2-year Period Research Articles

Care trajectories for musculoskeletal disorders following a new episode of low back pain

Abstract This study explored diverse care trajectories (CTs) for low back pain (LBP) and other musculoskeletal disorders (MSDs), over a 5-year period following a first episode of LBP. Based on Quebec's administrative health data from 2007 to 2011, this longitudinal cohort study involved 12,608 adults seeking health care for LBP. Using a new multidimensional state sequence analysis, we identified 6 distinct types of CTs. The most prevalent types 1, 2, and 3 (comprising 79.2%, 18.0%, and 21.7% of the cohort, respectively) exhibit rapid recovery and similar patterns of healthcare use over 5 years but differing in initial diagnoses: nonspecific LBP in type 1, trauma-related LBP in type 2 (mostly younger men and highest initial emergency consultation), and specific LBP in type 3. Types 4 to 6, representing smaller groups, show high healthcare utilization with comparable mixed LBP diagnoses at entry but distinctive subsequent care use patterns. Patients in types 4 and 6 (mainly older age groups and women) sought care for other MSDs from general practitioners or specialists, while middle-aged patients in type 5 experienced persistent nonspecific LBP with frequent general practitioner consultations over 5 years. The CTs typology revealed several key areas for improvement in nonpharmacological interventions, including the need to address possible inappropriate medical imaging and invasive interventions for older women with MSDs and the lack of ambulatory care access for younger patients with trauma-related LBP. Finally, results clearly highlighted poor access to rehabilitation physicians and rehabilitation services for all patients suffering from LBP and MSDs.

Exploring the role of paedological and climatic aspects in the medium-term decline of green roofs hydrological performance: an experimental study in a Mediterranean environment

ABSTRACT In the realm of sustainable strategies for urban flooding risk mitigation, green roofs (GRs) emerge as a key solution. The complex relationship between hydrological, paedological, and climatic aspects poses several challenges in the definition of GRs’ medium-term behaviour, emphasizing the imperative for further research. Embedding paedological and climatological evidence, this study focuses on relevant observed changes in the hydrological performance and behaviour of two extensive GR test beds located in southern Italy over a 7-year monitoring period. Experimental rainfall and runoff data, at the event scale, point to a reduction of approximately 12% in the stormwater retention capacity (RC) of monitored GRs. Additionally, a comparative analysis of RC values in two specific time windows revealed how, in an early stage, it was controlled by soil moisture content whereas it is currently (aged state) mainly related to rainfall characteristics. After excluding climate variability as a potential driver for observed RC changes, a paedological experimental campaign highlights variations in the physical and hydraulic parameters of the peat substrate, which, in turn, is addressed to affect the retention and detention capabilities of the GRs.

Association of changes and cumulative measures of triglyceride-glucose index-body mass index with hypertension risk: a prospective cohort study

BackgroundTo investigate the relationships of the dynamic changes in triglyceride glucose index-body mass index (TyG‑BMI) and cumulative TyG-BMI with the risk of hypertension among middle-aged and elderly Chinese.MethodsData were used from the China Health and Retirement Longitudinal Study (CHARLS). Participants who participated in the baseline study (2011–2012) and in subsequent surveys (2015–2018) were included in this study. The primary exposures were changes in TyG-BMI and cumulative TyG-BMI from 2012 to 2015. Changes in TyG-BMI were categorized using k-means clustering methods, while cumulative TyG-BMI was categorized into quartiles. Cox proportional hazards regression models were performed to examine the association between changes in TyG-BMI and cumulative TyG-BMI with the incidence of hypertension. Linear regression analyzes were performed to examine the association between changes in TyG-BMI and cumulative TyG-BMI with cumulative systolic blood pressure (SBP) and cumulative diastolic blood pressure (DBP).ResultsOf a total of 2,561 participants aged 56.93 ± 8.08 years old at baseline, 253 individuals (9.9%) developed hypertension during the 7-year follow-up period. The hazard ratios (HR) and 95% confidence interval (CI) for hypertension were 1.50 (1.10–2.03) for class 2 (persistently medium class) and 2.35 (1.61–3.42) for class 3 (persistently high class), compared to class 1 (persistently low class). Additionally, class 2 showed increases of 7.70 mmHg (95% CI: 5.18–10.21) in cumulative SBP and 6.53 mmHg (95% CI: 4.68–8.38) in cumulative DBP, while class 3 exhibited increases of 14.10 mmHg (95% CI: 10.56–17.64) in cumulative SBP and 12.64 mmHg (95% CI: 10.03–15.25) in cumulative DBP, compared with class 1. Regarding cumulative TyG-BMI, the HR for hypertension were 1.75 (95% CI: 1.18–2.59) for quartile 3 and 2.15 (95% CI: 1.43–3.23) for quartile 4, compared with quartile 1. In quartile 2, cumulative SBP increased by 3.99 mmHg (95% CI: 0.88–7.11) and cumulative DBP by 2.74 mmHg (95% CI: 0.45–5.02). Quartile 3 showed increases of 8.32 mmHg (95% CI: 5.09–11.54) in cumulative SBP and 7.13 mmHg (95% CI: 4.76–9.49) in cumulative DBP. Quartile 4 exhibited the highest increases, with cumulative SBP rising by 13.15 mmHg (95% CI: 9.70–16.60) and cumulative DBP by 12.20 mmHg (95% CI: 9.67–14.74). Furthermore, a linear relationship was observed between cumulative TyG-BMI and the risk of hypertension.ConclusionsChanges in TyG-BMI and cumulative TyG-BMI were associated with an increased risk of hypertension, as well as higher cumulative SBP and DBP in Chinese middle-aged and elderly population.

Association of obesity severity and duration with incidence of chronic kidney disease

IntroductionObesity is a known risk factor for chronic kidney disease (CKD), but the impact of obesity severity and duration on CKD incidence is unclear.MethodsCumulative Excess Weight (CEW) and Cumulative Excess Waist Circumference (CEWC) scores were calculated, which represent the accumulation of deviations from expected body mass index and waist circumference values over time until the development of CKD or the end of the follow-up period. Time-dependent Cox models were used to investigate the sex-stratified association of CEW and CEWC with CKD incidence while controlling for confounding variables.ResultsOut of the 8697 participants who were evaluated in this study, 56% (4865) were women and the mean age was 40 ± 14. During the 15-year follow-up period, 41.7% (3629) of the participants developed CKD. Among the CKD patients, 65.4% (829) of men and 77.9% (1839) of women had a BMI higher than 25, and high WC was found to be 73.7% (934) and 55.3% (1306) for men and women, respectively. We found a significant association between one standard deviation change of CEW and the development of CKD in both sexes (fully adjusted hazard ratios and 95% CI of CEW in men and women were 1.155 [1.081–1.232) and 1.105 (1.047–1.167)]. However, the association between CEWC and CKD development was only significant among men participants [HR = 1.074 (1.006–1.147)].ConclusionOver a 15-year follow-up, the accumulation of general and central obesity was associated with an increased incidence of CKD development.

Economic evaluation of Fasting Mimicking Diet vs. standard care in diabetic patients on dual or triple medications at baseline in the US: A cost-utility analysis

ObjectivesAccording to most guidelines, dietary interventions are essential in the management of diabetes. Fasting has emerged as potential therapeutic regimes for diabetes. The proof-of-concept study and the Fasting In diabetes Treatment trial are the first to explore the clinical impact of the Fasting Mimicking Diet (FMD™) in patients with T2DM. Their results showed that FMD™ cycles improve glycemic management, and can be integrated into usual care complementary to current guidelines. This economic evaluation aims to assess the 10-year quality of life effects, cost implications, and cost-effectiveness of adding a 3-year FMD™ program to diabetes standard care in diabetic population on dual or triple medications at baseline from the perspective of the US payer. MethodsWe constructed a microsimulation model in TreeAge using a published US-specific diabetes model. The model was populated using FMD™ effectiveness outcomes, and publicly available clinical and economic data associated with diabetes complications, use of diabetes medications, hypoglycemia incidence, direct medical costs in 2021 USD, quality of life, and mortality. All benefits were discounted by 3%. ResultsThis cost-utility analysis showed that the FMD™ program was associated with 11.4% less diabetes complications, 67.2% less overall diabetes medication use, and 45.0% less hypoglycemia events over the 10-year simulation period. The program generated an additional effectiveness benefit of 0.211 QALY and net monetary benefit of 41,613 USD per simulated patient. Thus, the FMD™ program is cost-saving. ConclusionsThese results indicate that the FMD™ program is a beneficial first-line strategy in T2DM management.

Considering the Cost-Effectiveness of Accredited Continuing Medical Education: A Landscape Analysis of Economic Concepts in Continuing Medical Education Research.

In health care, cost-effectiveness analysis evaluates changes in health outcomes as a function of costs. The cost-effectiveness of continuing professional development for health care providers has not been historically well characterized despite substantial investment. This literature review identified publications considering the costs and cost-effectiveness of accredited continuing medical education activities. Searches were conducted for English language records in PubMed and the gray literature using a 10-year lookback period from March 10, 2023. Search terms included concepts related to continuing medical education, cost, effect, and utilization. One reviewer conducted title/abstract screening, full-text review, and data extraction, with direction and adjudication of search and screening concepts provided by the lead advisor. Publications were categorized as related to costs of an educational intervention (Concept 1) and/or the impact of education on health care costs (Concept 2). Results were summarized using descriptive statistics. A total of 668 database records were screened, 125 (19%) underwent full-text review, and 25 of 125 (20%) were accepted; 7 of 351 (2%) gray literature sources were accepted for a total of 32 included records. The most common reason for rejection was not being an accredited activity. Of the 32 records, 27 (84%) were related to Concept 1 only, 3 (9%) to Concept 2 only, and 2 (6%) to both Concepts 1 and 2. Approximately half (n = 19, 59%) mentioned costs without supporting data. These findings show that considerations of cost and cost-effectiveness are rare in the accredited continuing medical education literature, which may limit how the value of continuing medical education is characterized.

Assessing the Impact of Nicotine Dependence on 90-Day Major Complications and 2-Year Hardware Outcomes in Open Reduction and Internal Fixation of the Distal Radius Fracture.

This study aims to assess the impact of nicotine dependence on both 90-day major postoperative outcomes and 2-year implant-related outcomes in patients undergoing open reduction internal fixation (ORIF) for distal radius fractures. We queried TriNetX, a national research database that provides real-time access to deidentified medical records, for patients of all ages who underwent an ORIF of the distal radius (Current Procedural Technology codes 25607, 25608, 25609) between 2001 and 2021. Patients were categorized by nicotine dependence history (International Classification of Diseases, Tenth Revision code: F17), with groups 1:1 propensity matched for age, sex, race, ethnicity, body mass index, type 2 diabetes, hypertension, cerebrovascular disease, and chronic obstructive pulmonary disease. The primary analysis examined major postoperative complications within 90 days, while the secondary analysis assessed hardware-related issues within 2 years. Risk ratios and 95% confidence intervals were generated for each outcome. Of 62 137 patients treated with distal radius ORIF, 7764 had nicotine dependence, and 54 373 did not. Each group comprised 7591 patients after 1:1 matching. Nicotine dependence was associated with increased risk of skin infections, sepsis, and wound disruption in the 90-day postoperative period (P < .001). Within the 2-year postoperative period, nicotine dependence was associated with increased risk of mechanical complication of internal fixation device (P < .001), nonunion (P < .01), and surgical intervention for nonunion (P = .009). Nicotine dependence is associated with increased risk of infection, sepsis, wound disruption within 90 days, and hardware complication, nonunion, and nonunion repair at 2 years. These data emphasize the importance of nicotine counseling by treating surgeons.

Paediatric Drug Development in Japan: Current Status and Future Challenges.

Until around 2000, the number of medicinal products labelled for paediatric use was limited worldwide. Regulatory measures to promote paediatric drug development in the US and Europe and the establishment of an international guideline (ICH-E11) have led to an increase in the number of paediatric labels. In Japan, efforts have been made to promote the development of paediatric drugs. This study was aimed to examine whether these supportive efforts are successful in Japan. This study examined the number of new drugs approved for paediatric indications in Japan from 2006 to 2023, as well as the clinical data package, that is, characteristics of the approved paediatric drugs and paediatric clinical trials, and the percentage of extrapolation of adult data, in the most recent 9-year period. The number of paediatric drug approvals showed an increasing trend between 2006 and 2023 with some fluctuations. The proportion of drugs indicated for paediatric patients to the total number of approved drugs was about 30% until 2022, but increased to 48% in 2023. During the period from 2015 to 2023, simultaneous development in adults and children accounted for 59% (159/269) of paediatric development, but the complete extrapolation of adult data to paediatric populations has not been widely utilized (11.2%, 30/269). The number of paediatric drug approvals has shown an upward trend, suggesting that measures to promote the development of paediatric drugs may have been exerting a favourable effect in Japan. However, there is still a limited number of drugs that have additional indications for paediatric use. Appropriate development strategies, such as the extrapolation of adult data to paediatric populations, should be considered if scientifically justified.

Grazing intensity by sheep affects spatial diversity in botanical composition of Inner Mongolian grassland

Overgrazing by sheep causes degradation of grasslands in the Inner Mongolian steppe, yet our understanding of its impact on grassland plant communities is limited by lack of observations at high spatial resolution. Employing a nested experimental design in a long-term grazing experiment provides insights into effects of increasing sheep grazing intensity on community composition, diversity, and spatial patterns in the grassland vegetation. Effects of observed changes in the plant community are discussed based on monthly weight gain of sheep during grazing. The design of the long-term experiment included four triplicated grazing intensities applied during an 8-year period. At the end of that period, we evaluated vegetation coverage, categorized plant species by functional groups, and analyzed the data using a mixed linear model. Moreover, spatial autocorrelation methods were employed to investigate spatial patterns, visualized via a kriging model. We found that the plant community composition differed among grazing treatments, with high grazing intensity showing higher plant species richness and stronger clustering of plants at our fine scale of observation. These fine-grained spatial scale observations are usually not recorded in larger spatial scale analyses of grassland responses to overgrazing. While the grazing intensities used in our study did not influence individual sheep weight gain, total sheep weight gain per hectare increased with an increase in grazing intensity. Our study shows that in a sheep grazing intensity experiment in Inner Mongolia grasslands total sheep weight gain may increase at the expense of fine-scale species composition and spatial dynamics of the grassland vegetation. These insights may be used for determining trade-offs of sheep meat production with original composition and structure of grassland plant communities. Effects on other ecosystem properties and functions, such as on belowground biodiversity, remain to be assessed.

Compulsory Community Treatment Orders and health outcomes for Ma-ori in New Zealand.

We have previously analysed outcomes for all community treatment orders commenced during a 10-year period in New Zealand. Given Te Tiriti O Waitangi obligations to scrutinise health and consider equity for Māori, we completed this analysis to consider community treatment-order outcomes according to ethnicity. Ministry of Health databases provided demographic, service use and medication dispensing data for community treatment-order recipients between 2009 and 2018. As non-Māori on community treatment orders are older, less deprived and less likely to be diagnosed with a Psychotic Disorder, data were categorised according to age (<35/⩾35 years), level of deprivation (New Zealand Dep levels ⩽3, 4-6 and ⩾7) and diagnosis (Psychotic Disorder/non-Psychotic Disorder). The incidences of key outcome measures (admissions, community care, medication dispensing) were calculated for periods on/off community treatment orders for Māori and non-Māori to consider the differential impact of community treatment orders according to ethnicity. Māori have high rates of community treatment order utilisation and are younger, more likely to be diagnosed with a Psychotic Disorder and spend longer receiving compulsory treatment than non-Māori. Non-Māori are more likely to receive more additional depot antipsychotic medication on-community treatment orders compared with periods off-community treatment order than Māori but other clear patterns of response distinguishing between Māori and non-Māori were not present. The differences between Māori and non-Māori for community treatment-order utilisation suggest the presence of structural inequity in underlying mental illness distribution and treatment provision. Māori cultural expertise at all levels of healthcare including healthcare planning and delivery is required to make advances and reduce disparity.

Chronic pain at 1-year following knee arthroplasty is associated with a worse joint-specific function and health-related quality of life.

The purpose of this study was to identify independent variables associated with chronic pain (CP) at 1 year following knee arthroplasty (KA) and whether this influenced functional outcomes. This retrospective study was conducted over a 2-year period and included 2588 patients with completed Oxford knee score (OKS) and EuroQol (EQ)-five domains (5D) preoperatively and at 1 and 2 years postoperatively. The OKS pain component score was used to define patients with CP (≤14 points). The mean age was 70.0 (range 34-94) years and there were 1553 (60.0%) females. There were 322 (12.4%) patients with CP at 1 year. A worse preoperative EQ-5D (p = 0.025), EQ-visual analogue scale (VAS) (p = 0.005) and OKS questions relating to washing (p = 0.010), limping (p = 0.007), kneeling (p = 0.003) and night pain (p = 0.004) were independently associated with risk of CP. However, the preoperative OKS (area under the curve [AUC]: 72.0, p < 0.001) and EQ-5D score (AUC: 70.1, p < 0.001) were the most reliable predictors, with threshold values of <18-points and <0.300 being predictive of CP, respectively. Of those with CP at 1 year, 231 were followed up at 2 years, of which 92 (39.8%) had resolution of their CP. A worse response to OKS question 11 (ability to shop) and EQ-5D (p = 0.028) at 1 year was independently associated with persistent CP. Patients with CP had significantly (p < 0.001) worse OKS, EQ-5D and EQ-VAS at 1 year compared to those without. However, for those that had resolution of their CP at 2 years, their outcomes were clinically equal to those that did not have CP at 1 year. One in eight patients had CP at 1 year following surgery, which was associated with clinically worse knee-specific outcomes and quality of life. However, by 2 years, two in five patients had resolution of their CP and had functional outcomes clinically equal to those without CP at 1 year. The risk factors identified could be used to inform patients of their risk for CP and the potential for resolution. Level III retrospective study.

Isolated Severe Neutropenia in Adults, Evaluation of Underlying Causes and Outcomes, Real-World Data Collected over a 5-Year Period in a Tertiary Referral Hospital

Isolated Severe Neutropenia in Adults, Evaluation of Underlying Causes and Outcomes, Real-World Data Collected over a 5-Year Period in a Tertiary Referral Hospital

The rate of ileostomy site incisional hernias: more common than we think?

Incisional hernias (IH) rates after diverting loop ileostomy reversal (DLI-R) have been reported up to 24%. We aimed to characterize the incidence rate and risk factors associated with DLI-R site IH formation within 1-year in a large patient cohort. A retrospective review at a single quaternary referral center hospital of adult patients who underwent DLI-R over a 5-year period and abdominal computerized tomography (CT) imaging performed within 1-year for any indication postoperatively was conducted. All CTs scans were independently reviewed by staff surgeons to determine the presence of a fascial defect at the DLI-R site. 2,196 patients underwent DLI-R; of these, 569 (25.9%) underwent CT imaging for any indication. Mean patient age, 54.8 (± 14.9), BMI 27.6kg/m2. 87 (15%) patients had a parastomal hernia at time of DLI-R. After median follow-up of 10 months, 203 patients (35.7%) had IH at the DLI-R site. Age (p = 0.14), sex (p = 0.39), race (p = 0.75), and smoking status (p = 0.82) weren't associated with IH after DLI-R. Comorbidities weren't significantly associated with IH following DLI-R. In univariate analysis, increased BMI (p < 0.001), presence of a parastomal hernia (p = 0.008), and suture type (p = 0.01) were associated with IH development. On multivariate analysis, BMI remained significant, and polyglyconate compared to polydioxanone suture were associated with higher rates of IH (p < 0.001). We observed that the rate of incisional hernias within 1-year of diverting ileostomy reversal was indeed common at 36%. Granted, a high percentage of the population was excluded due to heterogeneity in radiographic evaluation that could be mitigated in future prospective studies. Our study suggests that IH preventative strategies include weight loss for overweight and obese patients prior to DLI-R and that the optimal suture for DLI-R is polydioxanone.

Impacts of climate change on urban stormwater runoff quantity and quality in a cold region

Climate change poses significant challenges to urban environments affecting both flood risks and stormwater pollutant loadings. However, studies on variations in stormwater runoff quantity and quality in cold regions, which are highly sensitive to climate change, are notably limited. Integrating climatic, hydrologic, and hydraulic modelling, the study assesses the potential impacts of climate change on stormwater runoff volume and pollutant dynamics in a Canadian urban watershed (Calgary). A two-year field program was conducted to support the calibration and validation of the Storm Water Management Model (SWMM). Intensity–duration–frequency curves were employed to evaluate the impacts of climate change on peak flow rate and flooding duration. In addition, typical dry, average, and wet years were applied to continuously simulate stormwater runoff quantity and quality during the 2050s and 2080s. The results suggest substantial increases in peak flow rates and flooding durations, particularly for the 5-year return period rainfall, with 1-h, 4-h, and 24-h peak inflow rates increasing by 74.3% (170.7%), 89.2% (158.4%), and 64.1% (102.8%) in the 2050s (2080s) Furthermore, the runoff quantity is projected to rise by 2.4–10.2% in the 2050s and 11.8–17.5% in the 2080s. Total suspended solids (TSS), total nitrogen (TN), and total phosphorus (TP) loadings are anticipated to increase by 2.0–36.1%, 3.1–21.4%, and 4.1–20.7%, respectively. As a result, the current stormwater system could overload and stormwater quality is likely to deteriorate under the impact of climate change. The findings are beneficial for cold regions to develop adaptive strategies that enhance urban water security and environmental sustainability under climate change.

Total versus subtotal tonsillectomy for recurrent tonsillitis: 5-year follow up of a prospective randomized noninferiority clinical trial.

In long-term follow-up, it remains uncertain whether tonsillectomy, a procedure associated with significant comorbidity, can be substituted with partial tonsillectomy in patients with recurrent tonsillitis. This paper is to present the 5-year follow-up data of our previous study titled "Total versus subtotal tonsillectomy for recurrent tonsillitis-a prospective randomized noninferiority clinical trial." The underlying study was performed as single-blinded prospective noninferiority procedure in patients with recurrent chronic tonsil infection, where one side was removed completely (tonsillectomy) and the other side partially (intracapsular/partial tonsillectomy). Five years after surgery, we collected data on the frequency of tonsillitis in the first, second, third, fourth, and fifth year post-surgery. We obtained assessments from patients, their ENT physicians, and general practitioners separately. To assess the impact of surgical therapy on overall quality of life, we employed the Glasgow Benefit Inventory (GBI). Out of the 111 patients initially included in the years 2015-2018, 79 were eligible for the 5-year follow-up, representing a 71% follow-up rate. The mean follow-up time was 60months. Notably, during the first 12months post-surgery, no cases of bacterial inflammation were observed in the remaining tonsillar tissue following partial tonsillectomy, suggesting noninferiority compared to total tonsillectomy. This effect remained consistent over the 5-year study period. GBI results indicate that both total and partial tonsillectomy positively impact the physical and mental health of patients with recurrent tonsillitis. Considering that partial tonsillectomy is associated with less pain and reduced postoperative bleeding, it may emerge as a potential replacement for total tonsillectomy as the standard method in the future.

Monitoring of Pseudomonas aeruginosa mutational resistome dynamics using an enrichment panel for direct sequencing of clinical samples

Pseudomonas aeruginosa is a major cause of hospital-acquired and chronic infections, characterised by an extraordinary capacity to develop antimicrobial resistance through the selection of chromosomal mutations, leading to treatment failure. Here, we designed and tested a hybridisation-based capture system for the enrichment of genes of interest before sequencing to monitor resistant populations genomics directly from clinical samples. A panel for enrichment before sequencing of close to 200 genes related to P.aeruginosa antimicrobial resistance, multilocus sequence typing, mutability or virulence was designed, synthesised (KAPA HyperCap, Roche) and initially validated invitro using a multidrug-resistant ST175 isolate and representative isolates from major P.aeruginosa clades. Invivo testing included ventilator associated pneumonia by MDR P.aeruginosa in ICU (3-10 sequential samples from 3 patients) and chronic respiratory infection by hypermutable P.aeruginosa in cystic fibrosis (8 sequential samples from a single patient covering a 4-year period). Results from direct sequencing with the enrichment panel were compared with those of whole genome sequencing (WGS) and phenotypic profiling of 10 isolated colonies per sample. Invitro assays confirmed the selectivity of the enrichment panel and the correct identification of the vast mutational resistome of ST175, including specific mutations even when introduced in a 1:100 proportion. Invivo performance was at least equivalent to sequencing 10 colonies per sample, including the accurate identification of the sequence types and the basal and acquired mutational resistome. To note, specific resistance mutations, such as those in ampC leading to resistance to novel β-lactams, could be traced even at frequencies of 1%. Moreover, the coselection of mutator populations and antibiotic resistance mutations, predicted in theoretical and invitro studies, was evidenced invivo. This proof-of-concept study demonstrates that resistance genomics of P.aeruginosa can be analysed directly from clinical samples, determining not only a considerable reduction in turnaround time and cost from a diagnostics perspective, but also an unprecedented potency for accurate monitoring of invivo population dynamics in bacterial infections. Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea-NextGenerationEU.

Primary chronic osteomyelitis of the jaw - a descriptive study of the condition and its occurrence in Sweden between 2012 and 2018.

Primary chronic osteomyelitis (PCO) of the jaw is a non-infectious, inflammatory state of the jawbone of unknown etiology. This study aimed to investigate the occurrence of PCO in Sweden between the years 2012 and 2018, the characteristics of the condition, treatment methods, and outcomes. Material and methods: The search for patients with PCO in Sweden 2012-2018 was performed at 24 oral and maxillofacial surgery units in Sweden. During this 6-year period, 17 patients were identified as diagnosed with PCO in Sweden. The mean age was 10.6 years at diagnosis, and the female:male ratio was 4:1. We conclude that PCO is a very rare disease in Sweden, and that standardized, well-defined criteria are necessary to calculate incidence rates but also to increase knowledge about etiology, clinical characteristics, and treatment outcomes in rare conditions such as PCO.

Spatiotemporal Evolution and Tapio Decoupling Analysis of Energy-Related Carbon Emissions Using Nighttime Light Data: A Quantitative Case Study at the City Scale in Northeast China

As the world’s second-largest economy, China has experienced rapid industrialization and urbanization, resulting in high energy consumption and significant carbon emissions. This development has intensified conflicts between human-land relations and environmental conservation, contributing to global warming and urban air pollution, both of which pose serious health risks. This study uses nighttime light (NTL) data from 2005 to 2019, along with scaling techniques and statistical analysis, to estimate city-scale energy carbon emissions over a 15-year period. Focusing on Northeast China, a traditional industrial region comprising 36 cities across three provinces, we examine spatial patterns of energy carbon emissions and assess spatiotemporal evolution through spatial autocorrelation and dynamic changes. These changes are further evaluated using standard deviation ellipse (SDE) parameters and SLOPE values. Additionally, the Tapio decoupling index is applied to explore the relationship between city-scale emissions and economic growth. Our findings for the 36 cities over 15 years are: (1) Heilongjiang shows low, declining emissions; Jilin improves; Liaoning has high, steadily increasing emissions. (2) The global spatial autocorrelation of energy carbon emissions is significant, with a positive Moran’s I, while significant local Moran’s I clusters are concentrated in Heilongjiang and Liaoning. (3) The greatest emission changes occurred in 2015, followed by 2019, 2005, and 2010. (4) Emission growth is fastest in Heilongjiang, followed by Liaoning and Jilin. (5) Tapio analysis shows positive decoupling in Heilongjiang, declining decoupling in Jilin, and no change in Liaoning. This study provides a quantitative basis for dual carbon goals and offers emission reduction strategies for government, industry, and residents, supporting energy transition and sustainable urban planning.

Reusable glassware for routine cell culture—a sterile, sustainable and affordable alternative to single-use plastics

Cell culture is a cornerstone of in vitro biological research. Whilst glassware was once commonplace in tissue culture facilities, in recent decades laboratories have moved towards a heavy reliance on single use plastics for routine procedures. Single use plastics allow for accessible, sterile, and often affordable equipment that comes at a high environmental cost. We developed a glassware preparation and cleaning process that allowed the comparison of “traditional” plastic-heavy, and adapted “sustainable,” cell culture practices, to empirically compare the sterility, viability, and proliferative capacity of cells cultured with differing techniques, by observing IL-6 production, morphology, and proliferation rate of cultured human pulmonary fibroblast cells. During which, we calculated the carbon footprint of traditional versus sustainable methods. We additionally endeavored to provide a realistic overview of the steps required to transition to more sustainable cell culture practices and make suggestions to ease the cost, labor, and time required to uptake similar practices in other laboratories. Cells cultured using reusable glassware did not show signs of contamination or stress compared to cells grown solely with plasticware, and glassware baked at 180°C for 120 min was sufficiently decontaminated and depyrogenated for culturing these cells. An individual researcher adopting the same methodology could reduce their carbon footprint by 105.92 kg of Carbon dioxide equivalent (CO2e) whilst also saving money (£408.78) over a 10-year period. We predict that these benefits would be greater if more researchers were to uptake these adapted practices. We intend for this paper to reassure researchers that viable, sterile, and sustainable routine cell culture can be achieved with little upfront cost to the researcher, with the prospective benefit of greatly reducing the cost to the environment. We additionally hope that increased uptake, and thus demand of more sustainable practices, encourages suppliers, policy makers, and funding bodies to make sustainable practices more accessible to individual researchers and institutions worldwide.

Gender disparity in access to advanced therapies for patients with Parkinson's disease: a retrospective real-word study.

Gender differences in the access to advanced therapies for Parkinson's disease (PD) are poorly investigated. The objective of this study was to investigate the presence of any gender disparity in the access to advanced therapies for PD. Retrospective study. Data from patients with consistent access to the Parkinson's and Movement Disorder Center of L'Aquila over the last 10-year period were screened. Patients selected for advanced therapies were included. Out of 1,252 patients, 200 (mean age ± SD 71.02 ± 9.70; 72% males; median Hoen Yahr level: 3, minimum 1 maximum 5) were selected for advanced therapies: 133 for Magnetic Resonance guided Focused Ultrasound (MRgFUS) thalamotomy (mean age ± SD 70.0 ± 8.9; 77% males), 49 for Levodopa/Carbidopa Intestinal Gel (LCIG) infusion (mean age ± SD 74.3 ± 11.4; 59% males), 12 for Deep Brain Stimulation (DBS) (mean age ± SD 71.2 ± 6.3; 75% males), and 7 for Continuous Subcutaneous Apomorphine Infusion (CSAI) (mean age ± SD 69.7 ± 5.5; 43% males). No sex differences were found in relation to age (MRgFUS group: males vs. females 70.2 ± 8.9 vs. 70.8 ± 8.9, p-value = 0.809; LCIG group: males vs. females 73.5 ± 13.0 vs. 75.5 ± 8.5, p-value = 0.557; DBS group: males vs. females 77.2 ± 8.1 vs. 67.3 ± 8.6, p-value = 0.843; CSAI group: males vs. females 73.3 ± 4.0 vs. 67.0 ± 5.2, p-value = 0.144) and disease duration (MRgFUS group: males vs. females 8.3 ± 4.4 vs. 9.6 ± 6.7, p-value = 0.419; LCIG group: males vs. females 14.5 ± 5.81 vs. 17.3 ± 5.5; p-value = 0.205; DBS group: males vs. females 15.0 ± 9.6 vs. 15.5 ± 7.7, p-value = 0.796; CSAI group: males vs. females 11.7 ± 3.7 vs. 10.3 ± 3.7, p-value = 0.505). The predominance of males is higher than that expected based on the higher prevalence of PD in men. Women are less confident in selecting advanced therapies during the natural progression of their disease. Factors accounting for this discrepancy deserve further investigation.