Higher Median Research Articles

Application of the Theoretical Framework of Acceptability to assess a telephone-facilitated health coaching intervention for the prevention and management of type 2 diabetes.

Lifestyle interventions focusing on diet and physical activity for the prevention and management of type 2 diabetes have been found effective. Acceptance of the intervention is crucial. The Theoretical Framework of Acceptability (TFA) developed by Sekhon et al. (2017) describes the multiple facets of acceptance: Affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs and self-efficacy. The aims of this study were to develop and assess the psychometric properties of a measurement scale for acceptance of a telephone-facilitated health coaching intervention, based on the TFA; and to determine the acceptability of the intervention among participants living with diabetes or having a high risk of diabetes in socioeconomically disadvantaged areas in Stockholm. This study was nested in the implementation trial SMART2D (Self-management approach and reciprocal learning for type 2 diabetes). The intervention consisted of nine telephone-facilitated health coaching sessions delivered individually over a 6-month period. The acceptability of the intervention was assessed using a questionnaire consisting of 19 Likert scale questions developed using Sekhon's TFA. Exploratory factor analysis (EFA) was performed. Ratings from 49 participants (19 with type 2 diabetes and 30 at high risk of developing diabetes) in ages 38-65 were analyzed. The EFA on the acceptability scale revealed three factors with acceptable reliabilities: affective attitude (alpha 0.90), coherence and understanding (alpha 0.77), perceived burden (alpha 0.85), explaining 82% of the variance. Positive affect and coherence had high median scores and small variance. Median score for perceived burden was low, but with significant variance due to younger individuals and those at high risk reporting higher burden. The telephone-facilitated health coaching intervention was perceived as acceptable by the study population using a questionnaire based on Sekhon's TFA, with a wider variation in perceived burden seen among high risk and younger participants.

Radiomics-based analysis by machine learning techniques improves characterization of functionally significant coronary lesions

Abstract Background Computed Tomography Coronary Angiography (CTCA) is an effective non-invasive imaging modality for anatomo-functional assessment of coronary artery disease (CAD). Radiomics features have been used for diagnosis or outcome prediction, however, their potential value for characterizing flow limiting coronary lesions has not been explored. Purpose To assess whether application of novel radiomics and machine learning (ML) techniques on CTCA derived datasets improves characterization of functionally significant coronary lesions. Methods Consecutive patients with stable chest pain and intermediate pre-test likelihood for CAD, who underwent CTCA and PET-or SPECT-Myocardial Perfusion Imaging (MPI) respectively, were prospectively evaluated and included in the analysis. PET-MPI was considered abnormal when >1 contiguous segments showed both stress Myocardial Blood Flow ≤2.3mL/g/min and Myocardial Flow Reserve (MFR) ≤2.5 for 15O-water or <1.79 mL/g/min and ≤2.0 for 13N-ammonia respectively. Defect reversibility (DR) was defined as a summed difference score (SDS) between stress and rest images ≥2. CTCA and functional images were fused to assign each myocardial segment to the pertinent coronary territory. Stenosis severity, plaque characteristics and radiomic plaque features were assessed in the total length of the 3 main coronary vessels. In total, 1765 features were extracted from each vessel and a feature reduction and model creation pipeline was constructed [Figure 1]. Two separate datasets: a) coronary stenosis (≥50%) + plaque characteristics and b) coronary stenosis (≥50%) + plaque characteristics + radiomics were formulated and compared in terms of AUCs accordingly. Results A total of 292 coronary vessels (140 with corresponding PET-MPI data and 152 with SPECT MPI data) were analysed. Plaque burden and stenosis severity were the only independent predictors of impaired myocardial perfusion on PET-MPI, with an AUC = 0.749, (95% CI: 0.658–0.826). Stenosis severity, kurtosis, contrast, interquartile range and entropy were predictors of an abnormal PET-MPI result and their combination resulted in an AUC = 0.854, (95% CI: 0.775–0.914). The difference between the 2 models was statistically significant (p-diff: 0.02, 95% CI: 0.0165–0.194). Stenosis severity was the only predictor of a DR on SPECT-MPI, AUC = 0.624 (95% CI: 0.542–0.702). Small Dependence High Gray Level Emphasis, Cluster Prominence, Region Length, wavelet Median and square Median were predictors of a positive SPECT result, with AUC = 0.816, (95% CI: 0.745–0.875). The difference between the two models was statistically significant (p-diff: 0.006, 95% CI: 0.152–0.329) Conclusion Radiomic futures can be combined with anatomical and morphological characteristics of coronary lesions in CTCA imaging and provide valuable complementary information for characterizing functionally significant coronary lesions. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported from European Regional Development Fund, Operational Programme “Competitiveness, Entrepreneurship and Innovation 2014-2022 (EPAnEK)”, titled: The Greek Research Infrastructure for Personalized Medicine (pMED-GR)

Sahel Rainfall Projections Constrained by Past Sensitivity to Global Warming

AbstractAfrica's central Sahel region has experienced prolonged drought conditions in the past, while rainfall has recovered more recently. Global climate models project anything from no change to a strong wetting trend under unabated climate change; and they have difficulty reproducing the complex historical record. Here we show that when a period of dominant aerosol forcing is excluded, a consistent wetting response to greenhouse‐gas induced warming emerges in observed rainfall. Using the observed response coefficient estimate as a constraint, we find that Coupled Model Intercomparison Project Phase 6 climate models with a realistic past rainfall response show a smaller spread, and higher median, of projected future rainfall change, compared to the full ensemble. In particular, very small or negative rainfall trends are absent from the constrained ensemble. Our results provide further evidence for a robust Sahel rainfall increase in response to greenhouse‐gas forcing, consistent with recent observations, and including the possibility of a very strong increase.

Measurement of Serum N-Glycans in the Assessment of Early Vascular Aging (Arterial Stiffness) in Adults With Type 1 Diabetes.

Vascular aging (arterial stiffness [AS]) is an inflammation-linked process that predicts macro- and microvascular complications in adults with type 1 diabetes (T1D). We evaluated the utility of measuring the inflammation-linked N-glycans GlycA and GlycB to assess vascular aging in adults with T1D. Eighty-four adults with T1D (>10-year duration without cardiovascular events) and 68 healthy control subjects were evaluated for clinical characteristics (including microvascular complications in patients with T1D), aortic pulse wave velocity (aPWV) (surrogate measure of AS), and serum GlycA and GlycB (peak area [concentration] and height/width [H/W] ratio) using 1H-nuclear magnetic resonance spectroscopy. Patients with T1D had higher median (interquartile range) values than healthy control subjects for (P < 0.001 for all comparisons) aPWV 7.9 (6.9-9.1) vs. 6.1 (5.5-6.7) m/s, GlycA 850.4 (781.3-916.1) vs. 652.4 (581.5-727.1) μmoL; GlycB 386.1 (353.2-426.3) vs. 310.0 (280.5-331.9) μmol/L), H/W ratio of GlycA 16.5 (14.9-18.1) vs. 15.0 (13.7-16.7), and H/W ratio of GlycB 5.0 (4.6-5.5) vs. 4.0 (3.4-4.3). Moreover, aPWV correlated (P < 0.001 for all correlations) with GlycA (r = 0.550) and GlycB (r = 0.423) concentrations and with H/W ratios of GlycA (r = 0.453) and GlycB (r = 0.510). Adjusting for potential confounders, GlycA concentration (β = 0.212, P < 0.001) and the H/W ratios of GlycA (β = 0.150, P = 0.009) and GlycB (β = 0.155, P = 0.011) remained independently associated with aPWV. C-statistics for detecting individuals with aPWV >10 m/s were 0.866 (95% CI 0.794-0.937) for GlycA levels and 0.862 (0.780-0.943) for H/W ratio of GlycB. Measurement of serum GlycA and GlycB may have utility in assessing vascular aging in adults with T1D of >10-year duration and no previous cardiovascular events.

Health risk assessment and geospatial analysis of arsenic contamination in shallow aquifer along Ravi River, Lahore, Pakistan.

The exposure variation of arsenic from different ground and surface water sources has remained unpredictable which may cause severe human health problems. The current study is, therefore, designed to analyze the spatial variability of arsenic contamination in shallow aquifer and assess the potential human health risks. For this purpose, a total of 55 groundwater, 10 drain water, 4 river water, and 6 sediment samples were collected along zero to 5km stretch of the River Ravi, Lahore. All water samples were tested for As, pH, and total dissolved solids (TDS), whereas sediments were only tested for As. Health risk models were used to predict cancer and non-cancer risk in adults and children. Among water samples, highest median (minimum-maximum) concentrations (µg/L) of As were recorded 53.32 (1.98-1555) in groundwater, followed by 53.04 (1.58-351.5) in drain water, and 4.80 (2.13-8.67) in river water, respectively, whereas As concentration (mg/kg) in river sediments was 6.03 (5.56-13.92). Variation of As in groundwater was non-significant (P > 0.05) among every 1-km stretch from the Ravi River. However, maximum median concentrations (µg/L) of 60.18 and 60.08 were recorded between 2-3 and 0-1km from River Ravi, respectively, reflecting possible mixing of river water with shallow aquifers. A very high cancer and non-cancer risk (HI > 1.0 × 10-4) through groundwater As exposure was predicted for both children and adults. The current study concluded that prevalence of As above WHO prescribed limits in shallow aquifer along the urban stretch of the River Ravi is posing serious health risk to the exposed population.

Sex differences in machine learning computed tomography-derived fractional flow reserve

Coronary computed tomography angiography (CCTA) derived machine learning fractional flow reserve (ML-FFRCT) can assess the hemodynamic significance of coronary artery stenoses. We aimed to assess sex differences in the association of ML-FFRCT and incident cardiovascular outcomes. We studied a retrospective cohort of consecutive patients who underwent clinically indicated CCTA and single photon emission computed tomography (SPECT). Obstructive stenosis was defined as ≥ 70% stenosis severity in non-left main vessels or ≥ 50% in the left main coronary. ML-FFRCT was computed using a machine learning algorithm with significant stenosis defined as ML-FFRCT < 0.8. The primary outcome was a composite of death or non-fatal myocardial infarction (D/MI). Our study population consisted of 471 patients with mean (SD) age 65 (13) years, 53% men, and multiple comorbidities (78% hypertension, 66% diabetes, 81% dyslipidemia). Compared to men, women were less likely to have obstructive stenosis by CCTA (9% vs. 18%; p = 0.006), less multivessel CAD (4% vs. 6%; p = 0.25), lower prevalence of ML-FFRCT < 0.8 (39% vs. 44%; p = 0.23) and higher median (IQR) ML-FFRCT (0.76 (0.53–0.86) vs. 0.71 (0.47–0.84); p = 0.047). In multivariable adjusted models, there was no significant association between ML-FFRCT < 0.8 and D/MI [Hazard Ratio 0.82, 95% confidence interval (0.30, 2.20); p = 0.25 for interaction with sex.]. In a high-risk cohort of symptomatic patients who underwent CCTA and SPECT testing, ML-FFRCT was higher in women than men. There was no significant association between ML-FFRCT and incident mortality or MI and no evidence that the prognostic value of ML-FFRCT differs by sex.

Assessment of the educational value of endodontic access cavity preparation YouTube video as a learning resource for students.

ObjectiveTo evaluate the educational value of YouTube as a learning tool for dental students regarding endodontic access cavity preparation.Methods and findingsYouTube search was made for videos related to endodontic access cavity preparation using specific terms. After exclusions, 41 videos were chosen and assessed for tooth type, video length, days since upload, country of origin, number of views and likes, source of authorship, and viewing rate. To grade the content of videos, a usefulness score with seven elements was developed. Each element was given a score of 0 or 1. Statistical tests were run by using Kruskal-Wallis and Mann-Whitney tests (SPSS Inc, Chicago, IL, USA) at a 5% significance level. The videos received a mean of 181198.5 views with a mean duration of 686.1 seconds. The mean number of “likes” was 1047.8. Almost half of the videos covered content related to molar teeth. Most videos were provided by health care professionals with almost 50% uploaded from India. The mean usefulness score was 4.29 (range: 1–7) and the most discussed elements were description, instruments used, access cavity demonstration, and evaluation criteria. About a quarter of the videos were classified as good, while 46.3% as moderate and 29.3% as poor. Among the content usefulness categories, no difference was found in the video demographics (p>0.05) except “days since upload” (p = 0.018) in which good quality videos were found to have the highest median. Moreover, although insignificant, good videos were found to have the longest duration and lowest number of views, likes, and viewing rate. The mean usefulness score of videos released during the COVID-19 pandemic was lower than that for pre-pandemic videos (p = 0.042), and videos uploaded by academic institutions had a higher mean usefulness score than videos uploaded by health care professionals (p<0.001).ConclusionsInformation on endodontic access cavity preparation is not comprehensive in most of the reviewed YouTube videos and could be of low educational value.

Correlation between Endometriosis and Selected Allergic and Autoimmune Diseases and Eating Habits.

Background and Objectives: Endometriosis is a hormone-dependent chronic inflammatory disease with serious reproductive and general health consequences. It is viewed as a multifactorial problem, consisting of matters related to altered immunity and genetics. In this study, we determined the correlation between endometriosis and allergic and autoimmune diseases in patients at reproductive age. Materials and Methods: Online surveys distributed through websites related to gynecological problems. The questionnaire was composed of 63 single and multiple-choice questions concerning the course of endometriosis, diet, and allergic and autoimmune diseases. The obtained data were assessed using statistical tests. Results: 501 female patients (mean age 31.1 SD = 6.8) were included in the study. The control group (n = 155) consisted of healthy females, whereas the study group (n = 346) consisted of female patients with endometriosis; each group was subdivided according to allergy status. There were statistically significant differences between groups for the following: positive family history of endometriosis (p = 0.0002), onset of allergic symptoms (p = 0.0003), frequency and duration of abdominal pain (p = 0.00625), and defecation disorders (p = 0.0006). Asthma was less common in the study group (p = 0.00611). The group of patients with endometriosis and allergies had a high median of consumption of red meat (p = 0.0143), fish (p = 0.0016), and dairy products (p = 0.0001). Conclusions: Endometriosis did not affect autoimmune diseases and their courses. Patients with diagnosed endometriosis presented allergy symptoms much earlier than the healthy patients. The consumption of dietary products such as soya products, red meat, and alcohol had an influence on the occurrence of endometriosis.

Online Food Delivery System in India: Profile of Restaurants and Nutritional Value of Food Items

Online food delivery services (OFDs) have been growing steadily in India since the early 2000s, posing concerns about unhealthy eating behaviours and contributing to the rise of non-communicable diseases. Menu designing based on the principles of the ‘menu theory’ rarely emphasize the need to provide nutritional information or promote healthy eating behaviours. In this article, we characterized the restaurants and food items listed in a major Indian OFD service and describe the nutritional quality and price of different categories of food items. We conducted a cross-sectional study of all restaurants listed on the website of one of India’s largest OFD service during December 2020. A stratified random sample of 8,504 restaurants was obtained and the nutritional quality of all listed food items was extracted. We found that fast-food restaurants sold foods with the lowest price (Indian national rupee [INR]) [100 (IQR: 66, 150)] but with the highest calories (kilocalorie [kcal]) [194 (IQR: 130, 309)] and fat (g) [9 (IQR: 5, 16)]. Chinese cuisine restaurants sold more ‘soups and salads’ and served items with the second lowest calories per item served (kcal) [154 (IQR: 121, 230)], next only to Indian cuisine restaurants (kcal) [151 (IQR: 118, 210)]. Restaurants with high average cost (&gt;400 INR for two) served items with lower calories (kcal) [155 (IQR: 113, 226)] and had a higher proportion of healthier items on their menu but restaurants with higher median calories per item and a higher median price per item had higher average customer ratings. In conclusion, it can be said that restaurants that served items with the highest calories and fat were also the cheapest. There is a need to increase the number of affordable and healthier options on the menu of OFD restaurants to improve dietary consumption of Indians.

Biomarkers of Inflammation among Patients with COVID-19: A Single-Centre Prospective Study from Prishtina, Kosovo.

SARS-CoV-2 infection involves the phase of viral replication and inflammatory response predicting the severity of COVID-19. The aim of the study was to analyze the association between IL-6 and hematological and inflammatory parameters and outcomes of patients with COVID-19. Plasma interleukin 6 (IL-6) levels and other inflammatory and hematological parameters were analyzed in 86 adult patients diagnosed with SARS-CoV-2 infection in Kosovo. The median age of patients was 61.50 (49.75–67.25) years. Over half of patients were categorised as severe (58%) and had comorbidities (69%) with hypertension being the most common. The overall mortality rate was 4.7%. The distribution of biochemical parameters across disease severity groups was significantly different for C-reactive protein (CRP), lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), white blood cells (WBC), and granulocytes with higher median values in more severe and critically ill patients whereas lower percentage of lymphocytes, monocytes, and platelet count in severe and critically ill patients. IL-6 levels were increased in 63% of patients with significant differences in the distribution across the following groups; age, disease severity, hospitalisation status, pulmonary infiltrates, oxygen therapy, and hypertension status. IL-6 significantly correlated with CRP, LDH, CK, ESR, and percentages of granulocytes. IL-6 and other inflammatory and hematological parameters were strongly associated with disease severity and may predict the outcome of the SARS-CoV-2 infection.

Patient Experience with an NP-Led Community Wound Care Service

Aim: This study examined patient satisfaction with an NP-Led community wound care program.&#x0D; Background: Examining patient experience provides information to guide nurse practitioner (NP) practice regarding patient experience with wound care provided by NPs in Canada.&#x0D; Methods: This quantitative study utilized a Likert scale questionnaire to examine patient experience with a 12-week pilot NP-Led wound care service. The population included patients registered to receive community wound management through Southwestern Ontario LHIN.&#x0D; Findings: Forty-nine surveys were returned (response rate-42%). Participants reported positive experiences with NP care. Bivariate analysis (ANOVA) found no statistical difference between group means of the independent variables age, education, income level, marital status, and the dependent variable patient experience (p = &gt;.05). Mann-Whitney U demonstrated gender to be statistically significant (p = 0.14); females had higher median scores than males, 4.8 and 4.6 respectively. Linear regression determined that Males were less likely to have a positive experience (F (1, 45) = 7.7, p =.008).&#x0D; Conclusion: Patients had a positive experience with the NP-Led wound care service. This study provides information that is useful when designing an NP-Led wound care program.&#x0D;

Robust long-term immunity to SARS-CoV-2 in patients recovered from severe COVID-19 after interleukin-6 blockade.

SummaryBackgroundWhether interleukin-6 (IL-6) blockade in patients with COVID-19 will affect the protective immunity against SARS-CoV-2 has become an important concern for anti-IL-6 therapy. We aimed to investigate the effects of IL-6 blockade on long-term immunity to SARS-CoV-2.MethodsProspective, longitudinal cohort study conducted in patients hospitalized for severe or critical COVID-19 with laboratory confirmed SARS-CoV-2 infection. We assessed humoral (anti-S1 domain of the spike [S], anti-nucleocapsid [N], anti-trimeric spike [TrimericS] IgG, and neutralizing antibodies [Nab]) and T-cell (interferon-γ release assay [IGRA]) responses and evaluated the incidence of reinfections over one year after infection in patients undergoing IL-6 blockade with tocilizumab and compared them with untreated subjects.FindingsFrom 150 adults admitted with confirmed SARS-CoV-2 infection, 78 were 1:1 propensity score-matched. Patients receiving anti-IL6 therapy showed a shorter time to S-IgG seropositivity and stronger S-IgG and N-IgG antibody responses. Among unvaccinated subjects one year after infection, median (Q1-Q3) levels of TrimericS-IgG (295 vs 121 BAU/mL; p = 0.011) and Nab (74.7 vs 41.0 %IH; p = 0.012) were higher in those undergoing anti-IL6 therapy, and a greater proportion of them had Nab (80.6% vs 57.7%; p = 0.028). T-cell immunity was also better in those treated with anti-IL6, with higher median (Q1-Q3) interferon-γ responses (1760 [702–3992] vs 542 [35–1716] mIU/mL; p = 0.013) and more patients showing positive T-cell responses in the IGRA one year after infection. Patients treated with anti-IL6 had fewer reinfections during follow-up and responded to vaccination with robust increase in both antibody and T-cell immunity.InterpretationIL-6 blockade in patients with severe COVID-19 does not have deleterious effects on long-term immunity to SARS-CoV-2. The magnitude of both antibody and T-cell responses was stronger than the observed in non-anti-cytokine-treated patients with no increase in the risk of reinfections.FundingInstituto de Salud Carlos-III (Spain).

Perceived Effectiveness and Overall Satisfaction of Using a Toilet Stool to Prevent or Treat Constipation: An Analysis of Online Comments

Constipation is a common complaint in the general population. Squatting (using a toilet stool) is associated with faster and more complete bowel emptying, and could therefore help prevent or treat constipation. We analyzed the reviews of online buyers of a toilet stool to assess perceived effectiveness, overall satisfaction and potential side effects. In this exploratory mixed-method study, we collected all plain text reviews left between November 2013 and March 2020 by buyers of a toilet stool on Amazon. We adapted the Framework method to perform a seven-step process to analyze user reviews. We assigned numerical values from -5 (minimum) to +5 (maximum) to perceived effectiveness and overall satisfaction. We included comments left by 10,027 customers who purchased 19 different types of toilet stools (79.1% seven-inch stools, 16.1% folding stools, 4.8% other stools). Perceived effectiveness and overall satisfaction were high (median = 5 and interquartile range = 0 for both variables). Eighty-one individuals reported adverse events related to toilet stool use, mainly musculoskeletal pain (N = 26), numbness in the lower limbs (N = 16), falls (n = 11), constipation (N = 9), anorectal symptom (N = 8), and cramps (N = 6). Perceived effectiveness and overall satisfaction were rated high by those who purchased a toilet stool online. In addition, their use seems to be safe (<1% reported adverse effects). Our results suggest a good risk-benefit ratio. The device may offer an inexpensive option to treat or prevent constipation, and may reduce the frequency of medical visits and the risks associated with long-term use of laxatives.

Life satisfaction and athletic identity among Olympic para-alpine skiers: a survey.

The objective of this study was to examine life satisfaction and athletic identity among para-alpine skiers and explore their associations with sociodemographic, sports practice, and disability-related characteristics of the participants. The respondents to the on-site survey were 129 para-alpine ski racers with acquired disability from 33 countries on all five continents who competed in the Paralympic games in Sochi (aged 16-53 years, mean and median 30 years, 100 men). Two self-developed assessment instruments were used - a 7-point Likert-type life-satisfaction questionnaire probing seven domains (health, family, education, freedom, friends, travelling, and self) and the Athletic Identity Scale (AIS; possible score range 17-85). The independence between life-satisfaction items was confirmed by low interitem correlations (largest absolute value <0.25, 15 of 21, and <0.15). The estimated internal-consistency reliability (Guttman lambda-2) of AIS was 0.65. The reported life satisfaction was very high (median of 6 for all domains except education, where it was 5). Like life-satisfaction ratings, the AIS scores were also very high on average (mean and median score 81). In general, the level of life satisfaction and athletic identity were not notably associated with sociodemographic, sports practice, and disability characteristics of the participants. The likely reason is high average and, hence, low variability of life-satisfaction ratings, as well as imperfect metric characteristics of the AIS. Nonetheless, the overall findings encourage further research into factors that drive the participation of disabled athletes in (winter) Paralympic games and the possible role of the rehabilitation process in this regard.

Neighborhood disadvantage and biological aging biomarkers among breast cancer patients

Living in a disadvantaged neighborhood is associated with adverse clinical outcomes among breast cancer patients, but the underlying pathway is still unclear. Limited evidence has suggested that accelerated biological aging may play an important role. In this study, using a sub-sample of 906 women with newly diagnosed breast cancer at M.D. Anderson, we examined whether levels of selected markers of biological aging (e.g., allostatic load, telomere length, and global DNA methylation) were affected by neighborhood disadvantage. The Area Deprivation Index was used to determine the neighborhood disadvantage. Based on the median ADI at the national level, the study population was divided into low and high ADI groups. Overall, breast cancer patients from the high ADI group were more likely to be younger and non-Hispanic Black than those from the low ADI group (P < 0.001, respectively). They were also more likely to have higher grade and poorly differentiated breast tumors (P = 0.029 and 0.019, respectively). For the relationship with markers, compared to the low ADI group, high ADI group had higher median levels of allostatic load (P = 0.046) and lower median levels of global DNA methylation (P < 0.001). Compared to their counterparts, those from the high ADI group were 20% more likely to have increased allostatic load and 51% less likely to have increased levels of global DNA methylation. In summary, we observed that levels of allostatic load and global DNA methylation are influenced by neighborhood disadvantage among breast cancer patients.

Oral Health of Children One to Six Years after Dental Treatment under General Anaesthesia.

(1) Background: The aim of this study was to assess oral health in children following dental treatment under general anaesthesia and to obtain information about oral health measures in both the children and their parents. (2) Methods: Children were scheduled for regular dental re-examination one to six years after dental treatment under general anaesthesia. Scores for mixed dmft/DMFT, the plaque control record (PCR), and the gingival bleeding index (GBI) were determined. Information about children’s/parents’ oral hygiene habits and frequency of dental visits was obtained. Scores for mixed dmft/DMFT as assessed before dental treatment under general anaesthesia/at re-examination were compared (Wilcoxon test). (3) Results: From the 134 parents initially contacted, 35 attended regular dental control visits (response rate: 26%) with their children (median age 6 years). Of the 35 children (20 female, 15 male), 18 (51.4%) were healthy and 17 (48.6%) had a pre-existing condition. Mixed dmft/DMFT scores determined at the recall visit differed significantly from the earlier visit (p = 0.006). Children had 1.74 ± 3.64 teeth newly affected by caries. Four children (11.4%) needed dental treatment under general anaesthesia again. Oral hygiene was mediocre (median PCR: 32%). The GBI was high (median: 14%). Children with a high PCR also had a high GBI. (4) Conclusions: Children who had received dental treatment under general anaesthesia still had a high caries risk. Further prophylaxis programs are necessary to prevent caries and further use of general anaesthesia.

Postpartum acute kidney injury

Background. Postpartum acute kidney injury is a serious obstetric complication, and its diagnostic definition is highly variable in the literature. Recent studies reported an incidence up to 40% in both developed and developing countries. PP-AKI is associated with an increased risk of chronic kidney disease, and cardiovascular disease. Methods. We conducted a single center case control study for PP-AKI cases. Forty six women were recruited in the study, and they represented two groups, PP-AKI group (n=18), and healthy control group (n=38). Clinical examinations and laboratory investigations were collected. Results. Hypertension and CKD were reported in 5(27.8%), and 3(16.7%) of the included women in PP-AKI group respectively, while none of healthy control women had HTN, or CKD. PP-AKI patients exhibited significantly lower mean values for blood hemoglobin levels (7.9±1.36 g/dl), platelets counts (157.9±92.3×103/mm3), and serum albumin levels (2.9±0.4 gm/dl) in comparison with healthy controls. Additionally, PP-AKI patients exhibited significantly higher mean value for serum creatinine levels (5.3±2.9 mg/dl), and higher median and range values for prothrombin time 1(1-2.7) in comparison with healthy controls. Preeclampsia was the main possible etiology of PP-AKI.

Abstract 4002: Identification of signal transduction pathway activity with potential clinical target in high-grade serous ovarian carcinoma

Abstract Background: High-grade serous carcinoma (HGSC) is the most common subtype of ovarian cancer. It has a high mortality rate, even after successful first-line treatment with debulking surgery and chemotherapy. Although therapeutic options for targeted therapy are rapidly expanding, identification of patients who respond to these therapies remains a challenge. In recognition of the importance of the functional phenotype of cancer cells, Verhaegh et al. (Cancer Res 2014) developed assays to measure functional activity of signal transduction pathways (STPs) based on mRNA expression levels of pathway-specific target genes. In this study, we aimed to identify HGSCs with STP activity with a potential clinical target by comparing their activity with STP activity in normal Fallopian tube epithelium (FTE), the tissue of origin of most HGSCs. Methods: We included 50 primary tumor samples taken prior to start of chemotherapy of postmenopausal patients diagnosed with advanced stage HGSC and 9 morphologically normal FTE samples of healthy postmenopausal women. Using pathway assays, we assessed functional pathway activity of the androgen receptor (AR), estrogen receptor (ER), PI3K, MAPK, Hedgehog, TGFβ and Notch pathways. Differences in STP activity between groups were compared with Mann-Whitney U tests. Cut-off value for aberrant STP activity was defined as two standard deviations above the mean value of STP activity measured in FTE samples. Results: In the HGSC group we observed lower median ER (p &amp;lt; 0.001) pathway activity and higher median PI3K (p &amp;lt; 0.001), Hedgehog (p &amp;lt; 0.001) and TGFβ pathway (p = 0.020) activity as compared to the FTE group. In individual HGSC samples, aberrant activity was identified for the MAPK (n = 10), PI3K (n = 22), Hedgehog (n = 28) and TGFβ (n = 21) pathways. Frequently observed combinations of aberrant STP activity were Hedgehog/TGFβ (n = 12) and Hedgehog/PI3K (n = 9). In total, we identified at least one STP with potential clinical target in 88% (44/50) of HGSC samples. Conclusions: Our analysis enabled the identification of STP activity with a potential clinical target in 88% of the analyzed HGSC samples. Differentiation between normal and aberrant STP activity could have clinical utility in the selection of HGSC patients for targeted therapy. A prospective study (STAPOVER) has been designed to demonstrate clinical utility. Citation Format: Phyllis Van der Ploeg, Yvonne J.W. Wesseling-Rozendaal, Eveline C. Biezen-Timmermans, Jurgen M.J. Piek. Identification of signal transduction pathway activity with potential clinical target in high-grade serous ovarian carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4002.

#20 Bloodstream Infection is Associated with Prior Gut Microbiome Colonization of the Same Strain in the Neonatal Intensive Care Unit

Abstract Background Infants hospitalized in neonatal intensive care units (NICUs) have high incidence of bacterial bloodstream infections (BSIs) leading to up to 15% mortality and substantial morbidity. Common etiologies of BSI in the NICU are pathogens also capable of colonizing the preterm infant gut. However, differentiating susceptible neonates from those in the same environment remains challenging. We hypothesized that the same strains causing BSI increase in abundance in the gut of affected neonates prior to bacteremia and increased above controls in the same environment. Method We performed shotgun metagenomic sequencing on 462 fecal samples from 19 infants with BSI and 37 controls in the same NICUs paired for gestational age, days of life, antibiotic exposure, delivery mode, and sex. We whole genome sequenced the BSI isolate from 19 cases (6 Staphylococcus aureus, 3 Streptococcus agalactiae, 3 Serratia marcescens, 2 Enterococcus faecalis, 2 Klebsiella pneumoniae, 2 Escherichia coli, and 1 Enterobacter cloacae). We utilized MetaPhLan3 to infer taxonomy and InStrain to track the whole genome sequence of the BSI pathogen within the fecal metagenomes longitudinally. We performed generalized linear mixed effect models with MaAsLin2 to determine significant associations between the microbiome and metadata with subject as a random effect. Results We found no differences in gut microbiome diversity or richness between cases and controls relative to bacteremia day of life. However, infants who experience a BSI possess significantly higher median relative abundances of the causative species in their gut relative to paired controls in the 2 weeks prior to bacteremia (Figure 1A, median 21.4% IQR 0.33-52 vs. 0.4% IQR 0.23-10.5, p&amp;lt;0.05 Wilcoxon). 10/19 infants produced at least 1 stool before bacteremia containing an organism with 0-1 genomic substitutions from the BSI isolate, establishing isogenicity between gut residing and invasive pathogen. The coverage (abundance) of the BSI isolate increased in the stool of affected neonates in the 10 days before infection to an average maximum of 0.48/1.0 (Figure 1B, linear mixed effect model p&amp;lt;0.05). We observed the strongest associations between high gut microbiome abundance of E. faecalis, Klebsiella spp., E. coli, and S. marcescens in the gut microbiome of cases whose BSI was caused by that organism compared to all other samples (p&amp;lt;0.01). Conclusion We show high relative abundance of the same strain in stool prior to bacteremia in hospitalized neonates. The relative abundance of the causative species is higher in cases versus paired controls. These data suggest the potential of gut microbial surveillance and management to identify blooms of gut pathogens to limit the incidence of bacteremia.

SHS Students’ Engagement in Online Synchronous Collaborative Learning Activities: Correlations with Self-efficacy, Peer Social Support, Well-being and Academic Performance

The pandemic of COVID-19 prompted several paradigm shifts throughout society, including in education. This study aimed to examine the relationships of students' engagement in online synchronous collaborative learning activities (OSCLA) with their self-efficacy (LSE), peer social support (LPSS), state of well-being (SWB), and level of academic performance (LAP). A total of 176 Filipino Grade 12 SHS students, 18 years old and older, from a private educational institution were purposively selected for this study. Data were generated using an online survey. Results show that collaborative learning activities are frequently conducted (median = 4) in their synchronous online classes. It also revealed that their LSE is high (median = 4), their LPSS is high (median = 4), their LE is moderate (median = 3), their SWB is high (median = 4), and their LAP is high (median = 94.85). The results showed a statistically significant correlation of their LSE (r = 0.69, p 0.001) and LPSS with their OSCLA LE (r = 0.438, p 0.001). A statistically significant positive moderate correlation between LE and SWB (r = 0.536, p 0.001) was also found, however, no correlation was found between their OSCLA LE and LAP (r = 0.065, p = 0.393). Thus, the use of a well-designed OSCLA is strongly recommended as it positively impacts students' SWB but should be regularly reviewed for its effectiveness in sustaining improvement in the LAP of the students.