Healthy pregnancy is accompanied by various immunological and metabolic adaptations. Maternal obesity has been implicated in adverse pregnancy outcomes such as miscarriage, preeclampsia, and gestational diabetes mellitus (GDM), while posing a risk to the neonate. There is a lack of knowledge surrounding obesity and the maternal immune system. The objective of this study was to consider if immunological changes in pregnancy are sabotaged by maternal obesity. Peripheral blood was collected from fasted GDM-negative pregnant women at 26-28 weeks of gestation. Analysis was done using immunoassay, flow cytometry, bioenergetics analysis and cell culture. The plasma profile was significantly altered with increasing BMI, specifically leptin (r=0.7635), MCP-1 (r=0.3024) and IL-6 (r=0.4985). Circulating leukocyte populations were also affected with changes in the relative abundance of intermediate monocytes (r=-0.2394), CD4:CD8 T cell ratios (r=0.2789), and NKT cells (r=-0.2842). Monocytes analysed in more detail revealed elevated CCR2 expression and decreased mitochondrial content. However, LPS-stimulated cytokine production and bioenergetic profile of MNCs was not affected by maternal BMI. The Th profile skews towards Th17 with increasing BMI; Th2 (r=-0.3202) and Th9 (r=-0.3205) cells were diminished in maternal obesity, and CytoStimTM-stimulation exacerbates IL-6 (r=0.4166), IL-17A (r=0.2753), IL-17F (r=0.2973) and IL-22 (r=0.2257) production with BMI, while decreasing IL-4 (r=-0.2806). Maternal obesity during pregnancy creates an inflammatory microenvironment. Successful pregnancy requires Th2-biased responses yet increasing maternal BMI favours a Th17 response that could be detrimental to pregnancy. Further research should investigate key populations of cells identified here to further understand the immunological challenges that beset pregnant women with obesity.
Intense fishing pressure and climate change are major threats to coastal fisheries. Larimichthys crocea (large yellow croaker) is a long-lived fish, which performs seasonal migrations from its spawning and nursery grounds along the coast of the East China Sea (ECS) to overwintering grounds offshore. This study used length-based analysis and habitat suitability index (HSI) model to evaluate current life-history parameters and overwintering habitat suitability of L. crocea, respectively. We compared both life-history parameters and overwintering HSI between recent (2019) and historical (between 1971 to 1982) to analyze the fishing pressure and climate change effects on the overall population and overwintering phase of L. crocea. In the context of overfishing, the length-based analysis indicated serious overfishing of L. crocea, characterized by reduced catch yield, size truncation, constrained distribution, and advanced maturation in the ECS, namely recruitment bottleneck. In the context of climate change, the overwintering HSI modeling results indicated that climate change has led to decreased sea surface temperature during L. crocea overwintering phase over the last half-century, which in turn led to area decrease and an offshore-oriented shifting of optimal overwintering habitat. The fishing-caused size truncation may constrain the migratory ability and distribution of L. crocea, subsequently led to the mismatch of the optimal overwintering habitat against climate change background, namely habitat bottleneck. Hence, while heavily fishing was the major cause of L. crocea fishery collapse, climate-induced overwintering habitat suitability may have intensified the fishery collapse of L. crocea population. It is important for management to take both overfishing and climate change issues into consideration when developing stock enhancement activities and policy regulations, particularly for migratory long-lived fish that share a similar life history to L. crocea. Combined with China’s current restocking and stock enhancement initiatives, we propose recommendations for future restocking of L. crocea in China.
Background: Although women are encouraged to achieve good diet quality in preconception and pregnancy, the benefits on perinatal outcomes have not been established. Objective: To systematically review and quantify the association between diet quality and adverse perinatal outcomes. Search strategy: Medline, Embase, Food Science and Technology Abstracts and CINAHL were searched up to 5th March 2020. Selection criteria: Two authors independently screened, selected and coded relevant prospective cohort studies. Data collection and analysis: Thirty-three studies (315,431 participants) were included in the meta-analysis. Odds ratios and mean differences from individual studies were pooled using random-effects models. Main Results: The pooled results for the association between diet quality and excessive (OR: 0.91; 95 CI: 0.76, 1.10) or inadequate (OR: 0.90; 95 CI: 0.70, 1.17) gestational weight gain were not statistically significant. Women in the top tertile of diet quality scores during prepregnancy or pregnancy had a lower risk of gestational diabetes (OR: 0.77; 95 CI: 0.65, 0.90), hypertensive disorders of pregnancy (OR: 0.87; 95 CI: 0.83, 0.92), preterm birth (OR: 0.77; 95 CI: 0.66, 0.89), small for gestational age (OR: 0.88; 95 CI: 0.79, 0.99) and low birth weight (OR: 0.60; 95 CI: 0.37, 0.99) compared to those in the bottom tertile. No studies were found for delivery mode. Conclusions: Data from prospective cohort studies support the potential of improving maternal diet quality in the effort to prevent adverse perinatal outcomes. Funding: Canadian Institutes of Health Research HLT 151517, National Natural Sciences Foundation of China No. 81661128010 Keywords: Diet quality, perinatal outcomes.
Abstract Objective:Evaluate deformable slice-to-volume registration (DSVR) to calculate 3D-segmented total lung volume (TLV) in fetuses with congenital diaphragmatic hernia, congenital lung lesions and healthy controls, with comparison to 2D-manual segmentation. Design:Pilot study Setting:Regional fetal medicine referral centre Sample:Fetal MRIs performed for clinical indications (abnormal cases) or as research participants (healthy controls) Methods:Sixteen MRI datasets of fetuses (22-32 weeks GA). Diagnosis: CDH(n=5), CPAM(n=2), CDH with BPS(n=1) and healthy control(n=8). DSVR was used for reconstruction of 3D isotropic (0.85 mm) volumes of fetal body followed by semi-automated lung segmentation. The resulting 3D TLV were compared to the traditional 2D-based volumetry, and a normogram of DSVR-derived fetal lung volumes from 100 cases was produced. Main Outcome Measures:Concordance with 2D-volumetry assessed with Bland-Altman analysis, results of segmentations presented visually. Observed/Expected values were calculated for abnormal cases based upon the normogram. Results:DSVR-derived TLV values have high correlation with the 2D-based measurements but with a consistently lower volume; bias -1.44cm3 [95% limits: -2.6 to -0.3] with improved resolution able to exclude hilar structures even in severe motion corruption or in cases of lung hypoplasia. Conclusions:Application of DSVR for fetal MRI provides a solution for analysis of motion corrupted scans and does not suffer from the interpolation error inherent in 2D-segmentation as per current clinical practice. It increases information content of acquired data in terms of visualising organs in 3D space and quantification of volumes, which we believe will have important value for counselling and surgical planning. Keywords:Fetal MRI; congenital diaphragmatic hernia; CPAM; lung volume
Objective. To systematically review the evidence from randomised controlled trials evaluating the effects of goal oriented care against standard care for multimorbid adults. Data sources/Study setting. Existing literature presenting the resulto of randomized trials assessing the outcome of goal oriented care compared with usual care for adults with multimorbidity. Study design. Systematic review and meta-analysis. Data collection/Extraction methods. We searched the Cochrane Database of Systematic Reviews (CENTRAL), EMBASE, MEDLINE, CINHAL, trial registries such as ClinicalTrial.gov and World Health Organizational International Clinical Trials Registry Platform (ICTRP) and the references of eligible trials and relevant reviews. Goal-oriented care was defined by the following: goal setting at the individual level; collaborative identification of goals; valuing and using the individuals’ resources and skills combined with the medical standpoint; full entitlement of the person in the goal choice. A total of 197 studies were reviewed. Ten trials were included. We extracted outcome data on quality of life, hospital admission, patients’ satisfaction, patient and caregiver burden. Risk of bias was assessed and certainty of evidence was evaluated using GRADE.. Principal findings. No study was found fully free of bias. No effect was found on quality of life (Standardized Mean Difference (SMD) 0.10; 95% CI -0.06 to 0.26) and hospital admission (Risk Ratio (RR): 0.87; 95% CI 0.65 to 1.17). A very small effect was observed for patients’ satisfaction (SMD: 0.15; 95% CI 0.00 to 0.29) and caregiver burden (SMD -0.13; 95%CI -0.26 to 0.00). Certainty of evidence was low for all outcomes. Conclusions Despite its sound rationale and the strong push towards its dissemination, the results of this meta-analysis prevent to reach firm conclusions about effects of goal-oriented care. Future research should overcome the shortcomings of studies assessed in this meta-analysis. A sound application of the indications for research of complex healthcare interventions is warranted.
Objective: The aim of this study was to evaluate the diagnosis of sarcopenia by abdominal tomography, prevelance and prognosis in critical patient admitted to intensive care unit(ICU). Methods: It was planned as a retrospective observational study. Patients older than 40 years of age with abdominal tomography who needed to be in the ICU were included. Muscle mass was measured by abdominal tomography. All patients were divided into two groups as sarcopenic and non-sarcopenic according to the measurement results. We compared the prognosis and clinical features of patients with and without sarcopenia. Results: Fifty five(59%) of all patients were found as sarcopenic and 70.8% over 70 years of age. The length of stay in ICU and in hospital were 27.8 ± 29.7 and 33.0 ± 31.2 days in sarcopenic patients, 15.1±17 and 23.8±21.3 days in nonsarcopenic patients respectively(p <0.05). Thirty day mortality was found 49.1% in patients sarcopenic(<0.05). SMI was found lower over aged 70 years(p <0.05). Conclusions: Sarcopenia was associated with the increasing of 30 day mortality, a prolongation in the lenght of stay in ICU and hospital. Therefore, we believe that awareness about sarcopenia will be important in order to shorten the mortality and lenght of stay in ICU.
Background and aims: The type 2 diabetes mellitus (T2DM) is a common comorbidity of chronic hepatitis C (CHC). This study intended to investigate the impact of direct-acting antiviral agents (DAAs)-induced sustained virological response (SVR) on glycometabolism in CHC patients with T2DM. Methods: We searched PubMed, Scopus, Web of Science, and Embase up to July 7th, 2021. Studies reporting the association between DAA-induced SVR and glycometabolism in diabetic patients were retained. Changes in glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels before DAA treatment and after SVR were conducted meta-analyses with random-effects models. Results: 1371 potentially relevant articles were screened. Our analysis included 16 studies with data for 5024 patients. A significant improvement was noted in glycemic control in SVR group, with a mean HbA1c reduction of 0.57% (95% CI: 0.46–0.69%; I2=72.8%) and FPG reduction of 22.28mg/dL (95% CI: 13.35–31.21mg/dL; I2=96.18%). Conversely, changes of HbA1c in non-SVR group were a mean increase of 0.03% (95% CI: -0.15–0.22%; I2=68.75%). Subgroup analyses about HbA1c and FPG classified by study type both showed decline of the two indicators after SVR, and especially a reduction of HbA1c, 0.52% (95% CI: 0.39–0.65%; I2=73.5%) in retrospective study subgroup and 0.70% (95% CI: 0.54–0.87%; I2=36.15%) in prospective study subgroup, indicating lower heterogeneity in prospective studies. Egger’s test suggested publication bias in impact of DAAs on FPG, and no publication bias in impact on HbA1c. Sensitivity analyses confirmed robustness of the results. Conclusion: The glyco-metabolic control improved in terms of HbA1c and FPG level after DAA-induced SVR. However, further large and well-designed prospective cohort studies are still warranted and a prolonged follow-up is needed.
Plant physiological thresholds, based on the response of plant physiological parameters to soil available water, were proposed to optimize soil drought and desiccation studies. However, further research is lacked to explore the discrepancy between plant physiological thresholds and traditional threshold, stable field capacity (SFC), in prolong drought modelling. This discrepancy may misjudge the occurrence and severity of dry soil layer (DSL) and bring uncertainty to vegetation selection and planting years estimation. In this study, Environment Policy Integrated Climate (EPIC) model was used to predict soil water dynamics and drought yield loss (YL) in apple main production zone on the Chinese Loess Plateau from 2021 to 2080 under four General Circulation Models (GCMs). Subsequently, plant physiological thresholds were determined with leaf net photosynthetic (TPN) and transpiration rate (TTR) and compared with SFC in long-term DSL prediction. The present results showed that TPN and TTR significantly slowed down the formation of DSL and enhanced the correlation between DSL and YL. Forming serious DSL (Quantitative Index, QI > 0.5) has slowed from 20 to 30 years, and R2 of YL and QI increase from 0.265 to 0.528 (QIPN) and 0.409 (QITR). Moreover, future climate change accumulatively reduced 9.95-14.18% of the YL. These results indicated that traditional method overestimated the environmental contradiction between economic benefits and eco-hydrology of apple forests, which could bring unreliable messages to policymaker to restrict further development of apple industries. This study was emphasized that evaluating DSL based on plant physiological threshold reflected better plant growth and water stress, which contributed to further study the sustainable development of fragile ecosystem.
Background: This study aimed to investigate the risk factors for smoking and negative perinatal outcomes among Jordanian women about smoking status. Methods: A case-control study was conducted among singleton full-term pregnant women who gave birth at the main hospital in Jordan in June 2020. They were divided into three groups according to their smoking status (active, passive and non-smokers) and were interviewed using a semi-structured questionnaire, including demographic information, current pregnancy history, perinatal and neonatal outcomes. The study investigated the effect of smoking status on both independent and dependent variables. Results: Our study revealed that low-level maternal education (OR=25.38), unemployed maternal status (OR=2.67), the absence of following up during pregnancy (OR=5.8), smoking husband were risk factors for smoke exposure among pregnant women. The risk for cesarean section was increased in nulliparous smoking women (OR=9.0), those with low family monthly income (OR=7.8), and those who did not get any information about the hazard effect of smoking (OR=4.38), as well as in unemployed passive smoking women (OR=6.25). Parity of more than one has raised the risk of NICU admission inactive smoking women (OR=10.38). This risk was also increased in active and passive women with a lower level of education (OR=186.33 and OR=17.5), respectively, as well as inactive smoking women with low family monthly income (OR=4.11). Conclusions: Appropriate preventive strategies should focus on modifiable risk factors for smoking during pregnancy.
Foot-and-mouth disease (FMD) is widely distributed in Sudan where outbreaks occur on an annual basis especially during the winter months (December-February). This study aimed to increase our understanding of the epidemiological patterns of FMD in Sudan and connections to neighbouring countries by characterising the genetic sequences of FMD viruses (FMDV) collected from seven Sudanese states over a 10-year period (between 2009 and 2018). FMDV was detected in 91 of the 265 samples using an antigen-detection ELISA. Three serotypes were detected: O (46.2%), A (34.1%), and SAT 2 (19.8%). Fifty-three of these samples were submitted for sequence analyses, generating sequences that were characterised as belonging to O/EA-3 (n=18), A/AFRICA/G-IV (n=23) and SAT 2/VII/Alx-12 (n=12) viral lineages. Phylogenetic analyses provided evidence that FMDV lineages were maintained within Sudan, and also highlighted epidemiological connections to FMD outbreaks reported in neighbouring countries in East and North Africa (such as Ethiopia and Egypt). This study motivates continued FMD surveillance in Sudan to monitor the circulating viral lineages and broader initiatives to improve our understanding of the epidemiological risks in the region.
We studied COVID-19 hospitalisation rates in elderly Maltese residents, aged 80 years and older, after national attainment of 70% first-dose coverage of COVID-19 vaccine in this age cohort. The milestone resulted in almost 50% reduction of hospital admissions, as confirmed by time series modelling using national SARS-CoV-2 infection rates as the comparator. The reduction was not seen in younger, as yet unvaccinated, age groups, where hospital admissions actually increased during the same period following a third wave of infections.
Angioimmunoblastic T-cell lymphoma (AITL) is a special subtype of peripheral T-cell lymphoma, Histopathological examination is the main basis for the diagnosis of the disease, but the diagnosis is challenging. The study has shown that combining immunohistochemistry and gene rearrangement can increase the diagnostic accuracy
Background: Information regarding the effect of a multidisciplinary team (MDT) to improve cardiometabolic risk factors (CMRF) in routine clinical settings is lacking. Methods: In this one-year retrospective chart review (2018), 598 adults (African American 59%, Hispanic 35%, Caucasian 6%) with a mean age of 43.8 ± 14.0 were included. Qualifying patients (≥ 1 CMRF of overweight/obesity, prediabetes/diabetes, or hypertension) who were treated under an MDT protocol were compared to patients who qualified for MDT but were treated solely by a primary care provider (PCP). The MDT protocol included endocrinology-oriented visits, lifestyle counseling, care coordination, and shared medical appointments. Linear and binary regression were performed to identify the factors associated with CMRF changes. Results: Patients treated by MDT had a greater reduction (β, 95% CI) in weight (- 4.29 kg, -7.62, -0.97), BMI (-1.43 kg/m2, -2.68, -0.18), SBP (- 2.18 mmHg, -4.09, -0.26), and DBP (- 1.97 mmHg, -3.34, -0.60). They also had 77% higher odds of reducing ≥ 5% their initial weight, 83% higher odds of reducing 1 point of BMI, and 59% higher odds of reducing ≥2 mmHg DBP. No association was observed for MDT intervention and A1c changes. Conclusion: Compared to PCP, MDT-protocolized intervention improves CMRF in a multi-ethnic adult cohort in a routine clinical setting. Patient’s activation to access the best care and overcoming barriers from patients (weight perception, social determinants increasing no-shows to visits), providers (obesity stigma, clinical inertia), and health system (time constraints and high paperwork imposed by payers) is a priority.
15 patients successfully received submental artery perforator flaps with its pedicle elongated. The lesions were located in tongue,oropharynx,gingiva,mandible,auricle,infraorbital skin,buccal mucosa and parotid gland.All patients are satisfied with the reconstruction. 15 patients’ donor sites were recovered well and the flaps survival was 100% with no post-operation or further major complications occurred
Stuck drain tube is a rare postoperative complication. We present a case of 27 years female who underwent right salpingectomy with abdominal drain on left side. Postoperatively drain couldn't be removed and diagnosis of stuck drain was made. Laparotomy revealed Fallopian tube entering through both eyes of the drain tube.
Background: Diabetes mellitus has been associated with many different musculoskeletal system problems. Objective: This study aims to show the prevalence of musculoskeletal disorders in patients with diabetes and to reveal their relationship to the metabolic parameters and microvascular complications. Methods: Seven hundred two diabetic patients who consecutively applied to our clinic between March 2017 and February 2018 were included in this prospective cross-sectional study. The relationship of the musculoskeletal disorders including carpal tunnel syndrome, Dupuytren’s contracture, adhesive capsulitis, flexor tenosynovitis, limited joint mobility syndrome, Charcot arthropathy, diabetic foot and gout to the patients’ age, gender, type of diabetes, duration of diabetes, metabolic parameters, and microvascular complications were evaluated. Results: Musculoskeletal system disorders were detected in 45.9% (n = 322) of the 702 diabetic patients evaluated in our study. The most common disorders were carpal tunnel syndrome 17.7% (n = 124), Dupuytren’s contracture 14.4% (n = 101), and adhesive capsulitis 13.8% (n = 97). A statistically significant relationship of the HbA1c level with Dupuytren’s contracture, carpal tunnel syndrome, and adhesive capsulitis was detected (p<0.05). Conclusions: Patients’ age, duration of diabetes, HbA1c level, and presence of microvascular complications are associated with musculoskeletal disorders in this population.
Objective: Chemotherapy and radiotherapy, used to treat childhood hematological malignancies (HM), can negatively impact oral tissues and organs. This study aimed to evaluate oral health-related quality of life in children with HM. Material and Methods: A total of 99 children, including 49 undergoing HM (41 for acute lymphocytic leukemia, 8 for acute myelocytic leukemia,) and 50 healthy volunteers, were included in this cross-sectional study. The mean age of the entire study group was 78.63 ± 34.41 months. The mean age of the HM and control groups was 87.12 ± 35.04 and 70.95 ± 34.85 months, respectively. The Simplified Oral Hygiene Index (SOHI), Decayed, Missing, and Filled Teeth (DMFT/dmft) index, and Turkish version of the Early Childhood Oral Health Impact Scale (ECOHIS-T) were administered to all children. The data were analyzed using SPSS software (version 22.0). Results: The age and gender distributions of the two groups were similar. The SOHI was significantly higher in the HM group, whereas the DMFT/dmft score was similar between the groups. No significant difference in the total ECOHIS-T score was observed between the two groups, but there was a group difference in the responses to questions on pain and psychological processes. Conclusions: Oral health and self-care were negatively affected by childhood HM and the treatment thereof. Close clinical dental follow-up of such patients is required.
The structures and interactions of systems formed by the MPBCP (meta-Phenylene-Bridged Cyclic Oligopyrrole) functionalized with lanthanum atom were studied for investigating the abilities of MPBCP, [La-MPBCP]+3 and La-MPBCP to absorb biogas (CO2, N2, H2 and CH4) using density functional theory. The Eads calculated values for biogas molecules on [La-MPBCP]+3 and La-MPBCP showed that these gas molecules have favorable interactions with the lanthanum atom coordinated on the MPBCP. CO2 molecule shows strong interactions, with Eads values of -28.63 and -15.95 kcal/mol. In the case of H2 molecule, the Eads is lower with values of -7.51 and -5.28. It is easy to observe the CO2 molecule on the [La-MPBCP]+3 system has four times higher energy value than adsorption energy for the H2 molecule. The natural bond orbital analysis reveals that gas molecules are electron donator in the systems and the acceptor orbitals belong to lanthanum atom. Computational studies suggest that CO2, N2, CH4 and H2 molecules on [La-MPBCP]+3 and La-MPBCP present physisorption. Our findings divulge promising potential of the [La-MPBCP]+3 as an adsorber/separator CO2/H2.