bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of Cool-Season Snowfall Forecasts at a High-Elevation Site in Utah’s Little Cottonwood Canyon
Authors: Pletcher Michael D. , Veals Peter G. , Wessler Michael E. , Church David , Harnos Kirstin , Correia James , Chase Randy J. , Steenburgh W. James
Published: July 2024

Producing a quantitative snowfall forecast (QSF) typically requires a model quantitative precipitation forecast (QPF) and snow-to-liquid ratio (SLR) estimate. QPF and SLR can vary significantly in space and time over complex terrain, necessitating fine-scale or point-specific forecasts of each component. Little Cottonwood Canyon (LCC) in Utah’s Wasatch Range frequently experiences high-impact winter storms and avalanche closures that result in substantial transportation and economic disruptions, making it an excellent testbed for evaluating snowfall forecasts. In this study, we validate QPFs, SLR forecasts, and QSFs produced by or derived from the Global Forecast System (GFS) and High-Resolution Rapid Refresh (HRRR) using liquid precipitation equivalent (LPE) and snowfall observations collected during the 2019/20–2022/23 cool seasons at the Alta–Collins snow-study site (2945 m MSL) in upper LCC. The 12-h QPFs produced by the GFS and HRRR underpredict the total LPE during the four cool seasons by 33% and 29%, respectively, and underpredict 50th, 75th, and 90th percentile event frequencies. Current operational SLR methods exhibit mean absolute errors of 4.5–7.7. In contrast, a locally trained random forest algorithm reduces SLR mean absolute errors to 3.7. Despite the random forest producing more accurate SLR forecasts, QSFs derived from operational SLR methods produce higher critical success indices since they exhibit positive SLR biases that offset negative QPF biases. These results indicate an overall underprediction of LPE by operational models in upper LCC and illustrate the need to identify sources of QSF bias to enhance QSF performance.

Significance Statement

Winter storms in mountainous terrain can disrupt transportation and threaten life and property due to road snow and avalanche hazards. Snow-to-liquid ratio (SLR) is an important variable for snowfall and avalanche forecasts. Using high-quality historical snowfall observations and atmospheric analyses, we developed a machine learning technique for predicting SLR at a high mountain site in Utah’s Little Cottonwood Canyon that is prone to closure due to winter storms. This technique produces improved SLR forecasts for use by weather forecasters and snow-safety personnel. We also show that current operational models and SLR techniques underforecast liquid precipitation amounts and overforecast SLRs, respectively, which has implications for future model development.
Effects of temperature gradient on functional fruit traits: an elevation-for-temperature approach
Authors: Gómez-Devia Laura , Nevo Omer
Published: July 2024

Fruit traits mediate animal-plant interactions and have to a large degree evolved to match the sensory capacities and morphology of their respective dispersers. At the same time, fruit traits are affected by local environmental factors, which may affect frugivore-plant trait match. Temperature has been identified as a major factor with a strong effect on the development of fruits, which is of serious concern because of the rising threat of global warming. Nonetheless, this primarily originates from studies on domesticated cultivars in often controlled environments. Little is known on the effect of rising temperatures on fruit traits of wild species and the implications this could have to seed dispersal networks, including downstream consequences to biodiversity and ecosystem functioning. In a case study of five plant species from eastern Madagascar, we addressed this using the elevation-for-temperature approach and examined whether a temperature gradient is systematically associated with variation in fruit traits relevant for animal foraging and fruit selection. We sampled across a gradient representing a temperature gradient of 1.5–2.6 °C, corresponding to IPCC projections. The results showed that in most cases there was no significant effect of temperature on the traits evaluated, although some species showed different effects, particularly fruit chemical profiles. This suggests that in these species warming within this range alone is not likely to drive substantial changes in dispersal networks. While no systemic effects were found, the results also indicate that the effect of temperature on fruit traits differs across species and may lead to mismatches in specific animal-plant interactions.
Peripheral perfusion index as a predictor of reintubation in critically ill surgical patients
Authors: Abougabal Ayman , Hasanin Ahmed , Abdel-Fatah Marwa , Mostafa Maha , Ismail Ahmed A. , Habib Sara
Published: July 2024

Purpose

We aimed to evaluate the ability of the peripheral perfusion index (PPI) to predict reintubation of critically ill surgical patients.

Methods

This prospective observational study included mechanically ventilated adults who were extubated after a successful spontaneous breathing trial (SBT). The patients were followed up for the next 48 h for the need for reintubation. The heart rate, systolic blood pressure, respiratory rate, peripheral arterial oxygen saturation (SpO2), and PPI were measured before-, at the end of SBT, 1 and 2 h postextubation. The primary outcome was the ability of PPI 1 h postextubation to predict reintubation using area under the receiver operating characteristic curve (AUC) analysis. Univariate and multivariate analyses were performed to identify predictors for reintubation.

Results

Data from 62 patients were analysed. Reintubation occurred in 12/62 (19%) of the patients. Reintubated patients had higher heart rate and respiratory rate; and lower SpO2 and PPI than successfully weaned patients. The AUC (95%confidence interval) for the ability of PPI at 1 h postextubation to predict reintubation was 0.82 (0.71–0.91) with a negative predictive value of 97%, at a cutoff value of ≤ 2.5. Low PPI and high respiratory rate were the independent predictors for reintubation.

Conclusion

PPI early after extubation is a useful tool for prediction of reintubation. Low PPI is an independent risk factor for reintubation. A PPI > 2.5, one hour after extubation can confirm successful extubation.
The relationship between uric acid and bone mineral density in the intermediate stage of CKD 1–3
Authors: Yang Ruiling , Ding Ning , Qin Jiao , Peng Hongchun
Published: July 2024

Background

Some studies have suggested that uric acid has antioxidant properties that can prevent bone loss, but the relationship between uric acid and bone mineral density is controversial. The aim of this study was to investigate the relationship between UA and BMD in patients with CKD stage 1–3.

Methods

We extracted 13,047 participants from the NHANES database, including 7342 male subjects and 5705 female subjects. Weighted multiple linear regression analysis was used to investigate the correlation between UA and BMD in patients with CKD stages 1–3.

Results

In patients with CKD stage 1–3, UA was significantly correlated with BMD. In the male group, UA was positively associated with BMD (β, 7.94 [95%CI, 4.95, 10.94]). In the female group, there was a negative relationship between them (β, -5.33 [95%CI, -8.77, -1.89]). The relationship between UA and BMD in male group showed an inverted U-shaped curve, and UA was positively correlated before 6.1 mg/dl and negatively correlated after 6.1 mg/dl. The relationship was basically negative in the female group.

Conclusions

For the patients with CKD stage 1–3, the relationship between UA and BMD showed an inverted U-shaped curve in the males, while the relationship was largely negative in the females.
A safe and effective protocol for postdilution hemofiltration with regional citrate anticoagulation
Authors: Dimski Thomas , Brandenburger Timo , Vollmer Christian , Kindgen-Milles Detlef
Published: July 2024

Background

Regional citrate anticoagulation (RCA) is recommended during continuous renal replacement therapy. Compared to systemic anticoagulation, RCA provides a longer filter lifespan with the risk of metabolic alkalosis and impaired calcium homeostasis. Surprisingly, most RCA protocols are designed for continuous veno-venous hemodialysis or hemodiafiltration. Effective protocols for continuous veno-venous hemofiltration (CVVH) are rare, although CVVH is a standard treatment for high-molecular-weight clearance. Therefore, we evaluated a new RCA protocol for postdilution CVVH.

Methods

This is a monocentric prospective interventional study to evaluate a new RCA protocol for postdilution CVVH. We recruited surgical patients with stage III acute kidney injury who needed renal replacement therapy. We recorded dialysis and RCA data and hemodynamic and laboratory parameters during treatment sessions of 72 h. The primary endpoint was filter patency at 72 h. The major safety parameters were metabolic alkalosis and severe hypocalcemia at any time.

Results

We included 38 patients who underwent 66 treatment sessions. The mean filter lifespan was 66 ± 12 h, and 44 of 66 (66%) filters were patent at 72 h. After censoring for non-CVVH-related cessation of treatment, 83% of all filters were patent at 72 h. The delivered dialysis dose was 28 ± 5 ml/kgBW/h. The serum levels of creatinine, urea and beta2-microglobulin decreased significantly from day 0 to day 3. Metabolic alkalosis occurred in one patient. An iCa++ below 1.0 mmol/L occurred in four patients. Citrate accumulation did not occur.

Conclusions

We describe a safe, effective, and easy-to-use RCA protocol for postdilution CVVH. This protocol provides a long and sustained filter lifespan without serious adverse effects. The risk of metabolic alkalosis and hypocalcemia is low. Using this protocol, a recommended dialysis dose can be safely administered with effective clearance of low- and middle-molecular-weight molecules.

Trial registration

The study was approved by the medical ethics committee of Heinrich-Heine University Duesseldorf (No. 2018-82KFogU). The trial was registered in the local study register of the university (No: 2018044660) on 07/04/2018 and was retrospectively registered at ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT03969966) on 31/05/2019.
Cooperative housing under a grant-of-use in Catalonia and health: pre-post analysis
Authors: Reyes Alexia , Macaya Munell Irene , Borrell Carme , Carmezim Correia Joao Pedro , Fernández Ana , Vásquez-Vera Constanza , Pérez Katherine , Carrere Juli , Daví Lali , Novoa Ana M.
Published: July 2024

Background

Housing is considered a social determinant of health. In Catalonia and Spain, ensuring affordable housing is challenging and cooperative housing under a grant-of-use emerges as an alternative, challenging traditional housing models. This study aims to quantify its impact on health before and after moving to the cooperative house.

Methods

A longitudinal study of individuals in cooperative housing projects in Catalonia (July 2018-April 2023) was conducted. Data, including sociodemographic, housing information, and health-related details, were collected through baseline and follow-up surveys.

Results

Seventy participants (42 women, 28 men) showed positive changes in housing conditions during follow-up. Improved perceptions of health, mental health, and social support were observed. Despite limitations in sample size and short follow-up, initial findings suggest improvements in health.

Conclusions

Cooperative housing under a grant-of-use in Catalonia appears promising for improving health and living conditions. Further research is warranted to explore its full potential as an alternative amid housing challenges in the region.
The incidence of fractures in children under two years of age: a systematic review
Authors: Rosendahl Karen , de Horatio Laura Tanturri , Habre Celine , Shelmerdine Susan C. , Patsch Janina , Kvist Ola , Lein Regina K. , Plut Domen , Enoksen Edvard J. , Avenarius Rien , Laborie Lene B. , Augdal Thomas A. , Simoni Paolo , van Rijn Rick R. , Offiah Amaka C. ,   on behalf of the European Society of Paediatric Radiology (ESPR) Musculoskeletal and Child Abuse Task Forces
Published: July 2024

Background

Epidemiological research on fractures in children under the age of two is of great importance to help understand differences between accidental and abusive trauma.

Objective

This systematic review aimed to evaluate studies reporting on the incidence of fractures in children under two years of age, excluding birth injuries. Secondary outcome measures included fracture location, mechanisms of injury and fracture characteristics.

Methods

A systematic literature review (1946 to February 7th 2024), including prospective and retrospective cohort studies and cross-sectional cohort studies, was performed. Studies including children from other age groups were included if the actual measures for those aged 0–2 years could be extracted. We also included studies restricted to infants. Annual incidence rates of fractures were extracted and reported as the main result. Critical appraisal of was performed using the Appraisal tool for Cross-Sectional Studies.

Results

Twelve moderate to good quality studies met eligibility criteria, of which seven were based on data from medical records and five were registry studies. Studies investigated different aspects of fractures, making comprehensive synthesis challenging. There was an overall annual fracture incidence rate of 5.3 to 9.5 per 1,000 children from 0–2 years of age; with commonest sites being the radius/ulna (25.2–40.0%), followed by tibia/fibula (17.3–27.6%) and the clavicle (14.6–14.8%) (location based on 3 studies with a total of 407 patients). In infants, the reported incidence ranged between 0.7 to 4.6 per 1,000 (based on 3 studies), with involvement of the clavicle in 22.2% and the distal humerus in 22.2% of cases (based on 1 study). Only a single metaphyseal lesion was reported (proximal humerus of an 11-month-old infant). Fracture mechanisms were detailed in four studies, with fall from chair, bed, table, own height or fall following indoor activities causing 50–60% of fractures.

Conclusions

There is a paucity of good quality data on fracture incidence in children under the age of two. Larger, prospective and unbiased studies would be helpful in determining normal pattern of injuries, so that differences from abusive trauma may be better understood.
Association between carpal height ratio and ulnar variance in normal wrist radiography
Authors: AR Altamimi Anas , Gharaibeh Monther A. , Shokor Muntaser Abu , Dawod Moh’d S. , Alswerki Mohammad N. , Al-Odat Omar M. , Elkhaldi Raghda H.
Published: July 2024

Introduction

The wrist joint is a complex anatomical structure, and various radiographic parameters are utilized to assess its normal alignment and orientation. Among these parameters are carpal height ratio (CHR) and ulnar variance (UV). Previous literature has indicated that factors such as age and gender may influence these parameters; However, there is a lack of studies investigating these differences specifically in the Middle East or Jordan. Additionally, no prior research has explored the relationship between UV and CHR. Therefore, the objective of this study is to investigate these critical radiological parameters and their associations.

Methodology

A cross-sectional study design was employed, wherein a total of 385 normal wrist X-rays were reviewed, and CHR and UV were measured. Intra-observer and inter-observer reliability assessments were conducted to ensure the consistency and accuracy of measurements. Additionally, the association between UV and CHR was measured and plotted for further analysis.

Results

In our study, the mean CHR was 0.5 (range: 0.4 to 1.5), and the mean UV was − 0.3 mm (range: -5.8 mm to 4.1 mm). We found a significant negative correlation between CHR and age (p < 0.05). No significant gender differences were observed in UV and CHR. Additionally, a weak positive correlation was found between UV and CHR (Pearson correlation coefficient = 0.13, p = 0.01; adjusted R2 = 0.014, p = 0.02).

Conclusion

Age correlated significantly with a decline in carpal height ratio. Additionally, ulnar variance had a week positive yet significant correlation with carpal height ratio.

Level of evidence

Cross-sectional study, Level III.
Fully ambulatory robotic single anastomosis duodeno-ileal bypass (SADI): 40 consecutive patients in a single tertiary bariatric center
Authors: Studer Anne-Sophie , Atlas Henri , Belliveau Marc , Sleiman Amir , Deffain Alexis , Garneau Pierre Y , Pescarus Radu , Denis Ronald
Published: July 2024

Background

Single Anastomosis Duodeno-Ileal bypass (SADI) is becoming a key option as a revision procedure after laparoscopic sleeve gastrectomy (LSG). However, its safety as an ambulatory procedure (length of stay < 12 h) has not been widely described.

Methods

A prospective bariatric study of 40 patients undergoing SADI robotic surgery after LSG with same day discharge (SDD), was undertaken in April 2021. Strict inclusion and exclusion criteria were applied and the enhanced recovery after bariatric surgery protocol was followed. Anesthesia and robotic procedures were standardized. Early follow-up (30 days) analyzed postoperative (PO) outcomes.

Results

Forty patients (37 F/3 M, mean age: 40.3yo), with a mean pre-operative BMI = 40.5 kg/m2 were operated. Median time after LSG was 54 months (21–146). Preoperative comorbidities included: hypertension (n = 3), obstructive sleep apnea (n = 2) and type 2 diabetes (n = 1). Mean total operative time was 128 min (100–180) (mean robotic time: 66 min (42–85)), including patient setup. All patients were discharged home at least 6 h after surgery. There were four minor complications (10%) and two major complications (5%) in the first 30 days postoperative (one intrabdominal abscess PO day-20 (radiological drainage and antibiotic therapy) and one peritonitis due to duodenal leak PO day-1 (treated surgically)). There were six emergency department visits (15%), readmission rate was 5% (n = 2) and reintervention rate was 2.5% (n = 1) There was no mortality and no unplanned overnight hospitalization.

Conclusions

Robotic SADI can be safe for SDD, with appropriate patient selection, in a high-volume center.
The association between the neutrophil-to-lymphocyte ratio and type 2 diabetes mellitus: a cross-sectional study
Authors: Chen Hai long , Wu Chunwei , Cao Lei , Wang Ruolin , Zhang Tian yang , He Ze
Published: July 2024

Background

Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease often accompanied by low-grade inflammation. Recently, the neutrophil-to-lymphocyte ratio (NLR) has garnered researchers’ interest as an emerging inflammation biomarker. This study aimed to comprehensively explore the relationship between NLR and T2DM using the National Health and Nutrition Examination Survey (NHANES) database.

Method

We employed a cross-sectional study design to analyze data from five NHANES cycles from 2007 to 2016, excluding individuals with incomplete data. This study utilized a weighted logistic regression model, subgroup analyses, and restricted cubic spline (RCS) analysis to assess the potential relationship between NLR and T2DM.

Results

A total of 9903 participants were eligible for the analysis, of which 1280 were diagnosed with T2DM. The T2DM group exhibited significantly higher NLR levels than the non-T2DM group. After adjusting for potential confounders, elevated NLR levels were associated with an increased risk of developing T2DM, indicated by an odds ratio (OR) of 1.14, 95% CI: (1.05,1.24), P = 0.003. The results of the subgroup analyses revealed a significant interaction effect between NLR and T2DM concerning race and hypertension (P for interaction < 0.05). In contrast, no significant interactions were found for age, sex, education level, body mass index (BMI), smoking status, recreational activities, and alcohol drinker (P for interaction > 0.05). RCS analysis showed a significant non-linear relationship between NLR and T2DM, with an inflection point at 2.27 (all P for non-linearity < 0.05).

Conclusion

Our study indicates that an elevated neutrophil-to-lymphocyte ratio is associated with a higher risk of T2DM.
A scoping review of the links between early childhood caries and clean water and sanitation: the Sustainable Development Goal 6
Authors: Crystal Yasmi O. , Luo Yuanyuan Laura , Duangthip Duangporn , Tantawi Maha El , Benzian Habib , Schroth Robert J. , Feldens Carlos Alberto , Virtanen Jorma I. , Al-Batayneh Ola B. , Diaz Aida Carolina Medina , Vukovic Ana , Pavlic Verica , Mfolo Tshepiso , Daryanavard Hamideh A. , Gaffar Balgis O. , Shamala Anas , Foláyan Morẹ́nikẹ́ Oluwátóyìn ,   Early Childhood Caries Advocacy Group (ECCAG)
Published: July 2024

Introduction

The United Nation’s Sustainable Development Goal (SDG) 6 calls for universal access to clean water, sanitation and hygiene (WASH), which are crucial elements of health and well-being and fundamental for a life in dignity. Early childhood caries (ECC) is a preventable disease affecting health and quality of life of millions of young children worldwide. This scoping review aims to explore the connection between ECC and access to clean water and sanitation.

Methods

This scoping review, registered on the Open Science Framework and following PRISMA-ScR guidelines, conducted a thorough search in databases (PubMed, Web of Science, Embase, Google Scholar, SciELO) and websites (via Google) in November 2023. The search, without date limitations, targeted studies in English and Spanish linking ECC to SDG6. Exclusions were made for studies solely focusing on ECC without a direct connection to clean water and sanitation. Descriptive statistics summarized the retrieved papers.

Results

The initial search yielded 303 articles. After removing duplicates, 264 articles remained for title and abstract screening after which 244 were excluded and one report was added through citation searching. The 21 remaining articles underwent full text review. There were no studies on a direct association between access to clean water and sanitation and the prevalence of ECC. There were nine studies that showed indirect associations between ECC and access to clean water and sanitation through the links of: water and sanitation access as a marker for poverty (n = 1), water consumption as a feeding practice (n = 4), and the effectiveness of water fluoridation (n = 4). These were used to develop a conceptual model.

Conclusions

While it is conceivable that a direct link exists between ECC and access to clean water and sanitation, the available body of research only offers evidence of indirect associations. The exploration of potential pathways connecting water access to ECC warrants further investigation in future research.
A scoping review on the nature and impact of gender based violence on women primary producers
Authors: O’Mullan Cathy , Sinai Saba , Kaphle Sabitra
Published: July 2024

Background

Women in low- and middle-income countries (LMICs) are primary producers of subsistence food and significant contributors to the agricultural economy. Gender Based Violence (GBV) adversely impacts their capacity to contribute and sustain their families and undermines social, economic, and human capital. Addressing GBV, therefore, is critical to creating safe and inclusive environments for women as primary producers to participate fully in rural communities. The aim of this scoping review is to explore the existing evidence on GBV in the context of women primary producers in LMICs to inform research gaps and priorities.

Methods

A scoping review was conducted using PubMed, Web of Science, Ebscohost and Google Scholar using keywords related to GBV and women producers in LMICs. Peer-reviewed journal articles published between January 2012 and June 2022 were included in the review. Duplicates were removed, titles and abstracts were screened, and characteristics and main results of included studies were recorded in a data charting form. A total of 579 records were identified, of which 49 studies were eligible for inclusion in this study.

Results

Five major themes were identified from our analysis: (1) extent and nature of GBV, (2) the impact of GBV on agricultural/primary production livelihood activities, (3) sociocultural beliefs, practices, and attitudes, (4) aggravating or protective factors, and (5) GBV interventions. Addressing GBV in agriculture requires inclusive research approaches and targeted interventions to empower women producers, promote gender equality, enhance agricultural productivity, and contribute to broader societal development. Despite attempts by researchers to delve into this issue, the pervasive under-reporting of GBV remains a challenge. The true extent and nature of GBV perpetrated against women is far from fully understood in this context.

Conclusion

Despite the significant challenges posed by GBV to the health, economy and livelihoods of women primary producers in LMICs, there is a paucity in the current state of knowledge. To make meaningful progress, more research is required to understand the relationship between GBV and agricultural settings, and to gain nuanced insight into the nature and impact of GBV on women primary producers in different regions and contexts.
Examining the impact of self-stigma on workplace well-being: an empirical investigation of medical students with physical disabilities in China and the moderating role of trait mindfulness
Authors: Hu Minqiao , Wu Xiongfu , Qiu Shuang
Published: July 2024

Background

As societal evolution unfolds in China, individuals with physical disabilities are increasingly provided opportunities in higher education, particularly in the field of medicine. However, these medical students often encounter bias in their work environments, including during internships, which fosters self-stigma and impedes their experience for workplace well-being (WWB). Such a decrease in WWB detrimentally affects not only their mental health in the workplace but also hinders their sense of personal worth and assimilation into broader society. This study aims to examine the challenges faced by medical students with physical disabilities in China as they aspire to achieve WWB, and to explore potential intervention strategies.

Methods

Leveraging cognitive consistency theory (CCT), we introduces a conceptual framework to examine the relationships among self-stigma, perceived discrimination, and WWB. It also investigates the role of trait mindfulness as a potential mitigating factor in this dynamic. We employed the Internalized Stigma of Mental Illness Scale (ISMIS), Discrimination Perception Questionnaire (DPQ), Workplace Well-being Subscale (WWBS), and Mindful Attention Awareness Scale (MAAS) to survey 316 medical students with physical disabilities. Statistical analyses, including correlation, regression, and moderated mediation effect assessments, were conducted using SPSS 22.0 and AMOS 24.0.

Results

A notable negative correlation exists between self-stigma and WWB (r = -0.56, p < 0.01). Perceived discrimination partially mediates the relationship between self-stigma and WWB. The direct effect of self-stigma and its mediating effect through perceived discrimination account for 60.71% and 21.43% of the total effect, respectively. Trait mindfulness moderates the latter part of this mediating pathway. Moderation models indicate that trait mindfulness has a significant negative moderating effect on the impact of perceived discrimination on WWB (β = -0.10, p < 0.001).

Conclusions

Self-stigma adversely affects the positive work experiences of medical students with physical disabilities by eliciting a heightened sensitivity to discriminatory cues, thereby undermining their WWB. Trait mindfulness can effectively counter the detrimental effects of perceived discrimination on WWB. Consequently, this study advocates for the systematic incorporation of mindfulness training into educational services and workplace enhancement programs for medical students with disabilities, aiming to foster an inclusive and supportive external environment.
The relationship between community food environment around schools and student meal participation: the role of school CEP participation status
Authors: Melnick Emily M. , Acciai Francesco , Yedidia Michael J. , Ohri-Vachaspati Punam
Published: July 2024

Background

Despite the many benefits of school meals, not all students participate. One reason students may not participate in school meals is because they instead purchase breakfast or lunch from food outlets located around schools that mostly carry unhealthy items. This study examined whether school participation in the Community Eligibility Provision (CEP), which allows qualifying schools to serve free meals to all students, moderated the association between the community food environment around schools and student meal participation.

Methods

This study employed a longitudinal repeated-measures design using school-level data collected between 2014 and 2020 within four low-income school districts (n = 126 schools) in the US. We obtained meal participation data from state records and created a measure characterizing the community food environment within 0.25 miles of schools (characterized as low-density of unhealthy food outlets vs. high-density of unhealthy food outlets) through a latent class analysis. Regression analysis estimated associations between community food environments, CEP participation, and participation rates in school breakfast and school lunch, assessed in separate models.

Results

While no moderating effect of school CEP status was observed for breakfast or lunch participation, school breakfast participation was predicted to be 4% lower in high-density food environments than in low-density environments (P-value = .049) among non-CEP schools, and there was no difference in participation by the community food environment among CEP-participating schools. Differences in breakfast participation by the community food environment among non-CEP schools were mostly attributable to middle/high schools, with participation predicted to be 10% lower in high-density environments than in low-density environments among non-CEP middle/high schools (P-value < .001), whereas such a difference in participation was not observed among non-CEP elementary schools.

Conclusions

Negative associations between food environment around schools and school breakfast participation were observed only among middle and high schools not participating in CEP, suggesting that policy actions to increase access to free school meals may benefit students, particularly older children and adolescents.
Promoting reactive oxygen species accumulation to overcome tyrosine kinase inhibitor resistance in cancer
Authors: Lin Wei , Wang Xiaojun , Diao Mingxin , Wang Yangwei , Zhao Rong , Chen Jiaping , Liao Yongde , Long Qinghong , Meng Yunchong
Published: July 2024

Background

In tumor treatment, protein tyrosine kinase inhibitors (TKIs) have been extensively utilized. However, the efficacy of TKI is significantly compromised by drug resistance. Consequently, finding an effective solution to overcome TKI resistance becomes crucial. Reactive oxygen species (ROS) are a group of highly active molecules that play important roles in targeted cancer therapy including TKI targeted therapy. In this review, we concentrate on the ROS-associated mechanisms of TKI lethality in tumors and strategies for regulating ROS to reverse TKI resistance in cancer.

Main body

Elevated ROS levels often manifest during TKI therapy in cancers, potentially causing organelle damage and cell death, which are critical to the success of TKIs in eradicating cancer cells. However, it is noteworthy that cancer cells might initiate resistance pathways to shield themselves from ROS-induced damage, leading to TKI resistance. Addressing this challenge involves blocking these resistance pathways, for instance, the NRF2-KEAP1 axis and protective autophagy, to promote ROS accumulation in cells, thereby resensitizing drug-resistant cancer cells to TKIs. Additional effective approaches inducing ROS generation within drug-resistant cells and providing exogenous ROS stimulation.

Conclusion

ROS play pivotal roles in the eradication of tumor cells by TKI. Harnessing the accumulation of ROS to overcome TKI resistance is an effective and widely applicable approach.

Graphical Abstract
Differences in the cost and environmental impact between the current diet in Brazil and healthy and sustainable diets: a modeling study
Authors: Caldeira Thaís Cristina Marquezine , Vandevijvere Stefanie , Swinburn Boyd , Mackay Sally , Claro Rafael Moreira
Published: July 2024

Background

While healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the current Brazilian diet (CBD) and compare it with healthy and sustainable diets.

Methods

Data from the Brazilian Household Budget Survey 2017/18 and the Footprints of Foods and Culinary Preparations Consumed in Brazil database were used for a modeling study comparing the cost of healthy and sustainable diets (based on the Brazilian Dietary Guidelines (BDG) diet and the EAT-Lancet diet) versus the CBD. The DIETCOST program generated multiple food baskets for each scenario (Montecarlo simulations). Nutritional quality, cost, and environmental impact measures (carbon footprint (CF) and water footprint (WF)) were estimated for all diets and compared by ANOVA. Simple linear regressions used standardized environmental impacts measures to estimate differentials in costs and environmental impacts among diets scenarios.

Results

We observed significant differences in costs/1000 kcal. The BDG diet was cheaper (BRL$4.9 (95%IC:4.8;4.9) ≈ USD$1.5) than the CBD (BRL$5.6 (95%IC:5.6;5.7) ≈ USD$1.8) and the EAT-Lancet diet (BRL$6.1 (95%IC:6.0;6.1) ≈ USD$1.9). Ultra-processed foods (UPF) and red meat contributed the most to the CBD cost/1000 kcal, while fruits and vegetables made the lowest contribution to CBD. Red meat, sugary drinks, and UPF were the main contributors to the environmental impacts of the CBD. The environmental impact/1000 kcal of the CBD was nearly double (CF:3.1 kg(95%IC: 3.0;3.1); WF:2,705 L 95%IC:2,671;2,739)) the cost of the BDG diet (CF:1.4 kg (95%IC:1.4;1.4); WF:1,542 L (95%IC:1,524;1,561)) and EAT-Lancet diet (CF:1.1 kg (95%IC:1.0;1.1); WF:1,448 L (95%IC:1,428;1,469)). A one standard deviation increase in standardized CF corresponded to an increase of BRL$0.48 in the cost of the CBD, similar to standardized WF (BRL$0.56). A similar relationship between the environmental impact and the cost of the BDG (CF: BRL$0.20; WF: BRL$0.33) and EAT-Lancet (CF: BRL$0.04; WF: BRL$0.18) was found, but with a less pronounced effect.

Conclusions

The BDG diet was cost-effective, while the EAT-Lancet diet was slightly pricier than the CBD. The CBD presented almost double the CF and WF compared to the BDG and EAT-Lancet diets. The lower cost in each diet was associated with lower environmental impact, particularly for the BDG and EAT-Lancet diets. Multisectoral public policies must be applied to guide individuals and societies towards healthier and more sustainable eating patterns.
Correlation between serum trimethylamine-N-oxide and body fat distribution in middle-aged and older adults: a prospective cohort study
Authors: Chen Si , Chen Xiao-yan , Huang Zi-hui , Fang Ai-ping , Li Shu-yi , Huang Rong-zhu , Chen Yu-Ming , Huang Bi-xia , Zhu Hui-lian
Published: July 2024

Background

Trimethylamine-N-oxide (TMAO) is linked with obesity, while limited evidence on its relationship with body fat distribution. Herein, we investigated the associations between serum TMAO and longitudinal change of fat distribution in this prospective cohort study.

Methods

Data of 1964 participants (40–75y old) from Guangzhou Nutrition and Health Study (GNHS) during 2008–2014 was analyzed. Serum TMAO concentration was quantified by HPLC–MS/MS at baseline. The body composition was assessed by dual-energy X-ray absorptiometry at each 3-y follow-up. Fat distribution parameters were fat-to-lean mass ratio (FLR) and trunk-to-leg fat ratio (TLR). Fat distribution changes were derived from the coefficient of linear regression between their parameters and follow-up duration.

Results

After an average of 6.2-y follow-up, analysis of covariance (ANCOVA) and linear regression displayed women with higher serum TMAO level had greater increments in trunk FLR (mean ± SD: 1.47 ± 4.39, P-trend = 0.006) and TLR (mean ± SD: 0.06 ± 0.24, P-trend = 0.011). Meanwhile, for women in the highest TMAO tertile, linear mixed-effects model (LMEM) analysis demonstrated the annual estimated increments (95% CI) were 0.03 (95% CI: 0.003 – 0.06, P = 0.032) in trunk FLR and 1.28 (95% CI: -0.17 – 2.73, P = 0.083) in TLR, respectively. In men, there were no similar significant observations. Sensitivity analysis yielded consistent results.

Conclusion

Serum TMAO displayed a more profound correlation with increment of FLR and TLR in middle-aged and older community-dwelling women in current study. More and further studies are still warranted in the future.

Trial registration

NCT 03179657.
Sex- and age-specific associations of serum essential elements with diabetes among the Chinese adults: a community-based cross-sectional study
Authors: Wang Dongmei , Ye Hong , Liu Siyang , Duan Hualin , Ma Qintao , Yao Nanfang , Gui Zihao , Yu Genfeng , Liu Lan , Wan Heng , Shen Jie
Published: July 2024

Background

Although several studies have found the relationship between essential elements and diabetes, the studies about the association of essential elements with diabetes diagnosed according to an oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) in a sex- and age-specific manner were limited. To investigate the linear and nonlinear relationship of five essential elements including iron (Fe), copper (Cu), Zinc (Zn), magnesium (Mg), and calcium (Ca) with diabetes, fasting plasma glucose (FPG), 2-h postprandial plasma glucose (PPG), and HbA1c and to evaluate the sex- and age-specific heterogeneities in these relationships.

Methods

A total of 8392 community-dwelling adults were recruited to complete a questionnaire and undergo checkups of anthropometric parameters and serum levels of five metals (Fe, Cu, Zn, Mg, and Ca). The multivariable logistic and linear regression, the restricted cubic spline (RCS) analysis, and subgroup analysis were applied to find the associations between the essential elements and the prevalence of diabetes as well as FPG, PPG, and HbA1c.

Results

In the multivariable logistic regression and multivariable linear regression, serum Cu was positively associated with FPG, PPG, and HbA1c while serum Mg was significantly inversely correlated with FPG, PPG, HbA1c, and diabetes (all P < 0.001). In the RCS analysis, the non-linear relationship of Cu and diabetes (P < 0.001) was found. In the subgroup analysis, stronger positive associations of Cu with diabetes (P for interaction = 0.027) and PPG (P for interaction = 0.002) were found in younger women.

Conclusions

These findings may lead to more appropriate approaches to essential elements supplementation in people with diabetes of different ages and sexes. However, more prospective cohort and experimental studies are needed to probe the possible mechanism of sex- and age-specific associations between serum essential elements and diabetes.
Associations between adrenal gland volume and adipose tissue compartments – a whole body MRI study
Authors: Askani Esther , Rospleszcz Susanne , Lorbeer Roberto , Wintergerst Charlotte , Müller-Peltzer Katharina , Kiefer Lena S. , Kellner Elias , Reisert Marco , Rathmann Wolfgang , Peters Annette , Schlett Christopher L. , Bamberg Fabian , Storz Corinna
Published: July 2024

Background

Obesity is associated with alterations in the hypothalamic–pituitary–adrenal (HPA) axis. Effects of glucocorticoids on adipose tissues appear to depend on the specific adipose depot, in which they take place. In this study, we aimed to investigate the role of MRI-based adrenal gland volume as an imaging marker in association with different adipose tissue compartments.

Methods

The study cohort derives from the population-based research platform KORA (Cooperative Health Research in the Augsburg Region, Germany) MRI sub-study, a cross-sectional sub-study investigating the interactions between subclinical metabolic changes and cardiovascular disease in a study sample of 400 participants. Originally, eligible subjects underwent a whole-body MRI. MRI-based segmentations were performed manually and semi-automatically for adrenal gland volume, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), epi- and pericardial fat and renal sinus fat. Hepatic and pancreatic lipid content were measured as pancreatic proton density fraction (PDFF) and MR-spectroscopic hepatic fat fraction (HFF). Multivariable linear regression analyses were performed.

Results

A number of 307 participants (56.2 ± 9.1 years, 60.3% male, 14.3% with type 2 diabetes (T2DM), 30.6% with obesity, 34.2% with hypertension) were included. In multivariable analyses, strong positive associations between adrenal gland volume and VAT, total adipose tissue (TAT) as well as HFF persisted after extensive step-wise adjustment for possible metabolic confounders (VAT: beta = 0.31, 95%-CI [0.71, 0.81], p < 0.001; TAT: beta = 0.14, 95%-CI [0.06, 0.23], p < 0.001; HFF: beta = 1.17, 95%-CI [1.04, 1.31], p = 0.009). In contrast, associations between adrenal gland volume and SAT were attenuated in multivariate analysis after adjusting for BMI. Associations between pancreatic PDFF, epi- and pericardial fat and renal sinus fat were mediated to a great extent by VAT (pancreatic PDFF: 72%, epicardial adipose tissue: 100%, pericardial adipose tissue: 100%, renal sinus fat: 81.5%).

Conclusion

Our results found MRI-based adrenal gland volume as a possible imaging biomarker of unfavorable adipose tissue distribution, irrespective of metabolic risk factors. Thus, adrenal gland volume may serve as a potential MRI-based biomarker of metabolic changes and contributes to an individual characterization of metabolic states and individual risk stratification. Future studies should elucidate in a longitudinal study design, if and how HPA axis activation may trigger unfavorable adipose tissue distribution and whether and to which extent this is involved in the pathogenesis of manifest metabolic syndrome.
Synthetic CT generation for pelvic cases based on deep learning in multi-center datasets
Authors: Li Xianan , Jia Lecheng , Lin Fengyu , Chai Fan , Liu Tao , Zhang Wei , Wei Ziquan , Xiong Weiqi , Li Hua , Zhang Min , Wang Yi
Published: July 2024

Background and purpose

To investigate the feasibility of synthesizing computed tomography (CT) images from magnetic resonance (MR) images in multi-center datasets using generative adversarial networks (GANs) for rectal cancer MR-only radiotherapy.

Materials and methods

Conventional T2-weighted MR and CT images were acquired from 90 rectal cancer patients at Peking University People’s Hospital and 19 patients in public datasets. This study proposed a new model combining contrastive learning loss and consistency regularization loss to enhance the generalization of model for multi-center pelvic MRI-to-CT synthesis. The CT-to-sCT image similarity was evaluated by computing the mean absolute error (MAE), peak signal-to-noise ratio (SNRpeak), structural similarity index (SSIM) and Generalization Performance (GP). The dosimetric accuracy of synthetic CT was verified against CT-based dose distributions for the photon plan. Relative dose differences in the planning target volume and organs at risk were computed.

Results

Our model presented excellent generalization with a GP of 0.911 on unseen datasets and outperformed the plain CycleGAN, where MAE decreased from 47.129 to 42.344, SNRpeak improved from 25.167 to 26.979, SSIM increased from 0.978 to 0.992. The dosimetric analysis demonstrated that most of the relative differences in dose and volume histogram (DVH) indicators between synthetic CT and real CT were less than 1%.

Conclusion

The proposed model can generate accurate synthetic CT in multi-center datasets from T2w-MR images. Most dosimetric differences were within clinically acceptable criteria for photon radiotherapy, demonstrating the feasibility of an MRI-only workflow for patients with rectal cancer.
The correlation between hepatic controlled attenuation parameter (CAP) value and insulin resistance (IR) was stronger than that between body mass index, visceral fat area and IR
Authors: Li Zhouhuiling , Liu Renjiao , Gao Xinying , Hou Dangmin , Leng Mingxin , Zhang Yanju , Du Meiyang , Zhang Shi , Li Chunjun
Published: July 2024

Background

Hepatic controlled attenuation parameter (CAP) is a novel marker for quantifying hepatic fat accumulation. Insulin resistance (IR) plays a major role in the pathogenesis and natural history of hepatic steatosis. This study aimed to investigate the possible relationship between CAP value and IR.

Methods

This study included a total of 420 patients with overweight or obesity who came to the obesity clinic at Tianjin Union Medical Center. Vibration-controlled transient elastography examination was conducted to detect CAP and liver stiffness measurement (LSM) values. Body composition, including visceral fat area (VFA), and body fat mass (BFM), was evaluated by the direct segmental multi-frequency bioelectrical impedance analysis (BIA). The associations between CAP value, body mass index (BMI), VFA, BFM and homeostasis model assessment of insulin resistance (HOMA-IR) were analyzed.

Results

CAP value was positively associated with HOMA-IR (r = 0.568, P < 0.001), the strength of which was much stronger than BMI, VFA, and BFM. In multivariate linear regression, CAP value and HOMA-IR showed a significant positive association (adjusted β = 0.015, 95% CI 0.007–0.022, P < 0.001). Subgroup analysis suggested no significant interaction between CAP value and HOMA-IR across age, BMI, LSM, hypertension, and sex groups (all P for interaction > 0.05).

Conclusions

Hepatic CAP value is more remarkably than other obesity markers associated with HOMA-IR in individuals with overweight or obesity, regardless of age, BMI, LSM, hypertension, and sex.