Significant Change In Percentage Research Articles

Eight Weeks of Supervised Indoor Climbing Significantly Reduces Arterial Pressure and Total Cholesterol in Recreational Climbers

The present study sought to investigate physiological adaptations associated with an 8-week supervised climbing intervention in recreational climbers. Nine participants (5 males and 4 females; age: 37 ± 8 years; stature: 169.7 ± 10.6 cm; body mass 83.3 ± 20.3 kg) volunteered to complete the intervention concomitant with their recreational climbing activities. Blood pressure, body composition, peak aerobic capacity, total cholesterol, and handgrip strength were assessed before and after the intervention. Post-intervention, diastolic blood pressure was significantly reduced (pre: 87 ± 6 mmHg, post: 72 ± 10 mmHg, p<0.01), without significant changes in systolic blood pressure (pre: 136 ± 15 mmHg, post: 128 ± 20 mmHg, p=0.19). This resulted in a significant reduction in mean arterial pressure (pre: 103 ± 9 mmHg, post: 90 ± 13 mmHg, p<0.01). A significant reduction in total cholesterol was also observed following the 8-week climbing intervention (pre: 5.09 ± 0.49 mmol/L, post: 4.39 ± 0.63 mmol/L, p<0.01). However, there were no significant changes in body fat percentage (p=0.67), skeletal muscle mass (p=0.76), isometric hand-grip strength (dominant hand: p=0.93, non-dominant hand: p=0.12) or peak aerobic capacity (p=0.37). Supervised indoor climbing exercise may therefore serve as an important non-pharmacological intervention to improve cardiovascular health by reducing mean arterial pressure and total cholesterol levels in recreational climbers, independent of changes in body composition or peak aerobic capacity.

Influence of pneumococcal vaccination on the hospitalization of healthy pediatric patients due to typical Community-Acquired Pneumonia

IntroductionCommunity-Acquired Pneumonia (CAP) is one of the most frequent causes of hospital admission in children. Our objective is to measure the impact of the introduction of pneumococcal conjugate vaccines on the hospitalization of previously healthy children due to CAP. MethodFrom 2011 to 2016, a partially retrospective, prospective, and descriptive study was carried out on healthy pediatric patients (3 months–14 years old) with CAP, who required hospital admission. Clinical, epidemiological, and demographic characteristics were collected, and vaccination status was obtained from medical records. ResultsA total of 292 cases were included, with a mean age of 33.4 months, 54% males. There was a progressive and significant 42% decrease in the number of admissions each year, without significant changes in the annual percentage of parapneumonic pleural effusion (PPE). Fifty-six percent of patients were immunized with a pneumococcal conjugate vaccine (PCV). The percentage of children who were not vaccinated decreased by 14%, and the coverage with PCV-13 increased by 46%. This revealed a significant increase of PPE in vaccinated patients with PCV-7 (63%) compared with unvaccinated (45%) and with PCV-13 (57%), without association with the presence of severe PPE. Moreover, no significant differences in severity or hospital stay were observed in unvaccinated patients, compared to those who were vaccinated. In >2-year-olds, we observed a significant increase in PPE (59%) compared to 45% in younger children. ConclusionsThe increase in vaccination coverage with PCV-13 resulted in a decrease in hospitalizations due to CAP and PPE. Vaccination with PCV-7 is associated in our sample with an increase in PPE but not with severe PPE nor an increase in the hospital stay. There was an epidemiological shift of severe forms of pneumonia and empyema at later ages (>2 years).

1153-P: National Trend in Out-of-Pocket Burden in Adults Aged 18–64 Years with Diabetes: 2001-2017

Recent changes in health coverage benefits and increases in diabetes medication prices may have affected out-of-pocket (OOP) expenditures for people with diabetes. High OOP expenditures is a barrier to get adequate medical care. We assessed national trends in OOP expenditures overall and by OOP-component among adults aged 18-64 years with diabetes from 2001 to 2017 using data from the U.S. Medical Expenditure Panel Survey. OOP expenditures were defined as the amount paid by a family with one or more members with diabetes, including insurance premiums, deductions, copays, coinsurance and payments not covered by insurance. High OOP burden was defined as spending &amp;gt;10% of the family’s pretax income on OOP expenditures. We examined trends overall as well as by insurance type, income (as a ratio of federal poverty level, FPL), type of service, and whether patients used insulin. We tested for changes in trends using joinpoint analysis. OOP expenditures were adjusted to 2017 U.S. dollars. From 2001 to 2017, OOP expenditures decreased 4.3%, from $4328 to $4139, and the percentage of persons with high OOP burden fell 32%, from 28% to 19% (P&amp;lt;0.001). No significant changes in trends were identified for either measure. Both OOP expenditures and percentages with high OOP burden declined for those with public or no insurance and those with family income &amp;lt; 200% of FPL (P&amp;lt;0.001). There were increases in OOP expenditures (P&amp;lt;0.001) but no significant changes in percentages with high OOP burden for those with private insurance and those with income ≥ 400% of FPL. OOP expenditures on prescriptions decreased for all insurance types and income subgroups (P&amp;lt;0.001). Decreases in total (-$58 vs. -$37, P&amp;lt;0.001) and prescription (-$79 vs. -$68, P&amp;lt;0.001) OOP expenditures were larger for insulin users than non-users. These most recent data show that OOP expenditures for U.S. adults with diabetes are steadily declining, especially for those least able to afford them. Future studies are needed to explain these patterns. Disclosure Y. Wang: None. J. Park: None. R. Li: None. E. Luman: None. P. Zhang: None.

Macrophage inhibitory cytokine-1/growth differentiation factor-15 in premalignant and neoplastic tumours in a high-risk pancreatic cancer cohort

BACKGROUNDPancreatic cancer (PC) is a leading cause of cancer related mortality worldwide, with poor survival due to late diagnosis. Currently, biomarkers have limited use in early diagnosis of PC. Macrophage inhibitory cytokine-1 or growth differentiation factor-15 (MIC-1/GDF15) has been implicated as a potential serum biomarker in PC and other malignancies.AIMTo determine the role of MIC-1/GDF15 in detecting pre-malignant pancreatic lesions and neoplastic tumours in an asymptomatic high-risk cohort part of Australian Pancreatic Cancer Screening Program.METHODSA feasibility prospective single centre cohort study was performed. Participants recruited for yearly surveillance with endoscopic ultrasound (EUS) had serial fasting blood samples collected before EUS for MIC-1/GDF15, C-reactive protein and carbohydrate antigen 19-9. Patients were stratified into five groups based on EUS findings: Normal; pancreatic cysts, branch-duct intraductal papillary mucinous neoplasm; diffuse non-specific abnormalities; and neoplastic tumours. MIC-1/GDF15 serum levels were quantified using ELISA. Participants in whom EUS demonstrated abnormalities but not malignancy were closely followed up with magnetic resonance imaging (MRI) or computed tomography.RESULTSOne hundred twenty participants were prospectively recruited from 2011-2018. Forty-seven participants (39.2%) had an abnormal EUS and five participants (4.2%) were diagnosed with neoplastic tumours, three by EUS (two pancreatic and one liver) and two by MRI/computed tomography (breast cancer, bladder cancer), which were performed for follow up of abnormal EUS. Baseline serum MIC-1/GDF15 was a significant predictor of neoplastic tumours on receiver operator characteristic curve analysis [area under curve (AUC) = 0.814, P = 0.023]. Baseline serum MIC-1/GDF15 had moderate predictive capacity for branch-duct intraductal papillary mucinous neoplasm (AUC = 0.644) and neoplastic tumours noted on EUS (AUC = 0.793), however this was not significant (P = 0.188 and 0.081 respectively). Serial serum MIC-1/GDF15 did not demonstrate a significant percentage change between a normal and abnormal EUS (P = 0.213). Median baseline MIC-1/GDF15 was greater in those with neoplastic tumours (Median = 1039.6, interquartile range = 727.0-1977.7) compared to those diagnosed with a benign lesion (Median = 570.1, interquartile range = 460.7-865.2) on EUS and MRI (P = 0.012).CONCLUSIONIn this pilot study MIC-1/GDF15 has predictive capacity for neoplastic tumours in asymptomatic individuals with a genetic predisposition for PC. Further imagining may be warranted in patients with abnormal EUS and raised serum MIC-1/GDF15. Larger multicentric prospective studies are required to further define the role of MIC-1/GDF15 as a serological biomarker in pre-malignant pancreatic lesions and neoplastic tumours.

Effect of transportation and freeze-thaw procedure on hemostatic tests

Abstract Objective Coagulation tests are sensitive to pre-analytical variables. The aim of our study is to identify the effect of transportation and freeze-thaw status on for Factor VIII, Factor IX, Anti-thrombin III, Protein S, Protein C, Prothrombin time (PT) and Activated partial thromboplastin time (aPTT). Materials and methods The study was performed on 102 plasma samples obtained from 34 healthy volunteers. The samples were divided into three groups. Group A was analyzed whereas group B, C were frozen at −20°C. After 24 h, group B and C were transported for 2 h. Following the transfer, group B was analyzed and C was frozen at −20°C. After 24 h, group C was analyzed. Analyses of samples were performed in Thrombolyzer-XRM for PT, aPTT, Factor VIII, Factor IX, Anti-thrombin III, Protein C and Protein S. Results There were significant variations for PT, aPTT, Protein S, Factor VIII and Factor IX for group A&amp;B and A&amp;C comparisons in different stability criteria approaches. In significant change limit and percentage change calculations Protein S, Factor VIII and IX showed significant differences. For acceptable change limit approach, aPTT and Factor IX showed significant changes. Conclusion Laboratories should take precautions for transportation and freeze-thaw cycles to prevent inaccurate results.

Authorship and study characteristic trends in spine publications from years 2004 to 2017.

The goal of this study was to analyze the trends in authorship and study characteristics in Spine using two overlapping ten-year time periods: 2004-2014 and 2007-2017. To our knowledge, no other literature reports study characteristics and authorship in the same time period for spine that would allow for the assessment of confounding factors of trends. Authorship and study characteristic data was collected from all scientific manuscripts published in Spine during the years of 2004, 2007, 2014, and 2017. Basic statistics and Kruskal-Wallis test were used to analyze the data. We found a significant increase in total number of authors (P<0.0001) without discrepancy of unequivocal increases in author degree type: MD/Equivalent (P≤0.0001), PhD/Doctorate (P=0.0017), Masters (P=0.0015), and Bachelors (P≤0.0001). We observed an increase in industry authorship (P≤0.0001), but without a significant increase in industry funding during the same time span. Increases in administration database studies (P≤0.0001) and economic/value studies (P≤0.0001) were also noted. A significant change in percentage of articles with trauma pathology (decrease, P<0.0001) and deformity (increase, P=0.0002) occurred. The number of multi-institutional studies increased (P≤0.0001), while no change in the number of multi-disciplinary studies. Increases in author number for spine articles over time are a result of a general increase in authors in all degree types, not just non-doctorate degrees. This may be potentially influenced by the increase in multi-institutional studies. From 2004-2017, higher percentages of articles focus on economics. An increase in industry authorship without a corresponding increase in funding suggests industry's more 'hands-on' approach to publication results from their funded studies.

Redefined Measure of Early Neurological Improvement Shows Treatment Benefit of Alteplase Over Placebo.

Background and Purpose- The first of the 2 NINDS (National Institute of Neurological Disorders and Stroke) Study trials did not show a significant increase in early neurological improvement, defined as National Institutes of Health Stroke Scale (NIHSS) improvement by ≥4, with alteplase treatment. We hypothesized that early neurological improvement defined as a percentage change in NIHSS (percent change NIHSS) at 24 hours is superior to other definitions in predicting 3-month functional outcomes and using this definition there would be treatment benefit of alteplase over placebo at 24 hours. Methods- We analyzed the NINDS rt-PA Stroke Study (Parts 1 and 2) trial data. Percent change NIHSS was defined as ([admission NIHSS score-24-hour NIHSS score]×100/admission NIHSS score] and delta NIHSS as (admission NIHSS score-24-hour NIHSS score). We compared early neurological improvement using these definitions between alteplase versus placebo patients. We also used receiver operating characteristic curve to determine the predictive association of early neurological improvement with excellent 3-month functional outcomes (Barthel Index score of 95-100 and modified Rankin Scale score of 0-1), good 3-month functional outcome (modified Rankin Scale score of 0-2), and 3-month infarct volume. Results- There was a significantly greater improvement in the 24-hour median percent change NIHSS among patients treated with alteplase compared with the placebo group (28% versus 15%; P=0.045) but not median delta NIHSS (3 versus 2; P=0.471). Receiver operating characteristic curve comparison showed that percent change NIHSS (ROCpercent) was better than delta NIHSS (ROCdelta) and admission NIHSS (ROCadmission) with regards to excellent 3-month Barthel Index (ROCpercent, 0.83; ROCdelta, 0.76; ROCadmission, 0.75), excellent 3-month modified Rankin Scale (ROCpercent, 0.83; ROCdelta, 0.74; ROCadmission, 0.78), and good 3-month modified Rankin Scale (ROCpercent, 0.83; ROCdelta, 0.76; ROCadmission, 0.78). Conclusions- In the NINDS rt-PA trial, alteplase was associated with a significant percent change improvement in NIHSS at 24 hours. Percent change in NIHSS may be a better surrogate marker of thrombolytic activity and 3-month outcomes.

Abstract No. 628 Active interventional radiology drainage catheter management reduces drain dwell time and increases percentage of drains removed by interventional radiology

To evaluate the effect of active inpatient and outpatient interventional radiology (IR) drainage catheter management on drain dwell time and percentage of drains removed by IR. Retrospective review was performed of drains placed by IR at a tertiary medical center. Exclusion criteria were no documentation of removal, dwell time less than 1 day, and pediatric, seroma, urinoma, or enteric fistula drains. Data collected for the 283 eligible drains included dwell time, IR versus referrer removal, and IR documentation. Statistical analysis was used to compare IR drain management across three phases: passive (January – June 2016), active inpatient/passive outpatient (July 2016 – February 2017) and active all patients (March 2017 – June 2019). Management was still considered passive after June 2016 if drains were lost to IR follow-up or referrer removed without IR involvement. Active inpatient drain management during phase 2 led to a significant 5.6 day decrease in drain dwell time compared to passive management (mean, 12.8 vs. 21.1 days, P <0.01). However, only 43% of drains were actively managed by IR. As a result, there was no significant change in the overall percentage of IR-removed drains compared to phase 1 (31 vs. 25%, P = 0.42). The inclusion of outpatients during phase 3 significantly increased overall active IR drain management (68% vs. 43%, P <0.01) and percentage of IR-removed drains (61% vs. 31%, P <0.01) compared to phase 2. There was also no significant adverse effect on dwell time with the addition of outpatients when compared to phase 2 (mean, 14.1 vs. 12.8 days, P = 0.51). For the entire 42 month analysis period, active IR drain management reduced mean drain dwell time by 4 days (13.7 vs. 17.7 days, P = 0.01) and more than doubled the percentage of IR-removed drains (61 vs. 25%, P <0.01). Active IR drainage catheter management significantly decreases drain dwell time and increases the number of drains removed by IR. Reduction of dwell time has clear value for patients but further study is required to determine if this dwell time reduction and increased IR removal of drains have additional clinical benefits such as avoidance of surgery or recurrent infection.

Abstract WP106: Redefined Measure of Early Neurological Improvement Shows Treatment Benefit of Intravenous Tissue Plasminogen Activator Treatment in NINDS Rt-PA Acute Stroke Trial at 24 Hours

Background and Purpose: The first of the 2 NINDS Stroke Study trials did not show a significant increase in early neurological improvement (ENI), defined as NIHSS improvement by ≥ 4, with alteplase treatment. We hypothesized that ENI defined as a percentage change in NIHSS (percent change NIHSS) at 24 hours is superior to other definitions in predicting 3-month functional outcomes and using this definition there would be treatment benefit of alteplase over placebo at 24 hours. Methods: We analyzed the NINDS rt-PA Stroke Study (Parts 1 and 2) trial data. Percent change NIHSS was defined as [(admission NIHSS score–24-hour NIHSS score)x100/admission NIHSS score] and delta NIHSS as (admission NIHSS score–24-hour NIHSS score). We compared ENI using these definitions between alteplase vs. placebo patients. We also used receiver operating characteristic (ROC) curve to determine the predictive association of ENI with excellent 3-month functional outcomes [Barthel Index (BI) score 95 – 100 and modified Rankin scale (mRS) 0-1], good 3-month functional outcome (mRS 0-2) and 3-month infarct volume. Results: There was a significantly greater improvement in the 24-hour median percent change NIHSS among patients treated with alteplase compared to the placebo group (28% vs. 15%, p = 0.045) but not median delta NIHSS (3 vs. 2, p = 0.471). ROC curve comparison showed that percent change NIHSS (ROC percent ) was better than delta NIHSS (ROC delta ) and admission NIHSS (ROC admission ) with regards to excellent 3-month BI (ROC percent 0.83, ROC delta 0.76, ROS admission 0.75), excellent 3-month mRS (ROC percent 0.83, ROC delta 0.74, ROS admission 0.78), and good 3-month mRS (ROC percent 0.83, ROC delta 0.76, ROS admission 0.78). Percentage change had a stronger association with 90-day infarct volume than delta NIHSS score and both delta NIHSS and percent change in NIHSS were more pronounced with faster treatment times. Conclusion: In the NINDS rt-PA trial, alteplase was associated with a significant percent change improvement in NIHSS at 24 hours. Percent change in NIHSS may be a better surrogate marker of thrombolytic activity and 3-month outcomes.

Baseline Serum HE4 But Not Tissue HE4 Expression Predicts Response to the Levonorgestrel-Releasing Intrauterine System in Atypical Hyperplasia and Early Stage Endometrial Cancer.

The levonorgestrel-releasing intrauterine system (LNG-IUS) is a conservative management option for atypical hyperplasia (AH) and low grade early stage endometrial cancer (EEC), but around 1 in 3 patients fail to respond to treatment. The aim of this study was to investigate if serum and/or tissue HE4 expression could predict response to LNG-IUS therapy. Patients with AH or presumed Stage I EEC had serum and endometrial samples taken at baseline and at 3-month intervals over 12 months post-insertion of LNG-IUS. 74 patients were recruited and baseline demographics recorded. Of 57 patients for whom response was histologically determinable, 39 (68%) were responders and 18 (32%) non-responders. Mean baseline serum HE4 was significantly lower in responders (62.1 ± 1.1 pM, 95% confidence interval (CI) 52.7–73.2), compared to non-responders (125.6 ± 1.3 pM, 95% CI 74.5–211.7, p = 0.014), including when considering age, BMI, menopausal status, smoking status, and histological grade as covariables (p = 0.005). Baseline tissue HE4 expression was not significantly different in responders compared to non-responders (p = 0.999). Responders showed a significant mean reduction (−9.8 ± 3.4%, 95% CI −16.7 to −2.8%, p = 0.008) in serum HE4 between baseline and 3 months (p = 0.008), whereas non-responders showed no significant change (p = 0.676). Neither responders nor non-responders showed a significant percentage change in serum HE4 from baseline beyond 3 months (p > 0.05). Change in serum HE4 between baseline and 3 and 6 months and tissue HE4 tissue expression between baseline and 3, 6, and 12 months was not significantly different in responders compared to non-responders (p > 0.05). This study suggests that baseline serum HE4, but not baseline tissue HE4 expression, is independently predictive of response to the LNG-IUS and could be used to guide management decisions.

A micro-computed tomographic evaluation of root canal filling with a single gutta-percha cone and calcium silicate sealer.

ObjectivesThe purpose of this study was to evaluate the void of root canal filling over time when a calcium silicate sealer was used in the single gutta-percha cone technique.Materials and MethodsTwenty-four J-shaped simulated root canals and twenty-four palatal root canals from extracted human maxillary molars were instrumented with ProFile Ni-Ti rotary instruments up to size 35/0.06 or size 40/0.06, respectively. Half of the canals were filled with Endoseal MTA and the other half were with AH Plus Jet using the single gutta-percha cone technique. Immediately after and 4 weeks after the root canal filling, the samples were scanned using micro-computed tomography at a resolution of 12.8 μm. The scanned images were reconstructed using the NRecon software and the void percentages were calculated using the CTan software, and statistically analyzed by 1-way analysis of variance, paired t-test and Tukey post hoc test.ResultsAfter 4 weeks, there were no significant changes in the void percentages at all levels in both material groups (p > 0.05), except at the apical level of the AH Plus Jet group (p < 0.05) in the simulated root canal showing more void percentage compared to other groups. Immediately after filling the extracted human root canals, the Endoseal MTA group showed significantly less void percentage compared to the AH Plus Jet group (p < 0.05).ConclusionsUnder the limitations of this study, the Endoseal MTA does not seem to reduce the voids over time.

Effect of bisphosphonate on the prevention of bone loss in patients with gastric cancer after gastrectomy: A randomized controlled trial.

Bone loss is highly prevalent after gastrectomy in gastric cancer patients. Therefore, the efficacy of medical treatment should be evaluated in patients undergoing gastrectomy. We conducted an unblinded, randomized controlled trial of patients who underwent gastrectomy to treat gastric cancer. The intention-to-treat participants (n = 107) were randomly assigned to receive either alendronate at a weekly dose of 70 mg and daily elemental calcium (500 mg) with cholecalciferol (1000 IU) or daily elemental calcium (500 mg) with cholecalciferol (1000 IU) only. The primary endpoint was defined by the changes in bone mineral density of four measurement sites: the lumbar spine, femur neck, total hip, and trochanter. Changes in bone turnover markers, osteocalcin and collagen I carboxyterminal telopeptide were also observed. At baseline, there were no differences between the two groups in bone mineral density. In the lumbar spine and trochanter, there were no significant percentage changes compared with the baseline in the alendronate group, but a significant decrease was noted in the control group (p < 0.001 for both lumbar spine and trochanter). In the femur neck and total hip, a larger decrease was observed compared with the baseline in the control group (p < 0.001 for both femur neck and total hip). Significant percentage increases in serum osteocalcin compared with baseline were noted in the control group (p for trend <0.001), but there was no change in the alendronate group (p for trend = 0.713). Collagen I carboxyterminal telopeptide significantly declined in the alendronate group over 12 months (p for trend <0.001). Prevention and treatment with bisphosphonate effectively reduces bone loss by suppressing bone resorption in gastric cancer patients undergoing gastrectomy.

Social deprivation and adverse perinatal outcomes in France: national study of preterm and SGA birth

Abstract Introduction A slow but steady increase in preterm birth (PTB) rate has been reported in France in the last decades while decreasing in some European countries. Studies suggest PTB and small for gestational age (SGA) show a social gradient. Our objective was to determine whether this social gradient is changing in France over the study period. Methods We selected all births records after 22 weeks of gestation in France between 2010 to 2017 (N = 6, 439, 355) in the French National Health Data System (SNDS). PTB was defined as birth before 37 completed weeks and SGA as birth weight below the 10th percentile according to the French intrauterine growth references curves. The SNDS includes an ecological social disadvantage index in quintiles (Q1:least deprived, Q5:most deprived). PTB and SGA rates were estimated in each deprivation quintile. Trends were quantified using a Poisson regression model. Results The prevalence of PTB was 7.4% and SGA 11.9 % in 2017. French overseas regions (FOR) had the highest rates (7.2 vs. 10.9% and 11.5 vs. 18.0%, mainland France vs FOR respectively for PTB and SGA in 2017). Although we identified annual fluctuations, there was a significant average annual percentage change in prevalence of PTB and SGA respectively, +0.65% [IC95%:+0.1%; +1.2%; p = 0.03]; 0.66% [IC95%:+0.26%; +1.06%; p = 0, 01]. There was a marked but relatively stable social gradient over the study period. When combining all study years, PTB was more frequent among deprived women (Q5: 7.6% vs Q1: 6.8%) as well as SGA (Q5: 10.6% vs Q1: 12.1%). Conclusions PTB and SGA prevalence trends are still increasing in France with regional disparities. Social deprivation remains a predictor of PTB and SGA. Key messages A persisting social gradient is observed in PTB and SGA in France. A better understanding of its mechanism will help designing interventions that will reduce social inequalities in health.

Association of ambient fine particulate matter with increased emergency ambulance dispatches for psychiatric emergencies: a time-series analysis

BackgroundAs a top ambient pollutant in urban area, fine particulate matter (PM2·5) has been associated with the occurrence and deterioration of many medical conditions, while few studies have observed the association with psychiatric conditions. We aimed to investigate the association between short-term PM2·5 exposure and psychiatric emergency events, and further explored the variation by age, sex, and seasonal patterns, which have been suggested to be associated with both psychiatric risk and pollutant toxicity. MethodsWe used time-series analysis to investigate the association between short-time exposure (0–3 days) of PM2·5 and emergency ambulance dispatches for psychiatric emergencies in Beijing, one of the most polluted cities in China during the study period. We did stratified analyses to examine the effects of age, sex, and seasonal pattern. FindingsBetween 2008 and 2014, 158 634 psychiatric emergencies were recorded. Every 10 μg/m3 increase of the PM2·5 concentration was associated with a 0·12% increase of the same-day overall psychiatric emergencies (95% CI 0·03–0·22; p=0·013) and a 0·12% increase of the suicide-related psychiatric emergencies at lag 2 (2 days after PM2·5 exposure; 0·01–0·24; p=0·041). The associations remained when adjusted for sunlight duration. The age effect that children (<18 years) were more likely to be involved in suicide-related psychiatric emergencies after PM2·5 exposure than adults (18–64 years) was significant (percentage change for children vs adults of 0·84% vs 0·07% at lag 3; p=0·013). No significant association was found among the older population (≥65 years; p=0·050–0·825). However, sex and seasonal effects were not statistically significant on the PM2·5 and psychiatric emergencies association (p=0·052–0·999). InterpretationWe found a positive association between acute PM2·5 exposure and increased psychiatric emergency presentations as indicated by emergency ambulance dispatches data. Children were more vulnerable to acute PM2·5 elevation and developed psychiatric problems, especially suicide. We suggest that preventive attention for psychiatric emergencies should be paid after acute PM2·5 elevation, particularly to children. FundingNational Natural Science Foundation of China (81801344), China Postdoctoral Science Foundation (189826), Postdoctoral Fellowship of Peking-Tsinghua Center for Life Sciences, and the Swedish Research Council (2015-06372).

Enhancing the value of women\u2019s reproductive rights through community based interventions in upper Egypt governorates: a randomized interventional study

BackgroundIn 2012, the WHO described the quality of health care as the route to equity and dignity for women and children.Aim of the workTo provide community based support and empowerment to women in childbearing period to seek optimal prenatal, natal and postnatal healthcare. Achieving this is anticipated to decrease maternal morbidity and mortality in Egypt.Subjects and methodsAn interventional study was conducted among women in childbearing period in the poorest two governorates of Upper Egypt. The study passed through three stages over three and a half years; pre-interventional assessment of awareness (n = 1000), educational interventions targeting the health providers and all women in childbearing period in their communities (n = 20,494), and post-intervention evaluation of change in awareness of their rights for prenatal, natal and postnatal care (no = 1150).ResultsThe studied indicators relating to receiving care in pregnancy, labor, and puerperium have changed dramatically as a result of the study interventions. Results of the study showed that before interventions, the surveyed women had inaccurate knowledge regarding most of the items related to their rights. The percentages of women aware of their right to have pregnancy card increased and those who possessed a pregnancy card were doubled with a significant percent change of more than 25%. Some indicators showed more than 75% improvement, including; percent of surveyed women who knew that it’s their right to follow up their pregnancy and to deliver with a specialized doctor, a trained nurse or at an equipped health facility, and those who knew their right to have at least two home preparations necessary for safe delivery at home.Conclusion and recommendationsMore work is needed in order to achieve the targeted reduction of maternal mortality. This could be achieved by ensuring accessible and high quality care provided by the governmental health facilities together with increasing the awareness of women regarding their rights in receiving such care.

Priming-induced changes in germination, morpho-physiological and leaf biochemical responses of fenugreek (Trigonella foenum-graecum) under salt stress

Seed priming is a simple biotechnological tool which is potentially able to promote seed germination and invigoration as well as seedlings establishment and stress tolerance. In this study, the effects of seed pre-treatment with water (hydro-priming), 100 (HP-NaCl100) and 200 mM (HP-NaCl200) NaCl (halo-priming) for 6 h on some physiological and biochemical parameters of fenugreek was investigated under saline conditions (100 mM NaCl). For the three priming treatments, no significant changes in the final germination percentage were observed. However, a decrease in seed germination time was observed in hydro- and halo-primed (HP-NaCl200) seeds. Salt stress (100 mM NaCl) reduced growth (shoot and root dry weight), pigment content, disturbed the ionic balance and enhanced malondialdehyde content. Salinity-induced changes in lipid metabolism towards synthesis/accumulation of saturated and monounsaturated fatty acids were observed in stressed plants. Seed priming ameliorated the negative effects of NaCl, ensuring significant amelioration on growth, pigment content, increased the activity of catalase and glutathione peroxidase and enhanced the synthesis of very long chain n-alkanes. Taken together, these data provide compelling evidence that priming is an effective alternative that can be used to promote germination and improves establishment and acclimation of fenugreek seedlings under saline conditions.

A Mobile Application for Exercise Intervention in People Living with HIV.

This study aimed to assess 16-wk improvements of physical fitness, metabolic, and psychological parameters in people living with HIV (PLWH) exercising with the support of a smartphone application, as compared with a control group exercising without application. This was a randomized, open-label, pilot study enrolling PLWH in a 16-wk protocol consisting of moderate physical activity three times per week, which included an initial coach-supervised period of 4 wk, followed by 12 wk where participants trained independently. Participants were allocated to either an experimental group that trained using a smartphone application (APP) or a control group that practiced following a hard copy training program (No-APP). At baseline (BL) and after 16 wk (W16), patients were assessed for cardiorespiratory fitness, body composition, blood lipid profile, and POMS. Forty-eight PLWH were screened and 38 were eligible: 20 were allocated to the APP group and 18 to the No-APP group. Two APP and two No-APP participants were lost to follow-up. Intention-to-treat analysis showed a W16 improvement from BL of ≥15% V˙ O2peak in 13 (72%) of 18 in APP, but only in 3 (19%) of 16 in No-APP participants (P = 0.025). Significant W16 improvements were observed in APP, but not in No-APP participants, in V˙O2peak; fat mass and fat-free mass percent; total cholesterol, LDL cholesterol, and triglycerides; vigor; and total mood by POMS. Accordingly, significant percent change differences between the APP and the No-APP groups were observed in V˙O2peak; fat and fat-free mass percent; total cholesterol, LDL cholesterol, and triglycerides; and depression, vigor, anger, and total mood by POMS. Exercising using a smartphone application improved cardiorespiratory fitness, body composition, cholesterol profiles, and psychological outcomes in PLWH.

Evaluation of cerebral oxygen perfusion during shoulder arthroplasty performed in the semi–beach chair position

The beach chair position is commonly used when performing shoulder arthroplasty. However, this position has been associated with hypotension, potentially leading to cerebral hypoperfusion, which may cause neurologic injury. In addition, shoulder arthroplasty cases are associated with longer operative times, posing a potentially greater risk of cerebral hypoperfusion. We aim to evaluate the risk of cerebral desaturation events (CDEs) during the course of total shoulder arthroplasty. Twenty-six patients undergoing shoulder arthroplasties were monitored for changes in cerebral perfusion. Seven specific time-points during the procedure were labeled for comparison of events: baseline, beach chair, incision, humeral broaching, glenoid reaming, glenoid component implantation, and humeral component implantation. Cerebral oxygen perfusion was measured using near-infrared spectroscopy. A CDEwas described as a decrease of oxygen saturation greater than 20%. Nineteeen of 25 subjects experienced a CDE. 42% of these patients experienced CDEs during semi-beach chair positioning. Patients experienced the largest oxygen saturation drop during semi-beach chair positioning. Transition from baseline to semi-beach chair was the only event to have a statistically significant decrease in cerebral perfusion (8%, P < .05). There was a statistically significant percentage change in mean oxygen saturation in the semi-beach chair interval (10%, P < .01) and the semi-beach chair to incision interval (7%, P < .01). Most patients experienced an intraoperative CDE, with greatest incidence during semi-beach chair positioning. The largest decline in cerebral oxygen saturation occurred during semi-beach chair positioning. Implant implantation was not associated with decrease in cerebral oximetry.

Microvascular complications in orthokeratology (Ortho-K): A real-time study on the microvasculature of the bulbar conjunctiva in Ortho-K treatment.

Orthokeratology (Ortho-K) is an over-night hard contact lens therapy, which physically reshapes the corneal curvature in order to stabilize or temporally eliminate myopia in patients. We hypothesize that the prolonged physical contact and mechanical pressure induced by the Ortho-K lenses may create lasting inadvertent effects and damages (microangiopathy), and may bring about unwanted changes in the microvasculature of the bulbar conjunctiva. Computer-assisted intravital microscopy (CAIM) was used to view, document (via videotaping) and objectively quantify (via computer-assisted image analysis) the real-time dynamic and morphometric characteristics of the conjunctival microcirculation in long-term (at least over one year) Ortho-K patients (n = 11) and matched non-user control subjects (n = 8). Ortho-K patients were instructed to wear their lenses overnight following standard protocol. During the study, the conjunctival microcirculation of the left eye of all Ortho-K lens users was viewed, frequently re-focused and videotaped, without and with the lens in place, as outlined in Methods. The matched control subjects (non-lens wearing) were videotaped and studied in like manner. The dynamic and morphometric characteristics of each user and control subject were analyzed, quantified and summated as a severity index (SI) collectively for comparison. SI of Ortho-K lens users (4.18±1.08) differed significantly from SI of control subjects (1.75±1.39, p≤0.05). In addition, changes in the conjunctival microcirculation (e.g., flow velocity, vessel diameter, shape change, etc) were viewed and videotaped immediately after the myopic patients put on the Ortho-K lenses. Eight of the 11 Ortho-K lens users displayed significant percentage changes (p≤0.05) in flow velocity and 10 of 11 displayed significant percentage changes (p≤0.05) in vessel diameter, without and with the Ortho-K lenses. The results clearly indicated that significant microvascular changes via tissue remodeling occurred, and were caused directly by the physical presence of the Ortho-K lenses.

Plasminogen and the Plasminogen Receptor, Plg-RKT, Regulate Macrophage Phenotypic, and Functional Changes.

Inflammation resolution is an active process that functions to restore tissue homeostasis. Clearance of apoptotic leukocytes by efferocytosis at inflammatory sites plays an important role in inflammation resolution and induces remarkable macrophage phenotypic and functional changes. Here, we investigated the effects of deletion of either plasminogen (Plg) or the Plg receptor, Plg-RKT, on the resolution of inflammation. In a murine model of pleurisy, the numbers of total mononuclear cells recruited to the pleural cavity were significantly decreased in both Plg−/− and Plg-RKT−/− mice, a response associated with decreased levels of the chemokine CCL2 in pleural exudates. Increased percentages of M1-like macrophages were determined in pleural lavages of Plg−/− and Plg-RKT−/− mice without significant changes in M2-like macrophage percentages. In vitro, Plg and plasmin (Pla) increased CD206/Arginase-1 expression and the levels of IL-10/TGF-β (M2 markers) while decreasing IFN/LPS-induced M1 markers in murine bone-marrow-derived macrophages (BMDMs) and human macrophages. Furthermore, IL4-induced M2-like polarization was defective in BMDMs from both Plg−/− and Plg-RKT−/− mice. Mechanistically, Plg and Pla induced transient STAT3 phosphorylation, which was decreased in Plg−/− and Plg-RKT−/− BMDMs after IL-4 or IL-10 stimulation. The extents of expression of CD206 and Annexin A1 (important for clearance of apoptotic cells) were reduced in Plg−/− and Plg-RKT−/− macrophage populations, which exhibited decreased phagocytosis of apoptotic neutrophils (efferocytosis) in vivo and in vitro. Taken together, these results suggest that Plg and its receptor, Plg-RKT, regulate macrophage polarization and efferocytosis, as key contributors to the resolution of inflammation.