bluuebunny/crossref_metadata_2025 huggingface dataset:
Body mass index across adulthood and the development of airflow obstruction and emphysema
Authors: Trethewey Ruth E , Spartano Nicole L , Vasan Ramachandran S , Larson Martin G , O’Connor George T , Esliger Dale W , Petherick Emily S , Steiner Michael C
Published: November 2022

Background

Low body mass index (BMI) is associated with COPD, but temporal relationships between airflow obstruction (AO) development and emphysematous change are unclear. We investigated longitudinal changes in BMI, AO, and lung density throughout adulthood using data from the Framingham Offspring Cohort (FOC).

Methods

BMI trajectories were modelled throughout adulthood in 4587 FOC participants from Exam 2 (mean age = 44), through Exam 9 (mean age = 71), in AO participants and non-AO participants (AO n = 1036), determined by spirometry, using fractional polynomial growth curves. This process was repeated for low lung density (LLD) and non LLD participants (LLD n = 225) determined by Computed Tomography. Spirometry decline was compared separately between tertiles of BMI in those aged <40 years and associations between fat and lean mass (measured using Dual Energy X-ray Absorptiometry, DEXA) and development of AO and LLD were also assessed. Additional analyses were performed with adjustment for smoking volume.

Results

The BMI trajectory from 30 years of age was visually lower in the AO group than both non-AO smokers (non-<AO-S) and non-AO non-smokers (non-AO-N). Similarly, BMI trajectories were visually lower in participants with LLD throughout adulthood compared to normal lung density smokers and non-smokers. Differences remained after adjustment for smoking volume. The lowest BMI tertile in ages <40 years was associated with the steepest subsequent decline in FEV1/FVC ratio in both sexes.

Conclusion

Mean BMI is lower throughout adulthood in AO and LLD participants. Lower BMI is associated with a steeper decline in the ratio of FEV1/FVC. These findings suggest body mass may precede and potentially have a role in the development of COPD lung pathophysiology.
Characterization of Bioactives and Nutra-Pharmaceutical Potential of Supercritical Fluid and Hydro-Distilled Extracted Coriander Leaves Essential Oil
Authors: Abbas Ali , Anwar Farooq , Ahmad Naveed , Shahid Muhammad , Al-Mijalli Samiah H. , Yaseen Muhammad , Farooq Sidra , Iqbal Munawar
Published: November 2022

The volatiles chemical composition and biological attributes of coriander ( Coriandrum sativum L.) leaves essential oil obtained by two extraction techniques namely supercritical fluid extraction and hydro-distillation is appraised. The coriander essential oil yield (.12%) by hydro-distillation was slightly higher than that of supercritical fluid extraction (.09%). The physico-chemical variables of the essential oil obtained from both the techniques varied in significantly (P < .05). GC-MS analysis identified 23 different components in supercritical fluid extracted oil and 18 components in hydro-distilled essential oil having linalool as major component (51.32% and 61.78%, respectively) followed by phytol (12.71%). The oil recovered by supercritical fluid extraction exhibited greater DPPH radical scavenging activity as well as reducing power as compared to the essential oil obtained by hydro-distillation technique along with a stronger biofilm inhibition and least hemolysis. The results of antimicrobial activity revealed that super critical fluid extracted essential oil has potent antifungal and antibacterial activity against P. multocida and A alternata, whereas hydro-distilled essential oil displayed better antimicrobial potential against E coli and A niger. Overall, these results depict that supercritical fluid extraction is superior than hydro-distillation with regard to isolation of better-quality coriander essential oil for nutra-pharmaceutical developments.
Differential Inhibite Effect of Xanthohumol on HepG2 Cells and Primary Hepatocytes
Authors: Zhang Xiuli , Wang Tao , Zhou Haihong , Li Yonghui , Guo Hongyun , Su Haixiang
Published: November 2022

Xanthohumol (XN) is the major prenylated chalcone of the female inflorescences (cone) of the hop plant ( Humulus lupulus). It is also a constituent of beer, the major dietary source of prenylated flavonoids. It has shown strong antitumorigenic activity towards various types of cancer cells. In the present study, we show the impact on human hepatocarcinoma cell line HepG2 cell and potential adverse effects on rat primary hepatocytes. Cell growth/viability assay (MTT) demonstrated that HepG2 cells are highly sensitive to XN at a concentration range of 25-100 μM. The primary mode of tumor cell destruction was apoptosis as demonstrated by the binding of Annexin Ⅴ-FITC, we show that XN at a concentration of 25 μM induced apoptosis in HepG2. Further evidence that XN kills HepG2 by inducing apoptosis was provided by the impact of XN on the cleavage of PARP-1 and caspases-3. In contrast, XN concentrations up to 100 μM did not affect viability of primary rat hepatocytes in vitro, meanwhile, XN did not induce the apoptosis of primary rat hepatocytes in vitro . In summary, our data provide a rationale for clinical evaluation of XN for the treatment of liver cancer.
In vitro evaluation of how the presence of the stent retriever and microcatheter influences aspiration parameters in thrombectomy according to their position inside the aspiration catheter
Authors: Bernava Gianmarco , Brina Olivier , Reymond Philippe , Rosi Andrea , Hofmeister Jeremy , Yilmaz Hasan , Muster Michel , Kulcsar Zsolt , Lovblad Karl-Olof , Machi Paolo
Published: November 2022

Background

Several variations of the combined thrombectomy technique for acute ischemic stroke using a stent retriever and aspiration catheter have been described. The aim of our study was to assess how the presence of the microcatheter and stent retriever affect the basic aspiration parameters, namely, flow rate and aspiration force, depending on their position within the aspiration catheter.

Methods

Two experimental set-ups were designed to assess changes in flow rate and aspiration force according to the position of the stent retriever and microcatheter within the aspiration catheter.

Results

The transition of the stent retriever and microcatheter from the distal to proximal position resulted in a progressive increase in the flow rate, but with no impact on aspiration force. Additionally, the size of the stent retriever had no significant effect on flow rate changes and the reduction in flow rate was related to the microcatheter diameter. Negative pressure generated inside the aspiration catheter impacted on its distal segment located beyond the radiopaque marker, thus leading to its partial collapse. As a consequence, the measured aspiration force was lower than the theoretical aspiration force level for all tested aspiration catheters.

Conclusions

In our experimental model, the position of the stent retriever and microcatheter within the aspirator catheter affected the flow rate, but not the aspiration force. Negative pressure generated within the aspiration catheter appeared to determine a partial collapse of the distal segment that resulted in a less effective aspiration force than the theoretical aspiration force level.
Acute respiratory infections (ARIs) and factors associated with their poor clinical outcome among children under-five years attending pediatric wards of public hospital in Southwest district of Ethiopia: A prospective observational cohort study
Authors: Abayneh Mengistu , Muleta Dassaleng , Simieneh Asnake , Duguma Tadesse , Asnake Molla , Teressa Murtii , Endalkachew Biruk , Toru Milkiyas
Published: November 2022

This study was designed to assess the prevalence and factors associated with poor clinical outcome of acute respiratory infections (ARIs) among children less than five years of age at Mizan-Tepi university teaching public hospital in southwest district of Ethiopia. A prospective observational cohort study design was conducted from 01 June to August 30, 2020. Data related to socio-demographics, child nutritional status, clinical and environmental characteristics of patients were collected with structured questionnaire. Follow-up data were gathered from patient’s medical records using standard data collection tool. The data were analyzed using SPSS versions 25.0. In this study, 305 children of age less than five years were included. Of these, 124 (40.7%) of children were diagnosed with ARIs, of which 66 (53.2%) were female and 69 (55.6%) were age of 24–59 months. Of children diagnosed with ARIs, 21 (16.9%) were ended with poor clinical outcomes after completion of their treatment. In the multivariate analysis, age of children and presence of any other disease conditions (OR = 0.331; 95% CI: 0.123– 0.880; p= 0.024), exposure to indoor air pollution (OR = 0.344; 95% CI: 0.128– 0.925; p= 0.030),  malnutrition (OR = 0.175; 95% CI: 0.058– 0.523; p= 0.002) and end point pneumonia (OR = 0.305; 95% CI: 0.113–0.821; p= 0.015) were found to be independent factors for poor outcome of under-five children with ARIs. Our findings highlight that timely detection, proper management and treatments as well as addressing other contributing factors are essentials in order to reduce prevalence and poor clinical outcomes of under five children with ARIs.
Health promotion in primary care
Authors: Warwick Stephanie
Published: November 2022

Health promotion is the opportunistic encouragement of patients to manage their own health. Health promotion is an integral part of general practice and aims to improve patient, population and planetary health. During COVID-19, healthy behaviours have declined and health inequalities have widened in the UK. Now is a good time to encourage patients to engage with their overall health and well-being and to provide extra support to disadvantaged patients. GPs have a crucial role in helping to empower patients and guide them towards healthier living. This article will explore health promotion within primary care and suggest practical ways to implement health promotion holistically in practice.
Vestibular schwannoma
Authors: Michalik Daniel
Published: November 2022

Vestibular schwannomas (commonly referred to by the misnomer acoustic neuroma) are benign, slow-growing tumours arising from the Schwann cells on the sheath of the vestibulocochlear nerve. Vestibular schwannomas are the third most common benign intracranial tumour after meningioma and pituitary adenoma and are the most common tumour of the cerebellopontine angle. Vestibular schwannomas can present and grow in unpredictable ways. There is a lack of high-level evidence on appropriate management, and as such, this can vary significantly between centres. With the ease of access to sensitive neurological imaging, vestibular schwannomas are identified in more patients, at more advanced ages, and at smaller sizes, with a shift in the management towards a more conservative approach over previous decades. This article summarises the epidemiology, aetiology, clinical features, investigation, management and prognosis of vestibular schwannoma.
The war in Ukraine through far-right and jihadist lenses
Authors: Brzuszkiewicz Sara
Published: November 2022

This article examines the most widespread stances on the war in Ukraine taken within the far-right and the jihadist milieux. Within these contexts, positions are far from unified and the different narratives exploited on the topic reflect the heterogeneity of the radical postures. Far-right movements and supporters express views ranging from open hostility to Russia and President Vladimir Putin to complete mistrust of NATO and the West. This makes it possible to find these groups on both sides of the battlefield. However, it is necessary to emphasize here that the narrative about Ukraine being run by fascists is no more than Russian propaganda, designed to discredit Ukraine’s efforts to defend itself against Russia’s aggression and weaken international solidarity toward Kyiv. Similarly, a number of jihadist groups and ideologues urge their followers to join the conflict regardless of the side in order to harm unbelievers or, on the contrary, to stay away from it as this would imply giving assistance to the impious. The Russian war against Ukraine is having significant implications for both far-right and jihadi networks, both of which might be able to capitalise on events in organisational, political and communicative terms.
Lost in travelling: Europe’s regional and conceptual challenges linked to tourism
Authors: Benhamou Michael
Published: November 2022

The Covid-19 pandemic, as well as climatic and energy constraints, have heavily impacted Europe’s tourism and culture industries, which account for 4% to 5% of Europe’s gross domestic product. Some European regions have been hit harder than others, as the tourism and travel sectors represent 9% of the gross domestic product in the south. Administrations and companies need to develop a new strategy to anticipate future imbalances and inspire new standards around the world, standards that involve less high-tech hardware, fewer carbon-intensive projects, less worldwide marketing, and a greater focus on the European middle class and its desire for eco-tourism.
Modeling the Effect of Corporate Sponsorship on the Organizational Image of Selected Insurance Companies in Edo State, Nigeria
Authors: Okeibunor Ngozi Bibian , Okoro Nnanyelugo , Kenneth Udeh , Joel Ugwuoke C. , Apuke Oberiri Destiny , Celestine Gever Verlumun
Published: November 2022

This study current study examines the influence of corporate sponsorship on the organizational image of selected insurance companies in Edo State, Nigeria. The study was guided by six hypotheses. The survey research design was used for the study. A sample of 385 respondents was selected through a multi-stage sampling technique. The result of the study showed that corporate sponsorship programs of the selected insurance companies influence public perception of the image of insurance companies in the area of how flexible (dynamic image), friendliness (cooperative image), as well as how organized (business-wise image) the insurance companies are. The result of this study also showed that corporate sponsorship programs influence public perception of the reputation (character image), how successful (successful image) the insurance companies are as well as how secretive (withdrawn image), or otherwise of the insurance companies studied. Based on these results, the researcher recommends, among others, that insurance companies should improve on their communication approaches to ensure that there is a high level of awareness regarding their corporate sponsorship programs.
Who? What? How? From a Standard Teacher Meeting to a Preschool Positive Thinking Project
Authors: Gür Çağla , Eser Başak
Published: November 2022

This study was conducted as part of the project Art of Happiness: Positive Thinking in Preschool and Subjective Well-Being Project, a preventive psycho-educational project. The research was planned as an action study, structured with four interrelated studies. The first study was conducted qualitatively with 15 teachers. First, the data regarding the expectations and requirements of teachers were obtained, the evaluation process was conducted, and positive thinking training was tailored for teachers. In the second study, the teacher training process, having been designed in line with the first study was implemented and tested. The study was conducted with a sample group comprising 50 experimental and 50 control groups, while a quasi-experimental design with a pretest-posttest control group was employed. The third study refers to the planning and designing of the education intended for children in schools for positive thinking and well-being practices. In this context, a focus group discussion was held through the involvement of eight teachers. In the fourth study, the implementation process in schools was evaluated. This study included 80 children aged 5, 40 of whom were in the experimental group and 40 in the control group. The effect of positive thinking education delivered to children was evaluated through the pretest-posttest control group design. Also, the process evaluations of the teachers who educated the children in the experimental group were obtained through interviews. Educational programs for teachers and children were developed and implemented within the scope of the study, and significant findings were obtained for both preschool teachers and children. Besides positive thinking training, research findings indicated that planning the process through the active participation of teachers and their embracing the project contributed significantly to the meaningful learning outcomes.
Cognitive Behavioral Therapy (CBT) Telehealth Augmented With a CBT Smartphone Application to Address Type 2 Diabetes Self-Management: A Randomized Pilot Trial
Authors: Callan Judith A. , Sereika Susan M. , Cui Ruifeng , Tamres Lisa K. , Tarneja Monisha , Greene Brian , Van Slyke Ashley , Wu Megan , Lukac Gabriella R. , Dunbar-Jacob Jacqueline
Published: November 2022

Purpose:

The purpose of the study was to investigate the feasibility and acceptability of phone-delivered cognitive behavioral therapy (CBT) combined with an adjunctive smartphone application CBT MobileWork-DM© to improve self-management of type 2 diabetes mellitus (T2DM).

Methods:

Participants were 12 patients with T2DM on antihyperglycemic medication and had an A1C level of 8 or greater. A randomized controlled pilot study assessed treatment as usual (TAU) T2DM care versus a phone-delivered CBT (6, 8, or 12 weekly sessions) augmented with a CBT skills practice smartphone application. The CBT telehealth intervention addressed T2DM self-management and diabetes distress. Electronic and self-report medication taking, diabetes-related distress, and A1C were assessed at baseline and post-intervention.

Results:

After 16 weeks, a decrease in A1C and distress levels was observed in all 3 CBT phone groups and TAU group. The group with the most improvement was the 12-week CBT group, which had the greatest mean decrease in A1C (−2.33) and diabetes distress (−31.67). The TAU group exhibited a mean decrease of −2.15 and −21 for A1C and diabetes distress, respectively. The overall rate of completion for phone CBT sessions across the 3 CBT groups was 83%.

Conclusion:

This study demonstrates that telehealth CBT augmented with a smartphone application is feasible and acceptable. Patients demonstrated improvements in both T2DM management and distress.
A Non-Syndromic, Non-Micrognathic Neonate Presenting With Persistent Glossoptosis Who was Successfully Treated With Mandibular Distraction Osteogenesis
Authors: Silver Eric , Cekalniku Lirie , Yusupov Steve , Hoffman David
Published: November 2022

Most causes of upper airway obstruction are rare in the nonsyndromicneonatal period. However, if present, such as in cases of glossoptosis, they may cause major respiratory problems during the first few weeks of life. Historically, the subset of patients with severe glossoptosis resulting in respiratory distress have been dependent on tracheostomies to obtain a secure airway. Mandibular distraction osteogenesis (MDO) is a procedure in which osteotomies are performed in the mandible and a distraction device is fixated. After an optional latency phase, distraction is performed in order to lengthen the mandible and increase the airway diameter. MDO has been shown to improve airway diameter, eliminate desaturations, and reduce tracheostomy dependency in neonates who are prone to airway distress. Additionally, MDO has been shown to be more effective than other surgical alternatives. In this article, a case is presented of a non-syndromic, non-micrognathic neonate who presented with persistent glossoptosis of unknown origin resulting in sustained desaturations. The patient was treated with mandibular distraction osteogenesis using bilateral distractors. After a 10 days distraction period, the mandible was successfully advanced by 8.5 mm bilaterally. The airway diameter increased by 6 mm and airway resistance decreased from 82% to 0.3%. As a result of the surgical intervention, desaturations were eliminated and a tracheostomy was avoided. This case is unique in that the patient had repeated desaturations without evidence of an underlying syndrome or micrognathia. Other clinicians may use this case report as a guide to treat patients who have similar presentations.
Liver sinusoidal endothelial cells induce BMP6 expression in response to non–transferrin-bound iron
Authors: Charlebois Edouard , Fillebeen Carine , Presley John , Cagnone Gael , Lisi Véronique , Lavallée Vincent-Philippe , Joyal Jean-Sébastien , Pantopoulos Kostas
Published: November 2022

Homeostatic adaptation to systemic iron overload involves transcriptional induction of bone morphogenetic protein 6 (BMP6) in liver sinusoidal endothelial cells (LSECs). BMP6 is then secreted to activate signaling of the iron hormone hepcidin (HAMP) in neighboring hepatocytes. To explore the mechanism of iron sensing by LSECs, we generated TfrcTek-Cre mice with endothelial cell–specific ablation of transferrin receptor 1 (Tfr1). We also used control Tfrcfl/fl mice to characterize the LSEC-specific molecular responses to iron using single-cell transcriptomics. TfrcTek-Cre animals tended to have modestly increased liver iron content (LIC) compared with Tfrcfl/fl controls but expressed physiological Bmp6 and Hamp messenger RNA (mRNA). Despite a transient inability to upregulate Bmp6, they eventually respond to iron challenges with Bmp6 and Hamp induction, yet occasionally to levels slightly lower relative to LIC. High dietary iron intake triggered the accumulation of serum nontransferrin bound iron (NTBI), which significantly correlated with liver Bmp6 and Hamp mRNA levels and elicited more profound alterations in the LSEC transcriptome than holo-transferrin injection. This culminated in the robust induction of Bmp6 and other nuclear factor erythroid 2–related factor 2 (Nrf2) target genes, as well as Myc target genes involved in ribosomal biogenesis and protein synthesis. LSECs and midzonal hepatocytes were the most responsive liver cells to iron challenges and exhibited the highest expression of Bmp6 and Hamp mRNAs, respectively. Our data suggest that during systemic iron overload, LSECs internalize NTBI, which promotes oxidative stress and thereby transcriptionally induces Bmp6 via Nrf2. Tfr1 appears to contribute to iron sensing by LSECs, mostly under low iron conditions.
Impact of poverty and neighborhood opportunity on outcomes for children treated with CD19-directed CAR T-cell therapy
Authors: Newman Haley , Li Yimei , Liu Hongyan , Myers Regina M. , Tam Vicky , DiNofia Amanda , Wray Lisa , Rheingold Susan R. , Callahan Colleen , White Claire , Baniewicz Diane , Winestone Lena E. , Kadauke Stephan , Diorio Caroline , June Carl H. , Getz Kelly D. , Aplenc Richard , Teachey David T. , Maude Shannon L. , Grupp Stephan A. , Bona Kira , Leahy Allison Barz
Published: November 2022

Children living in poverty experience excessive relapse and death from newly diagnosed acute lymphoblastic leukemia (ALL). The influence of household poverty and neighborhood social determinants on outcomes from chimeric antigen receptor (CAR) T-cell therapy for relapsed/refractory (r/r) leukemia is poorly described. We identified patients with r/r CD19+ ALL/lymphoblastic lymphoma treated on CD19-directed CAR T-cell clinical trials or with commercial tisagenlecleucel from 2012 to 2020. Socioeconomic status (SES) was proxied at the household level, with poverty exposure defined as Medicaid-only insurance. Low-neighborhood opportunity was defined by the Childhood Opportunity Index. Among 206 patients aged 1 to 29, 35.9% were exposed to household poverty, and 24.9% had low-neighborhood opportunity. Patients unexposed to household poverty or low-opportunity neighborhoods were more likely to receive CAR T-cell therapy with a high disease burden (>25%), a disease characteristic associated with inferior outcomes, as compared with less advantaged patients (38% vs 30%; 37% vs 26%). Complete remission (CR) rate was 93%, with no significant differences by household poverty (P = .334) or neighborhood opportunity (P = .504). In multivariate analysis, patients from low-opportunity neighborhoods experienced an increased hazard of relapse as compared with others (P = .006; adjusted hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.3-4.1). There was no difference in hazard of death (P = .545; adjusted HR, 1.2; 95% CI, 0.6-2.4). Among children who successfully receive CAR T-cell therapy, CR and overall survival are equitable regardless of proxied SES and neighborhood opportunity. Children from more advantaged households and neighborhoods receive CAR T-cell therapy with a higher disease burden. Investigation of multicenter outcomes and access disparities outside of clinical trial settings is warranted.
The evidence for anthocyanins in the betalain-pigmented genus Hylocereus is weak
Authors: Pucker Boas , Brockington Samuel F.
Published: November 2022

Here we respond to Zhou (BMC Genomics 21:734, 2020) “Combined Transcriptome and Metabolome analysis of Pitaya fruit unveiled the mechanisms underlying peel and pulp color formation” published in BMC Genomics. Given the evolutionary conserved anthocyanin biosynthesis pathway in betalain-pigmented species, we are open to the idea that species with both anthocyanins and betalains might exist. However, in absence of LC-MS/MS spectra, apparent lack of biological replicates, and no comparison to authentic standards, the findings of Zhou (BMC Genomics 21:734, 2020) are not a strong basis to propose the presence of anthocyanins in betalain-pigmented pitaya. In addition, our re-analysis of the datasets indicates the misidentification of important genes and the omission of key flavonoid and anthocyanin synthesis genes ANS and DFR. Finally, our re-analysis of the RNA-Seq dataset reveals no correlation between anthocyanin biosynthesis gene expression and pigment status.
Modelling multiple time-scales with flexible parametric survival models
Authors: Batyrbekova Nurgul , Bower Hannah , Dickman Paul W. , Ravn Landtblom Anna , Hultcrantz Malin , Szulkin Robert , Lambert Paul C. , Andersson Therese M-L.
Published: November 2022

Background

There are situations when we need to model multiple time-scales in survival analysis. A usual approach in this setting would involve fitting Cox or Poisson models to a time-split dataset. However, this leads to large datasets and can be computationally intensive when model fitting, especially if interest lies in displaying how the estimated hazard rate or survival change along multiple time-scales continuously.

Methods

We propose to use flexible parametric survival models on the log hazard scale as an alternative method when modelling data with multiple time-scales. By choosing one of the time-scales as reference, and rewriting other time-scales as a function of this reference time-scale, users can avoid time-splitting of the data.

Result

Through case-studies we demonstrate the usefulness of this method and provide examples of graphical representations of estimated hazard rates and survival proportions. The model gives nearly identical results to using a Poisson model, without requiring time-splitting.

Conclusion

Flexible parametric survival models are a powerful tool for modelling multiple time-scales. This method does not require splitting the data into small time-intervals, and therefore saves time, helps avoid technological limitations and reduces room for error.
SARS-Cov-2 incubation period according to vaccination status during the fifth COVID-19 wave in a tertiary-care center in Spain: a cohort study
Authors: Cortés Martínez Jordi , Pak Daewoo , Abelenda-Alonso Gabriela , Langohr Klaus , Ning Jing , Rombauts Alexander , Colom Mireia , Shen Yu , Gómez Melis Guadalupe
Published: November 2022

Background

The incubation period of an infectious disease is defined as the elapsed time between the exposure to the pathogen and the onset of symptoms. Although both the mRNA-based and the adenoviral vector-based vaccines have shown to be effective, there have been raising concerns regarding possible decreases in vaccine effectiveness for new variants and variations in the incubation period.

Methods

We conducted a unicentric observational study at the Hospital Universitari de Bellvitge, Barcelona, using a structured telephone survey performed by trained interviewers to estimate the incubation period of the SARS-CoV-2 Delta variant in a cohort of Spanish hospitalized patients. The distribution of the incubation period was estimated using the generalized odds-rate class of regression models.

Results

From 406 surveyed patients, 242 provided adequate information to be included in the analysis. The median incubation period was 2.8 days (95%CI: 2.5–3.1) and no differences between vaccinated and unvaccinated patients were found. Sex and age are neither shown not to be significantly related to the COVID-19 incubation time.

Conclusions

Knowing the incubation period is crucial for controlling the spread of an infectious disease: decisions on the duration of the quarantine or on the periods of active monitoring of people who have been at high risk of exposure depend on the length of the incubation period. Furthermore, its probability distribution is a key element for predicting the prevalence and the incidence of the disease.
Cerebral infarction in HIV-negative patients with cryptococcal meningitis: its predictors and impact on outcomes
Authors: Tu Jiashan , Zhang Siyu , Liu Qinghua , Lin Yu
Published: November 2022

Background

Descriptions of the patterns of acute/subacute cerebral infarction (ASCI) in HIV-negative patients with cryptococcal meningitis (CM) are scarce, and the predictors of ischemic stroke and outcomes following ASCI remain unclear.

Aim

To study the clinical characteristics and evaluate the predictors of ASCI in HIV-negative patients with CM and assess the impact of ischemic stroke on the outcomes of the patients.

Methods

We retrospectively analyzed the data of 61 HIV-negative patients with CM treated between January, 2016 and February, 2022, and among them, 53 patients with complete neuroimaging and cerebrospinal fluid (CSF) data were enrolled in this study. The cohort was stratified by the occurrence of ASCI diagnosed based on MRI evidences for comparison of the clinical characteristics (consciousness disturbance, GCS score, duration of symptoms, and treatment), CSF parameters, imaging findings (meningeal inflammation, hydrocephalus, posterior fossa exudates) and outcomes of the patients. A favorable outcome was defined as a modified Rankin scale (mRS) score ≤ 2 and a poor outcome as a mRS score > 2. Logistic regression analysis was used to identify the risk factors of ASCI in the HIV-negative patients with CM.

Results

Of the 53 HIV-negative patients with CM, 14 (26.4%) had ASCI. The incidences of fever, headache, neck stiffness, duration of symptoms, CSF parameters, meningeal enhancement in brain MRI and the treatment regimens were similar between the patients with and those without ASCI. Most of the infarcts (92.9%) were of the lacunar type, involving both the anterior and posterior territories. Basal ganglia-corona radiata and the brainstem-cerebellum were the most frequently involved sites. Univariate logistic regression analysis suggested that consciousness disturbance (P = 0.002), MRI evidence of hydrocephalus (P = 0.042) and posterior fossa exudates (P = 0.028) were predictors of ASCI in these HIV-negative patients with CM. Multivariate analysis identified consciousness disturbance as a significant predictor of ASCI (P = 0.020). Compared with the patients without ASCI, the HIV-negative patients with CM and ASCI had poorer outcomes (P = 0.001).

Conclusion

ASCI can occur in HIV-negative patients with CM, presented commonly as multiple lacunar infarctions involving all the cerebrovascular territories. The presence of consciousness disturbance, hydrocephalus and posterior fossa exudates may increase the risk of ASCI in patients with CM. ASCI is associated with a poor outcome of the HIV-negative patients with CM.
Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials
Authors: Malik Abid , Drumm Brian , D’Anna Lucio , Brooks Isabelle , Low Benjamin , Raha Oishik , Shabbir Khawar , Vittay Orsolya , Kwan Joseph , Brown Zoe , Halse Omid , Jamil Sohaa , Kalladka Dheeraj , Venter Marius , Jenkins Harri , Rane Neil , Singh Abhinav , Patel Maneesh , Hall Charles , Fatania Gavin , Roi Dylan , Lobotesis Kyriakos , Banerjee Soma
Published: November 2022

Background

The evidence for mechanical thrombectomy in acute basilar artery occlusion has until now remained inconclusive with basilar artery strokes associated with high rates of death and disability. This systematic review and meta-analysis will summarize the available evidence for the effectiveness of mechanical thrombectomy in acute basilar artery occlusion compared to best medical therapy.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials using Embase, Medline and the Cochrane Central Register of Controlled Trials (CENTRAL). We calculated risk ratios (RRs) and 95% confidence intervals (CIs) to summarize the effect estimates for each outcome.

Results

We performed a random effects (Mantel-Haenszel) meta-analysis of the four included randomized controlled trials comprising a total of 988 participants. We found a statistically significant improvement in the rates of those with a good functional outcome (mRS 0–3, RR 1.54, 1.16–2.06, p = 0.003) and functional independence (mRS 0–2, RR 1.69, 1.05–2.71, p = 0.03) in those who were treated with thrombectomy when compared to best medical therapy alone. Thrombectomy was associated with a higher level of sICH (RR 7.12, 2.16–23.54, p = 0.001) but this was not reflected in a higher mortality rate, conversely the mortality rate was significantly lower in the intervention group (RR 0.76, 0.65–0.89, p = 0.0004).

Conclusions

Our meta-analysis of the recently presented randomized controlled studies is the first to confirm the disability and mortality benefit of mechanical thrombectomy in basilar artery stroke.
Ultrasonography and clinicopathological features of breast cancer in predicting axillary lymph node metastases
Authors: Xiong Jiajia , Zuo Wei , Wu Yu , Wang Xiuhua , Li Wenqu , Wang Qiaodan , Zhou Hui , Xie Mingxing , Qin Xiaojuan
Published: November 2022

Background

Early identification of axillary lymph node metastasis (ALNM) in breast cancer (BC) is still a clinical difficulty. There is still no good method to replace sentinel lymph node biopsy (SLNB). The purpose of our study was to develop and validate a nomogram to predict the probability of ALNM preoperatively based on ultrasonography (US) and clinicopathological features of primary tumors.

Methods

From September 2019 to April 2022, the preoperative US) and clinicopathological data of 1076 T1-T2 BC patients underwent surgical treatment were collected. Patients were divided into a training set (875 patients from September 2019 to October 2021) and a validation set (201 patients from November 2021 to April 2022). Patients were divided into positive and negative axillary lymph node (ALN) group according pathology of axillary surgery. Compared the US and clinicopathological features between the two groups. The risk factors for ALNM were determined using multivariate logistic regression analysis, and a nomogram was constructed. AUC and calibration were used to assess its performance.

Results

By univariate and multivariate logistic regression analysis, age (p = 0.009), histologic grades (p = 0.000), molecular subtypes (p = 0.000), tumor location (p = 0.000), maximum diameter (p = 0.000), spiculated margin (p = 0.000) and distance from the skin (p = 0.000) were independent risk factors of ALNM. Then a nomogram was developed. The model was good discriminating with an AUC of 0.705 and 0.745 for the training and validation set, respectively. And the calibration curves demonstrated high agreement. However, in further predicting a heavy nodal disease burden (> 2 nodes), none of the variables were significant.

Conclusion

This nomogram based on the US and clinicopathological data can predict the presence of ALNM good in T1-T2 BC patients. But it cannot effectively predict a heavy nodal disease burden (> 2 nodes).
CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care
Authors: Hwong Alison R. , Chagwedera D. Nyasha , Thomas Marilyn , Niu Grace , Quan Judy , Vittinghoff Eric , Schillinger Dean , Newcomer John W. , Gonzalez Ana , Essock Susan , Mangurian Christina
Published: November 2022

Background

Individuals with serious mental illness often do not receive guideline-concordant metabolic screening and human immunodeficiency virus (HIV) testing, contributing to increased morbidity and premature mortality. This study evaluates the effectiveness of CRANIUM (Cardiometabolic Risk Assessment and treatment through a Novel Integration model for Underserved populations with Mental illness), an intervention to increase metabolic screening and HIV testing among patients with serious mental illness in a community mental health clinic compared to usual care.

Methods

The study used a quasi-experimental design, prospectively comparing a preventive care screening intervention at one community mental health clinic (n = 536 patients) to usual care at the remaining clinics within an urban behavioural health system (n = 4,847 patients). Psychiatrists at the intervention site received training in preventive health screening and had access to a primary care consultant, screening and treatment algorithms, patient registries, and a peer support specialist. Outcomes were the change in screening rates of A1c, lipid, and HIV testing post-intervention at the intervention site compared to usual care sites.

Results

Rates of lipid screening and HIV testing increased significantly at the intervention site compared to usual care, with and without multivariable adjustment [Lipid: aOR 1.90, 95% CI 1.32–2.75, P = .001; HIV: aOR 23.42, 95% CI 5.94–92.41, P < .001]. While we observed a significant increase in A1c screening rates at the intervention site, this increase did not persist after multivariable adjustment (aOR 1.37, 95% CI .95–1.99, P = .09).

Conclusions

This low-cost, reverse integrated care model targeting community psychiatrist practices had modest effects on increasing preventive care screenings, with the biggest effect seen for HIV testing rates. Additional incentives and structural supports may be needed to further promote screening practices for individuals with serious mental illness.
Type 2 diabetes and depressive symptoms in the adult population in Mexico: a syndemic approach based on National Health and Nutrition Survey
Authors: Agudelo-Botero Marcela , Giraldo-Rodríguez Liliana , Dávila-Cervantes Claudio A.
Published: November 2022

Background

The syndemic approach allows the analysis of clusters of diseases that affect a population in contexts of geographic, social and economic inequalities at the same moment and time. This study aims to analyze, from a syndemic perspective, the relationship between type 2 diabetes (T2D) and depressive symptoms in Mexican adults and its association with individual, contextual and structural factors.

Methods

Observational, cross-sectional study based on secondary data from Mexico’s National Health and Nutrition Survey 2018–19. The sample of this study consisted of 16 835 adults, which represented a total of 78 463 734 persons aged ≥ 20 years. Bivariate descriptive analyses were performed and logistic regression models were estimated to analyze the association between T2D and depressive symptoms with various co-variables. In addition, interactions between T2D and depressive symptoms with obesity, educational level, and socioeconomic status were tested.

Results

In the study population, 12.2% of adults aged 20 years and older self-reported having T2D, 14.7% had depressive symptoms and 2.8% had both diseases. There was a statistically significant relationship between T2D and depressive symptoms. The prevalence of T2D and depressive symptoms was higher compared to people who did not have these two conditions. Obesity increased the probability of having T2D, while violence was statistically associated with people having depressive symptoms. A low level of education increased the odds ratio of having T2D and depressive symptoms.

Conclusion

The availability of analytical frameworks such as the syndemic perspective could help to identify areas of opportunity for decision making and actions for population groups that–because of their individual, contextual and structural disadvantages–are at greater risk of experiencing poorer health outcomes due to the presence of T2D and depressive symptoms.
Changes in agricultural context and mental health of farmers in different regions of Thailand during the fifth wave of the COVID-19 pandemic
Authors: Sapbamrer Ratana , Sittitoon Nalin , La-up Aroon , Pakvilai Nisa , Chittrakul Jiraporn , Sirikul Wachiranun , Kitro Amornphat , Hongsibsong Surat
Published: November 2022

Background

Thailand's agricultural sector is crucial to the country's development and economy. The COVID-19 pandemic caused negative effects on the agricultural context and the mental health of Thai farmers. This study aimed to compare changes in the agricultural context and mental health among farmers in different regions of Thailand during the fifth wave of the COVID-19 pandemic. We also investigated the determinants associated with the mental health of farmers.

Methods

This cross-sectional study was carried out from December 2021 to January 2022 in Thailand, with 1,676 Thai farmers interviewed.

Results

The results found that the Central region found to be the highest impact of increased agrochemical costs (91.0%) and decreased crop yields (92.0%), while the highest in the North and the North-East was found in decreased crop product prices (84.0 and 66.4%). In the context of economic status, the greatest impact in the Central region was found to be in increased household expense (96.3%), while the highest impact in the North, the North-East, and the South was found in decreased household income (91.5, 80.0, and 69.8%, respectively). Regarding mental health, the Central region was found to be the highest prevalence of extremely high stress and severe depression symptoms (18.3 and 23.4%), whereas the South region was found to be the highest prevalence of severe anxiety symptoms (7.4%). Interestingly, the multivariate analysis also found that the agricultural factors associated with mental health were decreased working days, changes in agrochemical type and crop cultivation, decreased crop rotation, increased difficulty in accessing agrochemicals and markets, decreased crop yields, and increased household debt.

Conclusion

The findings of this study are useful for government and relevant organizations to plan and implement supportive measures and improve mental health services to mitigate both short and long-term impacts of the COVID-19 pandemic suit on the regions. Specific measures and facilities should be tailored toward the target regions.
Health literacy and health care experiences of migrant workers during the COVID-19 pandemic: a qualitative study
Authors: Kang Soo Jin , Hyung Ji An , Han Hae-Ra
Published: November 2022

Background

Migrant workers are among the most vulnerable populations in society. This study explored the health-literacy experiences of migrant workers in South Korea and how the workers’daily lives have been affected by the coronavirus disease 2019 (COVID-19) pandemic.

Methods

We conducted a series of semi-structured individual and focus-group interviews with 23 migrant workers (eight Cambodians, six Nepalese, four Sri Lankans, three Bangladeshis, and two Pakistanis) residing in the Daegu and Busan metropolitan areas of South Korea. All interviews were digitally recorded and transcribed verbatim. The data were analyzed using content analysis.

Results

Migrant workers had difficulty accessing and using health care services due, in large part, to linguistic barriers and a lack of an adequate support system. Four main themes were identified: difficulty understanding and using medical services, obtaining necessary health and safety information, the impact of COVID-19, and protecting oneself from becoming infected with COVID-19. Most workers depended on information from social networking services (SNS) and co-workers.

Conclusions

Migrant workers’ difficulty with health care access was exacerbated during the COVID-19 pandemic. The findings suggest the necessity of enhancing migrant workers' health literacy, along with the use of SNS as a viable pathway for sharing health information and resources.
Temperature-controlled Laminar Airflow (TLA) in symptomatic severe asthma – a post hoc analysis of severe exacerbations, quality of life and health economics
Authors: Chauhan A. J. , Eriksson G. , Storrar W. , Brown T. , Peterson S. , Radner F. , D’Cruz L. G. , Miller P. , Bjermer L.
Published: November 2022

Purpose

Uncontrolled severe asthma constitutes a major economic burden to society. Add-ons to standard inhaled treatments include inexpensive oral corticosteroids and expensive biologics. Nocturnal treatment with Temperature-controlled Laminar Airflow (TLA; Airsonett®) could be an effective, safe and cheaper alternative. The potential of TLA in reducing severe asthma exacerbations was addressed in a recent randomised placebo-controlled trial (RCT) in patients with severe asthma (Global Initiative for Asthma (GINA) step 4/5), but the results were inconclusive. We re-analysed the RCT with severe exacerbations stratified by the level of baseline asthma symptoms and Quality of Life.

Methods

More uncontrolled patients, defined by Asthma Control Questionnaire 7 (ACQ7) > 3, EuroQoL 5-Dimension Questionnaire Visual Analogue Scale (EQ5D-VAS) ≤ 65 and Asthma Quality of Life Questionnaire (AQLQ) ≤ 4 were selected for re-analysis. The rates of severe asthma exacerbations, changes in QoL and health-economics were analysed and compared between TLA and placebo.

Results

The study population included 226 patients (113 TLA / 113 placebo.) The rates of severe asthma exacerbations were reduced by 33, 31 and 25% (p = 0.083, 0.073, 0.180) for TLA compared to placebo, dependent on selected control measures (ACQ7, EQ5D-VAS, AQLQ, respectively). For patients with less control defined by AQLQ≤4, the difference in mean AQLQ0-12M between TLA and placebo was 0.31, 0.33, 0.26 (p = 0.085, 0.034, 0.150), dependent on selected covariate (AQLQ, EQ5D-VAS, ACQ7, respectively). For patients with poor control defined by ACQ7 > 3, the difference in EQ5D-5 L utility scores between TLA and placebo was significant at 9 and 12 months with a cost-effective ICER. The results from the original study did not demonstrate these differences.

Conclusion

This post hoc analysis demonstrated an effect of TLA over placebo on severe exacerbations, asthma control and health economics in a subgroup of patients with more symptomatic severe allergic asthma. The results are consistent with the present recommendations for TLA. However, these differences were not demonstrated in the full study. Several explanations for the different outcomes have been outlined, which should be addressed in future studies.

Funding

NIHR Health Technology Assessment Programme and Portsmouth Hospitals NHS Trust.