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Tang Y, Zhou X, Cao J, Li Z, Yin W, Wan K, Huang C, Zhu W, Yin J, Zhang W, Zhu X, Sun Z. Synergistic effect of folate and MTHFR C677T on hippocampal subfields and perfusion in Alzheimer's disease. Prog Neuropsychopharmacol Biol Psychiatry 2024; 134:111071. [PMID: 38908503 DOI: 10.1016/j.pnpbp.2024.111071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/09/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Low folate intake and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism have been suggested to increase the risk of Alzheimer's disease (AD). However, the synergistic effects and their impact on brain structure and perfusion remain unclear. METHODS This study explored the effects of dietary and genetic deficiencies in folate metabolism on the volume of the hippocampal subregions, cerebral perfusion, and cognitive decline in 71 cognitively unimpaired (CU) individuals and 102 patients with mild cognitive impairment (MCI) due to AD or AD. All participants underwent magnetic resonance imaging, laboratory examinations, and neuropsychological assessments. The hippocampal subfields were segmented using Freesurfer, and arterial spin labeling was used to measure the cerebral blood flow. RESULTS We found a significant group-by-MTHFR interaction effect on folate. Patients with AD and the 677 T allele showed hypoperfusion in the left precuneus compared to patients without this mutation, which mediated the relationship between low folate level and cognitive decline in patients carrying the 677 T allele. Moreover, a synergistic effect was observed for the combination of decreased folate concentrations and the presence of the MTHFR 677 T allele on the atrophy of specific hippocampal subregions in patients with AD. CONCLUSIONS In addition to offering insights into the neuronal mechanism underlying gene-dependent folate-induced cognitive impairment in AD, these findings may have clinical significance for the allocation of auxiliary folate supplementation therapy in patients with AD with low folate levels and carrying the MTHFR 677 T allele and may eventually promote the selection of early individualized AD drug therapy.
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Affiliation(s)
- Yating Tang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Xia Zhou
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Jing Cao
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Zhiwei Li
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Wenwen Yin
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Ke Wan
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Chaojuan Huang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Wenhao Zhu
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Jiabin Yin
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Wei Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Xiaoqun Zhu
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Zhongwu Sun
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
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102
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Cazzanelli P, Lamoca M, Hasler J, Hausmann ON, Mesfin A, Puvanesarajah V, Hitzl W, Wuertz-Kozak K. The role of miR-155-5p in inflammation and mechanical loading during intervertebral disc degeneration. Cell Commun Signal 2024; 22:419. [PMID: 39192354 DOI: 10.1186/s12964-024-01803-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 08/20/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Intervertebral disc (IVD) degeneration is a multifactorial pathological process resulting in the dysregulation of IVD cell activity. The catabolic shift observed in IVD cells during degeneration leads to increased inflammation, extracellular matrix (ECM) degradation, aberrant intracellular signaling and cell loss. Importantly, these pathological processes are known to be interconnected and to collectively contribute to the progression of the disease. MicroRNAs (miRNAs) are known as strong post-transcriptional regulators, targeting multiple genes simultaneously and regulating numerous intracellular pathways. Specifically, miR-155-5p has been of particular interest since it is known as a pro-inflammatory mediator and contributing factor to diseases like cancer and osteoarthritis. This study investigated the role of miR-155-5p in IVD degeneration with a specific focus on inflammation and mechanosensing. METHODS Gain- and loss-of-function studies were performed through transfection of human Nucleus pulposus (NP) and Annulus fibrosus (AF) cells isolated from degenerated IVDs with miR-155-5p mimics, inhibitors or their corresponding non-targeting control. Transfected cells were then subjected to an inflammatory environment or mechanical loading. Conditioned media and cell lysates were collected for phosphorylation and cytokine secretion arrays as well as gene expression analysis. RESULTS Increased expression of miR-155-5p in AF cells resulted in significant upregulation of interleukin (IL)-8 cytokine secretion during cyclic stretching and a similar trend in IL-6 secretion during inflammation. Furthermore, miR-155-5p mimics increased the expression of the brain-derived neurotrophic factor (BDNF) in AF cells undergoing cyclic stretching. In NP cells, miR-155-5p gain-of-function resulted in the activation of the mitogen-activated protein kinase (MAPK) signaling pathway through increased phosphorylation of p38 and p53. Lastly, miR-155-5p inhibition caused a significant increase in the anti-inflammatory cytokine IL-10 in AF cells and the tissue inhibitor of metalloproteinases (TIMP)-4 in NP cells respectively. CONCLUSION Overall, these results show that miR-155-5p contributes to IVD degeneration by enhancing inflammation through pro-inflammatory cytokines and MAPK signaling, as well as by promoting the catabolic shift of AF cells during mechanical loading. The inhibition of miR-155-5p may constitute a potential therapeutic approach for IVD degeneration and low back pain.
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Affiliation(s)
- Petra Cazzanelli
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, USA
| | - Mikkael Lamoca
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, USA
| | - Johannes Hasler
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, USA
| | - Oliver Nic Hausmann
- Neuro- and Spine Center, Hirslanden Klinik St. Anna, Lucerne, Switzerland
- Neurosurgical Department, University of Berne, Berne, Switzerland
| | - Addisu Mesfin
- Medstar Orthopaedic Institute, Georgetown University School of Medicine Washington, Washington, DC, USA
| | - Varun Puvanesarajah
- Department of Orthopedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Wolfgang Hitzl
- Research and Innovation Management (RIM), Paracelsus Medical University, Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Karin Wuertz-Kozak
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, USA.
- Schön Clinic Munich Harlaching, Spine Center, Academic Teaching Hospital and Spine Research Institute of the Paracelsus Medical University Salzburg (Austria), Munich, Germany.
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Baker-Smith CM. Tracking of blood pressure levels from childhood. Pediatr Nephrol 2024:10.1007/s00467-024-06485-4. [PMID: 39196350 DOI: 10.1007/s00467-024-06485-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/29/2024]
Abstract
The overall goal of this review is to summarize what is currently known regarding the tracking of blood pressure levels from early childhood into later adulthood and to describe the factors contributing to increased hypertension prevalence across the lifespan. This review describes 4 theoretical constructs of blood pressure trajectory across the lifespan: forward development, forward tracking, forward reversal, and maintenance of normal blood pressure levels.
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Affiliation(s)
- Carissa M Baker-Smith
- Nemours Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, Preventive Cardiology Program, 1600 Rockland Road, Wilmington, DE, 19803, USA.
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Yu S, Xu X, Ma L, Zhao F, Mao J, Zhang J, Wang Z. Versatile and Tunable Performance of PVA/PAM Tridimensional Hydrogel Models for Tissues and Organs: Augmenting Realism in Advanced Surgical Training. ACS APPLIED BIO MATERIALS 2024. [PMID: 39194173 DOI: 10.1021/acsabm.4c00873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
The increasing complexity and difficulty of surgical procedures have led to a rise in medical errors within clinical settings in recent years. Gastrointestinal diseases, in particular, present significant medical challenges and impose substantial economic burdens, underscoring the urgent need for experiential, high-fidelity gastrointestinal surgical training tools. This study leverages patient-specific computed tomography (CT) and magnetic resonance imaging (MRI) data, combined with 3D printed manufacturing, to develop hydrogel organ models with tunable performance and tissue-mimicking softness. These properties are achieved by regulating the freeze-thaw cycles, cross-linking agents, and the concentration of incorporated antibacterial nanoparticles in DN hydrogels. Through the application of indirect 3D printing and the "sacrificial material method", we successfully fabricate organ tissues such as the stomach, intestines, and blood vessels with high precision. In ex vivo surgical training demonstrations, these tissue-like soft hydrogels provide an effective platform for preoperative simulation and surgical training in digestive surgery, accommodating various surgical procedures and accurately simulating intraoperative bleeding. The development of advanced bionic organ models with specific and tunable characteristics based on DN hydrogels is poised to significantly advance surgical training, medical device testing, and the reform of medical education.
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Affiliation(s)
- ShiJie Yu
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang 310014, China
- General Surgery, Cancer Center, Department of Hernia Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - XiaoDong Xu
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang 310014, China
- General Surgery, Cancer Center, Department of Hernia Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Liang Ma
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang 310014, China
- General Surgery, Cancer Center, Department of Hernia Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Fei Zhao
- Center for General Practice Medicine, Department of Gastroenterology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - JinLei Mao
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang 310014, China
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, China
| | - Jing Zhang
- College of Materials Science and Engineering, Zhejiang University of Technology, Hangzhou, Zhejiang 310014, China
| | - ZhiFei Wang
- General Surgery, Cancer Center, Department of Hernia Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
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Cao X, Tan J, Zheng R, Wang F, Zhou L, Yi J, Yuan R, Dai Q, Song L, Dai A. Targeting necroptosis: a promising avenue for respiratory disease treatment. Cell Commun Signal 2024; 22:418. [PMID: 39192326 DOI: 10.1186/s12964-024-01804-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 08/22/2024] [Indexed: 08/29/2024] Open
Abstract
Respiratory diseases are a growing concern in public health because of their potential to endanger the global community. Cell death contributes critically to the pathophysiology of respiratory diseases. Recent evidence indicates that necroptosis, a unique form of programmed cell death (PCD), plays a vital role in the molecular mechanisms underlying respiratory diseases, distinguishing it from apoptosis and conventional necrosis. Necroptosis is a type of inflammatory cell death governed by receptor-interacting serine/threonine protein kinase 1 (RIPK1), RIPK3, and mixed-lineage kinase domain-like protein (MLKL), resulting in the release of intracellular contents and inflammatory factors capable of initiating an inflammatory response in adjacent tissues. These necroinflammatory conditions can result in significant organ dysfunction and long-lasting tissue damage within the lungs. Despite evidence linking necroptosis to various respiratory diseases, there are currently no specific alternative treatments that target this mechanism. This review provides a comprehensive overview of the most recent advancements in understanding the significance and mechanisms of necroptosis. Specifically, this review emphasizes the intricate association between necroptosis and respiratory diseases, highlighting the potential use of necroptosis as an innovative therapeutic approach for treating these conditions.
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Affiliation(s)
- Xianya Cao
- School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, People's Republic of China
- Hunan Provincial Key Laboratory of Vascular Biology and Translational Medicine, Changsha, Hunan, 410208, People's Republic of China
| | - Junlan Tan
- Hunan Provincial Key Laboratory of Vascular Biology and Translational Medicine, Changsha, Hunan, 410208, People's Republic of China
- Department of Respiratory Medicine, School of Medicine, Changsha, Hunan, 410021, People's Republic of China
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, 410021, People's Republic of China
| | - Runxiu Zheng
- School of Integrated Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, People's Republic of China
- Hunan Provincial Key Laboratory of Vascular Biology and Translational Medicine, Changsha, Hunan, 410208, People's Republic of China
| | - Feiying Wang
- Hunan Provincial Key Laboratory of Vascular Biology and Translational Medicine, Changsha, Hunan, 410208, People's Republic of China
- Department of Respiratory Medicine, School of Medicine, Changsha, Hunan, 410021, People's Republic of China
| | - Lingling Zhou
- Hunan Provincial Key Laboratory of Vascular Biology and Translational Medicine, Changsha, Hunan, 410208, People's Republic of China
- Department of Respiratory Medicine, School of Medicine, Changsha, Hunan, 410021, People's Republic of China
| | - Jian Yi
- Hunan Provincial Key Laboratory of Vascular Biology and Translational Medicine, Changsha, Hunan, 410208, People's Republic of China
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, 410021, People's Republic of China
| | - Rong Yuan
- Hunan Provincial Key Laboratory of Vascular Biology and Translational Medicine, Changsha, Hunan, 410208, People's Republic of China
- Department of Respiratory Medicine, School of Medicine, Changsha, Hunan, 410021, People's Republic of China
| | - Qin Dai
- Hunan Provincial Key Laboratory of Vascular Biology and Translational Medicine, Changsha, Hunan, 410208, People's Republic of China
- Department of Respiratory Medicine, School of Medicine, Changsha, Hunan, 410021, People's Republic of China
| | - Lan Song
- Hunan Provincial Key Laboratory of Vascular Biology and Translational Medicine, Changsha, Hunan, 410208, People's Republic of China
- Department of Respiratory Medicine, School of Medicine, Changsha, Hunan, 410021, People's Republic of China
| | - Aiguo Dai
- Hunan Provincial Key Laboratory of Vascular Biology and Translational Medicine, Changsha, Hunan, 410208, People's Republic of China.
- Department of Respiratory Medicine, School of Medicine, Changsha, Hunan, 410021, People's Republic of China.
- Department of Respiratory Medicine, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, 410021, People's Republic of China.
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106
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Gulati A, Roytman M, Lin J, McGrath M, Klar A, Boone K, Higa K, Ma P. Association between Helicobacter pylori infection, MASLD, and liver fibrosis in patients with severe obesity: a single-center experience. Surg Endosc 2024:10.1007/s00464-024-11177-z. [PMID: 39192041 DOI: 10.1007/s00464-024-11177-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/05/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND AND METHODS Our study sought to evaluate if an association exists between Helicobacter pylori (H. pylori), metabolic dysfunction- associated steatotic liver disease (MASLD), and liver fibrosis in patients with severe obesity (BMI > 35). Our retrospective study included 584 patients over the age of 18 years with severe obesity, who underwent preoperative liver transient elastography (VCTE), upper endoscopy, blood work, and intra-operative liver biopsy concurrent with bariatric surgery at a single institution from July 2020 to September 2021. Liver fibrosis scores including FIB-4, APRI, NAFLD fibrosis score, BARD score, AST: ALT ratio, and NAFLD activity score (NAS) were calculated from the laboratory results and liver biopsy findings. The presence or absence of H. pylori was determined based on gastric biopsies obtained during upper endoscopy. Other variables collected included age, gender, mean preoperative weight, BMI, and the presence or absence of comorbidities. Student's t-test and non-parametric testing were used for the analysis of continuous variables and Chi-square analysis was used for categorical data. RESULTS Of the 584 patients, 14.7% were H. pylori positive and 85.3% were negative. Liver fibrosis scores including FIB-4, APRI, and NAFLD fibrosis scores were significantly higher in the positive group (p < 0.05), but there was no difference in AST: ALT ratio and BARD score. A significantly higher VCTE steatosis and fibrosis scores were noted in the H. pylori-positive group (p < 0.05). Similarly, a significantly higher NAS (NAFLD activity score) on liver biopsies was noted in the positive group, with all the individual components of NAS (steatosis, lobular inflammation, and hepatocyte ballooning) being significantly higher in the positive group (p < 0.05). A significantly higher incidence of fibrosis on liver biopsies was noted in the positive group overall and across all stages of fibrosis (p < 0.05). There were no significant differences between the groups in relation to gender, mean weight, BMI, presence of comorbidities including Diabetes Mellitus, and laboratory values. CONCLUSION Our study demonstrates that H. pylori colonization or infection is associated with a higher risk of development of MASLD and progression to fibrosis. Further, population-based studies are needed to corroborate our findings.
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Affiliation(s)
| | | | - Joanne Lin
- Temple University, Philadelphia, PA, USA
| | | | - Amarita Klar
- Fresno Heart and Surgical Hospital, Fresno, CA, USA
| | - Keith Boone
- Fresno Heart and Surgical Hospital, Fresno, CA, USA
| | - Kelvin Higa
- Fresno Heart and Surgical Hospital, Fresno, CA, USA
| | - Pearl Ma
- Fresno Heart and Surgical Hospital, Fresno, CA, USA
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107
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Chong MYC, Pejchinovska M, Alexander M. Estimating causes of maternal death in data-sparse contexts. Stat Med 2024. [PMID: 39189680 DOI: 10.1002/sim.10199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/24/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024]
Abstract
Understanding the underlying causes of maternal death across all regions of the world is essential to inform policies and resource allocation to reduce the mortality burden. However, in many countries there exists very little data on the causes of maternal death, and data that do exist do not capture the entire population at risk. In this article, we present a Bayesian hierarchical multinomial model to estimate maternal cause of death distributions globally, regionally, and for all countries worldwide. The framework combines data from various sources to inform estimates, including data from civil registration and vital systems, smaller-scale surveys and studies, and high-quality data from confidential enquiries and surveillance systems. The framework accounts for varying data quality and coverage, and allows for situations where one or more causes of death are missing. We illustrate the results of the model on three case-study countries that have different data availability situations.
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Affiliation(s)
- Michael Y C Chong
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Marija Pejchinovska
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Monica Alexander
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada
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108
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Guidotti S, Torelli P, Ambiveri G, Fiduccia A, Castaldo M, Pruneti C. From the latin "re-cordis, passing through the heart": autonomic modulation differentiates migraineurs from controls when recounting a significant life event. Neurol Sci 2024:10.1007/s10072-024-07739-7. [PMID: 39187673 DOI: 10.1007/s10072-024-07739-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVE The literature on clinical psychophysiology highlights the possibility of using Heart Rate Variability (HRV) as an index of psychophysical balance and resilience to stress. This study investigates the differences in stress reactivity and subsequent recovery between a group of migraineurs and healthy controls. METHODS Socio-demographic (i.e., sex, age, profession, marital status, and level of education) and psychophysiological (HR and HRV) measures of a group of thirty subjects with migraine (26 migraineurs without aura (86.7%), 2 migraineurs with aura (6.7%), and 2 migraineurs with and without aura (6.7%)) and from thirty healthy control subjects were collected. In particular, HRV was analyzed through frequency-domain parameters, including Low-Frequency (LF; 0.04-0.15 Hz) and High-Frequency (HF; 0.15-0.4 Hz) bands as well as LF/HF ratio during a Psychophysiological Stress Profile (PSP) structured in seven phases: (1) Baseline, (2) Objective stressor 1 (Stroop Test), (3) Rest 1, (4) Objective stressor 2 (Mental Arithmetic Task), (5) Rest 2, (6) Subjective stressor (recount a significant life event), and (7) Rest 3. The LF, HF, and LF/HF ratio values were transformed into a logarithmic scale (i.e., log-LF, log-HF, and log LF/HF ratio). Additionally, LF and HF were converted into normalized units (0-100) (i.e., LF% and HF%) which, in turn, were used to obtain reactivity and recovery to stress through delta values (Δ) calculation. RESULTS Subjects with migraine reported greater ΔLF% levels of reactivity and recovery to subjective stressor, demonstrating a prevalence of sympathetic activity while recounting a personal life event. At the same time, a lowering of the same values was found in the subjects of the group control. DISCUSSION Our results underline the importance of conducting a psychophysiological assessment in patients with headaches because reduced stress management skills could influence the clinical manifestations of the disease, considering stress as one of the most common triggers for migraine patients.
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Affiliation(s)
- Sara Guidotti
- Clinical Psychology, Clinical Psychophysiology, and Clinical Neuropsychology Labs., Dept. of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Paola Torelli
- Headache Center, Neurology Unit, University Hospital of Parma, Parma, Italy
| | | | - Alice Fiduccia
- Clinical Psychology, Clinical Psychophysiology, and Clinical Neuropsychology Labs., Dept. of Medicine and Surgery, University of Parma, Parma, Italy
| | - Matteo Castaldo
- Clinical Psychology, Clinical Psychophysiology, and Clinical Neuropsychology Labs., Dept. of Medicine and Surgery, University of Parma, Parma, Italy
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Carlo Pruneti
- Clinical Psychology, Clinical Psychophysiology, and Clinical Neuropsychology Labs., Dept. of Medicine and Surgery, University of Parma, Parma, Italy
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Greenley R, Tamambang R, Koroma A, Fasoranti B, Munetsi E, Chinoko H, Stevens N, Goba N, Kinyabo PA, Bella-Awusah T, Ryan G. SUCCEED Africa: protocol for a multi-method pilot study of a community-based intervention for people with psychosis in Sierra Leone, Nigeria, Zimbabwe and Malawi. Pilot Feasibility Stud 2024; 10:114. [PMID: 39192304 DOI: 10.1186/s40814-024-01536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/05/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Recent reviews have highlighted the need for participatory research to design and evaluate inclusive, community-based interventions that address the diverse needs of people with lived experience of psychosis, within and beyond the health sector. The SUCCEED Africa consortium aims to co-produce a 6-year programme of research across four countries in West (Sierra Leone, Nigeria) and Southeast Africa (Zimbabwe and Malawi). This protocol describes the pilot study in which SUCCEED's intervention, research tools and processes will be tested on a small scale in each country in preparation for future evaluation research. METHODS The SUCCEED intervention comprises peer support, case management and livelihood activities for people with lived experience of psychosis. The pilot uses a before-and-after study design investigating change in subjective quality of life in adults diagnosed with a primary psychotic disorder or another mental disorder with psychotic symptoms who are offered the SUCCEED intervention over a 4-month period. Nested within this study are the following: a baseline assessment of the feasibility, acceptability and face validity of the selected measurement tool and validity of proxy versus self-completion; and a multi-method process evaluation examining key process indicators and implementation, service and client-level outcomes. Methods include the following: baseline cognitive interviews; semi-structed observation and routine monitoring and evaluation of service delivery; endline interviews and focus group discussions; and a comparison of provider competencies at endline. At each of the four pilot sites, participants will include the following: ten people with lived experience of psychosis, recruited from either health services or community settings using purposive sampling to maximise variation; up to ten adult family members (one per participant with lived experience) involved in their care; the peer support worker, community support worker and supervisor responsible for delivering the intervention; and the data collectors. Recruitment will take place in July and August 2023. DISCUSSION To the best of our knowledge, this will be the first study of a community-based intervention incorporating lay-delivered case management, formal peer support and livelihoods activities for people with lived experience of psychosis in sub-Saharan Africa. Findings will be relevant not only to SUCCEED but also to others interested in promoting rights-based approaches to community mental health in low-resource settings. TRIAL REGISTRATION US National Library of Medicine (ClinicalTrials.gov), Protocol reference ID 28346. Initially registered retrospectively July 20/2023: In review.
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Affiliation(s)
- Rachel Greenley
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Rita Tamambang
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Alhaji Koroma
- Mental Health Department, University of Makeni, Lunsar-Makeni Highway, Makeni, Sierra Leone
| | - Bisola Fasoranti
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ephiphania Munetsi
- Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Hilda Chinoko
- Department of Mental Health, Kamuzu University of Health Sciences, P/Bag 360, Blantyre, Malawi
| | - Nancy Stevens
- Mental Health Department, University of Makeni, Lunsar-Makeni Highway, Makeni, Sierra Leone
| | - Nyaradzo Goba
- Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Philani Ama Kinyabo
- Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Tolulope Bella-Awusah
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Child and Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Al-Hassany L, Acarsoy C, Ikram MK, Bos D, MaassenVanDenBrink A. Sex-Specific Association of Cardiovascular Risk Factors With Migraine: The Population-Based Rotterdam Study. Neurology 2024; 103:e209700. [PMID: 39083723 PMCID: PMC11319068 DOI: 10.1212/wnl.0000000000209700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/20/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although several lines of evidence suggest a link between migraine and cardiovascular events, less is known about the association between cardiovascular risk factors (CVRFs) and migraine. This knowledge is clinically important to provide directions on mitigating the cardiovascular risk in patients with migraine. We hypothesized that CVRFs are associated with a higher migraine prevalence. Therefore, our primary objective was to investigate sex-specific associations between CVRFs and lifetime prevalence of migraine. METHODS We performed cross-sectional analyses within an ongoing population-based cohort study (Rotterdam Study), including middle-aged and elderly individuals. By means of (structured) interviews, physical examinations, and blood sampling, we obtained information on the lifetime prevalence of migraine and the following traditional CVRFs: current smoking, obesity, hypercholesterolemia, hypertension, and diabetes mellitus. Similarly, we obtained information on quantitative component data on these CVRFs, including pack-years of smoking, lipid levels, systolic and diastolic blood pressure (BP), body mass index, and fasting glucose levels. Patients with migraine were age-matched to individuals without migraine, and we performed conditional logistic regression analyses to investigate the sex-stratified association of CVRFs with migraine. RESULTS In total, 7,266 community-dwelling middle-aged and elderly persons were included (median age 66.6 [IQR 56.4-74.8] years, 57.5% females). The lifetime prevalence of migraine was 14.9%. In females, current smoking (odds ratio (OR) 0.72, 95% CI 0.58-0.90), more pack-years (OR per SD increase 0.91, 95% CI 0.84-1.00), diabetes mellitus (OR 0.74, 95% CI 0.56-0.98), and higher fasting glucose levels (OR per SD increase in glucose 0.90, 95% CI 0.82 - 0.98) were all related to a lower migraine prevalence while a higher diastolic BP related to a higher migraine prevalence (OR per SD increase 1.16, 95% CI 1.04-1.29). In males, no significant associations between CVRFs and migraine were observed. DISCUSSION Traditional CVRFs were either unrelated or inversely related to migraine in middle-aged and elderly individuals, but only in females. In males, we did not find any association between CVRFs and migraine. Because only an increased diastolic BP was related to a higher migraine prevalence in females, our study contributes to the hypothesis that migraine is not directly associated with traditional CVRFs. Future studies are warranted to extrapolate these findings to younger populations.
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Affiliation(s)
- Linda Al-Hassany
- From the Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.A-H., A.M.), and Departments of Epidemiology (C.A., M.K.I., D.B.), Neurology (M.K.I.), Radiology and Nuclear Medicine (D.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Cevdet Acarsoy
- From the Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.A-H., A.M.), and Departments of Epidemiology (C.A., M.K.I., D.B.), Neurology (M.K.I.), Radiology and Nuclear Medicine (D.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M Kamran Ikram
- From the Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.A-H., A.M.), and Departments of Epidemiology (C.A., M.K.I., D.B.), Neurology (M.K.I.), Radiology and Nuclear Medicine (D.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Daniel Bos
- From the Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.A-H., A.M.), and Departments of Epidemiology (C.A., M.K.I., D.B.), Neurology (M.K.I.), Radiology and Nuclear Medicine (D.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Antoinette MaassenVanDenBrink
- From the Division of Vascular Medicine and Pharmacology, Department of Internal Medicine (L.A-H., A.M.), and Departments of Epidemiology (C.A., M.K.I., D.B.), Neurology (M.K.I.), Radiology and Nuclear Medicine (D.B.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
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111
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Helldén D, Sok S, Nordenstam A, Orsini N, Nordenstedt H, Alfvén T. Exploring the determinants of under-five mortality and morbidity from infectious diseases in Cambodia-a traditional and machine learning approach. Sci Rep 2024; 14:19847. [PMID: 39191837 DOI: 10.1038/s41598-024-70839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 08/21/2024] [Indexed: 08/29/2024] Open
Abstract
Cambodia has made progress in reducing the under-five mortality rate and burden of infectious diseases among children over the last decades. However the determinants of child mortality and morbidity in Cambodia is not well understood, and no recent analysis has been conducted to investigate possible determinants. We applied a multivariable logistical regression model and a conditional random forest to explore possible determinants of under-five mortality and under-five child morbidity from infectious diseases using the most recent Demographic Health Survey in 2021-2022. Our findings show that the majority (58%) of under-five deaths occurred during the neonatal period. Contraceptive use of the mother led to lower odds of under-five mortality (0.51 [95% CI 0.32-0.80], p-value 0.003), while being born fourth or later was associated with increased odds (3.25 [95% CI 1.09-9.66], p-value 0.034). Improved household water source and higher household wealth quintile was associated with lower odds of infectious disease while living in the Great Lake or Coastal region led to increased odds respectively. The odds ratios were consistent with the results from the conditional random forest. The study showcases how closely related child mortality and morbidity due to infectious disease are to broader social development in Cambodia and the importance of accelerating progress in many sectors to end preventable child mortality and morbidity.
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Affiliation(s)
- Daniel Helldén
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - Serey Sok
- Research Office, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Alma Nordenstam
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
- Department of Medicine and Infectious Diseases, Danderyd University Hospital, Stockholm, Sweden
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
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Beattie TS, Pollock J, Kabuti R, Abramsky T, Kung’u M, Babu H, Huibner S, Udayakumar S, Nyamweya C, Okumu M, Mahero A, Beksinska A, Panneh M, Ngurukiri P, Irungu E, Adhiambo W, Muthoga P, Seeley J, Weiss H, Kaul R, Kimani J. Are violence, harmful alcohol/substance use and poor mental health associated with increased genital inflammation?: A longitudinal cohort study with HIV-negative female sex workers in Nairobi, Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003592. [PMID: 39190654 PMCID: PMC11349110 DOI: 10.1371/journal.pgph.0003592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/21/2024] [Indexed: 08/29/2024]
Abstract
Violence, alcohol use, substance use and poor mental health have been linked with increased HIV acquisition risk, and genital inflammation enhances HIV susceptibility. We examined whether past 6 month experience of these exposures was associated with increased genital inflammation, thereby providing a biological link between these exposures and HIV acquisition risk. The Maisha Fiti study was a longitudinal mixed-methods study of female sex workers in Nairobi, Kenya. Behavioural-biological surveys were conducted at baseline (June-December 2019) and endline (June 2020-March 2021). Analyses were restricted to HIV-negative women (n = 746). Women with raised levels of at least 5 of 9 genital inflammatory cytokines were defined as having genital inflammation. Multivariable logistic regression models were used to estimate (i) baseline associations between genital inflammation and violence, harmful alcohol/substance use, and poor mental health, and (ii) longitudinal associations between these exposures at different survey rounds, and genital inflammation at follow-up. Inflammation data was available for 711 of 746 (95.3%) women at baseline; 351 (50.1%) had genital inflammation, as did 247 (46.7%) at follow-up. At baseline, 67.8% of women had experienced physical and/or sexual violence in the past 6 months, 33.9% had harmful alcohol use, 26.4% had harmful substance use, 25.5% had moderate/severe depression/anxiety, and 13.9% had post-traumatic stress disorder. In adjusted analyses, there was no evidence that these exposures were associated cross-sectionally or longitudinally with genital inflammation. We report no associations between past 6 month experience of violence, harmful alcohol/substance use, or poor mental health, and immune parameters previously associated with HIV risk. This suggests that the well-described epidemiological associations between these exposures and HIV acquisition do not appear to be mediated by genital immune changes, or that any such changes are relatively short-lived. High prevalences of these exposures suggest an urgent need for sex-worker specific violence, alcohol/substance use and mental health interventions.
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Affiliation(s)
- Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James Pollock
- Department of Immunology, University of Toronto, Toronto, Canada
| | - Rhoda Kabuti
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Tanya Abramsky
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mary Kung’u
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | - Sanja Huibner
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Suji Udayakumar
- Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Monica Okumu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Anne Mahero
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mamtuti Panneh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Erastus Irungu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Wendy Adhiambo
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Peter Muthoga
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Weiss
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
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Hou L, Wang X, Li P, Zhang H, Yao Y, Liu Z, Wang J, Liu W. Adiposity modifies the association between heart failure risk and glucose metabolic disorder in older individuals: a community-based prospective cohort study. Cardiovasc Diabetol 2024; 23:318. [PMID: 39192249 DOI: 10.1186/s12933-024-02418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/22/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Glucose metabolic disorder is associated with the risk of heart failure (HF). Adiposity is a comorbidity that is inextricably linked with abnormal glucose metabolism in older individuals. However, the effect of adiposity on the association between glucose metabolic disorder and HF risk, and the underlying mechanism remain unclear. METHODS A total of 13,251 participants aged ≥ 60 years from a cohort study were categorized into euglycemia, prediabetes, uncontrolled diabetes, and well-controlled diabetes. Adiposity was assessed using body mass index (BMI), waist-to-hip ratio (WHR), and visceral fat area (VFA). Adiposity-associated metabolic activities were evaluated using adiponectin-to-leptin ratio (ALR), homeostatic model assessment of insulin resistance (HOMA-IR), and triglyceride-glucose index (TyG). The first occurrence of HF served as the outcome during the follow-up period. RESULTS A total of 1,138 participants developed HF over the course of an average follow-up period of 10.9 years. The rate of incident HF occurrence was higher in prediabetes, uncontrolled diabetes, and well-controlled diabetes participants compared to that in euglycemia participants. However, the high rates were significantly attenuated by BMI, VFA, and WHR. For WHR in particular, the hazard ratio for incident HF was 1.18 (95% confidence interval (CI): 1.03, 1.35, Padj.=0.017) in prediabetes, 1.59 (95% CI: 1.34, 1.90, Padj.<0.001) in uncontrolled diabetes, and 1.10 (95% CI: 0.85, 1.43, Padj.=0.466) in well-controlled diabetes. The population attributable risk percentage for central obesity classified by WHR for incident HF was 30.3% in euglycemia, 50.0% in prediabetes, 48.5% in uncontrolled diabetes, and 54.4% in well-controlled diabetes. Adiposity measures, especially WHR, showed a significant interaction with glucose metabolic disorder in incident HF (all Padj.<0.001). ALR was negatively associated and HOMA-IR and TyG were positively associated with BMI, WHR, VFA, and incident HF (all Padj.<0.05). ALR, HOMA-IR, and TyG mediated the associations for BMI, WHR and VFA with incident HF (all Padj.<0.05). CONCLUSIONS Adiposity attenuated the association of glucose metabolic disorder with incident HF. The results also showed that WHR may be an appropriate indicator for evaluating adiposity in older individuals. Adiposity-associated metabolic activities may have a bridging role in the process of adiposity attenuating the association between glucose metabolic disorder and incident HF. TRIAL REGISTRATION retrospectively registered number: ChiCTR-EOC-17,013,598.
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Affiliation(s)
- Liming Hou
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, No. 16766, Jingshi Road, Jinan, 250014, Shandong, China
- Cardio-Cerebrovascular Control and Research Center, Clinical and Basic Medicine College, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Xin Wang
- Department of Cardiology, The Second Hospital of Shandong University, No. 247, Beiyuan Street, Jinan, 250012, Shandong, China
| | - Peilin Li
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, No. 16766, Jingshi Road, Jinan, 250014, Shandong, China
| | - Hua Zhang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, No. 16766, Jingshi Road, Jinan, 250014, Shandong, China
- Cardio-Cerebrovascular Control and Research Center, Clinical and Basic Medicine College, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Yanli Yao
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, No. 16766, Jingshi Road, Jinan, 250014, Shandong, China
- Cardio-Cerebrovascular Control and Research Center, Clinical and Basic Medicine College, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China
| | - Zhendong Liu
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, No. 16766, Jingshi Road, Jinan, 250014, Shandong, China.
- Cardio-Cerebrovascular Control and Research Center, Clinical and Basic Medicine College, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, Shandong, China.
| | - Juan Wang
- Department of Cardiology, The Second Hospital of Shandong University, No. 247, Beiyuan Street, Jinan, 250012, Shandong, China.
| | - Weike Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Harbin, 150001, Heilongjiang, China.
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Karlström P, Pivodic A, Dahlström U, Fu M. Modern heart failure treatment is superior to conventional treatment across the left ventricular ejection spectrum: real-life data from the Swedish Heart Failure Registry 2013-2020. Clin Res Cardiol 2024:10.1007/s00392-024-02498-z. [PMID: 39186181 DOI: 10.1007/s00392-024-02498-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/15/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES This study is aimed to compare the effectiveness of modern therapy including angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) with conventional heart failure treatment in the real world. BACKGROUND Since ARNI and SGLT2i were introduced to treat heart failure (HF), its therapeutic regimen has modernized from previous treatment with beta-blocker (BB) and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB) with mineralocorticoid receptor antagonist (MRA) as added-on in HF with reduced ejection fraction (HFrEF). However, a comparison between conventional and modern treatment strategies with drugs in combination has not been performed. METHODS This observational study (2013-2020), using the Swedish HF Registry, involved 20,849 HF patients. Patients received either conventional (BB, ACEi/ARB, with/without MRA, n = 20,140) or modern (BB, ACEi/ARB, MRA, SGLT2i or BB, ARNI, MRA with/without SGLT2i, n = 709) treatment at the index visit. The endpoints were all-cause and cardiovascular (CV) mortality. RESULTS Modern HF therapy was associated with a significant 28% reduction in all-cause mortality (adjusted HR [aHR], 0.72 (0.54-0.96); p = 0.024) and a significant 62% reduction in CV mortality (aHR, 0.38 (0.21-0.68); p = 0.0013) compared to conventional HF treatment. Similar results emerged in a sensitivity analysis using propensity score matching. The interaction analyses did not reveal any trends for EF (< 40% and ≥ 40%), sex, age (< 70 and ≥ 70 years), eGFR (< 60 and ≥ 60 ml/min/1.73 m2), and etiology of HF subgroups. CONCLUSION In this nationwide study, modern HF therapy was associated with significantly reduced all-cause and CV mortality, regardless of EF, sex, age, eGFR, and etiology of HF.
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Affiliation(s)
- Patric Karlström
- Department of Internal Medicine, Ryhov County Hospital, SE-551 85, Jönköping, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Aldina Pivodic
- APNC Sweden, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Gothenburg, Sweden
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Baxter L, Cobo MM, Bhatt A, Slater R, Sanni O, Shinde N. The association between ibuprofen administration in children and the risk of developing or exacerbating asthma: a systematic review and meta-analysis. BMC Pulm Med 2024; 24:412. [PMID: 39187775 PMCID: PMC11348613 DOI: 10.1186/s12890-024-03179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 07/22/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Ibuprofen is one of the most commonly used analgesic and antipyretic drugs in children. However, its potential causal role in childhood asthma pathogenesis remains uncertain. In this systematic review, we assessed the association between ibuprofen administration in children and the risk of developing or exacerbating asthma. METHODS We searched MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and Scopus from inception to May 2022, with no language limits; searched relevant reviews; and performed citation searching. We included studies of any design that were primary empirical peer-reviewed publications, where ibuprofen use in children 0-18 years was reported. Screening was performed in duplicate by blinded review. In total, 24 studies met our criteria. Data were extracted according to PRISMA guidelines, and the risk of bias was assessed using RoB2 and NOS tools. Quantitative data were pooled using fixed effect models, and qualitative data were pooled using narrative synthesis. Primary outcomes were asthma or asthma-like symptoms. The results were grouped according to population (general, asthmatic, and ibuprofen-hypersensitive), comparator type (active and non-active) and follow-up duration (short- and long-term). RESULTS Comparing ibuprofen with active comparators, there was no evidence of a higher risk associated with ibuprofen over both the short and long term in either the general or asthmatic population. Comparing ibuprofen use with no active alternative over a short-term follow-up, ibuprofen may provide protection against asthma-like symptoms in the general population when used to ease symptoms of fever or bronchiolitis. In contrast, it may cause asthma exacerbation for those with pre-existing asthma. However, in both populations, there were no clear long-term follow-up effects. CONCLUSIONS Ibuprofen use in children had no elevated risk relative to active comparators. However, use in children with asthma may lead to asthma exacerbation. The results are driven by a very small number of influential studies, and research in several key clinical contexts is limited to single studies. Both clinical trials and observational studies are needed to understand the potential role of ibuprofen in childhood asthma pathogenesis.
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Affiliation(s)
- Luke Baxter
- Department of Paediatrics, University of Oxford, Oxford, UK.
| | - Maria M Cobo
- Department of Paediatrics, University of Oxford, Oxford, UK
- Colegio de Ciencias Biologicas y Ambientales, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Aomesh Bhatt
- Department of Paediatrics, University of Oxford, Oxford, UK
| | | | | | - Nutan Shinde
- Reckitt (Global Headquarters), Turner House, 103-105 Bath Road, Slough, Berkshire, SL1 3UH, UK
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Ghanem L, Essayli D, Kotaich J, Zein MA, Sahebkar A, Eid AH. Phenotypic switch of vascular smooth muscle cells in COVID-19: Role of cholesterol, calcium, and phosphate. J Cell Physiol 2024:e31424. [PMID: 39188012 DOI: 10.1002/jcp.31424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/11/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024]
Abstract
Although the novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily manifests as severe respiratory distress, its impact on the cardiovascular system is also notable. Studies reveal that COVID-19 patients often suffer from certain vascular diseases, partly attributed to increased proliferation or altered phenotype of vascular smooth muscle cells (VSMCs). Although the association between COVID-19 and VSMCs is recognized, the precise mechanism underlying SARS-CoV-2's influence on VSMC phenotype remains largely under-reviewed. In this context, while there is a consistent body of literature dissecting the effect of COVID-19 on the cardiovascular system, few reports delve into the potential role of VSMC switching in the pathophysiology associated with COVID-19 and the molecular mechanisms involved therein. This review dissects and critiques the link between COVID-19 and VSMCs, with particular attention to pathways involving cholesterol, calcium, and phosphate. These pathways underpin the interaction between the virus and VSMCs. Such interaction promotes VSMC proliferation, and eventually potentiates vascular calcification as well as worsens prognosis in patients with COVID-19.
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Affiliation(s)
- Laura Ghanem
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Dina Essayli
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Jana Kotaich
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
- MEDICA Research Investigation, Beirut, Lebanon
| | - Mohammad Al Zein
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Amirhossein Sahebkar
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali H Eid
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
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Raheem A, Soomar SM, Issani A, Rahim KA, Dhalla Z, Soomar SM, Mian AI, Khan NU. Thirty-year trends of triple burden of disease in the adult population of Pakistan. J Public Health (Oxf) 2024; 46:e369-e379. [PMID: 38654655 DOI: 10.1093/pubmed/fdae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/10/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The triple burden of disease, i.e. communicable diseases, non-communicable diseases and injuries, has significantly affected the healthcare system of Pakistan during the last three decades. Therefore, this study aims to determine and analyse the 30-year disease burden trends through prevalence, death rates and percentages. METHODS The data for the last three decades, i.e. 1990 to 2019, was extracted from the Global Burden of Disease for Pakistan. Percentage change in prevalence and deaths over 30 years was calculated. Poisson regression analysis was performed to evaluate the triple disease burden trends and the incidence rate ratio. RESULTS A relative decrease of 23.4% was noted in the prevalence rate of communicable diseases except for human immunodeficiency virus and dengue fever. A relative increase of 1.4% was noted in the prevalence rate of non-communicable diseases. A relative increase of 56.1% was recorded in the prevalence rate of injuries. The prevalence rate ratios of communicable diseases significantly decreased to 0.9796 [95% CI: 0.9887-0.9905], but the prevalence rate of injury increased to 1.0094 [95% CI: 1.0073-1.01145], respectively. CONCLUSION Pakistan must take the next steps and develop strategies to decrease this burden and mortality rates in the population to create better outcomes and therefore help the healthcare system overall.
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Affiliation(s)
- Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
| | | | - Ali Issani
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
| | - Komal Abdul Rahim
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Zeyanna Dhalla
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
- University of Michigan, School of Public Health, Ann Arbor, Michigan 48109, USA
| | | | - Asad Iqbal Mian
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
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Rinaldi AEM, Nucci LB, Enes CC. Modeling the potential impact of a sugar-sweetened beverage tax on ischemic heart disease and stroke in Brazil. J Public Health (Oxf) 2024; 46:357-365. [PMID: 38798018 DOI: 10.1093/pubmed/fdae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/25/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND A high intake of sugar-sweetened beverages (SSBs) is associated with the risk of several chronic diseases, including ischemic heart disease (IHD) and stroke. This study aimed to model the impact of a 20% tax on all SSBs for IHD and stroke among Brazilian adults. METHODS This was an ex-ante risk comparative study. The model applied a 20% tax on SSBs and projected the incidence, prevalence and mortality of IHD and stroke over a 20-year period (2019-39). Using data on consumption, previously published cross- and own-price elasticities of SSBs, and relative risk, we estimated changes in IHD and stroke burden. RESULTS Our model predicts that a 20% SSB tax may reduce new cases of IHD by ~13%, especially among women, and avert ~8% of the deaths attributable to IHD over 20 years. These results represent a decrease of 19 543 new cases and 8466 and 7274 fewer deaths in the period for men and women, respectively. Estimates of reduction in incidence, prevalence and deaths from stroke were not significant over 20 years. CONCLUSIONS Even under conservative assumptions, our study found that a small reduction in SSB consumption led to a substantial decrease in IHD incidence and mortality in Brazil.
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Affiliation(s)
- Ana Elisa M Rinaldi
- School of Medicine, Postgraduate Program in Health Sciences, Federal University of Uberlândia (FAMED-UFU), 1720, Pará Avenue, Block 2U, Uberlândia, MG 38400-902, Brazil
| | - Luciana Bertoldi Nucci
- School of Life Sciences, Postgraduate Program in Health Sciences, Pontifical Catholic University of Campinas (PUC-Campinas), Av. John Boyd Dunlop (no number), Campinas, SP 13060-904, Brazil
| | - Carla Cristina Enes
- School of Life Sciences, Postgraduate Program in Health Sciences, Pontifical Catholic University of Campinas (PUC-Campinas), Av. John Boyd Dunlop (no number), Campinas, SP 13060-904, Brazil
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Loosen SH, Mertens A, Klein I, Leyh C, Krieg S, Kandler J, Luedde T, Roderburg C, Kostev K. Association between Helicobacter pylori and its eradication and the development of cancer. BMJ Open Gastroenterol 2024; 11:e001377. [PMID: 39181567 PMCID: PMC11344509 DOI: 10.1136/bmjgast-2024-001377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 08/02/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) is a gram-negative gastrointestinal pathogen that colonises the human stomach and is considered a major risk factor for gastric cancer and mucosa-associated lymphoid tissue lymphoma. Furthermore, H. pylori is a potential trigger of a wide spectrum of extragastric cancer entities, extraintestinal chronic inflammatory processes and autoimmune diseases. In the present study, we evaluated the association between H. pylori infection and its eradication with the development of subsequent gastrointestinal and non-gastrointestinal cancer. METHODS We identified 25 317 individuals with and 25 317 matched individuals without a diagnosis of H. pylori from the Disease Analyzer database (IQVIA). A subsequent cancer diagnosis was analysed using Kaplan-Meier and conditional Cox-regression analysis as a function of H. pylori and its eradication. RESULTS After 10 years of follow-up, 12.8% of the H. pylori cohort and 11.8% of the non-H. pylori cohort were diagnosed with cancer (p=0.002). Results were confirmed in regression analysis (HR: 1.11; 95% CI 1.04 to 1.18). Moreover, a non-eradicated H. pylori status (HR: 1.18; 95% CI 1.07 to 1.30) but not an eradicated H. pylori status (HR: 1.06; 95% CI 0.97 to 1.15) was associated with a subsequent diagnosis of cancer. In subgroup analyses, H. pylori eradication was negatively associated with bronchus and lung cancer (HR: 0.60; 95% CI 0.44 to 0.83). CONCLUSION Our data from a large outpatient cohort in Germany reveal a distinct association between H. pylori infection and the subsequent development of cancer. These data might help to identify patients at risk and support eradication strategies in the future.
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Affiliation(s)
- Sven Heiko Loosen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Alexander Mertens
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Düsseldorf, Düsseldorf, Germany
| | | | - Catherine Leyh
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Sarah Krieg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Jennis Kandler
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Christoph Roderburg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Düsseldorf, Düsseldorf, Germany
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Ho CC, Peng SJ, Yu YH, Chu YR, Huang SS, Kuo PH. In perspective of specific symptoms of major depressive disorder: Functional connectivity analysis of electroencephalography and potential biomarkers of treatment response. J Affect Disord 2024:S0165-0327(24)01372-7. [PMID: 39187193 DOI: 10.1016/j.jad.2024.08.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 08/01/2024] [Accepted: 08/23/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND The symptom variability in major depressive disorder (MDD) complicates treatment assessment, necessitating a thorough understanding of MDD symptoms and potential biomarkers. METHODS In this prospective study, we enrolled 54 MDD patients and 39 controls. Over the course of weeks 1, 2, and 4 participants underwent evaluations, with electroencephalograms (EEG) recorded at baseline and week 1. Our investigation considered five previously identified syndromal factors derived from the 17-item Hamilton Depression Rating Scale (17-item HAMD) for assessing depression: core, insomnia, somatic anxiety, psychomotor-insight, and anorexia. We assessed treatment response and EEG characteristics across all syndromal factors and total scores, all of which are based on the 17-item HAMD. To analyze the topology of brain networks, we employed functional connectivity (FC) and a graph theory-based method across various frequency bands. RESULTS The healthy control group had notably higher values in delta band EEG FC compared to the MDD patient group. Similar distinctions were observed between the responder and non-responder patient groups. Further exploration of baseline FC values across distinct syndromal factors revealed significant variations among the core, psychomotor-insight, and anorexia subgroups when using a specific graph theory-based approach, focusing on global efficiency and average clustering coefficient. LIMITATIONS Different antidepressants were included in this study. Therefore, the results should be interpreted with caution. CONCLUSIONS Our findings suggest that delta band EEG FC holds promise as a valuable predictor of antidepressant efficacy. It demonstrates an ability to adapt to individual variations in depressive symptomatology, offering insights into personalized treatment for patients with depression.
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Affiliation(s)
- Chao-Chung Ho
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Syu-Jyun Peng
- Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Hsiang Yu
- Division of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan; College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yeong-Ruey Chu
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Shiau-Shian Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan.
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
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Feng L, Yuan J, Li L, Tang J. Identification of Pyroptosis-Related Molecular Subtypes and Diagnostic Model development in Major Depressive Disorder. Mol Biotechnol 2024:10.1007/s12033-024-01252-0. [PMID: 39177862 DOI: 10.1007/s12033-024-01252-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 08/07/2024] [Indexed: 08/24/2024]
Abstract
Major depressive disorder (MDD) is a prevalent psychological disorder associated with inflammation, with complex pathological mechanisms. Pyroptosis has been suggested to contribute to inflammation in central nervous system diseases. Little research, however, has examined what role pyroptosis played in MDD. In the present study, the differential expression pyroptosis-related genes (DE-PRGs) in MDD were identified from the GEO database (GSE98793 and GSE19738). Then, consensus clustering analysis was used to evaluate differences in MDD molecular subtypes characteristics based on PRGs. The characteristic diagnostic biomarkers for MDD were identified by Weighted Correlation Network Analysis (WGCNA) and multiple machine learning algorithms. Three intersection genes (GZMA, AKR1C3, and CD52) were obtained, which are expected to become potential biomarkers for MDD with excellent reliability and accuracy. Subsequently, the immune infiltration characteristics result indicated that the development of MDD is mediated by immune-related function, where three DE-PRGs were strongly related to the immune infiltration landscape of MDD. The biological experiments in vitro further proved that three unique PRGs are emerging as important players in MDD diagnosis. Our research aimed to provide novel ideas and biomarkers targeting MDD.
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Affiliation(s)
- Lin Feng
- Harbin Sport University, Harbin, Heilongjiang, China
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Jiabo Yuan
- The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Li Li
- Harbin Sport University, Harbin, Heilongjiang, China.
| | - Junze Tang
- Harbin Sport University, Harbin, Heilongjiang, China.
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Steen S, Horn D, Flechtenmacher C, Hoffmann J, Freier K, Ristow O, Hess J, Moratin J. Expression analysis of SOX2 and SOX9 in patients with oral squamous cell carcinoma. Head Neck 2024. [PMID: 39180200 DOI: 10.1002/hed.27925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/12/2024] [Accepted: 08/15/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Lately SOX2 and SOX9, transcription factors associated with stemness-like phenotypes of cancer cells, have been linked to tumor growth, metastasis, and resistance to therapy. METHODS This study aimed on evaluating the expression of SOX2 and SOX9 in a large cohort of patients with OSCC including primary and recurrent tumors and corresponding lymph node metastases. Semiautomatic digital pathology scoring was used to determine protein expression and survival analysis was performed to evaluate its prognostic significance. RESULTS We found a significant downregulation of SOX9 from primary disease to lymph node metastases (p < 0.001). SOX9 expression and the subgroup SOX2lowSOX9high were significantly correlated with worse overall survival (p < 0.05). Additionally, SOX2lowSOX9high expression pattern was confirmed as independent prognosticator for overall survival. CONCLUSIONS These results indicate the relevant role of SOX2 and SOX9 in patients with OSCC and show the clinical relevance for further investigation on the molecular mechanisms underlying SOX-related gene expression.
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Affiliation(s)
- Sonja Steen
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Dominik Horn
- Department of Oral and Cranio-Maxillofacial Surgery, Saarland University Hospital, Homburg, Germany
| | - Christa Flechtenmacher
- Tissue Bank of the National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Kolja Freier
- Department of Oral and Cranio-Maxillofacial Surgery, Saarland University Hospital, Homburg, Germany
| | - Oliver Ristow
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jochen Hess
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany
| | - Julius Moratin
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
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Tan YJ, Linden S, Ong SC. Cost-effectiveness of empagliflozin in the treatment of Malaysian patients with chronic heart failure and preserved or mildly reduced ejection fraction. PLoS One 2024; 19:e0305257. [PMID: 39178204 PMCID: PMC11343421 DOI: 10.1371/journal.pone.0305257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 05/28/2024] [Indexed: 08/25/2024] Open
Abstract
INTRODUCTION Empagliflozin demonstrates promising clinical benefits in patients with heart failure (HF). While an early study demonstrates that empagliflozin is cost-effective for treating HF patients with reduced ejection fraction (HFrEF) in Malaysia, its cost-effectiveness for HF with ejection fraction (EF)>40% remains unclear. Therefore, the current study aimed to assess the cost-effectiveness of adding empagliflozin to the standard of care (SoC) for HF patients with EF>40% from the perspective of Malaysian healthcare system. Subsequently, the results were consolidated with the findings for HFrEF to evaluate the cost-effectiveness of empagliflozin when used for all HF patients in Malaysia, irrespective of EF. METHODS A cost-utility analysis was performed using a validated Markov model, which modelled a cohort of adult patients through health states related to symptom severity and functional impairment, to estimate costs and quality-adjusted life-years (QALYs). The influence of model inputs and assumptions, sensitivity, scenario, and subgroup analyses were explored. All costs were expressed in 2022 Malaysian ringgits (RM). Costs and QALYs were discounted at an annual rate of 3.0% as per local pharmacoeconomic guideline. RESULTS The base-case incremental cost-effectiveness ratio (ICER) for HF patients with EF>40% was RM 40,454 per QALY gained. At a cost-effectiveness threshold of RM 47,439/QALY gained, empagliflozin was cost-effective in 57% of replications. The model outcomes were sensitive to inputs related to the treatment effect of empagliflozin in reducing HF-related hospitalisation and cardiovascular mortality, and empagliflozin cost. For the overall HF population, the ICER was RM 29,463/QALY gained. CONCLUSION The findings suggest that empagliflozin is a cost-effective treatment option for the Malaysian HF population, including those with EF>40%. As such, the intervention warrants consideration by the Malaysian healthcare provider to mitigate the burden of HF and address the unmet needs of the EF>40% population.
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Affiliation(s)
- Yi Jing Tan
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Hospital Seri Manjung, Ministry of Health Malaysia, Seri Manjung, Perak, Malaysia
| | - Stephan Linden
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Wang W, Zhang D, Liang Q, Liu X, Shi J, Zhou F. Global burden, risk factor analysis, and prediction study of leukaemia from 1990 to 2030. J Glob Health 2024; 14:04150. [PMID: 39173170 PMCID: PMC11345035 DOI: 10.7189/jogh.14.04150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
Background Leukaemia is a devastating disease with an incidence that progressively increases with advancing age. The World Health Organization has designated 2021-30 as the decade of healthy ageing, highlighting the need to address age-related diseases. We estimated the disease burden of leukaemia and forecasted it by 2030. Methods Based on the Global Burden of Disease 2019 database, we systematically analysed the geographical distribution of leukaemia and its subtypes. We used Joinpoint regression and Bayesian age-period-cohort models to evaluate incidence and mortality trends from 1990 to 2019 and projections through 2030. We analysed five leukaemia subtypes and the impact of age, gender, and social development. Decomposition analysis revealed the effects of disease burden on ageing and population growth. We used frontier analysis to illustrate the potential of each country to reduce its burden based on its development levels. Results Globally, the absolute numbers of leukaemia incidence and mortality have increased, while the age-standardised rates (ASRs) have shown a decreasing trend. The disease burden was more pronounced in men, the elderly, and regions with a high socio-demographic index (SDI), where ageing and population growth played varying roles across subtypes. From 2000 to 2006, disease burdens were most effectively controlled. Global ASRs of incidence might stabilise, while ASRs of death are expected to decrease until 2030. Frontier analysis showed that middle and high-middle SDI countries have the most improvement potential. Smoking and high body mass index were the main risk factors for leukaemia-related mortality and disability-adjusted life years. Conclusions The absolute number of leukaemia cases has increased worldwide, but there has been a sharp decline in ASRs over the past decade, primarily driven by population growth and ageing. Countries with middle and high-middle SDI urgently need to take action to address this challenge.
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Affiliation(s)
- Wenjun Wang
- Department of Haematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Donglei Zhang
- Department of Haematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qian Liang
- Zhoukou Central Hospital, Zhoukou, China
| | - Xiaoyan Liu
- Department of Haematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Shi
- Regenerative Medicine Clinic, State Key Laboratory of Experimental Haematology, National Clinical Research Centre for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Fuling Zhou
- Department of Haematology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Jiang Y, Zhang Y, Suo H, Lv Y, Liu S, Gao Z, Chen Y, Zhang M, Meng X, Gao S. Modulation of miR-466d-3p on Wnt signaling pathway in response to DEPs-induced blood-brain barrier disruption. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 284:116869. [PMID: 39178759 DOI: 10.1016/j.ecoenv.2024.116869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 08/04/2024] [Accepted: 08/09/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Diesel exhaust particles (DEPs), a predominant component of ambient particulate matter (PM), are classified as ultrafine particles with the capacity to penetrate the cerebral blood-brain barrier (BBB). This penetration is implicated in the pathogenesis of central nervous system (CNS) disorders. The integrity of the BBB is inextricably linked to cerebrovascular homeostasis and the development of neurodegenerative disease, highlighting the importance of studying the effects and mechanisms of DEPs on BBB function damage. METHODS AND RESULTS Utilizing mouse cerebral microvascular endothelial cells (bEnd.3 cells) as an in vitro model of the BBB, we explored the detrimental effects of DEPs exposure on BBB permeability and integrity, with particular focus on inflammation, cell apoptosis, and miRNA expression profiles. Our findings revealed that exposure to DEPs at varying concentrations for 48 h resulted in the inhibition of bEND.3 cell proliferation, induction of cell apoptosis, and an upregulation in the secretion of inflammatory cytokines/chemokines and adhesion molecules. The BBB integrity was further compromised, as evidenced by a decrease in trans-epithelial electrical resistance(TEER), a reduction in cytoskeletal F-actin, , and diminished tight junction (TJ) protein expression. Microarray analysis revealed that 23 miRNAs were upregulated and 11 were downregulated in response to a 50 μg/mL DEPs treatment, with miR-466d-3p being notably differentially expressed. Wnt3 was identified as a target of miR-466d-3p, with the Wnt signaling pathway being significantly enriched. We validated that miR-466d-3p expression was downregulated, and the protein expression levels of Wnt/β-catenin and Wnt/PCP signaling components were elevated. The modulation of the Wnt signaling pathway by miR-466d-3p was demonstrated by the transfection of miR-466d-3p mimic, which resulted in a downregulation of Wnt3 and β-catenin protein expression, and the mRNA level of Daam1, as well as an enhancement of TJ proteins ZO-1 and Claudin-5 expression. CONCLUSIONS Our study further confirmed that DEPs can induce the disruption of BBB integrity through inflammatory processes. We identified alterations in the expression profile of microRNAs (miRNAs) in endothelial cells, with miR-466d-3p emerging as a key regulator of tight junction (TJ) proteins, essential for maintaining BBB integrity. Additionally, our findings primarily demonstrated that the Wnt/ β-catenin and Wnt/PCP signaling pathway can be activated by DEPs and are regulated by miR-466d-3p. Under the combined effects of Wnt/PCP and inflammation, there is an ultimate increase in BBB hyperpermeability. METHODS AND RESULTS Employing mouse cerebral microvascular endothelial cells (bEnd.3 cells) as an in vitro model of the BBB, we investigated the adverse effects of DEPs exposure on BBB permeability and integrity, with particular focus on inflammation, cell apoptosis, and miRNA expression profiles. Our findings revealed that exposure to DEPs at varying concentrations for 48 h resulted in the inhibition of bEND.3 cell proliferation, induction of cell apoptosis, and an increase in the release of inflammatory cytokines/chemokines and adhesion molecules. The BBB integrity was further compromised, as evidenced by a decrease in trans-epithelial electrical resistance(TEER), a reduction in cytoskeletal F-actin, loss of intercellular junctional organization, and diminished tight junction (TJ) protein expression. Microarray analysis disclosed that 23 miRNAs were upregulated and 11 were downregulated in bEND.3 cells treated with 50 μg/mL DEPs compared to the controls. In particular, miR-466d-3p was identified as a significantly differentially expressed miRNA. Wnt3 was predicted to be a target of miR-466d-3p, and the Wnt signaling pathway was identified as one of the most significantly enriched pathways. We validated that miR-466d-3p expression was downregulated, and the protein expression levels of Wnt/β-catenin and Wnt/PCP signaling components were elevated. The modulation of the Wnt signaling pathway by miR-466d-3p was demonstrated by the transfection of miR-466d-3p mimic, which resulted in a downregulation of Wnt3 and β-catenin protein expression, and the mRNA level of Daam1, as well as an enhancement of TJ proteins ZO-1 and Claudin-5 expression. CONCLUSIONS Our study further confirmed that DEPs can induce the disruption of BBB integrity by inflammation. We identified changes in the expression profile of microRNAs (miRNAs) in endothelial cells, with miR-466d-3p emerging as a regulator of tight junction (TJ) proteins, which are critical for maintaining BBB integrity. Additionally, our findings primarily demonstrated that the Wnt/ β-catenin and Wnt/PCP signaling pathway can be activated by DEPs and is regulated by miR-466d-3p, and under the combined effects of Wnt/PCP and inflammation ultimately led to hyperpermeability BBB.
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Affiliation(s)
- Yue Jiang
- Department of Toxicology, School of Public Health, Harbin Medical University, Harbin 150081, China
| | - Ya Zhang
- Department of Toxicology, School of Public Health, Harbin Medical University, Harbin 150081, China
| | - Huimin Suo
- Department of Toxicology, School of Public Health, Harbin Medical University, Harbin 150081, China
| | - Yanming Lv
- Department of Toxicology, School of Public Health, Harbin Medical University, Harbin 150081, China
| | - Siqi Liu
- Department of Toxicology, School of Public Health, Harbin Medical University, Harbin 150081, China
| | - Zhijian Gao
- Department of Toxicology, School of Public Health, Harbin Medical University, Harbin 150081, China
| | - Yingying Chen
- Department of Toxicology, School of Public Health, Harbin Medical University, Harbin 150081, China
| | - Mingming Zhang
- School of Bioinformatics, Harbin Medical University, Harbin 150081, China
| | - Xiangning Meng
- Department of Medical Genetics, Harbin Medical University, Harbin 150081, China
| | - Shuying Gao
- Department of Toxicology, School of Public Health, Harbin Medical University, Harbin 150081, China.
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Zhang X, Fang W, Zhang Y, Yang M, Wang M, Fan X. The relationship between fatigue, exercise self-efficacy, fear of movement, and quality of life in patients with heart failure: A moderated mediation model. J Health Psychol 2024:13591053241273655. [PMID: 39175156 DOI: 10.1177/13591053241273655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
This study was aimed to examine the moderated mediating effects of exercise self-efficacy and fear of movement on the relationship between fatigue and quality of life in patients with heart failure. A total of 305 patients with heart failure were enrolled in this cross-sectional study. The results showed that fear of movement significantly mediated the relationship between fatigue and quality of life, indicating that relieving fear of movement may be beneficial to improve quality of life. Furthermore, exercise self-efficacy negatively moderated the mediating effect of fear of movement on the relationship between fatigue and physical health-related quality of life. It is suggesting that improving exercise self-efficacy may provide opportunities to buffer the negative effect of fear of movement on physical health-related quality of life in patients with heart failure, especially for those with fatigue. The findings provide additional strategies to optimize quality of life management in patients with heart failure.
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Affiliation(s)
- Xiuting Zhang
- School of Nursing and Rehabilitation, Shandong University, P.R. China
| | - Wenjie Fang
- School of Nursing and Rehabilitation, Shandong University, P.R. China
| | - Yilin Zhang
- School of Nursing and Rehabilitation, Shandong University, P.R. China
| | - Mei Yang
- School of Nursing and Rehabilitation, Shandong University, P.R. China
| | - Mei Wang
- School of Nursing and Rehabilitation, Shandong University, P.R. China
| | - Xiuzhen Fan
- School of Nursing and Rehabilitation, Shandong University, P.R. China
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Sánchez Carretero L, Cardeñosa Pérez ÀC, Peces-Barba G, Pérez-Rial S. Differential lung gene expression identified Zscan2 and Bag6 as novel tissue repair players in an experimental COPD model. PLoS One 2024; 19:e0309166. [PMID: 39172905 PMCID: PMC11340952 DOI: 10.1371/journal.pone.0309166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024] Open
Abstract
Chronic obstructive pulmonary disease is a common chronic lung disease with an ever-increasing incidence. Despite years of drug research and approvals, we are still not able to halt progress or restore normal lung function. Our previous studies have demonstrated that liver growth factor-LGF has an effect on the repair of the affected tissue in a mouse model of cigarette smoke exposure, but by what pathways it achieves this is unknown. The present study aimed to identify differentially expressed genes between emphysematous mice treated with LGF to identify potential therapeutic targets for the treatment of pulmonary emphysema. The emphysema mouse model was induced by prolonged exposure to cigarette smoke. To determine the gene expression profile of the lung in smokers treated or not with LGF, lung messenger RNA gene expression was assessed with the Agilent Array platform. We carried out differentially expressed gene analysis, functional enrichment and validated in treated mouse lung samples. The treated group significantly improved lung function (~35%) and emphysema level (~20%), consistent with our previous published studies. Microarray analysis demonstrated 290 differentially expressed genes in total (2.0-fold over or lower expressed). Injury repair-associated genes and pathways were further enhanced in the lung of LGF treated mice. The expression trends of two genes (Zscan2 and Bag6) were different in emphysematous lungs treated with LGF compared to untreated lungs. Therefore, Zscan2 and Bag6 genes could play a role in regulating inflammation and the immune response in the lung that undergoes partial lung regeneration. However, further studies are necessary to demonstrate this causal relationship.
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Affiliation(s)
- Laura Sánchez Carretero
- Respiratory Research Unit, Health Research Institute–Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Àdele Chole Cardeñosa Pérez
- Respiratory Research Unit, Health Research Institute–Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Germán Peces-Barba
- Respiratory Research Unit, Health Research Institute–Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Sandra Pérez-Rial
- Molecular Genetics Department, Ramón y Cajal University Hospital–IRYCIS, Madrid, Spain
- Network Biomedical Research Center for Rare Diseases, Carlos III Health Institute (CIBERER, ISCIII), Madrid, Spain
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Alcántara-Arreola EA, Silva-Garcés KN, Mendoza-Martínez J, Cardoso-Palomares MA, Torres-SanMiguel CR. Experimental Analysis of Stress Shielding Effects in Screw Spacers Placed in Porcine Spinal Tissue. J Funct Biomater 2024; 15:238. [PMID: 39194675 DOI: 10.3390/jfb15080238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 08/29/2024] Open
Abstract
Bone cortical tissues reorganize and remodel in response to tensile forces acting on them, while compressive forces cause atrophy. However, implants support most of the payload. Bones do not regenerate, and stress shielding occurs. The aim is to analyze the biomechanical behavior of a lumbar cage to study the implant's stress shielding. The ASTM E-9 standard was used with the necessary adjustments to perform compression tests on lumbar and thoracic porcine spinal vertebrae. Twelve cases were analyzed: six with the metal prosthesis and six with the PEEK implant. A mathematical model based on the Hertz contact theory is proposed to assess the stress shielding for endoprosthesis used in spine pathologies. The lumbar spacer (screw) helps to reduce the stress shielding effect due to the ACME thread. The best interspinous spacer is the PEEK screw. It does not embed in bone. The deformation capability increases by 11.5% and supports 78.6 kg more than a system without any interspinous spacer.
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Affiliation(s)
- Elliot Alonso Alcántara-Arreola
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica, Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de México 07738, Mexico
| | - Karla Nayeli Silva-Garcés
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica, Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de México 07738, Mexico
| | - Jocabed Mendoza-Martínez
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica, Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de México 07738, Mexico
| | - Miguel Antonio Cardoso-Palomares
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica, Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de México 07738, Mexico
| | - Christopher René Torres-SanMiguel
- Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica, Unidad Zacatenco, Sección de Estudios de Posgrado e Investigación, Ciudad de México 07738, Mexico
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Button E, Carter H, Gavin NC, LeBlanc TW, McCaffrey N. A systematic review of health state utility values for older people with acute myeloid leukaemia. Qual Life Res 2024:10.1007/s11136-024-03734-9. [PMID: 39172308 DOI: 10.1007/s11136-024-03734-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Older people with acute myeloid leukaemia (AML) have a poor prognosis, reduced health-related quality of life (HRQoL) and require substantial healthcare resources. The objectives of this systematic review were to determine what health state utility values (HSUVs) are reported in the literature that can be used in economic evaluations of interventions for older people with AML, identify research gaps, and discuss directions for future research. METHODS The following databases were searched for studies published from inception until Feb 2023: PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, and EconLit. Studies were included if they reported on HSUVs of people with AML >60 years, or HRQoL data that could be mapped to HSUVs using currently published algorithms. RESULTS Of 532 studies identified, 7 met inclusion (4 full studies and 3 conference abstracts). Twenty-eight potentially eligible studies were excluded as they did not report HRQoL measures in sufficient detail to be mapped to utility values. Included studies reported on health states of newly diagnosed disease (n=4 studies), intensive therapy (n=1 study), controlled remission (n=3 studies), and relapsed or refractory disease (n=2 studies). No studies reported on low intensity therapy or supportive care health states. Utility values were largely reported via the EuroQol and ranged from 0.535 (intensive therapy) to 0.834 (controlled remission). CONCLUSION There are gaps in knowledge on HSUVs for older people with AML, particularly for certain treatment-related health states. Future articles should publish comprehensive HRQoL outcomes to enable use in economic evaluation.
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Affiliation(s)
- Elise Button
- Centre for Healthcare Transformation, Cancer and Palliative Care Outcomes, Queensland University of Technology, Level 7, Q Block, 66 Must Avenue, Kelvin Grove, Brisbane, QLD, Australia.
| | - Hannah Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nicole C Gavin
- Cancer Care Services, Metro North Hospital and Health Services, Queensland Health Brisbane, Brisbane, QLD, Australia
| | | | - Nikki McCaffrey
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
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Yan Q, Liang J, Yuan Y, Li Y, Fan J, Wu W, Xu P, Wang Q, Xue J. Association between personality type and patient-reported outcomes (PRO) in patients with atrial fibrillation. BMC Cardiovasc Disord 2024; 24:437. [PMID: 39174904 PMCID: PMC11342585 DOI: 10.1186/s12872-024-04098-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 08/06/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Atrial Fibrillation (AF) is known to be associated with a negative emotional state. Patient-reported outcomes (PROs) are important tools for evaluating the endpoints of AF management. This study aims to examine the correlation between personality types and PROs in patients with AF. METHODS All included subjects were newly diagnosed with AF fewer than one month, and their personality types were assessed using the Eysenck Personality Questionnaire (EPQ). Quality of life (QoL) was measured using the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire. Anxiety and depression were assessed using the General Anxiety Scale (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9), respectively. We constructed stepwise linear regression analyses for factors related to the QoL and emotional state in patients with AF. RESULTS A total of 531 AF patients completed the survey and were categorized into four groups based on their personality types. Of these patients (mean age: 67.12 ± 10.93 years, 50.28% male), 357 (67.23%) had paroxysmal AF, and 16.95% (n = 90) had a sanguine personality. Compared to patients with other personality types, those with a sanguine personality had the highest average AFEQT scores (P < 0.001) and the lowest scores of GAD-7 and PHQ-9 scales (P < 0.05). Furthermore, multiple linear regression analyses suggested that sanguine personality was also independently associated with better QoL and emotional states (P < 0.05). CONCLUSION There is a significant association between the personality types and PROs in AF patients.
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Affiliation(s)
- Qing Yan
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, Shaanxi, 710004, China
| | - Jiaqi Liang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, Shaanxi, 710004, China
| | - Yide Yuan
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, Shaanxi, 710004, China
| | - Yuan Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, Shaanxi, 710004, China
| | - Jiali Fan
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, Shaanxi, 710004, China
| | - Wenhuan Wu
- Department of Cardiovascular Medicine, Zichang People's Hospital, Zichang, Shaanxi, 717300, China
| | - Pan Xu
- Department of Ultrasound, Xijing Hospital, Shaanxi, 710032, China
| | - Qunrang Wang
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, Shaanxi, 712000, China
| | - Jiahong Xue
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 West Five Road, Xi'an, Shaanxi, 710004, China.
- Xinjiang Medical University Affiliated Cancer Hospital, 789 East Suzhou Street, Urumqi, Xinjiang, 830000, China.
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Ahmaditabar P, Mahmoodi M, Taheri RA, Asefnejad A. Preparation and in vitro evaluation of tissue plasminogen activator-loaded nanoliposomes with anticoagulant coating. Biochim Biophys Acta Gen Subj 2024; 1868:130704. [PMID: 39178920 DOI: 10.1016/j.bbagen.2024.130704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/06/2024] [Accepted: 08/16/2024] [Indexed: 08/26/2024]
Abstract
The clinical efficacy of tissue plasminogen activator (tPA) is limited by its lack of specific delivery, requiring large therapeutic doses that increase the risk of intracerebral hemorrhage, bleeding at the surgical site, and patient mortality after angioplasty. To address these limitations, this study aimed to develop a chitosan polysulfate (CsPs)-coated liposomal formulation for the sustained release of tPA. The CsPs-coated liposomes containing tPA (Liposome-tPA/CsPs) were fabricated using the thin-film hydration technique and their properties were compared to tPA-encapsulated nanoliposomes without a coating layer (Liposome-tPA). Liposome-tPA/CsPs showed a quasi-spherical morphology with a hydrodynamic diameter of 110 nm, while Liposome-tPA had a diameter of 80 nm. The thermal analysis showed that the degradation temperature and glass transition temperature (Tg) of Liposome-tPA/CsPs were higher than that of tPA alone, indicating improved temperature stability. The in vitro release study demonstrated a slow and sustained release of tPA from the Liposome-tPA/CsPs, with a concentration of 0.02 mg/ml at 1 h and 0.23 mg/ml at 180 h. The CsPs coating layer enhanced the antibacterial and antioxidant activity of the nanoliposomes. Liposome-tPA/CsPs exhibited higher cell viability compared to Liposome-tPA. It also achieved a higher percentage of thrombolysis, with complete clot dissolution observed after 3 h of treatment. These findings suggest that the Liposome-tPA/CsPs can be a promising approach to overcome the limitations associated with the systemic administration of tPA, potentially enhancing its clinical efficacy while reducing the risk of adverse events.
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Affiliation(s)
- Parvin Ahmaditabar
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mahboobeh Mahmoodi
- Department of Biomedical Engineering, Yazd Branch, Islamic Azad University, Yazd, Iran; Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ramezan Ali Taheri
- Department of Biology, Faculty of Sciences, University of Tehran, Tehran, Iran
| | - Azadeh Asefnejad
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
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Muttalib F, Memon ZA, Muhammad S, Soomro A, Khan S, Bano S, Jawwad M, Soofi S, Hansen B, Adhikari NKJ, Bhutta Z. The spectrum of acute illness and mortality of children and adolescents presenting to emergency services in Sanghar district hospital, Pakistan: a prospective cohort study. BMJ Open 2024; 14:e082255. [PMID: 39179281 PMCID: PMC11344522 DOI: 10.1136/bmjopen-2023-082255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 07/19/2024] [Indexed: 08/26/2024] Open
Abstract
OBJECTIVE To describe presenting diagnoses and rates and causes of death by age category and sex among children with acute illness brought to a district headquarter hospital in Pakistan. DESIGN Prospective cohort study. SETTING Sanghar district headquarter hospital, Sindh, Pakistan between December 2019 and April 2020 and August 2020 and December 2020. PARTICIPANTS 3850 children 0-14 years presenting with acute illness to the emergency and outpatient departments and 1286 children admitted to the inpatient department. OUTCOME MEASURES The primary outcome was Global Burden of Disease diagnosis category. Secondary outcomes were 28-day mortality rate, cause of death and healthcare delays, defined as delay in care-seeking, delay in reaching the healthcare facility and delay in appropriate treatment. RESULTS Communicable diseases were the most common presenting diagnoses among outpatients and among inpatients aged 1 month to 9 years. Non-communicable diseases and nutritional disorders were more common with increasing age. Few children presented with injuries. Newborn period (age <28 days) was associated with increased odds of death (OR 4.34 [95% CI 2.38 to 8.18], p<0.001, reference age 28 days-14 years) and there was no significant difference in odds of death between female vs male children (OR 1.12, 95% CI 0.6 to 2.04, p=0.72). 47 children died in the hospital (3.6%) and three (0.2%) died within 28 days of admission. Most children who died were <28 days old (n=32/50, 64%); leading diagnoses included neonatal sepsis/meningitis (n=13/50, 26%), neonatal encephalopathy (n=7/50, 14%) and lower respiratory tract infections (n=6/50, 12%). Delays in care-seeking (n=15) and in receiving appropriate treatment (n=12) were common. CONCLUSION This study adds to sparse literature surrounding the epidemiology of disease and hospital outcomes for children with acute illness seeking healthcare in rural Pakistan and, in particular, among children aged 5-14 years. Further studies should include public and private hospitals within a single region to comprehensively describe patterns of care-seeking and interfacility transfer in district health systems.
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Affiliation(s)
- Fiona Muttalib
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Zahid Ali Memon
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shah Muhammad
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Asif Soomro
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Samia Khan
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shazia Bano
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Muhammad Jawwad
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Sajid Soofi
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
- Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Neill KJ Adhikari
- Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Managament, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zulfiqar Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
- Centre for Global Child Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Wu F, Zhang S, Zhuang R, Hu C, Zhu K. Blocking IL-33 decelerates cartilage degeneration in knee osteoarthritis through mice model. PLoS One 2024; 19:e0301199. [PMID: 39172956 PMCID: PMC11340949 DOI: 10.1371/journal.pone.0301199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/12/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Osteoarthritis (OA) is a chronic inflammatory disease where pro-inflammatory cytokines, damage-associated molecular patterns and macrophages play a crucial role. However, the interaction of these mediators, the exact cause, and the treatment of knee osteoarthritis (KOA) are still unclear. Moreover, the interaction of interleukin (IL)-33, platelet-derived growth factor-BB (PDGF-BB), and matrix metalloproteinase-9 (MMP-9) with other factors in the pathogenesis of KOA has not been elaborately explored. METHOD Therefore, in this study, we analyzed the expression of IL-33, PDGF-BB, and MMP-9 in the knee cartilage tissue of model mice, murine KOA was induced by using the destabilization of the medial meniscus (DMM) model. RESULTS Compared with the sham operation control group, the expression levels of PDGF-BB, IL-33, and MMP-9 were increased significantly, and the pathological sections showed obvious cartilage damage. Additionally, we assessed the levels of IL-33 and MMP-9 expression in the knee joint of KOA model mice following intervention with PDGF-BB antibody, and we found that the expression level of MMP-9 was reduced following intervention with IL-33 antibody. When the effects of the three antibodies were compared in a mouse disease model, it was discovered that the IL-33 antibody could dramatically lower the relative expression level of MMP-9, resulting in the least amount of cartilage damage and improved protection. In conclusion, inhibiting IL-33 can significantly lower inflammatory factor levels in the knee joint, including IL-33 and MMP-9, and it can improve cartilage breakdown in osteoarthritis of the knee. CONCLUSION Overall, the results indicate that IL-33 has a therapeutic function in the treatment of knee osteoarthritis and may be a novel target for treatment of the underlying causes of KOA. Additionally, PDGF-BB might be an upstream pathway of IL-33, and KOA's MMP-9 is an downstream pathway of IL-33.
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Affiliation(s)
- Fan Wu
- Department of Orthopaedics, Quzhou Traditional Chinese Medicine Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University, Quzhou, Zhejiang, China
| | - Siyuan Zhang
- Department of Orthopaedics, Quzhou Traditional Chinese Medicine Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University, Quzhou, Zhejiang, China
| | - Rujie Zhuang
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Chuanxiao Hu
- Department of Neuroelectrophysiology, People’s Hospital of Quzhou, Quzhou, Zhejiang, China
| | - Kangxiang Zhu
- Department of Orthopaedics, Quzhou Traditional Chinese Medicine Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University, Quzhou, Zhejiang, China
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Montes de Oca D, Paraje G, Cuadrado C. Impact of Total Indoor Smoking Ban on Cardiovascular Disease Hospitalizations and Mortality: The Case of Chile. Nicotine Tob Res 2024; 26:1166-1174. [PMID: 38457437 PMCID: PMC11339173 DOI: 10.1093/ntr/ntae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 01/22/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION The harmful effects of first and secondhand smoking are well-established. Smoke-free laws aim at protecting nonsmokers. This study aimed to assess the impact of the 2013 total ban on indoor smoking in Chile on hospitalizations and deaths of major cardiovascular events. AIMS AND METHODS The logarithm of the monthly hospitalization and death rates, standardized by age for every 100 000 inhabitants, were estimated for ischemic heart disease, acute myocardial infarction, strokes, and a composite outcome of ischemic heart diseases (which includes acute myocardial infarction) and strokes. In addition, interrupted time series with synthetic control groups were used to assess changes in levels and trends after the intervention. RESULTS The total ban on indoor smoking caused significant reductions in death rates for the three diseases studied for age groups above 20 years old. In addition, there were substantial decreases in the post-intervention hospitalization rates for ischemic heart disease: for the 20-44 age group, the decrease was 8.7% compared to the pre-intervention period (p < .01). In comparison, such a reduction was 4% (p < .01) for the ≥65 age group. For acute myocardial infarction, the decrease was 11.5% (p < .01) for the 20-44 age group, while for stroke, it was a 1.2% (p < .01) decrease for the total population. It is estimated that the smoking ban averted 15.6% of the deaths compared with the synthetic control groups. CONCLUSIONS The implementation of total smoke-free environments in Chile contributed to the reduction of mortality for main cardiovascular diseases. This study provides additional evidence of causality linking the policy to health outcomes. IMPLICATIONS The total indoor smoking ban significantly affected age-standardized hospitalization and deaths. The number of deaths averted by this policy is estimated at approximately 4758 and 5256 for IHD and stroke, respectively, during the 2013-2017 period (15.6% fewer deaths than predicted by the synthetic control groups). The study contributes to the body of evidence that supports total indoor smoking bans.
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Affiliation(s)
| | - Guillermo Paraje
- Business School, Universidad Adolfo Ibáñez, Peñalolén, Santiago de Chile, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Peñalolén, Santiago de Chile, Chile
| | - Cristóbal Cuadrado
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Peñalolén, Santiago de Chile, Chile
- School of Public Health, Universidad de Chile, Santiago de Chile, Chile
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Liang C, Sun Q, Li J, Ji B, Wu W, Zhang F, Chen Y, Wang C. An interpretable ensemble trees method with joint analysis of static and dynamic features for myocardial infarction detection. Physiol Meas 2024; 45:085006. [PMID: 39025104 DOI: 10.1088/1361-6579/ad6529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/18/2024] [Indexed: 07/20/2024]
Abstract
Objective.In recent years, artificial intelligence-based electrocardiogram (ECG) methods have been massively applied to myocardial infarction (MI). However, the joint analysis of static and dynamic features to achieve accurate and interpretable MI detection has not been comprehensively addressed.Approach.This paper proposes a simplified ensemble tree method with a joint analysis of static and dynamic features to solve this issue for MI detection. Initially, the dynamic features are extracted by modeling the intrinsic dynamics of ECG via dynamic learning in addition to extracting classical static features. Secondly, a two-stage feature selection strategy is designed to identify a few significant features, which substitute the original variables that are employed in constructing the ensemble tree. This approach enhances the discriminative ability by selecting significant static and dynamic features. Subsequently, this paper presents an interpretable classification method named StackTree by introducing a stacked ensemble scheme to modify the ensemble tree simplification algorithm. The representative rules of the raw ensemble trees are selected as the intermediate training data that is used to retrain a decision tree with performance close to that of the source ensemble model. Using this scheme, the significant precision and interpretability of MI detection are thus comprehensively addressed.Main results.The effectiveness of our method in detecting MI is evaluated using the Physikalisch-Technische Bundesanstalt (PTB) and clinical database. The findings suggest that our algorithm outperforms the traditional methods based on a single type of feature. Additionally, it is comparable to the conventional random forest, achieving 97.1% accuracy under the inter-patient framework on the PTB database. Furthermore, feature subsets trained on PTB are validated using the clinical database, resulting in an accuracy of 84.5%. The chosen important features demonstrate that both static and dynamic information have crucial roles in MI detection. Crucially, the proposed method provides clear internal workings in an easy-to-understand visual manner.
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Affiliation(s)
- Chunmiao Liang
- School of Control Science and Engineering, Shandong University, Jinan 250061, People's Republic of China
| | - Qinghua Sun
- School of Control Science and Engineering, Shandong University, Jinan 250061, People's Republic of China
- Center for Intelligent Medical Engineering, Shandong University, Jinan 250061, People's Republic of China
| | - Jiali Li
- School of Control Science and Engineering, Shandong University, Jinan 250061, People's Republic of China
| | - Bing Ji
- School of Control Science and Engineering, Shandong University, Jinan 250061, People's Republic of China
- Center for Intelligent Medical Engineering, Shandong University, Jinan 250061, People's Republic of China
| | - Weiming Wu
- School of Control Science and Engineering, Shandong University, Jinan 250061, People's Republic of China
- Center for Intelligent Medical Engineering, Shandong University, Jinan 250061, People's Republic of China
| | - Fukai Zhang
- School of Control Science and Engineering, Shandong University, Jinan 250061, People's Republic of China
- Center for Intelligent Medical Engineering, Shandong University, Jinan 250061, People's Republic of China
| | - Yuguo Chen
- Department of Emergency, Qilu Hospital of Shandong University, Jinan 250012, People's Republic of China
| | - Cong Wang
- School of Control Science and Engineering, Shandong University, Jinan 250061, People's Republic of China
- Center for Intelligent Medical Engineering, Shandong University, Jinan 250061, People's Republic of China
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Dam VH, Köhler-Forsberg K, Ozenne B, Larsen SV, Ip CT, Jorgensen A, Stenbæk DS, Madsen J, Svarer C, Jørgensen MB, Knudsen GM, Frokjaer VG. Effect of antidepressant treatment on 5-HT 4 receptor binding and associations with clinical outcomes and verbal memory in major depressive disorder. Biol Psychiatry 2024:S0006-3223(24)01537-3. [PMID: 39181386 DOI: 10.1016/j.biopsych.2024.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 08/08/2024] [Accepted: 08/08/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Brain serotonin 4 receptor (5-HT4R) levels are lower in untreated patients with Major Depressive Disorder (MDD) and are linked to verbal memory. We here investigate the relationship between 5-HT4R, clinical outcomes, and cognitive function in patients with MDD who initiate SSRI drug treatment. METHODS Ninety moderately to severely depressed patients underwent molecular brain imaging to measure 5-HT4R binding prior to antidepressant treatment with escitalopram. Pretreatment 5-HT4R binding was assessed for its ability to predict treatment outcome at week 4, 8 or 12. In 40 patients rescanned 8 weeks post treatment, the change in cerebral 5-HT4R binding was correlated to change in verbal memory and to change in depressive symptoms, as evaluated by the Hamilton Depressive Rating Scale 6 (HAMD6). RESULTS After 8 weeks of serotonergic intervention neostriatal 5-HT4R binding was reduced by 9%. Global change in 5-HT4R binding from baseline was associated with verbal memory outcomes, but not with overall clinical depressive symptom outcomes. Pretreatment 5-HT4R binding did not predict clinical recovery status at week 8, nor was it associated with change in HAMD6. CONCLUSIONS In patients with moderate to severe MDD, treatment with SSRI's downregulates neostriatal 5-HT4R levels, consistent with the notion that the drugs increase cerebral extracellular serotonin. The less global brain 5-HT4R levels are downregulated after SSRIs, the more verbal memory improves, highlighting the potential importance of 5-HT4R as a treatment target in MDD. The findings offer insights to mechanisms underlying antidepressant effects and point to new directions for precision medicine treatments for MDD.
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Affiliation(s)
- Vibeke H Dam
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Kristin Köhler-Forsberg
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Public Health, Section of Biostatistics, University of Copenhagen, Denmark
| | - Søren V Larsen
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Cheng Teng Ip
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Center for Cognitive and Brain Sciences, University of Macau, Taipa Macau SAR, China
| | - Anders Jorgensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Dea S Stenbæk
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Psychology, University of Copenhagen, Denmark
| | - Jacob Madsen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Claus Svarer
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Martin B Jørgensen
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Gitte M Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Vibe G Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Psychiatric Center Copenhagen, Copenhagen, Denmark.
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Al-Salmi S, Aly FW, Najeeb FSN, Shaikh Z, Zuaiter FAOA, Doherty S, Sefen JAN. Scoping review of healthcare professionals' views on intimate partner violence in the Middle East and North Africa. BMJ Open 2024; 14:e079866. [PMID: 39174067 DOI: 10.1136/bmjopen-2023-079866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVES This scoping review aims to survey healthcare providers (HCPs) in the Middle East and North Africa (MENA) about their knowledge, attitudes and barriers to working with women who have experienced intimate partner violence (IPV). This review aims to map the breadth of available peer-reviewed literature that may inform future educational training programmes. DESIGN Scoping review. DATA SOURCES The scoping review included studies up to December 2023 from PUBMED, Medline, COCHRANE, Cumulative Index of Nursing and Allied Health Literature, PsycINFO and Arabic medical journals. ELIGIBILITY CRITERIA Selected articles were restricted to those carried out in the MENA region, available in full text and with no date restrictions. DATA EXTRACTION AND SYNTHESIS Data were extracted from all studies to include research location, year of publication, type of journal, methodology, design, participants, knowledge, attitudes and barriers. By charting the information into a table, the data were analysed using frequency, counts and descriptive content analysis. RESULTS Of the 1060 articles reviewed, 29 eligible studies were included in this scoping review. 27% of the articles reported HCPs' lack of knowledge about IPV protocols. The dominant attitude reported was a preference to treat the presenting health complaint and avoid discussing IPV. Finally, 30% of articles reported HCPs' lack of training as the main barrier. CONCLUSION Our paper concluded that there is a lack of research in understanding the knowledge, attitudes and barriers surrounding HCPs in the MENA region and IPV. This scoping review highlights the need for further research, informed interventions and training for HCPs in the region.
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Affiliation(s)
- Sabrina Al-Salmi
- Royal College of Surgeons in Ireland and Medical University of Bahrain, Busaiteen, Bahrain
| | - Farah W Aly
- Royal College of Surgeons in Ireland and Medical University of Bahrain, Busaiteen, Bahrain
| | - Farah S N Najeeb
- Royal College of Surgeons in Ireland and Medical University of Bahrain, Busaiteen, Bahrain
| | - Zoya Shaikh
- Royal College of Surgeons in Ireland and Medical University of Bahrain, Busaiteen, Bahrain
| | - Farah A O A Zuaiter
- Royal College of Surgeons in Ireland and Medical University of Bahrain, Busaiteen, Bahrain
| | - Sally Doherty
- Royal College of Surgeons in Ireland and Medical University of Bahrain, Busaiteen, Bahrain
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Marques-Vidal P, Maung KK, Gouveia A. Twenty-year trends of potentially avoidable hospitalizations for hypertension in Switzerland. Hypertens Res 2024:10.1038/s41440-024-01853-x. [PMID: 39169149 DOI: 10.1038/s41440-024-01853-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/03/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024]
Abstract
We assessed the trends, characteristics, and consequences of potentially avoidable hospitalizations (PAH) for hypertension in Switzerland, for the period 1998 to 2018. Data from 117,507 hospitalizations (62.1% women), minimum age 20 years. Hospitalizations with hypertension as the main cause for admission were eligible. PAH for hypertension was defined according to the Organization for Economic Cooperation and Development criteria. The age-standardized rates of PAH for hypertension increased from 43 in 1998 to 81 per 100,000 in 2004, to decrease to 57 per 100,000 inhabitants in 2018. Compared to non-PAH, patients with PAH for hypertension were younger, more frequently women (66.9% vs. 56.7%), non-Swiss nationals (15.9% vs. 10.9%), were more frequently admitted as an emergency (78.9% vs. 59.5%), and by the patient's initiative (33.1% vs. 14.1%). Patients with PAH had also fewer comorbidities, as per the Charlson's index. Patients with PAH for hypertension were more frequently hospitalized in a semi-private or private setting, stayed less frequently in the intensive care unit (4.6% vs. 7.3%), were discharged more frequently home (91.4% vs. 73.0%), and had a shorter length of stay than patients with non-PAH for hypertension: median and [interquartile range] 5 [3-8] vs. 9 [4-15] days. In 2018, the total costs of PAH were estimated at 16.5 million CHF, corresponding to a median cost of 4936 [4445-4961] Swiss Francs per stay. We conclude that in Switzerland, PAH have increased, represent a considerable fraction of hospitalizations for hypertension, and carry a non-negligible health cost.
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Affiliation(s)
- Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
| | - Ko Ko Maung
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Alexandre Gouveia
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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139
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Assmus B, Bauer P. Beyond the snapshot: harnessing daily physical activity for heart failure characterization. Clin Res Cardiol 2024:10.1007/s00392-024-02511-5. [PMID: 39167192 DOI: 10.1007/s00392-024-02511-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Birgit Assmus
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany.
- Department of Cardiology and DZHK (German Centre for Cardiovascular Research), Partner Site Rhein/Main, Kerckhoff Heart Center, Bad Nauheim, Hessen, Germany.
- Med. Klinik I, Kardiologie / Angiologie, UKGM, Universitätsklinikum Gießen, Klinikstr. 33, 35392, Giessen, Germany.
| | - Pascal Bauer
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
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140
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Yan Q, Cheng M, Xu W, Cheng Y, Wu F, Wang Y, Yang Q, Shi Y, Wang J. The control rate of hypertension across months of year and hours of day in a large real-world database. Hypertens Res 2024:10.1038/s41440-024-01817-1. [PMID: 39169148 DOI: 10.1038/s41440-024-01817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 08/23/2024]
Abstract
We investigated the control rate of hypertension across months of year and hours of day in a real-world database. The study participants were hypertensive patients from 142 community health centers across 16 districts in Shanghai, China, who measured their blood pressure with an automatic office blood pressure measurement platform between 2018 and 2023. The 343,400 hypertensive patients included 53.7% of women, and had average age of 70.2 (±8.1) years (range 50-90 years). For months of year, the control rate of hypertension was lowest in February and highest in August (51.9% vs 71.8%). For hours of day, the control rate of hypertension was lowest at 7:00 AM and highest at 12:00 PM (52.1% vs 76.0%). When the months of year and hour of day were considered together, the control rate was lowest at 7 AM in February (42.1%), and highest at 12 PM in July (86.8%). In 8516 patients who had uncontrolled blood pressure in the early morning and had their blood pressure also measured around noon, 45.7% had masked uncontrolled morning hypertension, with higher rates in spring and summer, and in women, those aged 50-69 years, and non-diabetic patients. The control rate of hypertension varies greatly across months of year and hours of day, suggesting that the evaluation of blood pressure control has to take into full consideration the measurement time in terms of months and hours.
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Affiliation(s)
- Qinghua Yan
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Minna Cheng
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Wenli Xu
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yibang Cheng
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, the Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fei Wu
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yuheng Wang
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Qinping Yang
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yan Shi
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
| | - Jiguang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, the Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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141
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Abdelkarim A, Straus SL, Moghaddam M, Nakhaei P, Clary B, Malas MB. POSTOPERATIVE OUTCOMES IN ANEMIC PATIENTS UNDERGOING CAROTID REVASCULARIZATION. J Vasc Surg 2024:S0741-5214(24)01777-4. [PMID: 39179005 DOI: 10.1016/j.jvs.2024.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/08/2024] [Accepted: 08/11/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Preoperative anemia is associated with worse postoperative morbidity and mortality following major vascular procedures. Limited research has examined the optimal method of carotid revascularization in anemic patients. Therefore, we aim to compare the postoperative outcomes following carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and transcarotid artery revascularization (TCAR) among anemic patients. STUDY DESIGN This is a retrospective review of anemic patients undergoing CEA, TFCAS, and TCAR in the Vascular Quality Initiative database between 2016-2023. We defined anemia as a preoperative hemoglobin level of <13 g/dL in men and <12 g/dL in women. The primary outcomes were 30-day mortality and in-hospital major adverse cardiac events (MACE). Logistic regression models were used for multivariate analyses. RESULTS Our study included 40,383 (59.3%) CEA, 9,159 (13.5%) TFCAS, and 18,555 (27.3%) TCAR cases in anemic patients. TCAR patients were older and had more medical comorbidities than CEA and TFCAS patients. TCAR was associated with decreased 30-day mortality (aOR=0.45,95%CI:0.37-0.59],P<0.001), in-hospital MACE (aOR=0.58,95%CI:0.46-0.75,P<0.001) compared to TFCAS. Additionally, TCAR was associated with 20% reduction in the risk of 30-day mortality (aOR=0.80,95%CI:0.65-0.98,P=0.03), and similar risk of in-hospital MACE (aOR=0.86,95%CI:0.77-1.01, P=0.07) compared to CEA. Furthermore, TFCAS was associated with an increased risk of 30-day mortality (aOR= 2,95%CI: 1.5-2.68,P<0.001), in-hospital MACE (aOR=1.7,95% CI:1.4-2,P<0.001) compared to CEA. CONCLUSIONS In this multi-institutional national retrospective analysis of a prospectively collected database, TFCAS is associated with a high risk of 30-day mortality and in-hospital MACE compared to CEA and TCAR in anemic patients. TCAR was associated with lower risk of 30-day mortality compared to CEA. These findings suggest TCAR as the optimal minimally invasive procedure for carotid revascularization in anemic patients.
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Affiliation(s)
- Ahmed Abdelkarim
- Center for Learning and Excellence in Vascular and Endovascular Surgery (CLEVER), Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego (UCSD), San Diego, California
| | - Sabrina L Straus
- Center for Learning and Excellence in Vascular and Endovascular Surgery (CLEVER), Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego (UCSD), San Diego, California
| | - Marjan Moghaddam
- Center for Learning and Excellence in Vascular and Endovascular Surgery (CLEVER), Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego (UCSD), San Diego, California
| | - Pooria Nakhaei
- Center for Learning and Excellence in Vascular and Endovascular Surgery (CLEVER), Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego (UCSD), San Diego, California
| | - Bryan Clary
- Center for Learning and Excellence in Vascular and Endovascular Surgery (CLEVER), Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego (UCSD), San Diego, California
| | - Mahmoud B Malas
- Center for Learning and Excellence in Vascular and Endovascular Surgery (CLEVER), Division of Vascular & Endovascular Surgery, Department of Surgery, UC San Diego (UCSD), San Diego, California.
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142
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Vidavalur R, Bhutani VK. Managing the Historic Burden of Kernicterus Mortality in India. Indian J Pediatr 2024:10.1007/s12098-024-05227-6. [PMID: 39167302 DOI: 10.1007/s12098-024-05227-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024]
Abstract
Prevention of neonatal bilirubin injury exemplifies success of systems approach to avert adverse neonatal and childhood outcomes that rely on strategies including prenatal identification of Rhesus sensitization, universal maternal blood typing, risk assessment for neonatal extreme hyperbilirubinemia (EHB), unfettered access to safe, effective phototherapy, and application of patient safety principles. India's diverse landscape suggests varied real-time experiences of neonatal hyperbilirubinemia and consequent infant mortality rates (IMR). Utilizing Global Burden of Disease (GBD) database, the authors examined national and subnational trends, infant mortality timing, and the disease burden from hemolytic and perinatal jaundice over 30 y (1999 to 2019). They also assessed the correlation of EHB-IMR with socio-demographic index and health expenditure per capita, estimating economic losses from EHB-related infant mortality to guide policy decisions at national and state domains. From 1990 to 2019, India delivered 811,078,415 livebirths of which, 1,189,856 infant deaths were due to EHB. EHB-related deaths decreased from 57,773 in 1990 to 19,664 in 2019, a 60% reduction vs. 40% in overall IMR. Early (0-6 d), late (7-27 d), and post-neonatal (28-364 d) deaths accounted for 61%, 34%, and 5% of mortality, respectively. Uttar Pradesh and Bihar contributed to 38% of all EHB deaths. Economic analysis estimate losses between US $7.2 and 11.7 billion for the year 2019 secondary to EHB-related mortality. The present analysis reveals consistent declines across all states to reach current EHB-IMR of 0.8 per 1,000 live-births in India by 2019. Significant economic impact of lost human productivity highlight ongoing need for targeted life-saving public health strategies.
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Affiliation(s)
- Ramesh Vidavalur
- Department of Clinical Pediatrics, Cayuga Medical Center/Weill Cornell Medicine, 101 Dates Drive, Ithaca, NY, 14850, USA.
| | - Vinod K Bhutani
- Stanford University School of Medicine, Lucile Salter Packard Children's Hospital, Stanford, CA, 94305, USA
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143
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Scheuchzer P, Sinawat S, Donzé AS, Zeder C, Magalie S, Garcia-Garcera M, Ricci C, Kamontham T, Zimmermann MB, Baumgartner J. Iron absorption from an iron-fortified follow-up formula with and without the addition of a synbiotic or a human-identical milk oligosaccharide: a randomized cross-over stable isotope study in young Thai children. J Nutr 2024:S0022-3166(24)00467-X. [PMID: 39179207 DOI: 10.1016/j.tjnut.2024.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 07/26/2024] [Accepted: 08/17/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Previous studies showed that pre- and probiotics may enhance iron absorption. Probiotics combined with prebiotics (synbiotics), including human-identical milk oligosaccharides (HiMO), are commonly added to infant and follow-up formula (FUF). Whether these additions enhance iron absorption from iron-fortified commercial milk formula is uncertain. OBJECTIVE We determined the effect of adding: 1) a synbiotic (galacto-oligosaccharides (GOS)+Limosilactobacillus reuteri [L. reuteri]), or 2) the HiMO 2'-fucosyllactose (2'FL) to iron-fortified FUF on iron absorption in young Thai children. METHODS In a randomized, controlled, single-blinded (participants) cross-over study, 82 Thai children aged 8-14 months were enrolled to consume single servings (235ml) of FUF with isotopically labelled ferrous sulfate (2.2 mg iron) with: 1) the synbiotic (400 mg/100 ml GOS and L. reuteri DSM 17938); 2) the 2'FL (100 mg/100 ml); and 3) without synbiotic and without 2'FL (control) in random order and a 3-day wash-out period between administrations. Fractional iron absorption (FIA[%]) was assessed by measuring erythrocyte incorporation of isotopic labels 14 days (n=26) and 28 days (n=76) after consumption of the last test FUF. RESULTS Median (IQR) FIA from iron-fortified FUF with the synbiotic (8.2[5.2, 12.9]%) and with 2'FL (8.4[5.5, 14.1]%) did not differ from the control FUF (8.1[4.8,14.7]%) (synbiotic vs. control, P=0.24; 2'FL vs. control, P=0.95). FIA from all FUF did not differ when measured after 14 and 28 days of erythrocyte incorporation (Time, P=0.368; FUF, P=0.435; Time x FUF, P=0.937). Fecal pH and hemoglobin were negatively associated with FIA. CONCLUSION In young Thai children, the addition of a synbiotic (GOS+L. reuteri) or 2'FL to iron-fortified FUF did not impact FIA from a single serving. The trial was registered at ClinicalTrial.gov as NCT04774016. The study was registered at clinicaltrials.gov as NCT04774016.
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Affiliation(s)
- Pornpimol Scheuchzer
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Sangsom Sinawat
- College of Allied Health Sciences, Suan Sunandha Rajabhat University, Bang Kaeo, Samut Songkhram, Thailand
| | - Anne-Sophie Donzé
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Christophe Zeder
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Sabatier Magalie
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Vers-Chez-Les-Blanc, Lausanne, Switzerland
| | - Marc Garcia-Garcera
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Vers-Chez-Les-Blanc, Lausanne, Switzerland
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Thavatchai Kamontham
- College of Allied Health Sciences, Suan Sunandha Rajabhat University, Bang Kaeo, Samut Songkhram, Thailand
| | - Michael B Zimmermann
- Medical Research Council Translational Immune Discovery Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Jeannine Baumgartner
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Department of Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
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144
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Kim T, Kim Y, Cho W. Insights into Hip pain using Hip X-ray: Epidemiological study of 8,898,044 Koreans. Sci Rep 2024; 14:19405. [PMID: 39169165 PMCID: PMC11339292 DOI: 10.1038/s41598-024-70259-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024] Open
Abstract
Hip pain is a prevalent degenerative joint symptoms, imposing a significant global health burden. Hip pain is experiencing an increase in incidences in Korea due to its aging society, and the social burden of hip pain continues to rise as the hip joint is crucial for gait and balance. This study assessed the epidemiology of hip pain in Korea using data from the fifth version of Korea National Health and Nutrition Examination Survey (KNHANES V-5). The research analyzed data from 8,898,044 Koreans to evaluate the prevalence and characteristics of hip pain and abnormal hip X-ray. Variables encompassed medical, demographic, mental, social, and musculoskeletal factors. Descriptive analysis and propensity score matching analyses unveiled characteristics of Koreans experiencing hip pain or showing abnormal hip x-ray. The study provides insights into the epidemiology of hip pain in the entire Korean population, and further suggesting the effective management of hip pain.
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Affiliation(s)
- Taewook Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea.
| | - Yoonhee Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Woosup Cho
- Department of Rehabilitation Medicine, Armed Forces Medical Command, Armed Forces Yangju Hospital, 460-3, Yongam-ri, Eunhyeon-myeon, Yangju-si, Gyeonggi-do, Republic of Korea
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145
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Chen X, Zhou M, Wang J, Liu M, Zhu C, Wu C, Dong M, Liu Y, Ai S, Feng H, Luo T, Liang YY, Zhang J, Wing YK, Jia F, Ning Y, Lei B. Associations of objective sleep duration and physical activity with risk of heart failure: A prospective cohort study. Gen Hosp Psychiatry 2024; 90:141-149. [PMID: 39182467 DOI: 10.1016/j.genhosppsych.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/02/2024] [Accepted: 08/15/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE This study aimed to investigate the independent and joint associations of accelerometer-derived sleep duration and physical activity (PA) in different intensities with the risk of incident heart failure (HF). METHODS The study included 89,572 participants (mean age 62.2 ± 7.8 years, 42.8% male) from the UK Biobank. Sleep duration (short: <6 h/day; normal: 6-8 h/day; long: >8 h/day) and PA [total PA, light PA (LPA), moderate-to-vigorous PA (MVPA), vigorous PA (VPA)] were measured using accelerometers over 7 days. MVPA and VPA were categorized according to the World Health Organization's recommended levels, while LPA and total PA were categorized based on the median. HF cases were identified through hospital records or death registries. RESULTS Over a 7-year follow-up period, 1324 participants (2.1%; incidence rate, 2.1 per 1000 person-years) developed HF. Short, but not long, sleep duration was linked to a 33% increased risk of HF [hazard ratio (HR) 1.33, 95% confidence interval (CI): 1.11-1.59]. This increased risk associated with short sleep could be mitigated by increasing PA, especially to the levels of recommended MVPA or VPA. In joint analyses, compared to participants meeting the recommended MVPA and with normal sleep duration, those not meeting the MVPA recommendation and with short sleep had the highest HF risk (HR 1.78, 95% CI: 1.42-2.25). CONCLUSIONS Accelerometer-derived short, but not long, sleep duration was associated with a higher risk of incident HF. Engaging in sufficient PA, especially recommended MVPA or VPA, can partially mitigate this risk.
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Affiliation(s)
- Xinru Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China
| | - Mingqing Zhou
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510282, China
| | - Jinyu Wang
- Department of Rehabilitation, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Mingyang Liu
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; School of Health Management, Guangzhou Medical University, Guangzhou 511436, China
| | - Changguo Zhu
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China
| | - Chao Wu
- Institute for Heart and Brain Health, University of Michigan Medical Center, Ann Arbor, MI 48109, USA
| | - Mingchao Dong
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China
| | - Yaping Liu
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China
| | - Sizhi Ai
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China; Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Hongliang Feng
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China
| | - Tong Luo
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China
| | - Yannis Yan Liang
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China; Institute of Psycho-Neuroscience, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China
| | - Jihui Zhang
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China
| | - Yun-Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR 999077, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR 999077, China
| | - Fujun Jia
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510120, China.
| | - Yuping Ning
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510370, China; The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou 510370, China.
| | - Binbin Lei
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University; Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510120, China.
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146
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Dale H, Chirwa E, Patel P, Makuta G, Mwakiseghile F, Misiri T, Kadwala I, Mbewe M, Banda H, Silungwe N, Chizani K, Kambiya P, Henrion M, French N, Nyirenda T, Gordon M. Understanding the epidemiology of iNTS disease in Africa in preparation for future iNTS- vaccine studies in endemic countries: Seroepidemiology in Africa of iNTS (SAiNTS) Study Protocol: Malawi site [Version 9.0]. Wellcome Open Res 2024; 8:27. [PMID: 39183741 PMCID: PMC11344207 DOI: 10.12688/wellcomeopenres.18054.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 08/27/2024] Open
Abstract
Background Non-typhoidal Salmonella (NTS) are a major cause of bloodstream infections amongst children in sub-Saharan Africa. A clear understanding of the seroepidemiology and correlates of protection for invasive NTS (iNTS) in relation to key risk factors (malaria, anaemia, malnutrition) in children in Africa is needed to inform strategies for disease control including vaccine implementation. Methodology The SAiNTS study is a prospective community cohort study with paired serology samples from 2500 Malawian children 0-5 years at baseline and three months to measure age-stratified acquisition of lipopolysaccharide (LPS) O-antigen antibody (IgG) and serum bactericidal activity to the main serovars causing iNTS ( Salmonella Typhimurium and S. Enteritidis). Children are selected from mapped and censused randomly selected households in Chikwawa, Malawi; an area with substantial malaria burden. The sampling framework is set within a malaria vaccination (RTS,S/ AS01) phase 4 cluster randomized trial, known as the Epidemiology Study of Malaria Transmission Intensity (EPI-MAL), allowing exploration of the impact of malaria vaccination on acquisition of immunity to NTS. Risk factor data for invasive disease will be collected using rapid diagnostic tests for malaria and anaemia, anthropometry for malnutrition, and a validated questionnaire for indicators of socioeconomic status, water and sanitation. All data will be recorded through electronic case report forms using the REDCap and the Open Data Kit (ODK) platforms. Stool sample analysis includes NTS culture and pan-Salmonella polymerase chain reaction to assess enteric exposure and biomarkers of environmental enteric dysfunction. Cases with iNTS disease will be followed up for comparison with community controls. Conclusions The final cohort of 2500 children will allow investigation into the impact of risk factors for iNTS on the acquisition of immunity in children 0-5 years in an endemic setting, including comparisons to partner seroepidemiology studies in three other sub-Saharan African sites (1000 children per site). The data generated will be key to informing iNTS disease control measures including targeted risk factor interventions and vaccine implementation through investigation of correlates of protection and identifying windows of immune susceptibility in at-risk populations.
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Affiliation(s)
- Helen Dale
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, Merseyside, L69 3GF, UK
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Esmeda Chirwa
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, Merseyside, L69 3GF, UK
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Priyanka Patel
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Georgina Makuta
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Felistas Mwakiseghile
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Theresa Misiri
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Innocent Kadwala
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Maurice Mbewe
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Happy Banda
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Niza Silungwe
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Kenneth Chizani
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Paul Kambiya
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Marc Henrion
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Neil French
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, Merseyside, L69 3GF, UK
| | - Tonny Nyirenda
- Pathogy Department, Kamuzu University of Health Sciences, Blantyre, Southern Region, Private Bag 360, Malawi
| | - Melita Gordon
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, Merseyside, L69 3GF, UK
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
| | - Vacc-iNTS
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, Merseyside, L69 3GF, UK
- Clinical Research, Malawi-Liverpool-Wellcome Clinical Research-Program, Blantyre, Southern Region, PO Box 30096, Malawi
- Pathogy Department, Kamuzu University of Health Sciences, Blantyre, Southern Region, Private Bag 360, Malawi
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147
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Neumann N, Domin M, Lotze M. Gray matter volume of limbic brain structures during the development of chronic back pain: a longitudinal cohort study. Pain 2024:00006396-990000000-00686. [PMID: 39167465 DOI: 10.1097/j.pain.0000000000003351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 06/25/2024] [Indexed: 08/23/2024]
Abstract
ABSTRACT This study set out to investigate in a population-based longitudinal cohort, whether chronification of back pain (BP) is related to structural gray matter changes in corticolimbic brain structures. Gray matter volume (GMV) was measured in participants with chronic BP (CBP, n = 168) and controls without chronic pain (n = 323) at 2 time points with an interval of 7 years (baseline t1, follow-up t2). Over this time period, participants with CBP showed an increase of GMV in the left ventral striatum, whereas controls showed a decrease. By contrast, participants with CBP had a GMV decrease in the left parahippocampal gyrus. Within the CBP group, pain duration was negatively associated with GMV in the left caudate. Those with emerging CBP had less GMV in the right entorhinal area, right amygdala, and left medial frontal cortex. Additional variables differing between those who had BP at t1 and later developed CBP or not were pain intensity, body mass index, and depression score. In sum, these findings are in accordance with the notion that limbic brain properties are both predisposing risk factors and drivers of brain reorganization during the development of CBP.
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Affiliation(s)
- Nicola Neumann
- Institute of Diagnostic Radiology and Neuroradiology, Functional Imaging Unit, University Medicine Greifswald, Greifswald, Germany
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148
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Akpoviroro O, Sauers NK, Uwandu Q, Castagne M, Akpoviroro OP, Humayun S, Mirza W, Woodard J. Severe COVID-19 infection: An institutional review and literature overview. PLoS One 2024; 19:e0304960. [PMID: 39163410 PMCID: PMC11335168 DOI: 10.1371/journal.pone.0304960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 05/21/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Our study aimed to describe the group of severe COVID-19 patients at an institutional level, and determine factors associated with different outcomes. METHODS A retrospective chart review of patients admitted with severe acute hypoxic respiratory failure due to COVID-19 infection. Based on outcomes, we categorized 3 groups of severe COVID-19: (1) Favorable outcome: progressive care unit admission and discharge (2) Intermediate outcome: ICU care (3) Poor outcome: in-hospital mortality. RESULTS Eighty-nine patients met our inclusion criteria; 42.7% were female. The average age was 59.7 (standard deviation (SD):13.7). Most of the population were Caucasian (95.5%) and non-Hispanic (91.0%). Age, sex, race, and ethnicity were similar between outcome groups. Medicare and Medicaid patients accounted for 62.9%. The average BMI was 33.5 (SD:8.2). Moderate comorbidity was observed, with an average Charlson Comorbidity index (CCI) of 3.8 (SD:2.6). There were no differences in the average CCI between groups(p = 0.291). Many patients (67.4%) had hypertension, diabetes (42.7%) and chronic lung disease (32.6%). A statistical difference was found when chronic lung disease was evaluated; p = 0.002. The prevalence of chronic lung disease was 19.6%, 27.8%, and 40% in the favorable, intermediate, and poor outcome groups, respectively. Smoking history was associated with poor outcomes (p = 0.04). Only 7.9% were fully vaccinated. Almost half (46.1%) were intubated and mechanically ventilated. Patients spent an average of 12.1 days ventilated (SD:8.5), with an average of 6.0 days from admission to ventilation (SD:5.1). The intermediate group had a shorter average interval from admission to ventilator (77.2 hours, SD:67.6), than the poor group (212.8 hours, SD:126.8); (p = 0.001). The presence of bacterial pneumonia was greatest in the intermediate group (72.2%), compared to the favorable group (17.4%), and the poor group (56%); this was significant (p<0.0001). In-hospital mortality was seen in 28.1%. CONCLUSION Most patients were male, obese, had moderate-level comorbidity, a history of tobacco abuse, and government-funded insurance. Nearly 50% required mechanical ventilation, and about 28% died during hospitalization. Bacterial pneumonia was most prevalent in intubated groups. Patients who were intubated with a good outcome were intubated earlier during their hospital course, with an average difference of 135.6 hours. A history of cigarette smoking and chronic lung disease were associated with poor outcomes.
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Affiliation(s)
- Ogheneyoma Akpoviroro
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Nathan Kyle Sauers
- Department of Engineering, Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Queeneth Uwandu
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Myriam Castagne
- Clinical & Translational Science Institute, Boston University, Boston, Massachusetts, United States of America
| | | | - Sara Humayun
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Wasique Mirza
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
| | - Jameson Woodard
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, United States of America
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149
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Godos J, Micek A, Currenti W, Franchi C, Poli A, Battino M, Dolci A, Ricci C, Ungvari Z, Grosso G. Fish consumption, cognitive impairment and dementia: an updated dose-response meta-analysis of observational studies. Aging Clin Exp Res 2024; 36:171. [PMID: 39162889 PMCID: PMC11335789 DOI: 10.1007/s40520-024-02823-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/28/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Cognitive impairment is projected to affect a preponderant proportion of the aging population. Lifelong dietary habits have been hypothesized to play a role in preventing cognitive decline. Among the most studied dietary components, fish consumptionhas been extensively studied for its potential effects on the human brain. AIMS To perform a meta-analysis of observational studies exploring the association between fish intake and cognitive impairment/decline and all types of dementia. METHODS A systematic search of electronic databases was performed to identify observational studies providing quantitative data on fish consumption and outcomes of interest. Random effects models for meta-analyses using only extreme exposure categories, subgroup analyses, and dose-response analyses were performed to estimate cumulative risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS The meta-analysis comprised 35 studies. Individuals reporting the highest vs. the lowest fish consumption were associated with a lower likelihood of cognitive impairment/decline (RR = 0.82, 95% CI: 0.75, 0.90, I2 = 61.1%), dementia (RR = 0.82, 95% CI: 0.73, 0.93, I2 = 38.7%), and Alzheimer's disease (RR = 0.80, 95% CI: 0.67, 0.96, I2 = 20.3%). The dose-response relation revealed a significantly decreased risk of cognitive impairment/decline and all cognitive outcomes across higher levels of fish intake up to 30% for 150 g/d (RR = 0.70, 95% CI: 0.52, 0.95). The results of this relation based on APOE ε4 allele status was mixed based on the outcome investigated. CONCLUSIONS Current findings suggest fish consumption is associated with a lower risk of cognitive impairment/decline in a dose-response manner, while for dementia and Alzheimer's disease there is a need for further studies to improve the strength of evidence.
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Affiliation(s)
- Justyna Godos
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Center for Human Nutrition and Mediterranean Foods (NUTREA), University of Catania, Catania, Italy
| | - Agnieszka Micek
- Statistical Laboratory, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, 31-501, Poland
| | - Walter Currenti
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Carlotta Franchi
- Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, 20156, Italy
- Italian Institute for Planetary Health (IIPH), Milan, 20124, Italy
| | - Andrea Poli
- Nutrition Foundation of Italy (NFI), Milan, 20124, Italy
| | - Maurizio Battino
- Department of Clinical Sciences, Università Politecnica Delle Marche, Ancona, Italy
- Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, Santander, 39011, Spain
- International Joint Research Laboratory of Intelligent Agriculture and Agri-Products Processing, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Alberto Dolci
- Sustainable Development Department, Bolton Food SpA, Milan, 20124, Italy
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, 2531, South Africa
| | - Zoltan Ungvari
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Department of Public Health, Doctoral College, Semmelweis University, Budapest, Hungary
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Giuseppe Grosso
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.
- Center for Human Nutrition and Mediterranean Foods (NUTREA), University of Catania, Catania, Italy.
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150
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Rothman B, Slomkowski M, Speier A, Rush AJ, Trivedi MH, Lawson E, Fahmy M, Carpenter D, Chen D, Forbes A. Evaluating the Efficacy of a Digital Therapeutic (CT-152) as an Adjunct to Antidepressant Treatment in Adults With Major Depressive Disorder: Protocol for the MIRAI Remote Study. JMIR Res Protoc 2024; 13:e56960. [PMID: 39163592 DOI: 10.2196/56960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/31/2024] [Accepted: 06/17/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is common worldwide and can be highly disabling. People with MDD face many barriers to treatment and may not experience full symptom relief even when treated. Therefore, new treatment modalities are needed for MDD. Digital therapeutics (DTx) may provide people with MDD an additional treatment option. OBJECTIVE This study aimed to describe a phase 3 remote, multicenter, randomized, masked, sham-controlled trial evaluating the efficacy of a smartphone app-based DTx (CT-152) in adult participants diagnosed with MDD, used as an adjunct to antidepressant therapy (ADT). METHODS Participants aged 22-64 years with a current primary diagnosis of MDD and an inadequate response to ADT were included. Participants were randomized 1:1 to CT-152 or a sham DTx. CT-152 is a smartphone app-based DTx that delivers a cognitive-emotional and behavioral therapeutic intervention. The core components of CT-152 are the Emotional Faces Memory Task exercises, brief lessons to learn and apply key therapeutic skills, and SMS text messaging to reinforce lessons and encourage engagement with the app. The sham DTx is a digital working memory exercise with emotionally neutral stimuli designed to match CT-152 for time and attention. Participants took part in the trial for up to 13 weeks. The trial included a screening period of up to 3 weeks, a treatment period of 6 weeks, and an extension period of 4 weeks to assess the durability of the effect. Sites and participants had the option of an in-person or remote screening visit; the remaining trial visits were remote. Efficacy was evaluated using the Montgomery-Åsberg Depression Rating Scale, the Generalized Anxiety Disorder-7, Clinical Global Impression-Severity scale, the Patient Health Questionnaire-9, and the World Health Organization Disability Assessment Schedule 2.0. The durability of the effect was evaluated with the Montgomery-Åsberg Depression Rating Scale and Generalized Anxiety Disorder-7 scale. Adverse events were also assessed. Satisfaction, measured by the Participant and Healthcare Professional Satisfaction Scales, and health status, measured by the EQ-5D-5L, were summarized using descriptive statistics. RESULTS This study was initiated in February 2021 and had a primary completion date in October 2022. CONCLUSIONS This represents the methodological design for the first evaluation of CT-152 as an adjunct to ADT. This study protocol is methodologically robust and incorporates many aspects of conventional pivotal pharmaceutical phase 3 trial design, such as randomization and safety end points. Novel considerations included the use of a sham comparator, masking considerations for visible app content, and outcome measures relevant to DTx. The rigor of this methodology will provide a more comprehensive understanding of the effectiveness of CT-152. TRIAL REGISTRATION ClinicalTrials.gov NCT04770285; https://clinicaltrials.gov/study/NCT04770285. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/56960.
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Affiliation(s)
- Brian Rothman
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | - Mary Slomkowski
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | - Austin Speier
- Click Therapeutics, Inc, New York, NY, United States
| | - A John Rush
- School of Medicine, Duke University, Durham, NC, United States
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
- O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Erica Lawson
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | - Michael Fahmy
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | | | - Dalei Chen
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | - Ainslie Forbes
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
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