Large Sample Research Articles

Circulatory Indicators of Lipid Peroxidation, the Driver of Ferroptosis, Reflect Differences between Relapsing–Remitting and Progressive Multiple Sclerosis

Ferroptosis, a lipid peroxidation- and iron-mediated type of regulated cell death, relates to both neuroinflammation, which is common in relapsing-remitting multiple sclerosis (RRMS), and neurodegeneration, which is prevalent in progressive (P)MS. Currently, findings related to the molecular markers proposed in this paper in patients are scarce. We analyzed circulatory molecular indicators of the main ferroptosis-related processes, comprising lipid peroxidation (malondialdehyde (MDA), 4-hydroxynonenal (4-HNE), and hexanoyl–lysine adduct (HEL)), glutathione-related antioxidant defense (total glutathione (reduced (GSH) and oxidized (GSSG)) and glutathione peroxidase 4 (GPX4)), and iron metabolism (iron, transferrin and ferritin) to estimate their contributions to the clinical manifestation of MS and differences between RRMS and PMS disease course. In 153 patients with RRMS and 69 with PMS, plasma/serum lipid peroxidation indicators and glutathione were quantified using ELISA and colorimetric reactions, respectively. Iron serum concentrations were determined using spectrophotometry, and transferrin and ferritin were determined using immunoturbidimetry. Compared to those with RRMS, patients with PMS had decreased 4-HNE (median, 1368.42 vs. 1580.17 pg/mL; p = 0.03). Interactive effects of MS course (RRMS/PMS) and disease-modifying therapy status on MDA (p = 0.009) and HEL (p = 0.02) levels were detected. In addition, the interaction of disease course and self-reported fatigue revealed significant impacts on 4-HNE levels (p = 0.01) and the GSH/GSSG ratio (p = 0.04). The results also show an association of MS course (p = 0.03) and EDSS (p = 0.04) with GSH levels. No significant changes were observed in the serum concentrations of iron metabolism indicators between the two patient groups (p > 0.05). We suggest circulatory 4-HNE as an important parameter related to differences between RRMS and PMS. Significant interactions of MS course and other clinically relevant parameters with changes in redox processes associated with ferroptosis support the further investigation of MS with a larger sample while taking into account both circulatory and central nervous system estimation.

A pilot study of a virtual reality-based simulation platform for Neonatal Resuscitation Program training.

This pilot implementation study introduces a novel, neonatal-specific virtual reality (VR) simulation platform for resuscitation training and assesses its initial feasibility and reception in a neonatal intensive care unit setting. We developed a custom VR model simulating a resuscitation scenario for a 30-week neonate. Neonatal providers completed individualized training sessions and post-training surveys. Thirty-eight neonatal providers participated in the study. The VR platform was well-received, with 97% willing to use it again and 95% recommending it. Most participants (70.3%) found VR more realistic than traditional methods, with an average usefulness rating of 4.5/5. However, 40.5% reported adverse effects like eye strain and motion sickness. Feedback led to three significant VR platform upgrades. This study demonstrates strong enthusiasm for VR among neonatal providers. While promising, further research with larger samples and comparisons to traditional methods is needed to fully evaluate VR's effectiveness in neonatal resuscitation training.

Midwife students' attitudes towards violence against women: A pilot study.

The United Nations define violence against women (VAW) as any gender-based violence that causes mental, physical, or economic harm and restricts freedom. The topic has not been studied before in the context of the midwifery curriculum in Estonia. The purpose of the study is to investigate the attitudes of midwife students towards VAW. This pilot study followed a mixed-methods approach. The study population consisted of 77 midwifery students at Tallinn Health Care College from 2022-2023. The online survey was distributed to all Tallinn Health Care College midwifery students. The pilot study is used to validate the questionnaire and obtain initial information. The results show that the midwife students of this study have personal experiences and exposures to different types of violence, and some midwife students had sociocultural misconceptions about VAW. Midwife students have limited knowledge of the impact of violence on women's health and the legislation regarding violence. Midwife students stated that they would not be able to properly help the woman as a victim, as they lack knowledge, skills, and experience, which is an unfortunate factor. The present pilot study showed that midwife students' attitudes towards VAW need improvement. The study raises the need to investigate midwife students' attitudes towards VAW with a larger sample, better-designed method, and validated questionnaire. Topics related to violence should be included in the midwifery curriculum, along with developing practical skills.

Measuring Fidelity to Individual Placement and Support for Transition Age Youth: Psychometric Findings.

Individual Placement and Support (IPS), an evidence-based supported employment model for working-age adults with serious mental illness, also serves transition age adults (TAY; ages 16-24). The IPS-Y is a new IPS fidelity scale tailored to this younger population. Although adopted worldwide, it lacks research on the psychometric properties of its two components (employment and education). Six IPS programs serving TAY were assessed on IPS-Y (Employment) in an initial review (Time 1) and on both components in a second review one year later (Time 2). We examined scale calibration, reliability, and validity for the IPS-Y in this sample. Fidelity reviewers use the full range of ratings, from "not IPS" to "exemplary," on both IPS-Y components. On the employment component, item calibration was excellent; internal consistency reliability was good at Time 1 (r = .81) and test-retest reliability was fair (r = .63). The IPS-Y (Employment) showed excellent sensitivity to change, with the mean scale score increasing from 88.3 to 105.5. IPS-Y (Employment)item ratings at Time 2 were similar to corresponding items in a sample of conventional IPS programs using the standard IPS fidelity scale. Predictive validity was promising for both components, with fidelity scale ratings positively correlated with site-level competitive employment rates (r = .57) and education enrollment rates (r = .69). IPS can be implemented to good fidelity for programs serving TAY. Preliminary findings regarding the psychometric properties of the IPS-Y Employment are encouraging, but replication in larger samples is needed.

Comparing Cesarean Scar Defect Incidence After Locked and Unlocked Repair Methods Among Primiparous Patients: A Randomized Double-Blinded Trial.

To compare residual myometrial thickness (RMT) and cesarean scar defect (CSD) development after cesarean section using double-layer locked and unlocked closure techniques. We conducted a randomized double-blinded trial comparing double-layer locked and unlocked uterine closure techniques following cesarean section in primiparous women. The locked technique involved continuous suturing of the full myometrial thickness in the first layer, followed by back-and-forth needle maneuvering on both sides of the incision for the second layer. The unlocked method included running suturing of two-thirds of the myometrial thickness in the first layer, followed by suturing the upper half of the myometrial thickness in the second layer. Transvaginal ultrasonography was performed one year post-cesarean section, with RMT as the primary outcome and scar depth and width as secondary outcomes. Independent t-test and Chi-square test were utilized for statistical analysis. All 30 patients from the locked and 26 from the unlocked group in the follow-up were diagnosed with CSD (scar depth>2mm). The mean RMT for the unlocked and locked groups were 4.44±1.07mm and 4.12±0.48mm, respectively, showing no significant difference (p =0.14). There was also no significant difference in mean scar width between the locked and unlocked groups (3.68±1.44mm vs. 3.95±1.00mm, p =0.42). However, the mean scar depth was higher in the unlocked group (3.77±1.11 mm vs. 3.16±1.1mm, p =0.04). We have found no significant differences in the RMT and CSD prevalence between two-layered locked and unlocked uterine closure techniques, while the scar depth was greater in the unlocked group. Nonetheless, future randomized trials implementing larger sample sizes are required to precisely compare the outcomes of the double-layer locked and unlocked uterine suturing techniques.

Evaluation of Anogenital Distance and Anti-Müllerian Hormone Plasmatic Concentration as Potential Phenotypes to Predict Reproductive Performance in Holstein Heifers.

Anogenital distance (AGD) is a marker of the degree of prenatal exposure to androgens in multiple species, and it has been suggested that there is an inverse association between AGD and fertility. Therefore, the aim of this study was to determine the usefulness of AGD and anti-Müllerian hormone (AMH) concentrations, an indirect marker of the follicular population, as predictors of future reproductive potential in Holstein cattle. The AGD was measured in 566 females from 9 dairy farms in Galicia (Spain). A group of 172 females underwent a second measurement 9 months after. Additionally, data on the age at first insemination (1stAI age), number of AI (AI-PREG), age at first pregnancy (1stPREG age), age at first calving (1stCAL age), and calving-pregnancy (CAL-PREG) and calving-calving (CAL-CAL) intervals were collected. Blood samples were collected from 80 heifers to determine AMH concentrations. Our results showed that AGD varied minimally with age, and that cows with short AGD had earlier 1stAI age, 1stPREG age, and 1stCAL age (p < 0.05) than cows with long AGD. No significant differences were observed for the CAL-PREG and CAL-CAL intervals. Additionally, no significant association was found between AMH concentration and AGD or reproductive parameters. Consequently, the results suggest the possibility of using AGD as a marker of future reproductive performance in Holstein heifers. However, there was insufficient evidence to associate AMH concentrations and reproductive performance, underlining the need for further studies with larger sample sizes.

A Pilot Randomized Control Trial Testing a Smartphone-Delivered Food Attention Retraining Program in Adolescent Girls with Overweight or Obesity.

Attention bias (AB) toward food is associated with obesity, but it is unclear if programs designed to reduce AB can impact adolescents' eating behavior. We investigated whether a two-week, smartphone-delivered attention retraining (AR) program (vs a control program) altered food AB in adolescent girls with overweight. Participants completed three food-cue visual-probe trainings/day. The AR and control programs directed attention away from food stimuli during 100% and 50% of trainings, respectively. Before and after completion of the programs, girls completed a food-cue visual-probe task while undergoing magnetoencephalography (MEG), and then a laboratory test meal. Sixty-eight adolescents were randomized; 58 completed post-program visits. There was minimal effect of condition on AB scores (β [95%CI] = -1.9 [-20.8, 16.9]; d = -0.06). There was a small effect of condition on energy intake (EMMcontrol = 1017 kcal, EMMAR = 1088 kcal, d = 0.29). Within the AR group, there was slightly blunted initial engagement in brain areas associated with reward response and subsequent increased goal-directed attention and action control. We found preliminary support for efficacy of an intensive smartphone-delivered AR program to alter neural correlates of attention processing in adolescent girls with overweight or obesity. Studies with larger sample sizes are needed to elucidate if AR trainings disrupt the link between food AB and eating behavior.

Snow leopard phylogeography and population structure supports two global populations with single refugial origin

AbstractSnow leopards (Panthera uncia) inhabit the mountainous regions of High Asia, which experienced serial glacial contraction and expansion during climatic cycles of the Pleistocene. The corresponding impacts of glacial vicariance may have alternately promoted or constrained genetic differentiation to shape the distribution of genetic lineages and population structure. We studied snow leopard phylogeography across High Asia by examining range-wide historical and contemporary genetic structure with mitochondrial DNA and microsatellite markers. We genotyped 182 individuals from across snow leopard range and sequenced portions of the mitogenome in a spatially stratified subset of 80 individuals to infer historical biogeographic and contemporary patterns of genetic diversity. We observed a lack of phylogeographic structure, and analyses suggested a single refugial origin for all sampled populations. Molecular data provided tentative evidence of a hypothesized glacial refugia in the Tian Shan-Pamir-Hindu Kush-Karakoram mountain ranges, and detected mixed signatures of population expansion. Concordant assessments of microsatellite data indicated two global genetic populations, though we detected geographic differences between historical and contemporary population structure and connectivity inferred from mitochondrial and microsatellite data, respectively. Using the largest sample size and geographic coverage to date, we demonstrate novel information on the phylogeographic history of snow leopards, and corroborate existing interpretations of snow leopard connectivity and genetic structure. We recommend that conservation efforts incorporate genetic data to define and protect meaningful conservation units and their underlying genetic diversity, and to maintain the snow leopard’s adaptive potential and continued resilience to environmental changes.

Combination of oral anticoagulant and antiplatelet therapy does not change the 1-year prognosis compared to oral anticoagulant alone in stroke patients with atherosclerosis and atrial fibrillation

This study aims to evaluate the effectiveness of combined antiplatelet and oral anticoagulant (OAC) therapy versus OAC therapy alone on one-year post-stroke outcomes in patients with non-valvular atrial fibrillation (NVAF) and systemic atherosclerosis. A retrospective study was conducted using the recorded data of patients diagnosed with ischemic cerebrovascular disease between January 1, 2022, and January 1, 2023, at the Neurology Clinic, Afyonkarahisar Health Sciences University. Patients with non-valvular atrial fibrillation (NVAF) and systemic atherosclerosis were included in the study. Collected data included demographic information, medical history. Patients were divided into two groups based on the treatment regimen used at discharge: those receiving OAC alone and those receiving a combination of OAC and antiplatelet therapy. Clinical outcomes were evaluated within one year following the stroke. A total of 671 stroke patients were screened, and 565 (84.2%) had ischemic stroke. Among these, 113 (20%) had NVAF, and 53 had both NVAF and systemic atherosclerosis. Data from these 53 patients were analyzed. The mean age was 71.81±11.90 years, with a female gender ratio of 52.8%. Logistic regression analysis showed no statistically significant differences between the two treatment groups in terms of all-cause mortality, bleeding, recurrent stroke, and hemorrhagic stroke (p&gt;0.05 for all comparisons). The combination of antiplatelet and OAC therapy did not demonstrate superiority over OAC therapy alone in reducing the risks of recurrent ischemic stroke, hemorrhagic stroke, myocardial infarction, and mortality in patients with NVAF and systemic atherosclerosis. These findings suggest that OAC therapy alone may provide sufficient protection in this patient population. Prospective studies with larger samples are needed to confirm these results.

Exploring the Associations between Autistic Traits, Sleep Quality and Well-Being in University Students: A Narrative Review.

While research on autism spectrum disorder (ASD) has been growing, not enough research has been conducted to understand the impact of autistic traits and the broader autism phenotype (BAP), especially on the sleep quality and well-being of university students. The focus of this paper is to review the existing research on this topic and identify the key areas of interest for future research, presented in the form of a narrative review. While the review identifies the need for research on the topic, it also identifies other factors such as gender, age, culture, and internet and smartphone use that may have an impact on the relationship between autistic traits, sleep quality and well-being in university students. The review also identified the importance of using a larger sample size, appropriate measures, especially for quantifying autistic traits, and an appropriate analysis strategy involving a multivariate analysis.

Akkermansia muciniphila for the Prevention of Type 2 Diabetes and Obesity: A Meta-Analysis of Animal Studies

Background: More than half of the states in the U.S. report that over 30% of adults are obese. Obesity increases the risk of many chronic diseases, including type 2 diabetes, hypertension, and cardiovascular disease, and can even reduce one’s lifespan. Similarly, the prevalence of type 2 diabetes follows a comparable trend. As a result, researchers are striving to find solutions to reduce obesity rates, with a particular focus on gut health, which has been previously linked to both obesity and type 2 diabetes. Recent studies suggest that Akkermansia muciniphila (Akk) may have a positive probiotic effect on preventing the onset of type 2 diabetes and obesity. Methods: We conducted a quantitative meta-analysis of 15 qualified animal studies investigating the effects of Akk administration as a probiotic. Results: The statistical analyses showed that Akk administration significantly reduced body weight gain by 10.4% and fasting blood glucose by 21.2%, while also significantly improving glucose tolerance by 22.1% and increasing blood insulin levels by 26.9%. However, our analysis revealed substantial heterogeneity between the control and experimental groups across all subgroups. Conclusions: Overall, Akk appears to be effective at reducing the onset of type 2 diabetes and diet-induced obesity. Long-term studies with larger sample sizes are needed to confirm these beneficial effects, as the current animal studies were of short duration (less than 20 weeks).

Evaluating Surgical Accuracy in Bimaxillary Surgery: A Systematic Review and Meta-Analysis of Mandible-First versus Maxilla-First Approaches.

Mandible-first surgery (MdFS) has gained attention as an alternative to the traditional maxilla-first surgery (MxFS) in bimaxillary procedures. Given the distinct sequence of operations between these approaches, evaluating the clinical advantages of MdFS compared to MxFS is crucial for optimizing surgical decision-making. This systematic review and meta-analysis examine intraoperative achievability and postoperative stability between these two surgical approaches. A thorough literature search was performed using PubMed, Embase, Web of Science, and MEDLINE, covering articles published from 2013 to 2023. Studies included were retrospective, prospective, and randomized trials that compared the accuracy and/or stability of MdFS with MxFS. The primary endpoint for the meta-analysis was the standardized mean difference in surgical accuracy for translational movements, with a secondary focus on rotational accuracy. A total of 11 studies encompassing 712 patients met the inclusion criteria. The analysis suggested that MdFS might reduce accuracy in the sagittal dimension (CI, 0.05 to 0.74) but offered greater achievability in the vertical direction (CI, - 0.47 to - 0.07). Additionally, MdFS was associated with a relatively posterior (CI, - 1.18 to - 0.60) and inferior (CI, - 0.64 to - 0.07) positioning of the maxillomandibular complex. Despite certain limitations, our findings indicate that MdFS can achieve clinical outcomes similar to MxFS in terms of both accuracy and stability. However, further researches with larger sample sizes and more rigorous study designs are necessary to validate these conclusions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .

Mitochondrial haplogroup R offers protection against obesity in Kuwaiti and Qatari populations.

The Kuwaiti and Qatari populations have a high prevalence of obesity, a major risk factor for various metabolic disorders. Previous studies have independently explored mitochondrial DNA (mtDNA) variations and their association with obesity in these populations. This study aims to investigate the role of mtDNA haplogroups and variants in obesity risk among these Gulf populations. Whole exome sequencing data from 1,112 participants (348 Kuwaitis and 764 Qataris) were analyzed for mtDNA variants. Participants were classified as obese or non-obese based on body mass index (BMI). Association analyses were performed to examine the relationship between mtDNA haplogroups and obesity, adjusting for covariates such as age and sex. Haplogroup R was found to be protective against obesity, with an odds ratio (OR) of 0.69 (p = 0.045). This association remained significant after adjusting for age and sex (OR = 0.694; 95% CI: 0.482-0.997; p = 0.048). Several mtDNA variants, particularly those involved in mitochondrial energy metabolism, showed nominal associations with obesity, but these did not remain significant after correcting for multiple testing. Haplogroup R consistently demonstrates a protective association against obesity in both Kuwaiti and Qatari populations, highlighting its potential as a biomarker for obesity risk in the Gulf region. However, further research with larger sample sizes is needed to validate these findings and clarify the role of mtDNA variants in obesity.

Late-onset chylothorax after lung cancer surgery: clinical characteristics, management, and prevention.

The clinical characteristics and management of late-onset chylothorax after lung cancer surgery remained unknown. Here we aimed to provide evidence on the management of late-onset chylothorax by analysis of several cases with the largest sample size. We retrospectively collected clinical data of patients who developed late-onset chylothorax after lung cancer surgery and were re-admitted by a single surgeon in our center from 2016 to 2022. The clinical characteristics and management for these patients were analysed. The role of Hem-o-lok clipping after lymphadenectomy in preventing late-onset chylothorax was further explored by comparing the surgical outcomes between treated group and control group. A total of six patients who were re-admitted for late-onset chylothorax after lung cancer surgery were included for analysis. The mean age of them was 60.7 years old. The symptom of late-onset chylothorax was mainly dyspnea and cough and the diagnosis was all made by Sudan III staining between postoperative day 17 to 42. All patients were firstly treated with thoracocentesis and low-fat diet with intravenous nutrition. Four patients were successfully managed with low-fat diet and thoracocentesis, while the other two patients were further managed with pleurodesis with 50% glucose fluid solution. We found a significantly decreased risk of late-onset chylothorax in the treated group with improved procedure of applying Hem-o-lok clipping after lymphadenectomy than in the control group (0% versus 2.6%, P < 0.01). Late-onset chylothorax after lung cancer surgery was a rare and negligible complication, which may usually be managed by non-surgical methods. Hem-o-lok clipping during lymphadenectomy seemed to be an effective method to prevent late-onset chylothorax after lung cancer surgery.

"Revolutionizing retrosigmoid surgical precision: AI in free bone flap reconstruction".

Free bone flap reconstruction is essential to the retrosigmoid method of microvascular decompression (MVD) and can completely transform surgical methods worldwide. According to studies like Liao et al. (2023), 92.3% of patients report feeling better after receiving treatment. The study by Shize Li et al. emphasizes the affordability and accessibility of free bone flap reconstruction, demonstrating shorter recovery times, lower expenses, and similar rates of complications to those of conventional fixation techniques. With benefits like fewer headaches and a quicker recovery in the free bone flap group, their retrospective analysis of 189 patients showed no significant differences in hospital stay or complication rates between the fixed and unfixed bone flap groups.Despite these results, larger sample sizes and longer-term studies are needed to confirm these findings and address issues such as leakage of cerebrospinal fluid. Furthermore, adding Artificial Intelligence (AI) to this method may improve accuracy and results. AI has the potential to enhance MVD procedures and patient outcomes through its capacity to create 3D models, direct bone flap placement, and track postoperative progress. Standardizing AI's application in clinical practice still presents difficulties, though. In the end, even though Shize Li et al.'s research significantly advances the body of knowledge already in existence, more creativity and investigation are required to maximize free bone flap reconstruction in MVD.

Risk factors-adjusted performance and persistence during the post-subprime crisis period: evidence from Indian mutual fund industry

PurposeThe main objective of the paper is to find evidence of abnormal returns and performance persistence of actively managed equity funds in the Indian context on an annual basis during the post-subprime crisis period between 2009 and 10 and 2019 and 2020.Design/methodology/approachThe study is exploratory and empirical, used daily net asset value (NAV) of 180 equity funds for 10 years and applied the risk-adjusted, Jensen's (1968) single-factor, Fama and French's (1993) three-factor model and Carhart's (1997) four-factor model to evaluate the performance. The performance persistence has been tested using cross-section regression (Bollen and Busse, 2005), the non-parametric contingency approach, along with the robustness measure, i.e. Malkiel's (1995) Z-score, Brown and Goetzmann's (1995) cross-product ratio (CPR) and Kahn and Rudd's (1995) χ2 value.FindingsThe results show that the Indian equity funds are unable to generate abnormal returns, and the size, value and momentum strategies applied by the fund managers in generating abnormal returns do not work effectively. However, funds provide strong evidence of significant performance persistence on an annual basis in the short-term, mid-term and long-term periods. Both parametric as well as non-parametric tests provide identical evidence of persistence, and the performance persistence is independent of the choice of models, as all the models (i.e. two, three or four-factor models) provide significant evidence of persistence.Research limitations/implicationsThough the study is comprehensive and covered a longer period, there is a scope for future research by examining the influence of fund characteristics, fund rating and macroeconomic factors on performance and persistence. It can be extended over to a longer period covering the post-COVID-19 period, a larger sample size and a comparative study of Indian and foreign mutual funds (MFs).Practical implicationsThe outcomes of this research paper can help wealth-maximizing investors in the identification of persistent equity funds and can apply the previous period’s performance information as a useful investment strategy to generate higher returns in the future. We believe that these outcomes will have significant ramifications for all MF stakeholders and policymakers, especially for the Indian industry in ensuring and establishing the credibility of MF managers, in providing better returns as well as to make MF investment more attractive to Indian retail investors.Originality/valueDespite the exponential growth in the Indian MF industry, limited evidence is available on performance and persistence covering a large sample size during the post-sub-prime crisis period using different return models and parametric and non-parametric approaches. The study is based on the daily data set of a larger sample size representing all the Asset Management Company (AMC) and the longer period following the post-subprime crises, which affected capital flows significantly. Moreover, the application of all the measures enables us to understand performance persistence in a larger context.

Efficacy and Safety of MUC1 Antigen-Specific Vaccine as a Breakthrough Solution in the Treatment of Advanced Non-Small Cell Lung Cancer

Introduction: Non-Small Cell Lung Cancer (NSCLC) is the leading cause of death for cancer patients globally. Most of the patients are diagnosed in advanced stage that can only receive conventional chemotherapy with low overall survival and low progression-free survival outcomes. With the advancement of technology, researchers have discovered that antigen-specific vaccine could be utilized to fight tumor cells. MUC1 antigen-specific vaccine is a novel solution that has been proved to be specific and accurate against NSCLC. In this study, we would like to present current best evidences regarding the efficacy and safety of MUC1 antigen specific vaccine in battling NSCLC. Methods: Literature search was conducted on databases, namely PubMed, Scopus, Cochrane, Science Direct, EBSCOhost, and Google Scholar up to August 27th 2022. Our inclusion criteria include randomized controlled trials in patients with advanced stage NSCLC, given MUC1 antigen-specific vaccine as treatment, compared to placebo as control group, and measured the efficacy in terms of overall survival and progression-free survival, quality of life, and adverse events. Results and discussion: Six randomized controlled trials were included in this review. Overall, longer overall survival and progression-free survival is observed in all studies. However, significance differed from study to study. This could be attributed to different patient characteristics and chemotherapy regimens used. MUC1 antigen-specific vaccine is more effective in patients who received concurrent chemoradiotherapy, high sMUC1 and ANA level, and non-squamous tumor type. Minimum adverse events were reported and incidence is similar with the control group. No negative impact on quality of life was observed. Conclusion: MUC1 vaccine showed a promising impact on improving patients’ overall survival and progression-free survival while ensuring patient’s safety. However, further studies with larger sample size are recommended on more specific populations, for instance, patients with concurrent chemotherapy.

Genetic risk score for coronary artery calcification and its predictive ability for coronary artery disease

AimThe modest added predictive value of the existing genetic risk scores (GRSs) for coronary artery disease (CAD) could be partly due to missing genetic components, hidden in the genetic architecture of intermediate phenotypes such as coronary artery calcification (CAC). In this study, we investigated the predictive ability of CAC GRS for CAD. Materials and methodsWe investigated the association of CAC GRSs with CAD and coronary calcification among the participants in the Ludwigshafen Risk and Cardiovascular Health study (LURIC) (n = 2742), the Tampere Vascular Study (TVS) (n = 133), and the Tampere Sudden Death Study (TSDS) (n = 660) using summary data from the largest multi-ancestry GWAS meta-analysis of CAC to date. Added predictive value of the CAC GRS over the traditional CVD risk factors as well as metaGRS, a GRS for CAD constructed with 1.7 million genetic variants, was tested with standard train–test machine learning approach using the LURIC data, which had the largest sample size. ResultsCAC GRS was significantly associated with CAD in LURIC (OR=1.41, 95 % CI [1.28–1.55]), TVS (OR=1.79, 95 % CI [1.05–3.21]) as well as in TSDS (OR=4.20, 95 % CI [1.74–10.52]). CAC GRS showed strong association with calcification areas in left (OR=1.78, 95 % CI [1.16–2.74]) and right (OR=1.71, 95 % CI [1.98–2.67]) coronary arteries. There was statistically significant added predictive value of the CAC GRS for CAD over the used traditional CVD risk factors (AUC 0.734 vs 0.717, p-value = 0.02). Furthermore, CAC GRS improved the prediction accuracy for CAD when combined with metaGRS. ConclusionsThis study showed that CAC GRS is a new risk marker for CAD in three European cohorts, with added predictive value over the traditional CVD risk factors.

Cardiometabolic Morbidity (Obesity and Hypertension) in PTSD: A Preliminary Investigation of the Validity of Two Structures of the Impact of Event Scale-Revised.

Background: Posttraumatic stress disorder (PTSD) and/or specific PTSD symptoms may evoke maladaptive behaviors (e.g., compulsive buying, disordered eating, and an unhealthy lifestyle), resulting in adverse cardiometabolic events (e.g., hypertension and obesity), which may implicate the treatment of this complex condition. The diagnostic criteria for PTSD have lately expanded beyond the three common symptoms (intrusion, avoidance, and hyperarousal). Including additional symptoms such as emotional numbing, sleep disturbance, and irritability strengthens the representation of the Impact of Event Scale-Revised (IES-R), suggesting that models with four, five, or six dimensions better capture its structure compared to the original three-dimensional model. Methods: Using a convenience sample of 58 Russian dental healthcare workers (HCWs: mean age = 44.1 ± 12.2 years, 82.8% females), this instrumental study examined the convergent, concurrent, and criterion validity of two IES-R structures: IES-R3 and IES-R6. Results: Exploratory factor analysis uncovered five factors, which explained 76.0% of the variance in the IES-R. Subscales of the IES-R3 and the IES-R6 expressed good internal consistency (coefficient alpha range = 0.69-0.88), high convergent validity (item total correlations r range = 0.39-0.81, and correlations with the IES-R's total score r range = 0.62-0.92), excellent concurrent validity through strong correlations with the PTSD Symptom Scale-Self Report (PSS-SR: r range = 0.42-0.69), while their criterion validity was indicated by moderate-to-low correlations with high body mass index (BMI: r range = 0.12-0.39) and the diagnosis of hypertension (r range = 0.12-0.30). In the receiver-operating characteristic (ROC) curve analysis, all IES-R models were perfectly associated with the PSS-SR (all areas under the curve (AUCs) > 0.9, p values < 0.001). The IES-R, both hyperarousal subscales, and the IES-R3 intrusion subscale were significantly associated with high BMI. Both avoidance subscales and the IES-R3 intrusion subscale, not the IES-R, were significantly associated with hypertension. In the two-step cluster analysis, five sets of all trauma variables (IES-R3/IES-R6, PSS-SR) classified the participants into two clusters according to their BMI (normal weight/low BMI vs. overweight/obese). Meanwhile, only the IES-R, PSS-SR, and IES-R3 dimensions successfully classified participants as having either normal blood pressure or hypertension. Participants in the overweight/obese and hypertensive clusters displayed considerably higher levels of most trauma symptoms. Input variables with the highest predictor importance in the cluster analysis were those variables expressing significant associations in correlations and ROC analyses. However, neither IES-R3 nor IES-R6 contributed to BMI or hypertension either directly or indirectly in the path analysis. Meanwhile, age significantly predicted both health conditions and current smoking. Irritability and numbing were the only IES-R dimensions that significantly contributed to current smoking. Conclusions: The findings emphasize the need for assessing the way through which various PTSD symptoms may implicate cardiometabolic dysfunctions and their risk factors (e.g., smoking and the intake of unhealthy foods) as well as the application of targeted dietary and exercise interventions to lower physical morbidity in PTSD patients. However, the internal and external validity of our tests may be questionable due to the low power of our sample size. Replicating the study in larger samples, which comprise different physical and mental conditions from heterogenous cultural contexts, is pivotal to validate the results (e.g., in specific groups, such as those with confirmed traumatic exposure and comorbid mood dysfunction).

Measuring psychological immersion through cardiovascular response measures in subtitled films

Abstract This paper presents a conceptual replication of Kruger et al.’s (2017a) study, investigating the utility of heart rate (HR) and heart rate variability (HRV) indicators as objective measurements of psychological immersion in subtitled audiovisual products. The study employed a quasi-experimental design in ten participants viewing video clips with and without subtitles, while their physiological responses were monitored. Results suggest lower arousal levels in both conditions compared to baseline, with statistically significant differences observed in mean HR, mean RR, and RMSSD for the subtitles condition. While most inferential tests did not yield significant outcomes, descriptive trends indicate decreased arousal relative to the baseline. They also show increased arousal throughout the clip for most indicators and opposing trends for Mean HR, RMSSD and LF/HF between the two conditions. Methodological suggestions include using multiple data points for HR and HRV analysis, exploring ultra short-term measurements, selecting self-contained clips for viewing, and considering post-task baselines for a more accurate resting state representation. Despite limitations due to the small sample size, this study underscores the potential of HR and HRV as measures of immersion in translated audiovisual products, emphasising the need for larger sample sizes in future research to enhance statistical power and generalizability.