Tag: pubmed

Am J Kidney Dis. 2023 Sep 19:S0272-6386(23)00807-7. doi: 10.1053/j.ajkd.2023.07.015. Online ahead of print.

ABSTRACT

RATIONALE & OBJECTIVE: Survivors of acute kidney injury (AKI) are at high risk of adverse outcomes. Monitoring of kidney function, screening for proteinuria, use of statins and renin-angiotensin-aldosterone system inhibitors (RAASi), and nephrology follow-up among survivors have not been fully characterized. We sought to examine these processes of care after discharge in survivors of hospitalized AKI.

DESIGN: Population-based retrospective cohort study.

SETTING AND PARTICIPANTS: Adults in Alberta, Canada admitted to hospital between 2009 and 2017. Study participants were followed from their discharge date until 2019, with a median follow up of 2.7 years.

EXPOSURE: Hospital-acquired AKI diagnostically conforming to Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria for stage 2 or stage 3 disease, or the need for acute dialysis.

OUTCOMES: Outcomes following hospital discharge included the proportion of participants who had evaluation of kidney function, were seen by a specialist or general practitioner, and received prescriptions for recommended medications for chronic kidney disease (CKD) post-discharge.

ANALYTICAL APPROACH: Cumulative incidence curves were used to characterize the proportion of participants who received each process of care outcome within the first 90 days and subsequent 1-year follow-up period after hospital discharge. To avoid risks associated with multiple hypothesis testing, differences were not statistically compared across groups.

RESULTS: The cohort (n = 23,921) included 50.2% men (n = 12,015) with a median [IQR] age of 68.1 years [56.9, 78.8]. Within 90 days post-discharge, 21.2% and 8.6% of patients with and without pre-existing CKD, respectively, were seen by a nephrologist. 60.1% of AKI survivors had at least one serum creatinine measured but only 25.5% had an assessment for albuminuria within 90 days after discharge. 52.7% of AKI survivors with pre-existing CKD, and 51.6% with de novo CKD were prescribed a RAASi within 4-15 months after discharge from hospital.

LIMITATIONS: Retrospective data were collected as part of routine clinical care.

CONCLUSION: The proportion of patients receiving optimal care after an episode of AKI in Alberta was low and may represent a target for improving long-term outcomes for this population.

PMID:37734688 | DOI:10.1053/j.ajkd.2023.07.015

Respir Med. 2023 Sep 19:107408. doi: 10.1016/j.rmed.2023.107408. Online ahead of print.

ABSTRACT

OBJECTIVES: Pulse rate variability (PRV) predicts stroke in patients with sleep disordered breathing (SDB). However, the relationship between PRV and cardiovascular disease (CVD) was unknown in SDB.

METHODS: This was a cross-sectional study. Community residents in Guangdong were investigated. Sleep study were conducted with a type Ⅳ sleep monitoring. PRV parameters was assessed from the pulse waveforms derived from the sleep monitoring.

RESULTS: 3747 participants were enrolled. The mean age was 53.9 ± 12.7 years. 1149 (30.7%) were diagnosed as SDB. PRV parameters, except for the averages of pulse-to-pulse intervals (ANN), were higher in participants with SDB than those without. After adjusting for traditional CVD risk factors, deceleration capacity of rate (DC), ANN, and the percentage of pulse-to-pulse interval differences that were more than 50 ms (PNN50) were correlated with CVD risk in participants with SDB (OR were 0.826, 1.002, and 1.285; P were 0.003, 0.009, and 0.010), but not in participants without SDB. There was no interaction effect between DC, ANN, PNN50 and oxygen desaturation index. In hierarchical analysis, DC and ANN were predictors for CVD in SDB patients with age <60 years, male, overweight, diabetes, and normal lipid metabolism. PNN50 was predictor for CVD in the elderly SDB patients without overweight, diabetes or dyslipidemia.

CONCLUSIONS: PRV parameters may be specific predictors for CVD in SDB. PNN50 was a potent biomarker for CVD risk in the elderly with SDB, event without traditional CVD risk factors.

PMID:37734671 | DOI:10.1016/j.rmed.2023.107408

J Am Pharm Assoc (2003). 2023 Sep 19:S1544-3191(23)00302-3. doi: 10.1016/j.japh.2023.09.007. Online ahead of print.

ABSTRACT

BACKGROUND: Adverse Effects of Medical Treatment (AEMT) refer to unintended harm caused by medical care and are a significant public health concern.

OBJECTIVE: This study utilizes the Global Burden of Disease (GBD) database to investigate AEMT mortality trends among older adults in the United States from 1990 to 2019, focusing on crude mortality rates and age-standardized mortality rate trends by age group and sex.

METHODS: The study employs cause-of-death ensemble modeling and statistical analysis to examine crude and age-standardized mortality rates (ASR) for AEMT in older age groups and identify trends in mortality due to AEMTs in those over 65 years of age in the United States. Trends in the ASR of AEMT were analyzed using the Joinpoint regression model.

RESULTS: AEMT mortality rates increased among older adults from 2012 to 2019, with the highest increase observed in the 95 years or older age group. Significant differences were noted in AEMT mortality rates between older men and women, with older men having higher rates and showing an upward trend, while rates among older women decreased from 1990 to 2019.

CONCLUSION: The study highlights an overall increase in ASR related to AEMT among older adults in the US, with men shown to have a greater susceptibility to death from AEMT. Increased attention towards the detrimental impact of AEMT on our aging population, particularly for men, in conjunction with reinforcement of health policies and education, is warranted.

PMID:37734658 | DOI:10.1016/j.japh.2023.09.007

Environ Pollut. 2023 Sep 19:122580. doi: 10.1016/j.envpol.2023.122580. Online ahead of print.

ABSTRACT

Human exposure to phthalates (PAEs) occurs primarily through diet, but the contribution of dietary exposure to the total internal exposure of PAEs has not been well studied. This work investigated the relationship between dietary exposure and human internal exposure to PAEs. Daily food samples were determined to evaluate the health risk of dietary exposure, and phthalate metabolites (mPAEs) were determined from urine samples of 360 volunteers of Guangzhou to assess their internal exposure. The total mPAEs concentration in the urine samples ranged from 8.43 to 1872 ng/mL, with mono-(2-ethylhexyl) phthalate (MEHP), mono-n-butyl phthalate (MnBP), and mono-isobutyl phthalate (MiBP) being the most predominant mPAEs. The concentration of PAEs in food ranged from n.d-40200 μg/kg, and benzyl butyl phthalate (BBzP), di-n-butyl phthalate (DnBP) and di-(2-ethylhexyl) phthalate (DEHP) were the most prevalent. PAE exposure was significantly associated with age, and children exhibited the highest concentration of mPAEs. Using Monte Carlo simulation to estimate PAE exposure’s health risk eliminated uncertainties caused by single-point sampling and provided more reliable statistical results. The hazard quotient (HQ) was used to evaluate PAE exposure health risks. The results showed that 37% of the volunteers had HQ levels higher than 1 based on urinary mPAE concentrations, while 24% of the volunteers had HQ levels greater than 1 because of dietary exposure to PAEs. Dietary intake was the predominant exposure route for PAEs, and accounted for approximately 65% (24% out of 37%) of the cases where HQ levels exceeded 1. The work revealed the correlation between dietary external and internal exposure to PAEs, and further studies are needed to better understand the implications.

PMID:37734633 | DOI:10.1016/j.envpol.2023.122580

Brain Res Bull. 2023 Sep 19:110766. doi: 10.1016/j.brainresbull.2023.110766. Online ahead of print.

ABSTRACT

OBJECTIVES: Mapping the neurobiology of meditation has been bolstered by functional MRI (fMRI) research, with advancements in ultra-high field 7 Tesla fMRI further enhancing signal quality and neuroanatomical resolution. Here, we utilize 7 Tesla fMRI to examine the neural substrates of meditation and replicate existing widespread findings, after accounting for relevant physiological confounds.

METHODS: In this feasibility study, we scanned 10 beginner meditators (N=10) while they either attended to breathing (focused attention meditation) or engaged in restful thinking (non-focused rest). We also measured and adjusted the fMRI signal for key physiological differences between meditation and rest. Finally, we explored changes in state mindfulness, state anxiety and focused attention attributes for up to 2 weeks following the single fMRI meditation session.

RESULTS: Group-level task fMRI analyses revealed significant reductions in activity during meditation relative to rest in Default-mode network hubs, i.e., antero-medial prefrontal and posterior cingulate cortices, precuneus, as well as visual and thalamic regions. These findings survived stringent statistical corrections for fluctuations in physiological responses which demonstrated significant differences (p < 0.05/n, Bonferroni controlled) between meditation and rest. Compared to baseline, State Mindfulness Scale (SMS) scores were significantly elevated (F(3,9) = 8.16, p<0.05/n, Bonferroni controlled) following the fMRI meditation session, and were closely maintained at 2-week follow up.

CONCLUSIONS: This pilot study establishes the feasibility and utility of investigating focused attention meditation using ultra-high field (7 Tesla) fMRI, by supporting widespread evidence that focused attention meditation attenuates Default-mode activity responsible for self-referential processing. Future functional neuroimaging studies of meditation should control for physiological confounds and include behavioural assessments.

PMID:37734622 | DOI:10.1016/j.brainresbull.2023.110766

Photodiagnosis Photodyn Ther. 2023 Sep 19:103807. doi: 10.1016/j.pdpdt.2023.103807. Online ahead of print.

ABSTRACT

BACKGROUND: Central serous chorioretinopathy (CSC) is characterized by focal serous detachment of the retina, primarily affecting the macula. Photodynamic therapy (PDT) is the best choice for treatment of chronic and recurrent patients. In this study we aim to evaluate the early effects of the half dose protocol (3 mg/m² verteporfine) of PDT laser treatment on the micro vasculature of choroid.

METHODS: Among thirty-one patients (62 eyes), twenty eyes were in the control group and forty-two eyes received PDT laser treatment. Vision log MAR, CMT (central macular thickness), SRF (sub retinal fluid), BCT (baseline choroidal thickness), CVI (choroidal vascular index), and laser treated area were compared between two groups.

RESULTS: Results show that no strong correlation was detected between the impact of laser treatment and resolution of SRF in the first week in the fovea. The mean best corrected visual acuity (BCVA) of the patients significantly increased from 20/63 at the beginning of the study, according to the Snellen chart, to 20/49 in the first week and 20/38 in the sixth week. PDT can significantly reduce SRF and CMT in 6 weeks compared to the control group. Although there was initially a small, non-statistically significant increase in choroidal thickness and CVI after 1 week, a dramatic decrease occurs after 6 weeks. Therefore, after 6 weeks of PDT laser, all the indicators such as SRF, CMT, choroidal thickness, and CVI significantly reduced.

CONCLUSION: PDT laser can significantly reduce SRF and CMT at 1 and 6 weeks and choroidal thickness and CVI at 6 weeks in chronic CSC patients. Also, a larger laser treated area has no impact on the final outcome. Therefore, it seems that the mechanism of PDT in CSC disease is the recovery of choriocapillaris circulation.

PMID:37734563 | DOI:10.1016/j.pdpdt.2023.103807

Math Biosci. 2023 Sep 19:109072. doi: 10.1016/j.mbs.2023.109072. Online ahead of print.

ABSTRACT

The CD200 is a cell membrane protein expressed by tumor cells, and its receptor CD200 receptor (CD200R) is expressed by immune cells including macrophages and dendritic cells. The formation of CD200-CD200R inhibits the cellular functions of the targeted immune cells, so CD200 is one type of the immune checkpoint and blockade CD200-CD200R formation is a potential cancer treatment. However, the CD200 blockade has opposite treatment outcomes in different types of cancers. For instance, the CD200R deficient mice have a higher tumor load than the wild type (WT) mice in melanoma suggesting that CD200-CD200R inhibits melanoma. On the other hand, the antibody anti-CD200 treatment in pancreatic ductal adenocarcinoma (PDAC) and head and neck squamous cell carcinoma (HNSCC) significantly reduces the tumor load indicating that CD200-CD200R promotes PDAC and HNSCC. In this work, we hypothesize that different mechanisms of CD200-CD200R in tumor microenvironment could be one of the reasons for the diverse treatment outcomes of CD200 blockade in different types of cancers. We create one Ordinary Differential Equations (ODEs) model for melanoma including the inhibition of CCL8 and regulatory T cells and the switching from M2 to M1 macrophages by CD200-CD200R to capture the tumor inhibition by CD200-CD200R. We also create another ODEs model for PDAC and HNSCC including the promotion of the polarization and suppressive activities of M2 macrophages by CD200-CD200R to generate the tumor promotion by CD200-CD200R. Furthermore, we use these two models to investigate the treatment efficacy of the combination treatment between the CD200-CD200R blockade and the other immune checkpoint inhibitor, anti-PD-1. Our result shows that different mechanisms of CD200-CD200R can induce different treatment outcomes in combination treatments, namely, only the CD200-CD200R blockade reduces tumor load in melanoma and only the anti-PD-1 and CD200 knockout decrease tumor load in PDAC and HNSCC. Moreover, in melanoma, the CD200-CD200R mainly utilizes the inhibitions on M1 macrophages and dendritic cells to inhibits tumor growth, instead of M2 macrophages.

PMID:37734537 | DOI:10.1016/j.mbs.2023.109072

Math Biosci. 2023 Sep 19:109075. doi: 10.1016/j.mbs.2023.109075. Online ahead of print.

ABSTRACT

Understanding how tipping points arise is critical for population protection and ecosystem robustness. This work evaluates the impact of environmental stochasticity on the emergence of tipping points in a predator-prey system subject to the Allee effect and Holling type IV functional response, modelling an environment in which the prey has high group cohesion. We analyze the relationship between stochasticity and the probability and time that predator and prey populations in our model tip between different steady states. We evaluate the safety from extinction of different population values for each species, and accordingly assign extinction warning levels to these population values. Our analysis suggests that the effects of environmental stochasticity on tipping phenomena are scenario-dependent but follow a few interpretable trends. The probability of tipping towards a steady state in which one or both species go extinct generally monotonically increased with noise intensity, while the probability of tipping towards a more favourable steady state (in which more species were viable) usually peaked at intermediate noise intensity. For tipping between two equilibria where a given species was at risk of extinction in one equilibrium but not the other, noise affecting that species had greater impact on tipping probability than noise affecting the other species. Noise in the predator population facilitated quicker tipping to extinction equilibria, whereas prey noise instead often slowed down extinction. Changes in warning level for initial population values due to noise were most apparent near attraction basin boundaries, but noise of sufficient magnitude (especially in the predator population) could alter risk even far away from these boundaries. Our model provides critical theoretical insights for the conservation of population diversity: management criteria and early warning signals can be developed based on our results to keep populations away from destructive critical thresholds.

PMID:37734536 | DOI:10.1016/j.mbs.2023.109075

Chemosphere. 2023 Sep 19:140223. doi: 10.1016/j.chemosphere.2023.140223. Online ahead of print.

ABSTRACT

Covalent organic frameworks (COFs) are class of porous coordination polymers made up of organic building blocks joined together by covalent bonding through thermodynamic and controlled reversible polymerization reactions. This review discussed versatile applications of COFs for remediation of wastewater containing dyes, emphasizing the advantages of both pristine and modified materials in adsorption, membrane separation, and advanced oxidations processes. The excellent performance of COFs towards adsorption and membrane filtration has been centered to their higher crystallinity and porosity, exhibiting exceptionally high surface area, pore size and pore volumes. Thus, they provide more active sites for trapping the dye molecules. On one hand, the photocatalytic performance of the COFs was attributed to their semiconducting properties, and when coupled with other functional semiconducting materials, they achieve good mechanical and thermal stabilities, positive light response, and narrow band gap, a typical characteristic of excellent photocatalysts. As such, COFs and their composites have demonstrated excellent potentialities for the elimination of the dyes.

PMID:37734509 | DOI:10.1016/j.chemosphere.2023.140223

Int J Cardiol. 2023 Sep 19:131379. doi: 10.1016/j.ijcard.2023.131379. Online ahead of print.

ABSTRACT

BACKGROUND: Approximately 20-30% of patients with a cardiac disease suffer from anxiety and/or depression, leading to poor health outcomes. To identify this subgroup, clinical guidelines recommend screening for anxiety and depression in cardiac rehabilitation (CR). It is unknown how screening practice is delivered post-COVID.

METHODS: This observational study used data from the National Audit of Cardiac Rehabilitation from April 2018-March 2022. Descriptive statistics were used to assess screening rates and prevalence, while a multivariate logistic regression model was performed to analyse determinants for screening for anxiety and depression among patients participating in cardiac rehabilitation.

RESULTS: The population consisted of 245,705 patients, where 128,643 (52.4%) were screened and 117,062 (47.6%) were not. Patients attending CR during first year of COVID-19 were less likely to be screened. Patients with female gender, living alone, non-white ethnicity, living in the most deprived areas, current smoking, and physical inactivity were less likely to be screened, while patients who were revascularized, having an objective physical fitness test, and attending a certified CR center were more likely to be screened. For patients attending CR during COVID-19, the prevalence of anxiety and depression decreased significantly. For anxiety the prevalence dropped from 34.4% to 15.8%, for depression the prevalence dropped from 33.5% to 16.5%.

CONCLUSION: CR service provision was negatively impacted during COVID-19, leading to much lower screening for anxiety and depression in the CR setting. Prevalence of anxiety and depression decreased during COVID-19 for this population, possibly because psychologically affected patients refrained from attending CR.

PMID:37734491 | DOI:10.1016/j.ijcard.2023.131379