels. In addition, RORα expression levels were associated with glucose 6 phosphate dehydrogenase (G6PD) and phosphofructokinase-2/fructose-2,6-bisphosphatase (PFKFB3) expression levels, and GC patients with low RORα and high G6PD or low RORα and high PFKFB3 expression patterns had poorest disease-free survival (DFS). Functionally, RORα deletion promoted GC proliferation and drove glycolysis in vitro and in vivo. These phenomena were reversed by the RORα activator SR1078. Moreover, RORα deletion promoted GC proliferation through attenuating G6PD and PFKFB3 induced glycolytic activity in vitro and in vivo. Mechanistically, RORα was recruited to the G6PD and PFKFB3 promoters to modulate their transcription. Next, high proliferation and high glucose inhibited RORα expression, which indicated that negative feedback exists in GC. Moreover, RORα deletion improved fluorouracil chemoresistance through inhibition of glucose uptake.

Conclusion

RORα might be a novel biomarker and therapeutic target for GC through attenuating glycolysis.