Initial Days Research Articles

Clinical Outcomes of Tirzepatide or GLP-1 Receptor Agonists in Individuals With Type 2 Diabetes

Despite its demonstrated benefits in improving cardiovascular risk profiles, the association of tirzepatide with mortality and cardiovascular and kidney outcomes compared with glucagon-like peptide 1 receptor agonists (GLP-1 RAs) remains unknown. To investigate the association of tirzepatide with mortality and adverse cardiovascular and kidney outcomes compared with GLP-1 RAs in patients with type 2 diabetes. This retrospective cohort study used US Collaborative Network of TriNetX data collected on individuals with type 2 diabetes aged 18 years or older initiating tirzepatide or GLP-1 RA between June 1, 2022, and June 30, 2023; without stage 5 chronic kidney disease or kidney failure at baseline; and without myocardial infarction or ischemic or hemorrhagic stroke within 60 days of drug initiation. Treatment with tirzepatide compared with GLP-1 RA. The primary outcome was all-cause mortality, and secondary outcomes included major adverse cardiovascular events (MACEs), the composite of MACEs and all-cause mortality, kidney events, acute kidney injury, and major adverse kidney events. All outcomes were analyzed using Cox proportional hazards regression models. There were 14 834 patients treated with tirzepatide (mean [SD] age, 55.4 [11.8] years; 8444 [56.9%] female) and 125 474 treated with GLP-1 RA (mean [SD] age, 58.1 [13.3] years; 67 474 [53.8%] female). After a median (IQR) follow-up of 10.5 (5.2-15.7) months, 95 patients (0.6%) in the tirzepatide group and 166 (1.1%) in the GLP-1 RA group died. Tirzepatide treatment was associated with lower hazards of all-cause mortality (adjusted hazard ratio [AHR], 0.58; 95% CI, 0.45-0.75), MACEs (AHR, 0.80; 95% CI, 0.71-0.91), the composite of MACEs and all-cause mortality (AHR, 0.76; 95% CI, 0.68-0.84), kidney events (AHR, 0.52; 95% CI, 0.37-0.73), acute kidney injury (AHR, 0.78; 95% CI, 0.70-0.88), and major adverse kidney events (AHR, 0.54; 95% CI, 0.44-0.67). Treatment with tirzepatide was associated with greater decreases in glycated hemoglobin (treatment difference, -0.34 percentage points; 95% CI, -0.44 to -0.24 percentage points) and body weight (treatment difference, -2.9 kg, 95% CI, -4.8 to -1.1 kg) compared with GLP-1 RA. An interaction test for subgroup analysis revealed consistent results stratified by estimated glomerular filtration rate, glycated hemoglobin level, body mass index, comedications, and comorbidities. In this study, treatment with tirzepatide was associated with lower hazards of all-cause mortality, adverse cardiovascular events, acute kidney injury, and adverse kidney events compared with GLP-1 RA in patients with type 2 diabetes. These findings support the integration of tirzepatide into therapeutic strategies for this population.

Comparative effectiveness of vancomycin and metronidazole on event-free survival after initial infection in patients with Clostridioides difficile—a German multicentre cohort study

ObjectivesThe objective of this study is to examine the comparative effectiveness of vancomycin and metronidazole in a confirmatory analysis of event-free survival (EFS) after initial infection in patients with Clostridioides difficile from a German multicentre cohort study. MethodsThe IBIS multicentre cohort enrolled patients with an index episode of C. difficile infection between August 2017 and September 2020. The primary endpoint was EFS, defined as response to treatment with metronidazole or vancomycin within 10 days of initiation, absence of recurrence and death from any cause up to 90 days post-treatment. A Cox proportional hazards model with inverse probability of treatment weighting was used to investigate the comparative effectiveness of this outcome. Additionally, subgroup analyses were performed based on severe and non-severe infections. ResultsOf the 489 patients included, 118 (24%) received initial treatment with metronidazole and 371 (76%) with vancomycin. Of these, 78/118 (66.1%) and 247/371 (66.6%), respectively, responded to treatment within 10 days, neither developed a recurrence nor died within 90 days and thus achieved the outcome of EFS. In the subgroup of non-severe infections, 74/293 patients (25.3%) received metronidazole, and 219/293 (74.7%) received vancomycin. Of these, 33/74 (44.6%) metronidazole patients and 150/219 (68.5%) vancomycin patients survived event free. The Cox proportional hazards model revealed differences in EFS for the overall population and both subgroups (reference metronidazole: all severity levels: hazard ratio [HR] 0.46, [95% CI, 0.33–0.65]; non-severe: HR 0.39; [95% CI, 0.24–0.60]; severe: HR 0.52; [95% CI, 0.28–0.95]). DiscussionOur analysis confirms current changes in guidelines, as it supports the superiority of vancomycin compared with metronidazole across all severity levels.

Electrocardiogram Abnormalities in Children With Lyme Arthritis.

Classically, Lyme disease follows a staged illness pattern with carditis occurring in early disseminated disease and arthritis in late-stage disease. A more comprehensive understanding of Lyme suggests that clinical stages may intersect. Little is known regarding the overlap of electrocardiogram (ECG) abnormalities in children with Lyme arthritis. This study aimed to estimate the prevalence of ECG changes in pediatric patients presenting with Lyme arthritis. In this retrospective, cross-sectional study was conducted at a tertiary care children's hospital in a Lyme endemic area; patients were identified based on Lyme testing performed from January 2012 to August 2022. Children diagnosed with Lyme arthritis by 2-tiered serology with ECGs obtained within 2 days of antibiotic initiation were included. A study cardiologist reviewed all ECGs for evidence of carditis defined as atrioventricular block, ST-T wave changes, QTc interval prolongation, accelerated junctional rhythm or right bundle branch block. Two hundred thirty-three patients were diagnosed with Lyme arthritis; 90 (38.6%) had ECGs completed. Five patients (5.6%) had ECG abnormalities: 3 were diagnosed with first-degree atrioventricular block, 1 with QTc prolongation, and 1 with ST-T wave changes. No clinical or laboratory features in patients with Lyme arthritis were associated with an increased likelihood of having an abnormal ECG. All patients with ECG abnormalities were treated with oral antibiotics, and none had clinically significant cardiac disease. ECG abnormalities in children with Lyme arthritis rarely occur and, when present, are not reflective of clinically significant cardiac disease. These results do not support routine screening ECGs on asymptomatic pediatric patients with Lyme arthritis.

Micronutrient Dynamics in Soil under Integrated Thermochemical Organic Fertilizer Pellet Application

A soil incubation study was carried out in the Department of Soil Science and Agricultural Chemistry, to assess dynamics of micronutrient release. Soil pots were filled with 5 kg air-dried, 2 mm sieved soil. The study was laid in Completely Randomized Design with 5 treatments and 4 replications. Treatments were, T1: Pellet formulation 1; T2: Pellet formulation 2; T3: Pellet formulation 3; T4: FYM+NPK (RDF as per POP) and T5: Control (Soil alone). The Fe, Mn, Zn, Cu and B content of soil were 10.14 mg kg-1, 8.59 mg kg-1, 1.90 mg kg-1, 2.50 mg kg-1 and 0.30 mg kg-1, respectively. Three distinct pellet formulations P1, P2 & P3 were used in study based on thermochemical organic fertilizer (TOF). Fe, Mn and Zn exhibited a gradual and progressive release pattern throughout the incubation period. Whereas Cu and B availability showed a decreasing trend from the 15th day onwards. Highest Fe, Mn and Zn availability were observed towards the end of the incubation study. While the Cu and B recorded highest on the initial 15th day of incubation. Hence it can conclude that TOF based pellets significantly impact the micronutrient availability in soil compared to the FYM based and control treatment.

Prescription Patterns in Jails Before and Since the COVID-19 Pandemic: A Multisite Serial Cross-Sectional Investigation.

In response to the COVID-19 pandemic, jails were advised to reduce facility census, particularly the growing population of those with medical/behavioral health vulnerabilities that increased susceptibility to adverse outcomes. Although jail census decreased across the nation in the initial days to months following pandemic declaration, there are minimal data regarding the health status of those who remained in jail. The current investigation aspired to describe jail census trends before/since the onset of COVID-19 and offer snapshots of temporal changes and context for prevalence estimates of medical/behavioral health conditions in jail detainees from 2019 to 2023. Using a serial cross-sectional design, prescription information for individuals residing in 18 jails across the United States on June 30 of each respective year was extracted and categorized using MediSpan's ontological system to determine prevalence estimates of prescribed agents/products. Although data evidenced an initial 31% census reduction (followed by gradual return to prepandemic rates), prescribing patterns for all major therapeutic drug classes steadily increased, with 10% more individuals prescribed at least one agent in 2023 than 2019. The largest increases were observed for behavioral health agents (e.g., 32.4% of the sample was prescribed psychotropic agents in 2023 compared with 25.7% in 2019). We provide considerations for future investigations.

Association of Semaglutide With Tobacco Use Disorder in Patients With Type 2 Diabetes : Target Trial Emulation Using Real-World Data.

Reports of reduced desire to smoke in patients treated with semaglutide, a glucagon-like peptide receptor agonist (GLP-1RA) medication for type 2 diabetes mellitus (T2DM) and obesity, have raised interest about its potential benefit for tobacco use disorders (TUDs). To examine the association of semaglutide with TUD-related health care measures in patients with comorbid T2DM and TUD. Emulation target trial based on a nationwide population-based database of patient electronic health records. United States, 1 December 2017 to 31 March 2023. Seven target trials were emulated among eligible patients with comorbid T2DM and TUD by comparing the new use of semaglutide versus 7 other antidiabetes medications (insulins, metformin, dipeptidyl-peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors, sulfonylureas, thiazolidinediones, and other GLP-1RAs). The TUD-related health care measures (medical encounter for diagnosis of TUD, smoking cessation medication prescriptions, and smoking cessation counseling) that occurred within a 12-month follow-up were examined using Cox proportional hazards and Kaplan-Meier survival analyses. The study compared 222 942 new users of antidiabetes medications including 5967 of semaglutide. Semaglutide was associated with a significantly lower risk for medical encounters for TUD diagnosis compared with other antidiabetes medications, and was strongest compared with insulins (hazard ratio [HR], 0.68 [95% CI, 0.63 to 0.74]) and weakest but statistically significant compared with other GLP-1RAs (HR, 0.88 [CI, 0.81 to 0.96]). Semaglutide was associated with reduced smoking cessation medication prescriptions and counseling. Similar findings were observed in patients with and without a diagnosis of obesity. For most of the group comparisons, the differences occurred within 30 days of prescription initiation. Documentation bias, residual confounding, missing data on current smoking behavior, body mass index, and medication adherence. Semaglutide was associated with lower risks for TUD-related health care measures in patients with comorbid T2DM and TUD compared with other antidiabetes medications including other GLP-1Ras, primarily within 30 days of prescription. These findings suggest the need for clinical trials to evaluate semaglutide's potential for TUD treatment. National Institutes of Health.

Removal of Cadmium (II) from Aqueous Solution Using Galdieria sulphuraria CCMEE 5587.1.

The release of cadmium into the environment is a significant global concern due to its toxicity, non-biodegradability, and persistence in nature. There is an urgent need for effective, eco-friendly, and cost-effective systems for removing Cd because of the many drawbacks of conventional physicochemical techniques. This study investigated the ability of the extremophile red microalgal strain Galdieria sulphuraria CCMEE 5587.1 to tolerate and remove Cd (II) ions at acidic pH in a controlled laboratory environment. Three distinct concentrations of Cd (1.5 mg L-1, 3 mg L-1, and 6 mg L-1) were introduced to the cyanidium medium, and G. sulphuraria cells were introduced in the medium and grown for ten days. Four distinct aspects were identified regarding Cd removal: time course Cd removal, total Cd removal, extracellular Cd removal, and intracellular Cd removal. The inhibitory effects of Cd on G. sulphuraria growth were observed using a daily growth profile. Initial incubation days showed an inhibition of G. sulphuraria growth. In addition, increasing the Cd concentration in the medium decreased the growth rate of G. sulphuraria. Rapid Cd removal occurred on the first day of the experiment, followed by a steady removal of Cd until the last day. The highest total removal efficiency occurred in a medium containing 3 mg L-1 of Cd ions, which was 30%. In contrast, the highest sorption capacity occurred in a medium containing 6 mg L-1 of Cd ions, which was 1.59 mg g-1 of dry biomass. In all media compositions, a major fraction (>80%) of Cd removal occurred via adsorption on the cell surface (extracellular). These results showed that G. sulphuraria cells can remove Cd ions from aqueous solution, which makes them a potential bioremediation option for heavy metal removal.

Impact of Luteinizing Hormone on IVF/ICSI Assisted Reproduction on the Initiation Day of Gonadotropin-releasing Hormone Antagonist Protocol.

The aim of the study was to explore the optimal timing of gonadotropin initiation and the reasonable interval of luteinizing hormone (LH) levels in the gonadotropin-releasing hormone antagonist (GnRH-A) protocol. A retrospective cohort study was conducted to analyze the data concerning the oocyte retrieval cycles from 1,361 cases with the GnRH-A protocol implemented. The ovarian responses (including AMH, AFC) in these patients were divided into the poor ovarian response group (an antral follicle count [AFC] ≤ 6, n = 394), the normal ovarian response group (an AFC > 6 and < 15, n = 570), and the high ovarian response group (an AFC ≥ 15, n = 397), according to the AFC. The patients were sub-grouped according to LH levels on the protocol initiation day, and the clinical outcomes (including dose of Gn initiation, Gn administration days, GnRH-ant administration days, P levels on the HCG day, E2 levels on the HCG day, LH levels on the HCG day, number of embryos transferred, total fertilization rate, embryo implantation rate(%), proportion of 2PN, proportion of good-quality embryos, endometrial thickness on the hCG injection day(mm), moderate to severe OHSS, AFC on the initiation day, proportion of type A endometrium on the hCG injection day, clinical pregnancy rate, biochemical pregnancy rate, early abortion rate, ectopic pregnancy rate) were compared. On the GnRH-A protocol initiation day, among all patients with different ovarian responses, the body mass index (BMI) in those with an LH ≥ 5 IU/L was lower. The differences in pregnancy outcomes between the LH < 5 IU/L group and the LH ≥ 5 IU/L group were not statistically significant across the different ovarian response groups, but the LH < 5 IU/L group had a higher proportion of good-quality embryos (80.3±24.9 vs. 74.8±26.9, P =0.035) than the LH≥5IU/Lgroup in those with poor ovarian response. The total fertilization rate (82.2±18.1 vs 85.4±15.1, P =0.021) and proportion of two pronuclei (2PN) (69.0±20.9 vs 72.7±19.9, P =0.035) were higher in the LH ≥ 5 IU/L group than the LH<5 IU/L group for those with normal ovarian responses. The embryo implantation rate (41.4±41.3 vs 52.6±43.4, P =0.012) was higher in the LH ≥ 5 IU/L group than in the LH<5 IU/L group in those with high ovarian response. The results of the multivariate logistic analysis showed that the age of the female partner, number of embryos transferred, proportion of good-quality embryos, endometrial thickness on the hCG injection day, and moderate- to-severe ovarian hyperstimulation syndrome (OHSS) were independent factors correlated with the outcome of live births (P < 0.05). The LH levels on the gonadotropins (Gn) initiation day in the GnRH-A protocol will not affect pregnancy outcomes.

Dietary supplementation with mulberry leaf flavonoids and carnosic acid complex enhances the growth performance and antioxidant capacity via regulating the p38 MAPK/Nrf2 pathway.

This study aimed to investigate the regulatory effects of mulberry leaf flavonoids and carnosic acid complex (MCC) on the growth performance, intestinal morphology, antioxidant, and p38 MAPK/Nrf2 pathway in broilers. A total of 256 healthy 8-day-old female yellow-feathered broilers were randomly divided into 4 equal groups: a control group (CON) fed a basal diet, an antibiotic group (CTC) supplemented with 50 mg/kg chlortetracycline, and two experimental groups (MCC75, MCC150) fed basal diets with 75 mg/kg and 150 mg/kg of MCC, respectively. The experiment lasted for 56 days, with days 1-28 designated as the initial phase and days 29-56 as the growth phase. The results on the growth performance showed that diets supplemented with MCC and CTC decreased the feed-to-gain ratio (F/G), diarrhea rate, and death rate, while significantly increasing the average daily weight gain (ADG) (p < 0.05). Specifically, the MCC150 group enhanced intestinal health, indicated by reduced crypt depth and increased villus height-to-crypt depth ratio (V/C) as well as amylase activity in the jejunum. Both the MCC and CTC groups exhibited increased villus height and V/C ratio in the ileal (p < 0.05). Additionally, all treated groups showed elevated serum total antioxidant capacity (T-AOC), and significant increases in catalase (CAT) and glutathione peroxidase (GSH-Px) activities were observed in both the MCC150 and CTC groups. Molecular analysis revealed an upregulation of the jejunal mRNA expression levels of PGC-1α, Nrf2, and Keap1 in the MCC and CTC groups, as well as an upregulation of ileum mRNA expression levels of P38, PGC-1α, Nrf2, and Keap1 in the MCC150 group, suggesting activation of the p38-MAPK/Nrf2 pathway. These findings indicate that dietary supplementation with MCC, particularly at a dosage of 150 mg/kg, may serve as a viable antibiotic alternative, enhancing growth performance, intestinal health, and antioxidant capacity in broilers by regulating the p38-MAPK/Nrf2 pathway.

Comparison of the Fatty Acid Profiles of Sow and Goat Colostrum.

Currently, the utilization of hyperprolific sows has stimulated the search for supplements aimed at enhancing piglet survival, as these sows yield more offspring than they can adequately feed with their colostrum production. In contrast, intensive goat farming often yields surplus colostrum, thus necessitating its removal, since kids are exclusively fed colostrum through lactation solely within the initial day of birth. The objective of this study was to examine and compare the fatty acid (FA) profiles of colostrum from sows and goats, together with possible influencing factors such as sow parity and the postpartum day of the goat, for possible use as an energy supplement for neonatal piglets. Swine colostrum was collected from sows with a 0-5 parity. In addition, samples of goat colostrum were collected on their first (D1) and second (D2) days of postpartum milking. The FA profiles of the colostrum were analyzed via gas chromatography. The parity value of the sows did not affect (p > 0.05) the FA colostrum composition. High proportions of palmitic, oleic, and linoleic acids were found in both types of colostrum. Levels of palmitic, oleic, and linoleic acids were significantly higher in D1 goat colostrum, whereas saturated FAs of less than 14 carbons (4:0, 6:0, 8:0, 10:0, and 12:0) were found in higher proportions in D2. These FAs play an important role in colostrum as they are a readily available source of energy and have also been attributed strong antibacterial activity. Therefore, goat colostrum, especially D2, could be used as an alternative energy supplement for newborn piglets, in particular for the weakest and smallest of the litter, which are the most in need.

Extubated, Rehabilitation-Focused Extracorporeal Membrane Oxygenation for Pediatric Coronavirus Disease 2019: A Case Series.

During the coronavirus 2019 (COVID-19) pandemic, children suffered severe lung injury resulting in acute respiratory distress syndrome requiring support with extracorporeal membrane oxygenation (ECMO). In this case series, we described our center's experience employing a rehabilitation-focused ECMO strategy including extubation during ECMO support in four pediatric patients with acute COVID-19 pneumonia hospitalized from September 2021 to January 2022. All four patients tolerated extubation within 30 days of ECMO initiation and achieved mobility while on ECMO support. Duration of ECMO support was 35-152 days and hospital lengths of stay were 52-167 days. Three of four patients survived. Two of three survivors had normal functional status at discharge except for ongoing respiratory support. The third survivor had significant motor deficits due to critical illness polyneuropathy and was supported with daytime oxygen and nocturnal noninvasive support. Overall, these patients demonstrated good outcomes and tolerance of a rehabilitation-focused ECMO strategy.

Palliative Radiotherapy in Non-small Cell Lung Cancer: Patterns of Use and Predictors of 30-Day Mortality in End-of-Life Care.

Introduction Lung cancer is the leading cause of cancer-related deaths worldwide, with non-small cell lung cancer (NSCLC) being the most common type. More than half of patients require radiotherapy throughout their treatment. Palliative radiotherapy (PRT) is an important tool for symptom control and quality of life improvement in advanced NSCLC patients. However, the benefits of PRT must be balanced against possible disadvantages, especially in end-of-life (EOL) care. This study aims to describe the profile of PRT-treated deceased NSCLC patients, quantify the proportion of PRT recipients in the last 30 days of life and identify short-term survival prognostic factors in this group. Materials and methods This retrospective analysis was performed at two radiotherapy facilities within the Kent Oncology Centre, UK, for two years, running from January 1, 2022, to January 1, 2024. Data were collected from 857 deceased NSCLC patients who received PRT. Demographics, cancer diagnosis, histology, tumour, node, metastasis (TNM) staging, radiotherapy details, recent treatments, performance status (PS) and comorbidities were analysed. Patients have been stratified as long-term survivors (more than 30 days after PRT initiation, LTS group) along with short-term survivors (STS) (died within 30 days, STS group). Descriptive statistics, chi-squared tests, t-tests and multivariable logistic regression have been used in the data analysis. Results Out of 857 patients, 148 (17.3%) died within 30 days of PRT initiation. PS was considerably worse (p = 0.027), Adult Comorbidity Evaluation 27 (ACE-27) scores were higher (p = 0.018), and metastatic disease was more prevalent (60.1% vs. 47.5%, p = 0.02) in STS group patients. Fewer patients in the STS group completed their treatment compared to the LTS group (63.5% vs. 82.8%, p < 0.001). The STS group also received lower mean radiation dose (17.7 Gy vs. 19.6 Gy, p = 0.022) and fewer fractions (4.4 vs. 5.2, p = 0.019). The most common RT regimen in both cohorts was 20 Gy in five fractions, used in 55.4% of STS and 49.8% of LTS patients, with no significant difference in single fraction RT use between groups (33.1% in STS vs. 36.8% in LTS, p = 0.401). Multivariate logistic regression identified significant predictors of 30-day mortality: poorer PS (adjusted OR: 1.981, 95% CI: 1.33-3.12, p = 0.001), metastatic disease (adjusted OR: 2.02, 95% CI: 1.246-3.571, p = 0.002), incomplete PRT (adjusted OR: 0.337, 95% CI: 0.21-0.514, p < 0.001) and no recent chemotherapy (adjusted OR: 0.542, 95% CI: 0.342-0.941, p = 0.044). Conclusion This study demonstrated that compared with previous reports, a higher proportion of NSCLC patients who received PRT died within 30 days of treatment initiation, and low treatment adherence rates highlight challenges in EOL settings. Identification of poor PS and metastatic disease as predictors of short-term mortality would help inform PRT decision-making. The underutilisation of single-fraction radiotherapy and the link between recent chemotherapy and lower 30-day mortality warrant further study. These results highlight the need for better prognostic tools and more selective use of PRT, including increased consideration of single-fraction radiotherapy, in NSCLC patients approaching end of life and emphasise the importance of balancing benefit against treatment burden in this vulnerable population.

An exploratory study of the efficacy and safety of amenamevir for the treatment of herpes zoster in patients receiving immunosuppressive drugs.

Amenamevir is an oral once-daily antiherpesvirus drug that can be administered without dose adjustment in patients with impaired renal function. There are currently no clinical data on immunocompromised patients with herpes zoster treated with amenamevir. Therefore, an exploratory study of the efficacy and safety of amenamevir against herpes zoster in patients with immunosuppression was conducted. Inclusion criteria included patients with acute herpes zoster receiving immunosuppressive drugs or those with malignant tumors or autoimmune diseases. Twenty-four patients were included and received amenamevir (400 mg once daily after meals) for up to 14 days. The primary end point of overall improvement in skin symptoms 7 days after treatment initiation (day 7) was 58.3% for "markedly improved" and 20.8% for "improved." The combined improvement rate was 79.2% (95% confidence interval, 57.8-92.9), and 20.8% of patients experienced "worsened" symptoms. The secondary end points of overall improvement in skin symptoms on day 14 and day 28 were 95.7% and 100%, respectively. The skin symptoms progressed during treatment, peaking on day 7, and then began to heal. By Kaplan-Meier estimation, the median periods to complete crusting and healing were both day 14. There were five adverse events with a possible causal relationship to amenamevir (bacterial skin infection, anemia, hyponatremia, headache, and abnormal liver function) in one of the 24 patients. Although the bacterial skin infection was severe, all events in this patient were reported to be either recovered or recovering. These findings indicate that amenamevir can be effective and safe in immunocompromised patients with herpes zoster. However, as worsening can happen around day 7, it is necessary to carefully monitor such patients and switch to other therapies such as intravenous acyclovir if necessary. Clinical trial identifier: Japan Registry of Clinical Trials jRCTs031190208.

Investigation of WZ Sge-type Dwarf Nova ASASSN-19oc: Optical Spectroscopy and Multicolor Light Curve Analysis

In this study, we present an investigation of the newly discovered dwarf nova ASASSN-19oc during its superoutburst on 2019 June 2. We carried out detailed UBVR c I c -photometric observations and also obtained a spectrum on day 7 of the outburst, which shows the presence of hydrogen absorption lines commonly found in dwarf nova outbursts. Analysis of photometric data reveals the occurrence of early superhumps in the initial days of observations, followed by ordinary and late superhumps. We have accurately calculated the period of the ordinary superhumps as P ord = 0.05681(10) days and determined the periods at different stages, as well as the rate of change of the superhump period (P dot = Ṗ /P = 8.1 × 10−5). Additionally, we have derived the mass ratio of the components (q = 0.09), and estimated the color temperature during the outburst as ∼11,000 K, the distance to the system (d = 560 pc) and absolute magnitude of the system in outburst (M V = 5.3). We have shown that outbursts of this star are very rare: based on brightness measurements on 600 archival photographic plates, we found only one outburst that occurred in 1984. This fact, as well as the properties listed above, convincingly shows that the variable ASASSN-19oc is a dwarf nova of WZ Sge type.

Is Close Supervision by a Senior Surgeon Necessary During the Initial Days of Performing Endoscopic Lumbar Discectomy? A Retrospective Comparative Study between Two Fellowship Trained Surgeons to Assess the Learning Curve.

Endoscopic lumbar discectomy is a minimally invasive technique with a steep learning curve. The studies in the literature base the learning curve on the operative duration. We conducted this study to determine the learning curve based on the presence or absence of supervision by an experienced surgeon. This study involved two spine surgeons (surgeon A and surgeon B), who after their fellowship training from the same institute started practising in two different hospitals with different settings. The data of the first 80 patients operated by these two surgeons were extracted, and the patients were followed up for a minimum of 1 year. The data were split into first 30 cases and late 50 cases, which were compared to see the difference between the two surgeons. The first 30 cases were evaluated between the two surgeons, and the most significant difference between the two was the operative duration. There was difference between the two surgeons in approach towards migrated and foraminal/extra foraminal discs (P = 0.02). The surgeon B started operating on upper lumbar levels in his later 50 cases, but the foraminal and extraforaminal disc herniations were rarely treated by surgeon B. Endoscopic discectomy when supervised by senior faculty helps to reduce the operative duration especially in the initial phases of a surgeon's career. The surgeon under the supervision of a senior faculty performs more of migrated and foraminal herniated discs.

Assessment of endometrial and subendometrial three-dimensional power Doppler angiography evaluated by the VOCAL method in frozen-thawed embryo transfer cycles on hormone replacement therapy

BACKGROUND: The effectiveness of in vitro fertilization cycles / frozen-thawed embryo transfer cycles depends on a number of factors, the endometrial one being of great importance. Adequate endometrial and subendometrial blood supply is considered necessary for successful implantation. Currently, the possibilities of non-invasive assessment of the implantation properties of the endometrium are limited to the use of ultrasound. AIM: The aim of this study was to assess the performance of endometrial and subendometrial three-dimensional power Doppler angiography combined with the Virtual Organ Computer-aided Analysis (VOCAL) method in frozen-thawed embryo transfer cycles on hormone replacement therapy and compare the obtained data among the women examined. MATERIALS AND METHODS: This prospective study included 20 women. Doppler measurements were carried out three times — on the day of progesterone initiation, the day before embryo transfer and on the day of embryo transfer. The VOCAL software assessed the endometrial and subendometrial volume and blood flow indices such as vascularization index, flow index, and vascularization flow index. Patients were divided into two study groups depending on the onset of clinical pregnancy. RESULTS: On the day of progesterone initiation among patients who got pregnant, we observed higher vascularization (3.52 ± 1.99 vs. 1.05 ± 1.36; p = 0.03) and vascularization flow (1.54 ± 0.98 vs. 0.63 ± 0.55; p = 0.03) indices compared to women with a negative result. Moreover, endometrial vascularization index on the day of progesterone initiation was positively correlated with the estrogen dose among both pregnant (r = 0.61; p = 0.04) and non-pregnant (r = 0.9; p = 0.0008) women. No differences in subendometrial blood flow indices depending on the onset of pregnancy were obtained, just as endometrial blood flow indices the day before embryo transfer and on the day of embryo transfer were comparable between women in the both study groups. CONCLUSIONS: Three-dimensional power Doppler angiography evaluated by the Virtual Organ Computer-aided Analysis (VOCAL) method is a promising tool for non-invasive assessment of endometrial receptivity in frozen-thawed embryo transfer programs. However, further studies are required on a larger patient sample to form conclusions that are more accurate.

Untargeted blood serum proteomics identifies novel proteins related to neurological recovery after human spinal cord injury

BackgroundThe discovery of new prognostic biomarkers following spinal cord injury (SCI) is a rapidly growing field that could help uncover the underlying pathological mechanisms of SCI and aid in the development of new therapies. To date, this search has largely focused on the initial days after the lesion. However, during the subacute stage of SCI (weeks to months after the injury), there remains potential for sensorimotor recovery, and numerous secondary events develop in various organs. Additionally, the confounding effects of early interventions after the injury are less likely to interfere with the results.MethodsIn this study, we conducted an untargeted proteomics analysis to identify biomarkers of recovery in blood serum samples during the subacute phase of SCI patients, comparing those with strong recovery to those with no recovery between 30 and 120 days. We analyzed the fraction of serum that is depleted of the most abundant proteins to unmask proteins that would otherwise go undetected. Linear models were used to identify peptides and proteins related to neurological recovery and we validated changes in some of these proteins using Enzyme-linked Immunosorbent Assay (ELISA).ResultsOur findings reveal that differences in subacute recovery after SCI (from 30 to 120 days) are associated with an enrichment in proteins involved in inflammation, coagulation, and lipid metabolism. Technical validation using commercial ELISAs further confirms that high levels of SERPINE1 and ARHGAP35 are associated with strong neurological recovery, while high levels of CD300a and DEFA1 are associated with a lack of recovery.ConclusionsOur study identifies new candidates for biomarkers of neurological recovery and for novel therapeutic targets after SCI.

Recovery from severe cardio-respiratory failure: the trajectory of muscle mass, strength, function and health related quality of life

Abstract Background The impact of intensive care unit acquired weakness (ICUAW) is associated with reduced muscle mass, strength, function and health related quality of life (HRQoL). Patients suffering from severe cardio-respiratory failure are known to lose considerable muscle mass and strength in the first 7 days of admission to the intensive care unit (ICU). Furthermore, patients surviving critical illness have a considerable less HRQoL and physical function with long term outcomes such as inability to return to work being reported. However, more information regarding muscle loss and recovery is required when patients leave hospital. Currently there are no treatments for ICUAW as once the process is established management is supportive, such as physical therapy. Purpose We Sought to investigate the effects of severe cardio-respiratory failure, in patients receiving extra corporeal membrane oxygenation (ECMO), on ICUAW (including muscle mass, strength, function and HRQoL). Researching a real life model of ICUAW allows the observation of the loss of muscle mass and strength in the first stages of critical illness and severe cardio-respiratory failure. Methods Adults receiving ECMO for severe cardiorespiratory failure were included. Muscle mass was measured using ultrasound of the rectus femoris cross sectional area (RFcsa). Muscle strength was measured using hand held dynamometry for both hand held grip strength and isometric leg extension. HRQoL was measured using the EQ-5D-5L. Function was measured using the short physical performance battery (SPPB). Measurements were taken on day 0, day 7, ICU discharge, hospital discharge and at out-patient follow up. Results 17 patients were recruited with 10 patients completing follow up. Patients lost 24% muscle mass in the first 7 days of ICU admission and ECMO initiation, with muscle loss continuing up until ICU discharge. Contrary to the hypothesis only 50% of the patients were seen to recover muscle mass at follow up. Strength and function all considerably improved between ICU discharge and out patient follow up. The EQ5D crosswalk index supported this suggesting considerable functional improvement. Conclusion Patients in severe cardio-respiratory failure lose considerable muscle mass in the first 7 days of admission, with only 50% of these patients recovering the initial muscle loss at follow up. However, strength, function and HRQoL all improve following ICU discharge suggesting an element of functional recovery. Strength and function have shown to improve regardless of the status of the muscle mass. Therefore, given the advantages of the real-life model and novel findings, this could serve as a platform to assess muscle loss and recovery over a longer time frame continuing to build the understanding of the patients recovery trajectory from critical illness.Rectus Femoris Muscle MassHand-Held Grip Strength

OculoMotor & Vestibular Endurance Screening (MoVES) Normative, Repeatability, and Reliability Data.

This study aims to assess oculomotor and vestibular endurance by utilizing the Oculomotor and Vestibular Endurance Screening (MoVES) assessment in athletes' pre-season and post-season and after a suspected head injury to detect impairment. Athletes (N = 311, 19.4 ± 1.3 years) were recruited to perform the following seven tasks: (1) horizontal saccades, (2) vertical saccades, (3) vergence jumps, (4) horizontal vestibular-oculomotor reflex (VOR), (5) vertical VOR, (6) amplitude of accommodation (AoA), and (7) near point of convergence (NPC). At pre-season, the observed number of eye movements in 60 s are horizontal saccades (74 ± 13 initial 30 s; 67 ± 11 latter 30 s), vertical saccades (70 ± 13; 66 ± 10), vergence jumps (48 ± 12; 45 ± 13), horizontal VOR (38 ± 11; 38 ± 11), and vertical VOR (8 ± 11; 38 ± 11). These results establish a normative database for eye movements within the MoVES assessment and show consistency in the number of movements from pre-season to post-season. The initial results show a trending decrease in the number of eye movements in the initial days post-head injury, which improves to pre-season measures 14-21 days post-injury. This foundation can be used by future studies to explore the extent of binocular and vestibular endurance dysfunctions caused by head injuries that subside within two weeks.

Investigating the Radiobiological Response to Peptide Receptor Radionuclide Therapy Using Patient-Derived Meningioma Spheroids.

Peptide receptor radionuclide therapy (PRRT) using 177Lu-DOTA-TATE has recently been evaluated for the treatment of meningioma patients. However, current knowledge of the underlying radiation biology is limited, in part due to the lack of appropriate in vitro models. Here, we demonstrate proof-of-concept of a meningioma patient-derived 3D culture model to assess the short-term response to radiation therapies such as PRRT and external beam radiotherapy (EBRT). We established short-term cultures (1 week) for 16 meningiomas with high efficiency and yield. In general, meningioma spheroids retained characteristics of the parental tumor during the initial days of culturing. For a subset of tumors, clear changes towards a more aggressive phenotype were visible over time, indicating that the culture method induced dedifferentiation of meningioma cells. To assess PRRT efficacy, we demonstrated specific uptake of 177Lu-DOTA-TATE via somatostatin receptor subtype 2 (SSTR2), which was highly overexpressed in the majority of tumor samples. PRRT induced DNA damage which was detectable for an extended timeframe as compared to EBRT. Interestingly, levels of DNA damage in spheroids after PRRT correlated with SSTR2-expression levels of parental tumors. Our patient-derived meningioma culture model can be used to assess the short-term response to PRRT and EBRT in radiobiological studies. Further improvement of this model should pave the way towards the development of a relevant culture model for assessment of the long-term response to radiation and, potentially, individual patient responses to PRRT and EBRT.