2-year Study Research Articles

Predictors and Predictive Score of In-Hospital Mortality in Diabetic Ketoacidosis: A Retrospective Cohort Study

Background and Objectives: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus (DM). The primary objective of this study was to identify relevant clinical and biochemical predictors and create a predictive score for in-hospital DKA mortality. Materials and Methods: A 6-year retrospective cohort study of adult patients diagnosed with DKA and admitted to Chiang Mai University Hospital, a tertiary care center in Chiang Mai, Thailand, from 1 January 2015 to 31 December 2021, was conducted. Baseline clinical data and laboratory investigations were collected. The primary outcome was in-hospital mortality. Multivariable logistic regression analysis, clustered by type of diabetes, was performed to identify significant predictors. A predictive risk score was created using significant predictive factors identified by multivariable analysis. The results were presented as odds ratios (ORs) and 95% confidence intervals (CIs), with a significant p-value set at <0.05. Results: Ninety-three patients diagnosed with DKA were included in the study. Ten patients died during admission. Significant predictors for in-hospital mortality of DKA included age > 55 years (OR 7.8, p = 0.007), female gender (OR 3.5, p < 0.001), anion gap > 30 mEq/L (OR 2.6, p = 0.003), hemoglobin levels < 10 g/dL (OR 16.9, p < 0.001), and the presence of cardiovascular disease (OR 1.3, p = 0.046). The predictive risk score ranged from 1 to 14 for low risk, and 14.5–23.5 for high risk of in-hospital mortality. The predictive performance of the scoring system was 0.82 based on the area under the curve, with a sensitivity of 73.8% and specificity of 96.4%. Conclusions: Multiple clinical and biochemical factors, along with a predictive risk score, could assist in predicting in-hospital mortality of DKA and serve as a guide for physicians to identify patients at high risk. Nevertheless, as the predictive score was internally validated with data from a single institution, external validation in diverse healthcare settings with larger datasets or prospective cohorts is crucial to confirm the model’s generalizability and predictive accuracy.

Risk factors for shoulder pain and stiffness in adults aged 44 and older: an 11-year longitudinal population-based study

Objective We conducted a longitudinal observational study over 11 years to identify the risk factors for developing shoulder pain, stiffness, or both. Method The study population (n = 1645) was identified from Health 2000 Survey, a nationally representative sample of Finns aged ≥ 44 years, without shoulder pain and stiffness at the start of the study based on a questionnaire. The independent variables included age, sex, body mass index (BMI), education level, diabetes, physical work exposures, and Beck’s depression score. We used multinomial logistic regression models to estimate relative risk ratios and 95% confidence intervals for three outcomes: shoulder pain, shoulder stiffness, and both combined. Results We found that excess body mass and depressive symptoms were shared statistically significant risk factors for all three outcomes. However, we also observed distinct risk factor profiles: older age was associated with lower risk of shoulder pain but higher risk for shoulder stiffness with or without pain, while females had a lower risk of shoulder stiffness with or without pain. Participants with diabetes had higher risk of shoulder stiffness only. Physical workload factors predicted an increased risk of the combination of shoulder pain and stiffness. Conclusions Our study identified increased BMI and depressive symptoms as consistent risk factors for shoulder pain, stiffness, or both. Older age increased the risk of shoulder stiffness but lowered the risk of pain alone, while females had a lower risk of stiffness. Diabetes was specifically linked to shoulder stiffness, and physical workload increased the risk of combined pain and stiffness.

Managing fires in a woody encroachment context: Fine fuel load does not change across fire seasons in a Guinean savanna (West Africa)

Fine surface fuels play a key role in driving fire spread, and therefore play an important role in wildfire management in savannas. In protected areas of the Guinean savannas (humid savannas of West Africa), despite prescribed early-dry season (EDS) or mid-dry season fire (MDS), woody encroachment is increasingly occurring. Recently, N'Dri et al. (2022) showed that late-dry season (LDS) fire applied at least three successive years alternating with a maximum of two successives EDS or MDS fires could reduce woody encroachment in protected areas of the regions. However, the relationship between time of burning (TOB) and fine fuel load (standing grass and fallen leaves of grasses and trees) remains uncertain. In a 10-year experimental field study (2013–2023), we monitored fine fuel load under annual fires set in three different TOB within the dry season: EDS, MDS and LDS. We also explored how fuel loads were influenced by fireline intensity and vice-versa, in addition to grass growth dynamic during one year after each fire. Results showed that grass grows faster in height after fires, reaching the highest peak (∼2 m) in November regardless of the TOB. Overall, the TOB within the dry season did not affect significantly the total fine fuel load even after 10 years (1.22 ± 0.12, 1 ± 0.09 and 0.96 ± 0.09 kg m−2 respectively for EDS, MDS and LDS fires). Nevertheless, in EDS plots, the greatest biomass of grass and litter was generally observed in alternate years. This is most likely due to a high decomposition rate and termite activity which played a rôle in maintaining basic levels. Overall, fireline intensity did not influence the subsequent fine fuel load recorded in November and fine fuel load recorded just before fires did not influence fireline intensity. Given the results of the current study, the best procedure in setting successive fires to reduce woody encroachment in Guinean savannas, remains that of N'Dri et al. (2022).

Recurrence Detection by Hybrid [18F]FDG-PET in Advanced Head and Neck Squamous Cell Carcinoma.

In the clinical management of advanced stage head and neck squamous cell carcinoma, the use of hybrid [18F]FDG-PET imaging is well established. However, there is ongoing debate regarding the optimal frequency of hybrid PET scans to be included in follow-up protocols, particularly if the initial post-therapeutic scan is negative. We conducted a single-center 10-year retrospective study involving all patients who underwent hybrid PET scans for the follow-up of advanced stage head and neck cancer. A total of 285 patients were included. Out of 199 patients with a negative 3-month hybrid PET, 15% subsequently developed a recurrence during further follow-up. Notably, 90% of these recurrences were detected by hybrid PET. Fifteen percent of patients with a negative 3-month hybrid PET experienced a recurrence. Given that the majority of recurrences were detected by hybrid PET scans, there is a compelling argument for incorporating regular repetitive scans during follow-up.

Traumatic Dental Injuries in Children and Adolescents from a Major Dental Clinic in Bosnia and Herzegovina: A 5-Year Retrospective Study

The aim of this study was to investigate the epidemiology of dental trauma in a public dental clinic in Banja Luka, Bosnia and Herzegovina, from 2019 to 2024. Methods: This research was conducted as a retrospective cross-sectional study. The data were analysed and compared between injured primary and permanent maxillary and mandibular teeth. Results: The review of the dental records revealed 73 patients (49 boys and 24 girls) with TDIs, involving 55 primary and 64 permanent teeth. Most of the patients (27 patients, 36.98%) were aged 7–9 years. The main cause of TDI was falls in both dentitions (81.81% of injured primary teeth and 73.43% of injured permanent teeth). The time of arrival after a TDI for assistance in the dental clinic for most cases was after 24 h in both dentitions, 45.45% of injured primary teeth and 48.43% of permanent teeth. For both dentitions, enamel fractures were the most common injury of hard dental tissues and the pulp, and the necrosis of the maxillary central incisor was the most common complication. Conclusions: It is very important to improve trauma management and increase public knowledge on the way parents seek proper treatment for the TDIs of their children, and in due time.

Outcomes of single-incision-augmented core decompression using trochanteric autograft in osteonecrosis of femoral head—a mean 5-year follow-up study

Outcomes of single-incision-augmented core decompression using trochanteric autograft in osteonecrosis of femoral head—a mean 5-year follow-up study

The relationship between seasonality and the diagnosis of acute leukaemia in central South Africa

Background: Leukaemias are haematological malignancies resulting from the abnormal clonal proliferation of haematopoietic precursors. Their incidence is influenced by various environmental and genetic factors.Aim: With this retrospective descriptive study, the authors aimed to explore the possible influence of seasonality on the type and number of acute leukaemia (AL) diagnoses made at the Universitas Academic Hospital (UAH) National Health Laboratory Service (NHLS) from 01 January 2018 to 31 December 2021.Setting: Universitas Academic Hospital, Bloemfontein, South Africa.Methods: Archived laboratory reports of all patients diagnosed with lymphoid and myeloid during the study period were included. Patients’ age, sex, ethnicity, final diagnosis and date of diagnosis were recorded. Information was pseudonymised to maintain confidentiality. A descriptive statistical analysis was performed to explore the possible influence of seasonality on the number of cases and type of leukaemia diagnosed.Results: In all, 249 patients were included. Acute myeloid leukaemia (AML) was the most common AL subtype (n = 117; 47.0%). Over the 4-year study period, all AL subtypes were more frequently diagnosed in summer (n = 131; 52.6%). However, the monthly number of AL diagnoses was relatively consistent over the 4 years for all subtypes (p = 0.7603), with consistent peaks of AML cases during January and February (summer) and May (autumn).Conclusion: No statistically significant association between the different seasons and AL diagnosis was noted.Contribution: Further studies using a larger study population and a wider geographical area, conducted over a more extended period, might affect the observations made in this study

Anxiety and Depression Are Associated with Poor Long-term Quality of Life in Moderate-to-Severe Ulcerative Colitis: Results of a 3-Year Longitudinal Study of the MOSAIK Cohort.

We previously reported that patients with moderate-to-severe ulcerative colitis (UC) often experience common mental disorders (CMDs) such as anxiety and depression, necessitating immediate psychological interventions within the first 4 weeks of diagnosis. In this 3-year follow-up study of the MOSAIK cohort in Korea, we examined the effects of CMDs at initial diagnosis on clinical outcomes and health-related quality of life (HRQoL). We examined differences in clinical outcomes (evaluated based on clinical response, relapse, hospitalization, and medication use) and HRQoL (assessed using the Inflammatory Bowel Disease Questionnaire [IBDQ] and Short Form 12 [SF-12]) according to Hospital Anxiety and Depression Scale (HADS) scores at diagnosis. In a study involving 199 UC patients, 47.7% exhibited significant psychological distress (anxiety and/or depression) at diagnosis. Clinical follow-up showed no major differences in outcomes, including remission rates, response rates, or hospitalization rates, between patients with anxiety or depression at diagnosis and patients without anxiety or depression at diagnosis. The HRQoL at the end of follow-up was notably lower in those with baseline CMDs, particularly anxiety, across all domains of the IBDQ and SF-12. Linear mixed-effect models revealed that higher HADS scores, as well as higher Mayo scores, were independently associated with lower IBDQ scores and both summary domains of the SF-12. Additionally, regular attendance at follow-up visits during the study period was also related to improvements in HRQoL (all p<0.05). While CMDs present at the time of UC diagnosis did not influence long-term clinical outcomes, they persistently impaired HRQoL. Our findings support the routine incorporation of psychological interventions into the long-term management of moderate-to-severe UC.

Real-Life Data of Secukinumab in Patients with Moderate to Severe Plaque Psoriasis, Psoriatic Arthritis, and Ankylosing Spondylitis: Patient Baseline Characteristics Data from the PROMPT Study.

Secukinumab has proven to be effective and safe in psoriasis (PsO), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) in the phase3 studies. However, data on real-world practice is limited. This study is an ongoing, multicenter, 2-year observational study that focuses on patients with moderate to severe plaque PsO, active PsA, or AS receiving secukinumab. The aim of this study is to present baseline data for the entire study population. A total of 127 patients were enrolled, with 101having PsO, 12 with PsA, and 14 with AS. Among the patients, approximately 54.0% were male. The mean body mass index ranged from 25.0 to 27.4kg/m2 across all groups. Patients with PsO had the longest disease duration with an average of 11.0years, followed by AS (3.0years) and PsA (1.0year). Previous biologic therapy was observed in 6.9-8.1% of patients. Baseline disease severity scores revealed moderate to severe disease. In the PsO group, the mean Psoriasis Area and Severity Index score was 16.1. For patients with PsA, the mean Tender Joint Count was 9.1, and the mean Swollen Joint Count was 6.7. In the AS group, the mean Bath Ankylosing Spondylitis Disease Activity Index score was 4.6, and the mean Ankylosing Spondylitis Disease Activity Score was 3.7. The study demonstrates disease durations, disease activity, and treatment history in Thai patients that were generally consistent with previous randomized controlled studies. Long-term data on the efficacy and safety of the treatment will be presented in future publications.

Constructing a Classification Scheme - and its Consequences: A Field Study of Learning to Label Data for Computer Vision in a Hospital Intensive Care Unit

Research on data annotation for artificial intelligence (AI) has demonstrated that biases, power, and culture impact the ways that annotators apply labels to data and subsequently affect downstream AI systems. However, annotators can only apply labels that are available to them in the annotation classification scheme. Drawing on a 3-year ethnographic study of an R&amp;D collaboration between medical and AI researchers, we argue that the construction of the classification schema itself -- decisions about what kinds of data can and cannot be collected, what activities can and cannot be detected in the data, what the possible annotation classes ought to be, and the rules by which an item ought to be classified into each class -- dramatically shape the annotation process, and through it, the AI. We draw on Bowker and Star's [9] classification theory to detail how the creation of a training data codebook for a computer vision algorithm in hospital intensive care units (ICUs) evolved from its original, clinically-driven goal of classifying complex clinical activities into a narrower goal of identifying physical objects and simpler activities in the ICU. This work reinforces how trade-offs and decisions made long before annotators begin labeling data are highly consequential to the resulting AI system.

Thermal Ablation for Papillary Thyroid Carcinoma

Image-guided thermal ablation has been administered for patients with T1N0M0 papillary thyroid carcinoma (PTC) who elect to not undergo surgery or receive active surveillance. Considering the indolent nature of PTC, long-term outcomes of ablation are needed. To investigate l0-year outcomes of thermal ablation in treating T1N0M0 PTC. This multicenter study was conducted at 4 university-affiliated hospitals in China and included 179 consecutive patients with T1N0M0 PTC (median [IQR] volume, 88.0 [163.2] mm3) who underwent thermal ablation between June 2010 and March 2014. Patients who were ineligible to undergo surgery or elected not to were included, and patients had PTC tumors that were smaller than 20 mm as confirmed by biopsy; no clinical or imaging evidence of extrathyroidal extension, lymph node metastasis (LNM), or distant metastasis; and no history of neck irradiation. The primary outcomes were disease progression (LNM, newly developed tumors, persistent tumors, and distant metastasis) and disease-free survival (DFS). Secondary outcomes were technical success, volume reduction rate, tumor disappearance, complications, and delayed surgery. DFS was calculated using a Kaplan-Meier analysis. Among the 179 patients, the mean (SD) age was 45.8 (12.7) years, and 118 (65.9%) were female. During a mean (SD) follow-up period of 120.8 (10.8) months, disease progression was found in 11 of 179 patients (6.1%), including LNM in 4 patients (2.2%), newly developed tumors in 6 patients (3.3%), and persistent tumor in 1 patient (0.6%). The 10-year DFS was 93.9%. The technical success, median volume reduction rate, and tumor disappearance rate was 100%, 100%, and 97.2%, respectively. The magnitude of the disease progression (6.1% vs 7.1%; difference, 1.0%; 95% CI, -6.5% to 25.6%) and DFS (93.9% vs 92.9%; difference, 1.0%, 95% CI, -6.5% to 25.6%) between patients with T1a and T1b tumors was small. The difference in the rate of tumor disappearance between T1a and T1b tumors was large (99.4% vs 71.4%; difference, 28.0%; 95% CI, 10.9%-54.0%). One patient experienced transient voice hoarseness (0.6%). Because of anxiety, 1 patient underwent delayed surgery (0.6%). The results of this 10-year multicenter cohort study suggest that thermal ablation is an effective and safe alternative for patients with T1N0M0 PTC who do not undergo surgery or receive active surveillance. For safe and effective treatment, accurate radiologic evaluation, an understanding of ablation techniques, and experienced physicians are recommended.

Evaluation of Visual Disturbances After Mild Traumatic Brain Injury-A One-Year Follow-up Study.

To examine the persistence of visual symptoms in mild traumatic brain injury (MTBI) during the first months after injury. It is important to recognize visual disturbances because they can delay return to normal activities, while they might be simultaneously treated by visual therapy. Here we describe the results from a 1-year follow-up study of visual disturbances after MTBI. The study group comprised 26 patients from the Brain Injury Clinic of the Helsinki University Hospital. Inclusion criterion was a high score (≥21p) on the Convergence Insufficiency Symptom Survey (CISS) at an appointment with a neurologist within 6months after injury. The patients underwent baseline vision evaluation at 4months on average and follow-up at 14months after injury. The evaluation included tests for visual acuity, near point of convergence, convergence facility, near point of accommodation, accommodative facility, motility, heterophoria, binocular vision, dynamic visual acuity, and fusional vergence width at near and far distances. Further assessments included the Rivermead Post Concussion Questionnaire for posttraumatic symptoms, a visual analog scale for visual fatigue, and the Developmental Eye Movement Test for saccadic eye movements. Both CISS and Rivermead Post Concussion Questionnaire scores improved significantly from baseline to follow-up. The overall level of visual fatigue according to visual analog scale score was lower at follow-up, but the increase in visual fatigue (comparing fatigue before and after assessment session) was significant both at baseline and follow-up. In visual function assessments, spontaneous recovery from baseline to follow-up could be seen in vergence facility and pursuit eye movement but not in near point of convergence, near fusion, distance fusion, heterophoria, and dynamic visual acuity. The results point out the importance of evaluation of visual disturbances after MTBI. Early detection of these disturbances may provide an opportunity to provide visual therapy.

Aromatase inhibitors, bone microstructure, and estimated bone strength in postmenopausal women with breast cancer: a 5-year prospective study.

Aromatase inhibitors (AIs) are the standard treatment for early breast cancer (EBC) and are typical causative agents of cancer treatment-induced bone loss. However, the effects of long-term treatment with these drugs on bone microstructure remain unclear. This prospective, single-arm observational study included postmenopausal, non-osteoporotic women with hormone receptor-positive EBC. Patients who underwent dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and tartrate-resistant acid phosphatase-5b (TRACP-5b) or procollagen type I N-terminal propeptide levels were compared at baseline and at 60months after commencing AI treatment. Fifteen women were included in the study, with a median age of 58years and a quartile range of 56.5-62.5years. At 60months, HR-pQCT revealed that the cortical area and thickness decreased with increased cortical porosity in the cortical bone. In addition, the number of trabeculae decreased and trabecular separation increased trabecular bones decreases, and trabecular bone separation opens, resulting in a decrease in the trabecular bone volume fraction. Total bone mineral density (BMD), trabecular volumetric BMD, and cortical volumetric BMD, and estimated bone strength significantly decreased. DXA BMD values significantly decreased in the total hip and femoral neck but not the lumbar spine. TRACP-5b values after 5years of AI treatment showed a significant negative correlation with the rate of change in the total volumetric BMD in the distal tibia. Postmenopausal women who received AIs for 5years for EBC experienced significant deterioration in the bone microstructure, BMD, and estimated bone strength.

Prescription of benzodiazepines and antidepressants among Sami and non-Sami — How childhood violence shapes prescription patterns: the SAMINOR 2 questionnaire survey and the Norwegian prescription database

BackgroundMedication for mental health problems represents a significant proportion of overall medication use and the prescription of psychotropic medicine has increased in many western countries over the last decades. Childhood violence (CV) is strongly associated with mental health problems, which in turn may increase the likelihood of being prescribed psychotropic medication. However, the association between CV and prescription of benzodiazepines (BDZ) and antidepressants is rarely described, and no such study has been performed among the Indigenous Sami people.MethodsData from the SAMINOR 2 Questionnaire Survey (2012) was linked to the Norwegian Prescription Database. Information on filled prescriptions for BDZ and antidepressants in 2004–2019 was collected for 11,296 persons (55.8% women, 22.6% Sami). Gender-stratified chi-square tests and two-sample t-tests were used to test for differences between groups. Logistic regression was applied to investigate the association between CV and filled prescriptions for BDZ and antidepressants.ResultsDuring the 16-year study period, 16.7% of all women filled at least one prescription for BDZ. The figures were significantly lower among Sami women (14.1%) compared to non-Sami women (17.4%) (p = .003). Among all women, 23.6% filled at least one prescription for antidepressants, with no difference between ethnic groups. Filled prescriptions among men were 10.0% and 14.2%, respectively, with no difference between ethnic groups. During each year, and in total, a significantly higher proportion of women exposed to CV received at least one prescription for BDZ and antidepressants, respectively, compared to women not exposed to CV, with no differences between ethnic groups. Among men, the pattern was similar.ConclusionA lower proportion of Sami women filled prescriptions for BDZ than non-Sami women. Those who reported exposure to CV filled prescriptions for BDZ and antidepressants more often than those who did not report CV. There were no overall differences between Sami and non-Sami; the dispensing rates of antidepressants and BDZ were similar for Sami and non-Sami, and the effects of CV on the dispensing of antidepressants and BDZ were also similar. This study highlights the importance of preventing CV, and of identifying a history of CV when treating adults with mental health problems.

Prolonged outpatient parenteral antimicrobial treatment: frequency and evolution over a six-year period in a Swiss University Hospital

BackgroundEmerging research indicates the potential for early transition from intravenous to oral antimicrobial therapy in certain infections. This trend may have implications for outpatient parenteral antibiotic therapy (OPAT) programs, as the demand for prolonged intravenous treatment could decrease. The objective of this study was to evaluate the frequency and evolution of OPAT courses of ≥ 14 days over the years and determine the medical justification for those prolonged treatments.MethodsAll patients treated intravenously for ≥ 14 days by the OPAT program at Lausanne University Hospital, Switzerland, between 2017 and 2022 were included in the study. Data were extracted from a prospectively established OPAT database. Prevalence of prolonged antibiotic treatment and its clinical and microbiological information were identified.ResultsDuring the study period, a total of 2,448 treatment courses were administered: 1,636 intravenous (IV) and 812 oral treatments. Of the IV treatments courses, 749 (36%) were of a duration of ≥ 14 days, without discernible trend over the 6-year study period. The most common type of infections needing prolonged treatment were bone and joint infections (31%), endovascular infections (18%), complicated intra-abdominal infections (15%), and urinary tract infections (11%), with only minor fluctuations in these proportions during the study period. Finally, the use of second-line antibiotics (piperacillin-tazobactam, carbapenems and vancomycin) did not increase over the years, suggesting that prolonged intravenous antibiotic therapy is not linked to an increase of anti-microbial resistance in our cohort.ConclusionsDespite the general trend towards shorter intravenous treatment courses in infectious diseases, our OPAT unit did not observe a decline in the use of prolonged intravenous antibiotic therapy between 2017 and 2022, suggesting that OPAT units will probably not see a decrease in their activities in the near future.

Impact of Subsurface Drainage System Design on Nitrate Loss and Crop Production

Subsurface (or tile) drainage offers a valuable solution for enhancing crop productivity in poorly drained soils. However, this practice is also associated with significant nutrient leaching, which can contribute to water quality problems at the regional scale. This research presents the findings from a 4-year tile depth and spacing study in central Illinois that included three drain spacings (12.2, 18.3, and 24.4 m) and two drain depths (0.8 and 1.1 m) implemented in six plots under the corn and soybean rotation system (plots CS-1 and CS-3: 12.2 m spacing and 1.1 m depth, plots CS-2 and CS-4: 24.4 m spacing and 1.1 m depth, and plots CS-5 and CS-6 18.3 m spacing and 0.8 m depth). Our observations indicate that drain flow and NO3-N losses were higher in plots with narrower drain spacings, while plots with wider drain spacing showed reduced drain flow and NO3-N losses. Specifically, plots set up with drain spacings of 18.3 m and 24.4 m showed significant reductions in drain flow compared to plots featuring a 12.2 m drain spacing. Likewise, plots characterized by 18.3 m and 24.4 m drain spacings (except CS-4) showed better NO3-N retention and lower leaching losses than those with 12.2 m spacing (CS-1 and CS-3). Crop yield results over a 3-year period indicated that CS-2 (wider spacing plot) showed the highest productivity, with up to 13.6% higher yield compared to other plots. Furthermore, when comparing plots with the same drainage designs, CS-2 and CS-4 showed 5.1% to 2.6% higher corn yield (3-year average) compared to CS-1 and CS-3, and CS-5 and CS-6, respectively. Overall, a wider drainage system showed the capacity to export lower nutrient levels while concurrently enhancing productivity. These findings represent that optimizing tile drainage systems can effectively reduce nitrate losses while increasing crop productivity.

Antimicrobial Resistance Trends and Epidemiological Characteristics of Isolates from Intra-Abdominal Infections in China: A 6-Year Retrospective Study (2017-2022).

Background: Antimicrobial resistance represents a continuing threat to the health of patients with intra-abdominal infections (IAIs). This study aimed to provide clinicians with guidance to optimize antibiotic therapy. Methods: The clinical data and antibiotic susceptibility results of pathogens from patients with IAIs from 2017 to 2022 were retrospectively collected. The 6-year period was segmented into two stages, namely, the early (2017-2020) and recent stages (2021-2022). The distribution and antibiotic resistance of pathogens were compared between the stages. Results: In total, 5,795 pathogens were isolated from 2,283 patients diagnosed with IAIs. Gram-negative bacteria, Gram-positive bacteria, and fungi accounted for 71.0%, 21.4%, and 7.5% of the isolates, respectively. Klebsiella pneumoniae (1,037, 17.9%) was the primary isolate. The proportion of extended-spectrum β-lactamase-producing Enterobacteriaceae was 89.8% (2,028/2,259), with extended-spectrum β-lactamase-producing Escherichia coli and K. pneumoniae accounting for 27.4% and 43.2%, respectively, of all such isolates. The carbapenem resistance rates of E. coli and K. pneumoniae were 17.1% and 75.9%, respectively. Compared with that in the early stage, the imipenem resistance rate of E. coli was significantly higher in the recent stage (13.8% vs. 25.1%, p < 0.001). Among Gram-positive bacteria, 88 strains of vancomycin-resistant Enterococcus were detected, giving a resistance rate of 10.3%, and the detection rate of methicillin-resistant Staphylococcus aureus was 65.7%. Conclusions: Enterobacteriales and non-fermentative bacteria from IAIs remain highly resistant to carbapenems. The epidemiological characteristics and antibiotic resistance profiles of pathogens in various regions should be closely monitored to mitigate the appearance of drug-resistant bacteria in clinical settings.

Changes in clinical features and seasonal variations of Crohn’s disease at diagnosis: a 10-year observational study in China

Background and aimsThe clinical aspects of Crohn’s disease (CD) at diagnosis determine its therapy and management. The onset of CD follows a seasonal pattern. We aimed to analyze changes in the clinical features and seasonal variations of newly CD patients over the last decade.MethodsCD patients were divided into cohort 1 (2012–2016) and cohort 2 (2017–2021). The clinical characteristics were collected and the trends according to the year and season of diagnosis were analyzed.ResultsA total of 2038 patients were included. Cohort 1 had a considerably greater proportion of diarrhea, fever, hematochezia, weight loss and extraintestinal manifestations. The levels of platelet and C-reactive protein were higher in cohort 2 patients, but the opposite was true for albumin levels (p&amp;lt;0.05). The rate of increased eosinophils, increased gangliocyte and abundant lymphoplasmacytic infiltrate significantly decreased over the years. Patients with granulomas were diagnosed with CD at an earlier age (p = 0.006). Cohort 1 patients used more conventional drugs, while cohort 2 patients apply more biologics (p&amp;lt;0.05). The diagnosis occurred more frequently in summer and less frequently in winter. Patients diagnosed in winter had notably higher BMI, lower frequency of perianal disease and lowest incidence of asthenia and weight loss.ConclusionThe clinical phenotype, laboratory and pathological characteristics of CD has changed over time in China. The diagnosis of CD tends to have a seasonal trend with the highest incidence in summer. CD patients diagnosed in winter appear to have a milder form of the disease.

Periodontitis Is Associated With Arterial Stiffness as Measured by Serial Cardio-Ankle Vascular Index (CAVI): A10-Year Cohort Study.

To investigate the effect of periodontitis on the long-term changes of the cardio-ankle vascular index (CAVI). A 10-year retrospective cohort study of 3842 Thai participants (range 25-76 years) with normal CAVI at the study initiation was undertaken. Full-mouth periodontal examination was performed by calibrated periodontists, and the extent and severity of periodontitis were determined at 5-year intervals. Serial CAVI measurements were used to examine the incidence of high CAVI (≥ 9.0) and changes in CAVI over time (ΔCAVI). Participants with a higher extent or severity of periodontitis were found to have a significantly higher mean ΔCAVI. The incidence of high CAVI was also observed to be higher in those with periodontitis compared to those without it. The adjusted risk ratios for developing high CAVI were 1.309 and 1.513 for localized and generalized periodontitis, respectively. Participants with severe periodontitis had a 37% higher likelihood of developing CAVI ≥ 9.0 compared to individuals with no/mild periodontitis. This risk was consistent with a significant change in ΔCAVI of 0.054-0.140. Periodontitis, both in terms of extent and severity, was found to have a significant dose-dependent effect on the risk of developing high CAVI over a 10-year period, suggesting a causal relationship between these two parameters.

Enhancing Food Security in an Era of Rising Fertilizer Prices: Evaluation of an Intervention Promoting Mungbean Adoption in Nepal

The improved food security in Asia that has facilitated the region’s development progress depends on nitrogenous fertilizers. Rising prices and shortages of imported fertilizer have prompted countries to explore alternative sources of crop nitrogen, including diversification with legumes. We evaluate an intervention in Nepal that promoted mungbean adoption. Our doubly robust impact evaluation approach accounts for nonrandom patterns of adoption related to livestock rearing, participation in agricultural cooperatives and training, and greater irrigated land use. Adopters growing mungbean for the 2-year study period showed an average increase of 20 kilograms (kg) in their annual consumption of mungbean-based foods, applied almost 40[Formula: see text]kg per hectare (ha) less fertilizers to their rice crops, and obtained an additional 280[Formula: see text]kg in rice yield per ha. Hence, agricultural innovations that use legumes such as mungbean can help promote sustainable intensification of cereal-based production systems, while enhancing food security and reducing balance-of-payments issues for the countries dependent on fertilizer imports.