2-week Period Research Articles

Effects of Reduced Dietary Sodium and the DASH Diet on GFR: The DASH-Sodium Trial.

A potassium-rich DASH diet combined with low sodium reduces blood pressure. However, the effects of sodium reduction in combination with the DASH diet on kidney function are unknown. We aimed to determine the effects of sodium reduction and the DASH diet, on estimated glomerular filtration rate (eGFR) by cystatin C. DASH-Sodium was a controlled, feeding study in adults with elevated or stage 1 hypertension, randomly assigned to the DASH or a control diet. On their assigned diet, participants consumed each of three sodium levels for 30 days following a 2-week run-in period of a high sodium-control diet. The three sodium levels were low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). The primary outcome was change in eGFR based on cystatin C. Cystatin C was measured in 409 of the original 412 participants of which 207 were assigned the DASH diet and 202 to the control diet. Compared with control, the DASH diet did not affect eGFR (β=-0.96 mL/min/1.73 m2; 95%CI: -2.74, 0.83). In contrast, low versus high sodium intake decreased eGFR (β=-2.36 mL/min/1.73 m2; 95%CI: -3.64, -1.07). Together, compared to the high sodium-control diet, the low sodium-DASH diet decreased eGFR by 3.10 mL/min/1.73 m2 (95%CI: -5.46, -0.73). This effect was attenuated with adjustment for diastolic blood pressure and 24-hr urinary potassium excretion. A combined low sodium-DASH diet reduced eGFR over a 4-week period. Future research should focus on the impact of these dietary interventions on subclinical kidney injury and their long-term impact on progression to chronic kidney disease.

Optimizing Orthopedic Operative Notes: A Closed-Loop Audit and Interventional Approach for Improved Practices

Maintaining accurate and clear medical records is crucial for effective patient care. These records, detailing a patient's evaluation, management plan, surgical procedures, and post-operative instructions facilitate a seamless communication and care during the initial postoperative phase. The Royal College of Surgeons issued Good Surgical Practices guidelines in 2008 and updated them in 2014, setting parameters for operative notes. This audit aimed to evaluate handwritten operative note-keeping practices in Orthopedic Unit I at Dr. Ruth K.M. Pfau Civil Hospital Karachi in comparison to these established guidelines. The audit was conducted in two cycles between March and June 2023. In each cycle, 58 operative notes were evaluated against Good Surgical Practices (RCS) guidelines using a predefined form. After the initial audit, a meeting with the department team highlighted findings, stressed the importance of accurate operative notes, and introduced a new RCS-compliant format approved for implementation. Surgeons adapted to the new format during a 2-week period, followed by the second phase of the re-audit. The results were shared within the department to ensure ongoing improvement. In the initial audit, compliance with the RCS guidelines was observed at 40.7%. After implementing the new note format, significant enhancements were noted in 20 out of 22 parameters, resulting in an overall compliance rate of 64.8% and an improvement of 24.1%. Significant improvements were observed in recording patient identification, prosthesis details, antibiotic prophylaxis, surgical complications, incision name, theater anesthetist's name, and anticipated blood loss. However, documentation of 'any additional procedures performed and the reason why' and 'DVT prophylaxis' showed minimal to no improvement. The survey reveals notable gaps in orthopedic operative note documentation, emphasizing the limitations of traditional handwritten notes and a lack of adherence to operative notes guidelines. Rectifying this is crucial for optimal patient care, maintaining precise records, and minimizing legal risks.

An in vitro comparison of the dimensional stability of four 3D-printed models under various storage conditions.

To investigate the dimensional stability of various 3D-printed models derived from resin and plant-based, biodegradable plastics (PLA) under specific storage conditions for a period of up to 21 weeks. Four different printing materials, including Draft V2, study model 2, and Ortho model OD01 resins as well as PLA mineral, were evaluated over a 21-week period. Eighty 3D-printed models were divided equally into two groups, with one group stored in darkness and the other exposed to daylight. All models were stored at a constant room temperature (20°C). Measurements were taken at 7-week intervals using the Inspect 3D module in OnyxCeph software (Image Instruments GmbH, Chemnitz, Germany). Dimensional change was noted for all of the models with shrinkage of up to 0.26 mm over the study period. Most contraction occured from baseline to T1, although significant further contraction also arose from T1 to T2 (P < .001) and T1 to T3 (P < .001). More shrinkage was observed when exposed to daylight overall and for each resin type (P < .01). The least shrinkage was noted with Ortho model OD01 resin (0.16 mm, SD = 0.06), and the highest level of shrinkage was observed for Draft V2 resin (0.23 mm, SD = 0.06; P < .001). Shrinkage of 3D-printed models is pervasive, arising regardless of the material used (PLA or resin) and being independent of the brand or storage conditions. Consequently, immediate utilization of 3D printing for orthodontic appliance purposes may be preferable, with prolonged storage risking the manufacture of inaccurate orthodontic retainers and appliances.

Toxicity of a novel antifungal agent (ATB1651 gel) in Yucatan minipigs (Sus scrofa) following 4weeks of daily dermal administration.

ATB1651 gel is an antifungal drug candidate that enhances antifungal activity through substitution of several aryl rings, alkyl chains, and methyl groups. To ensure safety of use of ATB1651 gel, assessment of its potentially toxic side effects is necessary. In this study, we examined the repeated-dose toxicity of ATB1651 gel to Yucatan minipigs (Sus scrofa) in accordance with the Good Laboratory Practice guidelines. Five doses of ATB1651 gel (0%, 0.2%, 0.5%, 1.0%, 3.0%) were administered dermally to the left and right flanks of 38 minipigs daily for 4weeks. Mortality, clinical symptoms, dermal scores, body weights, and physiological, biochemical, pathological, and toxicokinetic analyses were performed after the treatment period. No systemic toxicological damage was observed in either male or female minipigs regardless of dose; however, dermal application of ATB1651 gel caused some skin alterations at the application sites. Specifically, erythema and eschar formation, edema, and scabs or raise spots were observed at the application site(s) in males in the 3.0% ATB1651 gel treatment group and in females at ATB1651 gel concentrations ≥ 1.0%, with dermal scores ranging from grade 1 to 2. Additionally, histopathological assay indicated infiltration of different types of inflammatory cells and the presence of pustule/crust at the application site(s) in both males and females at ATB1651 gel concentrations ≥ 0.5%. However, these changes were reversible after a 2-week recovery period and were considered a local irritation effect of ATB1651 gel. The no-observed-adverse-effect level of ATB1651 gel was 3.0% with regard to topical and systemic toxicity in both male and female minipigs. Collectively, our results imply that ATB1651 gel is a safe candidate for clinical development as an antifungal drug with a wide therapeutic window.

Longitudinal Measurements of Blood Biomarkers in Patients with Crohn's Disease or Ulcerative Colitis Treated with Infliximab: Only the Latest Values in the Induction Period Predict Treatment Failure.

Background: Few studies have incorporated longitudinal assessments or used combinations of blood biomarkers as predictors of loss of response to biologic therapy for patients with Crohn's disease (CD) or ulcerative colitis (UC). Methods: This is a population-based cohort study comprising Danish patients with CD or UC from 2008 to 2018. We used logistic regression to analyze whether levels and changes in levels of C-reactive protein (CRP), serum albumin, and hemoglobin, routinely measured during a 14-week infliximab induction period, predicted a change to another biologic medication or cessation of biologic therapy. Results: During the induction period, 2883 (1626 CD, 1257 UC) patients had 12,730, 12,040, and 13,538 specimens with CRP, serum albumin, and hemoglobin, respectively. In all, 284 patients (9.9%) switched to another biologic medication, and 139 (4.8%) ceased biologic therapy in the follow-up period. Only the most recent CRP and hemoglobin levels predicted the efficacy of infliximab treatment at approximately 14 weeks, a time point when the clinician often determines whether to continue treatment. Conclusion: Measurement of blood biomarkers prior to the clinical assessment does not predict the effectiveness of infliximab.

Risk of Stroke and Myocardial Infarction Among Initiators of Triptans

Triptans are contraindicated in patients with ischemic heart disease or previous myocardial infarction, and caution is advised when prescribing these drugs to patients with vascular risk factors. However, controlled observational studies have either shown no association or an apparent lower risk, possibly owing to a channeling of triptans to individuals at low risk of cardiovascular outcomes, and it remains unclear whether avoiding triptan treatment for these patients is meaningful. To establish whether an association between triptans and ischemic events could be demonstrated using a self-controlled design because this type of design is robust to the previously mentioned type of confounding. All people in nationwide Danish registries who were initiating triptans and all the ischemic events that they experienced were identified. A case-crossover design was used to estimate odds ratios (OR) for associations between first-ever triptan use and ischemic outcomes, comparing triptan exposure in the 2-week period up to the event with four 2-week reference periods. Data were obtained for the period January 1995 to August 2022. Included from the population of Denmark were individuals redeeming a prescription for any triptan and experiencing at least 1 of 3 predefined ischemic outcomes. No one was excluded. Initiation of any triptan. Acute myocardial infarction, ischemic stroke, or nonspecified stroke. Identified were a total of 429 612 individuals (median [IQR] age, 38 [28-48] years; 325 687 female [75.8%]) who redeemed a first prescription for a triptan in the study period. Of these patients, 11 (0.003%) had a myocardial infarction with the first triptan prescription in either a focal or referent window (odds ratio [OR], 3.3; 95% CI, 1.0-10.9), 18 (0.004%) had ischemic stroke (OR, 3.2; 95% CI, 1.3-8.1), and 35 (0.008%) had ischemic/nonspecified stroke (OR, 3.0; 95% CI, 1.5-5.9). Case patients had a median age of approximately 60 years and had a high-risk cardiovascular profile. Results of this case-crossover study suggest that triptan initiation was associated with higher risk of ischemic stroke and myocardial infarction. For the individual patient with low background cardiovascular risk, the risk of an ischemic event after triptan initiation was very low.

(083) The Association of Urinary Tract Infections with Anti-Androgen Medications: A Claims Database Analysis

Abstract Introduction Urinary tract infections (UTI) are highly prevalent among women, with 27% having recurrence within six months. While initial antibiotic treatment resolves symptoms for a subset of women; 20-40% experience symptom recurrence. Recent work has identified androgen receptors in the vestibule and vaginal mucosa, and the correlation between androgen deficiency and hormonally mediated vestibulodynia (HMV), frequently misdiagnosed as UTI, is widely accepted as a potential pathophysiological mechanism. Objective We sought to characterize rates of UTIs with anti-androgen medications utilizing a national claims database. Methods The TriNetX database was queried from May 2023 with selection criteria based on ICD-10 codes (Figure 1). The primary study outcome was a risk of UTI after anti-androgen medication within 2 weeks to 1-year from at least 3 anti-androgen medication prescriptions. We defined a 2-week lag period after the last medication prescription based on the assumption that UTI diagnosed immediately after an anti-androgen medication prescription was likely due to factors other than the medication. Moreover, other medications prescribed for UTIs were not included in the analysis due to their indication for various infections in addition to UTIs. Recurrent UTI (rUTI) was defined as greater than 2 diagnoses of UTI within 2-weeks to 6-months, or greater than 3 diagnoses of UTI within 2-weeks to 1-year of medication prescription. Results Our query identified 418,117 females aged 18 – 51 years with at least 3 anti-androgen prescriptions in the last 5 years; 209,669 females had 3-6 prescriptions; 94,193 females had 7-10 prescriptions; 45,624 females had 11-14 prescriptions; and 61,941 females had ≥ 15 prescriptions. Risk of UTI between two weeks-1 year after anti-androgen prescriptions was significantly higher compared to propensity-score matched controls (13.2% vs 10.2%; Risk Ratio (RR) 1.3, 95% Confidence Interval (CI) [1.28 – 1.32]). Significant difference in UTI-free survival was observed between the two groups (Hazard ration (HR) = 1.10, 95% CI [1.09 – 1.12]) (Figure 2). Compared to those with 3-6 prescriptions, propensity-score matched groups of those with 7-10, 11-14, or ≥ 15 prescriptions had significantly lower RR of UTIs within 2-weeks to 1-year from prescriptions (RR 7-10 vs 3-6 0.91, 95% CI [0.88-0.94]; RR 11-14 vs 3-6 0.90 [0.86-0.95]; RR ≥ 15 vs 3-6 0.88 [0.85-0.91]) (Figure 3). RR of UTI within 2-weeks to 1-year from prescriptions was comparable between propensity-score matched groups of 7-10, 11-14, and ≥ 15 prescriptions (RR 11-14 vs 7-10 1.03, 95% CI [0.98-1.08]; RR ≥ 15 vs 7-10 0.97, 95% CI [0.94-1.01]; RR ≥ 15 vs 11-14 0.96, 95% CI [0.91-1.01]). Conclusions The risk of UTI is notably higher with the use of anti-androgen medications. Further clinical studies are needed to further elucidate this correlation with the goal of including vulvar physiology and vulvar conditions in the diagnostic work up of recurrent UTIs. Disclosure No.

The Impact of the High-Fructose Corn Syrup on Cardiac Damage via SIRT1/PGC1-α Pathway: Potential Ameliorative Effect of Selenium.

High-fructose corn syrup (HFCS) has been a subject of intense debate due to its association with cardiovascular risks. This study investigates the potential protective effects of selenium (Se) supplementation against cardiac damage induced by HFCS. Thirty-two male Wistar albino rats were divided into four equal groups: control, CS (20%-HFCS), CS with Se (20%-HFCS, 0.3mg/kg-Se), and Se (0.3mg/kg-Se) only. After a 6-week period, heart and aorta tissues were collected for histopathological, immunohistochemical, biochemical, and genetic analyses. HFCS consumption led to severe cardiac pathologies, increased oxidative stress, and altered gene expressions associated with inflammation, apoptosis, and antioxidant defenses. In the CS group, pronounced oxidative stress within the cardiac tissue was concomitant with elevated Bcl-2-associated X protein (Bax) expression and diminished expressions of B-cell-lymphoma-2 (Bcl-2), nuclear factor erythroid 2-related factor 2 (Nrf2), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1-α), and silenced information regulator 1 (SIRT1). Se supplementation mitigated these effects, showing protective properties. Immunohistochemical analysis supported these findings, demonstrating decreased expressions of caspase-3, tumor necrosis factor-alpha (TNF-α), IL-1β, and vascular endothelial growth factor (VEGF) in the CS + Se group compared to the CS group. The study suggests that Se supplementation exerts anti-inflammatory, antioxidant, and antiapoptotic effects, potentially attenuating HFCS-induced cardiovascular toxicity. These findings highlight the importance of dietary considerations and selenium supplementation in mitigating cardiovascular risks associated with HFCS consumption.

Mini-MED: study protocol for a randomized, multi-intervention, semi-controlled feeding trial of a Mediterranean-amplified vs. habitual Western dietary pattern for the evaluation of food-specific compounds and cardiometabolic health

BackgroundDiet is among the most influential lifestyle factors impacting chronic disease risk. Nutrimetabolomics, the application of metabolomics to nutrition research, allows for the detection of food-specific compounds (FSCs) that can be used to connect dietary patterns, such as a Mediterranean-style (MED) diet, to health. This validation study is based upon analyses from a controlled feeding MED intervention, where our team identified FSCs from eight foods that can be detected in biospecimens after consumption and may therefore serve as food intake biomarkers.MethodsIndividuals with overweight/obesity who do not habitually consume a MED dietary pattern will complete a 16-week randomized, multi-intervention, semi-controlled feeding study of isocaloric dietary interventions: (1) MED-amplified dietary pattern, containing 500 kcal/day from eight MED target foods: avocado, basil, cherry, chickpea, oat, red bell pepper, walnut, and a protein source (alternating between salmon or unprocessed, lean beef), and (2) habitual/Western dietary pattern, containing 500 kcal/day from six non-MED target foods: cheesecake, chocolate frozen yogurt, refined grain bread, sour cream, white potato, and unprocessed, lean beef. After a 2-week washout, participants complete four, 4-week intervention periods, with biospecimen sampling and outcome assessments at baseline and at intervention weeks 4, 8, 12, and 16. The primary outcome is change in the relative abundance of FSCs from the eight MED target foods in participant biospecimens from baseline to the end of each intervention period. Secondary outcomes include mean change in cardiometabolic health indicators, inflammatory markers, and adipokines. Exploratory outcomes include change in diversity and community composition of the gut microbiota.DiscussionOur stepwise strategy, beginning with identification of FSCs in whole diets and biospecimens, followed by relating these to health indicators will lead to improved methodology for assessment of dietary patterns and a better understanding of the relationship between food and health. This study will serve as a first step toward validating candidate food intake biomarkers and allow for assessment of relationships with cardiometabolic health. The identification of food intake biomarkers is critical to future research and has implications spanning health promotion and disease prevention for many chronic conditions.Trial registrationRegistered at ClinicalTrials.gov: NCT05500976; Date of registration: August 15, 2022.

A Mixed-Methods Study of Compassionate Mind Training for Pupils (CMT-Pupils) as a School-Based Wellbeing Intervention

ObjectivesMental health difficulties in children are increasing, especially following transition from elementary to high-school education. In attempts to mitigate risk of these difficulties, proactive wellbeing interventions are becoming increasingly explored in school settings. Recently, Compassionate Mind Training (CMT) has been shown to be well-accepted and efficacious in promoting school staff wellbeing and prosocial behaviours. This paper outlines the impact of CMT as a pupil wellbeing intervention.MethodSixty-seven pupils aged 11–12 took part in either Personal, Social, Health and Economic (PSHE) lessons as usual (n=30), or CMT-Pupils (n=37) as their PSHE lessons, over a 5-week period. A mixed-methods quantitative and qualitative design was utilised to explore implementation and curricula effectiveness across several wellbeing parameters (e.g., anxiety, self-compassion, perfectionism, moods and feelings, self-esteem).ResultsPupils reported positively on their experiences of the CMT-Pupils lessons, content and practices. Quantitative analyses revealed a significant time-by-group interaction effect for anxiety, reflecting differences in anxiety post CMT-Pupils vs. PSHE as usual. No further interactions reached significance. Qualitative analyses revealed benefits of CMT-Pupils for pupil and classroom behaviour, including emotion regulation, kindness to others and feelings of inclusion. Benefits were also found to extend to the class teachers.ConclusionsCMT-pupils could be a promising school-based wellbeing intervention for improving prosocial behaviours, the classroom environment and protecting against deteriorations in child mental health. Larger scale explorations of CMT-Pupils across wider demographics, including investigation of who can deliver the curriculum efficaciously (e.g., teachers vs. external facilitators), are suggested as next steps for investigation.PreregistrationThis study was not preregistered.

COVID-19 on mind: Daily worry about the coronavirus is linked to negative affect experienced during mind-wandering and dreaming.

Despite a surge of studies on the effects of COVID-19 on our well-being, we know little about how the pandemic is reflected in people's spontaneous thoughts and experiences, such as mind-wandering (or daydreaming) during wakefulness and dreaming during sleep. We investigated whether and how COVID-19-related general concern, anxiety, and daily worry are associated with the daily fluctuation of the affective quality of mind-wandering and dreaming, and to what extent these associations can be explained by poor sleep quality. We used ecological momentary assessment by asking participants to rate the affect they experienced during mind-wandering and dreaming in daily logs over a 2-week period. Our preregistered analyses based on 1,755 dream logs from 172 individuals and 1,496 mind-wandering logs from 152 individuals showed that, on days when people reported higher levels of negative affect and lower levels of positive affect during mind-wandering, they experienced more worry. Only daily sleep quality was associated with affect experienced during dreaming at the within-person level: on nights with poorer sleep quality people reported experiencing more negative and less positive affect in dreams and were more likely to experience nightmares. However, at the between-person level, individuals who experienced more daily COVID-19 worry during the study period also reported experiencing more negative affect during mind-wandering and during dreaming. As such, the continuity between daily and nightly experiences seems to rely more on stable trait-like individual differences in affective processing. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Design and Implementation of a Brief, Self-Directed Course on Immunotherapy Best Practices for Neurology Trainees.

To create and implement a brief, self-directed course on immunotherapy (IT) best practices for trainees on a neuroimmunology elective rotation. A working group of neurology faculty developed a curriculum covering the mechanism of action, indications, and necessary monitoring for different IT used in neurology practice. The content was presented as a web-based course and hosted on local servers. Neurology residents and fellows participating in a neuroimmunology elective were given access to the curriculum over a 2-week period. A multiple-choice assessment and questionnaire assessing learner confidence with IT was administered prior to starting the course, and again upon course completion. Twelve months after implementation, the pretest and posttest were revised following an item analysis. Twenty-two neurology residents and fellows completed the course since July 2022. The average score on the first version of the pretest and posttest was 78% versus 92% (P = .02), and 51% versus 70% (P = .02) on the revised version. Trainee self-reported confidence with IT also improved, although only 59.1% of trainees completed the postcourse questionnaire. Respondents provided positive feedback on the format and content of the course and expressed a desire for a reference to the material for future use. In this pilot study, our course improved resident confidence and knowledge of IT best practices. The course was well-received, and our methods can be implemented in a variety of clinical environments to supplement trainee learning.

Perceptions of breast cancer screening programs and breast health among immigrant women: Qualitative study in Alberta.

To examine how women who have emigrated from the Middle East and North Africa (MENA) region perceive breast cancer risk and screening in Canada and how they approach breast health, and to explore barriers to breast cancer screening in this population. Focused ethnography. Edmonton, Alta. Women who were born in MENA countries (eg, Egypt, Iraq, Lebanon, Libya, Saudi Arabia, Somalia, Sudan, and Syria) and had immigrated to Canada less than 5 years prior to study recruitment and lived in Edmonton, Alta. Six focus groups were conducted over a 6-week period in July and August 2018 with 6 participants in each group (N=36); results were analyzed thematically. Three broad themes were identified: knowledge about breast health, cancer risk, and screening services; barriers to maintaining breast health and to screening; and potential solutions for overcoming these barriers. Findings indicated participants have limited knowledge about breast cancer screening practices in Alberta and that multiple barriers to screening remain. This study can help inform the development of culturally appropriate interventions to overcome barriers and to motivate women from MENA countries to use breast cancer screening.

Improved Learning Gain in Medical Students by Using Animated Whiteboard-Videos in Comparison to Textbooks in Surgery.

Animated videos have become popular in teaching medical students, although there is a certain lack of evidence concerning its efficacy. Surgery seems to be an ideal field for its application, since animations are very helpful to understand anatomic structures and complex procedures. The aim of this study was to investigate the effects of animated videos compared to textbooks on learning gain. A prospective 2-arm cohort study with 5th-year medical students was conducted during their 2-week surgical training module. The initial cohort of students received textbook sections on 3 major topics in visceral surgery as learning medium (text cohort). During the following semester, the second cohort of students received 3 animated whiteboard videos (animated videos) containing equivalent content (video cohort). All participants completed a multiple-choice test consisting of 15 questions on the learning content at baseline (pre-test) and after the learning period (post-test) and answered an additional evaluation questionnaire. Both cohorts were similar in their descriptive data and demonstrated significant learning gain during the 2-week learning period. The video cohort achieved better results (80% vs 73% correct answers; P = .028) and a higher learning gain (17% vs 11%; P = .034) in the post-test compared to the text cohort. The estimated learning time was longer in the video cohort (62 min vs 37 min; P < .001) and watching the videos resulted in higher learning gain (21% vs 6%; P < .001). Subgroups with higher learning gain by video learning were female gender (20% vs 11%; P = .040), native German speakers (18% vs 11%; P = .009), students without prior surgical experience (19% vs 12%; P = .033) and those undecided concerning a surgical career (22% vs 9%; P = .020). Interestingly, "low digital orientation" students benefited from videos (22% vs 13%; P = .021), whereas "high digital orientation" students did not. Animated videos increase medical students' learning gain and interest in surgery.

AI assisted reader evaluation in acute CT head interpretation (AI-REACT): protocol for a multireader multicase study

IntroductionA non-contrast CT head scan (NCCTH) is the most common cross-sectional imaging investigation requested in the emergency department. Advances in computer vision have led to development of several artificial intelligence...

A double-blinded, placebo-controlled, cross-over pilot trial in healthy men to study the effects of Angelica gigas herbal supplement on prostate cancer–relevant inflammatory cytokines.

170 Background: The ethanol extract of the root of Angelica gigas Nakai (AGN) dose-dependently inhibits animal models of prostate cancer. Multi-omic analyses have implicated immune and anti-inflammatory responses in the anti-cancer action. In our single dose-PK study (NCT02114957) in healthy volunteers with AGN dietary supplement CognI.Q, we observed a near doubling of the natural killer (NK) mRNA signature in peripheral blood mononuclear cells (PBMC) at 24 h after dosing while the inflammatory cytokine IL-8 mRNA was decreased by one half over the pre-dose baseline. Given NK incapacitation and inflammation have been linked to prostate cancer, the current trial (NCT03630328) was designed to assess safety and to delineate CognI.Q-specific immune and anti-inflammation functions. Methods: We used a double-blinded, placebo-controlled and crossover trial design to monitor hepatic and renal safety metrics based on Comprehensive Metabolic Panel (CMP) and compare the immune cell and cytokine responses to CognI.Q and placebo. Supplement period of 3 weeks was followed with a 2-week washout period. We employed the Ella microfluidic multiplex immunoassay to evaluate select plasma cytokines. Results: Fourteen healthy men completed the trial protocol. Physical examination on study visit days did not reveal any adverse events. Blood CMP monitoring detected abnormal hepatic integrity values in three subjects, all in the second washout period and were attributed to use of anti-allergy medication, an herbal tea for tooth ache, and excessive alcohol, respectively. Analysis of plasma cytokines detected corresponding elevation of MIG, CCL4, CXCL10 and IL-8 with these hepatic damage events. With the exclusion of these subjects or time point, the plasma cytokine measurement did not reveal a significant response to CognI.Q supplement vs. placebo. Conclusions: CognI.Q supplement at the current recommended dose (400 mg, twice per day) did not impair hepatic integrity or renal function, nor did it modulate select plasma cytokines in healthy men. Phase I dose-escalation trials should be implemented to establish safety profile and assess immune and inflammation modulatory effects of AGN supplement beyond the current dose. Clinical trial information: NCT03630328 .

How Active Are Our Patients in the First 6 Weeks Following Total Knee Arthroplasty?

BackgroundPatient activity after total knee arthroplasty (TKA) surgery has been estimated through patient-reported outcome measures. The use of data from an implanted sensor that transmits daily gait activity provides a more objective, complete recovery trajectory. MethodsIn this retrospective analysis of 794 patients who received a TKA with sensors in the tibial extension between October 4, 2021, and January 13, 2023, the average age of the patients was 64 years, and the cohort was 54.9% women. During the 6-week postoperative period, 90.3% of patients transmitted data. Patient activity in terms of qualified step count, cadence, walking speed, stride length, functional tibial range of motion (ROM), and functional knee ROM were compared at 1 week, 3 weeks, and 6 weeks postoperatively. ResultsAll gait parameters increased in the first 6 weeks postsurgery: qualified step count increased 733%, cadence increased 22%, walking speed increased 50%, stride length increased 17%, tibial ROM increased 19%, and functional knee ROM increased 14%. There were statistically significant differences at both postoperative periods (P = .029, P < .001, and P < .001 at 3 and 6 weeks, respectively) in step counts for different body mass index (BMI) categories, with qualified step counts decreasing with increasing BMI. Patients under 65 years tended to have a higher qualified step count than those 65 and older at all time points, but these differences were not statistically significant. Men had significantly higher step counts than women (P < .001 at 1, 3, and 6 weeks). ConclusionsInitial results with an implanted sensor that collects data during activities of daily living confirm that 90% of patients transmit objective gait metrics daily after TKA surgery. Those results differ by sex and BMI. Level of EvidenceIII Retrospective Cohort Study.

Predicting Time to Return to Cannabis Use After a Cessation Attempt: Impact of Cumulated Exposure to Nicotine-Containing Products

Objective: Cannabis is frequently co-used with tobacco/nicotine products, especially among young adults. Little is known about the effects of this co-use on cannabis cessation outcomes. Within a sample of young adults using cannabis frequently (current use of ≥5 days/week in the past 3 months), this study aimed to (a) document sources of exposure to tobacco/nicotine products, whether used simultaneously with cannabis or on different occasions, (b) examine if the level of cumulated exposure to tobacco/nicotine (self-reported or from biochemical testing) could predict time to cannabis lapse during a cannabis abstinence period, and (c) explore the relationship between nicotine/tobacco exposure and time to cannabis lapse according to tobacco cigarette smoking status. Method: Urine cotinine measures and self-reported data on use of different tobacco/nicotine products, collected from 32 participants (aged 19 to 23), were analyzed to predict time to lapse during a 2-week period of attempted abstinence from cannabis, controlling for cannabis dependence and sex. Results: Half of participants (56.3%) used at least one tobacco/nicotine product. Higher urine cotinine, representing higher cumulated tobacco/nicotine exposure, was related to a higher risk of lapsing (Hazard Ratio [HR] = 1.64; 95%CI [1.04, 2.58]). The risk of lapsing was even higher ([HR] = 3.46; 95%CI [1.17, 10.25]) among heavily tobacco/nicotine exposed (&gt;600 ng/mL, urine cotinine) participants than among unexposed (&lt;50 ng/mL) or lightly/moderately exposed (50-600 ng/mL) participants. Among those smoking cigarettes (solely or in combination with other products), there was no relation between cotinine level and time to lapse, likely due to a reduced variability in abstinence probability and a high likelihood of lapse observed for higher cotinine levels, mainly achieved by cigarette use. Conclusions: With a rapidly changing landscape of tobacco/nicotine use, our results underscore the need to consider all sources of tobacco/nicotine exposure to fully understand the specific and cumulative contributions of tobacco/nicotine to cannabis cessation outcomes.

Assessing the Role of Sports Participation on Depression, Suicide Ideation, and Suicide Behaviors Among Adolescents Before and During COVID-19.

To assess the association between sports participation, depression, suicide ideation, and suicide behaviors in a nationally representative sample of US adolescents before COVID-19 and during COVID-19. Data from the 2019 Youth Risk Behavior Survey (n = 13,526) and the 2021 Adolescent Behaviors and Experiences Survey (n = 7677) were used to analyze the association between past-year depression/suicide ideation/suicide behaviors and past-year sports participation. The analysis found that 57.4% of adolescents indicated participating in at least 1 sport in 2019; this dropped to 47.7% in 2021. Furthermore, 36.7% of adolescents indicated feeling sad or hopeless almost every day for 2 weeks or more in a row in 2019; this increased to 44.2% in 2021. The percentage of adolescents who indicated considering suicide, making a suicide plan, attempting suicide, and attempted suicide that lead to an injury was similar during 2019 and 2021. Multivariable analysis found that participation in 2 or more sports in 2019 was associated with lower odds of each of the outcomes for depression, suicide ideation, and suicide behaviors, whereas in 2021, participation in 2 or more sports was only associated with lower odds of indicating being sad or hopeless (an indicator for depression) for a 2-week period (adjusted odds ratios = 0.70; 95% confidence interval, 0.58-0.85). Participation in 2 or more sports lowered the risk of feeling sad or hopeless, suicide ideation, and suicide behaviors in 2019, but this effect was absent in 2021. Given the presence of multiple stressors during the COVID-19 pandemic, sports participation alone may not offer sufficient protective effects against suicide behaviors as it did pre pandemic.

Evaluation and Intercomparison of Small Uncrewed Aircraft Systems Used for Atmospheric Research

Abstract Small uncrewed aircraft systems (sUAS) are regularly being used to conduct atmospheric research and are starting to be used as a data source for informing weather models through data assimilation. However, only a limited number of studies have been conducted to evaluate the performance of these systems and assess their ability to replicate measurements from more traditional sensors such as radiosondes and towers. In the current work, we use data collected in central Oklahoma over a 2-week period to offer insight into the performance of five different sUAS platforms and associated sensors in measuring key weather data. This includes data from three rotary-wing and two fixed-wing sUAS and included two commercially available systems and three university-developed research systems. Flight data were compared to regular radiosondes launched at the flight location, tower observations, and intercompared with data from other sUAS platforms. All platforms were shown to measure atmospheric state with reasonable accuracy, though there were some consistent biases detected for individual platforms. This information can be used to inform future studies using these platforms and is currently being used to provide estimated error covariances as required in support of assimilation of sUAS data into weather forecasting systems.