Slight Non-significant Increase Research Articles

Effect of Shelf Life on Physicochemical and Biochemical Parameters of Camel Milk

Background: Animal feed, environmental conditions and the lactation period are the main factors affecting the composition of camel milk. Methods: In this study, samples from eight (8) camels were collected according to hygiene standards to determine the physico-chemical and biochemical parameters of milk during storage at ambient temperature. pH, titratable acidity, density, total dry matter, ash, fat, protein and vitamin C were determined. Result: The results of the physico-chemical analyses indicate a pH of 5.98±0.30, a titratable acidity of 17.51±1.35°D and a density of 1.01±0.02 after 24 hours of storage at ambient temperature. At the same time, biochemical analyses show an ash content of 7±0.58 g/l, a fat content of 50.09±5.97 g/l and a protein content of 2.31±0.21%. The total dry matter content of camel milk is 129.27±11.31 g/l. The vitamin C content is 41.89±4.51 mg/l. Monitoring of the pH changes of camel milk during storage at room temperature (22±6°C) showed low acidification of camel milk after 24 storage, confirmed by the statistical study which revealed a non-significant difference in pH (p greater than 0.41). While after 24 hours, the differences are significant for pH, dornic acidity and vitamin C content (p less than 0.0001). The remaining ingredients (dry matter, fat, ash) experienced a non-significant progressive decrease (p greater than 0.05). A still non-significant decrease in protein content occurred during the first two days of storage. From the second day, the difference became significant (p less than 0.001). The study of density variation showed a slight non-significant increase (p greater than 0.15) over time. These results have allowed us to confirm that the analyzed camel milk, has a number of particularities in its chemical and physical composition, which prolongs its shelf life.

Optimization of a Photobiomodulation Protocol to Improve the Cell Viability, Proliferation and Protein Expression in Osteoblasts and Periodontal Ligament Fibroblasts for Accelerated Orthodontic Treatment.

Numerous pieces of evidence have supported the therapeutic potential of photobiomodulation (PBM) to modulate bone remodeling on mechanically stimulated teeth, proving PBM's ability to be used as a coadjuvant treatment to accelerate orthodontic tooth movement (OTM). However, there are still uncertainty and discourse around the optimal PBM protocols, which hampers its optimal and consolidated clinical applicability. Given the differential expression and metabolic patterns exhibited in the tension and compression sides of orthodontically stressed teeth, it is plausible that different types of irradiation may be applied to each side of the teeth. In this sense, this study aimed to design and implement an optimization protocol to find the most appropriate PBM parameters to stimulate specific bone turnover processes. To this end, three levels of wavelength (655, 810 and 940 nm), two power densities (5 and 10 mW/cm2) and two regimens of single and multiple sessions within three consecutive days were tested. The biological response of osteoblasts and periodontal ligament (PDL) fibroblasts was addressed by monitoring the PBM's impact on the cellular metabolic activity, as well as on key bone remodeling mediators, including alkaline phosphatase (ALP), osteoprotegerin (OPG) and receptor activator of nuclear factor κ-B ligand (RANK-L), each day. The results suggest that daily irradiation of 655 nm delivered at 10 mW/cm2, as well as 810 and 940 nm light at 5 mW/cm2, lead to an increase in ALP and OPG, potentiating bone formation. In addition, irradiation of 810 nm at 5 mW/cm2 delivered for two consecutive days and suspended by the third day promotes a downregulation of OPG expression and a slight non-significant increase in RANK-L expression, being suitable to stimulate bone resorption. Future studies in animal models may clarify the impact of PBM on bone formation and resorption mediators for longer periods and address the possibility of testing different stimulation periodicities. The present in vitro study offers valuable insights into the effectiveness of specific PBM protocols to promote osteogenic and osteoclastogenesis responses and therefore its potential to stimulate bone formation on the tension side and bone resorption on the compression side of orthodontically stressed teeth.

Pre and post-operative serum levels of titanium cobalt and aluminium after implant placement.

The preoperative serum levels and postoperative serum levels of titanium, cobalt and aluminium from dental implants in order to assess the release of these ions and to assess any risk of toxicity from these ions after dental implant placement is of interest to dentists. It was observed that there was very slight increase in serum concentration of titanium, cobalt and aluminium after 12 months of placement of implants as compared to before placement of implants. However the increase was non-significant statistically. Our study concluded that the use of dental implants does not pose any risk of toxicity of metal ions like titanium, aluminium and cobalt because of very slight non-significant increase in serum levels of these ions 12 months after implant placement.

Real-World Demonstration of AI to Clinical Cytometry for Rapid and Reliable Decision Support and Automated Reporting of Blood Cancers Including B-NHL and Acute Leukemias

Introduction: Flow cytometry is an integral part of routine diagnostics for hematological malignancies. Unfortunately, a decreasing number of skilled operators have to cope with increasing case volumes. The current methods are also known to produce inter- and intra-observer variability. Aim: To reduce labor time, dependency on expert knowledge and interpretation variability, we aimed to build and validate clinical-grade decision support software in the routine using machine learning (ML) for clinical cytometry. Methods: We obtained ≈100k flow cytometry cases from multiple centers, taken from clinical routine and annotated by expert users using multiple diagnostic methods. These cases span the full spectrum of hematological malignancy, including 47% non-malignant reference samples. As the data were not measured using harmonized protocols, we developed data pooling techniques to merge the data, including synthetic imputation of missing markers. After data processing, we applied multi-layer artificial neural networks to predict sub-type or non-malignancy (B-NHL and acute leukemias, ten classes at time of writing), directly from the data without any human preprocessing. Transfer learning was then used to fine-tune the model to a particular protocol for which the model could be used in routine. Besides sub-typing recommendations, users need to report cell population frequencies, traditionally measured using manual ‘gating’. We trained separate supervised ML models to classify single cells based on a combination of curated and refined routine gating data, expanded with in-house annotations produced by a highly trained cytometrist. To enable clinicians to receive the diagnostic recommendations and produce reports for the treating doctor, we built a CE-IVD web-application (“hema.to”) in which selected users could upload cytometry data, inspect the raw data including abnormalities in the immunophenotype, and audit the ML recommendations against the WHO criteria. The user feedback from each case was recorded, from which the consistency of the ML recommendations with expert opinion could be compared. Before the product was integrated in the clinical routine, a ‘dry run’ retrospective two-arm, four-center blinded clinical study using 96 randomly selected non-overlapping B-NHL cases revealed that analysis time was reduced by >2x and accuracy saw a slight (non-significant) increase against a gold standard as compared to the control arm with a traditional workflow. Results: A worst-case sub-typing performance was computed by testing the model against historic data without expert supervision, and found an f1 score of >90% and sensitivity of 96%. The ML models for acute leukemias specifically show an f1 score of ≈90%, a false positive rate of ≈1.5% and false negative rate of 2-6%. These quality metrics demonstrate that the system can be used for both screening and sub-typing. We therefore integrated hema.to into the routine for B-NHL diagnosis at Result Laboratorium (Dordrecht) and the HpH (Hamburg) since January, for the latter including a deep integration into the laboratory database with automated reporting of expressed CD markers. To date, over a thousand routine cases have been analyzed using the system. We then measured the relationship between predicted sub-typing confidence of the model and agreement with the final expert judgment. The data showed that, on average, confidence≈accuracy ( R2=0.94), indicating that the model is neither over- nor underconfident. As such, the model is a “trustworthy” classifier. Expert agreement over time revealed that the quality of the diagnostic recommendations has been stable over time despite a change of device type and was consistently in excess of 90% across various metrics, including a 100% specificity during the four most recent recorded months. Conclusions: We've shown that machine learning can offer decision support and automated reporting for screening and classifying blood cancers from flow cytometry in a real-world routine setting. Our next focus is to expand the number of indications and increase the model sensitivity to small pathological populations, including measurable residual disease. These results represent major strides towards decision support software for any lab and all hematological neoplasms. Such a software will not only speed up and simplify diagnostic workflows, but also improve the quality of the analysis.

Prevalence and time trends of symptoms of allergic rhinitis and rhinoconjunctivitis in Spanish children: Global Asthma Network (GAN) study.

The time trends of the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy previously described in the ISAAC (International Study of Asthma and Allergies in Childhood) in 2002 are unknown; or if the geographical or age differences in Spain persist. To describe the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy in different Spanish geographical areas and compare them with those of the ISAAC. Cross-sectional study of the prevalence of rhinitis, rhinoconjunctivitis and nasal allergy, carried out in 2016-2019 on 19943 adolescents aged 13-14 years and 17215 schoolchildren aged 6-7 years from six Spanish areas (Cartagena, Bilbao, Cantabria, La Coruña, Pamplona, and Salamanca), through a questionnaire based on the Global Asthma Network (GAN) protocol. The prevalences of recent rhinitis and rhinoconjunctivitis (last 12 months), and nasal allergy/hay fever were 35.1%, 17.6%, and 14.6% in the adolescents and 20%, 8.5%, and 8.9% in the schoolchildren, respectively, with rhinoconjunctivitis in adolescents varying from 20.9% in Bilbao to 13.4% in Cartagena; and in schoolchildren, from 9.8% in La Coruña to 6.4% in Pamplona. These prevalences of rhinoconjunctivitis and nasal allergy in adolescents were higher than those described in the ISAAC (16.3% and 13%) and similar in schoolchildren to the ISAAC (9% and 9.4%). There has been a stabilisation of rhinitis, rhinoconjunctivitis and nasal allergy in schoolchildren that slows the previous upward trend of ISAAC; and a slight non-significant increase in rhinoconjunctivitis and nasal allergy in adolescents. The variability found in adolescents would require local research to be better understood.

Comparison of Analgesic Effects of Ketorolac Plus Apotel to Meperidine in Patients Undergoing Right Thoracotomy: A Double-Blind Randomized Clinical Trial.

Postoperative pain management using nonsteroidal anti-inflammatory drugs with no narcotic-attributed adverse effects, such as respiratory depression, nausea, and vomiting, is still the subject of extensive research. However, concerns about bleeding and nephrotoxicity have limited routine use. The present trial aimed to compare the effects of ketorolac/apotel and meperidine on postoperative pain relief in patients undergoing thoracotomy. This randomized controlled trial enrolled 122 patients who were candidates for right thoracotomy. The patients were randomly divided into two groups that received ketorolac (30 mg)/apotel (1 g) or meperidine (0.5 - 1 mg/kg) at the beginning of recovery, respectively. This study assessed the Numeric Rating Scale pain score immediately and 30 and 60 minutes after the surgery in the recovery room, blood pressure, oxygen saturation (SpO2), sweating, and pulse rate. The average pain score at recovery time was significantly lower in the ketorolac/apotel group (2.06 ± 1.40) than in the meperidine group (2.76 ± 1.61) (P = 0.011). In contrast to the ketorolac/apotel group, an increasing trend was observed in pain scores in the meperidine group throughout the time sequence (P < 0.05). However, a slight non-significant increase was also observed in the ketorolac/apotel group. No statistical differences were observed in blood pressure (P = 0.826), SpO2 (P = 0.826), and pulse rate (P = 0.811) between the two study groups. This study provides support that the combination of ketorolac/apotel offers a slightly superior analgesic effect for patients undergoing thoracotomy, compared to meperidine. Pain management is crucial during recovery, and the current study's findings suggest that administering ketorolac/apotel provides effective analgesia during recovery after thoracic surgery.

Aspirin desensitization in nonsteroidal anti-inflammatory exacerbated respiratory disease: The first prospective cohort in Chile.

Nonsteroidal anti-inflammatory exacerbated respiratory disease (N-ERD) is characterized by the Samter triad: chronic rhinosinusitis with nasal polyps, asthma, and nonallergic hypersensitivity to NSAIDs. Its diagnosis is based on a complete clinical history and an aspirin (ASA) challenge test. Medical treatments include biological drugs and ASA desensitization. This study aims to evaluate the clinical response of patients with N-ERD undergoing functional endoscopic surgery (FES), followed by ASA desensitization and maintenance treatment, being the first prospective cohort study carried out in Chile. We conducted 1-year follow-up of 12 patients with N-ERD treated with FES, desensitization, and maintenance with ASA. For each control, the medication score, sinonasal symptomatology (SNOT-22), PEF (peak expiratory flow), nasal polyposis (Lildholdt score), and the appearance of adverse effects were recorded. Computed tomography (CT) of the paranasal cavities was performed at baseline and at the 12-month follow-up to calculate the Lund-Mackay score. Patients presented a reduction of SNOT-22 after the FES, which was maintained at 12 months (p = 0.002); the symptoms that showed the greatest reduction were feeling embarrassed and nasal obstruction. The Lildholdt score was also significantly reduced (p = 0.001); in only three patients, the nasal polyps recurred, and all were small. The PEF showed a slight nonsignificant increase of 3.3%. In total, 75% of patients had an adverse effect, the most frequent being abdominal pain (66.7%), but none of the 12 patients required discontinuation of aspirin treatment in 1-year follow-up. The Lund-Mackay score had a significant reduction of 6.6 points (p < 0.001). ASA desensitization is safe and effective in reducing upper and lower respiratory symptoms in patients with N-ERD and delays the reappearance of nasal polyps, although it is not exempt from adverse effects, with the vast majority being mild.

Childhood blindness incidence and aetiologies trends in Israel 2014-2020: what should we focus on?

Analyse trends in incidence and aetiologies of childhood blindness (CHB) in Israel during 2014-2020, with comparison to the previous decade. Descriptive, retrospective population-based trend study using Poisson regression. Data retrieved from the Israeli National Registry of the Blind included demographics, registration-years, and aetiologies. Primary and secondary outcomes were incidence of new certified blindness cases and its comparison with the previous decade, respectively. In total, 4.19 new CHB certificates per 100,000 were issued in Israel during 2014-2020, with a slight non-significant increase (p = 0.31). Males and younger children had higher incidence rates (p = 0.0008 and p = 0.0002, respectively). Leading causes were optic nerve anomalies (ONA), retinal dystrophies (RDYS), other retinal disorders (ORD) and cerebral visual impairment (CVI) (16.9%, 15.1%, 12.4% and 10.5%, respectively). Compared with the previous decade: ONA rates remained unchanged (p = 0.13) as did some other main aetiologies (i.e., albinism, CVI and nystagmus), while rates of RDYS and ORD increased (by 21.9%, p = 0.001 and 9.9% p = 0.02, respectively). Rates of retinopathy of prematurity (ROP), glaucoma, cataract and amblyopia remained very low (weighted average of 0.15, 0.14, 0.09 and 0.03 per 100,000, respectively). The incidence of CHB certifications in Israel remained stable with a slight increase, stemming chiefly from RDYS resurgence and an increase in ORD. Main causes remained ONA and RDYS. The most common avoidable cause, ROP, remained scarce, maintaining the reduction seen in the earlier decade, as did cataract, glaucoma, and amblyopia. This may support future nationwide prevention policies to decrease the incidence of RDYS and ORD.

A Comparative Study on Quality of Life of Elderly among those Living with Families and in Old Age Homes in a District in South India

Introduction: The elderly population in India is steadily increasing and it is expected to triple in 2050 as of the census 2011. Drastic improvements in health care made betterment in physical health but their subjective well-being remains unaccounted. Therefore, the present study aims to assess the quality of life (QoL) among elderly and to compare the differences in QoL among elderly population residing in homes and in old age homes. Methodology: An analytical cross-sectional study among elderly above the age of 60 years residing with families and other 40 elderly population residing in old age homes. A questionnaire-based interview was conducted using a standard semistructured World Health Organization-BREF QoL questionnaire. Results: In the study, most of the participants 45 (56.3%) were male and 35 (43.8%) belonged to the age group of 70–79 years with a mean (standard deviation) age of 73.96 (7.44) years. The study found that there is nil significant difference in QoL among elderly living in old age homes and in family setups. The domain scores of psychological, social, and environmental domains showed a slight nonsignificant increase in elderly among old age homes. Conclusion: The study showed nil significant difference in QoL score in all domains for the elderly. The concept of QoL needs to be looked into with more preference to psychological, social, and environmental domains.

Global Perspectives on Violence Against Women: A Study of a Social Work Elective During COVID-19

ABSTRACT The purpose of this study was to glean understanding of student learning, global perspectives, and self-care in an elective that explored violence against women in diverse contexts. The study consisted of a survey with quantitative measures of global perspectives and self-care, and discussion groups conducted at four time-points. Results from the quantitative analysis showed significant increases for two global perspectives subscales and a slight (nonsignificant) increase in self-care frequency. Thematic analysis of qualitative data generated three themes: (a) forging connections, (b) learning in a global pandemic, and (c) grappling with preconceptions. The findings highlight the dramatic impact of the COVID-19 pandemic, opportunities for integrating critical global perspectives, and need for an explicit decolonizing framework to guide instructors and students.

Uso degli antibiotici in età pediatrica

The pharmaceutical prescription allows a quantitatively but not qualitative evaluation of a drug as it does not report the reason. The software used by family paediatricians is designed to receive the diagnosis, but the field is not usually filled in. The Pharmaceutical Service of the Piedmont Region has undertaken an experimental study to assess the feasibility of modifying the systems to expand the possibilities of evaluating the use of antibiotic. The work involved 15 paediatricians in the ASL CN1 district and 15 in Verbano-Cusio-Ossola one. In compliance with the available regulations and for about 24 months, the paediatricians voluntarily agreed to include the diagnosis along with an antibiotic prescription. At the end of the observation, more than 70 thousand prescriptions were made, with a slight non-significant increase between 2018 and 2019, in both districts. Prescriptions were compared with the previous year’s data. Information on diagnosis, before the project started, was present in about 40% of prescriptions and increased to 100%. The most diagnosed pathologies were acute bronchitis, acute tonsillitis and otitis media, without differences between CN1 and VCO. The most used antibiotic is amoxicillin in combination with clavulanic acid, which alone accounts for almost half of the prescriptions. At the end of the study, it is possible to affirm that the inclusion of the diagnosis does not seem to have created individual difficulties and/or to have modified the clinical/prescription behaviour. The presence of the data on the diagnosis, however, makes it possible to broaden the system’s ability to read the critical areas present in the prescriptive behaviour and to monitor any trend in relation to its appropriateness and available guidelines. Through a sustainable and minimal intervention, it is possible to expand the capacity of the prescriptive system to evaluate behaviours and to eventually plan targeted actions, consistently with the needs to counteract antibiotic resistance.

The effect of soil salinity and pepino mosaic virus infection on the expression of tomato defence‐related genes

AbstractTo reflect field conditions where cultivated plants are frequently exposed to multiple stresses simultaneously, the effect of salinity on the expression of defence‐related genes in tomato plants was examined in the absence and presence of pepino mosaic virus (PepMV) infection. Tomato seedlings were grown under three soil salinity regimes from the fourth day after transplantation: (a) no‐added salt (control), (b) low salinity (20 mM NaCl) and (c) high salinity (100 mM NaCl). The plants were non‐, mock‐ or PepMV‐inoculated 14 days after transplantation and systemic leaves were collected 4 days postinoculation for analysis by reverse transcription‐quantitative PCR (RT‐qPCR). In noninoculated tomato plants exposed to low and high salinity, expression of the salicylic acid (SA)‐, jasmonic acid‐, ethylene‐related genes was typically down‐regulated compared to control plants, with only a slight (nonsignificant) increase in ABA2 expression. In PepMV‐infected tomato plants, a strong induction of SA‐related genes was observed, which was compromised under low and high salt stress. The induction of PR1 gene expression by PepMV infection was the highest (an 82‐fold increase) in control plants, but was significantly less (a 20‐fold increase) under conditions of low and high soil salinity. No direct correlation between SA gene expression levels and PepMV RNA accumulation became apparent. In RT‐qPCR, the levels of PepMV genomic RNA and tomato LoxD and ACS1 RNA transcripts under mild salt stress were significantly reduced (the former 6‐fold), but under high salt stress the levels of all were similar to those in the nonstressed controls.

Epidemiological characteristics and serotype distribution of culture-confirmed pediatric pneumococcal pneumonia before and after PCV 10 introduction, a multicenter study in Bogota, Colombia, 2008–2019

BackgroundPneumococcal conjugate vaccines (PCVs) have decreased pneumonia in children. Colombia introduced mass vaccination with PCV10 in 2012. MethodsCases of pneumococcal pneumonia from 10 hospitals were included. Two periods were compared: pre-PCV10: 2008–2011 and post-PCV10: 2014–2019. The objective was to compare epidemiological and clinical characteristics before and after PCV10 vaccination. ResultsA total of 370 cases were included. Serotypes 1 (15, 11.2%) and 14 (33, 24.6%) were the most frequent in the pre-PCV10 period, with only 4 (3%) cases of serotype 19A and 1 case (0.7%) serotype 3. From the pre-PCV10 period to the post-PCV10 period, cases of serotypes 1 (6, 3.1%) and 14 (1, 7.8%) decreased, while cases of serotypes 19A (58, 30.2%), serotype 3 (32, 16.7%) and 6A (7, 3.6%) increased (p < 0.001); complicated pneumonia (CP) increased significantly (13.4% to 31.8%) (p < 0.001); hospitalizations increased from 8 (5.5–15) to 12 (7–22) days (p < 0.001); and the frequency of PICU admission increased from 32.8% to 51.6% (p = 0.001). The use of ampicillin-sulbactam (0.7% to 24%) and ceftriaxone/clindamycin (0.7% to 5.7%) increased in the post-PCV10 period. The duration of empirical antibiotic treatment was 7 (4–11) days in the pre-PCV10 period and increased to 10 (6–17) days (p < 0.001) in the post-PCV10 period. Lethality showed a slight nonsignificant increase (7.5% vs. 9.9%; p = 0.57) in the post-PCV10 period. ConclusionsPCV10 significantly decreased cases of serotypes 1 and 14, with an increase in cases of serotypes 19A, 3 and 6A, which were the predominant serotypes and had greater severity (e.g., admission to the PICU, CP and more resistance, with an increase in the use of broad-spectrum antibiotics and longer hospitalization) and subsequently included in PCV13. Current data support national and regional evidence on the importance of replacing PCV10 with a higher valence that includes 19A, such as PCV13, with the aim of reducing circulation, particularly of this serotype.

Cardiovascular Toxicity Induced by Chronic Vincristine Treatment.

Vincristine is an effective anticancer agent for treating leukemias, lymphomas, and other solid tumors. Vincristine’s better-known severe side effects include bone marrow depression, hyponatremia, peripheral neuropathy, and gastrointestinal distress. In recent years, cardiovascular damage also has been described during vincristine treatments. However, the vascular toxicity induced by vincristine is little studied. The aim of the present is to evaluate whether these alterations remain after the suspension of chemotherapy treatment (sequelae) and the possible mechanisms involved in this vascular damage. Adult male Wistar rats were used. The animals were divided into four treatment groups: two groups of saline (0.9% NaCl; saline, sequelae saline) and two groups of vincristine (100 μg/kg; vincristine, sequelae vincristine). Saline or vincristine was administered intraperitoneally in two cycles of 5 days each, leaving a rest period between cycles of 2 days. The final cumulative vincristine dose administered was 1 mg/kg. Sequelae groups correspond to 2 weeks after stopping treatment with the antitumor agent. At the end of the different experimental protocols, cardiac and vascular functions were analyzed. Alterations in the expression of different proteins in the cardiovascular tissues were also investigated. Chronic treatment with vincristine did not produce significant changes in basal cardiac function but provoked significant endothelial dysfunction in the aorta and a significant decrease in the mesenteric contractile function. These cardiovascular functional alterations disappeared 2 weeks after the suspension of chemotherapy treatment. Vincristine treatment caused a significant increase in the expression of tumor necrosis factor-alpha (TNFα), endothelial and inducible nitric oxide synthases (eNOS and iNOS), and connexin 43 in cardiac tissue. In the aorta, the chronic treatment with vincristine caused a slight non-significant increase in TNFα expression, a significant increase in eNOS and iNOS, and a significant decrease in connexin 43. After 2 weeks of vincristine treatment (sequelae group), the expression of TNFα increased and eNOS and iNOS expressions disappeared, but a significant decrease in the expression of connexin 43 was still observed in the aorta. In mesenteric arteries, similar data to those found in the aorta were observed. In conclusion, chronic treatment with vincristine causes functional alterations in the vascular function of both conductance and resistance vessels and changes in the expressions of TNFα, eNOS, iNOS, and connexin 43 in cardiovascular tissues, implicating direct toxicity during its treatment. These functional alterations are transitory and disappear after the suspension of its treatment.

Customized guidance/training improved the psychometric properties of methodologically rigorous risk of bias instruments for non-randomized studies

ObjectivesTo evaluate the impact of guidance and training on the inter-rater reliability (IRR), inter-consensus reliability (ICR) and evaluator burden of the Risk of Bias (RoB) in Non-randomized Studies (NRS) of Interventions (ROBINS-I) tool, and the RoB instrument for NRS of Exposures (ROB-NRSE). Study design and SettingIn a before-and-after study, seven reviewers appraised the RoB using ROBINS-I (n = 44) and ROB-NRSE (n = 44), before and after guidance and training. We used Gwet's AC1 statistic to calculate IRR and ICR. ResultsAfter guidance and training, the IRR and ICR of the overall bias domain of ROBINS-I and ROB-NRSE improved significantly; with many individual domains showing either a significant (IRR and ICR of ROB-NRSE; ICR of ROBINS-I), or nonsignificant improvement (IRR of ROBINS-I). Evaluator burden significantly decreased after guidance and training for ROBINS-I, whereas for ROB-NRSE there was a slight nonsignificant increase. ConclusionOverall, there was benefit for guidance and training for both tools. We highly recommend guidance and training to reviewers prior to RoB assessments and that future research investigate aspects of guidance and training that are most effective.

Impact of short- and long-term exposure to air pollution on blood pressure: A two-decade population-based study in Tehran.

Plenty of recent studies on the impact of air pollution on blood pressure (BP) exist; however, there is a lack of data for the highly polluted Eastern Mediterranean region. We evaluated the associations of short-term exposure to air pollutants with systolic BP (SBP) and diastolic BP (DBP) and the long-term impact of air pollutants on incident hypertension, among Tehranian adults. In the Tehran Lipid and Glucose Study, 4580 nonhypertensive participants aged 20-69 years (41.6% male) were followed from 2001 to 2018 through 3-year follow-ups and 4-5 examinations of them were recorded. The air pollutants included particulate matter with a diameter ≤10μm (PM10), carbon monoxide (CO), ozone (O3), nitrogen dioxide (NO2), and sulfur dioxide (SO2). The mixed-effects transition model estimated the air pollution impact on BP. The proportional hazards Weibull model measured the long-term effects of air pollutants on the multivariate hazard of incident hypertension. The air pollutants were put in the models in the form of mean annual level, applying three versions of 1, 2, and 3 years before the follow-ups. During a median follow-up of 12.3 years, 1618 cases of hypertension were found. In the short-term, increase in CO did not affect SBP but decreased DBP with a delay effect lasting for 14 days; increase in NO2 raised SBP with a 14-day lag, however did not change DBP; increase in O3 reduced SBP with a 14-day lag but made slight non-significant increase in DBP; rise in PM10 concentrations led to increased SBP (lag 0-3 days) and DBP with lags of 0-3 days and 12-14 days and increase in SO2 made the largest increases in DBP with lags lasting for 14 days, but did not affect SBP. Regarding incident hypertension in the long-term, the increase in CO had no significant effect; increase in NO2 decreased the risk over the 2- and 3-year time spans; rise in O3, PM10, and SO2 levels increased the risk in all time spans; the largest hazard ratio [1.96 (95% CI: 1.48, 2.62)] for incident hypertension was attributable to PM10 in 3 years. Considering the major effects of air pollutants including O3, SO2, and especially PM10 on incident hypertension, urgent public health policies should be implemented to reduce the burden of air pollution in metropolitan city of Tehran.

The Impact of Indoor Training Program Due to covid19 quarantine, on Some Physiological, Physical variables and performance efficiency in Elite Wrestlers

Egypt’s COVID-19 co-existence plan insisted on social distancing and keeping closure of physical and sport entities. WHO illustrated the importance of training at home with at least 150 minutes of moderate load exercises or 75 minutes of high load exercises in order to reduce the indoor related health problems such as; anxiety, stress, immunity deficiency, so the study aimed to investigate the Impact of Indoor Training Program Due to covid19 quarantine, on Some Physiological, Physical, and Technical Variables in Elite Wrestlers. 8 professional wrestlers with average age 19.3 years, agreed to participate in 12 week of indoor training. Long period change in training regime with short bouts of resistive physical and technical exercises affected the back flexibility with reduction of 20.673%, physiological variables significantly reduced, maximal oxygen consumption vo2max, breathing frequency BF recorded decrease with 8.781%, 6.132% respectively, ratio between carbon dioxide and oxygen RER recorded slight nonsignificant increase with 3.316%, and little change in calorie expenditure showing gradual decrease with stay home effect on wrestlers body. Performance efficiency decreased especially in performance endurance measured in time and score with 34.756%, 16.364% respectively, in correlation with the decrease in physiological variables.

Effects of short-term self-selected resistance training on anxiety and depression scores of sedentary individuals

A positive affective experience, making exercise more pleasurable, less stressful, achieving greater satisfaction and intrinsic motivation experience through resistance training may be accomplished by performing self-selected exercises. These exercises can also lead to other health-related and performance outcomes. Thus, this study aimed to analyze the effects of a short-term self-selected resistance training on levels of anxiety and depression in sedentary individuals. Twenty-one individuals, aged between 20 and 50 years, were assigned to Training Group (TG) and Control Group (CG). The TG underwent 4 weeks of resistance training, 2 sessions per week, with self-selected intensities. Anxiety and depression scores were collected before and after intervention using the Hospital Anxiety and Depression Scale (HAD). The results showed that the TG presented a significant reduction in anxiety scores (8.9±2.0 to 7.1±2.1; p=0.008) with a large effect size (d=0.71). Depression scores showed no significant difference after intervention (6.3±2.6 to 5.4±2.6; p=0.094), with a small effect size (d=0.346). The CG showed slight non-significant increase in depression scores (6.3±3.1 to 6.8±3.7; p=0.297), with small effect size (d= 0.146). In conclusion, resistance training with self-selected intensity reduced anxiety scores and kept depression scores in a healthy level in sedentary individuals.

Influence of growth hormone therapy on the occurrence of a second neoplasm in survivors of childhood cancer.

Growth hormone (GH) deficiency is a common late effect of cranial irradiation. However, concerns have been raised that GH treatment might lead to an increased risk of a second neoplasm (SN). To study the impact of GH treatment on the risk of SN in a French cohort of survivors of childhood cancer (CCS) treated before 1986. Cohort study and nested case-control study. Of the 2852 survivors, with a median follow-up of 26 years, 196 had received GH therapy (median delay from cancer diagnosis: 5.5 years). Occurrence of SN. In total, 374 survivors developed a SN, including 40 who had received GH therapy. In a multivariate analysis, GH treatment did not increase the risk of secondary non-meningioma brain tumors (RR: 0.6, 95% CI: 0.2-1.5, P = 0.3), secondary non-brain cancer (RR: 0.7, 95% CI: 0.4-1.2, P = 0.2), or meningioma (RR: 1.9, 95% CI: 0.9-4, P = 0.09). Nevertheless, we observed a slight non-significant increase in the risk of meningioma with GH duration: 1.6-fold (95% CI: 1.2-3.0) after an exposure of less than 4 years vs 2.3-fold (95% CI: 0.9-5.6) after a longer exposure (P for trend = 0.07) confirmed by the results of a case-control study. This study confirms the overall safety of GH use in survivors of childhood cancer, which does not increase the risk of a SN. The slight excess in the risk of meningioma in patients with long-term GH treatment is non-significant and could be due to difficulties in adjustment on cranial radiation volume/dose and/or undiagnosed meningioma predisposing conditions.

The association between oral bacteria, the cough reflex and pneumonia in patients with acute stroke and suspected dysphagia.

To establish how oral bacteria are related to cough sensitivity and pneumonia in a clinical stroke population. Stroke patients are at risk of colonisation by respiratory pathogens due, in part, to sudden discontinuation of effective oral hygiene. When combined with reduced cough reflex sensitivity, aspiration of contaminated oropharyngeal contents and can lead to pneumonia. Relationships between oral bacteria, cough sensitivity and pneumonia have not been established. A total of 102 patients with acute stroke underwent saliva sampling and cough reflex testing at admission to hospital, discharge and one month. A qPCR assay compared levels of bacteria in saliva. Pneumonia events were recorded. Relative levels of bacteria were lowest at admission to hospital (6.04×10-6 ). There was a slight (non-significant) increase in bacterial levels at discharge (1.69×10-2 , P=.73). By one month, bacterial levels had significantly increased (9.17×10-2 ) relative to admission [P<.001] and discharge [P<.001]. Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli are not typically found in healthy mouths, yet were detected in 22% of patients during hospitalisation. Combined bacterial levels measured at one month was associated with pneumonia (P=.004) but there was no relationship to cough sensitivity. Acute stroke patients were at increased risk of colonisation from respiratory pathogens throughout their recovery. The presence of these pathogens in saliva at one month was associated with adverse respiratory events. Data support the development of protocols to explore risk factors and sequelae of microbiological changes in stroke.