Trunk muscle endurance in Chinese adults

BACKGROUND

Previous studies in non-Chinese populations have found a relationship between performance on isometric trunk muscle endurance tests and low back pain (LBP). However, the relationship between trunk muscle endurance and LBP in Chinese populations has received little attention and age-referenced data have not been reported.

OBJECTIVE

Evaluate the relationship between age-referenced isometric trunk muscle endurance values and LBP in a Chinese cohort.

METHODS

One hundred and eighty-eight participants (20-59-years) performed four timed-endurance tests (Biering-Sørensen, plank, left/right side bridge) in random order. Participants with a history of LBP completed an Oswestry Disability Index (ODI) and pain scale. Holding-times for the four tests were summed and receiver operating characteristic (ROC) curve analysis was performed to differentiate participants with and without LBP.

RESULTS

Data were grouped by age. Analysis revealed similar endurance values to those reported in non-Chinese populations, except longer holding times were recorded in the 50-59 yr Chinese cohort. Pain scores were positively correlated with ODI scores. ROC curve analysis showed that the area under the curve was 0.723 and optimal cut-off was 288 sec (sensitivity and specificity both 0.75).

CONCLUSIONS

This study is the first to describe trunk muscle endurance reference data in Chinese people. Individuals with a summed endurance time of < 288 seconds appear more likely to suffer LBP.

Qualitative evaluation of coronary atherosclerosis in a large cohort of young and middle-aged Dutch tissue donors implies that coronary thrombo-embolic manifestations are stochastic

Background and aims

With the intention to gain support for the hypothesis that incident ischemic complications of atherosclerotic disease involve a stochastic aspect, we performed a histological, qualitative evaluation of the epidemiology of coronary atherosclerotic disease in a cohort of aortic valve donors.

Patients and methods

Donors (n = 695, median age 54, range 11–65 years) were dichotomized into a non-cardiovascular (non-CVD) and a cardiovascular disease death (CVD) group. Consecutive 5 mm proximal left coronary artery segments were Movat stained, and the atherosclerotic burden for each segment was graded (revised AHA-classification).

Results

Non-CVD and CVD groups showed steep increase of atherosclerosis severity beyond the age of 40, resulting in an endemic presence of advanced atherosclerosis in men over 40 and women over 50 years. In fact, only 19% of the non-CVD and 6% of the CVD donors over 40 years were classified with a normal LCA or a so called non-progressive lesion type. Fibrous calcified plaques (FCP), the consolidated remnants of earlier ruptured lesions, dominated in both non-CVD and CVD donors. Estimates of the atherosclerosis burden (i.e. average lesion grade, proportion of FCPs, and average number of FCPs per cross-section) were all higher in the CVD group (p<1.10⁻¹⁶, p<0.0001, and p<0.05, respectively).

Conclusions

Dominance of consolidated FCP lesions in males over 40 and females over 50 years, show that plaque ruptures in the left coronary artery are common. However, the majority of these ruptures remain asymptomatic. This implies that the atherosclerotic process is repetitive. A relative difference in disease burden between CVD and non-CVD donors supports the concept that complications of atherosclerotic disease involve a stochastic element.

Prevalence of Common Respiratory Viral Infections and Identification of Adenovirus in Hospitalized Adults in Harbin, China 2014 to 2017

Background: Respiratory infections pose a great challenge in global health, and the prevalence of viral infection in adult patients has been poorly understood in northeast China. Harbin is one of the major cities in northeast China, and more than half of any given year in Harbin is occupied by winter. To reveal the viral etiology and seasonality in adult patients from Harbin, a 4-year consecutive survey was conducted in Harbin, China.

Methods: From January 2014 to December 2017, specimens were obtained from adult patients admitted to the Second Affiliated Hospital of Harbin Medical University with lower respiratory tract infections. Sputum samples were examined by direct immunofluorescence assays to detect seven common respiratory viruses, including influenza virus (type A and B), parainfluenza virus (type 1 to 3), respiratory syncytial virus and adenovirus. Adenovirus positive samples were seeded onto A549 cells to isolate viral strains. Phylogenetic analysis was conducted on the highly variable region of adenoviral hexon gene.

Results: A total of 1,300 hospitalized adult patients with lower respiratory tract infections were enrolled, in which 189 patients (14.5%) were detected as having at least one viral infection. The co-infection rate in this study was 25.9% (49/189). The dominant viral pathogen from 2014 to 2017 was parainfluenza virus, with a detection rate of 7.2%, followed by influenza virus, respiratory syncytial virus and adenovirus. Based on the climate seasons determined by daily average temperature, the highest overall viral detection rate was detected in spring (22.0%, 52/236), followed by winter (13.4%, 109/813), autumn (11.4%, 13/114) and summer (10.9%, 15/137). Adenovirus type 3 strains with slight variations were isolated from positive cases, which were closely related to the GB strain from the United States, as well as the Harbin04B strain isolated locally.

Conclusion: This study demonstrated that common respiratory viruses were partially responsible for hospitalized lower respiratory tract infections in adult patients from Harbin, China, with parainfluenza virus as the dominant viral pathogen. Climate seasons could be rational indicators for the seasonality analysis of airborne viral infections. Future surveillance on viral mutations would be necessary to reveal the evolutionary history of respiratory viruses.

Identifying potential uses of crowdsourcing in global health, conflict, and humanitarian settings: an adapted CHNRI (Child Health and Nutrition Initiative) exercise

Background

Crowdsourcing, outsourcing problems and tasks to a crowd, has grown exponentially since the term was coined a decade ago. Being a rapid and inexpensive approach, it is particularly amenable to addressing problems in global health, conflict and humanitarian settings, but its potential has not been systematically assessed. We employed the Child Health and Nutrition Research Initiative's (CHNRI) method to generate a ranked list of potential uses of crowdsourcing in global health and conflict.

Process

94 experts in global health and crowdsourcing submitted their ideas, and 239 ideas were scored. Each expert scored ideas against three of seven criteria, which were tailored specifically for the exercise. A relative ranking was calculated, along with an Average Expert Agreement (AEA).

Findings

On a scale from 0-100, the scores assigned to proposed ideas ranged from 80.39 to 42.01. Most ideas were related to problem solving (n = 112) or data generation (n = 91). Using health care workers to share information about disease outbreaks to ensure global response had the highest score and agreement. Within the top 15, four additional ideas related to containing communicable diseases, two ideas related to using crowdsourcing for vital registration and two to improve maternal and child health. The top conflict ideas related to epidemic responses and various aspects of disease spread. Wisdom of the crowds and machine learning scored low despite being promising in literature.

Interpretations

Experts were invited to generate ideas during the Ebola crisis and to score during reports of Zika, which may have affected the scoring. However, crowdsourcing's rapid, inexpensive characteristics make it suitable for addressing epidemics. Given that many ideas reflected Sustainable Development Goals (SDGs), crowdsourcing may be an innovative solution to achieving some of the SDGs.

Changes in health and disease in Brazil and its States in the 30 years since the Unified Healthcare System (SUS) was created

The Unified Healthcare System (SUS) was created to ensure the population's right to universal, free and comprehensive healthcare. This study compares the health indicators measured in 1990 to those measured in 2015 in Brazil and its states. The goal is to contribute to understanding the role SUS played in changing the nation's health profile. Analyses use estimates in the Global Burden of Disease (GBD) study for Brazil and its states, and compares 1990 and 2015. The main results are increased life expectancy, as well as an increase in the population's longevity measured in health-adjusted life expectancy. These in turn are due to a sharp decline in mortality due to transmissible diseases, in maternal and infant morbi-mortality, and avoidable causes of death. NTCDs are the leading cause of death, followed by violence. Poor diet is the leading risk factor, followed by metabolic issues. Tobacco use decreased over the period, as did infant malnutrition. In the thirty years since the SUS was created, health indicators in this country have improved, and major progress has been made to reduce inequality across the country's regions.

Neuro-Immune Hemostasis: Homeostasis and Diseases in the Central Nervous System

Coagulation and the immune system interact in several physiological and pathological conditions, including tissue repair, host defense, and homeostatic maintenance. This network plays a key role in diseases of the central nervous system (CNS) by involving several cells (CNS resident cells, platelets, endothelium, and leukocytes) and molecular pathways (protease activity, complement factors, platelet granule content). Endothelial damage prompts platelet activation and the coagulation cascade as the first physiological step to support the rescue of damaged tissues, a flawed rescuing system ultimately producing neuroinflammation. Leukocytes, platelets, and endothelial cells are sensitive to the damage and indeed can release or respond to chemokines and cytokines (platelet factor 4, CXCL4, TNF, interleukins), and growth factors (including platelet-derived growth factor, vascular endothelial growth factor, and brain-derived neurotrophic factor) with platelet activation, change in capillary permeability, migration or differentiation of leukocytes. Thrombin, plasmin, activated complement factors and matrix metalloproteinase-1 (MMP-1), furthermore, activate intracellular transduction through complement or protease-activated receptors. Impairment of the neuro-immune hemostasis network induces acute or chronic CNS pathologies related to the neurovascular unit, either directly or by the systemic activation of its main steps. Neurons, glial cells (astrocytes and microglia) and the extracellular matrix play a crucial function in a “tetrapartite” synaptic model. Taking into account the neurovascular unit, in this review we thoroughly analyzed the influence of neuro-immune hemostasis on these five elements acting as a functional unit (“pentapartite” synapse) in the adaptive and maladaptive plasticity and discuss the relevance of these events in inflammatory, cerebrovascular, Alzheimer, neoplastic and psychiatric diseases. Finally, based on the solid reviewed data, we hypothesize a model of neuro-immune hemostatic network based on protein–protein interactions. In addition, we propose that, to better understand and favor the maintenance of adaptive plasticity, it would be useful to construct predictive molecular models, able to enlighten the regulating logic of the complex molecular network, which belongs to different cellular domains. A modeling approach would help to define how nodes of the network interact with basic cellular functions, such as mitochondrial metabolism, autophagy or apoptosis. It is expected that dynamic systems biology models might help to elucidate the fine structure of molecular events generated by blood coagulation and neuro-immune responses in several CNS diseases, thereby opening the way to more effective treatments.

Economic Evaluation of an Internet-Based Preventive Cognitive Therapy With Minimal Therapist Support for Recurrent Depression: Randomized Controlled Trial

Background

Major depressive disorder (MDD) is highly recurrent and has a significant disease burden. Although the effectiveness of internet-based interventions has been established for the treatment of acute MDD, little is known about their cost effectiveness, especially in recurrent MDD.

Objectives

Our aim was to evaluate the cost effectiveness and cost utility of an internet-based relapse prevention program (mobile cognitive therapy, M-CT).

Methods

The economic evaluation was performed alongside a single-blind parallel group randomized controlled trial. Participants were recruited via media, general practitioners, and mental health care institutions. In total, 288 remitted individuals with a history of recurrent depression were eligible, of whom 264 were randomly allocated to M-CT with minimal therapist support added to treatment as usual (TAU) or TAU alone. M-CT comprised 8 online lessons, and participants were advised to complete 1 lesson per week. The economic evaluation was performed from a societal perspective with a 24-month time horizon. The health outcomes were number of depression-free days according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) criteria assessed with the Structured Clinical Interview for DSM-IV axis I disorders by blinded interviewers after 3, 12, and 24 months. Quality-adjusted life years (QALYs) were self-assessed with the three level version of the EuroQol Five Dimensional Questionnaire (EQ-5D-3L). Costs were assessed with the Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness (TiC-P). Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that M-CT is cost effective compared to TAU.

Results

Mean total costs over 24 months were €8298 (US $9415) for M-CT and €7296 (US $8278) for TAU. No statistically significant differences were found between M-CT and TAU regarding depression-free days and QALYs (P=.37 and P=.92, respectively). The incremental costs were €179 (US $203) per depression-free day and €230,816 (US $261,875) per QALY. The cost-effectiveness acceptability curves suggested that for depression-free days, high investments have to be made to reach an acceptable probability that M-CT is cost effective compared to TAU. Regarding QALYs, considerable investments have to be made but the probability that M-CT is cost effective compared to TAU does not rise above 40%.

Conclusions

The results suggest that adding M-CT to TAU is not effective and cost effective compared to TAU alone. Adherence rates were similar to other studies and therefore do not explain this finding. The participants scarcely booked additional therapist support, resulting in 17.3 minutes of mean total therapist support. More studies are needed to examine the cost effectiveness of internet-based interventions with respect to long-term outcomes and the role and optimal dosage of therapist support. Overall, more research is needed on scalable and cost-effective interventions that can reduce the burden of recurrent MDD.

Trial registration

Netherlands Trial Register NTR2503; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2503 (Archived by WebCite at http://www.webcitation.org/73aBn41r3)

Seroprevalence of leptospiral antibodies among market workers and food handlers in the central state of Malaysia

OBJECTIVE

The high prevalence of leptospirosis in humans is of great public health concern, particularly in tropical and subtropical regions. This study aimed to determine the seroprevalence of leptospiral antibodies and distribution of serovars, and to assess the usefulness of enzyme-linked immunosorbent assay (ELISA) as a screening method for leptospiral antibodies in a high-risk healthy community.

METHODS

Cross-sectional study of 231 market workers and food handlers in wet markets and food premises from two localities in central Malaysia. Respondents' background information was obtained using a questionnaire. Serum samples were tested for leptospiral antibodies using ELISA and microscopic agglutination test (MAT).

RESULTS

Seroprevalence of leptospirosis among healthy workers was 46.3%. Detection of seropositivity was higher by MAT (46%) than ELISA (15%). We observed high seropositivity among local workers (49%), food handlers (49.5%), females (60.8%) and those aged 34 years and older (46.3%). Local strain LEP175 was the predominant serovar, followed by WHO strain Patoc.

CONCLUSION

Overall seroprevalence among healthy food handlers and market workers was high in this study. The workplace places susceptible individuals at risk of leptospirosis.

Prevalence and co-occurrence of unhealthy lifestyle habits and behaviours among secondary school students in Tuscany, central Italy

OBJECTIVES

Unhealthy habits acquired during adolescence may persist in adulthood and eventually increase the risk of chronic illnesses.

STUDY DESIGN

We reported on a survey conducted in 2013-2015 among secondary school students in Tuscany, central Italy.

METHODS

We compared the prevalence of self-reported lifestyle characteristics and overweight/obesity between genders and age groups (14-16 vs 17-21 years). We partitioned each gender- and age-specific stratum into groups based on cigarette smoking and engagement in sport activities, and compared the prevalence of other unhealthy lifestyles across groups using Poisson regression.

RESULTS

Overall, 2167 students (53.3% males, mean age 16.8 years) were included. Males were more frequently overweight/obese than females. Cigarette smoking increased with age and did not differ by gender. Males were more likely to engage in sport activities, drink alcoholic beverages and adopt other unhealthy lifestyle habits, whereas females reported a more frequent use of painkillers. Cigarette smoking was the single lifestyle characteristic most consistently associated with other unhealthy habits.

CONCLUSIONS

The prevalence and patterns of co-occurrence of unhealthy lifestyle habits varied by gender and age group among secondary school students in Italy. Our findings should be taken into account when planning public health initiatives aiming to combat obesity and tackle unhealthy lifestyles among secondary school students in Italy.

Combined testing for herpes simplex virus and Mycobacterium tuberculosis DNA in cerebrospinal fluid of patients with aseptic meningitis in Burkina Faso, West Africa

BACKGROUND

Little is known about the involvement of herpes simplex virus (HSV) or Mycobacterium tuberculosis (MTB) as potentially curable causes of central nervous system (CNS) infections in sub-Saharan Africa.

OBJECTIVE

In this study, we developed a PCR assay dedicated to simultaneous testing of HSV1/HSV2 and MTB in Burkina Faso, a country where HSV is neglected as a cause of CNS infection and where TB prevalence is high.

METHODS

A consensus HSV1/HSV2 set of primers and probe were designed and combined to primers and probe targeting the IS6110 repetitive insertion sequence of MTB. Analytical performances of the assay were evaluated on reference materials. Cerebrospinal fluid (CSF) collected from subjects with aseptic meningitis was tested for HSV1/HSV2 and MTB DNA.

RESULTS

The UL29 gene was chosen as a highly conserved region targeted by the HSV1/HSV2 nucleic acid test. The lower limits of detection were estimated to be 2.45 copies/µL for HSV1, 1.72 copies/µL for HSV2, and 2.54 IS6110 copies per µL for MTB. The PCR was used in 202 CSF collected from subjects suspected of aseptic meningitis. Five samples (2.46%) tested positive, including two children positive for HSV1 (0.99%) and three adults tested positive for MTB (1.47%).

CONCLUSION

Using an in-house real-time PCR assay, we showed that both HSV and MTB are etiologic pathogens contributing to aseptic meningitis in Burkina Faso. This molecular test may have clinical utility for early diagnosis for those treatable CNS infections.

Prognostic factors for recovery and non-recovery in patients with non-specific neck pain: a protocol for a systematic literature review

INTRODUCTION

Neck pain is a common musculoskeletal disorder worldwide. It can result in significant disability and impaired quality of life. More than 50% of patients with neck pain still report symptoms 1 year later despite receiving different forms of non-pharmacological and pharmacological treatment. Identifying patient characteristics that are modifiable or predict recovery and non-recovery for an individual patient might identify ways of improving outcomes. This systematic review aims to comprehensively summarise the existing evidence regarding baseline patient characteristics associated with recovery and non-recovery, as defined by measures of pain intensity, disability and global perceived improvement.

METHODS AND ANALYSIS

Six electronic databases, PubMed, CINAHL, PEDro Database, EMBASE, Cochrane Library and Web of Science, will be searched, with terms related to the review question such as neck pain, prognostic or predictive research, from inception to 28 September of 2018. Studies will be included if they have investigated an association between patient characteristics and outcomes, with at least one follow-up time point. Two independent reviewers will screen the titles and abstracts followed by a full-text review to assess papers regarding their eligibility. Data from included papers will be extracted using standardised forms, including study and participants' characteristics, outcomes, prognostic factors and effect size of the association. The risk of bias of each study will be assessed using the Quality in Prognostic Studies tool. A narrative synthesis will be conducted considering the strength, consistency of results and the methodological quality.

ETHICS AND DISSEMINATION

This systematic review does not require ethical approval. The results will be disseminated through publication in a peer-review journal, as a chapter of a doctoral thesis and through presentations at national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42018091183.

Efficacy and tolerability of erenumab in patients with episodic migraine in whom two-to-four previous preventive treatments were unsuccessful: a randomised, double-blind, placebo-controlled, phase 3b study

BACKGROUND

A substantial proportion of patients with migraine does not respond to, or cannot tolerate, oral preventive treatments. Erenumab is a novel CGRP-receptor antibody with preventive efficacy in migraine. We assessed its efficacy and tolerability in patients with episodic migraine in whom previous treatment with two-to-four migraine preventives had been unsuccessful.

METHODS

LIBERTY was a 12-week, double-blind, placebo-controlled randomised study at 59 sites in 16 countries. Eligible patients were aged 18-65 years and had a history of episodic migraine with or without aura for at least 12 months, had migraine for an average of 4-14 days per month during the 3 months before screening, and had been treated unsuccessfully (in terms of either efficacy or tolerability, or both) with between two and four preventive treatments. Eligible participants were randomly assigned (1:1) to receive either erenumab 140 mg (via two 70 mg injections) or placebo every 4 weeks subcutaneously for 12 weeks. Randomisation was by interactive response technology and was stratified by monthly frequency of migraine headache (4-7 vs 8-14 migraine days per month) during the baseline phase. Cenduit generated the randomisation list and assigned participants to groups. Participants, investigators, people doing various assessments, and the study sponsor were masked to treatment assignment. The primary endpoint was the proportion of patients achieving a 50% or greater reduction in the mean number of monthly migraine days during weeks 9-12. Efficacy was measured in the full analysis set, which included all randomly assigned patients who started their assigned treatment and completed at least one post-baseline monthly migraine day measurement. Safety and tolerability were assessed by recording adverse events and by physical examination, assessment of vital signs, clinical laboratory assessments, and electrocardiography. Safety was assessed in all randomly assigned patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT03096834. The trial is closed to new participants, but the open-label extension phase is ongoing.

FINDINGS

Between March 20, 2017, and Oct 27, 2017, 246 participants were randomly assigned, 121 to the erenumab group and 125 to the placebo group. 95 of 246 (39%) participants had previously unsuccessfully tried two preventive drugs, 93 (38%) had tried three, and 56 (23%) had tried four. At week 12, 36 (30%) patients in the erenumab had a 50% or greater reduction from baseline in the mean number of monthly migraine days, compared with 17 (14%) in the placebo group (odds ratio 2·7 [95% CI 1·4-5·2]; p=0·002). The tolerability and safety profiles of erenumab and placebo were similar. The most frequent treatment-emergent adverse event was injection site pain, which occurred in seven (6%) participants in both groups.

INTERPRETATION

Compared with placebo, erenumab was efficacious in patients with episodic migraine who previously did not respond to or tolerate between two and four previous migraine preventive treatments. Erenumab might be an option for patients with difficult-to-treat migraine who have high unmet needs and few treatment options.

FUNDING

Novartis Pharma.

New hypoglycemic agents and the kidney: what do the major trials tell us?

As the burden of diabetic kidney disease continues to expand, new therapies to preserve renal function or prevent diabetic nephropathy are urgently needed. In the past decade, a number of new hypoglycemic classes have emerged, each with a unique profile of action and benefits. Here we review the impact of glycemic control on renal outcomes and the results of the major clinical trials of glucagon-like peptide 1 (GLP-1) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium-glucose co-transporter 2 (SGLT2) inhibitors. Both GLP-1 agonists and SGLT2 inhibitors consistently demonstrate renal benefits. Further studies of these new agents in different patient groups and in comparison to (or in combination with) other treatments are required to better define their role in combating the burden of diabetic kidney disease.

Excess Weight in Spain: Current Situation, Projections for 2030, and Estimated Direct Extra Cost for the Spanish Health System

INTRODUCTION AND OBJECTIVES

Excess weight promotes the development of several chronic diseases and decreases quality of life. Its prevalence is increasing globally. Our aim was to estimate the trend in excess weight between 1987 and 2014 in Spanish adults, calculate cases of excess weight and its direct extra costs in 2006 and 2016, and project its trend to 2030.

METHODS

We selected 47 articles in a systematic literature search to determine the progression of the prevalence of overweight, nonmorbid obesity, and morbid obesity and average body mass index between 1987 and 2014. We projected the expected number of cases in 2006, 2016, and 2030 and the associated direct extra medical costs.

RESULTS

Between 1987 and 2014, the prevalence of overweight, obesity, and morbid obesity increased by 0.28%/y (P=.004), 0.50%/y (P <.001) and 0.030%/y (P=.006) in men, and by 0.10%/y (P=.123), 0.25%/y (P=.078), and 0.042%/y (P=.251) in women. The mean body mass index increased by 0.10 kg/m²/y in men (P <.001) and 0.26 kg/m²/y in women (significantly only between 1987 and 2002, P <.001). We estimated 23 500 000 patients with excess weight in 2016, generating 1.95 billion €/y in direct extra medical costs. If the current trend continues, between 2016 and 2030, there will be 3 100 000 new cases of excess weight, leading to 3.0 billion €/y of direct extra medical costs in 2030.

CONCLUSIONS

Excess weight in Spanish adults has risen since the creation of population registries, generating direct extra medical costs that represent 2% of the 2016 health budget. If this trend continues, we expect 16% more cases in 2030 and 58% more direct extra medical costs.

Magnetic resonance imaging analysis of work-related chronic low back pain: comparisons of different lumbar disc patterns

Background

Currently, there is a lack of comparative research about different lumbar disc patterns in patients with work-related chronic low back pain (CLBP) based on magnetic resonance imaging (MRI) analysis. Therefore, this study, on different patterns of lumbar disc degeneration or herniation in patients with CLBP, is valuable. In this study, we retrospectively investigated lumbar degenerative changes in patients with CLBP by using MRI analysis.

Materials and methods

Two hundred and eighty-three patients (110 women and 173 men) with work-related CLBP were enrolled and divided into four groups based on intervertebral disc morphology from MRI analysis, including normal discs (ND) group, degenerative discs (DD) group, bulging discs (BD) group, and herniated discs (HD) group. Demographic characteristics, occupational information, Visual Analog Scale (VAS) scores, and Oswestry Disability Index (ODI) scores were analyzed. Moreover, multiple parameters were investigated in the MRI analysis.

Results

The mean age of all 283 patients was 41.8±12.0 years (range, 18-80) and the mean duration of CLBP for all patients was 24.5±24.9 months. There were no significant differences in the patients' BMI, history of smoking, and education level (P>0.05). The three most common occupational types were manual worker, desk worker, and technician. The VAS and ODI scores of patients with CLBP in the DD, BD, and HD groups were significantly higher than those of patients in the ND group (P<0.05). The degrees of degeneration of L4/5 and L5/S1 were significantly higher than those of other intervertebral discs (P<0.05). The disc heights of L4/5 in the BD and HD groups were significantly lower than those of the ND group (P<0.05) and the disc height of L5/S1 in the HD group was significantly lower than that of the ND group (P<0.05). At the neutral position, the distances of L3/4, L4/5, and L5/S1 discs' bulge/herniation in the BD and HD groups were significantly higher than those in the ND and DD groups (P<0.05).

Conclusion

In summary, more severe degenerative changes of lower lumbar discs (L4/5 and L5/S1) such as higher degree of degeneration of disc, lower disc height, and significant displacement of disc were found in patients with work-related CLBP based on MRI analysis.

Inferring phenotypes from substance use via collaborative matrix completion

BACKGROUND

Although substance use disorders (SUDs) are heritable, few genetic risk factors for them have been identified, in part due to the small sample sizes of study populations. To address this limitation, researchers have aggregated subjects from multiple existing genetic studies, but these subjects can have missing phenotypic information, including diagnostic criteria for certain substances that were not originally a focus of study. Recent advances in addiction neurobiology have shown that comorbid SUDs (e.g., the abuse of multiple substances) have similar genetic determinants, which makes it possible to infer missing SUD diagnostic criteria using criteria from another SUD and patient genotypes through statistical modeling.

RESULTS

We propose a new approach based on matrix completion techniques to integrate features of comorbid health conditions and individual's genotypes to infer unreported diagnostic criteria for a disorder. This approach optimizes a bi-linear model that uses the interactions between known disease correlations and candidate genes to impute missing criteria. An efficient stochastic and parallel algorithm was developed to optimize the model with a speed 20 times greater than the classic sequential algorithm. It was tested on 3441 subjects who had both cocaine and opioid use disorders and successfully inferred missing diagnostic criteria with consistently better accuracy than other recent statistical methods.

CONCLUSIONS

The proposed matrix completion imputation method is a promising tool to impute unreported or unobserved symptoms or criteria for disease diagnosis. Integrating data at multiple scales or from heterogeneous sources may help improve the accuracy of phenotype imputation.

Stroke units, certification, and outcomes in German hospitals: a longitudinal study of patient-based 30-day mortality for 2006-2014

BACKGROUND

Treatment of stroke patients in stroke units has increased and studies have shown improved outcomes. However, a large share of patients in Germany is still treated in hospitals without stroke unit. The effects of stroke unit service line, and total hospital quality certification on outcomes remain unclear.

METHODS

We employ annual hospital panel data for 1100-1300 German hospitals from 2006 to 2014, which includes structural data and 30-day standardized mortality. We estimate hospital- and time-fixed effects regressions with three main independent variables: (1) stroke unit care, (2) stroke unit certification, and (3) total hospital quality certification.

RESULTS

Our results confirm the trend of decreasing stroke mortality ratios, although to a much lesser degree than previous studies. Descriptive analysis illustrates better stroke outcomes for non-certified and certified stroke units and hospitals with total hospital quality certification. In a fixed effects model, having a stroke unit has a significant quality-enhancing effect, lowering stroke mortality by 5.6%, while there is no significant improvement effect for stroke unit certification or total hospital quality certification.

CONCLUSIONS

Patients and health systems may benefit substantially from stroke unit treatment expansion as installing a stroke unit appears more meaningful than getting it certified or obtaining a total hospital quality certification. Health systems should thus prioritize investment in stroke unit infrastructure and centralize stroke care in stroke units. They should also prioritize patient-based 30-day mortality data as it allows a more realistic representation of mortality than admission-based data.

MicroRNA-504 modulates osteosarcoma cell chemoresistance to cisplatin by targeting p53

Chemoresistance implicates the therapeutic value of cisplatin and remains a primary obstacle to its clinical use. MicroRNAs (miRs) negatively modulate the expression of their target genes and are associated with the occurrence and progression of various types of tumor. The abnormal expression of miR-504 has been reported in certain types of human tumor and has been associated with tumor prognosis. However, the association between miR-504 and cisplatin in human osteosarcoma remains unclear. The present study therefore aimed to assess the in vitro effects and possible mechanism of miR-504 in cell proliferation, apoptosis and cisplatin resistance in MG63 osteosarcoma cells. The results demonstrated that miR-504 was overexpressed in osteosarcoma tissues and cells. This overexpression also induced cell proliferation, as determined by MTT and EdU staining assays. Furthermore, miR-504 suppressed cisplatin-induced apoptosis, which was demonstrated via MTT, cell morphology analysis and flow cytometry. Cisplatin-induced G₁ arrest was also suppressed, which was determined by flow cytometry. The potential target genes of miR-504 were predicted using bioinformatics. p53 was confirmed to be a direct target of miR-504 using a luciferase reporter assay and western blot analysis revealed that miR-504 negatively regulated p53 expression at a molecular level. These results indicate that miR-504 contributes to cisplatin resistance in MG63 osteosarcoma cells by suppressing p53. miR-504 may therefore be a potential biomarker for cisplatin resistance in patients with osteosarcoma.

Early childhood caries among 3- to 5-year-old children in Hong Kong

OBJECTIVE

The aim of this study was to describe the prevalence of dental caries among 3- to 5-year-old children in Hong Kong and to investigate the factors associated with their dental caries status.

METHODS

Seven kindergartens in Hong Kong were selected using stratified random sampling. The 3- to 5-year-old kindergarten children were invited to join the study. The participants' parents were asked to complete a questionnaire regarding their children's demographic and socio-economic backgrounds, their dental habits and their own dental knowledge. Dental caries experience was measured using the decayed, missing and filled primary teeth (dmft) index. The visible plaque index was adopted for recording oral hygiene. The relationships between caries experience and children's demographic backgrounds, dental habits, oral hygiene and parental dental knowledge were studied using a zero-inflated negative binomial (ZINB) regression analysis.

RESULTS

Among the 1,204 participating preschool children, the overall prevalence of dental caries (dmft > 0) was 46%. The mean dmft score was 2.1 ± 3.4. The prevalences of dental caries among the 3-, 4- and 5-year-old children were 38%, 43% and 55%, respectively. ZINB regression analysis revealed that the study children who were boys, came from families with lower incomes, had dental visit experiences, had higher plaque scores and had parents with lower levels of dental knowledge, had higher dmft scores (P < 0.05).

CONCLUSIONS

Dental caries is prevalent among preschool children in Hong Kong. The caries experiences of the study children are associated with gender, family income, parental dental knowledge, dental visit experience and oral hygiene.

Air quality co-benefits for human health and agriculture counterbalance costs to meet Paris Agreement pledges

Local air quality co-benefits can provide complementary support for ambitious climate action and can enable progress on related Sustainable Development Goals. Here we show that the transformation of the energy system implied by the emission reduction pledges brought forward in the context of the Paris Agreement on climate change (Nationally Determined Contributions or NDCs) substantially reduces local air pollution across the globe. The NDCs could avoid between 71 and 99 thousand premature deaths annually in 2030 compared to a reference case, depending on the stringency of direct air pollution controls. A more ambitious 2 °C-compatible pathway raises the number of avoided premature deaths from air pollution to 178-346 thousand annually in 2030, and up to 0.7-1.5 million in the year 2050. Air quality co-benefits on morbidity, mortality, and agriculture could globally offset the costs of climate policy. An integrated policy perspective is needed to maximise benefits for climate and health.

Exercise performance increase in smokeless tobacco-user athletes after overnight nicotine abstinence

The use of nicotine administered through smokeless tobacco (snus) has increased among athletes. The purpose of this study was to investigate the ergogenic effects of snus on aerobic performance during exercise until exhaustion in athletes after abstinence or satiety nicotine conditions. The study utilized a randomized, controlled, within-subject design experiment. Sixteen male snus-user athletes completed an exercise until exhaustion at a constant load of their 80% of V ˙ O 2 max (calculated by a maximal incremental test) in two separate sessions, corresponding to nicotine conditions: 12-hour overnight abstinence and satiety. A portion of 1 g of snus (~8 mg/g of nicotine) was administered 25 minutes before each experimental test. In each session, time to exhaustion (TTE), global rating of perceived exertion, cardiovascular and metabolic responses, and muscle and cerebral oxygenation were measured. Nicotine and cotinine analysis confirmed session conditions (abstinence or satiety). Snus induced a significant increase (+13.1%) of TTE following abstinence (24.1 ± 10.7 minutes) compared to satiety condition (20.9 ± 8.0 minutes; P = 0.0131). The baseline values revealed that abstinence of snus induced significant increase in the oxygenation of the muscular tissues (+4%), in metabolic values and in cardiovascular parameters, when compared to satiety condition. Our results indicate an increase of exercise performance (+13.1% TTE) due to snus administration in an abstinence condition. Considering that twelve hours of abstinence from snus-contained nicotine affected metabolic, cardiovascular and muscular tissue oxygenation, we suggest that snus administration at test time might relieve these withdrawal changes and yield an increase in time to exhaustion.

Sex differences in risk factors for vascular contributions to cognitive impairment & dementia

Vascular contributions to cognitive impairment and dementia (VCID) is the second most common cause of dementia. While males overall appear to be at a slightly higher risk for VCID throughout most of the lifespan (up to age 85), some risk factors for VCID more adversely affect women. These include female-specific risk factors associated with pregnancy related disorders (e.g. preeclampsia), menopause, and poorly timed hormone replacement. Further, presence of certain co-morbid risk factors, such as diabetes, obesity and hypertension, also may more adversely affect women than men. In contrast, some risk factors more greatly affect men, such as hyperlipidemia, myocardial infarction, and heart disease. Further, stroke, one of the leading risk factors for VCID, has a higher incidence in men than in women throughout much of the lifespan, though this trend is reversed at advanced ages. This review will highlight the need to take biological sex and common co-morbidities for VCID into account in both preclinical and clinical research. Given that there are currently no treatments available for VCID, it is critical that we understand how to mitigate risk factors for this devastating disease in both sexes.

Neighborhood socioeconomic status and adherence to dietary recommendations among Finnish adults: A retrospective follow-up study

Neighborhood socioeconomic status (SES) is associated with dietary habits among the residents, but few studies have examined this association separately among long-term residents and movers. We calculated cumulative neighborhood SES score weighted by residential time in each address over 6 years for non-movers (n = 7704) and movers (n = 8818) using national grid database. Increase in average neighborhood SES was associated with higher adherence to dietary recommendations in both groups. Among the movers, an upward trajectory from low to high neighborhood SES was also associated with better adherence. Our findings suggest high SES areas might offer healthier food environments than low SES areas.

Gender differences in the association between migration and cognitive function among older adults in China and India

OBJECTIVE

This study aims to examine gender differences in the association between migration and cognitive function among adults in China and India.

METHODS

Data from the World Health Organization Study on global AGEing and adult health (SAGE) study were used that included adults aged 50 + from China (N = 12,937) and India (N = 6244). Migration status included: urban residents, rural residents, urban-to-urban, rural-to-urban, rural-to-rural, and urban-to-rural migrants. Cognitive function was assessed by immediate and delayed recall tests, digit span tests, and verbal fluency test. Ordinary least square regression models were used to adjust for sociodemographic characteristics, psychosocial factors, health behaviors, and physical health status.

RESULTS

Controlling for multiple covariates, significant differences in cognitive function were found between men and women, and across migration groups. A consistent female disadvantage was found in China and India for cognitive function. Women who were rural residents or rural-to-rural migrants had the poorest cognitive function in both the Chinese and the Indian samples. Among males in China, rural residents had poorer cognitive function than urban residents, while urban-to-urban migrants had highest cognition scores; however, for male counterparts in India, rural-to-rural migrants had the poorest cognitive function.

CONCLUSIONS

The results suggest that the association between migration and cognitive function differs by gender and country. In our study populations, major sociodemographic characteristics play a key role in accounting for the differences in cognitive function.

EGCG Reduces Obesity and White Adipose Tissue Gain Partly Through AMPK Activation in Mice

(-)-Epigallocatechin-3-gallate (EGCG), which is the most abundant catechin in green tea, has many potential health benefits, including decreased weight gain and/or adipose tissue weight. Suggested mechanisms for body weight reduction by EGCG include: (1) a decrease in calorie intake and (2) activation of AMPK in liver, skeletal muscle, and white adipose tissue. However, only one study supports the AMPK hypothesis. To determine the role of AMPK in EGCG-induced reduction of body weight, we administrated 50 mg/kg and 100 mg/kg per day to mice, together with a high-fat diet (HFD), for 20 weeks. EGCG had a significant effect on obesity and decrease in epididymal adipose tissue weight, and also affected serum lipid characteristics, including triglyceride, cholesterol (CHOL), and high- and low-density lipoprotein CHOL (HDL-C, LDL-C) concentrations. In addition, EGCG increased the excretion of free fatty acids from feces. By measuring the mRNA expression levels of genes involved in lipid metabolism, we found that EGCG inhibited the expression of genes involved in the synthesis of de novo fatty acids (acc1, fas, scd1, c/ebpβ, pparγ, and srebp1) and increased the expression of genes associated with lipolysis (hsl) and lipid oxidization in white adipose tissue, in both the HFD and the EGCG groups. However, EGCG significantly increased the expression of genes involved in the synthesis of de novo fatty acids compared with the HFD group. Increased AMPK activity was found in both subcutaneous and epididymal adipose tissues. In conclusion, EGCG can decrease obesity and epididymal white adipose tissue weight in mice, only partially via activation of AMPK.

Ophthalmology research in the UK's National Health Service: the structure and performance of the NIHR's Ophthalmology research portfolio

PURPOSE

To report on the composition and performance of the portfolio of Ophthalmology research studies in the United Kingdom's National Institute for Health Research (NIHR) Clinical Research Network (UK CRN).

METHODS

Ophthalmology studies open to recruitment between 1 April 2010 and 31 March 2018 were classified by: sub-specialty, participant age, gender of Chief Investigator, involvement of genetic investigations, commercial/ non-commercial, interventional/observational design. Frequency distributions for each covariate and temporal variation in recruitment to time and target were analysed.

RESULTS

Over 8 years, 137,377 participants were recruited (average of 15,457 participants/year; range: 5485-32,573) with growth by year in proportion of commercial studies and hospital participation in England (76% in 2017/18). Fourteen percent of studies had a genetic component and most studies (82%) included only adults. The majority of studies (41%) enrolled patients with retinal diseases, followed by glaucoma (17%), anterior segment and cataract (13%), and ocular inflammation (6%). Overall, 68% of non-commercial studies and 55% of commercial studies recruited within the anticipated time set by the study and also recruited to or exceeded the target number of participants.

CONCLUSIONS

High levels of clinical research activity, growth and improved performance have been observed in Ophthalmology in UK over the past 8 years. Some sub-specialties that carry substantial morbidity and a very high burden on NHS services are underrepresented and deserve more patient-centred research. Yet the NIHR and its CRN Ophthalmology National Specialty Group has enabled key steps in achieving the goal of embedding research into every day clinical care.

Lipoprotein Subclass Profile after Progressive Energy Deficits Induced by Calorie Restriction or Exercise

Weight loss, induced by chronic energy deficit, improves the blood lipid profile. However, the effects of an acute negative energy balance and the comparative efficacy of diet and exercise are not well-established. We determined the effects of progressive, acute energy deficits (20% or 40% of daily energy requirements) induced by a single day of calorie restriction (n = 19) or aerobic exercise (n = 13) in healthy subjects (age: 26 ± 9 years; body mass index (BMI): 21.8 ± 2.9 kg/m²). Fasting plasma concentrations of very low-, intermediate-, low-, and high-density lipoprotein (VLDL, LDL, IDL, and HDL, respectively) particles and their subclasses were determined using nuclear magnetic resonance. Total plasma triglyceride and VLDL-triglyceride concentrations decreased after calorie restriction and exercise (all p ≤ 0.025); the pattern of change was linear with an increasing energy deficit (all p < 0.03), with no evidence of plateauing. The number of circulating large and medium VLDL particles decreased after diet and exercise (all p < 0.015), with no change in small VLDL particles. The concentrations of IDL, LDL, and HDL particles, their relative distributions, and the particle sizes were not altered. Our data indicate that an acute negative energy balance induced by calorie restriction and aerobic exercise reduces triglyceride concentrations in a dose-dependent manner, by decreasing circulating large and medium VLDL particles.

Control of metabolic predisposition to cardiovascular complications of chronic kidney disease by effervescent calcium magnesium citrate: a feasibility study

Aims

Cardiovascular (CV) complications are common in chronic kidney disease (CKD). Numerous metabolic disturbances including hyperphosphatemia, high circulating calciprotein particles (CPP), hyperparathyroidism, metabolic acidosis, and magnesium deficiency are associated with, and likely pathogenic for CV complications in CKD. The goal of this feasibility study was to determine whether effervescent calcium magnesium citrate (EffCaMgCit) ameliorates the aforementioned pathogenic intermediates.

Methods

Nine patients with Stage 3 and nine patients with Stage 5D CKD underwent a randomized crossover study, where they took EffCaMgCit three times daily for 7 days in one phase, and a conventional phosphorus binder calcium acetate (CaAc) three times daily for 7 days in the other phase. Two-hour postprandial blood samples were obtained on the day before and on the 7th day of treatment.

Results

In Stage 5D CKD, EffCaMgCit significantly increased T50 (half time for conversion of primary to secondary CPP) from baseline by 63% (P = 0.013), coincident with statistically non-significant declines in serum phosphorus by 25% and in saturation of octacalcium phosphate by 35%; CaAc did not change T50. In Stage 3 CKD, neither EffCaMgCit nor CaAc altered T50. With EffCaMgCit, a significant increase in plasma citrate was accompanied by statistically non-significant increase in serum Mg and phosphate. CaAc was without effect in any of these parameters in Stage 3 CKD. In both Stages 3 and 5D, both drugs significantly reduced serum parathyroid hormone. Only EffCaMgCit significantly increased serum bicarbonate by 3 mM (P = 0.015) in Stage 5D.

Conclusions

In Stage 5D, EffCaMgCit inhibited formation of CPP, suppressed PTH, and conferred magnesium and alkali loads. These effects were unique, since they were not observed with CaAc. In Stage 3 CKD, neither of the regimens have any effect. These metabolic changes suggest that EffCaMgCit might be useful in protecting against cardiovascular complications of CKD by ameliorating pathobiologic intermediates.

Stress Coping Strategies in the Heart: An Integrated View

The heart is made up of an ordered amalgam of cardiac cell types that work together to coordinate four major processes, namely energy production, electrical conductance, mechanical work, and tissue remodeling. Over the last decade, a large body of information has been amassed regarding how different cardiac cell types respond to cellular stress that affect the functionality of their elaborate intracellular membrane networks, the cellular reticular network. In the context of the heart, the manifestations of stress coping strategies likely differ depending on the coping strategy outcomes of the different cardiac cell types, and thus may underlie the development of distinct cardiac disorders. It is not clear whether all cardiac cell types have similar sensitivity to cellular stress, how specific coping response strategies modify their unique roles, and how their metabolic status is communicated to other cells within the heart. Here we discuss our understanding of the roles of specialized cardiac cells that together make the heart function as an organ with the ability to pump blood continuously and follow a regular rhythm.

Heme Induces Endoplasmic Reticulum Stress (HIER Stress) in Human Aortic Smooth Muscle Cells

Accumulation of damaged or misfolded proteins resulted from oxidative protein modification induces endoplasmic reticulum (ER) stress by activating the pathways of unfolded protein response. In pathologic hemolytic conditions, extracellular free hemoglobin is submitted to rapid oxidation causing heme release. Resident cells of atherosclerotic lesions, after intraplaque hemorrhage, are exposed to heme leading to oxidative injury. Therefore, we raised the question whether heme can also provoke ER stress. Smooth muscle cells are one of the key players of atherogenesis; thus, human aortic smooth muscle cells (HAoSMCs) were selected as a model cell to reveal the possible link between heme and ER stress. Using immunoblotting, quantitative polymerase chain reaction and immunocytochemistry, we quantitated the markers of ER stress. These were: phosphorylated eIF2α, Activating transcription factor-4 (ATF4), DNA-damage-inducible transcript 3 (also known as C/EBP homology protein, termed CHOP), X-box binding protein-1 (XBP1), Activating transcription factor-6 (ATF6), GRP78 (glucose-regulated protein, 78kDa) and heme responsive genes heme oxygenase-1 and ferritin. In addition, immunohistochemistry was performed on human carotid artery specimens from patients who had undergone carotid endarterectomy. We demonstrate that heme increases the phosphorylation of eiF2α in HAoSMCs and the expression of ATF4. Heme also enhances the splicing of XBP1 and the proteolytic cleavage of ATF6. Consequently, there is up-regulation of target genes increasing both mRNA and protein levels of CHOP and GRP78. However, TGFβ and collagen type I decreased. When the heme binding proteins, alpha-1-microglobulin (A1M) and hemopexin (Hpx) are present in cell media, the ER stress provoked by heme is inhibited. ER stress pathways are also retarded by the antioxidant N-acetyl cysteine (NAC) indicating that reactive oxygen species are involved in heme-induced ER stress. Consistent with these findings, elevated expression of the ER stress marker GRP78 and CHOP were observed in smooth muscle cells of complicated lesions with hemorrhage compared to either atheromas or healthy arteries. In conclusion, heme triggers ER stress in a time- and dose-dependent manner in HAoSMCs. A1M and Hpx as well as NAC effectively hamper heme-induced ER stress, supporting their use as a potential therapeutic approach to reverse such a deleterious effects of heme toxicity.

The impact of musculoskeletal injuries sustained in road traffic crashes on work-related outcomes: a protocol for a systematic review

BACKGROUND

Musculoskeletal injuries (strains/sprains, contusions, dislocations, and fractures) are the most common injury sustained in a road traffic crash. They can have a long-term impact upon the ability to engage in work. Persisting symptoms as well as poor physical and psychological recovery may reduce the ability to return to or remain at work necessitating the use of sick leave or alternate duties to enable a gradual return to full duties. There is also a need to investigate rates of return to work, along with other work-related outcomes in this population so that interventions designed to facilitate return to work can be targeted to this clinical population. In addition, there is a need to explore factors associated with work-related outcomes in people with musculoskeletal injuries subsequent to a road traffic crash.

METHODS

A systematic review will be conducted to determine the impact of sustaining a musculoskeletal injury during a road traffic crash on an individual's ability to work. Observational studies will be identified by searching six electronic databases for reports of adults having sustained musculoskeletal injuries during a road traffic crash. Studies featuring paediatric cohorts or those with neurological injuries will be excluded. To be eligible for inclusion, studies must report at least one of the following work-related outcomes: return to work status/rate, sick leave, work ability, work capacity, and health-related work productivity loss. The methodological quality of included studies will be assessed with the National Institutes of Health National Heart, Lung, and Blood Institute Study Quality Assessment Tools for observational cohort and cross-sectional studies, and case-control studies.

DISCUSSION

The results of this systematic review may increase our knowledge of work-related outcomes and understanding of the associated factors for people with musculoskeletal injuries following road traffic crashes. Future studies could use the results to plan interventions and influence policy and legislation, and raise awareness of the needs of this clinical population.

SYSTEMATIC REVIEW REGISTRATION

Registered on PROSPERO, reference number CRD42018099252 , dated 14 August 2018.

Ascaris Larval Infection and Lung Invasion Directly Induce Severe Allergic Airway Disease in Mice

Ascaris lumbricoides (roundworm) is the most common helminth infection globally and a cause of lifelong morbidity that may include allergic airway disease, an asthma phenotype. We hypothesize that Ascaris larval migration through the lungs leads to persistent airway hyperresponsiveness (AHR) and type 2 inflammatory lung pathology despite resolution of infection that resembles allergic airway disease. Mice were infected with Ascaris by oral gavage. Lung AHR was measured by plethysmography and histopathology with hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) stains, and cytokine concentrations were measured by using Luminex Magpix. Ascaris-infected mice were compared to controls or mice with allergic airway disease induced by ovalbumin (OVA) sensitization and challenge (OVA/OVA). Ascaris-infected mice developed profound AHR starting at day 8 postinfection (p.i.), peaking at day 12 p.i. and persisting through day 21 p.i., despite resolution of infection, which was significantly increased compared to controls and OVA/OVA mice. Ascaris-infected mice had a robust type 2 cytokine response in both the bronchoalveolar lavage (BAL) fluid and lung tissue, similar to that of the OVA/OVA mice, including interleukin-4 (IL-4) (P < 0.01 and P < 0.01, respectively), IL-5 (P < 0.001 and P < 0.001), and IL-13 (P < 0.001 and P < 0.01), compared to controls. By histopathology, Ascaris-infected mice demonstrated early airway remodeling similar to, but more profound than, that in OVA/OVA mice. We found that Ascaris larval migration causes significant pulmonary damage, including AHR and type 2 inflammatory lung pathology that resembles an extreme form of allergic airway disease. Our findings indicate that ascariasis may be an important cause of allergic airway disease in regions of endemicity.

A workplace intervention to reduce alcohol and drug consumption: a nonrandomized single-group study

BACKGROUND

The consumption of alcohol and other drugs causes social and health problems in industrialized societies. Furthermore, alcohol and drug consumption in the workplace is associated with work accidents, absenteeism and low productivity. The aim of the current study is to reduce alcohol and drug consumption among workers in the service industry and, as a secondary aim, to improve their healthy habits through the reduction of alcohol and other drug consumption in their leisure time.

METHODS

This nonrandomized, single-group study was conducted in 12 work centers. The intervention began in 2009 and emphasized 1) health promotion and health monitoring, which included a) alcohol and drug awareness and b) the evaluation and monitoring of alcohol and drug consumption through a semistructured interview designed to assess risky consumption; urine tests aimed at detecting alcohol, cannabis and cocaine use; an Alcotest based on expired air to test for the recent consumption of alcohol and a saliva exam to test for the recent consumption of six drugs; and 2) secondary prevention if risky consumption was identified. Risky alcohol consumption was defined as the ingestion of more than 28 standard drink units (SDUs)/week among men and more than 17 SDUs/week among women (taking into account both work and leisure time). Drug consumption was considered risky consumption.

RESULTS

A total of 1103 workers participated, and each received 5 h of awareness training. Those who presented with risky consumption received secondary prevention training. The prevalence of risky alcohol consumption decreased by 4.1% (baseline: 14.7% reduced to 10.6% in the first year; p = 0.001), a reduction that was maintained over a 3-year follow-up period.

CONCLUSION

A comprehensive program of worker health surveillance that involves stakeholders and includes monitoring can be a means of potentially improving compliance with workplace promotion programs, resulting in the facilitation of such beneficial, desired behavior change in areas such as alcohol and drug consumption.

Integrated models of care for diabetes and hypertension in low- and middle-income countries (LMICs) : Protocol for a systematic review

BACKGROUND

In low- and middle-income countries (LMICs), the burden of non-communicable diseases (NCDs) is growing against an existing burden of other diseases such as HIV/AIDS. Integrated models of care can help address the rising burden of multi-morbidity. Although integration of care can occur at various levels and has been defined in numerous ways, our aim is to assess the effects of integration of service delivery at primary healthcare level in LMICs.

METHODS

We will consider randomised controlled trials (RCTs), cluster RCTs, non-randomised trials, controlled before-after studies and interrupted time series that examine integrated models of care among people with multi-morbidities, of which diabetes or hypertension is one, living in LMICs. We will compare fully integrated models of care to stand-alone care, partially integrated models of care to stand-alone care and fully integrated models to partially integrated models of care. Primary outcomes include all-cause mortality, disease-specific morbidity, HbA1c, systolic blood pressure and cholesterol levels. Secondary outcomes include access to care, retention in care, adherence, continuity of care, quality of care and cost of care. We will conduct a comprehensive search in the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Control Trials, LILACS, Africa-Wide Information, CINAHL and Web of Science. In addition, we will search trial registries, relevant conference abstracts and check references lists of included studies. Selection of studies, data extraction and assessment of risk of bias will be performed independently by two review authors. We will resolve discrepancies through discussion with a third author. We will contact study authors in case of missing data. If included studies are sufficiently homogenous, we will pool results in a meta-analysis. Clinical heterogeneity related to the population, intervention, outcomes and context will be documented in table format and explored through subgroup analysis. We will assess χ 2 and I 2 tests for statistical heterogeneity. We will use GRADE to make judgements about the certainty of evidence and present findings in a summary of findings table.

DISCUSSION

In light of limited evidence on the provision of comprehensive care for diabetes and hypertension, and its comorbidity in LMCIs, we believe that the findings of this systematic review will provide a synthesis of evidence on effective models of integrated care for diabetes and hypertension and their comorbidities at primary healthcare level. This will enable policy-makers to device policies and programs that are evidence informed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018099314 .

Post-infectious ankylosis of the cervical spine in an army veteran: a case report

Background

Vertebral osteomyelitis is a rare, life-threatening condition. Successful management is dependent on prompt diagnosis and management with intravenous antibiotic therapy or surgery in addition to antibiotics. Reoccurrence is minimal after 1 year. However, very little is reported in the conservative spine literature regarding the long-term follow-up and the changes to the spine following management of the spinal infection. We report the dramatic radiologic findings of the long-term sequela of a cervical spine infection following a gunshot wound from 1969. Most impressive to the spine specialist is this patient’s ability to return to work despite significant alterations to spinal biomechanics.

Case presentation

A 69 year-old caucasian male presented to the chiropractic clinic at a Veterans Affairs Medical Center with complaint of chronic left shoulder pain secondary to an associated full thickness tear of the left infraspinatus. An associated regional assessment of the cervical spine ensued. Radiological imaging on file revealed ankylosis C2/C3 to C7/T1. The patient reported a history of multiple fragment wounds in 1969 to the left anterior neck and shoulder 45 years earlier. Osteomyelitis of the cervical spine resulted from the wounds.

Conclusion

Potential sequela of osteomyelitis is ankylosis of affected joints. In this particular case, imaging provides evidence of regional ankylosis of the cervical spine. Considering the patient did not complain of cervical pain or related symptoms apart from lack of cervical range of motion, and his Neck Disability Index score was 2 out of 50 (4%), no intervention was provided to the cervical spine. The patient reported he self-managed well, worked full-time as a postal worker after he was discharged due to the injury to his neck, and planned to retire in less than one month at age 70. The patient demonstrates successful return to work with pending retirement at age 70 following spondylodiscitis and subsequent ankylosis of the cervical region.

Expression of miR-664 and miR-184 on proliferation, apoptosis and migration of osteosarcoma cells

The expression of micro-ribonucleic acid miR-664 and miR-184 on the biological characteristics of osteosarcoma (OS) SOSP-9607 cells was investigated. Eighteen surgical specimens of OS and 18 normal tissue specimens were collected. The expression of miR-664 and miR-184 was detected via fluorescence reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The OS cell line SOSP-9607 was selected as the object of study, and miR-664 blank group, miR-664 mimic group, miR-664 inhibitor group, miR-184 blank group, miR-184 mimic group and miR-184 inhibitor group were established through transfection. Changes in apoptosis were detected via flow cytometry, the cell proliferation capacity was detected via Cell Counting Kit-8 assay, and the cell migration was observed via wound healing assay. In cancer tissues of OS patients, the relative expression of miR-664 and miR-184 was significantly higher than that in para-carcinoma tissues (P<0.05). The cell growth in miR-664 inhibitor group was obviously decreased compared with those in miR-664 blank and mimic groups (P<0.05). There were differences in the cell migration capacity among groups (P<0.01), and the cell scratch areas in miR-664 and miR-184 mimic groups were significantly decreased compared with those in miR-664 and miR-184 blank groups (P<0.05), while they were significantly increased in miR-664 and miR-184 inhibitor groups compared with those in miR-664 and miR-184 blank and mimic groups (P<0.05, P<0.01). There were differences in the apoptosis rate among groups (P<0.01) and apoptosis in miR-664 and miR-184 inhibitor groups was remarkably increased compared with those in miR-664 and miR-184 blank and mimic groups (P<0.05). Downregulating the expression of miR-664 and miR-184 may promote apoptosis, inhibit the proliferation and reduce the migration capacity of SOSP-9607 cells. Therefore, miR-664 and miR-184 may provide a theoretical basis for the target selection in clinical targeted therapy and drug development for OS.

Nurses' attitudes, beliefs and practices on sexuality for cardiovascular care: A cross-sectional study

AIMS AND OBJECTIVES

To describe nurses' attitudes, beliefs, and practices regarding sexuality care for patients with cardiovascular disease.

BACKGROUND

Limited sexual activity is common among patients with cardiovascular disease, yet assessment of sexuality and counselling is frequently not undertaken by nurses.

DESIGN

Cross-sectional study.

METHODS

This study recruited 268 cardiac nurses from seven tertiary hospitals in five cities of Henan province. The Sexual Attitudes and Beliefs Survey, along with investigator-developed questions regarding practices and perceived barriers, was administered to the nurses. The STROBE checklist was used to ensure quality reporting during this observational study (see Supporting Information Data S1).

RESULTS

The average age of nurses who participated was 31.81 years (SD = 7.41). The average score of Sexual Attitudes and Beliefs Survey was 47.72 (SD = 7.40), indicating moderate attitudinal barriers for nurses to discuss sexual activities with patients. Most nurses (91%) perceived that sexuality was too private to discuss with patients. Only 20% of nurses expressed that they would provide time to discuss sexual concerns with patients. Eighty per cent of nurses revealed that they felt uncomfortable discussing sexuality; moreover, they believed that hospitalised patients were too sick to be engaged in these types of conversations. Additionally, almost 85% of nurses conveyed that they have never conducted discussions regarding sexuality care in patients with cardiovascular disease. The most frequently reported perceived barriers preventing nurses from discussing sexual concerns included fear of offending patients (77.2%), uncertainty of how to communicate with patients (69.4%), feelings of embarrassment (67.5%), lack of safe and private environments (61.9%) and lack of knowledge (54.9%).

CONCLUSION

Nurses in this cross-sectional sample rarely discussed sexual concerns with their patients. There were several key barriers identified by nurses regarding providing sexuality care, including personal attitudes and beliefs, limited skills and knowledge, culture and organizational-related barriers.

RELEVANCE TO CLINICAL PRACTICE

Targeted training for nurses and creating a culturally safe environment is recommended to improve management of sexuality in patients with CVD.

Ezetimibe for the prevention of cardiovascular disease and all-cause mortality events

BACKGROUND

Cardiovascular disease (CVD) remains an important cause of mortality and morbidity, and high levels of blood cholesterol are thought to be the major modifiable risk factors for CVD. The use of statins is the preferred treatment strategy for the prevention of CVD, but some people at high-risk for CVD are intolerant to statin therapy or unable to achieve their treatment goals with the maximal recommended doses of statin. Ezetimibe is a selective cholesterol absorption inhibitor, whether it has a positive effect on CVD events remains uncertain. Results from clinical studies are inconsistent and a thorough evaluation of its efficacy and safety for the prevention of CVD and mortality is necessary.

OBJECTIVES

To assess the efficacy and safety of ezetimibe for the prevention of CVD and all-cause mortality.

SEARCH METHODS

We searched the CENTRAL, MEDLINE, Embase and Web of Science on 27 June 2018, and two clinical trial registry platforms on 11 July 2018. We checked reference lists from primary studies and review articles for additional studies. No language restrictions were applied.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that compared ezetimibe versus placebo or ezetimibe plus other lipid-modifying drugs versus other lipid-modifying drugs alone in adults, with or without CVD, and which had a follow-up of at least 12 months.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies for inclusion, extracted data, assessed risk of bias and contacted trialists to obtain missing data. We performed statistical analyses according to the Cochrane Handbook for Systematic Reviews of Interventions and used the GRADE to assess the quality of evidence.

MAIN RESULTS

We included 26 RCTs randomising 23,499 participants. All included studies assessed effects of ezetimibe plus other lipid-modifying drugs compared with other lipid-modifying drugs alone or plus placebo. Our findings were driven by the largest study (IMPROVE-IT), which had weights ranging from 41.5% to 98.4% in the different meta-analyses.Ezetimibe with statins probably reduces the risk of major adverse cardiovascular events compared with statins alone (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.90 to 0.98; a decrease from 284/1000 to 267/1000, 95% CI 256 to 278; 21,727 participants; 10 studies; moderate-quality evidence). Trials reporting all-cause mortality used ezetimibe with statin or fenofibrate and found they have little or no effect on this outcome (RR 0.98, 95% CI 0.91 to 1.05; 21,222 participants; 8 studies; high-quality evidence). Adding ezetimibe to statins probably reduces the risk of non-fatal myocardial infarction (MI) (RR 0.88, 95% CI 0.81 to 0.95; a decrease from 105/1000 to 92/1000, 95% CI 85 to 100; 21,145 participants; 6 studies; moderate-quality evidence) and non-fatal stroke (RR 0.83, 95% CI 0.71 to 0.97; a decrease 32/1000 to 27/1000, 95% CI 23 to 31; 21,205 participants; 6 studies; moderate-quality evidence). Trials reporting cardiovascular mortality added ezetimibe to statin or fenofibrate, probably having little or no effect on this outcome (RR 1.00, 95% CI 0.89 to 1.12; 19457 participants; 6 studies; moderate-quality evidence). The need for coronary revascularisation might be reduced by adding ezetimibe to statin (RR 0.94, 95% CI 0.89 to 0.99; a decrease from 196/1000 to 184/1000, 95% 175 to 194; 21,323 participants; 7 studies); however, no difference in coronary revascularisation rate was observed when a sensitivity analysis was limited to studies with a low risk of bias.In terms of safety, adding ezetimibe to statins may make little or no difference in the risk of hepatopathy (RR 1.14, 95% CI 0.96 to 1.35; 20,687 participants; 4 studies; low-quality evidence). It is uncertain whether ezetimibe increase or decrease the risk of myopathy (RR 1.31, 95% CI 0.72 to 2.38; 20,581 participants; 3 studies; very low-quality evidence) and rhabdomyolysis, given the wide CIs and low event rate. Little or no difference in the risk of cancer, gallbladder-related disease and discontinuation due to adverse events were observed between treatment groups. For serum lipids, adding ezetimibe to statin or fenofibrate might further reduce the low-density lipoprotein cholesterol (LDL-C), total cholesterol and triglyceride levels and likely increase the high-density lipoprotein cholesterol levels; however, substantial heterogeneity was detected in most analyses.None of the included studies reported on health-related quality of life.

AUTHORS' CONCLUSIONS

Moderate- to high-quality evidence suggests that ezetimibe has modest beneficial effects on the risk of CVD endpoints, primarily driven by a reduction in non-fatal MI and non-fatal stroke, but it has little or no effect on clinical fatal endpoints. The cardiovascular benefit of ezetimibe might involve the reduction of LDL-C, total cholesterol and triglycerides. There is insufficient evidence to determine whether ezetimibe increases the risk of adverse events due to the low and very low quality of the evidence. The evidence for beneficial effects was mainly obtained from individuals with established atherosclerotic cardiovascular disease (ASCVD, predominantly with acute coronary syndrome) administered ezetimibe plus statins. However, there is limited evidence regarding the role of ezetimibe in primary prevention and the effects of ezetimibe monotherapy in the prevention of CVD, and these topics thus requires further investigation.

Prediction of stillbirth in women with overweight or obesity-A register-based cohort study

OBJECTIVE

To develop a model for prediction of stillbirth after the 28th gestational week in singleton pregnancies of women with overweight or obesity.

METHOD

This is a register-based cohort study. The first trimester screening database including data from 2006 until 2015 was cross-linked with the Swedish Medical Birth Register and the Swedish Register of Total Population. The final study cohort comprised 145,319 pregnancies, out of which 45,859 pregnancies were complicated by overweight or obesity and without pre-gestational diabetes. There were in total 282 stillbirths. Prediction models for stillbirth in pregnancies with overweight or obesity were constructed based on maternal characteristics, pregnancy complications and biochemical markers. Receiver Operating Characteristic (ROC) and area under curve (AUC) were calculated, based on logistic regression analyses.

RESULTS

The prevalence of stillbirth was 1.6/1000 births and 2.6/1000 births in normal weight and overweight/obese women, respectively. The final predictive model had an AUC of 0.69 (95% CI: 0.64-0.74) with a sensitivity of 28% at a 90% fixed specificity.

CONCLUSIONS

It is possible to predict 28% of stillbirths in overweight or obese women, at a false positive rate of 10%. In particular, growth-restricted fetuses are at increased risk of stillbirth.

The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke-protocol for a systematic review

BACKGROUND

Stroke rehabilitation aims to optimise function and reduce complications post-stroke. Rehabilitation to optimise physical function post-stroke has beneficial effects for survivors of mild to moderate stroke. However, little is known about the effectiveness of interventions to rehabilitate physical function or manage immobility-related complications for survivors of severe stroke. The systematic review aims to evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke and identify topics for future research in this area.

METHODS

A systematic review of relevant electronic databases (MEDLINE, Embase, CINAHL, AMED, PEDro, DORIS and CENTRAL) between January 1987 and July 2017 will be undertaken to identify eligible published randomised controlled trials (RCTs) in any language. Ongoing RCTs will be identified by searching health-care trial registers (Stroke Trials Registry, ClinicalTrials.gov). Hand searches of identified study reference lists will also be performed. The PRISMA statement will be used to guide the systematic review. Two reviewers will screen search results, select studies using pre-defined selection criteria, extract data from and assess risk of bias for selected studies. Studies comparing the effect of one type of rehabilitation intervention to another or usual care on physical function and immobility-related complications for patients with severe stroke will be included. Studies may include participants with all levels of stroke severity but must provide sub-group analysis based on stroke severity. Studies will focus on any phase of the stroke rehabilitation pathway and will be grouped and analysed according to their timeframe post-stroke into acute and early sub-acute (up to 3 months post-stroke), early sub-acute to late sub-acute (from 3 to 6 months post-stroke) and chronic (greater than 6 months post-stroke). If sufficient studies demonstrate homogeneity, a meta-analysis will pool results of individual outcomes. The GRADE approach will be used to assess the evidence strength.

DISCUSSION

The results of this systematic review will summarise the strength of evidence for rehabilitation interventions used in the rehabilitation of physical function and immobility-related complications in severe stroke and identify gaps in evidence.

SYSTEMATIC REVIEW REGISTRATION

The systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO)-registration number CRD77737 .

Prenatal therapeutics and programming of cardiovascular function

Cardiovascular diseases (CVD) are a leading cause of mortality worldwide. Despite recognizing the importance of risk factors in dictating CVD susceptibility and onset, patient treatment remains a challenging endeavor. Increasingly, the benefits of prevention and mitigation of risk factors earlier in life are being acknowledged. The developmental origins of health and disease posits that insults during specific periods of development can influence long-term health outcomes; this occurs because the developing organism is highly plastic, and hence vulnerable to environmental perturbations. By extension, targeted therapeutics instituted during critical periods of development may confer long-term protection, and thus reduce the risk of CVD in later life. This review provides a brief overview of models of developmental programming, and then discusses the impact of perinatal therapeutic interventions on long-term cardiovascular function in the offspring. The discussion focuses on bioactive food components, as well as pharmacological agents currently approved for use in pregnancy; in short, those agents most likely to be used in pregnancy and early childhood.