bluuebunny/crossref_metadata_2025 huggingface dataset:
Habitat fragmentation through urbanization selects for low dispersal in an ant species
Authors: Finand Basile , Loeuille Nicolas , Bocquet Céline , Fédérici Pierre , Ledamoisel Joséphine , Monnin Thibaud
Published: December 2023

Increased habitat fragmentation is one of the major global changes affecting biodiversity. It is characterised by a decrease in habitat availability and by the isolation of suitable habitat patches. The dispersal capacities of species may evolve in response to increased habitat fragmentation. Spatial heterogeneities and/or costs of dispersal, which are directly linked to habitat fragmentation, tend to select for lower dispersal abilities. We studied the effects of habitat fragmentation on dispersal in forest and urban contexts, using an ant species that exhibits a marked dispersal polymorphism. Myrmecina graminicola produces winged queens dispersing by flight over long distances, or apterous queens dispersing on foot over short distances. We sampled queens in 24 forests around Paris and in 25 parks within Paris, representing varied levels of habitat fragmentation and habitat size. Winged queens predominated in both environments. However, apterous queens were comparatively more common in parks than in forests, suggesting that high fragmentation and/or urbanization counterselects dispersal in this species. We argue that this is because dispersing within urban environments is very costly for this species, and discuss the factors favouring each queen morph or resulting in their co‐occurrence (maintenance of polymorphism).
Energetic driving force for LHCII clustering in plant membranes
Authors: Manna Premashis , Hoffmann Madeline , Davies Thomas , Richardson Katherine H. , Johnson Matthew P. , Schlau-Cohen Gabriela S.
Published: December 2023

Plants capture and convert solar energy in a complex network of membrane proteins. Under high light, the luminal pH drops and induces a reorganization of the protein network, particularly clustering of the major light-harvesting complex (LHCII). While the structures of the network have been resolved in exquisite detail, the thermodynamics that control the assembly and reorganization had not been determined, largely because the interaction energies of membrane proteins have been inaccessible. Here, we describe a method to quantify these energies and its application to LHCII. Using single-molecule measurements, LHCII proteoliposomes, and statistical thermodynamic modeling, we quantified the LHCII-LHCII interaction energy as ~−5
k
B
T
at neutral pH and at least −7
k
B
T
at acidic pH. These values revealed an enthalpic thermodynamic driving force behind LHCII clustering. Collectively, this work captures the interactions that drive the organization of membrane protein networks from the perspective of equilibrium statistical thermodynamics, which has a long and rich tradition in biology.
A vibrating ingestible bioelectronic stimulator modulates gastric stretch receptors for illusory satiety
Authors: Srinivasan Shriya S. , Alshareef Amro , Hwang Alexandria , Byrne Ceara , Kuosmanen Johannes , Ishida Keiko , Jenkins Joshua , Liu Sabrina , Gierlach Adam , Madani Wiam Abdalla Mohammed , Hayward Alison M. , Fabian Niora , Traverso Giovanni
Published: December 2023

Effective therapies for obesity require invasive surgical and endoscopic interventions or high patient adherence, making it challenging for patients with obesity to effectively manage their disease. Gastric mechanoreceptors sense distension of the stomach and perform volume-dependent vagal signaling to initiate the gastric phase and influence satiety. In this study, we developed a new luminal stimulation modality to specifically activate these gastric stretch receptors to elicit a vagal afferent response commensurate with mechanical distension. We designed the Vibrating Ingestible BioElectronic Stimulator (VIBES) pill, an ingestible device that performs luminal vibratory stimulation to activate mechanoreceptors and stroke mucosal receptors, which induces serotonin release and yields a hormonal metabolic response commensurate with a fed state. We evaluated VIBES across 108 meals in swine which consistently led to diminished food intake (~40%,P< 0.0001) and minimized the weight gain rate (P< 0.05) as compared to untreated controls. Application of mechanoreceptor biology could transform our capacity to help patients suffering from nutritional disorders.
Forecasting histone methylation by Polycomb complexes with minute-scale precision
Authors: Lundkvist Moa J. , Lizana Ludvig , Schwartz Yuri B.
Published: December 2023

Animals use the Polycomb system to epigenetically repress developmental genes. The repression requires trimethylation of lysine 27 of histone H3 (H3K27me3) by Polycomb Repressive Complex 2 (PRC2), but the dynamics of this process is poorly understood. To bridge the gap, we developed a computational model that forecasts H3K27 methylation in
Drosophila
with high temporal resolution and spatial accuracy of contemporary experimental techniques. Using this model, we show that pools of methylated H3K27 in dividing cells are defined by the effective concentration of PRC2 and the replication frequency. We find that the allosteric stimulation by preexisting H3K27me3 makes PRC2 better in methylating developmental genes as opposed to indiscriminate methylation throughout the genome. Applied to
Drosophila
development, our model argues that, in this organism, the intergenerationally inherited H3K27me3 does not “survive” rapid cycles of embryonic chromatin replication and is unlikely to transmit the memory of epigenetic repression to the offspring. Our model is adaptable to other organisms, including mice and humans.
Divergent
Pseudomonas aeruginosa
LpxO enzymes perform site-specific lipid A 2-hydroxylation
Authors: Hofstaedter Casey E. , Chandler Courtney E. , Met Charles M. , Gillespie Joseph J. , Harro Janette M. , Goodlett David R. , Rasko David A. , Ernst Robert K.
Published: December 2023

Pseudomonas aeruginosa
is an opportunistic pathogen that causes severe infection in hospitalized and chronically ill individuals. During infection,
P. aeruginosa
undergoes adaptive changes to evade host defenses and therapeutic interventions, increasing mortality and morbidity. Lipid A structural alteration is one such change that
P. aeruginosa
isolates undergo during chronic lung infection in CF. Investigating genetic drivers of this lipid A structural variation is crucial in understanding
P. aeruginosa
adaptation during infection. Here, we describe two lipid A dioxygenases with acyl-chain site specificity, each with different evolutionary origins. Further, we show that loss of function in these enzymes occurs in CF clinical isolates, suggesting a potential pathoadaptive phenotype. Studying these bacterial adaptations provides insight into selection pressures of the CF airway on
P. aeruginosa
phenotypes that persist during chronic infection. Understanding these adaptive changes may ultimately provide clinicians better control over bacterial populations during chronic infection.
Plasmodium
female gamete surface HSP90 is a key determinant for fertilization
Authors: Cha Sung-Jae , Vega-Rodriguez Joel , Tao Dingyin , Kudyba Heather M. , Hanner Kelly , Jacobs-Lorena Marcelo
Published: December 2023

Malaria kills over half a million people every year and this number has not decreased in recent years. The development of new tools to combat this disease is urgently needed. In this article, we report the identification of a key molecule—HSP90—on the surface of the parasite’s female gamete that is required for fertilization to occur and for the completion of the parasite cycle in the mosquito. HSP90 is a promising candidate for the development of a transmission-blocking vaccine.
The microbiome, resistome, and their co-evolution in sewage at a hospital for infectious diseases in Shanghai, China
Authors: Ma Yingying , Wu Nannan , Zhang Tao , Li Yanpeng , Cao Le , Zhang Peng , Zhang Zhigang , Zhu Tongyu , Zhang Chiyu
Published: December 2023

The emergence of antibiotic-resistant bacteria (ARB) caused by the overuse of antibiotics severely threatens human health. Hospital sewage may be a key transmission hub for ARB. However, the complex link between the microbiome and resistomeresistance in hospital sewage remains unclear. In this study, metagenomic assembly and binning methods were used to investigate the microbial community, resistome, and association of antibiotic resistance genes (ARGs) with ARB in sewage from 10 representative sites (outpatient building, surgery building, internal medicine buildings [IMB1-4], staff dormitory, laboratory animal building, tuberculosis building [TBB], and hospital wastewater treatment plant) of a hospital in Shanghai from June 2021 to February 2022. A total of 252 ARG subtypes, belonging to 17 antibiotic classes, were identified. The relative abundance of KPC-2 was higher at IMBs and TBB than at other sites. Of the ARG-carrying contigs, 47.3%-62.6% were associated with mobile genetic elements, and the proportion of plasmid-associated ARGs was significantly higher than that of chromosome-associated ARGs. Although a similar microbiome composition was shared, certain bacteria were enriched at different sites. Potential pathogens
Enterococcus B faecium
and
Klebsiella pneumoniae
were primarily enriched in IMB2 and IMB4, respectively. The same ARGs were identified in diverse bacterial hosts (especially pathogenic bacteria), and accordingly, the latter possessed multiple ARGs. Furthermore, gene flow was frequently observed in the sewage of different buildings. The results provide crucial information on the characterization profiles of resistomes in hospital sewage in Shanghai.

IMPORTANCE

Environmental antibiotic resistance genes (ARGs) play a critical role in the emergence and spread of antimicrobial resistance, which poses a global health threat. Wastewater from healthcare facilities serves as a significant reservoir for ARGs. Here, we characterized the microbial community along with the resistome (comprising all antibiotic resistance genes) in wastewater from a specialized hospital for infectious diseases in Shanghai. Potential pathogenic bacteria (e.g.,
Escherichia coli
,
Pseudomonas aeruginosa
,
Klebsiella pneumoniae
,
Enterococcus B faecium
) were frequently detected in hospital wastewater and carried multiple ARGs. A complex link between microbiome and resistome was observed in the wastewater of this hospital. The monitoring of ARGs and antibiotic-resistant bacteria (ARB) in hospital wastewater might be of great significance for preventing the spread of ARB.
Provenance Evolution and Its Response to Sea Level Change in the South Yellow Sea since 1.0 Ma
Authors: Wang Zhonglei , Zhang Yong , Mi Beibei , Wang Zhongbo , Dou Yanguang , Cong Jingyi , Sun Jun
Published: December 2023

The sediments provenance of the South Yellow Sea is controlled by many factors such as sea level change, ocean circulation, and neotectonic movement. The short time scale sediments provenance changes in this region since the Holocene have been revealed well, and a unified understanding has been formed that the central muddy area in the South Yellow Sea is a mixed area of the Yellow River sediments and the Yangtze River sediments. However, the contribution of different rivers to the sediments of the South Yellow Sea since late Quaternary is still ambiguous. Through comparative analysis of several boreholes with precise annual data constraints in the central mud area, the process of sediments provenance change at different periods since the late Early Pleistocene (1.0 Ma) was reconstructed, and the coupling mechanism of sediments provenance change and sea level change was established. It is found that during the period from 1.0 to 0.88 Ma, the seawater entered the South Yellow Sea along the Yellow Sea trough from the southeast to north as a channel, and there were different phenomena at the same time in different regions. Since 0.88 Ma, the sea water has been advancing from east to west. In addition, the sediments in the western of Jeju Island are mainly from China, and the sediments in the eastern are mainly from the Korean Peninsula, which roughly coincides with the boundary between the silty area and the sandy area on the eastern of the South Yellow Sea. In the surface sediments, the boundary line between the Yellow River sediments and the Yangtze River sediments is approximately 33.4° N.
The impact of decentralisation on health systems: a systematic review of reviews
Authors: Sapkota Sujata , Dhakal Amshu , Rushton Simon , van Teijlingen Edwin , Marahatta Sujan B , Balen Julie , Lee Andrew CK
Published: December 2023

Background

Decentralisation is a common mechanism for health system reform; yet, evidence of how it impacts health systems remains fragmented. Despite published findings from primary and secondary research illustrating range of impacts, a comprehensive and clear understanding is currently lacking. This review synthesised the existing evidence to assess how decentralisation (by devolution) impacts each of the six WHO building blocks, and the health system.

Method

We systematically searched five electronic databases for reviews exploring impact of decentralisation on health systems, globally. Reviews, both systematic and non-systematic, published in the English language from January 1990 to February 2022 were included. Data were synthesised across each of six building blocks. Quality assessment of the reviews was conducted using Critical Appraisal Skills Program for systematic and Scale for Assessment of Narrative Review Articles for non-systematic reviews.

Results

Nine reviews, each addressing somewhat different questions, contexts and issues, were included. A range of positive and negative impacts of decentralisation on health system building blocks were identified; yet, overall, the impacts were more negative. Although inconclusive, evidence suggested that the impacts on leadership and governance and financing components in particular shape the impact on overall health system. Assessment of how the impact on building blocks translates to the broader impact on health systems is challenged by the dynamic complexities related to contexts, process and the health system itself.

Conclusions

Decentralisation, even if well intentioned, can have unintended consequences. Despite the difficulty of reaching universally applicable conclusions about the pros and cons of decentralisation, this review highlights some of the common potential issues to consider in advance.

PROSPERO registration number

CRD42022302013.
Benefits and harms of breast cancer screening revisited: a large, retrospective cross-sectional study quantifying treatment intensity in women with screen-detected versus non-screen-detected cancer in Australia and New Zealand
Authors: Dempsey Kathy , Costa Daniel SJ , Brennan Meagan E , Mann G Bruce , Snook Kylie L , Spillane Andrew J
Published: December 2023

Objectives

Non-mortality benefits of breast cancer screening are rarely considered in assessments of benefits versus harms. This study aims to estimate the rate of overdiagnosis in women with screen-detected breast cancer (SDBC) by allocating cases to either possibly overdiagnosed (POD) or not overdiagnosed categories and to compare treatment recommendations for surgery and adjuvant treatments by category, age at diagnosis and cancer stage.

Methods and analysis

Retrospective secondary analysis of 10 191 women diagnosed with breast cancer in Australia and New Zealand in 2018. Treatment recommendations for 5226 women with SDBC and 4965 women with non-SDBC (NSDBC) were collated and analysed. Descriptive statistics were used to calculate proportions and risk ratios (RRs).

Results

The POD rate was 15.8%. Screening detected 66.3% of stage 0 tumours, 59% of stage 1, 40% of stage 2 and 27.5% of stage 3 tumours. Women with SDBC were less likely than their NSDBC counterparts to receive chemotherapy (RR 0.60 Aus/0.53 NZ), immunotherapy (mostly human epidermal growth factor 2 receptor therapy) (RR 0.58 Aus/0.82 NZ), mastectomy (RR 0.55 Aus/0.63 NZ) and axillary lymph node dissection (RR 0.49 Aus/0.52 NZ), or to require both mastectomy and radiotherapy (RR 0.41 Aus/0.34 NZ). Less than 1% of POD women were recommended chemotherapy, 9.5% radiotherapy, 6.4% endocrine therapy, 2.2% mastectomy and 0.5% axillary lymph node dissection.

Conclusions

Women with SDBCs required less intensive treatment; rates of possible overtreatment of SDBCs are relatively low and may be minimised through multidisciplinary discussion and shared decision-making. Reduced treatment intensity should be considered when balancing the potential benefits and harms of screening.
Contribution of hospitals and clinical services to global warming: protocol for a scoping review
Authors: Merino-Urrutia Waldo , Cárcamo-Fuentes Claudio , Peña Mauricio , Martinez-Zapata María José
Published: December 2023

Introduction

Climate change is one of the greatest threats to public health today, placing considerable pressure on the healthcare sector. During patient care processes, hospital facilities contribute to greenhouse gas emissions through the use of greater resources and higher energy consumption. Consequently, there is growing interest among researchers, universities, organisations and governments to study the impact of the healthcare sector on the environment and to develop strategies to mitigate its effects. The aim of this scoping review is to determine the extent and nature of current literature on global warming from hospitals and clinical services, and ways in which they contribute to its effect. Planning and execution of future research are possible once those areas with existing gaps are identified.

Methods and analysis

A broad literature search will be carried out to illustrate the ways in which hospitals and clinical services, processes and activities contribute to climate change. Our protocol was drafted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The final protocol was registered prospectively with the Open Science Framework. All identified studies indexed in Medline, Scopus and Embase will be examined.

Ethics and dissemination

This project is literature-based research; therefore, it does not require ethical approval. The results will be presented to researchers as well as policymakers in this particular area, via conferences, webinars, podcasts and online events. A peer-reviewed publication will be submitted to specific journals of interest.
Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis
Authors: Liu Qianqian , Huang Min , Yang Jing , Jiang Mengyuan , Zhao Ziru , Zhao Haitong , He Tingting , Bai Yuping , Zhang Rui , Zhang Min
Published: December 2023

Objective

Clinical practice guidelines recommend retrieving at least 12 lymph nodes for correct staging in colorectal cancer. However, it is difficult to retrieve adequate lymph nodes because of various factors. We aimed to evaluate the association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer.

Design

Systematic review and meta-analysis of primary studies.

Data sources

PubMed, Embase, Cochrane and Web of Science were searched from January 2016 to June 2023.

Eligibility criteria for selecting studies

Studies that evaluated the association between retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer were included.

Data extraction and synthesis

OR with 95% conference intervals was extracted and pooled.

Results

A total of 54 studies containing 2 05 821 patients were included in this meta-analysis. The results showed that fewer nodes were retrieved from elderly patients (OR=0.70, 95% CI (0.54 to 0.90), p=0.005), and from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001). More lymph nodes were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006), from the advanced T stage (T3+T4) than T1+T2 stage (OR=1.57, 95% CI (1.25 to 1.97), p<0.001) and from the N2 stage than N0 stage (OR=1.32, 95% CI (1.15 to 1.51), p<0.001). Body mass index, ethnicity, N1 stage, M stage, tumour differentiation and lymph–vascular invasion were not significantly associated with the lymph node yield.

Conclusions

The study results suggest that clinicians have an increased opportunity to retrieve sufficient lymph nodes for accurate pathological staging to guide treatment decisions in patients with colorectal cancer who are young, female, with tumours located in the right colon, advanced T stage and N2 stage.
Nationwide survey of physicians’ familiarity and awareness of diabetes guidelines in China: a cross-sectional study
Authors: Jia Li-yan , Huang Cao-xin , Zhao Neng-jiang , Lai Bao-yong , Zhang Zhi-hai , Li Le , Zhan Na , Lin Yuan-bing , Cai Miao-na , Wang Shun-qin , Yan Bing , Liu Jian-ping , Yang Shu-yu
Published: December 2023

Objective

This study aims to investigate physicians’ familiarity and awareness of four diabetes guidelines and their practice of the recommendations outlined in these guidelines.

Design

A cross-sectional study.

Setting

An online questionnaire survey was conducted among physicians affiliated with the Specialist Committee for Primary Diabetes Care of China Association of Chinese Medicine, using the snowball sampling method to ensure a broader representation of physicians.

Participants

1150 physicians from 192 cities across 30 provinces in China provided complete data.

Results

Tertiary care hospital physicians (TCPs) exhibited the highest familiarity with the Guideline for the Prevention and Treatment of Type 2 Diabetes Mellitus in China (91.3%), followed by the National Guidelines for the Prevention and Control of Diabetes in Primary Care (76.8%), the Standards of Medical Care in Diabetes (72.2%) and the Guidelines for Prevention and Treatment of Diabetes in Chinese Medicine (63.8%). Primary care practitioners (PCPs) exhibited familiarity with these four guidelines at about 50% or less. Self-reported reference to modern diabetes guidelines by physicians is more frequent than traditional Chinese medicine (TCM) diabetes guidelines, with rates at 73.2% and 33.8%, respectively. Approximately 90% of physicians provided instructions on self-monitoring of blood glucose to their patients with diabetes. Less than one-third of physicians referred patients to a specialised nutritionist. In terms of health education management, TCPs reported having a diabetes health management team at the rate of 75.7%, followed by secondary care hospital physicians at 57.0% and PCPs at 27.5%. Furthermore, approximately 40% of physicians did not fully grasp hypoglycaemia characteristics.

Conclusions

Familiarity and awareness of the screening guidelines varied among physicians in different hospital settings. Importantly, significant discrepancies were observed between physicians’ awareness and their self-reported reference to modern medicine guidelines and TCM guidelines. It is essential to consistently provide education and training on diabetes management for all physicians, particularly PCPs.
Prevalence of psychological distress in nurses, physicians and leaders working in intensive care units during the COVID-19 pandemic: a national one-year follow-up study
Authors: Hovland Ingvild Strand , Skogstad Laila , Stafseth Siv , Hem Erlend , Diep Lien M , Ræder Johan , Ekeberg Øivind , Lie Irene
Published: December 2023

Objective

To report and compare psychological distress as symptoms of anxiety, depression and post-traumatic stress among intensive care units’ (ICU) nurses, physicians and leaders at 12 months after the baseline survey (spring 2020), during the COVID-19 pandemic in Norway. Furthermore, to analyse which baseline demographic and COVID ICU-related factors have a significant impact on psychological distress at 12 months.

Design

Prospective, longitudinal, observational cohort study.

Setting

Nationwide, 27 of 28 hospitals with COVID ICUs in Norway.

Participants

Nurses, physicians and their leaders. At 12 month follow-up 287 (59.3%) of 484 baseline participants responded.

Primary and secondary outcome measures

Symptoms of anxiety and depression using the Hopkins Symptoms Checklist-10 (HSCL-10). Symptoms of post-traumatic stress using the post-traumatic stress disease checklist for the Diagnostic and Statistical Manual of Mental Disorders 5 (PCL-5).

Demographics (included previous symptoms of anxiety and depression) and COVID ICU-related factors (professional preparations, emotional experience and support) impacting distress at 12 months.

Results

Psychological distress, defined as caseness on either or both HSCL-10 and PCL-5, did not change significantly and was present for 13.6% of the participants at baseline and 13.2% at 12 month follow-up. Nurses reported significantly higher levels of psychological distress than physicians and leaders. Adjusted for demographics and the COVID ICU-related factors at baseline, previous symptoms of depression and fear of infection were significantly associated with higher levels of anxiety and depression at 12 months. Previous symptoms of depression, fear of infection and feeling of loneliness was significantly associated with more symptoms of post-traumatic stress.

Conclusion

One year into the COVID-19 pandemic 13.2% of the ICUs professionals reported psychological distress, more frequently among the nurses. Fear of infection, loneliness and previous symptoms of depression reported at baseline were associated with higher levels of distress. Protective equipment and peer support are recommended to mitigate distress.

Trial registration number

ClinicalTrials.gov. Identifier:NCT04372056.
Study protocol for a national observational cohort investigating frailty, delirium and multimorbidity in older surgical patients: the third Sprint National Anaesthesia Project (SNAP 3)
Authors: Swarbrick Claire , Poulton Tom , Martin Peter , Partridge Judith , Moppett Iain Keith
Published: December 2023

Introduction

Older surgical patients are more likely to be living with frailty and multimorbidity and experience postoperative complications. The management of these conditions in the perioperative pathway is evolving. In order to support objective decision-making for patients, services and national guidance, accurate, contemporary data are needed to describe the impact and associations between frailty, multimorbidity and healthcare processes with patient and service-level outcomes.

Methods and analysis

The study is comprised of an observational cohort study of approximately 7500 patients; an organisational survey of perioperative services and a clinician survey of the unplanned, medical workload generated from older surgical patients. The cohort will consist of patients who are 60 years and older, undergoing a surgical procedure during a 5-day recruitment period in participating UK hospitals. Participants will be assessed for baseline frailty and multimorbidity; postoperative morbidity including delirium; and quality of life. Data linkage will provide additional details about individuals, their admission and mortality.

The study’s primary outcome is length of stay, other outcome measures include incidence of postoperative morbidity and delirium; readmission, mortality and quality of life. The cohort’s incidence of frailty, multimorbidity and delirium will be estimated using 95% CIs. Their relationships with outcome measures will be examined using unadjusted and adjusted multilevel regression analyses. Choice of covariates in the adjusted models will be prespecified, based on directed acyclic graphs.

A parallel study is planned to take place in Australia in 2022.

Ethics and dissemination

The study has received approval from the Scotland A Research Ethics Committee and Wales Research Ethics Committee 7.

This work hopes to influence the development of services and guidelines. We will publish our findings in peer-reviewed journals and provide summary documents to our participants, sites, healthcare policy-makers and the public.

Trial registration number

ISRCTN67043129.
Prevalence and factors associated with hypertension among adolescents in Sudan: a cross-sectional school-based study
Authors: Hassan Ahmed Ali , Al-Nafeesah Abdullah , AlEed Ashwaq , Adam Ishag
Published: December 2023

Objectives

There is an increasing rate of elevated blood pressure, or hypertension, in children and adolescents worldwide, including Sub-Saharan Africa (SSA). Only a few data on adolescent hypertension in SSA, including Sudan, have been published. The aim of the present study was to investigate the prevalence and associated factors of hypertension among adolescent schoolchildren (within the ages of 10 to 19 years) in Sudan.

Design

A cross-sectional school-based study was conducted from June to September 2022.

Settings

Six randomly selected schools in Almatamah, River Nile State, Sudan.

Participants

Adolescent schoolchildren (within the ages of 10 to 19 years).

Main outcome measures

Sociodemographic information. Anthropometric and blood pressure measurements were performed in accordance with the standard procedures. An adjusted logistic regression analysis was performed.

Results

Of the 384 enrolled adolescents, 166 (43.2%) and 218 (56.8%) were boys and girls, respectively. The median (IQR) age and body mass index (BMI) were 15.2 years (14.0‒16.4 years) and 18.5 kg/m2(16.4‒21.5 kg/m2), respectively. Of the 384 adolescents, 240 (62.5%) and 255 (66.4%) had educated mothers and fathers (≥secondary), respectively. 38 adolescents (9.9%) had hypertension (≥95th percentile). The multivariable logistic regression analysis revealed that age, sex and maternal educational level were not associated with hypertension. Paternal educational level according to secondary education attainment (adjusted OR (AOR), 2.72; 95% CI 1.36‒5.46) and increasing BMI (AOR, 1.12; 95% CI 1.02‒1.20) were associated with hypertension.

Conclusion

1 in 10 adolescents in northern Sudan was hypertensive. Low paternal educational level and increasing BMI were significantly associated with hypertension. The introduction of interventional nutritional programmes at early ages is needed to ensure that adolescents are healthy in their present and later lives. To sustain such programmes, involving all educational parties at early stage is essential.
Behavioural and social drivers of COVID-19 vaccination in Vietnam: a scoping review
Authors: Tran Luong , Dang Tho , Nguyen Mai , Kaufman Jessica , Overmars Isabella , Shrestha Shiva , Abdi Ikram , Nguyen Thao , Marahajan Muthu , Chu Trang , Danchin Margie , Fox Gregory , Nguyen Thu Anh
Published: December 2023

Background

Understanding of the behavioural and social drivers (BeSD) of vaccination is key to addressing vaccine hesitancy and accessibility issues. Vietnam’s national COVID-19 vaccination programme resulted in high uptake of primary doses among adults, but lower booster doses for adults and primary doses for 5–11 years. This scoping review assessed BeSD influencing COVID-19 vaccine uptake in Vietnam to design interventions on reaching the national vaccination targets.

Method

We conducted a scoping review by searching PubMed, MedRxiv, LitCOVID, COVID-19 LOVE platform, WHO’s COVID-19 research database and seven dominant Vietnamese language medical journals published in English or Vietnamese between 28 December 2019 and 28 November 2022. Data were narratively synthesised and summarised according to the four components of the WHO BeSD framework. The drivers were then mapped along the timeline of COVID-19 vaccine deployment and the evolution of the pandemic in Vietnam.

Results

We identified 680 records, of which 39 met the inclusion criteria comprising 224 204 participants. Adults’ intention to receive COVID-19 vaccines for themselves (23 studies) ranged from 58.0% to 98.1%. Parental intention to vaccinate their under 11-year-old children (six studies) ranged from 32.8% to 79.6%. Key drivers of vaccination uptake were perceived susceptibility and severity of disease, perceived vaccine benefits and safety, healthcare worker recommendation, and positive societal perception. Commonly reported COVID-19 vaccines’ information sources (six studies) were social and mainstream media (82%–67%), television (72.7%–51.6%) and healthcare workers (47.5%–17.5%). Key drivers of COVID-19 uptake remained consistent for both adults and children despite changes in community transmission and vaccine deployment.

Conclusion

Key enablers of vaccine uptake for adults and children included perceived disease severity, perceived vaccine benefits and safety and healthcare worker recommendations. Future studies should assess vaccine communication targeted to these drivers, national policies and political determinants to optimise vaccine uptake.
Prevalence of adequately iodised salt and associated factors among households in Gambela district, Southwest Ethiopia: a cross-sectional study
Authors: Tesfaye Getamesay Aynalem , Gemechu Ebissa Negera , Chanie Fentaneh Teshome , Umer Abdella Yasin
Published: December 2023

Background

Iodine deficiency disorders (IDDs) are among the major public health problems for populations worldwide. Although the recommended strategy for the prevention of IDD is universal salt iodisation, little is known about the availability of adequately iodised salt among households in Southwest Ethiopia. Therefore, this study aimed to determine the prevalence of adequately iodised salt and associated factors among households in Gambela district, Southwest Ethiopia.

Methods

A community-based cross-sectional study was conducted in July 2019. A multistage sampling method was employed to select 422 households. A structured questionnaire and rapid test kits were used as data collection instruments. Multivariate logistic regression was used to identify associated factors.

Results

Approximately 52.8% (95% CI: 47, 57%) of households had adequately iodised salt. Higher educational status (adjusted OR (AOR)=4.27, 95% CI: 1.47, 12.44), favourable attitude toward iodised salt use (AOR=5.69, 95% CI: 2.83, 11.42), walking less than 30 min to buy iodised salt (AOR=4.69, 95% CI: 2.56, 8.60), using packed salt (AOR=2.75, 95% CI: 1.54, 4.93) and using covered salt containers (AOR=3.93, 95% CI: 2.21, 6.98) were factors positively associated with the availability of adequately iodised salt among households.

Conclusions

The prevalence of adequately iodised salt among households in Gambela district is very low. Therefore, enhancing community awareness about the benefit and good practice of iodised salt should be emphasised in addition to improving accessibility. Measures to improve the literacy of households also need to be underlined.
CLivD score modifies FIB-4 performance in liver fibrosis detection in the US general population
Authors: Åberg Fredrik , Lääperi Mitja , Männistö Ville
Published: December 2023

Background and aims

Steatotic liver disease (SLD) is a growing global concern. The Chronic Liver Disease (CLivD) risk score predicts liver-related outcomes in the general population using easily accessible variables with or without laboratory tests (CLivDlaband CLivDnon-lab). We assessed CLivD’s associations with liver steatosis, fibrosis and its combined performance with fibrosis-4 (FIB-4) for advanced fibrosis detection.

Methods

Using the National Health and Nutrition Examination Survey data (2017–2020), 3603 participants aged 40–70 years with valid liver stiffness measurements (LSMs) were included. Advanced fibrosis was defined as LSM ≥12 kPa, and SLD as controlled attenuation parameter ≥288 dB/m.

Results

Significant associations were found between CLivD and SLD and advanced fibrosis. CLivDlabhad an area under the curve (AUC) for advanced fibrosis of 0.72 (95% CI 0.68 to 0.77), while CLivDnon-labhad an AUC of 0.68 (95% CI 0.64 to 0.72), both slightly higher than FIB-4 (AUC 0.66, 95% CI 0.60 to 0.72). Among participants without obesity, AUC of CLivDlabwas 0.82 (95% CI 0.76 to 0.88) and AUC of CLivDnon-labwas 0.72 (95% CI 0.65 to 0.79). The CLivD score improved FIB-4’s AUC for advanced fibrosis detection from <0.5 at minimal CLivD scores to >0.8 at high CLivD scores. A sequential CLivD→FIB-4 strategy outperformed universal FIB-4 testing, enhancing specificity from 72% to 83%, with sensitivity at 51%–53%. This strategy identified a subgroup with a 55% prevalence of advanced fibrosis, while 47% had minimal-risk CLivD scores, eliminating the need for FIB-4 testing.

Conclusions

The CLivD score, designed for predicting liver-related outcomes, effectively identifies liver steatosis and advanced fibrosis in the general population. Combining CLivD with FIB-4 enhances advanced fibrosis detection accuracy. The CLivD score could enhance population-based liver fibrosis screening, optimising resource allocation.
Enhancing pain modulation: the efficacy of synchronous combination of virtual reality and transcutaneous electrical nerve stimulation
Authors: Bi Yanzhi , Liu Xu , Zhao Xiangyue , Wei Shiyu , Li Jingwei , Wang Faguang , Luo Wenbo , Hu Li
Published: December 2023

Introduction

Virtual reality (VR) and transcutaneous electrical nerve stimulation (TENS) have emerged as effective interventions for pain reduction. However, their standalone applications often yield limited analgesic effects, particularly in certain painful conditions.

Aims

Our hypothesis was that the combination of VR with TENS in a synchronous manner could produce the best analgesic effect among the four experimental conditions.

Methods

To address this challenge, we proposed a novel pain modulation strategy that synchronously combines VR and TENS, aiming to capitalise on both techniques’ complementary pain modulation mechanisms. Thirty-two healthy subjects participated in the study and underwent three types of interventions: VR alone, a combination of VR with conventional TENS, and a combination of VR with synchronous TENS. Additionally, a control condition with no intervention was included. Perceived pain intensity, pain unpleasantness, positive and negative affect scores, and electroencephalographic (EEG) data were collected before and after the interventions. To delve into the potential moderating role of pain intensity on the analgesic efficacy of VR combined with synchronous TENS, we incorporated two distinct levels of painful stimuli: one representing mild to moderate pain (ie, low pain) and the other representing moderate to severe pain (ie, high pain).

Results

Our findings revealed that both combination interventions exhibited superior analgesic effects compared with the VR-alone intervention when exposed to low and high pain stimuli. Notably, the combination of VR with synchronous TENS demonstrated greater analgesic efficacy than the combination of VR with conventional TENS. EEG data further supported these results, indicating that both combination interventions elicited a greater reduction in event-related potential magnitude compared with the VR-alone intervention during exposure to low and high pain stimuli. Moreover, the synchronous combination intervention induced a more significant reduction in N2 amplitude than the VR-alone intervention during exposure to low pain stimuli. No significant differences in EEG response changes were detected between the two combination interventions. Both combination interventions resulted in a greater reduction in negative affect compared with the VR-alone intervention.

Conclusions

Altogether, our study highlights the effectiveness of the synchronous combination of VR and TENS in enhancing pain modulation. These findings offer valuable insights for developing innovative pain treatments, emphasising the importance of tailored and multifaceted therapeutic approaches for various painful conditions.
Electroencephalography microstates as novel functional biomarkers for
insomnia disorder
Authors: Guo Yongjian , Zhao Xumeng , Liu Xiaoyang , Liu Jiayi , Li Yan , Yue Lirong , Yuan Fulai , Zhu Yifei , Sheng Xiaona , Yu Dahua , Yuan Kai
Published: December 2023

Background

Insomnia disorder (ID) is one of the most common mental disorders.
Research on ID focuses on exploring its mechanism of disease, novel
treatments and treatment outcome prediction. An emerging technique in
this field is the use of electroencephalography (EEG) microstates, which
offer a new method of EEG feature extraction that incorporates
information from both temporal and spatial dimensions.

Aims

To explore the electrophysiological mechanisms of repetitive
transcranial magnetic stimulation (rTMS) for ID treatment and use
baseline microstate metrics for the prediction of its efficacy.

Methods

This study included 60 patients with ID and 40 age-matched and
gender-matched good sleep controls (GSC). Their resting-state EEG
microstates were analysed, and the Pittsburgh Sleep Quality Index (PSQI)
and polysomnography (PSG) were collected to assess sleep quality. The 60
patients with ID were equally divided into active and sham groups to
receive rTMS for 20 days to test whether rTMS had a moderating effect on
abnormal microstates in patients with ID. Furthermore, in an independent
group of 90 patients with ID who received rTMS treatment, patients were
divided into optimal and suboptimal groups based on their median PSQI
reduction rate. Baseline EEG microstates were used to build a
machine-learning predictive model for the effects of rTMS
treatment.

Results

The class D microstate was less frequent and contribute in patients
with ID, and these abnormalities were associated with sleep onset
latency as measured by PSG. Additionally, the abnormalities were
partially reversed to the levels observed in the GSC group following
rTMS treatment. The baseline microstate characteristics could predict
the therapeutic effect of ID after 20 days of rTMS, with an accuracy of
80.13%.

Conclusions

Our study highlights the value of EEG microstates as functional
biomarkers of ID and provides a new perspective for studying the
neurophysiological mechanisms of ID. In addition, we predicted the
therapeutic effect of rTMS on ID based on the baseline microstates of
patients with ID. This finding carries great practical significance for
the selection of therapeutic options for patients with ID.
Diagnosis and management of resistant hypertension
Authors: Camafort Miguel , Kreutz Reinhold , Cho Myeong-Chan
Published: December 2023

Resistant hypertension is a condition where blood pressure levels remain elevated above target despite changes in lifestyle and concurrent use of at least three antihypertensive agents, including a long-acting calcium channel blocker (CCB), a blocker of the renin-angiotensin system (ACE inhibitor or angiotensin receptor blocker) and a diuretic. To be diagnosed as resistant hypertension, maintaining adherence to therapy is required along with confirmation of blood pressure levels above target by out-of-office blood pressure measurements and exclusion of secondary causes of hypertension. The key management points of this condition include lifestyle changes such as reduced sodium and alcohol intake, regular physical activity, weight loss and discontinuation of substances that can interfere with blood pressure control. It is also recommended that current treatment be rationalised, including single pill combination treatment where antihypertensive drugs should be provided at the maximum tolerated dose. It is further recommended that current drugs be replaced with a more appropriate and less difficult treatment regimen based on the patient’s age, ethnicity, comorbidities and risk of drug–drug interactions. The fourth line of treatment for patients with resistant hypertension should include mineralocorticoid receptor antagonists such as spironolactone, as demonstrated in the PATHWAY-2 trial and meta-analyses. Alternatives to spironolactone include amiloride, doxazosin, eplerenone, clonidine and beta-blockers, as well as any other antihypertensive drugs not already in use. New approaches under research are selective non-steroidal mineralocorticoid receptor antagonists such as finerenone, esaxerenone and ocedurenone, selective aldosterone synthase inhibitors such as baxdrostat, and dual endothelin antagonist aprocitentan.
Scalable generation of functional human iPSC-derived CAR-macrophages that efficiently eradicate CD19-positive leukemia
Authors: Abdin Shifaa M. , Paasch Daniela , Kloos Arnold , Oliveira Marco Carvalho , Jang Mi-Sun , Ackermann Mania , Stamopoulou Andriana , Mroch Philipp J , Falk Christine S , von Kaisenberg Constantin S , Schambach Axel , Heuser Michael , Moritz Thomas , Hansen Gesine , Morgan Michael , Lachmann Nico
Published: December 2023

Background

Macrophages have recently become attractive therapeutics in cancer immunotherapy. The potential of macrophages to infiltrate and influence solid malignancies makes them promising targets for the chimeric antigen receptor (CAR) technology to redirect their stage of polarization, thus enhancing their anticancer capacities. Given the emerging interest for CAR-macrophages, generation of such cells so far mainly depends on peripheral blood monocytes, which are isolated from the respective donor prior to genetic manipulation. This procedure is time-intensive and cost-intensive, while, in some cases, insufficient monocyte amounts can be recovered from the donor, thus hampering the broad applicability of this technology. Hence, we demonstrate the generation and effectiveness of CAR-macrophages from various stem cell sources using also modern upscaling technologies for next generation immune cell farming.

Methods

Primary human hematopoietic stem and progenitor cells and induced pluripotent stem cells were used to derive anti-CD19 CAR-macrophages. Anticancer activity of the cells was demonstrated in co-culture systems, including primary material from patients with leukemia. Generation of CAR-macrophages was facilitated by bioreactor technologies and single-cell RNA (scRNA) sequencing was used to characterize in-depth response and behavior of CAR-macrophages.

Results

Irrespective of the stem-cell source, CAR-macrophages exhibited enhanced and antigen-dependent phagocytosis of CD19+target cancer cells with increased pro-inflammatory responses. Phagocytic capacity of CAR-macrophages was dependent on target cell CD19 expression levels with superior function of CAR-macrophages against CD19+cancer cell lines and patient-derived acute lymphocytic leukemia cancer cells. scRNA sequencing revealed CAR-macrophages to be distinct from eGFP control cells after co-culture with target cells, which includes the activation of pro-inflammatory pathways and upregulation of chemokines and cytokines associated with adaptive immune cell recruitment, favoring the repolarization of CAR-macrophages to a pro-inflammatory state. Taken together, the data highlight the unique features of CAR-macrophages in combination with the successful upscaling of the production pipeline using a three-dimensional differentiation protocol and intermediate scale bioreactors.

Conclusion

In summary, our work provides insights into the seminal use and behavior of CAR-macrophages which are derived from various sources of stem cells, while introducing a unique technology for CAR-macrophage manufacturing, all dedicated to the clinical translation of CAR-macrophages within the field of anticancer immunotherapies.