Mortality Index Research Articles

Modelling socio-economic mortality at neighbourhood level

AbstractIn this study, we quantify the relationship between socio-economic status and life expectancy and identify combinations of socio-economic variables that are particularly useful for explaining mortality differences between neighbourhoods in England. We achieve this by examining socio-economic variation in mortality experiences across small areas in England known as lower layer super output areas (LSOAs). We then consider 12 socio-economic variables that are known to have a strong association with mortality. We estimate the relationship between those variables and mortality rates using a random forest algorithm. Based on the resulting estimate, we then create a new socio-economic mortality index – the Longevity Index for England (LIFE). The index is constructed in a way that eliminates the impact of care homes that might artificially increase mortality rates in LSOAs with care homes compared to LSOAs that do not contain a care home. Using mortality data for different age groups, we make the index age-dependent and investigate the impact of specific socio-economic characteristics on the age-specific mortality risk. We compare the explanatory power of the LIFE index to the English Index of Multiple Deprivation (IMD) as predictors of mortality. While we find that the IMD can explain regional mortality differences to some extent, the LIFE index has significantly greater explanatory power for mortality differences between regions. Our empirical results also indicate that income deprivation amongst the elderly and employment deprivation are the most significant socio-economic factors for explaining mortality variation across LSOAs in England.

The association between vitamin D intake with inflammatory and biochemical indices and mortality in critically ill patients with COVID-19: A case-control study.

The coronavirus disease-2019 (COVID-19) has become a worldwide health issue with widespread hospitalization and dependence on the intensive care unit (ICU). Vitamin D has a key role in modulating immune cells and modulating the inflammatory responses. This study aimed to investigate the association of vitamin D supplementation with inflammatory, biochemical, and mortality indices in critically ill patients with COVID-19. This case-control study was conducted on critically ill COVID-19 patients hospitalized in the ICU including the survived >30 day patients as the case group and dead patients as the control group. The status of vitamin D supplementation and inflammatory and biochemical indices of the patients were retrieved from the medical records. Logistic regression method was used to assess the association between 30 days survival and vitamin D supplement intake. Compared to the group of COVID-19 patients who died in <30 day, the survived patients had a lower eosinophile level (2.2 ± 0.5 vs. 6 ± 0.0, p < .001) and higher vitamin D supplementation duration (9 ± 4.4 vs. 3.3 ± 1.9 day, p = .001). Vitamin D supplementation had a positive association with survival in COVID-19 patients (OR: 1.98, 95%CI:1.15-3.40, p < .05). The association remained significant after adjustments fot age, sex, underlying diseases,and smoking. Vitamin D supplementation in critically ill patients with COVID-19 has the potential to increase survivability within the first 30 days of hospitalization.

Comparison of the Risk Analysis Index and the modified 5-factor frailty index in predicting 30-day morbidity and mortality after spine surgery.

Frailty's role in preoperative risk assessment in spine surgery has increased in association with the increasing size of the aging population. However, previous frailty assessment tools have significant limitations. The aim of this study was to compare the predictive ability of the Risk Analysis Index (RAI) with the 5-factor modified frailty index (mFI-5) for postoperative spine surgery morbidity and mortality. Data were collected from the American College of Surgeons National Surgical Quality Improvement Program database for adults > 18 years who underwent spine surgery between 2015 and 2019. Multivariate modeling and receiver operating characteristic curve analysis, including area under the curve/C-statistic calculations, were performed to evaluate the comparative discriminative ability of RAI and mFI-5 on postoperative outcomes. In a cohort of 292,225 spine surgery patients, multivariate modeling showed that increasing RAI scores, and not increasing mFI-5 scores, were independent predictors of increased postoperative mortality for the trauma, tumor, and infection subcohorts. In the overall spine cohort, both increasing RAI and increasing mFI-5 scores were associated with increased mortality, but C-statistics indicated that the RAI (C-statistic 0.802 [95% CI 0.800-0.803], p < 0.0001, DeLong test) had superior discrimination compared with the mFI-5 (C-statistic 0.677 [95% CI 0.675-0.679], p < 0.0001, DeLong test). In subgroup analyses, the RAI had superior discriminative ability to mFI-5 for mortality in the trauma and infection groups (p < 0.001 and p = 0.039, respectively). The RAI demonstrates superior discrimination to the mFI-5 for predicting postoperative mortality and morbidity after spine surgery and the RAI maintains conceptual fidelity to the frailty phenotype. Patients with high RAI scores may benefit from knowing the possibility of increased surgical risk with potential spine surgery.

A Comparison of Clinical and Cost Outcomes After Pancreatectomies at a Safety-net Hospital using a National Registry.

Our institution (UFHJ) meets the criteria of both a large, specialized medical center (LSCMC) and a safety-net hospital (AEH). Our aim is to compare pancreatectomy outcomes at UFHJ against other LSCMCs, AEHs, and against institutions that meet criteria for both LSCMC and AEH. In addition, we sought to evaluate differences between LSCMCs and AEHs. Pancreatectomies for pancreatic cancer were queried from the Vizient Clinical Data Base (2018 to 2020). Clinical and cost outcomes were compared between UFHJ and LSCMCs, AEHs, and a combined group, respectively. Indices >1 indicated the observed value was greater than the expected national benchmark value. The mean number of pancreatectomy cases performed per institution in the LSCMC group was 12.15, 11.73, and 14.31 in 2018, 2019, and 2020, respectively. At AEHs, 25.33, 24.56, and 26.37 mean cases per institution per year, respectively. In the combined group of both LSCMCs and AEHs, 8.10, 7.60, and 7.22 mean cases, respectively. At UFHJ, 17, 34, and 39 cases were performed each year, respectively. Length of stay index decreased below national benchmarks at UFHJ (1.08 to 0.82), LSCMCs (0.91 to 0.85), and AEHs (0.94 to 0.93), with an increasing case mix index at UFHJ (3.33 to 4.20) from 2018 to 2020. In contrast, length of stay index increased in the combined group (1.14 to 1.18) and overall was the lowest at LSCMCs (0.89). Mortality index declined at UFHJ (5.07 to 0.00) below national benchmarks compared with LSCMCs (1.23 to 1.29), AEHs (1.19 to 1.45), and the combined group (1.92 to 1.99), and was significantly different between all groups (P<0.001). Thirty-day re-admissions were lower at UFHJ (6.25% to 10.26%) compared with LSCMCs (17.62% to 16.83%) and AEHs (18.93% to 15.51%), and significantly lower at AEHs compared with LSCMCs (P<0.001). Notably, 30-day re-admissions were lower at AEHs compared with LSCMCs (P<0.001) and declined over time and were the lowest in the combined group in 2020 (17.72% to 9.52%). Direct cost index at UFHJ declined (1.00 to 0.67) below the benchmark compared with LSCMCs (0.90 to 0.93), AEHs (1.02 to 1.04), and the combined group (1.02 to 1.10). When comparing LSCMCs and AEHs, there were no significant differences between direct cost percentages (P=0.56); however, the direct cost index was significantly lower at LSCMCs. Pancreatectomy outcomes at our institution have improved over time exceeding national benchmarks and often were significant to LSCMCs, AEHs, and a combined comparator group. In addition, AEHs were able to maintain good quality care when compared with LSCMCs. This study highlights the role that safety-net hospitals can provide high-quality care to a medically vulnerable patient population in the presence of high-case volume.

Spatiotemporal Patterns of Suicide in Korea From 2009 to 2019 Using Geographic Information Systems.

When analyzing factors related to suicide, it is necessary to consider the regional characteristics of the areas where individuals live in addition to individual factors. This study aimed to investigate the spatiotemporal association between suicide rates and geographic features and the patterns of this association for all administrative areas in South Korea from 2009 to 2019. The data used in this study were obtained from the National Statistical Office of the Korean Statistical Information Service. For suicide rates, age-standardized mortality index data per 100 000 people were used. All administrative districts from 2009 to 2019 were divided into 229 regions. Emerging hotspot analysis was used for a 3-dimensional analysis to simultaneously evaluate temporal and spatial clusters. In the 229 regions, there were 27 (11.8%) hotspots and 60 (26.2%) cold spots. Hotspot pattern analysis found 2 (0.9%) new spots, 1 (0.4%) persistent spot, 23 (10.0%) sporadic spots, and 1 (0.4%) oscillating spot. This study found geographic differences in the spatiotemporal patterns of suicide rates in South Korea. The utilization of national resources for suicide prevention should be selectively and intensively prioritized in 3 areas that exhibit unique spatiotemporal patterns.

Reduced Epigenetic Age in Older Adults With High Sense of Purpose in Life.

Psychosocial risk factors have been linked with accelerated epigenetic aging, but little is known about whether psychosocial resilience factors (eg, Sense of Purpose in Life) might reduce epigenetic age acceleration. In this study, we tested if older adults who experience high levels of Purpose might show reduced epigenetic age acceleration. We evaluated the relationship between Purpose and epigenetic age acceleration as measured by 13 DNA methylation (DNAm) "epigenetic clocks" assessed in 1 572 older adults from the Health and Retirement Study (mean age 70 years). We quantified the total association between Purpose and DNAm age acceleration as well as the extent to which that total association might be attributable to demographic factors, chronic disease, other psychosocial variables (eg, positive affect), and health-related behaviors (heavy drinking, smoking, physical activity, and body mass index [BMI]). Purpose in Life was associated with reduced epigenetic age acceleration across 4 "second-generation" DNAm clocks optimized for predicting health and longevity (false discovery rate [FDR] q < 0.0001: PhenoAge, GrimAge, Zhang epigenetic mortality index; FDR q < 0.05: DunedinPoAm). These associations were independent of demographic and psychosocial factors, but substantially attenuated after adjusting for health-related behaviors (drinking, smoking, physical activity, and BMI). Purpose showed no significant association with 9 "first-generation" DNAm epigenetic clocks trained on chronological age. Older adults with greater Purpose in Life show "younger" DNAm epigenetic age acceleration. These results may be due in part to associated differences in health-related behaviors. Results suggest new opportunities to reduce biological age acceleration by enhancing Purpose and its behavioral sequelae in late adulthood.

KETAKUTAN, PERAN INVESTOR INSTITUSI DAN PERILAKU HERDING DALAM FASE PANDEMI COVID 19

This study aims to examine the effect between fear of death caused by the covid 19 virus and institutional ownership on herding behavior in companies listed on the LQ45 index (JSII) in the period from 2019 to 2021. The fear variable with the GFI index is a variable that has never been used before by previous studies to be a variable that can estimate whether fear can affect herding behavior. The sample of this study is companies listed on the LQ45 Index on the IDX from 2019 to 2021. The analysis method used is multiple linear regression assisted by Eviews in data processing. The results showed that the fear associated with the global mortality index was able to influence the occurrence of herding behavior on the LQ45 index. Meanwhile, the role of institutional ownership in companies on the IDX is unable to influence the occurrence of herding behavior. This study also proved that at the end of the year and the beginning of 2020 (honeymoon phase) using rolling window regression. It is proved that there has been a herding behavior caused by the fear of investors.

TICAGRELOR VS. CLOPIDOGREL: CLINICAL OUTCOMES IN ST-ELEVATION MYOCARDIAL INFARCTION PATIENTS

A large, randomised control trial known as PLATO study proved a turning point in the assessment of superiority of ticagrelor over clopidogrel in post- MI cases. This breakthrough in assessing the quantum of efcacy of ticagrelor over clopidogrel in post-MI patients led to changes in international guidelines. However, based on the mortality index associated with these two drugs, the outcome is not encouraging, and both ticagrelor and clopidogrel are on par in terms of efcacy or safety. Recurrent episodes of bleeding were more common in patients who were prescribed ticagrelor than in patients who were given clopidogrel. However, future trials with longer follow-up time periods may be able to answer all the remaining questions

Multiple Myeloma: Risk Factors, Pathogenesis and Relationship with Anti-myeloma Therapies

Multiple myeloma (MM) is the second most common hematologic malignancy with high morbidity and mortality indices. The emerging risk factors and complex pathogenic mechanisms surrounding the disease evolution are challenging. Thus, understanding these risk factors and the pathogenic basis of the disease will lead to better interventions and targeted therapies. We conducted an integrated review of the literature on MM, risk assessment, pathogenic mechanisms, and the evolution of anti-myeloma target therapies using PubMed, Medline, CINAHL, Google Scholar, African Journal Online, and Cochrane databases. The review analyzed the prevalence, risk factors, and pathogenesis of MM, as well as highlights antimyeloma therapies. The literature indicates that eight risk factors are linked with MM, and two major pathogenic pathways are paramount in its evolution. We identified nine antimyeloma targeted pathways including immunomodulatory agents, proteasome inhibitors, monoclonal antibodies, fibrin growth factor receptor inhibitors, histone deacetylase inhibitors, BCL inhibitors, immune checkpoint inhibitors, chimeric antigen receptor T-cell and B-cell maturation antigen-targeted monoclonal antibody. To holistically address the burden of MM, there is need for in-depth knowledge of the environmental risk factors and disease pathogenic mechanisms. The cytogenetic, immunologic, and skeletal mechanisms that lead to disease evolution play significant roles in risk stratification, prognostication, and emergence of new antimyeloma therapies. A policy on MM risk assessment is therefore strongly recommended for exposed target population.

Performance of the supervised generative classifiers of spatio-temporal areal data using various spatial autocorrelation indexes

This article is concerned with a generative approach to supervised classification of spatio-temporal data collected at fixed areal units and modeled by Gaussian Markov random field. We focused on the classifiers based on Bayes discriminant functions formed by the log-ratio of the class conditional likelihoods. As a novel modeling contribution, we propose to use decision threshold values induced by three popular spatial autocorrelation indexes, i.e., Moran’s I, Geary’s C and Getis–Ord G. The goal of this study is to extend the recent investigations in the context of geostatistical and hidden Markov Gaussian models to one in the context of areal Gaussian Markov models. The classifiers performance measures are chosen to be the average accuracy rate, which shows the percentage of correctly classified test data, balanced accuracy rate specified by the average of sensitivity and specificity and the geometric mean of sensitivity and specificity. The proposed methodology is illustrated using annual death rate data collected by the Institute of Hygiene of the Republic of Lithuania from the 60 unicipalities in the period from 2001 to 2019. Classification model selection procedure is illustrated on three data sets with class labels specified by the threshold to mortality index due to acute cardiovascular event, malignant neoplasms and diseases of the circulatory system. Presented critical comparison among proposed approach classifiers with various spatial autocorrelation indexes (decision threshold values) and classifier based hidden Markov model can aid in the selection of proper classification techniques for the spatio-temporal areal data.

Effects of Dietary Phytosterol Supplementation on the Productive Performance, Egg Quality, Length of Small Intestine, and Tibia Quality in Aged Laying Hens

This study aimed at investigating the effects of phytosterols on the productive performance, egg quality, length of small intestine, and tibia quality in aged laying hens. A total of 960 Dawu Jinfeng commercial laying hens (75 weeks of age) were randomly assigned to three groups. Each group had 16 replicates and every replicate contained four cages (five birds/cage). The control group hens received the basal diet without phytosterols. The hens in the experimental groups received a diet containing phytosterols at concentrations of 20 mg/kg and 40 mg/kg for 7 weeks. The results showed that phytosterols had a linearly increasing effect on egg weight, eggshell surface area, albumen height, and haugh unit at week 5 of experiment (p < 0.05). Supplemental phytosterols linearly and quadratically increased eggshell thickness (p < 0.05). At week 7 of the experiment, dietary supplementation of phytosterols linearly increased egg weight and eggshell weight (p < 0.05). Supplementation of 20 mg/kg, but not 40 mg/kg, phytosterols increased the length of the small intestine. However, dietary phytosterols had no effect on the laying rate, mortality, or liver index (p > 0.1). The results of tibia quality detected by micro-CT also showed no difference in the treatment of phytosterols. Therefore, supplementation with 20 mg/kg phytosterols in the diet improves egg quality and increases the length of small intestine, but has no effects on the quality of the tibia.

Interhospital transfer of pediatric patients with malignant brain tumor not associated with increased mortality, but safe routine discharge.

Interhospital transfer (IHT) to obtain a higher level of care for pediatric patients requiring neurosurgical interventions is common. Pediatric patients with malignant brain tumors often require subspecialty care commonly provided at specialized centers. The authors aimed to assess the impact of IHT in pediatric neurosurgical patients with malignant brain tumors to identify areas of improvement in treatment of this patient population. Pediatric patients (age < 19 years) with malignant primary brain tumors undergoing craniotomy for resection between 2010 and 2018 were retrospectively identified in the Nationwide Readmissions Database. Patient and hospital data for each index admission provided by the Nationwide Readmissions Database was analyzed by univariate and multivariate analyses. Further analysis evaluated association of IHT on specific patient- or hospital-related characteristics. In a total of 2279 nonelective admissions for malignant brain tumors in pediatric patients, the authors found only 132 patients (5.8%) who underwent IHT for a higher level of care. There is an increased likelihood of transfer when a patient is younger (< 7 years old, p = 0.006) or the disease process is more severe, as characterized by higher pediatric complex chronic conditions (p = 0.0004) and increased all patient refined diagnosis-related group mortality index (p = 0.02). Patients who are transferred (OR 1.87, 95% CI 1.04-3.35; p = 0.04) and patients who are treated at pediatric centers (OR 6.89, 95% CI 4.23-11.22; p < 0.0001) are more likely to have a routine discharge home. On multivariate analysis, transfer status was not associated with a longer length of stay (incident rate ratio 1.04, 95% CI 0.94-1.16; p = 0.5) or greater overall costs per patient ($20,947.58, 95% CI -$35,078.80 to $76,974.00; p = 0.50). Additionally, IHT is not associated with increased likelihood of death or major complication. IHT has a significant role in the outcome of pediatric patients with malignant brain tumors. Transfer of this patient population to hospitals providing subspecialized care results in a higher level of care without a significant burden on overall costs, risks, or mortality.

Determinants of induced abortion among women of reproductive age: evidence from the 2013 and 2019 Sierra Leone Demographic and Health Survey

BackgroundWorldwide, pregnancy termination due to unintended pregnancy is crucial in maternal health, particularly in settings where abortion laws are restrictive. Presently, there is a paucity of literature on determinants of induced abortion among women of reproductive age in Sierra Leone. The study findings could be used to improve the country's maternal mortality indices and inform health programs and reproductive health policies geared toward tackling induced abortion.MethodsWe analyzed secondary data from the 2013 and 2019 Sierra Leone Demographic and Health Surveys. The surveys were nationally representative, with weighted samples comprising 16,658 (2013) and 15,574 (2019) women of reproductive age. Descriptive statistics, including frequencies and percentages, were computed, while Chi-square and Binomial Logistics Regression were employed to identify correlates of induced abortion.ResultsThe results showed that a minority (9%) of the participants had induced abortion in both surveys. Abortion was significantly associated with age, marital status, employment status, education, parity, and frequency of listening to the radio and watching television (p < 0.05). For instance, women aged 45–49 years (AOR = 7.91; 95% CI: 5.76–10.87), married women (AOR = 2.52; 95% CI: 1.95–3.26), and working women (AOR = 1.65; 95% CI: 1.45–1.87) had a higher likelihood of induced abortion compared to their counterparts. Moreover, women with primary education (AOR = 1.27; 95% CI:1.11–1.46) and those who watch television once a week (AOR = 1.29; 95% CI: 1.11–1.49) were more likely to terminate a pregnancy. Women with six or more children (AOR = 0.40; 95% CI: 0.31–0.52) were less likely to terminate a pregnancy compared to those with no child.ConclusionThe study revealed that a minority of the women had induced abortions. The prevalence of induced abortion did not change over time. Induced abortion was influenced by age, marital status, employment status, education, parity, and exposure to mass media. Therefore, policies and programs to reduce unwanted pregnancies should focus on increasing access to modern contraceptives among women of lower socio-economic status.

Predictive value of lactate dehydrogenase combined with the abbreviated burn severity index for acute kidney injury and mortality in severe burn patients

BackgroundExtensive burns are devastating trauma. This study aimed to explore the predictive value of early lactate dehydrogenase (LDH) level, the abbreviated burn severity index (ABSI) and their combination on acute kidney injury (AKI) and mortality after severe burns. Methods and results194 severe burn patients (TBSA ≥ 30%) were included. After multivariate analyses, early LDH value (first 24 h after admission) was an independent risk factor for early AKI (OR=1.095, CI,1.025–1.169,p = 0.007) and AKI (OR=1.452, CI,1.131–1.864, p = 0.003) in severe burn patients and was still a significant risk factor for mortality (OR=1.059, CI,1.006–1.115，p = 0.03). In ROC analysis, after combining LDH and ABSI, the AUC values were 0.925 for AKI, 0.926 for stage 3 AKI, and 0.904 for mortality. Based on cut-off values, patients were divided into different risk groups. The cumulative incidence of AKI (within 5 days, 30 days) and survival rate (within 60 days) were analyzed by the Kaplan-Meier method. The mortality, AKI incidence, and AKI staging showed a significant upward trend with the increasing risk level (P < 0.001). ConclusionEarly LDH level is an independent risk factor for early AKI and AKI. LDH combined with ABSI can better predict mortality and AKI than single indicators.

The prognostic value of the Barthel Index for mortality in patients with COVID-19: A cross-sectional study.

This study aimed to analyze the association between the activity of daily living (ADL), coronavirus disease (COVID-19), and the value of the Barthel Index in predicting the prognosis of patients. This study included 398 patients with COVID-19, whose ADL at admission to hospital were assessed with the Barthel Index. The relationship between the index and the mortality risk of the patients was analyzed. Several regression models and a decision tree were established to evaluate the prognostic value of the index in COVID-19 patients. The Barthel Index scores of deceased patients were significantly lower than that of discharged patients (median: 65 vs. 90, P < 0.001), and its decrease indicated an increased risk of mortality in patients (P < 0.001). After adjusting models for age, gender, temperature, pulse, respiratory rate, mean arterial pressure, oxygen saturation, etc., the Barthel Index could still independently predict prognosis (OR = 0.809; 95% CI: 0.750-0.872). The decision tree showed that patients with a Barthel Index of below 70 had a higher mortality rate (33.3-40.0%), while those above 90 were usually discharged (mortality: 2.7-7.2%). The Barthel Index is of prognostic value for mortality in COVID-19 patients. According to their Barthel Index, COVID-19 patients can be divided into emergency, observation, and normal groups (0-70; 70-90; 90-100), with different treatment strategies.

Assessment of integrated community case management of childhood illness (ICCM) practices by trained patent and proprietary medicine vendors (PPMVs) in Ebonyi and Kaduna states, Nigeria

IntroductionAn Integrated Community treatment of Childhood disease (ICCM)- focused intervention involving a large number of Patent and proprietary medicine vendors (PPMVs) was conducted by Society for Family Health Nigeria to improve management of childhood, malaria, pneumonia and diarrhea with an intervention approach focused on knowledge and skill improvement. The intervention was conducted in Kaduna and Ebonyi state; recruited and trained 15 interpersonal communication agents (IPCAs) who were saddled with the responsibility to sensitize and mobilize caregivers with children within the age bracket of 2 months to 5 years to our mapped PPMVs within the communities, on the account of Malaria, Diarrhea, and Pneumonia; while the IPCAs in return monitor the quality-of-service delivery. Following the intervention, the Society for Family health conducted a study to demonstrate the effectiveness of interventions such as ICCM training, supervision and linkage to quality ICCM commodities, among PPMVs to achieve high levels of knowledge and performance in diagnosing and treating common childhood illnesses.MethodsLongitudinal research (before and after study) was adopted for the study. From the 387 PPMVs recruited and trained by SFH, 165 PPMVs were systematically selected to participate in the study, before and after the implementation of the intervention. Using SPSS version 22, data from the observation and completed questionnaires were analyzed and a chi-square test was used to examine the associations between the categorical information collected prior and after the intervention. The analysis was conducted at 5% level of significance.ResultsMore than 50 % of the study participants were females (56.4%) and majority were either Junior community extension workers (35%) or Senior community extension worker (27%). About 21.8% trained PPMVs could not appropriately treat malaria in the first quarter of the intervention, however, there was a significant decrease to 1.8% in second quarter in the number of those that cannot appropriately diagnose and treat malaria. There was also a decrease in the number of those who could not treat cough and fast breathing from 47(28.5%) to 14(8.5%) in the second quarter and for diarrhea from 33.3% in the first quarter to 2.4% in the second quarter.ConclusionThe study revealed a significant improvement in the quality of treatment provided by the trained PPMVs across the three disease areas. PPMVs in hard-to-reach areas should be trained and supported to continuously provide quality services to change the indices of under-5 mortality in Nigeria.

Metabolic relay gene of aphid and primary symbiont as RNAi target loci for aphid control.

Aphids form a stable and mutually beneficial relationship with their primary symbiont Buchnera aphidicola, which play an important role in providing the missing nutrients to the host aphid. Based on the genome sequence of wheat aphid Siotobion miscanthi and its primary symbiont Buchnera that we obtained in our previously study, we identified a metabolic relay gene, ilvA, involved in the isoleucine synthesis pathway between aphids and Buchnera. In this study, we identified the location and sequence structure of ilvA gene in aphid genome, the expression level in different instars and tissues of aphids, and the effect of reducing ilvA expression on the growth and development of aphids by bioinformatics analysis, quantitative PCR, RNAi and bioassay experiments. Our study showed that ilvA was expressed at the highest level in the 2nd instar of the aphid, while the expression of this gene was significantly higher in the aphid bacteriocytes than in other tissues. Notably, this gene is localized on the aphid sex chromosome and remains highly conserved and collinearity across different aphid genomes. Knocking down the expression of ilvA reduced the aphid body weight and production. However, the indices of mortality decreased slightly, but were not significantly different, compared to the control. The results show that the relay genes between aphids and their symbionts in the metabolism of essential nutrients have potential roles in the growth and development of aphids, meanwhile, providing target loci and new ideas for RNAi-based aphid green control strategies.

Fluorescence Detecting of Paraquat and Diquat Using Host-Guest Chemistry with a Fluorophore-Pendant Calix[6]arene.

Paraquat (PQ) and diquat (DQ), some of the most widely used herbicides in the world, both present a high mortality index after intentional exposure. In this paper, a fluorescence sensing method for PQ and DQ, based on host-guest molecular recognition, is proposed. Calix[6]arene derivatives containing anthracene or naphthalene as pendant fluorophore at their lower rim recognize DQ and PQ in hydroalcoholic solution with a broad linear response range at the μg L-1 level concentration. The linear response ranges were found from 1.0 to 18 μg L-1 with the detection limit of 31 ng L-1 for paraquat, and from 1.0 to 44 μg L-1 with the detection limit of 0.16 μg L-1 for diquat. The recognition process is detected by following the decrease in the fluorescence emission consequent to complexation. The proposed quenching method has been applied to the determination of paraquat in drinking water samples.

Pregnancy outcomes and vaccine effectiveness during the period of omicron as the variant of concern, INTERCOVID-2022: a multinational, observational study

In 2021, we showed an increased risk associated with COVID-19 in pregnancy. Since then, the SARS-CoV-2 virus has undergone genetic mutations. We aimed to examine the effects on maternal and perinatal outcomes of COVID-19 during pregnancy, and evaluate vaccine effectiveness, when omicron (B.1.1.529) was the variant of concern. INTERCOVID-2022 is a large, prospective, observational study, involving 41 hospitals across 18 countries. Each woman with real-time PCR or rapid test, laboratory-confirmed COVID-19 in pregnancy was compared with two unmatched women without a COVID-19 diagnosis who were recruited concomitantly and consecutively in pregnancy or at delivery. Mother and neonate dyads were followed until hospital discharge. Primary outcomes were maternal morbidity and mortality index (MMMI), severe neonatal morbidity index (SNMI), and severe perinatal morbidity and mortality index (SPMMI). Vaccine effectiveness was estimated, adjusted by maternal risk profile. We enrolled 4618 pregnant women from Nov 27, 2021 (the day after WHO declared omicron a variant of concern), to June 30, 2022: 1545 (33%) women had a COVID-19 diagnosis (median gestation 36·7 weeks [IQR 29·0-38·9]) and 3073 (67%) women, with similar demographic characteristics, did not have a COVID-19 diagnosis. Overall, women with a diagnosis had an increased risk for MMMI (relative risk [RR] 1·16 [95% CI 1·03-1·31]) and SPMMI (RR 1·21 [95% CI 1·00-1·46]). Women with a diagnosis, compared with those without a diagnosis, also had increased risks of SNMI (RR 1·23 [95% CI 0·88-1·71]), although the lower bounds of the 95% CI crossed unity. Unvaccinated women with a COVID-19 diagnosis had a greater risk of MMMI (RR 1·36 [95% CI 1·12-1·65]). Severe COVID-19 symptoms in the total sample increased the risk of severe maternal complications (RR 2·51 [95% CI 1·84-3·43]), perinatal complications (RR 1·84 [95% CI 1·02-3·34]), and referral, intensive care unit (ICU) admission, or death (RR 11·83 [95% CI 6·67-20·97]). Severe COVID-19 symptoms in unvaccinated women increased the risk of MMMI (RR 2·88 [95% CI 2·02-4·12]) and referral, ICU admission, or death (RR 20·82 [95% CI 10·44-41·54]). 2886 (63%) of 4618 total participants had at least a single dose of any vaccine, and 2476 (54%) of 4618 had either complete or booster doses. Vaccine effectiveness (all vaccines combined) for severe complications of COVID-19 for all women with a complete regimen was 48% (95% CI 22-65) and 76% (47-89) after a booster dose. For women with a COVID-19 diagnosis, vaccine effectiveness of all vaccines combined for women with a complete regimen was 74% (95% CI 48-87) and 91% (65-98) after a booster dose. COVID-19 in pregnancy, during the first 6 months of omicron as the variant of concern, was associated with increased risk of severe maternal morbidity and mortality, especially among symptomatic and unvaccinated women. Women with complete or boosted vaccine doses had reduced risk for severe symptoms, complications, and death. Vaccination coverage among pregnant women remains a priority. None.

The Preoperative Uric Acid-to-Albumin Ratio as a New Indicator to Predict Long-Term Prognosis After Surgery for Patients with Acute Type A Aortic Dissection.

The long-term prognosis of patients with acute type A aortic dissection (AAD) is poor, despite emergency surgical treatment. Therefore, it is imperative to evaluate patient risk factors to improve the prognosis. The aim of this study was to analyze the ability of the uric acid-to-albumin ratio (UAR) to predict the long-term mortality of patients with type A AAD after surgery. A total of 289 patients with type A AAD who had received surgical treatment was enrolled in this study. Peripheral blood samples were collected before anesthesia induction. All patients were divided into the UAR < 9.875 group and the UAR ≥ 9.875 group, and mortality significantly differed between the two groups. The patients were further divided into survival and non-survival groups, according to whether death occurred after the procedure based on a one-year follow up. Factors, including age, hypertension, albumin, UAR, and D-dimer, differed significantly between the survival and non-survival groups. The independent risk factors for long-term death in patients with type A AAD were analyzed by univariable and multivariable COX regression analyses, and the predictive value of these indices for postoperative mortality was assessed based on the receiver operating characteristic (ROC) curves. Preoperative UAR (HR 1.904, 95% CI, 1.097 to 3.305; P < 0.05), D-dimer (HR, 1.991,95% CI, 1.116 to 3.554; P < 0.05 ), and age (HR 2.216, 95% CI, 1.287 to 3.815; P < 0.05) were identified as independent risk factors for one-year mortality in patients with Type A AAD. The area under the ROC curve (AUC) of UAR was 0.618 [95% (0.544, 0.693)], and the sensitivity and specificity were 69.6% and 51.8%, respectively (P = 0.003). The AUC for albumin was 0.349 [95% (0.274, 0.425)], and the sensitivity and specificity were 26.1% and 51.8%, respectively (P = 0.000), The AUC for uric acid was 0.544 [95% (0.470, 0.619)], and the sensitivity and specificity were 78.3% and 34.5%, respectively (P = 0.265). The AUC for UAR + age + D-dimer was 0.751 [95% (0.681, 0.821)], and the sensitivity and specificity were 76.8% and 68.2%, respectively. UAR in patients with type A AAD may be used as a new independent risk factor for long-term mortality. Its predictive value is superior to that of albumin or uric acid alone. The combination of UAR, age, and D-dimer provide good prognostic value.