Long-term Disease Risk Research Articles

Clinical and molecular characteristics of estrogen receptor-positive ultralow risk breast cancer tumors identified by the 70-gene signature.

The metastatic potential of estrogen receptor (ER)‐positive breast cancers is heterogeneous and distant recurrences occur months to decades after primary diagnosis. We have previously shown that patients with tumors classified as ultralow risk by the 70‐gene signature have a minimal long‐term risk of fatal breast cancer. Here, we evaluate the previously unexplored underlying clinical and molecular characteristics of ultralow risk tumors in 538 ER‐positive patients from the Stockholm tamoxifen randomized trial (STO‐3). Out of the 98 ultralow risk tumors, 89% were luminal A molecular subtype, whereas 26% of luminal A tumors were of ultralow risk. Compared to other ER‐positive tumors, ultralow risk tumors were significantly (Fisher's test, P < .05) more likely to be of smaller tumor size, lower grade, progesterone receptor (PR)‐positive, human epidermal growth factor 2 (HER2)‐negative and have low Ki‐67 levels (proliferation‐marker). Moreover, ultralow risk tumors showed significantly lower expression scores of multi‐gene modules associated with the AKT/mTOR‐pathway, proliferation (AURKA), HER2/ERBB2‐signaling, IGF1‐pathway, PTEN‐loss and immune response (IMMUNE1 and IMMUNE2) and higher expression scores of the PIK3CA‐mutation‐associated module. Furthermore, 706 genes were significantly (FDR < 0.001) differentially expressed in ultralow risk tumors, including lower expression of genes involved in immune response, PI3K/Akt/mTOR‐pathway, histones, cell cycle, DNA repair, apoptosis and higher expression of genes coding for epithelial‐to‐mesenchymal transition and homeobox proteins, among others. In conclusion, ultralow risk tumors, associated with minimal long‐term risk of fatal disease, differ from other ER‐positive tumors, including luminal A molecular subtype tumors. Identification of these characteristics is important to improve our prediction of nonfatal vs fatal breast cancer.

Health research priorities for wildland firefighters: a modified Delphi study with stakeholder interviews

ObjectivesThe increase in global wildland fire activity has accelerated the urgency to understand health risks associated with wildland fire suppression. The aim of this project was to identify occupational health...

Association of Nonrecovery of Kidney Function After Pediatric Acute Kidney Injury With 5-Year Kidney and Nonkidney Outcomes.

Evaluated whether nonrecovery of kidney function, following acute kidney injury, was associated with postdischarge mortality, healthcare utilization, and chronic kidney disease. Retrospective, two-center, observational study. Two ICUs at tertiary children's hospitals in Montreal, QC. Pediatric patients (age ≤ 18 yr) with index admission to intensive care between January 1, 2003, and March 31, 2005. Children were excluded if they 1) died during admission, 2) did not have serum creatinine or urine output measured, 3) did not develop acute kidney injury, 4) could not be linked to administrative health data, and 5) (for chronic kidney disease outcome) had pre-existing renal disease by chart review, baseline estimated glomerular filtration rate measurement, or administrative health data codes. Three-hundred seventy-eight patients' data were included for long-term mortality and healthcare utilization outcomes; 316 patients for long-term chronic kidney disease outcome. Outcomes were defined using provincial administrative healthcare data diagnosis, procedure, and billing codes. Nonrecovery of kidney function, defined as serum creatinine greater than or equal to 1.5× baseline at ICU discharge, occurred in 51 patients (13%). Nonrecovery of kidney function was not associated with long-term mortality (at 5-7 yr following hospital discharge), increased hospitalizations or emergency department visits (at 30-days, 1-year, and 5-yr follow-up), or increased physician visits (at 1- and 5-yr follow-up). Nonrecovery was associated with increased 30-day physician visits (adjusted relative risk, 1.40; 95% CI, 1.13-1.73) and chronic kidney disease diagnosis within 5 years of discharge (adjusted hazard ratio, 4.92, 95% CI, 1.77-13.70). Nonrecovery of kidney function following an episode of acute kidney injury in critically ill children is associated with nearly five-fold increased risk for long-term chronic kidney disease. Acute kidney injury nonrecovery may be a useful marker to identify patients that are particularly important to follow-up post discharge for chronic kidney disease detection.

24-Hour ambulatory blood pressure monitoring 7years after intensive care unit admission.

Children who develop acute kidney injury (AKI) in the pediatric intensive care unit (PICU) may be at higher risk of long-term chronic kidney disease and hypertension. The objectives of this study were to determine the prevalence of post-discharge hypertension and albuminuria using reference-standard measurements in children admitted to the PICU, and evaluate their association with AKI. Single-center longitudinal cohort study of children admitted to the PICU from 2005 to 2010 with 7-8years of follow-up (n = 207). Patients were excluded if they had pre-existing chronic kidney disease, were deceased, lived > 3.5-h drive away, were unwilling/unable to provide consent/assent, or had a clotting disorder. AKI was defined by the Kidney Disease: Improving Global Outcomes creatinine definition. Office blood pressure was evaluated using age, sex, and height-based percentiles. Hypertension was defined using 24-h ambulatory blood pressure monitoring (ABPM). Albuminuria was defined as first morning urine albumin:creatinine ratio ≥ 30mg/g. Prevalence of blood pressure outcomes was calculated. The association between AKI and outcomes was evaluated using multivariable regression. Sixty of 207 (29%) children developed AKI during PICU admission. Overall, 6% had albuminuria and 21% had elevated office blood pressure or worse. One-hundred-and-seventy-seven (86%) patients had successful ABPM data. Of these, 10 (6%) had white coat, 18 (10%) had masked, and 5 (3%) had ambulatory hypertension. There was no statistically significant difference in outcomes across AKI stages. Blood pressure abnormalities are common in children 7years after PICU admission. Future studies with longer follow-up are needed to further evaluate the association between AKI and hypertension. A higher-resolution version of the graphical abstract is available as Supplementary information.

Osteoporosis and the long-term risk of peripheral artery disease: a population-based longitudinal follow-up study in Taiwan.

Osteoporosis has been linked to atherosclerotic diseases such as coronary heart disease and ischemic stroke. However, the relationship between osteoporosis and peripheral artery disease (PAD) has not been investigated. This study aims to evaluate the risk of PAD in patients with osteoporosis and the impact of sex on this association. This population-based study used the Longitudinal Health Insurance Database 2005, a subset of Taiwan's National Health Insurance research database. A total of 54,324 individuals between 40 and 79 years old were included in this study. The osteoporosis group (n = 27,162) consisted of patients with a diagnosis of osteoporosis between January 1, 2002, and December 31, 2006, while the non-osteoporosis group were patients without osteoporosis selected by stratified random sampling (n = 27,162). The primary outcome was the occurrence of newly diagnosed PAD. Cox proportional hazard regression modeling was used to evaluate the association between osteoporosis and the risk of PAD, with adjustment for the baseline characteristics. The risk of PAD for the osteoporosis group was 28% higher than for the non-osteoporosis group (adjusted hazard ratio (HR) 1.28, 95% confidence interval [CI] 1.20-1.36, p < 0.001), and the PAD-free survival rate was lower in the osteoporosis group (p < 0.001). Sex-stratified analysis revealed a similar HR magnitude between osteoporotic men (HR 1.36; 95% CI 1.19-1.57) and women (HR 1.25; 95% CI 1.17-1.35), compared with their non-osteoporotic counterparts. This study found an increased long-term risk of PAD in both men and women with osteoporosis. Osteoporosis has been associated with increased risks of atherosclerotic diseases. However, the relationship between osteoporosis and peripheral artery disease remains uncertain. The present population-based longitudinal follow-up study showed that patients with osteoporosis are at an increased risk of developing peripheral artery disease.

Sleep: A Nightmare

Common Causes of Sleeplessness Include: (1) Stress – Concerns about work, school, health, finances, or family can keep your mind active at night, making it difficult to sleep. Stressful life events or trauma – such as the death or illness of a loved one, divorce, or a job loss can lead to stress. (2) Travel or work schedule – Disrupting your body’s circadian rhythms can lead to lack of sleep. Causes include jet lag from traveling across multiple time zones, working a late or early shift, or frequently changing shifts. (3) Poor sleep habits – Poor sleep habits include an irregular bedtime schedule, naps, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating, or watching TV. Computers, TVs, video games, smartphones, or other screens just before bed can interfere with your sleep cycle. (4) Eating too much late in the evening – Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down. Many people also experience heartburn, a backflow of acid, and food from the stomach into the esophagus after eating, which may keep you awake. (5) Mental health disorders – Anxiety disorders, such as post-traumatic stress disorder, may disrupt your sleep. Awakening too early can be a sign of depression. (6) Medications – Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications – such as some pain medications, allergy, and cold medications, and weight loss products – contain caffeine and other stimulants that can disrupt sleep. (7) Medical conditions – Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease, and Alzheimer’s disease. (8) Sleep-related disorders – Sleep apnea causes you to stop breathing periodically throughout the night, interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep. (9) Caffeine, nicotine, and alcohol – Coffee, tea, cola, and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night. Complications of Insomnia May Include: (1) Lower performance on the job or at school. (2) Slowed reaction time while driving and a higher risk of accidents. (3) Mental health disorders, such as depression, an anxiety disorder, or substance abuse. (4) Increased risk and severity of long-term diseases or conditions, such as high blood pressure and heart disease. Prevention: Good sleep habits can help prevent insomnia and promote sound sleep: (1) Keep your bedtime and wake time consistent from day to day, including weekends. (2) Stay active – regular activity helps promote a good night’s sleep. (3) Check your medications to see if they may contribute to insomnia. (4) Avoid or limit naps. (5) Avoid or limit caffeine and alcohol, and do not use nicotine. (6) Avoid large meals and beverages before bedtime. (7) Make your bedroom comfortable for sleep and only use it for sex or sleep. (8) Create a relaxing bedtime ritual, such as taking a warm bath, reading, or listening to soft music. Conclusion: Sleep deprivation is helping no one except the market. Brands are capitalizing on our lack of sleep, on our habits. Who are we giving excuses to, our web series can be paused, late night conversation can

Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association.

Hypertensive disorders of pregnancy (HDP) remain one of the major causes of pregnancy-related maternal and fetal morbidity and mortality worldwide. Affected women are also at increased risk for cardiovascular disease later in life, independently of traditional cardiovascular disease risks. Despite the immediate and long-term cardiovascular disease risks, recommendations for diagnosis and treatment of HDP in the United States have changed little, if at all, over past decades, unlike hypertension guidelines for the general population. The reasons for this approach include the question of benefit from normalization of blood pressure treatment for pregnant women, coupled with theoretical concerns for fetal well-being from a reduction in utero-placental perfusion and in utero exposure to antihypertensive medication. This report is based on a review of current literature and includes normal physiological changes in pregnancy that may affect clinical presentation of HDP; HDP epidemiology and the immediate and long-term sequelae of HDP; the pathophysiology of preeclampsia, an HDP commonly associated with proteinuria and increasingly recognized as a heterogeneous disease with different clinical phenotypes and likely distinct pathological mechanisms; a critical overview of current national and international HDP guidelines; emerging evidence that reducing blood pressure treatment goals in pregnancy may reduce maternal severe hypertension without increasing the risk of pregnancy loss, high-level neonatal care, or overall maternal complications; and the increasingly recognized morbidity associated with postpartum hypertension/preeclampsia. Finally, we discuss the future of research in the field and the pressing need to study socioeconomic and biological factors that may contribute to racial and ethnic maternal health care disparities.

Incidence of heart valve disease in women treated with the ergot-derived dopamine agonist bromocriptine

BackgroundErgot-derived dopamine agonists are thought to induce fibrotic changes in cardiac valve leaflets. We sought to determine the incidence of heart valve disease in women treated with bromocriptine compared with age and sex matched controls from the background population.MethodsIn nationwide Danish registries we identified female patients treated with bromocriptine in the period 1995–2018. Patients were included at date of second redeemed prescription and were matched 1:5 with controls from the background population based on age, sex and year of inclusion by use of incidence density sampling. The outcomes were hospital admission for or outpatient diagnosis of heart valve disease, and death as competing risk. Incidence rates, cumulative incidence curves, and adjusted cox-proportional hazard models adjusted for cardiovascular risk factors were used to assess outcomes in bromocriptine users versus controls.ResultsA total of 3035 female bromocriptine users and 15,175 matched controls were included. Median age at inclusion was 32 years (Q1–Q3, 28–37 years). Both bromocriptine users and controls had few comorbidities and low use of concomitant pharmacotherapy. Within 10 years of follow-up, 11 patients (0.34%, 95% CI 0.13–0.55%) and 44 controls (0.29%, 95% CI 0.20–0.37) met the primary endpoint of heart valve disease, p = 0.63. The adjusted cox regression analysis yielded a hazard ratio of 0.96 (95% confidence interval (CI) 0.55–1.69, p = 0.89).ConclusionsTreatment initiation with ergot-derived dopamine agonist bromocriptine in younger women with few comorbidities, was associated with a low absolute long-term risk of heart valve disease, not significantly different from the risk in age and sex matched population controls. Thus, indicating a low clinical yield of pre-treatment echocardiographic screening in this patient population in accordance with current guidelines.

Hematuria and subsequent long-term risk of end-stage kidney disease: A Danish population-based cohort study

BackgroundHematuria is a frequent incidental clinical finding and may be a symptom of pre-existing underlying benign or malignant urinary tract or kidney disease. However, in patients with no apparent underlying cause of hematuria, long-term prognosis of hematuria remains unknown. ObjectivesTo assess the long-term risk of end-stage-kidney disease (ESKD) in patients with a hospital-based hematuria diagnosis and no apparent underlying cause. MethodsPatients with a hospital diagnosis of hematuria were included and matched in a 1:5 ratio with comparison persons from the background population by age, sex and residency. We calculated the cumulative risk of ESKD considering death as a competing risk. Furthermore, we computed unadjusted and adjusted hazard ratios with 95% confidence intervals using Cox hazard regression with adjustment for age, sex, and comorbidities. ResultsWe included 170,189 hematuria-diagnosed patients. The absolute 10-year risk of ESKD was 0.7% (95%CI: 0.7–0.8) in patients with hematuria and 0.4% (95%CI: 0.3–0.4) in comparison persons, hence yielding an overall adjusted hazard ratio of 1.6 (95%CI: 1.4–1.7). Hematuria also increased the risk of EKSD in patients with pre-existing comorbidities like diabetes (adjusted HR: 1.3 [95%CI: 1.1–1.5]) and urogenital cancer (adjusted HR: 1.4 ([95%CI: 1.1–1.9]), whereas no association was observed in patients with previous kidney disease (adjusted HR: 0.9 (95%CI: 0.8–1.0). ConclusionA hospital-based hematuria diagnosis in patients with no apparent underlying cause of hematuria is a marker of an increased risk of future ESKD.

The neurological risks of playing association football.

SummaryAims:The present study aims to provide a narrative review of the literature surrounding concussion and head injury in football and its clarity in evaluating the risk of long-term neurological disease.Findings:Epidemiological studies have shown correlations between participation in professional football and increased incidence of neurodegenerative disease and there have been reports of chronic traumatic encephalopathy (CTE) in the brains of former players in autopsy. These findings have been assumed by some to be the result of repetitive brain injury from head injuries and/or from heading the ball over a player's career. Data linking increased heading exposure with dementia is conflicting, and studies are limited by the reliance on retrospection and undocumented reports of concussion. It remains unclear whether CTE is unique to sportsmen or a variant of dementia pathology endemic in the population.Conclusions:Although logically appealing, there is no current evidence that heading is the cause of neurodegeneration amongst footballers and risks should be balanced by the protective mental and physical benefits of the sport. Physicians have an important role in providing balanced views in this emotive and controversial area.

Increasing urinary podocyte mRNA excretion and progressive podocyte loss in kidney contribute to the high risk of long-term renal disease caused by preterm birth

Podocyte abnormalities are common mechanism driving the progression of glomerular diseases, which account for most chronic kidney diseases (CKDs). However, the role of podocyte in the mechanism of high-risk long-term CKD caused by prematurity has not been well clarified. In present study, urine samples of 86 preterm infants and 32 full-term infants were collected, and podocyte-specific podocin mRNA levels in urine pellet were applied to indicate urinary podocyte mRNA excretion. In addition, in a preterm animal rat model, preterm rats were identified by delivery 2 days early. From the age of 3 weeks–12 months, urine samples were collected to examine podocyte mRNA excretion by measuring podocyte-specific podocin mRNA levels. Kidney samples at the age of 3 weeks, 2 months, and 12 months were collected from 8, 5 and 6 preterm rats and 9, 6 and 8 full-term rats, respectively, to examine podocyte density and podocyte area by measuring the podocyte specific nuclear marker WT-1 and the podocyte specific marker synaptopodin. As results, a more than threefold increase of urinary podocyte-specific podocin mRNA excretion rate was found in preterm infants compared with full-term infants. In addition, there was negative correlation between gestational age at birth and urinary podocin mRNA excretion. In preterm rats, a reduction in the total number of differentiated podocytes in glomeruli and an increased podocyte podocin mRNA excretion rate in urine were detected at the end of kidney differentiation. Moreover, long-term follow-up data in preterm rats showed there was an increased the risk of renal disease indicated by persistent podocyte mRNA loss, proteinuria, and enlarged glomeruli. In conclusion, increasing podocyte mRNA excretion in urine and podocyte loss in kidney led by prematurity drive the progression of long-term abnormal kidney function and could potentially explain the high risk of long-term CKD in preterm infants.

Butyrate supplementation to pregnant mice elicits cytoprotection against colonic injury in the offspring.

BACKGROUND:Maternal diet during pregnancy can impact progeny health and disease by influencing the offspring’s gut microbiome and immune development. Gut microbial metabolism generates butyrate, a short-chain fatty acid which benefits intestinal health. Here, we assess the effects of antenatal butyrate on the offspring’s gastrointestinal health. We hypothesized that antenatal butyrate supplementation will induce protection against colitis in offspring.METHODS:C57BL/6 mice received butyrate during pregnancy and a series of experiments were performed on their offspring. RNA sequencing was performed on colonic tissue of 3-week-old offspring. Six to eight-week-old offspring were subjected to dextran sulfate sodium-induced colitis. Fecal microbiome analysis was performed on 6 to 8-week-old offspring.RESULTS:Antenatal butyrate supplementation dampened transcript enrichment of inflammation-associated colonic genes and prevented colonic injury in the offspring. Antenatal butyrate increased the offspring’s stool microbiome diversity and expanded the prevalence specific gut microbes.CONCLUSIONS:Antenatal butyrate supplementation resulted in down regulation of genes in the offspring’s colon that function in inflammatory signaling. In addition, antenatal butyrate supplementation was associated with protection against colitis and an expanded fecal microbiome taxonomic diversity in offspring.

Assessment of pre-donation glomerular filtration rate: going back to basics

Abstract The 2017 version of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines is the most recent international framework for the evaluation and care of living kidneys donors. Along with the call for an integrative approach evaluating the long-term end-stage kidney disease risk for the future potential donor, several recommendations are formulated regarding the pre-donation glomerular filtration rate (GFR) adequacy with no or little consideration for the donor candidate’s age or for the importance of using reference methods of GFR measurements. Herein, we question the position of the KDIGO guidelines and discuss the rationale and modalities for a more basic, but no less demanding GFR evaluation enabling a more efficient selection of potential kidney donors.

Association between Dental Scaling and Reduced Risk of End-Stage Renal Disease: A Nationwide Matched Cohort Study.

Periodontitis is prevalent in patients with chronic kidney disease (CKD) and is also associated with kidney function decline. It is unclear whether dental scaling treatment prevents the progression of CKD. In a nationwide cohort study, Taiwan’s National Health Insurance Research Database was used to select people with CKD. Propensity score-matching procedures were performed to compare the long-term risk of end-stage renal disease (ESRD) between CKD patients with and without the receipt of dental scaling. A total of 33,637 matched pairs with CKD were included, with 503,373 person-years of follow-up for analyses. Dental scaling was significantly associated with a lower risk of ESRD (adjusted hazard ratio (aHR): 0.83, 95% confidence interval (CI): 0.77–0.90). In addition, there was a dose-dependent relationship between the frequency of dental scaling and a reduced risk of ESRD. Dental scaling was also linked to reduced risks of major adverse cardiovascular events (aHR: 0.91, 95% CI: 0.87–0.95), sepsis (aHR: 0.81, 95% CI: 0.77–0.85), and all-cause mortality (aHR: 0.81, 95% CI: 0.76–0.87). Dental scaling was significantly associated with lower risks of progression to ESRD in patients with CKD. Regular dental scaling may serve as a prophylactic measure for kidney function decline.

Identifying Frail Populations for Disease Risk Prediction and Intervention Planning in the Covid-19 Era: A Focus on Social Isolation and Vulnerability.

The early identification of fragile populations in the Covid-19 era would help governments to allocate resources and plan strategies to contain consequences of the pandemic. Beyond frailty, social vulnerability to environmental stressors, such as the social distancing enforced to reduce the SARS-CoV2 contagion, can modify long-term disease risk and induce health status changes in the general population. We assessed frailty and social vulnerability indices in 1,258 Italian residents during the first lockdown phase via an on-line survey. We compared indices taking into account age categories and gender. While frailty showed a linear increase with age and was greater in females than in males, social vulnerability was higher in young adults and elders compared to middle aged and older adults, and in males than females. Both frailty and social vulnerability contributed in explaining the individual perception of the impact of Covid-19 emergency on health, which was further influenced by proactive attitudes/behaviors and social isolation. Social isolation and loneliness following the Covid-19 outbreak may exert dramatic psychosocial effects in the general population. The early detection of vulnerable categories, at risk to become ill and develop long-lasting health status changes, would help to prevent consequences on general well-being by allocating resources to targeted interventions managing psychosocial distress and increasing young adults and elderly resilience toward the post-Covid-19 crisis.

Glycogen storage disease type I patients with hyperlipidemia have no signs of early vascular dysfunction and premature atherosclerosis

Background and aimsGlycogen storage disease type I (GSD I) is associated with hyperlipidemia, a known risk factor for premature atherosclerosis. Few studies have addressed endothelial dysfunction in patients with GSD I, and these studies yielded controversial results. Methods and resultsWe investigated vascular dysfunction in a cohort of 32 patients with GSD I (26 GSD Ia, 6 GSD Ib, mean age 20.7 (4.8–47.5) years) compared to 32 age-, gender-, and BMI-matched healthy controls using non-invasive techniques such as quantification of carotid intima media thickness, retinal vessel analysis and 24 h-blood pressure measurements. In addition, early biomarkers of inflammatory and oxidative endothelial stress were assessed in blood. Although GSD I patients had a clearly proatherogenic lipid profile, increased oxidative stress, higher levels of high sensitivity C-reactive protein and increased lipoprotein associated phospholipase A2 activity, functional and structural parameters including carotid intima media thickness and retinal vessel diameters did not indicate premature atherosclerosis in this patient cohort. Blood pressure values and pulse wave velocity were comparable in patients and healthy controls, while central blood pressure and augmentation index were higher in GSD patients. ConclusionOur data suggest that GSD I is not associated with early vascular dysfunction up to the age of at least 20 years. Further studies are needed to elucidate the possibly protective mechanisms that prevent early atherosclerosis is GSD I. Longer follow-up studies are required to assess the long-term risk of vascular disease with increased oxidative stress being present in GSD I patients.

Bactericidal efficiency and photochemical mechanisms of micro/nano bubble–enhanced visible light photocatalytic water disinfection

Microbial contamination of water in the form of highly-resistant bacterial spores can cause a long-term risk of waterborne disease. Advanced photocatalysis has become an effective approach to inactivate bacterial spores due to its potential for efficient solar energy conversion alongside reduced formation of disinfection by-products. However, the overall efficiency of the process still requires significant improvements. Here, we proposed and evaluated a novel visible light photocatalytic water disinfection technology by its close coupling with micro/nano bubbles (MNBs). The inactivation rate constant of Bacillus subtilis spores reached 1.28 h−1, which was 5.6 times higher than that observed for treatment without MNBs. The superior performance for the progressive destruction of spores’ cells during the treatment was confirmed by transmission electron microscopy (TEM) and excitation-emission matrix (EEM) spectra determination. Experiments using scavengers of reactive oxygen species (ROSs) revealed that H2O2 and •OH were the primary active species responsible for the inactivation of spores. The effective supply of oxygen from air MNBs helped accelerate the hole oxidation of H2O2 on the photocatalyst (i.e. Ag/TiO2). In addition, the interfacial photoelectric effect from the MNBs was also confirmed to contribute to the spore inactivation. Specifically, MNBs induced strong light scattering, consequently increasing the optical path length in the photocatalysis medium by 54.8% at 700nm and enhancing light adsorption of the photocatalyst. The non-uniformities in dielectricity led to a high-degree of heterogeneity of the electric field, which triggered the formation of a region of enhanced light intensity which ultimately promoted the photocatalytic reaction. Overall, this study provided new insights on the mechanisms of photocatalysis coupled with MNB technology for advanced water treatment.

Dietary and lifestyle habits among university students at different academic years.

College serves as a transitionary period into adulthood where students begin making independent dietary and lifestyle choices and begin forming possibly detrimental habits. Such habits may persist into adulthood and negatively affect their long-term health and risk of disease. This study aimed at exploring the dietary and lifestyle habits among the Hashemite University students at different academic years. A cross-sectional design was used to study dietary and lifestyle habits as well as the occurrence of obesity among a convenient sample of undergraduate students at the Hashemite University during the academic year 2015-2016. Five hundred and forty students (184 males: 356 females) were enrolled in this study. Bodyweight and height were measured and body mass index was calculated. Personal information, dietary habits and physical activity data were collected using constructed questionnaires. Around 36% of the students were overweight and obese. The percentage of overweight among the freshmen was about 31% and 26.5% among the seniors. Additionally, 8.6% of freshmen and 16.3% of seniors were found to be obese. One-third (30.2%) of the study sample was hookah smokers, while 15.4% were cigarette smokers. The students showed similar physical activity levels in the four academic years. The majority of students at different academic levels consumed fruits 1-2 times/week and 5 times cereals, grains, and starchy vegetables/day. Our results show that approximately one-third of students are overweight or obese, and practicing unhealthy dietary and lifestyle habits. This indicates a need to address this problem, possibly through implementing a nutrition and health education programs at the university in addition to improving the quality of food available on campus.

Malaria-Associated Acute Kidney Injury in African Children: Prevalence, Pathophysiology, Impact, and Management Challenges.

Acute kidney injury (AKI) is emerging as a complication of increasing clinical importance associated with substantial morbidity and mortality in African children with severe malaria. Using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define AKI, an estimated 24–59% of African children with severe malaria have AKI with most AKI community-acquired. AKI is a risk factor for mortality in pediatric severe malaria with a stepwise increase in mortality across AKI stages. AKI is also a risk factor for post-discharge mortality and is associated with increased long-term risk of neurocognitive impairment and behavioral problems in survivors. Following injury, the kidney undergoes a process of recovery and repair. AKI is an established risk factor for chronic kidney disease and hypertension in survivors and is associated with an increased risk of chronic kidney disease in severe malaria survivors. The magnitude of the risk and contribution of malaria-associated AKI to chronic kidney disease in malaria-endemic areas remains undetermined. Pathways associated with AKI pathogenesis in the context of pediatric severe malaria are not well understood, but there is emerging evidence that immune activation, endothelial dysfunction, and hemolysis-mediated oxidative stress all directly contribute to kidney injury. In this review, we outline the KDIGO bundle of care and highlight how this could be applied in the context of severe malaria to improve kidney perfusion, reduce AKI progression, and improve survival. With increased recognition that AKI in severe malaria is associated with substantial post-discharge morbidity and long-term risk of chronic kidney disease, there is a need to increase AKI recognition through enhanced access to creatinine-based and next-generation biomarker diagnostics. Long-term studies to assess severe malaria-associated AKI’s impact on long-term health in malaria-endemic areas are urgently needed.

Coronary heart disease in mothers and fathers of adult children with alcohol use disorders.

Having a family member with an alcohol use disorder (AUD) may negatively affect a person's health. Our aim was to study the long-term risk of coronary heart disease (CHD) in parents who have an offspring with AUD. Cohort study with Cox regression models and co-sibling analyses. Sweden. From population registers, we selected all parent-offspring pairs in which the parent was born in Sweden between 1945 and 1965. Baseline was set when the offspring was 15years old and AUD was assessed from medical and criminal registers. The parents were followed for CHD during a mean follow-up of 18years. Hazard ratios (HRs) in mothers and fathers were calculated and adjusted for potential confounders (year of birth, age at childbirth, sex of the child, parent' AUD, educational level, and marital status). In mothers, the adjusted HR for CHD was 1.24 (95% CI = 1.19-1.28) in relation to having a child with AUD. In fathers, the HR for CHD was lower than in mothers but still increased; the adjusted HR was 1.08 (95% CI = 1.05-1.12). In the co-sibling analyses, the HRs for mothers were similar to the HRs estimated from the population-based sample, but in fathers the association did not remain significant (HR = 0.98 [0.90-1.06]). In Sweden, there appears to be an association between having an offspring with alcohol use disorder and increased risk of developing coronary heart disease. For fathers, the association did not remain in co-sibling analyses.