Long-duration Group Research Articles

The effects of varying negativity and presentation duration of images on formation of false memories

Studies about“False memory” are developing in the field of cognitive psychology. This study aims to investigate the interplay between presentation duration, negativity, and the presence of misinformation in the formation of false memories. Participants were exposed to slides of varying emotional valences (negative and neutral) and presentation durations (long and short), followed by questions containing either target or false options (either “critical lures” or “foil”. Confidence levels for each response were also recorded. The study found that subjects were more prone to false memories when presented with misinformation in the form of critical questions, especially when the slides were negatively valenced. Furthermore, confidence levels for artificially generated false memories were significantly higher in the long-duration group but lower in the short-duration group. These findings suggest that the presence of misinformation and the emotional valence of the stimuli significantly influence the formation of false memories.

Time patterns in online survey completion and offline psychological symptoms among college students in China.

Online psychological surveys allow for swift data collection among college students, thus providing a foundation for psychological interventions, particularly during emergent public health events. However, the association between online survey completion behaviors and offline psychological symptoms has yet to be explored. A large-scale web-based survey was conducted from December 31, 2022, to January 7, 2023, involving 22,624 participants. Psychological symptoms were assessed using standardized measures, while the time taken to complete the survey and the time of completion were recorded by the online survey platform. As the time duration increased, the prevalence of anxiety, depression, insomnia, and PTSD also increased significantly (P for trend < 0.001). The highest odds ratios were observed in the longer duration group. Only a longer duration was significantly associated with PTSD. The time period for completing the questionnaire from 7 p.m. to 10 p.m. was found to be significantly linked with anxiety symptoms and depression symptoms. Conversely, completing the questionnaire at other times was specifically associated with anxiety symptoms and insomnia symptoms. The prolonged duration needed to complete the questionnaire was more closely related to the comorbidity of anxiety, depression, and insomnia than to the comorbidity of those symptoms with PTSD. When questionnaires were completed during other times, specifically referring to the late-night and early morning hours, individuals were more likely to exhibit comorbid symptoms of insomnia. The study identified the specific associations between time durations, time points for completing online survey, and psychological symptoms/comorbidity among college students. Further exploration of their causal relationships and the underlying mechanisms is warranted.

The Effects of Longer Use of Teriparatide on Clinical and Radiographic Outcomes after Spinal Fusion in Geriatric Patients.

Background: Teriparatide is an anabolic agent for osteoporosis and is believed to improve the bone healing process. Previous studies showed that teriparatide could enhance not only fracture healing but also spine fusion. It has been reported that use of teriparatide could promote the spine fusion process and decrease mechanical complications. However, there was no consensus regarding optimal treatment duration. The purpose of this study was to compare surgical outcomes between short-duration and long-duration teriparatide treatment after lumbar fusion surgery in elderly patients. Materials and Methods: All consecutive patients older than 60 years who underwent 1-level lumbar fusion surgery for degenerative diseases between January 2015 and December 2019 were retrospectively reviewed. Based on the duration of teriparatide treatment (daily subcutaneous injection of 20 µg teriparatide), patients were subdivided into two groups: a short-duration (SD) group (<6 months) and a long-duration (LD) group (≥6 months). Mechanical complications, such as screw loosening, cage subsidence, and adjacent vertebral fractures, were investigated. Postoperative 1-year union rate was also evaluated on computed tomography. Clinical outcomes were recorded using visual analog scale (VAS) and Oswestry Disability Index (ODI). Between-group differences for these radiographic and clinical outcomes were analyzed. Results: Ninety-one patients were reviewed in this study, including sixty patients in the SD group and thirty-one patients in the LD group. Their mean age was 72.3 ± 6.2 years, and 79 patients were female. Mean T-score was -3.3 ± 0.8. Cage subsidence (6.7% vs. 3.2%), screw loosening (28.3% vs. 35.5%), and adjacent vertebral fracture (6.7% vs. 9.7%) were not significantly different between the SD and LD groups. Union rate at 1-year postoperative was 65.0% in the SD group and 87.1% in the LD group (p = 0.028). Both groups showed improvement in VAS and ODI after surgery. However, the differences of VAS from preoperative to 6 months and 1 year postoperative were significantly higher in the LD group. Conclusions: Longer teriparatide treatment after lumbar fusion surgery resulted in a higher union rate at 1-year postoperative than the shorter treatment. Also, it could be more beneficial for clinical outcomes.

Short versus long duration of ceftaroline combination therapy and outcomes in persistent or high-grade MRSA bacteremia: A retrospective single-center study.

Methicillin-resistant Staphylococcus aureus (MRSA) is associated with high mortality rates. Despite antibiotic therapy, persistent bacteremia is challenging to treat. Combination therapy with ceftaroline has emerged as a potential treatment option; however, the optimal duration and clinical implications after bacteremia clearance are unknown. This retrospective cohort study examined patients with high-grade or persistent MRSA bacteremia who were treated with ceftaroline combination therapy at the University of New Mexico Hospital between January 2014 and June 2021. Patients were categorized into short- (<7 days) or long-duration (≥7 days) groups based on the duration of combination therapy after bacteremia clearance. Outcomes included 30-day all-cause mortality, bacteremia recurrence, post-bacteremia clearance length of stay, and adverse events. A total of 32 patients were included in this study. The most common sources of bacteremia were bone/joint and endovascular (28.1%, 9/32 each). The median duration of combination therapy after clearance was seven days (IQR 2.8, 11). Patients in the long-duration group had a lower Charlson comorbidity index (1.0 vs 5.5, p = 0.017) than those in the short-duration group. After adjusting for confounders, there was no significant difference in the 30-day all-cause mortality between the groups (AOR 0.17, 95% CI 0.007-1.85, p = 0.18). No association was found between combination therapy duration and recurrence (OR 2.53, 95% CI 0.19-inf, p = 0.24) or adverse drug events (OR 3.46, 95% CI 0.39-74.86, p = 0.31). After controlling for total hospital length of stay, there was no significant difference in the post-bacteremia clearance length of stay between the two groups (p = 0.37). Prolonging ceftaroline combination therapy after bacteremia clearance did not significantly improve outcomes in patients with persistent or high-grade MRSA bacteremia. The limitations of this study warrant cautious interpretation of its results. Larger studies are needed to determine the optimal duration and role of combination therapy for this difficult-to-treat infection.

Effect of lateral wedge insole on medial meniscus extrusion and its association with knee osteoarthritis progression.

Medial meniscus extrusion (MME) is associated with knee osteoarthritis (OA) progression because of increased loading stress in the medial compartment of the knee. Using a lateral wedge insole (LWI) decreases loading stress and immediately reduces MME. To investigate whether the wearing duration of LWI affects the midterm response to MME and is associated with knee OA progression. Cohort study. Twenty-three patients with knee OA who were conservatively treated with LWI were classified according to the duration of the LWI wear per day: less than 5 h (short-duration group) or over 5 h (long-duration group). MME was evaluated in the single-leg standing position by ultrasound. Knee OA progression and limb alignment were evaluated radiographically. These evaluations were performed thrice: at the initial office visit as a baseline without LWI (time 0), with LWI (LWI-time 0), and 1 year after intervention with LWI (LWI-1 year). In both groups, the MMEs at LWI time 0 were significantly decreased compared with those at time 0. In the long-duration group, this reduction in MME was maintained 1 year after the intervention compared with time 0 (time 0: 3.9 ± 0.9, LWI-1 year: 2.6 ± 1.1), but this improvement was not observed in the short-duration group (time 0: 3.8 ± 1.7, LWI-1 year: 3.6 ± 1.7). In addition, three of four patients demonstrated OA progression, and varus alignment had significantly progressed compared with that at time 0 in the short-duration group. However, the long-duration group showed OA progression only in one patient and maintained limb alignment. The duration of wearing LWI affects the midterm reduction of MME and knee OA progression while maintaining limb alignment.

Expression of BAX and eNOS in Rabbit Pancreatic Tissues Injured by Hydrocortisone

Background: There have been cases of acute pancreatitis brought on by steroids, but identifying it is challenging and necessitates careful monitoring. However, according to new research, 3–5% of all cases of illness may be caused by drug-induced acute pancreatitis, making it the third most common cause. Objective: Evaluation of the effect of hydrocortisone injections on pancreatic structure immunohistochemically using BAX and eNOS markers. Methods: White New Zealand female rabbits weighing between 1.2 and 1.5 kg were used, and they were given free access to food. The rabbits were split into six groups, with five animals in each group receiving intramuscular hydrocortisone injections for 14 and 21 days, respectively, at a dose of 5 mg and 20 mg/kg for short and long durations, and two control groups. Results: There was an increase in weight in both long-duration groups (GL1 and GL2) after week 2 of injection when compared to both control and short-duration groups. There was a highly statistical difference in the expression of BAX in both short- and long-duration groups compared to the control group, and there was also a decrease in the expression of BAX when duration increased. Similarly, there was a highly statistical difference in the expression of eNOS in both the GS and GL groups when compared to the control group. Conclusions: The pancreas can be injured by high and low doses of hydrocortisone if used for more than 2 weeks.

Prevalence and predictors of developing vision-threatening diabetic retinopathy within the first three years of type 2 diabetes.

To investigate the prevalence of diabetic retinopathy (DR) and vision-threatening DR (VTDR) in patients with type 2 diabetes mellitus (T2DM) stratified by the duration of diabetes and to identify the clinical variations and risk factors for VTDR occurring at different stages of T2DM. This was a retrospective comparative study. Patients were divided into short- (≤3 years), intermediate- (3-7 years), and long-duration (>7 years) groups. All patients were followed-up for DR and VTDR development. Risk factors were explored using logistic regression analysis. A total of,2961 patients were included; among them, 1,036 (35.0%) patients developed DR, and 293 (9.9%) had VTDR. The frequency of VTDR in patients who developed DR in the short-duration group was significantly higher than that in the intermediate-duration group (25.7% vs. 15.0%; p = 0.019), but comparable with that of the long-duration group (25.7% vs. 31.8%; p = 0.138). Patients who developed VTDR within the first 3 years of T2DM were more likely to have a family history of diabetes (p = 0.024), had higher glycated hemoglobin (p = 0.025), were males (p = 0.042), and were notably older at the onset of diabetes (p <0.001) but younger when diagnosed with DR (p <0.001). Moreover, higher glycated hemoglobin (OR = 1.14; 95% CI: 1.00-1.29; p = 0.043) and diabetic nephropathy (DN) (OR = 2.31; 95% CI: 1.08-4.91; p = 0.030) were independent risk factors for developing VTDR during the first 3 years of T2DM. The risk of DR is not high in persons with ≤3 years' duration of T2DM, however, if afflicted, the risk of VTDR should never be neglected. More frequent retinal screening is warranted in patients with newly diagnosed T2DM.

Neuromotor variability partially explains different endurance capacities of expert pianists

During fatiguing piano tasks, muscle fatigue develops differently between expert pianists. Differences in neuromotor strategies employed could explain a slower rate of fatigue development. The objective was to compare muscle activation and kinematic variabilities between ShortDuration (i.e., pianists with less endurance) and LongDuration groups. Results from 49 pianists showed that EMG activation variability of most shoulder and upper limbs muscles was greater for the ShortDuration group with time during two piano fatiguing tasks, namely Digital and Chord tasks. Segment acceleration variability, assessed using inertial measurement units, was also greater with time for the ShortDuration group at the right arm during the Digital task, and at the thorax and head during the Chord task. Finally, thorax lateroflexion variability increased with time for the LongDuration group (but not the ShortDuration group) during the Digital task. During the Chord task, wrist flexion variability was higher for the LongDuration group compared to the ShortDuration group. These results showed a direct effect of time on the pianists’ acceleration variability and EMG activation variability. In contrast, a protective effect of fatigue development could be attributed to kinematic variability. Results also suggest a higher risk of injury among pianists in the ShortDuration group.

Risk Factors for Diabetic Retinopathy in Chinese Patients with Different Diabetes Duration: Association of C-Peptide and BUN/Cr Ratio with Type 2 Diabetic Retinopathy.

Controlling the risk factors was the most effective strategy to prevent diabetic retinopathy (DR). This study aimed to recognize the risk factors of DR, and explores whether the effect of those factors is modified by diabetes mellitus (DM) duration. A total of 1058 DM patients with information about DR assessment were included. DR was measured by a complete ophthalmic examination and was classified as having one or more distinct microaneurysms in the eyes. Data from the lab and clinical factors were gathered. Multivariate logistic analysis was used to examine the risk factors, and the best-fitting model was selected by a backward stepwise based on A1C. In the current study, 274 (25.9%) patients developed DR. In the entire subjects, baseline age, the level of C-peptide, and urinary creatinine were all presented as protective effects of DR, whose odds ratios (ORs) and 95% confidence intervals (CIs) were 0.79 (0.62, 0.99), 0.75 (0.61, 0.91), and 0.70 (0.52, 0.93), respectively. Conversely, systolic pressure (SBP), urinary albumin, and BUN/Cr ratio were the important risk factors for DR with ORs (95% CIs) 1.21 (1.01, 1.46), 1.55 (1.30, 1.84), and 1.33 (1.11, 1.59), respectively. In stratification analysis, females with higher SBP would be more likely to develop DR in the short-duration group, while C-peptide and urinary creatinine showed protective effects in the long-duration group. BUN/Cr ratio all presented as a risk factor, with ORs 1.38 (p = 0.041) and 1.33 (p = 0.014) in short- and long-duration groups, respectively. Although renal functions presented a significant association with DR in all DM patients, the risk factors of DR varied widely in different disease-duration subjects. Target strategies to prevent DR should be put forward individually, considering the patient's DM duration. Improving the BUN/Cr ratio may be beneficial to delaying DR.

Underutilization of Mineralocorticoid Antagonists in Patients With Heart Failure With Reduced Ejection Fraction

BackgroundIt is unknown how the efficacy and safety of mineralocorticoid receptor antagonists vary according to duration of heart failure with reduced ejection fraction (HFrEF). ObjectivesIn this study, we sought to evaluate the safety and efficacy of eplerenone according to duration of HFrEF. MethodsIn the EMPHASIS-HF trial, 3 patient groups were created according to HFrEF duration: <1 year, 1 to <5 years, and ≥5 years. The primary outcome was the composite of heart failure (HF) hospitalization or cardiovascular death. Outcomes were adjusted for prespecified prognostic variables and examined with the use of Cox regression models. ResultsThe numbers of patients in each group were: 975, <1 year; 769, 1 to <5 years; and 988, ≥5 years. Patients with longer-standing HF were older and more frequently had cardiovascular and noncardiovascular comorbidities. The rate of the primary outcome (per 100 person-years) increased with HFrEF duration: 9.8 (95% CI: 8.4-11.4) for <1 year, 13.5 (95% CI: 11.6-15.7) for 1 to <5 years, and 17.6 (95% CI: 15.6-19.8) for ≥5 years. The benefits of eplerenone were consistent across HF duration: HRs for the primary outcome were 0.57 (95% CI: 0.42-0.79) for <1 year, 0.81 (95% CI: 0.60-1.10) for 1 to <5 years, and 0.61 (95% CI: 0.48-0.78) for ≥5 years; Pinteraction = 0.24. The absolute benefit was greatest in the longest-duration group: the number needed to treat for the primary outcome was 14 for <1 year, 13 for 1 to <5 years, and 10 for ≥5 years duration. ConclusionsPatients with longer-standing HFrEF had worse clinical status and a higher rate of events, but the benefit of eplerenone was consistent regardless of HFrEF duration. (A Comparison of Outcomes in Patients in NYHA Class II Heart Failure When Treated With Eplerenone or Placebo in Addition to Standard Heart Failure Medicines [EMPHASIS-HF]; NCT00232180)

Duration of Symptoms Does Not Significantly Influence Short-term Outcomes for Patients Undergoing Periacetabular Osteotomy.

Factors influencing the clinical outcomes after periacetabular osteotomy (PAO) have not been well explored. This study evaluated the influence of symptom duration in developmental dysplasia of the hip on short-term patient-reported outcomes after PAO. A retrospective review of prospectively collected data identified PAOs performed on 139 patients. Sixty-five patients were then stratified into two groups based on preoperative symptom duration: 2 years or less (n=22) vs more than 2 years (n=43). We compared the results of hip-specific patient-reported outcome surveys collected preoperatively and postoperatively. When comparing the two groups, we found no significant differences in clinical outcome scores except for the UCLA Activity Scale. The shorter duration group achieved improvement 6 months postoperatively on the visual analog scale average pain score (from 4.5 to 2.167; P=.0017), International Hip Outcome Tool-12 (from 42.95 to 59.19; P=.0176), and Harris Hip Score (from 53.88 to 69.88; P=.049). The longer duration group also achieved postoperative improvement across multiple surveys. Nevertheless, a multivariate analysis controlling for age, sex, and body mass index and found that symptom duration did not independently affect the change in clinical outcomes. Although PAO leads to improvements in functional status and pain, preoperative symptom duration does not significantly affect these clinical outcomes. [Orthopedics. 2023;46(6):365-372.].

Clinical characteristics and risk factors analysis of viral shedding time in mildly symptomatic and asymptomatic patients with SARS-CoV-2 Omicron variant infection in Shanghai.

To analyze the clinical characteristics and risk factors of viral shedding time in mildly symptomatic and asymptomatic patients with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant (BA.2 and BA2.2) infection in Shanghai, and the effect of traditional Chinese medicine (TCM) treatment, so as to provide a reference basis for epidemic prevention, control and clinical treatment. A total of 6,134 asymptomatic or mildly symptomatic Omicron-infected patients admitted to Tianhua Road fangcang shelter hospital in Jinshan, Shanghai, between April 2022 and May 2022 were included. Demographic characteristics and clinical histories were collected and compared in subgroups according to the different durations of viral shedding. Spearman's correlation analysis was performed to explore the association between virus shedding time and clinical variables. Multiple linear regression was used to evaluate the risk factors for viral shedding time. Most patients with asymptomatic and mildly symptomatic Omicron infection were male, and more than half of patients had a viral shedding time of 8-15 days. The patients were divided into three groups according to the time of viral shedding: short-duration (≤ 7 days), intermediate-duration (8-15 days) and long-duration group (≥16 days). The proportion of patients aged ≤ 29 years was the highest in the short-duration group (30.2%), whereas the proportion of patients aged 50-64 yeas was the highest in the long-duration group (37.9%). The proportion of patients with the chronic non-communicable diseases among the short-, intermediate- and long-duration groups was 6.2, 9.4, and 14.9%, respectively. Among them, hypertension was the most found (4.9, 7.8, and 11.7%, respectively). By multivariate analyses, we identified that viral shedding time of Omicron variants was independently negatively correlated with male patients, TCM treatment, and manual laborers, while it was independently positively associated with age and hypertension. Additionally, TCM treatment could significantly shorten the length of viral shedding time, especially for men, age ≥30 years, comorbid chronic non-communicable diseases, unemployed people and manual worker. Our results suggested that age and hypertension were independent risk factors for the duration of viral shedding in asymptomatic and mildly symptomatic omicron infected patients. TCM can effectively shorten viral shedding time.

Effect of Vitamin E on Serum Creatinine level on Gentamicin Induced Nephrotoxicity in Long Evans rats

Background: The kidneys are one of the vital organs of our body to excrete metabolic waste products, drugs and chemicals in the form of urine. Objectives: This study was carried out to observe the effect of Vitamin E on gentamicin-induced nephrotoxicity by assessing serum creatinine level in Long Evans rats. Materials and Methods: The experimental study was carried out on 40 Long Evans rats of both sex with the weight ranges from 172-255 gm and the age ranges from 7 to 10 weeks. The rats were divided into four groups- Group A (control) received normal saline, group B, C and D received gentamicin for 6 days, rats of group C received vitamin E capsule for 9 days with gentamicin whereas, group D received vitamin E capsule with gentamicin for total 10 days. Serum creatinine level was measured at the end of experiment. Results: The mean (mean+ SD) serum creatinine levels in group A, B, C and D were 0.98+0.34, 2.36+ 0.44, 1.39+0.18 and 1.30+0.18 respectively. The differences between the groups were highly significant (p&lt;0.001) in group A&amp;B, B&amp;C and B&amp;D whereas the difference between C&amp;D was not significant (p&gt;0.50). Serum creatinine level on the normal saline control (group A) was within normal limit (0.98mg/dl). Serum creatinine level in gentamicin treated (group B) rats were more in comparison to gentamicin and vitamin E treated rats (group C&amp;D) and pretreatment with longer duration group (group D) showed lower serum creatinine level than the shorter one (group C) though there was no significant difference. Conclusion: Vitamin E treatment showed some protective effects against gentamicin induced nephrotoxicity. The results also indicated that effectiveness of vitamin E depends on a suitable duration of pretreatment for better protection against gentamicin-induced nephrotoxicity. KYAMC Journal Vol. 13, No. 03, October 2022: 149-152

408: EVALUATING LENGTH OF ANTIMICROBIAL THERAPY FOR NECROTIZING SOFT TISSUE INFECTIONS

Introduction: Necrotizing soft tissue infections (NSTI) result in severe tissue destruction. Mainstay of treatment is surgical debridement and antimicrobial therapy. There are no definitive recommendations regarding the duration of antibiotics for NSTI. This study aims to evaluate length of antimicrobial therapy following optimal source control. Methods: This was a retrospective medical chat review in a five-hospital system. Patients treated for an NSTI (January 2015 to December 2021) were identified. Adult patients who received treatment for a diagnosed NSTI with >1 debridement and concomitant antimicrobials were included. Patients who received a short (≤12 days) duration of antimicrobial therapy following source control were compared to long (>12 days) duration. Primary efficacy endpoint was the Necrotizing Infection Clinical Composite Endpoint (NICCE), defined as patients alive at day 28, receiving < 3 debridements before day 14 and no amputations beyond the first debridement, and mSOFA < 1 at day 14. Results: 969 patients were identified via ICD codes with 52 patients meeting inclusion criteria. Median age was 52.5 years (IQR 45.8-62.3) with 32 patients (61.5%) having diabetes mellitus. Patients in the short-duration group were older with lower incidence of immunocompromising conditions and more likely to have lower limb infections. The median antibiotic durations were 7.0 (IQR 5.5-9.0) and 30.0 (IQR 20.0-40.0) days. The most common antimicrobials initiated were vancomycin (94.2%), piperacillin-tazobactam (76.9%), and clindamycin (65.4%), with a median number of antimicrobials of 5 (IQR 5-6) vs. 5 (IQR 4-6.3) for the short and long-duration groups, respectively. A smaller proportion of patients achieved the NICCE endpoint in the short-duration group (40.0% vs. 56.8%). The short duration of antibiotics was associated with a lower incidence of achieving clinical cure, defined as resolution of fever and leukocytosis, on day 14 (46.7% vs. 67.6%) and increased number of wound debridements after hospital discharge (40.0% vs. 13.5%). There was no major difference in ICU admissions, ICU and hospital lengths of stay, 90-day inpatient readmissions or time between readmissions. Conclusions: This study provides a descriptive report for characteristics associated with more extended antibiotic regimens for NSTI.

Impact of S-1 adjuvant chemotherapy longer than 6months on survival in patients with resected pancreatic cancer: a nationwide survey by the Japan Pancreas Society based on real-world data.

Based on the Japan Adjuvant Study Group of Pancreatic Cancer 01 study, the standard duration of adjuvant chemotherapy with S-1 (an oral 5-fluorouracil prodrug consisting of tegafur, gimeracil, and oteracil) in patients with resected pancreatic ductal adenocarcinoma (PDAC) was considered to be 6months, but the impact of increasing its duration on postoperative survival was unknown. Here, the authors investigated this question by reviewing real-world data from a large cohort of patients with PDAC. In total, 3949 patients who underwent surgery for PDAC during the study period followed by S-1 adjuvant chemotherapy in board-certified institutions were included. Based on the duration of S-1 chemotherapy, two subgroups were defined: a standard-duration group that included patients who were treated for 180±30days and a longer duration group that included patients who received treatment for >210days. The median duration of S-1 chemotherapy was 167days, with a mean±standard deviation of 200±193days. After excluding patients who had a recurrence within 210days after the initiation of adjuvant chemotherapy, postoperative recurrence-free survival (RFS) and overall survival (OS) in the standard-duration group (n=1473) and the longer duration group (n=975) were compared. RFS and OS did not differ significantly between the standard-duration and longer duration groups (5-year RFS: 37.8% vs. 36.2% respectively; p=.6186; 5-year OS: 52.8% vs. 53.4%, respectively; p=.5850). The insignificant difference was verified by multivariate analysis and propensity-score matching analysis. The current findings suggest that extending S-1 adjuvant chemotherapy beyond 6months has no significant additional effect on survival in patients with PDAC. This could be useful in determining whether to extend S-1 chemotherapy in patients who have completed the standard 6-month treatment.

A Longitudinal Analysis of the Association Between Long-Term Exposure to Air Pollution and Cognitive Function Among Adults Aged 45 and Older in China.

Evidence suggests long-term exposure to fine particulate matter air pollution (PM2.5) is associated with a higher risk of cognitive impairment, especially among older adults. This study examines the relationship between PM2.5 exposure and cognitive function in China's aging population. We used longitudinal data from the China Health and Retirement Longitudinal Study (2011-2015) linked with historical PM2.5 concentrations (2000-2015) from remotely sensed satellite data. Growth curve models were applied to estimate associations between PM2.5 exposure (measured in intensity, duration, and a joint variable of intensity with duration for cumulative exposure) and cognitive function. Relative to the lowest exposure group, exposure in the second group of PM2.5 intensity (35-50 μg/m3) is associated with poorer cognitive function, but higher levels of PM2.5 appear to be associated with better cognitive function, indicating a U-shaped association. Similar patterns are seen for fully adjusted models of PM2.5 duration: the second group (13-60 months) is associated with worse cognitive function than the first group (0-12 months), but coefficients are nonsignificant in longer duration groups. Joint analysis of PM2.5 intensity with duration suggests that duration may play a more detrimental role in cognitive function than intensity. However, we do not find a statistically significant association between PM2.5 exposure and the rate of cognitive decline. Our findings are mixed and suggest that some categories of higher and longer exposure to PM2.5 are associated with poorer cognitive function, while that exposures do not hasten cognitive decline. However, more work is necessary to disentangle PM2.5 exposure from individuals' background characteristics, particularly those jointly associated with cognitive function and urban living.

Investigating causal relations between sleep duration and risks of adverse pregnancy and perinatal outcomes: linear and nonlinear Mendelian randomization analyses

BackgroundObservational studies have reported maternal short/long sleep duration to be associated with adverse pregnancy and perinatal outcomes. However, it remains unclear whether there are nonlinear causal effects. Our aim was to use Mendelian randomization (MR) and multivariable regression to examine nonlinear effects of sleep duration on stillbirth (MR only), miscarriage (MR only), gestational diabetes, hypertensive disorders of pregnancy, perinatal depression, preterm birth and low/high offspring birthweight.MethodsWe used data from European women in UK Biobank (N=176,897), FinnGen (N=~123,579), Avon Longitudinal Study of Parents and Children (N=6826), Born in Bradford (N=2940) and Norwegian Mother, Father and Child Cohort Study (MoBa, N=14,584). We used 78 previously identified genetic variants as instruments for sleep duration and investigated its effects using two-sample, and one-sample nonlinear (UK Biobank only), MR. We compared MR findings with multivariable regression in MoBa (N=76,669), where maternal sleep duration was measured at 30 weeks.ResultsIn UK Biobank, MR provided evidence of nonlinear effects of sleep duration on stillbirth, perinatal depression and low offspring birthweight. Shorter and longer duration increased stillbirth and low offspring birthweight; shorter duration increased perinatal depression. For example, longer sleep duration was related to lower risk of low offspring birthweight (odds ratio 0.79 per 1 h/day (95% confidence interval: 0.67, 0.93)) in the shortest duration group and higher risk (odds ratio 1.40 (95% confidence interval: 1.06, 1.84)) in the longest duration group, suggesting shorter and longer duration increased the risk. These were supported by the lack of evidence of a linear effect of sleep duration on any outcome using two-sample MR. In multivariable regression, risks of all outcomes were higher in the women reporting <5 and ≥10 h/day sleep compared with the reference category of 8–9 h/day, despite some wide confidence intervals. Nonlinear models fitted the data better than linear models for most outcomes (likelihood ratio P-value=0.02 to 3.2×10−52), except for gestational diabetes.ConclusionsOur results show shorter and longer sleep duration potentially causing higher risks of stillbirth, perinatal depression and low offspring birthweight. Larger studies with more cases are needed to detect potential nonlinear effects on hypertensive disorders of pregnancy, preterm birth and high offspring birthweight.

Cerebral gray matter volume changes in patients with anti-N-methyl-D-aspartate receptor encephalitis: A voxel-based morphometry study.

Background:Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease with typical clinical features. Whether and how cerebral gray matter structural damage inherent to the disorder affects cognitive function in patients is still unclear. Therefore, this study aimed to explore the changes in cerebral gray matter volume and whether these alterations contribute to cognitive impairment and mood disorders.MethodsForty patients with anti-NMDAR encephalitis and forty healthy controls (HCs) matched for gender, age, and education were recruited. All participants underwent attention network tests (ANT), neuropsychological tests and magnetic resonance imaging (MRI). Voxel-based morphological analysis (VBM) and correlation analysis was performed on all participants. Finally, according to the course of disease, patients were divided into two groups: NMDARE_SD (short duration; course ≤ 2 years since diagnosis) and NMDARE_LD (long duration; course >2 years since diagnosis), to evaluate gray matter volume changes that differ as a function of disease course.ResultsCompared to HCs, patients with anti-NMDAR encephalitis showed decreased executive control ability and lower MoCA score, while increased anxiety and depression as reflected by HAMA and HAMD24 scores (all P < 0.05). In VBM analysis, patients showed decreased gray matter volume in bilateral thalamus, left medial prefrontal cortex (mPFC_L), left superior temporal gyrus (STG_L), and left rectus gyrus. In the analysis stratified by disease course, the NMDARE_LD group exhibited decreased gray matter volume in the left precuneus and right posterior cerebellar lobe compared to the NMDARE_SD group.ConclusionsPatients with anti-NMDAR encephalitis have cognitive, executive, and emotional dysfunction, and the sites of gray matter atrophy are concentrated in the thalamus, frontal lobe, and temporal lobe. These abnormalities may be involved in the process of cognitive and affective dysfunction.Patients with different courses of anti-NMDAR encephalitis have different brain atrophy sites. These results may help to clarify the contradiction between clinical and imaging manifestations of anti NMDAR encephalitis, which is worthy of further longitudinal studies.

Comparison of Ischemic and Bleeding Events Between Short-Duration Versus Long-Duration Tirofiban Regimens in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

Tirofiban has been used historically as a bridge to platelet inhibition with clopidogrel in ST-segment myocardial infarction (STEMI) during percutaneous coronary intervention (PCI) to prevent stent thrombosis. However, ticagrelor and prasugrel reach similar levels of platelet inhibition at 30 minutes to that of clopidogrel at 6 hours, challenging the need for long-duration tirofiban. This 1-year, retrospective cohort study compared ischemic and bleeding outcomes of short-duration versus long-duration tirofiban regimens in patients with STEMI who received ticagrelor or prasugrel at the time of PCI. The primary outcome was major adverse cardiovascular events (MACEs) including cardiovascular mortality, recurrent myocardial infarction, urgent target vessel revascularization, or stroke. Secondary outcomes included individual MACE, all-cause mortality, bleeding events defined by the International Society on Thrombosis and Hemostasis, thirty-day readmissions for MACE and bleeding, and tirofiban pharmacy cost. A total of 283 charts were reviewed and 177 included (short duration n = 57; long duration n = 120). MACE rates were similar between short-duration and long-duration groups (0 [0%] vs. 5 [4.2%]; P = 0.18), including 4 cardiovascular deaths and 1 recurrent myocardial infarction. Bleeding event rates were also similar in short-duration versus long-duration groups including major bleeds (2 [3.5%] vs. 2 [1.7%]; P = 0.60) and clinically relevant nonmajor bleeds (3 [5.3%] vs. 9 [7.5%]; P = 0.75). Cost analysis indicated lower pharmacy cost with the short-duration group. In this cohort of patients with STEMI receiving a fast-acting P2Y12 inhibitor, the length of tirofiban infusion did not affect ischemic or bleeding outcomes, yet short-duration regimens were lower cost.

Intravenous Antibiotic Duration for Nontyphoidal Salmonella Bacteremia in Children.

The optimal duration of intravenous (IV) antibiotic therapy for children with nontyphoidal Salmonella bacteremia (NTSB) is unknown. The objective of the authors of this study is to evaluate differences in outcomes among children with NTSB who received a short (≤3 days; short-duration group [SDG]) versus long (>3 days; long-duration group [LDG]) course of IV antibiotics. This is a retrospective study of children 3 months to 18 years old with NTSB admitted to a tertiary pediatric health care system in the southeastern United States between 2008 and 2018. Among 57 patients with NTSB without focal infection, 24 (42%) were in the SDG and received IV antibiotics for a median of 3.0 days and 33 (58%) were in the LDG and received IV antibiotics for a median of 5.0 days. Demographic and clinical characteristics were similar between the SDG and LDG. The median total duration of antibiotics was 11.5 days in the SDG and 13.0 in the LDG (P = .068). The median length of stay was 3.0 days in the SDG and 4.0 in the LDG (P ≤ .001). Two children in the SDG (8%) and 1 child in the LDG (3%) returned to the emergency department for care unrelated to the duration of their IV antibiotic therapy (P = .567). None of the children were readmitted for sequelae related to salmonellosis. The duration of IV antibiotics varied for NTSB, but the outcomes were excellent regardless of the initial IV antibiotic duration. Earlier transitions to oral antibiotics can be considered for NTSB.