Physicochemical properties and in vitro release of formononetin nano-particles by ultrasonic probe-assisted precipitation in four polar organic solvents

Although formononetin has a considerable biological activity, its therapeutic use is limited by its low solubility. Formononetin was dissolved in ethanol, methanol, N, N-dimethylformamide (DMF), and dimethyl sulfoxide (DMSO) in this investigation, the antisolvent precipitation procedure with the assistance of an external ultrasonic probe was used to manufacture the formononetin nano-particles. The ideal parameters for response surface BBD optimization are as follows: feed volume flow rate of 6 mL/min; ultrasonic power of 860 W; and liquid-liquid ratio of 1:12.5. The formononetin nano-particles have a smaller particle diameter than raw sample; the lowest size can be as small as (329 ± 1.99) nm, which is 45 times smaller than raw. An in vitro digestion test using a solution that simulated intestinal solution revealed that the release rate of the nano-particle was 1.75 times than that of the raw formononetin. The formononetin nano-particles generated by the aforementioned four solvents have the following order of diameter: ethanol > methanol > DMF > DMSO. This study provided a technical reference for the functional food components in deep processing.

Serum angiopoietin-2/angiopoietin-1 ratio is associated with cardiovascular and all-cause mortality in peritoneal dialysis patients: a prospective cohort study

INTRODUCTION

Our objective was to examine the factors associated with the serum angiopoietin-2/angiopoietin-1 (Angpt-2/Angpt-1) ratio in peritoneal dialysis (PD) patients and to investigate the association between Angpt-2/Angpt-1 ratio and cardiovascular and all-cause mortality.

METHODS

Patients on PD who were prevalent between January 2014 and April 2015 in the center of Renji Hospital were enrolled. At the time of enrollment, serum and dialysate samples were collected to detect biochemical parameters, serum angiopoietin-2 and angiopoietin-1 levels. Patients were dichotomized into two groups according to a median of Angpt-2/Angpt-1 ratio and followed up prospectively until the end of the study.

RESULTS

A total of 325 patients were enrolled, including 168 males (51.7%) with a mean age of 56.9 ± 14.2 years and a median PD duration of 32.4 (9.8-55.9) months. Multiple linear regression showed pulse pressure (β = 0.206, p < .001) and high-sensitivity C-reactive protein (hs-CRP) (β = 0.149, p = .011) were positively correlated with serum Angpt-2/Angpt-1 ratio, while residual renal function (RRF) (β= -0.219, p < .001) was negatively correlated with serum Angpt-2/Angpt-1 ratio. Multivariate Cox regression analysis showed the high serum Angpt-2/Angpt-1 ratio was an independent predictor of cardiovascular mortality (hazard ratio (HR)=2.467, 95% confidence interval (CI) 1.243-4.895, p = .010) and all-cause mortality (HR = 1.486, 95%CI 1.038-2.127, p = .031). In further subgroup analysis by gender, a significant association was shown in high Angpt-2/Angpt-1 ratio with all-cause mortality in male (p < .05), but not in female patients (p>.05).

CONCLUSIONS

High Angpt-2/Angpt-1 ratio is an independent risk factor for cardiovascular and all-cause mortality in PD patients.

Fractal Analysis of Left Ventricular Trabeculae in Patients with End-Stage Renal Disease: A Random Survival Tree Analysis

BACKGROUND

The complexity of left ventricular (LV) trabeculae is related to the prognosis of several cardiovascular diseases.

PURPOSE

To evaluate the prognostic value of LV trabecular complexity in patients with end-stage renal disease (ESRD).

STUDY TYPE

Prospective outcome study.

POPULATION

207 participants on maintenance dialysis, divided into development (160 patients from 2 centers) and external validation (47 patients from a third center) cohorts, and 72 healthy controls.

FIELD STRENGTH

3.0T, steady-state free precession (SSFP) and modified Look-Locker imaging sequences.

ASSESSMENT

All participants had their trabecular complexity quantified by fractal analysis using cine SSFP images. Patients were followed up every 2 weeks until April 2023, or endpoint events happened. Random Forest (RF) and Cox regression models including age, diabetes, LV mass index, mean basal fractal dimension (FD), and left atrial volume index, were developed to predict major adverse cardiac events (MACE). Patients were divided into low- and high-risk groups based on scores derived from the RF model and survival compared.

STATISTICAL TESTS

Receiver operating characteristic curve analysis; Kaplan-Meier survival analysis with log rank tests; Harrel's C-index to assess model performance. A P value <0.05 was considered statistically significant.

RESULTS

Fifty-five patients (26.57%) experienced MACE during a median follow-up time of 21.83 months. An increased mean basal FD (≥1.324) was associated with a significantly higher risk of MACE. The RF model (C-index: 0.81) had significantly better discrimination than the Cox regression model (C-index: 0.74). Participants of the external validation dataset classified into the high-risk group had a hazard of experiencing MACE increased by 12.29 times compared to those in the low-risk group.

DATA CONCLUSION

LV basal FD was an independent predictor for MACE in patients with ESRD. Reliable risk stratification models could be generated based on LV basal FD and other MRI variables using RF analysis.

LEVEL OF EVIDENCE

2 TECHNICAL EFFICACY: Stage 2.

Neurofilament light chain is associated with olfactory dysfunction in US adults: findings from National Health and Nutrition Examination Survey

BACKGROUND

Many individuals who have olfactory dysfunction are not aware of their impairment, which results in delayed detection of potentially hazardous situations. Simple and accurate methods for objectively assessing olfactory function are needed. In this study, we aim to investigate the utility of serum neurofilament light chain (NfL) levels as an indicator of olfactory dysfunction.

METHODOLOGY

We analysed data on 1290 participants aged 40 years and older, who had valid data on olfaction and NfL level from the National Health and Nutrition Examination Survey 2013â€"2014. Multivariable modeling was used to investigate the relationship between olfactory dysfunction and NfL.

RESULTS

Among 1290 participants, 174 participants had olfactory dysfunction based on the results of the NHANES Pocket Smell Test. In ordinal regression models, objective olfactory dysfunction was associated with NfL. After adjusting for age, sex, race/ethnicity, diabetes, smoking, olfaction-related medical history, Parkinson's disease and Alzheimer’s disease, the association remained significant. In logistic regression models, compared to participants with lower levels of NfL in the first tertile, those in the second and third tertiles had higher odds of objective olfactory dysfunction. There was no association between self-reported olfactory dysfunction and NfL tertiles.

CONCLUSIONS

A strong association between objective olfactory dysfunction and serum NfL level was observed. NfL, independent of age, is a reliable marker indicating the development of olfactory dysfunction. The measurement of serum NfL level provides valuable support for assessment of olfactory dysfunction in clinical practice.

[Beneficial effects of extravascular lung water index-guided volum management in patients with cardiogenic shock]

Objective: To evaluate the role of volume management guided by extravascular lung water index(EVLWI) in improving the clinical outcomes and cardiac function for patients with cardiogenic shock. Methods: This study was a single-center, prospective cohort study. Patients with cardiogenic shock admitted to the Department of Cardiovascular Medicine, Shanghai East Hospital from July 2022 to December 2023 were enrolled. Patients were matched 1∶1 by propensity score and divided into EVLWI group and control group. In the control group, the volume management strategy was determined by the attending physician based mainly on conventional factors, including clinical features, biochemical assessments, and certain blood pressure measurements. In EVLWI group, the volume management plan was formulated by integrating conventional factors with EVLWI derived from pulse index continuous cardiac output (PiCCO) monitoring. Baseline clinical data, in-hospital treatment, and hemodynamic data were collected. Major adverse cardiovascular events and cardiac function related parameters were compared at 30 d after treatment between the two groups. Baseline EVLWI levels were compared between the non-survivors and the survivors in the EVLWI group. The receiver operating characteristic curve was plotted to assess the accuracy of baseline EVLWI and central venous pressure in predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, and subgroup analysis was performed according to ischemic/non-ischemic etiology and with/without use of inotropic drugs. Kaplan-Meier curve was used for survival analysis, with log-rank tests comparing all-cause mortality, cardiac death, and readmission rate for heart failure at 30 d after treatment. Results: A total of 200 patients with cardiogenic shock were enrolled, aged (71.35±12.82) years, 144(72%) males, EVLWI group and control group 100 patients each. Compared with the control group, EVLWI group had lower all-cause mortality (16%(16/100) vs. 42%(42/100), log-rank P<0.01), cardiac death (14%(14/100) vs. 34%(34/100), log-rank P<0.01), and readmission rate for heart failure (4%(4/100) vs. 12%(12/100), log-rank P=0.03) at 30 d after treatment. Subgroup analysis showed that EVLWI-guided volume management was associated with lower all-cause mortality at 30 d after treatment in patients with cardiogenic shock of ischemic or non-ischemic etiology and with or without inotropic drugs (all P<0.05). In EVLWI group, baseline EVLWI levels were higher in non-survivors than those in survivors [(15.99±6.47) ml/kg vs.(9.75±2.55) ml/kg, P<0.01]. The baseline EVLWI could predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, with an area under the receiver operating characteristic curve of 0.84 (95%CI: 0.75-0.94, P<0.01), while the baseline central venous pressure had no predicting value (AUC=0.54, 95%CI: 0.40-0.69, P=0.60). The optimal cutoff value of EVLWI in pridicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock was >10.3 ml/kg. With the optimization of hemodynamic parameters, left ventricular ejection fraction was improved in EVLWI group, and serum levels of N-terminal pro-brain natriuretic peptide, creatinine, alanine aminotransferase and lactic acid were decreased (all P<0.05). Conclusion: EVLWI-guided volume management exerts a beneficial effect on therapeutic decision-making and improves clinical outcomes and cardiac function in patients with cardiogenic shock.

[Progress in drug therapy of Wilson's disease]

Wilson's disease, also known as hepatolenticular degeneration, is an inherited disorder of copper metabolism caused by homozygous or compound heterozygous variants in the ATP7B gene, which is mainly clinically manifested as liver disease and/or neurological/psychological disorders, and Kayser-Fleischer ring in the peripheral cornea. Patients with Wilson's disease are currently treated with lifelong use of chelating agents that promote copper ion excretion and/or zinc agents that reduce copper absorption, but there is still an unmet clinical need because some patients who receive treatment have poor efficacy, disease progression, or serious adverse drug reactions. In recent years, new therapeutic drugs have been developed rapidly. This article will summarize the advances in drug treatment of Wilson's disease, shedding new light on the treatment of Wilson's disease.

Searches for new physics below twice the electron mass with GERDA

A search for full energy depositions from bosonic keV-scale dark matter candidates of masses between 65 and 1021 keV has been performed with data collected during Phase II of the GERmanium Detector Array (Gerda) experiment. Our analysis includes direct dark matter absorption as well as dark Compton scattering. With a total exposure of 105.5 kg years, no evidence for a signal above the background has been observed. The resulting exclusion limits deduced with either Bayesian or Frequentist statistics are the most stringent direct constraints in the major part of the 140-1021 keV mass range. As an example, at a mass of 150 keV the dimensionless coupling of dark photons and axion-like particles to electrons has been constrained toα ' / α < 8.7 × 10 - 24 andg ae < 3.3 × 10 - 12 at 90% credible interval (CI), respectively. Additionally, a search for peak-like signals from beyond the Standard Model decays of nucleons and electrons is performed. We find for the inclusive decay of a single neutron in76 Ge a lower lifetime limit ofτ n > 1.5 × 10 24 years and for a protonτ p > 1.3 × 10 24 years at 90% CI. For the electron decaye - → ν e γ a lower limit ofτ e > 5.4 × 10 25 years at 90% CI has been determined.

Supplementary Information

The online version contains supplementary material available at 10.1140/epjc/s10052-024-13020-0.

[Analysis of factors affecting the progression of visual field defects in patients with myopia and primary open-angle glaucoma]

Objective: To investigate the factors affecting the progression of visual field defects in patients with myopia and primary open-angle glaucoma (POAG), and to clarify whether the factors vary in patients with different degrees of myopia. Method: An ambispective cohort study was conducted among patients diagnosed with myopia and POAG from the glaucoma outpatient department at the Zhongshan Ophthalmic Center of Sun Yat-sen University between January 2006 and January 2024. Based on the criteria of functional visual field progression, patients were divided into the progression group and non-progression group, and further divided into the low to moderate myopia subgroup and high myopia subgroup according to the degree of myopia. The patient age, gender, type of glaucoma (high tension glaucoma and normal tension glaucoma), spherical equivalent refraction, best corrected visual acuity (BCVA, recorded as the logarithm of the minimum angle of resolution), intraocular pressure (IOP), central corneal thickness, baseline visual field, history of ophthalmic surgery (corneal refractive surgery and glaucoma surgery), and number of anti-glaucoma medications were summarized. The generalized estimation equation was used for comparison between groups, and the Cox proportional hazards model was used to analyze the factors affecting the progression of visual field defects. Results: A total of 182 eyes from 106 patients were included in this study. There were 57 eyes in the progression group and 125 eyes in the non-progression group. Compared with the non-progression group, the progression group had the older age [43 (29, 53) years old], worse BCVA [0.05 (0.00, 0.17)], greater IOP fluctuation [1.8 (1.3, 2.9)mmHg(1 mmHg=0.133 kPa)], more common baseline central defects [52.6%(30/57)], higher visual field pattern standard deviations [8.92 (5.32, 12.00)dB], lower visual field index [77% (67%, 88%)], and more anti-glaucoma medications [35.1% (20/57) patients used three medications] (all P<0.05). The Cox proportional hazards models showed that the baseline moderate visual field defects [hazard ratio (HR)=2.33, 95% confidence interval (CI): 1.25 to 4.36, P=0.008], baseline central defects (HR=2.09, 95%CI: 1.11 to 3.93, P=0.022), older age (Model A, HR=1.03, 95%CI: 1.00 to 1.05, P=0.017; Model B, HR=1.02, 95%CI: 1.00 to 1.05, P=0.019), and greater IOP fluctuation (Model A, HR=1.54, 95%CI: 1.32 to 1.81, P<0.001; Model B, HR=1.49, 95%CI: 1.26 to 1.75, P<0.001) were risk factors for visual field progression. In the low to moderate myopia subgroup, the increased risk of progression was associated with baseline central defects (HR=5.74, 95%CI: 1.72 to 19.20, P=0.005), worse BCVA (Model A, HR=15.80, 95%CI: 2.07 to 121.00, P=0.008; Model B, HR=12.50, 95%CI: 2.65 to 58.70, P=0.001), and older age (Model A, HR=1.05, 95%CI: 1.02 to 1.08, P=0.002; Model B, HR=1.07, 95%CI: 1.03 to 1.11, P<0.001). In the high myopia subgroup, the increased risk of progression was associated with baseline moderate visual field defects (HR=2.35, 95%CI: 1.12 to 4.92, P=0.024) and greater IOP fluctuation (Model A, HR=1.50, 95%CI: 1.24 to 1.82, P<0.001; Model B, HR=1.52, 95%CI: 1.26 to 1.83, P<0.001). Conclusions: Age, IOP fluctuation, baseline moderate visual field defects, and baseline central defects were the factors affecting the progression of visual field defects in patients with myopia and POAG. There were differences in the influencing factors of visual field progression in patients with different degrees of myopia.

Individual and area-level socioeconomic status, Life's Simple 7, and comorbid cardiovascular disease and cancer: a prospective analysis of the UK Biobank cohort

OBJECTIVES

We aimed to investigate the associations of individual and area-level socioeconomic status (SES) with incident cardiovascular diseases (CVD) alone, cancer alone, and comorbid CVD and cancer, and the mediation role of cardiovascular health score in these associations.

STUDY DESIGN

This was a population-based prospective cohort study.

METHODS

We used data from the UK Biobank, a population-based prospective cohort study. Latent class analysis was used to create an individual-level SES index based on three indicators (household income, education level, and employment status), and the Townsend Index was defined as the area-level socioeconomic status. We used the American Heart Association's (AHA) Life's Simple 7 (smoking, body weight, physical activity, diet, blood pressure, blood glucose, and total cholesterol) to calculate the cardiovascular health score. We used Cox proportional hazard regression models to estimate the hazard ratio (HR) and 95% confidence interval (CI) adjusted for demographic, environmental, and genetic factors.

RESULTS

Compared with high SES, the HRs in participants with low individual and area-level SES were 1.33 (95% confidence interval [CI] 1.29 to 1.38) and 1.24 (95% CI 1.20 to 1.29) for incident CVD, 0.96 (95% CI 0.93 to 0.99) and 0.95 (95%CI 0.92 to 0.98) for incident cancer, 1.32 (95%CI 1.24 to 1.40) and 1.15 (95%CI 1.08 to 1.22) for incident comorbid CVD and cancer, respectively. Additionally, the mediation proportion of CVD score for individual and area-level SES was 47.93% and 48.87% for incident CVD, 44.83% and 59.93% for incident comorbid CVD and cancer. The interactions between individual-level SES and CVD scores were significant on incident CVD, and comorbid CVD and cancer, and the protective associations were stronger in participants with high individual-level SES.

CONCLUSIONS

Life's Simple 7 significantly mediated the associations between SES and comorbid CVD and cancer, while almost half of the associations remained unclear.

Anxiety and its relationship to demographic and personality traits data among special operations divers: a cross-sectional study

INTRODUCTION

Special operation diving is becoming increasingly prevalent but has received less attention. The anxiety profile in special operation divers and its influencing factors remain unclear, posing great challenges to medical and psychological security of this unique population. The current study aimed to investigate the anxiety profile and to analyse the correlations between anxiety with demographic and personality traits data among special operation divers.

METHODS

From July to October 2023, 650 special operation divers participated this analytical cross-sectional study. The Spielberg's State-Trait Anxiety Inventory and the Neuroticism Extraversion Openness Five-Factor Inventory were used to evaluate anxiety and personality traits of special operation divers.

RESULTS

27.2% and 30.3% special operation divers showed high scores on state anxiety and trait anxiety, respectively. Special operation divers who are 30 years or older and who have dived for 15 years or more are prone to higher level of trait anxiety and state anxiety (all p<0.001). Neuroticism showed a significantly positive correlation with both trait anxiety (r=0.675, p<0.001) and state anxiety (r=0.674, p<0.001). Extraversion, openness, agreeableness and conscientiousness are all negatively correlated with both trait anxiety and state anxiety (r=-0.670 to -0.400, all p<0.001). Additionally, significant differences in neuroticism, extraversion, openness, agreeableness and conscientiousness were observed between the high anxiety group and the low anxiety group (all p<0.001).

CONCLUSION

The prevalence of trait anxiety and state anxiety are both relatively high among special operation divers. Individuals with older age and longer diving years are more prone to be anxious. Higher neuroticism, lower extraversion, lower openness, lower agreeableness and lower conscientiousness may be predictors of higher trait anxiety and higher state anxiety.

Collective Dynamical Fermi Suppression of Optically Induced Inelastic Scattering

We observe strong dynamical suppression of optically induced loss in a weakly interacting Fermi gas as the s-wave scattering length is increased. A single trapped cigar-shaped cloud behaves as a large spin lattice in energy space with a tunable Heisenberg Hamiltonian. The loss suppression occurs as the lattice transitions into a magnetized state, where the fermionic nature of the atoms inhibits interactions. The data are quantitatively explained by incorporating spin-dependent loss into a quasiclassical collective spin vector model, the success of which enables the application of optical control of effective long-range interactions to this system.

Adherence to guidelines and central-line-associated bloodstream infection occurrence during insertion and maintenance of intravascular catheters: evidence from 20 tertiary hospitals

OBJECTIVE

To investigate adherence to intravascular catheter (IVC) insertion and maintenance guidelines in Chinese tertiary hospitals.

METHODS

A cross-sectional questionnaire survey of adult inpatients with IVC placements was conducted from July to September 2022 in 20 tertiary hospitals in China. One clinical staff member from each department in each hospital was assigned to participate in the survey. Questionnaires were uniformly collected and reviewed after three months.

RESULTS

This study included 1815 cases (62.69%) of central venous catheter, 471 cases (16.27%) of peripherally inserted central catheter, 461 cases (15.92%) of PORT, and 147 cases (5.08%) of haemodialysis catheter insertions. Statistically significant differences in compliance were observed across the four IVC types, specifically in relation to the insertion checklist, standard operating procedure, and insertion environment (P<0.05). Practice adherence during IVC maintenance differed significantly across the four IVC types in aspects such as availability of IVC maintenance verification forms, daily scrubbing of the catheterized patients, and catheter connection methods (P<0.05). A total of 386 (13.34%) patients developed fever, 1086 (37.53%) were treated with therapeutic antibiotics, 16 (0.55%) developed central-line-associated bloodstream infections, two (0.07%) developed local skin infections, and six (0.21%) developed deep vein thrombosis.

CONCLUSIONS

Adherence to guidelines regarding insertion and maintenance differed across the four IVC types; there is a gap between the recommended measures and the actual operation of the guidelines. Therefore, it is necessary to further enhance training and develop checklists to prevent central-line-associated bloodstream infections.

Material extrusion 3D-printing technology: A new strategy for constructing water-soluble, high-dose, sustained-release drug formulations

The advantage of low-temperature forming through direct ink writing (DIW) 3D printing is becoming a strategy for the construction of innovative drug delivery systems (DDSs). Optimization of the complex formulation, including factors such as the printing ink, presence of solvents, and potential low mechanical strength, are challenges during process development. This study presents an application of DIW to fabricate water-soluble, high-dose, and sustained-release DDSs. Utilizing poorly compressible metformin hydrochloride as a model drug, a core-shell delivery system was developed, featuring a core composed of 96 % drug powder and 4 % binder, with a shell structure serving as a drug-release barrier. This design aligns with the sustained-release profile of traditional processes, achieving a 25.8 % reduction in volume and enhanced mechanical strength. The strategy facilitates sustained release of high-dose water-soluble formulations for over 12 h, potentially improving patient compliance by reducing formulation size. Process optimization and multi-batch flexibility were also explored in this study. Our findings provide a valuable reference for the development of innovative DDSs and 3D-printed drugs.

A modular DNA origami nanocompartment for engineering a cell-free, protein unfolding and degradation pathway

Within the cell, chemical reactions are often confined and organized through a modular architecture. This facilitates the targeted localization of molecular species and their efficient translocation to subsequent sites. Here we present a cell-free nanoscale model that exploits compartmentalization strategies to carry out regulated protein unfolding and degradation. Our synthetic model comprises two connected DNA origami nanocompartments (each measuring 25 nm × 41 nm × 53 nm): one containing the protein unfolding machine, p97, and the other housing the protease chymotrypsin. We achieve the unidirectional immobilization of p97 within the first compartment, establishing a gateway mechanism that controls substrate recruitment, translocation and processing within the second compartment. Our data show that, whereas spatial confinement increases the rate of the individual reactions by up to tenfold, the physical connection of the compartmentalized enzymes into a chimera efficiently couples the two reactions and reduces off-target proteolysis by almost sixfold. Hence, our modular approach may serve as a blueprint for engineering artificial nanofactories with reshaped catalytic performance and functionalities beyond those observed in natural systems.

Scientific epistemology beliefs and acceptance of Traditional Chinese Medicine: A multigroup analysis based on the UTAUT model in Southern China

Purpose

This study for the first time delves into the intricate relationship between scientific literacy and the acceptance of traditional Chinese medicine (TCM) by employing a multigroup path analysis based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model. We adopted Scientific Epistemology Belief (SEB) as an indicator for measuring scientific literacy due to its comprehensive reflection of individuals' understanding of scientific knowledge and knowing. In assessing TCM acceptance, we focused on Chinese parents' receptivity towards pediatric TCM, as it offers a more genuine representation of actual inclinations.

Methods

A convenience sample of 1016 Chinese parents in Southern China was assessed using online Likert-scale questionnaires on SEB and UTAUT determinants (including performance expectancy, social influence, risk awareness, and facilitating conditions). A K-means cluster analysis was employed to discern distinct SEB profiles, followed by a multigroup path analysis to ascertain UTAUT model variations across these profiles.

Results

Five SEB profiles were identified, namely, intermediate, absolutistic, multiplistic, sophisticated, and evidence-based. Evidence-based believers manifested the highest pediatric TCM acceptance, albeit with elements of blind faith, while multiplistic skeptics, prone to questioning everything, displayed the least acceptance. The absolutistic, intermediate, and sophisticated demonstrated moderate TCM acceptance levels, with the intermediate profile outscoring both absolutistic and sophisticated. These findings highlight that individuals with high scientific literacy do not blindly endorse TCM, nor do those with limited scientific understanding fully appreciate TCM's merits.

Conclusion

SEB significantly moderates TCM acceptance factors in the UTAUT model, indicating that extremes in scientific knowledge spectrum result in less balanced TCM perspectives. Our findings pave the way for novel insights into harmonizing modern and traditional medical practices.

Assessment of the Prognostic Value of MRI Left Ventricular Global Function Index (LVGFI) in Patients With End-Stage Renal Disease Under Maintenance Dialysis

BACKGROUND

Left ventricular global function index (LVGFI) integrates LV volumetric and functional parameters. In patients with end-stage renal disease (ESRD), cardiac injury manifests as LV hypertrophy and dysfunction. However, the prognostic value of LVGFI in this population remains unclear.

PURPOSE

To investigate the association of LVGFI with major adverse cardiac events (MACE) in patients with ESRD.

STUDY TYPE

Prospective.

POPULATION

One hundred fifty-eight ESRD patients (mean age: 54.1 ± 14.4 years; 105 male) on maintenance dialysis.

FILED STRENGTH/SEQUENCE

3.0 T, balanced steady-state free precession (bSSFP) cine and modified Look-Locker inversion recovery (MOLLI) sequences.

ASSESSMENT

LV volumetric and functional parameters were determined from bSSFP images. LVGFI was calculated as the ratio of stroke volume to global volume and native T1 was determined from MOLLI T1 maps. MACE was recorded on follow up. Models were developed to predict MACE from conventional risk factors combined with LVGFI, GLS, native T1, and LV mass index (LVMI), respectively. Subgroup analyses were further performed in participants with LVEF above median.

STATISTICAL TESTS

Cox proportional hazard regression and log-rank test were used to investigate the association between LVGFI and MACE. The predictive models were evaluated and compared using Harrell's C-statistics and DeLong tests. A P value <0.05 was considered statistically significant.

RESULTS

Thirty-four MACE occurred during the median follow-up period of 26 months. The hazard of MACE increased by 114% for each 10% decrease in LVGFI in univariable analysis. The predictive model consisting of LVGFI (C-statistic: 0.724) had significantly better predictive performance than the others (all P < 0.001). These results were consistent in patients (N = 79) with LVEF > median (63.54%).

DATA CONCLUSION

LVGFI is a novel marker for MACE risk stratification in patients with ESRD and was better able to predict MACE than native T1 mapping and GLS.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 3.

A machine learning model to predict therapeutic inertia in type 2 diabetes using electronic health record data

OBJECTIVE

To estimate the therapeutic inertia prevalence for patients with type 2 diabetes, develop and validate a machine learning model predicting therapeutic inertia, and determine the added predictive value of area-level social determinants of health (SDOH).

METHODS

This prognostic study with a retrospective cohort design used OneFlorida data (linked electronic health records (EHRs) from 1240 practices/clinics in Florida). The study cohort included adults (aged ≥ 18) with type 2 diabetes, HbA1C ≥ 7% (53 mmol/mol), ≥one ambulatory visit, and ≥one antihyperglycemic medication prescribed (excluded patients prescribed insulin before HbA1C). The outcome was therapeutic inertia, defined as absence of treatment intensification within six months after HbA1C ≥ 7% (53 mmol/mol). The predictors were patient, provider, and healthcare system factors. Machine learning methods included gradient boosting machines (GBM), random forests (RF), elastic net (EN), and least absolute shrinkage and selection operator (LASSO). The DeLong test compared the discriminative ability (represented by C-statistics) between models.

RESULTS

The cohort included 31,087 patients with type 2 diabetes (mean age = 58.89 (SD = 13.27) years, 50.50% male, 58.89% White). The therapeutic inertia prevalence was 39.80% among the 68,445 records. GBM outperformed (C-statistic from testing sample = 0.84, 95% CI = 0.83-0.84) RF (C-statistic = 0.80, 95% CI = 0.79-0.80), EN (C-statistic = 0.80, 95% CI = 0.80-0.81), and LASSO (C-statistic = 0.80, 95% CI = 0.80-0.81), p < 0.05. Area-level SDOH significantly increased the discriminative ability versus models without SDOH (C-statistic for GBM = 0.84, 95% CI = 0.84-0.85 vs. 0.84, 95% CI = 0.83-0.84), p < 0.05.

CONCLUSIONS

Using EHRs of patients with type 2 diabetes from a large state, machine learning predicted therapeutic inertia (prevalence = 40%). The model's ability to predict patients at high risk of therapeutic inertia is clinically applicable to diabetes care.

[Retrospective clinical study on cryopreservation-free integrated autologous hematopoietic stem cell transplantation model for newly diagnosed multiple myeloma]

Objective: To explore the efficacy and safety of cryopreservation-free integrated autologous hematopoietic stem cell transplantation (HSCT) model for patients with multiple myeloma. Methods: A total of 96 patients with newly diagnosed multiple myeloma (NDMM) between July 31, 2020, and December 31, 2022, were retrospectively analyzed, of which 41 patients in the observation group received integrated non-cryopreserved transplantation mode. After hematopoietic stem cells were mobilized and collected, melphalan was started immediately for pre-transplant conditioning, and non-cryopreserved grafts from the medical blood transfusion refrigerator were directly injected intravenously into the patient within 24-48 h after the melphalan conditioning. The control group consisted of 55 patients who received traditional transplantation mode. After hematopoietic stem cells were collected, stem cell cryopreservation was performed in liquid nitrogen, and then the transplant plans were started at the right time. All patients received mobilization of autologous hematopoietic stem cells using the G-CSF combined with the plerixafor. Results: ① A total of 34 patients (82.9% ) with VGPR plus CR in the observation group were significantly higher than 33 patients (60.0% ) in the control group (P=0.016). ②Compared with the control group, the incidence of grade 1 oral mucosal inflammation was higher in the observation group (P<0.001) ; however, the incidence of grades 2 and 3 oral mucosal inflammation was lower (P=0.004, P=0.048), and neither group experienced grade 4 or above oral mucosal inflammation. The incidence of grade 1 diarrhea was higher in the observation group (P=0.002), whereas the incidence of grade 3 diarrhea was lower (P=0.007). No statistically significant difference was observed in the incidence of grade 4 diarrhea (P=0.506), and neither group experienced grade 5 diarrhea. ③ The incidence of bacterial infection in the observation group was lower than that in the control group (34.1% vs 65.5%, P=0.002), whereas no statistically significant difference was observed in the incidence of fungal infection (29.3% vs 31.4%, P=0.863) and viral infection (4.88% vs 3.64%, P=0.831). ④No statistically significant difference was observed in the implantation time of granulocytes and platelets between the observation and control groups [10 (8-20) days vs 11 (8-17) days, P=0.501; 13 (10-21) days vs 15 (10-20) days, P=0.245]. ⑤ All patients did not receive lenalidomide treatment 100 days post-transplantation. At 30 days post-transplantation, the CTL, NK, and Th cell counts in the observation group were lower than those in the control group (P<0.001, P=0.002, P=0.049), and the NKT cell counts were higher than those in the control group (P=0.024). At 100 days post-transplantation, the CTL, NKT, and Th cell counts in the observation group were higher than those in the control group (P=0.025, P=0.011, P=0.007), and no statistically significant difference in NK cell counts was observed between the two groups (P=0.396). ⑥ The median follow-up was 18 (4-33) months. The overall 2-year survival rates of the observation and control groups post-transplantation were 91.5% and 78.2%, respectively (P=0.337). The recurrence-free survival rates were 85.3% and 77.6%, respectively (P=0.386), and the cumulative recurrence rates were 9.8% and 16.9%, respectively (P=0.373) . Conclusion: In NDMM, the cryopreservation-free integrated autologous HSCT model can achieve similar therapeutic effects as traditional transplantation models, with lower rates of severe mucosal inflammation and infection compared with traditional transplantation models.

Racial/ethnic disparities in exposure to e-cigarette advertising among U.S. youth

OBJECTIVES

This study aims to assess exposure to e-cigarette advertising across multiple marketing channels among U.S. youth and to examine whether racial/ethnic disparities exist in exposure to e-cigarette advertisements.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Cross-sectional data were drawn from a longitudinal survey of participants recruited from two nationally representative panels (NORC's AmeriSpeak® and GfK's KnowledgePanel). A total of 2043 youth aged 13-17 completed the initial 2018 survey, and 2013 youth completed the follow-up survey in 2019 (including a replenishment sample of 690 youth). Outcome variables were self-reported e-cigarette advertisement exposure in the past three months through various sources, such as television, point of sale, and online/social media. Generalized estimating equation models were used to estimate the adjusted odds ratios (AOR) of the association between racial/ethnic identity and e-cigarette advertisement exposure.

RESULTS

The prevalence of reported exposure to e-cigarette advertisements through any channel was 79.8% (95% CI: 77.1-82.2) in 2018 and 74.9% (95% CI: 72.5-77.1) in 2019, respectively. Point of sale was the most common source of e-cigarette advertisement exposure in both years. Non-Hispanic Black and non-Hispanic Asian youth were more likely to report exposure to e-cigarette advertisements through television (AOR = 2.07, 95% CI: 1.44-2.99 and AOR = 2.11, 95% CI: 1.17-3.82, respectively) and online/social media (AOR = 1.61; 95% CI: 1.11-2.33 and AOR = 1.99, 95% CI: 1.10-3.59, respectively) channels compared with non-Hispanic White youth.

CONCLUSIONS

A substantial proportion of U.S. youth reported exposure to e-cigarette advertising through a variety of marketing channels. Significant racial/ethnic disparities existed, with non-Hispanic Black and Asian youth reporting more marketing exposure than their non-Hispanic White counterparts.

A prospective cohort study exploring the impact of tonsillectomy on feeding difficulties in children

OBJECTIVES

Paediatric feeding difficulties are common, affecting up to 25% of otherwise healthy children, symptoms include food refusal, gagging, choking, and excessive mealtime duration. These symptoms are commonly described in pre-operative discussions about tonsillectomy. This prospective study explores the impact of tonsillectomy on paediatric feeding difficulties.

DESIGN

This prospective cohort study invited caregivers of children undergoing tonsillectomy to complete a PediEAT questionnaire about their children's feeding behaviours, pre and post-operatively. The study was completed in two phases with 9 questions administered in phase 1 and three additional questions added for phase 2. A free text comments box was also provided. Responses were graded from 0 to 5, where 0 is 'never a problem' and 5 is 'always a problem' with eating behaviours.

SETTING

The study was conducted at our institution, a tertiary paediatric ENT unit.

PARTICIPANTS

Children aged between 6 months - 7 years undergoing tonsillectomy for any indication were invited to participate.

MAIN OUTCOME MEASURES

Changes to the Pedi-EAT scores pre and post operatively were the main outcome measure.

RESULTS

102 participants were recruited between January 2020 and January 2022. The mean age of participants was 4.1 years, 87% had a concurrent adenoidectomy. The mean time to completion of post-operative questionnaire was 23 weeks after surgery. 9 of the 12 questions showed a statistically significant improvement in post-operative scores using a paired student t-test (p < 0.05). The most significant improvements related to 'gets tired from eating and is not able to finish' (1.49 pre-op, 0.91 post op, p < 0.01) and 'eats food that needs to be chewed' (1.4 pre-op, 0.72 post-op, p < 0.01). 13% of participants only underwent tonsillectomy and this group also showed a statistically significant improvement in fatigue during eating (p < 0.05).

CONCLUSION

Symptoms of fatigue during eating and avoidance of food requiring mastication are most likely to improve following tonsillectomy in children.

Research hotspots and development trends in volume management of peritoneal dialysis patients: a bibliometrics and visual analysis up to 2022

OBJECTIVES

Among different renal replacement therapies (RRTs), peritoneal dialysis (PD) is a family based treatment method with multiple advantages, which allowing patients to maintain autonomy, avoiding frequent hospital visits, and preventing the spread of the disease virus. To visually analyze the literatures related to volume management of PD patients through bibliometric methods, to explore research hotspots and development trends in this field.

METHODS

The relevant literatures of PD patient volume management in the Web of Science core collection database were retrieved with the terms of peritoneal dialysis, volume management, capacity management, fluid status, and volume overload. The retrieval time was from the establishment of the database to October 2022. CiteSpace 6.1.R3 software was used to visually analyze Country, Institution, Author, Keyword, and draw keyword clusters and keyword emergence maps.

RESULTS

A total of 788 articles were included in the analysis, and the annual number of papers was on the rise, with the American, China, and Brirain in the top three, and Peking University and University College London in the top. Keywords cluster analysis showed 11 clusters. In the keyword emergence analysis, the keywords with higher emergence intensity rank are continuous cyclic peritoneal dialysis, ambulatory peritoneal dialysis, and icodextrin. The current research hotspots and trends are in the evaluation of peritoneal dialysis patients' volume status, the selection and adjustment of dialysis prescriptions, and adverse health outcomes.

CONCLUSION

The research on peritoneal dialysis volume management in China started late, but it has developed rapidly, and has a firm grasp of current research hotspots. However, there is less cooperation with other countries, so international exchanges and cooperation should be strengthened. At present, the volume assessment methods and dialysis modes are still the research hotspots, paying more attention to the adverse health outcomes of patients.