bluuebunny/crossref_metadata_2025 huggingface dataset:
Ocular biomarkers of cognitive decline based on deep-learning retinal vessel segmentation
Authors: Li Rui , Hui Ying , Zhang Xiaoyue , Zhang Shun , Lv Bin , Ni Yuan , Li Xiaoshuai , Liang Xiaoliang , Yang Ling , Lv Han , Yin Zhiyu , Li Hongyang , Yang Yingping , Liu Guangfeng , Li Jing , Xie Guotong , Wu Shouling , Wang Zhenchang
Published: January 2024

Background

The current literature shows a strong relationship between retinal neuronal and vascular alterations in dementia. The purpose of the study was to use NFN+ deep learning models to analyze retinal vessel characteristics for cognitive impairment (CI) recognition.

Methods

We included 908 participants from a community-based cohort followed for over 15 years (the prospective KaiLuan Study) who underwent brain magnetic resonance imaging (MRI) and fundus photography between 2021 and 2022. The cohort consisted of both cognitively healthy individuals (N = 417) and those with cognitive impairment (N = 491). We employed the NFN+ deep learning framework for retinal vessel segmentation and measurement. Associations between Retinal microvascular parameters (RMPs: central retinal arteriolar / venular equivalents, arteriole to venular ratio, fractal dimension) and CI were assessed by Pearson correlation. P < 0.05 was considered statistically significant. The correlation between the CI and RMPs were explored, then the correlation coefficients between CI and RMPs were analyzed. Random Forest nonlinear classification model was used to predict whether one having cognitive decline or not. The assessment criterion was the AUC value derived from the working characteristic curve.

Results

The fractal dimension (FD) and global vein width were significantly correlated with the CI (P < 0.05). Age (0.193), BMI (0.154), global vein width (0.106), retinal vessel FD (0.099), and CRAE (0.098) were the variables in this model that were ranked in order of feature importance. The AUC values of the model were 0.799.

Conclusions

Establishment of a predictive model based on the extraction of vascular features from fundus images has a high recognizability and predictive power for cognitive function and can be used as a screening method for CI.
Feasibility, safety and effectiveness of prednisolone and vitamin B1, B6, and B12 in patients with post-COVID-19-syndrome (PreVitaCOV) – protocol of a randomised, double-blind, placebo-controlled multicentre trial in primary care (phase IIIb)
Authors: Tengelmann Caroline , Joos Stefanie , Kaußner Yvonne , Malzahn Uwe , Lunden Laura , Klug Andreas , Häusler Karl Georg , Escales Catharina , Maetzler Walter , Hügen Klemens , Zolk Oliver , Heuschmann Peter U. , Förster Christian , Kaduszkiewicz Hanna , Gágyor Ildikó
Published: January 2024

Background

After infection with SARS-CoV-2 a relevant proportion of patients complains about persisting symptoms, a condition termed Post-COVID-19-syndrome (PC19S). So far, possible treatments are under investigation. Among others, neurotropic vitamins and anti-inflammatory substances are potential options. Thus, the PreVitaCOV trial aims to assess feasibility, safety, and effectiveness of treating patients in primary care with prednisolone and/or vitamin B1, B6 and B12.

Methods

The phase IIIb, multi-centre randomised, double-blind, and placebo-controlled PreVitaCOV trial has a factorial design and is planned as a two-phase approach. The pilot phase assessed feasibility and safety and was transformed into a confirmatory phase to evaluate effectiveness since feasibility was proven. Adult patients with PC19S after a documented SARS-CoV-2 infection at least 12 weeks ago are randomly assigned to 4 parallel treatments: prednisolone 20 mg for five days followed by 5 mg for 23 days (trial drug 1), B vitamins (B1 (100 mg OD), B6 (50 mg OD), and B12 (500 µg OD)) for 28 days (trial drug 2), trial drugs 1 and 2, or placebo. The primary outcome of the pilot phase was defined as the retention rate of the first 100 patients. Values of ≥ 85% were considered as confirmation of feasibility, this criterion was even surpassed by a retention rate of 98%. After transformation, the confirmatory phase proceeds by enrolling 240 additional patients. The primary outcome for the study is the change of symptom severity from baseline to day 28 as assessed by a tailored Patient Reported Outcomes Measurement Information System (PROMIS) total score referring to five symptom domains known to be typical for PC19S (fatigue, dyspnoea, cognition, anxiety, depression). The confirmatory trial is considered positive if superiority of any treatment is demonstrated over placebo operationalised by an improvement of at least 3 points on the PROMIS total score (t-score).

Discussion

The PreVitaCOV trial may contribute to the understanding of therapeutic approaches in PC19S in a primary care context.

Trial registration

EudraCT: 2022-001041-20. DRKS: DRKS00029617. ClinicalTrials.gov: F001AM02222_1 (registered: 05 Dec 2022).
Validity and reliability of the Arabic version of the population postpartum depression literacy scale (PoDLiS): a web-based survey in Saudi Arabia
Authors: AlAteeq Deemah , Almajed Ebtesam , AlZabin Alya , AlOtaibi Aisha , Salamah Rawan Bin , AlDhafyan Shahad , AlMutiri Wijdan A. , AlHarbi Asma , AlQntash Norah , AlTamimi Reem , AlRasheed Raghad , Fayed Amel
Published: January 2024

Background

Proper knowledge about postpartum depression (PPD) will help recognize symptoms and encourage women to seek the needed professional help. Until now, there has been a scarcity of research on the literacy level of PPD among the Saudi population and the factors affecting it. This study translated the Postpartum Depression Literacy Scale (PoDLiS) into Arabic and evaluated its psychometric properties. Furthermore, the Saudi population’s mental health literacy for PPD and the factors associated with it were examined as a secondary objective.

Methods

This cross-sectional study involved 2,336 participants selected via convenience sampling from all over Saudi Arabia, all of whom willingly agreed to participate. Data collection was done through an online questionnaire using Google Forms, covering sociodemographic characteristics and the Arabic PoDLiS.

Results

The Arabic version of PoDLiS showed acceptable goodness-of-fit between the observed data and the resulting six-factor solution, RMSEA = 0.049, 90% confidence interval RMSEA (0.010–0.050), pCLOSE = 0.742, CFI = 0.962, TLI = 0.940, χ2(270) = 1576.12, p-value = 0.742. The total Cronbach’s alpha (α) of the PoDLiS showed acceptable internal consistency, measuring at 0.742. High literacy was seen in married and young participants with a postgraduate degree and sufficient household income who have known someone with PPD. Significantly lower literacy was seen in male, non-Saudi participants and those residing in the central and northern regions of Saudi Arabia.

Conclusions

The Arabic version of the PoDLiS showed good psychometric properties, and it can be used to assess PPD literacy among perinatal women and to examine the impact of PPD awareness programs. Despite reporting relatively good PPD literacy in the Saudi population, there is a persistent gap in participants’ beliefs about available professional help and the attitudes that facilitate recognizing PPD. Our findings highlight the importance of implementing public education campaigns to improve overall knowledge about PPD and promote prevention, early recognition, and treatment of PPD.
Severe COVID anxiety among adults in the United Kingdom: cohort study and nested feasibility trial
Authors: Crawford Mike J. , King Jacob D. , McQuaid Aisling , Bassett Paul , Leeson Verity C. , Tella Oluwaseun , Di Simplicio Martina , Tyrer Peter , Tyrer Helen , Watt Richard G. , Barnicot Kirsten
Published: January 2024

Background

People with severe COVID anxiety have poor mental health and impaired functioning, but the course of severe COVID anxiety is unknown and the quality of evidence on the acceptability and impact of psychological interventions is low.

Methods

A quantitative cohort study with a nested feasibility trial. Potential participants aged 18 and over, living in the UK with severe COVID anxiety, were recruited online and from primary care services. We examined levels of COVID anxiety in the six months after recruitment, and factors that influenced this, using linear regression. Those scoring above 20 on the short Health Anxiety Inventory were invited to participate in a feasibility trial of remotely delivered Cognitive Behavioural Therapy for Health Anxiety (CBT-HA). Exclusion criteria were recent COVID-19, current self-isolation, or current receipt of psychological treatment. Key outcomes for the feasibility trial were the level of uptake of CBT-HA and the rate of follow-up.

Results

204 (70.2%) of 285 people who took part in the cohort study completed the six month follow-up, for whom levels of COVID anxiety fell from 12.4 at baseline to 6.8 at six months (difference = -5.5, 95% CI = -6.0 to -4.9). Reductions in COVID anxiety were lower among older people, those living with a vulnerable person, those with lower baseline COVID anxiety, and those with higher levels of generalised anxiety and health anxiety at baseline. 36 (90%) of 40 participants enrolled in the nested feasibility trial were followed up at six months. 17 (80.9%) of 21 people in the active arm of the trial received four or more sessions of CBT-HA. We found improved mental health and social functioning among those in the active, but not the control arm of the trial (Mean difference in total score on the Work and Social Adjustment Scale between baseline and follow up, was 9.7 (95% CI = 5.8–13.6) among those in the active, and 1.0 (95% C.I. = -4.6 to 6.6) among those in the control arm of the trial.

Conclusions

While the mental health of people with severe COVID anxiety appears to improve over time, many continue to experience high levels of anxiety and poor social functioning. Health anxiety is highly prevalent among people with severe COVID anxiety and may provide a target for psychological treatment.

Trial registration

Retrospectively registered at ISRCTN14973494 on 09/09/2021.
Barriers and enabling structural forces affecting access to antiretroviral therapy in Nigeria
Authors: Oturu Kingsley , O’Brien Oonagh , Ozo-Eson Philomena I.
Published: January 2024

Background

Access to antiretroviral therapy (ART) helps to improve quality of life and reduces the spread of HIV. However, while a lot of studies focus on supply factors, such as resources for the purchase of antiretroviral drugs, demand and structural forces are not given much emphasis. In this paper it is argued that structural forces shape the way people access antiretroviral therapy in Nigeria.

Methods

A Grounded Theory methodology was undertaken in the research. Semi structured qualitative interviews were administered to select people living with HIV/AIDS in Nigeria. This was facilitated by the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) to understand their perspectives with regard to barriers and enablers to ART access in Nigeria. Thirty persons living with HIV/AIDS were interviewed and recorded. The interview recordings were transcribed and coded using a constructionist epistemological approach. This was triangulated with results of preliminary and secondary literature review analysis.

Results

In this research, the participants discussed structural forces (barriers and enablers) that influenced how they accessed ART. These included economic factors such as poverty that enabled transactional sex. Unequal gender relations and perceptions influenced how they accessed ART. The participants’ belief in ‘God’ and religious activities such as ‘prayer’ and the use of ‘traditional medicine’ had an impact on how and when they accessed ART. Political activity at the international, national, and local levels influenced access to ART as well as resources. The individual’s familial, social, and organisational connections also influenced their ease of accessing ART.

Conclusions

This study identifies structural forces that affect access to antiretroviral therapy and provides recommendations on how they can be harnessed to enable improved access to ART and consequently improved health.
Demographic and socio-economic factors affecting bed net ownership, usage, and malaria transmission among adult patients seeking healthcare in two Ghanaian urban cities
Authors: Paintsil Ellis Kobina , Boadi Enoch , Dwamena Anthony , Addo Bless Hayford , Kumi Agyei , Obiri-Danso Kwasi , Ofori Linda Aurelia
Published: January 2024

Background

The most cost-effective malaria prevention and control strategy is the use of a bed net. However, several factors affect the ownership and usage of bed nets among the adult population. Hence, this study aimed to examine socio-demographic factors affecting bed net ownership, usage and malaria transmission among adult patients seeking healthcare in two Ghanaian urban cities.

Methods

This hospital-based cross-sectional study was conducted, between January and September 2021, at Bremang Seventh-Day Adventist Hospital, Suame Municipal, Ashanti Region and Sunyani Municipal Hospital, Sunyani, Bono Region, Ghana. Structured questionnaires were administered to a total of 550 participants to ascertain their ownership and usage of the bed nets. Afterwards, finger prick blood samples were collected for malaria microscopy. Crude and adjusted prevalence ratios (PR) and their respective 95% CIs were calculated, using Poisson regression with robust standard errors, to show associated variables in bivariate and multivariate analyses respectively. R software (version 4.1.1) was used to perform all statistical analyses.

Results

About 53.3% (n = 293) of participants owned at least one-bed net but only 21.5% (n = 118) slept under it the previous night. Those married were 2.0 (95% CI: 1.6 – 2.5) and 2.4 (95% CI: 1.6 – 3.5) times more likely to own and use a bed net respectively than those who never married. Also, pregnant women were 1.3 (95% CI: 1.1 – 1.6) and 1.8 (95% CI: 1.3 – 2.5) times more likely to own and use a bed net respectively than non-pregnant. Even though income levels were not associated with bed net ownership and usage, students were 0.4 (95% CI: 0.2 – 0.6) and 0.2 (95% CI: 0.1 – 0.5) times less likely to own and use bed net respectively compared to formally employed persons. The overall malaria prevalence rate was 7.8%. Malaria-negative patients were 1.6 (95% CI: 1.2 – 2.0) and 2.4 (95% CI: 1.4 – 4.1) times more likely to own and use bed nets respectively than malaria positive. Patients with tertiary education recorded the lowest malaria prevalence (3.5%, n = 4). None of those with a monthly income > $300 recorded a case of malaria. On the contrary, majority 83%, n/N = 25/30) of the malaria-positive patients earned ≤ $150.

Conclusion

The National Malaria Control Program should conduct comprehensive mapping of all urban population segments before launching mass bed net distribution campaigns, taking into account demographic and socioeconomic factors to enhance bed net utilization and reduce malaria prevalence.
Incidence of renal cell carcinoma after solid organ transplantation: a systematic review and meta-analysis
Authors: Xu Chang , Geng Hefeng , Li Yannan , Sun Fang , Sun Huiwei , Zhang Yingshi , Zhao Qingchun
Published: January 2024

Background

The incidence rate of malignant tumors after solid organ transplantation is higher than the normal population. The aim of our study is to identify the risk of renal cell carcinoma (RCC) after liver, kidney, heart and lung transplantation, respectively, and suggest that transplant patients can be screened early for tumors to avoid risk.

Methods

PubMed, Embase and the Cochrane Library from their inception until August 16,2023. Retrospective and cohort studies which focus on the statistical data of standardized incidence ratios (SIRs) of RCC after solid organ transplantation (SOT) more than one year have been included and extracted. The study was registered with PROSPERO, CRD4202022343633.

Results

Sixteen original studies have been included for meta-analysis. Liver transplantation could increase the risk of RCC (SIR = 0.73, 95%CI: 0.53 to 0.93) with no heterogeneity(P = 0.594, I2 = 0.0%). And kidney transplantation could increase the risk of RCC(8.54, 6.68 to 10.40; 0.000,90.0%). Besides, heart and lung transplantation also could increase the risk of RCC(SIR = 0.73, 95%CI: 0.53 to 0.93; SIR = 1.61, 95%CI:0.50 to 2.71). Moreover, significance could also be found in most subgroups, especially the European group and retrospective study group. What’s more, after removing studies which have a greater impact on the overall outcome in RCC rate after kidney transplantation, heterogeneity did not solve and significant different was also observed in the European group (7.15, 5.49 to 8.81; 0.000, 78.6%).

Conclusion

Liver, kidney, heart and lung transplantation patients have an increased risk of processing RCC compared to the general population and most subgroups, especially in geographic location of European subgroup, which suggested that patients should be screened frequently after transplantation.
Trends in the use of complementary and alternative medicine between 1987 and 2021 in Denmark
Authors: Møller Sofie Rossen , Ekholm Ola , Christensen Anne Illemann
Published: January 2024

Background

Complementary and alternative medicine (CAM) has been widely and increasingly used worldwide during the past decades. Nevertheless, studies in long-term trends of CAM use are limited. The aim of this study was to assess long-term trends in the prevalence of CAM use (both overall and for specific CAMs) between 1987 and 2021 in the adult Danish population and to examine certain sociodemographic characteristics of CAM users.

Methods

Data derived from nationally representative health surveys in the general adult population (≥ 16 years) in Denmark (the Danish Health and Morbidity Surveys) conducted in 1987, 1994, 2000, 2005, 2010, 2013, 2017, and 2021. The response proportion declined from 79.9% in 1987 to 45.4% in 2021. CAM use was assessed by questions on ever use of specific types of CAMs and overall use within the past 12 months. Differences in use of CAMs across educational levels were assessed using the Slope Index of Inequality (SII).

Results

An overall increase in the prevalence of CAM use within the past 12 months was found between 1987 (10.0%) and 2021 (24.0%). However, a stagnation was observed between 2010 and 2017, after which the prevalence decreased in 2021. In all survey waves, the prevalence was higher among women than men. For both sexes, the prevalence tended to be highest among respondents aged 25–44 years and 45–64 years. The group with 13–14 years of education had the highest prevalence of CAM use compared to the other educational groups (< 10 years, 10–12 years, and ≥ 15 years). SII values for both men and women increased between 1987 and 2021, which indicates an increase in differences of CAM use across educational groups. In all survey waves the most frequently used CAMs included massage and other manipulative therapies, acupuncture, and reflexology.

Conclusions

The use of CAM has increased markedly within the last decades and recently stagnated at high levels, which underlines the importance of securing high quality information and education for the public, health professionals, and legislators to ensure and promote safe use of CAMs.
AI-driven decision support systems and epistemic reliance: a qualitative study on obstetricians’ and midwives’ perspectives on integrating AI-driven CTG into clinical decision making
Authors: Dlugatch Rachel , Georgieva Antoniya , Kerasidou Angeliki
Published: January 2024

Background

Given that AI-driven decision support systems (AI-DSS) are intended to assist in medical decision making, it is essential that clinicians are willing to incorporate AI-DSS into their practice. This study takes as a case study the use of AI-driven cardiotography (CTG), a type of AI-DSS, in the context of intrapartum care. Focusing on the perspectives of obstetricians and midwives regarding the ethical and trust-related issues of incorporating AI-driven tools in their practice, this paper explores the conditions that AI-driven CTG must fulfill for clinicians to feel justified in incorporating this assistive technology into their decision-making processes regarding interventions in labor.

Methods

This study is based on semi-structured interviews conducted online with eight obstetricians and five midwives based in England. Participants were asked about their current decision-making processes about when to intervene in labor, how AI-driven CTG might enhance or disrupt this process, and what it would take for them to trust this kind of technology. Interviews were transcribed verbatim and analyzed with thematic analysis. NVivo software was used to organize thematic codes that recurred in interviews to identify the issues that mattered most to participants. Topics and themes that were repeated across interviews were identified to form the basis of the analysis and conclusions of this paper.

Results

There were four major themes that emerged from our interviews with obstetricians and midwives regarding the conditions that AI-driven CTG must fulfill: (1) the importance of accurate and efficient risk assessments; (2) the capacity for personalization and individualized medicine; (3) the lack of significance regarding the type of institution that develops technology; and (4) the need for transparency in the development process.

Conclusions

Accuracy, efficiency, personalization abilities, transparency, and clear evidence that it can improve outcomes are conditions that clinicians deem necessary for AI-DSS to meet in order to be considered reliable and therefore worthy of being incorporated into the decision-making process. Importantly, healthcare professionals considered themselves as the epistemic authorities in the clinical context and the bearers of responsibility for delivering appropriate care. Therefore, what mattered to them was being able to evaluate the reliability of AI-DSS on their own terms, and have confidence in implementing them in their practice.
Synergism of fermented feed and ginseng polysaccharide on growth performance, intestinal development, and immunity of Xuefeng black-bone chickens
Authors: Liu Jie , Wang Huan , Luo Junyi , Chen Ting , Xi Qianyun , Sun Jiajie , Wei Limin , Zhang Yongliang
Published: January 2024

Microbial fermented feed (MF) is considered a valuable strategy to bring advantages to livestock and is widely practiced. Oral supplementation of Ginseng polysaccharide (Gps) eliminated weight loss in chickens following vaccination. This study investigated the effects of the combined use of Gps and MF on growth performance and immune indices in Xuefeng black-bone chickens. A total of 400 Xuefeng black-bone chickens at the age of 1 day were randomly assigned to four groups. Normal feed group (Control group), ginseng polysaccharide (200 mg/kg) group (Gps group), microbially fermented feed (completely replace the normal feed) group (MF group), and microbially fermented feed and add ginseng polysaccharide just before use (MF + Gps group). Each group contained 5 pens per treatment and 20 birds per pen. The body weight and average daily gain in the Gps, MF, and MF + Gps groups increased significantly (P < 0.01), while the feed conversion ratio decreased significantly (P < 0.01). The combined use of MF and Gps showed a synergistic effect. There was no significant difference in villus height (cecal) between the experimental group and the Con group. The crypt depth of the three experimental groups exhibited a significantly lower value compared to the Control group (P < 0.05). The V/C ratio of the Gps group and MF + Gps was significantly increased (P < 0.05), but there was no significant difference in the MF group. Moreover, the diarrhea rate of the Gps and the MF + Gps groups was lower than that of the Con group, while that of the MF + Gps group decreased the mortality rate (P < 0.05). The serum tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) levels in the MF, Gps, and MF + Gps groups decreased significantly (P < 0.01), the serum immunoglobulin G (IgG) levels increased significantly (P < 0.01), while the combination of MF and Gps had a synergistic effect. The combined use of Gps and MF not only further improved growth performance and immune parameters, but also reduced the diarrhea rate and mortality.
The role of empagliflozin-induced metabolic changes for cardiac function in patients with type 2 diabetes. A randomized cross-over magnetic resonance imaging study with insulin as comparator
Authors: Thirumathyam Roopameera , Richter Erik Arne , van Hall Gerrit , Holst Jens Juul , Fenger Mogens , Gøtze Jens P. , Dixen Ulrik , Vejlstrup Niels , Madsbad Sten , Madsen Per Lav , Jørgensen Nils Bruun
Published: January 2024

Background

Metabolic effects of empagliflozin treatment include lowered glucose and insulin concentrations, elevated free fatty acids and ketone bodies and have been suggested to contribute to the cardiovascular benefits of empagliflozin treatment, possibly through an improved cardiac function. We aimed to evaluate the influence of these metabolic changes on cardiac function in patients with T2D.

Methods

In a randomized cross-over design, the SGLT2 inhibitor empagliflozin (E) was compared with insulin (I) treatment titrated to the same level of glycemic control in 17 patients with type 2 diabetes, BMI of > 28 kg/m2, C-peptide > 500 pM. Treatments lasted 5 weeks and were preceded by 3-week washouts (WO). At the end of treatments and washouts, cardiac diastolic function was determined with magnetic resonance imaging from left ventricle early peak-filling rate and left atrial passive emptying fraction (primary and key secondary endpoints); systolic function from left ventricle ejection fraction (secondary endpoint). Coupling between cardiac function and fatty acid concentrations, was studied on a separate day with a second scan after reduction of plasma fatty acids with acipimox. Data are Mean ± standard error. Between treatment difference (ΔT: E–I) and treatments effects (ΔE: E-WO or ΔI: I -WO) were evaluated using Students’ t-test or Wilcoxon signed rank test as appropriate.

Results

Glucose concentrations were similar, fatty acids, ketone bodies and lipid oxidation increased while insulin concentrations decreased on empagliflozin compared with insulin treatment. Cardiac diastolic and systolic function were unchanged by either treatment. Acipimox decreased fatty acids with 35% at all visits, and this led to reduced cardiac diastolic (ΔT: −51 ± 22 ml/s (p < 0.05); ΔE: −33 ± 26 ml/s (ns); ΔI: 37 ± 26 (ns, p < 0.05 vs ΔE)) and systolic function (ΔT: -3 ± 1% (p < 0.05); ΔE: −3 ± 1% (p < 0.05): ΔI: 1 ± 2 (ns, ns vs ΔE)) under chronotropic stress during empagliflozin compared to insulin treatment.

Conclusions

Despite significant metabolic differences, cardiac function did not differ on empagliflozin compared with insulin treatment. Impaired cardiac function during acipimox treatment, could suggest greater cardiac reliance on lipid metabolism for proper function during empagliflozin treatment in patients with type 2 diabetes.

Trial registration: EudraCT 2017-002101-35, August 2017.
Evaluation of the role of atherogenic index of plasma in the reversion from Prediabetes to normoglycemia or progression to Diabetes: a multi-center retrospective cohort study
Authors: Yang Hongyi , Kuang Maobin , Yang Ruijuan , Xie Guobo , Sheng Guotai , Zou Yang
Published: January 2024

Background

Atherosclerosis is closely linked with glucose metabolism. We aimed to investigate the role of the atherogenic index of plasma (AIP) in the reversal of prediabetes to normal blood glucose levels or its progression to diabetes.

Methods

This multi-center retrospective cohort study included 15,421 prediabetic participants from 32 regions across 11 cities in China, under the aegis of the Rich Healthcare Group’s affiliated medical examination institutions. Throughout the follow-up period, we monitored changes in the glycemic status of these participants, including reversal to normal fasting glucose (NFG), persistence in the prediabetic state, or progression to diabetes. Segmented regression, stratified analysis, and restricted cubic spline (RCS) were performed based on the multivariable Cox regression model to evaluate the association between AIP and the reversal of prediabetes to NFG or progression to diabetes.

Results

During a median follow-up period of 2.9 years, we recorded 6,481 individuals (42.03%) reverting from prediabetes to NFG, and 2,424 individuals (15.72%) progressing to diabetes. After adjusting for confounders, AIP showed a positive correlation with the progression from prediabetes to diabetes [(Hazard ratio (HR) 1.42, 95% confidence interval (CI):1.24–1.64)] and a negative correlation with the reversion from prediabetes to NFG (HR 0.89, 95%CI:0.81–0.98); further RCS demonstrated a nonlinear relationship between AIP and the reversion from prediabetes to NFG/progression to diabetes, identifying a turning point of 0.04 for reversion to NFG and 0.17 for progression to diabetes. In addition, we observed significant differences in the association between AIP and reversion from prediabetes to NFG/progression to diabetes across age subgroups, specifically indicating that the risk associated with AIP for progression from prediabetes to diabetes was relatively higher in younger populations; likewise, a younger age within the adult group favored the reversion from prediabetes to NFG in relation to AIP.

Conclusion

Our study, for the first time, reveals a negative correlation between AIP and the reversion from prediabetes to normoglycemia and validates the crucial role of AIP in the risk assessment of prediabetes progression. Based on threshold analysis, therapeutically, keeping the AIP below 0.04 was of paramount importance for individuals with prediabetes aiming for reversion to NFG; preventatively, maintaining AIP below 0.17 was vital to reduce the risk of diabetes onset for those with prediabetes.
Triglyceride-glucose index as a suitable non-insulin-based insulin resistance marker to predict cardiovascular events in patients undergoing complex coronary artery intervention: a large-scale cohort study
Authors: He Jining , Song Chenxi , Yuan Sheng , Bian Xiaohui , Lin Zhangyu , Yang Min , Dou Kefei
Published: January 2024

Background

Insulin resistance (IR), a hallmark of proceeding diabetes and cardiovascular (CV) disease, has been shown to predict prognosis in patients undergoing percutaneous coronary intervention (PCI). The triglyceride-glucose (TyG) index, triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and metabolic score for insulin resistance (METS-IR) have been shown to be simple and reliable non-insulin-based surrogates for IR. However, limited studies have determined the associations between distinct non-insulin-based IR markers and CV outcomes in patients undergoing complex PCI who are at higher risk of CV events after PCI. Therefore, this study aimed to investigate and compare the prognostic value of these markers in patients undergoing complex PCI.

Methods

This was a descriptive cohort study. From January 2017 to December 2018, a total of 9514 patients undergoing complex PCI at Fuwai Hospital were consecutively enrolled in this study. The 3 IR indices were estimated from the included patients. The primary study endpoint was CV events, defined as a composite of CV death, nonfatal myocardial infarction and nonfatal stroke.

Results

During a median follow-up of 3.1 years, 324 (3.5%) CV events occurred. Multivariable Cox regression models showed per-unit increase in the TyG index (hazard ratio [HR], 1.42; 95% confidence interval [CI] 1.13–1.77), rather than per-unit elevation in either Ln(TG/HDL-C ratio) (HR, 1.18; 95%CI 0.96–1.45) or METS-IR (HR, 1.00; 95%CI 0.98–1.02), was associated with increased risk of CV events. Meanwhile, adding the TyG index to the original model led to a significant improvement in C-statistics (0.618 vs. 0.627, P < 0.001), NRI (0.12, P = 0.031) and IDI (0.14%, P = 0.003), whereas no significant improvements were observed when adding Ln (TG/HDL-C ratio) or METS-IR (both P > 0.05) to the original model.

Conclusions

The TyG index, not TG/HDL-C ratio and METS-IR, was positively associated with worse CV outcomes in patients undergoing complex PCI. Our study, for the first time, demonstrated that the TyG index can serve as the suitable non-insulin-based IR marker to help in risk stratification and prognosis in this population.
Glycemic control and cardiovascular outcomes in patients with diabetes and coronary artery disease according to triglyceride-glucose index: a large-scale cohort study
Authors: Lin Zhangyu , He Jining , Yuan Sheng , Song Chenxi , Bian Xiaohui , Yang Min , Dou Kefei
Published: January 2024

Background

The role of triglyceride-glucose (TyG) index, an insulin resistance indicator, in glycemic management for diabetic patients with coronary artery disease (CAD) was still unknown. Therefore, we aimed to explore the association between glycemic control and cardiovascular (CV) outcomes in patients with diabetes and CAD according to different TyG index levels.

Methods

A total of 9996 diabetic patients with angiograph-proven CAD were consecutively recruited from 2017 to 2018 at Fuwai Hospital. Patients were assigned into 3 groups according to TyG index tertiles (T) (T1: <8.895; T2: 8.895-9.400; T3: ≥9.400). According to American Diabetes Association guidelines, controlled glycemia was defined as targeting glycosylated hemoglobin Alc (HbA1c) < 7%. The primary endpoint was CV events including CV death, nonfatal myocardial infarction, and nonfatal stroke.

Results

During a median 3-year follow-up, 381 (3.8%) CV events occurred. Overall, high TyG index (T3) was associated with increased risk of CV events (hazard ratio [HR]: 1.40; 95% confidence interval [CI]: 1.02–1.94) compared with the lowest TyG index (T1) after multivariable adjustment. Upon stratification by the TyG index, in fully adjusted models, controlled glycemia was associated with reduced risk of CV events in the high TyG index (T3) subgroup (HR: 0.64; 95%CI: 0.42–0.96) but not in the low (T1; HR: 0.79; 95%CI: 0.53–1.16) and moderate (T2; HR: 0.84; 95%CI: 0.56–1.25) TyG index subgroups.

Conclusions

Controlled glycemia was associated with improved CV outcomes in patients with diabetes and established CAD, especially in those with high TyG index levels. Our study, for the first time, provided valuable information that TyG index could help making risk stratification on the glycemic management in diabetic patients with CAD.
Identification of TNFRSF21 as an inhibitory factor of osteosarcoma based on a necroptosis-related prognostic gene signature and molecular experiments
Authors: Li Xiang , Sun Zhenqian , Ma Jinlong , Yang Miaomiao , Cao Hongxin , Jiao Guangjun
Published: January 2024

Background

Osteosarcoma is one of the most common malignant bone tumors with bad prognosis. Necroptosis is a form of programmed cell death. Recent studies showed that targeting necroptosis was a new promising approach for tumor therapy. This study aimed to establish a necroptosis-related gene signature to evaluated prognosis and explore the relationship between necroptosis and osteosarcoma.

Methods

Data from The Cancer Genome Atlas was used for developing the signature and the derived necroptosis score (NS). Data from Gene Expression Omnibus served as validation. Principal component analysis (PCA), Cox regression, receiver operating characteristic (ROC) curves and Kaplan-Meier survival analysis were used to assess the performance of signature. The association between the NS and osteosarcoma was analyzed via gene set enrichment analysis, gene set variation analysis and Pearson test. Single-cell data was used for further exploration. Among the genes that constituted the signature, the role of TNFRSF21 in osteosarcoma was unclear. Molecular experiments were used to explore TNFRSF21 function.

Results

Our data revealed that lower NS indicated more active necroptosis in osteosarcoma. Patients with lower NS had a better prognosis. PCA and ROC curves demonstrated NS was effective to predict prognosis. NS was negatively associated with immune infiltration levels and tumor microenvironment scores and positively associated with tumor purity and stemness index. Single-cell data showed necroptosis heterogeneity in osteosarcoma. The cell communication pattern of malignant cells with high NS was positively correlated with tumor progression. The expression of TNFRSF21 was down-regulated in osteosarcoma cell lines. Overexpression of TNFRSF21 inhibited proliferation and motility of osteosarcoma cells. Mechanically, TNFRSF21 upregulated the phosphorylation levels of RIPK1, RIPK3 and MLKL to promote necroptosis in osteosarcoma.

Conclusions

The necroptosis prognostic signature and NS established in this study could be used as an independent prognostic factor, TNFRSF21 may be a necroptosis target in osteosarcoma therapy.
Determinants of disparities of diabetes-related hospitalization rates in Florida: a retrospective ecological study using a multiscale geographically weighted regression approach
Authors: Lord Jennifer , Odoi Agricola
Published: January 2024

Background

Early diagnosis, control of blood glucose levels and cardiovascular risk factors, and regular screening are essential to prevent or delay complications of diabetes. However, most adults with diabetes do not meet recommended targets, and some populations have disproportionately high rates of potentially preventable diabetes-related hospitalizations. Understanding the factors that contribute to geographic disparities can guide resource allocation and help ensure that future interventions are designed to meet the specific needs of these communities. Therefore, the objectives of this study were (1) to identify determinants of diabetes-related hospitalization rates at the ZIP code tabulation area (ZCTA) level in Florida, and (2) assess if the strengths of these relationships vary by geographic location and at different spatial scales.

Methods

Diabetes-related hospitalization (DRH) rates were computed at the ZCTA level using data from 2016 to 2019. A global ordinary least squares regression model was fit to identify socioeconomic, demographic, healthcare-related, and built environment characteristics associated with log-transformed DRH rates. A multiscale geographically weighted regression (MGWR) model was then fit to investigate and describe spatial heterogeneity of regression coefficients.

Results

Populations of ZCTAs with high rates of diabetes-related hospitalizations tended to have higher proportions of older adults (p < 0.0001) and non-Hispanic Black residents (p = 0.003). In addition, DRH rates were associated with higher levels of unemployment (p = 0.001), uninsurance (p < 0.0001), and lack of access to a vehicle (p = 0.002). Population density and median household income had significant (p < 0.0001) negative associations with DRH rates. Non-stationary variables exhibited spatial heterogeneity at local (percent non-Hispanic Black, educational attainment), regional (age composition, unemployment, health insurance coverage), and statewide scales (population density, income, vehicle access).

Conclusions

The findings of this study underscore the importance of socioeconomic resources and rurality in shaping population health. Understanding the spatial context of the observed relationships provides valuable insights to guide needs-based, locally-focused health planning to reduce disparities in the burden of potentially avoidable hospitalizations.
Dyslipidemia: prevalence and association with precancerous and cancerous lesions of the cervix; a pilot study
Authors: Mwangi Gakii Fridah , Niyonzima Nixon , Atwine Raymond , Tusubira Deusdedit , Mugyenyi Godfrey R , Ssedyabane Frank
Published: January 2024

Background

In Sub-Saharan Africa, the prevalence of dyslipidemia is on the rise, with studies showing dyslipidemia as a contributing factor to the progression of premalignant lesions to cervical cancer. In Uganda, cervical cancer and dyslipidemia are common health concerns, considering the increasing trends of dyslipidemia in the general population and inadequate information regarding dyslipidemia and cervical lesions. This study aimed to determine the prevalence of dyslipidemia and its association with precancerous and cancerous lesions of the cervix among women attending a cervical cancer clinic at the Uganda Cancer Institute.

Methods

This cross-sectional study was conducted from February to April 2022 among women with premalignant and malignant lesions of the cervix. Data on social demographics and health-seeking behaviours were collected using a pretested structured questionnaire after written informed consent had been obtained. Pap smear collection preceded visual inspection with acetic acid; cervical biopsies were collected appropriately from eligible participants; and cervical lesions were classified using the Bethesda system 2014. Serum lipids, total cholesterol (T.C.), high-density lipoprotein (HDLc), low-density lipoprotein (LDLc), and triglycerides (T.G.s) were analysed using the COBAS™ 6000 Clinical Chemistry Analyser. The associations were assessed using the chi-square test, and P ≤ 0.05 was considered statistically significant.

Results

The overall prevalence of dyslipidemia among women with cervical lesions was 118/159 (74%), and low HDLc was the most prevalent at 64.6% (95% CI 39.0–54.3). High T.C. (P = 0.05), high T.G.s (P = 0.011), and low HDL-c (P = 0.05) showed a significant association with precancerous lesions. High LDL-c (P = 0.019), high T.G.s (P = 0.02), and high T.G.s (P < 0.001) showed a statistically significant association with cancerous lesions.

Conclusion

The prevalence of dyslipidemia was high, with high TC, T.G.s, and low HDL-c significantly associated with precancerous lesions. Also, elevated T.G.s and high LDLc were significantly associated with cancerous lesions. Women may benefit from dyslipidemia screening along with cervical cancer screening.

What this study adds

The present study builds upon previous findings suggesting a link between dyslipidemia and cervical lesions by investigating the relationship between these two factors, specifically in women of this geographical location, where we need adequate information on these associations.
Lipid parameters, adipose tissue distribution and prognosis prediction in chronic kidney Disease patients
Authors: Chen Hui-fen , Xiao Bing-jie , Chen Lin-yi , OuYang Wen-wei , Zhang Xian-long , He Zhi-ren , Fu Li-zhe , Tang Fang , Tang Xiao-na , Liu Xu-sheng , Wu Yi-fan
Published: January 2024

Background

Lipid management in clinic is critical to the prevention and treatment of Chronic kidney disease (CKD), while the manifestations of lipid indicators vary in types and have flexible association with CKD prognosis.

Purpose

Explore the associations between the widely used indicators of lipid metabolism and their distribution in clinic and CKD prognosis; provide a reference for lipid management and inform treatment decisions for patients with non-dialysis CKD stage 3–5.

Methods

This is a retrospective cohort study utilizing the Self-Management Program for Patients with Chronic Kidney Disease Cohort (SMP-CKD) database of 794 individuals with CKD stages 3–5. It covers demographic data, clinical diagnosis and medical history collection, laboratory results, circulating lipid profiles and lipid distribution assessments. Primary endpoint was defined as a composite outcome(the initiation of chronic dialysis or renal transplantation, sustained decline of 40% or more in estimated glomerular filtration rate (eGFR), doubled of serum creatinine (SCr) from the baseline, eGFR less than 5 mL/min/1.73m2, or all-cause mortality). Exposure variables were circulating lipid profiles and lipid distribution measurements. Association were assessed using Relative risks (RRs) (95% confidence intervals (CIs)) computed by multivariate Poisson models combined with least absolute shrinkage and selection operator (LASSO) regression according to categories of lipid manifestations. The best model was selected via akaike information criterion (AIC), area under curve (AUC), receiver operating characteristic curve (ROC) and net reclassification index (NRI). Subgroup analysis and sensitivity analysis were performed to assess the interaction effects and robustness..

Results

255 individuals reached the composite outcome. Median follow-up duration was 2.03 [1.06, 3.19] years. Median age was 58.8 [48.7, 67.2] years with a median eGFR of 33.7 [17.6, 47.8] ml/min/1.73 m2. Five dataset were built after multiple imputation and five category-based Possion models were constructed for each dataset. Model 5 across five datasets had the best fitness with smallest AIC and largest AUC. The pooled results of Model 5 showed that total cholesterol (TC) (RR (95%CI) (per mmol/L) :1.143[1.023,1.278], P = 0.018) and percentage of body fat (PBF) (RR (95%CI) (per percentage):0.976[0.961,0.992], P = 0.003) were significant factors of composite outcome. The results indicated that comprehensive consideration of lipid metabolism and fat distribution is more critical in the prediction of CKD prognosis..

Conclusion

Comprehensive consideration of lipid manifestations is optimal in predicting the prognosis of individuals with non-dialysis CKD stages 3–5.
“All in one” nanoprobe Au-TTF-1 for target FL/CT bioimaging, machine learning technology and imaging-guided photothermal therapy against lung adenocarcinoma
Authors: Yang Zhe , Zhang Yujia , Tang Lu , Yang Xiao , Song Lei , Shen Chun , Zvyagin Andrei V. , Li Yang , Yang Bai , Lin Quan
Published: January 2024

The accurate preoperative diagnosis and tracking of lung adenocarcinoma is hindered by non-targeting and diffusion of dyes used for marking tumors. Hence, there is an urgent need to develop a practical nanoprobe for tracing lung adenocarcinoma precisely even treating them noninvasively. Herein, Gold nanoclusters (AuNCs) conjugate with thyroid transcription factor-1 (TTF-1) antibody, then multifunctional nanoprobe Au-TTF-1 is designed and synthesized, which underscores the paramount importance of advancing the machine learning diagnosis and bioimaging-guided treatment of lung adenocarcinoma. Bright fluorescence (FL) and strong CT signal of Au-TTF-1 set the stage for tracking. Furthermore, the high specificity of TTF-1 antibody facilitates selective targeting of lung adenocarcinoma cells as compared to common lung epithelial cells, so machine learning software Lung adenocarcinoma auxiliary detection system was designed, which combined with Au-TTF-1 to assist the intelligent recognition of lung adenocarcinoma jointly. Besides, Au-TTF-1 not only contributes to intuitive and targeted visualization, but also guides the following noninvasive photothermal treatment. The boundaries of tumor are light up by Au-TTF-1 for navigation, it penetrates into tumor and implements noninvasive photothermal treatment, resulting in ablating tumors in vivo locally. Above all, Au-TTF-1 serves as a key platform for target bio-imaging navigation, machine learning diagnosis and synergistic PTT as a single nanoprobe, which demonstrates attractive performance on lung adenocarcinoma.

Graphical Abstract