Critical Risk Research Articles

Early Detection of Cardiovascular Disease Using Photoplethysmography (PPG) Signal Analysis

Photoplethysmography (PPG) signals have gained prominence in clinical diagnostics for their non-invasive, cost-effective, and user-friendly applications in detecting cardiovascular diseases (CVDs). This study leverages machine learning techniques to enhance the accuracy of CVD detection from PPG data, addressing critical risk factors such as hypertension and stress, which significantly contribute to elevated blood pressure and, consequently, to cardiovascular disorders. The use of PPG provides a reliable approach for identifying cardiovascular anomalies by monitoring essential parameters like blood pressure and heart rate. In this work, we employ both machine learning and deep learning, specifically neural networks, to assist clinicians in diagnosing CVD, achieving a high accuracy rate of 98% on the PPG-BP dataset. The findings demonstrate the potential of PPG signals combined with advanced algorithms to support early diagnosis and personalized treatment, ultimately reducing mortality rates associated with cardiovascular diseases.

Activation of α7 Nicotinic Acetylcholine Receptor Augments Nerve Growth Factor Action on PCtrk Cells

Although cigarette smoking is known to be a critical risk factor for various organ systems and cancers, accumulating evidence indicates that nicotine – a main constituent of cigarette smoking – can exert neuroprotective effects on neuronal cells through nicotinic acetylcholine receptors (nAChRs). However, the precise molecular mechanisms for nicotinic neuroprotective actions remain to be fully elucidated. In this study, we examine the effects of agonists, such as nicotine and PNU282987, on tropomyosin-related kinase (Trk)-dependent neuroprotective pathways in PC12 cells overexpressing a Trk neurotrophin receptor (PCtrk cells). We found that even considerably higher concentrations (mM range for nicotine and µM range for PN282987) of nAChR agonists exert favorable effects, such as the augmentation of nerve growth factor (NGF)-induced Trk neurotrophin receptor autophosphorylation of tyrosine residues and NGF-induced neurite extension. Moreover, nicotine upregulated reactive oxygen species (ROS) levels in the cells. ROS production was completely cancelled by pretreatment with Mito-Tempo, a mitochondria-targeted antioxidant, indicating that the main source of ROS production by nicotine was mitochondria. Furthermore, treatment with nAChR agonists appeared to induce autophagic flux, as evidenced by the upregulation of LC3-II expression in cells. Furthermore, sucrose density ultracentrifugation of nicotine-treated cells clearly disclosed the augmented recruitment of α7nAChR protein into the lipid rafts fraction of the membrane. Intriguingly, a pull-down assay of anti-Trk antibody immunoprecipitates clearly included α7nAChR protein, indicating that Trk and α7nAChR proteins form a complex. These results reveal a new molecular interaction between activated α7nAChR and Trk protein that may serve as a new molecular basis of nicotine-induced neuroprotective action.

Advancing care in type 2 diabetes and atherosclerosis: assessing pharmacist-led strategies in England's primary care - a retrospective observational study

Abstract Background Type 2 diabetes (T2D) mellitus is a complex multi-system disorder with a tendency to develop complications. ‘Persistence to therapy’ plans affect almost 50% of all people with T2D, leading to suboptimal glycaemic and cardiovascular (CVD) risk factor control. The interplay between T2D and established atherosclerotic cardiovascular disease (ASCVD) underscores the need for a comprehensive, multidisciplinary approach to care that addresses both glycaemic control and CVD risk factors. Purpose This study retrospectively analysed pharmacist-led interventions in patients living with T2D and established ASCVD in general practices in a large UK city. Methods A retrospective pre-post observational study was conducted using electronic health record data from men and women diagnosed with T2D and ASCVD. Participants attended an independent prescribing pharmacist-led clinic within 21 general practices. The practices operated linked and comprehensive electronic health records systems, facilitating access to high-quality longitudinal data that align with study objectives. Results A total of 380 patients received pharmacist-led interventions. Comparisons of pre-intervention and post-intervention data revealed a significant decrease in HbA1c levels (73.7 ± 10.7 mmol/mol vs 67.2 ± 8.5 mmol/mol, p < 0.01), systolic blood pressure (132 ± 10.2 mmHg vs 125.9 ± 9.9 mmHg, p < 0.01), and diastolic blood pressure (76.8 ± 5.9 mmHg vs 72.4 ± 5.0 mmHg, p < 0.001). Additionally, total cholesterol levels significantly reduced from 4.4 ± 0.7 mmol/L to 3.9 ± 0.7 mmol/L (p < 0.001). The proportion of patients achieving the triple target of HbA1c (≤58 mmol/mol), BP (≤140/80 mmHg), and total cholesterol (≤5 mmol/L) increased significantly from 2.4% before the intervention to 23.4% afterward (p < 0.001). The initiation of the sodium-glucose co-transporter 2 inhibitors (SGLT2i) therapies was the most common prescribing intervention (67%). Conclusions Pharmacist-led interventions in a general practice setting significantly improved several critical diabetes and CVD risk related outcomes. These findings underscore the potential benefits of integrating pharmacist-led care models into the management of T2D, particularly for patients with concurrent ASCVD and adopting an individualised, evidence-based approach to prescribing interventions.

Trajectory of Obesity and the Impact of Eating Behaviors on Obesity in Preschool Children: A Nationwide Population-Based Cohort Study in Korea

Background: Early childhood obesity is highly associated with obesity in adolescents and adults. However, studies on specific eating behaviors that have a decisive effect on obesity in early childhood (aged 3–5 years) are scarce. We hypothesized that critical risk factors associated with eating behaviors leading to obesity at ages of 3–5 years may be different. To confirm this hypothesis, we conducted a study on the risk factors of obesity related to eating behaviors in preschool children. Methods: Using the National Health Screening Program for Infants and Children (NHSPIC) in Korea’s general population cohort, we found the obesity trends in 3–5-year-olds. The risk factors of obesity in 3–5-year-olds were analyzed through logistic regression. Results: Among children with obesity at 3 years old, but without obesity at 4 years old, only 10.1% (107/1063) transitioned to obesity at 5 years old, whereas among children with obesity at 3–4 years old, 62.7% (398/635) transitioned to obesity at 5 years old. The risk factors for obesity at 3 years old were inclusion of meat in complementary food, prolonged breastfeeding, and consumption of sweetened beverages; at ages 4–5 years, the risk factors were the inclusion of meat in complementary food and consumption of sweetened beverages. Conclusions: Obesity at 4 years is more likely to lead to obesity in the following year than obesity at 3 years. The dietary factor with the greatest impact on obesity in children aged 3–5 years has been found to be consumption of sweetened beverages.

Analysis of the role of perfusion parameters in predicting rupture of brain arteriovenous malformations: a multi-center study

This study aimed to investigate the potential correlation between the perfusion parameters of brain arteriovenous malformations (bAVMs) as determined by multiphase CT angiography and bAVM rupture. Based on the occurrence of bAVM-related hemorrhage, 480 diagnosed bAVM patients were divided into hemorrhage (n = 220) and non-hemorrhage (n = 260) groups in this retrospective multi-center study spanning 2010 to 2020. On initial rupture CT images, the bAVM nidus and major draining vein were segmented, and time-density curves were extracted to compute perfusion parameters including mean transit time (MTT), time to peak (TTP), blood volume (BV), and blood flow (BF). To examine the potential correlation between these parameters and bAVM rupture, logistic regression was utilized to analyze multifactorial data and compare differences between the two groups. The ruptured group demonstrated a bAVM nidus characterized by an increased BF, a shorter TTP and MTT, and a higher peak density. The veins that were draining exhibited a reduced TTP, MTT, and peak density. A nidus TTP of less than 4s was identified by the multifactorial analysis as a critical risk factor for bAVM rupture. The statistical results highlight the noteworthy correlation between nidus TTP and bAVM rupture, presenting an original framework for assessing the risk of rupture.

Applying FMEA for Operational Risk Management: Lessons from Minestar Implementation at PT. Borneo Indobara

PT Borneo Indobara (BIB) is planning to implement Minestar, an integrated mining management system, in 2025 to enhance operational efficiency and safety. However, the implementation of this system poses several operational risks that require careful management to ensure success. The aim of this research is to develop a comprehensive risk matrix and propose effective mitigation strategies for the Minestar implementation at BIB, using the SNI ISO 31000:2018 risk management framework. The research employs a mixed-method approach, combining qualitative techniques such as semi-structured interviews and focus group discussions (FGD) with quantitative analysis using Failure Mode and Effect Analysis (FMEA). Data was collected from key stakeholders directly involved in the Minestar project to assess the severity, occurrence, and detection of each identified risk, which were then used to develop a risk matrix. The results of the study identified and prioritized several critical operational risks, with a three-dimensional risk matrix providing a clear visualization of their severity, occurrence, and detection levels. This structured approach allows BIB's management to prioritize risks and allocate resources effectively for risk mitigation. The findings of this research contribute to operational risk management in the mining industry, particularly for the implementation of advanced technologies like Minestar. The practical insights provided can serve as a reference for similar projects in the industry, helping organizations to address operational challenges proactively.

Whole milk protein powder separated by low-temperature nanofiltration membrane administration alleviates sepsis-induced myopathy

Sepsis-induced myopathy (SIM) has been recognized as a critical risk factor for the development of acquired muscle weakness among patients in the intensive care unit. These individuals frequently encounter inadequate dietary intake and malnutrition. With the aggravation of the severity of the person’s condition, leading to increased skeletal muscle protein breakdown and reduced synthesis, which is an urgent problem to be solved in clinical nutritional treatment. Whole milk protein powder (WMPP) has promising bioactive nutrients and holds promising potential for enhancing skeletal muscle mass. The study was designed to delve into the potential effects and mechanisms of WMPP intervention for increaseing skeletal muscle mass on SIM mice. Our results clearly show that the intervention with WMPP can significantly improve the exercise capacity and skeletal muscle mass in SIM mice. It significantly increases the diameter and cross-sectional area (CSA) of skeletal muscle fibers, while effectively reducing the excessive aggregation of collagen fibers and the abnormal accumulation of adipose tissue in the skeletal muscle of SIM mice. Moreover, WMPP intervention also significantly alleviated the oxidative stress status of mitochondria, which subsequently enhanced the expression of mitochondrial metabolic enzymes. The mechanism may be associated with decreased AMPK phosphorylation in skeletal muscle tissue and simultaneously increased phosphorylation of mTOR, p70S6K1, and 4EBP-1 in SIM mice. In summary, the WMPP intervention significantly enhances exercise capacity and skeletal muscle mass while mitigating the oxidative stress status of mitochondria. Furthermore, it regulates skeletal muscle anabolism via the AMPK/mTOR signaling pathway in SIM mice.

Meta-analysis and systematic review of factors predicting conversion to radical nephrectomy following robotic-assisted partial nephrectomy in renal cancer patients.

Evaluating the risk factors for the conversion from robotic-assisted partial nephrectomy (RAPN) to radical nephrectomy (RN). Through a comprehensive database search encompassing PubMed, Web of Science, Embase, and the Cochrane Library, we identified pertinent English-language research published by June 2024. We utilized the NOS scale for quality assessment. The aggregate effect was quantified via the odds ratio (OR), alongside a 95% confidence interval (CI). Sensitivity analyses were conducted using both fixed-effects and random-effects models to evaluate reliability. The meta-analytical process was facilitated by the Stata 18 software suite. Our meta-analysis encompassed a total of 8 retrospective studies and 3 prospective studies, totaling 4056 patients. We found that increasing patient age (OR: 1.04; 95% CI 1.00-1.08; P = 0.005), higher American Society of Anesthesiologists (ASA) scores (3 or above) (OR: 2.74; 95% CI 1.52-4.93; P = 0.001), elevated R.E.N.A.L. scores (7 or above) (OR: 2.49; 95% CI 1.57-3.95; P < 0.001), and the use of off-clamp RAPN (OR: 7.21; 95% CI 2.60-19.93; P < 0.001) significantly raised the odds of surgical conversion. On the other hand, male sex (OR: 1.04; 95% CI 0.67-1.62; P = 0.858), the side of the tumor (OR: 0.97; 95% CI 0.48-1.95; P = 0.936), tumor size (OR: 3.43; 95% CI 0.57-20.55; P = 0.177), body mass index (BMI) (OR: 1.03; 95% CI 0.96-1.11; P = 0.426), clinical stage (OR: 3.78; 95% CI 0.46-30.70; P = 0.214), and the use of single-port RAPN (OR: 0.54; 95% CI 0.16-1.78; P = 0.31) did not show a statistically significant link to an increased conversion risk. This meta-analysis elucidates the critical risk factors for the conversion from robotic-assisted partial nephrectomy to radical nephrectomy, providing significant guidance for preoperative risk assessment and clinical decision-making. However, our findings necessitate validation through studies with larger sample sizes.

Evaluation of functional measures and laboratory parameters to portend limitations of spinal mobility in patients with radiographic axial spondyloarthritis

Aim of the workTo specify clinical and laboratory parameters related to limited spinal mobility in radiographic axial spondyloarthritis (r-axSpA) patients. Patients and methodsThe study included 202 adult r-axSpA patients. Clinical characteristics, medications, investigations including serum C-reactive protein (CRP) and human leukocytic antigen-B27 positivity were noted. Lateral lumbar flexion (LLF), chest expansion (CE) and tragus-to-wall distance (TWD) were measured. Values <2.5 percentile in LLF, CE and TWD were noted as reduced mobility of lumbar, thoracic and cervical spine, respectively. ResultsThe median age of patients was 43 years, male:female was 3.7:1. The time to diagnosis was 7.5 (3–40) years and were followed-up for 7.2 (4–22) years. Disease duration and high baseline CRP (>10 mg/L) were critical risk factors for reduced spinal mobility (p = 0.001 and p < 0.01). The duration to impaired LLF was significantly shorter in smokers (n = 105) (10.3;0–30.5 years) vs non-smokers (15.2;4.5–35 years) (p = 0.001) and in those with positive family history (n = 50) (9.7;0–20 years) compared to those without (12.9;4–35 years) (p = 0.09). LLF, CE and TWD were impaired in 40 % vs 75 %, 10 % vs 55 % and 12 % vs 60 % of patients with symptom duration of 10 vs 30 years respectively. Those with delayed introduction of biologics had significantly more impaired LLF, CE and TWD: 10.1(2–25) vs 14(3–33) years; 10.4(3–26) vs 17.5(8–33) years; 10.7(3–27) vs 16.7(5–33) years; p = 0.001 for all, respectively). ConclusionsThe most prominent factors affecting spinal mobility were the duration of symptoms and high serum CRP levels. The decreased spinal mobility was markedly less in patients with the early introduction of biologic therapy.

Chronic Exposure to Bioaerosols in PM2.5 from Garbage Stations Accelerates Vascular Aging via the NF-κB/NLRP3 Pathway.

The fine particulate matter (PM2.5) in air pollution is a critical risk factor influencing human health. Our study included 8144 participants andshowed that the risk of major adverse cardiovascular events increases by 35% (HR, 1.35; 95% CI, 1.14-1.60) for participants with thehighest quartile to PM2.5 exposure as compared to those with lowest quartile. Bioaerosols, as an important environmental exposure in PM2.5, can induce systemic chronic inflammation leading to vascular aging. Thus, the effects of bioaerosols are investigated from household garbage stations in PM2.5 on vascular aging, and the underlying mechanisms are explored. In vivo, chronic exposure to bioaerosols upregulated senescence marker expression levels while causing vascular dysfunction and remodeling. In vitro, bioaerosol exposure induced decreased proliferation, G0/G1 arrest, and impaired migration of human umbilical vein endothelial cells (HUVECs). Furthermore, a single bacterium (AS22a) from the bioaerosol community was isolated and demonstrated that it upregulated inflammatory factors and accelerated cell senescence and vascular aging by activating the NF-κB/NLRP3 signaling pathway, which may serve as a primary mechanism underlying vascular aging induced by bioaerosols in PM2.5. These findings suggest that high levels of bioaerosols in household garbage stations may adversely affect cardiovascular health.

The Staphylococcus aureus-antagonizing human nasal commensal Staphylococcus lugdunensis depends on siderophore piracy

BackgroundBacterial pathogens such as Staphylococcus aureus colonize body surfaces of part of the human population, which represents a critical risk factor for skin disorders and invasive infections. However, such pathogens do not belong to the human core microbiomes. Beneficial commensal bacteria can often prevent the invasion and persistence of such pathogens by using molecular strategies that are only superficially understood. We recently reported that the commensal bacterium Staphylococcus lugdunensis produces the novel antibiotic lugdunin, which eradicates S. aureus from the nasal microbiomes of hospitalized patients. However, it has remained unclear if S. lugdunensis may affect S. aureus carriage in the general population and which external factors might promote S. lugdunensis carriage to enhance its S. aureus-eliminating capacity.ResultsWe could cultivate S. lugdunensis from the noses of 6.3% of healthy human volunteers. In addition, S. lugdunensis DNA could be identified in metagenomes of many culture-negative nasal samples indicating that cultivation success depends on a specific bacterial threshold density. Healthy S. lugdunensis carriers had a 5.2-fold lower propensity to be colonized by S. aureus indicating that lugdunin can eliminate S. aureus also in healthy humans. S. lugdunensis-positive microbiomes were dominated by either Staphylococcus epidermidis, Corynebacterium species, or Dolosigranulum pigrum. These and further bacterial commensals, whose abundance was positively associated with S. lugdunensis, promoted S. lugdunensis growth in co-culture. Such mutualistic interactions depended on the production of iron-scavenging siderophores by supportive commensals and on the capacity of S. lugdunensis to import siderophores.EJt4aqYa_PFzdC4ihACHg3Video ConclusionsThese findings underscore the importance of microbiome homeostasis for eliminating pathogen colonization. Elucidating mechanisms that drive microbiome interactions will become crucial for microbiome-precision editing approaches.

Analysis of the environmental factors contributing to road traffic accidents involving school-aged pedestrian children in urban Algerian settings

Despite efforts by the Algerian government and civil society to improve road safety, traffic accidents remain a significant issue, particularly affecting children and youth. Data from the National Delegation for Road Safety (NDSR) reveals that this demographic is especially vulnerable, with 371 child fatalities recorded during the 2020-2021 school year. This study evaluated road safety around twelve primary schools in Oued El Abtal district, Mascara province, and aimed to identify effective interventions through a participatory approach involving 1,074 students. An anonymous questionnaire was used to capture students' perceptions of road risks, and the data were analyzed using IBM SPSS Statistics V27. Chi-square and Fisher’s exact tests were applied to examine associations between gender and variables like travel mode, school accompaniment, student behavior, and crossing locations. The sample was balanced by gender, consisting of 50.9% boys and 49.1% girls. Walking was the predominant travel mode (75.2%; n=808). Key risk factors included inadequate infrastructure (3.2%), insufficient signage (11.7%), sidewalk obstructions (5.1%), dangerous driving behaviors (12.2%, with speeding at 29.5%), heavy traffic (16.2%), and poor urban planning (e.g., lack of speed bumps and low visibility). These findings highlight the urgent need for targeted interventions to improve the safety of school commutes. This research identifies critical risk factors in school travel, providing a foundation for developing strategies aimed at enhancing road safety for children in Algeria.

Seizure outcomes in patients with brain metastases and epilepsy: A systematic review on the efficacy of antitumor treatment and antiseizure medication

Abstract Background Epilepsy is a common symptom in patients with brain metastases (BMs), and because of the rising incidence of BMs, adequate seizure management is warranted. We conducted a systematic review on seizure outcomes after antitumor treatment and antiseizure medication (ASM) in patients with BMs from solid tumors and epilepsy. Methods A literature search was performed in six databases up to February 2024. Extracted outcomes were rates for (1) seizure freedom; (2) ≥50% seizure reduction; and (3) treatment failure (for ASM only). Weighted averages (WAs) were calculated for outcomes after surgery at 6 months follow-up. Quality assessment of the included studies was performed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Results We retrieved 2244 references, of which 16 studies were eligible for inclusion. Eight studies were at critical, and 8 studies at serious risk of bias. The WA of seizure freedom rates at 6 months after surgical resection was 64% (based on 3 studies at serious risk of bias, n=151 patients). Results on ASM efficacy and tolerability were unreliable, as all eligible studies for these outcomes were at critical risk of bias. Conclusions Limited available evidence from heterogeneous study populations demonstrated that in the majority of patients with epilepsy due to BMs, seizure freedom 6 months after surgical resection may be reached. No substantial evidence on ASM efficacy and tolerability in patients with epilepsy due to BMs is available. High-quality cohort studies are warranted to expand the evidence on seizure outcomes after antitumor and ASM treatment.

Principal Component Analysis (PCA) of MALDI-TOF for the Identification of Waterborne Pathogenic Bacteria

The study focuses on the application of Principal Component Analysis (PCA) combined with MALDI-TOF MS (Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry) for the identification of waterborne pathogenic bacteria in urban water networks. In this comprehensive research, 168 bacterial strains were meticulously isolated from the water networks of Abidjan, Côte d'Ivoire, a region known for its inadequate wastewater treatment infrastructure. The analysis aimed to rapidly and precisely identify these bacterial pathogens, leveraging the power of MALDI-TOF MS and the sophisticated data reduction capabilities of PCA. This approach not only accelerates the identification process but also enhances the accuracy of detecting various pathogens. The study identified a diverse range of pathogens, including Pseudomonas aeruginosa, Escherichia coli, Salmonella, Shigella, Vibrio cholerae, Morganella morganii, Proteus mirabilis, Acinetobacter baumannii, Klebsiella pneumoniae, Providencia rettgeri, Providencia stuartii, Aeromonas hydrophila, Bacillus cereus, Lysinibacillus fusiformis, Lysinibacillus sphaericus, and Staphylococcus aureus. These findings underscore the critical public health risks posed by microbial contamination in water networks, particularly in areas with deficient waste management systems. This study highlights the necessity for improved wastewater management practices, robust public health strategies, and regular monitoring to mitigate the risks associated with waterborne pathogens. Moreover, the integration of PCA with MALDI-TOF MS proves to be a powerful tool for enhancing the efficiency and accuracy of pathogen identification in environmental water samples, offering a promising solution for better public health protection and water quality management in urban settings.

Associations Between Clinical Factors and Postoperative Thrombosis in Pediatric Cardiac Surgery Patients: A Single-Center Retrospective Study.

Postoperative thrombosis is a significant complication in pediatric cardiac surgery patients, contributing to morbidity and mortality. Identifying clinical factors associated with thrombosis can improve patient outcomes by guiding early detection and intervention. This study aimed to assess factors associated with postoperative thrombosis or thromboembolism in pediatric patients under 12 months old who underwent surgery for congenital heart disease (CHD). Design, Setting, and Participants: This retrospective cohort study analyzed electronic medical records from pediatric patients admitted to the Pediatric Cardiovascular Intensive Care Unit (PCICU) at the German Paediatric Heart Center, Bonn, between March 1, 2020, and March 1, 2021. A total of 197 children under 12 months old who underwent cardiac surgery were included in the analysis. Thrombosis was diagnosed postoperatively using imaging modalities such as ultrasound, echocardiography, and computed tomography. The primary outcome was the incidence of thrombosis and its association with clinical factors such as age, central venous catheter (CVC) duration, CRP levels, and D-dimer levels. Among 197 patients, the incidence of thrombosis was 8.63%, predominantly venous (70.6%). Initial associations were observed between thrombosis and younger age, lower body weight, higher hematocrit, cyanosis, longer central venous catheter (CVC) use, and elevated C-reactive protein (CRP) and d-dimer levels. Receiver operating characteristic analysis indicated a higher risk in patients with d-dimer levels above 5.47 mg/L. The stepwise multiregression analysis identified longer CVC duration in situ (β = 0.553; p < 0.001), higher CRP levels (β = 0.217; p = 0.022), and younger age at admission (β = -0.254; p = 0.006) as significant predictors of thrombosis. Decision tree analysis identified CVC use longer than 12.5 days and CRP levels above 118.01 mg/L as the most critical risk factors. Postoperative thrombosis is a notable risk in pediatric CHD patients, particularly in neonates. Prolonged CVC use and elevated CRP levels are critical risk factors. Routine monitoring of D-dimer and CRP levels, along with timely sonographic screening, can aid early thrombosis detection and intervention. Further research is warranted to optimize thrombosis prevention strategies in this population.

Curcumin attenuates smoking and drinking activated NF-κB/IL-6 inflammatory signaling axis in cervical cancer

BackgroundHigh-risk strains of HPV are known to cause cervical cancer. Multiple clinical studies have emphasized that smoking and drinking are critical risk factors for cervical cancer and its high-grade precursors. In this study, we investigated if smoking and/or drinking augment the molecular mechanisms of cervical carcinogenesis and defined a potential therapeutic approach for their attenuation.MethodsThe impact of benzo[a]pyrene (B[a]P) and/or ethanol (EtOH) exposure on cervical cancer cells was assessed by measuring changes in their cell migration and invasion characteristics. Expression of HPV16 E6/E7, NF-κB, cytokines, and inflammation mediators was determined using qRT-PCR, immunoblotting, ELISA, luciferase reporter assay, and confocal microscopy. Herein, we used curcumin (Cur), and PLGA nanoparticle formulation of curcumin (PLGA-Cur) and determined effectiveness of free Cur and PLGA-Cur formulation on smoking and drinking activated NF-κB/IL-6 mediated inflammatory signaling pathways using in vitro cervical cancer models.ResultsTreatments with B[a]P and/or EtOH altered the expression of HPV16 E6/E7 oncogenes and EMT markers in cervical cancer cells; it also enhanced migration and invasion. In addition, B[a]P and/or EtOH exposure promoted inflammation pathways through TNF-α and NF-κB signaling, leading to IL-6 upregulation and activation of VEGF. The molecular effects caused by B[a]P and/or EtOH exposure were effectively attenuated by curcumin (Cur)/PLGA-Cur treatment.ConclusionsThese data suggest a molecular link between smoking, drinking, and HPV infectivity in cervical carcinogenesis. In addition, attenuation of these effects by treatment with Cur/PLGA-Cur treatment, implies the role of curcumin in cervical cancer prevention and treatment.

Novel risk factors associated with retained placenta after vaginal birth.

To evaluate maternal and obstetric risk factors associated with retained placenta following singleton live vaginal births. We conducted a retrospective cohort study of women diagnosed with retained placenta after singleton live vaginal birth at or after 24 weeks of gestation, compared in a 1:2 ratio with women who had uncomplicated vaginal deliveries. The study and control groups were matched for maternal age, gestational age, and parity. Multivariate regression analysis assessed potential risk factors related to retained placenta. In all, 15,260 women who delivered at our medical center(both vaginal and non-vaginal)between 2015 and 2022, 170 (1.1%) were diagnosed with retained placenta. Ninety-nine women (0.65%) who met the inclusion criteria were matched with 198 controls (1.3%). Multivariate logistic regression identified potential risk factors not previously described for retained placenta, including in vitro fertilization (OR 3.8, 95% CI 1.3-11.7, P = 00.018), large-for-gestational-age fetuses (OR 28.2, 95% CI 5.4-148.5, P = 00.029), and endometriosis (OR 8.2, 95% CI 0.92-20, P = 00.024). Additional risk factors included pre-eclampsia, labor induction, vacuum-assisted delivery, and prolonged second-stage labor. This study identifies critical risk factors for retained placenta, highlighting the importance of early identification to improve maternal and neonatal outcomes.

Rate and predictors of loss to follow-up in HIV care in a low-resource setting: analyzing critical risk periods

BackgroundPatient loss-to-follow-up (LTFU) in HIV care is a major challenge, especially in low-resource settings. Although the literature has focused on the total rate at which patients disengage from care, it has not sufficiently examined the specific risk periods during which patients are most likely to disengage from care. By addressing this gap, researchers and healthcare providers can develop more targeted interventions to improve patient engagement in HIV care.MethodsWe conducted a retrospective cohort study on newly enrolled adult HIV patients at seven randomly selected high-volume health facilities in Ethiopia from May 2022 to April 2024. Data analysis was performed using SPSS version 26, with a focus on the incidence rate of LTFU during the critical risk periods. Cumulative hazard analysis was used to compare event distributions, whereas a Poisson regression model was used to identify factors predicting LTFU, with statistical significance set at p < 0.05.ResultsThe analysis included 737 individuals newly enrolled in HIV care; 165 participants (22.4%, 95% CI: 19.5–25.2) were LTFU by the end of two years, of which 50.1% occurred within the first 6 months, 29.7% within 7–12 months, and 19.4% from 13 to 24 months on ART. The overall incidence rate of LTFU was 18.3 per 1,000 PMO (95% CI: 15.9–20.6), with rates of 167.7 in the first 6 months, 55.4 in 7–12 months, and 18.1 in 13–24 months. Incomplete addresses lacking a phone number or location information (IRR: 1.61; 95% CI: 1.14, 2.27) and poor adherence (IRR: 1.78; 95% CI: 1.28, 2.48) were factors predicting the incidence rate of LTFU.ConclusionLTFU peaked in the first 6 months, accounting for approximately half of total losses, remained elevated from months 7–12, and stabilized after the first year of HIV care and treatment. Address information and adherence were predictors of LTFU. To effectively minimize LTFU, efforts should focus on intensive support during the first six months of care, followed by sustained efforts and monitoring in the next six months. Our findings highlight a critical period for targeted interventions to reduce LTFU in HIV care.

Risk Factors Associated with Unplanned Hospitalization Among Long-Term Care Facility Residents: A Retrospective Study in Central Taiwan.

Most residents of long-term care facilities (LTCFs) are patients with chronic diseases requiring long-term care. Unplanned hospitalization of older and frailer residents from LTCFs reduces their mobility and increases the number of infections, complications, and falls that might lead to severe disability or death. This study aimed to identify the critical risk factors associated with unplanned hospitalization among LTCF residents in Taiwan, providing insights that could inform better care practices in similar settings globally. A retrospective study was conducted using inpatient data from a medical center in central Taiwan, covering the period from 2011 to 2019. A total of 1220 LTCF residents were matched with general patients using propensity score matching. Multiple logistic regression analyses were performed to identify factors associated with unplanned hospitalization, controlling for relevant variables. LTCF residents had a significantly higher risk of unplanned hospitalization compared to general patients (OR = 1.44, 95% CI = 1.21-1.73). Key risk factors included advanced age (≥85 years, OR = 1.25, 95% CI = 1.02-1.54), the presence of comorbidities such as diabetes (OR = 1.17, 95% CI = 1.03-1.33) and renal failure (OR = 1.63, 95% CI = 1.42-1.86), high fall risk (OR = 2.67, 95% CI = 2.30-3.10), and being bedridden (OR = 6.55, 95% CI = 5.48-7.85). The presence of a tracheostomy tube also significantly increased hospitalization risk (OR = 1.73, 95% CI = 1.15-2.59). LTCF residents are at a higher risk of unplanned hospitalization, particularly those with specific comorbidities, physical limitations, and indwelling medical devices. These findings underscore the need for targeted interventions to manage these risks, potentially improving care outcomes for LTCF residents globally.

MUC5B rs35705950 Promoter Variant Is Associated with Usual Interstitial Pneumonia in Patients with Antisynthetase Syndrome

Background: The presence of the rs35705950 variant in the MUC5B gene promoter is a critical genetic risk factor in idiopathic pulmonary fibrosis (IPF). It has been associated with usual interstitial pneumonia (UIP) in several interstitial lung diseases (ILDs). In antisynthetase syndrome (ASSD), most high-resolution computed tomography (HRCT) patterns are inflammatory, but up to 13% have UIP, leading to a worse prognosis. Methods: This single-center study included 60 patients with ASSD-ILD. We investigated whether carrying the MUC5B rs35705950 promoter variant was associated with UIP. To estimate the strength of the association between the genotype of the MUC5B rs35705950 promoter variant and the fibrotic pattern we used the odds ratio (cOR), and to assess the effect of confounding variables (age, evolution time, and sex), we performed a logistic regression to obtained the adjusted odds ratio (aOR). Results: The GT genotype of the MUC5B rs35705950 promoter variant is associated with up to a 4-fold increased risk of UIP (cOR 5.0, 95% CI 1.13–22.10), and the effect was even maintained after adjusting for potentially confounding variables such as sex, age, and time to progression (aOR 5.2, 95% CI 1.04–25.89). Conclusions: our study supports the role of MUC5B rs35705950 in ASSD-ILD with UIP. It reinforces that this polymorphism in our population could have a similar genetic basis to that already described in other ILDs that present predominantly fibrotic patterns.