bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP77: Cost-effectiveness Analysis Of Increasing Dual Antiplatelet Therapy Treatment After High-risk Transient Ischemic Attack Or Minor Ischemic Stroke
Authors: Wechsler Paul M , Parikh Neal S , Razzak Junaid , Navi Babak , Kamel Hooman , Liberman Ava L
Published: February 2023

Background:
Use of guideline recommended dual antiplatelet therapy (DAPT) after high-risk TIA or minor ischemic stroke is suboptimal. We performed a cost-effectiveness analysis of current DAPT treatment patterns and modeled optimal parameters for future healthcare delivery quality improvement (QI) interventions designed to increase DAPT use.

Methods:
We constructed two decision tree models. Our first model compared DAPT (90 days of aspirin and clopidogrel) to aspirin alone at current national treatment rates (45% of eligible patients receive DAPT). Our second model compared current DAPT treatment patterns to a theoretical QI intervention that increases DAPT use at an initial cost of $20,000 per institution, in keeping with costs of published stroke QI interventions, with variable annual maintenance costs. Healthcare costs and outcomes (stroke, MI, major bleed, death) were modeled using 90-day and lifetime horizons. We calculated incremental cost-effectiveness ratios (ICER) and considered an ICER<$100,000 per quality-adjusted life year (QALY) to be cost-effective. Sensitivity analyses varying key inputs, including QI costs, were performed using Monte Carlo simulations.

Results:
Compared to aspirin alone, DAPT use was not cost-effective at 90 days (ICER $173,003/QALY) but was cost saving ($3,030) and more effective (0.31 more QALYs) over a lifetime at current treatment rates. Increasing the use of DAPT by 20% with a QI intervention was not cost-effective at 90 days (ICER $474,467/QALY) but was cost-effective over a lifetime (ICER $29,217/QALY). Increasing DAPT use with a QI intervention was the preferred strategy in 89% of Monte Carlo runs (lifetime horizon). QI interventions to increase DAPT use were cost-effective over a range of annual costs (Figure).

Conclusion:
In a modeling study, current rates of DAPT use after TIA/minor stroke are cost-effective over a lifetime, but a QI intervention to increase DAPT use is preferred in nearly all simulations.
Abstract WP90: Black Americans Have Worse Functional And Cognitive Outcomes Than White Americans After Stroke
Authors: Springer Mellanie V , Porter Neil C , Kwicklis Madeline , Lisabeth Lynda D , Morgenstern Lewis
Published: February 2023

Introduction:
We studied racial differences in post-stroke outcomes using a prospective, population-based cohort of stroke survivors as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project.

Methods:
Neurologic (NIHSS, range of 0-42, higher scores are worse), functional (ADLs/IADLs, range 1-4, higher scores are worse), and cognitive (3MSE, range 0-100, higher scores are better) outcomes were measured 90 days after stroke. Cox proportional hazards and negative binomial linear regression models were used to examine the associations between race and 90-day all-cause mortality and NIHSS, respectively, whereas linear regression was used for ADLs/IADLs and 3MSE scores. Covariates included demographics, initial NIHSS, comorbidities, prior stroke history, tPA, pre-stroke disability, and pre-stroke cognition. The mortality model also adjusted for DNR status.

Results:
At 90 days post-stroke, Black Americans (BAs) (n=130) had a median (IQR) NIHSS of 2 (1,6) compared to NIHSS of 1 (0,3) in non-Hispanic white Americans (NHWs) (n=868). BAs had a median (IQR) ADL/IADL score of 2.4 (1.5, 3.4) compared to 2 (1.3, 3.0) in NHWs. BAs scored a median of 85.0 (75.0, 92.5) on the 3MSE compared to NHWs’ score of 92.0 (83.0, 96.0). Death occurred in 23 (11%) of BAs and 268 (19%) of NHWs within 90 days. After adjustment for covariates, functional outcomes at 90 days were worse in BAs compared to NHWs, with 14% (95% CI=4.9, 23) greater limitations in ADLs/IADLs and 47.9% (95% CI=16.3, 88.1) greater severity of stroke symptoms. Cognition at 90 days was 7% (95% CI=2.7, 11.3) lower in BAs compared to NHWs. BAs had a 25.2% lower (95% CI=-19.9, 53.3) hazard rate of mortality than NHWs (Figure).

Conclusions:
In this prospective, population-based community sample, BAs had worse functional and cognitive outcomes at 90 days compared to NHWs. Future research should investigate the cause of these racial disparities.
Different Changing Patterns for Stroke Subtype Mortality Attributable to High Sodium Intake in China During 1990 to 2019
Authors: Wang Yan , Wang Jingyu , Chen Shufeng , Li Bingbing , Lu Xiangfeng , Li Jianxin
Published: February 2023

Background:

It is unclear whether sodium intake had similar effects on mortality of stroke subtypes. The purpose of this study is to compare the long-term trends in mortality of stroke subtypes attributable to high sodium intake in China during 1990 to 2019.

Methods:

Data for China in the GBD (Global Burden of Disease) 2019 study were obtained mainly from the Chinese surveillance systems and the KaiLuan Study. The trends in stroke mortality due to high sodium intake (>5 g/d) were evaluated using join-point regression and age-period-cohort methods adjusting for age, period, and cohort.

Results:

The age-standardized mortality rates of stroke attributable to high sodium intake showed downward trends during 1990 to 2019 in China, with an average annual percentage change of −0.6 (95% CI, −0.8 to −0.4) for ischemic stroke, −2.5 (95% CI, −2.8 to −2.2) for intracerebral hemorrhage, and −6.1 (95% CI, −6.6 to −5.7) for subarachnoid hemorrhage. The curves of local drifts, which reflected the average annual percentage change of stroke mortality due to high sodium intake across age groups, showed a slow upward trend with age for ischemic stroke, a slow downward trend for intracerebral hemorrhage, and a sharp downward trend for subarachnoid hemorrhage. The high sodium–related mortality increased dramatically with age for ischemic stroke and intracerebral hemorrhage, while it reached a peak at 50 to 70 years old for subarachnoid hemorrhage. The period and cohort rate ratios of stroke mortality due to high sodium intake decreased in the past 3 decades, with the greatest decline for subarachnoid hemorrhage and the weakest decrease for ischemic stroke. Notably, men had higher high sodium–related mortality and risk but slighter declines for all stroke subtypes than women.

Conclusions:

Our results provided powerful evidence that high sodium–related age-standardized mortality rates and risk of stroke in China decreased in the past 3 decades, with diverse changing patterns for different stroke subtypes, highlighting that salt reduction had distinct impact on stroke subtypes.
Rapid Activation of Neuroinflammation in Stroke: Plasma and Extracellular Vesicles Obtained on a Mobile Stroke Unit
Authors: Kowalski Robert G. , Ledreux Aurélie , Violette John E. , Neumann Robert T. , Ornelas David , Yu Xiaoli , Griffiths Steven G. , Lewis Scott , Nash Priscilla , Monte Andrew A. , Coughlan Christina M. , Deighan Clayton , Grotta James C. , Jones William J. , Graner Michael W.
Published: February 2023

Background:

Neuroinflammation is ubiquitous in acute stroke and worsens outcome. However, the precise timing of the inflammatory response is unknown, hindering the design of acute anti-inflammatory therapeutic interventions. We sought to identify the onset of the neuroinflammatory cascade using a mobile stroke unit.

Methods:

The study is a proof-of-concept, cohort investigation of ultra-early blood- and extracellular vesicle–derived markers of neuroinflammation and outcome in acute stroke. Blood was obtained, prehospital, on an mobile stroke unit. Outcomes were biomarker concentrations, modified Rankin Scale score, and National Institutes of Health Stroke Scale score.

Results:

Forty-one adults were analyzed, including 15 patients treated on the mobile stroke unit between August 2021 and April 2022, and 26 healthy controls to establish biomarker reference levels. Median patient age was 74 (range, 36–97) years, 60% were female, and 80% White. Ten (67%) were diagnosed as stroke, with 8 (53%) confirmed and 2 likely transient ischemic attack or stroke averted by thrombolysis; 5 were stroke mimics. For strokes, median initial National Institutes of Health Stroke Scale score was 11 (range, 4–19) and 6 (75%) received tPA (tissue-type plasminogen activator). Blood was obtained a median of 58 (range, 36–133) minutes after symptom onset. Within 36 minutes after stroke, plasma IL-6 (interleukin-6), neurofilament light chain, UCH-L1 (ubiquitin C-terminal hydrolase L1), and GFAP (glial fibrillary acidic protein) were elevated by as much as 10 times normal. In EVs, MMP-9 (matrix metalloproteinase-9), CXCL4 (chemokine (C-X-C motif) ligand 4), CRP (C-reactive protein), IL-6, OPN (osteopontin), and PECAM1 (platelet and endothelial cell adhesion molecule 1) were elevated. Inflammatory markers increased rapidly in the first 2 hours and continued rising for 24 hours.

Conclusions:

The neuroinflammatory cascade was found to be activated within 36 to 133 minutes after stroke and progresses rapidly. This is earlier than observed previously in humans and suggests injury from neuroinflammation occurs faster than had been surmised. These findings could inform development of acute immunomodulatory stroke therapies and lead to new diagnostic tools and improved outcomes.
Association Between Hospital-Documented Atrial Fibrillation and Central Retinal Artery Occlusion
Authors: Lusk Jay B. , Song Ailin , Unnithan Shakthi , Al-Khalidi Hussein R. , Delic Alen , de Havenon Adam , Biousse Valérie , Schrag Matthew , Poli Sven , Piccini Jonathan P. , Xian Ying , O’Brien Emily C. , Mac Grory Brian
Published: February 2023

Background:

Carotid stenosis is thought to be the primary risk factor for central retinal artery occlusion (CRAO); however, it is not known whether atrial fibrillation (AF)—a cardiac arrhythmia that underlies over 25% of cerebral ischemic strokes—predisposes patients to CRAO.

Methods:

A retrospective, observational, cohort study was performed using data from the State Inpatient Databases and State Emergency Department Databases from New York (2006–2015), California (2003–2011), and Florida (2005–2015) to determine the association between AF and CRAO. The primary exposure was hospital-documented AF. The primary end point was hospital-documented CRAO, defined as having an
International Classification of Diseases, Ninth Revision, Clinical Modification
, code 362.31 in the primary diagnosis position. Cause-specific hazard models were used to model CRAO-free survival among patients according to hospital-documented AF status.

Results:

Of 39 834 885 patients included in the study, 2 723 842 (median age, 72.7 years; 48.5% women) had AF documented during the exposure window. The median follow-up duration was 6 years and 1 month. Patients with AF were older, more likely to be of non-Hispanic White race/ethnicity, and had a higher burden of cardiovascular comorbidities compared with patients without AF. The cumulative incidence of CRAO determined prospectively after exclusions was 8.69 per 100 000 at risk in those with AF and 2.39 per 100 000 at risk in those without AF over the study period. Before adjustment, AF was associated with higher risk of CRAO (hazard ratio, 2.55 [95% CI, 2.15–3.03]). However, after adjustment for demographics, state, and cardiovascular comorbidities, there was an inverse association between AF and risk of CRAO (adjusted hazard ratio, 0.72 [95% CI, 0.60–0.87]). These findings were robust in our prespecified sensitivity analyses. By contrast, positive control outcomes of embolic and ischemic stroke showed an expected strong relationship between AF and risk of stroke.

Conclusions:

We found an inverse association between AF and CRAO in a large, representative study of hospitalized patients; however, this cohort did not ascertain AF or CRAO occurring outside of hospital or emergency department settings.
A new deep-sea palaemonid shrimp assigned to Periclimenes Costa, 1844 (Decapoda: Caridea) from the West Mariana Ridge, northwestern Pacific
Authors: KOMAI TOMOYUKI , TSUCHIDA SHINJI , FUJIWARA YOSHIHIRO
Published: January 2023

A new palaemonid species, Periclimenes variabilis, is described and illustrated on the basis of four specimens from the Ritto Seamount, West Marina Ridge, northwestern Pacific, at depths of 642–666 m. Specimens of the new species were collected with an unidentified hexacoral of Primnoidae (Cnidaria), an antipatharian octocoral Leiopathes sp. (Cnidaria), and an unidentified crinoid (Echinodermata), suggesting association with those invertebrates. Morphological comparison and molecular phylogenetic analyses using the mitochondrial 16S ribosomal RNA and cytochrome C oxidase subunit I genes indicate that the new species is closest to Periclimenes uniunguiculatus Bruce, 1990 although the possession of more than two spiniform setae on either side of the telson in the new species is consistent with the generic diagnosis of Bathymenes Kou, Li & Bruce, 2016. In reference to the close relationship to the species currently assigned to Periclimenes Costa, 1844 and the unsettled taxonomy of the genus, the new species is provisionally assigned to Periclimenes. Differentiating characters between the new species and closely related taxa are discussed.
A revision of eastern Palaearctic Anthobium Leach, 1819 (Coleoptera: Staphylinidae: Omaliinae: Anthophagini). VII. Six new species and faunistic records from Middle Asia, Himalayan Region and China
Authors: SHAVRIN ALEXEY V.
Published: January 2023

Seven species of the genus Anthobium Leach, 1819 from the eastern Palaearctic Region are (re-) described and illustrated: Nepalese A. jaegeri Shavrin & Smetana, 2019 of the consanguineum group, A. schawalleri sp. n. (China, Gansu: Lianhuashan) of the convexior group, A. ruzickai sp. n. (China, Yunnan: Biluo Mts.) of the crassum group, and a. faillei sp. n. (Nepal, Myagdi Khola), A. luteolum sp. n. (Nepal, Kulanga Khola), A. pauxillum sp. n. (Nepal, Solukhundu) and A. wittmeri sp. n. (India, Kashmir) of the fusculum group. Distributional maps for all (re-) described species are provided. Key to species of the Fusculum group is modified. Faunistic records of eleven species of the atrocephalum, fusculum, gracilipalpe, nigrum and reflexum groups are provided. Anthobium nigrum (Cameron, 1924) is recorded from Nepal for the first time. A checklist of species of the eastern Palaearctic Region is provided.
The ERA5 Extreme Seasons Explorer as a Basis for Research at the Weather and Climate Interface
Authors: Boettcher Maxi , Röthlisberger Matthias , Attinger Roman , Rieder Joëlle , Wernli Heini
Published: February 2023

Meteorological extremes on the seasonal time scale have received increased attention due to their relevance for society and economy. A recently developed approach to identify seasonal extremes is applied here to ERA5 reanalyses from 1950 to 2020 to identify hot and cold, wet and dry, and stormy and calm extreme seasons globally. The approach consists of (i) fitting a statistical model to seasonal mean values (of temperature, precipitation, and wind speed) at each grid point, (ii) selecting a local return period threshold above which seasonal mean values are deemed extreme, and (iii) forming spatially coherent extreme season objects. The paper introduces the ERA5 extreme season explorer, an open-access web portal enabling researchers to visualize and download extreme season objects of any of the six types in their region of interest, for further investigating their underlying dynamics, statistical properties, and impacts. To illustrate the potential of our extreme season objects, we first discuss the top 10 cold winters in ERA5 globally and then focus on an unusual triple-compound extreme season in winter 1953/54 in Europe, which was simultaneously extremely cold, dry, and calm. We show that detailed analysis of weather system dynamics, including cyclones, blocks, jets, and Rossby waves, provides important insight into the processes leading to extreme seasons. In summary, this study presents for the first time a catalogue of objectively identified extreme seasons in the last decades, shows exemplarily how large-scale dynamics can lead to such seasons, and with the help of the explorer supports the community in accelerating research in this important area at the interface of weather and climate dynamics.
Sanctions-Busting, Material Power, and Institutional Support for Economic Sanctions
Authors: Jeong Jin Mun
Published: February 2023

International institutions play a key role in sanctions success. However, little is known about when senders mobilize institutional sanctions and how they induce international institutions to support their sanctioning efforts. Senders may need institutional support when they expect third-party states to engage in sanctions-busting. I suggest that senders anticipate sanctions-busting when they face third-party rivals which also have an alliance tie with targets. The presence of such potential sanctions busters may lead senders to seek institutional support. Also, senders should possess substantial material power to induce member states of international institutions to approve the sanctioning efforts. I assess the theoretical claim of this research by analyzing 1,038 sanctions episodes over the period 1951–2005. The findings support my argument that senders pursue institutional support when they face potential sanctions busters, and the success of their efforts partly depend on their material power.
Analysis of motion and vibration characteristics of elastic composite cylindrical roller bearing
Authors: Zhang Xiangyun , Bian Qiang , Chen Ming , Zhao Chunjiang , Zeng Guang , Jiao Bowen , Liu Bingyang
Published: January 2023

To investigate the motion characteristics and vibration characteristics of elastic composite cylindrical roller bearings (ECCRBs), a simulation model of the ECCRB is established in ABAQUS software. The influences of filling degrees and working conditions on motion characteristics of the ECCRB are compared, and the modal characteristics and harmonic response of the ECCRB are analyzed. Calculation results show that when the filling degree increases from 0% to 60%, there is a nonlinear relationship between the filling degree and the slip rate of cage, the natural frequency of each order decreases, and the vibration displacement of ECCRB increases under the excitation load; increasing the rotation speed and decreasing the radial load reasonably is beneficial to the motion stability of the ECCRB. At the same time, with the increase of the excitation load, the vibration displacement of the ECCRB increases. The analysis results can present some theoretical basis for the structural optimization of the ECCRB.
Flow characteristics of a centrifugal fan with optimized edge curvatures of an impeller front disk
Authors: Zheng Shuihua , Shao Zhenghao , Liu Jianfei , Chen Jinxue , Li Yiliang , Chai Min
Published: January 2023

In this study, the flow characteristics of different radiated impeller front disk fans were investigated by computational fluid dynamics to explore the effect of the radiated impeller front disk of the centrifugal fan on the three-dimensional flow of the volute-free centrifugal fan. Specifically, the flow-static pressure performance curve of the prototype fan was obtained to compare the numerical simulation results with the experimental results, so as to verify the accuracy of the numerical simulation. Besides, the linear fitting function of the radian edge of the front disk of the impeller was adjusted to acquire improved optimized fans. After numerical simulation analysis, the modification increases the outlet flow, static pressure at the outlet of the fan, static pressure efficiency, and total efficiency by 19 m³/h, 4.7 Pa, 5.6%, and 6.8%, respectively. The research reveals that the curvature of the front disk edge of the impeller can increase the flow channel volume between the blades and reduce the energy loss generated inside the impeller, thereby improving the static pressure and efficiency of the fan.
The ethical pathway – Does the perceived realisation of the individuals’ values change during the post-stroke time?
Authors: Rannikko Sunna Eva Erika , Leino-Kilpi Helena , Pasanen Miko , Suhonen Riitta
Published: January 2023

Background

Stroke causes ethically challenging changes in the lives of individuals with stroke (IwS). However, it is unclear whether the changes are stable or dynamic. In this study, a novel concept ‘ethical pathway’ is used to describe the potential changes in the perceived realisation of IwS’ values in temporal passage post-stroke. Ethical pathway includes three central values of nursing: dignity, privacy and autonomy. Aim of the study was to analyse the perceived ethical pathway of IwS over a non-limited post-stroke period, with the purpose to understand the existence of the IwS’ ethical pathway in theoretical level.

Design

A descriptive and correlational design.

Methods

The volunteer participants were recruited via the Finnish Brain Association. Data were collected with questions of background variables and the Ethical Pathway of Individuals with Stroke (EPIS) instrument and analysed statistically. The Ethics Committee of the University approved the study and permission for data collection was obtained from the association.

Results

Sixty-one IwS participated in the study. The ethical pathway varied during the post-stroke time. Of the values, dignity and privacy were realised lower with longer post-stroke time. The life situational factors were associated with the realisation of the values, but not consistently.
Standardized airway wall thickness Pi10 from routine CT scans of COPD patients as imaging biomarker for disease severity, lung function decline, and mortality
Authors: Kahnert Kathrin , Jörres Rudolf A. , Kauczor Hans-Ulrich , Alter Peter , Trudzinski Franziska C. , Herth Felix , Jobst Bertram , Weinheimer Oliver , Nauck Sebastian , Mertsch Pontus , Kauffmann-Guerrero Diego , Behr Jürgen , Bals Robert , Watz Henrik , Rabe Klaus F. , Welte Tobias , Vogelmeier Claus F. , Biederer Jürgen
Published: January 2023

Background:

Chest computed tomography (CT) is increasingly used for phenotyping and monitoring of patients with COPD. The aim of this work was to evaluate the association of Pi10 as a measure of standardized airway wall thickness on CT with exacerbations, mortality, and response to triple therapy.

Methods:

Patients of GOLD grades 1–4 of the COSYCONET cohort with prospective CT scans were included. Pi10 was automatically computed and analyzed for its relationship to COPD severity, comorbidities, lung function, respiratory therapy, and mortality over a 6-year period, using univariate and multivariate comparisons.

Results:

We included n = 433 patients (61%male). Pi10 was dependent on both GOLD grades 1–4 ( p = 0.009) and GOLD groups A–D ( p = 0.008); it was particularly elevated in group D, and ROC analysis yielded a cut-off of 0.26 cm. Higher Pi10 was associated to lower FEV1 % predicted and higher RV/TLC, moreover the annual changes of lung function parameters ( p < 0.05), as well as to an airway-dominated phenotype and a history of myocardial infarction ( p = 0.001). These associations were confirmed in multivariate analyses. Pi10 was lower in patients receiving triple therapy, in particular in patients of GOLD groups C and D. Pi10 was also a significant predictor for mortality ( p = 0.006), even after including multiple other predictors.

Conclusion:

In summary, Pi10 was found to be predictive for the course of the disease in COPD, in particular mortality. The fact that Pi10 was lower in patients with severe COPD receiving triple therapy might hint toward additional effects of this functional therapy on airway remodeling.

Registration:

ClinicalTrials.gov, Identifier: NCT01245933
Integrated Sociology Programs: Five Pillars to Guide Blended Curriculum Design
Authors: Nathenson Sophie , Chapman Kyle
Published: February 2023

The field of sociology is uniquely poised as a discipline that can be combined with specialized training in other fields. Many work sectors are undergoing systemic or cultural changes based on demographic, political, and economic trends. At the same time, many graduates of sociology programs do not find jobs as “sociologists” or academics and must seek additional skill sets to enter the job market. In this paper, we introduce the concept of Integrated Sociology Programs (ISPs), outlining five pillars of such programs: (1) a focus on sociology as a skill set, (2) integration with a non-academic industry, (3) applied experiences, (4) integrated Industry Advisory Boards, and (5) inclusion of career-focused outcomes. We present a case study ISP that integrates Medical Sociology with the emerging field of Population Health Management. While there are many innovative combinations of subfields of sociology and non-academic fields, our case study offers an example that informed the conception of the five pillars of ISPs.
Indole-3-propionic acid alleviates chondrocytes inflammation and osteoarthritis via the AhR/NF-κB axis
Authors: Zhuang Huangming , Ren Xunshan , Jiang Fuze , Zhou Panghu
Published: January 2023

Background

Osteoarthritis (OA) is a common chronic disease characterized by chronic inflammation and extracellular matrix degradation. Indole-3-propionic acid (IPA) is a tryptophan metabolite secreted by intestinal flora, which can exert anti-inflammatory effects in a variety of diseases. In this study, we further investigated the potential therapeutic role of IPA in OA and the underlying mechanism.

Methods

IL-1β was utilized to induce chondrocyte inflammation. Then, the cytotoxicity of IPA on rat chondrocytes was assessed. Meanwhile, RT-qPCR, Griess reaction, ELISA, Western blot and immunofluorescence were performed to evaluate the expression of inflammatory factors and stromal proteins, and the NF-κB pathway in chondrocytes treated with IL-1β alone, with IPA or with aryl hydrocarbon receptor (AhR) knockdown. An OA rat model was established by anterior cruciate ligament transection, and hematoxylin-eosin staining, Safranin-O/Fast Green staining and immunochemistry were applied to estimate OA severity.

Results

IPA did not affect cellular viability at concentrations up to 80 µM. IPA significantly inhibited the IL-1β-induced expression of inflammatory factors (Nitric oxide, PGE2, TNF-α, IL-6, iNOS and COX-2) and matrix-degrading enzymes (MMP-3, MMP-13 and ADAMTS-5), upregulated the expression of anabolic markers (aggrecan and collagen-II) and inactivated the NF-κB pathway. However, AhR knockdown could abolish the above protection capabilities and the suppression of the NF-κB pathway induced by IPA. Furthermore, IPA significantly reduced serum inflammatory cytokines expression, cartilage destruction and synovitis in vivo, demonstrating its protective role in OA progression.

Conclusion

IPA improved IL-1β-induced chondrocyte inflammation and extracellular matrix degradation through the AhR/NF-κB axis, which provides an innovative therapeutic strategy for OA.
Pristine/folate-functionalized graphene oxide as two intrinsically radioiodinated nano-theranostics: self/dual in vivo targeting comparative study
Authors: Swidan Mohamed M. , Essa Basma M. , Sakr Tamer M.
Published: February 2023

Background

Nanomedicine offers great potentials for theranostic studies via providing higher efficacy and safety levels. This work aimed to develop and evaluate a new nanoplatform as a tumor theranostic probe.

Results

Carboxyl-functionalized graphene oxide nanosheets (FGO) was well synthesized from graphite powder and then conjugated with folic acid to act as a targeted nano-probe. Full characterization and in vitro cytotoxicity evaluation were conducted; besides, in vivo bio-evaluation was attained via intrinsic radioiodination approach in both normal and tumor-bearing Albino mice. The results indicated that FGO as well as conjugated graphene oxide nanosheets (CGO) are comparatively non-toxic to normal cells even at higher concentrations. Pharmacokinetics of FGO and CGO showed intensive and selective uptake in the tumor sites where CGO showed high T/NT of 7.27 that was 4 folds of FGO at 1 h post injection. Additionally, radioiodinated-CGO (ICGO) had declared a superior prominence over the previously published tumor targeted GO radiotracers regarding the physicochemical properties pertaining ability and tumor accumulation behavior.

Conclusions

In conclusion, ICGO can be used as a selective tumor targeting agent for cancer theranosis with aid of I-131 that has a maximum beta and gamma energies of 606.3 and 364.5 keV, respectively.
Cudraflavone B induces human glioblastoma cells apoptosis via ER stress-induced autophagy
Authors: Pan Jinlin , Zhao Rongchuan , Dong Caihua , Yang Jiao , Zhang Ruobing , Sun Minxuan , Ahmad Nafees , Zhou Yuanshuai , Liu Yanxiang
Published: January 2023

Background

Glioblastoma (GBM) is the most common malignant intracranial tumor with a low survival rate. However, only few drugs responsible for GBM therpies, hence new drug development for it is highly required. The natural product Cudraflavone B (CUB) has been reported to potentially kill a variety of tumor cells. Currently, its anit-cancer effect on GBM still remains unknown. Herein, we investigated whether CUB could affect the proliferation and apoptosis of GBM cells to show anti-GBM potential.

Results

CUB selectively inhibited cell viability and induced cell apoptosis by activating the endoplasmic reticulum stress (ER stress) related pathway, as well as harnessing the autophagy-related PI3K/mTOR/LC3B signaling pathway. Typical morphological changes of autophagy were also observed in CUB treated cells by microscope and scanning electron microscope (SEM) examination. 4-Phenylbutyric acid (4-PBA), an ER stress inhibitor, restored the CUB-caused alteration in signaling pathway and morphological change.

Conclusions

Our finding suggests that CUB impaired cell growth and induced cell apoptosis of glioblastoma through ER stress and autophagy-related signaling pathways, and it might be an attractive drug for treatment of GBM.
Exogenous hydrogen sulfide and methylglyoxal alleviate cadmium-induced oxidative stress in Salix matsudana Koidz by regulating glutathione metabolism
Authors: Guo Long , Ling Long , Wang Xiaoqian , Cheng Ting , Wang Hongyan , Ruan Yanan
Published: February 2023

Background

Cadmium (Cd) is a highly toxic element for plant growth. In plants, hydrogen sulfide (H2S) and methylglyoxal (MG) have emerged as vital signaling molecules that regulate plant growth processes under Cd stress. However, the effects of sodium hydrosulfide (NaHS, a donor of H2S) and MG on Cd uptake, physiological responses, and gene expression patterns of Salix to Cd toxicity have been poorly understood. Here, Salix matsudana Koidz. seedlings were planted in plastic pot with applications of MG (108 mg kg− 1) and NaHS (50 mg kg− 1) under Cd (150 mg kg− 1) stress.

Results

Cd treatment significantly increased the reactive oxygen species (ROS) levels and malondialdehyde (MDA) content, but decreased the growth parameters in S. matsudana. However, NaHS and MG supplementation significantly decreased Cd concentration, ROS levels, and MDA content, and finally enhanced the growth parameters. Cd stress accelerated the activities of antioxidative enzymes and the relative expression levels of stress-related genes, which were further improved by NaHS and MG supplementation. However, the activities of monodehydroascorbate reductase (MDHAR), and dehydroascorbate reductase (DHAR) were sharply decreased under Cd stress. Conversely, NaHS and MG applications restored the MDHAR and DHAR activities compared with Cd-treated seedlings. Furthermore, Cd stress decreased the ratios of GSH/GSSG and AsA/DHA but considerably increased the H2S and MG levels and glyoxalase I-II system in S. matsudana, while the applications of MG and NaHS restored the redox status of AsA and GSH and further improved glyoxalase II activity. In addition, compared with AsA, GSH showed a more sensitive response to exogenous applications of MG and NaHS and plays more important role in the detoxification of Cd.

Conclusions

The present study illustrated the crucial roles of H2S and MG in reducing ROS-mediated oxidative damage to S. matsudana and revealed the vital role of GSH metabolism in regulating Cd-induced stress.
Effects of dexmedetomidine on evoked potentials in spinal surgery under combined intravenous inhalation anesthesia: a randomized controlled trial
Authors: Jiang Xinyu , Tang Xiaoning , Liu Shaoquan , Liu Ling
Published: January 2023

Objective

We aimed to investigate the effects of different doses of dexmedetomidine (Dex) on evoked potentials in adult patients undergoing spinal surgery under intravenous anesthesia with low-concentration desflurane.

Methods

Ninety patients were divided into three groups at random. To maintain anesthesia in the control group (group C), desflurane 0.3 MAC (minimal alveolar concentration), propofol, and remifentanil were administered. Dex (0.5 μg·kg−1) was injected for 10 min as a loading dose in the low-dose Dex group (group DL), then adjusted to 0.2 μg·kg−1·h−1 until the operation was completed. Dex (1 μg·kg−1) was injected for 10 min as a loading dose in the high-dose Dex group (group DH), then adjusted to 0.7 μg·kg−1·h−1 until the operation was completed. The additional medications were similar to those given to group C. The perioperative hemodynamics, body temperature, intraoperative drug dosages, fluid volume, urine volume, blood loss, the latency and amplitude of somatosensory evoked potentials (SEPs) at four different time points, the incidence of positive cases of SEPs and transcranial motor evoked potentials (tcMEPs), and perioperative adverse reactions were all recorded.

Results

Data from 79 patients were analyzed. The MAP measured at points T2-T4 in group DH was higher than at corresponding points in group C (P < 0.05). The MAP at point T4 in group DL was higher than at corresponding points in group C (P < 0.05). The remifentanil dosage in group DH was significantly lower than in group C (P = 0.015). The fluid volume in group DL was significantly lower than in group C (P = 0.009). There were no significant differences among the three groups in the amplitude and latency of SEP at different time points, nor in the incidence of warning SEP signals. The incidence of positive tcMEP signals did not differ significantly between groups C and DL (P > 0.05), but was significantly higher in group DH than in groups DL (P < 0.05) or C (P < 0.05). The incidence of intraoperative hypertension was significantly higher in group DH than in group C (P = 0.017).

Conclusions

Low-dose Dex has no effect on the SEPs and tcMEPs monitoring during spinal surgery. High-dose Dex has no effect on SEPs monitoring, but it may increase the rate of false positive tcMEPs signals and the incidence of intraoperative hypertension.

Trial registration

This study has completed the registration of the Chinese Clinical Trial Center at 11/09/2020 with the registration number ChiCTR2000038154.
Improvement in the diagnosis and practices of emergency healthcare providers for heat emergencies after HEAT (heat emergency awareness & treatment) an educational intervention: a multicenter quasi-experimental study
Authors: Khan Nadeem Ullah , Khan Uzma Rahim , Ahmed Naveed , Ali Asrar , Raheem Ahmed , Soomar Salman Muhammad , Waheed Shahan , Kerai Salima Mansoor , Baig Muhammad Akbar , Salman Saima , Saleem Syed Ghazanfar , Jamali Seemin , Razzak Junaid A.
Published: January 2023

Background

The incidence of heat emergencies, including heat stroke and heat exhaustion, have increased recently due to climate change. This has affected global health and has become an issue of consideration for human health and well-being. Due to overlapping clinical manifestations with other diseases, and most of these emergencies occurring in an elderly patient, patients with a comorbid condition, or patients on poly medicine, diagnosing and managing them in the emergency department can be challenging. This study assessed whether an educational training on heat emergencies, defined as heat intervention in our study, could improve the diagnosis and management practices of ED healthcare providers in the ED setting.

Methods

A quasi-experimental study was conducted in the EDs of four hospitals in Karachi, Pakistan. Eight thousand two hundred three (8203) patients were enrolled at the ED triage based on symptoms of heat emergencies. The pre-intervention data were collected from May to July 2017, while the post-intervention data were collected from May to July 2018. The HEAT intervention, consisting of educational activities targeted toward ED healthcare providers, was implemented in April 2018. The outcomes assessed were improved recognition—measured by increased frequency of diagnosing heat emergencies and improved management—measured by increased temperature monitoring, external cooling measures, and intravenous fluids in the post-intervention period compared to pre-intervention.

Results

Four thousand one hundred eighty-two patients were enrolled in the pre-intervention period and 4022 in the post-intervention period, with at least one symptom falling under the criteria for diagnosis of a heat emergency. The diagnosis rate improved from 3% (n = 125/4181) to 7.5% (n = 7.5/4022) (p-value < 0.001), temperature monitoring improved from 0.9% (n = 41/4181) to 13% (n = 496/4022) (p-value < 0.001) and external cooling measure (water sponging) improved from 1.3% (n = 89/4181) to 3.4% (n = 210/4022) (p-value < 0.001) after the administration of the HEAT intervention.

Conclusion

The HEAT intervention in our study improved ED healthcare providers' approach towards diagnosis and management practices of patients presenting with health emergencies (heat stroke or heat exhaustion) in the ED setting. The findings support the case of training ED healthcare providers to address emerging health issues due to rising temperatures/ climate change using standardized treatment algorithms.
Association of dementia comorbidities with caregivers’ physical, psychological, social, and financial burden
Authors: Zhang Jingyi , Wang Jing , Liu Hua , Wu Chenkai
Published: January 2023

Background

Informal caregivers of older adults with dementia may experience substantial burdens during their caregiving process, especially when caring for older adults with other comorbid conditions. This study evaluated whether and how comorbidity burden for persons with dementia (PWD) was associated with caregivers’ physical, psychological, social, and financial burden as well as caregiving gain.

Methods

Data were from 1,065 community-dwelling older adults living with dementia and their primary caregivers in the National Health and Aging Trends Study and the National Study of Caregiving. PWD’s comorbidity burden was measured by the count of chronic conditions and the pattern of comorbidity identified by the latent class analysis (LCA). We considered four domains of caregiving burden—physical, psychological, social, and financial burden. We used linear regressions to identify the unadjusted and adjusted associations between PWD’s comorbidity burden and caregiving burden and gain.

Results

Of 1,065 PWD, 13.5% had 0–1 and 24.9% had 5 or more number of comorbid chronic conditions, respectively. After multivariable adjustment, an additional chronic condition is associated with an 0.11- and 0.36-point increase in caregivers’ physical and psychological burden, respectively. Caregivers of PWD with 5 or more chronic conditions had a 0.64- and 2.22-point higher score of physical and psychological burden, respectively, than those caring for PWD with 0 or 1 comorbid condition. LCA divided PWD into two classes, a high comorbidity class (69.0%) and a low comorbidity class (31.0%). Caregivers of PWD in the high comorbidity burden class had a 0.46-point higher score of physical caregiving burden than those in the low comorbidity burden class. No significant association was found between care recipients’ comorbidity burden and their caregivers’ social and financial burden or caregiving gain.

Conclusions

The comorbidity burden of PWD was associated with their caregivers’ physical and psychological caregiving burden. Relevant interventions to manage the comorbid conditions of people living with dementia and support their caregivers are crucial to improving their physical health and psychological wellbeing.
One-year change in handgrip strength in patients with hip fracture: a prospective comparison with hip disease
Authors: Kim Chul-Ho , Han Jeongae , Kim Ji Wan
Published: February 2023

Background

Handgrip strength (HGS) has been adopted as one of the diagnostic tools for sarcopenia and is gaining attention because of its association with osteoporotic hip fractures. Longitudinal data of HGS at multiple follow-up intervals in older hip fractures are lacking. We aimed to investigate and compare the HGS changes in patients with hip fracture within 1-year with those in patients with hip diseases.

Methods

This prospective study was conducted between June 2018 and July 2020. The HGS was measured preoperatively, at predischarge, and at 3, 6, and 12 months postoperatively. We prospectively compared the number of patients with low muscle strength (LMS) as well as the HGS changes over time between the two groups.

Results

A total of 115 consecutive patients with hip fracture (n = 58) and hip disease (57) were enrolled. The rate of preoperative LMS was higher in the hip fracture group than control (P = 0.005), but there was no significant difference in the postoperative period (P = 0.343). The mean HGS was lower in the hip fracture group at all measured time periods. The preoperative HGS increased right before discharge (15.2 kg to 17.0 kg), and plateaued thereafter 1-year in the fracture group, whereas there were no statistically significant changes in serial follow-up trends in the control group.

Conclusions

The preoperative HGS in fracture patients may have been underestimated, due to different position of the arm, insufficient practice, or pain. Subsequently, HGS was rather constant during 1-year indicating no development of general sarcopenia after treatment for hip fracture. Therefore, in hip fracture patients, the predischarge HGS might be more reliable than preoperative HGS.
Clearance of blood stream infections in patients receiving extracorporeal membrane oxygenation: a retrospective single-center cohort study
Authors: Frankford Stone A. , Sobieszczyk Michal J. , Markelz Ana E. , Marcus Joseph E.
Published: February 2023

Background

There are limited data on the treatment of blood stream infections (BSIs) in patients receiving extracorporeal membrane oxygenation (ECMO). Current guidance recommends documenting clearance only in fungal and Gram-positive BSIs. This study investigates the incidence and clinical significance of blood stream infections with positive repeat cultures (BSIPRC) in ECMO as well as clinical factors that may predict positive repeat cultures.

Methods

All BSIs in patients receiving ECMO at Brooke Army Medical Center between September 2012 and October 2021 were included in this study. BSIPRC was defined as re-isolation of the same organism on repeat blood cultures following an initial positive blood culture.

Results

A total of 60 patients developed 87 BSI (38.5 BSI per 1000 ECMO days). Of the 80 (92%) BSIs who had repeat blood cultures drawn, patients had BSIPRC in 35 (44%) of cases. Fever, leukocytosis, and vasopressor requirement on day of repeat culture were not associated with persistent positivity. There was no difference in survival to discharge for patients with BSIPRC as compared to single day BSI (58% vs. 63%, p = 0.78). 19% of patients with Gram-negative bacteremia had BSIPRC, and gram-negative bacteremia in general was associated with an 83% morality.

Conclusions

There were no clinical findings that differentiated patients with BSIPRC from those who had a single day of positivity. BSI was associated with high mortality in patients with Gram-negative bacteremia. Given high incidence of positive repeat cultures being seen in Gram-negative BSIs, repeat blood cultures have utility for all BSIs in patients receiving ECMO.
Seroprevalence and risk factors for Kaposi’s Sarcoma associated herpesvirus among men who have sex with men in Shanghai, China
Authors: Li Yi , Zhang Xingcan , Zhang Yue , Wei Minqi , Tao Sijie , Yang Ying
Published: January 2023

Background

This study aimed to facilitate the understanding of the transmission route and risk factors that might contribute to the infection of Kaposi’s sarcoma associated herpesvirus (KSHV) among men who have sex with men (MSM).

Methods

A cross-sectional study of 520 subjects was conducted in Shanghai, China in 2020. Plasma samples were collected and screened for KSHV, HIV, HBV, HCV, and syphilis. Univariate and multivariate logistic regression analyses were conducted to explore potential correlates of KSHV infection.

Results

The overall seroprevalence of KSHV was 43.8%, with an adjusted value of 29.8% according to the sensitivity and specificity of the KSHV screening assay. Individuals with lower levels of monthly income (Chi-sqauretrend = 4.11, P = 0.043) and more male sex partners (Chi-sqauretrend = 6.06, P = 0.014) were more likely to be infected with KSHV. Also, KSHV seropositivity was positively associated with being a student (aOR = 1.96; 95%CI: 1.09–3.61), being coinfected with HCV (aOR = 2.61; 95%CI: 1.05–7.10), and syphilis (aOR = 2.91; 95%CI: 1.30–6.89).

Conclusions

The prevalence of KSHV in MSM remains high. As a risky sexual behavior, having multiple male sex partners is a key contributor to KSHV infection among this population. Efforts designed to control modifiable risk factors in order to reduce the burden of KSHV infection are indispensable. High KSHV seroprevalence among students MSM deserves more attention.