Epidemiological Studies Research Articles

Influence of vitamin D receptor signaling and vitamin D on colonic epithelial cell fate decisions in ulcerative colitis.

Epidemiological studies have shown that subnormal levels of vitamin D (25(OH)D) are associated with a more aggravated clinical course of ulcerative colitis (UC). Despite an increased focus on the therapeutic importance of vitamin D and vitamin D receptor (VDR) signaling, the mechanisms underlying the effects of the vitamin D-VDR axis on UC remain elusive. Therefore, we aimed to investigate whether exposure to active vitamin D (1,25(OH)2D3)/VDR signaling in human organoids could influence the maintenance of the colonic epithelium. Intestinal VDR expression was studied by immunohistochemistry, RNA expression arrays, and single-cell RNA sequencing of colonic biopsy specimens obtained from patients with UC and healthy individuals. To characterize the functional and transcriptional effects of 1,25(OH)2D3, we used patient-derived colonic organoids. The dependency of VDR was assessed by knocking out the receptor with CRISPR/Cas9. Our results suggest that 1,25(OH)2D3/VDR stimulation supports differentiation of the colonic epithelium and that impaired 1,25(OH)2D3/VDR signaling thereby may compromise the structure of the intestinal epithelial barrier, leading to flares of UC. Furthermore, a transcriptional response to VDR activity was observed primarily in fully differentiated cells at the top of the colonic crypt, and this response was reduced during flares of UC. We identified an important role of vitamin D signaling in supporting differentiated cell states in the human colonic epithelium, and thereby maintenance of the intestinal barrier integrity. This makes the vitamin D-VDR signaling axis an interesting target for therapeutic efforts to achieve and maintain remission in patients with UC.

Long-Term Course of Remission and Recovery in Psychotic Disorders.

Understanding prognosis is critical to anticipating public health needs and providing care to individuals with psychotic disorders. However, the long-term course of remission and recovery remains unclear. In this study, the most common trajectories of illness course are described for a cohort of individuals followed for 25 years since first admission for psychosis. Participants are from the Suffolk County Mental Health Project, an epidemiological study of first-admission psychosis. Data for the present study was collected from six follow-ups, with 311 individuals assessed at the 25-year follow-up. Common patterns of remission and recovery were assessed in the baseline cohort of 591 individuals and the subsample from the 25-year follow up. In the baseline cohort and the 25-year subsample, the most common trajectory for individuals with schizophrenia spectrum disorders was no remission and no recovery. Among individuals with other psychotic disorders, in both the baseline and 25-year cohorts, the modal pattern was one of intermittent remission and recovery. Individuals with other psychotic disorders were more likely to experience stable remission (15.1%) and stable recovery (21.1%), outcomes that were rare among individuals with schizophrenia spectrum disorders (0% and 0.6%, respectively). The modal longitudinal pattern for individuals with other psychoses is one of multiple transitions into and out of symptomatic and functional recovery. Engagement in a long-term health care plan may help individuals detect and respond to these changes. Sustained remission and recovery are rare among people with schizophrenia spectrum disorders. Efforts should be directed toward developing more effective treatments for this population.

Colorectal cancer outcomes among Hispanic/Latino patients in the United States: a scoping review protocol.

This scoping review will identify the patterns of survival, treatment, and recurrence among Hispanic and/or Latino/a/x (H/L) patients with colorectal cancer (CRC) living in the United States (US) and Puerto Rico. Additionally, population- and individual-level determinants of cancer outcomes among H/L CRC patients will be mapped to highlight under-reported/under-investigated research areas. CRC is the third most common cancer excluding skin cancers in the US. Unlike non-Hispanic White populations, cancer is the number one cause of death in H/L populations and currently represents 21% of total deaths. Despite this, a lack of consensus exists on CRC outcomes for H/L patients. Most research on H/L individuals has examined incidence and screening of CRC, with fewer studies focusing on cancer outcomes. All epidemiological study designs and systematic reviews will be considered. The review will only include peer-reviewed studies that report on survival, treatment, and/or recurrence patterns for H/L patients with CRC residing in the US and Puerto Rico. A 3-step search with a 2-stage study selection process will be followed, as recommended by JBI and Arksey and O'Malley. Databases to be searched will include MEDLINE (PubMed), Embase (Ovid), and Scopus. A data extraction tool will be designed based on JBI recommendations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRSIMA-ScR) will be used, with the results presented in a PRISMA diagram. Publications in English from database inception to the present will be considered.

Blood smears examination and prevalence of malaria in Addis Zemen Town, Northwest Ethiopia (2013–2021): a retrospective study

IntroductionIn Ethiopia, malaria is one of the major public health and socioeconomic problems, though tremendous efforts have been made. Currently, the country has a plan to eliminate malaria by 2030. To achieve this plan, epidemiological studies associated with malaria prevalence with gender, age groups, species types, and seasons are essential. Therefore, the aim of this study was to assess the prevalence of malaria from 2013 to 2021 in Addis Zemen town, Northwest Ethiopia.MethodsA retrospective study was conducted at assess the trend of malaria prevalence over the last nine years using recorded blood smear reports in the laboratory logbook from governmental health institutions. Trends in malaria cases and the proportion of genders, age groups, species, and seasons over time were compared. The data were analyzed using the SPSS-23 software package.ResultsThe overall malaria prevalence between 2013 and 2021 was 10.4%. From all confirmed cases, the minimum and maximum prevalence of malaria cases were recorded in 2018 (2%) and 2016 (33.2%) years, respectively. The infectious rate of males (59.3%) was significantly higher than that of females (40.7%) (p < 0.0001). In all survey periods, all age groups were infected by malaria parasites; the majority of the cases were between 15 and 45 years (57%) older than others. Statistically, a greater proportion of P. falciparum (80.1%) was recorded than P. vivax (18.5%) (p < 0.0001). Malaria cases were occurring throughout each month. The relative highest peaks of total malaria cases were observed during the months of September, October, and November. Seasonally, the highest infection rate was observed during spring (40.20%) compared to other seasons.ConclusionsIn conclusion, the study revealed that malaria transmission remained high, which affected males more than females and potentially reproductive ages. Two of the most important Plasmodium species were identified and found during all reviewed months and years, though P. falciparum was the most prevalent. Hence, the problem can be alleviated by using season-based long-lasting insecticide treated nets, regularly overseeing ongoing irrigation activity, overseeing the reduction of the water level of the Sheni River, health education, and providing immediate patient treatment.

Co-occurrence of depressive and anxious symptoms and their influence on self-rated health: a national representative survey among Chinese older adults.

The prevalence of the co-occurrence of depressive and anxious symptoms (CO) and their influence on perceived overall health were not clear in community dwelling Chinese older adults. The aims of the study were to investigate the prevalence of CO and to explore its influence on self-rated health (SRH). This study included 12301 individuals aged ≥65 years from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationally representative survey of older adults in mainland China. Participants received face-to-face interviews and assessments of depressive symptoms and anxious symptoms via 10-item of the Center for Epidemiologic Studies Depression Scale (CES-D-10) and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), respectively. SRH was measured by self-reported. A logistic regression model was used to examine the association between CO and SRH after adjusting for confounding variables. The average age was 83.4 (SD: 11.0) years and there were 6576 (53.5%) females. The age- and sex-standardized prevalence of depressive symptoms only (DSO) was 38.6%, anxious symptoms only (ASO) was 1.5%, and CO was 10.8%. Compared with those without depressive and anxious symptoms, the older adults with DSO or ASO were more likely to have significant influence on SRH. And particularly, CO was likely to produce the greatest decrement in the level of SRH. CO was not rare in Chinese older adults nationwide. The older adults having CO had increased risk for lower level of SRH than having DSO or ASO. More attention should be given to CO among the older adults.

Hearing Loss and Reduced Income Growth: A Longitudinal Socioeconomic Analysis.

Hearing loss (HL) has been linked to negative socioeconomic states, including low income. This study examines the relationship between HL and income growth. Longitudinal observational study. Multicentered US epidemiologic study (Hispanic Community Health Study, HCHS). Using data from 2 waves of the HCHS, we analyzed the association between HL and income growth in adults ages 18 to 74 years using generalized estimating equations. The exposure was HL, measured by 4-frequency pure-tone average (PTA). The outcome was yearly household income growth, with income graded on a 10-bracket scale from <$10,000 to >$100,000. Models controlled for demographics, hearing aid use, and vascular risk. A total of 1342 participants met inclusion criteria. At visit 1, average age was 47.6 years (SD = 12.2), and average PTA was 13.9 decibels (dB, SD = 9.5). Average follow-up was 5.9 years (SD = 0.6). There was a significant time × HL interaction: with each 10 dB worsening in HL, the odds of belonging to a higher versus a lower income bracket changed by a factor of 0.979 (P < .001) between waves 1 and 2. In other words, the odds of belonging to a higher income group decreased with worsening HL. At 38.6 dB, the odds for income growth became <1, indicating income loss rather than growth. Increased HL is associated with reduced income growth, including the possibility of negative growth (ie, income decline). This study emphasizes the value of including socioeconomic measures in randomized controlled trials assessing the impact of HL treatment and the importance of extended follow-up for study participants.

Revisiting resistant hypertension in kidney disease.

As compared to controlled or uncontrolled hypertension, resistant hypertension in patients with chronic kidney disease (CKD) poses a significantly increased healthcare burden due to greater target end-organ damage including cardiovascular disease and CKD progression. Patients with CKD have two to three times higher risk of developing resistant hypertension. True resistant hypertension needs to be distinguished from apparent treatment resistant hypertension (aTRH); however, it is usually not possible in epidemiological studies. Moreover, impact of contemporary guidelines changes in the target blood pressure (BP) goal to less than 130/80 mmHg remains to be determined. Up to half of patients with CKD meet aTRH criteria using 2017 ACC/AHA target BP less than 130/80 mmHg. Excess sodium retention in extracellular and tissue compartment remains the cornerstone cause of resistance to the treatment in CKD. Maximizing and optimizing the diuretic regimen in addition to dietary sodium restriction plays a critical role in these patients. Management requires a trustworthy provider-patient relationship facilitating identification and intervention for the barriers restricting the uptake of lifestyle modifications and medications. Recently, renal denervation has been approved and many other novel agents are on the horizon for treatment of true resistant hypertension associated with CKD. This review discusses the latest in the pathophysiology, definition, identification and treatment strategies of resistant hypertension in individuals with CKD. Further investigations are required to identify the prevalence, future implication and treatment outcome data for true resistant hypertension associated with CKD.

Hyperglycemic Impact On Sleep Quality In Patients With Type 2 Diabetes Mellitus-A Cross Sectional Study

Background: Diabetes mellitus (DM) causes high morbidity and mortality and loss of quality of life significantly. It is an important public health concern. In epidemiologic studies, people with poor sleep quality are more prone to develop diabetes or metabolism disorder of glucose. Sleep has an important role for metabolic function and specifically homeostasis of glucose metabolism. Many studies have shown a correlation between increased diabetes risk and poor sleep quality or sleep deprivation. DM creates a negative effect impact on quality of sleep on patients. Prevalence of obesity and diabetes becomes greater among aged people, it is of vital importance to fix on sleep for overall medical management. This is aimed to determine hyperglycaemia with sleep quality among the patient. Methods: This was a cross sectional study carried out at Ibrahim General Hospital, National Health Care Network (NHN), Mirpur-10, Dhaka during the period of January 2014 to December 2014. Total 129 respondents were selected purposively for this study. Semi-structured questionnaire was pretested first and then it was used for data collection. Pittsburgh Sleep Quality Index score (PSQI) was used to assess sleep quality. Statistical Package for Social Sciences (SPSS) version 22.0. was used for analysis of the collected data. Results: Among 129 respondents, 98(76%) were male and 31(24%) were female. 93.8% respondents were married and rest 6.2% of them were unmarried. Mean(±SD) age was found 53.64(±9.26) years and range 35 to 70 years. 79.1% of the respondents had co-morbidity of DM, 70(54.3%) had diabetes more than 10 years duration. Mean(±SD) of overall sleep quality score was 9.04(±3.965) and range 1 to 18. Among the respondents of age group &gt;64, 95.70% had poor sleep quality, 76.14% respondents sleep less than 6 hours in a day. So association between sleep quality and glycemic status of type 2 DM was significant(p&lt;0.05). Conclusion: The prevalence of high blood sugar level in Type 2 DM patients have poor sleep quality. Type 2 DM patients with high blood sugar level have to overcompensate kidneys to visit washroom more frequent and lead to disturbance in sleep. Type 2 DM patients with controlled blood sugar level have good sleep quality. It is evident from the study that Type 2 DM patients with high sugar level (Hyperglycaemia) frequently experience sleep difficulties. Bangladesh Armed Forces Med J Vol 56 No (1) June 2023, pp 21-27

An epidemiological and clinicopathological study of type 1 vs. type 2 morphological subtypes of papillary renal cell carcinoma– results from a nation-wide study covering 50 years in Iceland

IntroductionPapillary renal cell carcinoma (pRCC) is the second most common histology of renal cell carcinoma (RCC), accounting for 10–15% of cases. Traditionally, pRCC is divided into type 1 and type 2, although this division is currently debated as a prognostic factor of survival. Our aim was to investigate the epidemiology and survival of the pRCC subtypes in a whole nation cohort of patients during a 50-year period.Materials and methodsA Population based retrospective study including consecutive cases of RCC in Iceland from 1971–2020. Comparisons were made between histological classifications of RCC, with emphasis on pRCC subtypes (type 1 vs. 2) for outcome estimation. Changes in RCC incidence were analyzed in 5-year intervals after age standardization. The Kaplan–Meier method and Cox regression were used for outcome analysis.ResultsA total of 1.725 cases were identified, with 74.4%, 2.1% and 9.2% having clear cell (ccRCC), chromophobe (chRCC), and pRCC, respectively. The age standardized incidence (ASI) of pRCC was 1.97/100.000 for males and 0.5/100.000 for females, and the proportion of pRCC increased from 3.7% to 11.5% between the first and last intervals of the study (p < 0.001). Age standardized cancer specific mortality (ASCSM) of pRCC was 0.6/100.000 and 0.19/100.000 for males and females, respectively. The annual average increase in ASI was 3.6% for type 1 pRCC, but the ASI for type 2 pRCC and ASCSM for both subtypes did not change significantly. Male to female ratio was 4.4 for type 1 pRCC and 2.3 for type 2. The average tumor size for type 1 and 2 was 58.8 and 73.7 mm, respectively. Metastasis at diagnosis was found in 8.7% in the type 1 pRCC, compared to 30.0% of patients with type 2 pRCC (p < 0.001). Estimated 5-year cancer-specific survival (CSS) were 94.4%, 80.7%, and 69.3% for chRCC, pRCC and ccRCC, respectively (p < 0.001). For the pRCC subtypes, type 1 was associated with better 5-year CSS than type 2 (86.3% vs. 66.0%, p < 0.001), although this difference was not significant after adjusting for cancer stage and grading.ConclusionspRCC histology was slightly less common in Iceland than in other countries. Males are more than three times more likely to be diagnosed with pRCC, compared to other RCC histologies. The subtype of pRCC was not found to be an independent risk factor for worse survival, and as suggested by the most recent WHO Classification of Urinary Tumors, grade and TNM-stage seem to be the most important factors for estimation of survival for pRCC patients.

Medullary Thyroid Cancer: Epidemiology and Characteristics According to Data From the Marne-Ardennes Register 1975-2018.

Medullary thyroid cancer (MTC) is a rare disease. The main objective of our study was to analyze the incidence evolution of MTC with a follow-up of more than 40 years. Further, a descriptive and survival analysis was performed according to the Kaplan-Meier analysis. This is a retrospective epidemiological study using data from the Marne-Ardennes registry from 1975 to 2018. Two hundred sixty patients with MTC were included. The incidence was calculated in the territory of the register (Marne and Ardennes departments of France) and standardized on the demographic structure of France. Patient and tumor characteristics were described. An analysis in a subgroup comparing hereditary and sporadic forms was performed. An analysis of survival was performed. The standardized incidence shows an increasing trend over time. The incidence increased significantly from 0.41 to 0.57/100 000 person-years between 1986 and 1996 and 2008 and 2018. The MTC was hereditary in 21.2% of cases. The sex ratio (males:females) was 0.73. The average age at diagnosis was 53 years. Ninety-seven patients (37.3%) were N1, 26 (10%) were M1, and 56 (21.5%) developed metastases during the follow-up. Complete remission was obtained in 58.5% of patients. The disease was refractory for 18.1% of patients. The 5-year survival rate was 88.4%. Sporadic cases had a poorer prognosis than hereditary MTC. Our study demonstrates a moderate increase in the incidence of MTC between 1975 and 2018. The prognosis remains worse for sporadic MTC than for hereditary MTC.

A novel method for rapid estimation of active bone marrow dose for radiotherapy patients in epidemiological studies.

In a dedicated effort to improve the assessment of clonal hematopoiesis (CH) and study leukemia risk following radiotherapy, we are developing a large-scale cohort study among cancer patients who received radiation. To that end, it will be critical to analyze dosimetric parameters of red bone marrow (ABM) exposure in relation to CH and its progression to myeloid neoplasms, requiring reconstruction method for ABM doses of a large-scale patients rapidly and accurately. To support a large-scale cohort study on the assessment of clonal hematopoiesis and leukemia risk following radiotherapy, we present a new method for the rapid reconstruction of ABM doses of radiotherapy among cancer patients. The key idea of the presented method is to segment patient bones rapidly and automatically by matching a whole-body computational human phantom, in which the skeletal system is divided into 34 bone sites, to patient CT images via 3D skeletal registration. The automatic approach was used to segment site-specific bones for 40 radiotherapy patients. Also, we segmented the bones manually. The bones segmented both manually and automatically were then combined with the patient dose matrix calculated by the treatment planning system (TPS) to derive patient ABM dose. We evaluated the performance of the automatic method in geometric and dosimetric accuracy by comparison with the manual approach. The pelvis showed the best geometric performance [volume overlap fraction (VOF): 52% (mean) with 23% (σ) and average distance (AD): 0.8cm (mean) with 0.5cm (σ)]. The pelvis also showed the best dosimetry performance [absorbed dose difference (ADD): 0.7Gy (mean) with 1.0Gy (σ)]. Some bones showed unsatisfactory performances such as the cervical vertebrae [ADD: 5.2Gy (mean) with 10.8Gy (σ)]. This impact on the total ABM dose, however, was not significant. An excellent agreement for the total ABM dose was indeed observed [ADD: 0.4Gy (mean) with 0.4Gy (σ)]. The computation time required for dose calculation using our method was robust (about one minute per patient). We confirmed that our method estimates ABM doses across treatment sites accurately, while providing high computational efficiency. The method will be used to reconstruct patient-specific ABM doses for dose-response assessment in a large cohort study. The method can also be applied to prospective dose calculation within a clinical TPS to support clinical decision making at the point of care.

Sexual orientation concealment, hope, and depressive symptoms among gay and bisexual men: a moderated-moderation model

ABSTRACT The prevalence of depressive symptoms among gay and bisexual men is cause for concern. This study aimed to investigate whether hope and its two components (agency and pathways) moderated the relationship between sexual orientation concealment and depressive symptoms in gay and bisexual men and whether the moderating effects were conditional on sexual orientation. Participants were 197 gay men aged 18 to 71 years (M = 35.13 years, SD = 12.18 years) and 212 bisexual men aged 18 to 66 years (M = 29.24 years, SD = 10.46 years) who completed The Centre for Epidemiologic Studies Depression Scale, The Sexual Orientation Concealment Scale, and The Adult Hope Scale. Results did not support the moderating role of hope, agency, or pathways. The interaction between sexual orientation and pathways was significantly associated with depressive symptoms. Higher levels of pathways were associated with lower levels of depressive symptoms for both groups of men, however, the association was stronger for gay men compared with bisexual men. Higher levels of hope, agency, and pathways were associated with lower levels of depressive symptoms. Interventions aimed at increasing hope may be beneficial for reducing depressive symptoms among gay and bisexual men.

Causal mediation analysis with a three-dimensional image mediator.

Causal mediation analysis is increasingly abundant in biology, psychology, and epidemiology studies and so forth. In particular, with the advent of the big data era, the issue of high-dimensional mediators is becoming more prevalent. In neuroscience, with the widespread application of magnetic resonance technology in the field of brain imaging, studies on image being a mediator emerged. In this study, a novel causal mediation analysis method with a three-dimensional image mediator is proposed. We define the average casual effects under the potential outcome framework, explore several sufficient conditions for the valid identification, and develop techniques for estimation and inference. To verify the effectiveness of the proposed method, a series of simulations under various scenarios is performed. Finally, the proposed method is applied to a study on the causal effect of mother's delivery mode on child's IQ development. It is found that cesarean section may have a negative effect on intellectual performance and that this effect is mediated by white matter development. Additional prospective and longitudinal studies may be necessary to validate these emerging findings.

The Lipid–Heart Hypothesis and the Keys Equation Defined the Dietary Guidelines but Ignored the Impact of Trans-Fat and High Linoleic Acid Consumption

In response to a perceived epidemic of coronary heart disease, Ancel Keys introduced the lipid–heart hypothesis in 1953 which asserted that high intakes of total fat, saturated fat, and cholesterol lead to atherosclerosis and that consuming less fat and cholesterol, and replacing saturated fat with polyunsaturated fat, would reduce serum cholesterol and consequently the risk of heart disease. Keys proposed an equation that would predict the concentration of serum cholesterol (ΔChol.) from the consumption of saturated fat (ΔS), polyunsaturated fat (ΔP), and cholesterol (ΔZ): ΔChol. = 1.2(2ΔS − ΔP) + 1.5ΔZ. However, the Keys equation conflated natural saturated fat and industrial trans-fat into a single parameter and considered only linoleic acid as the polyunsaturated fat. This ignored the widespread consumption of trans-fat and its effects on serum cholesterol and promoted an imbalance of omega-6 to omega-3 fatty acids in the diet. Numerous observational, epidemiological, interventional, and autopsy studies have failed to validate the Keys equation and the lipid–heart hypothesis. Nevertheless, these have been the cornerstone of national and international dietary guidelines which have focused disproportionately on heart disease and much less so on cancer and metabolic disorders, which have steadily increased since the adoption of this hypothesis.

Association of depressive symptoms with incident fractures: the Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT).

A relationship between depressive symptoms and fractures has not been clearly demonstrated. We aimed to investigate the relationship between depressive symptoms and 5-year fracture risk in the Japan Public Health Center-based Prospective Study for the Next Generation. From 2011 to 2016, 114,092 participants were enrolled, and a follow-up survey was conducted 5years later. We analyzed 30,552 men and 38,063 women aged 40-74years who had no past fractures at baseline. Presence of depressive symptoms was defined as a modified 11-item Center for Epidemiological Studies Depression Scale score of 8 or higher, a history of depression, or use of antidepressants. Subjects were asked to report vertebral, upper limb, and/or hip fractures, except for traffic or work accidents, that occurred during the follow-up period. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for fracture were analyzed via logistic regression analysis to evaluate the relationship between depressive symptoms and fracture. Women with depressive symptoms demonstrated a high AOR for hip fractures (AOR: 2.78, 95% CI: 1.30 - 5.92); this result was consistent in post menopause women. In men, this association was not found for any age group or any type of fracture. Depressive symptoms in women may increase the risk of hip fractures. Further studies are required to explore this relationship in more detail.

Extracorporeal life support after surgical repair for acute type a aortic dissection: A systematic review and meta-analysis.

The use of extracorporeal life support (ECLS) in patients after surgical repair for acute type A aortic dissection (ATAAD) has not been well documented. We performed a systematic review and meta-analysis to assess the outcomes of ECLS after surgery for ATAAD with data published by October 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. The protocol was registered in PROSPERO (CRD42023479955). Twelve observational studies met our eligibility criteria, including 280 patients. Mean age was 55.0 years and women represented 25.3% of the overall population. Although the mean preoperative left ventricle ejection fraction was 59.8%, 60.8% of patients developed left ventricle failure and 34.0% developed biventricular failure. Coronary involvement and malperfusion were found in 37.1% and 25.6%, respectively. Concomitant coronary bypass surgery was performed in 38.5% of patients. Regarding ECLS, retrograde flow (femoral) was present in 39.9% and central cannulation was present in 35.4%. In-hospital mortality was 62.8% and pooled estimate of successful weaning was 50.8%. Neurological complications, bleeding and renal failure were found in 25.9%, 38.7%, and 65.5%, respectively. ECLS after surgical repair for ATAAD remains associated with high rates of in-hospital death and complications, but it still represents a chance of survival in critical situations. ECLS remains a salvage attempt and surgeons should not try to avoid ECLS at all costs after repairing an ATAAD case.

Expansion of a food composition database for the food frequency questionnaire in the Korean Genome and Epidemiology Study (KoGES): a comprehensive database of dietary antioxidants and total antioxidant capacity

Expansion of a food composition database for the food frequency questionnaire in the Korean Genome and Epidemiology Study (KoGES): a comprehensive database of dietary antioxidants and total antioxidant capacity

Remission of HPV-Related Diseases by Antivirals for Herpesvirus: Clinical Cases and a Literature Review

Epidemiological studies have shown that HPV-related diseases are the most prevalent sexually transmitted infections. In this context, this report will present various clinical cases demonstrating the effectiveness of Acyclovir (ACV) or its prodrug Valaciclovir (VCV), both acyclic guanosine analogs commonly used for the treatment of HHV-1 and HHV-2, for the treatment of HPV-related diseases. The report shows the remission of five cases of penile condyloma and a case of remission in a woman affected by cervical and vaginal condylomas and a vulvar giant condyloma acuminate of Buschke and Lowenstein. The literature review shows that ACV is effective in treating skin warts when administered orally, topically, and intralesionally, suggesting its therapeutic potential in other diseases associated with HPV. ACV was also used successfully as an adjuvant therapy for juvenile and adult forms of laryngeal papillomatosis, also known as recurrent respiratory papillomatosis, prolonging the patient’s symptom-free periods. Although the prevention of HPV infections is certainly achieved with the HPV vaccine, ACV and VCV have shown to be effective even against genotypes not included in the current vaccine and can be helpful for those problematic clinical cases involving unvaccinated individuals, immunocompromised patients, people who live with HIV, or non-responders to the vaccine. We and others concluded that randomized clinical trials are necessary to determine the efficacy of ACV and VCV for HPV-related diseases.

The value and limitations of self-administered questionnaires in clinical practice and epidemiological studies.

The value and limitations of self-administered questionnaires in clinical practice and epidemiological studies.

Are there opportunities to strengthen animal welfare through improved management of feedlot chronic pens?

In feedlot cattle production systems, there is a population of sick cattle that fail to respond to treatment, are deemed chroni­cally ill, and typically placed in a “chronic pen”. This popula­tion of chronic cattle is understudied in the current literature, and the absence of evidence-based protocols and guidance re­sources may lead to specific cattle welfare risks associated with chronic pens. Anecdotally, management of this population of animals varies widely across feedlots with potential impacts on animal welfare and productivity. The purpose of this descrip­tive epidemiologic study was to identify and describe key demo­graphic patterns in chronic feedlot cattle populations.