Non-significant Increase Research Articles

Analysis of choroidal markers of activity in pachychoroid disease spectrum.

To detect choroidal markers of disease activity in eyes with chronic active unilateral pachychoroid disease spectrum (PDS) compared to the non-active contralateral eyes, based on multimodal imaging and particularly indocyanine green angiography (ICGA). An observational retrospective case-control study. The study evaluated individuals diagnosed with chronic active unilateral PDS (group 1) by comparing the eyes with the non-active fellow eyes (group 2). Imaging was performed using fundus photographs, ICGA, and spectral-domain optical coherence tomography (SD-OCT). Choroidal thickness, choroidal vascular density, choroidal vasodilation, choroidal vascular leakage, and choroidal meridian breakdown were evaluated. Of the 90 patients with chronic PDS with ICGA at our database, 27 Caucasians (mean age: 55.9 years) were identified with active unilateral PDS. Group 1 showed a higher prevalence of the following parameters compared to Group 2: choroidal meridian breakdown (81.5% vs. 25.9%; p < 0.001), choroidal vasodilation (88.9% vs. 48.1%; p < 0.001), greater subfoveal choroidal thickness (420 ± 79.8μm vs. 346 ± 78.5μm; p = 0.002), ICGA choroidal vascular leakage (96.3% vs. 29.6%; p < 0.001), and choroidal hyperpermeability (100% vs. 29.6%; p < 0.001), with a nonsignificant increase in choroidal vascular density (55.4%±13.4 vs. 49.3%±13.5 in the contralateral eye; p = 0.167). Choroidal meridian breakdown, thicker choroid, choroidal vasodilation, and ICGA choroidal vascular leakage are potential posterior choroidal markers of disease activity in PDS.

Efficacy of a clinical decision support tool to promote guideline concordant evaluations in patients with high-risk microscopic hematuria: a cluster randomized quality improvement project.

We aimed to determine whether implementation of clinical decision support (CDS) tool integrated into the electronic health record (EHR) of a multi-site academic medical center increased the proportion of patients with American Urological Association (AUA) "high risk" microscopic hematuria (MH) who receive guideline concordant evaluations. We conducted a two-arm cluster randomized quality improvement project in which 202 ambulatory sites from a large health system were randomized to either have their physicians receive at time of test results an automated CDS alert for patients with 'high-risk' MH with associated recommendations for imaging and cystoscopy (intervention) or usual care (control). Primary outcome was met if a patient underwent both imaging and cystoscopy within 180 days from MH result. Secondary outcomes assessed individual completion of imaging, cystoscopy or placement of imaging orders. There were 917 patients randomized to intervention (n=476) or control (n=441) arms between October-December 2021. The percentage of eligible patients for whom the alert correctly triggered in the intervention arm was 83%. Primary outcome was achieved in 0.6% vs. 0.9% (RR: 0.69; 95% CI 0.15, 3.10) of patients in the intervention and control arms, respectively. Patients in the intervention and control groups had similar rates of completed imaging (17.7% vs. 14.7%) and cystoscopy (1.5% vs. 0.9%). Those in the intervention arm had a higher likelihood of CT urogram order (5.5% vs. 1.1%, p=0.003) and a non-significant increase in urology evaluation (11.1% vs. 7.5%, p=0.09). Implementing an EHR-integrated CDS tool to promote evaluation of patients with high-risk MH did not lead to improvements in patient completion of a full guideline-concordant evaluation. The development of an algorithm to trigger a CDS alert was demonstrated to be feasible and effective. Further multi-level assessment of barriers to evaluation are necessary to continue to improve the approach to evaluating high risk patients with MH.

Efficacy of Ceftazidime-avibactam in treating Gram-negative infections: a systematic review and meta-analysis.

Ceftazidime-avibactam (CAZ-AVI) has emerged as a promising treatment option for Gram-negative infections, particularly those caused by CAZ-Non-Susceptible (NS) pathogens. This systematic review and meta-analysis aim to assess the efficacy and safety of CAZ-AVI in these challenging infections. We systematically queried EMBASE, Cochrane CENTRAL, and PubMed/Medline for studies published until September 15, 2024. Randomized Controlled Trials (RCTs) evaluating CAZ-AVI against Gram-negative infections were included. A meta-analysis was performed to calculate pooled odds ratios (OR) for both clinical and microbiological success. A total of 146 studies were identified through database searches, leading to the inclusion of 17 studies. Among the efficacy studies for Gram-negative pathogens, there was no significant difference in clinical success rates for CAZ-AVI compared to comparators (pooled OR: 0.90, p = 0.22), and a non-significant increase in microbiological success was observed (pooled OR: 1.20, p = 0.41). In contrast, for CAZ-NS pathogens, six studies reported no significant difference in clinical cure rates (pooled OR: 0.77, p = 0.24), while four studies indicated a non-significant increase in microbiological cure rates (pooled OR: 1.83, p < 0.02). This study suggests that CAZ-AVI is a viable option for treating Gram-negative infections, including CAZ-NS pathogens. While it has shown promising activity against these resistant pathogens, its clinical and microbiological success rates are comparable to other antibiotics in the overall analysis. However, CAZ-AVI may offer an advantage in managing resistant infections. These findings underscore the need to consider CAZ-AVI in treatment guidelines and emphasize the importance of antibiotic stewardship programs to optimize its use and prevent resistance. Ongoing monitoring of resistance patterns and patient outcomes is essential to ensure its long-term efficacy.

Effects of tongue tamers and customized bonded spurs as an early treatment of anterior open bite: a randomized clinical study

BackgroundAnterior open bite is a challenging condition for pediatric dentists and orthodontists as it causes aesthetic, speech, feeding, and psychological problems; this emphasizes the need for early diagnosis and interception of this malocclusion.AimThis study aimed to evaluate the effects of prefabricated metal-bonded tongue tamers and customized bonded spurs in the early treatment of anterior open bite.Materials and methodsA sample of seventy-five children aged 7–9 years were assigned into three groups in which anterior open bite was treated using tongue tamers (group-I), customized composite bonded spurs(group-II), and conventional fixed palatal cribs (group-III). Study model and cephalometric x-ray evaluations were done before and after a three-month follow-up. Data was gathered and statistically analyzed using ANOVA and Bonferroni tests.ResultsModel overbite at central and lateral incisors was increased in all groups. The highest increase was found in group-I(3.16 ± 1.17, 2.81 ± 0.94)and group-III(3.08 ± 1.10,2.99 ± 1.00) though the difference was not statistically significant. Also, cephalometric overbite was non-significantly increased in all groups with a high increase in group-III(3.13 ± 1.10). Overjet decreased in all groups, with the greatest reduction observed in group-I(-2.58 ± 1.02 and -2.47 ± 0.80 in model and cephalometric respectively) and was significantly different from group-II using pairwise analysis. There was a decrease in SNA and ANB in all groups with more significant improvement in groups-I(-1.20 ± 0.88,-1.65 ± 0.74) and -III(-1.31 ± 0.92, -1.62 ± 0.75) than group-II(-0.63 ± 0.46, -0.90 ± 0.43). Moreover, FMA measurements decreased significantly in group-I (-2.6 ± 1.11). Regarding SNB measurement, there was a non-significant increase in all three groups with the highest increase in group-I(0.49 ± 0.48) followed by group-III(0.34 ± 0.63). The U1/FHP and L1/GoGn angles were non-significantly decreased in all tested groups with the highest decrease in group-I(-1.76 ± 1.00 and-2.54 ± 0.87 respectively).ConclusionEarly treatment of anterior open bite, along with tongue tamers' simplicity and aesthetics promoted the malocclusion correction and occlusal function restoration.Trial registrationClinicalTrials.gov, NCT05792553, “Effects of Tongue Tamers as an Early Treatment of Anterior Open Bite”, Retrospectively registered: 31/03/2023.

Impact of trypanosomiasis on male camel infertility

IntroductionBlood parasitism is a significant clinical disease that silently undermines the livestock industry, particularly affecting camels. This study aimed to assess the prevalence of Trypanosoma evansi in Arabian camels (Camelus dromedarius) and its impact on infertility by examining serum protein fractions, lipids, reproductive indices, and the expression of heat shock protein (HSP70) during breeding season.MethodsA total of 107 male post-pubertal camels, aged between 5 and 10 years, were collected randomly from slaughtering house in Assiut Governorate, Egypt.ResultsMicroscopic and serological examinations revealed that 23.4% (25/107) of the camels were infected with T. evansi. Infected camels exhibited a highly significant increase in total serum protein. The assessment of dyslipidemia, measure as binary variables for lipid profiles (cholesterol, triglycerides, HDL, and LDL), indicated a nonsignificant increase in risk of dyslipidemia in infected camels compared to healthy camels. Proteomic analysis identified four major protein fractions in the infected camels compared to healthy camels with molecular weights of 181.72, 87.59, 30.5, and 19.5 kDa using SDS electrophoresis. Testicular tissue of the infected camels showed degeneration and necrotic changes in seminiferous tubules and interstitial tissue, along with edema and congestion. There was a significant reduction in the diameter of seminiferous tubules and germinal epithelium height. A marked reduction in testosterone levels and a high expression of HSP70 in spermatogonia, spermatocytes, Sertoli cells, and Leydig cells were observed.DiscussionConsequently, a combination of physiological and hormonal analyses may serve as a reliable indicator of Trypanosoma infection.

Increased cardiac macrophages in Sorbs2-deficient hearts: revealing a potential role for macrophage in responding to embryonic myocardial abnormalities

Macrophages are known to support cardiac development and homeostasis, contributing to tissue remodeling and repair in the adult heart. However, it remains unclear whether embryonic macrophages also respond to abnormalities in the developing heart. Previously, we reported that the structural protein Sorbs2 promotes the development of the second heart field, with its deficiency resulting in atrial septal defects (ASD). In analyzing RNA-seq data, we noted an upregulation of macrophage-related genes in Sorbs2−/− hearts. Immunostaining and lineage-tracing confirmed an increase in macrophage numbers, underscoring a macrophage response to myocardial abnormalities. Partial depletion of macrophages led to downregulation of genes involved in lipid metabolism, muscle development and organ regeneration, alongside upregulation of genes associated with DNA damage-induced senescence and cardiomyopathy. Additionally, a non-significant increase in septal defects in macrophage-depleted Sorbs2−/− hearts suggests a potential reparative function for macrophages in maintaining structural integrity. Valve formation, however, remained unaffected. Our findings suggest that embryonic macrophages might sense abnormalities in embryonic cardiomyocytes and could adaptively support cardiac structure and function development in response to myocardial abnormalities.

Impact of a new case-based payment scheme on volume distribution across public hospitals in Zhejiang, China: does ‘Same disease, same price’ matter

BackgroundWith the implementation of the hierarchical medical system (HMS) in China, Zhejiang Province introduced an innovative payment scheme called “payment method by disease types with point counting”. This scheme was initially adopted in Jinhua in July 2017, and was later integrated with the “same disease, same price” policy in Hangzhou in January 2020. This study aimed to investigate the impact of these reforms on the distribution of health service volume.MethodsData were obtained from 104 hospitals, including 12 tertiary and 14 secondary hospitals from each of four regions: Jinhua (intervention) vs. Taizhou (control), and Hangzhou (intervention) vs. Ningbo (control). A total of 3848 observation points were examined using two sets of controlled interrupted time series analyses to assess the effects of this new case-based payment, without and with “same disease, same price”, on the proportion of discharges, total medical revenue and hospitalization revenue. The Herfindahl–Hirschman Index (HHI) were analyzed to evaluate changes in market competition.ResultsFollowing the introduction of the new case-based payment without “same disease, same price”, secondary hospitals in Jinhua experienced a significant decline in the proportion of discharges (β6 = -0.1074, p = 0.047), total medical revenue (β6 = -0.0729, p = 0.026), and hospitalization revenue (β6 = -0.1062, p = 0.037) compared to those in Taizhou, while tertiary hospitals showed a non-significant increase. After incorporating “same disease, same price”, the proportion of discharges (β6 = 0.2015, p = 0.031), total medical revenue (β6 = 0.1101, p = 0.041) and hospitalization revenue (β6 = 0.1248, p = 0.032) in Hangzhou’s secondary hospitals increased compared with Ningbo’s, yet the differences in both the level and trend changes between tertiary hospitals in the two cities were not statistically significant. The HHI in Jinhua (β7 = 0.0011, p = 0.043) presented an upward trend during the pilot period of the case-based payment, while the HHI in Hangzhou (β6 = -0.0234, p = 0.021) decreased immediately after the introduction of “same disease, same price”.ConclusionThis new case-based payment scheme may worsen the disproportionate distribution of service volume across hospitals of different levels. While “same disease, same price” shows potential benefits, further evidence is needed to assess its effectiveness in promoting HMS. Policymakers should consider hospital interests in payment design and address unintended strategic behaviors.

Economics of Seed Spices in Gujarat: Analyzing Parity of Cost, Price, and Income

This study analyzes the cost, price, and income parity in three major seed spices cultivated in Gujarat by examining indices of average input prices, Farm Harvest Prices, cost of production, and gross income to evaluate the profitability and challenges faced by farmers. The secondary data on input cost, cost of production and gross income were collected for the period of eleven years from 2011-12 to 2021-22 from the reports of “The Scheme for Farm Cost Studies of Important Crops in Gujarat State” and “The Scheme for Creating a Permanent Machinery for studying Cost of Cultivation/ Production of Principal crops grown in Gujarat state, further analysis of parity indices were estimated by taking 2011-12 as base year. The results indicate that for cumin crop, input prices grew significantly, while farm harvest prices exhibited a non-significant increase. Parity indices between Farm Harvest Prices and input prices remained below 100, indicating that farm harvest prices did not cover rising input costs. However, in years like 2016-17, 2018-19, and 2021-22, the farm harvest price and gross income were favorable, indicating profitability for farmers. In fennel, input prices and production costs showed significant growth, while farm harvest prices and gross income had minimal increases. Parity indices suggested that farm harvest prices were insufficient to cover rising costs in most years, though 2012-13 and 2021-22 were favorable for farmers in terms of both price and income. Coriander, with significant growth in input prices, showed a slight increase in farm harvest prices and a decrease in production costs. Parity indices indicated that the farm harvest price consistently exceeded input prices and the cost of production, ensuring favorable profitability and encouraging investment in coriander cultivation. Overall, the findings underscore the need for policy interventions to stabilize farm harvest prices and control input cost inflation, ensuring sustained profitability for farmers growing seed spices.

Trend analysis and change point detection in precipitation time series over the Eastern Province of Rwanda during 1981–2021

This study examines trends and change points in agroclimatic variables at 56 meteorological stations’ locations and region levels in Rwanda’s Eastern Province from 1981 to 2021. We used the Mann–Kendall and Regional Kendall tests, along with Sen’s Slope and Sequential Mann–Kendall Rank Statistic tests, to analyse six key agricultural indicators: seasonal rainfall totals, number of rainy days, rainfall intensity (light, moderate, heavy), onset and cessation dates, and season duration. In the March to May (MAM) season, 39 out of 56 stations recorded a decreasing rainfall trend, with significant trends observed at eight stations in the south. Conversely, 17 stations showed increasing trends, with only one in the north being significant. Regionally, the trend was a non-significant decrease. In the September to December (SOND) season, 31 stations (one significant) experienced decreasing rainfall trends. Among the 25 stations showing increasing trends, only one was significant. The regional trend indicates a non-significant increase. Onset days showed a decreasing trend at 41 stations (12 significant) in both MAM and SOND and a significant regional trend in SOND. Season duration increased at 43 stations in MAM (five significant) and 48 stations in SOND (six significant), with the regional trend being significant only in SOND. Heavy rainy days indicate a significantly regional decreasing trend in MAM. The change point of most stations with decreasing and increasing trends occurred between 2000–2020 and 1980–2000, respectively. These fluctuations have affected agricultural practices and led to crop failures, emphasizing the region’s need for better climate information services and adaptation strategies.

The feasibility and efficacy of a psychospiritual intervention with the insights from Bhagavad Gītā and Yin Yoga on a Turkish population: A mixed method approach

ABSTRACT This pilot study examines the feasibility of a psychospiritual intervention integrating Bhagavad Gītā and Yin Yoga to reduce anxiety and enhance meaning in life and resilience among 20 Turkish women. Amidst challenges like COVID-19 and earthquakes, this novel approach, using quasi-experimental single-group mixed-methods pre-test/post-test design, aimed to assess the intervention’s adaptability and effectiveness within a cultural context unfamiliar with such methods. The online intervention used the Beck Anxiety Inventory, Meaning in Life Questionnaire, and Brief Resilience Scale and semi-structured interviews. SPSS was used for quantitative data analysis, and thematic analysis was applied to qualitative responses. Results showed a significant reduction in anxiety, with participants reporting improved coping strategies and a deeper sense of life’s meaning. While resilience scores showed only a slight, non-significant increase, qualitative feedback suggested subtle improvements in handling adversity. Additionally, the presence and search for meaning scores showed nuanced changes, with qualitative responses indicating a refined understanding of meaning in life post-intervention. This study underscores the value of mixed-methods research in psychospirituality, demonstrating the potential of integrating ancient spiritual teachings with modern psychological practices to support mental health and coping strategies in diverse cultural contexts.

Testing the Recruitment Frequency, Implementation Fidelity, and Feasibility of Outcomes of the Heart Failure Activity Coach Study (HEALTHY): Pilot Randomized Controlled Trial.

Heart failure (HF) is a common and deadly disease, precipitated by physical inactivity and sedentary behavior. Although the 1-year survival rate after the first diagnosis is high, physical inactivity and sedentary behavior are associated with increased mortality and negatively impact the health-related quality of life (HR-QoL). We tested the recruitment frequency, implementation fidelity, and feasibility of outcomes of the Activity Coach app that was developed using an existing mobile health (mHealth) tool, Optilogg, to support older adults with HF to be more physically active and less sedentary. In this pilot clinical randomized controlled trial (RCT), patients with HF who were already using Optilogg to enhance self-care behavior were recruited from 5 primary care health centers in Sweden. Participants were randomized to either have their mHealth tool updated with the Activity Coach app (intervention group) or a sham version (control group). The intervention duration was 12 weeks, and in weeks 1 and 12, the participants wore an accelerometer daily to objectively measure their physical activity. The HR-QoL was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), and subjective goal attainment was assessed using goal attainment scaling. Baseline data were collected from the participants' electronic health records (EHRs). We found 67 eligible people using the mHealth tool, of which 30 (45%) initially agreed to participate, with 20 (30%) successfully enrolled and randomized to the control and intervention groups in a ratio of 1:1. The participants' daily adherence to registering physical activity in the Activity Coach app was 69% (range 24%-97%), and their weekly adherence was 88% (range 58%-100%). The mean goal attainment score was -1.0 (SD 1.1) for the control group versus 0.6 (SD 0.6) for the intervention group (P=.001). The mean change in the overall HR-QoL summary score was -9 (SD 10) for the control group versus 3 (SD 13) in the intervention group (P=.027). There was a significant difference in the physical limitation scores between the control (mean 45, SD 27) and intervention (mean 71, SD 20) groups (P=.04). The average length of sedentary bouts increased by 27 minutes to 458 (SD 84) in the control group minutes and decreased by 0.70 minutes to 391 (SD 117) in the intervention group (P=.22). There was a nonsignificant increase in the mean light physical activity (LPA): 146 (SD 46) versus 207 (SD 80) minutes in the control and intervention groups, respectively (P=.07). The recruitment rate was lower than anticipated. An active recruitment process is advised if a future efficacy study is to be conducted. Adherence to the Activity Coach app was high, and it may be able to support older adults with HF in being physically active. ClinicalTrials.gov NCT05235763; https://clinicaltrials.gov/study/NCT05235763.

Morbid obesity among Crohn's disease patients is on the rise and is associated with a higher rate of surgical complications after ileocolic resection.

Crohn's disease (CD) is regarded as a wasting disease, yet there is a growing population of CD patients with a body mass index (BMI) of 35 and above. The rate of postoperative complications is relatively high in CD patients but might be even higher in CD with morbid obesity (MO). This was a retrospective study using a prospectively maintained database of all patients undergoing Ileocolic resection for CD between 2014 and 2021 in two referral centres, comparing postoperative complication rates according to BMI. Three hundred and forty-six patients were identified. Sixty patients (17%) had a BMI over 30 kg/m2, and 28 (8.1%) had a BMI of over 35 kg/m2 (>35 group). The BMI >35 group had more women (78.6% vs. 52%, P < 0.1), a higher rate of patients not receiving an anastomosis (7.1% vs. 2.5%, P = 0.02), a higher rate of any postoperative surgical complication (32.1% vs. 25.2%, P = 0.4), with a higher rate of Clavien-Dindo ≥3 (14.3% vs. 7.2%, P = 0.25), a higher rate of stoma creation on reoperation for complications (7.2% vs. 1.7%, P = 0.04), a higher rate of 30-day readmission due to intra-abdominal abscess (10.7% vs. 4.7%, P = 0.2), but a lower rate of postoperative medical complications (3.6% vs. 15.7%, P < 0.01). The rate of MO among CD patients requiring ileocolonic resection is on the rise. MO in this setting is associated with statistically non-significant increases in all surgical complications, severe complications, readmission, and a higher chance for a bailout stoma creation upon reoperation. However, MO seems to be a protective factor for medical postoperative complications, which might suggest better nutritional status.

Evaluation of corneal epithelial changes after corneal collagen cross-linking by using anterior segment optical coherence tomography

Background The thickness of the corneal epithelium can be precisely measured using anterior segment optical coherence tomography (AS-OCT). Aim This study aimed to conduct an AS-OCT evaluation of changes in the corneal epithelial thickness following collagen cross-linking (CXL). Patient and methods This prospective interventional study utilized 23 eyes from 13 cases who underwent treatment for progressive keratoconus (KC) with epi-off corneal CXL according to the Dresden’s Protocol. Results After 6 months postoperative the central minimum epithelial thickness (0.0–2.0 mm) showed a statistically significant increase, while the mid-peripheral (5.0–7.0 mm) showed a statistically significant decrease compared with the preoperative level. The central average epithelial thickness (0.0–2.0 mm) showed statistically nonsignificant increase, while the mid-peripheral and peripheral (5.0–7.0, 7.0–9.0 mm) showed a statistically significant decrease in comparison to the level before the operation. At 6 months postoperative, a decrease in Mean k was associated with statistically significant elevation in average central and paracentral epithelial thickness (0.0–2.0, 2.0–5.0 mm) as compared with the preoperative level (negative correlation). At 6 months postoperative, reduction in thinnest pachymetry was associated with statistically significant increase in central and paracentral average epithelial thickness (0.0–2.0, 2.0–5.0 mm) (negative correlation) as compared with the preoperative and 3 months postoperative. Conclusions With AS-OCT, it is simple to track changes in the epithelium over time. Epithelial remodeling occurs after CXL in the areas of protrusion and thinning. The thickness of the epithelium is greatest at the cone’s base and diminishes as one moves away from it.

Causes of Death Following Coronary Revascularization in Patients with Diabetes.

In patients with diabetes and multivessel coronary artery disease, percutaneous coronary intervention (PCI) has been associated with higher long-term cardiovascular mortality compared to coronary artery bypass grafting (CABG), but the specific causes of death are not well known. We aimed to determine the causes of death among patients with diabetes and multivessel disease undergoing coronary revascularization with PCI versus CABG. We analyzed the centrally adjudicated causes of death of 1,900 participants in the FREEDOM trial. Cause-specific hazard ratios (csHR) were used to compare mortality rates. There were 197 deaths during the five years of follow-up, 63.5% were classified as cardiovascular deaths and the remaining (36.5%), non-cardiovascular deaths. Sudden cardiac death was the most common cause of cardiovascular mortality (40% of all cardiovascular deaths), followed by myocardial infarction deaths (16% of all cardiovascular deaths). Compared to CABG, PCI was associated with increased ischemic-related mortality, namely sudden cardiac death (csHR: 2.04;95%CI: 1.13 to 3.70; p=0.02) and the composite of sudden cardiac death and myocardial infarction death (csHR: 2.10, 95%CI: 1.27 to 3.48, p=0.004). PCI was associated with a non-significant increase in overall cardiovascular mortality compared to CABG (csHR: 1.35;95%CI: 0.95 to 1.93; p=0.09). Sudden cardiac death was the most common cause of long-term mortality among patients with diabetes and multivessel coronary artery disease undergoing a revascularization procedure. Compared to CABG, PCI was associated with increased long-term rates of ischemic-related mortality. Operative techniques and secondary prevention should target reducing post-revascularization spontaneous myocardial infarction in patients treated with PCI.

Effect of Reproductive Tract Microbiota on Vaginal Fibroblasts in Pelvic Organ Prolapse

Importance The effect of vaginal bacteria on wound healing is an evolving area of study. Bacterial vaginosis (BV), characterized by an overgrowth of anaerobic bacteria, is linked to increased surgical site infections after pelvic surgery. While BV-associated microbes are known to impair epithelial repair, their effects on fibroblasts, which are crucial for wound healing and prolapse recurrence after pelvic organ prolapsesurgery, are unclear. Understanding these interactions can deepen knowledge of vaginal tissue remodeling. Objective This study aimed to compare the effects of BV-associated bacteria and commensal lactobacilli on fibroblast cell number and function, using estradiol as a positive control. Study Design Fibroblasts were isolated from vaginal wall biopsies of 9 participants undergoing pelvic organ prolapse surgery. Cells were co-cultured in media alone, media containing estradiol, and media with cell-free supernatants (CFS) from Lactobacillus crispatus, Lactobacillus iners, and Gardnerella vaginalis. Intact cell number was assessed using an lactate dehydrogenase assay at 0, 24, and 48 hours, and ELISA measured IL-6, type I collagen, and fibronectin levels. Results Fibroblasts exposed to G vaginalis CFS showed significantly reduced cell number and type I collagen production, with increased fibronectin levels. Cell-free supernatants from L crispatus and L iners did not affect fibroblast proliferation. While some donor cells showed an increase in cell number with estradiol, the change was inconsistent and not statistically significant. IL-6 levels showed a nonsignificant increase with any bacterial CFS. Conclusions G vaginalis significantly impairs fibroblast cell number and type I collagen production, suggesting BV-associated microbes may alter fibroblast function, emphasizing the vaginal microbiome’s role in outcomes.

The evaluation of depression prevalence and its association with obesity phenotypes in a community-dwelling aged population

BackgroundDepression is one of the most debilitating mental disorders and a risk factor for many other chronic diseases that are commonly seen in the geriatric population. It has been claimed in previous studies that depression can be associated with obesity in this age group, but there is no common consensus between their results.AimThis study aims to evaluate the association between depression metabolic syndrome and obesity phenotypes in community-dwelling older adults living in the East of Iran.Method and materialsAs a part of the Birjand Longitudinal Aging Study, this retrospective cross-sectional study was conducted on participants older than 60. They were categorized based on their body mass index and components of metabolic syndrome into four phenotypes: metabolic non-healthy obese (MNHO), metabolic healthy obese (MHO), metabolic healthy non-obese (MHNO), and metabolic non-healthy non-obese (MNHNO). The relative risk ratio (RRR) of the obesity phenotypes, the severity of depressive symptoms, and the 95% confidence intervals (95% CI) were evaluated by univariate and multinomial logistic regression.ResultsOf 1344 eligible participants, 268 (19.94%) had depression. Moderate, moderate-severe, and severe depression were observed in 179 (13.32%), 67 (4.99%), and 22 (1.64%) participants, respectively. Our findings showed a non-significant increase in the RRR of mild depressive symptoms in MNHO (RRR:1.22, 95% CI 0.56–2.66) and severe symptoms in MNHNO (RRR:1.20, 95% CI 0.02–63.17) females. However, in male participants, the RRR of moderate-severe depressive symptoms only increased non-significantly for the MNHO category (RRR:1.34, 95% CI 0.45–3.98).ConclusionWe did not observe a meaningful association between depressive symptoms and obesity phenotypes. Also, other than malnutrition or its risk, various severities of depressive symptoms correlate with different sociodemographic and medical risk factors among male and female senior citizens.

Effects of choline alfoscerate on cognitive function and quality of life in type 2 diabetes: A double-blind, randomized, placebo-controlled trial.

This study evaluated the effects of choline alfoscerate on cognitive function and quality of life in T2DM patients with mild cognitive decrements. In a double-blind, randomized, placebo-controlled trial, we recruited 36 individuals with T2DM and mild cognitive impairment which was assessed by the Mini-Mental State Examination (MMSE) score of 25-28, and randomly assigned them to receive either 1200 mg/day of choline alfoscerate or a placebo. Four additional questionnaires-the 36-Item Short Form Survey, the modified Informant Questionnaire on Cognitive Decline in the Elderly, the Korean version of Activities of Daily Living, and the Patient Health Questionnaire-were investigated at 6 and 12 months and analysed via mixed-effects models for repeated measures. The mean age of study participants was 71.8 ± 5.3 years and 69.4% women. Six-month treatment with choline alfoscerate resulted in a non-significant increase in the MMSE score from 26.2 ± 1.3 to 26.9 ± 2.0, whereas the placebo group showed a non-significant decline from 26.6 ± 1.3 to 25.9 ± 2.3, resulting in a mean difference of +1.4 between the two groups (p = 0.059). At 12 months, the mean difference increased to +1.7 with statistical significance (p < 0.001). Physical health, as measured by the SF-36 survey, was significantly better in the choline alfoscerate group than in the placebo group. Choline alfoscerate 1200 mg once daily treatment showed marginal improvement in cognitive function in T2DM patients with mild cognitive impairment at 6 months but leading to significance at 12 months compared to placebo, suggesting its potential as an adjunct therapy for managing early cognitive decline.

Evaluating the estrogenic activity and toxicity of Tectona grandis leaf extract on the reproductive and endocrine system of female wistar rats

Female reproductive complications continue to be a major health challenge worldwide. Medicinal plants richer in secondary metabolites such as phytoestrogens have been used over decades for the treatment of reproductive health problems like infertility, with limited knowledge on their toxicities. The present study was designed to evaluate the estrogenic potential and safety of Tectona grandis leaves extract on female wistar rats. Following acclimatization and pre-evaluation of the estrous cycle, female wistar rats, 6 weeks old were placed in groups of 3 animals each and T. grandis extracts administered daily in graded doses of 500, 1000, 2000mg/Kg body weight against controls for 28 days (Sub-acute toxicity). A dose dependent increase in 17-Beta estradiol was observed in the serum and ovary homogenates versus an increase in cholesterol when compared to the control groups. Results from the three animals per group showed an increase in the weights of the animals and a non-significant increase in alanine aminotransferase (ALT), white blood cells, haemoglobin and haematocrit at the dose of 2000 mg/kg. Also, there was no significant difference in the organ weights and histopathological examinations of necropsied animals showed no abnormalities in the various organs. T. grandis leave extract contains phytochemicals such as lignans that can be converted by microflora to phytoestrogens, which can compete with endogenous estrogen for the estrogen receptor potentiating similar activities like estrogens. This indicates that T. grandis could be explored as hormonal replacement therapies in infertility, menopausal and/or breast cancer related problems. Keywords: 17-β-estradiol, Tectona grandis, lignans, phytoestrogens, toxicity, hormonal replacement therapy

Comparison of 1-hour floatation-REST versus conventional napping on heart rate variability in active individuals

ObjectivesThis study aimed to investigate the short-term effects of a 1-hour floatation-resting environmental therapy (FLO) versus conventional napping (NAP) on heart rate variability (HRV) in highly trained individuals.Methods20 non-fatigued participants...

Acceptability, User Satisfaction, and Feasibility of an App-Based Support Service During the COVID-19 Pandemic in a Psychiatric Outpatient Setting: Prospective Longitudinal Observational Study.

Patients with mental disorders often have difficulties maintaining a daily routine, which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies. The aim of this study was to evaluate the acceptability, usability, and feasibility of an app-based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic. Patients in a psychiatric outpatient department at a German university hospital were invited to use an app-based support service designed transdiagnostically for mental disorders for 4 weeks. The app included 7 relaxation modules, consisting of video, audio, and psychoeducational text; ecological momentary assessment-like questionnaires on daily mood answered via a visual smiley-face scale; and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0; preintervention time point) and after 4 weeks (T2; postintervention time point) were analyzed. Feedback via the smiley-face scale was provided after using the app components (T1; during the intervention). Measures included depressive symptoms, quality of life, treatment credibility and expectancy, and satisfaction. Furthermore, participation rates, use of app modules and the activity button, and daily mood and the provided feedback were analyzed (T2). In total, 57 patients participated in the study, and the data of 38 (67%) were analyzed; 17 (30%) dropped out. Satisfaction with the app was high, with 53% (30/57) of the participants stating being rather satisfied or satisfied. Furthermore, 79% (30/38) of completers stated they would be more likely or were definitely likely to use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half (18/38, 47%) of the completers trying relaxation modules and 71% (27/38) regularly responding to the ecological momentary assessment-like questionnaire between 15 and 28 times (mean 19.91, SD 7.57 times). The activity button was used on average 12 (SD 15.72) times per completer, and 58% (22/38) felt "definitely" or "rather" encouraged to perform the corresponding activities. Depressive symptomatology improved significantly at the postintervention time point (P=.02). Quality of life showed a nonsignificant increase in the physical, psychological, and social domains (P=.59, P=.06, and P=.42, respectively) and a significant improvement in the environment domain (P=.004). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.02 and P<.001, respectively). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=-0.36; P=.03). App-based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them in maintaining a daily routine, complementing existing face-to-face treatments, and overall helping respond to challenging situations such as the COVID-19 pandemic.