[Prevalence and risk factors of medication non-adherence in children with inflammatory bowel disease]

Objective: To investigate the prevalence and risk factors of medication non-adherence in children with inflammatory bowel disease (IBD). Methods: A cross-sectional study was conducted in Children's Hospital, Zhejiang University School of Medicine from September 2020 to March 2022 and 112 children with IBD were enrolled. Their general information, medication adherence, and parental disease-related knowledge were collected by questionnaires. According to the medication adherence score, the children were divided into the adherence group (score of 6 to 8) and the non-adherence group (score of <6), then the demographic and clinical characteristics of the two groups were compared. Subsequently, a multivariate binary Logistic regression analysis was performed to determine the risk factors of medication non-adherence. Results: Of the 112 children, 76 were males and 36 females, with the age of 12.9 (9.5, 14.0) years. There were 50 (44.6%) in the non-adherence group and 62 (55.4%) in the adherence group. Regarding the demographic and clinical characteristics, the results showed that the dosage frequency and the parental disease related knowledge were associated with medication non-adherence (both P<0.05). Multivariate binary Logistic regression analysis showed that compared with 0-6 years old children, the risk of medication non-adherence was significantly increased in children aged 7-12 years (OR=9.30, 95%CI 1.58-54.87, P=0.014) and 13-18 years (OR=8.26, 95%CI 1.49-45.85, P=0.016); and the risk was also significantly increased in children who took medication twice or more per day (OR=12.88, 95%CI 2.77-59.80, P=0.001) compared with children who took medication once per day. Meanwhile, the parental score of the questionnaire on Crohn's disease and ulcerative colitis related knowledge (OR=0.76, 95%CI 0.66-0.89, P=0.001) was also a significant risk factor. Conclusions: Medication non-adherence is common in children with IBD. Children older than 7 years, a dosage frequency of twice or more per day, and parental poor disease-related knowledge are the independent risk factors for medication non-adherence in children with IBD. Clinicians should pay attention to promoting patients' adherence to improve clinical outcomes.

[Relationship between valve ablation and bladder function in children with posterior urethral valves disorder]

This study is to investigate the effect of valve ablation on bladder function in patients with posterior urethral valves. The clinical data of patients with posterior urethral valves who received urodynamic examination before and after valve ablation were retrospectively analyzed.The bladder compliance improved during urine storage after operation, and the maximum detrusor pressure decreased during micturition. The postoperative urinary system ultrasound showed that the residual urine volume of the group with significantly improved upper urinary tract hydrocephalus was significantly less than that of the group with no improvement. The bladder compliance was significantly higher than that of the group with no improvement, and the maximum urine flow rate was significantly higher than that of the group with no improvement (all P<0.05). Valve ablation has limited effect on improving bladder function in patients with PUV. Valve incision can help improve the maximum bladder volume, residual urine volume and maximum urinary flow rate. It has a certain effect on bladder compliance and maximum detrusor pressure.

Prescriptive appropriateness in primary cardiovascular prevention: data from our hospital

Background

The main cause of waste of health resources is represented by overuse of diagnostic and therapeutic procedures. Given its high prevalence and the importance of identifying hypertensive-mediated organ damage, management of patients with arterial hypertension can lead to a lack of appropriateness. The aim of this study was to evaluate the prescriptive appropriateness of non-invasive diagnostic tests (Echocardiography, Carotid ultrasound, ECG exercise testing, 24h Ambulatory blood pressure monitoring) in outpatients referring to an ambulatory of primary cardiovascular prevention.

Methods

559 specialistic ambulatory visits were retrospectively analysed and appropriateness of every prescription was evaluated. An integration of different Italian and European guidelines was used to define appropriateness. Moreover, we evaluated the correlation between prescriptions, appropriateness and clinical characteristics of the population.

Results

During the 559 ambulatory visits analysed, 449 prescriptions were made, including 198 echocardiographies, 148 carotid ultrasound, 85 24h ABPM and 18 ECG exercise testing. The global percentage of appropriate prescriptions was 40.3%. Focusing on each test, appropriateness rate was 49.4% in 24h ABPM, 43.9% in echocardiography, 38.9% in ECG exercise testing and 30.4% in carotid ultrasound. A significant correlation was identified between the age and cardiovascular risk category of patients and the appropriateness of echocardiography, 24h ABPM and carotid ultrasound, and a correlation between appropriateness of echocardiography and the duration of hypertension and the presence of valvular heart disease.

Conclusions

Our study shows a relevant percentage of inappropriate prescriptions of non-invasive cardiologic exams; moreover, there might be a greater lack of appropriateness in young and low risk patients.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Niguarda Hospital, Milan, Italy

Polygenic risk scores for mood disorders predict future strokes in women: a Mendelian randomization study

Objectives

Mood disorders and strokes are often comorbid, and their health toll worldwide is huge. This study characterizes prognostic and etiological roles of mood disorders in stroke.

Methods

We tested if genetic susceptibilities for mood disorders could predict future strokes using the Malmö Diet and Cancer cohort (24 631 individuals). Additionally, Mendelian randomization was employed to further examine the causality using summary statistics from large genome wide association studies (mood disorders: up to 287,932 individuals; strokes: up to 446,696 individuals).

Results

Among 24,366 stroke-free participants at baseline, 2,632 individuals developed strokes, 2,172 of them ischemic, during a follow-up of up to 25 years. After all adjustments, participants in the highest quintile (5th quintile) of polygenic risk scores (PRS) for mood disorders had 1.46x (95% confidence interval (CI): 1.22–1.74) higher risk of strokes and 1.45x (95% CI: 1.19–1.77) higher risk of ischemic strokes compared to the lowest quintile (1st quintile) of PRS in women. Univariable and multivariable Mendelian randomization analyses showed that mood disorders had causal effect on smoking (odds ratio (OR) = 1.19, 95% CI: 1.07–1.31), type 2 diabetes mellitus (T2D, OR=1.22, 95% CI: 1.04–1.43) and women's body mass index (BMI, coefficient = 0.11, 95% CI: 0.01–0.21), whereas causal effects for smoking, T2D and BMI on stroke/ischemic stroke were consistently observed.

Conclusion

Our results suggest that mood disorders can cause stroke through smoking, T2D and BMI. Using PRS, women, who benefit from prevention and treatment of smoking, T2D and BMI, could possibly be early identified to prevent mood disorders and strokes.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Swedish Research Council, Swedish Heart and Lung Foundation, Skåne University Hospital Foundations, Lund University Diabetes Center - Industrial Research Center from the Swedish Foundation of Strategic Research, Region Skåne Grants, Swedish Stroke Foundation, Swedish society of medicine, Söderström König Foundation, Emil and Wera Cornell Foundation, Hjelt Foundation, and Diabetes Research and Wellness Foundation Sweden.

Age-related difference in muscle metabolism patterns during upper limb's encircling exercise: a near-infrared spectroscopy study

Aging is usually accompanied by decrease in limb motor function and change in muscle metabolism patterns. However, few studies have investigated the aging effect on muscle hemodynamics of the upper extremity. This study aims to explore the aging effect on muscle metabolism patterns during upper limb's exercise. Twelve middle-aged and elderly subjects and 12 young subjects were recruited, and muscle oxygenation signals from these subjects' biceps brachii muscles were collected during active and passive upper limb's encircling exercise with near-infrared spectroscopy (NIRS). The old group showed stronger muscle hemodynamic metabolism than the young group. The multiscale fuzzy approximate entropy and multiscale transfer entropy analyses indicated higher complexity and stronger interlimb coupling of the muscle oxygenation signals for the old group. Based on the selected muscle metabolism features, the constructed support vector machine model showed a high accuracy rate for classifying the two groups of subjects: 91.6% for the passive mode and 87.5% for the active mode. Our results proved the specific muscle metabolism patterns in the upper limb's exercise for old subjects, promoting the understanding of the aging effect on muscle hemodynamics.

First Measurement of the Z→μ^{+}μ^{-} Angular Coefficients in the Forward Region of pp Collisions at sqrt[s]=13 TeV

The first study of the angular distribution of μ^{+}μ^{-} pairs produced in the forward rapidity region via the Drell-Yan reaction pp→γ^{*}/Z+X→ℓ^{+}ℓ^{-}+X is presented, using data collected with the LHCb detector at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 5.1  fb^{-1}. The coefficients of the five leading terms in the angular distribution are determined as a function of the dimuon transverse momentum and rapidity. The results are compared to various theoretical predictions of the Z-boson production mechanism and can also be used to probe transverse-momentum-dependent parton distributions within the proton.

Margetuximab with retifanlimab as first-line therapy in HER2+/PD-L1+ unresectable or metastatic gastroesophageal adenocarcinoma: MAHOGANY cohort A

Background

Human epidermal growth factor receptor 2 (HER2)-positive metastatic gastric and gastroesophageal adenocarcinoma (GEA) is globally treated with chemotherapy plus trastuzumab. Novel therapeutic strategies strive to not only optimize efficacy, but also limit toxicities. In MAHOGANY cohort A, margetuximab, an Fc-engineered, anti-HER2 monoclonal antibody (mAb) was combined with retifanlimab, an anti-programmed cell death protein 1 mAb, in the first-line HER2-positive/programmed death-ligand 1 (PD-L1)-positive GEA.

Patients and methods

MAHOGANY cohort A part 1 is a single-arm trial to evaluate margetuximab plus retifanlimab in patients with HER2 immunohistochemistry 3+, PD-L1-positive (combined positive score ≥1%), and non-microsatellite instability-high tumors. Primary objectives for cohort A were safety/tolerability and the confirmed objective response rate (ORR).

Results

As of 3 August 2021, 43 patients were enrolled and received margetuximab/retifanlimab. Nine grade 3 treatment-related adverse events (TRAEs) were reported in eight (18.6%) patients and eight serious TRAEs in seven (16.3%) patients. There were no grade 4/5 TRAEs. Three patients discontinued margetuximab/retifanlimab because of immune-related adverse events. The ORR by independent assessment was 53% [21/40 (95% confidence interval (CI) 36.1-68.5)], with a median duration of response of 10.3 months (95% CI 4.6-not evaluable); disease control rate was 73% [29/40 (95% CI 56.1-85.4)]. The study sponsor discontinued the study in advance of the planned enrollment when it became apparent that the study design would no longer meet the requirements for drug approval because of recent advances in the treatment of GEA.

Conclusions

The chemotherapy-free regimen of combined margetuximab/retifanlimab as first-line treatment in double biomarker-selected patients demonstrated a favorable toxicity profile compared with historical outcomes using chemotherapy plus trastuzumab. The ORR observed in this study compares favorably versus ORR observed with other chemotherapy-free approaches.

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The margetuximab/retifanlimab regimen has a favorable toxicity profile versus historical chemotherapy-based regimens in GEA.

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The margetuximab/retifanlimab regimen as first-line therapy for GEA met the prespecified boundary for antitumor activity.

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The 53% ORR [21/40 (95% CI 36.1-68.5)] in the combined regimen compared favorably with other chemotherapy-free approaches.

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Median duration of response was 10.3 months (95% CI 4.57-not evaluable) and disease control rate was 73% [29/40 (95% CI 56.1-85.4)].

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The study was discontinued for business reasons as chemotherapy-based regimens remain the dominant therapy for GEA.

[Outcomes at discharge of preterm infants born <34 weeks' gestation]

Objective: To investigate the incidence and trend of short-term outcomes among preterm infants born <34 weeks' gestation. Methods: A secondary analysis of data from the standardized database established by a multicenter cluster-randomized controlled study "reduction of infection in neonatal intensive care units (NICU) using the evidence-based practice for improving quality (REIN-EPIQ) study". This study was conducted in 25 tertiary NICU. A total of 27 192 infants with gestational age <34 weeks at birth and admitted to NICU within the first 7 days of life from May 2015 to April 2018 were enrolled. Infants with severe congenital malformation were excluded. Descriptive analyses were used to describe the mortality and major morbidities of preterm infants by gestational age groups and different admission year groups. Cochran-Armitage test and Jonckheere-Terpstra test were used to analyze the trend of incidences of mortality and morbidities in 3 study-years. Multiple Logistic regression model was constructed to analyze the differences of outcomes in 3 study-years adjusting for confounders. Results: A total of 27 192 preterm infants were enrolled with gestational age of (31.3±2.0) weeks at birth and weight of (1 617±415) g at birth. Overall, 9.5% (2 594/27 192) of infants were discharged against medical advice, and the overall mortality rate was 10.7% (2 907/27 192). Mortality for infants who received complete care was 4.7% (1 147/24 598), and mortality or any major morbidity was 26.2% (6 452/24 598). The incidences of moderate to severe bronchopulmonary dysplasia, sepsis, severe intraventricular hemorrhage or periventricular leukomalacia, proven necrotizing enterocolitis, and severe retinopathy of prematurity were 16.0% (4 342/27 192), 11.9% (3 225/27 192), 6.8% (1 641/24 206), 3.6% (939/25 762) and 1.5% (214/13 868), respectively. There was a decreasing of the overall mortality (P<0.001) during the 3 years. Also, the incidences for sepsis and severe retinopathy of prematurity both decreased (both P<0.001). However, there were no significant differences in the major morbidity in preterm infants who received complete care during the 3-year study period (P=0.230). After adjusting for confounders, infants admitted during the third study year showed significantly lower risk of overall mortality (adjust OR=0.62, 95%CI 0.55-0.69, P<0.001), mortality or major morbidity, moderate to severe bronchopulmonary dysplasia, sepsis and severe retinopathy of prematurity, compared to those admitted in the first study year (all P<0.05). Conclusions: From 2015 to 2018, the mortality and major morbidities among preterm infants in Chinese NICU decreased, but there is still space for further efforts. Further targeted quality improvement is needed to improve the overall outcome of preterm infants.

3D-Stacked Multistage Inertial Microfluidic Chip for High-Throughput Enrichment of Circulating Tumor Cells

Whether for cancer diagnosis or single-cell analysis, it remains a major challenge to isolate the target sample cells from a large background cell for high-efficiency downstream detection and analysis in an integrated chip. Therefore, in this paper, we propose a 3D-stacked multistage inertial microfluidic sorting chip for high-throughput enrichment of circulating tumor cells (CTCs) and convenient downstream analysis. In this chip, the first stage is a spiral channel with a trapezoidal cross-section, which has better separation performance than a spiral channel with a rectangular cross-section. The second and third stages adopt symmetrical square serpentine channels with different rectangular cross-section widths for further separation and enrichment of sample cells reducing the outlet flow rate for easier downstream detection and analysis. The multistage channel can separate 5 μm and 15 μm particles with a separation efficiency of 92.37% and purity of 98.10% at a high inlet flow rate of 1.3 mL/min. Meanwhile, it can separate tumor cells (SW480, A549, and Caki-1) from massive red blood cells (RBCs) with a separation efficiency of >80%, separation purity of >90%, and a concentration fold of ~20. The proposed work is aimed at providing a high-throughput sample processing system that can be easily integrated with flowing sample detection methods for rapid CTC analysis.

[Research progress in the methodology used in phenome-wide association studies]

Phenome-wide association study (PheWAS) is a reverse genetic analysis method to identify the potential phenotypes associated with genetic variations. With the increasing availability of biomedical databases and electronic medical records (EMR), PheWAS has gradually become an effective tool to unveil the relationships between exposure and a broad range of health phenotypes. The unique advantage of this method is that it can simultaneously explore the associations of a specific exposure with a variety of disease outcomes, thus helping to reveal multiple causal relationships and the shared pathogenic mechanisms among diseases. However, PheWAS has limitations, including selecting instrumental variables and the heavy burden of various corrections. In addition, how to interpret the biological mechanisms underlying significant findings is another crucial issue of PheWAS. This review will focus on the methodology and application of PheWAS to provide meaningful suggestions and insights for future studies.

Reorganization of prefrontal network in stroke patients with dyskinesias: evidence from resting-state functional near-infrared spectroscopy

Stroke usually causes multiple functional disability. To develop novel rehabilitation strategies, it is quite necessary to improve the understanding of post-stroke brain plasticity. Here, we use functional near-infrared spectroscopy to investigate the prefrontal cortex (PFC) network reorganization in stroke patients with dyskinesias. The PFC hemodynamic signals in the resting state from 16 stroke patients and 10 healthy subjects are collected and analyzed with the graph theory. The PFC networks for both groups show small-world attributes. The stroke patients have larger clustering coefficient and transitivity and smaller global efficiency and small-worldness than healthy subjects. Based on the selected network features, the established support vector machine model classifies the two groups of subjects with an accuracy rate of 88.5%. Besides, the clustering coefficient and local efficiency negatively correlate with patients' motor function. This study suggests that the PFC of stroke patients with dyskinesias undergoes specific network reorganization.

[The 497th case: fever, anterior hypopituitarism, lymphadenopathy]

A 57-year-old woman was admitted to hospital with fever. She still had fever treated with multiple antibiotics, and no definite evidence for infection was found. Hypothermia and hypotension developed, and magnetic resonance imaging (MRI) examination showed enlarged anterior pituitary and multiple small nodular lesions with mild enhancement on the left side. Hormone replacement and anti-infection treatment were administrated, but fever did not improve. Remarkable lymphadenopathy was found in left supraclavicular area. The pathology of lymph node biopsy indicated peripheral T-cell lymphoma (not otherwise specified, NOS). Positron emission tomography-computed tomography (PET-CT) revealed hypermetabolism in multiple lymph nodes, infiltration of the liver and spleen. The final diagnosis were peripheral T-cell lymphoma with involvement of liver and spleen (stage Ⅳ) and anterior hypopituitarism. After chemotherapy, fever alleviated and the function of anterior pituitary recovered gradually.

Feasibility of an ultra-low dose contrast media protocol for coronary CT angiography

AIM

To evaluate the feasibility of an ultra-low volume contrast media (CM) protocol for coronary computed tomography angiography (CTA).

MATERIALS AND METHODS

In total, 214 patients receiving coronary CTA were enrolled prospectively and divided into group A (n=107) receiving a conventional dose of CM and group B (n=107) receiving an ultra-low dose. CT values of the right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX) were measured and radiation doses recorded. The image quality was compared between the groups. Changes in renal function indices and proteinuria before, 24, and 72 hours after coronary CTA among those with chronic kidney disease (CKD) were also assessed.

RESULTS

There were significant differences in CT values and radiation doses between groups A and B. In group A, the average RCA, LAD, and LCX CT values were 412.5 ± 79.2, 423.5 ± 73.7, and 422.0 ± 88.1 HU, respectively. In group B, the average RCA, LAD, and LCX CT values were 275.2 ± 16.2, 277.8 ± 16.4, and 278.9 ± 16.5 HU, respectively. The radiation dose in the ultra-low protocol recipients (118.70 ± 18.52 mGy·cm) was significantly lower than that used in conventional coronary CTA (131.75 ± 20.96 mGy·cm). The image quality of group B was comparable to that of group A, satisfying the diagnostic requirement. In patients with mild CKD, there were no significant differences in renal functions after coronary CTA.

CONCLUSION

An ultra-low CM protocol was established for coronary CTA, providing comparable image quality and diagnostic yields but significantly lower radiation dose compared with a conventional protocol. This new protocol might be applicable to patients with mild CKD.

Study of the doubly charmed tetraquark [Formula: see text]

Quantum chromodynamics, the theory of the strong force, describes interactions of coloured quarks and gluons and the formation of hadronic matter. Conventional hadronic matter consists of baryons and mesons made of three quarks and quark-antiquark pairs, respectively. Particles with an alternative quark content are known as exotic states. Here a study is reported of an exotic narrow state in the D0D0π+ mass spectrum just below the D*+D0 mass threshold produced in proton-proton collisions collected with the LHCb detector at the Large Hadron Collider. The state is consistent with the ground isoscalar [Formula: see text] tetraquark with a quark content of [Formula: see text] and spin-parity quantum numbers JP = 1+. Study of the DD mass spectra disfavours interpretation of the resonance as the isovector state. The decay structure via intermediate off-shell D*+ mesons is consistent with the observed D0π+ mass distribution. To analyse the mass of the resonance and its coupling to the D*D system, a dedicated model is developed under the assumption of an isoscalar axial-vector [Formula: see text] state decaying to the D*D channel. Using this model, resonance parameters including the pole position, scattering length, effective range and compositeness are determined to reveal important information about the nature of the [Formula: see text] state. In addition, an unexpected dependence of the production rate on track multiplicity is observed.