Significant Increase In Frequency Research Articles

Metabolic Dysfunction Associated Fatty Liver Disease in Long-Term Cholecystectomy Patients: A Cross-Sectional Study.

Cholecystectomy, while generally safe with low perioperative morbidity and mortality, has been linked to an increase in metabolic disorders. Metabolic dysfunction-associated fatty liver disease (MAFLD) is a globally prevalent condition that leads to both hepatic and systemic complications. This study aimed to investigate the association between cholecystectomy and MAFLD. This cross-sectional study was designed to evaluate the relationship between cholecystectomy and MAFLD. Metabolic dysfunction-associated fatty liver disease was defined by the presence of hepatic steatosis in combination with any of the following conditions: diabetes mellitus (fasting plasma glucose ≥126 mg/dL), overweight (body mass index (BMI) ≥25 kg/m2), or metabolic dysregulation. A total of 163 participants with BMI ≥25 kg/m2, including consecutive cholecystectomized (N = 83) and non-cholecystectomized (N = 80) subjects, were included. The prevalence of MAFLD was found in 64 out of 83 (77.1%) cholecystectomized patients and in 30 out of 80 (37.5%) non-cholecystectomized subjects (P < .001). When age, gender, BMI, exercise habits, hypertension, diabetes mellitus, and cholecystectomy status were included in regression analyses, we found that only BMI [odds ratio (OR) = 1.155 (95% CI: 1.040-1.283)] and cholecystectomy [OR = 4.540 (95% CI: 2.200-9.370)] were independently associated with MAFLD (both P < .01). ROC analysis identified 10 years as the cut-off, with MAFLD risk being 2.7-7.3 times higher in patients with cholecystectomy for ≤10 and >10 years. In our study, MAFLD was found to be 4.5 times more likely in cholecystectomized patients compared to those without cholecystectomy, with a significant increase in frequency observed after 10 years. These results suggest that cholecystectomized patients should be monitored for MAFLD.

A Synoptic Scale Perspective of Solar Forcing on Extreme Precipitation and Floods Over Europe During Summer

AbstractThe relationship between total solar irradiance (TSI) forcing and summer extreme precipitation and flood frequency over western Europe is investigated from a synoptic‐scale perspective, with a focus on the role of Rossby wave packets (RWPs). Utilizing observational, model, and proxy data, we reveal a significant increase in RWP frequency along a zonal band centered around 50°N, extending from North America to western Europe, during periods of low TSI. This anomaly in RWP frequency is consistent with a significant increase in the frequency of extreme precipitation events recorded over western Europe. Sensitivity experiments conducted with a state‐of‐the‐art chemistry‐climate model corroborate our findings based on observational data. Additionally, a flood record from western Europe demonstrates a significant increase in flood frequency during low TSI years, a relationship that persists across timescales. We argue that the frequency patterns associated with TSI forcing presented in this study are robust and, therefore, valuable for estimating the frequency of extreme precipitation events over western Europe under various solar irradiance scenarios. Moreover, our findings indicate that the North Atlantic sector is more responsive to changes in solar forcing during the boreal summer than previously thought, with this effect manifesting primarily on synoptic timescales rather than the long‐term climatological mean.

Leukemic B cells expression of CD200 and Leukocyte-associated immunoglobulin-like receptor-1 (LAIR-1, CD305) in Chronic Lymphocytic Leukemia patients in relation to Treg frequency

BackgroundChronic lymphocytic leukemia (CLL) is characterized by a wide range of tumor-induced immune alterations. Regulatory T cells (Treg) play a central role in these immune responses. CD200 and Leukocyte-associated immunoglobulin-like receptor-1 (LAIR-1, CD305) are inhibitory markers said to be involved in Treg immune response. We aimed to analyze the expression of CD200 and LAIR-1 on leukemic cells and assess their interactions with the Treg frequency to elucidate their role in the CLL course. Subjects and methodsThis study was conducted on 70 participants: 50 newly diagnosed CLL cases classified according to Rai staging system into group 1 (n = 25) patients with stages 0, I, and II, and group 2 (n = 25) of advanced patients with stages III and IV. In addition to control group (n = 20) of healthy adults. Flow cytometry was used to investigate Treg frequency in bone marrow (BM) proportional to CD4+ T cell and to assess leukemic cell expression of CD200 and LAIR-1. Also, in-silico database analysis was performed to identify study markers interactions for future personalized target therapy. ResultsComparison between CLL groups 1 and 2 revealed increased leukemic cell percentage expressing LAIR-1 (p = 0.021) in group 1. Group 2 showed significant increase in frequency of Treg in BM and leukemic cells expressing CD200. There was a strong positive correlation between frequency of Treg and leukemic cells expressing CD200 (r = 0.669, p = 0.000). On the other hand, there was a negative correlation between frequency of Treg and leukemic cell expressing LAIR-1 (r = −0.342, p = 0.015). ROC curve analysis revealed that increased frequency of leukemic cells expressing CD200 yielded sensitivity (SN) and specificity (SP) of 96 % and 84 %, respectively in detecting CLL progression, with an AUC of 0.965. Leukemic cell percentages expressing LAIR-1 yielded a lower SN (75 %), SP (72 %), with an AUC of 0.688. ConclusionTreg frequency in BM was significantly increased in CLL advanced stages according to Rai classification. Leukemic cells CD200 and LAIR-1 expression were differently associated with Treg frequency. Increased CD200 expressions on leukemic cells can be considered a sensitive and specific biomarker in detecting CLL progression. As demonstrated by the in-silico research, CD200 blockade targeting may offer therapeutic benefits for CLL treatment through Treg suppression.

Examining the impact of the COVID-19 pandemic on hospital-associated Clostridioides difficile infection.

To evaluate the impact of changes in the size and characteristics of the hospitalized patient population during the COVID-19 pandemic on the incidence of hospital-associated Clostridioides difficile infection (HA-CDI). Interrupted time-series analysis. A 576-bed academic medical center in Portland, Oregon. We established March 23, 2020 as our pandemic onset and included 24 pre-pandemic and 24 pandemic-era 30-day intervals. We built an autoregressive segmented regression model to evaluate immediate and gradual changes in HA-CDI rate during the pandemic while controlling for changes in known CDI risk factors. We observed 4.5 HA-CDI cases per 10,000 patient-days in the two years prior to the pandemic and 4.7 cases per 10,000 patient-days in the first two years of the pandemic. According to our adjusted segmented regression model, there were neither significant changes in HA-CDI rate at the onset of the pandemic (level-change coefficient = 0.70, P-value = 0.57) nor overtime during the pandemic (slope-change coefficient = 0.003, P-value = 0.97). We observed significant increases in frequency and intensity of antibiotic use, time at risk, comorbidities, and patient age before and after the pandemic onset. Frequency of C. difficile testing did not significantly change during the pandemic (P= 0.72). Despite large increases in several CDI risk factors, we did not observe the expected corresponding changes in HA-CDI rate during the first two years of the COVID-19 pandemic. We hypothesize that infection prevention measures responding to COVID-19 played a role in CDI prevention.

Levels of Matrix Metalloproteinase-9 (MMP-9) and its gene polymorphism of Hydatid Cyst Disease in an Infected Patients

Hydatid cystic disease is an economic burden in Iraq since it decreases the productivity of sheep, goats, cows, and camels by making the organs unpalpable for human consumption, hence weight-loss and ill health. This is one of the most common zoonosis diseases shared between human beings and animals and appears in man hosts inlcuded some organes, such as liver and lung as hydatid cyst . it causes many complications that may lead to death in repured parasites. Now there are no safe and effective in the fight against this parasite, and the search for such medications is in research. The Matrix Metalloproteinase-9 is a one of the enzymes that belong to the family of matrix metalloproteinases (MMPs), which play a crucial role in the proteolytic degradation of the extracellular matrix (ECM). These enzymes have a zinc ion in the active site that is important for their proteolytic activity. MMP-9, also known as Gelatinase B, catalyzes gelatin and degrades components of the ECM, including abundant type IV collagen in basement membranes. MMP-9 plays an important role in various biological processes, including tissue remodeling, angiogenesis, and tissue inflammation. The objective of the study is to determine the impact of MMP-9 serum levels and specific single nucleotide polymorphisms (SNPs) rs17576 and rs76070157 on patients with hydatid disease, in comparison to a control group of healthy individuals. A total of (62) patients diagnosed with hydatid disease, consisting of 18 males and 44 females, were compared to a control group of(75) individuals, comprising 29 males and 46 females .The study examined the MMP-9 rs17576 and rs76070157 )SNPs( in patients with hydatid disease, comparing them to a control group of healthy individuals. The study revealed no statistically significant difference in the average age between the two groups at a significance level of 0.05. Additionally, the study found higher concentrations of MMP-9 in the sera of the infected group (20.40 ± 1.52 pg/µl) compared to the control group (19.49 ± 1.62 pg/µl). The rs17576 )SNPs( data indicated that the TT genotype and T allele exhibited a slightly higher frequency percentage in the group of patients with hydatid disease compared to the healthy group, however this difference was not statistically significant. The values are (98.4% and 99.0%) the value of pc is 0.001. The elevated odds ratio (OR) associated with the TT genotype and T allele may serve as a potential risk factor for hydatid disease. The rs17576 SNPs displayed genotypes that were not in accordance with Hardy-Weinberg equilibrium. However, these genotypes were consistent with those observed in a control group. The GG genotype showed a significant increase in frequency compared to the control group (100.0% vs. 100.0%), while the G allele exhibited a non-significant increase in frequency. The odds ratio (OR) for the TG genotype was 3.68, and the p-value (pc) was 0.05.Elevated value could potentially increase the risk of hydatid disease. The presence of the TG genotype was shown to considerably increase the frequency percentage in the group of patients with hydatid disease. The odds ratio (OR) value of 1.6 suggests that it may be a risk factor for hydatid disease, with a frequency of 98.4% compared to 0.99 % in the control group. The p-value of 0.001 indicates a statistically significant association. The GG genotype was present in (0%) of the affected group but absent (100.0%) in the healthy group. The odds ratio (OR) of 3.68, with a p-value of 0.001, suggests that the GG genotype is associated with a significantly lower risk of hydatid disease.

Beyond medications: a multifaceted approach to alleviating comorbid anxiety and depression in clinical settings.

Comorbid anxiety and depression are common and can make the problems more complex and sometimes resistant to pharmacological treatment. In existing research, the diagnoses are often studied separately, and physical activity, healthy nutrition, psychoeducation, and social support have shown good effects. The aim of the present study was to explore the longitudinal effects of a comprehensive treatment on patients with comorbid anxiety and depression in a clinical context. Eighty inpatients (15 men and 65 women) in age range 23-65 years receiving psychiatric treatment in Norwegian clinic participated in the longitudinal study. Treatment was person-centered and was most frequently given for anxiety and depression, e.g., pharmacological treatment and psychotherapy, individually and in groups. In combination with this, physical activity, healthy nutrition, psychoeducation and social support in contacts with authorities and relatives were also a part of treatment. Depression and anxiety were assessed using the Beck Anxiety Inventory and Beck Depression Inventory at three points in time: baseline, at the end of treatment, and 3 months after treatment. The answers were categorized and combined into four groups according to severity of anxiety and depression to measure effects on comorbidity. Mann Whitney U test, Chi-square, Friedmans test, and McNemar test were used to analyze the data. The results showed a significant increase of frequencies in the group with mild anxiety and depression 3 months past treatment compared to baseline. Through the comprehensive, person-centered treatment more patients had low levels of both anxiety and depression 3 months after treatment. We suggest that clinics working with comorbid depression and anxiety patients should add physical activity, nutrition advice, social support, and psychoeducation to the traditional treatment regimes. More research concerning comorbid anxiety and depression are urgent to further expand the treatment possibilities.

Consumer evaluation of health and environmental label concepts on sensory acceptance and wellness perception of fortified oat beverage

The study aimed to determine how health and environmental labels affect consumer perception of sensory attributes, overall liking, and wellness perception of oat milk fortified with β-glucan and pea protein. Oat milk was fortified with 6.25 g β-glucan and 14.12 g pea protein per liter. Consumers (n = 108) evaluated oat milk for four consecutive days: Day 1 (label pre-exposure) in a food sensory laboratory; Day 2 and 3 evaluations through a Home-Use-Test (HUT) of bottles labeled with either health or environmental benefits; Day 4 (post-exposure) in a food sensory laboratory. Oat flavor and creaminess intensity, and overall liking on the 9-point hedonic scale were evaluated daily and wellness perception (six dimensions assessed by 31 CATA items) was evaluated on Days 1 and 4. Creaminess was perceived to be significantly greater on Day 1 than Day 4, attributed to adaptation effects, while oat flavor and overall liking (‘like moderately’) were not significantly different over four days. Overall liking was not significantly influenced by location of evaluation (CLT and HUT) or exposure to labels. For wellness perception, the most mentioned terms were from general, physical, and emotional dimensions after health and environment label exposure. Additionally, post-exposure to labels resulted in a significant increase in frequency of mentions for general, social, spiritual, and emotional dimensions. The study outcome provided information on how labels influenced wellness perception, providing a positive experience for the consumers, but did not influence the overall liking of the product.

Minimally invasive ureteral reimplantation: trends in regions of the Russian Federation and The Republic of Belarus. Multi-center study

Introduction. Until recently, open ureteral reimplantation was considered the gold standard for the surgical treatment of ureterovesical junction (UVJ) pathologies. The introduction of minimally invasive ureteral reimplantation (MIUR) for the treatment of vesicoureteral reflux (VUR) and primary obstructive megaureter (POM) in children started in the 1990s. However, studies describing national trends in the use of minimally invasive and open approaches in the surgical treatment of UVJ pathology in children are limited.Objective. To describe changes in the use of MIUR and open ureteral reimplantation (OUR) between 2007 and 2022 in some regions of the Russian Federation and the Republic of Belarus and compare the results and complication rates of the two surgical approaches. Materials &amp; methods. The study includes 1273 patients (1793 ureters), operated on for UVJ pathology in the period from 2007 to 2022. MIR was performed in 1356 (75.6%) ureters (913 for VUR and 443 for POM). The studied parameters included an annual amount of reimplantation, the age of patients, the frequency of intra- and postoperative complications, as well as the medium-term results of operations.Results. The use of MIUR techniques has increased significantly over time, and in 2022, seventy-five percent of surgeries were performed using MIUR. Analysis of the rate of adoption of MIUR by clinics showed that those that began using it first experienced a significant increase in frequency of use after 4 to 6 years, while those that started later took 2 to 3 years to achieve a significant positive trend. There were 5 (0.4%) intraoperative complications in the MIUR group. All these complications were classified as grade I according to the Satava grading system. There was no significant difference between MIUR and OUR in terms of postoperative complication rates (6.6% vs. 7.6%, p = 0.8). The efficiency of reimplantation was 96.6% in the MIUR group compared to 95.9% in the OUR group for POM and 96.2% in the MIR group compared to 94.6% in the OUR for VUR.Conclusion. In the regions of Russia involved in the study, there has been a trend towards completely replacing open surgery with minimally invasive techniques. Regarding complication rates and efficacy, MIUR is not significantly different from OUR.

Effective and Successful Quantification of Leukemia-Specific Immune Cells in AML Patients' Blood or Culture, Focusing on Intracellular Cytokine and Degranulation Assays.

Novel (immune) therapies are needed to stabilize remissions or the disease in AML. Leukemia derived dendritic cells (DCleu) can be generated ex vivo from AML patients' blasts in whole blood using approved drugs (GM-CSF and PGE-1 (Kit M)). After T cell enriched, mixed lymphocyte culture (MLC) with Kit M pretreated (vs. untreated WB), anti-leukemically directed immune cells of the adaptive and innate immune systems were already shown to be significantly increased. We evaluated (1) the use of leukemia-specific assays [intracellular cytokine production of INFy, TNFa (INCYT), and degranulation detected by CD107a (DEG)] for a detailed quantification of leukemia-specific cells and (2), in addition, the correlation with functional cytotoxicity and patients' clinical data in Kit M-treated vs. not pretreated settings. We collected whole blood (WB) samples from 26 AML patients at first diagnosis, during persisting disease, or at relapse after allogeneic stem cell transplantation (SCT), and from 18 healthy volunteers. WB samples were treated with or without Kit M to generate DC/DCleu. After MLC with Kit M-treated vs. untreated WB antigen-specific/anti-leukemic effects were assessed through INCYT, DEG, and a cytotoxicity fluorolysis assay. The quantification of cell subtypes was performed via flow cytometry. Our study showed: (1) low frequencies of leukemia-specific cells (subtypes) detectable in AML patients' blood. (2) Significantly higher frequencies of (mature) DCleu generable without induction of blast proliferation in Kit M-treated vs. untreated samples. (3) Significant increase in frequencies of immunoreactive cells (e.g., non-naive T cells, Tprol) as well as in INCYT/DEG ASSAYS leukemia-specific adaptive-(e.g., B, T(memory)) or innate immune cells (e.g., NK, CIK) after MLC with Kit M-treated vs. untreated WB. The results of the intracellular production of INFy and TNFa were comparable. The cytotoxicity fluorolysis assay revealed significantly enhanced blast lysis in Kit M-treated vs. untreated WB. Significant correlations could be shown between induced leukemia-specific cells from several lines and improved blast lysis. We successfully detected and quantified immunoreactive cells at a single-cell level using the functional assays (DEG, INCYT, and CTX). We could quantify leukemia-specific subtypes in uncultured WB as well as after MLC and evaluate the impact of Kit M pretreated (DC/DCleu-containing) WB on the provision of leukemia-specific immune cells. Kit M pretreatment (vs. no pretreatment) was shown to significantly increase leukemia-specific IFNy and TNFa producing, degranulating cells and to improve blast-cytotoxicity after MLC. In vivo treatment of AML patients with Kit M may lead to anti-leukemic effects and contribute to stabilizing the disease or remissions. INCYT and DEG assays qualify to quantify potentially leukemia-specific cells on a single cell level and to predict the clinical course of patients under treatment.

Dynamics of pulmonary mucosal cytotoxic CD8 T-cells in people living with HIV under suppressive antiretroviral therapy

BackgroundDespite the success of antiretroviral therapy (ART), people living with HIV (PLWH) suffer from a high burden of pulmonary diseases, even after accounting for their smoking status. Cytotoxic CD8 T-cells are likely implicated in this phenomenon and may act as a double-edged sword. While being essential in viral infection control, their hyperactivation can also contribute to lung mucosal tissue damage. The effects of HIV and smoking on pulmonary mucosal CD8 T-cell dynamics has been a neglected area of research, which we address herein.MethodsBronchoalveolar lavage (BAL) fluid were obtained from ART-treated PLWH (median duration of supressed viral load: 9 years; smokers: n = 14; non-smokers: n = 21) and HIV-uninfected controls (smokers: n = 11; non-smokers: n = 20) without any respiratory symptoms or active infection. Lymphocytes were isolated and CD8 T-cell subsets and homing markers were characterized by multiparametric flow cytometry.ResultsBoth smoking and HIV infection were independently associated with a significant increase in frequencies of total pulmonary mucosal CD8 T-cell. BAL CD8 T-cells were primarily CD69 + expressing CD103 and/or CD49a, at least one of the two granzymes (GzmA/GzmB), and little Perforin. Higher expression levels of CD103, CD69, and GzmB were observed in smokers versus non-smokers. The ex vivo phenotype of GzmA + and GzmB + cells revealed increased expression of CD103 and CXCR6 in smokers, while PLWH displayed elevated levels of CX3CR1 compared to controls.ConclusionSmoking and HIV could promote cytotoxic CD8 T-cell retention in small airways through different mechanisms. Smoking likely increases recruitment and retention of GzmB + CD8 Trm via CXCR6 and CD103. Heightened CX3CR1 expression could be associated with CD8 non-Trm recruitment from the periphery in PLWH.

Ethnic diversity and divergent perceptions of climate change: a case study in Southwest China

Understanding divergent perceptions of ethnic groups to climate change in mountainous regions home to multi-ethnic cultures and the factors influencing these perceptions is crucial for policymakers to predict the trending impacts of climate change and make long-term decisions. Based on the case of Southwest China, 1216 households were interviewed by questionnaire surveys to gain insight into the perceptions of local people on the dynamic evolution characteristics of climate events in the uplands of Yunnan, China, which is an area home to rich ethnic diversity, and also to determine the factors that influence these perceptions. Results indicated that climate events have now become important events for farmers’ livelihoods, ranking only after family diseases and livestock diseases. Drought, long-term drought, and erratic rainfall are the three kinds of climatic events with the most significant increase in frequency and severity in mountainous areas. Farmers’ perceptions on whether drought, long-term drought, and erratic rainfall occurred 10 years ago as well as changes in frequency and severity are significantly influenced by characteristics of respondents, ethnic culture, geographical environment of farmer residences, farmland characteristics, and sources of livelihood. Ultimately, taking ethnic differences into consideration for long-term planning will be an important part of the local response to climate change in the future.

Metal wire embrittlement monitoring by the measurement of wire oscillation frequency

In the process of irradiation of materials by fluxes of heavy particles (protons, neutrons, alpha particles), damage to material structure is often observed. As a result of the accumulation of such damages, there is a subsequent change in the properties of materials, in particular, its embrittlement and hardening. Monitoring of the embrittlement process is important for nuclear reactor vessels exposed to high neutron fluxes. In this work, to observe the effect of heavy irradiation particles on the mechanical properties of metals, we propose to use vibrating wire resonators, in which the natural frequency of oscillations of the wire strongly depends on its tension. The change in the elastic characteristics of the wire alters the value of the natural frequency of wire oscillations. The natural oscillations are generated by a special circuit. Preliminary experiments to study the embrittlement effect of a stretched wire are performed by heating the wire with an electric current. In the case of short pulses, a significant increase in frequency is achieved, which is explained by the process of hardening of the material as a result of the thermal impact on the wire (rapid heating and cooling).

(359) Vasectomy Trends in Western NY Following Dobbs v. Jackson Women’s Health Organization

Abstract Introduction On June 24, 2022, the United States Supreme Court ruled on Dobbs v. Jackson Women’s Health Organization (Dobbs) that the Constitution of the United States does not confer a right to abortion. The court’s decision overruled both Roe v. Wade (1973) and Planned Parenthood v. Casey (1992), giving individual states the full power to regulate any aspect of abortion not protected by federal law. Objective Our study aims to identify the difference, if any, in the number of vasectomies performed in Western NY before and after the ruling on Dobbs v. Jackson Women’s Health Organization. Methods We performed a retrospective chart review of 2428 patients who had vasectomies in Western New York from August 2021 – March 2023. Leveraging a dataset containing de-identified patient information, we compared the rates of all men undergoing vasectomies in the six-month period before and after the ruling. Vasectomy case information collected by urologists in Buffalo dating back to 1996 was collected and tabulated using Excel. Statistical analyses were performed to compare differences in both the overall change in frequency of vasectomies among all men in the six-month period before and after the court decision, as well as by specific demographic groups. Statistical analyses were performed in R and SAS. Results Men with no children had a statistically significant increase (p=0.009) in the number of vasectomies in the six-month period after the Dobbs decision (n=138) compared to before (n=98). Rates of vasectomies pre- and post- Dobbs were organized by age quartiles (&amp;lt;33.20, 33.20-36.65, 36.66-40.59, ≥40.60). In the “No Child” group, men with ages &amp;lt;33.2 (p=0.0137) and ages 33.2-36.65 (p=0.0394) had significant increases in frequency of vasectomy after the court decision. Conclusions Our data demonstrates that in the wake of Dobbs v. Jackson Women’s Health Organization (2022), the number of vasectomies among men with no children significantly increased after the court decision. There were significant increases in the number of vasectomies within different age groups of men without children following the decision. Future aims of this study will seek to create statistical models to determine the underlying reasons that influenced the observed change in frequency of vasectomies following the court decision in men without children. Disclosure No.

Analysis of the Temporal and Spatial Development of Cold Waves in Fujian Province over the Last 58 Years

The escalation in the risk of extreme weather events due to climate system warming has caused a distinct alteration in the frequency and intensity of cold waves in China. Moreover, these changes exhibit distinct regional variations in their altering characteristics. Using daily temperature data from 70 weather stations in Fujian Province of China from 1961 to 2018, this study looks at how cold waves move through the province and how they change over time. It does this by combining linear regression trend, spatial interpolation, and spatial autocorrelation analyses. The findings indicate that the occurrence frequency of cold waves in the designated study area is notably higher in the western and northern regions, while it is comparatively lower in the eastern coastal cities. Furthermore, there is an overall downward trend in the frequency of cold waves, with a declining frequency from 1961 to 2000, followed by a significant increase in frequency after 2000. Furthermore, the number of cold waves in the study area increased significantly after 2010.

Menstrual symptoms and subjective well-being among postmenarchal adolescents

BackgroundMenstrual symptoms are predominantly studied among adults but may occur directly after menarche. Adolescent menstrual health care, however, faces specific obstacles and more research into menstrual symptoms as a determinant of adolescent well-being is therefore advocated. Objective(s)To study menstrual symptoms and their impact on everyday life and well-being among postmenarchal adolescents. Study Design: A survey was delivered to a random sample of 1644 schoolgirls, drawn from a population-based project involving 116 lower secondary education schools (7th-8th grade) in Stockholm, Sweden. Menstrual symptoms (i.e., dysmenorrhea; heavy bleeding; irregular periods; mood disturbance; other general symptoms) were investigated through multiple choice questions and defined according to their impact on everyday life as mild (seldom affected), moderate (affected but possible to cope) and severe (affected and difficult to cope). Subjective well-being was measured with the World Health Organisation Five Well-Being Index (WHO-5). Postmenarchal respondents were eligible for analysis whereas those with incomplete outcome data or using hormonal contraception were excluded. The frequency and severity of symptoms across different postmenarchal years (1st, 2nd, 3rd, 4th, or 5th+ year after menarche) were studied with Chi-square and Kendall's tau statistics. Analysis of variance was used to study the association between menstrual symptoms and WHO-5 scores. A composite Menstrual Health index variable was obtained through principal component analysis and used to study the overall impact of menstrual symptoms on well-being in regression analyses. ResultsOf 1100 postmenarchal girls (mean age 14.1±0.7), 93.2% reported menstrual symptoms, 81.3% had at least one moderate symptom and 31.3% had at least one severe symptom. The most frequent symptoms were dysmenorrhea (80.4%) and mood disturbance (81.1%), followed by irregular periods (67.9%), heavy bleeding (60.4%) and other general symptoms (60.4%). Throughout postmenarchal years, there was a significant increase in frequency and severity (p<.001) of dysmenorrhea (τ=0.148), heavy bleeding (τ=0.134), mood disturbance (τ=0.117) and other general symptoms (τ=0.110), but not irregular periods (τ=-0.0201; p=.434). Girls with menstrual symptoms had significantly lower WHO-5 scores than those without symptoms (mean difference [MD] =17.3; 95%CI 12.3-22.4). Analysis of variance showed significant associations (p<.001) with WHO-5 scores for each of the examined menstrual symptoms. In post-hoc pairwise comparisons with peers without symptoms, the greatest reductions in WHO-5 score were found among girls with severe symptoms (MD for: dysmenorrhea -20.72; heavy bleeding -15.75; irregular periods -13.81; mood disturbance -24.97; other general symptoms -20.29) but significant differences were observed even for moderate or mild symptoms. The composite Menstrual Health index was significantly associated with WHO-5 scores in regression analysis, independently of age, age at menarche, BMI, smoking, physical activity, own and parental country of birth, biparental care, and socioeconomic status. ConclusionsDespite growing awareness about the relevance of menstruation to women's health, unmet menstrual health needs are a potential threat to the well-being of adolescents. Education, screening, and clinical competence are important tools to reduce the burden of menstrual symptoms during adolescence and to prevent long-term consequences. The development of novel person-centered strategies should be a priority for clinical practice and research in adolescent menstrual health.

Augmentation Strategies for Partial or Non-responders to Clozapine in Patients with Schizophrenia: A Bayesian Network Meta-analysis of Randomized Controlled Trials.

Clozapine is the only approved drug for treatment-resistant schizophrenia, but the response to the drug is often inadequate. Augmentation with other antipsychotics, anticonvulsants, and antidepressants is recommended for such patients, but there is a lack of evidence regarding the most effective therapy. This network meta-analysis was conducted to evaluate the efficacy of pharmacological agents used in the augmentation strategies in patients who were partial/ non-responders to clozapine. Relevant data were extracted from 30 randomized controlled trials through searches of electronic databases (MEDLINE/PubMed, Embase, Cochrane, clinical trial registries). PRISMA guidelines were followed for the extraction, management, analysis, and reporting of the data. The outcome measure in this study was a reduction in symptom severity according to total PANSS/BPRS and was reported as the standardized mean difference with a 95% credible interval. Bayesian network meta-analysis with random effects model and uninformative priors was conducted, and the ranking probability of each intervention was done. Meta-regression was done to assess the effect of duration on the reduction in symptom severity scores. Mirtazapine (-5.2 [95%CrI: -7.7, -2.7]) and memantine (-2.1 [95%CrI: -4.0, -0.19]] were more efficacious than placebo for augmentation of clozapine in partial/non-responders and were the most effective adjunctive agents as per SUCRA scores. Both drugs did not cause a significant increase in frequency of adverse events compared to placebo. There was a significant effect of duration on the reduction in symptom severity. There was no evident publication bias. Mirtazapine and memantine may prove beneficial for augmentation of clozapine in non/partial responders to monotherapy.

Intensification of heatwaves in Central Asia from 1981 to 2020 – Role of soil moisture reduction

Heatwaves pose increasing threats on water resources for ecosystems and human consumption especially in arid region, such as Central Asia (CA). As the hinterland of Eurasia, water scarcity and land degradation in CA have increased its vulnerability to heatwaves. While the frequency of heatwaves has been examined, more heatwave metrics such as timing are less known, possible influences of soil moisture on heatwave changes in this region are not fully understood. Using reanalysis and observational datasets, here we examine the spatial–temporal changes of heatwaves in CA during 1981–2020 and the role of various associated factors including soil moisture. The results show that the extreme heatwaves occurred more frequently in northwestern Kazakhstan. Temporally, heatwaves have been intensifying with significant increases in frequency (0.10 events/year), intensity (0.81 °C/year), and duration (0.08 days/year) since the 1980 s, and these trends have accelerated since 1997. The first yearly heatwave event tended to occur earlier in more recent decades, indicating an advanced heatwave season. We also found that the heatwave occurrences were significantly correlated with hydro-meteorological factors. In northwestern of CA, extreme heatwaves are exacerbated by a rapid decrease in soil moisture resulting from reduced precipitation and increased solar net radiation in this area. Our findings provide a scientific basis for understanding the mechanisms and predictions of heatwave in arid regions from the climate change perspective.

Detection and Assessment of Changing Drought Events in China in the Context of Climate Change Based on the Intensity–Area–Duration Algorithm

Drought can have a significant impact on both society and the economy, resulting in issues such as scarcity of water and shortages of food and energy, as well as elevated health risks. However, as global temperatures continue to rise, the impact of drought events is increasingly exacerbated, manifested by an increase in the frequency, intensity, duration, and spatial extent of their effects. Therefore, studying the changing characteristics of drought events with the background of climate change is of great significance. Based on the high-precision and high-resolution CN05.1 dataset, this study obtained the monthly Standardized Precipitation Evapotranspiration Index (SPEI) dataset from 1961 to 2020, and then identified regional drought events in China using the Intensity–Area–Duration (IAD) method, which considers both temporal continuity and spatial dynamics. On this basis, the spatiotemporal variations in frequency, intensity, duration, and affected area of drought events in China and its seven subregions were analyzed. The results showed that the subregions located in the northern region of China generally have lower mean, maximum, and minimum temperatures than those located in the southern region, but the associated interannual change rate of the subregions in the north is higher than that in the south. As for the annual total precipitation, results show a clear pattern of decreasing southeast–northwest gradient, with an increasing trend in the northern subregions and a decreasing trend in the southern subregions except for the subregion south China (SC). The northeast of China (NE), SC, the southwest of China (SW) and north China (NC) are the regions with a high frequency of drought events in China, while the frequency of drought events in NW and Qinghai–Tibetan Plateau (QTP), although lower, is on a significantly increasing trend, and the increasing rate is higher than for the other regions. For drought intensity, Xinjiang (XJ) and QTP had greater drought intensity, and the change rate of these regions with greater drought intensity was also greater. The drought impact area in China showed a significant increasing trend, mainly concentrated in QTP, NW and NE. Particular attention needs to be focused on the southwest of QTP, where drought events in this region show a significant increase in frequency, intensity, duration and impact area.

Effects of in utero exposure to fluoxetine on the gastrointestinal tract of rat offspring.

Perinatal exposure to selective serotonin reuptake inhibitors (SSRIs) has been shown to disrupt the development of serotonergic signaling pathways in the brain and enteric nervous system. Serotonin (5-hydroxytryptamine; 5-HT) signaling is critical for gastrointestinal homeostasis; changes in 5-HT expression and regulation have been associated with gastrointestinal diseases of motility and inflammation. We tested the hypothesis that perinatal exposure to the SSRI fluoxetine can influence the development of the gastrointestinal tract in exposed offspring. Female nulliparous Wistar rats were given fluoxetine (10 mg/kg) or vehicle control from 2 wk before mating until weaning; small and large intestines of female and male offspring were collected at postnatal days 1, 21 (P1, P21, respectively), and 6 mo of age. In histological preparations, the proportion of serotonergic neurons significantly increased in the colons of both female and male fluoxetine-exposed compared with control offspring at P21, a time point that signifies maximal exposure to fluoxetine. At 6 mo of age, male but not female fluoxetine-exposed offspring had a significant increase in circulating 5-HT, with a significant decrease in transcripts encoding the 5-HT2A receptor and monoamine oxidase as compared with control offspring. Measurement of spatiotemporal mapping of contractile activity of the small and large intestine at 6 mo of age revealed no changes in motility in the small bowel of fluoxetine-exposed offspring but revealed a significant increase in the frequency of colonic contractions in the female fluoxetine-exposed compared with control animals. Susceptibility to inflammation was examined at 6 mo using the dextran sulfate sodium model of acute colitis. In utero exposure to fluoxetine was not found to exacerbate colitis severity. These findings suggest that fluoxetine exposure during fetal and early postnatal development can lead to changes in serotonergic neurons at the peak of exposure with sex-specific changes in 5-HT signaling and colonic motility in adulthood.NEW & NOTEWORTHY There is increasing recognition of the relevance of in utero and early postnatal exposures in the developmental programming of the gastrointestinal tract. Perinatal exposure to selective serotonin reuptake inhibitors and antidepressant medications is of particular relevance as they are commonly prescribed during pregnancy, and serotonergic pathways play key roles during gastrointestinal development and in postnatal homeostasis. Here, we provide a comprehensive evaluation of clinically relevant outcomes of gastrointestinal motility and susceptibility to colitis in fluoxetine-exposed offspring and highlight changes in colonic serotonergic neurons at the peak of perinatal fluoxetine exposure with sex-dependent changes in serotonin signaling and colonic motility in adulthood.

Midwife-led pandemic telemedicine services for maternal health and gender-based violence screening in Bangladesh: an implementation research case study

BackgroundThe COVID-19 pandemic disrupted maternal and newborn health services in Bangladesh, exacerbating the large gaps in service utilization that existed prior to the pandemic. As part of its response, Bangladesh initiated remote antenatal and postnatal care telemedicine services led by midwives in 36 sub-district hospitals across five of Bangladesh’s 64 districts. Gender-based violence screening and referral were integrated into the service to address a reported rise in violence following the country’s pandemic lockdown.MethodsMixed-methods implementation research was used to develop an intrinsic case study describing the design and implementation of the telemedicine program. Qualitative analysis comprised document review, key informant interviews, and focus group discussions. Quantitative analysis employed an interrupted time series analysis with segmented multi-variate regression to compare maternity care service use trends before and after implementation. Poisson regression analysis was used to examine the trend in number of gender-based violence remote screenings, sessions held, and cases identified.ResultsA statistically significant change in trend for onsite antenatal and postpartum care as well as women seeking care at the hospital as a result of postpartum hemorrhage arising in the community was observed following the introduction of telemedicine. Facility births and cases of eclampsia appropriately identified and managed also had significant increases. In addition, over 6917 women were screened for GBV, 223 received counseling and 34 referrals were made, showing a statistically significant increase in frequency over time following the implementation of the telemedicine program. Challenges included that not all midwives adopted GBV screening, some women were reluctant to discuss GBV, there was an unanticipated need to introduce a patient visit scheduling system in all intervention hospitals, and many women were not reachable by phone due to lack of access or network coverage.ConclusionsMaternal health and gender-based violence telemedicine led by midwives was an effective, low-cost intervention in Bangladesh for addressing pandemic and pre-pandemic gaps in service use. Other low and middle-income countries planning to implement remote maternal health interventions via midwives should consider whether a patient visit scheduling system needs to be introduced, as well as limitations around mobile phone access and connectivity. Future research should include care quality oversight and improvement, and a more well-informed strategy for facilitating effective GBV screening.