Controlled Rate Research Articles

Value of parametric indexes to identify tracheal atresia with or without fistula on fetal magnetic resonance imaging.

Tracheal atresia causes some secondary changes (dilated trachea, flattened/inverted diaphragm, hyperintense and hyperinflated lungs). They can be reduced if a high airway fistula is present. This study evaluated fetal MR images of tracheal atresia and the secondary changes, focusing on the presence of a fistula. We assessed fetal MR images of tracheal atresia without fistula (n=4, median 26weeks), tracheal atresia with fistula (n=4, median 33weeks) and controls (n=30, median 32weeks). We evaluated airway obstruction using true-positive rate in tracheal atresia and false-positive rate in controls indicating they are likely normal variants. Tracheal diameter, craniocaudal-anteroposterior ratio of the right hemidiaphragm, lung-to-liver signal intensity ratio, and cardiothoracic ratio were compared among the three groups using the Kruskal-Wallis test followed by pairwise comparison using the Mann-Whitney U test. True-positive rate was 100% in tracheal atresia, while false-positive rate was 20% in controls. The Kruskal-Wallis test showed differences among groups in craniocaudal-anteroposterior ratio and cardiothoracic ratio (P<0.001) but not in tracheal diameter (P=0.256) or lung-to-liver signal intensity ratio (P=0.082). The pairwise comparison in craniocaudal-anteroposterior ratio and cardiothoracic ratio showed differences between controls and tracheal atresia without fistula (P<0.01) and with fistula (P<0.05). Fetal MRI is useful for the diagnosis of tracheal atresia, and detection of airway obstruction is essential. Lower craniocaudal-anteroposterior ratio and cardiothoracic ratio might be reliable measures even if a fistula is present.

Prenatal Exposure to Glyphosate and Its Environmental Degradate, Aminomethylphosphonic Acid (AMPA), and Preterm Birth: A Nested Case-Control Study in the PROTECT Cohort (Puerto Rico).

Background:Glyphosate (GLY) is the most heavily used herbicide in the world. Despite nearly ubiquitous exposure, few studies have examined prenatal GLY exposure and potentially adverse pregnancy outcomes. Preterm birth (PTB) is a risk factor for neonatal mortality and adverse health effects in childhood.Objectives:We examined prenatal exposure to GLY and a highly persistent environmental degradate of GLY, aminomethylphosphonic acid (AMPA), and odds of PTB in a nested case–control study within the ongoing Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) pregnancy cohort in northern Puerto Rico.Methods:GLY and AMPA in urine samples collected at (Visit 1) and (Visit 3) wk gestation (53 cases/194 randomly selected controls) were measured using gas chromatography tandem mass spectrometry. Multivariable logistic regression was used to estimate associations with PTB (delivery completed gestation).Results:Detection rates in controls were 77.4% and 77.5% for GLY and 52.8% and 47.7% for AMPA, and geometric means (geometric standard deviations) were 0.44 (2.50) and 0.41 for GLY and 0.25 (3.06) and 0.20 for AMPA, for Visits 1 and 3, respectively. PTB was significantly associated with specific gravity–corrected urinary GLY and AMPA at Visit 3, whereas associations with levels at Visit 1 and the Visits 1–3 average were largely null or inconsistent. Adjusted odds ratios (ORs) for an interquartile range increase in exposure at Visit 3 were 1.35 (95% CI: 0.99, 1.83) and 1.67 (95% CI: 1.26, 2.20) for GLY and AMPA, respectively. ORs for Visit 1 and the visit average were closer to the null.Discussion:Urine GLY and AMPA levels in samples collected near the 26th week of pregnancy were associated with increased odds of PTB in this modestly sized nested case–control study. Given the widespread use of GLY, multiple potential sources of AMPA, and AMPA’s persistence in the environment, as well as the potential for long-term adverse health effects in preterm infants, further investigation in other populations is warranted. https://doi.org/10.1289/EHP7295

PDE4B and PDE4D differentially regulate cardiac pacemaker activity

During sympathetic stimulation, the activation of β-adrenergic receptors (βAR) increases cAMP levels, leading to positive chronotropic effect. Among the 6 cardiac cAMP-PDE families, PDE4 is critical for controlling excitation-contraction coupling (ECC) during β-stimulation in atrial and ventricular myocytes. PDE4 may also be important for automaticity. Three genes encode for PDE4 in the heart (pde4a, 4b, 4d). To investigate the respective contribution of PDE4 isoforms to the regulation of pacemaker activity. Total PDE activity in mouse SAN was determined as the cAMP-hydrolytic activity measured in the absence of PDE inhibitor and the fraction corresponding to PDE4 activity was assessed by including the PDE4 inhibitor Ro-20-1724. The in vitro pacemaker activity was assessed by measuring spontaneous Ca 2+ transients in Fluo4-loaded-SAN tissue from Wild-type (WT) and PDE4KO using confocal microscopy. Telemetry EKG was recorded in conscious mice in control (CTRL) conditions, after pharmacological denervation (atropine + propranolol) and after isoproterenol (ISO). PDE4 activity represents 60% of total cAMP-PDE activity in SAN. PDE4A, 4B and 4D isoforms are expressed in mouse SAN. In PDE4BKO, the effect of ISO on SAN beating rate was higher than in WT. Ablation of PDE4D induced decreased beating rate in CTRL and ISO conditions and increased Ca 2+ spark frequency compared to WT. In vivo, PDE4BKO and PDE4DKO mice displayed increased resting HR during day and night. After pharmacological denervation, the rhythmic phenotype was only maintained in PDE4BKO but not in PDE4DKO. The response to ISO was higher in PDE4BKO than in PDE4DKO. In addition, ISO provoked more premature beats and atrioventricular blocks in PDE4DKO than in PDE4BKO mice. PDE4B controls intrinsic SAN automaticity and PDE4D might be important for autonomic nervous system-mediated regulation of HR and conduction.

A longitudinal investigation of the happy victimizer tendency in childhood: A matter of control or care?

This study examined the course and correlates of the happy victimizer tendency-the expectation that harming others to achieve a goal will result in positive emotional outcomes for the transgressor-from 4 to 6 years of age in a community sample of Canadian children (N = 150; 50% female; Time 1 Mage = 4.53 years, SD = .30; 33% European background). At each time point, we conducted semistructured interviews with children to assess their emotion expectancies and reasoning in response to hypothetical acts of aggression. Caregivers (84% mothers; 91% college diploma or higher; 41% yearly household income ≥$125,000 CAD [approximately $90,500 USD]) provided ratings of children's inhibitory control and sympathy at study onset. Most 4-year-old children expected to feel good after victimizing others, but this tendency declined through age 6. Children higher in sympathy were less likely to happy victimize at age 4, whereas greater inhibitory control predicted faster decreases in happy victimizing over time. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study

SummaryBackgroundThe Pfizer-BioNTech (BNT162b2) and the Oxford-AstraZeneca (ChAdOx1 nCoV-19) COVID-19 vaccines have shown excellent safety and efficacy in phase 3 trials. We aimed to investigate the safety and effectiveness of these vaccines in a UK community setting.MethodsIn this prospective observational study, we examined the proportion and probability of self-reported systemic and local side-effects within 8 days of vaccination in individuals using the COVID Symptom Study app who received one or two doses of the BNT162b2 vaccine or one dose of the ChAdOx1 nCoV-19 vaccine. We also compared infection rates in a subset of vaccinated individuals subsequently tested for SARS-CoV-2 with PCR or lateral flow tests with infection rates in unvaccinated controls. All analyses were adjusted by age (≤55 years vs >55 years), sex, health-care worker status (binary variable), obesity (BMI <30 kg/m2vs ≥30 kg/m2), and comorbidities (binary variable, with or without comorbidities).FindingsBetween Dec 8, and March 10, 2021, 627 383 individuals reported being vaccinated with 655 590 doses: 282 103 received one dose of BNT162b2, of whom 28 207 received a second dose, and 345 280 received one dose of ChAdOx1 nCoV-19. Systemic side-effects were reported by 13·5% (38 155 of 282 103) of individuals after the first dose of BNT162b2, by 22·0% (6216 of 28 207) after the second dose of BNT162b2, and by 33·7% (116 473 of 345 280) after the first dose of ChAdOx1 nCoV-19. Local side-effects were reported by 71·9% (150 023 of 208 767) of individuals after the first dose of BNT162b2, by 68·5% (9025 of 13 179) after the second dose of BNT162b2, and by 58·7% (104 282 of 177 655) after the first dose of ChAdOx1 nCoV-19. Systemic side-effects were more common (1·6 times after the first dose of ChAdOx1 nCoV-19 and 2·9 times after the first dose of BNT162b2) among individuals with previous SARS-CoV-2 infection than among those without known past infection. Local effects were similarly higher in individuals previously infected than in those without known past infection (1·4 times after the first dose of ChAdOx1 nCoV-19 and 1·2 times after the first dose of BNT162b2). 3106 of 103 622 vaccinated individuals and 50 340 of 464 356 unvaccinated controls tested positive for SARS-CoV-2 infection. Significant reductions in infection risk were seen starting at 12 days after the first dose, reaching 60% (95% CI 49–68) for ChAdOx1 nCoV-19 and 69% (66–72) for BNT162b2 at 21–44 days and 72% (63–79) for BNT162b2 after 45–59 days.InterpretationSystemic and local side-effects after BNT162b2 and ChAdOx1 nCoV-19 vaccination occur at frequencies lower than reported in phase 3 trials. Both vaccines decrease the risk of SARS-CoV-2 infection after 12 days.FundingZOE Global, National Institute for Health Research, Chronic Disease Research Foundation, National Institutes of Health, UK Medical Research Council, Wellcome Trust, UK Research and Innovation, American Gastroenterological Association.

Impact of adherence to disease-modifying therapies on employment among veterans with multiple sclerosis

Purpose Patients who adhere to their disease-modifying therapies (DMTs) have a lower rate of MS-related relapses and disability. We sought to determine the adherence rate to DMTs and the association between adherence to DMTs and employment in patients with multiple sclerosis (MS). Method One hundred and forty-two patients with MS who were periodically followed in our clinic between January 2000 and January 2020. We compared three groups of patients, defined according to their adherence to DMTs (non-adherent; poorly adherent; adherent), on their obtaining paid employment. Results Forty-seven MS patients (33.1%) were non-adherent to any DMT medication, while 88 MS patients (62.0%) demonstrated good and 7 (4.9%) poor adherences. More patients in the good-adherence group were in paid employment 42.0% compared to 23.4% in the non-adherent group (p = 0.587) after controlling for potential co-founders. Conclusion In this study veterans who adhered to their DMTs were 2.4 times more likely to be in paid-employment compared to non- or poorly-adherent patients. The clinical significance of this study is to encourage MS patients to adhere to their DMTs as a motivating factor of being in paid-employment. Implications for rehabilitation What is known about this subject? In the setting of a randomized controlled trial adherence rates reported for different injectable DMTs vary from 79–85% for once a week interferon beta-1a (IM IFNb-1a) to 49–78% for other injectable DMTs. •What are the new findings and/or impact on clinical practice? •Paid employment was more common among veterans whose adherence to DMTs was good (42.0% employed) or poor (42.9%) than among those who were non-adherent (23.4%). Veterans who adhered to DMTs were also younger, had less severe MS, and displayed less cognitive and physically impairment than those who did not adhere. •Being employed can act as a motivating factor to encourage adherence to treatment aimed at preventing accumulation of mental and physical disabilities.

Mechanism of hepatic stellate cell proliferation and apoptosis in rats by promoting circulation, removing stasis, and dredging collaterals based on the theory of liver collateral disease

This study aims to investigate the impacts on the proliferation, inhibition, apoptosis, and cell cycle of hepatic stellate cells (HSC-T6) in rats by using traditional Chinese medicine (TCM) in serum. Twenty-seven rats were randomly divided into nine groups on average: a blank control (BC) group (fed by distilled water), a positive control group (colchicine solution, 0.05 mg/mL), and seven TCM groups [with the aim of clearing the liver of choleresis with 0.24 g/mL (weight of TCM herbs per milliliter), 0.73 g/mL, 1.22 g/mL, 2.45 g/mL, 7.34 g/mL, 12.24 g/mL, 24.48 g/mL]. Each rat received gavage with a dose of 1 mL/100 g twice a day for 7 days to prepare the drug serum. The HSC-T6 were divided into a TCM serum group, a positive control group, and a BC group. The TCM group and the positive control group were given corresponding drug serum for incubation, while the BC group received the medium without drug serum. The cellular proliferation inhibition rate in the positive control and TCM groups was significantly higher (P<0.01) than that in the BC group. The number of cells in the positive, 0.24 g/mL TCM, 1.22 g/mL TCM, and 7.34 g/mL TCM groups increased significantly (P<0.05) in the G0/G1 phase compared with the BC group. The number of cells in the positive group and all the TCM groups clearly increased in phase S by 0.73 g/mL in the TCM group, 2.45 g/mL in the TCM group, 12.24 g/mL in the TCM group, and 24.48 g/mL in the TCM group compared with the BC group, and the difference was statistically significant (P<0.05). The number of cells in the G2/M phase of the positive control group and all the TCM groups decreased significantly. Compared with the BC group, the positive group, 0.24 g/mL TCM group, 0.73 g/mL TCM group, 1.22 g/mL TCM group, 2.45 g/mL TCM group have statistically difference (P<0.05). A Qinggan Lidan prescription may exert anti-hepatic fibrosis effects by blocking HSC-T6 in the G0/G1 and S phases and by suppressing the proliferation of HSC-T6.

Transmission and control pressure analysis of the COVID-19 epidemic situation using multisource spatio-temporal big data.

Taking the Guangdong-Hong Kong-Macao Greater Bay Area as the research area, this paper used OD cluster analysis based on Baidu migration data from January 11 to January 25 (before the sealing-off of Wuhan) and concluded that there is a significant correlation 1the migration level from Wuhan to the GBA and the epidemic severity index. This paper also analyzed the migration levels and diffusivity of the outer and inner cities of the GBA. Lastly, four evaluation indexes were selected to research the possibility of work resumption and the rating of epidemic prevention and control through kernel density estimation. According to the study, the amount of migration depends on the geographical proximity, relationship and economic development of the source region, and the severity of the epidemic depends mainly on the migration volume and the severity of the epidemic in the source region. The epidemic risk is related not only to the severity of the epidemic in the source region but also to the degree of urban traffic development and the degree of urban openness. After the resumption of work, the pressure of epidemic prevention and control has been concentrated mainly in Shenzhen and Canton; the further away a region is from the core cities, the lower the pressure in that region. The mass migration of the population makes it difficult to control the epidemic effectively. The study of the relationship between migration volume, epidemic severity and epidemic risk is helpful to further analyze transmission types and predict the trends of the epidemic.

Developing critical thinking skills among Transportation Security officers (TSOs) through sharing tacit knowledge

This paper summarizes results from a research project collaboration between a Transportation Security Administration (TSA) organization responsible for aviation security at a mid-sized airport in the western United States and a local university. The purpose of this project was to explore the potential and utility of a learning tool designed to enhance critical thinking skills among Transportation Security Officers (TSO). Employees of the TSA are provided comprehensive and continuous training from point of hire throughout the duration of a TSO’s employment. However performance problems continue to be identified and while TSOs are annually rated on their ability to think critically no training is provided for this specific skill. During Phase 1 of this two-phased study, a learning tool was developed in the form of a situational judgment test based tacit knowledge inventory comprised of work scenarios that were oriented on developing critical thinking skills common to TSOs. In Phase 2, TSOs organized into an experimental group, participated in structured facilitated discussions that supplemented the traditional training protocol and were based on the critical thinking tacit knowledge inventory; a control group took part in only the traditional training. A significant difference was found between the experimental and control group annual performance ratings for the critical thinking scale.

Role of Tissue Glue in Overlay Tympanoplasty vs Conventional Overlay Method

ABSTRACT Purpose The purpose of this research is to study the role of tissue glue (TISSEL) in overlay tympanoplasty when compared with the conventional overlay method. Study design A prospective randomized comparative study was carried out at the ENT department of Base Hospital, Delhi, in which 60 patients with dry central perforation underwent overlay tympanoplasty. Out of these, 30 underwent conventional overlay tympanoplasty (control) and in the rest of the 30, overlay tympanoplasty was done with the use of tissue glue (cases). Results Graft take-up rate in control is 90% and in cases 96.7% (p &gt; 0.05). Hearing improvement within 20 dB of A–B gap (at 03 months) in control is 86.70 and 96.70% in cases (p &gt; 0.05). Early hearing improvement (at 6 weeks) in cases was better when compared with the control (p &lt; 0.05). The complication rate in cases is 10% with residual perforation in 01 patient, while that in control is 16.66% with residual perforation in 03 patients (p &gt; 0.05). Conclusion Graft take-up rate in hearing improvement was found to be better in overlay tympanoplasty with the use of tissue glue when compared with the conventional method with no statistically significant difference. The only significant advantage with the TISSEL group was found to be an early hearing improvement at 6 weeks. Tissue glue (TISSEL) was found to be safe and effective. How to cite this article Pimparkar SV, Sethi A, Das A, et al. Role of Tissue Glue in Overlay Tympanoplasty vs Conventional Overlay Method. J Med Acad 2020;3(2):33–37.

Lessons learnt from the variation across 6741 family/general practices in England in the use of treatments for hypogonadism

We have previously reported rates of diagnosis of male hypogonadism in United Kingdom (UK) general practices. We aimed to identify factors associated with testosterone prescribing in UK general practice. We determined for 6741 general practices in England, the level of testosterone prescribing in men and the relation between volume of testosterone prescribing and (1) demographic characteristics of the practice, (2) % patients with specific comorbidities and (3) national GP patient survey results. The largest volume (by prescribing volume) agents were injectable preparations at a total cost in the 12-month period 2018/19 of £8,172,519 with gel preparations in second place: total cost £4,795,057. Transdermal patches, once the only alternative to testosterone injections or implants, were little prescribed: total cost £222,022. The analysis accounted for 0.27 of the variance in testosterone prescribing between general practices. Thus, most of this variance was not accounted for by the analysis. There was a strong univariant relation (r=.95, P<.001) between PDE5-I prescribing and testosterone prescribing. Other multivariant factors independently linked with more testosterone prescribing were as follows: HIGHER proportion of men with type 2 diabetes(T2DM) on target control (HbA1c≤58mmol/mol) and HIGHER overall practice rating on the National Patient Survey for good experience, while non-white ethnicity and socio-economic deprivation were associated with less testosterone prescribing. There were a number of comorbidity factors associated with less prescribing of testosterone (such as T2DM, hypertension and stroke/TIA). Our analysis has indicated that variation between general practices in testosterone prescribing in a well developed health economy is only related to small degree (r2 =0.27) to factors that we can define. This suggests that variation in amount of testosterone prescribed is largely related to general practitioner choice/other factors not studied and may be amenable to measures to increase knowledge/awareness of male hypogonadism, with implications for men's health.

CARBON FOOTPRINT OF THE LEGALIZATION OF ACTIVITIES AT THE CITY OF SEVILLE

The reduction of Greenhouse Gases (GHG) emission in cities is vital because cities generate 60% of global GHG emissions. By the middle of this century, two-thirds of the planet's population is expected to be concentrated in cities. For this reason, energy demand and GHG emissions in large cities will continue to increase, concentrating on urban centres, productive, transport and commercial activities. This increase in economic activities in cities leads to an increase in the number of legalization procedures that are processed by municipalities to authorize and control their implementation. In response to the problems raised, it is presented the results of an investigation undertaken to demonstrate that the application of a Knowledge-Based System (KBS) can significantly reduce the carbon footprint that is currently generated in the Licensing Service of the city council of Seville, as a consequence of the current high failure rate in the subsequent control after the start-up of activities by responsible declaration. The implementation of the SBC would reduce the carbon footprint by 78%, considering an average establishment with 300 m2 of built area. This proposal can be applied in any city council of the more than 8000 that exist in Spain, which would have an enormous impact on reducing the carbon footprint of cities and reducing costs for public coffers, and all this without the need to invest in renewing the fleet of vehicles with others that produce fewer emissions, and facilitating the task of promoters of economic activities, with the help of knowledge management. Keywords: Carbon footprint, Greenhouse Gas Emissions, Local administration, Knowledge-based system, Compliance.

Effects of Nitrogen Sources on the Growth and Biochemical Composition of Diatom (Amphora coffeaeformis) Used for Shrimp Larviculture

Amphora coffeaeformis is a benthic diatom and serves as a rich nutritional feed for various aquaculture industries. The objective of this experiment was to compare the effects of different nitrogen sources on the growth and biochemical composition of the diatom (A. coffeaeformis) culture. Sodium nitrate in Guillard’s f medium, used as a control treatment, was compared with sodium nitrite and ammonium sulfate. The results in the 3rd batch of culture showed that all treatments led to the highest growth on Day 6. The highest cell dry weight occurred in the ammonium sulfate treatment with significance (0.78±0.06 mg/mL). The cultures in each treatment were harvested at the exponential phase (Day 3) for biochemical composition analysis. A. coffeaeformis in the ammonium sulfate treatment significantly accumulated the highest protein content, at 44.82 % by dry weight, while the highest lipid content at 29.78 % by dry weight was significantly found in the sodium nitrate treatment. The cell size and structure showed no significant differences among the treatments. The experiment demonstrated the effects of different nitrogen sources on the growth and biochemical composition of A. coffeaeformis. After that, we selected A. coffeaeformis that was cultured with the nitrate and ammonia nitrogen sources for feeding to shrimp larvae. This experiment was conducted to evaluate the effects of A. coffeaeformis on the growth, survival rate, salinity stress test, and ammonia stress test for shrimp. The experiment was designed with four treatments, as follows: 1) the control feed with flake winner (no water exchange for 28 days), 2) Am-NO3 supplement with A. coffeaeformis cultured using nitrates (no water exchange for 28 days), 3) Am-NH3 supplement with A. coffeaeformis cultured using ammonia (no water exchange for 28 days), and 4) the positive control feed with flake winner (daily water exchange at 20 %). The results showed that the growth of shrimp fed with the diet supplemented with A. coffeaeformis cultured using nitrate and ammonia were not significantly different from the negative and positive controls (P &gt; 0.05). However, the survival rate in the negative control was significantly lower than the other groups (P &lt; 0.05). In this study, the stress test for white shrimp postlarvae utilized 2 methods: the ammonia or salinity stress tests. The survival rate of the shrimp after the ammonia stress test was not statistically and significantly different (P &gt; 0.05). However, the results from the salinity stress test indicated that the highest survival rate was observed in the shrimp fed with the diet supplemented with A. coffeaeformis cultured using nitrate. A. coffeaeformis cultured with the sodium nitrate treatment had a positive effect on shrimp tolerance to salinity changes.

EASL position paper on the use of COVID-19 vaccines in patients with chronic liver diseases, hepatobiliary cancer and liver transplant recipients

According to a recent World Health Organization estimate, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which originated in China in 2019, has spread globally, infecting nearly 100 million people worldwide by January 2021. Patients with chronic liver diseases (CLD), particularly cirrhosis, hepatobiliary malignancies, candidates for liver transplantation, and immunosuppressed individuals after liver transplantation appear to be at increased risk of infections in general, which in turn translates into increased mortality. This is also the case for SARS-CoV-2 infection, where patients with cirrhosis, in particular, are at high risk of a severe COVID-19 course. Therefore, vaccination against various pathogens including SARS-CoV-2, administered as early as possible in patients with CLD, is an important protective measure. However, due to impaired immune responses in these patients, the immediate and long-term protective response through immunisation may be incomplete. The current SARS-CoV-2 pandemic has led to the exceptionally fast development of several vaccine candidates. A small number of these SARS-CoV-2 vaccine candidates have already undergone phase III, placebo-controlled, clinical trials in healthy individuals with proof of short-term safety, immunogenicity and efficacy. However, although regulatory agencies in the US and Europe have already approved some of these vaccines for clinical use, information on immunogenicity, duration of protection and long-term safety in patients with CLD, cirrhosis, hepatobiliary cancer and liver transplant recipients has yet to be generated. This review summarises the data on vaccine safety, immunogenicity, and efficacy in this patient population in general and discusses the implications of this knowledge on the introduction of the new SARS-CoV-2 vaccines.

Incidence, Prevalence, and Health Care Outcomes in Idiopathic Intracranial Hypertension: A Population Study.

ObjectiveTo characterize trends in incidence, prevalence, and health care outcomes in the idiopathic intracranial hypertension (IIH) population in Wales using routinely collected health care data.MethodsWe used and validated primary and secondary care IIH diagnosis codes within the Secure Anonymised Information Linkage databank to ascertain IIH cases and controls in a retrospective cohort study between 2003 and 2017. We recorded body mass index (BMI), deprivation quintile, CSF diversion surgery, and unscheduled hospital admissions in case and control cohorts.ResultsWe analyzed 35 million patient-years of data. There were 1,765 cases of IIH in 2017 (85% female). The prevalence and incidence of IIH in 2017 was 76/100,000 and 7.8/100,000/y, a significant increase from 2003 (corresponding figures = 12/100,000 and 2.3/100,000/y) (p < 0.001). IIH prevalence is associated with increasing BMI and increasing deprivation. The odds ratio for developing IIH in the least deprived quintile compared to the most deprived quintile, adjusted for sex and BMI, was 0.65 (95% confidence interval 0.55 to 0.76). Nine percent of IIH cases had CSF shunts with less than 0.2% having bariatric surgery. Unscheduled hospital admissions were higher in the IIH cohort compared to controls (rate ratio 5.28, p < 0.001) and in individuals with IIH and CSF shunts compared to those without shunts (rate ratio 2.02, p < 0.01).ConclusionsIIH incidence and prevalence is increasing considerably, corresponding to population increases in BMI, and is associated with increased deprivation. This has important implications for health care professionals and policy makers given the comorbidities, complications, and increased health care utilization associated with IIH.

Nuclear Pore Complexes Cluster in Dysmorphic Nuclei of Normal and Progeria Cells during Replicative Senescence.

Hutchinson-Gilford progeria syndrome (HGPS) is a rare premature aging disease caused by a mutation in LMNA. A G608G mutation in exon 11 of LMNA is responsible for most HGPS cases, generating a truncated protein called “progerin”. Progerin is permanently farnesylated and accumulates in HGPS cells, causing multiple cellular defects such as nuclear dysmorphism, a thickened lamina, loss of heterochromatin, premature senescence, and clustering of Nuclear Pore Complexes (NPC). To identify the mechanism of NPC clustering in HGPS cells, we evaluated post-mitotic NPC assembly in control and HGPS cells and found no defects. Next, we examined the occurrence of NPC clustering in control and HGPS cells during replicative senescence. We reported that NPC clustering occurs solely in the dysmorphic nuclei of control and HGPS cells. Hence, NPC clustering occurred at a higher frequency in HGPS cells compared to control cells at early passages; however, in late cultures with similar senescence index, NPCs clustering occurred at a similar rate in both control and HGPS. Our results show that progerin does not disrupt post-mitotic reassembly of NPCs. However, NPCs frequently cluster in dysmorphic nuclei with a high progerin content. Additionally, nuclear envelope defects that arise during replicative senescence cause NPC clustering in senescent cells with dysmorphic nuclei.

Patient Perception of Pain Control (Not Opiate Amount) Affects Hospital Consumer Assessment of Healthcare Providers and Systems and Press Ganey Satisfaction Scores After Orthopaedic Trauma.

Opiate abuse is a public health issue linked to prescribing. Prescribing increased partly in response to adopting pain as the fifth vital sign. Assessing pain control on patient satisfaction surveys, including government-mandated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and optional private surveys (Press Ganey) administered on hospital discharge, may contribute. This study evaluates whether opiate amounts affect orthopaedic trauma patient perception of pain control and overall hospital rating on HCAHPS and Press Ganey surveys. Consecutive adult patients >18 years surgically treated for isolated fractures (UE = upper extremity, LE = lower extremity, and PA = pelvis/acetabulum) at a level 1 trauma center between January 1, 2014, and December 31, 2016, were retrospectively analyzed. Hospital charts, HCAHPS, and Press Ganey data were reviewed; patients without survey responses were excluded. Data included comorbidities, psychiatric history, substance use, injury type, and surgery. Analysis included Spearman's rho for correlations, Wilcoxon rank-sum and Kruskal-Wallis for continuous variables, and adjusted ordinal regression to estimate association between opioid prescribing and patient ratings. One hundred fifty-two total patients (UE 29, LE 112, and PA 11) with mean age of 57 years and median length of stay 3 days were included. Adjusted models showed longer duration outpatient prescriptions were associated with lower rating on how often inpatient pain was controlled (P = 0.002), lower total MME inpatient was associated with higher ratings (HCAHPS P = 0.015; Press Ganey, P = 0.03), lower average daily MME inpatient was associated with lower ratings (HCAHPS P = 0.008; Press Ganey, P = 0.037), and shorter outpatient prescription duration was associated with lower ratings (P = 0.008). Patient perception of pain control was strongly associated with overall HCAHPS (P < 0.05) and Press Ganey (P < 0.001) ratings. Inpatient and outpatient opiate amounts and duration demonstrated some associations with overall scores. However, patients' pain control perception seems to have the strongest relationship with hospital rating. Counseling and multimodal pain control may lead to strong satisfaction scores without needing high opiates after orthopaedic trauma.

A Novel Brain-Computer Interface Virtual Environment for Neurofeedback During Functional MRI.

Virtual environments (VEs), in the recent years, have become more prevalent in neuroscience. These VEs can offer great flexibility, replicability, and control over the presented stimuli in an immersive setting. With recent developments, it has become feasible to achieve higher-quality visuals and VEs at a reasonable investment. Our aim in this project was to develop and implement a novel real-time functional magnetic resonance imaging (rt-fMRI)–based neurofeedback (NF) training paradigm, taking into account new technological advances that allow us to integrate complex stimuli into a visually updated and engaging VE. We built upon and developed a first-person shooter in which the dynamic change of the VE was the feedback variable in the brain–computer interface (BCI). We designed a study to assess the feasibility of the BCI in creating an immersive VE for NF training. In a randomized single-blinded fMRI-based NF-training session, 24 participants were randomly allocated into one of two groups: active and reduced contingency NF. All participants completed three runs of the shooter-game VE lasting 10 min each. Brain activity in a supplementary motor area region of interest regulated the possible movement speed of the player’s avatar and thus increased the reward probability. The gaming performance revealed that the participants were able to actively engage in game tasks and improve across sessions. All 24 participants reported being able to successfully employ NF strategies during the training while performing in-game tasks with significantly higher perceived NF control ratings in the NF group. Spectral analysis showed significant differential effects on brain activity between the groups. Connectivity analysis revealed significant differences, showing a lowered connectivity in the NF group compared to the reduced contingency-NF group. The self-assessment manikin ratings showed an increase in arousal in both groups but failed significance. Arousal has been linked to presence, or feelings of immersion, supporting the VE’s objective. Long paradigms, such as NF in MRI settings, can lead to mental fatigue; therefore, VEs can help overcome such limitations. The rewarding achievements from gaming targets can lead to implicit learning of self-regulation and may broaden the scope of NF applications.

Non-Invasive Low PEEP Versus High PEEP Ventilation Strategy in Severe COVID-19 Patients: An Observational Case – Control Study

Since the best ventilation strategy of severe covid-19 patients is still uncertain, we conducted a retrospective case–control study to evaluate the outcome of severe covid-19 patients treated in the emergency department (ED) with a non-invasive low positive end-expiratory pressure (PEEP) and early weaning strategy and compared it to a non-invasive high-PEEP strategy. Primary outcome was a composite outcome of ETI rate and/or in-hospital mortality at 7 and 28 days from admission to the ED. We compared 24 severe covid-19 patients treated with non-invasive low-PEEP to 26 sex- and age-matched controls. Main demographic characteristics, p/F ratio, creatinine, procalcitonine, C-reactive protein, d-dimer levels, APACHE II score and NEWS were comparable at admission. The case group received more frequently antivirals (mainly darunavir/cobicistat) and hydroxychloroquine (p = 0.004 and 0.011 respectively). As to primary outcome, at 7 days, 13 cases versus 20 controls experienced ETI or died (p not significant). In the remaining population, at 28 days, 2 out of 18 low-PEEP cases died as opposed to 11 out of 21 high-PEEP controls (11.1% vs 52.4%, p = 0.008; OR 0.11 CI95% 0.02 –0.62). Our analysis of Kaplan-Meier curves confirmed the statistical significance of higher mortality and ETI rate in controls. Although larger trials are needed to confirm our results, this retrospective case-control trial provides a modest evidence that a noninvasive low- PEEP ventilation strategy could reduce ETI rate and mortality at 28 days compared to a high-PEEP approach and be a game changer in the ventilation strategy of COVID-19 patients.

Etiology of diarrhea by multiplex polymerase chain reaction among young children in the United Arab Emirates: a case-control study

BackgroundLittle is known about the etiology of childhood diarrhea in the United Arab Emirates (UAE) especially after the introduction of rotavirus vaccines. This study aimed to identify gastrointestinal pathogens in children with diarrhea (cases) and the carriage rate of these pathogens in asymptomatic children (controls).MethodsStool samples were collected from 203 cases and 73 controls who presented to two major hospitals in Al Ain city, UAE. Samples were analyzed with Allplex™ Gastrointestinal Full Panel Assay for common entero-pathogens. The association between diarrhea and the isolated pathogens was calculated in a multivariate logistic regression model. The adjusted attributable fractions (aAFs) were calculated for all pathogens significantly associated with cases.ResultsAt least one pathogen was identified in 87 samples (42.8%) from cases and 17 (23.3%) from controls (P < 0.001). Rotavirus, norovirus GII and adenovirus were significantly more prevalent in cases. Their aAFs with 95% ci are 0.95 (0.64, 1.00) for rotavirus, 0.86 (0.38, 0.97) for norovirus GII and 0.84 (0.29, 0.96) for adenovirus. None of the 13 bacteria tested for were more commonly found in the cases than in controls. Cryptosporidium spp. were more significantly detected in cases than in controls. Co-infections occurred in 27.9% of the children. Viruses and parasites were significantly more likely to occur together only in the cases.ConclusionsMultiplex PCR revealed high positivity rates in both cases and controls which demand a cautious interpretation. Rotavirus remains the main childhood diarrhea pathogen in UAE. Effective strategies are needed to better control rotavirus and other causative pathogens.