Large Population Research Articles

Can the number of confirmed COVID-19 cases be predicted more accurately by including lifestyle data? An exploratory study for data-driven prediction of COVID-19 cases in metropolitan cities using deep learning models.

The COVID-19 outbreak has significantly impacted human lifestyles and life patterns. Therefore, data related to human social life may tell us the increase or decrease in the number of confirmed COVID-19 cases. However, although the number of confirmed cases is affected by social life, it is difficult to find studies that attempt to predict the number of confirmed cases using various lifestyle data. This paper attempted an exploratory data analysis to see if the number of confirmed cases could be predicted more accurately by including various lifestyle data. We included taking public transportation, watching a movie at the cinema, and accommodation at a motel in the lifestyle data. Finally, a 'lifestyle addition' set was constructed that added lifestyle data to the number of past confirmed cases and search term frequency data. The deep learning algorithms used in the analysis are deep neural networks (DNNs) and recurrent neural networks (RNNs). Performance differences across data sets and between deep learning models were tested to be statistically significant. Among metropolitan cities in South Korea, Seoul (9.6 million) with the largest population and Busan (3.4 million) with the second largest population had the lowest error rate in 'lifestyle addition' set. When predicting with the 'lifestyle addition' set, in Seoul, the error rate was reduced to 20.1%, and in Busan, the graph of the actual number of confirmed cases and the predicted graph were almost identical. Through this study, we were able to identify three notable results that could contribute to predicting the number of patients infected with epidemic in the future.

Simulation and applicability evaluation of providing different grades of water based on household functional needs in urban areas.

Providing different grades of water is a promising solution to address the challenges of urban water supply, including water quality, quantity, and energy consumption. However, quantifying the effectiveness of this strategy and understanding its economic, environmental, and social impacts remain significant challenges. This study introduces a simulation-based method to predict household water use and evaluate the applicability and sustainability of the water supply system. A system dynamics model was developed to simulate household water behavior under different water supply scenarios, incorporating different water quality combinations, price mechanisms, and regional population composition. The results were analyzed regarding the optimal water completion degree, user satisfaction, water supply yield, and water volume stability to evaluate the system's applicability. Our findings suggest that scenarios involving simultaneous provision of high-quality and common water are deficient due to overlapping functions. In addition, a dynamic water pricing mechanism can improve user satisfaction and supply stability, especially in the area with a large population. Concurrent supply of high-quality, low-quality, and reclaimed water emerges as an efficient alternative, achieving dual objectives of resource conservation and water quality improvement.

A comparative cohort study of post-COVID-19 conditions based on physical examination records in China.

Coronavirus disease-2019 (COVID-19), caused by SARS-CoV-2 virus infection, is characterized as a multisystem disease, potentially yielding multifaceted consequences on various organs at multiple levels. At the end of 2022, over 90% of the Chinese population was infected by SARS-CoV-2 within 35 days because of adjustments to epidemic prevention and control policies. This short-term change provides an unprecedented opportunity for comparative studies on COVID-19 infection among large populations. In this study, the physical examination data of 136,713 people in the past three consecutive years was employed to study the impact of COVID-19. Standard physical examination data, comprising evaluations of nearly a hundred indicators, were investigated for a comprehensive assessment of COVID-19's effect on human health. The results suggested that most indicators remained stable or changed within a permissible range after the COVID-19 outbreak in December 2022, but several specific indicators presented abnormal patterns of varying durations. There was an observed increase in the fraction of T-wave abnormalities during the outbreak, especially in people with chronic diseases such as hypertension, liver steatosis, and hyperglycemia. These findings highlighted the impact of COVID-19 on cardiovascular health and its potential interaction with chronic diseases. This work was supported by the National Key Research and Development Program of China (2019YFE0108100), the National Natural Science Foundation of China General Program (82270159, 82070147).

Acquired gene alterations potentially related to resistance to anti-HER2 therapy in HER2-positive metastatic colorectal cancer (mCRC).

277 Background: While HER2-targeted therapies benefit patients (pts) with advanced HER2-positive mCRC, the development of resistance remains inevitable. This study aims to explore the landscape and frequency of genetic alterations putatively associated with acquired resistance to anti-HER2 therapy in HER2-positive mCRC. Methods: In this retrospective-multicenter international study involving Mayo Clinic, Duke Cancer Center and National Cancer Center Hospital East (Japan), we descriptively compared comprehensive genomic analyses from tissue or blood samples of pts with HER2-positive CRC pre-treatment and post-treatment with HER2-targeting agents. Results: A total of 36 pts were included in this study. 29 (80%) had HER2-positive mCRC as confirmed by immunohistochemistry (IHC) and fluorescent in situ hybridization (ISH), the remaining pts had HER2 amplification detected on blood or tissue . 34/36 (94%) pts were administered their first anti-HER2 agent after progressing on ≥2 prior lines of treatment. The most common anti-HER2 regimen administered was trastuzumab/pertuzumab (50%, 18/36), followed by trastuzumab-tyrosine kinase inhibitors (TKIs) (tucatinib or neratinib) (30%, 11/36) and trastuzumab deruxtecan (14%, 5/36). Putative genomic mechanisms of acquired resistance were detected in 72% (26/36), while the remaining pts lacked new genomic alterations that might explain resistance to anti-HER2 therapy, suggesting alternative escape mechanisms. Acquired alterations in downstream or alternate bypass pathways were identified in 72% (26/36) of pts; most commonly in the RAS/RAF pathway and in EGFR (34.6%, 9/26 each), followed by 27% (7/26) of pts with MET point mutations (mts) and amplification; activating muts in PI3K/AKT and in 27% (7/26), most commonly CDK12 (60%, 4/7) . HER2 receptor alterations were detected in 3 pts (8.3%), all of whom received trastuzumab-tucatinib and included HER2 L755S, HER2 V777L, HER2 D769Y, HER2 G727A and HER2 S310F, which are known to cause resistance to , however, information about tucatinib resistance is not yet available. Other altered pathways included AR, RB, NOTCH and HRD. Two pts lost HER2 expression on blood and tissue NGS post anti-HER2 therapy. Conclusions: The emergence of resistance might be in part related to acquired alterations that constitutively activate signaling pathways parallel or downstream of HER2, bypassing HER2 inhibition. Additional histologic studies, deep mutational scanning, larger populations and correlative analysis are needed to validate these findings.

Is there a relationship between vitamin D levels and graft versus host disease?

Vitamin D deficiency is common in adult patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT). Since vitamin D is an important regulatory factor for the immune system, vitamin D deficiency may have effects on antitumor activity, relapse rates, graft versus host disease (GVHD) occurrence and infection rates in allo-HSCT. We aimed to investigate the effects of vitamin D levels on the outcome of allo-HSCT. This study included 211 patients who underwent allo-HSCT at seven transplant centers in Türkiye. The impact of pretransplant vitamin D level on overall survival (OS), relapse rate, GVHD occurrence and engraftment times was analyzed retrospectively RESULTS: Pretransplant vitamin D levels were not related to the neutrophil engraftment day (p: 0.887), relapse rate (p: 0.433) and GVHD occurrence (p: 0.391). At a median follow-up of 14 months, OS was 84.8 % and median OS was not reached. Univariate Cox Regression analysis showed that higher levels of vitamin D (>12 ng/mL) affected the survival rates (p = 0.029) (HR: 0.392: 95 % CI: 10.170-0.907). In our study, pretransplant vitamin D levels were not related to GVHD occurrence, relapse rate and engraftment times. However, we found that higher levels of pretransplant vitamin D levels (threshold is 12 ng/mL) were associated with increased survival. Further studies with a larger population are necessary to reveal the role of vitamin D in patients undergoing allo-HSCT.

Patient-reported outcomes in physical, cognitive, and sexual health in early-onset gastrointestinal cancers (EOGIC).

72 Background: Incidence of early-onset (ages 18-49) gastrointestinal cancers is alarmingly increasing. To assess unmet needs in health-related quality of life (HRQoL), we conducted this pilot study using PRO measures in patients with EOGIC. Methods: Patients ages 18-49 with any GI cancer seen at our center during a clinic visit were invited to participate in this cross-sectional study. Validated PRO tools PROMIS 29+2, GP5 from FACT-G, AYA Sexual Health PRO Battery and Adult Neuro-QOL Cognitive Function short form were administered. Participants’ PROMIS 29+2 responses were scored to generate a T score, and two-tailed t-tests were used to compare T scores with the average score from a large general US population. The electronic medical record was reviewed to collect demographic, diagnosis and treatment information. Results: 39 (85% response rate) patients were enrolled from 03-08/24. Table 1 describes demographics, diagnoses, and treatment. In the PROMIS 29+2, EOGIC patients reported significantly lower physical function and higher anxiety, depression, fatigue and pain interference compared to the general US population: t-score (T-test p-value) 40.4 (p 0.0003), 57.7 (p 0.005), 55.7 (p 0.017), 55.1 (p 0.033) and 58.5 (p 0.0001), respectively. 56% reported being at least somewhat “bothered by side effects of treatment,” and this measure has a known correlation with clinician reported adverse events. Regarding sexual health (SH) in prior 30 days, 79% of participants felt less whole or “damaged” due to their disease, 64% were sexually active, 56% had some distress due to change in SH, and 50% were worried about their romantic relationship(s). Patients identified discussing safe sex with low counts, body image, contraception and addressing sexual problems as areas of unmet need during their care. They reported not receiving counseling from their care teams: only 15% discussed safe sex with low counts, 28% contraception, 13% STI prevention, and 18% discussed effect of cancer on body image. No significant change in cognitive functioning over the preceding 7 days was reported in this study. Conclusions: PROs are an important tool in clinical and survivorship care of young patients with GI cancers. We discovered that decreased physical function, increased anxiety, depression, fatigue and pain significantly effect HRQoL patients with EOGIC. We also found high unmet need to address sexual health in patients with EOGIC. Our ongoing work aims to better understand and address these needs for our patients. Demographic, diagnostic, and therapeutic characteristics of participants. Age At study participation 24-49 median 43 Gender Female 26 66.7% Primary cancer Colorectal 19 48.7% Pancreatic 5 12.8% Biliary tract cancers 5 12.8% Esophageal/Gastric 3 7.7% Other (including anal, NET, GIST, appendiceal) 7 17.9% Stage Metastatic 22 56.4% Treatment On any active treatment 24 61.5% On chemotherapy 20 51.2%

Unveiling the seasonal transport and exposure risks of atmospheric microplastics in the southern area of the Yangtze River Delta, China.

This study investigates the prevalence and impacts of suspended atmospheric microplastics (SAMPs) in the coastal metropolitan city of Ningbo in the Yangtze River Delta Region, China. The sampling was conducted at both urban centre and urban-rural fringe areas, near the coast but distant from large urban populations. SAMP abundance ranged from 0.017 to 0.430 items m-³, with an average of 0.145±0.09 items m⁻³. The urban centre exhibited approximately 70% more SAMPs than the urban-rural fringe, highlighting the influence of population density and human activity on microplastic pollution. Fibres dominated SAMP composition at both sites, while urban samples featured a greater variety of microplastic forms, such as fragments, beads, and films. Rayon and Polyethylene terephthalate were the predominant polymers, which were found to be directly related to local industrial activities. SAMPs ranged in size from 20μm to 4984.4μm, with over 60% smaller than 1000μm. Seasonal variation followed a winter>autumn>spring>summer pattern. Correlation and principal component analyses identified atmospheric temperature, pressure, wind speed, and rainfall as key factors influencing SAMP abundance. Notably, backward trajectory analysis showed that oceanic air masses carried significantly fewer SAMPs compared to terrestrial air, diluting concentrations in coastal regions. Annually, an estimated 4.67×101³ microplastics are suspended over Ningbo. This is the first comprehensive study of SAMP pollution in this region, revealing interactions between local sources, environmental variations, air mass dynamics, and exposure. The findings underscore the need for targeted strategies to mitigate atmospheric microplastic pollution in coastal urban environments.

Dissociable ventral and dorsal sensorimotor functional circuits linking the hypomanic personality traits to aggression via behavioral inhibition system.

Hypomanic personality traits (HPT) are susceptibility markers for psychiatric disorders, particularly bipolar disorder, and are strongly associated with aggressive behaviors. However, the neuropsychological mechanisms underlying this association remain unclear. This study utilized psychometric network analysis and Inter-Subject Representation Similarity Analysis (IS-RSA) to explore the neuropsychological circuits that link HPT to aggression in a large non-clinical population. Psychometric network analysis (n = 716) identified two key nodes: the Behavioral Inhibition System (BIS) and mood volatility, a core dimension of HPT. We observed a positive correlation between mood volatility and aggression, with BIS serving as a mediating factor. Task-based functional imaging (n = 53) further revealed a double dissociation between the dorsal (dSMC) and ventral (vSMC) sensorimotor cortices to HPT, specifically during the processing of reward magnitude and delay in a delayed reward paradigm. Functional patterns within these regions mediated the relationship between individual differences in mood volatility and aggression, with BIS acting as a mediator through parallel pathways. Resting-state functional imaging (n = 505) replicated this functional segregation and revealed distinct integrative patterns: the dSMC was functionally connected to the frontoparietal network (FPN) and the vSMC to the sensorimotor network (SMN). These circuits collectively mediated the associations among mood volatility, aggression, and BIS. These findings highlight the critical role of sensorimotor circuits and BIS in understanding the neuropsychological pathways linking HPT-related mood volatility to aggression.

Effects of disease aetiology on outcomes for unresectable HCC treated with lenvatanib or atezobev: A real world retrospective study.

554 Background: Hepatocellular Carcinoma (HCC) is the most common primary liver cancer and a leading cause of cancer-death worldwide. 1 Standard of care first line treatment for unresectable HCC is Atezolizumab plus Bevacizumab (AtezoBev) 1 while the multi-kinase inhibitor Lenvatinib 2 is also available in the first line setting. No randomised studies have compared these treatments directly. Real world data suggests similar overall survival (OS) with AtezoBev possibly superior in patients with a viral hepatitis aetiology and Lenvatinib superior in NAFLD. 3,4,5,6,7 Methods: We evaluated patients treated with Lenvatinib or AtezoBev in a retrospective cohort of patients who commenced first-line treatment in the West of Scotland from 04/12/2015 to 28/11/2023. 102 received Lenvatinib and 52 AtezoBev. We collected data on progression free survival (PFS), OS, demographics and disease aetiology- classified primarily as viral hepatitis, acholic liver disease (ALD) or NAFLD. Results: AtezoBev patients had improved mOS compared with Lenvatinib (13.8 vs 9. 1 months, p = 0.04). No statistically significant differences were observed in mPFS (5.5 vs 3.5 months, p = 0.31). Of the three aetiologies considered, the only statistically significant (p<0.05) difference between the treatments was OS in the NAFLD group (24.1 vs 9.1 months, p = 0.04). When considering patient demographic and disease factors, Child-Pugh score was most significant. Patients with Childs=5 liver disease had much longer OS and PFS compared with Childs≥6 disease. Similarly, patients with ECOG PS=0 had improved survival than PS≥1. There were no statistically significant (p<0.05) differences between AtezoBev and Lenvatinib. Age, sex and social deprivation (SIMD) score had minimal effects on survival although high levels of social deprivation and male sex were over-represented in our population. Conclusions: In contrast to other real world analyses, our patients demonstrated improved mOS with Atezo/Bev vs Lenvatinib. 3 However, mPFS was similar for the two regimes. The difference in OS may be explained by differences in patient selection, with the Lenvatinib group disproportionately representing patients with a poorer performance status (PS>0) and higher Childs-Pugh scores (CP>5). Furthermore, patients in the AtezoBev group who progressed were often offered Lenvatinib second-line, possibly improving mOS, whereas Lenvatinib patients who progressed were offered either Sorafenib, a clinical trial or best supportive care. However, we cannot rule out a direct survival benefit from the use of AtezoBev vs Lenvatinib in the first line setting. The choice of first line therapy for HCC remains complex and must account for patient preferences such as convenience and side effect profile in addition to observed trial outcomes and the increasing body of real world evidence. 1. Finn RS et. al. Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma. N. Engl. J. Med. 2020 May 14;382(20):1894-1905. 2. Kudo, Masatoshi et. al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet. 2018. Volume 391, Issue 10126, 1163 – 1173. 3. Wang, BC. et. al. Lenvatinib Versus Atezolizumab Plus Bevacizumab in the First-Line Treatment for Unresectable Hepatocellular Carcinoma: A Meta-Analysis of Real-World Studies. Targ. Oncol. 2024. 19, 203–212. 4. Casadei-Gardini A et. al. Atezolizumab plus bevacizumab versus lenvatinib for unresectable hepatocellular carcinoma: a large real-life worldwide population. Eur. J. Cancer. 2023; 180:9-20. 5. Rimini M et. al. Atezolizumab plus bevacizumab versus lenvatinib or sorafenib in non-viral unresectable hepatocellular carcinoma: an international propensity score matching analysis. ESMO Open. 2022 Dec;7(6):100591. 6. Su CW et. al. Similar efficacy and safety between lenvatinib versus atezolizumab plus bevacizumab as the first-line treatment for unresectable hepatocellular carcinoma. Cancer Med. 2023. 12(6):7077-7089. 7. Rimini, M., et al. Survival outcomes from atezolizumab plus bevacizumab versus Lenvatinib in Child Pugh B unresectable hepatocellular carcinoma patients. J. Cancer. Res. Clin. Oncol. 2023. 149, 7565–7577.

Sex-specific anatomical variation of circle of Willis arteries.

Anatomical variations in the circle of Willis (CoW) arteries are common and can affect hemodynamic stress, thereby influencing the risk of cerebrovascular pathology. Previous studies have suggested sex differences in CoW anatomy, but findings vary due to limited study population size and different measurement methods. This study aims to investigate sex differences in artery diameters, anatomical variants and bifurcation angles of the CoW using a large population cohort and semi-automatic measurements. Sex-specific CoW anatomical variations were assessed using Magnetic Resonance Angiography (MRA) scans of 1,052 individuals without intracranial vascular abnormalities. Diameters and bifurcation angles of large CoW arteries (>1.2 mm) were measured with a semi-automatic tool. Diameters of smaller anterior communicating artery (Acom) and posterior communicating arteries (Pcoms) and the anatomical variants of the CoW were determined manually. Generalized Linear Models (GLMs) and logistic regression models with adjustments for covariates were used to compare anatomical variations between sexes. Men exhibited larger diameters in all semi-automatically measured CoW arteries. A complete anterior CoW was more prevalent in men than women, while there was no difference for the posterior CoW. Aplasia/hypoplasia of the Acom was more prevalent in women. Aplasia/hypoplasia of one Pcom was more common in women, while aplasia/hypoplasia of both Pcoms was more common in men. No sex differences were found in CoW bifurcation angles and in the occurrence of fetal-type posterior cerebral arteries. This study identified significant CoW differences in artery diameters and anatomical variants between sexes, while bifurcation angles between arteries were comparable. Future research should investigate the association between these sex-specific CoW variations and cerebrovascular pathology.

Click Reaction Inspired Enzyme Inhibitors in Diabetes Care: An Update in the Field of Chronic Metabolic Disorder.

Diabetes is a chronic metabolic disorder that impacts all age groups and affects a large population worldwide. Humans receive glucose from almost every food source, and after absorption from the gut, it reaches the liver, which functions as the distribution center for it. The insulin-responsive glucose transporter type 4 (GLUT-4) is a major carrier of glucose to the various cells (majorly expressed in myocytes, adipocytes, and cardiomyocytes) in a well-fed state. In fasting periods, the glucose supply is maintained by glycogenolysis and gluconeogenesis. In diabetes, the distribution of glucose is hampered due to several reasons. Furthermore, to treat this disorder, several drugs have been synthesized, and click chemistry plays an important role. A more recent concept for producing pharmaceuticals with a click chemistry approach makes any reaction more practical and stereospecific, along with a higher yield of products and a smaller number of by-products. This approach comprises a compiled study of the activity of numerous compelling antidiabetic drugs containing 1, 2, 3-triazole derivatives supported by click chemistry. In this review, we discuss the synthetic antidiabetic drugs made via click chemistry and their commendable role in improving diabetes care.

Range expansion in Western Pygmy Blue butterfly Brephidium exilis (Boisduval), with records from the Red Sea coast and north-west Saudi Arabia (Lepidoptera: Lycaenidae)

The Western Pygmy Blue Brephidium exilis (Boisduval), a North American butterfly that began its overseas expansion in Arabia more than thirty years ago, was recently observed for the first time at two sites in the western part of the Kingdom of Saudi Arabia: (i) a wintertime record of a few individuals in near-freezing temperatures at a peri-agricultural site outside the northwestern desert city of Tabuk, and (ii) a large population among extensive urban landscaping along the central Red Sea coast north of Jeddah, similar to sites where it flourishes in eastern Arabia. These observations (a) fill a large observational gap in the expanding range of this non-native species in the Middle East, South-west Asia and even North Africa; (b) demonstrate the breadth of its ecological tolerance; and (c) indicate its potential for continued dispersal, including the possibility that it may already be established at other urban sites in the growing cities in the west of the Kingdom.

Abnormal characteristics of inferior vena cava and abdominal aorta among neonates with early onset septic shock

BackgroundThe variety of shocks in neonates, if not recognized and treated immediately, is a major cause for fatality. The use of echocardiography may improve assessment and treatment, but its reference values across gestational age (GA) and birth weight (BW) are lacking. To address the information gap, this study aimed at correlating GA and BW of newborns with nonhemodynamic abnormalities, and at evaluating the usefulness of such reference values in neonates with early onset septic (EOS) -shock.MethodsA total of 200 normal newborns were enrolled as controls and subdivided into groups based on GA, BW, days of age, and patent ductus arteriosus (PDA). Echocardiography was used to document inferior vena cava diameter (IVC), inferior vena cava collapsibility index (IVC-CI), and inferior vena cava to abdominal aorta ratio (IVC/AO). In addition, 18 neonates with EOS shock were recruited and evaluated using echocardiography.ResultsAmong the control newborns, IVC and AO were significantly increased with GA and BW (P < 0.05) but IVC-CI and IVC/AO did not correlate with GA, BW, day of age, and PDA. Compared to the control group, the EOS-shock group had significantly decreased IVC and IVC/AO, and increased IVC-CI (P < 0.05). The cut-off values for indicating EOS-shock were > 34.15% for IVC-CI, < 47.58% for IVCmin/AO, and < 66.11% for IVCmax/AO.ConclusionsThe IVC-CI, IVCmin/AO, and IVCmax/AO indices are applicable to all neonates. Although the number of neonates with EOS-shock in our study is small, the cut-off values showed usefulness for diagnosis. Further research is needed to determine the application of the indices in a larger population and among other populations, especially for clinical application in treatment of shock among neonates.

Help-seeking for depression among Vietnamese migrant workers in Japan and factors related to their intentions to seek help from a psychiatrist: a cross-sectional study

BackgroundForeign workers are at risk for depression, and Vietnamese people tend to be reluctant to seek professional mental health care. Although Vietnamese people are the largest population among foreign workers in Japan, evidence concerning their help-seeking experiences and strategies to promote help-seeking in this population is lacking. This study aimed to identify the percentage of Vietnamese migrant workers in Japan who have sought help from healthcare professionals for depressive symptoms and to explore the factors related to their intentions to seek help from a psychiatrist.MethodsAn online questionnaire was administered to Vietnamese migrants working in Japan from October 5, 2021, to November 1, 2021. Patient Health Questionnaire-9 (PHQ-9) scores were calculated to measure the severity of the respondents’ depression. Help-seeking experiences related to depressive symptoms were also investigated. The General Help-Seeking Questionnaire Vignette Version (GHSQ-V) was modified and adapted to measure the respondents’ intention to seek help from a psychiatrist for depressive symptoms. To investigate the factors related to help-seeking intention, potential factors were selected from literature reviews and discussions with professionals in the field. Descriptive statistics were calculated, and multiple logistic regression analysis was conducted.ResultsA total of 803 eligible data points were collected. Among the 53.5% of participants who scored 10 or more on the PHQ-9, 4.4% had sought help from a healthcare professional in Japan. A lower preference for coping on one’s own, greater recognition of the effectiveness of help, greater ability to make work adjustments, and a higher level of Japanese language proficiency were related to greater intentions to seek help from a psychiatrist.ConclusionsMany Vietnamese migrant workers in Japan are unable to seek help from healthcare professionals for depressive symptoms. It may be beneficial to acknowledge not only linguistic barriers but also other related factors when planning strategies to enhance Vietnamese migrant workers’ intentions to seek help from psychiatrists.

Use of Preoperative Spinal Angiography in Severe Spinal Deformity Patients Who Require Thoracic 3 Column Osteotomy: A Case Series and Review of the Literature.

Three-column osteotomy (3CO) offers substantial spinal deformity correction. Thoracic neurovascular bundle sacrifice is often required, and anterior spinal artery (ASA) perfusion can be compromised. Spinal angiography allows localization of variable ASA vascular contribution. This study's objective was to describe a series of patients who underwent preoperative spinal angiography and discuss the impact on surgical planning and execution of thoracic 3CO for deformity correction. Patients who underwent preoperative spinal angiograms and thoracic 3CO for deformity correction were reviewed. Preoperative, angiographic, and postoperative information was recorded. A literature review on preoperative spinal angiography in deformity surgery was performed. Eight patients were identified: single-level pedicle subtraction osteotomies (1), single-level vertebral column resections (2), and multilevel vertebral column resections (5). The average age was 40.0 years, and 75.0% were female. Thoracic scoliosis ranged from 0 to 105° preoperatively and 0 to 45.1° postoperatively. Thoracic kyphosis ranged from 29° to 120° preoperatively and 20.6° to 54.9° postoperatively. Twelve ASA supply vessels were identified bilaterally in 6 patients. Four patients had nontraditional ASA supply at T4 (1), T6 (1), and L2 (2), and 4 had multiple ASA feeders. Based on angiographic results, osteotomy site was changed (1), and neurovascular bundles were spared (2), a 37.5% rate of surgical plan alteration. There were no permanent neuromonitoring changes or postoperative neurologic deficits. No articles reported on using spinal angiography specifically for deformity surgery. Spinal angiography is low risk and provides critical information regarding ASA supply to potentially mitigate ischemic risk during neurovascular bundle takedown during thoracic 3CO. Further case series are warranted to evaluate the benefits in larger populations, but its clinical applications appear practical.

Economic loss attributable to premature deaths and morbidity among adolescents in India and its states

BackgroundIndia’s large youth population presents a significant opportunity to harness the demographic dividend. The disease burden in adolescents could be a hindrance for the future economy if not appropriately addressed.MethodsWe utilised the data on the number of adolescent deaths and attributable years lived with disability (morbidity) in every state of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. We estimated the economic impact as the cost of lost output due to premature adolescent deaths and morbidity for every state of India in 2021, using an output-based method. The cost of lost output is reported in US Dollars (USD) and as a percentage of Gross Domestic Product (GDP) for all diseases/conditions together, and separately for communicable diseases (CDs), non-communicable diseases (NCDs), and injuries.ResultsThe lost output from premature deaths and morbidity attributable to adolescents was USD 9.87 (95% CI 9.04–10.71) and USD 28.13 (95% CI 20.53–37.71) billion respectively, in India in 2021. The total economic loss of USD 38.01 billion (95% CI 29.57–48.41) was 1.30% (1.01–1.65) of India’s GDP. The total economic loss as a percentage of the state’s GDP varied 3.42 times between the states in 2021, ranging from 2.43% in Bihar to 0.71% in Sikkim. The total economic loss due to CDs, NCDs, and injuries was estimated at 0.45%, 0.69% and 0.16% of India’s GDP in 2021, with significant variations across the states.ConclusionsStrengthening the Indian Adolescent Health Strategy to address the diseases/ conditions contributing most to the total economic loss is needed to facilitate substantial avoidance of the high economic losses attributable to adolescent premature deaths and morbidity in India.

Population imaging of internal state circuits relevant to psychiatric disease: a review.

Internal states involve brain-wide changes that subserve coordinated behavioral and physiological responses for adaptation to changing environments and body states. Investigations of single neurons or small populations have yielded exciting discoveries for the field of neuroscience, but it has been increasingly clear that the encoding of internal states involves the simultaneous representation of multiple different variables in distributed neural ensembles. Thus, an understanding of the representation and regulation of internal states requires capturing large population activity and benefits from approaches that allow for parsing intermingled, genetically defined cell populations. We will explain imaging technologies that permit recording from large populations of single neurons in rodents and the unique capabilities of these technologies in comparison to electrophysiological methods. We will focus on findings for appetitive and aversive states given their high relevance to a wide range of psychiatric disorders and briefly explain how these approaches have been applied to models of psychiatric disease in rodents. We discuss challenges for studying internal states which must be addressed with future studies as well as the therapeutic implications of findings from rodents for improving treatments for psychiatric diseases.

Thoracic Aortic Three-Dimensional Geometry

Background: Aortic structure impacts cardiovascular health through multiple mechanisms. Aortic structural degeneration occurs with aging, increasing left ventricular afterload and promoting increased arterial pulsatility and target organ damage. Despite the impact of aortic structure on cardiovascular health, three-dimensional (3D) aortic geometry has not been comprehensively characterized in large populations. Methods: We segmented the complete thoracic aorta using a deep learning architecture and used morphological image operations to extract multiple aortic geometric phenotypes (AGPs, including diameter, length, curvature, and tortuosity) across various subsegments of the thoracic aorta. We deployed our segmentation approach on imaging scans from 54,241 participants in the UK Biobank and 8,456 participants in the Penn Medicine Biobank. Conclusion: Our method provides a fully automated approach towards quantifying the three-dimensional structural parameters of the aorta. This approach expands the available phenotypes in two large representative biobanks and will allow large-scale studies to elucidate the biology and clinical consequences of aortic degeneration related to aging and disease states.

Evaluating Pediatric NAFLD with Controlled Attenuation Parameter: A Comprehensive Narrative Review

Non-alcoholic fatty liver disease (NAFLD) in the pediatric population has emerged as a significant health concern due to its alarming rise in prevalence. In children, the characteristics of the disease differ from those seen in adults. NAFLD may progress to more severe liver disease in children compared to adults with similar profiles. Liver biopsy remains the gold standard for diagnosis; its invasive nature and high cost limit its use as a first-line tool. Alternatively, magnetic resonance imaging (MRI) techniques, such as magnetic resonance imaging-estimated liver proton density fat fraction (MRI-PDFF), have shown a good correlation with the degree of histological steatosis, although their use is limited by high costs and limited accessibility. Controlled attenuation parameter (CAP), integrated with vibration-controlled transient elastography (VCTE) (FibroScan®), is a novel non-invasive, accessible, and effective method for diagnosing hepatic steatosis. In this article, we reviewed the existing literature on the diagnostic accuracy of CAP in pediatric NAFLD. The PubMed and EMBASE databases were searched. Seven relevant studies were identified, conducted in pediatric hospital populations with specific demographic characteristics. Two of these studies compared CAP with liver biopsy, one compared CAP with liver biopsy and MRI-PDFF, and the remaining four compared CAP with MRI. Overall, CAP proved to be accurate in detecting the presence or absence of fatty infiltration, positioning it as a promising tool to simplify the diagnosis of NAFLD in children. However, further studies in larger populations are needed to confirm these findings and facilitate its implementation in routine clinical practice.

Environmental variability across space and time drives the recolonization pattern of a historically persecuted large carnivore

Wildlife populations are not static. Intrinsic and extrinsic factors affect individuals, which lead to spatiotemporal variation in population density and range. Yet, dynamics in density and their drivers are rarely documented, due in part to the inherent difficulty of studying long-term population-level phenomena at ecologically meaningful scales. We studied the spatiotemporal density dynamics in a recolonizing large carnivore population, the wolverine Gulo gulo, across the Scandinavian Peninsula over nine years. We fitted open-population spatial capture-recapture models to noninvasive genetic sampling data collected across Norway and Sweden to estimate annual density surfaces and their drivers. This approach allowed us to model sex-specific changes in wolverine density and the effect of landscape-level environmental determinants over time. Our results revealed that, as wolverines successfully recolonized many parts of their historical range in Scandinavia, the relationship with spatial determinants of density has changed over time. We also found support for sex-specific responses of the Scandinavian wolverine to the environmental determinants of density and differences in the temporal dynamics of their relationships, indicating disproportionate recolonization ability and anthropogenic pressures. We observed significant changes in the relationship of female wolverine density with several determinants during the study period, suggesting still ongoing expansion of female wolverines whereas males might have already reached the range limits. These findings show that the Scandinavian wolverine population is still recovering from centuries of persecution and severe range contraction. Our study sheds light on the dynamics and challenges of recolonizing large carnivores in human-dominated landscapes across time and space.