Time Of Cessation Research Articles

Landscape Influences on Microclimate and Tree Growth Cessation in a Semi‐Arid Montane Forest

AbstractAs climate change impacts the severity and frequency of drought, knowledge of hillslope‐to‐watershed scale ecohydrology is increasingly necessary to inform appropriate conservation, restoration, and management of forested ecosystems. In mountain environments, spatial patterns of water and energy organize forest productivity at plot, hillslope, and watershed scales. These microclimatic patterns are impacted by gradients in elevation, aspect, and local topographic convergence and divergence. In water‐limited ecosystems, such patterns may be first‐order drivers of tree growth. However, there is limited field‐based research characterizing how seasonal drivers of forest growth may vary across complex terrain. Throughout the growing season, we measured soil moisture, vapor pressure deficit, soil and air temperatures, and radial growth at 27 Douglas‐fir (Pseudotsuga menziesii) sites within Lubrecht Experimental Forest, Montana USA. Using these data, we assessed the influences of elevation, aspect, and local topographic position on hillslope‐scale microclimates. These seasonal microclimates were then compared to the observed timing of tree growth cessation. Generally, trees located in high elevations, north‐facing aspects, and convergent topographic positions were correlated with decreased temperatures, greater soil moisture, and reduced vapor pressure deficits, leading to later growth cessation. However, at the wettest positions, persistently saturated soil moisture conditions contributed to earlier cessation. Our findings highlight the landscape partitioning of forest microclimates and subsequently, their contribution to the spatial organization of growing seasons in semi‐arid mountain watersheds. Lastly, we suggest that over longer timescales these seasonal microclimates influence tree growth year after year, contributing to the organization of cumulative forest growth previously observed within the watershed.

Serum Albumin Assessment in Neonatal Jaundice: Impact on Phototherapy Decision-Making.

The objective of this study was to investigate the impact of serum albumin assessment on early neonatal jaundice treatment decisions. A retrospective review of medical records was conducted for infants of 35 weeks' gestation or more, evaluated for early neonatal jaundice in 3 hospitals in Thailand from January 1 to December 31, 2023. Per hospital protocol, serum albumin levels were routinely measured during the jaundice evaluation. Infant demographics; serum albumin; total serum bilirubin (TSB); laboratory work-up for jaundice; hyperbilirubinemia neurotoxicity risk factors; hour-specific, risk-based phototherapy threshold; and rates of phototherapy treatment were evaluated. Out of 935 infants evaluated for hyperbilirubinemia, 250 infants (26.7%) had serum albumin levels less than 3.0g/dL. Among 121 infants who received phototherapy at TSB levels meeting the guideline threshold, 49 infants had serum albumin less than 3.0g/dL as one of the neurotoxicity risk factors. However, the decision for phototherapy would not have changed when other neurotoxicity risk factors were present, when TSB at the time of initiation of phototherapy was higher than the threshold without neurotoxicity risk factors, or when TSB at the time of cessation of phototherapy was lower than the threshold with neurotoxicity risk factors. As a result, the identification of serum albumin less than 3.0g/dL affected phototherapy treatment decision in 16 infants (affected initiation in 13, cessation in 1, and both the initiation and cessation in 2) or 1.7% of all infants evaluated for jaundice. Serum albumin levels less than 3.0g/dL are common, affecting 1 in 4 infants assessed for jaundice. However, this has minimal impact on phototherapy decisions.

Trajectories in smoking habits and outcomes in patients with stable coronary artery disease

Abstract Background Smoking is a well-identified risk factor for recurrent cardiovascular (CV) events in patients with stable coronary artery disease (CAD). However, smoking status is not binary, and there is a wide diversity of smoking habits trajectories within this population, with different consequences on residual CV risk. Purpose To better understand how smoking status evolves in patients with CAD, and how it is associated with subsequent CV events. Methods We analysed the CLARIFY registry, which included 32,378 patients with CAD. We defined groups according to smoking status at inclusion in the registry: never, former and active smokers. For former smokers, we assessed the timing of definitive smoking discontinuation and its relationship with subsequent CV events. For active smokers, we investigated the association between smoking reduction or discontinuation in active smokers with outcomes. Our primary endpoint was the occurrence of MACE defined by CV death or myocardial infarction (MI) during the 5-year follow-up period adjusted on known predictors for MACE in CAD patients. Results At inclusion, 13,366 (41.3%) patients had never smoked, 14,973 (46.2%) were former smokers, and 4,039 (12.5%) were current smokers, after an average of 6.5 (±6.3) years following CAD diagnosis. In former smokers that were smoking at the time of CAD diagnosis, 72.8% definitively discontinued smoking within the first year following diagnosis, while only 27.2% quit in subsequent years. Each additional year of active smoking after CAD diagnosis increased the risk of MACE (adjusted HR [aHR] 1.08, 95% CI 1.04-1.12 per year). However, regardless of the duration of smoking cessation, former smokers did not return to the cardiovascular risk levels observed in individuals who never smoked (figure). In active smokers at inclusion, smoking cessation was associated with improved CV outcomes, irrespective of the timing of cessation during follow-up (aHR 0.56, 95% CI 0.42-0.76, p < 0.001). Among active smokers, 25.7% reduced their quantity smoked within the first year of follow-up without quitting, but this did not significantly reduce the rate of CV death and MI (aHR 0.96, 95% CI 0.74-1.26, p = 0.78) compared to other active smokers. Conclusion In active smokers diagnosed with CAD, the vast majority of definite quitters cease smoking within the first year of CAD diagnosis. Each subsequent year of active smoking adversely affects CV outcomes. Smoking cessation at any time significantly reduces the risk of CV death or recurrent MI compared to persistent active smokers, although CV risk of former smokers does not decrease to the levels observed in never-smokers. Finally, smoking quantity reduction is not enough to reduce CV risk in this population. These findings underscore the critical importance of timely interventions for smokers diagnosed with CAD, and emphasize that when it comes to smoking cessation, sooner is better, but it is never too late.

Limited Value of HBV-RNA for Relapse Prediction After Nucleos(t)ide Analogue Withdrawal in HBeAg-negativeHepatitis B Patients.

International guidelines suggest cessation of nucleos(t)ide analogues (NA) independent of HBsAg loss in HBeAg-negative patients after 2-3 years of viral suppression. Detectable HBV-RNA levels at the time of NA cessation were linked to a better prediction of relapse after NA withdrawal in small cohorts of HBeAg-negative patients. This study proves the impact of HBV-RNA levels in the prediction of relapse in a large cohort of HBeAg-negative patients, mainly infected with genotype B or C. Serum levels of HBV-RNA, HBsAg, anti-HBc and HBcrAg were determined before NA withdrawal in 154 HBeAg-negative patients, participating either in a therapeutic vaccination trial (NCT02249988) or in an observational register trial (NCT03643172). Importantly, vaccination showed no impact on relapse. Endpoints of the study were virological relapse (HBV-DNA > 2000 IU/mL) or biochemical relapse (attendant ALT levels ≥ 2 × ULN) 24 weeks after NA cessation. Virological relapse occurred in 54.5% of patients (N = 84/154), including eight patients (10%) developing an ALT flare. Baseline HBV-RNA level did not differ significantly between relapsers and off-treatment responders (p = 0.92). No significant difference occurred in proportions of detectable HBV-RNA levels between off-treatment responders (N = 27/70; 38.6%) and relapsers (N = 31/84; 36.9%) (p = 0.99). Combining predefined HBsAg cut-offs (100 IU/mL, p = 0.0013), anti-HBc cut-offs (325 IU/mL, p = 0.0117) or HBcrAg cut-offs (2 log U/mL, p = 0.66) with undetectable HBV-RNA (HBsAg, p = 0.0057; anti-HBc, p = 0.085; HBcrAg, p = 0.60) did not improve relapse prediction. The value of HBV-RNA levels at timepoint of NA cessation for the prediction of relapse is limited in HBeAg-negative patients. Trial Registration: ABX 203-002: NCT02249988; Terminator 2: NCT03643172.

Hexavalent chromium exposure induces lung injury via activation of NLRP3 and AIM2 inflammasomes in rats

Hexavalent chromium (Cr(VI)) has been identified as a Class I human carcinogen, but its carcinogenic mechanism is currently unclear. There is still a lack of understanding of its associations with early pulmonary inflammatory damages. Inflammation is an important stage before the occurrence of tumors, and under the long-term stimulation of inflammation, it can promote the development of tumors. In this study, the aim is to explore the effect of Cr(VI) exposure on pulmonary inflammation and its relationship with the mechanism of inflammation cancer transformation. We established a Cr(VI) exposure model in SD rats using tracheal instillation of potassium dichromate solution, and collected samples at the time of cessation of exposure and 14 days after cessation of exposure. Analyzing the experimental results, it was found that the lung index increased after exposure to Cr(VI), promoting the occurrence of apoptosis in lung tissue cells and exacerbating lung tissue damage. The damage situation improved after exposure termination; Inductively coupled plasma mass (ICPRQ) spectrometer detection found that the exposed group had significantly increased levels of blood chromium, blood manganese, blood copper, blood arsenic, urine chromium, urine copper, and urine lead; After two weeks of repair, blood chromium and blood manganese levels were significantly lower than those in the same dose group of the exposure group, while blood copper levels were significantly higher than those in the same dose group of the exposure group. There was no significant difference in blood arsenic levels between the exposure group and the exposure group. Urine chromium and urine lead levels were significantly lower than those in the same dose group of the exposure group, while urine copper levels only increased. At the same time, it was found that Cr(VI) exposure caused disruption of oxidative stress levels in rat lung tissues. After 14-day exposure, Cr(VI) significantly decreased and oxidative stress levels significantly decreased. Further investigation revealed that Cr(VI) induces activation of inflammasomes NLRP3, AIM2, and their signaling pathways in lung inflammatory injuries, but this condition persists even after cessation of exposure. The study suggested that in hexavalent chromium induced lung tissue injuries in rats, NLRP3 and AIM2 inflammasomes and their signaling pathways activation. Furthermore, the characteristic of sustained activation after cessation of exposure was also indicated. These results provide new ideas and references for further elucidating the mechanisms of Cr(VI), lung inflammation and inflammation cancer transformation.

Comparative efficacy of doxycycline and its analogues with autologous blood patch pleurodesis for persistent air leak following secondary spontaneous pneumothorax in adults-a systematic review.

The presence of free air in the pleural space of lungs is termed pneumothorax and in individuals with underlying lung disease, it is known as secondary spontaneous pneumothorax. The incidence of spontaneous pneumothorax is 16 to 18 per lakh population. The most common causes for secondary spontaneous pneumothorax are chronic obstructive pulmonary disease (COPD), tuberculosis (TB), human immunodeficiency virus (HIV), cystic fibrosis of lung, and history of smoking. The clinical signs and symptoms include acute dyspnea, thoracic pain and cough. Persistent air leaks are frequently seen in secondary spontaneous pneumothorax. The incidence of persistent air leaks in post-surgical patients varies from 8% to 43%. The aim of the study is to compare the efficacy of doxycycline, tetracycline, and minocycline to other pleurodesis agents in the cessation of air leaks and reducing the recurrence of pneumothorax in adults with persistent air leaks following secondary spontaneous pneumothorax. A systematic search from PubMed, Cochrane, Embase, Web of Science, and clinical trials.gov was performed. After screening, three studies were selected which includes 2 randomized controlled trials (RCTs) and 1 prospective study with a pooled sample size of 168. The mean age and standard deviation of the study participants was 50.57±13.23 years. The success rate of autologous blood patch pleurodesis (ABPP) was reported as 94.70% followed by doxycycline with 84.20%, talc with 84% and tetracycline 63%. The mean time of cessation of air leaks was lowest with doxycycline (11 and 36 hours) and ABPP (24 and 27 hours). Furthermore, ABPP is reported having fewer complications when compared with other agents. Among chemical pleurodesis agents, doxycycline is reported to be having higher success rate and less recurrences. However, it is found to be inferior when compared directly to ABPP.

Allergen-specific immunotherapy at the extremes of age: below 5 years and elderly: evidence beyond indications?

Allergen-specific immunotherapy (AIT) has been used in clinical practice to treat allergic diseases for over 100 years. The effectiveness and safety of AIT have been substantiated in numerous studies; however, children before 5 years of age and elderly are not encompassed generally. This review aims to present the current understanding of AIT in the extremes of age. Early allergen immunotherapy during infancy or early childhood may prevent the development of allergic sensitization to common allergens, thereby reducing the risk of developing allergic diseases later in life. In the elderly, improved symptoms and quality of life and reduced dependence on medication are indicated the importance on the implementation of AIT. Both clinical and immunological parameters demonstrated that the treatment was effective at the time of cessation and trend to sustained tolerance. There is no specific lower or upper age limit for initiating immunotherapy; however, it is important to thoroughly evaluate the severity of disease and the risks and benefits in each case.

Effect of different anticoagulants and antiplatelets on intraoral bleeding time during professional oral hygiene session

ObjectivePatients with thromboembolic problems, prosthetic valves, or coagulation issues are commonly prescribed anticoagulants and antiplatelets. Anticoagulant and antiplatelet medication might constitute a challenge for dentists and dental hygienists since possible prolonged bleeding might interfere with dental procedures. The aim of the present study was to examine the bleeding durations associated with various anticoagulants and antiplatelets during professional dental hygiene sessions, utilizing a modified Ivy test adapted for the oral context.Materials and methodsNinety-three consecutive patients undergoing professional oral hygiene were recruited. Debridement during oral hygiene was performed using ultrasonic mechanical instrumentation, and bleeding sites were assessed and treated with gentle pressure using sterile gauzes. The time for bleeding cessation was recorded. Patients were categorized into six groups based on their drug intake, Control: no anticoagulants or antiplatelets DTI: direct thrombin inhibitors (dabigatran) AntiXa: directa factor Xa inhibitors (endoxaban, apixaban, rivaroxaban) VKA: vitamin K antagonists (warfarin, acenocoumarol) SAPT: single anti-platelet therapy (acetylsalicylic acid or clopidogrel) DAPT: dual anti-platelet therapy (acetylsalicylic acid and clopidogrel). Bleeding time was measured in seconds and mean values were assessed among the different groups. Differences between groups were investigated with Kruskal-Wallis test followed by Dunn’s post-hoc correction for multiple comparisons or two-way ANOVA followed by Dunnett post-hoc;ResultsControl patients presented the lowest bleeding time 50 s, followed by AntiXa (98), SAPT (105), DTI (120), DAPT (190) and VKA (203). A statistically significant difference was present among control and DTI (p = 0.004), VKA (p < 0.001), DAPT (p < 0.001).ConclusionsBased on the present outcomes, an increased risk of prolonged bleeding emerged in patients taking VKA and DAPT.Clinical significancebleeding did not interfere with the oral hygiene session The optimal period for dental treatment of these patients should be 2–3 h before the next dose, without the need to temporarily suspend the medication.

Controversies and Clarifications Regarding the Role of Aspirin in Preeclampsia Prevention: A Focused Review.

Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. In recent decades, many studies have evaluated different interventions in order to prevent the occurrence of preeclampsia. Among these, administration of low-dose aspirin from early pregnancy showed consistent evidence of its prophylactic role. In this article, we review the scientific literature on this topic, highlighting the rationale for aspirin use, who should be treated, the timing of initiation and cessation of therapy, the importance of proper dosing, and its role in the prevention of other adverse outcomes.

Prolonged prophylactic antibiotic use following megaprosthesis surgery may reduce periprosthetic infection

IntroductionMegaprostheses provide a reconstructive option for patients with bone loss after musculoskeletal tumor resection. However, the postoperative surgical site infection (SSI) risk is significant. This study aims to evaluate outcomes of extended postoperative antibiotic regimens in patients after megaprosthesis surgery and gather insight into strategies to minimize SSI. MethodsThis retrospective cohort study evaluated patients who underwent megaprosthesis surgery by a single surgeon at a single center from 2014 to 2022. Patient demographics, comorbidities, cancer treatment details, and antibiotic regimens were collected. Excluded were patients with less than 1 year of follow-up, active infection at time of surgery, non-healing wounds unrelated to SSI, and preoperative antibiotic regimens secondary to being immunocompromised. Measures of interest included the development of SSI within 1 year of surgery and development of antibiotic-related complications. ResultsIncluded were 49 patients, with a mean age of 61.2 ± 2.0 years and a mean BMI of 29.4 ± 7.0. The mean drain duration was 6.5 days (standard deviation [SD], 6.9 days), and the mean intravenous antibiotic administration duration was 6.4 days (SD, 6.9 days). The median time to drain removal was five days, and the median time for intravenous antibiotic cessation was five days. The mean total antibiotic administration duration (intravenous and oral) was 25.4 days (SD, 13.4 days). Only 1 patient in the included cohort (2.04 %) developed an SSI requiring operative intervention. No other patient within the cohort experienced an antibiotic-related complication. DiscussionThis study suggests that the site's current protocol for managing post-megaprosthesis antibiotic prophylaxis based on drain duration and incision healing status has resulted in a low rate of SSI and antibiotic-related complications. Further research is needed to validate these findings and gain additional insights into managing antibiotic prophylaxis after megaprosthesis surgery.

To wean or not to wean: proton pump inhibitor management after anti-reflux surgery amongst foregut experts.

Most patients undergoing anti-reflux surgery (ARS) have a history of preoperative proton pump inhibitor (PPI) use. It is well-established that ARS is effective in restoring the anti-reflux barrier, eliminating the ongoing need for costly PPIs. Current literature lacks objective evidence supporting an optimal postoperative PPI cessation or weaning strategy, leading to wide practice variations. We sought to objectively gauge current practice and opinion surrounding the postoperative management of PPIs among expert foregut surgeons and gastroenterologists in the United States. We created a survey of postoperative PPI management protocols, with an emphasis on discontinuation and timing of PPI cessation, and aimed to determine what factors played a role in the decision-making. An electronic survey tool (Qualtrics XM, Qualtrics, Provo, UT) was used to distribute the survey and to record the responses anonymously for a period of threemonths. The survey was viewed 2658 times by 373 institutions and shared with 644 members. In total, 121 respondents participated in the survey and 111 were surgeons (92%). Fifty respondents (42%) always discontinue PPIs immediately after ARS. Of the remaining 70 respondents (58%), 46% always wean or taper PPIs postoperatively and 47% wean or taper them selectively. The majority (92%) of practitioners taper within a 3-month period postoperatively. Five respondents never discontinue PPIs after ARS. Overall, only 23 respondents (19%) stated their protocol is based on medical literature or evidence-based medicine. Instead, decision-making is primarily based on anecdotal evidence/personal preference (42%, n = 50) or prior training/mentors (39%, n = 47). There are two major protocols used for PPI discontinuation after ARS: Nearly half of providers abruptly stop PPIs, while just over half gradually tapers them, most often in the early postoperative period. These decisions are primarily driven by institutional practices and personal preferences, underscoring the need for evidence-based recommendations.

#2200 Kidney stem/progenitor cells can be isolated from the urine of neonates independently of their gestational age at birth

Abstract Background and Aims In the human kidney, nephron structures derive from a population of SIX2 positive kidney stem/progenitor cells. These cells are only present during kidney development, which is reported to terminate at approximately 36 weeks of gestation. We have previously described a non-invasive strategy to isolate the native SIX2 positive kidney stem/progenitor cells from the urine of neonates born before 36 weeks of gestation, named the neonatal kidney/stem progenitor cells (nKSPC) [1]. In preterm neonates, nephrogenesis is still ongoing at the time of birth and continues postnatally, enabling isolation of kidney stem/progenitor cells from the voided urine. In this study, we aimed to determine the efficiency of nKSPC isolation from the urine of neonates and which gestational age (GA) results in the highest yield of nKSPC. We hypothesized that the lower the gestational age, the higher the probability of isolating nKSPC. Method 37 fresh urine samples were obtained from 36 neonates (9 female, 27 male) at day 1 after birth at the Neonatology department of University Hospitals Leuven. Five urine samples were collected from extreme preterm (&amp;lt; 28 weeks GA), 6 samples from very preterm (28–32 weeks GA), 18 samples from moderate to late preterm (32-37 weeks GA) and 8 samples from term neonates (&amp;gt;37 weeks). When a sample yielded cell growth, cell colonies were subcultured to achieve clonal expansion. Cell lines were characterized for the SIX2 stem cell marker using RT-qPCR and immunofluorescence (IF) staining. SIX2 positive cell lines were further evaluated for their potential to differentiate into kidney epithelial cells (i.e. proximal tubular epithelial cells (PTEC) and podocytes) in 2D cultures using our previously established protocols [1]. Results From the 37 urine samples collected, 28 samples yielded cell growth (76%). After subcloning, 147 cell lines were characterized for the expression of SIX2, of which 42 were SIX2 positive. Four SIX2 positive cell lines were derived from extreme preterm, 12 from very preterm, 13 from moderate to late preterm and 13 from term neonates. SIX2 positive cell lines isolated from term neonates exhibited similar cells growth and differentiation potential compared to those isolated from extreme preterm neonates. Additionally, we observed a dose-response effect with regard to expression levels of SIX2 and the differentiation potential: cell lines with higher levels of SIX2 maintained their undifferentiated, uninduced state while lower levels of SIX2 enabled successful differentiation to PTEC and/or podocytes. Conclusion This study demonstrates that SIX2 positive nKSPC can be isolated from the urine of neonates, independently of their GA at birth. This could indicate that nephrogenesis persists longer than what has previously been reported (i.e. 36 weeks). Furthermore, the nKSPC exhibit a dose-response effect with regard to levels of SIX2 and induction of differentiation. This effect has previously been observed in an in vivo mice model [2]. To further investigate the timing of nephrogenesis cessation, we aim to perform a SIX2 staining on human fetal kidney tissue across different GA. Furthermore, we aim to further characterize in detail the isolated nKSPC using single cell RNA sequencing.

Renal replacement therapy in critical ill patients

Acute kidney injury (AKI), especially when caused or accompanied by sepsis, is associated with prolonged hospitalization, progression of chronic kidney disease (CKD), financial burden on the health care system, and increases mortality in various entities. Extended renal replacement therapy (CRRT) is the predominant form of renal replacement therapy (RRT) in intensive care units (ICU) by providing hemodynamic stability in critically ill patients, more precise control of fluid balance, correction of acid-base imbalances, electrolyte disorders and achieving a stable level of osmolarity correction, including in multimorbid patients. This article examines the various aspects of CRRT in critically ill patients with severe AKI with high comorbidity, as well as in patients with sepsis and multiple organ failure. An analytical evaluation of the choice of CRRT over intermittent/intermittent hemodialysis (IHD) in selected clinical settings is being conducted. Filter/dialyzer life is assessed, including assessment of filtration fraction, use of anticoagulation options including regional citrate anticoagulation (RCA), dose of CRRT prescribed and delivered, vascular access management, general criteria, timing of initiation and cessation of CRRT, and initiation of renal replacement therapy for nonrenal indications. with AKI and/or sepsis.

How to Wean: A Case Report of Abrupt Weaning and Acute Dystonia

World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months, followed by continued breastfeeding with complementary foods until 2 years of age or beyond. Despite these recommendations, there is limited research on the timing and methods of breastfeeding cessation, with abrupt weaning potentially causing unforeseen consequences. This report describes a case involving a 33-month-old girl who experienced acute dystonic reaction following the abrupt cessation of breastfeeding. It was learned that medication containing chlorpheniramine was given to the child to alleviate the uneasiness that developed due to abrupt cessation of breastfeeding. Patient’s symptoms were consistent with an acute dystonic reaction due to medication side effects, which improved with successful medical intervention. Breastfeeding initiation, continuation, and cessation influence the mental and physical health of the mother-baby pair. Abrupt weaning can pose challenges. While there are no strict guidelines for weaning, gradual weaning is generally considered a more comfortable approach for both mother and baby. To safeguard the well-being of the mother-baby pair, healthcare professionals should inform mothers about the discontinuation of breastfeeding and support a gradual weaning process. The presented case highlights the importance of careful consideration and professional guidance during the weaning process to prevent adverse outcomes.

A study to assess the prevalence of menopausal symptoms and its impact on quality of life in the menopausal women in a selected Urban community, Kolkata, West Bengal

Menopause is the end of menstruation. Menopause is cessation of menstruation for 12 months or a period that equivalent to three previous cycles or as time of cessation of ovarian function resulting in permanent amenorrhea. Menopause is a part of a women’s natural ageing process when lower level of estrogen &amp; progesterone is produced by ovaries. This cross-sectional study was conducted on a total of 400 women in the age group of 45-50 years in a selected urban community, Kolkata, West Bengal in 2020. Menopause Specific Quality of Life scale was used to assess the prevalence of menopausal symptoms and its impact. Data analysis was performed calculating mean, frequency and percentage and chisquare. Among the vasomotor symptoms prevalence of sweating was maximum (98%), among psychological symptoms anxiety and nervousness was the maximum prevalent symptoms(98%), most prevalent physical symptom was lack of energy (89.25%). Vasomotor symptoms had mild moderate and severe impact on quality of life where the other symptoms had mild and moderate impact on quality of life. Menopausal symptoms had significant association with socio demographic variables. The results support the popular belief that menopause causes vasomotor, physical and psychological problems. From the findings of the present study it can be concluded that almost all areas or domains evaluated were impaired in menopausal women but the vasomotor and psychological symptoms affects women’s quality of life more than the physical and sexual symptoms of menopause

Relationship between the natural cessation time of umbilical cord pulsation in full-term newborns delivered vaginally and maternal-neonatal outcomes: a prospective cohort study

BackgroundTo analyze the impact of the time of natural cessation of the umbilical cord on maternal and infant outcomes in order to explore the time of clamping that would be beneficial to maternal and infant outcomes.MethodsThe study was a cohort study and pregnant women who met the inclusion and exclusion criteria at the Obstetrics and Gynecology Department of Qilu Hospital of Shandong University from September 2020 to September 2021. Analysis using Kruskal-Wallis rank sum test, Pearson’s Chi-squared test, generalized linear mixed model (GLMM) and repeated measures ANOVA. If the difference between groups was statistically significant, the Bonferroni test was then performed. A two-sided test of P < 0.05 was considered statistically significant.ResultsA total of 345 pregnants were included in this study. The subjects were divided into the ≤60 seconds group (n = 134), the 61–89 seconds group (n = 106) and the ≥90 seconds group (n = 105) according to the time of natural arrest of the umbilical cord. There was no statistically significant difference in the amount of postpartum hemorrhage and the need for iron, medication, or supplements in the postpartum period between the different cord spontaneous arrest time groups for mothers (P > 0.05). The weight of the newborns in the three groups was (3316.27 ± 356.70) g, (3387.26 ± 379.20) g, and (3455.52 ± 363.78) g, respectively, and the number of days of cord detachment was 12.00 (8.00, 15.75) days, 10.00 (7.00, 15.00) days and 9.00 (7.00, 13.00) days, respectively, as the time of natural cessation of the cord increased. The neonatal lymphocyte ratio, erythrocyte pressure, and hemoglobin reached a maximum in the 61–89 s group at (7.41 ± 2.16) %, (61.77 ± 8.17) % and (194.52 ± 25.84) g/L, respectively. Lower incidence of neonatal hyperbilirubinemia in the 61–89 s group compared to the ≥90s group 0 vs 4.8 (P < 0.05).ConclusionsIn full-term singleton vaginal births, maternal and infant outcomes are better when waiting for 61–89 s after birth for the cord to stop pulsating naturally, suggesting that we can wait up to 90s for the cord to stop pulsating naturally, and if the cord does not stop pulsating after 90s, artificial weaning may be more beneficial to maternal and infant outcomes.

Predictor of smoking cessation among school-going adolescents in Indonesia: a secondary analysis based on the transtheoretical model of behavioral change.

This study elucidates the complex journey of adolescents toward smoking cessation, investigating the association of relevant demographic factors, advertising, promotion, anti-cigarette messages, and individual knowledge and attitudes with being in different smoking cessation stages. Utilizing data from the 2019 Indonesia Global Youth Tobacco Survey, this secondary analysis included adolescents who reported ever smoking. The Transtheoretical Model (TTM) guided the categorization of the outcome variable into three smoking cessation stages based on the responses to two questions related to the intention and timing of the smoking cessation. This included contemplation, action, and maintenance stages. Multinomial logistic regression analyzed the associations between each independent variable and being in each stage of smoking cessation. The study comprised 3596 Indonesian adolescents from grades 7-12, of which 2484 responded to two questions related to intention and timing of smoking cessation and were included in regression analysis. Findings indicate that males and those aged ≥16 were predominantly in contemplation phase. Early smoking initiation, usage of other tobacco products, and exposure to various forms of smoke increased the likelihood of being in contemplation and action phases. Parental smoking, school smoking exposure, and second-hand smoke were significant contemplation phase predictors. Exposure to tobacco advertising was linked to an increased likelihood of being in contemplation and action phases, whereas anti-cigarette messages showed no significant impact. Awareness of cigarette and second-hand smoke harms reduced the odds of being in the contemplation phase, while enjoying smoking and willingness to accept cigarettes from friends increased the odds of being in contemplation and action phases rather than in maintenance phase. Addressing age, gender, cultural influences, environmental factors, and attitudes towards smoking through tailored interventions is vital for aiding smoking cessation in Indonesian adolescents. Strengthened tobacco control in schools and public places is recommended to bolster these efforts. Longitudinal studies are required to explore the evolving patterns of smoking cessation behaviors over time, enhancing our understanding of the factors influencing sustained cessation.

Immediate postpartum cessation of tenofovir did not increase risk of virological or clinical relapse in highly viremic pregnant mothers with chronic hepatitis B infection

Background & AimsPeripartum prophylaxis (PP) with tenofovir disoproxil fumarate (TDF) is the standard of care to prevent mother-to-child transmission of chronic hepatitis B (CHB) infection in mothers who are highly viremic. We investigated the maternal and infant outcomes in a large Chinese cohort of TDF-treated CHB pregnant participants. MethodsIn this prospective study, treatment-naive mothers with CHB and highly viremic (HBV DNA ≥200,000 IU/ml) but without cirrhosis were treated with TDF at 24–28 weeks of pregnancy. In accordance with Chinese CHB guidelines, TDF was stopped at delivery or ≥4 weeks postpartum. Serum HBV DNA and alanine aminotransferase were monitored every 6–8 weeks to determine virological relapse (VR). Infants received standard neonatal immunization, and HBV serology was checked at 7–12 months of age. ResultsAmong 330 participants recruited (median age 30, 82.7% HBeAg+, median HBV DNA 7.82 log IU/ml), TDF was stopped at delivery in 66.4% and at ≥4 weeks in 33.6%. VR was observed in 98.3%, among which 11.6% were retreated with TDF. Timing of TDF cessation did not alter the risk of VR (99.0 vs. 96.9%), clinical relapse (19.5 vs. 14.3%), or retreatment (12.6 vs. 10.1%) (all p > 0.05). A similar proportion of patients developed alanine aminotransferase flare five times (1.1 vs. 2.1%; p = 0.464) and 10 times (0.5 vs. 0%; p = 0.669) above the upper limit of normal (ULN) in the early withdrawal and late withdrawal groups, respectively. No infants developed HBsAg-positivity. ConclusionsPP-TDF and neonatal immunization were highly effective in preventing mother-to-child transmission of HBV in mothers who are highly viremic. Timing of cessation of PP-TDF did not affect the risk of VR or retreatment. Impact and ImplicationsIn pregnant mothers with chronic hepatitis B infection who are started on peripartum tenofovir to prevent mother-to-child-transmission (MTCT), the optimal timing for antiviral withdrawal during the postpartum period remains unknown. This prospective study demonstrates that stopping tenofovir immediately at delivery, compared with longer treatment duration of tenofovir, did not lead to an increased risk of virological relapse, retreatment, or transmission of the virus to the baby. Shortening the duration of peripartum antiviral prophylaxis from 12 weeks to immediately after delivery can be considered. The immediate withdrawal of peripartum tenofovir, combined with standard neonatal immunization schemes, is 100% effective in preventing MTCT among pregnant mothers with CHB who are highly viremic, with a high rate of vaccine response in infants.

Volabolomic Fingerprinting for Post-Mortem Interval Estimation: A Novel Physiological Approach.

Death is a multifaceted process wherein each individual cell and tissue has a metabolic homeostasis and a time of functional cessation defined by the dying process as well as by intrinsic and extrinsic factors. Decomposition is physiologically associated with the release of different types of volatile organic compounds (VOCs), and these form volaboloma mortis. The main purpose of this study was to record the volabolomic fingerprint produced by volatile molecules during the physiological decomposition process of human tissue and muscle cells. The volatile chemical signature has important implications for an open issue in forensics and pathology, namely the estimation of the postmortem interval (PMI), which decreases in accuracy with the passage of time. Volatile metabolites emitted from human tissues and muscle cells at 0, 24, 48, and 72 h were recorded in real time with an electronic nose sensor device. The key findings were the continuous sampling of VOCs emitted from tissues and cells. These showed a common behavior as time progressed; particularly, after 48 h the distributions became dispersed, and after 72 h they became more variable. Volabolomic fingerprinting associated with time progression relevant to the study of PMIs was reconstructed. Additionally, there may be broader applications, such as in dog training procedures for detecting human remains, and perhaps even for studying scavenger and insect attractants.

Optimal duration of breastfeeding

Introduction. The question of the optimal timing of cessation of lactation from the perspective of maternal-child relationships remains controversial.Aim. Тo determine the optimal timing for stopping breastfeeding based on data on the formation of the child’s personal characteristics and the relationship with the mother.Materials and methods. The results of a prospective study of mother-child relationships during the period of cessation of breastfeeding are presented. The age of the child was assessed at the termination of breastfeeding, the difficulties experienced by the mother and the child at its termination (affective attachment, characteristics of the child’s behavior). Observation was carried out in the classroom in the group of short-term stay in preschool conditions 1–2 times a week for at least 1.5 hours. 108 mother-child pairs were under observation. Depending on the duration of breastfeeding, couples were divided into two groups. The first group – 64 children who are breastfed for no more than 18 months, the second group – 44 children who are breastfed for more than 18 months. Statistical processing of the obtained data was carried out using the Excel program using Student’s t-test and Pearson’s χ2 method. Differences were considered statistically significant at p &lt; 0.05.Results and discussion. Since the conditions of the children’s polyclinic do not allow for monitoring the child and his mother, the study was carried out in a group of short-term stay in a preschool educational institution, which is quite typical for the modern urban maternal population. The work was carried out jointly with teachers and psychologists who developed criteria for assessing mother-child relations and the child’s behavioral characteristics. In the group of children who were breastfed after 18 months, affective attachment to the mother, use of the breast to soothe them in the absence of breast milk, anxiety when falling asleep, were 2 times more common than in children who were breastfed for less than 18 months. The data obtained indicate the need to inform nursing mothers about the mental characteristics of a child’s development in certain age periods, a decrease in lactation after a year, and its frequent termination by 18 months.Conclusions. Based on the data obtained, it can be considered appropriate the optimal duration of breastfeeding up to one and a half years.