Differences Research Articles

The effects of experimental sleep disruption on daytime performance among children with asthma living in urban environments.

Children with asthma living in urban environments are at risk for disrupted sleep due to the presence of nocturnal asthma symptoms and urban stressors. Suboptimal sleep can affect children's daily functioning. The current study examined the effects of experimental sleep disruption on daytime performance in children with persistent asthma from urban backgrounds. Twenty-four children (8-10 years old) with asthma living in urban environments participated in an experimental, laboratory-based sleep disruption protocol. Children completed a baseline night consisting of uninterrupted sleep, followed by a disruption night, with 2-minute arousals every 20minutes of sleep. Sleep and sleep disruptions were monitored via polysomnography. Daytime performance measurements (Psychomotor Vigilance Task; Daytime Sleepiness, child- and caregiver-report) were evaluated at baseline and after sleep disruption using t-tests and percent change calculations. No significant differences in attention or daytime sleepiness were observed between the uninterrupted night of sleep and the disrupted night of sleep (p-values >.05). Percent change calculations showed that children demonstrated poorer attention (decreased response speed; increased reaction time, lapses, total errors, false starts) and more daytime sleepiness (caregiver- and child-report) following a night of sleep disruption compared to an uninterrupted night of sleep. Gender and racial/ethnic group differences in outcomes were also examined. Children with asthma living in urban environments may be at risk for sleep disruption and impaired daytime functioning. More experimental sleep research with larger samples is necessary to further explore these associations.

Global, regional, and national burden of major depressive disorders in adults aged 60 years and older from 1990 to 2021, with projections of prevalence to 2050: Analyses from the Global Burden of Disease Study 2021.

To estimate the burden of major depressive disorder (MDD) among older adults and project its prevalence through 2050. Using data from the Global Burden of Disease Study 2021, we calculated age-standardized rates (ASRs) for the incidence, prevalence, and years lived with disability (YLDs) of MDD among people aged ≥60 years from 1990 to 2021. Trends were analyzed using average annual percentage changes (AAPCs). Polynomial regressions were utilized to assess the relationship between economic levels and MDD burden. Prevalence of MDD was forecasted to 2050 using a mixed-effects model with Socio-demographic Index as the predictor. Globally, the ASRs for incidence, prevalence and YLDs of MDD in older adults increased annually by 0.24 % (95 % CI: 0.18-0.31), 0.25 % (0.19-0.30), and 0.24 % (0.18-0.30), respectively. The fastest growth was observed in adults aged 60-69 years. The burden of MDD among females was approximately 1.5 times higher than males, although rates grew faster among males. Lower-income countries, particularly in sub-Saharan Africa, exhibited the highest burden and growth rates. By 2050, global MDD cases are projected to reach 97.04 million (95 % uncertainty interval [UI]: 71.27-129.85), with an ASR of 4.53 % (3.33-6.07). The global burden of MDD among older adults has increased since 1990 and its prevalence is projected to continue increasing through 2050. Increments were faster in males, younger-old adults and people living in lower-income countries. Comprehensive and integrated management systems at nation, community and individual levels for MDD among older adults are essential to mitigate this growing burden and promote healthy aging.

Evolving landscape of colorectal cancer: Global and regional burden, risk factor dynamics, and future scenarios (the Global Burden of Disease 1990-2050).

Presently, colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. We provided global, regional, and national estimates of the burden of CRC and their attributable risks from 1990 to 2021, aiming to guide screening, early detection, and treatment strategies, optimize healthcare resource allocation, and facilitate the rational management of burden of CRC. Using data derived from the Global Burden of Disease database, we estimated the incidence, mortality, and disability-adjusted life years (DALYs) of CRC. The temporal trends of the age-standardized rate of CRC were quantified by calculating the estimated annual percentage changes (EAPC). Deaths from CRC attributable to each risk factor that had evidence of causation with CRC were estimated. CRC's deaths and DALYs was forecast through 2050 by logistic regression with Socio-Demographic Index as a predictor, then multiplying by projected population estimates. Globally, between 1990 and 2021, the incident cases, death cases, and DALYs attributed to CRC have doubled, the age-standardized incidence rate (ASIR) presented a slightly upward tendency, while the age-standardized death rate (ASMR) and the age-standardized DALYs rate (ASDR) exhibited a decreasing trend. From 1990-2021, the ASIR for males has an increased trend, while females presented a downward trend. The ASIR and ASDR of CRC were higher in high and high-middle sociodemographic index (SDI) countries. The ASIR of CRC in 165 countries and territories showed escalating trend. Globally, for males and both sexes combined, diet low in whole grains was the leading risk factor for age-standardized deaths from CRC in 2021. However, among females, diet low in milk was the leading risk factor. We forecast that 2.18 million (1.53-2.94) individuals will death for CRC worldwide by 2050, and the DALYs achieve 41.7 million (29.9-55.4) by 2050. The doubling of incidence counts and mortality cases and the rising ASIR in most countries indicates a significant burden of CRC. Authorities should devise suitable measures to address the increasing burdens, such as optimizing screening programs, enhancing awareness and screening efforts for males, and reducing exposure to modifiable risk factors.

Cryoblebbing with 5-fluorouracil versus cryoblebbing with melanocyte keratinocyte transplant procedure or cryoblebbing alone in treatment of stable vitiligo.

Both the surgical non-cultured melanocyte-keratinocyte transplant procedure (MKTP) and intradermal injection of 5-Fluorouracil (5-FU) are effective in the treatment of vitiligo. Intrablisters injection of MKTP was done in one study with better results than MKTP application after ablative CO2 laser of the reciepient area. However, intrablister injection of 5-FU was not done before. To compare the efficacy of 5-FU, MKTP after preparation of the recipient site by cryoblebing in the treatment of stable vitiligo. Treatment efficacy was evaluated clinically, histopathologically, and immunohistochemically. This prospective, single-blinded, randomized comparative study included 20 patients with stable vitiligo in 128 areas. The recipient sites were prepared by cryoblebbing. The blisters were injected with either a suspension of MKTP in area A (MKTP group, 49 areas), 5-FU in area B (5-FU group, 48 areas) or left without injection in area C (control group, 31 areas). The assessment was performed 6months after the procedure based on the percentage of repigmentation, histopathologically and immunohistochemically for the pigmented lesions. Six months after treatment, the mean percentage change in repigmentation was 82.96% ± 31.46% in the MKTP group, 44.79% ± 39.38% in the 5-FU group, and 28.23% ± 24.00% in the control group.The median of the percent change was 100%, 37.5% and 25% in MKTP group, 5-FU group and control group, respectively, with a significant difference (P < 0.001) between the groups. After treatment, H&E-stained sections from the repigmented lesions showed the reappearance of melanocytes (MCs) and melanin pigmentation, especially in the MKTP group followed by 5-FU. Immunohistochemical staining revealed large MCs with an increased density of reactions and dendricity with positive expression of Melan A, and HMB45 especially in the MKTP and 5-FU groups. Intrablister injection with 5-FU appears to be effective for the management of stable vitiligo with less efficacy than MKTP.

Spatio-temporal clustering of drowning mortality in Iran, from 2005 to 2022

BackgroundDrowning is a serious and neglected public health threat, and prevention of drowning has a multisectoral nature and requires multidimensional research. Therefore, this study aimed to evaluate the spatio-temporal variation...

Sex and age distribution of global disease burden of non-rheumatic calcific aortic valve disease from 1990 to 2021.

To analyze sex and age distribution of global disease burden of non-rheumatic calcific aortic valve disease (CAVD) from 1990 to 2021. CAVD data 1990-2021 were obtained from the IHME website for Global Burden of Disease (GBD). The prevalence, mortality, years lived with disability (YLDs), and disability-adjusted life years (DALYs) were analyzed by gender and age groups. Joinpoint regression was used to calculate annual percent change (APC) and average annual percent change (AAPC). In 2021, there were 13.32 million CAVD patients and 142 000 deaths caused by CAVD globally. Age-standardized prevalence was higher in males (193.2/105) than that in females (128.9/105). Patients in 65-85 age group accounted for 64.0% of total cases, while those ≥85 years old accounted for 16.1%. From 1990-2021, prevalence increased in both sexes with an AAPC of 0.72% for males and 0.57% for females, respectively. Prevalence grew fastest from 2000-2010, slowed thereafter, and declined from 2015-2021. In those <65 years old, the mortality of males was 2.4 times higher than that of females, while in those ≥85 years old, mortality of females (117.3/105) exceeded that of males (99.1/105). YLD rates increased with age, and were higher in males for all age groups. DALY rates decreased overall but increased in those ≥85 years old, with a greater increase in females. There are significant gender and age disparities in global disease burden of CAVD, with particular concern for the elderly, especially super-elderly females, indicating the need for personalized intervention strategies.

Promoting longus colli muscle activation: Force direction in sitting matters.

There is limited evidence to inform exercise prescription for deep neck flexor activation out of supine. To compare activation of longus colli (LC) and sternocleidomastoid (SCM) from supine to sitting, and to compare the effect of craniocervical flexion (CCF) exercises in sitting on activation. Twenty-four individuals without neck pain (mean age 28.8 years, 12 females) completed 7 isometric CCF exercises (1 supine CCF, 6 sitting with applied head resistance through an elastic band in straight or oblique planes from the contra- or ipsilateral sides) while muscle activation was captured using ultrasound imaging. A 2-way analysis of variance examined the effects of exercise and muscle on percent change activation using planned post-hoc comparisons and Cohen's D to establish effect sizes. Supine CCF was equivocal to sitting CCF with resistance for LC activation (p=0.758). The LC muscle was most robustly activated by applying an ipsilateral oblique resistance force compared to a straight lateral force (p=0.002, Cohen's d=-0.82). LC activation was higher when oblique resistance was applied from the ipsilateral than contralateral side (p=0.002, Cohen's d=-0.84). SCM activation was higher resisting an ipsilateral lateral force compared to a contralateral force (p=0.0006, Cohen's d=1.06). Craniocervical flexion in supine and sitting activate LC equally but in sitting, applying oblique resistance during lateral flexion with extension enhances LC activation most effectively. Care should be taken with straight laterally applied forces since this can promote unwanted SCM activation.

Impact of hemoadsorption with CytoSorb® on meropenem and piperacillin exposure in critically ill patients in a post-CKRT setup: a single-center, retrospective data analysis

PurposeCytoSorb® (CS) adsorbent is a hemoadsorption filter for extracorporeal blood purification often integrated into continuous kidney replacement therapy (CKRT). It is primarily used in critically ill patients with sepsis and related conditions, including cytokine storms and systemic inflammatory responses. Up to now, there is no evidence nor recommendation for the use of CS filters in sepsis (22). There is limited clinical data on the effect of CS on the plasma concentrations of beta-lactams. We aimed to evaluate the statistical and clinical impact of CS in a post-filter CKRT-CS setting on the plasma concentrations of the antibiotics meropenem and piperacillin in critically ill patients.MethodsPatients admitted to the intensive care unit (ICU) who received a prolonged infusion of piperacillin or meropenem with CS-combined CKRT were included in this retrospective analysis. TDM (therapeutic drug monitoring) plasma blood samples were collected at three different points. The differences in antibiotic concentrations between Pre, Intra, and Post were statistically compared to evaluate the total and isolated contributions of CKRT and CS to antibiotic removal. CS, CKRT and combined clearance (CL) values were calculated. The hypothesis was that the CS filter would have no clinically relevant impact on antibiotic levels.Results207 TDM samples were taken from 24 critically ill patients requiring beta-lactam antibiotics. Among these, 129 were meropenem samples, and 78 were piperacillin samples. A decrease in both antibiotic levels was observed between Pre and Intra, and Pre and Post, and the median relative difference between was >15% (meropenem: Pre–Intra 34.8%, Pre–Post 35.8%; piperacillin: Pre–Intra 41.1%, Pre–Post 34.7%), indicating a statistically and clinically significant effect of CKRT on both antibiotic exposures. No significant difference was observed between Intra and Post indicating no clinically relevant drug removal via the CS filter. Changes in CL attributed to CS were minimal, with combined CL differing by ≤8.60% compared to CKRT clearance.ConclusionThe application of CS does not appear to significantly affect plasma concentrations of meropenem and piperacillin in critically ill patients.

Switching to Besifovir in Patients with Chronic Hepatitis B Receiving Tenofovir Disoproxil Fumarate: A Randomized Trial.

Besifovir (BSV) showed comparable antiviral activity superior safety profiles to tenofovir disoproxil fumarate (TDF) in treatment-naïve chronic hepatitis B (CHB). However, no data are available regarding the antiviral efficacy and safety of BSV in patients with CHB who switched from long-term TDF to BSV. This study aimed to evaluate the outcome of a 48-week BSV therapy in patients with CHB who switched from long-term TDF treatment. In this non-inferiority trial, 153 CHB patients treated with TDF for ≥48 weeks who had hepatitis B virus (HBV) DNA <20 IU/mL were randomized to receive either BSV 150 mg or TDF 300 mg for 48 weeks. The per-protocol analysis included 130 patients (BSV group, 64; TDF group, 66). The median duration of TDF use before enrollment was 4.14 years. After 48 weeks, 100.0% and 98.5% patients in the BSV and TDF groups, respectively, met the primary endpoint (HBV DNA <20 IU/mL), demonstrating the non-inferior antiviral efficacy of BSV to TDF (95% CI -0.01 to 0.04; P=1.000), with a predefined margin of -0.18. The mean percentage changes in estimated glomerular filtration rates were slightly better in the BSV group (1.67±11.73%) than in the TDF group (-1.24±11.02%). The BSV group showed a significant improvement in bone turnover biomarkers compared to the TDF group; accordingly, hip and spine bone mineral density increased in the BSV group. In patients with CHB receiving long-term TDF, switching to BSV may improve renal and bone safety with non-inferior antiviral efficacy compared to that of maintaining TDF. ClinicalTrials.gov Identifier: NCT04202536.

National trends in heart failure admissions in Peru: Insights on regional and demographic disparities from 2018 to 2023.

Heart failure (HF) represents a significant public health challenge, particularly in low- and middle-income countries, where demographic shifts and healthcare disparities influence disease patterns. This study aimed to analyze trends in HF admissions across Peru from 2018 to 2023. We conducted a secondary data analysis of emergency department morbidity records of patients aged ≥20 years registered in the National Superintendence of Health (SUSALUD) database. HF admissions were identified using ICD-10 codes. Age-adjusted standardized HF admission rates per 100,000 persons were estimated using the direct method. Annual percentage changes with their 95% confidence intervals (CI) were estimated using Poisson regression models. In total, 38,931 HF admissions were recorded, with the majority occurring in patients aged ≥60 years (69.2%), and 51.2% of cases were men. HF admissions showed an overall annual growth rate of 2.78% (95% CI 0.95% - 4.65%), 2.92% (95% CI 1.13% - 4.74%) for men, and 2.57% (95% CI 0.45% - 4.73%) for women. Regional disparities were evident, with the highest rates observed in the Amazon region. HF admissions declined during 2020, followed by a rebound in subsequent years. HF admissions in Peru increased from 2018 to 2023, with notable disparities by sex and region. These findings underscore the need for targeted interventions to address regional and demographic variations in HF burden.

Study on Distribution Law of Ground Stress in Main Coal Seam of Qinshui Coalfield

Abstract In order to investigate the distribution patterns of in situ stress in the main coal seams (3# and 15#) of the Qinshui coalfield, an in-depth analysis was conducted on the in situ stress measurement results obtained from 139 measurement points across 46 mines within the mining area. The findings indicate that the maximum horizontal principal stress in the coal mining area of both seams is generally higher than the vertical principal stress. The stress field exhibits characteristics of a tectonic stress field, while deeper regions display features of a vertical stress field. The in situ stress values in the mining area of coal seam 3# are predominantly characterized by moderate stress field zones, while those in the mining area of coal seam 15# are mainly composed of low to moderate stress field zones. The maximum horizontal principal stress in the Yangquan and Changzhi mining areas for both coal Seams 3# and 15# is concentrated in the NE direction, whereas in the Jincheng mining area, it is predominantly concentrated in the NW direction, indicating a clear directionality. With increasing depth, the following trends can be observed approximately: the maximum and minimum horizontal principal stress values generally exhibit an increasing trend, and the geological structures throughout the mining area are primarily dominated by horizontal tectonic movements; the lateral pressure ratio gradually decreases and tends to concentrate near the value of 1; the relative difference between the maximum and minimum principal stresses tends to increase, with the horizontal principal stress difference ratio concentrating near 0.5. The relationship between the average horizontal principal stress ratio (k) and vertical principal stress at different depths within the measured area follows Hawke-Brown’s general law for this relationship curve. The research results have important guiding significance for the design of coal mining engineering in this area.

The clinical efficacy of scalp acupuncture for tinnitus: A systematic review and meta-analysis.

No single treatment is considered to be universally effective for tinnitus. Scalp acupuncture has been explored as a potential treatment. This systematic review and meta-analysis aim to evaluate the clinical efficacy of scalp acupuncture in treating tinnitus. A comprehensive search of relevant databases was conducted to identify randomized controlled trials comparing scalp acupuncture with a control treatment for tinnitus.The clinical efficacy rate and reduction in tinnitus severity were assessed using relative risk (RR) and standardized mean difference (SMD), respectively. Sensitivity analyses was performed to investigate sources of heterogeneity. A total of 20 research studies,with 1430 participants,were included.The systematic review and meta-analysis revealed that the scalp acupuncture groups had a significantly higher clinical effective rate compared to the control groups (RR=1.25, 95 % CI 1.16-1.35, p < 0.00001),with low heterogeneity(p = 0.27,I2=20 %).The scalp acupuncture groups and scalp acupuncture plus auxiliary acupoints groups had greater reduction in tinnitus severity compared to the control groups(SMD=-0.76,95 %CI:-1.02,-0.51,p < 0.00001;SMD:-0.93,95 %CI:-1.52,-0.33,p = 0.002, respectively),with a moderate heterogeneity(p = 0.005,I2=62 %) and a significant heterogeneity (p < 0.00001,I2=86 %) observed due to differences in study design, sample characteristics, and intervention protocols.Sensitivity analysis confirmed the stability of the results.The summary table generated through GRADEpro indicated that the certainty of evidence ranged from moderate to low. Scalp acupuncture has demonstrated promising efficacy in the treatment of tinnitus compared to traditional acupuncture or pharmacotherapy. However, the current evidence is limited due to potential biases and heterogeneity across studies.Future studies should standardize protocols, ensure higher methodological rigor, and explore long-term effects to validate the findings further. The review was registered with PROSPERO (CRD42024537806):Jiadi Chen, Ruizhi Jing.Analysis of clinical effect of scalp acupuncture on tinnitus. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024537806.

Intravenous dexmedetomidine for delirium prevention in elderly patients following orthopedic surgery: a meta-analysis of randomized controlled trials

ObjectivesWe conducted a meta-analysis to investigate the effect of dexmedetomidine on postoperative delirium in elderly orthopedic surgery patients.MethodsA meta-analysis was conducted to identify randomized controlled trials of dexmedetomidine in elderly patients undergoing orthopedic surgery. The data was published on October 25, 2024. PubMed, Embase, and Cochrane Library databases were searched. Outcome measures included incidence of delirium, length of hospital stay, visual analogue scale, and postoperative complications. Estimates are expressed as relative risk (RR) or mean difference (MD) with a 95% confidence interval (CI). The publications were reviewed according to the guidelines of the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).ResultsThis study was registered with INPLASY (number INPLASY2024110004). A total of 3159 patients were included in 9 randomized controlled trials. The results showed that dexmedetomidine exhibited a preventive effect on delirium compared with the control group in elderly patients after orthopedic surgery (RR: 0.55, 95% CI: 0.45–0.66, P < 0.01, I2 = 0%). Subgroup analysis suggested that dexmedetomidine was significantly different from saline(RR: 0.56; 95% CI: 0.44–0.73, P<0.01, I²=31%) and propofol(RR: 0.52; 95% CI: 0.39–0.70, P<0.01, I²=0%) in reducing postoperative delirium in elderly fracture patients. No statistically significant differences were observed in length of hospital stay, visual analogue scale, and postoperative complications (P > 0.05). Certainty of evidence for postoperative delirium was moderate.ConclusionsDexmedetomidine has been shown to have a protective effect on postoperative delirium in elderly patients following orthopedic surgery.

Comparing laboratory toxicity of selective intra-arterial radionuclide therapy for primary and metastatic liver tumors: resin versus glass microspheres.

To compare the acute (within 30days of treatment) laboratory toxicities of Yttrium-90 (Y-90) resin and glass microspheres. Selective intra-arterial radionuclide therapies (SIRTs) with Y-90 resin and glass microspheres were retrospectively reviewed. Liver-hematological data were collected at baseline and at 1week and 1month follow-up. The percentage change of laboratory data and the albumin-bilirubin (ALBI) score were calculated. A total of 219 SIRTs (n: 110 resin, n: 109 glass) from 177 patients were included. There was no difference in age, liver pathologies, extrahepatic disease, baseline liver function tests, and total blood counts between the two microsphere groups. Administered activity was higher in treatments with Y-90 glass microspheres (p < 0.001). An increase in serum liver enzymes was observed after treatment with both microspheres. The difference between the treatment groups was the higher percentage increase of AST and ALT at the first week following Y-90 glass treatment (p < 0.001). However, this situation was not observed after 1month. No difference in the percentage change of other laboratory parameters was found between two groups. The number of patients with an increase [resin n: 24 (24.7%) vs glass n: 26 (27.1%), p: 0.711) and decrease [resin n: 13 (13.4%) vs glass n: 8 (8.3%), p: 0.258] in the ALBI grade after SIRT was similar among groups. An increase in liver enzymes was observed in the early period after SIRT with both microspheres. No significant difference in liver and hematological data was detected during early follow-up between the two groups, except that the percentage increase of AST and ALT were higher at the first week in the Y-90 glass group, possibly due to higher administered activity.

A surge in female condom distribution during the COVID-19 pandemic in Gauteng province, South Africa

BackgroundFemale Condoms are 90–95% effective against HIV transmission when correctly and consistently used and are also cost-effective. In general, condoms prevent sexually transmitted infections (STIs) and unwanted pregnancies. Although the COVID-19 pandemic had the potential to undermine routine healthcare services delivery and utilisation, there is limited evidence about the pandemic’s effect on Female Condom uptake in Gauteng, one of the hardest-hit provinces in South Africa. This study aimed to compare female condom distribution in Gauteng Province, South Africa, before and during COVID-19, to inform decision-making for the attainment of universal access to sexual and reproductive health (SRH) by 2023 as per the sustainable development goal 3.7 and also, to empower women over their SRH during future pandemics.MethodsThis secondary data anslysis examined the percentage change in routine female condom distribution in Gauteng province and its five districts as an indirect effect (lockdown) of the COVID-19 pandemic, by comparing the aggregated District Health Information System (DHIS) data collated from primary health care facilities within the ditrict, before COVID-19 (2018–2019) and during COVID-19 (2020). Analysis in MS Excel 2016 illustrates the changes in the patterns and the trend in female condom distribution over the study period.ResultsIn 2020, during the COVID-19 pandemic, Gauteng province experienced a 43.7% increase in female condom distribution compared to the pre-COVID-19 period of 2019. The highest female condom distribution during the pandemic was observed in the Ekurhuleni Metropolitan (150.0%), followed by the Sedibeng (92.8%) and the Johannesburg Metropolitan (67.9%) districts respectively. However, the Tshwane Metropolitan (-8.5%) and the West Rand (-16.6%) districts experienced a decline in female condom distribution during COVID-19.ConclusionGauteng province witnessed a substantial surge in female condom distribution during COVID-19 in 2020, with a disproportionate district variation in demand. Female condom distribution is crucial, necessitating its enhancement and the continuum of distribution and stakeholders stockpiling at all times with particular attention to a potential increase in demand during outbreaks with lockdowns. Undisrupted access to female condoms will enable a consistent and correct use and empower women against HIV, STIs and unintended pregnancies, as a strive towards universal access to SRH.

Muscle Loss During First-Line Chemotherapy Impairs Survival in Advanced Pancreatic Cancer Despite Adapted Physical Activity.

Advanced pancreatic ductal adenocarcinoma (aPDAC) is often accompanied by significant muscle mass loss, contributing to poor prognosis. SarcAPACaP, an ancillary study of the GERCOR-APACaP phase III trial, evaluated the role of adapted physical activity (APA) in aPDAC Western patients receiving first-line chemotherapy. The study aimed to assess (1) the potential impact of computed tomography (CT)-quantified muscle mass before and during treatments on health-related quality of life (HRQoL) and overall survival (OS) and (2) the role of APA in mitigating muscle mass loss. In the APACaP trial, aPDAC patients with ECOG performance status (PS) 0-2 were randomized 1:1 to usual care including first-line chemotherapy or usual care plus a 16-week home-based APA program. In the SarcAPACaP study, the surface muscular index (SMI) was determined from L3 CT scan slices. Two patient populations were analysed: those with CT scan available at baseline (modified[m] intent-to-treat [ITT]1-W0) and those with CT scans available at both W0 and W16 (mITT2 W0-W16). Low muscle mass was defined by low SMI with SMI < 41 cm2/m2 for women and < 43 and < 53 cm2/m2 for men with body max index < 25.0 and ≥ 25.0 kg/m2, respectively. Muscle loss was defined by the relative difference of SMI between W0 and W16 (100*[SMI W16-SMI W0]/SMI W0). In mITT2 W0-W16, patients were stratified into three groups based on the severity of muscle loss: none, moderate (0%-10%) and high (≥ 10%). Associations between muscle mass loss and OS, time until definitive deterioration (TUDD) of HRQoL and the effect of APA on loss of muscle mass were assessed. Between October 2014 and May 2020, 313 patients were prospectively enrolled, with 225 in mITT1 W0 and 128 in mITT2 W0-W16, with 65 assigned to the APA arm. Both groups had similar baseline characteristics with comparable OS and TUDD. A low SMI at W0 was not associated with OS and TUDD of HRQoL in either group. Among mITT2 W0-W16 patients, high muscle mass loss (n = 27) independently predicted OS (p = 0.012) and showed a trend toward negatively affecting TUDD of HRQoL. Notably, APA did not mitigate muscle loss in our study population. Longitudinal muscle mass loss emerged as a predictive factor for both OS and HRQoL in aPDAC patients undergoing chemotherapy, while a low SMI at diagnosis did not provide prognostic value. APA did not impact muscle mass loss in this population.

Real-world safety and effectiveness of romosozumab following daily or weekly administration of teriparatide in primary and secondary osteoporosis.

Romosozumab is an anti-sclerostin antibody that increases bone formation and decreases bone resorption, and it became available for patients at high risk of osteoporotic fractures in Japan in 2019. The aim of this study was to clarify the clinical effects, safety, and predictors of the effectiveness of 12months of romosozumab therapy following daily or weekly administration of teriparatide. The study had an observational pre-post design and included 171 female patients. Romosozumab was administered at a dose of 210mg subcutaneously every 4weeks for 12months following daily or weekly administration of teriparatide. The incidence of new fractures, safety, and changes in bone mineral density (BMD) and bone turnover markers were recorded. New fractures occurred in 3 cases (2.2%). Four patients (2.3%) with secondary osteoporosis experienced cardiovascular events, which were fatal in 1 patient (0.6%). The percent changes in BMD at the spine and total hip at 12months from baseline were+7.9% and+2.4%, respectively. The percent change in spine BMD did not significantly differ according to whether daily or weekly teriparatide was given as previous treatment. Romosozumab following teriparatide showed greater effectiveness in patients with primary osteoporosis, high P1NP level at 1month, and low percent changes in TRACP-5b after 12months of treatment. Romosozumab after treatment with daily or weekly teriparatide was relatively safe and more effective in patients with primary osteoporosis than in those with secondary osteoporosis.

The incidence, mortality, and survival rate of colorectal cancer in Xiamen, China, from 2011 to 2020

IntroductionCurrently, nearly one-third of newly diagnosed Colorectal cancer (CRC) cases and associated deaths worldwide are from China. Among Chinese provinces, Fujian exhibited the highest CRC mortality rate. This study aims to analyze long-term trends of CRC epidemiology in Xiamen, Fujian, China.MethodsData were obtained from various cancer surveillance systems, including the Xiamen Cancer Register system, the Xiamen Death Register system, and the household registration system. Trends in incidence, mortality and survival rates from 2011 to 2020 were analyzed using annual percent changes (APC) and average annual percent changes (AAPC), stratified by sex and residency status.ResultsA total of 7,406 new cases and 3,726 CRC-related deaths were reported from Xiamen. The age-standardized of incidence and mortality rates were 26.09 per 100,000 and 12.70 per 100,000, respectively. The observed 5-year survival rate was 46.65%, with an age-standardized survival of 51.24%. CRC incidence in Xiamen is significantly increasing (AAPC = 4.90%). In contrast, trends in CRC mortality and survival rates are not significant. Urban areas exhibited higher rates of CRC incidence, mortality, and survival rate compared to rural areas, though rural areas showed a more marked upward trend.ConclusionsThe burden of CRC in Xiamen is notably high, with a concerning increasing in incidence. This underscores the urgent need for targeted strategies to address this public health challenges.

Medication underuse in real-life practice: the impact of galcanezumab towards achieving very low frequency episodic migraine in a southeast Asian middle-income nation

BackgroundMigraine progression, particularly from episodic to chronic migraine (CM), increases disease burden and healthcare costs. Understanding the new concept of “Medication Underuse Headache” should encourage the health care provider to consider early intervention with calcitonin gene-related peptide (CGRP) monoclonal antibodies. Galcanezumab given early in the course of the disease, may prevent migraine chronification and have a robust response, moreso than when initiated in later stages of migraine. We aimed to determine the efficacy of galcanezumab in achieving very low-frequency episodic migraine (VLFEM) among patients with high-frequency episodic migraine (HFEM) and CM in a real world-setting in Thailand.MethodsA single-center, retrospective real-world, cohort study was conducted between 2023 and 2024. Adults aged 18 years or more who were diagnosed with HFEM or CM were included in this trial and categorized into two groups: galcanezumab and oral migraine preventive medication (OMPM). In the galcanezumab group, oral preventive medications were slowly tapered off within 3 months. The primary outcome was the differences in percentage of patients achieving VLFEM at months 3 and 6 between the two groups. Secondary outcomes included the differences in migraine class improvement, sustained response, and headache day reduction.ResultsA total of 62 patients (31 in each group) were included: median age was 36.5 (IQR: 29.0–48.0) and 82% were female. There were no significant differences in the baseline demographic features between the two groups. The cumulative incidence of patients achieving VLFEM was significantly higher among the galcanezumab group compared to OMPM group (45.2% vs. 19.4% at month 3 and 52.9% vs. 32.4% at month 6, p = 0.03). After 6 months of follow-up, patients with HFEM who received galcanezumab were significantly more likely to achieve any improvements in migraine class compared to those who received OMPM (92.9% vs. 46.7%, p = 0.01). Among 15 patients who achieved VLFEM at month 3, 81.8% (9/11) of those who received galcanezumab and 50.0% (2/4) of those who received OMPM were able to sustain VLFEM at month 6.ConclusionsThis study emphasizes the benefit of early anti-CGRP therapy initiation, especially in patients with fewer headache days, and highlights the need for accessible migraine-specific treatments in low- to middle-income countries.

The global, regional, and national burden of type 2 diabetes mellitus attributable to low physical activity from 1990 to 2021: a systematic analysis of the global burden of disease study 2021

BackgroundLow physical activity (LPA) is a leading risk factor for type 2 diabetes mellitus (T2DM). We examine the temporal and spatial trends in the burden of T2DM attributable to LPA at the global, regional, and country scales.MethodsData were obtained from the Global Burden of Disease Study 2021. The numbers of deaths and disability-adjusted life years (DALYs) of LPA-related T2DM, and the corresponding age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) were compared across regions and countries by age, sex, and sociodemographic index (SDI). The annual percentage changes (EAPCs) in the ASMR or ASDR were calculated to quantify temporal trends from 1990 to 2021. We also quantified the relationship between SDI and the ASMR and ASDR of T2DM attributable to LPA.ResultsGlobally, the number of T2DM deaths and DALYs attributable to LPA were approximately 0.15 million and 5.52 million respectively in 2021, which more than doubled compared to 1990. Over the past 32 years, the global EAPCs of ASMR and ASDR were 0.26 (95% CI: 0.20, 0.31) and 0.97 (95% CI: 0.93, 1.02), respectively. The ASMR or ASDR had a reverse U-shaped relationship with the SDI, with the most severe burden observed in the low-middle and middle SDI regions. The age group older than 60 years had the highest rate of DALYs for LPA-related T2DM in 2021, while the 25–44 age group showed the largest increase between 1990 and 2021.ConclusionsOver the past 32 years, the global burden of LPA-related T2DM has continued to increase at an alarming rate in almost all countries, particularly in regions with low-middle and middle SDI. Substantial increases in national action are urgently needed to target elder populations especially in low-middle and middle SDI regions, and special efforts should be made to promote physical activity in young adults with LPA.