bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Food Insecurity and Undernutrition on Frailty and Physical Functioning in Aging People With HIV in the United States
Authors: Horvat Davey Christine , Navis Brianna , Webel Allison R. , Jankowski Catherine , Oliveira Vitor H. F. , Khuu Vincent , Cook Paul F. , Erlandson Kristine M.
Published: February 2023

We conducted an observational cross-sectional study to explore whether food insecurity or undernutrition was associated with frailty or low physical functioning in aging persons with HIV (PWH). Forty-eight PWH aged 50 years and older were enrolled. Independent samples t-tests and chi-square tests were used to examine the relationship of food insecurity or undernutrition to frailty or physical function. Participants were 58.6 (±6.3) years old, 83% male, 77% White, 21% Hispanic. In total, 44% experienced food insecurity and 71% experienced undernutrition, whereas 23% were frail and 69% were prefrail. Food insecurity was associated with impaired total short physical performance battery score (p = .02), impaired balance (p = .02), slower chair rise time (p = .03), and weight loss within 12 months (p = .05). Undernutrition was related to female gender (p = .01), worse frailty (p = .04), and weaker grip strength (p = .03). In this sample of undernourished and frail PWH, strong relationships between undernutrition and frailty were observed.
Genetic determinants of pancreatitis: relevance in severe hypertriglyceridemia
Authors: Hang Shyann M.T. , Hegele Robert A. , Berberich Amanda J.
Published: February 2023

Purpose of review

Not all patients with severe hypertriglyceridemia develop acute pancreatitis. We surveyed recent literature on inter-individual genetic variation in susceptibility to pancreatitis.

Recent findings

Genetic determinants of pancreatitis include: rare Mendelian disorders caused by highly penetrant pathogenic variants in genes involved in trypsinogen activation; uncommon susceptibility variants in genes involved in trypsinogen activation, protein misfolding as well as calcium metabolism and cystic fibrosis, that have variable penetrance and show a range of odds ratios for pancreatitis; and common polymorphisms in many of the same genes that have only a small effect on risk. The role of these genetic variants in modulating pancreatitis risk in hypertriglyceridemia is unclear. However, among genetic determinants of plasma triglycerides, those predisposing to more severe hypertriglyceridemia associated with chylomicronemia appear to have higher pancreatitis risk.

Currently, among patients with severe hypertriglyceridemia, the most consistent predictor of pancreatitis risk is the triglyceride level. Furthermore, pancreatitis risk appears to be modulated by a higher genetic burden of factors associated with greater magnitude of triglyceride elevation. The role of common and rare genetic determinants of pancreatitis itself in this metabolic context is unclear.
Obesity and kidney transplantation
Authors: Chang Jae-Hyung , Mushailov Vladimir , Mohan Sumit
Published: February 2023

Purpose of review

Obesity has reached epidemic proportions in the United States. It is a risk factor for developing, among others, heart disease, stroke, type 2 diabetes, and chronic kidney disease (CKD), and thus a major public health concern and driver of healthcare costs. Although the prevalence of obesity in the CKD/end-stage kidney disease population is increasing, many obese patients are excluded from the benefit of kidney transplant based on their BMI alone. For this reason, we sought to review the experience thus far with kidney transplantation in obese patients and associated outcomes.

Recent findings

Obesity is associated with a lower rate of referral and waitlisting, and lower likelihood of kidney transplantation. Despite increased risk for early surgical complications and delayed graft function, experience from multiple centers demonstrate a clear survival benefit of transplantation over dialysis in most obese patients, and comparable graft and patient survival rates to nonobese recipients.

Data suggest that long-term transplant outcomes among obese recipients are similar to those among nonobese. Strategies to achieve pretransplant weight reduction and minimally invasive surgical techniques may further improve results of kidney transplantation in obese recipients.
Analyzing the Effects of Family Presence and Visitation Restrictions During the COVID-19 Pandemic Among Nurse Leaders and Non–Nurse Leaders
Authors: Brewer Katherine C. , Horning Melanie A. , Walker Mark S. , Ness Michelle M.
Published: February 2023

AIM

This analysis seeks to identify the effect of family presence and visitation during COVID-19 pandemic among nurses and nurse leaders.

BACKGROUND

Visitation restrictions were widespread during the initial months of the COVID-19 pandemic and were a potential source of distress for nurses. Few studies have examined sources of distress, such as visitation restrictions, among nurse leaders and non–nurse leaders.

METHODS

Secondary analysis was performed using a national survey of nurses conducted by the American Nurses Foundation.

RESULTS

More nurse leaders than nonleaders reported that nurses were involved in policy decisions/discussions and that visitation restrictions created additional burdens. There was similar level of agreement among nurse leaders and nonleaders that restrictions were not in the best interest of the patients. Many nurses reported the restrictions impacted their own well-being.

CONCLUSION

Visitation restrictions were a likely source of distress. Improvements to communication, planning, and transparency should be considered in preparation for future emergencies that may require visitation restrictions.
Physical Activity in Multiple Sclerosis: Meeting the Guidelines at the Time of the COVID-19 Pandemic
Authors: Pedullà Ludovico , Santoyo-Medina Carme , Novotna Klara , Moumdjian Lousin , Smedal Tori , Arntzen Ellen Christin , van der Linden Marietta L. , Learmonth Yvonne , Kalron Alon , Güngör Feray , Nedeljkovic Una , Kos Daphne , Jonsdottir Johanna , Coote Susan , Tacchino Andrea
Published: February 2023

Background and Purpose:

Regular physical activity (PA) helps to reduce the severity of physical and mental symptoms and improves quality of life in people with multiple sclerosis (PwMS). Based on current evidence and expert opinion, the recent multiple sclerosis guidelines recommend at least 150 minutes/week of PA. This study presents the results of a survey analyzing whether and how PwMS met the guidelines before and during the pandemic.

Methods:

We developed and disseminated an international online survey between December 2020 and July 2021, investigating changes in self-reported PA type, duration, frequency, and intensity due to the COVID-19 outbreak in PwMS with differing disability levels.

Results:

Among respondents (n = 3810), 3725 were eligible. The proportion of those who conducted at least one activity decreased with increasing disability level at both time points (pre and during). Overall 60% of respondents met the guidelines before the pandemic (mild: 64.43%; moderate: 51.53%; severe: 39.34%; χ2
(2) = 109.13, P < 0.01); a reduction of approximately 10% occurred during the pandemic in all disability groups (mild: 54.76%; moderate: 42.47%; severe: 29.48%; χ2
(2) = 109.67, P < 0.01). Respondents with higher disability participated more in physical therapy and less in walking, cycling, and running at both time points. Most respondents reported practicing PA at a moderate intensity at both time points; frequency and duration of sessions decreased as disability level increased.

Discussion and Conclusions:

The percentage of those meeting the guidelines reduced with increasing disability level and during the pandemic. PA type and intensity varied widely across the disability categories. Interventions accounting for disability level are required to enable more PwMS to reap the benefits of PA.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A415).
The sustained impact of a virtual disability education curriculum with fourth year medical students in a mandatory physical medicine and rehabilitation clerkship
Authors: Hartsgrove Caitlin , Delauter Gabrielle , Kirshblum Steven
Published: February 2023

Objective

To measure the short and long-term impact of a virtual disability education curriculum associated with a two-week mandatory physical medicine and rehabilitation (PM&R) clerkship for fourth-year medical students.

Design

A prospective pre-post intervention survey-based study measuring the impact of a virtual disability education series at 1-week and 6-month timepoints following a mandatory PM&R clerkship including eight hours of virtual didactics with an emphasis on physical disabilities. The surveys assessed the overall virtual curriculum, perceived benefit of a virtual encounter, and the long-term applicability of the information learned from the clerkship.

Results

The PM&R clerkship was effective in improving medical students’ perceived comfort and clinical knowledge regarding treatment of persons with disabilities (PWD) (p < 0.01). There were no statistical differences at the six-month timepoint, indicating sustained benefit and integration of knowledge in the long-term (p > 0.05). Additionally, 84% of students reported using the information in clinical experiences at six months.

Conclusion

The PM&R clerkship including a virtual disability education curriculum improved long-term perceived medical student comfort and knowledge of treating PWD, with a focus on those with physical disabilities. Virtual encounters with PWD are viable and impactful avenues to provide this education.
Reoperative Microsurgical Free Flap Surgery
Authors: Pu Lee L. Q. , Song Ping
Published: February 2023

Microsurgical free flap surgery has revolutionized reconstructive surgery at most academic centers worldwide. However, free flap failures still occur even in the hands of the most experienced microsurgeon. Although we have achieved a great deal of success performing microsurgical free flap reconstruction for various indications, complications from initial free flap surgery that result in reoperation remain a small, but steady percentage. Venous flap congestion is one of the most challenging conditions that result in free flap failure if not resolved promptly. It can be caused by several conditions, and salvage for venous congestion is often difficult and time consuming. Over 20 years, the senior author has encountered 2 unique situations that resulted in venous congestion of the flap requiring reoperative surgery for flap salvage or a second free flap. Several medical conditions can compromise free flap surgery and result in total flap loss. The senior author has also encountered 2 medical conditions resulting in total flap loss. However, both patients received successful second free tissue transfers when combined with unique perioperative management strategies. It is our hope that this review will highlight some unique management strategies for reoperative microsurgical free tissue transfer and serve as “lessons learned” for initial salvage procedures and a second free tissue transfer. We also hope our reoperative approach demonstrated in this review will help the future generation of microsurgeons to avoid such complications altogether so that overall outcome after microsurgical free flap surgery can further be improved.
The Impact of Breast Cancer Type, Staging, and Treatment on Vascular Complications of Immediate Free-Flap Breast Reconstruction
Authors: Talwar Ankoor A. , Mazzaferro Daniel , Morris Martin P. , Davis Harrison , Hitchner Michaela , Shulkin Jared , Christopher Adrienne N. , Broach Robyn B. , Brooks Ari D. , Serletti Joseph M.
Published: February 2023

Background

Patients with advanced cancer staging have a greater risk of developing venous thromboembolism than noncancer patients. The impact of breast cancer stage and treatment on outcomes after autologous free-flap breast reconstruction (ABR) is not well-established. The objective of this retrospective study is to determine the impact of breast cancer characteristics, such as cancer stage, hormone receptor status, and neoadjuvant treatments, on vascular complications of ABR.

Methods

A retrospective review was conducted examining patients who underwent ABR from 2009 to 2018. Breast cancer stage, cancer types, hormone receptor status, and treatments were collected in addition to demographic data. Intraoperative vascular concerns, postoperative vascular concerns, and flap loss were analyzed. Univariate analysis and fixed-effects models were used to associate breast cancer characteristics with outcomes.

Results

Neoadjuvant hormone therapy was associated with increased risk for intraoperative vascular concern (odds ratio, 1.059 [P= 0.0441]). Neoadjuvant trastuzumab was associated with decreased risk of postoperative vascular concern (odds ratio, 0.941 [P= 0.018]). Breast cancer stage, somatic genetic mutation, receptor types, neoadjuvant chemotherapy, and neoadjuvant radiation had no effect on any vascular complications of ABR.

Conclusion

Autologous free-flap breast reconstruction is a reliable reconstructive option for patients with all stages and types of breast cancer. There is potentially increased risk of intraoperative microvascular compromise in patients who have neoadjuvant hormone therapy. Trastuzumab is potentially protective against postoperative microvascular compromise. Patients should feel confident that, despite higher stage cancer, they can pursue their desired reconstructive option without fear of vascular compromise.
Outcomes Using Two Unique Methods of Immediate Implant-Based Breast Reconstruction After Nipple-Sparing Mastectomy in Ptotic Patients
Authors: Erlichman Zachary , Buro Justin , Waraich Minah , Veeramachaneni Haritha
Published: February 2023

Objective

After nipple-sparing mastectomy (NSM) and immediate implant-based reconstruction, patients with significant ptosis are at increased risk for nipple-areolar complex (NAC) necrosis. Attempts to salvage the nipple using inferior dermal pedicles have yielded unsatisfactory results. This study aims to evaluate complications using 2 unique methods of breast reconstruction using either a Wise incision with dermal infolding or batwing incision after NSM.

Materials and Methods

A retrospective chart review was conducted on all patients who underwent NSM and immediate implant reconstruction using the methods described by a single surgeon between 2016 and 2022. Outcomes were assessed by comparing average complications rates.

Result

Seventy-three reconstructions were performed after NSM in patients with ptosis. Sixteen reconstructions used a prior technique, Wise pattern with inferior dermal flap. Thirty reconstructions used the Wise incision with dermal infolding, while 27 other reconstructions used a batwing incision. For the Wise with inferior dermal flap technique, NAC necrosis occurred in 43.8%. In the cases in which the newer techniques were used, NAC necrosis occurred in 11.1% in the batwing group and 10% in the dermal infolding group. Other complications measured were within acceptable percentiles between both groups. Aesthetic outcomes were acceptable for most of the cases involving NAC necrosis.

Conclusions

A batwing pattern incision or a Wise pattern with a broad, infolded dermal pedicle is a more effective method of immediate reconstruction after NSM in patients with ptosis according to these findings. Nipple-areolar complex necrosis continues to be a major complication that is important to discuss with patients. However, these methods offer patients with ptosis the benefit of preserving a native NAC while allowing for simultaneous skin reduction during an immediate reconstruction.
Profile of psychotropic agents used in autism spectrum disorder according to comorbidities in Turkey: A 4-year evaluation
Authors: Karabacak Yurdum , Barun Sureyya , Vural İsmail Mert , Vural Elif , Iseri Elvan , Kahve Aybeniz Civan , Yilmaz Esra Şafak , Isli Fatma , Turkes Sena , Ezber Enes , Paykal Gokcen
Published: February 2023

It is known that the use of psychotropic pharmaceuticals is common in comorbidities seen in autism spectrum disorder (ASD). We have very limited knowledge about which psychotropic drugs are prescribed when comorbidities are diagnosed in patients with ASD. It is aimed to determine the profile of psychotropic agents in patients diagnosed with ASD associated with comorbidities between the ages of 0–24 in Turkey over 4 years. Data belonging to ASD in Prescription Information System (PIS) was obtained from the ‘Turkish Medicines and Medical Devices Agency’. A total of 34 066 prescriptions including 45 624 psychotropic drugs were analyzed. A total of psychotropic drugs prescribed for patients with ASD was 75.4%. The following psychotropic drugs were prescribed for the patients with ASD and its comorbidities; risperidone (28.6%), aripiprazole (13.7%), and valproic acid (11.3%) are the most preferred psychotropics. The percentage of pharmaceuticals containing psychotropic active substances in prescriptions with ASD and its comorbidities is 7.5%. This study is the first research in which psychotropics used in ASD were evaluated over a wide period and nationwide. Antipsychotics were most commonly prescribed with the diagnosis of ASD. In the presence of ASD and its comorbidities, risperidone was most frequently prescribed.
Active sinking particles: sessile suspension feeders significantly alter the flow and transport to sinking aggregates
Authors: Krishnamurthy Deepak , Pepper Rachel , Prakash Manu
Published: February 2023

Sinking or sedimentation of biological aggregates plays a critical role in carbon sequestration in the ocean and in vertical material fluxes in wastewater treatment plants. In both these contexts, the sinking aggregates are ‘active’, since they are biological hot-spots and are densely colonized by microorganisms including bacteria and sessile protists, some of which generate feeding currents. However, the effect of these feeding currents on the sinking rates, trajectories and mass transfer to these ‘active sinking particles’ has not previously been studied. Here, we use a novel scale-free vertical tracking microscope (a.k.a. gravity machine; Krishnamurthy
et al.
2020
Nat. Methods
17
, 1040–1051 (
doi:10.1038/s41592-020-0924-7
)) to follow model sinking aggregates (agar spheres) with attached protists (
Vorticella convallaria
), sinking over long distances while simultaneously measuring local flows. We find that activity due to attached
V. convallaria
causes significant changes to the flow around aggregates in a dynamic manner and reshapes mass transport boundary layers. Further, we find that activity-mediated local flows along with sinking modify the encounter and plume cross-sections of the aggregate and induce sustained aggregate rotations. Overall, our work shows the important role of biological activity in shaping the near-field flows around aggregates with potentially important effects on aggregate fate and material fluxes.
Hydrodynamic clustering of two finite-length flagellated swimmers in viscoelastic fluids
Authors: Mo Chaojie , Fedosov Dmitry A.
Published: February 2023

Clustering of flagellated microswimmers such as sperm is often mediated by hydrodynamic interactions between them. To better understand the interaction of microswimmers in viscoelastic fluids, we perform two-dimensional simulations of two swimming sheets, using a viscoelastic version of the smoothed dissipative particle dynamics method that implements the Oldroyd-B fluid model. Elasticity of sheets (stiff versus soft) defines two qualitatively different regimes of clustering, where stiff sheets exhibit a much more robust clustering than soft sheets. A formed doublet of soft sheets generally swims faster than a single swimmer, while a pair of two stiff sheets normally shows no speed enhancement after clustering. A pair of two identical swimmers is stable for most conditions, while differences in the beating amplitudes and/or frequencies between the two sheets can destroy the doublet stability. Clustering of two distinct swimmers is most stable at Deborah numbers of De =
τω
≈ 1 (
τ
is the relaxation time of a viscoelastic fluid and
ω
is the beating frequency), in agreement with experimental observations. Therefore, the clustering of two swimmers depends non-monotonically on De. Our results suggest that the cluster stability is likely a dominant factor which determines the cluster size of collectively moving flagellated swimmers.
Mechanics and optimization of undulatory locomotion in different environments, tuning geometry, stiffness, damping and frictional anisotropy
Authors: Yaqoob Basit , Rodella Andrea , Del Dottore Emanuela , Mondini Alessio , Mazzolai Barbara , Pugno Nicola M.
Published: February 2023

One of the oldest yet most common modalities of locomotion known among limbless animals is undulatory, also recognized for its stability compared to legged locomotion. Multiple forms of active mechanisms, e.g. active gait control, and passive mechanisms, e.g. body morphology and material properties, have adapted to different environments. The current research explores the passive role of body stiffness and internal losses in meeting terrain requirements. Furthermore, it addresses the influence of the environment on the resultant gait and how the interplay between various environments and body properties can lead to different speeds. We modelled undulatory locomotion in a dry friction environment where frictional anisotropy determines propulsion. We found that the body stiffness, the moment of inertia, the dry frictional coefficient ratio between normal and tangential frictional constants, and the internal damping of the body play an essential role in optimizing speed and animal adaptability to external conditions. Furthermore, we demonstrate that various known gaits like swimming, crawling and polychaete-like locomotion are achieved as a result of the interaction between body and environment parameters. Moreover, we validated the model by retrieving a corn snake's speed using data from the literature. This study demonstrates that the dependence between morphology, body material properties and environment can be exploited to design long-segmented robots to perform in specialized situations.
Detection and characterization of hybrid uropathogenic Escherichia coli strains among E. coli isolates causing community-acquired urinary tract infection
Authors: Yousefipour Mahta , Rezatofighi Seyedeh Elham , Ardakani Mohammad Roayaei
Published: February 2023

Introduction. The main aetiological agent of urinary tract infection (UTI) is

Escherichia coli

, categorized as uropathogenic

E. coli

(UPEC). The genome of UPEC shows a high degree of plasticity, which leads to the emergence of ‘intermediary strains’ with different traits from the parental pathotypes.

Gap Statement/Aim. We aimed to assess the frequency and types of the hybrid UPEC among isolates causing UTI and characterize virulence properties of these hybrid isolates molecularly and phenotypically.

Methodology. After detection of intestinal pathogenic

E. coli

(IPEC) virulence markers among 200 UPEC isolates, they were assessed for the presence of 40 virulence genes (VGs) of extraintestinal, uropathogenic and diarrhoeagenic

E. coli

, phylogenetic group typing, phenotypic traits including biofilm formation, adherence and invasion to HeLa cells, haemolysis activity and antimicrobial resistance.

Results. The analysis showed 21 (10.5 %) UPEC isolates carried enteroaggregative

E. coli

(EAEC) and enteropathogenic

E. coli

(EPEC) virulence markers. Twenty isolates carried the aggR (EAEC) and one the eae and escV genes (EPEC), which were classified as hybrid strains. The most commonly identified genes were fimH (71.5 %), fyuA (66.7 %), iutA (62 %), chuA (57.1) and traT (47.6 %). Biofilm production, adhesion and invasion were found among 17 (81), 18 (85.7) and 11 (52.4 %) hybrids, respectively. Investigation of the genetic characteristics, phylogenetic group and virulence profile of the detected hybrids revealed that they have genetic diversity and do not belong to a particular clonal lineage.

Conclusion. The present study reveals that some UPEC may carry virulence markers of IPEC pathotypes. EAEC and EPEC seem to have a greater tendency to form hybrids and cause UTI. Further studies are needed to elucidate what factors contributed to survival in the urinary tract system and facilitate infection and whether these combinations lead to an increase in pathogenicity or not.
Prediction of American Society of Anesthesiologists Physical Status Classification from Preoperative Clinical Text Narratives Using Natural Language Processing
Authors: Chung Philip , Fong Christine T. , Walters Andrew M. , Yetisgen Meliha , O’Reilly-Shah Vikas N.
Published: February 2023

Importance

Large volumes of unstructured text notes exist for patients in electronic health records (EHR) that describe their state of health. Natural language processing (NLP) can leverage this information for perioperative risk prediction.

Objective

Predict a modified American Society of Anesthesiologists Physical Status Classification (ASA-PS) score using preoperative note text, identify which model architecture and note sections are most useful, and interpret model predictions with Shapley values.

Design

Retrospective cohort analysis from an EHR.

Setting

Two-hospital integrated care system comprising a tertiary/quaternary academic medical center and a level 1 trauma center with a 5-state referral catchment area.

Participants

Patients undergoing procedures requiring anesthesia care spanning across all procedural specialties from January 1, 2016 to March 29, 2021 who were not assigned ASA VI and also had a preoperative evaluation note filed within 90 days prior to the procedure.

Exposures

Each procedural case paired with the most recent anesthesia preoperative evaluation note preceding the procedure.

Main Outcomes and Measures

Prediction of a modified ASA-PS from preoperative note text. We compared 4 different text classification models for 8 different input text snippets. Performance was compared using area under the receiver operating characteristic curve (AUROC) and area under the precision recall curve (AUPRC). Shapley values were used to explain model predictions.

Results

Final dataset includes 38566 patients undergoing 61503 procedures. Prevalence of ASA-PS was 8.81% for ASA I, 31.4% for ASA II, 43.25% for ASA III, and 16.54% for ASA IV-V. The best performing models were the BioClinicalBERT model on the truncated note task (macro-average AUROC 0.845) and the fastText model on the full note task (macro-average AUROC 0.865). Shapley values reveal human-interpretable model predictions.

Conclusions and Relevance

Text classification models can accurately predict a patient’s illness severity using only free-form text descriptions of patients without any manual data extraction. They can be an additional patient safety tool in the perioperative setting and reduce manual chart review for medical billing. Shapley feature attributions produce explanations that logically support model predictions and are understandable to clinicians.
Assessment of a 60-biomarker health surveillance panel (HSP) on whole blood from remote sampling devices by targeted LC/MRM-MS and discovery DIA-MS analysis
Authors: Whelan Stephen A. , Hendricks Nathan , Dwight Zachary L. , Fu Qin , Moradian Annie , Van Eyk Jennifer E. , Mockus Susan M.
Published: February 2023

Telehealth, accessing healthcare and wellness remotely, should be a cost effective and efficient way for individuals to receive care. The convenience of having a robust remote collection device for blood tests will facilitate access to precision medicine and healthcare. Herein, we tested a 60-biomarker health surveillance panel (HSP), containing 35 FDA/LDT assays and covering at least 14 pathological states, on 8 healthy individuals’ ability to collect their own capillary blood from a lancet finger prick and directly compared to the traditional phlebotomist venous blood and plasma collection methods. Samples were quantitatively analyzed by a liquid chromatography-multiple reaction monitoring-mass spectrometry method targeting 114 peptides representing 60 HSP proteins and by a data-independent acquisition mass spectrometry discovery method, resulting in up to 3,811 protein identifications including 122 FDA approved biomarkers. The >90% similarity between the three biofluids indicate that remote collection devices are a viable option for personal blood proteome biosignature stratification and health analysis.
Longitudinal changes in IgG-type SARS-CoV-2 antibody titers after COVID-19 vaccination and, prominent increase in antibody titers when infected after vaccination
Authors: Kusunoki Hiroshi , Ohkusa Michiko , Iida Rie , Saito Ayumi , Kawahara Mikio , Ekawa Kazumi , Kato Nozomi , Yamasaki Keita , Motone Masaharu , Shimizu Hideo
Published: February 2023

[Objective]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody titers level and duration of elevated levels are considered important indicators for confirming the efficacy of coronavirus disease 2019 (COVID–19) vaccines. The objective of this study was to demonstrate the changes in antibody titers after the second and third doses of the COVID–19 vaccine, and to determine the antibody titers in cases of spontaneous infection with SARS-CoV-2 after vaccination.

[Materials and Methods]

From June 2021 to February 2023, IgG-type SARS-CoV-2 antibody titers were measured in 127 participants, including 74 outpatients and 53 staffs, at the Osaka Dental University Hospital (65 males and 62 females, mean age 52.3 ± 19.1 years).

[Results]

Consistent with previous reports, the SARS-CoV-2 antibody titer decreased with time, not only after the second dose, but also after the third dose of the vaccine if there is no spontaneous COVID–19 infection. We also confirmed that the third booster vaccination was effective in increasing the antibody titer.

21 cases of natural infections were observed after administering two or more doses of the vaccine. 13 of these patients had post-infection antibody titers exceeding 40,000 AU/mL, and some cases continued to maintain antibody titers in the tens of thousands of AU/mL even after more than 6 months had passed since infection.

[Conclusion]

The rise in and duration of antibody titers against SARS-CoV-2 are considered important indicators for confirming the efficacy of novel COVID–19 vaccines. A longitudinal follow-up of antibody titers after vaccination in larger studies is warranted.
A qualitative exploration of the psychosocial factors affecting antiretroviral therapy adherence among HIV infected young adults in Eastern Uganda
Authors: Twekambe Easton , Epuitai Joshua , Kawala Enid Kagoya , Namanya Vian , Ayikobua Emmanuel Tiyo , Obakiro Samuel Baker , Napyo Agnes , Kiyimba Kenedy
Published: February 2023

Background

The use of anti-retroviral therapy (ART) in management and prevention of HIV/AIDS epidemic is a globally accepted strategy. In Uganda, despite the efforts to increase uptake of ART, adherence remains a huge challenge. This study, therefore, was conducted to explore psychosocial factors which influenced non-adherence to ART among young adults in Eastern Uganda.

Methods

This was an exploratory qualitative study conducted at the ART clinic of Mbale Regional Referral Hospital. A total of 35 in-depth interviews with young adults who had defaulted from taking ART drugs were conducted. Also, five key-informant interviews were conducted among the healthcare workers in the hospital. Thematic analysis approach was followed to analyze the data using NVIVO software (version 11).

Results

Non-adherence to ART was perceived to result from poor social support, poor coping mechanisms, unpredictable and busy work schedules, poverty, incompatible religious beliefs and practices. The poor social support factors included poor caregiver support, non-disclosure of HIV status, stigma and discrimination while factors linked to poor coping mechanisms included alcohol and substance abuse, psychosocial stress, depression, forgetfulness and feelings of self-hatred. Poverty limits access to treatment and basic needs including transportation to health facilities. Long waiting time at the ART clinic was the healthcare system factor which was thought to cause non-adherence among young adults.

Conclusion

Non-adherence to ART at Mbale Regional Referral Hospital in Eastern Uganda is attributed to various psychosocial factors such as stigma and discrimination, mental health problems, work-related problems and low socio-economic status, religious beliefs and poor knowledge, long waiting time in ART clinic and poor family support. Psychosocial counselling should therefore target the perceived causes of ART non-adherence so as to improve the adherence /compliance to ART.
Distribution of Obesity-related Health Outcomes Across the Urban-Rural Commuting Area in Mississippi, Alabama, Louisiana, and Georgia
Authors: Ahmmad Roungu , Faruque Fazlay
Published: February 2023

Obesity-related chronic diseases are still major public health concerns in the United States, particularly in the south. The purpose of this study is to examine the association between obesity-related chronic diseases and rurality/urbanicity in the four Deep South states-Mississippi, Alabama, Louisiana and Georgia. We used publicly available Zip Code level approximations of USDA-developed RUCA Code for rurality designation and Zip Code level PLACES data developed by CDC for selected obesity-related health outcomes-Asthma, Obesity, Chronic Obstructive Pulmonary Disease, Coronary Heart Disease, Diabetes, High Cholesterol, Stroke and High Blood Pressure. This study employed the random forest method, partial least squares discriminant analysis and multinomial logistic regression to investigate the association between selected health outcomes and degrees of rurality. There are significant differences in the prevalence of Asthma, Obesity, COPD and Stroke between Metropolitan and small towns or complete rural areas. On the other hand, while considering Micropolitan and small towns or complete rural areas, Asthma, Obesity, COPD, Diabetes, High Cholesterol and Stroke show significant differences in prevalence. This study revealed disparities in health outcomes per RUCA Codes, which can be useful to target specific geographic areas for appropriate interventions.
Long-Term Comparison of Cilostazol versus Clopidogrel in Secondary Prevention of Noncardioembolic Ischemic Stroke
Authors: Lee Yu Jeong , Je Nam Kyung
Published: February 2023

Background

Cilostazol is a widely used antiplatelet drug for secondary stroke prevention in Asia, but its comparison with clopidogrel, another commonly used antiplatelet drug, is not well understood. This study aims to investigate the effectiveness and safety of cilostazol compared to clopidogrel for the secondary prevention of noncardioembolic ischemic stroke.

Methods

A retrospective comparative effectiveness research analysis was conducted using 1:1 propensity-matched data from insured individuals between Jan 1, 2012, and Dec 31, 2019. The study used administrative claims data in Health Insurance and Review Assessment in Korea. Patients with diagnosis codes for ischemic stroke without atrial fibrillation, heart failure, valvular diseases, and myocardial infarction were included and divided into two groups, those receiving cilostazol and those receiving clopidogrel. The primary outcome was a recurrent ischemic stroke. Secondary outcomes included all-cause death, myocardial infarction, hemorrhagic stroke, and a composite of these outcomes. The safety outcome was major gastrointestinal bleeding.

Results

A total of 4754 patients were included in the propensity-matched population, with a median age of 67 years, 3080 (40.7%) were male, and 4480 (59.3%) were female. The study found no statistically significant difference in recurrent ischemic stroke (cilostazol group vs clopidogrel group, 2.7% vs 3.2%; 95% CI, 0.62-1.21), the composite outcome of recurrent ischemic stroke, all-cause death, myocardial infarction, and hemorrhagic stroke (5.1% vs 5.5%; 95% CI 0.75-1.22), and major gastrointestinal bleeding (1.3% vs 1.5%; 95% CI 0.57-1.47) between cilostazol and clopidogrel use patients. In subgroup analysis, cilostazol was associated with a lower incidence of recurrent ischemic stroke compared to clopidogrel in hypertensive patients (2.5% vs 3.9%; interaction P = 0.41).

Conclusions

This real-world, comparative effectiveness research study suggests that cilostazol is effective and safe for noncardioembolic ischemic stroke and may be associated with better effectiveness in hypertensive patients compared to clopidogrel over an 8-year period.
The Alfin-like transcription factor GmAlfin09 regulates endoplasmic reticulum stress in soybean via a peroxidase GmPRDX6
Authors: Chen Kai , Guo Dongdong , Yan Jiji , Zhang Huijuan , He Zhang , Wang Chunxiao , Tang Wensi , Zhou Yongbin , Chen Jun , Xu Zhaoshi , Ma Youzhi , Chen Ming
Published: February 2023

Soybean is a valuable oil crop cultivated throughout the world, but also highly susceptible to environmental stressors. The development of approaches to enhancing soybean stress resistance is thus vital to improving yields. In prior studies, Alfin has been shown to serve as an epigenetic regulator of plant growth and development. No studies of Alfin have yet been reported in soybean, however. In this study, the endoplasmic reticulum (ER) stress- and reactive oxygen species (ROS)-related transcription factor GmAlfin09 was identified. Screening of genes co-expressed withGmAlfin09unexpectedly led to the identification of the peroxidase GmPRDX6. Further analyses revealed that bothGmAlfin09andGmPRDX6were responsive to ER stress, with GmPRDX6 localizing to the ER under stress. Promoter binding experiments confirmed the ability of GmAlfin09 to directly bind theGmPRDX6promoter. WhenGmAlfin09andGmPRDX6were overexpressed in soybean, enhanced ER stress resistance and decreased ROS levels were observed. Together, these findings suggest that GmAlfin09 can promote the upregulation ofGmPRDX6, which subsequently localizes to the ER, reduced ROS levels, promotes ER homeostasis, and helps ensure the normal growth of soybean even under ER stress. This study highlights a novel genetic target for the future molecular breeding of stress-resistant soybean cultivars.

HIGHLIGHT

GmAlfin09 can increase the expression ofGmPRDX6to reduce ROS level under ER stress.
Parental body mass index and offspring childhood body size and eating behaviour: causal inference via parental comparisons and extended children of twins structural equation modelling
Authors: Bond Tom A , McAdams Tom A , Warrington Nicole M , Hannigan Laurie J , Eilertsen Espen Moen , Ayorech Ziada , Torvik Fartein A , Smith George Davey , Lawlor Deborah A , Ystrøm Eivind , Havdahl Alexandra , Evans David M
Published: February 2023

Background

The intergenerational transmission of obesity-related traits could propagate an accelerating cycle of obesity, if parental adiposity causally influences offspring adiposity via intrauterine or periconceptional mechanisms. We aimed to establish whether associations between parental peri-pregnancy body mass index (BMI) and offspring birth weight (BW), BMI until 8 years and 8-year eating behaviour are due to genetic confounding.

Methods

We used data from the Norwegian Mother, Father and Child Cohort Study and the Medical Birth Registry of Norway. We compared the strength of the associations of maternal versus paternal BMI with offspring outcomes, and used an extended children of twins structural equation model (SEM) to quantify the extent to which associations were due to genetic confounding (n = 17001 to 85866 children).

Findings

Maternal BMI was more strongly associated than paternal BMI with offspring BW, but the maternal-paternal difference decreased for offspring BMI after birth. Greater parental BMI was associated with obesity-related offspring eating behaviours. SEM results indicated that genetic confounding did not explain the association between parental BMI and offspring BW, but explained the majority of the association with offspring BMI from 6 months onwards. For 8-year BMI, genetic confounding explained 79% (95% CI: 62%, 95%) of the covariance with maternal BMI and 94% (95% CI: 72%, 113%) of the covariance with paternal BMI.

Interpretation

We found strong evidence that parent-child BMI associations are primarily due to genetic confounding, arguing against a strong causal effect of maternal or paternal adiposity on childhood adiposity via intrauterine or periconceptional mechanisms.
Acquisition and Clearance Dynamics ofCampylobacterin Children in Low- and Middle-Income Countries
Authors: Chen Dehao , Havelaar Arie H. , Platts-Mills James A. , Yang Yang
Published: February 2023

Background

The burden ofCampylobacterinfection is high in children under five years of age in low- and middle-income countries (LMIC), but its acquisition and clearance process is understudied due to scarcity of longitudinal data. We aim to quantify this process using a statistical modeling approach, leveraging data from a multi-nation study.

Methods

Motivated by the MAL-ED study in which children from eight low- and middle- income countries were followed up for enteric infections during their first two years of life, we developed a two-stage Markov model to compare the dynamics of acquisition and clearance ofCampylobacterin children across countries and to explore antibiotic effectiveness onCampylobacterclearance. This model was validated using simulations and applied to the longitudinal data from MAL-ED.

Findings

The clearance rate was higher than the acquisition rate at most sites and times, but the temporal trend of these rates varied across countries. ForCampylobacter jejuni/coli, clearance was faster than acquisition under two years of age at all sites. ForCampylobacterspp., the acquisition rate surpassed the clearance rate in the second half of the first year in Bangladesh, Pakistan and Tanzania, leading to high prevalence in these countries. Bangladesh had the shortest (28 and 57 days) while Brazil had the longest (328 and 306 days) mean times to acquisition forCampylobacterspp. andC. jejuni/coli, respectively. South Africa had the shortest (10 and 8 days) while Tanzania had the longest (53 and 41 days) mean times to clearance forCampylobacterspp. andC. jejuni/colrespectively. The use of macrolides was associated with accelerated clearance ofC. jejuni/coliin Bangladesh and Peru and ofCampylobacterspp. in Bangladesh and Pakistan. The use of fluoroquinolones showed statistically meaningful effectiveness only in Bangladesh but for bothC. jejuni/coliandCampylobacterspp.

Interpretation

Higher burden ofCampylobacterinfection was mainly driven by high acquisition rate that was close to or surpassing the clearance rate. Acquisition usually peaked in 11-17 months in the LMIC setting, indicating the importance of targeting the first year of life for effective intervention.

Funding

Bill & Melinda Gates Foundation.
Diabetes-related Distress and the Association to Hypertension and Cardiovascular Disease Among Individuals Living with Type 2 Diabetes in Rural areas in Vietnam
Authors: Sahl Amalie Sophie , Khong Thi Diep , Nguen Duc Thanh , Huyen Dieu , Søndergaard Jens , Nielsen Janni , Bygbjerg Ib Christian , Gammeltoft Tine , Meyrowitsch Dan W.
Published: February 2023

Objective

The prevalence of diabetes has been rising in rural areas of Vietnam over the last years to the extend where it has become a public health burden. Individuals with diabetes-related distress (DRD) is in greater risk of adverse health outcomes e.g. lower blood sugar control and polypharmacy. The objective of this study is to assess the association between hypertension and cardiovascular disease (CVD) and the occurrence of DRD among individuals with type 2 diabetes (T2D) in rural areas of Vietnam.

Method

This is a cross-sectional study of 806 individuals who had been receiving treatment for T2D at a district hospital in the northern Vietnamese province Thai Binh. Based on self-reported data DRD was assessed through Problem Areas in Diabetes scale 5 (PAID5) and defined as a score of 8 or above. The occurrence of the comorbid conditions hypertension and CVD were self-reported.

Results

Among 806 individuals with T2D 37.7% of the men and 62.3% of the women presented with DRD. Out of the total group 35.6% reported hypertension, 7.3% reported CVD and 21.2% reported a combination of hypertension and CVD. The results of the multivariate analyses showed that the odds ratio of DRD was significantly higher (OR=1.67, CI95: 1.11-2.52) in the group who reported a combination of hypertension and CVD.

Conclusion

Among individuals with T2D in rural areas of Vietnam there is an increased risk of DRD if a combination of hypertension and cardiovascular disease is also present. Hence, considering diabetes-related comorbidities can be useful in order to successfully identify individuals in risk of DRD.
Supervised exercise training in patients with cancer during anthracycline-based chemotherapy to mitigate cardiotoxicity - a randomized controlled trial.
Authors: Schneider Caroline , Ryffel Christoph , Manuela Rabaglio , Suter Thomas M. , Campbell Kristin L , Eser Prisca , Wilhelm Matthias
Published: February 2023

Background Exercise training (ET) has been shown to mitigate cardiotoxicity of anthracycline-based chemotherapies (AC) in animal models. Data from randomized controlled trials in patients with cancer are sparse. Methods Patients with breast cancer or lymphoma receiving AC were recruited from four cancer centres and randomly assigned to three months supervised ET during (EXduringAC) or after (EXpostAC) AC. All patients were counselled on physical activity (PA) and PA was objectively measured with an activity tracker with PA feedback option. Primary endpoint was change in left ventricular global longitudinal strain (GLS) between baseline and AC completion (AC-end) assessed by transthoracic 2D echocardiography. Secondary endpoints were change in high sensitivity Troponin T (hsTnT) and NT-pro-brain natriuretic peptide (NT-proBNP) between baseline and AC-end. Exploratory analyses were performed at 6 months (follow-up). Primary and exploratory analysis were performed by linear mixed models and robust linear models, respectively. Results One-hundred-and-forty-three patients were eligible for the study. Fifty-seven patients (median age 47 [1st and 3rd quartiles 38, 57] years; 95% women) consented to participate, of whom 28 and 29 patients were randomized to the EXduringAC and EXpostAC group, respectively. GLS deteriorated in both study groups from baseline to AC-end with 7.4% and 6.2% relative increase in EXduringAC and EXpostAC, respectively, and hsTnT and NT-proBNP significantly increased in both groups, without difference between groups for any parameter. Duration of moderate-to-vigorous PA (MVPA) was also similar between groups with a median of 33 [26, 47] min/day and 32 [21, 59] min/day in the EXduringAC and EXpostAC group, respectively. In the robust linear model including the pooled patient population, MVPA was significantly associated with a more negative GLS and lesser increase in hsTnT. Conclusion In physically active patients with cancer receiving AC, supervised ET during chemotherapy was not superior to PA advice and tracker monitoring only to mitigate cardiotoxicity. Objectively measured PA was inversely related to markers of LV function and myocardial injury.