Abatacept retention and clinical effectiveness in patients with rheumatoid arthritis in a real-world setting in Taiwan.

AIM: To evaluate real-world abatacept retention and clinical outcomes in patients with rheumatoid arthritis in Taiwan. METHODS: This prospective, observational study enrolled patients with rheumatoid arthritis aged ≥20 years who received abatacept in real-world practice. The primary endpoint was the abatacept retention rate at 24 months. Patients were categorized into subgroups based on abatacept treatment status and previous biological disease-modifying antirheumatic drug (bDMARD) therapy. Risk factors affecting abatacept retention were determined by regression analysis. RESULTS: A total of 212 patients were enrolled. The overall abatacept retention rate at 24 months among all patients was 59.9% (95% confidence interval 53.0%-66.6%). Patients who were ongoing users of abatacept and bDMARD-naïve had the highest retention rate (76.3%); of these, 31.6% achieved low disease activity or remission after 2 years. Previous treatment with bDMARDs was associated with an increased risk of abatacept discontinuation (hazard ratio 1.99; p = .002). The most common reasons for abatacept discontinuation were drug switch (11.3%) and loss to follow-up (6.1%). Abatacept was well-tolerated with no new safety signals. CONCLUSION: The 24-month retention rate of abatacept was 59.9%; abatacept was associated with improved clinical outcomes and was well-tolerated in the real-world setting in Taiwan.

Effect of early removal of urinary catheter on recovery after vaginal surgery: A systematic review and meta-analysis.

Prolonged retention of urinary catheters (UC) after vaginal surgery is a common practice aimed at preventing postoperative urinary retention and enhancing the success rate of surgery. However, this approach also increases the chance of urinary tract infection (UTI), prolongs hospital stay (LOS), and delays recovery. Balancing these considerations, we investigated the effect of the timing of UC removal. We conducted a comprehensive literature search using four databases to identify all randomized controlled trials (RCTs) involving patients who underwent transvaginal surgery and had UC removal within 7 days postsurgery. This systematic review was conducted by two reviewers independently following the PRISMA guideline. This study investigated the timing of catheter removal in relation to the incidence of urinary retention, UTI, and LOS. A total of 8 RCT studies, involving 952 patients were included in the meta-analysis. Six studies revealed no significant difference in the urinary retention rate between early catheter removal group (24 h) and delayed removal group (>48 h, P = 0.21), but exhibited a significantly reduced UTI rate (P < 0.001) in 4 studies. In 2 studies, no significant difference in urinary retention rate between the earlier removal (3 h) and removal at 24 h (P = 0.09), and also UTI rate (P = 0.57). Overall, 5 studies revealed that early catheter removal significantly shortened the LOS by an average of 1-3 days (P ≤ 0.001). Early removal of UC can considerably reduce the rate of UTI and shorten the LOS. Moreover, it has potential benefits in terms of improving the quality of patient care and reducing medical costs.

ProPept-MT: A Multi-Task Learning Model for Peptide Feature Prediction.

In the realm of quantitative proteomics, data-independent acquisition (DIA) has emerged as a promising approach, offering enhanced reproducibility and quantitative accuracy compared to traditional data-dependent acquisition (DDA) methods. However, the analysis of DIA data is currently hindered by its reliance on project-specific spectral libraries derived from DDA analyses, which not only limits proteome coverage but also proves to be a time-intensive process. To overcome these challenges, we propose ProPept-MT, a novel deep learning-based multi-task prediction model designed to accurately forecast key features such as retention time (RT), ion intensity, and ion mobility (IM). Leveraging advanced techniques such as multi-head attention and BiLSTM for feature extraction, coupled with Nash-MTL for gradient coordination, ProPept-MT demonstrates superior prediction performance. Integrating ion mobility alongside RT, mass-to-charge ratio (m/z), and ion intensity forms 4D proteomics. Then, we outline a comprehensive workflow tailored for 4D DIA proteomics research, integrating the use of 4D in silico libraries predicted by ProPept-MT. Evaluation on a benchmark dataset showcases ProPept-MT's exceptional predictive capabilities, with impressive results including a 99.9% Pearson correlation coefficient (PCC) for RT prediction, a median dot product (DP) of 96.0% for fragment ion intensity prediction, and a 99.3% PCC for IM prediction on the test set. Notably, ProPept-MT manifests efficacy in predicting both unmodified and phosphorylated peptides, underscoring its potential as a valuable tool for constructing high-quality 4D DIA in silico libraries.

Improvement of knowledge following diabetes self-management education with respect to socioeconomic status: A retrospective cohort study among type 2 diabetes in Eastern India.

Introduction: We assessed the baseline knowledge and the improvement and retention of knowledge after attending diabetes self-management education (DSME) programs with respect to different socioeconomic status (SES). We also looked into the change in body mass index (BMI), blood pressure, and glycemic parameters after attending the DSME sessions. Materials and Methods: This was a retrospective, cohort study carried out via chart review based on data collected from manual or electronic medical records (EMR) and questionnaire responses of 160 adult patients with type 2 diabetes (T2D) who attended two DSME sessions with a gap of at least six months. Results: Baseline knowledge on diabetes was uniform (P = 0.06), irrespective of differences in SES, and DSME sessions significantly improved the knowledge in all socioeconomic classes (P value < 0.05 in each SES group). However, SES did have a significant influence on the finally acquired knowledge of diabetes as was evident from the final score after attending two DSME sessions. A significant number of patients (48.1%) from our cohort either improved or retained their knowledge of diabetes over a mean follow-up of 15.5 months. The BMI of our cohort was significantly reduced from baseline to final follow-up (P = 0.016). Conclusion: DSME sessions were effective in improving knowledge and awareness among T2D patients, irrespective of socioeconomic classes in Eastern India. The acquired knowledge from DSME sessions was retained over a long time.

Engaging adolescents in research: Home self-collection of biological samples and health questionnaires.

Adolescent health research with biomarker data collection is limited due to difficulties in recruiting and engaging this age group. Thus, successful recruitment, engagement, and retention of adolescents in translational research are necessary to elucidate factors influencing mental and physical health conditions, uncover novel biomarkers, and expand prevention and treatment options. This paper describes strategies for effective recruitment and retention of adolescents in a research study, using a project examining depressive symptoms and the microbiome to illustrate these approaches. This cross-sectional study collected electronic self-reported survey data and self-collected biospecimens (stool and salivary samples) from adolescents 13-19 years old. All but two participants completed the questionnaires, with few missing responses. 94% provided at least one salivary sample and 89% supplied a stool sample. Participants were able to adhere to the study instructions. Using a participant-centered approach, our study successfully recruited and engaged the targeted 90 participants in self-collection of electronic survey data and biospecimens. Successful strategies of recruitment and retention included: 1) on-site clinic recruitment by research team, 2) active involvement of parents as appropriate, 3) use of electronic surveys and self-collection of biospecimens to foster control and ease of participation while addressing privacy concerns, 4) noninvasive collection of data on biospecimen, 5) frequent texting to communicate with participants, 6) flexibility in the pickup and transferring of biospecimens to accommodate adolescent schedules, 7) developmentally appropriate research, 8) participant reimbursement, and 9) sensitivity toward discussing stool sample materials. As a result of these strategies, adolescent participation in the research proved feasible.

Immersive Leadership Training for Physicians: Comparing Retrospective Pre- and Post-Test Virtual vs in-Person 6-Month Follow-Up of Learning.

Purpose: Little is known about the long-term efficacy of virtual leadership training for physicians. This study compares two highly similar groups of Obstetricians-Gynecologists' (OB-GYN) 6-month post-program changes in competency and skills after experiencing equity-centered leadership training in a virtual or in-person format. Participants and Methods: Using a retrospective pre- and post-test method, we collected 6-month post-program data on 14 competencies for knowledge gains and skills use, comparing the virtual cohort (2021, n = 22) to the in-person cohort (2022, n = 33) in 55 total participants. Qualitative data from open-ended feedback questions informed on skills relevancy and professional impact since program participation. Results: Data indicate strong, statistically significant knowledge and skills retention in both cohorts, with 63% of the virtual and 85% of the in-person participants responding. Data indicate participants report the course having a positive impact on their healthcare provision and nearly all report they made changes to their communication and leadership approaches in the 6-months after the program. 59% of the virtual and 55% of the in-person cohorts report new leadership opportunities since their participation and that the course helped prepare them for those roles. Qualitative data support the need for the training, specific elements of the training these physicians found particularly helpful, and that the learning was "sticky", in that it stayed with them in the months post-program. There was a clear stated preference for in-person experiences. Conclusion: Either virtual or in-person leadership training can result in long-term (6-month) significant retention and application of knowledge and skills in physicians. While limited in size, this study suggests that in-person experiences seem to foster more effective bonds and also greater willingness to participate in post-program follow-up. Physicians find equity-centered leadership training to impact their subsequent communication and leadership practices and they report career benefits even in 6-month follow-up.

While physicians serve in many leadership roles in healthcare, leadership training is generally not part of their medical training. The American College of Obstetricians and Gynecologists (ACOG) Robert C. Cefalo Leadership Institute has provided an annual leadership training for obstetrician and gynecologist leaders since 2006. Our previous research has repeatedly shown the program is effective, with participants experiencing significant and impressive gains in leadership learning and skills development. The COVID-19 pandemic led to the 2021 program being held virtually with a return to an in-person format possible with the 2022 program. As such, the opportunity arose to compare the 6-month post-program learning and impact of these two formats, virtual versus in-person training, in two highly similar groups experiencing nearly identical program content. Both virtual and in-person participants rated their six-month post-program skill level/ability and skills use/implementation as significantly higher than pre-program and both groups noted the learning helped them be better physicians, communicators, and leaders. Additionally, many experienced new leadership opportunities in the 6-months post-program and most of those agreed that the program prepared them to take on those new roles. This study shows that our approach to physician leadership development is highly effective and that the learning demonstrated "stickiness" in that it persisted over time. While both virtual and in-person programs were highly effective, overwhelmingly the participants prefer in-person training to virtual training.

Continued professional development (CPD) provision for nurses: A qualitative exploration.

Background: For approximately 1.5 million healthcare practitioners working and registered within the United Kingdom there exists a mandatory requirement to undertake Continued Professional Development. Internationally, healthcare Continued Professional Development is fundamental for frontline staff to practice safely, effectively and maintain up to date skills combined with knowledge. A generally accepted purpose for these regulations is to help nurses and midwives maintain an updated skill set to care for patients safely and competently. This qualitative paper presents the findings from the first phase of, "Converting Willingness to Engagement" project conducting focus groups and interviews with stakeholder nurses in England, UK. This study used a phenomenological approach to draw on the lived experiences of the nurse participants who organise, manage and budget Continued Professional Development activities. Objectives: To explore ways to capture and retain nursing staff in postgraduate training and education to facilitate professional advancement, maintenance of registration and improve patient care. Design: Phase one involved a series of qualitative online (virtual) focus group discussions and interviews with stakeholder nurses who commission Continued Professional Development. Settings: A series of online (virtual) focus group discussions and interviews were then conducted between February and May 2021. Methods: A purposive sample was identified consisting of clinical service leads, advanced practitioners and matrons involved in workforce development as stakeholders. Results: Three key themes were identified; the role of the healthcare providers in staff development, staff support provision requirements, and the university's provision including Continued Professional Development. Conclusion: Partnership working allows academic partners in universities and healthcare institutions to support nurses in their endeavors to maintain their registrations, develop professionally through further education and Continued Professional Development.

[Acupoint massage, acupoint sticking combined with moxibustion for postpartum urinary retention: a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy of acupoint massage, acupoint sticking combined with moxibustion at Shuidao (ST 28) for postpartum urinary retention. METHODS: A total of 120 patients with postpartum urinary retention were randomly divided a triple-combination group, a double-combination group, and a massage group, with 40 patients in each group. All groups received standard postpartum care to stimulate urination. The patients in the massage group received rapid acupoint massage at the bilateral Shuidao (ST 28); the patients in the double-combination group additionally received acupoint sticking of self-made Tongquan powder at bilateral Shuidao (ST 28); the patients in the triple-combination group further received moxibustion at bilateral Shuidao (ST 28). The treatment was given once in all three groups. After 5 hours of treatment completion, bladder residual volume was measured; the time and volume of first urination as well as total urination volume after 5 hours of treatment completion were recorded; the patients' sensation of urination smoothness, satisfaction rate, length of hospital stay, and hospital costs were evaluated. RESULTS: The triple-combination group showed significantly lower residual urine volumes (P<0.05), earlier first urination time (P<0.05, P<0.001), and higher first urination volumes and total urination volumes after 5 hours of treatment completion compared to the other two groups (P<0.05, P<0.001). The sensation of urination smoothness and patient satisfaction were also significantly better in the triple-combination group (P<0.001, P<0.05). The double-combination group had higher volume of first urination and total urination volume after 5 hours of treatment completion than the massage group (P<0.05), and better sensation of urination smoothness and patient satisfaction (P<0.05). There was no significant difference in the length of hospital stay and costs among the three groups (P>0.05). The total effective rates were 100.0% (40/40) for the triple-combination group, 90.0% (36/40) for the double-combination group, and 70.0% (28/40) for the massage group, with the triple-combination group significantly outperforming the other two groups (P<0.05, P<0.001), and double-combination group outperforming the massage group (P<0.05). CONCLUSION: Acupoint massage, acupoint sticking combined with moxibustion at Shuidao (ST 28) could effectively improve urination in patients with postpartum urinary retention, and enhance patient satisfaction.

Enhanced sludge granulation and stable performance of an anammox expanded granular sludge bed (EGSB) reactor through the utilization of hydroxyapatite (HAP) particles.

The reuse of hydroxyapatite particles (HAPs) as a granulation activator for anammox sludge was explored to address the remaining issues of time-consuming and unstable granular structure in anammox granulation. During the granulation, nitrogen removal capacity from 2.8 to 13.7 gN/L/d was obtained within 193 days, accompanied by an enhancement in bio-activity from 0.23 to 0.52 gN/gVSS/d. HAPs and anammox microorganisms coupled well to aggregate into granules for denser biomass, higher settleability, and stronger mechanical properties, which effectively improved the biomass retention capacity and structural strength of the sludge system. A skeleton structure formed by the HAPs was characterized during the transformation of the granules, playing a crucial role in strengthening the stability of the sludge. The intermediate processes of granulation were thus clarified to propose an evolutionary pathway for anammox-HAP granules. The pre-addition of HAPs is conducive to achieving faster anammox granulation and rapid process start-up for high-strength wastewater treatment.

Determinants of job continuity among older workers: a mixed-methods research in Japan.

This study aims to determine the factors that encourage older workers to continue working. This study had an exploratory sequential design using a mixed-methods approach, including interviews and questionnaire surveys. In the interview survey, we targeted 30 workers aged between 60-65 across three manufacturing companies. After using the results of the content analysis in the interviews, we conducted an online questionnaire survey with 1,500 workers aged between 60-89 across the country. We analyzed whether the 15 factors were related to intention to continue working using logistic regression analysis. We identified factors affecting job continuity from three perspectives: individual, company, and life. We determined several factors: health condition, job performance, self-esteem, conservatism, employment system, workload, medical insurance and welfare programs, monetary and non-monetary rewards, relationships, attachment to the organization, distance between living and work, social support, economic situation, and employment policy. In the questionnaire survey, some factors had no relationship with job continuity, including conservatism, employment systems, monetary rewards, and the distance between living and work. Employers and policymakers can use the findings to consider appropriate ways of supporting older workers.

New Perspective to Evaluate the Carbon Offsetting by Urban Blue-Green Infrastructure: Direct Carbon Sequestration and Indirect Carbon Reduction.

Urban blue-green infrastructure (BGI) offers a multitude of ecological advantages to residents, thereby playing a pivotal role in fortifying urban resilience and fostering the development of climate-resilient cities. Nonetheless, current research falls short of a comprehensive analysis of BGI's overall potential for carbon reduction and its indirect carbon reduction impact. To fill this research gap, we utilized the integrated valuation of ecosystem services and trade-offs model and remote sensing estimation algorithm to quantify the direct carbon sequestration and resultant indirect carbon reduction facilitated by the BGI within the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) (China). To identify the regions that made noteworthy contributions to carbon offsets and outliers, spatial autocorrelation analysis was also employed. The findings of this study reveal that in 2019, the BGI within the study area contributed an overall carbon offset of 1.5 × 108 t·C/yr, of which 3.5 × 107 and 11.0 × 107 t·C/yr were the result of direct carbon sequestration and indirect carbon reduction, respectively. The GBA's total CO2 emissions were 1.1 × 108 t in 2019. While the direct carbon sequestration offset 32.0% of carbon emissions, the indirect carbon reduction mitigated 49.9% of potential carbon emissions. These results highlight the critical importance of evaluating BGI's indirect contribution to carbon reduction. The findings of this study provide a valuable reference for shaping management policies that prioritize the protection and restoration of specific areas, thereby facilitating the harmonized development of carbon offset capabilities within urban agglomerations.

Enhanced biodegradation of 2, 4-dichlorophenol in packed bed biofilm reactor by impregnation of polyurethane foam with Fe3O4 nanoparticles: Bio-kinetics, process optimization, performance evaluation and toxicity assessment.

In this work, an effort has been made to enhance the efficacy of biological process for the effective degradation of 2, 4-dichlorophenol (2, 4-DCP) from wastewater. The polyurethane foam was modified with Fe3O4 nanoparticles and combined with polyvinyl alcohol, sodium alginate, and bacterial consortium for biodegradation of 2, 4-DCP in a packed bed biofilm reactor. The maximum removal efficiency of 2, 4-DCP chemical oxygen demand, and total organic carbon were found to be 92.51 ± 0.83 %, 86.85 ± 1.32, and 91.78 ± 1.24 %, respectively, in 4 days and 100 mg L-1 of 2, 4-DCP concentration at an influent loading rate of 2 mg L-1h-1 and hydraulic retention time of 50 h. Packed bed biofilm reactor was effective for up to four cycles to remove 2, 4-DCP. Growth inhibition kinetics were evaluated using the Edward model, yielding maximum growth rate of 0.45 day-1, inhibition constant of 110.6 mg L-1, and saturation constant of 62.3 mg L-1.

The impact of combined administration of ropivacaine and dexamethasone on postoperative analgesia in perianal surgery with pudendal nerve block under ultrasound guidance: a prospective randomized controlled study.

Background: In recent years, severe pain after perianal surgery has seriously affected the prognosis of hospitalized patients. How to maximize the improvement of postoperative pain and perioperative comfort becomes particularly important. Methods: This study was a double-blind randomized controlled trial (Registration No.: ChiCTR2100048760, Registration Date: 16 July 2021, Link: www.chictr.org.cn/showproj.html?proj=130226), and patients were randomly divided into two groups: one group underwent postoperative 20 mL bilateral pudendal nerve block with 0.5% ropivacaine (P group), and the other group underwent postoperative 20 mL bilateral pudendal nerve block with 0.5% ropivacaine + 8 mg dexamethasone (PD group). The primary outcome was the incidence of moderate to severe pain at the first postoperative dressing change. Secondary outcomes included Quality of recovery-15 (QoR-15) score at 3 days after surgery, sleep quality, pain score at 3 days after surgery, and incidence of adverse events. Results: In the main outcome indicators, the incidence was 41.7% in the P group and 24.2% in the PD group (p = 0.01). The QoR-15 score and sleep quality in PD group were better than those in P group 2 days before surgery. The incidence of postoperative urinary retention was significantly decreased in PD group (p = 0.01). Conclusion: Local anesthesia with dexamethasone combined with pudendal nerve block after perianal surgery can reduce the incidence of moderate to severe pain during the first dressing change. This may be one of the approaches to multimodal analgesia after perianal surgery. Clinical Trial Registration: https://www.chictr.org.cn/, identifier ChiCTR2100048760.

Implicit Versus Explicit Learning a Novel Skill for High School Students.

The aim of the study was to compare the effects of implicit learning using dual task-paradigm, with explicit learning on learning a novel skill, and if the performance is maintained over a prolonged period of time. Twenty-six high school adolescents (n = 26, boys n = 15, girls n = 11, age: 16 ± 0.66 years) performed a four-week front-flip learning program, where participants underwent two hours front flip practice in total between the pre- and post-test session followed by two tests; three and six months after the post-test, in which the front-flip was not practiced. Performance was evaluated by two independent gymnastics judges. Both groups increased performance at the post test, with significantly higher scores in the explicit group compared with the implicit group. Probably benefiting from error correction to select positive action outcomes and avoid negative ones consciously. However, the explicit group was also the only group that significantly decreased performance again at first retention test, suggesting that their reliance on the retrieval of declarative knowledge from working memory was subject to decay. While it seems that performance learned via implicit learning may deteriorate more slowly, but also continuously throughout six months suggesting that the directly accumulated procedural knowledge may need for proper reinforcement and practice.

Challenges in Medicine, Magnified by the Pandemic: A Dual Battle for Female Physicians.

INTRODUCTION:  We aimed to understand how the pandemic impacted work hours and employment status of female physicians.  Methods: An anonymous survey of female physicians was distributed through social media and email lists from 12/2021 to 2/2022. Primary outcomes were changes in physicians' work schedules and employment status. Analyses included descriptive statistics of closed-ended items and qualitative content analysis of open-ended responses. RESULTS:  We restricted our analysis to four specialties: obstetrics and gynecology, internal medicine, anesthesia, and pediatrics (n=626). The majority (92%) of respondents had caretaking responsibilities; 43% changed work schedules to accommodate those responsibilities. Around 17% of physicians changed jobs. The most common reasons for job changes included: negative work environment, lack of work-life balance, burden of work, and lack of efforts to mitigate COVID-19.  Conclusion: The pandemic highlighted the need for flexibility, improvements in workplace culture, and financial incentives to increase retention.

Evolution of Whirly1 in the angiosperms: sequence, splicing, and expression in a clade of early transitional mycoheterotrophic orchids.

The plastid-targeted transcription factor Whirly1 (WHY1) has been implicated in chloroplast biogenesis, plastid genome stability, and fungal defense response, which together represent characteristics of interest for the study of autotrophic losses across the angiosperms. While gene loss in the plastid and nuclear genomes has been well studied in mycoheterotrophic plants, the evolution of the molecular mechanisms impacting genome stability is completely unknown. Here, we characterize the evolution of WHY1 in four early transitional mycoheterotrophic orchid species in the genus Corallorhiza by synthesizing the results of phylogenetic, transcriptomic, and comparative genomic analyses with WHY1 genomic sequences sampled from 21 orders of angiosperms. We found an increased number of non-canonical WHY1 isoforms assembled from all but the greenest Corallorhiza species, including intron retention in some isoforms. Within Corallorhiza, phylotranscriptomic analyses revealed the presence of tissue-specific differential expression of WHY1 in only the most photosynthetically capable species and a coincident increase in the number of non-canonical WHY1 isoforms assembled from fully mycoheterotrophic species. Gene- and codon-level tests of WHY1 selective regimes did not infer significant signal of either relaxed selection or episodic diversifying selection in Corallorhiza but did so for relaxed selection in the late-stage full mycoheterotrophic orchids Epipogium aphyllum and Gastrodia elata. Additionally, nucleotide substitutions that most likely impact the function of WHY1, such as nonsense mutations, were only observed in late-stage mycoheterotrophs. We propose that our findings suggest that splicing and expression changes may precede the selective shifts we inferred for late-stage mycoheterotrophic species, which therefore does not support a primary role for WHY1 in the transition to mycoheterotrophy in the Orchidaceae. Taken together, this study provides the most comprehensive view of WHY1 evolution across the angiosperms to date.

Comparison of chairside rectangular chain retainers and multi-stranded conventional retainers: a randomized controlled trial.

BACKGROUND: While retention appliances are widely used in orthodontics, there is still no evidence-based consensus regarding the optimal type of appliance or time of retention. OBJECTIVES: To compare chairside rectangular chain retainers, which can be placed in one sitting, with conventional multi-stranded bonded retainers regarding their levels of stability, biological side effects, complications, and patient experiences. TRIAL DESIGN: A single-centre, two-arm, parallel-group randomized controlled trial. METHODS: In total, 48 patients were included in this single-centre, randomized controlled trial conducted in Varberg, Region Halland, Sweden. The patients were randomized to two groups: the chairside rectangular chain retainer group, using the Ortho FlexTech retainer (OFT); and the conventional retainer group, using the 0.0195 Penta One multi-stranded spiral wire (PeO). The primary outcome was Little´s irregularity index (LII) evaluated at debond (T0) and at 3 months (T3) and 12 months (T12). The secondary outcomes were inter-canine distance (ICD), plaque index (PI), calculus index (CI), bleeding on probing (BoP), and caries, evaluated at T0, T3, and T12, as well as patients' perceptions, evaluated at T3 and T12, and technical complications that were registered throughout the study period. The Mann-Whitney U-test was used for continuous variables for inter-group comparisons, and the Wilcoxon Signed Rank test was used for intra-group comparisons. RESULTS: There were no statistically significant differences between the groups regarding LII, biological side effects, technical complications, or patients' experiences. However, there was a small but statistically significant difference between the groups regarding the maintenance of the ICD. Within the OFT group, there was a significant increase in CI, and within the PeO group, there was a significant increase in BoP. CONCLUSIONS: In terms of clinical relevance, the chairside rectangular chain retainer and the conventional multi-stranded spiral wire provide similar outcomes with respect to the stability of alignment, biological side-effects, technical complications, and patients' experiences short-term. TRIAL REGISTRATION: VGFOUreg-929962. Keywords: Orthodontic retainers; fixed retainers; retention; stability.

Straw Retention with Reduced Fertilization Enhances Soil Properties, Crop Yields, and Emergy Sustainability of Wheat-Soybean Rotation.

Cereal + legume rotation is an integrated system that facilitates soil fertility and sustainable agricultural production. However, research on the management compatibility affecting soil physico-chemical properties yields overall agro-ecosystem sustainability, but profitability is lacking, especially under straw retention and potential reductions in fertilizer application. An 11-year field experiment investigated three treatments: no straw retention + traditional mineral fertilization (TNS), straw retention + traditional mineral fertilization (TS), and straw retention + reduced mineral fertilization (DS). Compared with TNS, TS significantly improved soil physico-chemical properties, including macro-aggregates (R > 0.25 mm), porosity, field water capacity (FWC), soil organic carbon (SOC) storage, total nitrogen storage, microbial biomass carbon (MBC), and microbial biomass nitrogen (MBN) by 17.3%, 3.2%, 13.0%, 5.5%, 3.2%, 15.5%, and 13.8%, respectively. TS also significantly increased total (wheat + soybean) yields (TYs), economic profits, and emergy sustainability index (ESI) by 15.8%, 25.0%, 3.7 times that of TNS, respectively. Surprisingly, compared with TS, DS further significantly improved R > 0.25 mm, porosity, FWC, SOC storage, MBC, MBN, TY, economic profits, and ESI by 11.4%, 1.5%, 6.1%, 3.0%, 10.6%, 7.2%, 5.7%, 11.1%, and 36.5%, respectively. Overall, retaining straw with reduced fertilization enhances soil properties, yields, and emergy sustainability in wheat-soybean rotation systems.

Breastfeeding Practices and Postpartum Weight Retention in an Asian Cohort.

This study examines relationships between breastfeeding practices and postpartum weight retention (PPWR) at 6 and 12 months postpartum among 379 first-time mothers participating in a clinical trial in Singapore. We categorized feeding modes at 6 months into exclusive breastfeeding, mixed feeding, and exclusive formula feeding. Participants were analyzed in two groups based on their PPWR assessment at 6 and 12 months postpartum, with complete datasets available for each assessment. We calculated PPWR by subtracting pre-pregnancy weight from self-reported weight at 6 and 12 months postpartum, defining substantial PPWR as ≥5 kg retention. Modified Poisson regression models adjusted for potential confounders were performed. At 6 and 12 months, 35% (n = 132/379) and 31% (n = 109/347) of women experienced substantial PPWR, respectively. Compared to exclusive breastfeeding, mixed feeding (risk ratio 1.85; 95% confidence interval 1.15, 2.99) and exclusive formula feeding (2.11; 1.32, 3.28) were associated with a higher risk of substantial PPWR at 6 months. These associations were slightly attenuated at 12 months and appeared stronger in women with pre-pregnancy overweight or obesity. This study suggests that breastfeeding by 6 months postpartum may help mitigate PPWR, particularly with exclusive breastfeeding. It also draws attention to targeted interventions to promote breastfeeding among women with overweight or obesity.

Subsequent biologic and targeted synthetic disease modifying anti rheumatic drugs after fulfilling difficult-to-treat rheumatoid arthritis criteria: a survival analysis.

OBJECTIVES: To evaluate the survival of different biologic or targeted-synthetic disease-modifying antirheumatic drugs (b/tsDMARD) administered after fulfilling difficult-to-treat rheumatoid arthritis (D2TRA) criteria, and to assess factors related to treatment discontinuation. METHODS: Retrospective study including D2TRA patients. Drug retention of the b/tsDMARD administered after fulfilling D2TRA was assessed by Kaplan-Meier plots and the log-rank test. Cox hazard models were used to identify factors affecting treatment discontinuation. RESULTS: Of the 122 patients included, 75 maintained active treatment (61.5%) with a subsequent line after D2T compared to 47 (38.5%) who discontinued and required more successive lines of b/tsDMARDs. The median survival of the treatments was 78.3(7.6) months and the treatment after D2T with the better rate of survival was rituximab, followed by JAKi and IL6Ri, while worse survival rates were associated with abatacept and TNFi. Significant differences were noted among b/tsDMARDs (log-rank p < 0.01) and to evaluate these differences, a Cox regression was performed, taking each b/tsDMARD as a reference and comparing it with the others. DAS28 values 6-months after initiation of treatment were higher in those patients who discontinued treatment [4.4(1.2) vs 3.5(1.3), p = 0.01]. The multivariate cox regression model revealed that treatment choice after D2T [HR = 1.26(95%CI 1.06-1.05)] and lower DAS28 values at 6 months [HR = 1.49(95%CI 1.16-1.52)] were independent risk factors associated with treatment discontinuation. CONCLUSIONS: Once patients met the D2TRA criteria, the subsequent line of b/tsDMARDs with the best survival rates were rituximab, JAKi and IL6Ri. Moreover, DAS28 at 6-months of treatment after D2T was an independent risk factor for drug discontinuation. Key Points • Rituximab, IL6Ri and JAKi have better retention rates in patients after fulfilling D2TRA criteria • Clinical disease activity in the first six months after fulfillment of D2TRA criteria is an independent risk factor of subsequent treatment survival.