Factors associated with referrals for directly observed treatment and unsuccessful treatment

OBJECTIVE

To describe the characteristics of people indicated for directly observed treatment (DOT) in Spain, and the factors associated with unsuccessful treatment.

METHODS

This was a multicentre observational study based on a prospective follow-up of patients over 18 years old diagnosed with TB between 2006 and 2019 from the registry of the Programa Integrado de Investigación en Tuberculosis (PII-TB). Sociodemographic and clinical variables were collected. Adjusted odds ratios (aORs) were calculated for the indication of DOT and for having an unsuccessful treatment.

RESULTS

A total of 7,883 patients were included. The indication of DOT was associated with being homeless (aOR 5.93, 95% CI 3.03-11.59), inactivity status (aOR 2.55, 95% CI 2.02-3.23), alcohol consumption (aOR 1.94, 95% CI 1.51-2.48), parenteral drug use (aOR 1.77, 95% CI 1.06-2.95) and HIV diagnosis (aOR 1.96, 95% CI 1.16-3.29). Unsuccessful treatment was associated with having an HIV diagnosis (aPR 2.31, 95% CI 1.31-4.08), having a worse clinical and radiological evolution (clinical progression: APR 15.59, 95% CI 8.21-29.60; radiological progression: aPR 12.84, 95% CI 6.46-25.52), need for hospitalisation (aPR 1.73, 95% CI 1.10-2.73), unsatisfactory tolerability (aPR 2.82, 95% CI 1.49-5.29), the existence of difficulties in understanding the prescribed treatment (aPR 1.92, 95% CI 1.21-3.06), as well as worse treatment satisfaction (aPR 7.27, 95% CI 4.32-12.24).

CONCLUSION

The prioritisation of vulnerable populations is a key aspect to carry out the new Global Plan to End TB 2023-2030. In these groups DOT indication should be increased to ensure adherence and patient follow-up and outcomes..

Quality improvements in radiation oncology clinical trials

Clinical trials have become the primary mechanism to validate process improvements in oncology clinical practice. Over the past two decades there have been considerable process improvements in the practice of radiation oncology within the structure of a modern department using advanced technology for patient care. Treatment planning is accomplished with volume definition including fusion of multiple series of diagnostic images into volumetric planning studies to optimize the definition of tumor and define the relationship of tumor to normal tissue. Daily treatment is validated by multiple tools of image guidance. Computer planning has been optimized and supported by the increasing use of artificial intelligence in treatment planning. Informatics technology has improved, and departments have become geographically transparent integrated through informatics bridges creating an economy of scale for the planning and execution of advanced technology radiation therapy. This serves to provide consistency in department habits and improve quality of patient care. Improvements in normal tissue sparing have further improved tolerance of treatment and allowed radiation oncologists to increase both daily and total dose to target. Radiation oncologists need to define a priori dose volume constraints to normal tissue as well as define how image guidance will be applied to each radiation treatment. These process improvements have enhanced the utility of radiation therapy in patient care and have made radiation therapy an attractive option for care in multiple primary disease settings. In this chapter we review how these changes have been applied to clinical practice and incorporated into clinical trials. We will discuss how the changes in clinical practice have improved the quality of clinical trials in radiation therapy. We will also identify what gaps remain and need to be addressed to offer further improvements in radiation oncology clinical trials and patient care.

Adequacy of Healthcare by Insurance Type in Traumatic Brain Injury Patients

Traumatic brain injury (TBI) is a significant contributor to disability, especially among patients younger than 18 years old in the United States. While insurance is often needed to receive services, studies investigating whether TBI treatment adequacy is dependent on the insurance type are scant. Our objective was to determine whether private insurance in paediatric TBI patients is associated with a higher perceived adequacy of healthcare compared with non-private insurance. This was a cross-sectional study utilising secondary data collected from the National Survey of Children Health 2011/12. The main exposure of interest was the insurance status of children at the time of a TBI (private vs non-private). The study outcome was the perceived adequacy of healthcare, defined as having coverage needs that were usually or always met by insurance. Unadjusted and adjusted logistic regression analysis were used. After adjustments for the covariates, the odds of adequate healthcare among those with non-private insurance compared with those with private were not statistically significant (OR 1.49; 95% CI 0.87–2.55). This study implicates paediatric TBI patients do not believe they receive adequate healthcare independent of insurance status. Clinicians, policy makers, and researchers need to better evaluate and address this issue.

P-115 The ageing sperm: molecular mechanisms underlying the age-associated decline in human sperm quality

Study question

Are there ageing-related alterations in human sperm protein and small RNA content that can be responsible for the age-associated decline in male fertility?

Summary answer

Our results revealed a set of proteins and small RNAs, particularly miRNAs, that are altered in older men.

What is known already

Male infertility is a common health problem strongly influenced by lifestyle and environment. Advanced paternal age, in particular, has been largely associated with alterations in testicular structure and function, impaired semen parameters and DNA integrity, lower pregnancy rates and decline in offspring fitness. The decline in sperm quality with age was also associated with an increase in oxidative stress. However, only a few studies reported the deregulation of specific sperm proteins or RNAs associated with this risk factor for male infertility.

Study design, size, duration

A hundred and twenty Portuguese men from the Aveiro region were recruited between January 2019 and December 2020 at Hospital Infante D. Pedro E.P.E. (Aveiro, Portugal). All donors provided semen samples for in vitro studies with human spermatozoa. Samples were divided into four groups according to men’s age: (G1) less than 30 years; (G2) between 30 and 35 years; (G3) between 35 and 40 years and (G4) more than 40 years.

Participants/materials, setting, methods

One hundred twenty human sperm samples from volunteer donors were included in this study. Basic semen analyses were performed according to WHO’s guidelines. To avoid the possible contamination by somatic cells, density gradient sperm selection was performed. Nineteen normozoospermic human sperm samples were divided into four groups according to their age and their proteome was evaluated by quantitative proteomic analysis. The small RNA content of sixteen human sperm samples was investigated using small RNA sequencing.

Main results and the role of chance

In this study 120 men aged between 19- and 56-years old (mean age 35.2 ± 6.32 years) were recruited. Our data showed no correlation between paternal age and any seminal parameter investigated, contrary to what was previously described in other study populations. Proteomic analyses revealed 46 differentially expressed proteins (DEPs) between the four study groups (p-value< 0.05;|log2FC|=1.5). In particular, lysosomal protein LAMP1 was significantly upregulated in sperm from men younger than 30 years old compared with men with more than 35 years old. In men younger than 35 years old, cytochrome c oxidase subunit 3 (MT-CO3) and DnaJ homolog subfamily A member 1 (DNAJA1) were consistently downregulated in relation to sperm from men aged between 35 and 40 years old. Gene ontology analysis of all the deregulated sperm proteins shown that response to unfolded protein, positive regulation of mitochondrion organization, negative regulation of phosphoprotein phosphatase activity, positive regulation of apoptotic process, and spermatogenesis are common biological processes affected. Transcriptomic analysis identified 5 differentially expressed miRNAs (DEMs) between the four groups studied (p-value< 0.05), among which has-miR-374c-3p and miR-103a-3p were significantly upregulated in men younger than 35 years old compared to sperm from men aged between 35 and 40 years old.

Limitations, reasons for caution

The major limitations of this study are the relatively small sample size and the limited number of participants younger than 20 years and older than 45 years. Additionally, we cannot exclude the influence of unmeasured confounders, including lifestyle factors such as alcohol consumption, diet, exercise, and stress, in our findings.

Wider implications of the findings

Despite reproductive history and basic semen analysis being the primary steps in the assessment of male infertility, this routine examination is insufficient to explain almost 30% of the cases. The DEPs and DEMs identified could help to elucidate and/or became potential diagnostic markers for age-associated decline in human sperm quality.

Trial registration number

not applicable

Stress response pathways in the male germ cells and gametes

The unfolded protein response (UPR) is a conserved and essential cellular pathway involved in protein quality control that is activated in response to several cellular stressors such as diseases states, ageing, infection and toxins. The cytosol, endoplasmic reticulum (ER) and mitochondria are continuously exposed to new proteins and in situations of aberrant protein folding; one of three lines of defence may be activated: (i) heat-shock response, (ii) mitochondrial UPR and (iii) ER UPR. These pathways lead to different signal transduction mechanisms that activate or upregulate transcription factors that, in turn, regulate genes that increase the cell's ability to correct the conformation of poorly folded proteins or, ultimately, lead to apoptosis. Despite the recent progress in understanding such biological processes, few studies have focused on the implications of the UPR in male infertility, highlighting the need for a first approach concerning the presence of these components in the male reproductive system. In testis, there is a high rate of protein synthesis, and the UPR mechanisms are well described. However, the presence of these mechanisms in spermatozoa, apparently transcriptionally inactive cells, is contentious, and it is unclear how sperm cells deal with stress. Here, we review current concepts and mechanisms of the UPR and highlight the relevance of these stress response pathways in male fertility, especially the presence and functional activation of those components in male germinal cells and spermatozoa.

Aortic stiffness and distensibility in elite athletes: impact of discipline and gender

Background

Aortic remodeling in athletes is variable among sports disciplines with more ascending aorta (Asc Ao) dilatation in endurance (EAs) as compared to power athletes (PAs). Nevertheless, the impact of this differential remodeling on the Asc Ao functional properties is not well established. The aim of this study was to assess the distensibility and stiffness of the ascending aorta in endurance and power elite athletes in order to evaluate if this aortic remodeling implies functional changes.

Methods

119 elite athletes (61 EA and 58 PA, 49% female sex, mean age: 18.7±7.1 years) underwent standardized pre-participation screening with 12 lead ECG, transthoracic echocardiography and maximum stress test. Asc Ao diameter was measured from parasternal long axis views in 2D echocardiography. The aortic distensibility index (ADi) was calculated as 2 × (systolic Asc Ao diameter − diastolic Asc Ao diameter) / (diastolic Asc Ao diameter) × (pulse pressure) (cm–2 dyn–1 10–6). Aortic stiffness (AS) index was defined as Ln (systolic blood pressure/diastolic blood pressure) / (systolic Asc Ao diameter − diastolic Asc Ao diameter)/diastolic proximal Asc Ao diameter.

Results

Globally, EA presented larger AscAO, both in absolute and indexed values, than PA (28±3.0 vs 26±3.0cm, p<0.001 and 16.4±1.5 vs 15.7±1.9cm, p<0.05, while were no differences in AS or ADi) (Figure 1A). Nevertheless, ADi in male EAs was higher than in male PAs (ADi: 4.3±1.7 vs 3.2±1.3 cm2/dyn/10–6, p<0.05) and AS was lower (AS: 4.7±1.7 vs 6.3±3.8, P<0.005) (Figure 1B and 1C). Female athletes presented higher ADi (ADi: 4.7±1.9 vs 4.0±1.6 cm, p<0.05) and a trend towards lower AS (4.8±2.9 vs 5.1±2.6, p: 0.4) than male athletes. There were no differences in AS or ADi between female EAs and PAs.

Conclusion

Male EAs showed an increased aortic distensibility with lower stiffness as compared to that observed in male PAs. This difference was not observed in female EAs and PAs, potentially due to better baseline distensibility with less room for improvement with endurance training.

Funding Acknowledgement

Type of funding source: None

CONCENTRATION GRADIENTS INSIDE MICRODROPLETS

Small water microdroplets in microfluidic systems have a high surface charge density resulting from charged surfactants. As a result, an electric double layer forms inside the droplet. Depletion of ions from the center of the droplet to form the double layer can shift the concentration of ions dramatically from that of the microdroplet precursor solution. Here we show numerical solutions to the Gouy-Chapman model in spherical coordinates. Some notable effects include: 1) large percentages of the microdroplet volume experience very large DC electric fields; 2) many ions get forced into a Stern layer giving dramatically different conditions from the bulk.

Protocol for a randomized controlled trial examining multilevel prediction of response to behavioral activation and exposure-based therapy for generalized anxiety disorder

BACKGROUND

Only 40-60% of patients with generalized anxiety disorder experience long-lasting improvement with gold standard psychosocial interventions. Identifying neurobehavioral factors that predict treatment success might provide specific targets for more individualized interventions, fostering more optimal outcomes and bringing us closer to the goal of "personalized medicine." Research suggests that reward and threat processing (approach/avoidance behavior) and cognitive control may be important for understanding anxiety and comorbid depressive disorders and may have relevance to treatment outcomes. This study was designed to determine whether approach-avoidance behaviors and associated neural responses moderate treatment response to exposure-based versus behavioral activation therapy for generalized anxiety disorder.

METHODS/DESIGN

We are conducting a randomized controlled trial involving two 10-week group-based interventions: exposure-based therapy or behavioral activation therapy. These interventions focus on specific and unique aspects of threat and reward processing, respectively. Prior to and after treatment, participants are interviewed and undergo behavioral, biomarker, and neuroimaging assessments, with a focus on approach and avoidance processing and decision-making. Primary analyses will use mixed models to examine whether hypothesized approach, avoidance, and conflict arbitration behaviors and associated neural responses at baseline moderate symptom change with treatment, as assessed using the Generalized Anxiety Disorder-7 item scale. Exploratory analyses will examine additional potential treatment moderators and use data reduction and machine learning methods.

DISCUSSION

This protocol provides a framework for how studies may be designed to move the field toward neuroscience-informed and personalized psychosocial treatments. The results of this trial will have implications for approach-avoidance processing in generalized anxiety disorder, relationships between levels of analysis (i.e., behavioral, neural), and predictors of behavioral therapy outcome.

TRIAL REGISTRATION

The study was retrospectively registered within 21 days of first participant enrollment in accordance with FDAAA 801 with ClinicalTrials.gov, NCT02807480. Registered on June 21, 2016, before results.

Bovine semen thermoresistance tests and their correlation with pregnancy rates after fixed-time artificial insemination

ABSTRACT The objective of the study was to determine whether or not there is a correlation between thermoresistance tests (TT) after semen thawing and pregnancy rate (PR) after fixed-time artificial insemination (FTAI). Four different TT were performed on ten samples used for AI; a rapid test (RTT) (30min / 46°C) and three slow tests (STT): STT1 (60min/38°C), STT2 (180min/38°C), and STT3 (300min/38°C). Two hundred and fifteen multiparous crossbred cows were submitted to FTAI under the following protocol: on day zero (d0) the animals received a P4 device +EB; on d7 PGF2α; on d8 P4 was removed and eCG+EC were administered; IATF was performed on d10. Three gestational diagnoses (G D) were performed on d40, d70 and d120. The mean sperm motility (%) in RTT and STTs were 19.84±6.13, 28.55±10.48, 17.62±5.87 and 8.63±3.46, respectively, and TP in the three DG 61.86%, 57.67%, and 55.81%, respectively. Through Person test a significant negative correlation (P< 0.05) was found between STT2 and PR at 60 days (r= -0.644) and between STT3 and all TPs (r= -0.774, -0.752, 0.748). It was concluded that TT parameters are not able to determine correlation between semen quality and TP.

Being Overweight Is Related to Faster Decline in Annual Glomerular Filtration Rate in Kidney Transplant

Few studies have examined the relationship between non-immunological factors and glomerular filtration rate (GFR) decline in kidney transplant. Correcting these factors in native kidneys slows the progression of chronic kidney disease. The aim of this study was to analyze the association between the control of non-immunological factors and the annual decline of GFR.

METHODS

A single-center, retrospective study was performed. We included 128 patients who received kidney transplants between 2000 and 2015, with at least 1-year post-transplant follow-up. Clinical records were reviewed. GFR was estimated by CKD-EPI. Three groups were defined according to the annual change in eGFR (ΔGFR 2016-1015): non-progressors (> -1 mL/min/1.73 m²), slow progressors (> -1 and < -5 mL/min/1.73 m²), and fast progressors (< -5 mL/min/1.73 m²). Percentage of achievement of KDIGO target was also analyzed.

RESULTS

The mean GFR was 62.5 mL/min/1.73 m². Glomerulonephritis was the most common cause of kidney failure (36%). When the fast progressor group was compared with the non-progressor group, they differed significantly in age-patients were younger (40 ± 12.3 vs 45 ± 13.1 years)-post-transplant body mass index (27.4 ± 5.6 vs 25.2 x ± 5.9 kg/m²), and serum uric acid, which was significantly higher (6.4 ± 1.7 vs 5.5 ± 1.58 mg/dL). There were no differences between the groups with regard to blood pressure, dyslipidemia, proteinuria, or venous bicarbonate. Target systolic blood pressure was achieved by 45% of patients. Biopsy-proven acute rejection was higher in the fast progression group, although this was not statistically significant (13 [24.5%] vs 8 [13.1%]).

CONCLUSIONS

High body mass index was associated with a faster decline in glomerular filtration rate in this study. Target blood pressure <140/90 mm Hg was achieved in less than 50% of cases.

Overnight memory consolidation facilitates rather than interferes with new learning of similar materials-a study probing NMDA receptors

Although sleep-dependent consolidation and its neurochemical underpinnings have been strongly researched, less is known about how consolidation during sleep affects subsequent learning. Since sleep enhances memory, it can be expected to pro-actively interfere with learning after sleep, in particular of similar materials. This pro-active interference should be enhanced by substances that benefit consolidation during sleep, such as D-cycloserine. We tested this hypothesis in two groups (Sleep, Wake) of young healthy participants receiving on one occasion D-cycloserine (175 mg) and on another occasion placebo, according to a double-blind balanced crossover design. Treatment was administered after participants had learned a set of word pairs (A-B list) and before nocturnal retention periods of sleep vs. wakefulness. After D-cycloserine blood plasma levels had dropped to negligible amounts, i.e., the next day in the evening, participants learned, in three sequential runs, new sets of word pairs. One list-to enhance interference-consisted of the same cue words as the original set paired with a new target word (A-C list) and the other of completely new cue words (D-E set). Unexpectedly, during post-retention learning the A-C interference list was generally better learned than the completely new D-E list, which suggests that consolidation of previously encoded similar material enhances memory integration rather than pro-active interference. Consistent with this view, new learning of word pairs was better after sleep than wakefulness. Similarly, D-cycloserine generally enhanced learning of new word pairs, compared to placebo. This effect being independent of sleep or wakefulness, leads us to speculate that D-cycloserine, in addition to enhancing sleep-dependent consolidation, might mediate a time-dependent process of active forgetting.

Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study

Background

Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.

Methods and Results

A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P <0.003; −5.3% risk for 10% higher 2,3 dinor‐8 iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments.

Conclusions

Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.

Clinical Trial Registration

URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

Arabidopsis ILITHYIA protein is necessary for proper chloroplast biogenesis and root development independent of eIF2α phosphorylation

One of the main mechanisms blocking translation after stress situations is mediated by phosphorylation of the α-subunit of the eukaryotic initiation factor 2 (eIF2), performed in Arabidopsis by the protein kinase GCN2 which interacts and is activated by ILITHYIA(ILA). ILA is involved in plant immunity and its mutant lines present phenotypes not shared by the gcn2 mutants. The functional link between these two genes remains elusive in plants. In this study, we show that, although both ILA and GCN2 genes are necessary to mediate eIF2α phosphorylation upon treatments with the aromatic amino acid biosynthesis inhibitor glyphosate, their mutants develop distinct root and chloroplast phenotypes. Electron microscopy experiments reveal that ila mutants, but not gcn2, are affected in chloroplast biogenesis, explaining the macroscopic phenotype previously observed for these mutants. ila3 mutants present a complex transcriptional reprogramming affecting defense responses, photosynthesis and protein folding, among others. Double mutant analyses suggest that ILA has a distinct function which is independent of GCN2 and eIF2α phosphorylation. These results suggest that these two genes may have common but also distinct functions in Arabidopsis.

Polarization-controlled orbital angular momentum switching in nonlinear wave mixing

We demonstrate polarization-controlled switching of the orbital angular momentum (OAM) transfer in nonlinear wave mixing. By adjusting the input beam geometry, we are able to produce a three-channel orbital OAM, with arbitrary topological charges simultaneously generated and spatially resolved in the second-harmonic wavelength. The use of path and polarization degrees of freedom allows nearly perfect optical switching between different OAM operations. These results are supported by a theoretical model showing very good agreement with the experiments.