Concentration Index Research Articles

Effect of the Japanese herbal medicine Hochuekkito for systemic inflammation, prognostic nutrition index, and body composition status in patients with gastrointestinal cancer

A systemic inflammatory response via host-tumor interactions is a cancer hallmark that plays a pivotal role in the pathogenesis of malnutrition and sarcopenia in patients with malignancies. Hochuekkito (TJ-41) is a traditional Japanese herbal medicine that modulates inflammation in patients with various chronic inflammatory diseases. However, the clinical efficacy of TJ-41 in patients with malignancies remains unclear. We systemically analyzed chronological changes in levels of systemic inflammatory parameters, nutrition-related parameters, and body composition status in 99 patients who received TJ-41 treatment for more than 3 months. The cohort comprised 56 patients with gastrointestinal cancer (Cancer Cohort) and 43 with other diseases (Other Disease Cohort). We also performed invivo experiments in mice to validate the clinical findings. Despite no significant changes in serum albumin concentration and prognostic nutrition index, the serum C-reactive protein (CRP) concentration significantly decreased in a time-dependent manner in all patients. However, the serum CRP concentration significantly decreased during TJ-41 treatment in the Cancer Cohort but not the Other Disease Cohort. Furthermore, downregulation of CRP during TJ-41 treatment occurred only in patients with metastases. The psoas muscle index, as a muscle quantity marker, was significantly lower in the CRP-increased group compared with the CRP-decreased group during TJ-41 treatment. Invivo experiments using a Colon-26 syngeneic model showed that the plasma CRP, amyloid A, and interleukin-6 concentrations were significantly lower in the TJ-41 group than the control group. TJ-41 might be useful as part of multimodality therapy for gastrointestinal cancer, especially in patients with metastases.

α-Lactalbumin based scaffolds for infected wound healing and tissue regeneration

Interruption of wound healing by multi-drug resistant-bacterial infection is a harmful issue for the worldwide health care system, and conventional treatment approaches may not resolve this issue due to antimicrobial resistance. So, there is an unmet need to develop scaffolds with intrinsic wound healing properties to combat bacterial-infected wounds. Inspired by the α-lactalbumin’s (Lalb’s) ability to promote collagen synthesis, we herein electrospun Lalb with cephalexin (CPL) and epigallocatechin (EP) to produce nanofibers (CE-Lalb NFs) to solve this issue. The CE-Lalb NFs were prepared using the electrospinning technique and subjected to physicochemical characterizations, in vitro, and in vivo assessments. The CE-Lalb NFs promoted fibroblast migration, proliferation, and collagen synthesis, while CPL/EP annihilated MRSA and E. coli infections. Physicochemical characterizations proved the successful fabrication and doping of CE-Lalb NFs. Antimicrobial assays and fractional inhibitory concentration index (FICI) declared synergistic antibacterial activity of CE-Lalb NFs against MRSA and E. coli. The in vivo and immunohistochemical data evidenced its exceptional potential for wound healing, promoting growth factor, collagen synthesis, and reduced scar formation. The presence of mature collagen, fewer inflammatory cytokines, increased expression of blood vessels, and low expression of IL-6 at the wound site support in vitro and in vivo results. In our view, the tailored scaffold is the next step for personalized wound dressings that could meet patients with infected wounds’ unmet needs by the subscription of noninvasive and easily navigable therapeutic options.

Effect of heat stress on semen characteristics and genetics in Thai native grandparent roosters

Grandparent roosters are crucial in poultry breeding programs and significantly influence future bird generations' genetic makeup and performance. However, these roosters face considerable challenges from heat stress, which can adversely affect their reproductive performance, semen quality, and overall health and welfare. Our study aimed to investigate the effects of heat stress on the genetics of semen characteristics, identify the appropriate temperature and humidity indices (THI), and determine the threshold point of heat stress to prevent thermal stress. We analyzed data from 3,895 records of 242 Thai native grandparent roosters in conjunction with the THI using 7 THI functions and the regression method. The threshold point of heat stress, genetic parameters, rate of decline of semen characteristics per level of THI, estimated breeding values and selection index values were analyzed using the multivariate test-day model in the AIREML and BLUPF90 programs. Based on the regression coefficient and statistical criteria of the lowest -2logL and AIC values, the results showed that a THI of 78 was considered the threshold point of heat stress. The estimated heritability values ranged from 0.023 to 0.032, 0.066 to 0.069, 0.047 to 0.057, and 0.022 to 0.024 for mass movement, semen volume, sperm concentration, and the semen index, respectively. The reduction rates of mass movement, semen volume, sperm concentration, and semen index at a THI of 78 were -0.009, -0.003, -0.170, and -0.083 per THI, respectively. The genetic correlations among the semen traits were moderately to strongly positive and ranged from 0.562 to 0.797. The genetic correlations between semen traits and heat stress were negative and ranged from -0.437 to -0.749. The permanent environmental correlations among the semen traits (0.648-0.929) were positive and greater than the genetic correlations. Permanent environmental correlations between semen traits and heat stress were negative and ranged from -0.539 to -0.773. The results of the selection indices showed that the higher the selection intensity was, the greater the degree to which the selection index corresponded to genetic progress. The recommendation for animal genetic selection is that the top 10% is appropriate because it seems most preferred. Therefore, using a multivariate test-day model and selection index for the high genetic potential of semen traits and heat tolerance in Thai native grandparent roosters makes it possible to achieve genetic assessment in a large population.

Mitigation of hypoxia and ocean acidification on the inner East China Sea shelf impacted by the 2023 summer drought

Hypoxia and acidification are universal environmental issues in coastal seas, especially in large river dominated shelves, and the East China Sea shelf is a typical case among them. However, the responses of status of hypoxia and acidification in coastal seas to the extremes of river discharges are still to be revealed. This study surveyed the influences of a summer drought on the status of hypoxia and acidification on the inner East China Sea shelf off the Changjiang estuary. In August of 2023 during a summer drought, carbonate system parameters and dissolved oxygen (DO) were surveyed on the East China Sea shelf off the Changjiang estuary. As expected, dissolved inorganic carbon (DIC) removal (up to >40 μmol kg−1) and DO over-saturation (up to >110 %) accompanied by high pH (up to >8.15) in the surface water were observed. However, low DO (32–172 μmol kg−1), low pH (7.63–8.04) and low saturation state index of aragonite (ΩAr) (1.34–3.06) in the bottom water were observed. Relationships of Excess DIC with DO consumption, and pH and ΩAr with Excess DIC indicated that the hypoxia and acidification in the bottom water was due mainly to the remineralization of the marine-sourced organic matter. Nevertheless, both hypoxia and acidification were mitigated, i.e. the hypoxic area was smaller, the minimum DO concentration, pH and saturation state index of aragonite were higher in August of 2023 than under the general summer condition. The lower Changjiang discharge (∼60 % of the long-term monthly average) mitigated eutrophication of the East China Sea shelf and decreased the phytoplankton biomass in the surface water and subsequently the hypoxia and acidification in the bottom water. However, acidification of the bottom water on the East China Sea shelf was still severe even during the summer drought. Regulating the anthropogenic impact on the coastal marginal seas is still urgently needed to mitigate the acidification status.

PRODUCTS MAPPING: THE CASE OF ARMENIA

From the point of view of the export promotion strategy, it is crucial to choose industries in which a given country has comparative advantages and the development of which can lead to export-led economic growth. In this article, the indices of Revealed Symmetrical Comparative Advantage (RSCA), Normalized Revealed Symmetric Comparative Advantage (NRCA), and the Trade Balance (TBI) were calculated based on the export data of about 100 commodity groups (chapters at 2-digit level) of Harmonized System (HS) to carry out the Products Mapping for the period 2018-2022. The market concentration index of exports and the product concentration index of exports were also calculated as well. The results show that Armenia had comparative advantages in producing some product groups, and in some, government support is required to increase the competitiveness thereof. We conclude that the majority of products that Armenia has a comparative advantage in producing thereof were mostly exported to Russia. We believe that it is necessary to diversify merchandise exports since the concentration index of export markets in 2022 was 0.427 (normalized Herfindahl-Hirschman index), and exports of products should be channeled more to middle- and upper-middle-income countries. This, in turn, would contribute to the transformation of the structure of the Armenian economy.

Spatial variation of skilled birth attendance and associated factors among reproductive age women in Ethiopia, 2019; a spatial and multilevel analysis.

The majority of maternal deaths were associated with a lack of access to skilled birth attendance. Because childbirth accounts for most maternal deaths, skilled birth attendance is crucial for reducing maternal mortality. The use of skilled birth attendance in Ethiopia is low, and it is crucial to identify factors that determine the use of skilled birth attendance. Hence, this study aimed to assess the spatial distribution, wealth-related inequality, and determinants for skilled birth attendance in Ethiopia. Secondary data analysis was done with a total weighted sample of 5,251 reproductive-aged women using the 2019 mini EDHS. The concentration index and graph were used to assess wealth-related inequalities. Spatial analysis was done to identify the spatial distribution and multilevel logistic regression analysis was used to identify predictors of skilled birth attendance in Ethiopia. Analysis was done using STATA version 14, ArcGIS, and SaTscan software. The prevalence of skilled birth attendance was 50.04% (95% CI: 48.69%, 51.40%) in Ethiopia. Old age, being married, being educated, having television and radio, having ANC visits, being multiparous, having large household sizes, having a rich wealth index, living in rural residence, and living in a high level of community poverty and women's education were significant predictors of skilled birth attendance. Skilled birth attendance was disproportionately concentrated in rich households [C = 0.482; 95% CI: 0.436, 0.528]. High prevalence of unskilled birth attendance was found in Somalia, SNNP, Afar, and southern parts of the Amhara regions. Primary clusters of unskilled birth attendance Somalia and some parts of Oromia region of Ethiopia. Half of the women in Ethiopia did not utilize skilled birth attendants with significant spatial clustering. Age, marital status, educational status, ANC Visit, having television and radio, parity, household size, wealth index, residence, community level poverty, and community level of women's education were significant predictors of skilled birth attendance. Skilled birth attendance was unevenly concentrated in rich households. The regions of Somalia, SNNP, Afar, and southern Amhara were identified as having a high prevalence of using unskilled birth attendance. Public health interventions should target those women at high risk of using unskilled birth attendants.

Bioflavonoid Baicalein Modulates Tetracycline Resistance by Inhibiting Efflux Pump in Staphylococcus aureus.

The rise in antibiotic resistance among bacterial pathogens, particularly Staphylococcus aureus, has become a critical global health issue, necessitating the search for novel antimicrobial agents. S. aureus uses various mechanisms to resist antibiotics, including the activation of efflux pumps, biofilm formation, and enzymatic modification of drugs. This study explores the potential of baicalein, a bioflavonoid from Scutellaria baicalensis, in modulating tetracycline resistance in S. aureus by inhibiting efflux pumps. The synergistic action of baicalein and tetracycline was evaluated through various assays. The minimum inhibitory concentration (MIC) of baicalein and tetracycline against S. aureus was 256 and 1.0 μg/mL, respectively. Baicalein at 64 μg/mL reduced the MIC of tetracycline by eightfold, indicating a synergistic effect (fractional inhibitory concentration index: 0.375). Time-kill kinetics demonstrated a 1.0 log CFU/mL reduction in bacterial count after 24 hours with the combination treatment. The ethidium bromide accumulation assay showed that baicalein mediated significant inhibition of efflux pumps, with a dose-dependent increase in fluorescence. In addition, baicalein inhibited DNA synthesis by 73% alone and 92% in combination with tetracycline. It also markedly reduced biofilm formation and the invasiveness of S. aureus into HeLa cells by 52% at 64 μg/mL. These findings suggest that baicalein enhances tetracycline efficacy and could be a promising adjunct therapy to combat multidrug-resistant S. aureus infections.

Synergistic interaction between Chlorella vulgaris extract and Origanum elongatum essential oil against methicillin-resistant Staphylococcus aureus.

The massive emergence of antimicrobial resistance in recent decades has rendered the use of a single-agent strategy ineffective. Consequently, the combination of different therapeutic agents has emerged as a promising new approach. The aim of the present study was to investigate the combined effect of Chlorella vulgaris methanol extract (CVME) and Origanum elongatum essential oil (OEEO) on methicillin-resistant Staphylococcus aureus (MRSA). Thus, the antibacterial activity of OEEO and CVME on Escherichia coli, Staphylococcus aureus, and MRSA was evaluated using the agar well diffusion and broth microdilution methods. The killing activity of CVME and OEEO, individually and in combination, on MRSA ATCC 43300 was tested using the time-kill assay. The synergistic effect was examined by determining the fractional inhibitory concentration index (FICI) using the checkerboard test. The results showed very significant antibacterial activity against all the bacteria tested, for both OEEO and CVME, with minimum inhibitory concentrations (MICs) ranging from 0.125 to 0.25% (v/v) for OEEO and from 3.12 to 6.25 mg mL-1 for CVME. Minimum bactericidal concentration (MBC) values for OEEO and CVME were in the range 0.125-0.5% (v/v) and 6.25-12.5 mg mL-1, respectively. The inhibition zones associated with OEEO were distinctly greater than those associated with CVME for all the bacteria examined. When used individually, the time-kill curves of OEEO and CVME revealed a dose-dependent effect on MRSA proliferation. Compared with controls, both agents were able to prolong the latent phase of growth curves and decelerate bacterial growth. The killing effect of OEEO on MRSA was considerably higher than that observed with CVME. OEEO prevented MRSA proliferation at only 1/2 of its MIC, while the CVME did so at 2 times its MIC. The combination of OEEO with CVME demonstrated a synergistic effect against MRSA, with a FIC index value of 0.49. The findings therefore suggest that the combination of C. vulgaris methanol extract and O. elongatum essential oil at very low doses may be promising anti-MRSA candidates. A search of the published literature revealed that, to our knowledge, no studies have yet been carried out on the antibacterial potential of combining essential oils and microalgae extracts in the fight against MRSA.

RNA-Seq Analysis in Non-Small Cell Lung Cancer: What Is the Best Sample from Clinical Practice?

RNA-based next-generation sequencing (RNA-seq) represents the gold standard for detecting gene fusion in non-small cell lung cancer (NSCLC). Despite this, RNA instability makes the management of tissue samples extremely complex, resulting in a significant number of test failures with missing data or the need to switch to other techniques. In the present study, we analyzed pre-analytical variables in 140 tumor tissue samples from patients affected by NSCLC to detect features that increase the chances of successful RNA-seq. We found that the success rate of the analysis positively correlates with the RNA concentration and fragmentation index. Interestingly, small biopsies were more suitable samples than surgical specimens and cell blocks. Among surgical specimens, wedge resections demonstrated better results than lobectomy. Moreover, samples stored for less than 30 days (1 month) had a better chance of success than older samples. Defining the role of pre-analytical variables in RNA-seq allows the detection of more suitable samples for analysis and more effective planning of molecular-based diagnostic approaches in NSCLC.

Vidarabine as a novel antifungal agent against Candida albicans: insights on mechanism of action.

Around 1.5 million mortality cases due to fungal infection are reported annually, posing a massive threat to global health. However, the effectiveness of current antifungal therapies in the treatment of invasive fungal infections is limited. Repurposing existing antifungal drugs is an advisable alternative approach for enhancing their effectiveness. This study evaluated the antifungal efficacy of the antiviral drug vidarabine against Candida albicans ATCC 90028. Antifungal susceptibility testing was performed by microbroth dilution assay and further processed to find the minimum fungicidal concentration. Investigation on probable mode of vidarabine action against C. albicans was assessed by using the ergosterol reduction assay, reactive oxygen species (ROS) accumulation, nuclear condensation, and apoptosis assay. Results revealed that C. albicans was susceptible to vidarabine action and exhibited minimum inhibitory concentration at 150µg/ml. At a concentration of 300µg/ml, vidarabine had fungicidal activity against C. albicans. 300µg/ml vidarabine-treated C. albicans cells demonstrated 91% reduced ergosterol content. Annexin/FITC/PI assay showed that vidarabine (150µg/ml) had increased late apoptotic cells up to 31%. As per the fractional inhibitory concentration index, vidarabine had synergistic activity with fluconazole and caspofungin against this fungus. The mechanism underlying fungicidal action of vidarabine was evaluated at the intracellular level, and probably because of increased nuclear condensation, enhanced ROS generation, and cell cycle arrest. In conclusion, this data is the first to report that vidarabine has potential to be used as a repurposed antifungal agent alone or in combination with standard antifungal drugs, and could be a quick and safe addition to existing therapies for treating fungal infections.

Dynamic changes in place-based measures of structural racism and preterm birth in the USA

BackgroundStructurally racist systems, ideologies and processes generate and reinforce inequities among minoritised racial/ethnic groups. Prior cross-sectional literature finds that place-based structural racism, such as the Index of Concentration at the...

Synergistic combination of baicalein and rifampicin against Staphylococcus aureus biofilms.

Staphylococcus aureus, a Gram-positive bacterium, is a predominant pathogen associated with various infections. The rapid emergence of antibiotic resistance has intensified the challenge of managing fracture-related infections in severe osteoporotic patients. Rifampicin, a potent antimicrobial agent employed against fracture and implant-related infections, necessitates combination therapies due to its susceptibility to antibiotic resistance. In this study, we explored the potential of baicalein, a bioactive flavonoid from Oroxylum indicum and Scutellaria baicalensis, in combination with rifampicin against S. aureus biofilms invitro. The minimum inhibitory concentration of baicalein and rifampicin were determined as 500 μg/mL and 12.5 ng/mL respectively. The synergistic activity of baicalein and rifampicin was determined by the fractional inhibitory concentration index (FICI) using checkerboard assay. The results showed the FICI of baicalein and rifampicin was lesser than 0.5, demonstrating synergistic effect. Furthermore, the efficacy of baicalein and rifampicin, both individually and in combination, was evaluated for biofilm inhibition and eradication. Scanning electron microscopy and confocal laser microscopy also confirmed that the synergistic combinations effectively removed most of the biofilms and partially killed pre-formed biofilms. In conclusion, the findings demonstrate that baicalein is as effective as rifampicin in inhibiting and eradicating S. aureus biofilms. Their combination exhibits synergistic effect, enhancing their bactericidal effect in completely eradicating S. aureus biofilms. The findings of this research underscore the research potential of combining baicalein and rifampicin as a novel therapeutic strategy against S. aureus biofilms, offering a promising direction for future research in the treatment of fracture-related S. aureus infections.

The global burden, trends and cross-country inequalities of female breast and gynaecologic cancers: A population based study.

To analyse the global burden, trends and cross-country inequalities of female breast and gynaecologic cancers (FeBGCs). Population-Based Study. Data sourced from the Global Burden of Disease Study 2019. Individuals diagnosed with FeBGCs. Age-standardised mortality rates (ASMRs), age-standardised Disability-Adjusted Life Years (DALYs) rates (ASDRs) and their 95% uncertainty interval (UI) described the burden. Estimated annual percentage changes (EAPCs) and their confidence interval (CI) of age-standardised rates (ASRs) illustrated trends. Social inequalities were quantified using the Slope Index of Inequality (SII) and Concentration Index. The main outcome measures were the burden of FeBGCs and the trends in its inequalities over time. In 2019, the ASDRs per 100 000 females were as follows: breast cancer: 473.83 (95% UI: 437.30-510.51), cervical cancer: 210.64 (95% UI: 177.67-234.85), ovarian cancer: 124.68 (95% UI: 109.13-138.67) and uterine cancer: 210.64 (95% UI: 177.67-234.85). The trends per year from 1990 to 2019 were expressed as EAPCs of ASDRs and these: for Breast cancer: -0.51 (95% CI: -0.57 to -0.45); Cervical cancer: -0.95 (95% CI: -0.99 to -0.89); Ovarian cancer: -0.08 (95% CI: -0.12 to -0.04); and Uterine cancer: -0.84 (95% CI: -0.93 to -0.75). In the Social Inequalities Analysis (1990-2019) the SII changed from 689.26 to 607.08 for Breast, from -226.66 to -239.92 for cervical, from 222.45 to 228.83 for ovarian and from 74.61 to 103.58 for uterine cancer. The concentration index values ranged from 0.2 to 0.4. The burden of FeBGCs worldwide showed a downward trend from 1990 to 2019. Countries or regions with higher Socio-demographic Index (SDI) bear a higher DALYs burden of breast, ovarian and uterine cancers, while those with lower SDI bear a heavier burden of cervical cancer. These inequalities increased over time.

Susceptibility of Staphylococcus aureus to Anti-Inflammatory Drugs with a Focus on the Combinatory Effect of Celecoxib with Oxacillin In Vitro.

Musculoskeletal infections (MIs) are among the most difficult-to-treat staphylococcal diseases due to antibiotic resistance. This has encouraged the development of innovative strategies, such as combination therapy, to combat MI. The aim of this study was to investigate the in vitro antistaphylococcal activity of anti-inflammatory drugs and the combined antimicrobial effect of celecoxib and oxacillin. The minimum inhibitory concentrations (MICs) of 17 anti-inflammatory drugs against standard strains and clinical isolates of S. aureus, including methicillin-resistant strains (MRSAs), were determined using the broth microdilution method. The fractional inhibitory concentration indices (FICIs) were evaluated using checkerboard assays. Celecoxib produced the most potent antistaphylococcal effect against all tested strains (MICs ranging from 32 to 64 mg/L), followed by that of diacerein against MRSA3 and MRSA ATCC 33592 (MIC 64 mg/L). Several synergistic effects were observed against the tested S. aureus strains, including MRSA (FICI ranging from 0.087 to 0.471). The strongest synergistic interaction (FICI 0.087) was against MRSA ATCC 33592 at a celecoxib concentration of 2 mg/L, with a 19-fold oxacillin MIC reduction (from 512 to 26.888 mg/L). This is the first report on the combined antistaphylococcal effect of celecoxib and oxacillin. These findings suggest celecoxib and its combination with oxacillin as perspective agents for research focused on the development of novel therapies for MI caused by S. aureus. This study further indicates that celecoxib could resensitize certain MRSA strains, in some cases, to be susceptible to β-lactams (e.g., oxacillin) that were not previously tested. It is essential to mention that the in vitro concentrations of anti-inflammatory drugs are higher than those typically obtained in patients. Therefore, an alternative option for its administration could be the use of a drug delivery system for the controlled slow release from an implant at the infection site.

Assessment of the Radioactivity, Metals Content and Mineralogy of Granodiorite from Calabria, Southern Italy: A Case Study.

In this paper, an assessment of the natural radioactivity level, radon exhalation, metal contamination, and mineralogy of a granodiorite rock sample from Stilo, in the Calabria region, Southern Italy is presented as a case study. This rock was employed as a building material in the area under study. The specific activity of 226Ra, 232Th and 40K natural radioisotopes was assessed through high-purity germanium (HPGe) gamma-ray spectrometry. Then, several indices such as the absorbed gamma dose rate (D), the annual effective dose equivalent (AEDE), the activity concentration index (ACI) and the alpha index (Iα), were quantified to determine any potential radiological health risk related to radiation exposure from the analyzed rock. Furthermore, E-PERM electret ion chambers and inductively coupled plasma mass spectrometry (ICP-MS) measurements were carried out to properly quantify the radon exhalation rate and any possible metal pollution, respectively. In particular, to further address metal pollution factors, the geo-accumulation index (Igeo) was calculated to properly address the toxicity levels of the ecosystem originating from the detected metals. Finally, with the aim of successfully discriminating the provenance of such naturally occurring radionuclides, a combined approach involving X-ray diffraction (XRD) and µ-Raman spectroscopy was employed for the identification of the main radioisotope-bearing minerals characterizing the investigated granodiorite. The results achieved in this case study can be taken as the basis for further inquiries into background levels of radioactivity and chemical contamination in natural stone employed as building materials.

Associations between Individual- and Structural-Level Racism and Gestational Age at Birth in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be.

The purpose of this study was to investigate the associations between multilevel racism and gestational age at birth among nulliparous women. We conducted a secondary analysis of data of the nuMoM2b Study (2010-2013) to examine the associations between individual- and structural-level experiences of racism and discrimination and gestational age at birth among nulliparous women (n = 9148) at eight sites across the U.S. Measures included the individual Experiences of Discrimination (EOD) scale and the Index of Concentration at the Extremes (ICE) to measure structural racism. After adjustment, we observed a significant individual and structural racism interaction on gestational length (p = 0.012). In subgroup analyses, we found that among those with high EOD scores, women who were from households concentrated in the more privileged group had significantly longer gestations (β = 1.27, 95% CI: 0.48, 2.06). Women who reported higher EOD scores and more economic privilege had longer gestations, demonstrating the moderating effect of ICE as a measure of structural racism. In conclusion, ICE may represent a modifiable factor in the prevention of adverse birth outcomes in nulliparas.

Risk factors underlying racial and ethnic disparities in tuberculosis diagnosis and treatment outcomes, 2011–19: a multiple mediation analysis of national surveillance data

Despite an overall decline in tuberculosis incidence and mortality in the USA in the past two decades, racial and ethnic disparities in tuberculosis outcomes persist. We aimed to examine the extent to which inequalities in health and neighbourhood-level social vulnerability mediate these disparities. We extracted data from the US National Tuberculosis Surveillance System on individuals with tuberculosis during 2011-19. Individuals with multidrug-resistant tuberculosis or missing data on race and ethnicity were excluded. We examined potential disparities in tuberculosis outcomes among US-born and non-US-born individuals and conducted a mediation analysis for groups with a higher risk of treatment incompletion (a summary outcome comprising diagnosis after death, treatment discontinuation, or death during treatment). We used sequential multiple mediation to evaluate eight potential mediators: three comorbid conditions (HIV, end-stage renal disease, and diabetes), homelessness, and four census tract-level measures (poverty, unemployment, insurance coverage, and racialised economic segregation [measured by Index of Concentration at the ExtremesRace-Income]). We estimated the marginal contribution of each mediator using Shapley values. During 2011-19, 27 788 US-born individuals and 57 225 non-US-born individuals were diagnosed with active tuberculosis, of whom 27 605 and 56 253 individuals, respectively, met eligibility criteria for our analyses. We did not observe evidence of disparities in tuberculosis outcomes for non-US-born individuals by race and ethnicity. Therefore, subsequent analyses were restricted to US-born individuals. Relative to White individuals, Black and Hispanic individuals had a higher risk of not completing tuberculosis treatment (adjusted relative risk 1·27, 95% CI 1·19-1·35; 1·22, 1·11-1·33, respectively). In multiple mediator analysis, the eight measured mediators explained 67% of the disparity for Black individuals and 65% for Hispanic individuals. The biggest contributors to these disparities for Black individuals and Hispanic individuals were concomitant end-stage renal disease, concomitant HIV, census tract-level racialised economic segregation, and census tract-level poverty. Our findings underscore the need for initiatives to reduce disparities in tuberculosis outcomes among US-born individuals, particularly in highly racially and economically polarised neighbourhoods. Mitigating the structural and environmental factors that lead to disparities in the prevalence of comorbidities and their case management should be a priority. US Centers for Disease Control and Prevention National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention Epidemiologic and Economic Modeling Agreement.

A systematic review and meta-analysis of the placebo effect on both semen quality and male infertility.

Placebo influence on such objective indicators, as sperm quality and infertility, has not been studied previously, but some studies report that placebo may distort even objective outcomes. The aim of current study is to assess the placebo effect on fertility in patients suffering from sperm abnormalities and/or infertility. We conducted a search of two databases (Scopus and MEDLINE) and identified placebo-controlled clinical trials which focused on sperm abnormalities and/or male infertility treatment. Primary outcomes included changes in semen parameters (volume, total count, sperm concentration in semen, progressive motility, morphology (normal cells)). Secondary outcomes included DNA fragmentation and change in pregnancy rate. Seventy-seven articles published from 1983 to 2022 were included. Statistically significant changes were observed for the following values: total sperm count, mean change 0.16 (95% CI 0.05, 0.26); P=0.004, I2=75.1%; and progressive motility, mean change 0.13 (95% CI 0.02, 0.24); P=0.026, I2=84.9%. In contrast, placebo did not affect sperm concentration, sperm volume, sperm morphology or DNA fragmentation index. The publication bias for all the values measured with Egger's test and funnel plots was low. The current meta-analysis indicated a statistically significant increase of total sperm count and progressive motility in the placebo group. In contrast, placebo did not affect sperm concentration, sperm volume, sperm morphology and DNA fragmentation index. These findings should be considered while planning or analyzing placebo-controlled clinical trials.

Harnessing Chlorella vulgaris for the phycoremediation of azo dye: A comprehensive analysis of metabolic responses and antioxidant system

This study investigates the phycoremediation potential of microalgae Chlorella vulgaris in the degradation of Direct green 6 (DG6), a synthetic azo dye commonly used in the textile industry, which poses significant environmental and health risks due to its toxic and carcinogenic properties. Over 50 days of treatment, we analyzed the effects of varying concentrations of DG6 on the biodegradation capabilities of C. vulgaris with the characterization of growth and antioxidant parameters. The findings demonstrate that C. vulgaris reduced DG6 levels significantly (p < 0.05) at higher temperatures (40 °C) compared to other environmental ambient temperatures. Within the acidic range pH < 7 progressive removal efficiency was observed within 25 days in consistency with the enhanced growth indices of biomass concentration (Xm), productivity (Px), specific growth rate (μm), and doubling time (td) at the higher concentration of 60 mg L−1. Induction of both enzymatic and non-enzymatic antioxidant activities were quantified for superoxide dismutase (SOD), catalase (CAT), peroxidase (POD), ascorbate peroxidase (APX), azoreductase, and laccase, as well as changes in the total ascorbate pool (AsA + DHA) and ferric reducing antioxidant power (FRAP). Furthermore, the underlying biodegradation mechanisms were elucidated by identifying the reductive cleavage of azo bonds by azoreductase and breakdown by peroxidases and laccase. These molecular by-products were identified using gas chromatography–mass spectrometry (GC–MS), which shed light on the metabolic pathways involved in DG6 biodegradation. This study underscores the effectiveness of C. vulgaris as a sustainable, low-cost solution for the bioremediation of azo-dye-polluted water. This study lays the groundwork for further exploration into the genetic and metabolic adaptations of algae under complex organic pollutant stress, with potential implications for ecophysiology, biotic interactions, and evolutionary biology.

Disparities and Determinants of Testing for Early Detection of Cervical Cancer among Nepalese Women: Evidence from a Population-Based Survey.

Cervical cancer presents a considerable challenge in South Asia, notably in Nepal, where screening remains limited. Past research in Nepal lacked national representation and a thorough exploration of factors influencing cervical cancer screening, such as educational and socioeconomic disparities. This study aims to measure these gaps and identify associated factors in testing for early detection of cervical cancer among Nepalese women. Data from the 2019 Nepal Noncommunicable Disease Risk Factors survey (World Health Organization STEPwise approach to noncommunicable risk factor surveillance), involving 2,332 women aged 30 to 69 years, were used. Respondents were asked if they had undergone cervical cancer testing through visual inspection with acetic acid, Pap smear, or human papillomavirus test ever or in the past 5 years. The slope index of inequality (SII) and relative concentration index were used to measure socioeconomic and education-based disparities in cervical cancer test uptake. Only 7.1% [95% confidence interval (CI): 5.1-9.9] Nepalese women had ever undergone cervical cancer testing, whereas 5.1% (95% CI: 3.4-7.5) tested within the last 5 years. The ever uptake of cervical cancer testing was 5.1 percentage points higher (SII: 5.1, 95% CI: -0.1 to 10.2) among women from the richest compared with the poorest households. Education-based disparities were particularly pronounced, with a 13.9 percentage point difference between highly educated urban residents and their uneducated counterparts (SII: 13.9, 95% CI: 5.8-21.9). Less than one in ten women in Nepal had a cervical cancer testing, primarily favoring higher educated and wealthier individuals. Targeted early detection and cervical cancer screening interventions are necessary to address these disparities and improve access and uptake.